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Objective:To study the correlation between liver imaging reporting and data system (LI-RADS) category with tumor differentiation, Ki67 index, microvascular infiltration, and predictive prognosis in hepatocellular carcinoma (HCC).Methods:We retrospectively analyzed the clinical and radiological data of 178 patients with HCC who were confirmed by histopathological studies after liver resection between January 2015 and September 2020 at Lishui Central Hospital and Lishui People’s Hospital. There were 156 males and 22 females, with age of (57±10) years old. These patients were assessed for LI-RADS categories according to the 2018 version of LI-RADS, and they were divided into 4 groups according to the assessment results: 12 patients with LI-RADS-3 (the LI-RADS-3 group); 26 patients with LI-RADS-4 (the LI-RADS-4 group); 102 patients with LI-RADS-5 (the LI-RADS-5 group); and 38 patients with LI-RADS-M (the LI-RADS-M group). The patients' general information, tumor markers, pathology and other clinical data were recorded. Correlation analysis between the LI-RADS category with pathology was performed by the Kendall's tau-b test. Survival analysis between groups was performed by the Kaplan-Meier analysis. The Cox regression risk model was used to analyze the relationship between these variables with the risk of death.Results:The Kendall's tau-b test showed that LI-RADS category was positively correlated with the degree of tumor differentiation ( t=0.204, P=0.002), but not with microvascular infiltration and Ki 67 index ( P>0.05). All patients were followed up for 4.2 to 84.2 months (median follow-up 36.3 months). By the end of follow-up, 31 patients had died and 147 patients were alive. The cumulative 1-year and 3-year survival rates of the LI-RADS-5 group were 97% and 90% respectively, which were significantly higher than those in the LI-RADS-M group (81% and 63%), and the LI-RADS-4 group (96% and 81%), ( P<0.05). The cumulative 1-year and 3-year survival rates of patients in the LI-RADS-3 group were 100% and 67% respectively, and there was no statistically significant difference with the LI-RADS-5 group ( P>0.05). The Cox multivariate regression analysis showed that tumor glycoantigen 199 (>50 μl/ml) to be an independent influencing factor in survival of HCC patients ( HR=0.43, 95% CI: 0.24-0.76, P=0.004). Conclusion:The LI-RADS category of HCC was positively correlated with the degree of tumor differentiation, and patients with HCC meeting the LI-RADS-5 criteria had relatively better prognosis.
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Objective:To investigate the correlation between the enhancement characteristics in arterial phase and the prognosis of patients with massive intrahepatic cholangiocarcinoma (IMCC).Methods:The imaging and clinical data of 92 patients with IMCC who were pathologically confirmed and underwent enhanced MRI or CT in Central Hospital of Lishui from June 2004 to February 2019 were retrospectively analyzed. According to the enhancement pattern of the primary lesion in the arterial phase, patients were divided into rich arterial blood supply group （17 cases） and deficient arterial blood supply group （75 cases）. The clinical data and imaging features of these patients were studied. Differences between measurement data and count data between the two groups were compared using t test and Fisher test. Kaplan-Meier analysis and log-rank test were used to analyze overall survival. The Cox regression multivariate analysis was used to study the relationship between the variables and the risk of death. Result:The enlargement of lymph nodes, long diameter of the primary lesion, CA19-9, treatment and HPD around the primary lesion in arterial phase were statistically different in the two groups ( P<0.05), others were no statistical difference. CA19-9>200 U/ml, lymph node enlargement, HPD around the primary lesion in arterial phase and deficient arterial blood supply were independent factors for the prediction of prognosis in IMCC patients with surgery ( P values were 0.008, 0.002, 0.049 and 0.005, respectively). Lymph node enlargement and deficient arterial blood supply were independent risk factors for the prediction of prognosis in IMCC patients with surgery ( P values are 0.049 and 0.045, respectively). Conclusion:The blood supply characteristics of arterial phase are independent factors for the prognosis of patients with IMCC.
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Objective To access the value of MRI in differential diagnosis between intrahepatic cholangiocarcinoma and atypical hepatic abscess. Methods Retrospectively collecting and analyzing the clinical and MRI imaging data of 19 patients with intrahepatic cholangiocarcinoma (ICC) and 17 patients with atypical hepatic abscess, confirmed by reexamination after anti‐inflammation therapy, surgery or puncture etiology, from June 2011 to July 2018 in Central Hospital of Lishui City.They were divided into ICC and abscess groups.All patients underwent routine liver plain MRI, DWI and contrast‐enhanced MR scan. The MRI features of the two groups (including morphology, boundary, cystic change and necrosis, pseudocapsule, hemorrhage, lipid composition, the signature of lesion in different phases of MRI and surrounding tissue) were studied. Fisher exact test and t test were used. Result This study showed that there was statistical difference between the two groups in the following aspects, the presence of cystic degeneration, the degree of annular enhancement in arterial phase, the homogeneous enhancement in portal venous phase and balanced phase and the central filling enhancement sign (P<0.05).The results showed that necrotic cystic lesion was more common in the abscess group (15/17 cases) than in the ICC group (0/19 cases);in the cases with annular enhancement in arterial phase,the degree of enhancement in the ICC group (13/16 cases) was higher than that in the abscess group (2/9 cases); the enhancement of the central parenchyma of lesion on out‐of‐phase images (1/19 cases) was slower in the ICC group than that in the abscess group (14/17 cases);and the ICC group was likely to present as central filling enhancement compared to the abscess group. Conclusion The presence of cystic lesions in DWI, the enhancement degree of marginal parenchyma, the enhancement speed of central parenchyma and the whole enhancement pattern are essential signs for differentiating intrahepatic cholangiocarcinoma and atypical hepatic abscess. 图1 女,53岁,右肝脓肿.病灶最大径4.0 cm,病灶中的小囊变区在DWI上呈高信号(↑) 图2 女,39岁,右肝脓肿.病灶最大径3.1 cm,病灶中的小囊变区在DWI上呈高信号(↑) 图3 女,66岁,右肝肝内胆管细胞癌(ICC).病灶最大径5.3 cm,横轴面T2WI病灶整体呈不均匀高信号,内见相对更高信号的富黏液区(↑) 图4 男,45岁,右肝ICC.病灶最大径5.8 cm,横轴面T2WI病灶整体呈高低混杂信号,内见散在片状低信号的凝固性坏死区(↑) 图5 与图1为同一患者.横轴面T2WI病灶实质部分呈均匀高信号,小囊变区呈明显高信号(↑) 图6 与图2为同一患者.横轴面T2WI病灶实质部分呈等信号,小囊变区呈明显高信号(↑)图7 与图3为同一患者.增强扫描动脉期横轴面示病灶边缘轻度不规则环形强化 图8 与图4为同一患者.增强扫描动脉期横轴面示病灶强化环有多处中断征象(↑) 图9,10 男,45岁,右肝ICC.病灶最大径5.8 cm,增强扫描动脉期横轴面(图9)示病灶边缘局部显著环形强化,局部强化环明显中断(↑).平衡期横轴面像(图10)示病灶中央有填充强化 图11 与图3,7为同一患者.平衡期横轴面示病灶内富黏液区出现轻微中央填充强化(↑) 图12 与图4、8为同一患者.平衡期横轴面像示病灶中央有填充强化 图13,14 男,59岁,右肝脓肿.病灶最大径4.3 cm,动脉期横轴面像(图13)示脓壁散在强化,周围见片状异常灌注.平衡期横轴面像(图14)示脓壁均匀强化,其内囊变区无强化 图15 与图2,6为同一患者.平衡期横轴面像示脓壁均匀强化呈相对等信号,其内囊变区无强化(↑) 图16 与图1,5为同一患者.平衡期横轴面像示脓壁均匀强化呈相对等信号,其内囊变区无强化(↑)
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Objective To study the effect of MRI on the enhancement of normal prostate, benign prostatic hyperplasia and prostate cancer by pharmacokinetic model. Methods A total of 80 patients with prostate cancer diagnosed by pathological examination in Lishui Central Hospital from February 2015 to August 2016 were selected as the subjects in this study. 1.5T superconducting magnetic resonance imaging was used, the serial needle was FMPSPGR for enhanced scan of the prostate of the patient, interlayer was 2 mm and the thickness was 7 mm, continuous scanning was performed 35 times, after the elbow vein indwelling catheter, the Gd-DTPA was injected rapidly at the beginning of the scan according to the 0.1 mmol/kg dose. By scanning data, inspection data transfer and workstation for patients with scanning results were analyzed using two room pharmacokinetic model calculation of ROI, the patients of normal prostate peripheral zone, benign prostatic hyperplasia and prostate cancer index, maximum enhancement of contrast agent distribution index, exchange rate, contrast absorption amplitude. Results After a series of calculation and analysis, the maximum enhancement index of prostate cancer, the distribution index of contrast agent, the contrast agent exchange rate and the contrast agent absorption index of prostate cancer were the highest. The maximum enhancement index, contrast agent distribution index, contrast agent exchange rate and contrast agent absorption index were significantly lower than those of prostate cancer, The difference was statistically significant (P<0.05). The indexes of normal prostate were significantly lower than those of benign prostatic hyperplasia (BPH) and prostate cancer (P<0.05). Conclusion The application of drug evaluation pharmacokinetic model of prostate MRI in different tissues to enhancing effect on patients with prostate tumor and non tumor tissue blood supply characteristics more accurately describe and differentiate, to improve the accuracy of identification and diagnosis of prostate in clinical treatment in a certain extent, with further clinical promotion and application significance.
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Objective To investigate the value of MSCT and its reconstruction technique for etiological factors of adult non traumatic acute abdomen.Methods The CT findings and clinical data of 1 632 adult patients with non traumatic acute abdomen confirmed by clinical treatment or pathological examination from July 2007 to June 2013 were retrospectively analyzed.Six hundred and sixty-four patients underwent plain scan and 968 patients underwent plain and enhanced scan.We observed MSCT manifestations of acute abdomen , calculated the accurate rate of diagnosis , and analyzed causes of missed diagnosis or misdiagnosis.Results CT diagnosis of 1 580 cases were entirely or partially consistent with the final results in 1 632 cases.Overall accuracy rate was 96.8%.Misdiagnosis or missed diagnosis accounted for 3.2% ( 52/1 632 ).The corresponding accuracy rates using CT with various etiology were: urinary system stones 100.0% ( 293/293 ) , appendicitis 99.3% ( 278/280 ) , abdominal tumors 98.3%(227/231), cholecystitis and cholelithiasis 96.4% (213/221), acute pancreatitis 95.8% (159/166), intestinal adhesion 92.6%(100/108), gastrointestinal perforation 97.9%(92/94), internal and external hernia 95.2% ( 59/62 ) , intussusceptions 95.4% ( 42/44 ) , volvulus 91.7% ( 33/36 ) , foreign bodies 95.6%(22/23), ectopic pregnancy 92.3%(12/13), vascular disease 100.0% (16/16), inflammatory bowel disease 77.8%(7/9), and other diseases 75.0%(27/36).The main cause of missed diagnosis was the absence of obvious morphologic changes at early stage of the diseases.Atypical MSCT features resulted in misdiagnosis.Conclusion MSCT is a valuable tool in diagnosing adult non traumatic acute abdomen and its etiology.