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OBJECTIVE: To determine whether diffusion kurtosis imaging (DKI) is effective in monitoring tumor response to neoadjuvant chemotherapy in patients with osteosarcoma. MATERIALS AND METHODS: Twenty-nine osteosarcoma patients (20 men and 9 women; mean age, 17.6 ± 7.8 years) who had undergone magnetic resonance imaging (MRI) and DKI before and after neoadjuvant chemotherapy were included. Tumor volume, apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and change ratio (ΔX) between pre- and post-treatment were calculated. Based on histologic response, the patients were divided into those with good response (≥ 90% necrosis, n = 12) and those with poor response (< 90% necrosis, n = 17). Several MRI parameters between the groups were compared using Student's t test. The correlation between image indexes and tumor necrosis was determined using Pearson's correlation, and diagnostic performance was compared using receiver operating characteristic curves. RESULTS: In good responders, MDpost, ADCpost, and MKpost values were significantly higher than in poor responders (p < 0.001, p < 0.001, and p = 0.042, respectively). The ΔMD and ΔADC were also significantly higher in good responders than in poor responders (p < 0.001 and p = 0.01, respectively). However, no significant difference was observed in ΔMK (p = 0.092). MDpost and ΔMD showed high correlations with tumor necrosis rate (r = 0.669 and r = 0.622, respectively), and MDpost had higher diagnostic performance than ADCpost (p = 0.037) and MKpost (p = 0.011). Similarly, ΔMD also showed higher diagnostic performance than ΔADC (p = 0.033) and ΔMK (p = 0.037). CONCLUSION: MD is a promising biomarker for monitoring tumor response to preoperative chemotherapy in patients with osteosarcoma.
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Female , Humans , Male , Bone Neoplasms , Diffusion , Drug Therapy , Magnetic Resonance Imaging , Necrosis , Osteosarcoma , ROC Curve , Tumor BurdenABSTRACT
Objective To investigate the clinical and imaging characteristics of phosphaturic mesenchymal tumor and improve the clinical diagnosis. Methods From November 2014 to September 2017, 22 patients with pathologically confirmed diagnosis as phosphaturic mesenchymal tumor (PMT) were retrospectively analyzed, including 12 males and 10 females, age ranged from 30-72 years, mean (47 ± 11) years old. The clinical data, laboratory tests [serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 1, 25- (OH) 2 D] and imaging examinations (X-ray, CT, MRI, nuclide) were collected and explored. Sixteen patients underwent SPECT scan and seven underwent PET/CT scan. Twenty patients had X-ray, eighteen patients had CT and 12 patients had MRI with enhancement. Results All patients suffered from diffuse pain for one to fifteen years, especially in lower back and lower extremities. All patients were found with low serum phosphorus, normal serum calcium. Twenty-one patients were found with elevated alkaline phosphatase, 16 with increased parathyroid hormone and 15 with decreased 1, 25 - (OH) 2 D. Thirteen lesions were located in the medullary cavity, seven in the soft tissue and two in the sinuses. Nineteen cases showed varying degrees of trabecular bone sparse, osteoporosis and osteomalacia on X-ray;There were 15 cases of multiple pseudo-fractures, including four cases of pelvic fracture complicated with femoral fracture, six cases of single fracture of pelvis, four cases of femur and one case of fibula. And seven cases showed multiple vertebral compression fractures. Thirteen lesions showed soft-tissue density and four in the medullary cavity showed high density on CT scan. The lesions presented low signal intensity on T1WI,high or low signal intensity on T2WI FLAIR and obviously enhanced in 12 patients who underwent MRI enhancement. Conclusion For patients with decreased serum phosphorus, elevated alkaline phosphatase, bone softening and fracture, octreotide or other nuclides should be primary imaging modality for confirming the location of the lesion. CT and MRI can further evaluate the nature of the lesion and improve diagnostic accuracy.
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Objective To investigate clinical and imaging features of malignant transformation in monostotic fibrous dysplasia (FD).Methods Radiography (n=12),computed tomography (CT)(n=7)and magnetic resonance imaging (MRI)(n=5)data of 12 monostotic FD cases proved by surgery and pathology were retrospectively reviewed.Results Among 12 cases,6 cases underwent surgery.Their images showed osteolytic lesions in the operative area with direct signs of aggressiveness (poorly defined margin,cor-tical destruction and soft tissue mass).For the 6 cases without surgery,radiography and CT showed poorly margin,osteolytic le-sions within or near the area of ground-glass opacity.MRI showed lesions with heterogeneous signal intensity and pronounced con-trast-enhancement.Histopathologically,9 cases were osteosarcomas,2 cases were fibrosarcomas,and 1 case was malignant fibrous histiocytoma (MFH).Conclusion The imaging information of malignant transformation of FD can provide evidence of possible ma-lignancy.
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Objective To compare signal characteristics and image qualities of MR diffusion-weighted imaging (DWI)at 1.5T and 3.0T in patients with the complex adnexal masses.Methods Magnetic resonance imaging including routine MRI and DWI(b=0 s/mm2 ,400 s/mm2 , 600 s/mm2 ,800 s/mm2 ,1 000 s/mm2 )of 1.5T (50 patients with 31 benign and 1 9 malignant lesions )and 3.0T (53 patients with 29 benign and 24 malignant lesions )were performed in 103 patients with histopathologically proved adnexal masses.The optimal b value was analyzed,and the apparent diffusion coefficient (ADC)value and signal intensity (SI)value and contrast to noise ratio (CNR)of solid and cystic components in adnexal masses from both 1.5T and 3.0T MR were respectively compared statistically.Results The 800 s/mm2 was the optimal b value in demonstrating adnexal masses at 1.5T and 3.0T.The CNR of solid and cystic components in adnexal masses were significantly higher at 3.0T than at 1.5T on all b values(all P =0.000).The difference in ADC value of solid lesions between 1.5T and 3.0T on all b values DWI had no statistically significant (all P >0.05),nor did the difference in SI value of solid lesions as well as ADC value of cystic lesions on b800 DWI(P >0.05).Conclusion MR diffusion-weighted imaging at 3.0T compared with 1.5T has quantitative and qualitative advantages of evaluating for adnexal masses,while the 800 s/mm2 is the optimal b value for both of them.
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Objective To study the role of CT in the evaluation after patellar dislocation triple surgeries.Methods Retrospectively analysed the CT measurements of 60 recurrent patellar dislocation patients (61 knees),who had undergone patellar dislocation triple surgeries,within one month before and after procedures.The measurements included patellar tilt angle,lateral patellar displacement,trochlear con-gruence angle,Tibial Tuberosity-Trochlear Groove distance,Insall-Salvati Ratio and Caton-Deschamps Index.Moreover,the troch-lear dysplasia classifications of all patients were evaluated.In addtion,an analysis has also been completed for 40 (41 knees)of 60 patients who had second postoperative CT examinations as follow-up assessment 3 to 6 months after surgeries.Results All one-month postoperative measurements decreased obviously with statistical significance(P <0.05 ).Furthermore,one case of subluxa-tion,1 1 cases of abnormal Tibial Tuberosity-Trochlear Groove distance,13 cases of abnormal Insall-Salvati Ratio and 14 cases of Ca-ton-Deschamps Index abnormities were also observed.Besides that,it was also found that all patients had trochlear dysplasia and 5 cases were diagnosed with patellar subluxation or dislocation at the second postoperative follow-up assessment.Conclusion The patients with redislocation or risks for patellar instability can be detectecd by CT which provides objective evidence for postoperative evaluation and further treatments.
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Objective To analyze the imaging characteristics and the diagnostic value of conventional MRI and indirect MR arthrography in shoulder joint injury.Methods MR imaging in90 patients with shoulder joint disease were retrospectively analyzed by two musculoskeletal radiologist based on the results of arthroseopic examination,including 57 cases of rotator cuff disease and 33 cases of recurrent shoulder instability.The result of the indirect MR arthrography and conventional MR was statistically compared by Fisher exact probability test.Results (1)In the group of rotator cuff disease,37 patients underwent indirect MRA,demonstrating 10 cases of partial-thickness rotator cuff tear and 1 case of missed diagnosis;demonstrating 17 cases of full-thickness rotator cuff tear and 2 cases of misdiagnosis.For partialthickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 90.9%(10/11),92.3%(24/26),and 91.9%(34/37),respectively;for full-thickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 89.5%(17/19),94.4%(17/18),and 91.9%(34/37),respectively.Indirect MR arthrography in the diagnosis of partial and full thickness rotator cuff was significantly better than conventional MR(P＜0.05).(2)In the group of recurrent shoulder instability,labium tear was found in 26 cases,Hill-sachs lesion in 27,reverse Hill-sachs in 2,bony Bankart lesion in 7,and capsular tear in 18 cases,respectively.Twenty patients underwent indirect MRA,demonstrating 14 cases of labrum tear,1 case of missed diagnosis,and 5 cases of normal labrum.For labrum tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 93.3%(14/15),100.0%(5/5),and 95.0%(19/20),respectively.Indirect MR arthrography in the diagnosis of labrum tear was significantly better than conventional MR(P＜0.05).Conclusion MRI,especially indirect MR arthrography,is the most helpful method for the diagnoses of shoulder joint injury.
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Objective To evaluate the diagnostic value of indirect MR arthrography(MRA) and conventional MR for shoulder instability.Methods 24 cases of shoulder instability were retrospectively analyzed.13 patients underwent conventional MR,11 patients underwent indirect MRA.Based on the results of arthroscopic examination,the efficacy of indirect MRA images and conventional MR images in diagnosis of the labrum,the capsule, and the bone structure injury.Results Indirect MRA in diagnosis of labrum tear was signifiantly better than conventional MR(P0.05).Conclusion Indirect MRA is more helpful to diagnose the labrum tear than conventional MR.Further study should be taken for capsule and ligament injury.