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Objective To identify the preoperative MRI findings for predicting microvascular invasion (MVI) using texture analysis (TA) on multiple MRI sequences. Methods Two hundred and fifty patients with HCC pathologically confirmed by surgery in Zhongshan Hospital from October 2015 to October 2016 were analyzed retrospectively. All patients underwent conventional MRI plain scan and dynamic contrast?enhanced examination within 2 weeks before operation. According to the ratio of 1∶1, the patients were divided into a training set (125 cases) and a test set (125 cases).The training set was used to establish a classifier to predict MVI of HCCs via the TA, and the test set was used to evaluate the performance of the classifier. An image analysis was performed using an in?house software contained a set of 2 415 features which were generated from all conventional axial sequences, including the T2WI, DWI, ADC map, and dynamic enhancement images.. A four?fold cross validation (FFCV) and sequential forward floating feature selection strategy (SFFS) were employed to select an optimal subset of features and a linear discriminant analysis (LDA) was employed to establish a classifier. The clinical laboratory examination, morphologic characteristics and quantitative analysis of conventional MR were used to compare the performance of predicting MVI with the classifier. A Chi?squared test or Fisher exact probablities test were used for categorical variables, and independent t test or Mann?Whitney U test were used for used for continuous variables. Factors with a P value less than 0.05 at univariate analyses were entered into the multivariate model to identify independent predictors. The Hosmer?Lemeshow test was performed to explain the goodness of fit of the multivariate logistic model. A receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance. Results The classifier set up by the training set consists of 13 texture features. When conventional MRI texture features of test set were used to judge whether there was MVI or not, the AUC of all texture features of arterial phase (AP) was the highest (0.506 3). Univariate regression analysis showed that there were significant differences in pathological grade (P=0.026), AFP level (P=0.033), lesion edge shape (P=0.038), AP enhancement (P=0.038), and AP peritumoral enhancement (P=0.008). Multivariate binary logistic regression analysis showed that peritumoral enhancement and texture classifier assessed MVI with P values of 0.005 and 0.001,which were independent risk factors for MVI. The significance level of Hosmer Lemeshow test was 0.796, indicating the goodness of fit of acceptable models. The AUCs of single variable, combined variable (including of AFP level, irregular tumor margin, enhancement intensity in AP and peritumoral enhancement in AP) and texture classifier for MVI were 0.588 to 0.627, 0.798 and 0.733, respectively. When compared the AUC of the combination features (including of AFP level, irregular tumor margin, enhancement intensity in AP and peritumoral enhancement in AP) with the classifier to identify MVI of HCC in the test set, no significant difference was found(P=0.108 6). However, although the sensitivity of them were same as 70.73%, the specificity of the combination features was mildly higher than that of classifier (82.14% vs. 78.57%). Conclusions Combination features of AFP level, tumor margin, enhancement intensity in AP and peritumoral enhancement in AP can be used to predict MVI of HCCs. It is a new method of noninvasive evaluation of MVI before operation. The performance of the classifier made by TA was not superior to that of combination features based on clinic and conventional MR sequences.
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Objective@#To investigate the diagnostic value of extracellular volume (ECV) imaging by magnetic resonance imaging for liver fibrosis of hepatitis B.@*Methods@#A retrospective analysis was recruited in patients with chronic hepatitis B, who underwent liver surgery from April to October 2017 for pathological evaluation of liver tissues, and all patients underwent Gd-EOB-DTPA-enhanced T1 mapping to calculate the liver ECV score. The correlation between ECV and staging of hepatic fibrosis and inflammatory activity were compared to clarify the diagnostic value of staging of fibrosis.@*Results@#66 patients were enrolled in this study. Concerning the staging of liver fibrosis, there were 13, 4, 13, 10, and 26 cases with F0, F1, F2, F3 and F4 stages, respectively. ECV values had high interobserver consistency (correlation coefficient 0.860). The ECV difference between different stages of liver fibrosis was statistically significant (F = 15.02, P < 0.001). There was a significant positive correlation between ECV and fibrosis stage (r = 0.622, P < 0.001), and weak correlation with inflammatory activity (r = 0.332, P = 0.007). Fibrosis staging was an independent factor influencing ECV (P < 0.001). The area under the receiver operator characteristic curve for the diagnosis of liver fibrosis staging F≥1, F≥3 and F4 were 0.760, 0.846 and 0.873, respectively. The diagnostic sensitivity and specificity were 64.15%, 92.31%, 77.78%, 80.00% and 88.46, 72.50%, respectively.@*Conclusion@#MRI-ECV imaging has great value for staging hepatic fibrosis of hepatitis B, and it can provide an effective method for diagnosis, staging, and evaluating the curative effect of fibrosis.
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Objective To compare the MRI features of focal nodular hyperplasia (FNH) and inflammatory hepatocellular adenoma (Ⅰ-HCA),with an aim to improve the diagnostic accuracy in the two lesions.Methods Patients who underwent dynamic-enhanced MRI with histopathologically confirmed FNHs (21 patients with 21 tumors) and Ⅰ-HCAs (10 patients with 12 tumors) were included in this retrospective study.The clinical and the imaging features,including the T2-and T1-weighted,diffusion weighted images,and the dynamic enhanced imagings were analyzed.Results No significant difference was observed in the clinical data between the 2 groups of patients,except in the serum levels of C-reactive protein.The serum C-reactive protein levels were significantly elevated in Ⅰ-HCA than in FNH.Significant differences between patients with FNHs and Ⅰ-HCAs were also found in the morphologic findings and the signal intensities (including shape,centre scar,necrosis,signal intensity of T2WI and DWI,and lesion signal intensity compared to those of the liver in the portal venous phase and delayed phase).The differences in lesion to liver signal in FNH were significantly lower than those in Ⅰ-HCA in the T2WI and the delayed phases.The area under the curve (AUC) for the 2 groups of patients were 0.843 and 0.743,respectively,with no significant difference between them.Conclusions The MRI appearances of atypical FNHs overlapped with Ⅰ-HCA.MRI features of isointensity on T2 Wl and DWI,and isointensity to the liver in the delayed phase were valuable to differentiate FNHs from Ⅰ-HCAs.Most Ⅰ-HCAs showed moderate and marked high signal intensity on T2WI and DWI.These features,when combined with an elevated serum C-reaction protein,necrosis in the lesion and hyperintensity in the delayed phase,were valuable in differentiating Ⅰ-HCAs from FNH.
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Objective To investigate the MRI findings of combined hepatocellular cholangio-carcinoma(cHCC-CC)and their correlation with pathologic types. Methods Twenty-nine patients with surgical pathology-confirmed cHCC-CC(20 patients with 24 cHCC-CCs were categorized as classical, and 9 patients with 10 cHCC-CCs as subtypes with stem cell features)were retrospectively analyzed. The clinical features, morphological and MRI signal characteristics on T1WI, T2WI, dynamic enhancement patterns and diffusion-weighted imaging were evaluated in detail and compared these imaging findings with pathologic types. The ADC values of 17 patients with 24 cHCC-CCs were measured. The imaging features were compared by using t test and Fisher test. Results The average maximum diameter of classical type and stem cell feature type were (3.8 ± 2.5) cm and (4.5 ± 1.8) cm, respectively, there was no significant difference(t=0.749,P=0.462). Seven cHCC-CCs showed heterogeneously high signal and twenty-seven cHCC-CCs showed low signal on T1WI. Seventeen cHCC-CCs showed hypointense in the central with mixed high and low signal on T2WI. Twenty-one cHCC-CCs showed peripheral enhancement and 13 lesions showed heterogeneously enhancement during arterial phase. The enhancement pattern of quickly wash-in and quickly wash-out were seen in 17 lesions, the other 17 lesions showed reversal enhancement. Twenty-five lesions presented with pseucapsule. There was no significant difference in clinical features and MRI findings between the two pathologic tumor types(classical type versus stem cell feature type)except for the enhancement pattern in arterial phase and peri-tumoral bile duct dilatation(P<0.05).The mean ADC value of the tumors with stem cell feature type(1.41 ± 0.52) × 10-3mm2/s was mildly lower than that of classical type (1.60 ± 0.39) × 10-3mm2/s, and no statistical differences were found(t=-1.005,P=0.326). Conclusions The MRI findings of cHCC-CCs has specificity. However, it is not easy to distinguish the classical type and stem cell feature type of cHCC-CC only by MRI findings.
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Objective To investigate the MRI findings of combined hepatocellular cholangio-carcinoma(cHCC-CC)and their correlation with pathologic types. Methods Twenty-nine patients with surgical pathology-confirmed cHCC-CC(20 patients with 24 cHCC-CCs were categorized as classical, and 9 patients with 10 cHCC-CCs as subtypes with stem cell features)were retrospectively analyzed. The clinical features, morphological and MRI signal characteristics on T1WI, T2WI, dynamic enhancement patterns and diffusion-weighted imaging were evaluated in detail and compared these imaging findings with pathologic types. The ADC values of 17 patients with 24 cHCC-CCs were measured. The imaging features were compared by using t test and Fisher test. Results The average maximum diameter of classical type and stem cell feature type were (3.8 ± 2.5) cm and (4.5 ± 1.8) cm, respectively, there was no significant difference(t=0.749,P=0.462). Seven cHCC-CCs showed heterogeneously high signal and twenty-seven cHCC-CCs showed low signal on T1WI. Seventeen cHCC-CCs showed hypointense in the central with mixed high and low signal on T2WI. Twenty-one cHCC-CCs showed peripheral enhancement and 13 lesions showed heterogeneously enhancement during arterial phase. The enhancement pattern of quickly wash-in and quickly wash-out were seen in 17 lesions, the other 17 lesions showed reversal enhancement. Twenty-five lesions presented with pseucapsule. There was no significant difference in clinical features and MRI findings between the two pathologic tumor types(classical type versus stem cell feature type)except for the enhancement pattern in arterial phase and peri-tumoral bile duct dilatation(P<0.05).The mean ADC value of the tumors with stem cell feature type(1.41 ± 0.52) × 10-3mm2/s was mildly lower than that of classical type (1.60 ± 0.39) × 10-3mm2/s, and no statistical differences were found(t=-1.005,P=0.326). Conclusions The MRI findings of cHCC-CCs has specificity. However, it is not easy to distinguish the classical type and stem cell feature type of cHCC-CC only by MRI findings.
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Objective To investigate the diagnostic value of diffusion kurtosis imaging(DKI)in the classification of hepatic fibrosis. Methods Thirty-five male SD rats were randomly divided into two groups:the hepatic fibrosis group(n=28)and the control group(n=7). The rats in hepatic fibrosis group were randomly divided into 4 subgroups and seven rats per group, the rats were administrated 50％ CCl4 intraperitoneally twice a week to establish hepatic fibrosis , and the four subgroups were injected 2, 4, 6, and 8 weeks, respectively. The rats in the control group were administrated same dose of olive oil for 8 weeks. One rat in hepatic fibrosis group was died of liver failure in the 7th week, and a total of 27 fibrosis experimental rats and 7 control rats were finally included in this study. DKI was performed at the end of the injection period for all rats, the apparent diffusion(D)and kurtosis(K)values were evaluated. Rats were sacrificed immediately after MRI scan and liver specimens were collected. The liver tissues were examined by pathology, liver fibrosis degree, which was graded from S0 to S4, and inflammatory activity, which was graded from G0 to G3 were graded. The difference of D value and K value between different liver fibrosis and inflammatory activity scores was compared by one-way ANOVA(normal distribution)or Kruskal-Wallis test(skewed distribution). Spearman correlation analysis and multiple regression analysis were used to reveal the correlation between DKI parameters and fibrosis staging/necroinflammatory activity grade. To confirm the efficiency of using the ROC curve of DKI parameters to qualify the liver fibrosis grade, which grade was≥3. Results Seven, 6, 6, 7, 8 rats were diagnosed as S0 to S4, respectively. The difference of D value and K value among different fibrosis grades was statistically significant(P<0.05). D value and the degree of fibrosis was negatively correlated(r=-0.650, P<0.01);K value and liver fibrosis grade no correlation(r=0.336, P=0.080). Thirteen, 6, 8, 7 rats were diagnosed as G0 to G3, respectively. D value was negatively correlated with inflammatory activity(r=-0.590, P=0.001);K value was no correlation with inflammatory activity(r=0.169, P=0.389). Compared with inflammatory activity, fibrosis classification was an independent factor in determining D values(P=0.001). ROC analyses demonstrated an area under the curve(AUC)of D value, K value, D value combined with K value in the diagnosis of liver fibrosis grading ≥ 3 level were 0.781, 0.672 and 0.833, respectlively. The sensitivity and specificity of D value combined with K value were 83.3％ and 75.0％, respectively. Conclusion DKI imaging is of great value in the classification of hepatic fibrosis and can be used as an effective method for the diagnosis of fibrosis.
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Objective To explore the value of diffusion tensor imaging (DTI) in differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).Methods Fifty-two patients including 20 patients with ICC (ICC group) and 32 patients with HCC (HCC group) confirmed by histopathological examination were recruited in the study.All the patients were performed MR exams on a 1.5T scanner in a protocol containing the routine T1WI,T2WI,DWI and DTI.The values of ADC,fractional anisotropy (FA),diffusion coefficient (D) were blindly reviewed and analyzed by two experienced observers,and were compared between two groups.The ROC curve was used to evaluate the di agnostic efficiency.Results The border clear percentage of ICC group (9/20,45.00％) had no significant difference compared with that of HCC group (15/32,46.88％;x2 =0.02,P=0.90),the detection rate of bile duct expansion in ICC group (11/20,55.00％) was higher than that in HCC group (4/32,12.50％;x2=10.83,P=0.001).Theintraclasscor relation coefficient value of ADC,D and FA in the ICC group and HCC group were all more than 0.90.The mean FA of ICCgroup (0.45±0.16) were significantly higher than that of HCC group (0.30±0.13;P=0.001),while the mean ADC and D values in ICC and HCC groups had no significant difference (both P＞0.05).The area under the ROC curve of FA was 0.76.And when FA=0.31,there was a higher sensitivity (85.0％) in identifying ICC and HCC.Conclusion The FA of DTI shows a stronger capability than the ADC and D values in differentiating the ICC from HCC.
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Purpose To investigate the effect of low contrast dose and low tube voltage combined with adaptive statistical iterative reconstruction (ASIR) on image quality of abdominal CT angiography. Materials and Methods 139 patients with body mass index (BMI) 0.80) in both groups, the subjective score of group A and group B were 4.60±0.51 and 3.81±0.76, respectively, and the difference was statistically significant (Z= - 6.86, P0.05). The total amount of iodine dose in group A and group B was 270 mg and 350 mg respectively, with a 22.86% reduce of the total iodine for each patient in A group than in B group. Conclusion For patients with BMI<22 kg/m2, it is feasible to use low dose contrast medium with low tube voltage and ASIR, which may not only improve the image quality of abdominal CTA but also reduce the radiation dose and iodine content.
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Objective To explore the relationship between the characteristics of dynamic contrastenhanced MRI (DCE-MRI) and the stages of endometrial cancer.Methods A retrospective analysis of DCE-MRI manifestation in 55 patients with scratch-pathologically confirmed endometrial cancer was performed.All patients were divided into different groups according to differentiation,muscle layer infiltration,cervix involvement and metastasis.The enhanced rate,including the arterial phase relative signal increase ratio (ARSI％),the maximal relative signal increase ratio (MRSI％) and the signal enhancement ratio (SER％),was calculated at different time (i.e.16 s,32 s,48 s,64 s and 300 s),respectively.Time-intensity curves (TIC) of lesions were also obtained and divided into 4 subtypes.Two sample t test was performed to compare the MRSI％ among groups,and the Mann-Whitney U test was performed in ARSI％ and SER％ as well.Results The early phase enhanced rate of normal tissue was 894 ± 355,higher than that of tumor 716 ± 215 (t =-2.911,P ＜ 0.01).The delayed phase enhanced rate of normal tissue was 1111 ± 289,higher than that of tumor 803-± 289 (t =-4.926,P ＜ 0.01).ARSI％ of low differentiation group (n =16,M =1.07％) was higher than that of middle to high differentiation group (n =39,M=0.36％).ARSI％ of deep muscle layer infiltration group (n =19,M =0.76％) was higher than that of no muscle layer infiltration group (n =36,M =0.32％).ARSI％ of cervix involvement group (n =27,M =0.84％) was higher than that of no cervix involvement group (n =28,M =0.25％).SER％ of cervix involvement group (n =27,M =2.90％) was higher than that of no involvement group (n =28,M =1.40％) and SER％ of parauterine involvement and metastasis group (n =7,M =2.03％) was higher than that of uterine involvement group (n =48,M =1.60％).The differences between these groups were statistically significant (Z =-2.038,-2.260,-2.172,-2.695 and-2.621 respectively,P ＜ 0.05).Based on the TIC types,type Ⅰ occurred in 13 tumors (23.6％),type Ⅱ in 22 tumors (40％),type Ⅲ in 9 tumors (16.4％),and type Ⅳ in 11 tumors (20％).Conclusions Based on TIC curves,most of endometrial cancers showed significant enhancement which reflected of their rich blood supply.The parameters of DCE-MRI is helpful in staging of uterus tumors.
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Objective To explore the efficacy of intervention combined with traditional Chinese medicine for the treatment of early femoral head necrosis. Methods 62 cases of early femoral head necrosis were treated with interventional and traditional Chinese medicine, all patients were assessed for clinical efficacy before treatment and 6 months after treatment. The clinical hip function, pain index evaluation and rating of the femoral head venography were recorded. Results 41 cases were cured, 18 cases improved,no improvement in 3 cases,the total effective rate was 95. 2%. Clinical hip function after treatment compared with before treatment increased by 32.5%,there was a statistically significant difference (P＜0.01); compared with before treatment, significantly reduced pain (P＜0. 01). After treatment, Ⅲ and Ⅳ were significantly increased number of cases, respectively, compared with the preoperative increase of 146.2% and 160.0%,femoral venography ratings before and after treatment had significant difference(P＜0.01). Conclusion Intervention combined with traditional Chinese medicine treatment could significantly improve the early femoral head necrosis.
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Objective To evaluate the feasibility of renal artery angiography with interpolated finite impulse response (IRFR) sequence on 1.5T MR. Methods A total of 122 subjects underwent MR scan with IFIR sequence. On axial image of IFIR, bilateral signal-to-noise ratio (SNR) and breath artifact of renal artery were measured and 3D maximum intensity projection (MIP) images were reconstructed on workstation ADW 4.3, and each branch was scored according to its displaying quality. Influence of SNR, age and breath artifact on the displaying of renal artery were compared and analyzed. Results Renal segmental artery could be seen in 112 subjects (91.80%). Among them, segmental artery was showed clearly in 78 subjects (63.93%), post-segmental artery was showed in 54 subjects (44.26%) and branches of post-segmental artery was showed in 22 subjects (18.03%). There was statistical difference of renal artery scores mean rank between ≥60 years group and ＜60 years group (49.25 vs 67.48, P=0.006), as well as between the group without and with breath artifact (66.66 vs 43.35, P=0.002). No statistical difference of SNR was found among renal artery scores from 1-5 (P=0.177). Conclusion IFIR sequence is simple and safe for renal artery angiography on 1.5T MR, and different grades of renal artery branch can be showed clearly.
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ul in some degree in prognostic assessment and staging of the uterine cervical cancer.
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Aim To design and synthesize new phenyloxyisobutyric acid analogues as antidiabetic compounds. Methods Eight new target compounds were synthesized by combination of lipophilic moieties and acidic moiety with nucleophilic replacement or Mitsunobu condensation. The eight compounds were confirmed by 1H NMR, 13C NMR, IR and MS. Results In vitro insulin-sensitizing activity (3T3-L1adipocyte) demonstrated, that the cultured glucose concentration of up-clear solution detected with GODpioglitazone, compounds A and B were added to the insulin-resistant system. Conclusion In vitro insulin-sensitizing activity of target compound A is in between that of rosiglitazone and pioglitazone, and activity of target compound B is slightly less than that of pioglitazone.