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Objective:To build and validate a radiomics and clinical nomogram for preoperative discrimination between low- and high-grade sinonasal squamous cell carcinoma (SNSCC).Methods:From January 2017 to May 2021, 167 SNSCC patients including 78 low-grade (grade Ⅰ or Ⅱ) and 89 high-grade (grade Ⅲ) were retrospectively analyzed at the Eye & ENT Hospital of Fudan University. All patients were randomly divided into a training cohort ( n=117, 64 high-grade and 53 low-grade SNSCC) and a validation cohort ( n=50, 25 high-grade and 25 low-grade SNSCC) in a ratio of 7∶3 using a stratified sampling method. The radiomics features were extracted in contrast enhanced T 1WI with manual segmentation of lesions. The least absolute shrinkage and selection operator regression was used to reduce the dimension of the radiomics features and then the radiomics model was built to predict SNSCC histological grade in training cohort. Independent clinical predicting factors were screened using logistic regression and the clinical model was built. The clinical-radiomics model was built by the radiomics features and clinical factors in the training cohort based on logistic regression and the nomogram was drawn. The receiver operator characteristic curves were drawn to evaluate the performance of clinical model, radiomics model and nomogram. The calibration curve was used to evaluate the consistency between the nomogram prediction and the actual observation risk, and the decision curve analysis (DCA) was used to evaluate the clinical applicability of the nomogram. Results:Using logistic regression analysis, the clinical model was built by the tumor primary site (OR value 7.376, 95%CI 2.517-21.618, P<0.001) and TNM stage (OR value 10.020, 95%CI 3.654-27.472, P<0.001) and the area under the curve (AUC) in the training cohort and validation cohort were 0.798 and 0.784, sensitivity were 84.4% and 84.0%, specificity were 58.5% and 68.0%, respectively. Based on the contrast enhanced T 1WI, a total of 9 radiomics features were screened for establishing the radiomics model. The AUC of radiomics model were 0.833 (sensitivity 82.8%, specificity 73.6%) and 0.851 (sensitivity 92.0%, specificity 68.0%) in the training and validation cohorts. The nomogram based on the clinical-radiomics model predicted histological grade with the highest AUC in the training cohort (AUC 0.920, sensitivity 89.1%, specificity 83.0%) and validation cohort (AUC 0.912, sensitivity 92.0%, specificity 84.0%). The calibration curve of the nomogram was close to the ideal line in both training and validation cohorts. DCA showed that the use of nomogram with a threshold in the range of <85% in training cohort, in the range of 20%-65%, 72%-90% in validation cohort, had a greater clinical application value in predicting the SNSCC histological grade. Nomogram model had a better clinical net benefit than the clinical and radiomics models. Conclusion:Nomogram combining clinical factors (tumor primary site and TNM stage) with radiomics features obtained from contrast enhanced T 1WI has a better ability for predicting histological grade of SNSCC than clinical and radiomics models.
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Objective To evaluate the correlation between the degree of cochlea endolymphatic hydrops(EH) and hearing loss and symptoms in patients with unilateral Meniere's disease. Methods Fifty seven patients with unilateral Meniere's patients were retrospectively quantitatively analyzed, which evaluated the correlation between the cochlea EH and hearing loss and symptoms. The affected ears in the experimental group(57 ears) and the asymptomatic ears in the control group(57 ears), were confirmed by bilateral intratympanic Gd-DTPA injection and 3D real IR MRI scan after 24 h. The maximum length of endolymph space and labyrinth chamber along the modiolus cochleae and their ratio which represented the endolymph space proportion of each turn(R1, the basal turn;R2, the middle turn;R3, the apical turn) were calculated. And the paired t test was used to compare the differences in EH degree between the experimental and control group;Pearson correlation analysis was used to analyze the correlation between the cochlea EH degree and hearing loss and duration of symptoms. Results R1, R1 and R3 of ipsilateral cochlea were higher than normal cochlea(ipsilateral R1:0.354±0.097 vs. normal R1:0.185±0.031, P0.05). In addition, there was a correlation between the degree of EH in the apical turn and low, medium, high-frequency hearing loss(r=0.271, 0.269, 0.329, respectively; all P<0.05). Conclusions The degree of cochlea EH in the basal and second turn showed great relevance with the high-frequency hearing loss, and the apical turn EH degree was relevant with the low, medium, high-frequency hearing loss, but there was no correlation between the EH degree of each turn, ages and symptoms.
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Objective To discuss the value of high resolution MRI in the evaluation of small intralabyrinthine lesions with the symptom of vertigo. Methods We retrospectively analyzed the imaging examination techniques and imaging finding of 13 cases of labyrinthine hemorrhage or exudate and 6 cases of intralabyrinthine schwannoma (ILS) with the symptom of vertigo. Two cases of labyrinthine hemorrhage or exudate and 3 cases of ILS underwent temporal bone high resolution CT(HRCT) scan and all the 19 patients received highresolution MR examination. Patients of labyrinthine hemorrhage or exudate received fluid?attenuated inversion recovery (FLAIR)T2WI in addition to routine pre?contrast temporal bone MR. Pre?and post?contrast MR of the temporal bone were performed on the ILS patients. In particular, 3 ILS cases received three?dimensional sampling perfection with application?optimized contrasts by using different flip angle evolutions (3D?SPACE) sequence. Results There was no abnormal finding on HRCT of the inner ear of the 2 labyrinthine hemorrhage cases. On T1WI, regions of mild increased signal intensity of the labyrinth of affected side could be spotted in 7 patients whereas no abnormal signal intensity was found in the other 6 patients. On T2WI, all the 13 labyrinthine hemorrhage or exudate cases had no abnormal finding in the inner ear. On FLAIR T2WI sequence, regions of increased signal intensity of the labyrinth of affected side could be found in all the 13 cases. Thress ILS patients that received HRCT scan showed no valuable finding. On T1WI, no abnormal signal intensity was found in the labyrinth of the 6 patients. On T2WI, regions of decreased signal intensity of the labyrinth could be found in only 3 patients. All the 3 cases that received 3D?SPACE sequence appeared as a filling defect in the high?signal labyrinth clearly while 2 of the 3 lesions could not be found on T2WI. After Gadolinium administration, all the 6 ILSs were obviously enhancing. Conclusions High resolution MRI is valuable in the diagnosis of labyrinthine hemorrhage or exudate and ILS. The use of FLAIR T2WI sequence can help us to find labyrinthine hemorrhage or exudate more sensitively. The use of 3D?SPACE sequence can help us to detect and diagnose small intralabyrinthine lesions.
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Background and purpose:Parotid gland is rich in fat and has obvious contrast with bone and muscle in CT image.The preoperative examination of CT could help to evaluate the scale of tumor invasion and the relationship between tumor and normal tissues so that the proper therapy could be properly designed.The purpose of this study was to evaluate the roles of computer tomography(CT)in differential diagnosis of benign and malignant parotid tumors and to improve the diagnostic accuracy.Methods:CT images of 17 patients with benign parotid tumors and 15 patients with malignant parotid tumors proved by pathology were analyzed retrospectively.All patients underwent CT contrast-enhanced examination preoperatively.Images of all patients were retrospectively reviewed by two experienced radiologists in the diagnosis of head and neck tumors.Results:14 of 17 cases of benign tumors had round shapes and 9 of 15 cases of malignant tumors exhibited lobular or irregular masses(P
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Objective To study the evaluation between the X-ray findings and ultrasound(US) manifestations of upper digestiveobstruction in infancy.Methods X-ray and US manifestations of 20 cases of infant with upper digestive obstruction proved by operationwere analysed respectively.Results In 20 cases,12 patients had pyloric stenosis,3 duodenal stresia,3 midgut malformation,2 hiatalhernia.Pyloric stenosis was diagnosed by X-ray in 11 cases,by US in 9,misdiagnosed by US in 1 case.Duodenal stresia was observed by X-ray and US in 2 cases separately,not observed by X-ray and US in 1 case separately.Midgut malformation was demonstrated by X-ray and US in 1 case separately,not demonstrated in 2 cases separately.Hiatal hernia was found by X-ray in 2 cases,misdiagnosed by US in 2 cases.Conclusion The two methods can't substitute with each other but complement.X-ray is better than US in the diagnosis of pyloric stenosis and hiatal hernia.US is better than X-ray in the diagnosis of midgut malformation.