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Objective@#To explore the value of diffusion-weighted magnetic resonance imaging (MR-DWI) technique in predicting the efficacy of radiotherapy in patients with esophageal cancer, using experimental animal models.@*Methods@#BALB/c nude mice were subcutaneously injected with Eca-109 cell lines and then tumor formed. The experimental group (16 cases) received a single dose of 15 Gy (6 MV X-rays) delivered by a medical linear accelerator, while the control group (24 cases) did not receive any treatment. The two groups were scanned every other day, started one day before the radiotherapy. The scanning sequences included T1-weight imaging, T2-weight imaging, and DWI. The observation time was 1 month. According to the changes of the tumor volume and apparent diffusion coefficient (ADC) value of the two groups, 7 key time points were selected to observe the difference of cell density and tissue necrosis ratio between the two groups (6 cases in each group).@*Results@#From day 7 after radiotherapy, the experimental group had statistically smaller volume of transplanted tumors than the control group, namely (1.729±0.906) cm3 vs (2.671±0.915) cm3(P<0.05). From day 3 after radiotherapy, the experimental group had statistically higher ADC values [(1.017±0.255)×10-6 vs (0.833±0.142)×10-6 mm2/s, P<0.05], lower cell density of transplanted tumor (25.56±1.40 vs 33.48±4.18%, P<0.05), and less proportion of tissue necrosis [(32.19±1.21) % vs (29.16±2.16)%, P<0.05], respectively. The ADC value was negatively correlated with cell density (r=-0.703, P<0.001) and positively correlated with tissue necrosis ratio (r=0.658, P=0.003).@*Conclusions@#Single dose of large fraction radiotherapy could inhibit the growth of xenograft. ADC values may change at the early stage prior to morphological changes of tumor. The change of cell density and necrosis ratio of transplanted tumor are in line with the change of ADC value. MR-DWI has the value of early prediction of esophageal cancer radiotherapy efficacy.
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Objective To explore the value of diffusion kurtosis imaging (DKI) in predicting radiotherapy sensitivity of esophageal cancer from the animal model level.Methods BALB/c nude mice were subcutaneously injected with Eca-109 cell lines to form xenograft tumors.The tumors received a single dose of 15 Gy (6 MV X-rays) in the experimental group or had no any treatment as control.The volume of transplanted tumor,the change of ADC,MK and MD values,and the tumor cell density and necrosis ratio of these two groups were observed at the corresponding time points.Results The growth of xenograft volume in the experimental group was suppressed and it was significantly smaller than that in the control group (t=3.206-6.149,P＜0.05) at the 7th day after radiotherapy.From the 3rd day after radiotherapy,the ADC and MD values of the experimental group were significantly higher than those of the control group,and the MK values was lower than those in the control group (tADC =-11.018--2.049,tMD =-6.609--2.052,tMK =2.492-9.323,P＜0.05).Meanwhile,the tumor cell density of the control group was higher than that of the experimental group,and the proportion of necrosis in the experimental group was higher than that in the control group (tdensity =-8.387--2.239,t is =2.980-17.430,P＜0.05).Conclusions A single large dose radiation could inhibit the growth of xenograft.ADC,MK,MD values changed at the early stage prior to morphological changes of tumor in consistent with the change of cell density and necrosis ratio.DKI has the potential value in predicting radiotherapy sensitivity of esophageal carcinoma.
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Tumor angiogenesis is closely related to the biological behavior of tumor tissue.Microvessel density is the gold standard to evaluate tumor angiogenesis,but it is invasive.Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI),a robust imaging method,is commonly used to non-invasively characterize changes in tumor vascularity and to assess the therapeutic effect of anticancer strategies.This review introduces the DCE-MRI and its current application in the diagnosis and treatment of tumor.
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Objective To investigate the clinical application value of hippocampal volume (HV)measurement with MMSE score in varying different degrees cognitive impairment.Methods 30 Alzheimer’s disease(AD)patients,30 mild cognitive impairment (MCI)patients and 30 normal controls(NC)were recruited,HV was measured by Siemens Tim-avanto 3.0T super conductance magnetic resonance.Standardized HV and MMSE scores of three groups were comprehensive analyzed.Results The left and right sides and the total HV of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05).The HV had no significant differences between the MCI and the NC group.The MMSE scores of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05),the score had no significant differences between the MCI and the NC group.Conclusion HV measurement with MMSE score would be helpful to provide effective basis for the AD diagnosis,the sensitivity in the diagnosis of MCI is not high.
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Objective To explore the best keV conditions of show hepatocellular carcinoma lesions with the best contrast-to-noise ratio (CNR)and image quality,and evaluate the effect of monochromatic energy imaging on the detection of hepatocellular carcinomas.Methods The dual-energy CT imaging of 30 patients with hepatocellular carcinoma were analyzed retrospectively.Monochromatic energy images (40 to 140 keV,interval 10 keV)were produced by the dual-engery software.CNR and image noise of monochromatic energy,100 keV and 140 keV images were measured respectively.The CNR and the imaging noise were optimized.The results between the monochromatic energy images and the mixed energy images were compared by using the two related samples of non-parameter rank test.Results In the arterial phase, the monochromatic energy level with the highest CNR was concentrated at 70 keV,and the lowest level of the image noises was at 70 and 80 keV.The images at 70 keV were chosen to be compared with the fusion images.The CNR values of the monochromatic images at 70 keV were similar as those at 100 keV (1 .68 ± 1 .04 vs 1 .88 ± 1 .59 ,P =0 .149 ),and significantly higher than those at 140 keV (1 .68 ± 1 .04 vs 0.62±0.92,P =0.000).The image noises at 70 keV were similar as those at 140 keV (6.52±1.53 vs 7.60±2.73,P =0.050), and significantly lower than those at 100 keV (6.52±1.53 vs 8.55±1.11,P =0.000).Conclusion The monochromatic energy imaging at 70 keV can improve the CNR of the hepatocellular carcinoma lesions without reducing the image quality,which will help the lesion detection.
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Objective To explore the best keV conditions of show hepatocellular carcinoma lesions with the best contrast-to-noise ratio (CNR)and image quality,and evaluate the effect of monochromatic energy imaging on the detection of hepatocellular carcinomas.Methods The dual-energy CT imaging of 30 patients with hepatocellular carcinoma were analyzed retrospectively.Monochromatic energy images (40 to 140 keV,interval 10 keV)were produced by the dual-engery software.CNR and image noise of monochromatic energy,100 keV and 140 keV images were measured respectively.The CNR and the imaging noise were optimized.The results between the monochromatic energy images and the mixed energy images were compared by using the two related samples of non-parameter rank test.Results In the arterial phase, the monochromatic energy level with the highest CNR was concentrated at 70 keV,and the lowest level of the image noises was at 70 and 80 keV.The images at 70 keV were chosen to be compared with the fusion images.The CNR values of the monochromatic images at 70 keV were similar as those at 100 keV (1 .68 ± 1 .04 vs 1 .88 ± 1 .59 ,P =0 .149 ),and significantly higher than those at 140 keV (1 .68 ± 1 .04 vs 0.62±0.92,P =0.000).The image noises at 70 keV were similar as those at 140 keV (6.52±1.53 vs 7.60±2.73,P =0.050), and significantly lower than those at 100 keV (6.52±1.53 vs 8.55±1.11,P =0.000).Conclusion The monochromatic energy imaging at 70 keV can improve the CNR of the hepatocellular carcinoma lesions without reducing the image quality,which will help the lesion detection.
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Objective To assess the feasibility of K value of dynamic contrast enhanced MRI (DCE-MRI) in evaluation of anti-angiogenic effects on nude mice with orthotopic transplantation tumor model of gastric cancer.Methods Nude mice with orthotopic transplantation tumor model of gastric cancer were randomly assigned to two groups:Treatment group (n =15),mice were given apatinib intragastrically for 18 days (100 mg/kg),and control group (n=15),mice were given ddH2O2 in the same manner.After 18 days,DCE-MRI was performed and K value was measured.Then the tumors were dissected from the adjacent tissues in order to detect the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression levels.MVD and VEGF expression level were compared between treatment group and the control group.Results MVD (x2 =4.89,P＜0.05) and VEGF expression level (x2 =8.69,P＜0.01) of treatment group were much lower than those of control groups.The Kt value of treatment group was significantly lower than that of control groups ([0.63±0.05]/min vs [1.66±0.23]/min,t=17.05,P＜0.01).Conclusion The value of k in DCE-MRI can be utilized to assess the effects of apatinib on nude mice with orthotopic transplantation model of gastric cancer.
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Objective To study the feasibility of DCE-MRI application in the orthotopic transplantation model of gastric cancer in nude mice.Methods Orthotopic transplantation model of gastric cancer in nude mice was established, and 15 models underwent DCE-MRI using the contrast agent of gadopentetate.Subsequently, the tumor was dissected in order to detect the MVD.The MVD was compared between orthotopic transplantation tumor model of gastric cancer and normal gastric mucosa.Results Fifteen nude mice with orthotopic transplantation of gastric cancer successfully underwent DCE-MRI examination.As for the cancer, the values of Ktrans, Kep and Ve were (2.11±0.44) min-1, (4.59±0.93) min-1, and 0.46±0.06, respectively.The MVD in gastric cancer tissues was significantly higher than that in normal gastric mucosa (χ2=16.205, P<0.001).Conclusion DCE-MRI can be used for noninvasively quantitative evaluation of vascular parameters of gastric carcinoma.
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Objective To investigate the effect of gastric filling degree on the thickness of advanced gastric carcinoma and the clinical value of the thickness measured by CT.Methods Totally 38 patients with advanced gastric carcinoma were enrolled and 21 patients were newly diagnosed,17 patients were reexamination after non surgical treatments.The stomach cavity was filled with oral gas-producing powder.The plain scanning (before filling) and enhanced scanning in venous phase (after filling) were performed.The thickness of the normal gastric wall and gastric carcinoma before and after filling were measured on axial images,and the differences were compared.The patients were measured again one month later by the same investigator,and the consistency between the twice measurements was evaluated.Results Before and after filling,the normal gastric wall thickness of each regions was significantly different (all P＜0.001),and the change was greatest at the region of greater curvature.Carcinoma thickness was similar in newly diagnosed patients (P＜0.05),but significantly different in patients for reexamination (P＜0.05).The twice measurements had a good consistency.Conclusion The thickness of gastric carcinoma can be considered as a baseline measurement indicator in newly diagnosed patients.It is critical to maintaining a similar gastric filling degree during reexamination,which is helpful to evaluate the efficacy of treatment accurately.
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Objective To investigate the parameters of diffusion?weighted magnetic resonance imaging ( DWMRI) for prediction of the efficacy of chemoradiotherapy ( CRT) for esophageal squamous cell carcinoma ( ESCC) , to determine the optimal time point and threshold for prediction, and to provide a basis for clinical practice. Methods From 2010 to 2011, 38 patients with ESCC were consecutively enrolled as subjects. All patients received three?dimensional conformal radiotherapy with 60 Gy in 30 fractions for 6 weeks. They also received concurrent or consolidation chemotherapy ( FP or TP scheme ) as adjuvant treatment. Patients received DWMRI scans before radiotherapy and at weeks 1?6 during radiotherapy. The apparent diffusion coefficient ( ADC ) values and tumor lengths obtained from serial DWMRI scans were recorded and analyzed. Comparison was made by paired t test. Repeated measurements were analyzed by analysis of variance ( ANOVA) and multivariate ANOVA. The prognosis was predicted by the Logistic model. The effectiveness analysis and threshold screening were performed using the receiver operating characteristic (ROC) curve. Results In all patients, 20(52?6%) had complete response (CR) and 18(47?4%) had partial response ( PR) . There were no significant differences in the ADC values before radiotherapy and at weeks 1?6 during radiotherapy between patients with CR and PR ( 1?82 vs. 1?42;1?92 vs. 1?49;2?06 vs. 1?67;2?35 vs. 1?79;2?62 vs. 2?11;2?71 vs. 2?18;2?96 vs. 2?28×10-3 mm2/s;P=0?006,0?003,0?012, 0?001,0?003,0?008,0?002) . The ADC value at third week during radiotherapy was the only independent prognostic factor for short?term treatment outcomes in patients with ESCC ( OR=0?134, P=0?007) . These results were also supported by the multivariate ANOVA analyses. The analysis of the ROC curve showed that at the third week during radiotherapy, the area under the ADC curve was the largest ( A z=0?857) and the diagnostic effectiveness was the best;the threshold value, sensitivity, and specificity were 2?02×10-3 mm2/s, 80?0%, and 92?9%, respectively. Eight patients who had tumor out of control or recurrence within 1 year after treatment had the ADC curve fall down at the end of the fifth week and the reduction of tumor length substantially slow down from the fifth week. Conclusions DWMRI is an effective imaging approach for monitoring tumor response to CRT in patients with ESCC. The ADC value at the end of the third week during radiotherapy may be the optimal time point for prediction of treatment outcomes. The reduction in the ADC value or non?reduction in tumor length at the end of the treatment indicates a high risk of recurrence.
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Objective To observe the differences of metabolite ratios among mild cognitive impairment (MCI),Alzheimer’s disease (AD) and normal cognitive state (NC)patients in the hippocampus.Methods According to the clinical features,patients were divided into three groups:MCI group (n=30),AD group (n=28)and NC group (n=30).All the patients were examined by 1 H MRS and compared the ratios of NAA/Cr,Ins/Cr,NAA/Ins,Cho/Cr of both the left and right side of the hippocampus.Results The NAA/Cr in MCI group and AD group were much lower than that in NC group (P <0.05).The Ins/Cr and NAA/Ins in MCI group and AD group showed significant differences compared with NC group (P <0.05).On Ins/Cr and NAA/Ins of the left side,there were significant differences among three groups (P <0.05).Conclusion 1 H MRS as a non-invasive diagnostic technique has higher sensitivity in the early diagnosis and differential diagnosis between MCI and AD patients.
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Objective To investigate the accuracy of measurement of lesion length by computed tomography (CT) scan and diffusion?weighted imaging (DWI) for esophageal carcinoma, and to provide an optimized imaging method as a reference for target delineation in esophageal carcinoma. Methods Thirty?five patients with thoracic esophageal carcinoma from 2012 to 2013 were prospectively enrolled as subjects. All patients underwent examinations of esophageal endoscopy, CT scan of the thorax and abdomen, and DWI before radical surgery. Lesion lengths were measured by the above methods and compared with the real length of pathological specimen resected at surgery. The consistency between the lesion length measured by each imaging method and the pathological standard were evaluated using the intraclass correlation coefficient (ICC) and the Bland?Altman method. Results Four patients had no hyperintense signal on DWI, resulting in a false?negative rate of 11% in all patients and a false?negative rate of 44%(4/ 9) in patients with stage T1 esophageal carcinoma. Thirty?one patients had lesion lengths measured by DWI for analysis. The tumor length of pathological specimen after surgery was 4?? 58 cm, while the tumor lengths measured by endoscopy, CT scan, and DWI with b?values of 600, 800, and 1000 s/ mm2 were 4?? 56, 5?? 58, 4?? 41, 3?? 99, and 3?? 83 cm, respectively. The ICC values were 0?? 703, 0?? 764, 0?? 946, 0?? 890, and 0?? 882, respectively, with P value of 0?? 000 for all. According to the results of the Bland?Altman method, the highest degree of consistency was achieved between the tumor lengths measured by endoscopy and DWI with a b?value of 600 s/ mm2 and the pathological standard. Conclusions The esophageal tumor lengths measured by DWI are close to the real tumor length of the pathological specimen, in which the lesion length measured by DWI with a b?value of 600 s/ mm2 is most reliable. However, the value of DWI in the early diagnosis of esophageal carcinoma is limited.
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PurposeTo evaluate the effect of tube current on the pseudo-enhancement of renal cyst by simulating the phantom model of simple renal cyst.Materials and Methods 10% glucose and iodine solution with a certain concentration was used to simulate the renal parenchymal background concentration in plain scan, moderate enhancement and maximum enhancement respectively. The diameters of the cysts were 6 mm, 10 mm and 15 mm, respectively, and the cysts were divided into three groups according to different tube current: 119 mAs (group A), 178 mAs (group B) and 297 mAs (group C) while the tube voltage were all 120 kV. Whether pseudo-enhancement exists in cyst under different conditions was determined using an increase of CT value of 10 HU as the critical value. Results In group A, there was pseudo enhancement at the 240 HU background, and it was most significant with the diameter of 6 mm, which was 21 HU. In group B, pseudo-enhancement occurred in cysts with diameter of both 10 mm and 6 mm under the background of 180 HU and 240 HU, moreover, the biggest difference was 20.4 HU and it occurred in cyst with diameter of 6 mm under the background of 240 HU. In group C, pseudo-enhancement only occurred in cyst with diameter of 6 mm under the condition of 125 HU and 240 HU background concentration. Background concentration (F=17.587, P<0.01) and cyst diameter (F=4.214,P<0.05) had greater impact on cyst pseudo-enhancement, the higher the background concentration and smaller the diameter, more significantly the pseudo-enhancement would occur. With the increase of the tube current, the CT volume dose index increased, and the pseudo enhancement value was smaller, but there was no obvious regularity of pseudo-enhancement occurrence rate in cysts with different background concentration and diameter in each group.Conclusion The increase of tube current cannot completely eliminate cyst pseudo-enhancement. High background concentration and small diameter cyst are important factors in pseudo-enhancement. However, increasing the tube current can reduce the probability of occurrence of pseudo-enhancement to some extent. For those with heavier body weight, it might be necessary to increase the tube current to improve image quality and reduce the occurrence of renal cyst pseudo-enhancement.
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Objective To evaluate the efficacy of computed tomography ( CT ) and diffusion?weighted magnetic resonance imaging ( DWMRI ) in the diagnosis of regional lymph node metastasis in thoracic carcinoma, and to figure out the methods and thresholds for delineation of lymph nodes with higher reasonability and accuracy. Methods A total of 43 patients with thoracic carcinoma, including 35 patients with esophageal cancer and 8 patients with non?small cell lung cancer, were enrolled as subjects from 2012 to 2013. All patients received abdominal CT scan and DWMRI examination one week before surgery, and regional lymph node metastasis was diagnosed based on the images of CT scan or DWMRI. With the postoperative pathology as the gold standard, the diagnostic efficacy was evaluated and compared between the two methods. The two sets of obtained images were analyzed using the χ2?test. Results The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’ s index of CT versus DWMRI in the diagnosis of regional lymph node metastasis were 57?1% vs. 60?0%, 96?3% vs. 98?9%, 93?8% vs. 96?5%, 50?0% vs. 77?8%, 97?2% vs. 97?4%, and 53?4% vs. 58?9%, respectively;the specificity, accuracy, and positive predictive value of DWMRI were significantly superior to those of CT ( P=0?005,0?038,0?022) . Twenty out of forty lymph nodes diagnosed by CT scan were false positive, and 15( 75%) of them could be corrected by DWMRI. Fifteen out of forty lymph nodes diagnosed by CT scan were false negative, and 3 ( 20%) of them could be recognized by DWMRI. In all 35 metastatic lymph nodes, 5 lymph nodes had no apparent swelling on images, and 13(43?3%) out of the other 30 lymph nodes had a short diameter less than 1?0 cm. Conclusions CT scan has apparent limitation in the diagnosis of regional lymph node metastasis. Many metastatic lymph nodes would be missed if a short diameter not less than 1? 0 cm is the only standard for target volume delineation . With superior specificity , accuracy , and positive predictive value to CT in the diagnosis of regional lymph node metastasis, DWMRI can effectively rule out non?cancerous intumescent lymph nodes and recognize some of small metastatic lymph nodes.
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Objective To investigate the factors that influence the fermentation process of compound Chinese medicine and determining the optimum fermentation with single factor experiment and response surface methodology. Methods Through controlling the factors in the fermentation process of compound Chinese medicine (such as fermentation bacteria, fermentation time, fermentation temperature, inoculum amount, etc.), with its increase rate of total peak area as evaluation indicator, the alcohol extracts before and after fermentation were monitored and comparative evaluated by HPLC, and the optimum fermentation process was determined by response surface methodology. Results The fermentation process optimized by single factor experiment and response surface methodology was as follows:SZ-2 strain served as the fermentation bacteria, temperature was 33 ℃, inoculum amount was 4%, and time was 3.5 d, the average increase rate of total peak area was 31.24%. Conclusion HPLC can be used to identify and evaluate the fermentation of compound Chinese medicine under the different factors, and to clarify the optimal fermentation process by response surface methodology, which provide reference for the development of fermentation process.
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Objective To evaluate the capability of virtual non-contrast (VNC)of the second-generation dual-source CT (DSCT), and to display the adipose tissue of gastric serosa.Methods 48 patients with gastric cancer undergoing preoperative DSCT and sur-gery were enrolled.The true non-contrast (TNC)values and VNC values of perigastric adipose tissue were measured and compared with conventional non-contrast scanning and VNC of arterial phase and venous phase.The VNC values of perigastric adipose tissue were compared between serosal involvement group and non-serosal involvement group.Results There was statistical difference be-tween TNC values and VNC values of perigastric adipose tissue (P <0.05),the absolute differences were under 13 HU.The differ-ence of VNC values between serosal involvement group and non-serosal involvement group was significant (P <0.05).Conclusion VNC of the second-generation DSCT can clearly display the adipose tissue of gastric serosa.It has certain capability in judging sero-sal involvement.VNC has the proficiency to replace conventional non-contrast scanning.
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Objective To investigate the clinical utility of dual-energy virtual non-contrast CT(VNCT)of dual source CT in the di-agnosis and differential diagnosis of solitary pulmonary nodule(SPN).Methods Thirty-six patients with suspected SPN underwent chest plain single energy CT and dual-phase contrast enhanced CT (DECT)(25 and 90 s).The images of dual energy were sent to a commercial workstation for VNC image generation.CT values of SPN on VNC and true non-contrast(TNC),as well as signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were compared.The accuracy of calcification detection was compared according to the diameter and density of the calcification.The TNC images were used as the reference.Results CT values,SNR and CNR of VNC had no statistical difference among TNC and VNC at 25 s and 90 s(P >0.05).DECT VNC(5mm slice)could accurate detected calci-fication(diameter>2 mm,CT value>1 50 HU)in SPN.The 2 mm slice performed significantly better than 5 mm slice VNC images. Conclusion The VNC could provide consistent diagnostic information with TNC.The thin slice DECT VNC images can be used in clinical practice to replace TNC without losing small calcification in SPN,which has potential to reduce the patient radiation dose.
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Purpose To evaluate the feasibility of using dual-energy CT scanner to differentiate two contrast media bismuth and gadolinium. Materials and Methods Two phantoms containing contrast media of different ratio were scanned on dual-energy CT. Group 1 was mixture of iodine and gadolinium solution with volume ratio of 0∶1, 1∶6, 1∶1, 6∶1 and 1∶0. Group 2 was mixture of iodine and bismuth solution with mass ratio of 0∶1, 1∶6, 1∶1, 6∶1, 1∶0. Monoenergetic image reconstruction was performed at 80 keV. Liver VNC software was used for virtual scanning and iodine concentration analysis. Results Under 80 keV reconstruction, the measured CT attenuation of Group 1 was 379-383 HU, and 170-173 HU in group 2. The iodine concentration of two groups was not signiifcantly different between the calculated and actual iodine concentration (P>0.05). The dual-energy CT can distinguish two contrast media. Iodine and gadolinium contrast media were not statistically different, while iodine and bismuth contrast media agent could be easily differentiated. Conclusion Dual-energy CT can distinguish two contrast media with different attenuation.
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Objective To investigate the feasibility of new criteria for evaluating the radiotherapeutic effect on esophageal cancer by barium meal (BM) combined with CT scans.Methods A total of 189 patients who were diagnosed with esophageal cancer (confirmed by biopsy) from January 2004 to December 2010 were enrolled as subjects.All patients underwent BM and CT scans before and after radiotherapy.The maximal esophageal wall thickness (EWT) and changes in the volumes of regional lymph nodes measured by CT scans were analyzed.New criteria for evaluating the short-term radiotherapeutic effect on esophageal cancer was studied considering the analysis results as well as the BM-based criteria for evaluating short-term radiotherapeutic effect and follow-up results.Results The BM-based evaluation criteria were still useful,but had certain limitations.There were 115 patients who had regional lymph node metastasis as detected by CT scans before radiotherapy,and they were divided into complete remission (CR) group and partial remission (PR) group according to BM results after radiotherapy; the local control rate (LCR) of CR group was significantly higher than that of PR group,but there was no significant difference in survival rate (SR) between the two groups.There were 65 patients who had no regional lymph node metastasis,and they were also divided into CR group and PR group according to BM results after radiotherapy;the LCR and SR of CR group were significantly higher than those of PR group.In summary,the patients who had a CR as evaluated by BM and had the maximal EWT of ≤ 1.20 cm and the volumes of residual lymph nodes of ≤ 1.00 cm3 on CT were defined as CR ; the patients who had a PR as evaluated by BM or had the maximal EWT of ＞ 1.20 cm or those who had a CR evaluated by BM and had the maximal EWT of ≤ 1.20 cm and the volumes of residual lymph nodes of ＞ 1.00 cm3 on CT were defined as PR.The cases evaluated by BM as no remission (NR) or showing metastasis were defined as NR or progressive disease.There were significant differences in LCR and SR between the CR group and PR group determined by the new criteria.Conclusions Simply using BM to evaluate the short-term radiotherapeutic effect on esophageal cancer has certain limitations; instead,the evaluation based on both BM and CT scans is more accurate.
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ObjectiveTo explore the application of diffusion-weighted magnetic resonance imaging (DWMRI) in precise radiotherapy of esophageal carcinoma.MethodsThirty-seven patients with biopsy proven esophageal cancer from March 2010 to January 2011 were included.To delineate the gross tumor volume (GTV) using CT and DWMRI images,each patient was examined by DWMRI and CT scan using the same position before radiotherapy.To compare the maximum diameters and volumes of tumor between CT and DWMRI. The tumor lengths measured by esophagogram,esophagoscope,CT and DWMRI were compared.ResultsTumor lengths under esophagogram,esophagoscope,CT and DWMRI were 5.70 cm,6.06 cm,7.97 cm and 5.79 cm respectively. The lengths between CT and esophagogram,CT and esophagoscope,CT and DWMRI had statistical significance respectively (F=4.88,P=0.003).The maximum diameters of tumor shown on CT and DWMRI were 3.79 cm and 3.81 cm respectively ( t =-0.32,P=0.751 ).The GTV were 45.75 cm3 and 38.05 cm3 in CT and DWMRI respectively (t=5.30,P =0.001 ).53 lymph nodes were assessed positive on both CT and DWMRI.DWMRI excluded 25 positive lymph nodes assesed by CT; also confirmed 15 negative lymph nodes excluded by CT,6 of which were paraesophageal lymph nodes.The addition of DWMRI information altered the clinical stage in 6 patients.ConclusionsTumor lengths measured on DWMRI and esophagogram had the optimal approximation.It was easy to find paraesophageal lymph nodes via DWMRI.With the addition of DWMRI information,the target range and clinical stage were alerted in some patients.