Histogram analysis of based on two-dimensional ultrasound images to differentiate medullary thyroid carcinoma and thyroid adenoma / 中华肿瘤杂志

Objective: To investigate the feasibility and value of histogram analysis based on two-dimensional gray-scale ultrasonography in the differential diagnosis of medullary thyroid carcinoma (MTC) and thyroid adenoma (TA). Methods: The preoperative ultrasound images of 86 newly diagnosed MTC patients and 100 TA patients treated in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to October 2021 were collected. Histograms were performed based on the regions of interest (ROIs) delineated manually by two radiologists, thereafter, mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th) were generated. The histogram parameters between the MTC group and the TA group were compared, and the independent predictors were screened by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to compare the individual diagnostic efficacy and joint diagnostic efficacy of independent predictors. Results: Multivariate regression analysis showed that mean, skewness, kurtosis and 50th percentile were independent factors. The skewness and kurtosis in the MTC group were significantly higher than those in the TA group, and the mean and 50th percentile were significantly lower than those in the TA group. The area under the individual ROC curve of mean, skewness, kurtosis and 50th percentile is 0.654-0.778. The area under the combined ROC curve is 0.826. Conclusion: Histogram analysis based on two-dimensional gray-scale ultrasonography is a promising tool to distinguish MTC from TA, in which the joint diagnosis value of mean, skewness, kurtosis and 50th percentile is the highest.

Prognostic value of diffusion kurtosis imaging histogram based nomogram model for cervical cancer / 中华放射肿瘤学杂志

Objective:To analyze the prognostic value of nomogram model for cervical cancer based on the imaging features of diffusion kurtosis imaging (DKI) histogram.Methods:The DKI and clinical data of 272 patients with cervical cancer who were admitted to Affiliated Hospital of Guangdong Medical University from March 2015 to February 2022 were collected and retrospectively analyzed. All patients were randomly divided into the training group ( n=190) and validation group ( n=82) at a ratio of 7 vs. 3. The parameters of DKI histogram were obtained by GE AW 4.2 MRI software. The best prognostic imaging features were screened by LASSO regression. The DKI radiomics score was calculated by linear combination. The independent risk factors of prognosis were identified by univariate and multivariate regression analyses, and a nomogram model was constructed. The model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The internal consistency of the model was evaluated by the calibration map. Results:Adenocarcinoma ( HR=2.496, 95% CI=1.312-4.749, P=0.005), DKI score ( HR=24.087, 95% CI=6.062-95.711, P<0.001), depth of invasion ≥ 1/2 muscular layer ( HR=2.277, 95% CI=1.156-4.487, P=0.017) and neutrophil to lymphocyte ratio (NLR) ( HR=1.800, 95% CI=1.313-2.468, P<0.001) were the independent risk factors for prognosis of cervical cancer. The AUC of the nomogram model in the training and validation groups were 0.860 and 0.757, respectively. The calibration curve was well fitted with the 45° diagonal. The prediction results of long-term prognosis of this model were in good agreement with the actual situation. Conclusions:Adenocarcinoma, NLR, DKI score and depth of invasion ≥ 1/2 muscular layer are the independent risk factors for the prognosis of patients with cervical cancer. The constructed nomogram model could reliably predict the 3-year survival rate of patients with cervical cancer.

Correlation between three-dimensional histogram analysis of dynamic contrast-enhanced MRI and Gleason score in prostate cancer / 中华老年医学杂志

Objective:To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital, and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods:A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca, including transport constant(K trans), rate constant(K ep), percent volume of the extravascular extracellular space(V e)and fraction of the Intraplasmic contrast volume(V p), were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum, maximum, median, mean, area, 10 thpercentile, 25 thpercentile, 75 thpercentile and 90 thpercentile.The correlations between quantitative parameters and GS, and diagnostic efficiencies were analyzed. Results:102 Pca patients were divided into low-grade prostate cancer group(GS≤3+ 4)(n=44)and high-grade Pca group(GS≥4+ 3)(n=58). There were no statistically significant differences in age and location of lesions between the two groups( P>0.05), but there were statistically significant differences in Gleason score, PSA level and lesion diameter between the two groups( U=0.000, 730.000, 711.000, all P<0.05). The median, mean, 10 thpercentile, 25 thpercentile, 75 thpercentile, 90 thpercentile derived from K trans, and K ep(median, mean, 10%, 25%, 75%, 90%)together with maximum of K transand mean for V e were positively correlated with GS( r=0.405 to 0.583, P<0.05), in which mean of K transhad the highest positive correlation( r=0.583, P=0.000). The histogram parameters derived from V pwere negatively correlated with GS( r=-0.301 to 0.341, P<0.05). The area under ROC of 75th percentile derived from K transwas the highest(0.832). When the cut-off value of 75 thpercentile derived from K transwas ≥0.680/min, its Youden index, sensitivity, and specificity were 0.594, 0.776, 0.818, respectively. Conclusions:The three-dimensional histogram of DCE-MRI quantitative parameters has correlation with GS in Pca patients, can be used to discriminate low-grade from high-grade Pca.

Contrast-enhanced CT histogram analysis in differentiating benign and malignant thyroid nodules / 中国医学影像技术

Objective: To explore the value of histogram features based on plain and enhanced CT for differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 132 patients with 140 thyroid nodules confirmed by postoperative pathology were retrospectively analyzed. The level with the largest axial focus was selected, and then Mazda software was used to sketch ROI along the edge of focus and perform histogram analysis to obtain 9 parameters. The parameters were compared between benign and malignant nodules, and then statistically significant gray-scale histogram parameters were used to analyze their value of differentiating benign and malignant thyroid nodules. Results: On plain CT, the mean value, the 10th, 50th and 90th percentiles of malignant nodules were higher than those of benign ones (all P0.05). Among the parameters of CT plain and enhanced histogram, the 10th percentile AUC was the highest of 0.68, and the sensitivity of identifying benign and malignant thyroid nodules was 74.32%,and specificity was 62.12%. Conclusion: CT histogram analysis can be used as an important auxiliary means to identify benign and malignant thyroid nodules.

In Vivo Detection of Lipid-Core Plaques by Coronary CT Angiography: A Head-to-Head Comparison with Histologic Findings

200 µm, a circumference > 60 degrees, and a cap thickness < 450 µm. The percentage distributions of CT pixel attenuation ≤ 20, 30, 40, and 50 HU were calculated using quantitative histogram analysis.RESULTS: A total of 271 transverse sections were co-registered between CCTA and pathological analysis. Overall, 26 lipid cores and 16 fibrous plaques were identified by pathological analysis. There was no significant difference in median CT attenuation between the lipid and fibrous plaques (51 HU [interquartile range, 46–63] vs. 57 HU [interquartile range, 50–64], p = 0.659). The median percentage of CT pixel attenuation ≤ 30 HU accounted for 11% (5–17) of lipid-core plaques and 0% (0–2) of fibrous plaques (p < 0.001). The sensitivity and specificity of the method for diagnosing lipid plaques by the average CT pixel attenuation ≤ 30 HU were 80.8% and 87.5%, respectively. The area under the receiver operator characteristics curve was 0.898 (95% confidence interval: 0.765–0.970; 3.0% was the best cut-off value). The diagnostic performance was significantly higher than those of the average pixel CT attenuation percentages ≤ 20, 40, and 50 HU and the mean CT attenuation (p < 0.05).CONCLUSION: In in vivo conditions, with the pathological lipid core as the gold standard, quantification of the percentage of average CT pixel attenuation ≤ 30 HU in the histogram can be useful for accurate identification of lipid plaques.

Grayscale histogram analysis to study the echogenicity and echotexture of the walls of the common carotid arteries of horses and mules / Análise por histograma em escala de cinza para estudo da ecogenicidade e ecotextura das paredes das artérias carótidas comuns de equinos e muares

Visual inspection of ultrasound examination for assessment of echogenicity and echotexture of blood vessel tissues is a technique routinely used in medical practice in humans. However, simple visual inspection can lead to poor quality diagnoses and errors. The use of grayscale histogram (GSH) analysis has proved to be an efficient technique to quantify the region of interest, allowing minimization of image interpretation errors. This study aimed to evaluate and compare the echogenicity and echotexture of the walls of the common carotid arteries of healthy female horses and mules using the GSH technique and correlate them with age, body mass, and vessel diameters. B-mode ultrasound examinations were performed in the left and right common carotid arteries in three regions (cranial, middle, and caudal) in 11 horses and 11 healthy mules. The GSH of the animals showed heterogeneous walls, but did not differentiate statistically between female horses and mules. The Mean variable of the middle right, middle left and caudal right sides showed differences, more significant in the mules. On the middle right side, the Min variable was different, higher in the mules. On the middle and caudal left side, the variables Max and Mode showed higher values in the mules. For the mules, the age factor presented negative correlation with the Mean, Mode,, Mode(Count), and Mode(Count)/Count(%) variables, and the body mass factor presented negative correlation with the Mode, Mean and Max variables. For the female horses, the body mass factor showed positive correlation with the Mean and Mode variables. Echogenicity of the carotid artery walls differed between female horses and mules, whereas echotexture was heterogeneous and statistically similar among the animals. The age and body mass factors inversely influenced the echogenicity of the mules, but were not significant in the female horses, in which only the body mass factor positively influenced echogenicity.(AU)

A técnica de avaliação da ecogenicidade e ecotextura dos tecidos dos vasos sanguíneos por inspeção visual do exame de ultrassonografia, já é uma prática da rotina médica em humanos. No entanto, a simples visualização manual pode induzir à erros e diagnósticos de pouca qualidade. O uso de análise por histograma em escala de cinza (HEC) tem se demostrado uma eficiente técnica para quantificar a região avaliada, permitindo minimizar erros de interpretação. O objetivo deste trabalho foi avaliar e comparar a ecogenicidade e ecotextura das paredes das artérias carótidas comuns das fêmeas equina e muares hígidos usando a técnica de HEC, e correlacioná-las com a idade, massa corpórea e diâmetros dos vasos. Exames de ultrassonografia modo-B foram realizados nas artérias carótidas comuns esquerda e direita em três regiões (cranial, médio e caudal) em 11 fêmeas equina e 11 muares hígidos. O HEC dos animais apresentou paredes heterogêneas, mas não diferenciaram estatisticamente entre fêmeas equinas e muares. A variável Mean do lado direito médio, esquerdo médio e caudal apresentou diferenças, sendo maiores nos muares. No lado direito médio, o Min foi diferente, sendo superior nos muares. Já para o lado esquerdo médio e caudal, as variáveis Max e Mode apresentaram valores maiores nos muares. Para os muares, o fator idade apresentou correlação negativa com Mean, Mode, Mode (Count) e Mode(Count)/Count (%) e o fator massa corpórea apresentou correlação negativa com Mode, Mean e Max. Para as fêmeas equinas o fator massa corpórea apresentou correlação positiva com Mean e Mode. A ecogenicidade das paredes das artérias carótidas diferiram entre fêmeas equina e muares, já a ecotextura foi heterogênea e semelhante estatisticamente entre os animais. A idade e a massa corpórea influenciaram inversamente na ecogenicidade dos muares, enquanto que nas fêmeas equina a idade não foi significativa, apenas a massa corpórea influenciou positivamente com a ecogenicidade.(AU)

Impact of different ROI selection methods on histogram analysis parameters based on enhanced T1WI of high-grade gliomas / 中国医学影像技术

Objective: To investigate the repeatability of different ROI seletion methods on histogram analysis parameters of enhanced T1-weighted images of high-grade gliomas (HGGs). Methods: Four ROI selecting methods (small ROI method, contour ROI method, threshold ROI method and volume ROI method) were used to measure the histogram parameters on enhanced T1WI of 45 HGGs patients. The consistency between 2 observers and the differences of histogram parameters were evaluated. Results: The consistent of the mean, standard deviation and kurtosis values measured using volume, contour and threshold ROI methods between 2 observers were good (ICC≥0.80), and of the skewness values were moderate to good (ICC=0.73-0.90). The consistent of histogram characteristic parameters measured using small ROI method between 2 observers were low to medium (ICC=0.30-0.69). Histogram characteristic parameters measured with volume ROI method and contour ROI method had no significant difference (all P>0.05), but the average value, skewness value and kurtosis value measured with threshold ROI method were higher than those with volume and contour ROI method (all P<0.05), and the standard deviation of threshold ROI method was lower than that of volume ROI method and contour ROI method (both P<0.05). Standard deviation measured with small ROI method was lower than that of volume ROI method and contour ROI method (all P<0.05). Conclusion: The consistency of histogram characteristic parameters of HGGs on enhanced T1WI measured with volume ROI method is the highest, and different ROI selection methods have some impact on the measurement results of histogram characteristic parameters of enhanced T1WI.

Correlation of whole-volume apparent diffusion coefficient histogram parameters of rectal adenocarcinoma with clinico-pathological characteristics / 解放军医学杂志

Objective: To investigate the correlation between the histogram parameters of apparent diffusion coefficient (ADC) with clinico-pathological characteristics of rectal adenocarcinoma. Methods: The preoperative magnetic resonance imaging data of 64 patients diagnosed by pathology as rectal adenocarcinoma were collected. OmniKinetics software was employed to draw the outline of the ADC image on each layer of the tumor. The whole-volume ADC histogram parameters were automatically calculated with the post-processing software, including the minimum (ADCmin), maximum (ADCmax), median (ADCmedian), mean (ADCmean), 10th percentile (ADC10), 25th percentile (ADC25), 75th percentile (ADC75), 90th percentile (ADC90), skewness, and kurtosis. The differences in ADC parameters of tumor markers, immunohistochemical index, tumor size and lymph node metastasis were compared, and multiple linear regression was performed to analyze the correlation between the ADC histogram parameter and the clinico-pathological characteristics of rectal adenocarcinoma. Results: The ADC25 values were significantly lower in the groups of lymph node metastasis, Ki-67 ≥50%, CA199 ≥37 U/ml and CA72-4 ≥8.2 U/ml than those in the groups of lymph node non-metastasis, Ki-67 0.05). Multiple linear regression analysis reveled that positive CD31 was significantly correlated with ADCmean, ADC25 and ADC75 (P<0.05), and the ADC25 showed the greatest effect on CD31 positive (standard regression coefficient was 0.210). Conclusion: ADCmax, ADCmean, ADCmedian, ADC10, ADC25 and ADC75 possess high reliability in diagnosis of rectal adenocarcinoma. Among them, ADCmean, ADC25 and ADC75 have higher correlation with tumour markers and immunohistochemical indicators, may be used as important imaging biomarkers for evaluating the prognosis of rectal adenocarcinoma.

The clinical value of histogram analysis of diffusion kurtosis imaging in prostate cancer and the correlation between histogram parameters and Gleason score / 中华放射学杂志

Objective@#To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score.@*Methods@#Twenty-one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in-bore MR-guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent-samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer.@*Results@#Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing.@*Conclusion@#Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.

The clinical value of histogram analysis of diffusion kurtosis imaging in prostate cancer and the correlation between histogram parameters and Gleason score / 中华放射学杂志

Objective To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods Twenty?one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in?bore MR?guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent?samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.

Preliminary study on the relationship between histogram analysis of DCEGMRI quantitative parameters and clinical stage of nasopharyngeal carcinoma / 实用放射学杂志

Objective To investigate the relationship between histogram analysis of DCE-MRI quantitative parameters and clinical stage of nasopharyngeal carcinoma (NPC).Methods 70 patients with NPC confirmed by pathology underwent MRI examination and staging.NPC tumors were measured by full-volume ROI setting method,and the obtained DCE-MRI quantitative parameters were analyzed by histogram.Spearman correlation coefficients were obtained to evaluate the potential correlation between the DCE-MRI histogram quantitative parameters and NPC clinical stages.Results The histogram-based Ktrans (mean,10 th,75 th,90 th),Kep (mean,10 th,kurtosis),and Ve (mean,90 th,skewness)had correlation with T stage (P＜0.05,respectively).The histogram-based Ktrans (mean)and Ve (mean,90 th) showed correlation with N stage (P＜0.05,respectively).The histogram-based Kep (kurtosis)and Ve (mean)had correlation with M stage (P＜0.05,respectively).The histogram-based Kep had no correlation with N stage,and Ktrans had no correlation with M stage. The histogram-based Ktrans (mean,10 th,75 th,90 th),Kep (10 th,75 th,kurtosis)and Ve (mean,75 th,90 th)had correlation with overall stage (P＜0.05,respectively).Conclusion The histogram analysis of DCE-MRI quantitative parameters showed that the multiple parameters associated with NPC overall stages.DCE-MRI quantitative parameters non-invasively reflect the aggressiveness and progression of NPC.The histogram analysis of DCE-MRI quantitative parameters may play a role in clinical stage of NPC.

Histogram analysis of dynamic contrast enhancement MRI in predicting long-term treatment effect of cervical cancer after chemoradiotherapy / 中华放射学杂志

Objective To investigate the potential value of pre-treatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting long-term survival of cervical cancer treated by concurrent chemoradiotherapy. Methods Uterine cervical cancer patients who received chemo-radiation therapy during 2008 to 2014 in a single institute were retrospectively collected and followed up. Pre-treatment DCE-MRI images were retrieved to generate four hemodynamic related parameters including positive enhancement integral (PEI), maximum slop of increase (MSI), maximum slope of decrease (MSD) and signal enhancement ratio (SER). Region of interests were drawn manually on T2WI along the rim of tumors on each slice, and were then registered to DCE-MRI parametric maps. Histogram analysis software was used to calculate the mean, median, maximum, minimum,10th percentile, 90th percentile, kurtosis and skewness values for each DCE-MRI parameters. Median follow-up time was 54.7 months (range 2.1 to 94.6 months). Uni-and multivariable Cox regression analyses were used to evaluate correlation between the above values and the disease free survival (DFS). Kaplan-Meier curve was used to evaluate survival time. Results Of the 75 patients, 16 of them died from cervical cancer, 3 patients had metastasis, and 1 patient continued to progress. Median, mean, 10th and 90th percentile from MSI, and minimum, kurtosis, skewness were the influencing factors of disease-free survival of cervical cancer with concurrent chemoradiotherapy (P<0.1) Pearson relationship analysis and multivariable Cox regression analysis was performed which indicated PEI kurtosis value of cervical cancer was an independent influencing factor for cervical cancer without disease survival (hazard ratio 1.658, P=0.001). Conclusion PEI kurtosis was an independent factor for DFS of locally advanced cervical cancer treated with concurrent chemoradiotherapy.

Evaluation of the Impact of Iterative Reconstruction Algorithms on Computed Tomography Texture Features of the Liver Parenchyma Using the Filtration-Histogram Method

OBJECTIVE: To evaluate whether computed tomography (CT) reconstruction algorithms affect the CT texture features of the liver parenchyma. MATERIALS AND METHODS: This retrospective study comprised 58 patients (normal liver, n = 34; chronic liver disease [CLD], n = 24) who underwent liver CT scans using a single CT scanner. All CT images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (IR) (iDOSE4), and model-based IR (IMR). On arterial phase (AP) and portal venous phase (PVP) CT imaging, quantitative texture analysis of the liver parenchyma using a single-slice region of interest was performed at the level of the hepatic hilum using a filtration-histogram statistic-based method with different filter values. Texture features were compared among the three reconstruction methods and between normal livers and those from CLD patients. Additionally, we evaluated the inter- and intra-observer reliability of the CT texture analysis by calculating intraclass correlation coefficients (ICCs). RESULTS: IR techniques affect various CT texture features of the liver parenchyma. In particular, model-based IR frequently showed significant differences compared to FBP or hybrid IR on both AP and PVP CT imaging. Significant variation in entropy was observed between the three reconstruction algorithms on PVP imaging (p 0.75) for CT imaging without filtration. CONCLUSION: CT texture features of the liver parenchyma evaluated using the filtration-histogram method were significantly affected by the CT reconstruction algorithm used.

Measurement of Pancreatic Fat Fraction by CT Histogram Analysis to Predict Pancreatic Fistula after Pancreaticoduodenectomy

OBJECTIVE: To evaluate the effectiveness of computed tomography (CT) Hounsfield unit histogram analysis (HUHA) in postoperative pancreatic fistula (PF) prediction. MATERIALS AND METHODS: Fifty-four patients (33 males and 21 females; mean age, 65.6 years; age range, 37–89 years) who had undergone preoperative CT and pancreaticoduodenectomy were included in this retrospective study. Two radiologists measured mean CT Hounsfield unit (CTHU) values by drawing regions of interest (ROIs) at the level of the pancreaticojejunostomy site on preoperative pre-contrast images. The HUHA values were arbitrarily divided into three categories, comprising HUHA-A ≤ 0 HU, 0 HU < HUHA-B < 30 HU, and HUHA-C ≥ 30 HU. Each HUHA value within the ROI was calculated as a percentage of the entire area using commercial 3-dimensional analysis software. Pancreas texture was evaluated as soft or hard by manual palpation. RESULTS: Fifteen patients (27.8%) had clinically relevant PFs. The PF group had significantly higher HUHA-A (p < 0.01) and significantly lower mean CTHU (p < 0.01) values than those of the non-PF group. The HUHA-A value had a moderately strong correlation with PF occurrence (r = 0.60, p < 0.01), whereas the mean CTHU had a weak negative correlation with PF occurrence (r = −0.27, p < 0.01). The HUHA-A and mean CTHU areas under the curve (AUCs) for predicting PF occurrence were 0.86 and 0.65, respectively, with significant difference (p < 0.01). The HUHA-A and mean CTHU AUCs for predicting pancreatic softness were 0.86 and 0.64, respectively, with significant difference (p < 0.01). CONCLUSION: The HUHA-A values on preoperative pre-contrast CT images demonstrate a strong correlation with PF occurrence.

Histogram Analysis of Diffusion Kurtosis Magnetic Resonance Imaging for Diagnosis of Hepatic Fibrosis

OBJECTIVE: To investigate the diagnostic value of diffusion kurtosis imaging (DKI) histogram analysis in hepatic fibrosis staging. MATERIALS AND METHODS: Thirty-six rats were divided into carbon tetrachloride-induced fibrosis groups (6 rats per group for 2, 4, 6, and 8 weeks) and a control group (n = 12). MRI was performed using a 3T scanner. Histograms of DKI were obtained for corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis and 25th and 75th percentiles were generated and compared according to the fibrosis stage and inflammatory activity. RESULTS: A total of 35 rats were included, and 12, 5, 5, 6, and 7 rats were diagnosed as F0–F4. The mean, median, 25th and 75th percentiles, kurtosis of D map, median, 25th percentile, skewness of K map, and 75th percentile of ADC map demonstrated significant correlation with fibrosis stage (r = −0.767 to 0.339, p < 0.001 to p = 0.039). The fibrosis score was the independent variable associated with histogram parameters compared with inflammatory activity grade (p < 0.001 to p = 0.041), except the median of K map (p = 0.185). Areas under the receiver operating characteristic curve of D were larger than K and ADC maps in fibrosis staging, although no significant differences existed in pairwise comparisons (p = 0.0512 to p = 0.847). CONCLUSION: Corrected apparent diffusion of DKI histogram analysis provides added value and better diagnostic performance to detect various liver fibrosis stages compared with ADC.

The value of histogram quantitative analysis based on diffusion kurtosis imaging in detecting prostate cancer and assessing tumor aggressiveness / 中华放射学杂志

Objective To explore the application value of histogram quantitative analysis based on diffusion kurtosis imaging (DKI) in detecting prostate cancer (PCa) and assessing tumor aggressiveness. Methods One hundred and twenty patients were retrospectively enrolled in Zhongnan Hospital of Wuhan University from November 2014 to November 2016,with diagnosis confirmed by prostate biopsy,definitive Gleason score(GS) results and prostate MRI examinations. There were 90 tumor foci in 67 prostate cancer patients, including 23 cases with GS≤6 (37 tumor foci), 7 GS 3+4=7(7 tumor foci), 3 GS 4+3=7(3 tumor foci).Thirty four cases who were with GS≥8(43 tumor foci)were divided into low-grade PCa(37 GS≤6)and high-grade PCa(53 GS≥7).Fifty three patients were diagnosed with benign prostatic hyperplasia(BPH).All patients underwent conventional prostate MRI examination and multi b value DKI examination. The apparent diffusion coefficient(Dapp)corrected by non-Gaussian model,apparent kurtosis coefficient(Kapp)and ADC value were obtained for histogram analysis.Student's t test was executed to compare the differences of ADCs,Dappand Kappvalues between prostate cancer(PCa)and BPH,low-grade PCa and high-grade PCa.ROC curves were used to evaluate the diagnostic value of ADCs,Dappand Kappvalues in differentiating PCa from BPH and differentiating high-grade PCa from low-grade PCa. Pearson correlation was used to assess the correlations between the histogram quantitative parameters of ADCs,Dappand Kappvalues and Gleason score. Results Except skew of Kapp, the other histogram quantitative parameters of Kappbetween PCa and BPH were statistically significant (all P<0.05). Except the skew of Kapp, the other histogram quantitative parameters of Kappbetween low-grade PCa and high-grade PCa were statistically significant(all P<0.05).The median,mean and standard deviation of ADC,Dappand Kapphave good diagnostic value in detecting PCa from BPH and differing high-grade PCa from low-grade PCa.The area under ROC curve was ranging from 0.558 to 0.985.There were moderate to high correlations between median,mean of ADC(r=-0.701 and-0.676, respectively),median,mean of Dapp(r=-0.712 and-0.701,respectively),median,standard deviation,and kurtosis of Kapp(r=0.458,0.516 and-0.528,respectively)and Gleason score(all P<0.05).Conclusion The DKI parameters combined with histogram quantitative analysis is helpful in detecting prostate cancer and assessing tumor aggressiveness.

A Whole-Tumor Histogram Analysis of Apparent Diffusion Coefficient Maps for Differentiating Thymic Carcinoma from Lymphoma

OBJECTIVE: To assess the performance of a whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating thymic carcinoma from lymphoma, and compare it with that of a commonly used hot-spot region-of-interest (ROI)-based ADC measurement. MATERIALS AND METHODS: Diffusion weighted imaging data of 15 patients with thymic carcinoma and 13 patients with lymphoma were retrospectively collected and processed with a mono-exponential model. ADC measurements were performed by using a histogram-based and hot-spot-ROI-based approach. In the histogram-based approach, the following parameters were generated: mean ADC (ADCmean), median ADC (ADCmedian), 10th and 90th percentile of ADC (ADC10 and ADC90), kurtosis, and skewness. The difference in ADCs between thymic carcinoma and lymphoma was compared using a t test. Receiver operating characteristic analyses were conducted to determine and compare the differentiating performance of ADCs. RESULTS: Lymphoma demonstrated significantly lower ADCmean, ADCmedian, ADC10, ADC90, and hot-spot-ROI-based mean ADC than those found in thymic carcinoma (all p values < 0.05). There were no differences found in the kurtosis (p = 0.412) and skewness (p = 0.273). The ADC10 demonstrated optimal differentiating performance (cut-off value, 0.403 × 10−3 mm2/s; area under the receiver operating characteristic curve [AUC], 0.977; sensitivity, 92.3%; specificity, 93.3%), followed by the ADCmean, ADCmedian, ADC90, and hot-spot-ROI-based mean ADC. The AUC of ADC10 was significantly higher than that of the hot spot ROI based ADC (0.977 vs. 0.797, p = 0.036). CONCLUSION: Compared with the commonly used hot spot ROI based ADC measurement, a histogram analysis of ADC maps can improve the differentiating performance between thymic carcinoma and lymphoma.

Progress in quantitative imaging evaluation of tumor spatial heterogeneity / 中华放射肿瘤学杂志

Tumor heterogeneity is characteristic in malignant tumors. It is a new challenge in imageology to achieve the visualization of tumor heterogeneity and precise quantification using modern imaging techniques. To solve this problem,the newly emerging radiomics is applied to analyze tumor spatial heterogeneity,with a visualization effect.Image quantification methods,including histogram analysis,texture analysis,and parametric response mapping, can accelerate the research and development of new drugs, improve the efficacy prediction,modify the treatment regimen,and promote the prognostic evaluation.

Application of MRI histogram analysis in assessment risk of medulloblastoma recurrence / 中国介入影像与治疗学

Objective To explore the value of MRI histogram analysis in the risk assessment of medulloblastoma recur rence.Methods The data of 28 patients pathologically confirmed of medulloblastoma was analyzed retrospectively.All patients were divided into recurrent group and the non recurrent group (each n=14).The ROIs were drawn on the maximum level of enhanced MR sagittal images,and the histogram analysis were performed using the software named Mazda.The statistical analysis was performed on the histogram parameters to find out the different characteristics between the two groups,and the ROC curve was drawn to evaluate its diagnostic efficacy for recurrence of medulloblastoma.Results In all of the 9 parameters which are extracted from histogram,kurtosis had statistical significance between the 2 groups (P=0.018).The area under the ROC curve was 0.776 (P=0.018),and the sensitivity and specificity of kurtosis in the risk assessment of medulloblastoma recurrence were 64.3％ and 71.4％,respectively.Conclusion MRI histogram analysis can be an important method to assess the risk of medulloblastoma recurrence.

Differential diagnostic value of CT scan minimum attenuation values in adrenal adenomas and non-adenomas / 中华内分泌外科杂志

Objective To investigate the differential diagnostic value of CT scan minimum attenuation values (minAVsCT) in adrenal adenomas and non-adenomas.Methods CT scan data of 89 cases of clinical and pathologically confirmed adrenal adenomas were subjected to retrospective analysis and compared with data of 46 cases involving 50 non-adenomas (25 metastases,20 pheochromocytomas,3 lymphomas,and 2 cortical carcinomas).The distributions of mean attenuation values (meanAVs) ￥ 10 Hu and minAVs ￥0 Hu and CT histogram analysis with ≥ 10％ negative pixels were observed in adrenal adenomas and non-adenomas,and the diagnostic sensitivity and specificity of these 3 methods for adenomas were calculated.Results The distributions of unenhanced meanAVs ￥ 10 Hu,minAVs ￥0 Hu,and CT histogram analysis with ≥ 10％ negative pixels among cases of adenoma and non-adenoma were 62.9％ (56/89) and 0％ (0/50) (x2=52.687,P=0.000),84.3％ (75/89) and 2％ (1/50) （x2=83.917,P=0.000),and 77.5％ (69/89) and 0％ (0/50) (x2=83.917,P=0.000),respectively.The respective diagnostic sensitivities,specificities,false negative rate (FNR),false positive rate (FPR),positive pre dictive value (PPV),negative predictive value (NPV) and accuracy of these 3 methods for adenomas were 62.9％vs 84.3％ vs 77.5％,100％ vs 98.0％ vs 100％,37.1％ vs 15.7％ vs 22.5％,0 vs 2％ vs 0,100％ vs 98.7％ vs 100％,60.2％ vs 77.8％ vs 71.4％,and 76.3％ vs 89.2％ vs 85.6％.Conclusion Although the specificity and PPV of minAVs≤0Hu is slightly less than meanAVs≤10Hu and CT histogram analysis with ≥ 10％ negative pixels,it exhibits the best sensitivity and accuracy with a simple operation,and is thus suitable for clinical application.