RESUMO
Objective@#To compare and correlate the findings of intravoxel incoherent motion (IVIM) magnetic resonance (MR) imaging and arterial spin labeling (ASL) imaging in characterizing parotid gland tumors. @*Materials and Methods@#We retrospectively reviewed 56 patients with parotid gland tumors evaluated by MR imaging. The true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and fraction of perfusion (f) values of IVIM imaging and tumor-to-parotid gland signal intensity ratio (SIR) on ASL imaging were calculated. Spearman rank correlation coefficient, chi-squared, Mann-Whitney U, and Kruskal-Wallis tests with the post-hoc Dunn-Bonferroni method and receiver operating characteristic curve assessments were used for statistical analysis. @*Results@#Malignant parotid gland tumors showed significantly lower D than benign tumors (p = 0.019). Within subgroup analyses, pleomorphic adenomas (PAs) showed significantly higher D than malignant tumors (MTs) and Warthin’s tumors (WTs) (p < 0.001). The D* of WTs was significantly higher than that of PAs (p = 0.031). The f and SIR on ASL imaging of WTs were significantly higher than those of MTs and PAs (p < 0.05). Significantly positive correlation was found between SIR on ASL imaging and f (r = 0.446, p = 0.001). In comparison with f, SIR on ASL imaging showed a higher area under curve (0.853 vs. 0.891) in discriminating MTs from WTs, although the difference was not significant (p = 0.720). @*Conclusion@#IVIM and ASL imaging could help differentiate parotid gland tumors. SIR on ASL imaging showed a significantly positive correlation with f. ASL imaging might hold potential to improve the ability to discriminate MTs from WTs.
RESUMO
Objective To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery(MCA)occlusion.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018.According to the ASPECTS collateral circulation score,the patients were divided into two groups: good collateral group(n=31)and poor collateral group(n=18).The benefits and risks after thrombolysis in the two groups were compared,including 24-h NIHSS score,30-day mortality,90-day modified rankin scale(mRS)score,and the incidence of symptomatic cerebral hemorrhage.Statistical analysis was performed using t test,corrected x2 test,or Fisher's exact test.Results The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group(4.6±5.6 vs 12.5±8.4,P=O.OO; 1.7±1.7 vs 3.1±1.5,P＜0.05).The incidence of NIHSS score improved by ≥50％and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis(77.4％vs 27.8％,P＜0.05; 80.6％vs 27.8％,P=O.OO); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group(9.7％vs 50.0％,P＜0.05).There was no significant difference in mortality between the two groups after 30 days of thrombolysis(P＞0.05),but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group(11.1％vs 0％).Conclusion For patients with acute MCA infarction and receiving vascular recanalization therapy,patients with good collateral circulation can achieve good clinical outcomes,restore better recent neurological function,and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.
RESUMO
Objective@#To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion.@*Methods@#This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test.@*Results@#The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P<0.05). The incidence of NIHSS score improved by ≥50% and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis (77.4% vs 27.8%, P<0.05; 80.6% vs 27.8%, P=0.00); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group (9.7% vs 50.0%, P<0.05). There was no significant difference in mortality between the two groups after 30 days of thrombolysis (P>0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%).@*Conclusion@#For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.
RESUMO
Objective To evaluate the value of quantitative analysis of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) for differentiating malignant from benign orbital lymphoproliferative disorder(OLPD). Methods Forty-three patients with OLPDs(20 patients with benign OLPDs and 23 patients with orbital lymphoma) confirmed by histopathology or clinical follow-up were enrolled in this retrospective study.Quantitative parameters of DCE-MRI including volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and mean apparent diffusion coefficient(ADC)values were obtained. χ2test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic ability of each parameter and its combination. Results Malignant group showed significantly lower mean ADC values and higher Kepvalues than benign group [ADC:(0.674±0.126)×10-3mm2/s vs(1.030±0.304)×10-3mm2/s,P<0.001;Kep:(1.299±0.566)/min vs(0.787± 0.311)/min, P= 0.001], while no significant differences was found on Ktrans(P= 0.637) and Ve(P= 0.023). ROC analyses results indicated that,a sensitivity of 95.7%,specificity of 80.0% and area under curve(AUC) of 0.896 could be obtained,when using ADC=0.809×10-3mm2/s as the cut-off value.Setting the Kepvalue of 0.863/min as the cut-off value, a sensitivity of 91.3%, specificity of 75.0% and AUC of 0.848 could be obtained. When combination of mean ADC and Kepwas used, optimal diagnostic performance could be obtained (AUC, 0.926;sensitivity, 91.3%;specificity, 90.0%). Conclusion Mean ADC values and Kepare significant variables in predicting malignant OLPDs. Combination of DWI and DCE-MRI can further improve the diagnostic capability in differentiating malignant from benign OLPDs.
RESUMO
OBJECTIVE: To compare the diagnostic performance of readout-segmented echo-planar imaging (RS-EPI)-based diffusion kurtosis imaging (DKI) and that of diffusion-weighted imaging (DWI) for differentiating malignant from benign masses in head and neck region. MATERIALS AND METHODS: Between December 2014 and April 2016, we retrospectively enrolled 72 consecutive patients with head and neck masses who had undergone RS-EPI-based DKI scan (b value of 0, 500, 1000, and 1500 s/mm2) for pretreatment evaluation. Imaging data were post-processed by using monoexponential and diffusion kurtosis (DK) model for quantitation of apparent diffusion coefficient (ADC), apparent diffusion for Gaussian distribution (Dapp), and apparent kurtosis coefficient (Kapp). Unpaired t test and Mann-Whitney U test were used to compare differences of quantitative parameters between malignant and benign groups. Receiver operating characteristic curve analyses were performed to determine and compare the diagnostic ability of quantitative parameters in predicting malignancy. RESULTS: Malignant group demonstrated significantly lower ADC (0.754 ± 0.167 vs. 1.222 ± 0.420, p < 0.001) and Dapp (1.029 ± 0.226 vs. 1.640 ± 0.445, p < 0.001) while higher Kapp (1.344 ± 0.309 vs. 0.715 ± 0.249, p < 0.001) than benign group. Using a combination of Dapp and Kapp as diagnostic index, significantly better differentiating performance was achieved than using ADC alone (area under curve: 0.956 vs. 0.876, p = 0.042). CONCLUSION: Compared to DWI, DKI could provide additional data related to tumor heterogeneity with significantly better differentiating performance. Its derived quantitative metrics could serve as a promising imaging biomarker for differentiating malignant from benign masses in head and neck region.