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Objective@#To investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy. @*Methods@#Thirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed. @*Results@#All 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55–85.15; p=0.017). @*Conclusion@#Decompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy.
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Ewing's sarcoma in the cervix is characterized by extremely rare occurrence,high degree of malignancy,and rapid progression.The diagnosis of this disease is based on pathology and immunohistochemistry. The main image of the case reported in this paper showed the cervical cyst with solid mass,large volume,and uneven density and signal,and the solid part can be strengthened in enhanced scanning.Because of the rapid growth,the lesion is prone to liquefaction necrosis and bleeding.Since the metastasis occurs early,timely diagnosis is essential.
Subject(s)
Female , Humans , Cervix Uteri/pathology , Immunohistochemistry , Neuroectodermal Tumors, Primitive, Peripheral/pathology , Sarcoma, Ewing/pathology , Uterine Cervical NeoplasmsABSTRACT
Objective To retrospectively determine the features of stones and calcifications in hepatobiliary system on virtual nonenhanced (VNE) dual-energy computed tomography (CT), and to evaluate the possibility of VNE images in diagnosis for those lesions.Methods A total of 128 gall stones and calcifications of the liver found in 110 patients were examined with triple phase abdominal CT scan from July 2007 to December 2011, in which true nonenhanced (TNE) phase and arterial phase were performed with single-energy CT (120 kVp) and portal venous phase was performed with dual-energy CT (100 kVp and 140 kVp). VNE images were generated from the portal venous phase dual-energy CT data sets by using commercially VNC software. The mean CT values for the stone, liver, bile and paraspinal muscle, mean lesion density and size in area dimension, contrast-to-noise ratio (CNR) of lesion to the liver or bile, and image noise were assessed and compared between VNE and TNE images. The effective dose and size-specific dose estimate (SSDE) were also calculated.Results The mean CT values of the lesions measured on VNE images declined significantly compared with those measured on TNE images (164.51±102.13 vs. 290.72±197.80 HU, P<0.001), so did the lesion-to-liver CNR (10.80±11.82 vs.18.81±17.06, P<0.001) and the lesion-to-bile CNR (17.24±14.41 vs. 21.32±17.31, P<0.001). There was no significant difference in size of lesions area between VNE and TNE images (0.69±0.88 vs. 0.72±0.85 cm, P=0.062). Compared to the 128 lesions found in TNE images, VNE images showed the same density in 30 (23.4%) lesions, lighter density in 88 (68.8%) lesions, while failed to show 10 (7.8%) lesions, and showed the same size in 61 (47.7%) lesions and smaller size in 57 (44.5%) lesions. The CT cutoff values of lesion and size were 229.21 HU and 0.15 cm, respectively. The total effective dose for triple phase scan protocol with TNE images was 19.51±7.03 mSv, and the SSDE was 39.84±11.10 mGy. The effective dose for dual phase scan protocol with VNE images instead of TNE images was 13.29±4.89 mSv, and the SSDE was 27.83±9.99 mGy. Compared with TNE images, the effective dose and SSDE of VNE images were down by 32.05%±3.69 % and 30.63%±2.34 %, respectively.Conclusions Although the CT values and CNR of the lesions decreased in VNE images, the lesions of which attenuation greater than 229.21 HU and size larger than 0.15 cmcould be detected with good reliability and obvious dose reduction. There was good consistency in the size of stones and calcifications in hepatobiliary system between VNE images and TNE images, which ensured the possibility of the clinical application of VNE images.
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<p><b>OBJECTIVE</b>To assess the upper urinary tract opacification and the diagnostic performance of one-bolus dual-source dual-energy CT urography (CTU) for painless hematuria.</p><p><b>METHODS</b>Totally 205 patients who underwent dual-source dual-energy CTU for painless hematuria were enrolled in this study. CTU included true non-enhanced phase, dual-energy mode nephrographic phase, and FLASH mode excretory phase imaging of the urinary tract. Two radiologists independently evaluated the degree of upper urinary tract opacification. Prospective interpretations using true non-enhanced, nephrographic and excretory phase imaging for hematuria were recorded, as well as retrospective diagnosis using virtual non-enhanced, nephrographic and excretory phase imaging. The standard of reference included all available clinical, imaging, laboratory and follow-up data for up to 36 months after CTU exam. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated. The prospective and retrospective diagnostic performance for hematuria and the radiation dose of two CTU protocols were compared.</p><p><b>RESULTS</b>It was found that 87.8% and 86.8% of segments were at least 50% opacified, respectively. The sensitivity, specificity, PPV, NPV and accuracy for hematuria for prospective interpretation were 95.2%, 91.9%, 98.2%, 81.0% and 94.6%, respectively. Comparable figures for retrospective diagnosis were 98.8%, 91.9%,98.2%, 94.4% and 97.6%. The AUC for prospective and retrospective diagnosis were 0.931±0.027 and 0.940±0.026, respectively (z=1.425, Bonferroni-corrected P>0.05). The radiation dose of the CTU protocol using in retrospective diagnosis[(12.732±3.485)mSv] was significantly lower than that of prospective diagnosis [(17.002±4.013)mSv] (P<0.05), with dose reduction of (32.74±8.92)%.</p><p><b>CONCLUSION</b>One-bolus two-phase dual-source dual-energy CT urography provides at least 50% opacification of upper urinary tract segments and has high diagnostic performance for painless hematuria with relatively low radiation dose.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Contrast Media , Hematuria , Diagnostic Imaging , Predictive Value of Tests , Sensitivity and Specificity , Tomography, X-Ray Computed , Urography , MethodsABSTRACT
<p><b>OBJECTIVE</b>To retrospectively evaluate the clinical feasibility of high-pitch excretory phase images during dual-source CT urography with Stellar photon detector.</p><p><b>METHODS</b>Totally 100 patients received dual-source CT high-pitch urinary excretory phase scanning with Stellar photon detector [80 kV, ref.92 mAs, CARE Dose 4D and CARE kV, pitch of 3.0, filter back projection reconstruction algorithm (FBP)] (group A). Another 100 patients received dual-source CT high-pitch urinary excretory phase scanning with common detector(100 kV, ref.140 mAs, CARE Dose 4D, pitch of 3.0, FBP) (group B). Quantitative measurement of CT value of urinary segments (Hounsfield units), image noise (Hounsfield units), and effective radiation dose (millisievert) were compared using independent-samples t test between two groups. Urinary system subjective opacification scores were compared using Mann-Whitney U test between two groups.</p><p><b>RESULTS</b>There was no significant difference in subjective opacification score of intrarenal collecting system and ureters between two groups (all P>0.05). The group A images yielded significantly higher CT values of all urinary segments (all P<0.01). There was no significant difference in image noise (P>0.05). The effective radiation dose of group A (1.1 mSv) was significantly lower than that of group B (3.79 mSv) (P<0.01).</p><p><b>CONCLUSION</b>High-pitch low-tube-voltage during excretory phase dual-source CT urography with Stellar photon detector is feasible, with acceptable image noise and lower radiation dose.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Image Processing, Computer-Assisted , Retrospective Studies , Tomography, Spiral Computed , Methods , Urography , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the image quality, radiation dose and diagnostic value of the low-tube-voltage high-pitch dual-source computed tomography (DSCT) with sinogram affirmed iterative reconstruction (SAFIRE) for non-enhanced abdominal and pelvic scans.</p><p><b>METHODS</b>This institutional review board-approved prospective study included 64 patients who gave written informed consent for additional abdominal and pelvic scan with DSCT in the period from November to December 2012. The patients underwent standard non-enhanced CT scans (protocol 1) [tube voltage of 120 kVp/pitch of 0.9/filtered back-projection (FBP) reconstruction] followed by high-pitch non-enhanced CT scans (protocol 2) (100 kVp/3.0/SAFIRE). The total scan time, mean CT number, signal-to-noise ratio (SNR), image quality, lesion detectability and radiation dose were compared between the two protocols.</p><p><b>RESULTS</b>The total scan time of protocol 2 was significantly shorter than that of protocol 1 (1.4±0.1 seconds vs. 7.6±0.6 seconds, P<0.001). There was no significant difference between protocol 1 and protocol 2 in mean CT number of all organs (liver, 55.4±6.3 HU vs. 56.1±6.8 HU, P=0.214; pancreas, 43.6±5.9 HU vs. 43.7±5.8 HU, P=0.785; spleen, 47.9±3.9 HU vs. 49.4±4.3 HU, P=0.128; kidney, 32.2±2.3 HU vs. 33.1±2.3 HU, P=0.367; abdominal aorta, 44.8±5.6 HU vs. 45.0±5.5 HU, P=0.499; psoas muscle, 50.7±4.1 HU vs. 50.3±4.5 HU, P=0.279). SNR on images of protocol 2 was higher than that of protocol 1 (liver, 5.0±1.2 vs. 4.5±1.1, P<0.001; pancreas, 4.0±1.0 vs. 3.6±0.8, P<0.001; spleen, 4.7±1.0 vs. 4.1±0.9, P<0.001; kidney, 3.1±0.6 vs. 2.8±0.6, P<0.001; abdominal aorta, 4.1±1.0 vs. 3.8±1.0, P<0.001; psoas muscle, 4.5±1.1 vs. 4.3±1.2, P=0.012). The overall image noise of protocol 2 was lower than that of protocol 1 (9.8±3.1 HU vs. 11.1±3.0 HU, P<0.001). Image quality of protocol 2 was good but lower than that of protocol 1 (4.1±0.7 vs. 4.6±0.5, P<0.001). Protocol 2 perceived 229 of 234 lesions (97.9%) that were detected in protocol 1 in the abdomen and pelvis. Radiation dose of protocol 2 was lower than that of protocol 1 (4.4±0.4 mSv vs. 7.3±2.4 mSv, P<0.001) and the mean dose reduction was 41.4%.</p><p><b>CONCLUSION</b>The high-pitch DSCT with SAFIRE can shorten scan time and reduce radiation dose while preserving image quality in non-enhanced abdominal and pelvic scans.</p>
Subject(s)
Humans , Algorithms , Pelvis , Pathology , Radiography, AbdominalABSTRACT
Objective To quantitatively compare and determine the best pancreatic tumor contrast to noise ratio (CNR) in different dual-energy derived datasets. Methods In this retrospective, single center study, 16 patients (9 male, 7 female, average age 59.4±13.2 years) with pathologically diagnosed pancreatic cancer were enrolled. All patients received an abdominal scan using a dual source CT scanner 7 to 31 days before biopsy or surgery. After injection of iodine contrast agent, arterial and pancreatic parenchyma phase were scanned consequently, using a dual-energy scan mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs) in the pancreatic parenchyma phase. A series of derived dual-energy datasets were evaluated including non-liner blending (non-linear blending width 0-500 HU; blending center -500 to 500 HU), mono-energetic (40-190 keV), 100 kVp and 140 kVp. On each datasets, mean CT values of the pancreatic parenchyma and tumor, as well as standard deviation CT values of subcutaneous fat and psoas muscle were measured. Regions of interest of cutaneous fat and major psoas muscle of 100 kVp and 140 kVp images were calculated. Best CNR of subcutaneous fat (CNRF) and CNR of the major psoas muscle (CNRM) of non-liner blending and mono-energetic datasets were calculated with the optimal mono-energetic keV setting and the optimal blending center/width setting for the best CNR. One Way ANOVA test was used for comparison of best CNR between different dual-energy derived datasets. Results The best CNRF (4.48±1.29) was obtained from the non-liner blending datasets at blending center -16.6±103.9 HU and blending width 12.3±10.6 HU. The best CNRF (3.28±0.97) was obtained from the mono-energetic datasets at 73.3±4.3 keV. CNRF in the 100 kVp and 140 kVp were 3.02±0.91 and 1.56±0.56 respectively. Using fat as the noise background, all of these images series showed significant differences (P<0.01) except best CNRF of mono-energetic image sets vs. CNRF of 100 kVp image (P=0.460). Similar results were found using muscle as the noise background (mono-energetic image vs. 100 kVp image: P=0.246; mono-energetic image vs. non-liner blending image: P=0.044; others: P<0.01). Conclusion Compared with mono-energetic datasets and low kVp datasets, non-linear blending image at automatically chosen blending width/window provides better tumor to the pancreas CNR, which might be beneficial for better detection of pancreatic tumors.
Subject(s)
Humans , Adenocarcinoma , Noise , Radiographic Image Interpretation, Computer-Assisted , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility of in vitro and in vivo magnetic resonance imaging (MRI) and fluorescence imaging tracking of transplanted bone mesenchymal stem cells (BMSCs) dual-labeled with ultrasmall superparamagnetic iron oxide (USPIO) and red fluorescence protein (RFP).</p><p><b>METHODS</b>BMSCs were incubated with culture medium containing USPIO for 24 hours. The Prussian-blue staining, transmission electron microscopy and trypan-blue staining were used to study the efficacy and safety of labeling. F344 rat model of acute myocardial infarction was established by ligating the left anterior descending coronary artery. The dual-labeled BMSCs were injected into the margin of the infraction myocardium. Then MRI and fluorescence imaging were performed to trace the cells both in vitro and in vivo. Postmortal study was carried out to observe the distribution of transplanted cells in myocardium.</p><p><b>RESULTS</b>The percentage of dual-labeled BMSCs reached 99% after co-incubating with USPIO for 24 hours. USPIO particles were mainly located in lysosomes. As demonstrated by trypan-blue staining, there was no significant deference in viability between labeled and unlabeled groups (P>0.05). All dual-labeled transplanted BMSCs showed a significant decreasing signal on MRI, and the signal intensity changes had no significant difference over 4 weeks (P=0.66). In vitro cell tracing with fluorescence imaging of isolated heart from F344 rats was successful,while in vivo cell tracing with fluorescence imaging failed. Prussian blue staining showed that USPIO distributed near the infarcted myocardium, corresponding with the fluorescence imaging.</p><p><b>CONCLUSION</b>MRI can be used to trace the dual-labeled BMSCs transplanted into F344 rat hearts in vivo, while fluorescence imaging and pathological fluorescence imaging can trace the transplanted cells in vitro.</p>