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1.
Chinese Journal of Radiology ; (12): 1065-1070, 2021.
Article in Chinese | WPRIM | ID: wpr-910269

ABSTRACT

Objective:To explore the value of intravoxel incoherent motion (IVIM) DWI in preoperative prediction of angiolymphatic invasion in esophageal squamous cell carcinoma (ESCC).Methods:From April 2016 to April 2019, 63 ESCC patients who planned to undergo resection of esophageal cancer were prospectively collected at Henan Cancer Hospital.According to the postoperative pathological results, 63 patients were divided into angiolymphatic invasion group (30 cases) and no angiolymphatic invasion group (33 cases). All patients underwent IVIM sequence and routine MRI examination before operation. The ADC, true diffusion coefficient (D), pseudodiffusion coefficient (D *) and pseudodiffusion fraction (f) were measured. The differences of parameter values between ESCC with and without angiolymphatic invasion were analyzed using Student′s t test or Wilcoxon rank sum test.The logistic regression was used to analyze the significance of various parameters. For the parameters with statistical significance, the ROC curves were performed to evaluatethe diagnostic performance of parameters for identifying angiolymphatic invasion.The Z test was used to compare the area under the ROC curves(AUC) of parameters. Results:The difference of ADC, D and f values between angiolymphatic invasion group and no angiolymphatic invasion group were statistically signi?cant ( t=4.476, 5.033 and 5.712 respectively, all P<0.001). The D * values showed no statistically signi?cant di?erence ( Z=0.184, P=0.854). The logistic regression analysis showed that D (OR=9.042) and f (OR=26.221) were in correlation with angiolymphatic invasion. The ROC analyses demonstrated that the AUCs of ADC, D and f values in predicting angiolymphatic invasion of ESCC were 0.787, 0.822 and 0.853, respectively. D combined with f had highest AUC (0.917) in predicting the angiolymphatic invasion of ESCC, sensitivity and specificity were 93.3% and 75.8%. D combined with f showed better diagnostic performance than the D and the f value, and the difference were statistically significant ( Z=2.403, 2.289, P=0.016, 0.022). Conclusions:IVIM can be used as an effective functional imaging modality for preoperative evaluation and prediction of the angiolymphatic invasion of ESCC. D value combined with f value can further improve prediction performance of angiolymphatic invasion.

2.
Chinese Journal of Lung Cancer ; (12): 305-322, 2021.
Article in Chinese | WPRIM | ID: wpr-880262

ABSTRACT

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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3.
Article in English | WPRIM | ID: wpr-875282

ABSTRACT

Objective@#To evaluate the radiological tumor response patterns and compare the response assessments based on immunebased therapeutics Response Evaluation Criteria in Solid Tumors (iRECIST) and RECIST 1.1 in metastatic clear-cell renal cell carcinoma (mccRCC) patients treated with programmed cell death-1 (PD-1) inhibitors. @*Materials and Methods@#All mccRCC patients treated with PD-1 inhibitors at Henan Cancer Hospital, China, between January 2018 and April 2019, were retrospectively studied. A total of 30 mccRCC patients (20 males and 10 females; mean age, 55.6 years; age range, 37–79 years) were analyzed. The target lesions were quantified on consecutive CT scans during therapy using iRECIST and RECIST 1.1. The tumor growth rate was calculated before and after therapy initiation. The response patterns were analyzed, and the differences in tumor response assessments of the two criteria were compared. The intra- and inter-observer variabilities of iRECIST and RECIST 1.1 were also analyzed. @*Results@#The objective response rate throughout therapy was 50% (95% confidence interval [CI]: 32.1–67.9) based on iRECIST and 30% (95% CI: 13.6–46.4) based on RECIST 1.1. The time-to-progression (TTP) based on iRECIST was longer than that based on RECIST 1.1 (median TTP: not reached vs. 170 days, p = 0.04). iRECIST and RECIST 1.1 were discordant in 8 cases, which were evaluated as immune-unconfirmed PD based on iRECIST and PD based on RECIST 1.1. Six patients (20%, 6/30) had pseudoprogression based on iRECIST, of which four demonstrated early pseudoprogression and two had delayed pseudoprogression.Significant differences in the tumor response assessments based on the two criteria were observed (p < 0.001). No patients demonstrated hyperprogression during the study period. @*Conclusion@#Our study confirmed that the iRECIST criteria are more capable of capturing immune-related atypical responses during immunotherapy, whereas conventional RECIST 1.1 may underestimate the benefit of PD-1 inhibitors. Pseudoprogression is not rare in mccRCC patients during PD-1 inhibitor therapy, and it may last for more than the recommended maximum of 8 weeks, indicating a limitation of the current strategy for immune response monitoring.

4.
Chinese Journal of Radiology ; (12): 1207-1211, 2020.
Article in Chinese | WPRIM | ID: wpr-868390

ABSTRACT

Objective:To investigate the feasibility and safety of the X-ray guided obstructive double J tube replacement in ureter.Methods:The clinical data of 44 patients with double J tube obstruction who underwent double J tube replacement from April 2016 to August 2019 were analyzed retrospectively. Among the 44 cases, there were 3 males and 41 females, aged from 27.0 to 70.0 (54.6±11.2) years. The time since last double J tube placement, the method of transurethral remove of double J tube, the method of double J tube replacement, the location of double J tube obstruction and postoperative complications were collected, and the success rate of operation was calculated. According to the different positions of calcium salt deposition in double J tubes, the obstructive double J tubes were divided into bladder end type, renal pelvis end type, two-end type and whole partial type. The replacement method was differentiated according to different types of double J tube obstruction. The cut-off end method was to cut off the obstructed bladder end of double J tube by scissors, and the internal unobstructed double J tube could be seen. The guide wire could be introduced into the renal pelvis through the double J tube, and the new double J tube could be replaced. This method was only used for bladder end type double J tube obstruction. The thine guide wire method was to replace the common guide wire which could not pass through the renal pelvis end obstruction with the microguide wire, so that it could pass through the end of the double J tube of the renal pelvis end obstruction or through the side hole, enter into the renal pelvis, withdraw the original double J tube, and then replace the new double J tube. This method was suitable for renal pelvis end type double J tube obstruction, or combined with cut-off end method for two-end type double J tube obstruction. In the auxiliary sheath method, the obstructed double J tube was used as the support, the vascular sheath tube was sent into the ureter, and the guide wire was sent to the renal pelvis through the sheath tube to replace the new double J tube. This method was suitable for all types of double J tube obstruction.Results:A total of 47 X-ray-guided double J tube replacements were performed in 44 patients. In the removal of double J tube, 37 cases of direct method and 10 cases of indirect method were used, and the overall success rate of double J tube removal was 100% (47/47). The time from the last double J tube placement was (4.2±1.3) months. There were 23 cases of bladder end type obstruction, 8 cases of renal pelvis end obstruction, 5 cases of two-end type obstruction, and 11 cases of whole partial type obstruction.The success rate of replacing double J tubes by cut-off end method, thin guide wire method and auxiliary sheath method was 76.0% (19/25), 50.0% (2/4) and 77.8% (14/18), respectively. After the failure of the cut-off end method or the thin guide wire method, 4 cases were further replaced by the thin guide wire method or auxiliary sheath method, and 3 cases were successful. Therefore, the overall success rate of double J tube replacement was 80.9% (38/47). The double J tubes were inserted by percutanous pyelostomy in 9 patients who failed to replace double J tube successfully. Among the 44 cases, there were 4 cases of urethral orifice pain and discomfort, and 2 cases of gross hematuria, all of which relieved spontaneously.Conclusion:It is feasible and safe to replace the obstructive double J tube in ureter under X-ray guidance.

5.
Chinese Journal of Radiology ; (12): 552-556, 2020.
Article in Chinese | WPRIM | ID: wpr-868310

ABSTRACT

Objective:To evaluate the value of a novel multiphase three-dimensional deep learning neural network of computer-aided diagnosis (CAD) used in LDCT lung cancer screening.Methods:Eight thousand eight hundred and fifty volunteers with 1 111 nodules were enrolled in the lung cancer screening from November of 2013 to December of 2017, and the baseline LDCT imaging data of volunteers accompanied with clinical information were retrospectively analyzed. All volunteers in this study were designed to receive LDCT test at least once. All the imaging of volunteers were read through the methods of visual detectioin (VD), CAD, and VD Combined CAD. The criteria of the true pulmonary nodule was determinated by the consistent opinion of two specialists in chest imaging(in case of disagreement, the decision should made by the third chief physician). In terms of the numbers, types or Lung-RADS categories of nodules, the detection rate, missed diagnosis rate and false positive rate of pulmonary nodules or lung cancer among three methods were compared, and the rates between groups were compared by χ 2test. Results:Compared with VD or CAD ,the detection rate of nodules in the CAD combined VD was significantly increased (95.7% , 94.2%, vs. 80.1% P<0.05 ), and the rate of missed diagnosis was significantly reduced (5.8%, 4.3% vs. 19.9% ,χ2=101.650, 128.500 ,P<0.05); Compared with VD, the methods of CAD or VD combined CAD significantly increased the the detection rates of Lung-RADS categories (χ2 =25.083,23.449, P=0.000, 0.000) or different types of nodules (χ2=6.955,6.821, P=0.031, 0.033), but there was no statistically significant difference between CAD and VD combined CAD for Lung-RADS categories and different types of nodules (all P>0.05); Compared with VD and VD combined CAD, the positive prediction rate of CAD for lung cancer was significantly reduced, and the rate of missed diagnosis and false positive rate were significantly increased, but there was no significant difference between VD and VD combined CAD in the prediction rate, missed diagnosis rate and false positive rate of lung cancer. Conclusion:The method of CAD combined VD can reduce the detection of false positive nodules and improve the detection rate of true pulmonary nodules,which is the preferred method using in LDCT lung cancer screening for city population.

6.
Chinese Journal of Radiology ; (12): 573-578, 2019.
Article in Chinese | WPRIM | ID: wpr-754954

ABSTRACT

Objective To investigate the correlation between quantitative parameters of dynamic contrast?enhanced MRI (DCE?MRI) after neoadjuvant chemotherapy and pathological grades in esophageal squamous cell carcinoma. Methods Fifty?six patients with esophageal squamous cell carcinoma who were confirmed by esophagoscope and received neoadjuvant chemotherapy before operation between September 2015 and December 2017 in the Affiliated Cancer Hospital of Zhengzhou University were prospectively analyzed, and MRI examination was performed within one week before operation. All patients underwent routine chest MRI and DCE?MRI scanning, and quantitative parameters of DCE?MRI, including volume transfer constant (Ktrans),exchange rate constant (Kep) and extravascular extracellular volume fraction (Ve) were measured. Pathological grading was assessed as highly differentiated, moderately differentiated, poorly differentiated,and undifferentiated. Intraclass correlation coefficient (ICC) was calculated from the results of two radiologists. Kruskal?Wallis H test was used to compare the differences of quantitative parameters between different pathological grade groups of DCE?MRI,and Mann?Whitney U test was utilized to compare the intraclass differences among pathological grades. Spearman rank correlation analysis was performed for evaluating the correlation between DCE?MRI parameters and pathological grade of esophageal squamous cell carcinoma. The receiver operating characteristic (ROC) curves were used to evaluate the diagnosis accuracy of different DCE?MRI parameters in pathological grade of esophageal squamous cell carcinoma after neoadjuvant chemotherapy. Results The 56 patients were divided into four groups according to pathological findings: well differentiated group (n=8), moderately differentiated group (n=39), poorly differentiated group (n=9) and undifferentiated group (n=0). The differences of Ktransmean,Ktrans75%,Kepmax, Kepmean,Kep75% between different pathological grading groups were statistically significant (all P<0.05),and these parameters showed positive correlation significantly with pathological grading (r values were 0.778, 0.632, 0.594, 0.725, 0.489 respectively, all P<0.05). The ROC curve area of Ktransmean, Ktrans75% in the diagnosis of pathological grade for esophageal squamous cell carcinoma was 0.750,0.856,respectively. The diagnostic efficiency of Ktrans75% was the best with the diagnostic threshold of 0.693/min,sensitivity of 87.5%, specificity of 78.5%, respectively. Conclusion The quantitative parameters of DCE?MRI after neoadjuvant chemotherapy in esophageal squamous cell carcinoma have the potential value for predicting pathological grade.

7.
Chinese Journal of Radiology ; (12): 385-388, 2019.
Article in Chinese | WPRIM | ID: wpr-754935

ABSTRACT

Objective To investigate the effectiveness and safety of esophageal covered stent for the treatment of esophagogastric cervical anastomotic fistula. Methods Retrospective analysis of clinical and imaging data of patients with esophageal and gastric anastomotic neck fistula treated by esophageal membrane stent implantation in the Affiliated Tumor Hospital of Zhengzhou University from July 2015 to June 2018. Twenty‐one cases, 15 males and 6 females were enrolled. All patients showed fistula after esophagogastrostomy for esophageal carcinoma. All the fistulas were located in the cervical segment of esophagus and were diagnosed as anastomotic fistula 2 to 13 days after surgery. The length of esophagus residue, the position and size of the fistula were measured by esophagography. We retrospectively analyzed the data of patients with cervical anastomotic fistula treated with esophageal covered stent. Patients were followed up for more than 6 months by review and telephone follow‐up. Results In the 21 patients, 19 (90.5%) were successfully implanted stents at one time, and 2 (9.5%) were placed at a lower position. The esophageal stent was implanted for 10 to 60 days (31±19) days, and the stent was successfully removed after the fistula healed, with a procedure time of 6 to 23 minutes. No recurrence of fistula was found during follow‐up. Four patients had anastomotic scar stenosis, and eating smoothly after balloon dilatation. Conclusion Esophageal covered stent implantation is a safe and effective technique for gastroesophageal cervical anastomotic fistula.

8.
Article in Chinese | WPRIM | ID: wpr-752987

ABSTRACT

Objective To explore the predictive value of intravoxel incoherent motion (IVIM) imaging for the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma (ESCC).Methods The prospective study was conducted.The clinicopathological data of 33 patients with locally advanced ESCC who were admitted to Affiliated Hospital of Zhengzhou University from September 2015 to October 2017 were collected.Patients received magnetic resonance imaging (MRI) and IVIM imaging examination before and after neoadjuvant chemotherapy.Two radiologists read the imaging together,manually delineated the region of interest in the diffusion-weighted imaging,and the apparent diffusion coefficient (ADC),diffusion coefficient (D),perfusion coefficient (D*),and perfusion score of the tumor (f) were automatically measured.Patients underwent neoadjuvant chemotherapy with paclitaxel plus cisplatin,and underwent radical surgery for esophageal cancer after 2 cycles of chemotherapy.Observation indicators:(1) comparison of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with ESCC;(2) comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with different tumor regression grade (TRG);(3) predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG.Measurement data with normal distribution were presented as Mean±SD,and comparison before and after neoadjuvant chemotherapy was done using the paired t test,and comparison between different TRG patients was done using the t test.Measurement data with skewed distribution were presented as M(P25,P75),and comparison before and after neoadjuvant chemotherapy and between different TRG patients were done using the Wilcoxon rank sum test.The receiver operating characteristic (ROC) curve was used to evaluate predictive value of IVIM imaging parameters.Results Thirty-three patients were screened for eligibility,including 26 males and 7 females,aged from 44 to 74 years,with an average age of 60 years.All the 33 patients were diagnosed as ESCC by pathological examination.(1) Comparison of IVIM parameters before and after neoadjuvant chemotherapy in patients with ESCC:33 patients with ESCC showed a significant difference in the ADC,D,and f value after neoadjuvant chemotherapy [ADC:(1.95±0.56) × 10-3 mm2/s vs.(2.54±0.50) × 10-3 mm2/s,t=-6.98;D:(1.26×10-3 mm2/s (0.81×10-3 mm2/s,2.44×10-3 mm2/s) vs.1.68×10-3 mm2/s (0.83×10-3 mm2/s,2.27×10-3 mm2/s),Z=-3.96;f:0.33%±0.14% vs.0.42%±0.15%,t=-3.13,P< 0.05].(2) Comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in different TRG patients:of 33 patients,15 were in TRG 2 and 18 were in TRG 3.The ADC change value,ADC change rate,D change value,D change rate were (0.85±0.52)× 10-3 mm2/s,52.91%± 32.51%,0.64× 10-3 mm2/s (0.05× 10-3 mm2/s,1.41 × 10-3 mm2/s),48.20% (3.03%,16.95%) of TRG 2 patients,and (0.38±0.35)×10-3 mm2/s,21.94%±19.08%,0.26×10-3 mm2/s (-1.43×10-3 mm2/s,0.81× 10-3 mm2/s),20.18% (-58.61%,77.14%) of TRG 3 patients,respectively,with significant differences between two groups (t=3.09,3.41,Z=-3.04,-2.93,P<0.05).(3) Predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG:ROC curve analysis showed that ADC change value exhibited an area under curve (AUC) of 0.798,a sensitivity of 66.7% and a specificity of 94.4% in predicting TRG,when 0.86× 10-3 mm2/s was used as the cut-off value.With 43.3% as the cut-off value,ADC change rate had an AUC of 0.793,a sensitivity of 66.7% and a specificity of 88.9% in predicting TRG.With 0.35× 10-3 mm2/s as the cut-off value,D change value had an AUC of 0.809,a sensitivity of 73.3% and a specificity of 77.8% in predicting TRG.With 25.9% as the cut-off value,D change rate had an AUC of 0.800,a sensitivity of 80.0% and a specificity of 72.2% in predicting TRG.Conclusions The change value and change rate of ADC and D values before and after neoadjuvant chemotherapy are potential predictors of pathologic response in ESCC.The significantly increased ADC and D values after neoadjuvant chemotherapy are prone to good pathologic response.The change value and change rate of D values show a better predictive value for pathologic response to neoadjuvant chemotherapy in ESCC compared with those of ADC values.

9.
Journal of Practical Radiology ; (12): 977-980, 2019.
Article in Chinese | WPRIM | ID: wpr-752479

ABSTRACT

Objective To explore whether CT perfusion imaging (CTPI)parameters can early predict the curative effect of anlotinib hydrochloride and their predictive accuracy for the treatment in lung cancer patients.Methods 2 6 patients with advanced nonGsmall cell lung cancer (NSCLC)were treated with anlotinib hydrochloride and underwent CTPI scanning before chemotherapy,after the first and second treatment cycle respectively.The average values of perfusion value (PV),peak enhancement image (PEI),time to peak (TTP),blood volume (BV)and the change rate of these parameters after one treatment cycle every time were measured and recorded. According to the response evaluation criteria in solid tumors 1.1 (RECIST1.1),the maximum diameter of the target tumor was measured and the tumor regression rate after two treatment cycles was calculated.Then a correlation analysis was conducted between the change rate of perfusion parameters (PV%,PEI%,TTP%,BV%)after one treatment cycle and the tumor regression rate (D%)after two treatment cycles. The ROC curve was performed to evaluate the accuracy of those parameters.Results PV after one treatment cycle was significantly lower than that before treatment,and PV% showed a statistical difference (P=0.00).The PV% after one treatment cycle was positively correlated with D% after two treatment cycles (r=0.56).In addition,the AUC of PV% and BV% were 0.99 and 0.88 respectively, and specificity were both 100%,with sensitivity respectively 75.7% and 82.6%.Conclusion CTPI can early reflect the curative effect of anlotinib hydrochloride for advanced NSCLC and provide more options for clinical evaluation.

10.
Chinese Journal of Radiology ; (12): 127-132, 2019.
Article in Chinese | WPRIM | ID: wpr-745220

ABSTRACT

Objective To investigate the effect of embolization with ethanol-soaked gelatin sponge for the treatment of arterioportal shunting (APS) in patients with hepatocellular carcinoma (HCC). Methods From January 2016 to June 2017, a total of 78 patients with unresectable HCC were enrolled in this study. These patients were randomly divided into two groups by digital random method. The experimental group (n=39) received transarterial embolization of the shunt with ethanol-soaked gelatin sponge, while the control group (n=39) received only gelatin sponge shunt. Both of the two groups underwent transarterial chemoembolization if available. Changes in APS, tumor response (according to modified response evaluation criteria in solid tumor), changes in Eastern Cooperative Oncology Group (ECOG), and haemodynamics changes of the portal vein were analyzed. χ2 test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. The APS grades were compared between the two groups before treatment and 2 months after treatment using rank sum test. Results Six patients were lost during the 2-month follow-up, and 72 patients were followed up, which include 38 patients in the experimental group and 34 patients in the control group. Compared to (14/34), the experimental group (25/38) has higher The APS improvement rates of the experimental group and the control group were 65.8%(25/38) and 41.2%(14/34), and there was significant difference (χ2=4.379, P<0.05). Of the 72 patients, 66 cases were conform to modified response evaluation criteria in solid tumor, which include 35 patients in the experimental group and 31 patients in the control group. Tumor response at 2 months of the experimental group and the control group were 57.1%(20/35) and 32.3%(10/31), and there was significant difference (χ2=4.106, P<0.05). The ECOG score was significantly decreased from 2 points to ≤1 point in 19 cases in the experimental group, while 12 cases in the control group (χ2=6.894, P<0.05). Compared with the control group, the diameter of the portal vein dropped significantly (t=2.082, P<0.05), while the blood flow velocity of portal vein increased (t=2.219, P<0.05) obviously in the experimental group 1 month after treatment. Conclusion Tansarterial embolization with ethanol-soaked gelatin sponge can effectively improve APS improvement rate, and quality of life of patients with unresectable HCC accompanied with APS.

11.
Article in Chinese | WPRIM | ID: wpr-773516

ABSTRACT

OBJECTIVE@#To observe the inhibitory effects of PEG-APTES-MNP magnetic heating on liver cancer cells.@*METHODS@#The magnetic nanoparticle complex PEG-APTES-MNP was synthesized and its physiochemical properties and biocompatibility were characterized. HepG2 cells were incubated with the PEG-APTES-MNP nanoparticles for magnetic heating or nanoparticle therapy. Prussian blue staining was used to detect the uptake efficiency of the magnetic nanoparticles by HepG2 cells. MTT assay and flow cytometry were used to evaluate the inhibitory effect of the nanoparticles on HepG2 cells, and laser scanning confocal microscopy was used to detect the production of reactive oxygen species (ROS) in the cells. Fifteen nude mice bearing HepG2 cell xenografts were randomized equally into PEG-APTES-MNP injection group (with nanocomposite injection only), PEG-APTES-MNP magnetic heating group and control group (with PBS injection), and the tumor growth were observed in the mice after the treatments.@*RESULTS@#The synthesized PEG-APTES-MNP nanoparticles showed good physicochemical properties and biocompatibility. Incubation of HepG2 with the nanoparticles resulted in significantly increased ROS production, obvious inhibition of the cell growth through the synergetic effects of magnetic heating ( < 0.05), and significantly enhanced cell apoptosis. In the tumor-bearing nude mice, the nanoparticles strongly inhibited the tumor growth by magnetic heating ( < 0.05).@*CONCLUSIONS@#The magnetic nanocomposite PEG-APTES-MNP has good physicochemical properties and bioavailability and can strongly inhibit the growth of liver cancer cells both and in nude mice through magnetic heating, demonstrating its potential as a candidate nanomedicine for liver cancer treatment.


Subject(s)
Animals , Cell Line, Tumor , Cell Proliferation , Humans , Hyperthermia, Induced , Liver Neoplasms , Magnetics , Mice , Mice, Nude , Nanocomposites
12.
Journal of Practical Radiology ; (12): 501-504,525, 2018.
Article in Chinese | WPRIM | ID: wpr-696844

ABSTRACT

Objective To explore the clinical and MRI features of central neurocytoma(CNC).Methods The clinical and MRI data of the pathologically confirmed CNC were retrospectively collected and compared,all the patients had undergone pre-surgery MRI plain and contrast enhanced scans.Patients were divided according to the location of the tumor as intra-lateral ventricle and ex-lateral ventricle group.Results Forty patients were finally enrolled,all tumors were solitary,39 of which were located in the ventricular system,including 2 7 cases located in lateral ventricle and 1 2 in the lateral ventricle,2 in third ventricle,5 in both lateral and third ventricle and 5 involving the whole ventricles;and 1 located in ex-ventricle(left temporal lobe).The tumors showed iso-intense on T1WI and T2WI with varying degrees of cystic degeneration.Hemorrhage was shown in 5 cases,calcification in 2 cases,markedly hyper-vascular enhancements were shown in 36 cases with 26 cases presented visible enhanced vessel sign.The comparison analysis between intra-and ex-lateral ventricle groups revealed that,the patients age,tumor size and Ki-67 expression were higher in ex-lateral ventricle group(P<0.05);hypervascular enhancement (P<0.05),gender ratio,cystic/cystic-solid appearance and vessel sigh(P>0.05)were lower than those in intra-lateral ventricle group.Conclusion CNC is typically located in lateral ventricle,with cystic and necrotic degeneration areas,hypervascular enhancement with visible vessels in solid portion on enhanced MR images;The ex-lateral ventricle CNC is rare,it commonly presents a larger tumor with high Ki-67 expression,and moderate enhancement with less visible vessels on enhanced MRI.

13.
Chinese Journal of Oncology ; (12): 851-856, 2018.
Article in Chinese | WPRIM | ID: wpr-807669

ABSTRACT

Objective@#To study the application of intravoxel incoherent motion (IVIM) quantitative index combined with time-signal intensity curve (TIC) of dynamic contrast enhanced 3.0T magnetic resonance in the early precise diagnosis of residual lesions in non-small cell lung cancer (NSCLC) after argon-helium cryosurgery.@*Methods@#One hundred NSCLC patients who underwent argon-helium cryosurgery were collected and divided into the residual group (21 cases) and non-residual group (79 cases) according to the result of needle biopsy and follow-up. The apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (sADC), fast apparent diffusion coefficient (fADC), fraction of fast apparent diffusion coefficient (ffADC) and TIC type of IVIM quantitative index between the two groups were compared at 7 days and 1 month after argon-helium cryosurgery, respectively. The diagnosis performance of each quantitative index was analyzed by receiver operating characteristic (ROC) curve and the best cut-off value was computed. The specificity and sensitivity of TIC types were calculated as diagnostic criteria. The diagnosis performance of IVIM quantitative index combined with TIC type was evaluated and compared with the conventional MRI and DWI.@*Results@#The differences of ADC, sADC and ffADC at 7 days and 1 month after argon-helium cryosurgery between the residual group and non-residual group were statistically significant (all P<0.05), in which the diagnosis performance of sADC and ffADC were better. The AUC of sADC and ffADC at 7 days after argon-helium cryosurgery were 0.861 and 0.895, the sensitivity were 81.0% and 90.5%, and the specificity were 77.2% and 73.4%, respectively. The AUC of sADC and ffADC at 1 month after argon-helium cryosurgery were 0.836 and 0.883, the sensitivity were 100.0% and 76.2%, and the specificity were 58.2% and 89.9%, respectively. The diagnosis performance of TIC type Ⅱ&Ⅲ was best. The sensitivity and specificity were 80.9% and 58.2% at 7 days after treatment, 85.7% and 62.0% at 1 month after treatment, respectively. At 7 days after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 85.7%, while at 1 month after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 90.5%, respectively. The diagnosis performance of IVIM quantitative index combined with TIC type was better than conventional MRI and DWI.@*Conclusion@#The combination of IVIM quantitative index and TIC type can be used in the early diagnosis of residual lesions after argon-helium cryosurgery for NSCLC, whose effect is better than conventional MRI and DWI.

14.
Chinese Journal of Radiology ; (12): 581-586, 2018.
Article in Chinese | WPRIM | ID: wpr-807124

ABSTRACT

Objective@#To assess intravoxel incoherent motion(IVIM) in evaluating and predicting response to neoadjuvant chemotherapy(NAC) in esophageal squamous cell carcinoma(ESCC).@*Methods@#Forty-seven patients with ESCC diagnosed by pathological findings on biopsy from September 2015 to March 2017 were prospectively collected. All patients were examined before and after NAC using routine MRI scan and IVIM. The standard apparent diffusion coefficient (ADCstandard), diffusion coefficient (D), perfusion coefficient (D*) and perfusion score (f) were measured. The patients were divided into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) according to the 1.1 version of the response evaluation criteria in solid tumors (RECIST). Thirty-one patients underwent surgery after NAC, and the patients were divided into TRG 0-3 according to tumor regression grade (TRG). The differences of parameter values before and after NAC between different groups were analyzed using Student's t test (normal distribution) and Wilcoxon rank sum tests (non-normal distribution). The parameters with statistical significance were evaluated by the receiver operating characteristics (ROC) curves.@*Results@#The ADCstandard values before and after NAC were (1.97±0.51) ×10-3, (2.42±0.52)×10-3 mm2/s. The D values before and after NAC were (1.30±0.30)×10-3, (1.63±0.35)×10-3 mm2/s. The ADCstandard and D values after NAC were significantly higher than those before NAC, and the differences were statistically significant (t=-6.35, -5.25 respectively, both P<0.01). There were no statistical differences on D* and f between before and after NAC (P>0.05). The patients were divided into PR group (29 cases) and SD group (18 cases) after NAC, without CR and PD patients. The ADCstandard, D and f values of PR group were significantly lower than those of the SD group before NAC (t=-3.11, -2.53 and -2.10 respectively, all P<0.05). The ADCstandard, D, D* and f values after NAC revealed no significant difference between PR and SD groups. Thirty-one patients received operation after NAC, which were divided into TRG 2 group (14 cases) and TRG 3 group (17 cases) according to TRG standard, without TRG 0 and TRG 1 patients. All the parameter values before NAC revealed no significant difference between TRG 2 and TRG 3 groups. The D values after NAC in TRG 2 and TRG 3 groups were (1.81±0.31)×10-3, (1.46±0.39)×10-3 mm2/s respectively, and the significant difference was found between two groups (t=2.76, P<0.05). The efficiency of efficacy evaluation for NAC was the highest at D value of 1.68×10-3 mm2/s, with sensitivity and specificity being 85.7% and 70.6%, respectively.@*Conclusion@#IVIM can be used as a new imaging method to evaluate and predict the efficacy of NAC for ESCC, among which the parameter D was the most valuable.

15.
Chinese Journal of Radiology ; (12): 199-203, 2018.
Article in Chinese | WPRIM | ID: wpr-707917

ABSTRACT

Objective To evaluate the value of 3T magnetic resonance imaging (MRI) in the preoperative T staging of potentially resectable esophageal cancer(EC), compared with endoscopic ultrasonography (EUS). Methods Patients with resectable EC pathologically confirmed by biopsy from March 2015 to September 2016 were prospectively enrolled. All patients underwent MRI (including T2-TSE-BLADE,DWI and radial-VIBE)and EUS one week after the biopsy,and MRI were performed prior to EUS, both MRI and EUS were acquired within one week before surgery. Two readers with more than 5 years experiences in the MRI diagnosis evaluated the MR image quality using a 5-point score independently. T staging was assigned on MRI and EUS by the two MRI readers using double-blind method and one endoscopist in accordance with the 7th edition of AJCC TNM Classification for EC, and any disagreement between two MRI readers was resolved by consensus with discussion to the third senior MRI doctor. The inter-observer agreement between two MRI readers were calculated using Kappa test for image quality scores and T staging results. Considering postoperative pathological T staging results as the gold standard, the performances of MRI and EUS were evaluated based on the accuracy rate and analyzed by χ2 test. Results A total of 70 patients were enrolled in the study, the good image quality cases (≥ 3 scores) were 66 in reader 1 and 68 in reader 2. The inter-observer agreement of the image quality scores by two readers was excellent (Kappa=0.824, P<0.05). The pathological results revealed 16 cases of T1 stage, 18 cases of T2 stage, 30 cases of T3 stage, and 6 cases of T4a stage. The inter-observer agreement of the preoperative T staging of EC by two readers was excellent (Kappa=0.809, P<0.05). The accuracy rates of MRI and EUS for preoperative T staging of EC were 92.9% (65/70) and 67.1% (47/70), respectively, and the difference in accuracy rates of two techniques was statistically significant (χ2=14.5, P<0.05). Conclusions The accuracy rate of MRI for preoperative T staging of EC is significantly higher than that of EUS. MRI can be used as a noninvasive method for preoperative T staging of EC.

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Chinese Journal of Radiology ; (12): 192-198, 2018.
Article in Chinese | WPRIM | ID: wpr-707916

ABSTRACT

Objective To investigate the value of introvoxel incoherent motion(IVIM)using 3.0 T MRI to evaluate response to concurrent chemoradiotherapy(CCRT)in patients with advanced uterine cervix cancer. Methods From July 2015 to December 2016,63 patients with advanced(≥ⅡB)cervical cancer diagnosed by clinical and imaging study, who had completed CCRT plan in Henan Cancer Hospital, were prospectively enrolled.Pelvic MRI protocol including T1WI,T2WI,IVIM and dynamic contrasted enhanced scans were performed in each patient before CCRT and 3 weeks after starting therapy(total dose of 30 Gy), and at the end of therapy (total dose of 90 Gy, 8 weeks after therapy). The mean values of ADC, true molecular diffusion coefficient(D),pseudodiffusion coefficient(D*)and perfusion fraction(f)in each tumor at pre-therapy, in the middle of therapy and post-therapy were measured and recorded as ADC-pre, D-pre, D*-pre,f-pre;ADC-mid,D-mid,D*-mid,f-mid and ADC-post,D-post,D*-post,f-post,respectively;the change rates of these parameters during and after therapy (recorded as ΔADC-mid, ΔD-mid, ΔD*-mid, Δf-mid;ΔADC-post, ΔD-post, ΔD*-post, Δf-post) were also calculated. Patients were classified into response group and non-response group,according to response evaluation criteria in solid tumors after CCRT.MRI imaging study was performed in each patient within 1 month after CCRT to follow up,and tumor regression rate was calculated.The Mann-Whitney U test was used to compare differences of parameters and their change rates between response group and non-response group. Spearman correlation analysis was performed to assess relationships between parameters, parameter change rates and tumor regression rate. Logistic regression model was applied to find potential ADC values for predicting therapeutic response. ROC was used to analyze efficacy of ADC values for evaluating therapeutic response in advanced uterine cervix cancer after CCRT. Results The mean value of tumor maximum diameter before and after therapy was (47.5 ± 12.9) and(12.8 ± 10.0)mm,tumor regression rate was(66.7 ± 33.6)%.Forty-eight patients were in the response group and 15 in the non-response group.The mean value of ADC-pre,D-pre,D*-pre and f-pre was 0.74(0.43, 1.14)×10-3,0.58(0.33,0.91)×10-3,12.12(2.30,21.4)×10-3mm2/s,9.65%(4.45%,13.89%),respectively.Tumor regression rate had positive correlation with ADC-pre and D-pre (r=0.773,0.840;P<0.05). Responders had increased ADC-pre, D-pre values than non-responders, which had statistically significant difference (P<0.05). Responders had increased ADC-mid, D-mid and f-mid values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-mid, D-mid and f-mid (r=0.808,0.834,0.563;P<0.05). Responders had increased ADC-post, D-post and f-post values than non-responders,which had statistically significant difference(P<0.05),tumor regression rate had positive correlation with ADC-post and D-post (r=0.799, 0.829;P<0.05).Tumor regression rate had positive correlation with ΔADC-mid,ΔD-mid,Δf-mid(r=0.526,0.573,0.454;P<0.05)and with ΔADC-post,ΔD-post, Δf-post (r=0.541, 0.555, 0.388;P<0.05). Responders had increased ΔADC-mid, ΔD-mid, Δf-mid and ΔADC-post, ΔD-post, Δf-post, which had statistically significant difference (P<0.05). Logistic regression analysis revealed only ADC-pre and D-post could be independent factors to predict therapeutic response in advanced uterine cervix cancer after CCRT,values of B,Wald,odds ratio and P was 22.488,8.431,1.429, 0.004 and 16.542,8.517,1.779,0.004.ROC analysis showed the area under the curve(AUC)of ADC-pre, D-pre,ΔADC-mid,ΔD-mid,Δf-mid,ΔADC-post,ΔD-post and Δf-post for predicting therapeutic response in advanced uterine cervix cancer after CCRT were 0.890,0.926,0.942,0.851,0.803,0.929,0.951 and 0.906, respectively. Conclusion The IVIM parameters before and during CCRT process and their changes are valuable for predicting and evaluating therapeutic response in advanced uterine cervix cancer after CCRT, with high clinical practice value.

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Article in Chinese | WPRIM | ID: wpr-706279

ABSTRACT

Objective To investigate the correlation between CT manifestations of intramural vascular abnormalities and pathological subtypes,ground glass types in ground-glass opacity (GGO) lung adenocarcinoma.Methods CT data of 50 patients (55 lesions) with GGO lung adenocarcinoma confirmed by operative pathology were analyzed.The vascular morphology was observed.Correlation between vascular abnormalities (vascular thickening and hyperplasia) and pathological subtypes,ground glass types in GGO lung adenocarcinoma were analyzed.Results Among 55 GGO lung adenocarcinoma lesions,5 were pre-invasive lesions,no vascular thickening was observed,whereas vascular increasing was noticed in 1 lesion.Among 16 minimally invasive adenocarcinomas (MIA),vascular thickening and vascular increasing were observed in 11 and 16 lesions,respectively.All 34 invasive adenocarcinomas (IAC) were found with vascular thickening and increasing.The overall difference of vascular thickening and vascular increasing among pre-invasive lesions,MIA and IAC was statistically significant (x2 =27.67,20.08,both P<0.05).There was positive correlation between pathological subtypes and vascular thickening and vascular increasing (r=0.61,0.66,P<0.01).Significant differences of vascular thickening were found between pre-invasive lesions and MIA (x2=9.19,P=0.01),pre-invasive lesions and IAC (x2 =29.87,P<0.01),as well as MIA and IAC (x2 =12.63,P<0.01).There were significant differences of vascular increasing between pre-invasive lesions and MIA,pre-invasive lesions and IAC (x2 =15.45,20.79,both P<0.01).Of all 55 GGO lung adenocarcinoma lesions,25 were pGGO,17 with vascular thickening and 21 vascular increasing;30 were mGGO,28 with vascular thickening and 30 vascular increasing.There were significant differences of vascular thickening and increasing in pGGO and mGGO (x2=6.12,6.69,both P<0.05).Conclusion Vascular abnormalities in GGO lung adenocarcinoma suggest increasing of invasion.Vascular thickening and increasing can occur independently.

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Chinese Journal of Radiology ; (12): 114-118, 2017.
Article in Chinese | WPRIM | ID: wpr-507228

ABSTRACT

Objective To analyze the value of conventional T2WI combining with breath-hold Cartesian VIBE sequence, and compared with Blade combining with breath-free radial VIBE sequences in pre-operative T staging of potentiallly resectable esophageal carcinoma. Methods Sixty-five cases of esophageal carcinoma were concluded prospectively. All patients had received pathological examination of gastroscope biopsy before MRI. Patients received MR examination, including T2WI, breath-hold VIBE, Blade, and breath-free radial VIBE sequences. Two radiologists with more than five years experiences in the diagnosis of chest, performed T staging in MRIby referring to the the 7th edition of UICC-AJCC TNM classification. The results of MRI T staging and the postoperative pathological T staging were analyzed byχ2 test. Results Sixty-five patients were included. Diagnostic coincidence rates of the preoperative T staging by using conventional T2WI combining with breath-hold Cartesian VIBE sequences and Blade combining with breath-free radial VIBE sequences were 51%(33/65) and 88%(57/65) ,with 32 and 8 cases overstaging or understaging respectively, and the statistical differences were significant(χ2=20.80, P<0.05). The former diagnostic accuracy of esophageal carcinoma in situ, muscularis violation and esophageal fiber membrane were 42%(8/19), 54%(14/26), 55%(11/20), and the latter were 89%(17/19), 88%(23/26), and 85%(17/20). Conclusions Diagnostic coincidence rate of the preoperative T staging by using Blade combining with breath-free radial VIBE sequences is much higher than conventional T2WI combining with breath-hold Cartesian VIBE sequences. Blade combining with breath-free radial VIBE sequences could be used as non-invasive imaging method in preoperative T staging of potentially resectable esophageal carcinoma.

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Journal of Interventional Radiology ; (12): 1114-1117, 2017.
Article in Chinese | WPRIM | ID: wpr-694181

ABSTRACT

Objective To evaluate the clinical value of CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy in treating refractory and recurrent pelvic malignant tumors.Methods A total of 35 patients with refractory and recurrent pelvic malignant tumor,who were admitted to authors' hospital during the period from January 2013 to January 2016 to receive CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy,were selected and used as the study group,while other 39 patients with refractory and recurrent pelvic malignant tumor received simple 125I particle implantation and were used as the control group.The short-term and long-term curative effect,as well as the improvement of clinical symptoms,were compared between the two groups.Results The objective effective rate and the benefit rate in the study group were 60.0% (21/35) and 85.7% (30/35) respectively,while those in the control group were 53.8% (21/39) and 84.6% (33/39) respectively,the differences between the two groups were not statistically significant (P=0.594 and P=0.894 respectively).In the study group the mean disease progressionfree period was 12.2 months,which was 3.6 months longer than that of 8.6 months in the control group,the difference between the two groups was statistically significant (P=0.002).The recurrence rates in the study group and the control group were 40.0%(12/30) and 57.6% (19/33) respectively,the difference between the two groups was statistically significant (P=0.018).The mean preoperative and postoperative KPS values in the study group were 72.4 points and 82.7 points respectively,which in the control group were 68.9 points and 79.1 points respectively;in each group statistically significant difference existed between the preoperative KPS value and the postoperative one (P=0.043 and P=0.039 respectively),however,no statistically significant difference in postoperative KPS value existed between the study group and the control group (P=0.745).Conclusion For the treatment of refractory and recurrent pelvic malignant tumors,CT-guided 125I particle implantation is an effective therapy,however,combination use of iliac artery infusion chemotherapy can reduce the incidence of tumor recurrence and prolong the disease progression-free period.

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Article in Chinese | WPRIM | ID: wpr-702620

ABSTRACT

Objective To investigate the clinical characteristics of percutaneous gastrostomy guided by different imaging techniques,in an effort to inform selection of imaging guidance.Methods A retrospective analysis was conducted on the clinical data of 277 patients who underwent percutaneous gastrostomy at Affiliated Tumor Hospital of Zhengzhou University from January 2014 to December 2016.The patients were divided into three groups according to the imaging techniques used,i.e.group A guided by fluoroscopy of digital subtraction angiography (DSA),group B by C-arm computed tomography (CT),and group C by CT throughout the process.The technical success rate,complication rate,operation time and patient's radiation dose were compared among the three groups.Results There was no siguificant difference in technical success rate (93.8%vs.97.3% vs.100%,x2=2.797,P=0.247) and complication rate (10.0% vs.11.3% vs.20.0%,x2=1.343,P=0.511) among the 3 groups,but the operation time [(25.57±5.99) min vs.(29.01±6.63) min vs.(45.47±8.98) min,x2 =27.977,P<0.001] and patient's radiation [(27.30± 19.27) mGy vs.(145.07±106.08) mGy vs.(2 590.26±1 088.22) mGy,x2 =204.444,P<0.001] dose were significantly different (x2=87.977,P<0.001;x2=204.444,P<0.001),with group A and B lower than group C (P< 0.001) and group A lower than group B (P≤0.001).Conclusions DSA fluoroscopic guidance should be the first choice for percutaneous gastrostomy,but before the operation,abdominal CT scan should be performed to exclude such situations as hypertrophy of left lobe of liver,and colon in front of the stomach.If the DSA machine is equipped with C-arm CT function,the surgery can also be directly guided by C-arm CT.Complete CT guidance can be used as a supplement in the case of failure by both DSA fluoroscopy and C-arm CT guidance.

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