A case report of primary small cell carcinoma of the breast and review of the literature / 癌症

Primary small cell carcinoma (SCC) of the breast, an exceedingly rare and aggressive tumor, is often characterized by rapid progression and poor prognosis. We report a case of primary SCC of the breast that was diagnosed through pathologic and immunohistochemical examinations. Computed tomography (CT) scans failed to reveal a non-mammary primary site. Due to the scant number of relevant case summaries, this type of tumor is proved to be a diagnostic and therapeutic challenge. Therefore, we also reviewed relevant literature to share expertise in diagnosis, clinicopathologic characteristics, treatment, and prognosis of this type of tumor. Future studies with more cases are required to define more appropriate treatment indications for this disease.

Dynamic enhanced CT evaluation of solitary pulmonary nodules / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of dynamic enhanced-CT in differential diagnosis of solitary pulmonary nodules.</p><p><b>METHODS</b>Sixty-three solitary pulmonary nodules were evaluated by dynamic enhanced multi-slice CT. Images were obtained before and at 20 s, 30 s, 45 s, 60 s, 75 s, 90 s, 120 s, 180 s, 300 s, 540 s, 720 s, 900 s and 1200 s after the injection of contrast media. All lesion enhanced parameters and morphological features were recorded. The differences between benign and malignant nodules were analyzed. The diagnostic sensitivity and specificity of solitary pulmonary nodules were evaluated by receiver operator characteristic analysis.</p><p><b>RESULTS</b>CT enhancement value at 120 s [(29.5 ± 30.2) HU vs. (32.5 ± 14.7) HU, P = 0.023], washout at 20 min [(36.5 ± 24.6) HU vs. (15.6 ± 16.6) HU, P = 0.044], washout ratio at 20 min [(36.5 ± 24.6)% vs. (17.8 ± 14.5)%, P = 0.006], slope of washout at 20 min [(0.006 ± 0.005)%/s vs. (0.002 ± 0.0016)%/s, P = 0.001], type II (24/42 vs. 4/21, P = 0.004) and III (5/42 vs. 9/21, P = 0.005) curves were significantly different between benign and malignant nodules. Using the above mentioned parameters, the results of receiver operator characteristic analysis had a sensitivity of 64.3% and specificity of 84.2% for identification of malignant tumors. The morphological features including round-like, triangle-like, multi-angle, spiculation, light lobulation, the degree of edge (sharp, clear, blur), vessel convergence sign, vacuole sign, airing of bronchi, cut-off of the bronchi and depression of pleura were significantly different between benign and malignant nodules. The results of ROC analysis showed that the above mentioned morphological features had a sensitivity of 92.9% and specificity of 100% for differentiating malignant tumors from benign nodules. The results of ROC analysis showed that combination of morphological features and dynamic enhancement parameters had a sensitivity of 95.2% and specificity of 100% for identification of malignant tumors.</p><p><b>CONCLUSIONS</b>Dynamic enhanced CT images can evaluate morphological and enhancement features of solitary pulmonary nodules. Combination of morphological features and enhancement characteristics can improve the accuracy of diagnosis.</p>

Water mobility of diffusion MRI in prediction of response to chemoembolization in liver cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the value of pretreatment and posttreatment changes of apparent diffusion coefficients (ADCs) in predicting response to chemoembolization in liver cancer.</p><p><b>METHODS</b>Patients with liver cancer were examined with diffusion-weighted MRI at two b values (0 and 500 s/mm(2)) before and after chemoemblization. Quantitative ADC maps were calculated using images under b values of 0 and 500 s/mm(2). The mean ADC values of lesions before and after chemoemblization were compared. The correlation of response to chemoembolization with ADC value was analyzed.</p><p><b>RESULTS</b>The mean value of pretreatment ADC in non-responding lesions were significantly higher than that in the responding lesions (1.687 x 10(-3) mm(2)/s vs. 1.278 x 10(-3) mm(2)/s, P < 0.05). The results of receiver operator characteristic (ROC) analysis showed that when a threshold ADC value was set on 1.618 x 10(-3) mm(2)/s, the sensitivity and specificity for identification of non-responding lesions were 96.0% and 77.8%, respectively. After transarterial chemoembolization, the responding lesions had a significant increase in ADC values than non-responding lesions (32.6% vs. 5.2%, P = 0.025). The results of ROC analysis indicated that when the changes of ADC value for identification of responding lesions before and after transarterial chemoembolization was > or = 16.2%, the sensitivity and specificity were 72% and 100%, respectively. However, no significant change was observed in normal liver parenchyma and spleen (P > 0.05).</p><p><b>CONCLUSION</b>Pretreatment mean ADC value can be used to predict the response to chemoembolization, and for selection of therapy in liver cancer. A significant increase in mean ADC can be observed if the lesions responds to chemoembolization.</p>

Comparison by dynamic enhancement in spiral CT to differentiate peripheral squamous cell carcinoma from adenocarcinoma of the lung / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the manifestations of peripheral lung squamous cell carcinoma by CT dynamic enhancement with that of adenocarcinoma, and evaluate the difference of CT dynamic enhancement to distinguish peripheral lung squamous cell carcinomas from adenocarcinoma.</p><p><b>METHODS</b>Thirty peripheral lung squamous cell carcinomas and 40 adenocarcinomas were examined with dynamic contrasted CT, enhancement at various phases recorded, based on which the time-intensity curves were produced. The enhancement patterns were compared and analyzed.</p><p><b>RESULTS</b>There was no statistically significant difference in the enhancement degree and peak time between peripheral lung squamous cell carcinoma and adenocarcinoma (P > 0.05). The difference in enhancement pattern between these two different types of carcinoma was not statistically significant when the lesion was larger than 3 cm in diameter (P > 0.05), whereas it became statistically significant when the lesion is less than 3 cm (P < 0.05). Most of the squamous cell carcinoma showed heterogeneous enhancement or peripheral enhancement in the tumor zone, however, most of the adenocarcinomas had homogenous enhancement.</p><p><b>CONCLUSION</b>The maximum enhancement and the peak time are not helpful in differentiating peripheral lung squamous cell carcinoma from adenocarcinoma. When the lesion is less than 3 cm in diameter, the enhancement pattern of peripheral squamous cell carcinomas is different from that of adenocarcinoma.</p>

Impact of multi-layer spiral CT angiography of bronchial artery and pulmonary artery in assessment of the main blood supply to the primary lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the blood supply of primary lung cancer (PLC) using CT angiography for bronchial artery (BA) and pulmonary artery (PA).</p><p><b>METHODS</b>Thin-section enhanced multi-layer spiral CT (MSCT) were carried out in 147 primary lung cancer patients and 46 healthy subjects as control. Three-dimensional images of bronchial artery and pulmonary artery were obtained using volume render (VR) and multi-planar reconstruction (MPR) or maximum intensity projection (MIP) at the workstation, and their morphological findings and relationship with the mass were assessed.</p><p><b>RESULTS</b>136 primary lung cancer patients and 32 healthy controls were evaluated for at least one bronchial artery displayed clearly in VR. The detective rate of the bronchial artery was 92.5% and 69.6%, respectively. The bronchial artery caliber and the total section area of lesion side in lung cancer patients were significantly larger than that on the contralateral side and that of the control (P < 0.05). Bronchial artery on the lesion side in lung cancer was dilated and tortuous, directly penetrating into the mass with reticularly anastomosed branches. In the PLC patients, all PA were shown clearly with normal morphological image though crossing over the masses in 54 patients; In 25 PLC patients, the PA being essentially intact, was pushed around and surrounded the mass, giving the "hold ball" sign; In 40 other PLC patients, PA being also intact, the mass surrounded and buried the PA from the outside, crushing the PA flat resulting in an eccentric or centrifugal shrinkage, forming the "dead branch" sign; In the rest 28 patients, the PA was surrounded and even compressed, forming the "residual root" sign.</p><p><b>CONCLUSION</b>Primary lung cancer patient shows dilated bronchial arteries and increased bronchial artery blood flow, whereas pulmonary arteries just pass through the mass or are compressed by the mass. It is further demonstrated that the bronchial artery, instead of the pulmonary artery, is the main vessel of blood supply to the primary lung cancer as shown by MSCT angiography of bronchial artery and pulmonary artery.</p>

Contrast-enhanced MRA of pulmonary artery combined with pulmonary perfusion imaging in pigs: a comparative study with DSA / 第二军医大学学报

Objective:To optimize the injection protocol of contrast medium for contrast-enhanced MRA (CEMRA) of pulmonary artery and to evaluate the diagnostic value of CEMRA and pulmonary perfusion imaging (PPI) in an experimental model of acute pulmonary embolism. Methods:CEMRA and PPI were performed in 6 normal pigs with different doses of gadolinium contrast agent (5ml, 10ml, 15ml, 20ml and 25ml) at an injection rate of 3ml/s, and 3 pulmonary embolism models were injected with 20 ml contrast agent at 3 ml/s. DSA was also performed for comparison. Results:The signal intensities and the signal to noise ratios of the pulmonary arteries kept increasing with the dose increase of the contrast agent, but the best angio-pulmonary contrast dose was 10-15ml (0.25-0.375mmol/kg), while the optimal dose for PPI was 15-20ml (0.375-0.5mmol/kg). Although CEMRA demonstrated less obstructed pulmonary arteries than DSA (5/10 vs 8/10)did, it detected all obstructions when combined with PPI. The pulmonary infarction zones showed wedge-shaped perfusion defects on the PPI images, with the signal intensities lower than those of the normal areas (137.86±45.32 vs 330.14±46.52, P<0.001). Conclusion:It is suggested that the optimal dose of the contrast agent is 0.25mmol/kg to 0.375mmol/kg for CEMRA, and 0.375mmol/kg to 0.5mmol/kg for lung perfusion. CEMRA combined with PPI may be better than DSA in demonstrating pulmonary embolism.

Contrast-enhanced MRA of pulmonary artery combined with pulmonary perfusion imaging in pigs: a comparative study with DSA / 第二军医大学学报

Objective:To optimize the injection protocol of contrast medium for contrast-enhanced MRA (CEMRA) of pulmonary artery and to evaluate the diagnostic value of CEMRA and pulmonary perfusion imaging (PPI) in an experimental model of acute pulmonary embolism. Methods:CEMRA and PPI were performed in 6 normal pigs with different doses of gadolinium contrast agent (5ml, 10ml, 15ml, 20ml and 25ml) at an injection rate of 3ml/s, and 3 pulmonary embolism models were injected with 20 ml contrast agent at 3 ml/s. DSA was also performed for comparison. Results:The signal intensities and the signal to noise ratios of the pulmonary arteries kept increasing with the dose increase of the contrast agent, but the best angio-pulmonary contrast dose was 10-15ml (0.25-0.375mmol/kg), while the optimal dose for PPI was 15-20ml (0.375-0.5mmol/kg). Although CEMRA demonstrated less obstructed pulmonary arteries than DSA (5/10 vs 8/10)did, it detected all obstructions when combined with PPI. The pulmonary infarction zones showed wedge-shaped perfusion defects on the PPI images, with the signal intensities lower than those of the normal areas (137.86±45.32 vs 330.14±46.52, P<0.001). Conclusion:It is suggested that the optimal dose of the contrast agent is 0.25mmol/kg to 0.375mmol/kg for CEMRA, and 0.375mmol/kg to 0.5mmol/kg for lung perfusion. CEMRA combined with PPI may be better than DSA in demonstrating pulmonary embolism.

Preliminary clinical application of contrast-enhanced MR angiography using three-dimensional timeresolved imaging of contrast kinetics / 中华放射学杂志

Objective To assess the clinical application of contrast-enhanced MR angiography using three-dimensional(3D)time-resolved imaging of contrast kinetics(CE-MRA 3D-TRICKS).Methods TRICKS is a high temporal resolution(2—6s)MR angiographic technique using a short TR(2.8— 4.0 ms)and TE(0.9—1.3 ms),partial echo sampling and the central part of the k-space being updated more frequently than the peripheral part of the k-space.Pre-contrast mask 3D images are first acquired and 15--20 sequential 3D images following bolus injection of Gd-DTPA are then acquired.Results Thirty patients underwent contrast-enhanced MR angiography using TRICKS.Twelve vertebral arteries were well displayed on TRICKS.Seven of them showed normal,bilateral vertebral artery stenosis was shown in 1 case, and unilateral vertebral artery stenosis was shown in 4 wth aecompaning ipsilateral carotid artery bifurcation stenosis in one case.Bilateral renal artery showed normal in 4 cases,and the artery in transplanted kidney showed normal in one case and stenosis in another case.The cerebral artery showed normal in 2 cases, sagittal sinus thrombosis was detected in one case and intracranial arteriovenous malformation in one case. Pulmonary artery displayed normal in 3 cases,pulmonary artery thrombosis was seen in one case and pulmonary sequestration's abnormal feeding artery and draining vein was revealed in one case.The feeding artery in left lower limb fibrolipoma was showed in one case.The radial-ulnar artery artificial fistula stenosis was seen in one case,and left antebrachium hemangioma was showed in one case.Conclusion TRICKS can clearly delineate the whole body vascular system and can reveal any vascular abnormality.It is convenient and with high successful rate,which make it the first method of choice in displaying vascular abnormality.