Quantitative evaluation of sternocleidomastoid muscle fibrosis after radiotherapy for nasopharyngeal carcinoma based on mapping technique of MRI / 中华放射学杂志

Objective:To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods:From August 2019 to March 2021, 45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study. According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) classification criteria of late radiation reactions respectively, the sternocleidomastoid muscle injury in the NPC group was divided into grade Ⅰ, Ⅱ and Ⅲ, which included 8, 32 and 5 patients respectively. All patients underwent T 1 mapping and T 2 mapping imaging of the neck. Firstly, the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared. Using NUMARIS/4 software of Siemens image post-processing workstation, the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram. Then, T 1 and T 2 values and the long and short diameters of sternocleidomastoid muscle were measured respectively. Finally, the differences of the parameters between the two groups were compared by independent sample t-test, Spearman rank correlation was used to analyze the relationship between the average T 1 and T 2 values of bilateral sternocleidomastoid muscles and the grade of late radiation injury. Results:Compared with the control group, the shape of sternocleidomastoid muscle in the NPC group was smaller in shape, with irregular edge and uneven increase of T 1 mapping color scale. There was no significant difference in muscle signal in T 2 mapping. The T 1 values of left and right sternocleidomastoid muscles in the NPC group were (1 524.7±97.6) and (1 496.5±93.2) ms respectively, which were significantly higher than those in the normal control group [(1 231.5±85.3) and (1 275.9±90.9) ms] ( P<0.05), and the T 2 values of left and right sternocleidomastoid muscles in the NPC group were (28.4±4.8) and (28.4±3.6) ms respectively, which were lower than those in the normal control group [(30.4±3.5) and (30.4±3.5) ms] ( P<0.05). The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group ( P<0.05). The average T 1 and T 2 values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were (1 510.6±95.4) and (28.4±4.2) ms respectively, The T 1 value was positively correlated with the classification of advanced radiation injury ( r=0.78, P<0.001), and T 2 value was negatively correlated with the level of advanced radiation injury ( r=-0.87, P<0.001). Conclusion:Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy, which has potential clinical application value.

The value of enhanced computed tomography-based nomograph model in the differential diagnosis of gastric schwannoma and gastric stromal tumor / 中华消化杂志

Objective:To construct enhanced computed tomography (CT)-based nomograph model, to assist physicians in differentiating gastric schwannoma from gastric stromal tumor.Methods:From January 1, 2012 to January 1, 2022, at the Second Affiliated Hospital of Zhejiang University School of Medicine and Ningbo Hwamei Hospital, University of Chinese Academy of Sciences, 57 patients with gastric schwannoma and 275 patients with gastric stromal tumor confirmed by surgical pathology were retrospectively collected, among whom 39 patients with gastric schwannoma and 201 patients with gastric stromal tumor were enrolled in the training set, and the other 18 patients with gastric schwannoma and 74 patients with gastric stromal tumor were enrolled in the validation set. The contrast-enhanced CT imaging features (tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement, etc.) and clinical data (history of gastritis, carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen, and monocyte to lymphocyte ratio (MLR), etc.) were collected. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen the independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor, and a nomograph model was constracted. Logistic regression analysis was used to analyze and screen the independent predictive factors of clinical indicators to distinguish gastric schwannoma from gastric stromal tumor, and a clinical control model was established. The receiver operating characteristic curve(ROC) was used to analyze the area under the curve (AUC) of the nomograph model in the training set and the verification set, and concordance index (CI) and decision curve analysis (DCA) were used to evaluate the predictive efficiency and clinical application value of the nomograph model. DeLong test was used for statistical analysis.Results:The results of LASSO regression analysis showed that tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement were independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor(all P<0.05). The results of logistic regression analysis indicated that the history of gastritis ( OR=0.280, 95% confidence interval 0.138 to 0.566), CA19-9 ( OR=0.940, 95% confidence interval 0.890 to 0.993), carcinoembryonic antigen ( OR=0.794, 95% confidence interval 0.661 to 0.952), and MLR ( OR=0.087, 95% confidence interval 0.009 to 0.860) were independent predictive factors of clinical indicators in the differential diagnosis of gastric schwannoma and gastric stromal tumor ( P<0.001, =0.028, 0.013 and 0.037). The AUCs of the nomograph model in the training and validation set were 0.881 and 0.850, respectively, and the AUCs of the clinical control model in the training and validation set were 0.814 and 0.772, respectively, and the differences were statistically significant ( Z=2.57 and 1.96, P=0.005 and 0.030). The average CI of the nomograph model was 0.885. The results of DCA analysis showed that the overall benefit of the nomograph model was higher than that of the clinical control model. Conclusion:The enhanced CT-based nomograph model can effectively distinguish gastric schwannoma from gastric stromal tumor, and can help physicians to make precise clinical decisions.

Comparative study of clinical and imaging features of pancreatic adenosquamous carcinoma and pancreatic ductal adenocarcinoma / 中华消化杂志

Objective:To explore the differences in clinical and imaging features between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data, imaging and pathological data of 171 patients pathologically diagnosed with PASC after surgical resection (PASC group) (from February 2011 to October 2020, 148 patients from the First Affiliated Hospital of Naval Medical University and 23 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine) and 100 patients pathologically diagnosed with PDAC after surgical resection (PDAC group) (from January to June, 2018, at the First Affiliated Hospital of Naval Medical University) were retrospectively analyzed. Computed tomography and magnetic resonance imaging features were analyzed by two associate chief physician of department of radiology. Independent sample t test, rank sum test, chi-square test or Fisher exact probability test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze independent predictors of PASC. Results:The longest diameter of tumor of PASC group was larger than that of PDAC group (35.0 mm (28.0 mm to 45.0 mm) vs. 29.5 mm (23.0 mm to 36.0 mm)), and the rates of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma of PASC group were higher than those of PDAC group (62.0%, 106/171 vs. 12.0%, 12/100; 66.1%, 113/171 vs. 25.0%, 25/100; 52.0%, 89/171 vs. 12.0%, 12/100; 70.2%, 120/171 vs. 29.0%, 29/100, respectively); and the differences were statistically significant ( Z=-4.001, χ2=72.183, 42.612, 43.284 and 43.221, all P<0.01). The results of multivariate logistic regression analysis showed that the cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma were indenpendent predictors of PASC (odds ratio=10.083, 2.361, 3.086 and 2.632, 95% confidence interval 8.736 to 11.639, 2.096 to 2.660, 2.605 to 3.656 and 2.267 to 3.057, all P<0.01); and the sensitivity for PASC diagnosis was 62.0%, 66.1%, 51.7% and 70.3%, respectively; the specificity was 88.0%, 75.0%, 88.0% and 71.0%, respectively; the positive predictive value was 89.3%, 81.9%, 88.1% and 80.5%, respectively. Conclusions:PASC and PDAC have similar clinical features. The imaging features of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma are independent predictive factors of PASC.

A study on application value of susceptibility weighted imaging combined with platelet distribution width in intravenous thrombolysis for treatment of patients with acute cerebral infarction / 中国中西医结合急救杂志

Objective To investigate the application value of susceptibility weighted imaging (SWI) combined with platelet distribution width (PDW) in intravenous thrombolysis for treatment of patients with acute cerebral infarction (ACI). Methods One hundred and ten patients with ACI treated by intravenous thrombolysis admitted to the Department of Radiology of the Second Affiliated Hospital of Medical College of Zhejiang University from February 2017 to June 2018 were enrolled as the subjects. Before treatment, all patients were detected by routine magnetic resonance imaging (MRI), SWI scanning and PDW detection. The patients were divided into hemorrhage group (77 cases) and non-hemorrhage group (33 cases) according to the presence or absence of hemorrhage shown in SWI, and according to the amount of bleeding, the hemorrhage group patients were subdivided into light (24 cases), medium (32 cases) and severe (21 cases) three groups. After intravenous thrombolysis, the patients were scanned by SWI to show whether bleeding being present or not, the cerebral microbleeding (CMBs) after 24 hours treatment in two groups, and after treatment of 14 days, modified Rankin score (MRS), PDW and hemorrhagic transformation (HT) situation in the two groups were evaluated and compared, the differences in hemorrhagic infarction 1 (HI1), hemorrhagic infarction 2 (HI2), parenchymal hemorrhage 1 (PH1) and parenchymal hemorrhage 2 (PH2) in different bleeding volume groups were compared. Results Before treatment, 129 lesions detected by SWI were significantly greater than 14 lesions detected by T1 weighted imaging, 22 lesions detected by T2 weighted imaging and 86 lesions detected by diffusion weighted imaging. After treatment for 24 hours, the number of CMBs (number: 10 vs. 0), after treatment for 14 days, the incidence of HT [36.36% (28/77) vs. 12.12% (4/33)], MRS (1.78±0.39 vs. 1.51±0.42) and PDW [(12.34±5.29)% vs. (6.79±3.27)%] in the hemorrhagic group were higher than those in non-hemorrhagic group (all P < 0.05). After treatment of 14 days, the incidences of HT [71.43% (15/21) vs. 20.83% (5/24), 25.00% (8/32)], PDW [(14.52±4.11)% vs. (10.78±3.67)%, (11.34±3.89)%] in severe group were higher than those in light group and moderate groups (all P < 0.05), and the rate of good prognosis was significantly lower than those in mild and moderate groups [42.86% (9/21) vs. 70.83% (17/24), 71.88% (23/32), P < 0.05]. The incidence of HT in severe group was also significantly higher than those in the non-hemorrhage group [71.43% (15/21) vs. 11.76% (4/34), P < 0.05]. Conclusion SWI combined with PDW can guide the intravenous thrombolysis very well for patients with ACI, and has relatively high clinical value.

Study on the optimized scanning conditions of cerebral CT angiography based on the angiographic CT head phantom / 中华放射学杂志

Objective To study the impacts of different tube voltage and different noise index(NI) guided automatic tube current modulation on the image quality and radiation dose in cerebrovascular imaging and determine the optimal scanning condition. Methods PH3 angiographic CT head phantom was used for head CTA examination. Scanning protocols: all the scanning objectives were divided into three groups according to the different tube voltages of 80, 100 and 120 kV. Each group applied certain tube current(300,400 mA)and automatic tube current modulation technique with NI from 3 to 10 to perform head CTA. There were 30 scanning proposals with different parameter combinations of tube voltage and tube current. The radiation dose [ CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED)], objective indicators of images(CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio , contrast-to-noise ratio) and the subjective scores of the five cerebrovascular segments were recorded. Differences of CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio and contrast-to-noise ratio between different tube voltages and tube currents were analyzed by One-Way ANOVA. Results When the tube voltage was certain, the CTDIvol, DLP and ED were all dropped while NI was increased from 3 to 10. Compared with group(120 kV, 300 mA), CTDIvol of group with 100 kV, 300 mA decreased 35.32%(12.22/34.59), CTDIvol of group(100 kV, NI=6) decreased 46.72%(16.16/34.59). Compared with group(100 kV, 300 mA), CTDIvol of group (100 kV, NI=6) decreased 17.61%(3.94/22.37). When the tube voltage was certain and the tube current and NI were not certain, there is no statistical difference (P>0.05) between CT values of blood vessel and brain, while blood vessel noise, noise of brain, SNR and CNR showed statistical difference (P<0.05). When tube current and NI were certain while tube voltage was varied, all objective indicators discussed above all exhibited statistical difference (P<0.05). SNR and CNR of group(100 kV, NI=6) were higher than group(120 kV, 300 mA) with 6.31%(2.69/42.66)and 7.18%(2.64/36.78), respectively. The tube voltage, NI and tube current had no effect on the subjective scores of first and second grade vessel but greater impact on the fourth and fifth grade vessel. Conclusion In the head CTA scanning, combined the use of NI 6 guided automatic adjustment tube current and low tube voltage(100 kV)technique not only can get better image quality but also significantly decreased the radiation dose.

Study on the optimized scanning conditions of cerebral CT angiography based on the angiographic CT head phantom / 中华放射学杂志

Objective To study the impacts of different tube voltage and different noise index(NI) guided automatic tube current modulation on the image quality and radiation dose in cerebrovascular imaging and determine the optimal scanning condition. Methods PH3 angiographic CT head phantom was used for head CTA examination. Scanning protocols: all the scanning objectives were divided into three groups according to the different tube voltages of 80, 100 and 120 kV. Each group applied certain tube current(300,400 mA)and automatic tube current modulation technique with NI from 3 to 10 to perform head CTA. There were 30 scanning proposals with different parameter combinations of tube voltage and tube current. The radiation dose [ CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED)], objective indicators of images(CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio , contrast-to-noise ratio) and the subjective scores of the five cerebrovascular segments were recorded. Differences of CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio and contrast-to-noise ratio between different tube voltages and tube currents were analyzed by One-Way ANOVA. Results When the tube voltage was certain, the CTDIvol, DLP and ED were all dropped while NI was increased from 3 to 10. Compared with group(120 kV, 300 mA), CTDIvol of group with 100 kV, 300 mA decreased 35.32%(12.22/34.59), CTDIvol of group(100 kV, NI=6) decreased 46.72%(16.16/34.59). Compared with group(100 kV, 300 mA), CTDIvol of group (100 kV, NI=6) decreased 17.61%(3.94/22.37). When the tube voltage was certain and the tube current and NI were not certain, there is no statistical difference (P>0.05) between CT values of blood vessel and brain, while blood vessel noise, noise of brain, SNR and CNR showed statistical difference (P<0.05). When tube current and NI were certain while tube voltage was varied, all objective indicators discussed above all exhibited statistical difference (P<0.05). SNR and CNR of group(100 kV, NI=6) were higher than group(120 kV, 300 mA) with 6.31%(2.69/42.66)and 7.18%(2.64/36.78), respectively. The tube voltage, NI and tube current had no effect on the subjective scores of first and second grade vessel but greater impact on the fourth and fifth grade vessel. Conclusion In the head CTA scanning, combined the use of NI 6 guided automatic adjustment tube current and low tube voltage(100 kV)technique not only can get better image quality but also significantly decreased the radiation dose.

Advances in imaging research of the digestive system tumors from 2017 annual meeting of the American Society of Clinical Oncology / 中华消化外科杂志

The 2017 Annual Meeting of the American Society of Clinical Oncology (ASCO) was held on June 2-6,2017 in Chicago,United States.And the academic event showed the frontier researches in the field of oncology.Survival prediction in patients treated by FOLFIRI regimen and bevacizumab for metastatic colorectal cancer using radiomics approach was made in Abstract 3601.Authors aim to summarize the application and development of radiomics in digestive system tumors.

Imaging understanding of the updates of the classification for pancreatic cancer in the American Joint Committee on Cancer cancer staging manual (8th edition) / 中华消化外科杂志

Pancreatic cancer is a highly malignant tumor with a high mortality.Surgery is the only potential hope of cure for patients with pancreatic cancer.Imaging examination plays an essential role in both the early diagnosis and preoperative assessment.Accurate tumor staging has guiding significance for clinical practice.Appropriate therapeutic schedule will be selected according to the tumor staging,and then patients' prognosis can be evaluated.Recently,the TNM staging systems for pancreatic cancer have been updated by American Joint Committee on Cancer (AJCC).Major changes were made in the T and N staging.This article will review the updates of the 8th edition of AJCC cancer staging for pancreatic cancer from radiography aspect.

Accurate imaging diagnosis and evaluation of pancreatic cancer / 浙江大学学报·医学版

Pancreatic cancer is a highly malignant tumor and surgical resection is the only curative treatment option. In order to improve the prognosis of patients with pancreatic cancer, it is very important to diagnose and evaluate pancreatic cancer accurately and early. Imaging examinations play an important role in tumor detection, staging and surgical resectability evaluation, which can provide reliable evidences for diagnosis and treatment of pancreatic cancer. At present, the imaging techniques commonly used for diagnosis of pancreatic cancer include conventional ultrasound, endoscopic ultrasonography, PET-CT, multi-detector row CT (MDCT), magnetic resonance imaging (MRI), in which MDCT and MRI are the most widely used. In this article, the application and research progress of imaging in accurate diagnosis and evaluation of pancreatic cancer are reviewed.

Imaging diagnosis of pancreatic cancer and preoperative imaging evaluation of resectability and staging / 临床肝胆病杂志

Pancreatic cancer is an invasive malignant tumor with a high mortality rate. As the preferred imaging method for pancreatic imaging, multi-slice CT angiography can evaluate the presence or absence, extent, and degree of invasion of peripancreatic major vessels to provide reliable evidence for tumor staging and surgical resectability evaluation. As an important supplementary method of CT, magnetic resonance imaging has an important guiding value in disease diagnosis, liver metastasis, and prognostic evaluation. Vascular invasion of pancreatic cancer is the main indicator for preoperative evaluation of respectability. Lymph node metastasis, distant metastasis, neural invasion of pancreatic cancer, and hepatic artery abnormalities are influencing factors for patients′ prognosis. It is pointed out that preoperative imaging evaluation for patients with pancreatic cancer has guiding significance for the development of treatment regimens, selection of surgical procedures, and prognostic evaluation.

Modified FOLFIRINOX for advanced pancreatic cancer: a tertiary center experience from China / 中华外科杂志

<p><b>OBJECTIVE</b>To explore efficacy and safety of modified FOLFIRINOX (mFOLFIRINOX) regimen by dose attenuation in locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer(MPC).</p><p><b>METHODS</b>Between April 2014 and October 2015, 35 patients with LAPC (n=18) or MPC (n=17) were treated with mFOLFIRINOX regimen (irinotecan 135 mg/m(2), oxaliplatin 68 mg/m(2), 5-FU 2 400 mg/m(2), no bolus of 5-FU, leucovorin 400 mg/m(2)) in the Second Affiliated Hospital of Zhejiang University School of Medicine. The primary end point was progression free survival. The second end points were overall survival, objective response rate, adverse effects, surgical resection rate for LAPC.</p><p><b>RESULTS</b>Among 35 patients, 6 patients (17.1%) who dropped out and received less than 2 cycles were excluded for response analysis. Among the other 29 patients, 9 patients had grade 3 or 4 adverse effects. No patients ceased treatment due to adverse effects. The 29 patients received 5 (2-13) cycles were evaluated by efficacy and found partial remission in 16 cases, stable disease in 10 cases, progression disease in 3 cases. Response rate was 55.2%. Nine patients with LAPC accomplished surgery after neoadjuvant treatment without perioperative complication and death, and 6 patients accepted R0 resection.</p><p><b>CONCLUSIONS</b>The mFOLFIRINOX regimen used in the study is well-tolerated in Chinese population with high treatment efficacy on patients with LAPC and MPC. Further investigation of efficacy and adverse effects on more advanced pancreatic cancer patients is necessary.</p>

Computed tomography and magnetic resonance imaging findings of lymphoepithelial carcinoma in parotid gland: a report of 6 cases / 中华全科医师杂志

To summarize the imaging characteristic of parotid lymphoepithelial carcinoma (LEC) by retrospective analyses of computed tomography (CT) and magnetic resonance imaging (MRI) findings for 6 cases of parotid LEC confirmed by operation and pathology and review the relevant literatures.All lesions were located in unilateral parotid.There were single (n =5) and multi-module fusion (n =1).All were located in superficial lobe of parotid gland.And deep lobe (3/6) was involved.An infiltration of casting shape was found along superficial parotid (4/6).There was an irregular margin with small spines,uniform density and signal and above moderate enhancement.An infiltration of casting shape along superficial lobe,uniform density and signal and rich blood supply suggest a diagnosis of LEC.

Comparison of magnetic resonance imaging artifacts of five common dental materials / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare five materials commonly used in dentistry, including three types of metals and two types of ceramics, by using different sequences of three magnetic resonance imaging (MRI) field strengths (0.35, 1.5, and 3.0 T).</p><p><b>METHODS</b>Three types of metals and two types of ceramics that were fabricated into the same size and thickness as an incisor crown were placed in a plastic tank filled with saline. The crowns were scanned using an magnetic resonance (MR) machine at 0.35, 1.5, and 3.0 T field strengths. The TlWI and T2WI images were obtained. The differences of various materials in different artifacts of field MR scans were determined.</p><p><b>RESULTS</b>The zirconia crown presented no significant artifacts when scanned under the three types of MRI field strengths. The artifacts of casting ceramic were minimal. All dental precious metal alloys, nickel-chromium alloy dental porcelain, and cobalt-chromium ceramic alloy showed varying degrees of artifacts under the three MRI field strengths.</p><p><b>CONCLUSION</b>Zirconia and casting ceramics present almost no or faint artifacts. By contrast, precious metal alloys, nickel-chromium alloy dental porcelain and cobalt-chromium ceramic alloy display MRI artifacts. The artifact area increase with increasing magnetic field.</p>

Correlation of neurochemical metabolism with memory function in young adult patients with first-episode depression studied with proton magnetic resonance spectroscopy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the correlation of neurochemical metabolism in hippocampus with memory function in young adult patients with first-episode depression.</p><p><b>METHODS</b>Twenty patients with first-episode depression (patient group) and fifteen health subjects (control group) were enrolled in the study. The neurochemical metabolism, including the levels of N-acetylaspartate (NAA), Choline (Cho), Creatine (Cr), Myoinositol (mI) were measured by proton magnetic resonance spectroscope (1H-MRS) in bilateral hippocampus. Wechsler Memory Scale (WMS) were used to examine the memory function in both groups.</p><p><b>RESULTS</b>The memory quotient (89.15 ±6.62) of patient group was significantly lower than that of controls (P <0.01),the scores of long-term memory,short-term memory and immediate memory in patients were also lower than those of controls (P<0.05 or 0.01). In patient group, the ratio of NAA/Cr (1.34 ±0.08) in the left hippocampus was significantly lower than that of control group (P<0.01); and the ratio of mI/Cr in the bilateral hippocampus [(0.63 ±0.13) in left and (0.6 ±0.1) in right] was significantly higher than those in control group (P<0.05). In patient group,the ratio of NAA/Cr in the left hippocampus was positively correlated with WMS scores (P<0.01), and the ratio of mI/Cr in the left hippocampus was negatively correlated with WMS scores (P<0.05).</p><p><b>CONCLUSION</b>The memory deficit and abnormal metabolism function of neuron cell in hippocampus coexist in young adult patients with first-episode depression, and the lower NAA/Cr and higher mI/Cr ratio in the left hippocampus may result in the memory deficit.</p>

CT and MRI findings of central nervous system complications of leukemia / 中华放射学杂志

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.

Chest CT features of microscopic polyangiitis / 中华放射学杂志

Objective To evaluate chest CT features of microscopic polyangiitis(MPA).Methods Clinical data and chest CT images of 66 patients diagnosed as MAP had been collected.Depending on clinical manifestations.the 66 cases were divided into the active group and the stable group.The data of two groups were analyzed by x2 test.Results Forty-three of 66(65.2%)CT images were abnormal including 32 of them in active group and 11 in stable group. In these patients,CT images showed ground glass opacities(53.5%),lung consolidations(23.2%),scattered patchy opacities(44.2%),ground glass opacities and/or lung consolidations(76.7%),reticular opacities(65.1%),honeycomb(14.0%),pleural effusions(48.8%),emphysema(18.6%),and mediastinal adenopathies(58.1%).Lung consolidations,ground glass opacities,scattered patchy opacities,mediastinal adenopathies,and pleural effusion in the active group are more common than that in the stable group(X2=4.479,4.083,4.053,9.697,9.345 respectively,P<0.05).Conclusion Chest CT features of in patients with MPA have difference between active and stable periods.The chest CT scan is a useful tool to diagnose MAP in different periods and guide the treatment.

Reproducibility and influencing factors of 31p MR spectroscopy in rabbit liver with two-dimensional chemical shift imaging / 中华放射学杂志

Objective To investigate the reproducibility and influencing factors of relative quantification of phosphorus metabolites with two-dimensional chemical shift imaging (2D CSI) in rabbit liver. Methods Using 2D CSI MRS, 500 ml phosphate (NaH2PO4) solution phantom with 0. 05 mol/E concentration and one healthy rabbit were scanned 30 times respectively in one day and rescanned 30 times in the next day, and the stability of MR scanner and reproducibility of within-run and between-days in the same individual were analyzed. Each of thirty rabbits was scanned and rescanned one time respectively in different days, and the reproducibility of between-days in one group was analyzed. The data were statistically analyzed with t tests. Results (1) Phosphate solution phantom had a good reproducibility of within-run with the coefficient variation (CV) of 4. 92% and 5. 12% respectively in different two days. No significant change of phosphorus metabolites was detected in between-days, which was 16. 68 ± 0. 82 and 16. 56 ± 0. 85 respectively(t = 0. 665, P > 0. 05 ). (2) The CV of metabolites in one healthy rabbit ranged from 8. 04% to 34. 13%. Among the metabolites, β-ATP had the best reproducibility with the CV less than 10%. PME was 0. 88 ± 0. 28 and 0. 88 ± 0. 30, PDE was 4. 35 ± 0. 66 and 4. 35 ± 0, 66, Pi was 0. 95 ± 0.30 and 0.97±0.28, α-ATP was 5.58±0.60 and 5.61±0.61, β-ATP was 2.70±0.22 and 2.71± 0. 22, γ-ATP was 2. 20±0. 63 and 2. 18±0.44 respectively, no significant changes of metabolites were detected in between-days( P >0. 05 ). (3) The CV of metabolites in 30 healthy rabbits ranged from 8.48% to 36. 21%. Among the metabelites, β-ATP had the best reproducibility with CV less than 10%. PME was 0. 84 ± 0. 30 and 0. 79 ± 0. 28, PDE was 4. 29 ± 0.72 and 3.94 ± 0. 84, Pi was 0. 91 ± 0. 28 and 0. 92 ± 0. 31, α-ATP was 5.65±0. 66 and 5. 36±0. 60, β-ATP was 2. 71±0. 23 and 2. 66±0. 25, γ-ATP was 2. 07±0. 29 and 1.99±0. 37 respectively, no significant changes of metabolites were detected in between-days (P > 0. 05). Conclusions The relative quantification of hepatic β-ATP may be most reliable among the phosphorus metabolites for rabbit liver because of its good reproducibility and small CV. The quantification of phosphorus metabolites by 31p MRS with 2D CSI in rabbit liver is affected by many factors.

The study on relationship between energy metabolic changes tested by phosphoras-31 magnetic resonance spectroscopy and the severity of acute hepatic injury / 中华消化杂志

Objective To study the relationship between energy metabolic changes tested by phosphorus-31 magnetic resonance(MR)spectroscopy(31P MRS)and the liver damage score(LDS)in rabbit models and investigate the diagnostic value of 31P MRS in acute hepatic injury.Methods A total of 30 rabbits were received different radiation dose(ranging from 5 Gy to 20 Gy)to establish acute hepatic injury models.31P MRS was than carried out 24 hrs after radiation.The rabbits were divided into mild(LDS≤3 U),moderate(LDS 3-6 U)and severe(LDS＞6 U)hepatie injury groups.Ten healthy rabbits were served as controls.MR examination was performed on a 1.5 T imager using a 1H/31P surface coil by the 2D chemical shift imaging technique.The relative quantification of phosphomonoesters(PME),phosphodiesters (PDE), inorganic phosphate (Pi) and adenosine severe hepatic injury groups were 1.83±0.33,1.55±0.24,1.27±0.07 and 0.98±0.18,respectively,with significant differences(P＜0.05).The ATP level was progressively decreased with the increase of severity Of hepatic injury.The relative quantification of PME and Pi were decreased in severe hepatic injury group compared to control group(P＜0.05).There was no significant difference higher in moderate(1.94±0.50)and severe(1.96±0.72)hepatic injury groups compared to control group(1.43±0.31)and mild hepatic injury group(1.40+0.38)(P＜0.05).No significant difference was found in ratio of relative quantification of other phosphorus metabolites.Conclusions 31P MRS is a useful method in evaluating acute hepatic injury.The relative quantification of hepatic ATP level,which can reflect the severity of acute hepatic injury,is correlated with LDS.

Preliminary study of high-dose CT radiation injury on liver in rabbit models / 中华急诊医学杂志

Objective To investigate acute CT radiation injury on rabbit liver after the whole body CT scans with high-dose abdominal CT scan model.Methods The forty-six New Zealand white rabbits were randomly assigned into 3 groups.High-dose CT scanning groups included one-off CT scanning group(group 1)and repeated CT scanning group (group 2)with high-dose abdominal CT scan modes,and 18 rabbits in each group.The other two groups were routine-dose CT scanning group(n=5)and control group(n=5).Rats in both group 1 and 2 were divided into 6 subgroups(n= 3).Four to twenty-four times of continuous or discontinuous CT scans with 240 mAs and 140 Kv were performed on every rabbit.The liver samples of every animal were eoUected at 48 h or 24 h after CT scans and pathological examination and immunohistochemistry assay of Cpp32 and Bax expression were performed.Results(1)Light microscope showed①in group 1,slight hepatic injury occurred at 6 times of continuous CT scanning;after 6～18 times of continuous CT scanning,hepatocytes were slight swelling at first,followed by hydropic or fatty degeneration,constriction or emphraxis of hepatic sinuses,puncture necrosis of hepatocytes,and local hepatic hemorrhage;②in group 2:slight hepatic injury occurred at 8 times of CT scanning,and after 8～24 times of CT scanning,hepatocytes were slight or mild swelling at first,followed by moderate or diffuse swelling,hydropic degeneration,and dispersed karyopyknosis of hepatocytes near central vein.(2)Immunohistochemistry assay showed:①in group 1,positive expressions of the apoptosis-inducing protein Bax and Cpp32 were observed in part of liver samples,the expressions of Bax and Cpp32 were correlated with CT radiation dose;②in group 2,positive expressions of the apoptosis-inducing protein Bax and Cpp32 were found in every subgroup,but the expression was not correlated with CT scan times.(3)The hepatic tissues of routine-dose CT scanning group were normal under the light microscope and immunohistochemistry assay.Conclusion Routine-dose CT scanning on liver is very safe,but high-dose CT scanning with non-routine scan times may cause acute pathological hepatic injury and hepatocyte apoptosis.

CT manifestations of pancreatic tuberculosis / 中华放射学杂志

Objective　To assess the CT manifestations and diagnostic value in the pancreatic tuberculosis(PTB)with review of the literatures. Methods　All cases of PTB proved by surgery or biopsy were examined with plain and enhanced CT scans. Results　The CT findings in one case with multiple-nodular type of PTB were diffuse enlargement of the pancreas with multiple, nodular, and low-density lesions; The nodular lesions had peripheral enhancement. 7 cases of local type of PTB encroached on pancreatic head. 4 cases showed local soft tissue masses with multiple flecked calcifications in 2 cases and mild enhancement in one case; Cystic masses was found in 2 cases, with mural calcification in 1 case and multiloculated cystic mass in 1 case, respectively; Massive pancreatic head calcification was demonstrated in one case. In these 8 cases of PTB, the lesion extended out of pancreas in 4 cases, including abdominal tuberculous lymph nodes, tuberculous peritonitis, and hepatosplenic tuberculosis. Conclusion　CT findings of PTB were various but had some characteristics. Pancreatic masses with multiple flecked calcification or mild enhancement could suggest the diagnosis. Abdominal tuberculosis accompanied with the pancreatic lesion, especially tuberculous lymph nodes, was highly suggestive of the diagnosis of PTB.