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Objective:To compare the predictive value of parameters extracted from circular region-of-interest (ROI) with whole-liver histogram on gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced T 1 map for postoperative liver failure in patients with liver focal lesions. Methods:The data of patients who underwent Gd-EOB-DTPA-enhanced MRI for focal liver lesions in Zhongshan Hospital, Fudan University from March 2016 to March 2018 were analyzed retrospectively. Forty patients were enrolled, including 30 males and 10 females, aged (56.6±12.1) years. According to the occurrence of postoperative liver failure, forty patients were divided into liver failure group ( n=14) and control group ( n=26). The parameters extracted from circular ROIs and whole liver histogram on T 1 map before Gd-EOB-DTPA enhancement and in hepatobiliary phase (HBP) were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of these parameters in predicting postoperative liver failure. Results:The mean, standard deviation, median and 95% quantile of T 1 HBP in histogram parameters of liver failure group were significantly higher than those of control group (all P<0.05). The three parameters extracted from circular ROIs were not effective in predicting liver failure after hepatectomy (all P>0.05). Among all the liver histogram parameters, the area under the ROC curve of the 95% quantile before T 1 enhancement for predicting postoperative liver failure was 0.702 (95% CI: 0.523-0.881), the standard deviation of T 1 HBP was 0.739 (95% CI: 0.568-0.910), and the 95% quantile of T 1 HBP was 0.721 (95% CI: 0.540-0.903). The predictive efficacy were good (all P<0.05). Among them, the predictive performance of T 1 HBP standard deviation was the best, the area under the ROC curve was 0.739, the sensitivity was 85.7%, the specificity was 57.7%, and the best threshold was 54.8 ms. Conclusions:When Gd-EOB-DTPA enhanced T 1 mapping is used to predict postoperative liver failure in patients with focal liver lesions, the whole-liver histogram analysis is superior to the conventional circular ROI-based statistical method.
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OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
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Humans , Collateral Circulation , Coronary Vessels , Follow-Up Studies , Infarction , Magnetic Resonance Imaging , Myocardial Infarction , Myocardial Ischemia , Myocardium , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
Objective To explore the correlations between intravoxel incoherent motion (IVIM) parameters measured at different time points and histopathological markers in an orthotopic xenograft hepatocellular carcinoma (HCC) nude mice model. Methods A total of 40 HCC orthotopic bearing mouse models were established. When they grew to 21 days, 10 HCC-bearing mice were randomly selected as the baseline group (Group A) by a numeric table method. Then the rest mice were randomly selected on the 28th day, 35th day, and 42nd day of the growth by using the same method, 10 each for B, C, and D groups, respectively. All mice underwent MR IVIM study and apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f) were measured. After the MRI scanning, the tumors were removed for pathological examination. The necrosis score (NF), tumor size and microvessel density (MVD) were calculated. The IVIM parameters were compared among these 4 groups by Kruskal-Wallis H test and the correlations between these IVIM parameters and histological features were studied with Spearman rank correlation test. Results One tumor in each of C and D groups was excluded because f values of IVIM were close to zero. There were significant differences found in ADC and D among all the 4 groups (P＜0.05). However, no difference was found in D*and f (P＞0.05). Compared with the baseline (group A), ADC decreased significantly at 7 and 14 days, whilst D decreased significantly at 7 days. The differences in tumor size, MVD and NF between the 4 groups were statistically significant. Compared with the baseline, the tumor size and NF significantly increased at 7, 14 and 21 days, and MVD increased at 14 and 21 days. Significantly positive correlations were demonstrated between ADC and MVD, NF (r=0.461 and 0.442, P＜0.05), between D and MVD, NF (r=0.568 and 0.519, P＜0.05) after exclusion of the data from the baseline. The parameter f from all the time points including the baseline was positively correlated with histological MVD and NF (r=0.590 and 0.458, P＜0.05). Conclusion IVIM parameters may reflect the intratumoral vascularity, tumor cell proliferation and necrosis of HCC, and they are correlated with the pathological indicators.
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Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the staging of chronic kidney disease(CKD).Methods From May 2016 to April 2017,seventy-two patients diagnosed as CKD according to the criteria of clinical diagnostic and 20 healthy volunteers (control group) underwent routine MRI and IVIM-DWI ( 8 b values, 0 to 800 s/mm2).CKD patients were divided into two groups based on their estimated glomerular filtration rate (eGFR): mild CKD group(45 cases,eGFR≥60 ml·min-1·1.73m-2)and moderate to severe CKD group(27 cases,eGFR<60 ml·min-1·1.73 m-2).The ADC,true diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction (f) were measured on both cortex and medulla. The paired-samples t test was used to compare the cortico-medullary difference of the ADC,D,D*and f values in three groups.Differences of the ADC,D, D*and f values among three groups were compared using the one-way analysis of variance (ANOVA). Correlations between eGFR and the IVIM-DWI parameters in CKD were evaluated by using Pearson correlation analysis. ROC was performed to evaluate the diagnostic efficiency of using IVIM-DWI parameters to distinguish CKD with moderate to severe renal impairment from mild renal impairment, as well as distinguish CKD with mild renal impairment from healthy volunteers.Results The cortical ADC,D, D*and f values were significantly higher than that in the medulla in healthy volunteers(all P<0.05). The cortical ADC,D*and f values were significantly higher than that in the medulla in mild CKD group(all P<0.05). The cortical ADC,D and f values were significantly higher than that in the medulla in moderate to severe CKD group (all P<0.05). The ADC,D,D*and f values of cortex and medulla showed significantly differences among three groups(all P<0.05).In CKD patients,no significant correlation was found between medullary D*,f values and eGFR, there was a significant positive correlation between eGFR and cortical ADC,D,D*and f values(r=0.475,0.362,0.625,0.276;all P<0.05),as well as between eGFR and medullary ADC,D values(r=0.427,0.615;P<0.05). The results of the ROC analysis for distinguishing the mild CKD group from the moderate to severe CKD group revealed that the cortical D*value had the highest area under the ROC curve (AUC=0.965), cortical f value showed high sensitivity(92.6%) to distinguish CKD with different degree of renal impairment, with the threshold of 32.99%, and cortical D*value showed high specificity(97.8%)with the threshold of 17.07×10-3mm2/s;the results of the ROC analysis for distinguishing the mild CKD group from healthy volunteers revealed that the cortical D*value had the highest AUC(0.885), medullary ADC value showed high sensitivity (82.2%) to distinguish mild CKD group from healthy volunteers,with the threshold of 1.83×10-3mm2/s,and medullary f value showed high specificity(100.0%)with the threshold of 21.70%,as well as medullary D value showed high specificity(100.0%)with the threshold of 1.75× 10-3mm2/s.Conclusion IVIM-DWI may be useful for CKD early diagnosis and assessing renal function.
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Objective To investigate the clinical significance and changes of serum complement in lipid metabolism disorder in patients with fatty liver disease.Methods One hundred and forty patients with FLD from October 2015 to May 2017 were included in the study,in addition,120 patients with hyperlipidemia(the hyperlipidemia group)and 130 healthy subjects(the control group)in the same period were enrolled as controls.The differences in serum lipid,liver function enzymology,immunoglobulin,serum complement among the three groups were compared.Results There were significant differences in the levels of TC,TG,HDL-C,LDL-C,apoA and apoB among the three groups(TC:(5.7±1.6)mmol/L vs.(4.2±1.0)mmol/L vs.(3.5±1.1) mmol/L,F=105.01,P<0.05;TG:(2.8± 0.6)mmol/L vs.(1.5 ± 0.3)mmol/L vs.(1.1 ± 0.2)mmol/L,F=628.46,P<0.05;HDL-C:(1.2±0.3)mmol/L vs.(1.5±0.3)mmol/L vs.(1.8±0.4)mmol/L,F=107.10, P<0.05;LDL-C:(3.6±0.9)mmol/L vs.(3.0±0.8)mmol/L vs.(2.2±0.6)mmol/L,F=109.07,P<0.05;apoA:(1.0±0.2)g/L vs.(1.2±0.2)g/L vs.(1.4±0.3)g/L,F=95.20,P<0.05;apoB:(1.1±0.2)g/L vs.(0.9±0.2)g/L vs.(0.8±0.2)g/L,F=79.04,P<0.05).The levels of TC,TG,LDL-C and apoB in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of HDL-C and apoA in the FLD groups were significantly lower than those in the hyperlipidemia group and control group.The levels of TC,TG,LDL-C and apoB in the hyperlipidemia group were significantly higher than those in the control group.The levels of HDL-C and apoA in the hyperlipidemia group were significantly lower than those in the control group.There were significant differences in the levels of GGT,ALT,AST,IgG and IgM among the three groups(GGT:(77.4±15.3)U/L vs.(43.3±10.6)U/L vs.(25.5±8.2)U/L,F=668.12,P<0.05;ALT:(61.5±18.8)U/L vs.(35.7±11.2)U/L vs.(18.9±5.4)U/L,F=355.67,P<0.05;AST:(55.3±12.2)U/L vs.(32.4±12.5)U/L vs.(14.4±4.7)U/L,F=521.80,P<0.05;IgG:(15.7±3.9)g/L vs.(11.6±3.2)g/vs.,(8.5±2.6)g/L,F=162.34,P<0.05;IgM:(1.9±0.6)g/L vs.(1.2±0.4)g/L vs.(0.8±0.3)g/L,F=201.38,P<0.05).The levels of GGT,ALT,AST,IgG and IgM in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of GGT,ALT,AST,IgG and IgM in the hyperlipidemia group were significantly higher than those in the control group.There were significant differences in the levels of C3,C5,ASP and BF among the mild,moderate and severe fatty liver patients(C3:(2.1±0.4) g/L vs.(1.8±0.3)g/L vs.(1.0±0.2)g/L,F=436.37,P<0.05;C5:(92.3±10.7)mg/L vs.(71.8±8.8) mg/L vs.(58.9±6.5)mg/L,F=486.09,P<0.05; ASP:(51.4±6.8)nmol/L vs.(42.5±4.4)nmol/L vs.(32.8±5.2)nmol/L,F=369.29,P<0.05;BF:(0.48±0.13)g/L vs.(0.34±0.09)g/L vs.(0.23±0.04) g/L,F=233.39,P<0.05).The levels of C3,C5,ASP and BF in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of C3,C5,ASP and BF in the hyperlipidemia group were significantly higher than those in the control group.There were significant differences in the levels of C3,C5,ASP and BF among patients with mild,moderate and severe fatty liver disease(C3:(1.8±0.3)g/L vs.(2.1±0.4)g/L vs.(2.5±0.4)g/L,F=30.85,P<0.05;C5:(80.5±9.6)mg/L vs.(92.3±10.5)mg/L vs.(100.7±8.)mg/L,F=39.39,P<0.05; ASP:(42.4±6.3)nmol/L vs.(52.8±5.7)nmol/L vs.(61.9±5.6) nmol/L,F=98.19,P<0.05;BF:(0.33±0.12)g/L vs.(0.45±0.11)g/L vs.(0.57±0.09)g/L,F=41.26,P<0.05).The levels of C3,C5,ASP and BF in the mild FLD patients were significantly lower than those in moderate and severe FLD patients.The levels of C3,C5,ASP and BF in the moderate FLD patients were significantly lower than those in severe FLD patients.Conclusion The detection of C3,C5,ASP and BF levels based on routine testes has important clinical value for the assessment of the condition,the treatment and the prognosis of FLD patients.
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Objective To investigate the clinical significance and changes of serum complement in lipid metabolism disorder in patients with fatty liver disease.Methods One hundred and forty patients with FLD from October 2015 to May 2017 were included in the study,in addition,120 patients with hyperlipidemia(the hyperlipidemia group)and 130 healthy subjects(the control group)in the same period were enrolled as controls.The differences in serum lipid,liver function enzymology,immunoglobulin,serum complement among the three groups were compared.Results There were significant differences in the levels of TC,TG,HDL-C,LDL-C,apoA and apoB among the three groups(TC:(5.7±1.6)mmol/L vs.(4.2±1.0)mmol/L vs.(3.5±1.1) mmol/L,F=105.01,P<0.05;TG:(2.8± 0.6)mmol/L vs.(1.5 ± 0.3)mmol/L vs.(1.1 ± 0.2)mmol/L,F=628.46,P<0.05;HDL-C:(1.2±0.3)mmol/L vs.(1.5±0.3)mmol/L vs.(1.8±0.4)mmol/L,F=107.10, P<0.05;LDL-C:(3.6±0.9)mmol/L vs.(3.0±0.8)mmol/L vs.(2.2±0.6)mmol/L,F=109.07,P<0.05;apoA:(1.0±0.2)g/L vs.(1.2±0.2)g/L vs.(1.4±0.3)g/L,F=95.20,P<0.05;apoB:(1.1±0.2)g/L vs.(0.9±0.2)g/L vs.(0.8±0.2)g/L,F=79.04,P<0.05).The levels of TC,TG,LDL-C and apoB in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of HDL-C and apoA in the FLD groups were significantly lower than those in the hyperlipidemia group and control group.The levels of TC,TG,LDL-C and apoB in the hyperlipidemia group were significantly higher than those in the control group.The levels of HDL-C and apoA in the hyperlipidemia group were significantly lower than those in the control group.There were significant differences in the levels of GGT,ALT,AST,IgG and IgM among the three groups(GGT:(77.4±15.3)U/L vs.(43.3±10.6)U/L vs.(25.5±8.2)U/L,F=668.12,P<0.05;ALT:(61.5±18.8)U/L vs.(35.7±11.2)U/L vs.(18.9±5.4)U/L,F=355.67,P<0.05;AST:(55.3±12.2)U/L vs.(32.4±12.5)U/L vs.(14.4±4.7)U/L,F=521.80,P<0.05;IgG:(15.7±3.9)g/L vs.(11.6±3.2)g/vs.,(8.5±2.6)g/L,F=162.34,P<0.05;IgM:(1.9±0.6)g/L vs.(1.2±0.4)g/L vs.(0.8±0.3)g/L,F=201.38,P<0.05).The levels of GGT,ALT,AST,IgG and IgM in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of GGT,ALT,AST,IgG and IgM in the hyperlipidemia group were significantly higher than those in the control group.There were significant differences in the levels of C3,C5,ASP and BF among the mild,moderate and severe fatty liver patients(C3:(2.1±0.4) g/L vs.(1.8±0.3)g/L vs.(1.0±0.2)g/L,F=436.37,P<0.05;C5:(92.3±10.7)mg/L vs.(71.8±8.8) mg/L vs.(58.9±6.5)mg/L,F=486.09,P<0.05; ASP:(51.4±6.8)nmol/L vs.(42.5±4.4)nmol/L vs.(32.8±5.2)nmol/L,F=369.29,P<0.05;BF:(0.48±0.13)g/L vs.(0.34±0.09)g/L vs.(0.23±0.04) g/L,F=233.39,P<0.05).The levels of C3,C5,ASP and BF in the FLD group were significantly higher than those in the hyperlipidemia group and the control group.The levels of C3,C5,ASP and BF in the hyperlipidemia group were significantly higher than those in the control group.There were significant differences in the levels of C3,C5,ASP and BF among patients with mild,moderate and severe fatty liver disease(C3:(1.8±0.3)g/L vs.(2.1±0.4)g/L vs.(2.5±0.4)g/L,F=30.85,P<0.05;C5:(80.5±9.6)mg/L vs.(92.3±10.5)mg/L vs.(100.7±8.)mg/L,F=39.39,P<0.05; ASP:(42.4±6.3)nmol/L vs.(52.8±5.7)nmol/L vs.(61.9±5.6) nmol/L,F=98.19,P<0.05;BF:(0.33±0.12)g/L vs.(0.45±0.11)g/L vs.(0.57±0.09)g/L,F=41.26,P<0.05).The levels of C3,C5,ASP and BF in the mild FLD patients were significantly lower than those in moderate and severe FLD patients.The levels of C3,C5,ASP and BF in the moderate FLD patients were significantly lower than those in severe FLD patients.Conclusion The detection of C3,C5,ASP and BF levels based on routine testes has important clinical value for the assessment of the condition,the treatment and the prognosis of FLD patients.
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Objective To observe the muscles and skeleton involvement surrounding sacroiliac joint (SIJ) of axial seronegative spondyloarthropathy (SPA) patients with magnetic resonance imaging (MRI),and to analyze the relationship between them.Methods A prospective study of 38 patients who meet the 2009 axial SpA diagnostic criteria was conducted.We carried out MRI of the SIJ for these patients to evaluate the muscles and skeleton involvement.Those cases were divided into muscles differences between the two groups of image scores,including Spondyloarthritis Research Consortium of Canada (SPARCC) scores and Spondyloarthritis Research Consortium of Canada MRI Sacroiliac Joint Structural Score (SPARCC SSS).The extent of muscles edema in patients with sacroiliac joints was ranked into twelve grades from 0-12,and we did Spearman rank correlation test of muscles edema scope and two indexes.Results We found that 28 cases (73.68％) of the 38 patients had significant muscle involvement by analyzing the STIR sequence,and found erector spinae in 22 cases (57.89 ％)gluteal muscles in 13 cases (34.21 ％),iliacus muscle in 11 cases (28.95 ％),obturator muscle in 5 cases (13.16％),piriform muscle in 5 cases (13.16％) and other 4 cases (10.53％).SPARCC (t =2.28,P =0.03) and SPARCC SSS (t =3.37,P =0.00) were statistically different between the two groups.SPARCC (P =0.00,r =0.67) and SPARCC SSS (P-0.01,r =0.47) were positively correlated with the extent of muscles edema.Conclusions The muscles edema around sacroiliac joint is an important sign of axial SpA magnetic resonance imaging.Patients who had muscles edema tended to have more serious skeleton changes.
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Objective To investigate the feasibility of computer-aided pancreas segmentation based on three-dimensional (3D) Dixon MRI at 3.0-T.Methods Five volunteers with health pancreas underwent upper abdominal 3D Dixon MRI at 3.0T with the same scan parameters while holding breath.The automatic segmentation of pancreas is based on the Medical Imaging Interaction ToolKit (MITK) with homemade software.A experienced radiologist performed manual segmentation and computer aided segmentation of the pancreas on the opposed phase and water phase images twice.Similarity was analyzed and compared for the manual and automated segmentations for the two group images.Similarity was presented as Dice coefficients.Results Both of the oppose phase and water phase images of Dixon MRI showed that the signal intensity of pancreas was higher than that of the surrounding tissue,the similarity of water phase was obviously higher than that of oppose phase and the differences were statistically significant.Based on Dixon MRI water phase and oppose phase images,the mean dice coefficients for the manual segmentations were 0.81 ± 0.01 and 0.85 ±0.03,respectively,for both the oppose phase and water phase images (P=0.013).For the automated segmentations,the dice coefficients were 0.69 ± 0.08 and 0.75 ± 0.03 for water phase images and the oppose images,respectively,and the difference was not statistically significant (P =0.155).Conclusions 3.0T oppose phase and water phase of Dixon images could clearly show the pancreas,and automated pancreas segmentation based on water phase Dixon MRI obtained higher similarity,which was feasible.
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OBJECTIVE: To compare the diagnostic accuracy of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) in distinguishing between renal cell carcinoma (RCC) and fat poor angiomyolipoma (AML). MATERIALS AND METHODS: Eighty-three patients with pathologically confirmed renal tumors were included in the study. All patients underwent renal 1.5T MRI, including IVIM protocol with 8 b values (0–800 s/mm²). The ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were calculated. One-way ANOVA was used for comparing ADC and IVIM-derived parameters among clear cell RCC (ccRCC), non-ccRCC and fat poor AML. The diagnostic performance of these parameters was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS: The ADC were significantly greater in ccRCCs than that of non-ccRCCs and fat poor AMLs (each p 0.97 × 10⁻³ mm²/s, D* < 28.03 × 10⁻³ mm²/s, and f < 13.61% maximized the diagnostic sensitivity for distinguishing non-ccRCCs from fat poor AMLs. The final estimates of AUC (95% confidence interval), sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the entire cohort were 0.875 (0.719–0.962), 100% (23/23), 75% (9/12), 88.5% (23/26), 100% (9/9), and 91.4% (32/35), respectively. CONCLUSION: The ADC and D showed similar diagnostic accuracy in distinguishing between ccRCCs and fat poor AMLs. The IVIM-derived parameters were better than ADC in discriminating non-ccRCCs from fat poor AMLs.