ABSTRACT
Objective To explore the value of ultra-high b-value diffusion-weighted imaging(DWI) in diagnosis of prostate cancer. Methods According to inclusion and exclusion criteria, 73 consecutive examinees in Chinese PLA General Hospital from June 2014 to May 2015 were screened. Written informed consent was obtained from all patients. T2WI, conventional DWI with b-value of 1 000 s/mm2and ultra-high b-value DWI with 2 000 s/mm2and 3 000 s/mm2were performed in each examinee. Images were interpreted and were corresponding to histological results conducted by ultrasound guided prostate systematic biopsy. Reference biopsy as the gold standard,the sensitivity,specificity, positive predictive value(PPV) and negative predictive value (NPV) were calculated for each image. Sensitivity and specificity differences between ultra-high b-value DWI and conventional DWI were analyzed. The areas under the curves (AUCs) between ultra-high b-value DWI and other modalities were compared. Results The sensitivity and specificity for ultra-high b-value DWI were 92.5 % and 68.8 % with b-value of 3 000 s/mm2, and they were 88.1 % and 53.1 % for 2 000 s/mm2in peripheral zone. The sensitivity and specificity for ultra-high b-value DWI were 88.0 % and 88.2 % with a b-value of 3 000 s/mm2, and they were 80.0 % and 52.9 % for 2 000 s/mm2in transition zone. The values of sensitivity for ultra-high b-value DWI were significantly higher than those for conventional DWI both in peripheral zone and transition zone (all P <0.000 1). The detection of lesions was comparable with ultra-high b-value DWI at 2 000 s/mm2and 3 000 s/mm2in peripheral zone (P >0.05), whereas the value of specificity for 3 000 s/mm2were significantly higher than that for 2 000 s/mm2in transition zone (P<0.000 1). PPV and NPV for 3 000 s/mm2were significantly higher than those for the other three modalities both in peripheral zone(86.1 % and 81.5 %) and transition zone (91.7 % and 83.3 %). In peripheral zone, the AUCs were 0.591, 0.553, 0.698 and 0.806 in T2WI, conventional DWI and ultra-high b-value DWI at 2 000 s/mm2 and 3 000 s/mm2respectively, for the diagnosis of transition zone cancer were 0.693, 0.506, 0.665 and 0.881 respectively, and the AUCs for the ultra-high b-value with 3 000 s/mm2were the largest. Conclusion Ultra-high b-value DWI is an accurate and reliable method in the diagnosis of prostate cancer.
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ObJective To evaluate the multi-slice spiral CT (MSCT) in the diagnosis of early small renal cell carcinoma (RCC). Methods 32 cases of small RCC proved by pathology were retrospectively analyzed. The relationship of imaging features MSCT with pathology was compared. Results Of the 32 RCC in this study, 19 patients were with low density, 6 medium density, and 5 minimal high density. In 24 patients, the lesion were seen as a mixed enhancement pattern, 8 were with the homogeneous enhancement pattern.In cortical phase, clear cell RCC (25/32) tended to be marked enhancement or mixed enhancement pattern; 2 chromophobe lesions and 2 angsarcomakoid renal cell carcinoma (2/32, 2/32 respectively) tended to enhance moderately, papillary lesions (3/32) were mostly hypovascular and homogeneous enhancement pattern. The detection and characterization as well as accuracy of staging in 32 small RCC on MSCT were 100%, 93.75%, and 84.38%, respectively. Conclusion Muhiphase enhanced MSCT scan was a reliable technique in the dectection and clinical predicting subtype of small RCC.
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Objective To evaluate the correlation between imaging features of spiral computed tomography(SCT) and pathology, MVD, and the expression of VEGF in renal cell carcinoma(RCC). Methods Thirty patients with RCC diagnosed by pathology underwent SCT examinations.MVD and the expression of VEGF were examined immunohistochemically using SABC techniques. Results The detection and characterization rate as well as accuracy of staging before operation about 30 RCC of multiphasic SCT scans were 100 %, 100 % and 83.3 %, respectively. In 30 cases of RCC, the mean MVD was 36±12.4. The positive expression rate of VEGF were 73.33 %. There were no correlation between the MVD and the expression of VEGF in RCC (r =0.057, P >0.05). The features of SCT: on multiphasic SCT scans, the pathological nuclear grade, the MVD and positive expression of VEGF in groups of RCC with diameter larger than 3.0 cm, central necrosis, pseudocapsule and intravenous tumor emboli were obviously higher than those of the contrast group (P <0.05, P <0.05, P <0.05, respectively). The pathological nuclear grade and MVD in groups of RCC with lymph node metastasis were higher than the contrast group (P <0.05, P <0.05, respectively). There were the positive correlation between the enhanced Hounsfield' s units in the CMP and the MVD in 30 cases of RCC(r =0.784, P <0.05). The degree of enhancement correlated well positively with the MVD in 30cases of RCC (P < 0.05). Conclusion Multiphasic enhanced SCT scan is a reliable technique in the detection, pathologic characterization of RCC. Some SCT features are closely correlated with MVD and expressions of VEGF in RCC, which could be a noninvasive method in predicting aggressiveness and metastasis.
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Objective To study the imaging features and pathological characteristics of MCRCC in order to improve its diagnostic accuracy. Methods The multi-phase SCT and contrast-enhanced ultrasound were performed in 18 cases of MCRCC proved by the pathology before their operation.The imaging features of MCRCC in 18 patients were reviewed. Results All tumors appeared as well-defined round or oval multilocular cystic masses composed of serous fluid with regular thin cystic wall and an irregular renal shape. There were thin coarse septum(6 cases), thick septum(8 cases) and septum with nodule(4 cases) of all the tumor. Dynamic SCT presented enhancement from slight to moderate degree in thin septum cases, obviously homogeneous enhancement in septum with nodule cases and two different previously enhancement in thick septum cases, so did CEUS. The degree of enhancement correlated well positively with the dynamic SCT and CEUS in 18 cases of MCRCC(P ＜0.05). Conclusion The typical imaging features of MCRCC are multilocular cystic masses composed of serous fluid with regular thin cystic wall, thin coarse septum, thick septum and septum with nodule. There are enhancement from slight to moderate degree in septum cases by SCT and CEUS. The imaging features of SCT and CEUS are integrated in MCRCC, which may improve the accurate diagnosis of MCRCC and provide strong guidance for the clinical treatment.