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Primary hepatic carcinoma has ranked as the sixth most commonly diagnosed cancer and the third leading cause of cancer death. China shares about 50% of new liver cancer cases, including 80% of hepatic carcinoma. Non-surgical therapy continues to make breakthroughs. The authors report a case of hepatic carcinoma with intrahepatic metastasis and tumor thrombus in the left portal vein, which has achieved continious partial response after the treatment of atezoli-zumab combined with bevacizumab, without adverse reactions such as liver and kidney function damage. The life quality of the patient was improved, showing safety and efficacy of the treatment.
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Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.
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Objective To explore the validity of the size-specific dose estimate (SSDE) derived from the water-equivalent diameter (Dw)value of the slice located in the middle of the scan range in the head CT examination. Methods A total of 197 patients underwent head CT nonenhanced scan were enrolled in this retrospective study. The Dw, size-dependent conversion factor (f), normalized volume CT dose index (CTDIvol) and SSDE values of all slices were calculated. Two sets of SSDE, SSDEgroand SSDEcenbased on the Dwvalues slice by slice (Dw-gro) and the Dwvalues of the slices in the middle of the scan range (Dw-cen), were obtained across all patients. Pearson correlation analysis and linear regression analysis were performed for Dw-grovs Dw-cen, Spearman correlation analysis and linear regression analysis for SSDEgrovs SSDEcen, SSDE vs Dw, CTDIvolvs Dw. With the reference of SSDEgrovalue, mean absolute relative difference (MARD) of SSDEcen values were calculated to assess its accuracy and the correlated factors of MARD was analyzed with multivariate linear stepwise regression analysis. Results The minimal Dwvalue close to the roof of the skull corresponded to the maximal value of f and SSDE, which was the minimal value of CTDIvol. The significant positive correlation was showed between Dw-grovs Dw-cen, SSDEgrovs SSDEcen, SSDE vs Dw, CTDIvolvs Dw(r=0.947, 0.931, 0.416, 0.626;P＜0.05). The values of Dw,groand Dw-cenwere (16.94±0.69) and (18.50±0.62) cm respectively. The values of SSDEgroand SSDEcenwere [54.10 (52.29, 56.39)] mGy and [53.77 (51.85, 55.25)] mGy respectively. An approximation of SSDEcenvalues with an average of 1.62% of the gross MARD was found to match the reference value. Multivariate linear stepwise regression analysis indicated that MARD had negative correlation with Dw(β=–1.319,P＜0.05), positive correlation with CTDIvol(β=0.202,P＜0.05), and f was not included in the multivariate regression equation. Conclusion SSDEcenbased on the Dwvalue of the slice located at the center of the scan range yields small MARD value and can represent a reliable SSDE estimation in the head CT examination.
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To realize the remote operation of the slit lamp microscope for department of ophthalmology consultation, and visual display the real-time status of remote slit lamp microscope, a remote slit lamp microscope consultation system based on B/S structure is designed and implemented. Through framing the slit lamp microscope on the website system, the realtime acquisition and transmission of remote control and image data is realized. The three dimensional model of the slit lamp microscope is established and rendered on the web by using WebGL technology. The practical application results can well show the real-time interactive of the remote consultation system.