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Objective:To summarize the clinical data and experience of pure single-port lumpectomy non-lipolysis breast-conserving surgery (PSLN-BCS) in patients with early-stage breast cancer.Methods:A retrospective analysis was conducted on 400 patients who underwent breast-conserving surgery for early-stage breast cancer in the Second Department of Breast Surgery at Harbin Medical University Cancer Hospital from Jan. 2022 to Jan. 2023. Patients were divided into two groups: PSLN-BCS group ( n=200) and conventional breast-conserving surgery (C-BCS) group ( n=200). The surgical time, intraoperative blood loss, postoperative drainage within three days, and short-term (3 months to 6 months after surgery) complications, including the incidence of residual fluid after drain removal and incision infection were observed. Long-term (6 months after surgery) complications, including the incidence of skin and pectoralis major muscle adhesions in the surgical area and cosmetic results after breast-conserving surgery, were also evaluated. Statistical analysis was performed using R language, and quantitative data were expressed as mean ± standard deviation ( ± s) and analyzed using t-test, while count data were analyzed using χ2 test. A p-value less than 0.05 was considered statistically significant. Results:PSLN-BCS had a longer average surgical time than C-BCS (198.341min vs 62.961min, P<0.001, 95% CI:132.028 vs 138.732). PSLN-BCS had less intraoperative bleeding (18.824 ml vs 22.627 ml, P=0.003, 95% CI: -6.294 vs -1.311) and lower postoperative drainage volume (346.157 ml vs 406.191 ml, P<0.001, 95% CI: -70.571-a-49.496). There were no significant differences in short-term postoperative complications such as subcutaneous fluid accumulation ( χ2=2.33, P=0.127) or incisional infection ( χ2=0.14, P=0.708) between the two groups. The incidence of skin and muscle adhesions in the surgical area was lower in patients who underwent PSLN-BCS at 6 months postoperatively ( χ2=11.58, P<0.001). Patients who received PSLN-BCS achieved better cosmetic outcomes, with a statistically significant difference ( χ2=273.00, P<0.001) compared to those who received C-BCS. Conclusion:Pure single-port lumpectomy non-lipolysis breast-conserving surgery is a safe and effective treatment option for early-stage breast cancer and can be considered as a surgical option for patients with cosmetic requirements.
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Objective ::To investigate the role of trehalose in hepatic ischemia-reperfusion injury and its underlying mechanisms.Methods:C57BL/6J mice were randomly divided into no-ischemia group, ischemia-reperfusion group, trehalose-treated group and normal saline control group. After ischemia for 90 minutes, reperfusion immediately or 6h, blood and liver tissues were collected, and serum was separated. The liver function parameters of ALT, AST, the inflammatory factors of TNF-α, IL-1β and IL-2, and the pathological changes of liver were detected to study the role of trehalose during hepatic ischemia-reperfusion injury. Hypoxia-reoxygenation cell model was established by AML12 mouse hepatocyte line, and divided into experimental group and control group. The experimental group was divided into low dose group and high dose group according to the concentration of trehalose administrated. And the control group had no use of trehalose. The level of apoptosis was measured to study the effect of trehalose on apoptosis induced by hepatic ischemia-reperfusion injury with flow cytometry. Western blot was utilized for detecting the levels of Caspase-3, Cleaved Caspase-3 and Bcl-2 protein to understand the molecular mechanisms of trehalose in apoptosis during hepatic ischemia-reperfusion injury.Results:In vivo animal experiments showed that liver function and such inflammatory factors as ALT, AST, TNF-α, IL-1β and IL-2 increased in ischemia-reperfusion group after hepatic ischemia-reperfusion ( P<0.05), and liver tissue became necrotic. After a treatment of trehalose, the levels of ALT, AST, TNF-α, IL-1β and IL-2 were lower than those of normalsaline control group and the area of liver tissue necrosis also decreased ( P<0.05). In vitro cell experiments showed that the apoptosis level of hepatocytes in the experimental group decreased compared with the control group.And the level of activated pro-apoptotic protein Cleaved Caspase-3 decreased, the level of anti-apoptotic protein Bcl-2 increased. Conclusions:Trehalose has protective effects on hepatic ischemia-reperfusion injury in vivo and in vitro. The mechanism may be involved in inhibiting inflammation induced by hepatic ischemia-reperfusion injury, suppressing the activation of Caspase-3 and promoting the expression of Bcl-2, thus played a protective role by extenuation of hepatocyteapoptosis.
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Objective@#To investigate the value of MR unenhancement and dynamic enhancement scans for distinguishing non-hypervascular pancreatic neuroendocrine tumor (PNET) from pancreatic ductal adenocarcinoma (PDAC).@*Methods@#Thirty five patients (45 lesions) with pathologically confirmed PNETs and 52 patients (53 lesions) with PDACs were retrospectively analyzed before surgery. All patients underwent MR unenhanced and dynamic enhanced scans (including arterial, venous and delayed phase). Based on arterial enhancement, PNETs were divided into hypervascular and non-hypervascular lesions. The morphologic characteristics (including location, size, quantity, margin and signal intensity) and enhancement patterns of non-hypervascular PNETs and PDACs were evaluated. Involvement of the pancreatic duct and bile duct, vascular invasion, peripancreatic infiltration and other organs metastasis were observed. Independent sample ttest was used to compare signal intensity ratio of nonhypervascular PNET and PDAC. Chi-square test was used to compare MRI characteristic and secondary signs.@*Results@#PNET included 20 hypervascular and 25 nonhypervascular lesions. Enhancement degree of non-hypervascular PNET was higher than PDAC in the arterial, venous and delayed phase (P<0.01). Non-hypervascular PNET showed significantly higher frequencies (P<0.01) of venous hyper-or isoenhancement (20/25), delayed hyper-or isoenhancement (23/25) and a well-defined margin (17/25), but lower frequencies of ductal stricture and dilatation (P<0.01), pancreas atrophy (P<0.05), bile duct stricture (2/25), peripancreatic infiltration (8/25, P<0.01) and vascular invasion (8/25, P<0.05), when compared with PDAC.@*Conclusion@#A well-defined margin, hyper-or isoenhancement in the venous and delayed phase,and without ductal dilatation and pancreas atrophy are more common in non-hypervascular PNET, which may be distinguished from PDAC.
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Objective To investigate the value of quantitative analysis parameters of dynamic contrast-enhanced MRI (DCE-MRI) in distinguishing low or high grade prostate cancer.Methods Data of DCE-MRI in 26 patients with prostate cancer confirmed by surgical pathology following radical prostatectomy were retrospectively analyzed.These patients were divided into low grade prostate cancer (n=10) group or high grade prostate cancer group (n=16).The parameters,including transport constant (K trans),rat constant (Kep) and extravascular extracellular volume fraction (Vc.) were measured and compared between the two groups.ROC curve was used to determine the efficacy of the parameters in distinguishing low or high grade prostate cancer.The correlation between the parameters and Gleason score were assessed.Results Ktrans,Kep and Ve values in the low grade prostate cancer group was (0.22± 0.07)/min,(1.24 ± 0.57)/min and 0.21±0.08 respectively,and (0.36±0.10)/min,(1.82±0.66)/min,0.21±0.10 respectively in the high grade prostate cancer group.The differences of K trans and Kep were statistically significant between the two groups (both P＜0.05),while of Vc.was not statistically significant (P=0.994).The area under ROC curves of K trans and keapvalues for distinguishing low or high grade prostate cancers was 0.872 and 0.737,respectively.No correlation was found between any parameters nor Gleason scores (all P＞0.05).Conclusion K trans and Kep,the quantitative analysis parameters of DCE-MRI,contribute to the differential diagnosis of low and high grade prostate cancer.
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Purpose To evaluate parameter changes of pelvic floor muscles in patients with female pelvic organ prolapse (POP) through diffusion tensor imaging (DTI).Materials and Methods Fifty female patients with POP at Ⅲ or ⅣV degree (research group) and fifty healthy women volunteers (control group) were collected to make prospective research.The axial DTI sequence was performed in subjects,with b=500 s/mm2,at 15 directions.DTI original images were imported into the post-processing software,and the corresponding DTI mappings were formed.In the original images,pelvic floor muscles were sketched out layer by layer,and various DTI parameters,including fractional anisotrophy (FA),mean diffusivity (MD),λl,λ2,λ3,linear anisotropy (CL),planar anisotropy (CP) and spherical anisotropy (CS),were calculated.Six kinds of pelvic floor muscles,including anal sphincter,superficial transverse perineal muscle,pubic visceral muscle,puborectal muscle and iliococcygeal muscle were measured,and five of them were measured on both sides.The difference of DTI parameters between right and left side of each muscle,and the difference of DTI parameters between research and control group were compared.Results Between the right and left side of five kinds of pelvic floor muscles in control group,significant difference was only found in FA,λ3,CP,CS value of internal obturator muscle (P＜0.01,P＜0.001).There were significant differences in FA,λ3,CL,CP and CS values of the left and right muscles in the study group (P＜0.05,P＜0.001).Compared with control group,FA value and CS value of superficial transverse perineal muscle,CL value of left pubic visceral muscle,FA,λ3,CL,CS and CP value of right pubic visceral muscle,λ1 and λ3 value of left iliococcygeal muscle of research group were significantly different (P＜0.01,P＜0.05).Conclusion DTI for observation of female pelvic floor muscle is technically feasible,and it can detect the injury of pelvic floor muscle in POP patients,and may be helpful to reveal the pathogenesis of POP.
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Objective To evaluate the diagnostic performance of the histogram analysis of mono-exponential and intravoxel incoherent motion(IVIM) models to the dualistic model of epithelial ovarian cancer(EOC). Methods Forty female patients with histopathologically proven epithelial ovarian cancer underwent preoperative MR examination. Scanning sequences included conventional imaging, diffusion-weighted magnetic resonance imaging with 11 b values (0, 30, 50, 100, 150, 200, 400, 600, 800, 1 000, 1 500 s/mm2) and dynamic contrast enhanced MRI (DCE-MRI). Based on the dualistic model of EOC, all patients were divided into two groups:typeⅠ(low grade, n=16) and typeⅡ(high grade, n=24). ADC, D, D*and f maps and their corresponding histograms were generated by post-processing software. Based on an entire-tumour measurement, the following histogram parameters were recorded, respectively: (a) Mean; (b) the 10th percentile (10th);(c) the mean of the top 10 percent (MeanL);(d) the 90th percentile (90th);(e) the mean of the bottom 10 percent (MeanR). Two types were compared using independent sample t test or Mann-Whitney U test. And areas under ROC curve between two groups were assessed. Results For ADC , D, and f, all indices(Mean,10th,MeanL,90th,MeanR) of the histogram were significantly lower in typeⅡthan in type Ⅰ(P0.05). D demonstrated a comparable accuracy with ADC in differentiating the grade of EOC (area under curve: Mean, 0.898 vs. 0.893; 10th, 0.880 vs. 0.846; MeanL, 0.878 vs. 0.858; 90th, 0.895 vs. 0.839; MeanR, 0.872 vs. 0.814), and both ADC and D have better performance than f. Conclusion It is feasible to stratify the grade of EOC by mono-exponential and IVIM models with histogram metrics,diagnositic efficiency of ADC and D values are higher.
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Objective To investigate the diagnostic value of dynamic MRI with coupling agent filled vaginal and rectumin the display of vaginal vault prolapse and rectocele. Methods Thirty three female patients, who were diagnosed with pelvic organ prolapse with Ⅲ degrees and above by gynecologic outpatient clinic and prepared to be treated with surgery were prospectively collected. All of them underwent two types of dynamic MRI, one was routine dynamic MRI (Group A) and the other was dynamic MRI with vaginal and rectum filled with coupling agent (Group B). Two radiologists evaluated and scored the display of vaginal vault and rectocele on these two groups of dynamic MRI images. According to the joint result of two radiologists, two gynecologists made surgical planning. Kappa test was used to compare the consistency of scores performedby two radiologists, and Fisher exact test was used to compare the differentiation fromboth groups, as well as the differentiation of probability of high uterosacral ligament suspension.Results The Kappa value of both groups was 0.65 and 1.00 respectively, where the consistency of Group B was superior than Group A. There were significant differences between the two groups(P<0.01), where Group B was better than Group A. Based on the imaging results of Group A, 7 patients (21.2%, 7/33) were decided to make high uterosacral ligament suspension. Based on the imaging results of Group B, 20 patients (60.6%, 20/33) were decided to make high uterosacral ligament suspension, and differences were statistical significance between the two groups(P<0.05). Conclusions Fo purpose of the displaying vaginal vault and rectocele, the dynamic MR imaging with vaginal and rectum filled with coupling agent was better than routine method. The proposed method can provide important information and reference for the establishment of surgical planning.
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Objective To evaluate the diagnostic performance of multi ? b value DWI to differentiate pancreatic adenocarcinoma from healthy pancreas using the apparent diffusion coefficient (ADC) and parameters derived from the intravoxel incoherent motion (IVIM) theory. Methods Forty?eight patients with histopathologically proven pancreatic adenocarcinoma and fifty patients with healthy pancreas were examined at 3.0 Tesla using a single?shot echo?planar imaging DWI pulse sequence. Eight b?values ranging from 0 to 1 000 s/mm2 were used. ADC, diffusion coefficient (D), perfusion?related diffusion (D*) and perfusion fraction (f) were compared between pancreatic adenocarcinoma and healthy pancreas, t test or Mann?Whitney U test was used to compare the MRI parameters, ROC was used to evaluate the diagnostic efficiency. Results In comparison to healthy pancreatic tissue, a significant reduction of the ADC, D*and f was found in pancreatic adenocarcinoma [healthy pancreatic tissue:(1.68±0.31)×10-3mm2/s, 27.10×10-3mm2/s, (36.92±12.47)%;pancreatic adenocarcinoma:(1.51±0.37)×10-3mm2/s, 13.90×10-3mm2/s, (30.06±19.84)%] (P0.05). In the ROC?analyses, the area under curve for D* was the largest (0.727), followed by f and ADC in order (0.680 and 0.669). Conclusion Using the IVIM DWI approach, the D*, f and ADC value are useful for differentiating pancreatic adenocarcinoma from healthy pancreatic tissue.
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Objective To investigate the value of intravoxel incoherent motion (IVIM) model of diffusion weighted MRI in assessing grades and enhancement patten of uterine cervical cancer. Methods Thirty one patients with pathologically proven cervical cancer, who underwent MRI scan preoperatively, were analyzed retrospectively and were divided into 3 groups according to their pathological grading of cacer, including 6 with G1 cancer, 17 with G2 and 8 with G3. The diameter of each lesion was≥1 cm. 10 b values (0, 30, 50, 100, 150, 200, 400, 800, 1 000, 1 500 s/mm2) were used in DWI, and DCE-MRI was performed with a time resolution of 9.8 s. Parameters of DWI (ADC, D, f, D*) and semiquantitative parameters of DCE-MRI (Slop, Maxslop, CER, Washout, AUC90) were measured. One-way ANOVA analysis of variance and Pearson correlation were used to analyze normally distributed continuous data. Kruskal-Wallis H test and Spearman correlation were used to analyze abnormally distributed continuous data. Tumor volume and all of the MRI parameters were compared as well as correlated with pathological grading.The perfusion parameters derived from IVIM were correlated with those derived from dynamic enhanced MR imaging. The sensitivity and specificity of f value to to diagnose G3 cervical cancer and the best cutoff were calculated from areas under the ROC curves.Results Tumor volume of G1,G2 and G3 cancers were(33.8±31.1),(19.6±16.9)and(31.2±29.1)cm3(F=1.147,P=0.332), respectively.ADC values of the three groups were(1.03 ± 0.11)× 10-3,(1.00 ± 0.10)× 10-3 and(0.90 ± 0.05)× 10-3mm2/s,respectively(F=4.619,P=0.018).D values of the three groups were (0.80 ± 0.11) × 10-3, (0.77 ± 0.06) × 10-3and (0.69 ± 0.06) × 10-3mm2/s ,respectively(F=5.272, P=0.011).f values of the three groups were 0.20±0.02, 0.22±0.03 and 0.24± 0.03, respectively (F=3.524, P=0.043).All of the others were of no significant difference (P>0.05).Both ADC and D correlated negatively with tumor grading (r=-0.464 and-0.493, P=0.009 and 0.005, respectively). f value correlated positively with tumor grading (r=0.436, P=0.014).Areas of ADC, D and f value under ROC curves to diagnose G3 cancers were 0.179, 0.147 and 0.690, respectively. While the cut-off value of f was 0.22, the diagnostic performance for G3 cancer was with a sensitivity of 75.0% (6/8) and a specificity of 60.9% (14/23). The value of f had weak positive correlations with Slop, Maxslop, CER and AUC90 of semiquantitative analysis of DCE-MRI (r=0.319, 0.337, 0.293 and 0.344, respectively, P<0.01). Conclusion IVIM model of multi-b value DWI may provide information in the assessment of differentiation and en hancement pattern of cervical cancer.
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Objective To analyze the clinical effectiveness,safety and significance of treatment with external circular fixator,through the relationship of inducible nitric oxide synthase (iNOS) and bone regeneration to further explore the mechanism of the molecular biology of bone lengthening at the same time.Methods Collected bone defect after tibial shaft fractures secondary infection who were treated with external circular fixator as study group (28 cases),all the cases fixed by external circular fixator,20 healthy volunteers as control group.Study group in different time point measured the levels of serum iNOS content,were compared with the control group.Results All patients were scheduled to reach the extremity lengthening and the bone defect were repaired and healed in study group.The bacterial culture results showed that 18 cases (64.29％,18/28) of resistant Staphylococcus aureus,5 cases (17.86％,5/28) of Hemolytic streptocaccus,2 cases (7.14％,2/28) ofP.aeruginosa,one case (3.57％,1/28) of drug-resistant Enterobacter cloacae,one case(3.57％,1/28) of Staphylococcus epidermidis,one case(3.57％,1/28) of Onion-like aeromonas,the proportion of the former two was significantly higher than other bacteria (P ＜ 0.05).The levels of serum iNOS content 1 d after surgery in study group were increased,compared with control group,difference was no significant (P ＞ 0.05).The levels of serum iNOS content 14 d after surgery,stoped extend,1 d stoped extend,3 d stoped extend in study group were significantly higher than those in control group [(118.8 ± 6.6) U/L vs.(86.4 ± 5.4) U/L,(136.2 ± 8.4) U/L vs.(88.2 ± 3.6) U/L,(132.6 ± 9.0) U/L vs.(87.6 ± 4.8) U/L,(103.8 ± 5.4) U/L vs.(86.4 ± 4.2) U/L] (P ＜ 0.05),there was no significant difference between two groups in other times (P ＞ 0.05).Conclusions External circular fixator for the repair and reconstruction effects in patients with bone defect can achieve the desired therapeutic goal,the higher expression of iNOS may be one of the molecular biological mechanisms of bone lengthening.
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Objective To investigate the diagnostic value of the quantitative analysis parameters of dynamic contrast-enhanced MRI (DCE-MRI) for prostate cancer.Methods MR examination were performed in 26 patients and correlations were made with surgical pathology following radical prostatectomy.According to the localization of pathologic specimens,ROI were drawn on areas of cancerous regions,noncancerous regions in peripheral zone and central gland to measure the values of Ktrans,kep and Ve.The values of the three parameters in different tissue were compared with Kruskal-Wallis H and Mann-Whitney U.Results Twenty six patients had prostate cancer confirmed by pathology.Data from 468 assessable regions of prostate were acquired,including 115 cancerous regions and 142 noncancerous regions in central gland,68 cancerous regions and 143 noncancerous regions in peripheral zone.Prostate cancer showed a multifocal distribution.The K,kep and Ve values were (1.04 ± 0.26)/min,(1.43 ± 0.46)/min,(0.76 ±0.12) respectively for cancerous regions in central gland,and (0.82 ±0.19)/min,(1.12 ±0.26)/min,(0.75 ± 0.14) respectively for noncancerous regions in central gland,(0.95 ±0.31)/min,(1.31 ±0.51)/min,(0.76 ± 0.13) respectively for cancerous regions in peripheral zone and (0.32 ± 0.07)/min,(0.52 ± 0.13)/min,(0.64 ± 0.14) respectively for noncancerous regions in peripheral zone.The differences among the three parameters were statistically significant (x2 =316.008,297.985,63.681,P ＜0.01).The Ktrans,kep values of cancerous regions were significantly higher than the corresponding values of noncancerous regions,respectively.Conclusion Quantitative analysis parameters of DCE-MRI contribute to the diagnosis of prostate cancer,including cancer located in central gland.
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Purpose To explore the three-dimensional display and parameter features of 3.0T MR diffusion tensor imaging (DTI) in the imaging of normal female pelvic floor muscle fiber bundles, and to provide a reference standard for the application of DTI in patients with pelvic organ prolapse. Materials and Methods Fifty cases of females who had not given birth or had given birth by cesarean delivery were divided into four groups:20 to 29 years (15 cases), 30 to 39 years (15 cases), 40 to 49 years (12 cases) and 50 to 54 years (8 cases). First, the conventional sagittal, axial, coronal T2WI and axial T1WI images were acquired with a 3.0T MRI scanner;then a dynamic sagittal fiesta sequence was executed to exclude pelvic organ prolapse; at last, the transverse two-dimensional diffusion-weighted spin echo-echo planar imaging (SE-EPI) pulse sequence was executed to acquire pelvic floor DTI data, through the post-processing of the data, normal female pelvic floor muscle fiber bundle images can be obtained and apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value were calculated. Results Content three-dimensional muscle fiber bundle images and corresponding ADC and FA values of the pubic visceral muscles in pelvic wall and obturator muscles in pelvic wall were acquired in all subjects;there was no statistically significant difference (P>0.05) for the ADC and FA values between the left and right side of the pubic visceral muscles and obturator muscles within the same age group;and the difference of ADC and FA values of pubic visceral muscles and obturator muscles among different age groups were not statistically significant (P>0.05), either. Conclusion 3.0T MR DTI fiber tracking imaging can be applied for the three-dimensional observation of the complicated muscle fiber bundle structures in female pelvic floor, through the measurement of ADC and FA value changes, functional abnormity can be suggested before the anatomy structure changes of the pelvic muscles occurs, thus provides an important new approach for further study of pelvic organ prolapse.
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Objective To evaluate characteristic clinical and imaging findings of pancreatic neuroendocrine tumors (NET) in dual-phase contrast enhancement MSCT.Methods The dual-phase contrast enhancement MSCT images of 23 lesions in 20 patients with histologically confirmed pancreatic NET were studied retrospectively.Their clinical presentations,imaging characters as well as the intensities of lesions and normal pancreas in each phase were measured,and the following indices were calculated.First,the absolute enhancement of lesions,including the increasing of CT value of the maximum enhancement area within a tumor in arterial phase,that was named A1 in short,and that of the minimum enhancement area was labeled as A2.The same ROI measured increasing CT values in portal venous phase was labeled as V1 and V2 respectively.Secondly,the relatively enhancement indices comparing with the normal pancreas in the same patient within the same phase were calculated.This included the differences between the maximum,as well as the minimum,enhancement areas of tumors and the normal pancreas in arterial phase,which was named as AP1 and AP2 respectively,and those differences in portal venous phase,which were labeled as VP1 and VP2 respectively.All of the tumors were graded as G1 to G3 according to the WHO classification in 2010.A Kruskal Wallis test were performed to compare differences of tumor diameters and the enhancement indices.The change trend of enhancement indices varying with pathology grading were described.Fisher exact test was used to find differences of clinical and imaging characters.Results Twenty-three lesions in 20 patients included 13 lesions in grade 1 (G1),8 in G2,and 2 in G3.Among the 10 patients with G1 NET,7 of them had no endocrine symptoms,while the other 3 had endocrine symptoms.Six of them had no abdominal pain,while 4 of them complained of it.All of the 10 patients with G1 NET had no hepatic metastasis.Among 8 patients with G2 NET,4 of them were with endocrine abnormality,and the other 4 were not.Five of them complained of abdominal pain while the other 3 did not.Six of them had no hepatic metastasis,and 2 of them had.Both of the 2 patients with NET in G3 did not have any endocrine abnormality,and one of them complained abdominal pain.Both of them were with hepatic metastasis.There was no difference between groups that whether or not endocrine syndrome and abdominal pain was presented (x2 =2.238,0.713,P =0.318,1.000),while hepatic metastasis was of significant differences (x2 =9.516,P =0.003).Tumor location,distinct outline,necrosis and/or calcification were not significantly different.Tumor enhancement showed a probable trend of decrease in group of higher grade.A1 decreased from (126.4 ± 45.7)HU to (38.7± 8.5)HU (x2 =7.254,P=0.027),A2 decreased from (94.1 ±31.1)HU to (22.8 ± 14.0) HU (x2 =7.323,P =0.026) and AP1 dropped from 80.6 HU(-21.8 — 169.7 HU) to -36.7 HU(-41.6—-31.7 HU) (x2 =6.778,P =0.034).All of the indices mentioned above were of significant difference and the other indices showed no significant difference (P ＞ 0.05).Conclusions Quantitative assessment of their enhancement patterns may provide useful information to preoperative grading of pancreatic NET,and tumors in a higher grade may show poorer enhancement.
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Objective To evaluate contrast-enhanced MRI sequence for diagnosing cholangiocarcinoma.Methods Cholangiocarcinoma was confirmed by surgery and pathology in 17 cases,all underwent preoperative CT and MRI T1-VIBE scan with contrast-enhancement sequence.We retrospectively analyzed imaging signs in two scan methods,including lesion position,number,size,enhancement degree,expansion degree of bile duct,invasion of adjacent artery and portal vein,and portal vein tumor thrombosis.The differences on detecting lesions between two methods were compared.Results The contrast to noise ratio (CNR) between tumor and liver tissue in MRI T1-VIBE images was obviously superior to that in CT images.Peripheral lesion boundary in T1-VIBE enhanced images was clearer than CT.One hemorrhage lesion was shown in T1-VIBE images,and tumor thrombosis was visible in the left branch of portal vein in 1 case.Bile duct wall lesions in T1-VIBE enhanced images was more evident than CT in hilar cholangiocarcinoma and extrahepatic cholangiocarcinoma.The VIBE enhanced images find more lesions in 9 out of 11 multiple focus cases,compared with CT images.Conclusions Contrast-enhanced MRI T1-VIBE sequence can give more comprehensive and clear evaluation on cholangiocarcinoma,and has important clinical diagnostic values.
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Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.
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ObjectiveTo investigate the imaging characteristics of solitary fibrous tumor(SFT).MethodsThis study included 11 cases with SFT proved by pathological results.The imaging manifestations were retrospectively reviewed and analyzed in comparison with surgical and pathological results. Among them,8 patients underwent CT plain scan (1/8) or enhanced scan (7/8),4 patients underwent MR plain scan (2/4) or enhanced scan (2/4),and only 1 patient underwent both CT and MR scan.Results( 1 )SFT were located in the thoracic cavity(2/11 ),abdominal and pelvis(5/11 ),and somatic soft tissues (4/11 ).The average tumor size was 11.8 cm ( 2.5 to 23.0 cm).Among them,4 tumors were round or ellipse,and 7 tumors were irregular.Eight tumors had well-defined contours,and the others showed illdefined contours.(2)On CT scan,all SFTs showed inhomogeneous density with low density areas.Calcification was seen in I case,and hemorrhagic foci were detected in 2 cases.(3)On MR scan,all SFTs showed intermediate signal intensity on T1 WI.Three tumors were slightly hyperintense and the other was hypointense on T2WI.All of them were rich of vascular signal voids.Three tumors,including 2 tumors with scattered long T1 and T2 signal and 1 tumor in the liver with hyperintense haemorrhage,displayed inhomogeneous mixed signal.One tumor in the orbit showed homogeneous signal.(4)On enhanced scan,9 tumors showed irregular enhancement with multiple circuitous vessels in the arterial phase,and continuous or progressive enhancement with patch non-enhanced areas in the venous phase.( 5 ) Histologically,SFTs were composed of juxtaposed hyper- and hypo-cellular spindle cells,dense collagenous stromas and numerous thin-walled blood vessels with a staghorn configuration.Conclusion The possibility of SFT should be considered when a single soft tissue mass with sharp border,inhomogeneous density is detected,especially with inhomogeneous enhancement maintaining in the venous phase.
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Objective To explore MRI appearances of malignant mixed mesodermal tumors (MMMT) of the uterus. Methods All 9 patients with MMMT were proved by pathology. MRI characteristics of MMMTs in 9 patients were analyzed retrospectively.Results Of 9 MMMTs,6 were uterus body-based and 3 were cervical-based.Body-based MMMTs tended to be expansive or infiltrative growth with expanded uterus cavity. Cervical-based.MMMTs tended to be exophytic growth without myometrial infiltration. The tumors presented iso- or low signal on T1WI. The body-based MMMTs presented heterogeneously hyper-intense on T2WI ( n =5 ),hemorrhage ( n =1 ),cystic degeneration and necrosis (n =5) were seen within the tumors. Cervical-based MMMTs presented relative hyper-intense signal on T2WI with band or tree-like hypo-intense signal,without hemorrhage and necrosis. Body-based MMMTs were enhanced more obviously than cervical-based MMMTs.Conclusions The growth pattern,MRI signal and enhancement characteristics of cervix and uterus body MMMTs are different. MRI is helpful for the diagnosis of MMMT.
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ObjectiveTo evaluate characteristic imaging findings of tumor attenuation in 4-phase CT between renal oncocytoma ( RO ) and clear-cell renal ceil carcinoma ( ccRCC ) of small tumor size (≤Scm).Methods Fifty-six patients with histologically confirmed renal masses (11ROs and 45 ccRCCs) were included in this study.Heterogeneous enhancement was found all tumors during the corticomedullary phase (CMP).The CT values of the normal renal cortex,the relatively high enhanced region and the relatively less-enhanced region of the tumor were measured in each phase.Statistical comparison was carried out by Chi-square test or Mann-Whitney test.ResultsIn CMP,the CT value of the relatively high enhanced region in RO [ 163.0 HU ( 141.0—178.0 HU) ] was significantly lower than that in ccRCC [ 194.0 HU ( 166.5—235.0 HU) ; Z = -2.847,P =0.004].Compared CMP with the excretory phase,the attenuation of the relatively highly enhanced region in RO [70.0 HU (41.0—86.0 HU)] were significantly lower than that in ccRCC [87.0 HU (65.0—126.5 HU) ] (Z= -2.032,P =0.042).In the excretory phase,9 of 11 ROs had a further enhancement with its relatively less-enhanced region which was significantly higher than that in ccRCC (21/45 ; x2 = 4.391,P = 0.036).ConclusionsIn CMP,the CT value of the relatively high enhanced region in RO was significantly lower than that in ccRCC.Compared with ccRCC,in the excretory phase,the RO had less attenuation of the relatively highly enhanced region with homogeneous density.
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@#ObjectiveTo evaluate the clinical and functional outcome of traumatic segmental defects of the tibia treated by internal bone transport using the the adjustable mono-lateral external fixation.Methods12 patients who underwent internal bone transport using the the adjustable mono-lateral external fixation for traumatic segmental defects in the tibia were reviewed, the length of bone defect was 6～10 cm.ResultsMean follow-up was 14 months. All the cases got primary bone union. The length of time in healing was 9～14 months.ConclusionTraumatic segmental defects of the tibia treated by internal bone transport using the adjustable mono-lateral external fixation is a simple, less traumatic, non-bone graft and effective way.
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Objective To explore the effective disinfection and management measures of standby aspirators. Methods Randomly sampled 17 standby aspirators in our hospital and examined whether their liquid storage bottles and covers were contaminated by pathogens.According to the situation,we developed appropriate measures to intervene.4 months after intervention,we sampled 17 standby aspirators which were tested again. Results 82.4% liquid storage bottles and 88.2% covers were contaminated. While the contamination rate after intervention was zero.The pathogens found were mainly Pseudomonas Aeruginosa, Klebsiella pneumoniae and other opportunistic pathogens.Conclusions To strengthen the disinfection management of standby aspirators can control the contamination of standby aspirators.