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Objective:To investigate the safety and efficacy of FOLFOX (5-fluorouracil + calcium folinate + oxaliplatin) hepatic arterial infusion chemotherapy (FOLFOX-HAIC) combined with immune and targeted therapy as triple combination therapy for patients with single China Liver Cancer Staging (CNLC) Ⅰb hepatocellular carcinoma.Methods:A total of 20 patients with single CNLC Ⅰb hepatocellular carcinoma who received FOLFOX-HAIC combined with immune and targeted therapy as triple combination therapy in the First Affiliated Hospital of Guangxi Medical University from October 2021 to August 2022 were included. The clinical data of all patients was retrospectively analyzed. There were 18 males and 2 females, with the age of (55.1±9.9) years. Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were used to evaluate the efficacy of FOLFOX-HAIC combined with immune and targeted therapy, and the clinical safety of triple combination therapy was evaluated by common terminology criteria for adverse events 4.0.Results:According to RECIST 1.1, objective response rate of 20 patients was 70.0% (14/20) and disease control rate was 100.0% (20/20) after 2 cycles of treatment (one cycle of FOLFOX-HAIC plus programmed death-1 antibody). According to mRECIST, objective response rate was 90.0% (18/20) and the disease control rate was 100.0% (20/20) after 2 cycles of treatment. Following the treatment, 12 patients (60.0%) received liver tumor resection, and all of them achieved R 0 resection, 2 patients (10.0%) received radiotherapy, 3 patients (15.0%) stopped drug treatment for surgery, 2 patients (10.0%) refused surgery, and 1 patient (5.0%) died of multiple organ failure caused by immune hepatitis. According to pathological results, 3 patients (25.0%, 3/12) achieved pathological complete response, and 4 patients (33.3%, 4/12) achieved major pathological response. In the safety evaluation, the overall incidence of adverse events was 100.0% (20/20). Seven patients (35.0%) had grade 3 adverse events and 1 patient (5.0%) died of multiple organ failure due to immune hepatitis (grade 5). Grade 1-3 adverse events could be relieved after symptomatic treatment. Conclusion:The triple combination therapy of FOLFOX-HAIC combined with immune and targeted therapy is safe and has high objective response rate and disease control rate, which could be a new strategy for the neoadjuvant treatment of hepatocellular carcinoma.
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Objective To investigate the value of diffusion kurtosis imaging (DKI) in diagnosing early diabetic nephropathy. Methods Twelve pigs were divided into the experimental group (7 pigs) and the control group (5 pigs), used the random number table method. The experimental group was fed with high?fat high?sugar diet,and then repeatedly injected small doses(50 mg/kg) of Streptozotocin (STZ) through the ear vein. Meanwhile,the control group was fed with normal diet and injected with the same dose of citric acid?sodium citrate buffer solution.After the type 2 diabetes was established successfully, T1WI, T2WI and DKI sequence imaging were performed every month for 2 pigs from the experimental group and the control group,respectively.Mean kurtosis(MK), axial kurtosis (K∥), radial kurtosis (K⊥), fractional anisotropy (FA) and mean diffusivity(MD) were measured on the pseudo?color map of the post?processing workstation. fasting blood glucose(GLU),insulin (INS),renal function, urine routines and random albumin creatinine ratio(RACR) were measured before MRI scan. Specimens from bilateral kidneys were taken for pathological examination after MRI scan. The paired t test was used to compare the parameter values of the cortex and medulla. Independent sample t test was used tocompare the parameter values of the experimental group and the control group. Results In the experimental group,the MK, FA values of medulla were 0.66±0.07 and 0.19± 0.04, the MK, FA values of cortex were 0.60±0.06 and 0.16±0.03.In the control group,the MK, FA values of medulla were 0.59±0.03 and 0.20±0.04, the MK, FA values of cortex were 0.53±0.03 and 0.17±0.04.The MK and FA values of medulla were increased compared with the cortex and the difference were statistically significant (P<0.01). The MK, K⊥ values of cortex and medulla were increased in the experimental group compared with the control group and the difference were statistically significant (P<0.05). There was no significant differences in the K∥, FA and MD values between two groups (both cortex and medulla, P>0.05). Conclusion DKI sequencehas certain value in the diagnosis of early diabetic nephropathy, and to some extent reveals the pathological change in early diabetic nephropathy.
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Objective ToinvestigatetheenhancedCTfindingsandpathologicalfeaturesoflocalized malignantperitonealmesothelioma (LMPM)andimprovetheaccuracyofdiagnosis.Methods Theimagingandclinicaldataof5casesofLMPMconfirmedbypathology werecollected,thefeaturesofCTenhancedimagingwereanalyzedretrospectivelyandcomparedwiththepathologicalresults.Results Allofthe5caseswereisolatedsolidandcysticmasswithirregularshape,andtherangeofmaximumdiameterofthelesionbeing 8.4-13.3cm,inwhich1casewaspolycystic,andtheother4casesweresolidandcysticmass.CTvalueofthecysticpartwasabout 13.0-27.8 HU,andnoenhancementshowedoncontrast-enhancedphase.Thethicknessofcysticwallandseparationwasuneven, whiletheCTvalueofsolidpartwasabout32.6-40.8HU,andmoderateenhancementwasseeninarterialphase(△CTvaluewasabout30.9-38.4HU ),followedbyslightlyincreaseofenhancementdegreeinvenousphase,andthedecreaseofenhancementdegreeinequilibriumphase. Separationandalotofvesselshadowwereseenin3caseswhileperitonealcavity,pelviceffusionandintraperitonealimplantmetastasiswereseen in1case.Forthepathologicaltypesofpatientsinthisgroup,1casewasepithelialtype,mainlycomposedofcysticcomponent,andthe other4caseswerefibroustypeorbiphasictype,mainlycomposedofcysticandsolid,withsmallcysticdegeneration,necrosis,fibrousseptum, bloodsupplyvessels,andetc.Somelesionsinvadedthesurroundingstructure.Conclusion Thepathologicaltypesoflocalizedmalignantperitoneal mesotheliomaaremostlyfibroustypeandbiphasictypewhichCTfindingsaremostlymanifestedascysticandsolidmasses.Lobulatedand wallnodules,uneventhicknessofcysticwallandseptumcanbeseen,andthedensityofcysticpartialisrelativelyhigher.Solidpartis moderateenhancement,andinvenousphaseismoreobviouswithenhancedvascularseenintheseptum.CTenhancementcombined withclinicalmanifestationsarehelpfultomakeinsuggestivediagnosis.
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Objective@#To explore the value of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA) enhanced MRI T1 mapping in diagnosing and distinguishing dysplastic nodule (DN) and hepatocellular carcinoma (HCC) with different degrees of differentiation.@*Methods@#A retrospective study in the first affiliated Hospital of Guangxi Medical University from September 2015 to December 2017 was conducted. Seventy-one patients with HCC or DN (a total of 79 lesions) that confirmed by biopsy or surgical pathology findings. Seventy-nine lesions were divided into DN (n=10), well differentiated HCC (n=15), moderately differentiated HCC (n=36) and poorly differentiated HCC (n=18) according to histopathology. All the patients underwent plain MRI scan and Gd-EOB-DTPA-MRI T1 mapping before surgery or needle biopsy. The T1 values of each lesion and non-tumorous liver parenchyma were measured on 20 min hepatobiliary phase (HBP) T1 mapping after Gd-EOB-DTPA administration, respectively. The increment rate of T1 value in lesions relative to non-tumorous liver parenchyma were calculated. One-way ANOVA was used to compare the differences of T1 value and the increment rate of T1 value of DN and 3 groups of HCC with different degrees of differentiation. Spearman correlation was used to evaluate the correlation between T1 mapping parameters and the malignancy degree of DN and HCC. Area under the receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T1 mapping parameters in the differential diagnosis of DN and HCC with different degree of differentiation.@*Results@#Significant differences were found in T1 value and increase rate of T1 value of DN and HCC with different degrees of differentiation (P< 0.05). The T1 value and increase rate of T1 value showed an increasing trend from DN to poorly differentiated HCC after enhancement. The T1 value and increase rate of T1 value were positively correlated with the malignancy of DN and HCC (r=0.418 and 0.634, P<0.01). There were significant differences in the increase rate of T1 value between well-differentiated HCC and moderately-differentiated, well-differentiated HCC and poorly-differentiated HCC, respectively (P<0.05). The area under ROC curve of T1 value and the increase rate of T1 value for differentiating DN from well-differentiated, moderately differentiated and poorly differentiated HCC was 0.933, 0.928, 0.939 and 0.867, 0.961, 0.961, respectively. The area under ROC curve of the increase rate of T1 value for differentiating well-differentiated HCC from moderately-differentiated, well-differentiated HCC from poorly-differentiated HCC was 0.770 and 0.844, respectively.@*Conclusions@#Gd-EOB-DTPA enhanced MRI combined with T1 mapping can provide valuable diagnostic information for identifying DN and HCC with different degrees of differentiation.
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Objective To explore the significance of ADC value combined with MRI signs on identifying benign and malignant breast lump lesions with the type of TICⅡ.Methods 187 patients with breast lump lesions of TICⅡ,which were confirmed by surgical pathology,proceeded MRI.The ADC value,early-phase enhancement rate,length of lesions,lobulated appearance and spiculation, inverted nipple,thickening of the skin and the length of ipsilateral axillary lymph nodes were analyzed and recorded.T-tests was used to analyzed the measurement data,χ2test was used to analysis the attribute data.The ROC curves were used to evaluate the diagnostic efficiency of ADC value and MRI signs.Results The ADC value was (1.418±0.299)×10-3mm2/s and(0.860±0.142)× 10-3mm2/s (P<0.01)for breast benign and malignant lesions respectively,while the early-phase enhancement rate were (170.387± 74.580)% and (160.778±39.786)%(P=0.258)respectively.When ADC values were used for differential diagnosis of breast benign and malignant lesions with a threshold of 1.017×10-3mm2/s,the area under the sensitivity and specificity were 89.0% and 98.0% The sensitivity and specificity of lobulated appearance,spiculation,inverted nipple and thickening of the skin were 92.6% and 33.3%, 88.2% and 88.2%,20.5% and 94.1%,35.3% and 88.2%,respectively.When the 1.0 cm was used as the threshold of the length of ipsilateral axillary lymph,its sensitivity and specificity were 47.8% and 80.4%.The ROC curve of early-phase enhancement rate showed no diagnostic capability(P>0.05).Conclusion ADC value combined with MRI features are helpful to improve the sensitivity and specificity in breast lesions with the type of TICⅡ.
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Objective To investigate the diagnostic value of some measured values of CT for nutcracker syndrome(NCS).Methods 28 patients with NCS confirmed by clinical diagnosis and other 81 normal controls were enrolled in the study.The angle between the superior mesenteric artery and the abdominal aorta,and the diameter and the area of left renal vein before/within this angle were measured on enhanced CT and MPR reconstruction images.The ratios of the diameter and the area before the angle to those within the angle were calculated.ROC curve was established to calculate the cut-off value and to evaluate the sensitivity,specificity,positive predictive value and negative predictive value of these parameters.Results In patient group,the mean aortomesenteric angle was 22.4°± 7.16°,mean diameter ratio was 5.10 ± 1.76 and the mean area ratio was 4.07 ± 2.10.In control group,the mean aortomesenteric angle was 61.32°± 22.82°,mean diameter ratio was 1.38 ± 0.40 and mean area ratio was 1.29 ± 0.49.The area under the ROC of the aortomesenteric angle,and the diameter ratio and area ratio were 0.979,1.000 and 0.989 respectively with corresponding cut-off values of 32.5°,2.63 and 2.06,sensitivity of 92.8%,100% and 96.4%,specificity of 95.1%,100% and 92.6%,positive predictive value of 86.7%, 100% and 81.8%,and negative predictive value of 97.5%,100% and 98.7%,respectively.Conclusion The aortomesenteric angle, the diameter and area ratios of left renal vein before/within the aortomesenteric angle have significant diagnostic value in the patients with NCS,and the value of diameter ratio is the highest.
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Objective To explore the value of MRI T2*quantification of visceral iron deposition in patients with β-thalassemia major. Methods A total of one hundred and two patients with β-thalassemia major were retrospectively analyzed. They underwent genetic testing and the cardiac and (or) abdominal MRI scanning. Among them, 47 patients underwent splenectomy operation, 95 patients underwent cardiac MRI scanning, 102 underwent abdominal MRI scanning for their livers, pancreases and kidneys, and 55 underwent splenic MRI scanning. The T2* values of the hearts, livers, pancreases and kidneys were measured, meanwhile the liver iron concentrations (LIC) were measured. The levels of serum ferritin (SF) patients were measured in 81 patients. The Spearman rank correlation was employed to analyze the relationship between SF, LIC, age and each organs T2* values. Independent sample t test (normal distribution) or the Mann- Whitney U test (non-normal distribution) were used to compare the hepatic, cardiac, renal and splenic T2* values differences between patients with splenectomy and those without. Results Serum ferritin were highly positively correlated with LIC, moderately correlatied with age, moderately negatively correlated with hepatic and pancreatic T2* values, with r values of 0.833, 0.537,-0.623 and -0.403, respectively (P0.05). The hepatic and pancreatic T2*values were reduced (P0.05). Conclusions The patients with β-thalassemia major have prone to suffer from excessive iron deposition in the heart and abdominal organs. The technology of MRI quantification of T2*values could reflect the body iron overload.
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Objective Study the apply of diffusional kurtosis imaging(DKI) value to assess liver cancer and tumoral cell invasion of peritumoral liver zone. Methods This research belonging to prospective study which included 24 patients with liver cancer and confirmed by clinical history and imaging features(liver cancer group), 10 healthy volunteers as control group. The liver cancer group underwent MRI plain and contrast enhanced scan, and DKI examination, while control group underwent MRI plain scan and DKI scan. The signal features of liver parenchyma and liver cancer lesion could be observed from the routine MRI and DKI. Fractional anisotropy (FA), mean diffusion (MD), axial diffusivity (Da), radial diffusivity (Dr), fractional anisotropy kurtosis (Fak), mean kurtosis (MK), kurtosis anisotropy (Ka) and radial kurtosis (Kr) value of four groups, the distant liver parenchyma(far away from the tumor>2 cm), peritumoral liver parenchyma(the distance≤2 cm around the tumor) and liver cancer were recorded. The differences of DKI parameters were evaluated using one-way analysis of variance (ANOVA). Results The signal of liver cancer in MR plain scan showed mild long T1 and mild long T2 signal, fast in and fast out enhanced feature of the neoplasms could be observed from the enhanced MRI and signal of liver cancer would not lower in DKI with b value up to top. The difference of DKI parameters including FA, MD, Da, Dr and Ka value had statistical significance in these four groups excepted for MK and Kr value. MD, Da and Dr value of normal parenchyma were higher than that of peritumoral parenchyma and liver cancer,while the Ka value was reverse. The differences of MD, Da, Dr and Ka value only had no statistical significance between the distant liver parenchyma and peritumoral liver parenchyma(P>0.05),and the differences of them had statistical significance among the rest group(P<0.05). Conclusion The DKI quantitative parameters can reflect the differences of different tissue, meaning that they can provide molecular imaging information for evaluating liver cancer and peritumoral zone.
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Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, and in the process of HCC development, early identification and timely treatment can significantly improve patient survival rate. Imaging techniques play an important role in the monitoring of chronic liver diseases, evolution of cirrhotic nodules, and early diagnosis of HCC. Multi-phase or dynamic contrast-enhanced computed tomography and magnetic resonance imaging (MRI) reflect the changes in blood supply during the evolution of liver cirrhotic nodules. Functional MRI can reflect the structure and function of living organisms at the molecular level. The application of liver-specific contrast agents can improve the detection rate and identification of early-stage HCC. With the development of MRI techniques and the accumulation of clinical experience in functional imaging will further improve the diagnostic rate of early-stage HCC.
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Objective To explore the feasibility,reproducibility and reliability of the T 2* MRI technique in quantifying different concentrations of MnCl2water phantoms at 3.0T.Methods The water phantoms with different concentrations of MnCl2underwent T2* imaging at both 1.5T and 3.0T MRI,and repeated imaging at 3.0T MRI after 1 month.A Spearman correlation was used to determine the relationship of T2* values and Mn concentrations,and established the linear regression equations by using the simple linear regression.W ilcoxon signed-rank sum test and Bland-Altman method were used to evaluate the reproducibility of twice T 2* measurements at 3.0T,and the interclass correlation coefficient(ICC)was calculated.Results T2* values of the phantoms were negatively correlated to Mn concentrations(r= -1.000,P<0.001),and R2* values of the phantoms were positively correlated to Mn concentrations(r=1.000,P<0.001). T2* values of the phantoms measured at 3.0T were positively correlated to that measured at 1.5T(r=1.000,P<0.001).The linear regression equation was T2* 3.0T =0.651T2* 1.5T +0.041.There was no statistical difference of T2* values between the two measurements at 3.0T (Z= -1.732,P=0.083),and ICC was 1.000.Conclusion 3.0T MRI is feasible to quantify cardiac iron deposition.
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Objective To discuss the imaging findings and pathological features of primary pulmonary lymphoepithelioma-like carcinoma (LELC). Methods Imaging and pathological data of 13 patients (9 male and 4 female, age from 17 to 72 years, median age 52 years) with pathology-proven primary pulmonary LELC from January 2010 to March 2015 were retrospectively analyzed. Thirteen patients underwent X-ray examination, two of them underwent non-enhanced CT scan, eight underwent non-enhanced and enhanced CT scans, one underwent non-enhanced MR scan. All imaging data including location, number, shape, size and density of lesions were analyzed by two experienced chest radiologists respectively and reached an agreement after consultations. Surgery was performed in 11 cases and aspiration biopsy in 2 cases. HE staining was performed in all cases and immunohistochemistry staining in 6 cases. Results All thirteen primary pulmonary LELC were unilateral. Nine peripheral tumors and four central tumors were identified. Lobulations (n=11), spiculas (n=7), vessel convergences (n=3), vascular encasements (n=2), pleural indentations (n=4) and punctuate calcification sign (n=1) were seen in the CT images. Thirteen tumors had diameters ranging from 1.3—11.0 cm, average diameter of (4.4 ± 2.7) cm, and all showed homogeneous density in non-enhanced CT. CT value ranged from 22—48 HU, average value of(34± 10)HU, and during arterial phase it ranged from 33—70 HU, average value of(53 ± 13)HU;and during venous phase it ranged from 43—86 HU, average value of(66±14)HU;the tumor had long T1 and long T2 signal in non-enhanced MR scan, and signals were homogeneous. Pathologically, the tumor was from pleomorphic epithelial with large cells, syncytia in the infiltration of lymphocytes or accompanied with collagenzation. Large nucleus showed vacuole-shape. Immunochemistry CK(+), P63(+), CK5/6(+), CK14(-) supported the diagnosis of LELC. Conclusions There are certain imaging characteristics for primary pulmonary LELC. Histopathological and immunohistochemistry examination could provide the definitive diagnose.
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Objective To study the characteristic differences using CTs and MRIs between intracranial hemangiopericytomas (HPCs)and meningiomas of different pathological type.Methods 8 cases of HPC and 5 1 cases of meningioma approved by patholo-gy were selected.All cases underwent MRIs,CTs and enhancements before operation.The imaging characteristics of these tumors were analyzed with chi-square test.Results Compared with atypical meningioma,tumor bleeding(χ2 = 1 1.484),blood vessel flow void phenomenon(χ2 =8.571),skull damage(χ2 =5.529)showed remarkably significant statistical differences(P <0.05);compared with malignant meningioma,tumor bleeding(χ2 =1 1.484),blood vessel flow void phenomenon(χ2 = 1 1.429)showed remarkably significant statistical differences(P <0.05).Conclusion There are differences between HPC and meningiomas of different pathologi-cal type.It is helpful to improve the diagnosis level through comparative analysis of the MRI and CT findings.
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Objective To explore the change characteristics of early renal blood infusion in patients with diabetes and its relation-ship with fasting blood sugar by using multi-slice spiral CT (MSCT)perfusion scan.Methods Thirty cases of T2DM patients within five years of disease course that meet clinical diagnostic criteria (poor DN glycemic control group and good DN glycemic control group with 1 5 cases in each group)and 1 5 cases in the control group underwent bilateral renal perfusion scan using 64-detector spiral CT,thus obtaning their cortical perfusion parameters of bilateral kidneys,including blood flow (BF),blood volume (BV),mean transit time (MTT)and capillary permeability surface (PS).At the same time,for each case,fasting glucose,blood urea nitrogen, serum creatinine and blood uric acid value on the third days after and before perfusion were also measured;the glomemlar filtration rate (C-GFR)was estimated.Statistical analysis was performed on all of these obtained values.Results (1).For the poor DN gly-cemic control group,the average BF value,average BV value and average PS value were reduced,average MTT was prolonged sig-nificantly,and compared with normal group,average BF value and average MTT were statistically significant (P 0.05)for both normal control group and DN groups in the third day before and after renal CT perfusion imaging examination.Conclusion BF,BV and MTT of MSCT perfusion scan can reflect the characteris-ticsof early renal blood infusion in patients with diabetes.And changes of fasting blood sugar in patients with diabetes may influence mean BF and mean MTT of kidney.
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Objective To observe the growth characteristics and multi-time dynamic contrast-enhanced MR(DCE-MR)findings of rabbit VX2 liver tumor on MR imaging, and to provide a reliable basis for the values of MR in assessment of non-surgical treatment effect of rabbit VX2 liver tumor.Methods 10 rabbit VX2 liver tumor models were established by liver tissue embedding through laparotomy under direct vision and DCE-MRI scaning was performed at the 2nd,3rd,4th and 5th week after establishment.The tumor volume (V)and tumor growth rate (TGR)were calculated at different time points and the signal characteristics were analyzed on MR imaging;then all the rabbits were excuted and HE staining were performed to observe the cancer cells in different places with microscope.Results The TGR at the 3rd week after establishment (404.16%±114.64%)was significantly higher than that at the 4th week (223.49%±65.90%)(t=3.417,P<0.05).The tumors with well-boundary were rim-like enhanced significantly and the central parts were not enhanced on DCE-MR imaging,and the parts between the edge and centre of tumors were heterogeneously mild enhanced. The HE staining results showed that 6 cases of tumor were squamous cell carcinoma and the cells were distributed densely in the edge,the cancer cells and necrosis were distributed equally in the parts between the edge and centre of tumors and the centre of tumors were necrosis parts.Conclusion The rabbit VX2 liver tumor grows rapidly at the 3rd week after establishment, and its histological features can be better reflected by DCE-MRI.
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Objective To analyze the computed tomography (CT)characteristics of splenic lymphangioma and the association be-tween CT findings and pathological results.Methods The CT characteristics and pathological findings of 9 patients with splenic lym-phangioma were retrospectively analyzed.Results There were 8 cavernous lymphangioma and 1 cystic lymphangioma.Of the 9 ca-ses,it revealed that the percentage of blood vessel elements ranging from 5% to 50% via microscope.CT found 2 cases were with single lymphangioma,3 with multiple lesions,exhibiting as round or round-like mass;4 cases were found with diffuse lymphangio-ma and different size of cystic masses distributed across spleen.Five of the 9 cases who were with single or multiple lymphangioma showed circular and thin line-like cyst wall,while the remaining 4 cases showed latticed cyst wall in CT characteristics.The content in the cysts were with uneven density in all the 9 cases with CT value ranging from 10 to 40 HU,3 of which combined with sand-like calcification.Enhancement scanning found two characteristics:(a)cyst wall and separation were mildly enhanced,especially in the delayed phase;(b)the content in the cyst presents anomalous small patchy and mild enhancement.The enhancement of the content in the cyst did not change as the increasing of blood vessel composition.Conclusion CT examination will help the diagnosis of splenic lymphangioma and is of significance in informing clinical treatment.
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Objective To investigate effective MSCT perfusion index and evaluate its significance in the renal function of diabetic nephropathy patients.Methods The 64-slice spiral CT perfusion scanning was performed on experimental group with 25 cases dia-betic nephropathy patients and control group with 25 cases healthy volunteers.The index including the dual-renal blood flow (BF), blood volume (BV),mean transit time (MTT),and permeability of surface (PS)were measured.At the same time,the levels of microalbumin and urinary protein (mg/24 h)were quantitated,and the blood urea and serum creatinine were measured on diabetic nephropathy patients one day before and the second day after renal CT perfusion scanning.Results All indexes of renal MSCT per-fusion,which are BF,BV,MTT and PS,were associated with 24 h quantitative urinary protein and fasting blood-glucose.Only BF and MTT were related to microalbumin and in a good correlation with indexes of diabetic nephropathy (microalbumin,24 h quantita-tive urinary protein,and fasting blood-glucose).Within them,the BF value was negatively correlated to the indexes,and the MTT was positively correlated.The area below the ROC curve of BF and MTT was more than 0.8,it indicated the good effect for the in-dexes in diagnosis of diabetic nephropathy.The usage of non-ionic contrast agent in the renal perfusion scanning process has no sig-nificant impact on the measured index values.Conclusion MSCT renal perfusion index can be used to evaluate the renal function of diabetic patients.BF,BV and MTT could be used in prediction,diagnosis and screening of DN patients,among them BF and MTT indexes were the optimal.
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Objective To explore the value of MRI-R2 * and to compare clinical effect of two iron chelators(deferasirox and deferoxamine) in iron-overloaded patients.Methods By completely randomized balanced design,24 iron-overloaded patients were randomly divided into 2 groups,which consisted of 12 patients treated with deferasirox and 12 patients treated with deferoxamine.The planned deferasirox dose was 40 mg· kg-1 · d-1,and the deferoxamine dose was no less than 50 mg · kg-1 · d-1 All patients underwent quantitative MRI at the time points of the primary screening,6 months and 12 months.Pair Wilcoxon rank sum test was used to compare the differences of liver R2 * values of the 2 groups at various time points respectively.Wilcoxon rank sum test was used to compare the differences of change rate of liver R2 * values between the two groups at the time point of 6 months,12 months,respectively.Results Deferasirox group's liver R2 * values of primary screening,6 months and 12 months were 1081,889 and 712 Hz,while deferoxamine group's liver R2 * values were 1042,838 and 488 Hz.There was no statistically significant difference between liver R2 * values of two groups at primary screening (Z =-0.029,P ＞ 0.05).The change rate of liver R2 * of deferasirox group at 12 month was-32％,while it was-58％ for the deferoxamine group,and there was statistically significant difference between the two groups (Z =-3.060,P ＜0.01).The change rate of serum ferritin of deferasirox group at 12 month was-15％,while it was -55％ for the deferoxamine group,and there was statistically significant difference between the two groups (Z =-2.945,P ＜ 0.01).Conclusion By using MRI-R2*,it suggest that both deferasirox and deferoxamine can effectively remove liver iron and deferoxamine is superior to deferasirox.
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ObjectiveTo investigate the value of the MSCT liver perfusion imaging parameters inthe evaluation of the chronic hepatic fibrosis and cirrhosis. Methods Liver CT perfusion ( CTP ) was performed in 107 participants,including 31 patients with mild hepatic fibrosis( S1,S2),34 patients with severe hepatic fibrosis ( S3,S4 ) and early stage of hepatic cirrhosis which conformed by liver pathologic biopsy,42 patients with hepatic cirrhosis who had typical clinical and image signs,and 30 healthy subjects as control group.The data of CTP ( HAP,PVP,LTP,HPI and TTP) at different stages were obtained with Body perfect CT-syngo CT2007A and control study with histopathologic stage.Compared the study index by the one-way ANOVA analysis. Used Spearman rank correlation to analysis the relationship between liver perfusion imaging parameters and the degrees of the chronic hepatic fibrosis. Used Logistic regression to analysis the maximum.regression coefficient among the liver perfusion imaging paraneters,which affected the histopathologic stage mostly.ResultsIn the subgroups of the chronic hepatic fibrosis S1,S2,S3,S4 to the hepatic cirrhosis,HAP values was (28.9 ±8.6),(24.6 ±2.4),(29.2 ±2.3) and (38.9 ± 7.0) ml · 100 ml -1 · min-1,respectively.HAP decreased firstly,then increased.Statistic analysis showed the difference of HAP between later-stage cirrhosis and other groups( F =40.26,P ＜ 0.01 ).PVP values of above subgroups was (111.3 ± 18.1),(92.9 ±5.3),(73.0 ±9.0) and (54.1 ± 13.8) ml · 100 ml-1 ·min -1,respectively.TLP values of above subgroups was ( 140.2 ± 25.9 ),( 117.1 ± 4.5 ),( 102.3 ± 8.7 )and (93.0 ± 11.8) ml · 100 ml-1.min-1,respectively.The difference of PVP,TL.P among each subgroup was significant ( F =136.79,67.40,respectively,P ＜ 0.01 ).HPI values of above subgroups was (20.4 ± 2.6)％,(21.0 ±2.1)％,(28.5 ±3.1)％ and (42.6± 11.1)％,respectively.TTP values of above subgroups was (123.7±22.2),(137.1 ±27.1),(145.0 ±28.6) and (166.5 ±25.1)s,respectively.The difference of HPI,TTP among each subgroup was significant( F =93.05,17.37,respectively; P ＜0.01 ).PVP,TLP was significant negative correlation with the degree of the hepatic fibrosis( r =-0.920,-0.846,respectively; P ＜0.01 ).HAP,HPI and TTP was significant positive correlation with the degree of the hepatic fibrosis( r =0.611,0.882 and 0.545,respectively; P ＜ 0.01 ).Logistic regression analysis showed the regression coefficient of PVP( - 8.798) was maximum.With an area under the receiver operating characteristic curve of PVP =84.76 ml · 100 ml- 1 · min- 1 as a diagnose critical point.The sensitivity was 0.890,the specificity was 0.950,and the accuracy was 0.931 in the prediction of the chronic hepatic fibrosis.Conclusions MSCT liver perfusion imaging parameters can reflect the hemodynamic changes of chronic hepatic fibrosis and cirrhosis.CTP may be helpful for differentiation the severe hepatic fibrosis and early stage of hepatic cirrhosis and later-stage cirrhosis.
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Objective To study the correlation of multi-slice CT portography (MSCTP) and digestive endoscopy in the diagnosis and evaluation of esophageal and gastric varices (EGV) caused by cirrhosis.Methods A total of 92 patients with cirrhosis were enrolled in the prospective study.All the patients were examined by endoscopy and 64-slice spiral CT scan in 4 weeks.The types,grading of EGV were observed by endoscopy and MSCTP,and Kappa conformance test was applied with the endoscopic findings as gold standard.The sensitivity,specificity,consistency,and Youden index were evaluated for the diagnosis of sophageal and gastric varices by MSCTP.Results Sixty-five patients were diagnosed to have EGV by endoscopy and 27 were negative.The positive patients included 45 patients of GOV1,19 of GOV2 and 1 patient of IGV1.MSCTP diagnosed 67 cases of EGV and 25 patients of negative results.The positive patients included 46 of GOV1,18 of GOV2 and 3 of IGV1.Two patients of IGV1 varicose veins without positive findings on endoscopy were diagnosed by using MDCTP,which revealed isolated varicose veins under the gastric mucosa.There was high consistency between MSCTP and EGV in the diagnosis of EGV (Kappa =0.732,P ＜ 0.01).The sensitivity of MSCTP was 93.8％,specificity was 77.8％,consistency was 89.1％,and Youden index 71.6％.There was high consistency between MSCTP and EGV in the classification of EGV (Kappa values were 0.743 and 0.763,P ＜ 0.01).Conclusions There is high consistency between MSCTP and digestive endoscopic in the diagnosis and classification of EGV in cirrhosis.MSCTP is superior to endoscopy in the detection of gastric varices.
ABSTRACT
Objective Using MRI-T2 * method to quantify the cardiac iron overload in patients with β-thalassemia major and to evaluate the correlation between cardiac T2 * values and serum ferritin (SF),liver iron concentration(LIC).Methods Fifty-eight over 10 years old transfusion-dependent patients with β-thalassemia major were underwent MRI heart measurement to obtain T2 * values.Spearman rank correlation was used to analyze the relationship between cardiac T2*,SF,and LIC.Patients were divided into two groups based on standard setting (SF ＞2500 μg/L or LIC ＞ 15 mg/g of dry tissue).Differences of cardiac T2 * values between two groups were evaluated by Wilcoxon rank sum test with cardiac T2 * ＜ 20 ms as diagnosis standard.The sensibilities and specificities of prediction for cardiac iron deposition with the index of SF ＞ 2500 μg/L or LIC ＞ 15 mg/g dry tissue were calculated,and receiver operating characteristic (ROC) curve analysis was performed.Results The range (median) of cardiac T2 * values,SF and LIC in 58 patients were 4.7-51.1 ms (14.0 ms),1345-23 640 μg/L (5741 μg/L),9.0-＞43.0 mg/g dry tissue (41.4 mg/g),respectively.There was no linear correlation between cardiac T2 * values and SF (r =-0.240,P =0.070).Cardiac T2 * values and LIC was weakly correlated (r =-0.420,P =0.002).The range (median) of cardiac T2 * values was 6.1-47.6 ms (23.7 ms) in 7 patients of SF ≤ 2500 μg/L group.The range (median) of cardiac T2 * values was 4.7-51.1 ms(13.5 ms) in 51 patients of SF ＞2500 μg/L group.There was no statistically significant difference between two groups (Z =-0.489,P =0.625).The range (median) of cardiac T2 * values was 24.4-51.1 ms (44.8 ms) in 5 patients of the LIC ≤15 mg/g dry tissue group.The range (median) of cardiac T2 * values was 4.7-45.5 ms (13.2 ms) in 53 patients of HIC ＞ 15 mg/g dry tissue group.There was significant difference between T2 * values of the two groups(Z =-2.895,P =0.004).To predict cardiac iron deposition,the sensibilities and specificities were 90.9％ (30/33) and 16.0％ (4/25) for the index of SF ＞2500 μg/L,100.0％ (33/33) and 20.0％(5/25) for LIC ＞ 15 mg/g dry tissue respectively.The areas under the ROC curve were 0.652 with the index of SF and 0.775 with the index of LIC.Conclusions MRI-T2 * method can directly quantify the cardiac iron overload in patients with β-thalassemia major.There is no linear correlation between cardiac T2 * values and SF.Cardiac T2 * values and LIC is weakly correlated.Using SF or LIC as an indirect index to predict cardiac iron deposition is not reliable in clinical.