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Objective@#To compare the Bismuth-Corlette typing, modified T-staging and Mayo staging system in predicting the radical resection rates and prognosis of patients with hilar cholangiocarcinoma (HCC).@*Methods@#The clinical data of 138 patients with hilar cholangiocarcinoma treated in the First Bethune Hospital of Jilin University were retrospectively analyzed. Three different staging methods were used.@*Results@#With increase in the classification level of the Bismuth-Corlette classification, the radical resection rate did not significantly decrease (P>0.05). The radical resection rates of stage T1, T2 and T3 in the modified T-staging system were 60.0% (27/45), 36.0% (10/28) and 14.0% (9/65) respectively (all P<0.05). The radical resection rates of patients in the stages I, II, III, IV of the Mayo Staging System were 86.0% (12/14), 50.0% (14/28), 29.0% (19/66) and 3/0% (1/30) respectively (all P<0.05). The overall survival time were no significant differences between the different Bismuth-Corlette and the modified T-staging system patients (P>0.05). However, there were significant differences among the survival rates in the various tumor staging levels using the Mayo Staging System.@*Conclusions@#The modified T-staging system and the Mayo staging system were more accurate than the Bismuth-Corlette typing system in predicting radical resection rates in patients with hilar cholangiocarcinoma. The Mayo staging system was superior to the Bismuth-Corlette typing system and the modified T-staging system in predicting prognosis of patients with hilar cholangiocarcinoma.
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@# Objective Toexploretheapplicationvalueof3.0TMRIinthepreoperativestagingandassessmentof rectal cancer. Methods Data of 103 patients with rectal cancer diagnosed by biopsy was collected. The T staging, situationsofparacoliclymphaticmetastasisandfasciainvolvement,anddistanceoftumoredgetoanalvergewereestimated bypreoperativeMRI.ThestageandassessmentofpreoperativeMRIandpostoperativepathologywerecompared. Results MRIshowedthattherewere5patientswithstageT1-2,72patientswithstageT3,and26patientswithstageT4.And pathologicaldiagnosisshowedthattherewere5patientswithstageT1,16patientswithstageT2,60patientswithstageT3, and22patientswithstageT4.ThesensitivityandspecificityofstageT1-2,T3,andT4were23.8%and100%,96.7%and 67.4%,90.9%and92.6%,respectively.ResultsofMRIwerebroadlyconsonantwiththeresultsofpathology(Kappa=0.748, P＜0.01).MRIshowedthattherewere74patientswithparacoliclymphaticmetastasis.Pathologicaldiagnosisaftersurgery showedthattherewere66patientswithparacoliclymphaticmetastasis.ThesensitivityandspecificityforMRIdiagnosis were92.4%and64.9%,respectively(Kappa=0.601,P＜0.01).Amongthe18patientsreceivedanalresection,thedifferent valueofdistanceoftumoredgetoanalvergewaslessthanorequalto6mmbetweenMRIandpostoperativespecimen,with nosignificantdifference(P＞0.05).Totally65patientswithoutfasciainvolvementdiagnosedbyMRIwereconsonantwith theresultsofpostoperativepathology.Amongthe38patientswithfasciainvolvementdiagnosedbyMRI,12patientswere false-positive.Thesensitivityandspecificitywere100.0%and84.4%,respectively(Kappa=0.732, P=0.000).Conclusion 3.0TMRIcanprovideaccuratepreoperativestagingandevaluationforpatientswithrectalcancerbeforetheoperation,and helpinclinicaldiagnosisandtreatment.
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Objective To investigate the application value of functional magnetic resonance imaging nethods diffusion weighted imagingand dynamic contrast-enhanced magnetic resonance imaging in theT stagingof rectal cancer.Methods Through the retrospectively analysis of DWI and DCE-MRI images of 78 rectal cancer patients confirmed by pathology,the different of routine sequence examination and functional magnetic resonance imaging combined with routine sequence examination in T thestaging diagnosis were contrasted analysis.The correlation of ADC value and quantitative parameters of Ktrans,Kep and Ve values with tumor T staging was analyzed.Results The functional magnetic resonance imaging combined with routine sequence examination in T staging screened 68 cases successfully,and the accuracy rate was 87.2％.preoperative T staging and postoperative pathology of rectal cancerwas better thanroutine sequence examinationin T staging (59 cases,with the accuracy rate 75.6％) (Kappavalue:0.81 vs 0.65,P ＜ 0.05).The ADCvalue andDCE-MRI quantitative parameters values of K and Ve increased with the increase of tumor T staging (P ＜ 0.05).There was no statistically significant difference of Kep values.Conclusions The ADC value and DCE-MRI quantitative parameters (K and Ve values) had certain relevance with Tstaging of rectal cancer.The functional magnetic resonance imaging had a high accuracy in the preoperative T staging of rectal cancer,which proves certain clinical value in judging invasion depth of tumor in the rectal wall.
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Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.
Subject(s)
Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Neoplasm Staging , Stomach Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Objective To assess the efficacy of diffusion weighted imaging( DWI) with Magnetic Reso-nance Imaging to predict the T-staging in rectal cancer.Methods One hundred and seven cases confirmed by pathology of rectal adenocarcinoma patients were retrospectively analyzed.T-staging was determined by MRI and DWI combined with MRI.All the patients were underwent surgery within one week after MRI.We compared the results with the pathological T-staging after surgery,and compared the two methods of the preoperative T-stag-ing rectal cancer diagnosis accuracy.Results The accurate rates for T-staging of rectal cancer using MRI was 84.11%(90/107) .There was a correlation between the result of preoperative MRI and postoperative pathological T-staging(kappa=0.652,P<0.001);The accurate rates for T-staging of rectal cancer using combined MRI with DWI was 90.65%(97/107).There was a better correlation between the result of MRI with DWI and postop-erative pathological T-staging(kappa=0.732,P<0.001).Conclusion Compared with the conventional MRI sequences,the accuracy of MRI combined with DWI for diagnosis of T-staging in rectal carcinoma is higher.It can provide a more reasonable treatment.
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Objective To compare the diagnostic accuracy of magnetic resonance (MR) images with multislice computer tomography (MSCT) for preoperative T-staging of patients with cardiac cancer. Methods MR and MSCT were performed in 28 cases of cardiac cancer diagnosed by biopsy prior to operation within one week. After an oral intake of 1000 ml water and an injection of hypotonic agent, MR and MSCT scan were carried out. MR sequences included FSE T1W, FSE T2W, FSE T1W with fat suppression and dynamic enhanced FSPGR with fat suppression. MSCT was applied with dynamic triphasic contrast enhancement. All of the findings were prospectively analyzed by two doctors separately and compared with the surgical and pathological findings. Results According to histopathologic staging, the accuracy of MR and MSCT in T1-staging were 88.8% and 11.1%, in T2-staging were 77.8% and 22.2%, in T3-staging were 83.3% and 32.7%, in T4-staging were 100.0% and 50.0%, respectively. Dynamic enhanced and delayed MR with fat suppression was superior to MSCT for revealing the involvement of esophagus and aorta, early stage of invasiveness and providing more evidences in T2 to T3 or T3 to T4 staging (P
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BACKGROUND: Despite the technical developments in diagnosis and therapy, esophageal cancer is highly lethal disease and the survival is largely dependent upon the stage of the disease. Preoperative cancer staging is crucial in choosing a therapeutic option as well as in predicting the prognosis of the patients. Staging has been based on computerized tomography (CT) and transabdominal ultrasonography. However CT has a limit in pre-cisely discriminating the depth of invasion or the lymph node metastases. With the devel-opment of endoscopic ultrasonography (EUS) and with its superiority in delineating wall structure and detecting lymph node metastases, its usefulness in staging for esophageal cancer has been cknowledged. In order to evaluate the accuracy of EUS, we compared EUS with pathologic findings in patients with esophageal carcinoma. METHODS: From July 1990 to August 1997, 136 patients with esophageal cancer received preoperative cancer staging with EUS. Among them, 48 patients who underwent surgical procedures with the intention of radical resection were included. We compared the EUS and pathologic find-ings and analysed the accuracy of EUS for preoperative staging. RESULTS: The overall accu-racy of EUS for T-staging was 43.8%. Twenty five percents of the patients (12/48) pre-sented high-grade tumor strictures, which precluded the passage of the endoscope. There was no statistical significance according to tumor site, size or gross morphology. However theaccuracy was significantly lower in tumors with ulceration than in tumors without ulceration (35.3% vs 64.3%, p=0.004). Mainly, ulceration in tumors caused significant overstaging of the T-stage. In the assessment of regional lymph node metastasis, the overall accuracy achieved by EUS was 66.6%; the sensitivity was 95.5%, specificity 42.3%, positive predictive value 58.3%, and negative predictive value 91.7%. Tumors with more than 2 lymph nodes rendered more accurate N-staging than tumors with less than 2 lymph nodes. CONCLUSIONS: In conclusion, the accuracy of the EUS for preoperative staging of esophageal cancer was not satisfactory, mostly influenced by ulceration in tumors and its resultant inflammatory reactions around the tumors, therefore more systematic study will be needed to establish the precise diagnostic criteria of EUS staging.