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Objective:To evaluate the feasibility and the application values of quantitative susceptibility mapping (QSM) for the assessment of meniscal injury and in distinguishing meniscus degeneration and tears.Methods:The clinical and imaging data of 70 patients suspected of meniscus injury and scheduled for arthroscopy in Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University from November 2019 to June 2020 were analyzed retrospectively. Thirty age-and sex-matched healthy subjects were also examined as controls. All subjects received knee joint QSM and routine MR imaging. According to the results of arthroscopy, the patients was divided into meniscus degeneration and meniscus tear groups, respectively. The conventional MR was evaluated by two radiologists. The meniscus injury area was delineated on the original QSM magnitude images (the central area of the posterior corner of the lateral meniscus was selected in the healthy controls) and mapped to the corresponding QSM maps, and the magnetic susceptibility values were measured. Kruskal-Wallis H test was used to analyze the magnetic sensitivity values of meniscal degeneration, meniscal tear and healthy control groups; and Bonferroni was used to correct the pairwise comparison. ROC curve was established to evaluate the threshold and efficacy of magnetic susceptibility value in the diagnosis of meniscal tear. The results were compared with those of conventional MRI. Results:The magnetic susceptibility values of meniscus of healthy controls, meniscal degeneration and meniscal tear groups were (0.035±0.016)ppm, -0.031(-0.040,-0.005)ppm, and(-0.122±0.115)ppm, respectively, with significant difference found among the three groups (χ2=44.419, P<0.05). The magnetic susceptibility values of meniscus of healthy controls was significantly higher than those of meniscus degeneration patients and meniscus tear patients (χ2=-23.843, -48.253, P<0.05). The magnetic susceptibility values of meniscus of meniscus tear group was significant lower than those of meniscus degeneration group (χ2=-24.410, P<0.05). Taking magnetic susceptibility values of -0.062 5 ppm as threshold, the area under the ROC curve for the diagnosis of meniscal tears was 0.949, with the sensitivity as 87% and the specificity as 100%. The sensitivity and specificity of conventional MRI in the diagnosis of meniscal tears were 86.8% and 87.5%, respectively. Conclusion:QSM can quantitatively evaluate meniscus injury and can be used as an effective supplement method to conventional MRI, which is helpful to improve the diagnosis of meniscus tear.
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Objective:To evaluate partial splenectomy (LPS) in the treatment of benign solid tumors of the spleen.Methods:The clinical data of patients with benign solid tumors of spleen treated by laparoscopy from Jan 2010 to Jun 2018 in the Third Affiliated Hospital of Soochow University was retrospectively analyzed. Patients were divided into LPS group and laparoscopic total splenectomy (LTS) group.Results:There were 21 cases in LPS group and 25 cases in LTS group. Differences between the two groups, operative time, blood loss, transfusion rate, maintenance of drain, postoperative hospital stay, costs, postoperative WBC and platelet count, and postoperative complications such as hemorrhage, fever, splenic fossa effusion, pancreatic fistula, venous thrombosis were statistically insignificant. However, the postoperative incidence of thrombocythemia in the LPS group were significantly lower compared to the LTS group (χ 2 =4.293, P<0.05). Conclusions:Patients with benign solid tumors of the spleen will benefit more from LPS compared to LTS.
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As a prefecture-level hospital, the First People's Hospital of Changzhou has completed 200 cases of laparoscopic pancreaticoduodenectomy from the December of 2015 to June 2019. The operation time is (378.9±105.4) mins, and the intraoperative blood loss is (291.3±263.4) ml. The length of hospital stay after operation was (17.3±8.1) days. The postoperative complications were: 35 cases of grade B pancreatic fistula (17.5%), 4 cases of grade C pancreatic fistula (2.0%), 2 cases of bile leakage (1.0%), 12 cases of postoperative bleeding (6.0%), 18 cases of abdominal infection (9.0%), 15 cases of delayed gastric emptying (7.5%), and 5 cases of secondary surgery (2.5%). Our experience is that prefecture-level hospitals need to define their own positioning, focus on technology accumulation and introduction, attach importance to specialized development and team building. In the follow-up work, prefecture-level hospitals should attach importance to the establishment of standardized treatment systems, the combination of clinical and scientific researches, and cultivation of young doctors.
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Objective:To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods:From January 2014 to December 2018, 54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital, Soochow University were recruited into this study. The patients were 40 to 60 years old, and 27 were males and 27 females. Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients (the intermittent occlusion group). The remaining patients underwent Pringle’s maneuvre (the Pringle group). Postoperative liver function, intraoperative blood loss, intraoperative blood transfusion, operation time and postoperative complications between the two groups were compared.Results:Intraoperative hemorrhage and blood transfusion of the Pringle group (534±42)ml, (2.88±0.54)U were significantly higher than the intermittent occlusion group (374±21)ml, (1.86±0.29)U (all P<0.05). The operation time of the Pringle group was significantly shorter than the intermittent occlusion group ( P<0.05). Two patients developed CO 2 embolism in each group, which led to 2 patients in the intermittent occlusion group being converted to open operations. Postoperative hepatic function (except albumin) of the intermittent occlusion group was significantly better than the Pringle group, while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group (all P<0.05). Six patients (25.0%) developed postoperative complications in the intermittent occlusion group versus 8 (26.7%) in the Pringle group ( P>0.05). Conclusion:Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment, and shortened hospital stay. However, it required higher operation skills and it should gradually be promoted.
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Objective@#To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD.@*Methods@#A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability.@*Results@#The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ2=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05).@*Conclusions@#The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.
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Objective@#To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined grade degree Ⅲ acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments.@*Methods@#History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method.The systematic laboratory and imaging examination was performed to evaluate the condition. The comprehensive analysis was conducted to determine the diagnosis and treatment plan.@*Results@#At 3d after the exposure, "Ren" felt mild pain and discomfortable on the skin of the right index finger. The body of the right hand index finger was covered with blister at 21 d after exposure.The estimation of biological dose was 0.43 Gy (95%CI: 0.31-0.58 Gy), and the physical dose was estimated to be 36-164 Gy for each part of the right hand finger. The hematopoietic system, immune system and endocrine system were normal. The liver function index value was transiently increased. The liver damage resulted from the use of antibiotic-induced combined with the patient′s past medical history and admission examination result, and the relevant antibiotics were discontinued. The liver function returned to normal after liver protection treatment. At 22 d after irradiation, a right finger incision and decompression surgery were performed. The stem cells were extracted and implanted into the right index finger. After 59 days of hospitalization, there was no obvious discomfort in the body, and the right index finger recovered well, as well as the pain significantly relieved, and the knuckle activity was basically normal.@*Conclusions@#The patient with excessive radiation and grade Ⅲ acute radiation skin injury was successfully treated, and local application of autologous adipose-derived stem cell transplantation achieved good result .
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Objective@#To investigate the quantitative evaluation efficiency of gadolinium- ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B.@*Methods@#One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer-Ludwig scoring system. Non-enhanced and Gd-EOB-DTPA-enhanced MRI were performed in all subjects. Look-Locker sequences were performed to acquire T1 mapping of pre and post-contrast at 20 minutes after Gd-EOB-DTPA administration. The T1 value after 20 minutes of Gd-EOB-DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min%), the increase of 1/T1 value (ΔR1 20 min%) were measured and calculated. The one-way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2, ≥ S3, ≥ S4. P<0.05 was considered to be statistically significant.@*Results@#The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2 were 0.844, 0.905, 0.869; and diagnosing ≥ S3 were 0.832, 0.907, 0.862; and diagnosing ≥ S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best.@*Conclusion@#Gd-EOB-DTPA-enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.
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Objective@#To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step.@*Methods@#112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way.@*Results@#The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study.@*Conclusions@#The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.
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Objective To study the learning curve of laparoscopic pacreaticoduodenectomy ( LPD) with a view to find an appropriate way to develop LPD step by step. Methods 112 consecutive patients who completely underwent LPD in a single surgery center at the First People ' s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum ( CUSUM) and the risk-adjusted CUSUM ( RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results The learning curve could be divided into three phases:Phase 1, the initial period (the initial 45 patients);Phase 2, the enhancement period (the subsequent 31 patients);Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448. 4 ± 75. 0), (381. 3 ± 74. 3), and (336. 2 ± 52. 1) min, respectively (P<0. 05). The intraoperative blood losses were (373. 3 ± 250. 1), (332. 3 ± 211. 6), and (265. 3 ± 253. 2) ml, respectively (P<0. 05). The times to oral intake were 6. 0(5. 0,8. 0), 5. 0 (3. 0,6. 0), and 3. 0(3. 0,5. 0) days, respectively (P<0. 05). The number of lymph nodes harvested were (10. 0 ± 7. 0), (8. 8 ± 4. 3), and (13. 3 ± 6. 2), respectively (P<0. 05). All these showed signifi-cant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pan-creatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.
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Objective To investigate the quantitative evaluation efficiency of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B. Methods One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer?Ludwig scoring system. Non?enhanced and Gd?EOB?DTPA?enhanced MRI were performed in all subjects. Look?Locker sequences were performed to acquire T1 mapping of pre and post?contrast at 20 minutes after Gd?EOB?DTPA administration. The T1 value after 20 minutes of Gd?EOB?DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min% ), the increase of 1/T1 value (ΔR1 20 min% ) were measured and calculated. The one?way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2,≥S3,≥S4. P<0.05 was considered to be statistically significant. Results The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2 were 0.844, 0.905, 0.869; and diagnosing≥S3 were 0.832, 0.907, 0.862; and diagnosing≥S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best. Conclusion Gd?EOB?DTPA?enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.
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Objective To explore the safety,feasibility,clinical efficacy and prognosis of gallbladder carcinoma treated by laparoscopy.Methods The clinical data of 43 patients with gallbladder carcinoma treated by laparoscopy radical cholecystectomy from Jan 2010 to Oct 2017 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed.Results 15 cases underwent simple laparoscopic cholecystectomy,13 cases underwent laparoscopic cholecystectomy + lymphadenectomy and 15 cases underwent laparoscopic cholecystectomy + liver wedge resection + lymphadenectomy.The average operation time was (64 ± 32) min,(100 ± 45) min,and (217 ± 74) min,respectively.The average intraoperative blood loss was (67 ± 83) ml,(58 ± 63) ml and (182 ± 165) ml.The average postoperative hospital stay was (4.3 ± 2.2) days,(5.2 ± 2.0) days,(7.0 ± 1.7) days.All patients were diagnosed as gallbladder carcinoma by postoperative pathology.The median follow-up time was 14.5 months (range from 3 to 97 months).The cumulative survival rates of Tis,T1b,T2 and T3 stage were 100％,90％,52.7％ and 0,respectively (x2 =25.333,P ＜ 0.05).Conclusions It is safe and feasible to treat early gallbladder carcinoma by laparoscopy.
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Objective To investigate the effectiveness of T1 mapping on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-enhanced) MRI for the assessment of liver function.Methods One hundred and twenty six patients with clinically suspected focal liver lesions and chronic viral hepatitis B underwent MRI were prospectively enrolled.Patients were divided into four subgroups as follows: chronic viral hepatitis B (n=22), liver cirrhosis with Child-Pugh A (n=52), Child-Pugh B(n=41),Child-Pugh C(n=11).Twenty three healthy volunteers with normal liver function were enrolled as control group.Non-enhanced and Gd-EOB-DTPA enhanced MRI of liver were performed in all subjects.Look-Locker sequences with exactly the same scan parameters and geometry position(the level of porta hepatis) were performed pre and post-contrast separately at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA administration.T1 relaxation times and reduction rates of T1 relaxation times[ΔT1(%)]of the liver parenchyma were measured and calculated.One-way ANOVA was used to compare T1 relaxation times and ΔT1(%) for control group, chronic viral hepatitis B group, liver cirrhosis with Child-Pugh A group, Child-Pugh B group,and Child-Pugh C group.ROC curve analysis was performed to compare the diagnostic performance of T1 relaxation times and ΔT1(%) values in discriminating control group + chronic viral hepatitis B group + liver cirrhosis with Child-Pugh A group from Child-Pugh B + C group. Results T1 relaxation times and ΔT1(%)showed significant difference(P<0.05)among control group and different liver function groups. T1 relaxation times and ΔT1(%) of both liver cirrhosis with Child-Pugh B group and Child-Pugh C group were significantly different(P<0.05)in comparison with those of control group,chronic viral hepatitis B group and liver cirrhosis with Child-Pugh A group at all time points.T1 relaxation times of the control group,chronic viral hepatitis B group,liver cirrhosis with Child-Pugh A group and Child-Pugh B group reduced with the scanning time increase,ΔT1(%)raised with the scanning time increase.T1 relaxation times progressively increased from control group to Child-Pugh C group at every time point.ΔT1(%)showed a constant decrease from control group to Child-Pugh C group at all time points.The areas under ROC curve of T1 relaxation time pre and post-contrast at 5,10,15 and 20 minutes for assessment of liver function were 0.817,0.952,0.950,0.946,and 0.949 respectively.The areas under ROC curve of ΔT1(%)post-contrast at 5, 10, 15 and 20 minutes for evaluation of liver function were 0.873, 0.876, 0.885, and 0.898, respectively. Conclusion Gd-EOB-DTPA-enhanced T1 mapping MRI is useful for the evaluation of liver function, and helpful for distinguishing patients with moderate and severe liver damage from normal and mild liver damage.
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Objective To evaluate the value of T1 mapping in Gd-EOB-DTPA-enhanced MRI for the assessment of liver function with HBV-related cirrhosis according to the model for end-stage liver disease (MELD) score.Methods 158 patients with HBV-related cirrhosis were included in this prospective study,and divided into MELD score ≤10 (n =103) group and MELD score ＞ 10 (n =55) group.All patients un derwent non-enhanced and Gd-EOB-DTPA enhanced MRI of liver,and T1 mapping was performed using Look-Locker sequences with the same scan parameters and geometry position (the level of porta hepatis) preand post-contrast at 5,10,15 and 20 minutes after Gd-EOB-DTPA administration.T1 relaxation times of the liver were measured and reduction rates of T1 relaxation times (△T1) were calculated.Independent samples t test was performed to compare T1 relaxation times and △T1 between MELD score≤ 10 and MELD score ＞ 10 groups.Receiver operating characteristic curve (ROC) analysis were done to differentiate the diagnostic performance of T1 relaxation times and △T1 between MELD score ≤ 10 and MELD score ＞ 10 groups.Pearson correlation analysis was used to analyse the correction between T1 relaxation times,△T1 and MELD scores.Results T1 relaxation times pre-and post-contrast at 5,10,15 and 20 minutes and △T1 post-contrast at 5,10,15 and 20 minutes of MELD score≤10 group were (889.3 ±91.2) ms,(377.5 ± 55.0) ms,(350.8±61.2)ms,(328.0±69.4)ms,(302.7±73.7)ms,(57.4±5.6)％,(60.4± 6.5) ％,(63.0 ± 7.3) ％ and (65.9 ± 7.8) ％,respectively,and those of MELD score ＞ 10 group were (936.6 ±95.4) ms,(460.2 ±68.5) ms,(457.5 ±94.5) ms,(453.4 ± 116.4) ms,(444.6 ± 134.6) ms,(50.8 ± 5.7) ％,(51.3 ± 7.9) ％,(51.8 ± 10.3) ％ and (52.8 ± 12.2) ％,respectively,and T1 relaxation times and △T1 at all time points were significantly different (P ＜ 0.05) between the two groups.The areas under ROC curve of T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes and △T1 post-contrast at 5,10,15,20 minutes for differentiating MELD score ≤ 10 and MELD score ＞ 10 groups were 0.638,0.824,0.832,0.832,0.830 and 0.795,0.814,0.820,0.825,respectively.The correlation coefficients between T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes,△T1 post-contrast at 5,10,15,20 minutes and MELD scores were 0.256,0.499,0.540,0.538,0.548,-0.412,-0.495,-0.507 and-0.527,respectively.Conclusions T1 mapping on Gd-EOB-DTPA-enhanced MRI is helpful for evaluating liver function with HBV-related cirrhosis.T1 relaxation times post-contrast on different time points were equally accurate as △T1.T1 relaxation times post-contrast and △T1 were superior to T1 relaxation times pre-contrast.
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Objective To monitor the dynamic changes of radiation-induced parotid damage using T2 ? mapping.Methods Thirty-four patients with nasopharyngeal carcinoma (NPC)were enrolled.All patients underwent T1 WI,T2 WI and T2 ? mapping for bilateral parotid glands at pre-RT (2 weeks before radiotherapy),mid-RT (5 weeks after the beginning of radiotherapy)and post-RT (4 weeks after the completion of radiotherapy).Parotid MR parameters,mean radiation dose and xerostomia degrees of the patients at different time points were recorded.Furthermore,nine healthy volunteers were enrolled,who undergone T2 ? mapping twice with an interval of 4 weeks in order to analyze the reproducibility of T2 ? value.Results From pre-RT to mid-RT and post-RT,parotid volume decreased [atrophy rates,(25.34±11.33)％ and (25.74±9.93)％,respectively]and T2 ? values decreased [change rates,(-5.63±8.86)％ and (-4.81±10.67)％, respectively]significantly (all P < 0.01 ).Parotid normalized T1 signal intensity decreased significantly from pre-RT to post-RT [change rate,(-7.43±10.61)％,P =0.007],and the change rate was correlated inversely with mean radiation dose significantly (r =-0.646, P <0.001).Parotid volume and T2 ? value changed correspondingly with xerostomia degrees of the patients during radiotherapy.Parotid MR parameters showed excellent reproducibility (intraclass correlation coefficient,0.843 -0.993).Conclusion The dynamic changes of radiation-induced parotid damage in patients with NPC can be noninvasively evaluated by routine MRI and T2 ? mapping.
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Objective To investigate the late effects induced by ionizing radiation and the rehabilitation treatment of local radiation injury by medical follow-up of the patient exposed to192 Ir at 5.7 accident in Nanjing,and to provide more experience for the treatments in the medical emergency of nuclear or radiological accident.Methods According to the history inquiry and physical examination of the patient in detail and the record of clinical symptoms and signs,the changes of the blood system,immune system,reproductive system,eyes,nervous system were systematically evaluated.The effects of rehabilitation treatment for the patient with lower limb dysfunction were also assessed.Results After the medical treatments of the patient,the hematopoietic immune system was restored,but the bone marrow aspiration still showed low bone marrow hyperplasia in right ilium.Meanwhile,the level of sex hormones was within the normal range,but semen examination showed sperm motility was 0.The radiation damage also occurred in the eye lens,retina and fundus.Howevcr,the psychological evaluation showed that the patient was stable and the right lower limb skin wound healing was well except for dysfunction and pain in some extent,which was relieved after the rehabilitation treatment.Conclusions The physiological function of the exposed victim with mild bone marrow type acute radiation sickness could be completely or partially restored after the clinical treatment in the early stage.
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Objective To investigate a dose response curve based on a genetic workstation with automatic analysis system of dicentric chromosome assay (DCA) for establishing a high speed dose estimation method.Methods Peripheral blood from three healthy volunteers was irradiated in vitro using 60Co γ-rays,and then lymphocytes were cultured and fixed on slides using the standard protocol for DCA.Dicentric chromosome in metaphase cells was analyzed automatically with the genetic workstation and confirmed manually,and the dose response curve of automated dicentric chromosome was fitted.Dicentric chromosome of another peripheral blood sample irradiated with different doses was manually analyzed to verify the accuracy of the above automated DCA.Results The yield of automated DCA was well fitted by an equation Y =0.018 06D2 + 0.012 79D + 0.000 489 1 with a correlation coefficient R2 =0.961.The biological dose of radiation could be accurately estimated by this dose response curve within a few minutes.Conclusions We had successfully established a new dosimetry method by analyzing dicentric chromesome automatically,which can save a lot of manual analysis time and hence has important significance for emergency rescue in nuclear accidents.
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Objective To investigate the value of MR diffusion tensor imaging (DTI) quantitative parameters in evaluating the injury of the tibial nerve and the common peroneal nerve in patients with Guillain-Barre syndrome(GBS). Methods Sixteen healthy volunteers and sixteen patients with GBS underwent DTI examination of the tibial nerve and the common peroneal nerve. The denervation of skeletal muscles controlled by the tibial nerve and the common peroneal nerve was observed. The apparent diffusion coefficient (ADC) value, fractional anisotropy (FA) value, axial diffusivity (AD) value and radial diffusivity (RD) value were measured respectively,and diffusion tensor tractography (DTT) of the tibial nerve and the common peroneal nerve was performed. Between-groups comparison was made with the independent sample t test and receiver-operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy of the parameters. Results (1)The MR features of denervated skeletal muscles comprehend hyperintensity on T2WI SPAIR sequence and the instinct boundary, muscle atrophy occationally. (2)Compared with the healthy volunteer group, the ADC value of the tibial nerve and the common peroneal nerve of GBS group was increased and the FA value, AD value, RD value were decreased, and there was significant difference between the ADC value, FA value, AD value and RD value of GBS and volunteer groups respectively(P<0.05). The area under the curve (AUC) of FA value was higher than that of the corresponding ADC value in the tibial nerve and the common peroneal nerve. (3)DTT showed that the number of fibers decreased in patients with GBS compared to the normal volunteers. Conclusion MR can clearly show the denervated skeletal muscles controlled by the tibial nerve and the common peroneal nerve. The ADC value, FA value, AD value and RD value, the quantitative parameters of DTI, can evaluate the injury of the tibial nerve and the common peroneal nerve in patients with GBS.
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Objective To assess the optimal visiualization capacity of brachial plexus with three-dimensional nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation imaging (3D SHINKEI), exploring the feasibility of preliminary diagnostic value on brachial plexus diseases. Methods MRI scans were performed on 24 healthy volunteers with no history of brachial plexus injury, and 46 patients whose outcomes of lesions had been verified as post-ganglionic brachial plexus injuries by surgery or clinical follows-up . The scan series consist 3D SHINKEI, STIR in the coronal plane as well as DW-MRN in the axial plane using a 3.0 T MR system. The source and post-processed images of 3D SHINKEI and DW-MRN were scored according to the optimal visibility on brachial plexus, in the meanwhile, contrast-to-noise ratio of the original images in the 3D SHINKEI and STIR sequences were calculated separately. Two radiologists blindly compared the detection rate of positive brachial plexus injuries between 3D SHINKEI and STIR in 46 patients. And then analyze the outcomes by means of Kappa test, Mann-Whitney test , independent sample t test, and Chi-square test. Results Post-ganglionic brachial plexus showed high intensity in the 3D SHINKEI sequence. In the 24 healthy volunteers, the scores by the two radiologists were 3.6 ± 0.6, 3.5 ± 0.6, 3.0 ± 0.2, 2.9 ± 0.1, respectively. There was statistical difference between the two sequences (Z=2.667,P=0.008,P<0.05). And the Kappa was 0.8 and 0.6 with favorable consistency. The CNR of 3D SHINKEI and STIR were 0.61 ± 0.07, 0.42 ± 0.03 (t=12.78, P=0.001, P<0.05). The positive detection rates of post-ganglionic brachial plexus injuries on 3D SKINKEI and STIR were, 78.3%, 52.2%(χ2=9.421, P<0.05). Conclusions 3D SHINKEI sequence demonstrates robust visibility consistently and can clearly display the structures and signals of post-ganglionic abnormality, compared with DW-MRN and STIR. This technique can be helpful to provide more complementary information to further confirm the diagnosis of brachial plexus injuries.
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Objective To monitor the dynamic changes of radiation-induced parotid damage using T2 ? mapping.Methods Thirty-four patients with nasopharyngeal carcinoma (NPC)were enrolled.All patients underwent T1 WI,T2 WI and T2 ? mapping for bilateral parotid glands at pre-RT (2 weeks before radiotherapy),mid-RT (5 weeks after the beginning of radiotherapy)and post-RT (4 weeks after the completion of radiotherapy).Parotid MR parameters,mean radiation dose and xerostomia degrees of the patients at different time points were recorded.Furthermore,nine healthy volunteers were enrolled,who undergone T2 ? mapping twice with an interval of 4 weeks in order to analyze the reproducibility of T2 ? value.Results From pre-RT to mid-RT and post-RT,parotid volume decreased [atrophy rates,(25.34±11.33)％ and (25.74±9.93)％,respectively]and T2 ? values decreased [change rates,(-5.63±8.86)％ and (-4.81±10.67)％, respectively]significantly (all P < 0.01 ).Parotid normalized T1 signal intensity decreased significantly from pre-RT to post-RT [change rate,(-7.43±10.61)％,P =0.007],and the change rate was correlated inversely with mean radiation dose significantly (r =-0.646, P <0.001).Parotid volume and T2 ? value changed correspondingly with xerostomia degrees of the patients during radiotherapy.Parotid MR parameters showed excellent reproducibility (intraclass correlation coefficient,0.843 -0.993).Conclusion The dynamic changes of radiation-induced parotid damage in patients with NPC can be noninvasively evaluated by routine MRI and T2 ? mapping.
ABSTRACT
Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging ( IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0?1 000 s/mm2), and contrast?enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer ( stage ≥Ⅱb ) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi?exponential model to generate three parameters, containing pure diffusion coefficient ( D ) , pseudodiffusion coefficient ( D?) , and perfusion fraction ( f ) . Apparent diffusion coefficient ( ADC ) was obtained using the mono?exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment ( 0?96 × 10-3 vs. 1?77 × 10-3 mm2/s, P=0?000;0?76 × 10-3 vs. 1.34± 0?12 × 10-3 mm2/s, P=0?000;0?14% vs. 0?24%, P=0?012). The above three values significantly increased after two weeks of treatment (all P=0?000) and kept increasing until the end of the treatment. In contrast, the D? value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.