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Objective:To investigate the value of magnetization transfer imaging (MTI) and fat suppression T 2WI (FS-T 2WI) in predicting the clinical activity of Graves ophthalmopathy (GO). Methods:From October 2020 to July 2021, 64 GO patients were prospectively enrolled in the First Affiliated Hospital of Nanjing Medical University. According to the clinical activity score (CAS), the patients were divided into active group (CAS≥3, 39 patients and 78 eyes) and inactive group (CAS<3, 25 patients and 50 eyes). The coronal MTI and FS-T 2WI were scanned for pre-treatment assessment. Magnetization transfer ratio (MTR) of extraocular muscles, and signal intensity ratio (SIR) between extraocular muscles and temporalis were measured, respectively. The independent-sample t-test was used to compare the MTR and SIR between two groups. The correlations between MRI parameters and CAS were analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curve was performed to evaluate the value of each and combined parameters for predicting the clinical activity of GO. The DeLong test was used to compare the area under the curve (AUC). Results:The MTR of active group and inactive group were 0.45±0.04 and 0.51±0.04, respectively, the difference was statistically significant ( t=7.62, P<0.001). The SIR were 3.4±0.6 and 2.6±0.5, respectively, and the difference was also statistically significant ( t=-8.20, P<0.001). MTR was negatively correlated with CAS ( r=-0.46, P<0.001), while SIR was positively correlated with CAS ( r=0.63, P<0.001). The AUC of MTR, SIR and the combination of MTR and SIR for predicting the clinical activity of GO were 0.840, 0.845 and 0.905, respectively. The combination of MTR and SIR showed higher performance than MTR or SIR alone, and the differences were statistically significant ( Z=2.61, P=0.009; Z=2.15, P=0.032). Conclusions:The quantitative parameters of MTI and FS-T 2WI, namely MTR and SIR, can be used to evaluate the clinical activity of GO. Integrating MTI and FS-T 2WI can improve the diagnostic efficiency.
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Objective:To explore the diagnostic value of radiomics based on arterial-venous mixed images derived from dual-energy CT (DECT) data in diagnosis of cervical lymph nodes (LNs) metastasis of papillary thyroid cancer (PTC).Methods:From June 2017 to December 2018, eighty-four patients with preoperatively DECT scanning and pathologically confirmed PTC (129 non-metastatic LNs and 97 metastatic LNs) in the First Affiliated Hospital of Nanjing Medical University were included in this study. The clinical and imaging data of all patients were retrospectively analyzed. The training cohort consisted of 62 PTC cases with 156 LNs (91 non-metastatic LNs and 65 metastatic LNs). An independent validation cohort consisted of 22 PTC patients with 70 LNs (38 non-metastatic LNs and 32 metastatic LNs). Semi-automatic LNs segmentation was conducted on arterial-venous mixed images derived from DECT using Syngo.via Frontier Radiomics software. Totally 1 226 radiomics features were extracted from arterial-venous mixed images for each LN. The least absolute shrinkage and selection operator (LASSO) regression was applied for radiomics features selection and signature building. The logistic regression modeling was used to construct diagnostic models based on the CT image features of LNs (model 1), the radiomics signature (model 2) and the combination of the CT image features and radiomics signature (model 3). An intuitive nomogram was plotted for model 3. The ROC curve analyses and area under the curve (AUC) were performed to evaluate the diagnostic efficiency of the three models, with the performances compared using the Delong test.Results:Model 1 was developed with LNs shape, degree of enhancement, pattern of enhancement, calcification and extra nodal extension. Three arterial phase radiomics features were selected and used to establish radiomics signature using LASSO regression (model 2). Model 3 was developed with LNs size, shape, degree of enhancement and radiomics signature. In both the training and validation cohort, model 3 showed the best diagnostic performance (AUC=0.965, 0.933), followed by model 2 (AUC=0.947, 0.910), and both these two models significantly outperformed model 1 (AUC=0.850, 0.846) (training cohort, Z=4.066 and 3.758, P both<0.001; validation cohort, Z=2.871 and 1.998, P=0.017 and 0.042) respectively. Conclusion:The radiomics model based on arterial-venous mixed images derived from DECT data can realize effective diagnosis of LNs metastasis in patients with PTC; and the combination model of radiomics signature with CT image features can further improve the diagnostic accuracy.
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Objective Toinvestigatetheclinicalvalueofreadoutsegmentationoflongvariableecho-trainsdiffusion-weightedimaging (RESOLVE-DWI)inthediagnosisandstagingofthyroid-associatedophthalmopathy(TAO).Methods Atotalof30consecutivepatientswith TAOand30healthycontrols(HCs)whounderwentRESOLVE-DWIwereenrolledinourstudy.ADCvaluesofextraocularmuscles (superiorrectus,inferiorrectus,medialrectusandlateralrectus)were measuredandcomparedbetween TAOsand HCs,active TAOsandinactiveTAOs,orinactiveTAOsandHCs.ROCanalysiswasperformedtoevaluatethediagnosticvalueofsignificantparametersfor discriminatingactivefrominactiveTAOs.Results TheADCvaluesofallextraocularmusclesinTAOsweresignificantlyhigherthan thoseinHCs(P<0.05).Meanwhile,alltheextraocularmusclesinactiveTAOsshowedsignificantlyhigherADCvaluesthanthose ininactiveTAOs(P<0.05),exceptlateralrectus(P=0.267).WhilstnosignificantdifferenceswerefoundontheADCvaluesofall extraocularmusclesbetweeninactiveTAOsandHCs(P>0.05).ROCanalysisresultsindicatedthattheADCvalueofmedialrectus showedtheoptimalstagingefficacy(cutoffvalue,1.40×10-3 mm2/s;AUC,0.766;sensitivity,92.1%;specificity,59.1%).Conclusion RESOLVE-DWIanditsderivedADCvaluesofextraocularmusclescanassistinthediagnosisofTAO.TheADCvalueofmedial rectushastheoptimalefficacyontheevaluationofitsclinicalactivity.
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Objective To evaluate the value of quantitative analysis of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) for differentiating malignant from benign orbital lymphoproliferative disorder(OLPD). Methods Forty-three patients with OLPDs(20 patients with benign OLPDs and 23 patients with orbital lymphoma) confirmed by histopathology or clinical follow-up were enrolled in this retrospective study.Quantitative parameters of DCE-MRI including volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and mean apparent diffusion coefficient(ADC)values were obtained. χ2test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic ability of each parameter and its combination. Results Malignant group showed significantly lower mean ADC values and higher Kepvalues than benign group [ADC:(0.674±0.126)×10-3mm2/s vs(1.030±0.304)×10-3mm2/s,P<0.001;Kep:(1.299±0.566)/min vs(0.787± 0.311)/min, P= 0.001], while no significant differences was found on Ktrans(P= 0.637) and Ve(P= 0.023). ROC analyses results indicated that,a sensitivity of 95.7%,specificity of 80.0% and area under curve(AUC) of 0.896 could be obtained,when using ADC=0.809×10-3mm2/s as the cut-off value.Setting the Kepvalue of 0.863/min as the cut-off value, a sensitivity of 91.3%, specificity of 75.0% and AUC of 0.848 could be obtained. When combination of mean ADC and Kepwas used, optimal diagnostic performance could be obtained (AUC, 0.926;sensitivity, 91.3%;specificity, 90.0%). Conclusion Mean ADC values and Kepare significant variables in predicting malignant OLPDs. Combination of DWI and DCE-MRI can further improve the diagnostic capability in differentiating malignant from benign OLPDs.
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Objective To investigate the clinical, radiological and pathological characteristics, treatment and prognosis of pulmonary benign metastasizing leiomyoma (PBML). Methods The clinical and image data of 6 patients with PBML confirmed by pathology from October 2012 to December 2016 were retrospectively analyzed, and the related literature was reviewed. Results Six cases were female, age was from 32 to 55 (43.80 ± 7.17) years. Two cases were found by physical examination, 2 cases had chest distress and asthma, 1 case had chest pain, and 1 case had hemoptysis. Pulmonary abnormalities were detected between 1 month and 15 years after uterine myomectomy. Chest CT showed that multiple lung nodules or masses were observed in 5 patients, among which random distribution was in 3 cases, diffuse military nodule pattern was in 2 cases, and single mass combined with primary lung adenocarcinoma was in 1 case. Fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F- FDG PET/CT) of one patient showed no obvious uptake of the maximum standardized uptake value. All patients were confirmed histologically with CT guided lung biopsy (2 cases), thoracoscopic lung biopsy (2 cases), and thoracoscopic lobectomy with wedge resection (2 cases). Tumor cells revealed the characteristics of smooth muscle cell differentiation. Immunohistochemistry showed strong positive express of Desmin, SMA smooth muscle specific markers, estrogen receptor and progesterone receptor. Three patients were treated with oral tamoxifen anti estrogen therapy with follow-up from 5 months to 5 years. Four cases had a good prognosis, and 2 cases were lost in follow-up. Conclusions PBML is a rare disease that is prone to occur in women of childbearing age. The clinical symptoms are atypical. Imaging examination and pathology are necessary for diagnosis. Surgery combined with endocrine therapy is effective.
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Objective To explore the feasibility of the applicatoin of readout-segmented echo-planar imaging (RS-EPI) at 3.0T MR of the orbit DWI and compared with single-shot echo-planar imaging (SS-EPI).Methods Forty-two volunteers underwent both standard SS-EPI and RS-EPI DWI of the orbit at a 3.0T MR unit.Two sets of DWI images were independently qualitatively scored in the number of distinguishable normal structures,fat suppression,ghosting artifact and overall image quality.SNR of the vitreous body,geometric distortion ratio (GDR) in both anterior-posterior (AP) and right-left (RL) direction,and ADC value of the vitreous body and pons were also quantitatively calculated and compared between two sets of DWI images.The statistical analysis was performed.Results For qualitative assessment,the RS-EPI was superior to SS-EPI on the number of distinguishable normal structures (P=0.009 0),ghosting artifact (P＜0.000 1),and overall image quality (P＜0.000 1),while no significant difference was found on fat suppression (P=0.753 9).For quantitative assessment,RS-EPI had significantly lower GDR than the SS-EPI in both AP and RL direction (P=0.001 4,0.001 7).The SNR in RS-EPI was significantly lower than that of SS-EPI (P=0.004 0).Meanwhile,there was no significant difference of ADC on vitreous body and pons between RS-EPI and SS-EPI (P=0.143 8,0.126 2).Conclusion The RS-EPI can provide better image quality than SS-EPI protocol in orbital DWI at 3.0T MR imaging.
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Objective To evaluate the value of diffusion weighted imaging (DWI)and apparent diffusion coefficient (ADC)in differentiating solid schwannoma and meningioma located in cerebellopontine angle.Methods DWI data of 12 patients with solid schwannoma and 27 patients with meningioma confirmed by postoperative pathology were analyzed retrospectively.Tumor was described carefully slice by slice as the whole region of the interest (ROI)to measure mean ADC value (mADC).ADC ratio (rADC)was calculated as mADC of tumor divided by mADC of brain stem.mADC and rADC were compared between the solid schwannoma and meningioma by using independent-samples t test. The receiver operating characteristic (ROC)curve was used to evaluate the value of mADC and rADC in differentiating solid schwannoma and meningioma.Results mADC and rADC values of the solid schwannoma were significantly higher than those of the meningioma (mADC,P=0.001;rADC,P=0.002,respectively).The optimal diagnostic performance was achieved if 0.994×10-3 mm2/s was set as the cutoff value of mADC in differentiating solid schwannoma and meningioma (AUC 0.917;sensitivity 92%;specificity 89%).Conclusion MR DWI is helpful to differentiate solid schwannoma and meningioma in cerebellopontine angle.
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Objective To investigate the diagnostic value of conventional MRI combined with DWI in the differential diagnosis of orbital lymphoproliferative disorders (LPD). Methods As a retrospective study, 42 patients were enrolled, including 23 orbital lymphoma and 19 benign orbital LPD confirmed pathologically or clinically. These patients underwent conventional MR, DWI and contrast?enhanced MRI examination of orbit. Qualitative MR imaging features [location, margin, patient ratio of involved quadrants (≥2), signal intensity,“flow void sign”, sinusitis] and quantitative features [ADC and contrast enhanced ratio of the lesion to temporal muscle (CER)] were evaluated. Chi?square test and t test were used for the analysis of qualitative and quantitative features between lymphoma and benign orbital LPD groups, respectively. Multivariate Logistic regression analysis was employed to identify the significant variable for predicting malignant LPD. ROC analysis was used to evaluate the ability of the diagnostic models established based on identified variables. Results “Flow void sign”(9 lymphomas and 17 benign LPDs) and sinusitis (5 lymphomas and 13 benign LPDs) were statistically significant (P0.05). Both ADC [(0.79±0.09)×10?3 mm2/s of lymphoma, (1.29±0.35)×10?3 mm2/s of benign LPD] and CER (1.43±0.17 of lymphoma, 1.79±0.31 of benign LPD) between the two groups had significant difference (t=-6.630, -8.257;P<0.01). Multivariate logistic regression analysis showed that ADC value, CER and“flow void sign”were significant variables for predicting malignant orbital LPD (P<0.05). ROC curve showed that ADC value was the most significant single variable in differentiating orbital LPD [threshold value, 0.74 × 10- 3 mm2/s; areas under ROC curve (AUC), 0.97; sensitivity, 87.0%; specificity, 94.7%]. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD (AUC, 0.90;sensitivity, 78.3%;specificity, 100.0%, accuracy 88.1%). Conclusions ADC, CER and“flow void sign”on T2WI were significant variables for predicting malignant orbital LPD. ADC value was the most significant single variable. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD.
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Objective To evaluate the role of conventional and functional MR in the diagnosis of orbital mucosa-associated lymphoid tissue lymphoma (MALToma).Methods Twenty-two patients with pathologically confirmed orbital MALToma were enrolled in our study.The number,location,morphology,involvement of surrounding structure and imaging features were evaluated.Apparent diffusion coefficient (ADC) values derived from diffusion weighted imaging and time-intensity curve (TIC)pattern derived from dynamic contrast enhanced MRI were assessed. Results Orbital MALToma occurred unilaterally in 1 7 cases and bilaterally in 5 cases.Anterior orbit preseptal region was involved most frequently (20 cases),followed by intraconal(19 cases),extraxonal (17 cases)and lacrimal fossa (12 cases)regions.Most cases showed as homogeneously iso-intensity on both T1 and T2 weighted images.Mean ADC value of the lesions was (0.61 ± 0.08)× 10 -3 mm2/s.A washout-type TIC pattern was observed in 1 5 cases,while plateau pattern was found in 7 cases.Conclusion Conventional MRI can assist in describing the extent,while the functional MRI can quantitatively reflect the histo-pathological features of orbital MALToma.Combination of conventional and functional MRI can help the diagnosis of orbital MALToma.
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Objective To evaluate the diagnostic and staging value of orbital structures quantitative measurement with 3T mag-netic resonance imaging in patients with Graves’ophthalmopathy (GO).Methods Twenty-three GO patients (patient group)and eighteen healthy volunteers (contrast group)were enrolled.Quantitative measurement of orbital structures including exophthalmos values,fatty tissue thickness of the inner side of eye balls,cross-sectional areas of extraocular muscles and signal intensity ratios of extraocular muscles to the ipsilateral temporal muscles (SIR values),and they were compared between two groups.Correlations be-tween the quantitative values and clinical active score (CAS)were accessed.Receiver operating characteristic (ROC)analysis was performed to evaluate the most relevant quantitative parameter and its diagnostic value in discriminating active from inactive GO pa-tients.Results There were significant differences between the GO group and contrast group regarding to all the quantitative parame-ters (P <0.05).Strong correlation was found between SIR values and CAS (r =0.730,P <0.001 ).Significant difference of SIR was found between patients with active GO and inactive GO (P =0.002),and a cut off value of 3.25 might be the critical threshold value,with diagnostic sensitivity of 81.8% and specificity of 83.3% respectively.Conclusion Quantitative measurement of orbital structures with 3T MR imaging could provide assistant in diagnosing and staging of GO.
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Objective To assess the association between Toll-like receptor 9 (TLR9) gene single nucleotide polymorphisms (SNPs) and systemic lupus erythematosus (SLE) development in Guangxi Zhuang and Han populations,as well as the difference in TLR9 SNPs between the two populations.Methods Totally,41 SLE patients of Zhuang nationality and 56 of Han nationality,as well as 82 healthy checkup examinees of Zhuang nationality and 120 of Han nationality were enrolled in this study.Venous blood samples were obtained from all of these subjects and subjected to DNA extraction.The single nucleotide polymorphisms in TLR9 gene were detected by PCR-restriction fragment length polymorphism (PCR-RFLP) analysis followed by direct sequencing.Chi-square test and adjusted Chi-square test were conducted to assess the relationship between the genotype and allele frequencies of TLR9 SNPs and some clinical and laboratory parameters of patients with SLE,as well as the differences in genotype and allele frequencies of TLR9 SNPs between the two populations.Results The frequencies of CC,CT and TT genotypes of TLR9 SNP rs352140 were 42.9％,41.1％ and 16.1％ respectively in the patients of Han nationality,compared to 38.3％,55.8％ and 5.8％ in the healthy controls of Han nationality (all P ＜ 0.05),but no significant difference was observed in the frequency of C or T allele of the SNP rs352140 between the patients and controls of Han nationality (both P ＞ 0.05).There was no significant difference in the genotype or allele frequency of TLR9 SNP rs352140 between the patients and healthy controls of Zhuang nationality,or between the patients of Han nationality and Zhuang nationality (all P ＞ 0.05).The patients with anti-dsDNA antibodies showed a significantly higher frequency of TT genotype (P ＜ 0.05),but similar T allele frequency at TLR9 SNP rs352140 (P ＞ 0.05) compared with those without.The frequencies of both TT genotype and T allele of TLR9 SNP rs352140 were significantly increased in the patients with a SLE disease activity index (SLEDAI) ≥ 9 compared with those with a SLEDAI ＜ 9 (both P ＜ 0.05).There was no statistical difference in either the TT genotype or the T allele frequency at TLR9 SNP rs352140 between antinuclear antibody-positive and-negative patients with SLE (both P ＞ 0.05).Conclusions The TLR9 SNP rs352140 is correlated with several clinical and laboratory parameters of SLE,and might contribute to the susceptibility to SLE in Guangxi Han population.