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Objective:To investigate the value of spectral CT based iodine concentration (IC) parameters for preoperative prediction of lymphovascular invasion (LVI) in gastric cancer.Methods:Between January 2021 and November 2021, 266 patients diagnosed as gastric adenocarcinomas by endoscopy and undergoing gastrectomy at the Affiliated Cancer Hospital of Zhengzhou University were recruited prospectively. They were divided into LVI and non-LVI groups according to pathological reports. Triple phase contrasted enhanced CT scans, including arterial phase (AP), venous phase (VP) and delayed phase (DP) were performed on a spectral CT platform within one week before surgery. The IC of gastric cancer lesions at three enhanced phases were measured based on iodine maps, and the normalized IC (nIC) was calculated. The thickness of the tumor was measured. Clinicopathological features were collected, including ulceration, pathological tumor staging (pT), pathological node staging (pN), histodifferentiation, Lauren subtype, perineural invasion (PNI), positive node numbers and positive node ratio. Student′s t tes t or Mann-Whitney U test were used to compare the differences of continuous variables between the two groups, while Chi-square test or Fisher′s exact test was used for categorical data. Multivariable logistic regression analysis was used to screen independent risk factors of LVI, and to build a combined parameter based on risk factors. The receiver operating characteristic curve analysis was performed to determine the predictive efficacy of IC parameters and the combined parameter for LVI. DeLong′s test was used to compare the differences among different area under the curve (AUC). Results:There were statistical differences in tumor thickness, ulceration, pT, pN, histodifferentiation, positive node numbers, positive node ratio, Lauren subtype and PNI between LVI and non-LVI groups ( P<0.05). The values of IC VP, IC DP, nIC VP, nIC DP in LVI group were statistically higher than those in non-LVI group ( t=3.77, 4.23, 4.25, 6.12, all P<0.001), with the AUC (95%CI) of 0.674 (0.610-0.738), 0.677 (0.614-0.741), 0.731 (0.671-0.792), 0.700 (0.636-0.764) for predicting LVI, respectively. Multivariable logistic regression analysis revealed that tumor thickness (OR=1.148, 95%CI 1.085-1.237, P<0.001) and nIC VP (OR=209.904, 95%CI 14.874-644.362, P<0.001) were independent predictors for LVI, the combined parameter incorporating these two factors yielded an AUC (95%CI) of 0.790 (0.736-0.937), which was statistically higher than any single parameter of IC VP, IC DP, nIC VP and nIC DP ( Z=3.07, 3.29, 2.10, 2.60, P=0.002, 0.001, 0.036, 0.009). Conclusion:The IC and nIC values of gastric cancer lesions derived from the VP and DP on spectral CT can effectively predict LVI status in gastric adenocarcinomas, and the combination of nIC VP and tumor thickness can further improve the predictive efficacy.
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Objective:To investigate the application value of intravoxel incoherent motion (IVIM) imaging in preoperative evaluating perineural invasion (PNI) of esophageal squamous cell carcinoma (ESCC).Methods:The prospective study was conducted. The clinicopathological data of 63 ESCC patients who underwent IVIM imaging before surgery in the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital from January 2016 to April 2019 were selected. Patients underwent routine magnetic resonance imaging scan and IVIM sequence examination. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*) and pseudodiffusion fraction (f) values were measured. Observation indicators: (1) situations of enrolled patients; (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The interclass correlation coefficient (ICC) was used to evaluate cosistency of results. The receiver operating characrteristic curve was used to evaluate diagnostic efficiency. Results:(1) Situations of enrolled patients. A total of 63 patients were selected for eligibility. There were 41 males and 22 females, aged 60(range, 43?74)years. Of the 63 ESCC patients, 17 cases had PNI and 46 cases had no PNI. Cases with well differentiated tumor, moderate differentiated tumor or low differentiated tumor, cases in stage T1, T2, T3, T4 of infiltra-tion depth, cases with or without lymph node metastasis were 0, 6, 11, 0, 3, 13, 1, 15, 2 in patients with PNI, versus 6, 24, 16, 1, 22, 23, 0, 12, 34 in patients without PNI, showing significant differences between them ( Z=?2.32, ?2.49, χ2=19.58, P<0.05). (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. The ADC, D, D*, f values were (2.21±0.33)×10 ?3 mm 2/s, (1.46±0.31)×10 ?3 mm 2/s, 32.50 (15.55,46.75)×10 ?3 mm 2/s, (0.34±0.09)×10 ?3 mm 2/s in patients with PNI, versus (2.45±0.45)×10 ?3 mm 2/s, (1.72±0.38)×10 ?3 mm 2/s, 34.85(23.43,51.20)×10 ?3 mm 2/s, (0.42±0.13)×10 ?3 mm 2/s in patients without PNI, showing significant differences in the ADC, D and f values between them ( t=?2.03, ?2.52, ?2.34, P<0.05) and no significant difference in the D* value between them ( Z=?0.84, P>0.05). The cosistency of ADC, D, D* and f values in the 63 ESCC patients measured by 2 radiologists was good, with the ICC as 0.96, 0.92, 0.89 and 0.95. The receiver operating characrteristic curve demons-trated the best cut-off value of ADC, D and f values were 2.50×10 ?3 mm 2/s, 1.68×10 ?3 mm 2/s and 0.41, with the areas under the curve as 0.67 (95% confidence interval as 0.54?0.79), 0.70 (95% confidence interval as 0.58?0.81) and 0.69 (95% confidence interval as 0.57?0.80), respectively. The combina-tion of D and f value for diagnosing PNI of ESCC had the area under the curve as 0.74 (95% confidence interval as 0.62?0.84), with the cut-off value as 0.20, sensitivity and specificity as 94.1% and 56.5%. Conclusions:IVIM parameters D and f values can evaluate and predict the PNI of ESCC preopera-tively. The combination of D and f values can further improve the diagnostic efficiency.
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Objective:To explore the value of intravoxel incoherent motion (IVIM) DWI in preoperative prediction of angiolymphatic invasion in esophageal squamous cell carcinoma (ESCC).Methods:From April 2016 to April 2019, 63 ESCC patients who planned to undergo resection of esophageal cancer were prospectively collected at Henan Cancer Hospital.According to the postoperative pathological results, 63 patients were divided into angiolymphatic invasion group (30 cases) and no angiolymphatic invasion group (33 cases). All patients underwent IVIM sequence and routine MRI examination before operation. The ADC, true diffusion coefficient (D), pseudodiffusion coefficient (D *) and pseudodiffusion fraction (f) were measured. The differences of parameter values between ESCC with and without angiolymphatic invasion were analyzed using Student′s t test or Wilcoxon rank sum test.The logistic regression was used to analyze the significance of various parameters. For the parameters with statistical significance, the ROC curves were performed to evaluatethe diagnostic performance of parameters for identifying angiolymphatic invasion.The Z test was used to compare the area under the ROC curves(AUC) of parameters. Results:The difference of ADC, D and f values between angiolymphatic invasion group and no angiolymphatic invasion group were statistically signi?cant ( t=4.476, 5.033 and 5.712 respectively, all P<0.001). The D * values showed no statistically signi?cant di?erence ( Z=0.184, P=0.854). The logistic regression analysis showed that D (OR=9.042) and f (OR=26.221) were in correlation with angiolymphatic invasion. The ROC analyses demonstrated that the AUCs of ADC, D and f values in predicting angiolymphatic invasion of ESCC were 0.787, 0.822 and 0.853, respectively. D combined with f had highest AUC (0.917) in predicting the angiolymphatic invasion of ESCC, sensitivity and specificity were 93.3% and 75.8%. D combined with f showed better diagnostic performance than the D and the f value, and the difference were statistically significant ( Z=2.403, 2.289, P=0.016, 0.022). Conclusions:IVIM can be used as an effective functional imaging modality for preoperative evaluation and prediction of the angiolymphatic invasion of ESCC. D value combined with f value can further improve prediction performance of angiolymphatic invasion.
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Objective:To investigate the clinical significance of MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction.Methods:The clinical data of 73 patients with adenocarcinoma on the esophagogastric junction operated from Jul 2018 to Aug 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent MRI examination within one week before surgery. First, the T 2WI, diffusion-weighted imaging and dynamic enhanced images of each patient were carefully observed to define the tumor location, size, shape, signal and enhancement mode, then the distances between the upper edge of the tumor and the cardiac incisure on MRI dynamic enhancement were measured independently, and compared with the measured distance in surgical fresh specimens. Results:The mean location of tumor upper edge measured in MRI of 73 patients was (1.75±1.98)cm, while measured in the surgical specimen was (1.72±1.97)cm. There was no significant difference between the two groups ( t=0.572, P=0.569). The intraclass correlation efficient between the two groups was excellent (ICC=0.974, 95% CI: 0.959-0.984, P<0.01). Conclusion:The measurement result of tumor upper edge in MRI is basically consistent with that of surgical specimens. MRI can be used to locate the tumor upper edge for adenocarcinoma of esophagogastric junction before operation.
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Objective To explore the predictive value of intravoxel incoherent motion (IVIM) imaging for the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma (ESCC).Methods The prospective study was conducted.The clinicopathological data of 33 patients with locally advanced ESCC who were admitted to Affiliated Hospital of Zhengzhou University from September 2015 to October 2017 were collected.Patients received magnetic resonance imaging (MRI) and IVIM imaging examination before and after neoadjuvant chemotherapy.Two radiologists read the imaging together,manually delineated the region of interest in the diffusion-weighted imaging,and the apparent diffusion coefficient (ADC),diffusion coefficient (D),perfusion coefficient (D*),and perfusion score of the tumor (f) were automatically measured.Patients underwent neoadjuvant chemotherapy with paclitaxel plus cisplatin,and underwent radical surgery for esophageal cancer after 2 cycles of chemotherapy.Observation indicators:(1) comparison of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with ESCC;(2) comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with different tumor regression grade (TRG);(3) predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG.Measurement data with normal distribution were presented as Mean±SD,and comparison before and after neoadjuvant chemotherapy was done using the paired t test,and comparison between different TRG patients was done using the t test.Measurement data with skewed distribution were presented as M(P25,P75),and comparison before and after neoadjuvant chemotherapy and between different TRG patients were done using the Wilcoxon rank sum test.The receiver operating characteristic (ROC) curve was used to evaluate predictive value of IVIM imaging parameters.Results Thirty-three patients were screened for eligibility,including 26 males and 7 females,aged from 44 to 74 years,with an average age of 60 years.All the 33 patients were diagnosed as ESCC by pathological examination.(1) Comparison of IVIM parameters before and after neoadjuvant chemotherapy in patients with ESCC:33 patients with ESCC showed a significant difference in the ADC,D,and f value after neoadjuvant chemotherapy [ADC:(1.95±0.56) × 10-3 mm2/s vs.(2.54±0.50) × 10-3 mm2/s,t=-6.98;D:(1.26×10-3 mm2/s (0.81×10-3 mm2/s,2.44×10-3 mm2/s) vs.1.68×10-3 mm2/s (0.83×10-3 mm2/s,2.27×10-3 mm2/s),Z=-3.96;f:0.33％±0.14％ vs.0.42％±0.15％,t=-3.13,P＜ 0.05].(2) Comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in different TRG patients:of 33 patients,15 were in TRG 2 and 18 were in TRG 3.The ADC change value,ADC change rate,D change value,D change rate were (0.85±0.52)× 10-3 mm2/s,52.91％± 32.51％,0.64× 10-3 mm2/s (0.05× 10-3 mm2/s,1.41 × 10-3 mm2/s),48.20％ (3.03％,16.95％) of TRG 2 patients,and (0.38±0.35)×10-3 mm2/s,21.94％±19.08％,0.26×10-3 mm2/s (-1.43×10-3 mm2/s,0.81× 10-3 mm2/s),20.18％ (-58.61％,77.14％) of TRG 3 patients,respectively,with significant differences between two groups (t=3.09,3.41,Z=-3.04,-2.93,P＜0.05).(3) Predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG:ROC curve analysis showed that ADC change value exhibited an area under curve (AUC) of 0.798,a sensitivity of 66.7％ and a specificity of 94.4％ in predicting TRG,when 0.86× 10-3 mm2/s was used as the cut-off value.With 43.3％ as the cut-off value,ADC change rate had an AUC of 0.793,a sensitivity of 66.7％ and a specificity of 88.9％ in predicting TRG.With 0.35× 10-3 mm2/s as the cut-off value,D change value had an AUC of 0.809,a sensitivity of 73.3％ and a specificity of 77.8％ in predicting TRG.With 25.9％ as the cut-off value,D change rate had an AUC of 0.800,a sensitivity of 80.0％ and a specificity of 72.2％ in predicting TRG.Conclusions The change value and change rate of ADC and D values before and after neoadjuvant chemotherapy are potential predictors of pathologic response in ESCC.The significantly increased ADC and D values after neoadjuvant chemotherapy are prone to good pathologic response.The change value and change rate of D values show a better predictive value for pathologic response to neoadjuvant chemotherapy in ESCC compared with those of ADC values.
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Objective To investigate the correlation between quantitative parameters of dynamic contrast?enhanced MRI (DCE?MRI) after neoadjuvant chemotherapy and pathological grades in esophageal squamous cell carcinoma. Methods Fifty?six patients with esophageal squamous cell carcinoma who were confirmed by esophagoscope and received neoadjuvant chemotherapy before operation between September 2015 and December 2017 in the Affiliated Cancer Hospital of Zhengzhou University were prospectively analyzed, and MRI examination was performed within one week before operation. All patients underwent routine chest MRI and DCE?MRI scanning, and quantitative parameters of DCE?MRI, including volume transfer constant (Ktrans),exchange rate constant (Kep) and extravascular extracellular volume fraction (Ve) were measured. Pathological grading was assessed as highly differentiated, moderately differentiated, poorly differentiated,and undifferentiated. Intraclass correlation coefficient (ICC) was calculated from the results of two radiologists. Kruskal?Wallis H test was used to compare the differences of quantitative parameters between different pathological grade groups of DCE?MRI,and Mann?Whitney U test was utilized to compare the intraclass differences among pathological grades. Spearman rank correlation analysis was performed for evaluating the correlation between DCE?MRI parameters and pathological grade of esophageal squamous cell carcinoma. The receiver operating characteristic (ROC) curves were used to evaluate the diagnosis accuracy of different DCE?MRI parameters in pathological grade of esophageal squamous cell carcinoma after neoadjuvant chemotherapy. Results The 56 patients were divided into four groups according to pathological findings: well differentiated group (n=8), moderately differentiated group (n=39), poorly differentiated group (n=9) and undifferentiated group (n=0). The differences of Ktransmean,Ktrans75%,Kepmax, Kepmean,Kep75% between different pathological grading groups were statistically significant (all P<0.05),and these parameters showed positive correlation significantly with pathological grading (r values were 0.778, 0.632, 0.594, 0.725, 0.489 respectively, all P<0.05). The ROC curve area of Ktransmean, Ktrans75% in the diagnosis of pathological grade for esophageal squamous cell carcinoma was 0.750,0.856,respectively. The diagnostic efficiency of Ktrans75% was the best with the diagnostic threshold of 0.693/min,sensitivity of 87.5%, specificity of 78.5%, respectively. Conclusion The quantitative parameters of DCE?MRI after neoadjuvant chemotherapy in esophageal squamous cell carcinoma have the potential value for predicting pathological grade.
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Objective@#To assess intravoxel incoherent motion(IVIM) in evaluating and predicting response to neoadjuvant chemotherapy(NAC) in esophageal squamous cell carcinoma(ESCC).@*Methods@#Forty-seven patients with ESCC diagnosed by pathological findings on biopsy from September 2015 to March 2017 were prospectively collected. All patients were examined before and after NAC using routine MRI scan and IVIM. The standard apparent diffusion coefficient (ADCstandard), diffusion coefficient (D), perfusion coefficient (D*) and perfusion score (f) were measured. The patients were divided into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) according to the 1.1 version of the response evaluation criteria in solid tumors (RECIST). Thirty-one patients underwent surgery after NAC, and the patients were divided into TRG 0-3 according to tumor regression grade (TRG). The differences of parameter values before and after NAC between different groups were analyzed using Student's t test (normal distribution) and Wilcoxon rank sum tests (non-normal distribution). The parameters with statistical significance were evaluated by the receiver operating characteristics (ROC) curves.@*Results@#The ADCstandard values before and after NAC were (1.97±0.51) ×10-3, (2.42±0.52)×10-3 mm2/s. The D values before and after NAC were (1.30±0.30)×10-3, (1.63±0.35)×10-3 mm2/s. The ADCstandard and D values after NAC were significantly higher than those before NAC, and the differences were statistically significant (t=-6.35, -5.25 respectively, both P<0.01). There were no statistical differences on D* and f between before and after NAC (P>0.05). The patients were divided into PR group (29 cases) and SD group (18 cases) after NAC, without CR and PD patients. The ADCstandard, D and f values of PR group were significantly lower than those of the SD group before NAC (t=-3.11, -2.53 and -2.10 respectively, all P<0.05). The ADCstandard, D, D* and f values after NAC revealed no significant difference between PR and SD groups. Thirty-one patients received operation after NAC, which were divided into TRG 2 group (14 cases) and TRG 3 group (17 cases) according to TRG standard, without TRG 0 and TRG 1 patients. All the parameter values before NAC revealed no significant difference between TRG 2 and TRG 3 groups. The D values after NAC in TRG 2 and TRG 3 groups were (1.81±0.31)×10-3, (1.46±0.39)×10-3 mm2/s respectively, and the significant difference was found between two groups (t=2.76, P<0.05). The efficiency of efficacy evaluation for NAC was the highest at D value of 1.68×10-3 mm2/s, with sensitivity and specificity being 85.7% and 70.6%, respectively.@*Conclusion@#IVIM can be used as a new imaging method to evaluate and predict the efficacy of NAC for ESCC, among which the parameter D was the most valuable.
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Objective To evaluate the value of 3T magnetic resonance imaging (MRI) in the preoperative T staging of potentially resectable esophageal cancer(EC), compared with endoscopic ultrasonography (EUS). Methods Patients with resectable EC pathologically confirmed by biopsy from March 2015 to September 2016 were prospectively enrolled. All patients underwent MRI (including T2-TSE-BLADE,DWI and radial-VIBE)and EUS one week after the biopsy,and MRI were performed prior to EUS, both MRI and EUS were acquired within one week before surgery. Two readers with more than 5 years experiences in the MRI diagnosis evaluated the MR image quality using a 5-point score independently. T staging was assigned on MRI and EUS by the two MRI readers using double-blind method and one endoscopist in accordance with the 7th edition of AJCC TNM Classification for EC, and any disagreement between two MRI readers was resolved by consensus with discussion to the third senior MRI doctor. The inter-observer agreement between two MRI readers were calculated using Kappa test for image quality scores and T staging results. Considering postoperative pathological T staging results as the gold standard, the performances of MRI and EUS were evaluated based on the accuracy rate and analyzed by χ2 test. Results A total of 70 patients were enrolled in the study, the good image quality cases (≥ 3 scores) were 66 in reader 1 and 68 in reader 2. The inter-observer agreement of the image quality scores by two readers was excellent (Kappa=0.824, P<0.05). The pathological results revealed 16 cases of T1 stage, 18 cases of T2 stage, 30 cases of T3 stage, and 6 cases of T4a stage. The inter-observer agreement of the preoperative T staging of EC by two readers was excellent (Kappa=0.809, P<0.05). The accuracy rates of MRI and EUS for preoperative T staging of EC were 92.9% (65/70) and 67.1% (47/70), respectively, and the difference in accuracy rates of two techniques was statistically significant (χ2=14.5, P<0.05). Conclusions The accuracy rate of MRI for preoperative T staging of EC is significantly higher than that of EUS. MRI can be used as a noninvasive method for preoperative T staging of EC.
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Objective To investigate the value of introvoxel incoherent motion(IVIM)using 3.0 T MRI to evaluate response to concurrent chemoradiotherapy(CCRT)in patients with advanced uterine cervix cancer. Methods From July 2015 to December 2016,63 patients with advanced(≥ⅡB)cervical cancer diagnosed by clinical and imaging study, who had completed CCRT plan in Henan Cancer Hospital, were prospectively enrolled.Pelvic MRI protocol including T1WI,T2WI,IVIM and dynamic contrasted enhanced scans were performed in each patient before CCRT and 3 weeks after starting therapy(total dose of 30 Gy), and at the end of therapy (total dose of 90 Gy, 8 weeks after therapy). The mean values of ADC, true molecular diffusion coefficient(D),pseudodiffusion coefficient(D*)and perfusion fraction(f)in each tumor at pre-therapy, in the middle of therapy and post-therapy were measured and recorded as ADC-pre, D-pre, D*-pre,f-pre;ADC-mid,D-mid,D*-mid,f-mid and ADC-post,D-post,D*-post,f-post,respectively;the change rates of these parameters during and after therapy (recorded as ΔADC-mid, ΔD-mid, ΔD*-mid, Δf-mid;ΔADC-post, ΔD-post, ΔD*-post, Δf-post) were also calculated. Patients were classified into response group and non-response group,according to response evaluation criteria in solid tumors after CCRT.MRI imaging study was performed in each patient within 1 month after CCRT to follow up,and tumor regression rate was calculated.The Mann-Whitney U test was used to compare differences of parameters and their change rates between response group and non-response group. Spearman correlation analysis was performed to assess relationships between parameters, parameter change rates and tumor regression rate. Logistic regression model was applied to find potential ADC values for predicting therapeutic response. ROC was used to analyze efficacy of ADC values for evaluating therapeutic response in advanced uterine cervix cancer after CCRT. Results The mean value of tumor maximum diameter before and after therapy was (47.5 ± 12.9) and(12.8 ± 10.0)mm,tumor regression rate was(66.7 ± 33.6)%.Forty-eight patients were in the response group and 15 in the non-response group.The mean value of ADC-pre,D-pre,D*-pre and f-pre was 0.74(0.43, 1.14)×10-3,0.58(0.33,0.91)×10-3,12.12(2.30,21.4)×10-3mm2/s,9.65%(4.45%,13.89%),respectively.Tumor regression rate had positive correlation with ADC-pre and D-pre (r=0.773,0.840;P<0.05). Responders had increased ADC-pre, D-pre values than non-responders, which had statistically significant difference (P<0.05). Responders had increased ADC-mid, D-mid and f-mid values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-mid, D-mid and f-mid (r=0.808,0.834,0.563;P<0.05). Responders had increased ADC-post, D-post and f-post values than non-responders,which had statistically significant difference(P<0.05),tumor regression rate had positive correlation with ADC-post and D-post (r=0.799, 0.829;P<0.05).Tumor regression rate had positive correlation with ΔADC-mid,ΔD-mid,Δf-mid(r=0.526,0.573,0.454;P<0.05)and with ΔADC-post,ΔD-post, Δf-post (r=0.541, 0.555, 0.388;P<0.05). Responders had increased ΔADC-mid, ΔD-mid, Δf-mid and ΔADC-post, ΔD-post, Δf-post, which had statistically significant difference (P<0.05). Logistic regression analysis revealed only ADC-pre and D-post could be independent factors to predict therapeutic response in advanced uterine cervix cancer after CCRT,values of B,Wald,odds ratio and P was 22.488,8.431,1.429, 0.004 and 16.542,8.517,1.779,0.004.ROC analysis showed the area under the curve(AUC)of ADC-pre, D-pre,ΔADC-mid,ΔD-mid,Δf-mid,ΔADC-post,ΔD-post and Δf-post for predicting therapeutic response in advanced uterine cervix cancer after CCRT were 0.890,0.926,0.942,0.851,0.803,0.929,0.951 and 0.906, respectively. Conclusion The IVIM parameters before and during CCRT process and their changes are valuable for predicting and evaluating therapeutic response in advanced uterine cervix cancer after CCRT, with high clinical practice value.
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Objective To analyze the value of conventional T2WI combining with breath-hold Cartesian VIBE sequence, and compared with Blade combining with breath-free radial VIBE sequences in pre-operative T staging of potentiallly resectable esophageal carcinoma. Methods Sixty-five cases of esophageal carcinoma were concluded prospectively. All patients had received pathological examination of gastroscope biopsy before MRI. Patients received MR examination, including T2WI, breath-hold VIBE, Blade, and breath-free radial VIBE sequences. Two radiologists with more than five years experiences in the diagnosis of chest, performed T staging in MRIby referring to the the 7th edition of UICC-AJCC TNM classification. The results of MRI T staging and the postoperative pathological T staging were analyzed byχ2 test. Results Sixty-five patients were included. Diagnostic coincidence rates of the preoperative T staging by using conventional T2WI combining with breath-hold Cartesian VIBE sequences and Blade combining with breath-free radial VIBE sequences were 51%(33/65) and 88%(57/65) ,with 32 and 8 cases overstaging or understaging respectively, and the statistical differences were significant(χ2=20.80, P<0.05). The former diagnostic accuracy of esophageal carcinoma in situ, muscularis violation and esophageal fiber membrane were 42%(8/19), 54%(14/26), 55%(11/20), and the latter were 89%(17/19), 88%(23/26), and 85%(17/20). Conclusions Diagnostic coincidence rate of the preoperative T staging by using Blade combining with breath-free radial VIBE sequences is much higher than conventional T2WI combining with breath-hold Cartesian VIBE sequences. Blade combining with breath-free radial VIBE sequences could be used as non-invasive imaging method in preoperative T staging of potentially resectable esophageal carcinoma.
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Objective To comparatively analyze the application of conventional echo planar imaging-diffusion weighted imaging (EPI-DWI) and readout-segmented echo-planar diffusion imaging (RESOLVE) in the diagnosis of nasopharyngeal carcinoma.Methods A total of 35 patients with nasopharyngeal carcinoma confirmed by pathology were included in this study.All patients underwent conventional EPI-DWI and RESLOVE (b=800 s/mm2) with a 3.0 T MRI scanner.ADC values of the tumors and normal nasopharyngeal tissues were calculated.Scoring (Five-point score) for imaging quality of conventional EPI-DWI and RESLOVE was independently performed by two radiologists with 5 years experiences and the agreement evaluation was performed using Kappa analysis.The numbers of cases with effectively ADC values,the ADC values of the same tissue in different sequences and the ADC values of the tumor and the normal muscle tissue in the same sequence were compared.The data was statistically analyzed by x2 test,paired sample t test and independent sample t test.Results The agreement between two radiologists was excellent.The Kappa value of the conventional EPI-DWI was 0.91 1(P＜0.01).The Kappa value of the RESOLVE was 0.827(P＜0.01).Four points or more accounted for 97.1％ (34/35) in the RESOLVE group,while only 2.9％ (7/35) images scored four points and most of them were less than four points in the conventional EPI-DWI group.The effectively ADC values can be measured in the conventional EPI-DWI,accounting for 54.3％ (19/35) cases.The ADC values could be measured in all cases of group (100.0％,35/35).The scores of imaging quality of RESOLVE were higher than those of conventional EPI-DWI,which were significantly different (x5=19.091,P＜0.001).The ADC values of the normal nasopharyngeal tissue were (1.65 ±0.13) × 10-3,(1.96±0.14) × 10-3 mm2/s and the ADC values of the tumor were (0.87±0.09) × 10-3,(0.83±0.10)× 10-3 mm2/s in the conventional EPI-DWI and the RESOLVE,respectively.The ADC values were significantly different between the tumors and the normal nasopharyngeal tissues (t=-23.284,-31.509,P＜0.05).The ADC values of the tumors were apparently lower than the normal nasopharyngeal tissues.There were no significant difference of the ADC values between the conventional EPI-DWI and the RESOLVE measuring the same tissue (t=-0.957,-0.921,P＞0.05).Conclusion Compared with conventional EPI-DWI,RESLOVE can provide a higher quality image and may be helpful to accurate diagnosis.
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Objective To investigate the value of multi slice spiral computed tomography (MSCT) reconstruction technique for diagnosis and preoperative evaluation of pancreatic carcinoma.Methods The multi-phase enhanced CT images of thirty-five cases of pancreatic carcinoma proved histologically were analyzed retrospectively.The techniques of volume rendering (VR),multi-planar reconstruction (MPR) and curved planar reformation (CPR) were used to deal with the images,and the relation between the pancreatic tumor and its surrounding structures,vessels,bile duct were observed,then the evaluation of possible surgical resection was performed,then it was compared with operative results.Results Among the 35 patients,27 vessels invasion was showed in 9 patients,common bile duct invasion in 19 patients,pancreatic duct invasion in 12 patients,duodenum invasion in 7 patients,posterior wall of stomach in 2 patients was invaded; one patient had regional portal hypertension with splenomegaly,peri-pancreatic lymph nodes enlargement was detected in 14 patients,para-aortic lymph nodes enlargement was detected in 4 patients,and liver metastasis was found in 3 patients.According to CT evaluation,surgery could be performed in 21 cases,finally 19 patients underwent curative pancreatic cancer resection,and 2 patients underwent palliative surgery.According to CT evaluation,surgery could not be performed in 14 cases,and all of the patients underwent palliative surgery.The coincidence percentage of pre-operative evaluation and post-operative results of curative surgery,palliative surgery was 90％ and 88％.Conclusions MSCT reconstruction technique is useful for diagnosis of pancreatic carcinoma regional invasion and metastasis,and it can increase the accuracy of assessment of tumor resectability.
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Objective To investigate introvoxel incoherent motion (IVIM) sequence features of cervical cancer and to analyze the difference between cervical cancer and normal cervix by using biexponential model parameters of IVIM sequence.Methods MR imaging data of 26 patients with cervical cancer confirmed by surgical pathology and 26 patients of normal cervical confirmed by clinical or MR examination were analyzed retrospectively.All patients underwent routine pelvic MRI sequences,including T1WI,T2WI,DWI (b =800 s/mm2) and IVIM sequence.The IVIM sequence was applied using a biexponential model with factors from 0 to 1200 s/mm2.The standard ADC,slow ADC,fast ADC and fraction of fast ADC values of cervical cancer and normal cervix groups were measured and analyzed by using t test.Diagnostic efficacy of these parameters in cervical cancer group was evaluated by using area under the curve.Results The standard ADC,slow ADC,fast ADC and fraction of fast ADC of cervical cancer group were (0.47 ± 0.09) × 10-3 mm2/s,(0.45 ± 0.09) × 10-3 mm2/s,(5.00 ± 1.68) × 10-3 mm2/s,0.30 ±0.06 and those of normal cervical group were (0.77 ± 0.15) × 10-3 mm2/s (0.61 ± 0.06) × 10-3 mm2/s,(4.29 ±0.57) × 10-3 mm2/s and 0.44 ± 0.04,respectively.The differences of standard ADC,slow ADC value and fraction of fast ADC value between two groups were statistically significant (t =8.841,7.540,10.591,P ＜0.01,respectively).There was no difference of fast ADC between the two groups (t =0.120,P ＞ 0.05).The area under the curve of fraction of fast ADC was the maximum,and it may be the most valuable parameter for the diagnosis of cervical cancer.Conclusions Cervical cancer group has characters on IVIM with lower standard ADC,slow ADC and fraction of fast ADC compared with the normal cervix group.IVIM sequence can reflect diffusion and perfusion of cervical cancer quantitatively.It may play a complementary role in the diagnosis and has some application prospects.
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Objective To investigate the effect of Kang' ai injection and Shenqifuzheng injection on liver function of patients with advanced primary liver cancer after being performed transcatheter arterial chemomembolization (TACE).Methods 120 patients with advanced primary liver cancer were randomly divided into three groups:a control group,a Kang'ai injection group,and a Shenqifuzheng injection group,with 40 patients in each group.All three groups were treated with TACE,and after TACE the control group was treated with anti-infection,inhibiting-acid,protecting-liver function and Shuganning tablets,20 ml/day.On this basis,the Kang'ai injection group was additionally injected with Kang'ai injection,40ml/day,and Shenqifuzheng injection group was additionally injected with Shenqifuzheng injection,250ml/day.All three groups were treated for 15 days.Liver function was tested and compared at the 3rd day,the 7th day and 14th day after TACE in all three groups.Results At the 14th day after TACE,ALT,AST,TBiL,and TBA of the Kang' ai group and Senqifuzheng group [(40.35 ± 10.10) μmol/L、(37.52 ± 10.57) μmol/L、(40.13 ± 8.36) μmol/L、(45.19 ± 19.65) μmol/L in Senqifuzheng group; (40.11 ±7.31) μmol/L,(34.99±9.38) μmol/L,(32.15±6.58) μmol/L,(40.75 ± 6.79) μmol/L in Kang'ai group] were greatly improved than the control group [(61.28 ± 13.38) μmol/L,(57.53 ± 13.36) μmol/L,(68.69± 7.25) μmol/L,(67.75 ± 17.88) μmol/L],with statistical significance (P＜ 0.01).Conclusion Kang'ai injiection and Shenqifuzhcng injection both can reduce liver function damage caused by TACE,thus they can be used together with TACE for treating advanced primary liver cancer.
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Objective To assess the diagnostic value of MR imaging in follow-up evaluation of patients with hepatocellular carcinomas ( HCC ) treated with radiofrequency ablation ( RFA ) and to compare it with that of multi-slice CT.Methods From December 2009 to September 2011,there were 48 patients (56 HCCs) treated with RFA after transcatheter arterial chemoembolization (TACE). MR imaging and multi-slice CT were performed for follow-up.Two radiologists independently reviewed these images,detection of residual or recurrent tumor were assessed on a five-point scale and compared with Kappa test and with the method of receiver operating characteristic (ROC) curve analysis.Sensitivity,specificity and accuracy were evaluated.Results The observer agreement rate for MR imaging was higher ( 0.925 ) than for multi-slice CT (0.701,P ＜ 0.05).The area under the ROC curve (AUC)of MR imaging( 0.987 and 0.971 by two radiologists respectively) was significantly higher than that of CT( 0.674 and 0.598 by two radiologists respectively),P ＜0.05. The sensitivity, specificity and accuracy of detection rate for MRI [100％(22/22),95.5％ (86/90) and 95.5％ ( 107/112),respectively] were significantly different with that for multi-slice CT [40.9％ ( 9/22 ),57.8％ ( 52/90 ) and 60.7％ ( 68/112 ),respectively]. Conclusion Diagnostic accuracy and detection rate of residual or recurrent tumor were found to be superior with MR imaging than with multi-slice CT.