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Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.
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Objective: To clarify the diagnostic value of magnetic resonance imaging based on liver imaging reporting and data system (LI-RADS) for phosphatidylinositol proteoglycan-3 (GPC3) expression in hepatocellular carcinoma (HCC). Methods: Clinical and pathological data of 95 HCC cases with positive GPC3 expression (+) and 40 HCC cases with negative GPC3 expression (-) were retrospectively analyzed, and their MRI image features based on the 2018 version of LI-RADS were compared. Multivariate logistic regression analysis was used to determine the main predictors of GPC3 expression. Receiver operating characteristic curve was used further to determine the diagnostic efficacy of combined clinical imaging model to predict GPC3 expression. Enumeration data were compared with χ2 test or Fisher's exact test. Measurement data were compared using independent samples t-test or Mann-Whitney U-test. Results: There were statistically significant differences between HCC in GPC3 (+) and GPC3(-) group at alpha-fetoprotein (AFP) levels (χ2=31.814, P<0.000 1), and MRI features: capsular enhacement (χ2=4.108, P=0.043), halo type enhancement (χ2=4.847, P=0.028), and lesion apparent dispersion coefficient (ADC) (t=2.552, P=0.011 8). Multivariate regression analysis showed that AFP>20 μg/L (OR=9.358, P<0.000 1) and ADC≤1.404×10-3 mm2/s (OR=1.003, P=0.017) were independent predictors for GPC3 expression in HCC. The combined model and the area under the curve value for the diagnosis of GPC3(+) in HCC was 0.810, and its diagnostic sensitivity and specificity were 76.8% and 77.5%, respectively. Conclusion: AFP>20 μg/L and ADC≤1.404×10-3 mm2/s may indicate the expression of GPC3 in HCC, and the combination of the two diagnostic indicators can provide a simple and effective non-invasive diagnostic method for clinical practice.
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Biomarkers, Tumor , Carcinoma, Hepatocellular/pathology , Glypicans/metabolism , Humans , Liver Neoplasms/pathology , Magnetic Resonance Imaging , Phosphatidylinositols , Retrospective Studies , alpha-Fetoproteins/metabolismABSTRACT
Objective:To investigate the value of imaging features of contrast-enhanced computed tomography (CT) of pancreatic neuroendocrine neoplasm (panNEN) in predicting preoperative pathological grade.Methods:From February 2009 to August 2020, at Zhongshan Hospital affiliated to Fudan University, the CT data of 136 patients with panNEN diagnosed by surgery and pathology were retrospectively analyzed. According to World Health Organization classification of digestive tumors (5th edition, 2019), panNEN was classified into G1, G2, G3 neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC). The differences in CT values and correlative parameters of solid part of lesions with different pathological grades were compared. The receiver operator characteristic curve was drawn and the area under the curve (AUC) was calculated to evaluate the CT value and related parameters in the differential diagnosis of panNEN of different pathological grades. The Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 142 tumor lesions were detected in 136 panNEN patients, of which the numbers of G1, G2, G3 NET and NEC were 58, 73, 7 and 4, respectively. Along with the increase of pathological grade, the degree of CT enhancement in the solid part of panNEN lesions gradually decreased. The CT value, CT value difference and relative density of arterial phase and venous phase of patients with G2 NET were all lower than those of patients with G1 NET (Arterial phase: 105 HU, 46 to 251 HU vs. 126 HU, 57 to 195 HU; 62 HU, 6 to 212 HU vs. 81 HU, 23 to 166 HU; 1.1, 0.4 to 2.5 vs. 1.4, 0.7 to 2.0. Venous phase: 90 HU, 49 to 159 HU vs. 107 HU, 63 to 162 HU; 49 HU, 9 to 134 HU vs. 62 HU, 24 to 128 HU; 1.1, 0.5 to 2.0 vs. 1.4, 0.9 to 2.0), and the differences were statistically significant ( Harterial phase=2.880, 2.607 and 3.482, Hvenous phase=3.426, 3.323 and 3.891, all P<0.05). The CT value difference, the percentage of lesion enhancement, the index of lesion enhancement in arterial phase, and the CT value difference and the index of lesion enhancement in venous phase of patients with G3 NET were all lower than those of patients with G2 NET (31 HU, 27 to 52 HU vs. 62 HU, 6 to 212 HU; 67%, 59% to 153% vs. 151%, 15% to 705%; 0.6 HU, 0.5 to 0.9 HU vs. 1.3 HU, 0.1 to 5.8 HU; 40 HU, 36 to 52 HU vs. 49 HU, 9 to 134 HU; 0.9, 0.7 to 1.6 vs. 1.5, 0.2 to 5.4), and the differences were statistically significant ( H=2.634, 2.801, 3.267, 2.264 and 2.882, all P<0.05). The relative density index of arterial phase and venous phase to identify G1 and G2 NET received maximum AUC value of 0.679 (95% confidence interval ( CI) 0.587 to 0.771, P<0.01) and 0.701 (95% CI 0.609 to 0.793, P<0.01), respectively. The index of lesion enhancement in arterial phase and venous phase to identify G2 and G3 NET received maximum AUC value of 0.875 (95% CI 0.793 to 0.956, P=0.001) and 0.828 (95% CI 0.700 to 0.956, P=0.004), respectively. Conclusion:The enhanced CT parameters of panNEN can be used to predict the pathological grade before operation.
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Objective:To analyse the MRI features of hilar schwannomas and pathology.Methods:The MRI and pathological features of 5 patients with hilar schwannomas which were confirmed histopathologically at Zhongshan Hospital, Fudan University from January 2012 to August 2019 were retrospectively analyzed. There were 3 males and 2 females, with age ranging from 47 to 67 years (median age 59 years). Contrast-enhanced MRI scans were performed in these 5 patients. The site, shape, size, edge, signal and enhancement pattern of these lesions and pathologicl findings were analysed.Results:All the lesions were single, located in and around the perihilar region. Four lesions were oval or roundish, and 1 lesion was sausage-shaped. Two lesions were solid while 3 lesions were cystic solid. All lesions had clear borders with intact capsules. The solid parts in all the lesions showed isointensity or slightly hypointensity on T 1 weighted imaging, hyperintensity on fat-suppression T 2 weighted imaging (T 2WI), hyperintensity on diffusion weighted imaging, slightly hyperintensity / isointensity / slightly hypointensity on apparent diffusion coefficient maping with progressive mild to moderate enhancement. Thick septum was observed in the cystic part. The septum and capsule showed mild to moderate delayed enhancement. Fluid-fluid level was seen in one lesion. The cystic solid lesion in one patient showed the " target sign" on fat-suppression T 2WI. All the 5 tumors were close to blood vessels, and their long axes followed the shape of the portal vein. In 1 patient, the lesion slightly compressed the adjacent bile ducts. Pathological examination showed that all the tumors in the 5 patients had complete fibrous envelopes, and the solid parts of the tumor showed mainly spindle cells. Conclusions:The MRI features of hilar schwannomas were oval or sausage-shaped lesions, with the long axis along the portal vein. They were prone to develop cystic changes, and a"target sign"could be shown on fat-suppression T 2WI. The solid parts, septa and capsules of the lesions showed mild to moderate progressive enhancement after contrast-injection.
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Objective To investigate the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) on oxaliplatin-induced liver function injury in C57BL/6 mice.Metbods Forty male and six weeks old C57BL/6 mice without specific pathogens were included and the body weght ranged from 19 to 23 g.They were randomly assigned into control group,experimental group A,experimental group B and experimental group C (10 mice/group).The mice in the control group was intraperitoneally injected with saline solution.The mice in the experimental groups were intraperitoneally injected with oxaliplatin twice a week.The experimental group A,B and C were administered for 2 weeks,4 weeks and 6 weeks,respectively.The T1 relaxation time on the hepatobiliary phase and the first rapid enhancement slope percentage (ESP) in liver parenchyma were measured and calculated.Serum albumin and bilirubin values were measured and albumin and bilirubin (ALBI) scores were calculated.Pathological staining was used to observe liver tissue damage and fibrosis.The receiver operating characteristic (ROC) curve evaluated the ALBI score,ESP and T1 relaxation time on hepatobiliary phase for the diagnosis of liver function.Results Sixteen mice in the experimental groups (including group A,B and C) were included in the hepatic degeneration group (hepatocyte degeneration without fibrosis).Fourteen mice were included in the hepatic fibrosis group.T1 relaxation time on hepatobiliary phase in the hepatic fibrosis group was higher than that in the control group and in the hepatic degeneration group.The differences were statistically significant (P ＜ 0.05).The ESP of the control group,the hepatic degeneration group and the hepatic fibrosis group was increased,with statistically significant differences (all P ＜ 0.05).Compared with the control group,ALBI scores of the hepatic degeneration group and the hepatic fibrosis group were both decreased,with statistically significant differences (P ＜ 0.05).In the hepatic fibrosis group,the areas under the curve of ALBI scores,the T1 relaxation time on hepatobiliary phase and the ESP were 0.734,0.962 and 0.989,respectively.Conclusion The T1 relaxation time on hepatobiliary phase and the ESP of gadoxetic acid-enhanced MRI can effectively evaluate the hepatic function reduction induced by oxaliplatin-induced hepatic tissue injury in C57BL/6 mice.
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Objective:To investigate CT imaging appearance of pancreatic solid pseudopapillary neoplasm (pSPN) in predicting pathological invasive behaviors.Methods:The clinical data and CT data of 103 patients with solid pseudopapillary neoplasm confirmed by surgical resection and pathology were retrospectively analyzed. According to the pathological results, all cases were divided into two groups: invasive group with 38 cases and non-invasive group with 65 cases. All 103 cases of pSPN had a single lesion. Image analysis included tumor location, size, shape, capsule,calcification, hemorrhage and proportion of cystic or solid component, etc. The density of solid components in all lesions was measured in plain scan, arterial phase and venous phase of CT images. Enhancement degree in arterial phase, enhancement degree in venous phase and enhancement degree between venous phase and arterial phase were calculated, and the differences between the two groups were statistically analyzed. For data analysis, the comparison of continuous variables between two groups was done with Student′s t-test. Categorical variables were tested using the χ 2 test or Fisher′s exact test. Diagnostic accuracy of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were assessed as the area under the receiver-operating characteristic (ROC) curve. Results:There were statistically significant differences in tumor capsule and proportion of cystic or solid component between the two groups ( P<0.05). There were no significant differences in neoplasm maximum diameter, location, morphology, calcification, hemorrhage, pancreaticobiliary dilatation and pancreatic atrophy between the two groups ( P>0.05). The density[(76.65±16.71) HU] and enhancement degree[(41.04±17.02) HU] in venous phase in invasive group were higher than those in non-invasive group [respectively (70.09±12.02),(34.55±11.41) HU] and the differences were statistically significant ( P<0.05). There were no statistically significant differences in the density in plain scan, density in arterial phase, enhancement degree in arterial phase and enhancement degree between venous phase and arterial phase ( P>0.05). The area under the ROC curve of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were respectively 0.598, 0.634, 0.613, and 0.617, among which only density in venous phase had the discriminant efficacy, and the optimal critical value was 78.65 HU. Conclusion:The pSPN has no capsule or incomplete capsule, more solid components, and obvious enhancement of the solid components in the tumor in venous phase may suggest that the tumor has more invasive behavior.
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Objective To compare the MR] features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.Methods The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed.Of the 26 males and 7 females aged (56.0 ± 9.8) years,there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients.All patients underwent contrast-enhanced abdominal MRI scans.The differences in the MRI features,including morphology,margin,signal intensity on plain scanning and enhancement patterns were compared statistically.The apparent diffusion coefficient (ADC) values of peliosis hepatis,hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.Results In 14 lesions of the 11 patients with peliosis hepatis,10 lesions were ill-defined and 4 lesions were well-defined.In 31 lesions of the 22 patients with hepatic metastases,5 lesions were ill-defined and 26 lesions were well-defined.Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P ＜ 0.05).The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P ＜ 0.05).In all the 14 lesions of peliosis hepatis,10 lesions showed gradual filling enhancement,and 4 lesions showed marked and persistent enhancement.In all the 31 lesions of hepatic metastases,28 lesions showed a ring-shaped enhancement,and 3 lesions showed "quick in and quick out" enhancement.Conclusions The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined,with no restriction of water diffusion in the diffusion weighted imagings,and with progressive enhancement.The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To compare the compressed sensing (CS)and parallel imaging (PI)techniques applied to contrast-enhanced MRI (CE-MRI)scanning of liver and to determine their clinical applicability.Methods Thirty patients with liver mass who underwent the CE-MRI scanning with both CS and PI techniques were recruited in the current study.The SNR of the liver,acquisition time and subjective image quality scores were compared between CS (CE-MRI with CS)and PI (CE-MRI with PI)groups respectively.Results The SNR values of pre-enhancement T1 WI in CS group were lower than those in PI group (1 97.82±32.5 3 vs 204.94±35.28,P＜0.05).However,there was no significant difference in the SNR values of images in equilibrium phase between the two groups (CS vs PI:392.38±72.93 vs 405.03±82.09,P＞0.05).The acquisition time in CS group was significantly shorter than that in PI group [(11.71±0.23)s vs (17.85±0.42)s, P＜0.01].Significantly higher subjective image quality scores were found in CS group than those in PI group (3.54±0.57 vs 2.91±0.80,P＜0.01). Conclusion CS technique may benefit the patients who cannot hold breath well and improve the CE-MRI image quality.
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Objective To identify the preoperative MRI findings for predicting microvascular invasion (MVI) using texture analysis (TA) on multiple MRI sequences. Methods Two hundred and fifty patients with HCC pathologically confirmed by surgery in Zhongshan Hospital from October 2015 to October 2016 were analyzed retrospectively. All patients underwent conventional MRI plain scan and dynamic contrast?enhanced examination within 2 weeks before operation. According to the ratio of 1∶1, the patients were divided into a training set (125 cases) and a test set (125 cases).The training set was used to establish a classifier to predict MVI of HCCs via the TA, and the test set was used to evaluate the performance of the classifier. An image analysis was performed using an in?house software contained a set of 2 415 features which were generated from all conventional axial sequences, including the T2WI, DWI, ADC map, and dynamic enhancement images.. A four?fold cross validation (FFCV) and sequential forward floating feature selection strategy (SFFS) were employed to select an optimal subset of features and a linear discriminant analysis (LDA) was employed to establish a classifier. The clinical laboratory examination, morphologic characteristics and quantitative analysis of conventional MR were used to compare the performance of predicting MVI with the classifier. A Chi?squared test or Fisher exact probablities test were used for categorical variables, and independent t test or Mann?Whitney U test were used for used for continuous variables. Factors with a P value less than 0.05 at univariate analyses were entered into the multivariate model to identify independent predictors. The Hosmer?Lemeshow test was performed to explain the goodness of fit of the multivariate logistic model. A receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance. Results The classifier set up by the training set consists of 13 texture features. When conventional MRI texture features of test set were used to judge whether there was MVI or not, the AUC of all texture features of arterial phase (AP) was the highest (0.506 3). Univariate regression analysis showed that there were significant differences in pathological grade (P=0.026), AFP level (P=0.033), lesion edge shape (P=0.038), AP enhancement (P=0.038), and AP peritumoral enhancement (P=0.008). Multivariate binary logistic regression analysis showed that peritumoral enhancement and texture classifier assessed MVI with P values of 0.005 and 0.001,which were independent risk factors for MVI. The significance level of Hosmer Lemeshow test was 0.796, indicating the goodness of fit of acceptable models. The AUCs of single variable, combined variable (including of AFP level, irregular tumor margin, enhancement intensity in AP and peritumoral enhancement in AP) and texture classifier for MVI were 0.588 to 0.627, 0.798 and 0.733, respectively. When compared the AUC of the combination features (including of AFP level, irregular tumor margin, enhancement intensity in AP and peritumoral enhancement in AP) with the classifier to identify MVI of HCC in the test set, no significant difference was found(P=0.108 6). However, although the sensitivity of them were same as 70.73%, the specificity of the combination features was mildly higher than that of classifier (82.14% vs. 78.57%). Conclusions Combination features of AFP level, tumor margin, enhancement intensity in AP and peritumoral enhancement in AP can be used to predict MVI of HCCs. It is a new method of noninvasive evaluation of MVI before operation. The performance of the classifier made by TA was not superior to that of combination features based on clinic and conventional MR sequences.
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Objective Myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO) was prospectively predicted using extracellular volume fraction (ECV) based on cardiovascular magnetic resonance (CMR). Methods Thirty patients with CTO underwent CMR before and 6 months after percutaneous coronary intervention (PCI) were enrolled. The CMR scan protocol included cine, pre?contrast and post?contrast T1 mapping and late gadolinium enhancement (LGE). Ejection fraction (EF) and segmental wall thickening (SWT) were calculated using CVI 42 software. SWT less than 45% indicated myocardial segment dysfunction. According to the American Heart Association (AHA) scientific statement, the dysfunctional segments assigned to CTO vessel were selected, and three baseline imaging markers, ECV, transmural extent of infarction (TEI) and unenhanced rim thickness (RIM) were respectively evaluated. The myocardial segments were divided into two subgroups, group with well?developed collaterals and group with poorly?developed collaterals, based on the collateral circulation using Rentrop classification. Baseline and follow?up values of SWT and EF were evaluated using paired Student′s t?test. Using an increase in SWT>10% as standard reference, ROC analysis was conducted to describe the predictive performance of baseline markers. A mixed linear model was used to probe the relationship between collateral circulation and SWT. Stepwise logistic regression analysis was used to determine the independent predictors of regional functional recovery. The differences of EF between poorly?developed and well?developed collaterals were compared by Student t test. Results The baseline mean segmental wall thickening (SWT) of the dysfunctional segments increased from 21.6% (9.7%, 33.3%) to 38.4% (19.0%, 51.2%) after PCI (Z=-6.869, P<0.001), and EF was also significantly higher compared with baseline (54.5%±8.5 % vs. 50.7%± 6.6%, t=-5.706, P<0.001). ECV showed good performance in predicting functional recovery with cutoff value 34.7%, area under ROC curve (AUC) 0.86, sensitivity 91%, and specificity 66%. The AUC of ECV was superior to TEI and RIM (AUC: 0.75 and 0.73, all P value<0.01). The segments with well?developed collaterals were associated with a higher SWT at follow?up [46.6% (36.6%, 64.2%) vs. 33.5% (12.8%, 47.8%),F=5.791, P=0.02]. Logistic regression analysis demonstrated that mean segmental ECV was the only independent predictors of regional functional outcome after PCI (OR=0.83, 95% confidence interval: 0.77—0.89; P<0.001). Conclusions ECV by CMR may provide incremental value for the prediction of regional functional recovery in CTO patients, and baseline collateral circulation correlates with the regional systolic function after revascularization.
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Objective To identify the risk factors of early post-surgical recurrence of hepatocellular carcinoma (HCC) within 2 years.Methods This retrospective study included 178 consecutive patients with HCC who underwent curative resection between January 2009 to December 2012 at Zhongshan Hospital,Fudan University.There were 151 males and 27 females,with a mean age of (58±11) years.The CT features including rim enhancement,satellite nodule,two-trait predictor of venous invasion (TTPVI),and nonsmooth tumor margins were reviewed.After hospital discharge,the patients were followed-up regularly for at least 2 years to detect tumor recurrence.The primary end point was recurrence of HCC.Results On univariate analyses AFP ≥ 200 μg/L,rim enhancement,TTPVI,non-smooth tumor margins and largest diameter ＞5 cm were correlated with early post-surgical recurrence of HCC.On multivariate analyses,AFP≥200 pg/L (HR=2.144,95％CI:1.350～ 3.406),rim enhancement (HR =2.196,95％ CI:1.345 ～ 3.587),TTPVI (HR=1.735,95％CI:1.086～2.772),and non-smooth tumor margins (HR=2.065,95％CI:1.242～3.432) were independent risk factors of early post-surgical recurrence of HCC.Conclusion AFP≥200 μg/L,rim enhancement,TTPVI,and non-smooth tumor margins were independent risk factors of early post-surgical recurrence of HCC.
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OBJECTIVE: To evaluate a modified subtraction coronary computed tomography angiography (CCTA) technique with a two-breathhold approach in terms of image quality and stenosis grading of calcified coronary segments and in the detection of significant coronary stenosis in segments with severe calcification. MATERIALS AND METHODS: The institutional board approved this study, and all subjects provided written consent. A total of 128 patients were recruited into this trial, of which 32 underwent subtraction CCTA scans and invasive coronary angiography (ICA). The average Agatston score was 356 ± 145. In severely calcified coronary segments, the presence of significant (> 50%) stenosis was assessed on both conventional CCTA and subtraction CCTA images, and the results were finally compared with ICA findings as the gold standard. RESULTS: For severely calcified segments, the image quality in conventional CCTA significantly improved from 2.51 ± 0.98 to 3.12 ± 0.94 in subtraction CCTA (p < 0.001). In target segments, specificity (70% vs. 87%; p = 0.005) and positive predictive value (61% vs. 79%, p < 0.01) were improved using subtraction CCTA in comparison with conventional CCTA, with no loss in the negative predictive value. The segment-based diagnostic accuracy for detecting significant stenosis was significantly better in subtraction CCTA than in conventional CCTA (area under the receiver operating characteristic curve, 0.94 vs. 0.85; p = 0.03). CONCLUSION: This modified subtraction CCTA method showed lower misregistration and better image quality in patients with limited breathhold capability. In comparison with conventional CCTA, modified subtraction CCTA would allow stenosis regrading and improve the diagnostic accuracy in coronary segments with severe calcification.
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Angiography , Constriction, Pathologic , Coronary Angiography , Coronary Stenosis , Humans , Methods , ROC Curve , Sensitivity and SpecificityABSTRACT
OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
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Collateral Circulation , Coronary Vessels , Follow-Up Studies , Humans , Infarction , Magnetic Resonance Imaging , Myocardial Infarction , Myocardial Ischemia , Myocardium , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
Objective@#The characteristics of T1 relaxation values and the expression levels of organic anion transport system (OATP) and multidrug resistance protein carrier (MRP) on hepatocyte surface membrane were quantitatively studied to evaluate liver function in normal C57BL/6 mice with gadoxetic disodium-enhanced MRI.@*Methods@#Ten 6-weeks-old, normal C57BL/6 mice were included in this study. Gadoxetic disodium- enhanced MRI examination was performed. Longitudinal relaxation time images before and 20 min after contrast injection (hepatobiliary-specific phase) were acquired. T1-relaxation time, T1 relaxation time decline rate (△T) and rapid initial enhancement slope percentage in the first-pass study of the liver parenchyma before and after administration of gadoxetate disodium were measured. Liver parenchyma specimens were detected by Western blotting and the values of OATP1, MRP2, and MRP3 were recorded. Statistical results were expressed in mean.@*Results@#The mean T1 relaxation time of 10 normal C57BL/6 mice before and after enhancement was 659.13 ± 24.07, and 408.87 ± 27.21 ms. The mean T1 relaxation time decline rate and rapid initial enhancement slope percentage in the first-pass study was 37.12% ± 4.95% and 4.14% ± 0.96% ms. Furthermore, the mean value of OATP1, MRP2 and MRP3 were 29 952.1 ± 11 475.2, 34 376.4 ± 33 228.4 and 357 308.9 ± 64 646.5.@*Conclusion@#T1-relaxation values, T1 relaxation time decline rate and rapid initial enhancement slope percentage in the first-pass study before and after gadoxetic disodium-enhanced MRI were determined in normal C57BL/6 mice as well as quantitative values of OATP1, MRP2 and MRP3 at the molecular level on the hepatocyte surface membrane were helpful for liver injury model with control study.
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Objective@#To compare the MRI features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.@*Methods@#The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of the 26 males and 7 females aged (56.0±9.8) years, there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients. All patients underwent contrast-enhanced abdominal MRI scans. The differences in the MRI features, including morphology, margin, signal intensity on plain scanning and enhancement patterns were compared statistically. The apparent diffusion coefficient (ADC) values of peliosis hepatis, hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.@*Results@#In 14 lesions of the 11 patients with peliosis hepatis, 10 lesions were ill-defined and 4 lesions were well-defined. In 31 lesions of the 22 patients with hepatic metastases, 5 lesions were ill-defined and 26 lesions were well-defined. Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P<0.05). The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P<0.05). In all the 14 lesions of peliosis hepatis, 10 lesions showed gradual filling enhancement, and 4 lesions showed marked and persistent enhancement. In all the 31 lesions of hepatic metastases, 28 lesions showed a ring-shaped enhancement, and 3 lesions showed "quick in and quick out" enhancement.@*Conclusions@#The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined, with no restriction of water diffusion in the diffusion weighted imagings, and with progressive enhancement. The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To analyze magnetic resonance imaging (MRI) features of adenosquamous carcinoma of the pancreas and to summarize MRI signs with diagnostic value.Methods From August 2010 to June 2017,at Zhongshan Hospital Affiliated to Fudan University,the MRI data of 20 patients with pathologically diagnosed adenosquamous carcinoma of pancreas were retrospectively analyzed.The image analysis included tumor location,size,morphology,lesion borders,signal intensity,enhancement pattern,bile duct and main pancreatic duct dilatation,pancreatic atrophy,extrapancreatic invasion,lymph node metastasis and liver metastasis.Results The lesions of all the 20 patients with pancreatic adenosquamous carcinoma were single,and the diameter was (3.39 ± 1.17) cm (1.37 to 5.87 cm).The lesions of 12 patients were located in the head of pancreas,and eight cases were located in body and (or)tail.Eleven lesions were round and nine lesions were irregular.Eight lesions had clear lesion boundaries,and 12 lesions had blurred lesion boundaries.The imagines of 20 lesions showed slightly lower or hypointensity signal on T1 weighted imaging (T1WI),and equal or slightly higher signal on T2 weighted imaging (T2WI).There were different sizes of necrosis or cystic areas in 18 lesions,and two lesions were complete solid masses.The imagines of 19 lesions showed uneven enhancement during dynamic enhanced scan,which were ring-shaped or separated.The enhancement started from the periphery of tumors,and the signal intensity of the enhanced areas within the lesions approached or exceeded the signal intensity of the normal pancreatic tissue.Conclusion Pancreatic adenosquamous carcinoma is prone to cystic necrosis,and its enhanced MRI imaging has certain characteristics.
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Objective@#To evaluate the measured value of gadoxetic disodium - enhanced T1-weighted magnetic resonance for the prediction of liver damage (LD) including liver fibrosis and inflammation.@*Methods@#Retrospectively analyzed laboratory data of 115 patients with pathological results including prothrombin time (PT), albumin, serum total bilirubin level (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and magnetic resonance measurements (T1 measurement before and after enhancement and hepatobiliary specific phase T1pre, T1post, and changes in T1 relaxation time before and after enhancement were measured). The correlation between LD and magnetic resonance measurements was assessed by Spearman’s correlation. All cases were divided into two groups: LD < 1 and LD≥1 (n1 = 26, n2 = 89), and the mean value of both groups was compared by t-test or Mann-Whitney U test. The independent influence factors of LD were obtained by binary logistic regression model. The area under receiver operating characteristics (AUROC) curve was performed on T1pre, T1post, and variation values.@*Results@#Spearman's correlation test showed that T1post and variation values were significantly associated with LD, and the correlation coefficients were 0.435, -0.353 and P < 0.05, respectively. The mean values of T1post, variation values, PT, albumin, ALT and AST were statistically significant (P < 0.05). Binary logistic regression model showed T1post (P = 0.006), PT (P = 0.003), and AST (P = 0.032) were independent influencing factors of LD. T1- post contrast was good predictor of liver damage (AUC = 0.800).@*Conclusion@#T1-post contrast predicts the existence of liver damage and provides useful information for clinical diagnosis and treatment.
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Objective To investigate the value of quantitative multi-phase enhanced MRI combined with histogram analysis of ADC in differential diagnosis of intrahepatic biliary cystadenoma (HBCA) and intrahepatic biliary cystadeno carcinoma (HBCAC). Methods Twenty-five patients with pathologically confirmed intrahepatic biliary cystic tumor (HBCT), including 16 cases of HBCA and 9 cases of HBCAC, were retrospectively analyzed. All the patients underwent upper abdominal MR plain scan and multi-phase enhanced scan. The MRI findings of the lesions were observed. The peak contrast enhancement ratio (pCER) of the lesions in the arterial phase, portal venous phase and delayed phase was calculated. ADC histogram analysis was performed and the quantitative parameters were acquired, including the average,standard deviation, median, kurtosis, skewness, and the 10th, 30th,70th, 90th percentile. Qualitative parameters were compared using Fisher exact test. The continuous variables with normal distribution and homogeneous variance were compared by independent sample t test. The continuous variables with skewed distribution were compared by Mann-Whitney U test. The ROC curve analysis was used to evaluate the differential diagnostic ability of the variables with significant differences between HBCA and HBCAC patients.Results There was a statistically significant difference between HBCA and HBCAC in terms of gender, age and whether there was bile duct dilatation or mural nodules (all P<0.05). However, the maximum diameter, high signal intensity of the cystic fluid on T1WI and septa of the lesions were not statistically significant (all P>0.05). The pCER of arterial phase, portal venous phase and delayed phase of HBCAC patients were higher than those of HBCA patients (all P<0.05).The standard deviation of ADC value of HBCAC group was higher than that of HBCA group, while the kurtosis and the 10th percentile were lower than those of HBCA group, and the differences were statistically significant between the two groups (all P<0.05). When the 10th percentile value of ADC histogram was≤ 2.060 × 10-3 mm2/s, the area under the ROC curve of discriminating between HBCA and HBCAC was the largest (0.861), and the diagnostic accuracy, sensitivity and specificity were 84.0 % and 77.8 % and 87.5 %, respectively. Conclusion Quantitative multi-phase enhanced MRI combined with histogram analysis of ADC had certain value for the differential diagnosis of HBCA and HBCAC, and the 10th percentile of the ADC histogram had the best diagnostic efficiency.
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Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the staging of chronic kidney disease(CKD).Methods From May 2016 to April 2017,seventy-two patients diagnosed as CKD according to the criteria of clinical diagnostic and 20 healthy volunteers (control group) underwent routine MRI and IVIM-DWI ( 8 b values, 0 to 800 s/mm2).CKD patients were divided into two groups based on their estimated glomerular filtration rate (eGFR): mild CKD group(45 cases,eGFR≥60 ml·min-1·1.73m-2)and moderate to severe CKD group(27 cases,eGFR<60 ml·min-1·1.73 m-2).The ADC,true diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction (f) were measured on both cortex and medulla. The paired-samples t test was used to compare the cortico-medullary difference of the ADC,D,D*and f values in three groups.Differences of the ADC,D, D*and f values among three groups were compared using the one-way analysis of variance (ANOVA). Correlations between eGFR and the IVIM-DWI parameters in CKD were evaluated by using Pearson correlation analysis. ROC was performed to evaluate the diagnostic efficiency of using IVIM-DWI parameters to distinguish CKD with moderate to severe renal impairment from mild renal impairment, as well as distinguish CKD with mild renal impairment from healthy volunteers.Results The cortical ADC,D, D*and f values were significantly higher than that in the medulla in healthy volunteers(all P<0.05). The cortical ADC,D*and f values were significantly higher than that in the medulla in mild CKD group(all P<0.05). The cortical ADC,D and f values were significantly higher than that in the medulla in moderate to severe CKD group (all P<0.05). The ADC,D,D*and f values of cortex and medulla showed significantly differences among three groups(all P<0.05).In CKD patients,no significant correlation was found between medullary D*,f values and eGFR, there was a significant positive correlation between eGFR and cortical ADC,D,D*and f values(r=0.475,0.362,0.625,0.276;all P<0.05),as well as between eGFR and medullary ADC,D values(r=0.427,0.615;P<0.05). The results of the ROC analysis for distinguishing the mild CKD group from the moderate to severe CKD group revealed that the cortical D*value had the highest area under the ROC curve (AUC=0.965), cortical f value showed high sensitivity(92.6%) to distinguish CKD with different degree of renal impairment, with the threshold of 32.99%, and cortical D*value showed high specificity(97.8%)with the threshold of 17.07×10-3mm2/s;the results of the ROC analysis for distinguishing the mild CKD group from healthy volunteers revealed that the cortical D*value had the highest AUC(0.885), medullary ADC value showed high sensitivity (82.2%) to distinguish mild CKD group from healthy volunteers,with the threshold of 1.83×10-3mm2/s,and medullary f value showed high specificity(100.0%)with the threshold of 21.70%,as well as medullary D value showed high specificity(100.0%)with the threshold of 1.75× 10-3mm2/s.Conclusion IVIM-DWI may be useful for CKD early diagnosis and assessing renal function.