The impact of image quality on the diagnostic performance of CT-derived fractional flow reserve / 中华放射学杂志

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

The value of combined analysis of plaque characteristics and stenosis based on coronary CT angiography in improving CT diagnostic performance for lesion-specific myocardial ischemia / 中华放射学杂志

Objective:To probe the diagnostic performance of the combined evaluation of stenosis and plaque characteristics based on coronary computed tomography angiography (CCTA) in identification of myocardial ischemic lesions, using the invasive coronary angiography (ICA)-based fractional flow reserve (FFR) as the gold standard.Methods:From November 2018 to March 2020, the patients with suspected or known coronary artery disease and scheduled for ICA at 5 clinical trials centers were enrolled in this study. All the patients underwent CCTA, ICA and FFR in turn in one week. The luminal stenosis and plaque characteristics were measured and assessed including plaque burden, volume ratios of calcification and non-calcification, lesion length and CT vulnerable features. All culprit vessels were divided into FFR≤0.8 and FFR>0.8 groups, and the parameters of plaque characteristics were compared. The correlation of ischemic lesions with CCTA stenosis and plaque characteristics was analyzed by the logistic regression analysis. The ROC curve was used to evaluate the sensitivity and specificity of CCTA stenosis rate and plaque characteristics, meanwhile the area under curve (AUC) of each parameter was compared by Delong test.Results:Three hundred and sixty-six culprit vessels in 317 patients were analyzed in this study (169 vessels in ischemia group and 197 in nonischemia group). The plaque burden [34.3% (30.3%, 38.8%) vs. 32.4% (28.5%, 37.9%); Z=-2.622, P=0.009], proportion of CT vulnerable features [26.9% (45/169) vs.11.7% (23/197); χ 2=15.311, P<0.001] and lesion length [22.1 (14.4, 35.0) mm vs. 17.6 (11.0, 26.0) mm; Z=-4.388, P<0.001] in FFR≤0.8 group were higher than those in FFR>0.8 group. The results of logistic regression analysis revealed that CCTA stenosis, lesion length, and CT vulnerable features were significant predictors for myocardial ischemia (OR values: 3.794, 2.461, 1.027; P<0.001, P=0.002, P=0.002). The diagnostic performance of CCTA ≥50% stenosis alone in identification of ischemic lesions was low (AUC=0.625). When it combined high-risk plaque characteristics and lesion length, the AUC was improved to 0.714 with a statistical significance. Conclusions:CCTA stenosis, lesion length, and CT vulnerable features are major predictors in identification of myocardial ischemic lesions, and the combination will significantly improve the diagnostic performance of CCTA ≥50% stenosis.

A study of a breast MRI abbreviated protocol for breast neoplasm screening / 中华健康管理学杂志

Objective:This study aimed to evaluate the performance of breast magnetic resonance imaging (MRI) abbreviated protocol (AP) in diagnosing breast neoplasms.Methods:We retrospectively analyzed the data of 86 patients who had undergone breast MRI examinations and compared the images using an AP and full diagnostic protocol (FDP). The AP consisted of axial T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and four-phase dynamic enhancement sequences. The FDP consisted of sagittal T2WI, axial T2WI, T1-weighted imaging, DWI, and seven-phase dynamic enhancement sequences. All the images were analyzed using the Breast Imaging Reporting and Data System (BI-RADS). The consistencies between the different protocols were then calculated. With the pathological diagnosis as the gold standard, the diagnostic capabilities of the two protocols were compared.Result:Two radiologists analyzed the AP and FDP images. The consistencies in the BI-RADS between the different protocols were 0.856 and 0.900, and those in time-signal intensity curves (TICs) were 0.822 and 0.922. Within the same protocol, the consistencies in the BI-RADS between different radiologists were 0.744 and 0.822, and those in TICs were 0.889 and 0.878. No significant differences were found ( P>0.05). In terms of diagnosing malignant neoplasms using the BI-RADS, the sensitivities of the AP and FDP were 89.8% (95 %CI: 0.785-0.958) and 91.5% (95 %CI: 0.806-0.968), respectively; their specificities were 71.0% (95 %CI: 0.518-0.851) and 77.4% (95 %CI: 0.585-0.897), respectively; and the areas under the curves (AUCs) were 0.804 (95 %CI: 0.698-0.910) and 0.845 (95 %CI: 0.748-0.941), respectively. Diagnosing malignant neoplasms using TICs, the sensitivities of the AP and FDP were 86.4% (95 %CI: 0.745-0.936) and 89.8% (95 %CI: 0.785-0.958), respectively; their specificities were 61.3% (95 %CI: 0.423-0.776) and 67.7% (95 %CI: 0.485-0.827), respectively, and the AUCs were 0.739 (95 %CI: 0.623-0.855) and 0.788 (95 %CI: 0.679-0.897), respectively. There was no significant difference between the AP and FDP ( P>0.05). The MRI acquisition times of the AP and FDP were 11.97±0.94 min and 21.25±1.12 min, respectively, with a significant difference ( P<0.001). The average reading time was reduced by 13.5% using the AP compared with that using the FDP. Conclusion:Compared with the FDP, the AP reduced the acquisition time and maintained the diagnostic accuracy, which can be used as an improved pattern for MRI screening in high-risk populations of breast neoplasms.

Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction / 浙江大学学报·医学版

OBJECTIVE@#To assess the predictive value of myocardial scar mass in malignant ventricular arrhythmia (MVA) after myocardial infarction.@*METHODS@#Thirty myocardial infarction patients with complete electrophysiology and cardiac MRI data admitted from January 2012 to August 2017 were enrolled in the study. According to the results of intracavitary electrophysiological study, MVA developed in 16 patients (MVA group) and not developed in 14 patients (non-MVA group). The qualitative and quantitative analysis of left ventricular ejection fraction (LVFE) and scar mass was performed with CV post-processing software and predictive value of myocardial scar and LVEF for MVA after myocardial infarction was analyzed using ROC curves.@*RESULTS@#LVEF in MVA group was significantly lower than that in non-MVA group, and scar mass in MVA group was significantly higher than that in non-MVA group (all <0.05). Regression analysis showed that LVEF (=1.580) and scar mass (=6.270) were risk factors for MVA after myocardial infarction. For predicting MVA, the area under ROC curve () of LVEF was 0.696 with a sensitivity of 0.786 and the specificity of 0.685; the of the scar mass was 0.839 with a sensitivity was 0.618 and the specificity of 0.929; the of LVEF combined with scar mass was 0.848 with a sensitivity of 0.688 and specificity of 0.857.@*CONCLUSIONS@#Myocardial scar assessed by late gadolinium enhancement MRI is more effective than LVEF in predicting MVA after myocardial infarction.

Differential diagnosis of adrenal metastasis and lipid-poor adrenal adenoma with CT / 中华内分泌外科杂志

Objective To study the CT characteristics of adrenal metastasis (AM) and lipid-poor adrenal adenoma (Lp-AA).Methods We retrospectively analyzed clinical and CT dates of AM (n=25) and Lp-AA (n=61) which were pathologically or clinically confirmed.The size,location,number,contour,cystic degeneration,calcification,hemorrhage and the clinical data were analyzed,as well as,CT value of tumor were measured and calculated.Receiver operating characteristic (ROC) curves were employed to assess the significant continuous variables to tell AM from Lp-AA.Results 34 adrenal lesions were detected for 25 cases of AM (9 case showed bilateral with 18 lesions).There were 65 lesions for 61 cases of Lp-AA (3 cases showed bilateral and 1case showed two lesions in unilateral side).Sex and age had significant difference between the two groups (P＜0.05).On the categorical variables of CT examination,number,cystic degeneration and contour had significant difference between the two groups (P＜0.05),while tumor location,hemorrhage and calcification had no significant difference (P＞0.05).For the continuous variables,plain scan CT value,enhancement amplitude,relative percentage washout (RPW) and tumor size had significant difference between the two groups (P＜0.05).Area under ROC curve analysis showed that when the plain scan CT value＞30.4 HU,area under ROC curve,sensitivity and specificity were 0.878,91.2％,and 72.3％,respectively.When RPW was ＞-33.4％,the area under ROC curve,sensitivity and specificity were 0.643,79.4％,64.7％,respectively.When the maximum and minimum diameter of tumor were ＞2.9 cm and 2.2 cm respectively,the area under the curve,sensitivity,specificity were 0.762,73.5％,75.4％ and 0.706,64.7％,69.2％,respectively.When venous phase increase and the largest increase were ＜37.7 HU and 37.3 HU respectively,the area under the curve,sensitivity,specificity were 0.805,89.2％,64.7％ and 0.833,95.4％,64.7％ respectively.Conclusion Tumor size,number,contour,cystic degeneration,CT measured and calculated value,as well as the patients' clinical data are of great value in differentiating AM and Lp-AA.

Application of iterative reconstruction in upper limb intravascular fistula CT angiography / 中华放射医学与防护杂志

Objective To assess the image quality (IQ) of an iterative reconstruction (IR) technique(sinogram affirmed iterative reconstruction,SAFIRE) for upper limb intravascular fistula CT angiography on a second generation dual-source CT scanner and determine the optimal dose level using IR with IQ comparable to filtered back projection(FBP).Methods The experiment was a prospective study.A total of 150 patients were averagely divided into 5 groups to perform upper limb intravascular fistula CT angiography.The control group was scanned with conventional tube output (120 kV,110 mAs) and images were reconstructed with FBP.The tube current of the other 4 groups (reconstructed with SAFIRE) was successively reduced to 70％,60％,50％ and 40％ of that of control group.Quantitative measurements of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were obtained in two regions of interest (ROI) in each group.The ROIs were placed at the subclavian artery near shoulder joint,and the stoma of radial artery and cephalic vein.Analysis of variance (ANOVA) was used for comparisons of objective evaluation parameters (SNR,CNR) and radiation dose (CTDIvol,DLP,E) among 5 groups.Two radiologists graded IQ in a blinded fashion on a 4-point scale (4-excellent,3-good,2-fair and 1-poor).The Kruskal-Wallis nonparametric test was performed for detection of differences in subjective evaluation of IQ among groups.Results The radiation doses of groups 77,66,55 and 44 mAs were 70％,55％,40％ and 25％ of the control group respectively.The differences of SNR and CNR among groups 77,66,44 mAs and the control group were statistically significant in ROI1 (F =24.018,20.386,P ＜ 0.05),SNR and CNR of group 77 and 66 mAs were higher than the control group while group 44 mAs was lower.The difference of SNR and CNR among group 55 mAs and the control group was not statistically significant in ROI1 (P ＞ 0.05).The differences of SNR and CNR among groups 77,66,55 mAs and the control group were statistically significant in ROI2 (F =15.934,13.818,P ＜ 0.05),and groups 77,66 and 55 mAs had higher SNR and CNR.The difference of SNR and CNR between group 44 mAs and the control group was not statistically significant in ROI2 (P ＞ 0.05).Groups 77,66,55 mAs and the control group had higher scores of the subjective IQ (≥ 3) which was descended in group 44 mAs.The differences of contrast,sharpness,noise and general impression of images among the 5 groups were statistically significant by Kruskal-Wallis nonparametric test(H =10.268,14.542,15.840,11.014,P ＜ 0.05).Using the criterion of excellent IQ(score 4),the ROC curve of dose levels and IQ acceptability established a reduction of 60％ of effective dose [Group 55 mAs:(3.545 ± 1.396) mSv] as an optimum cutoff point (AUC:0.844,95％ CI:0.705-0.982).Conclusions Iterative reconstruction technique could provide a dose reduction to 40％ (3.545 mSv) compared with the filtered back projection in upper limb intravascular fistula CT angiography without reducing equivalent image quality.

Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify cellular leiomyoma / 中华放射学杂志

Objective To evaluate the value of histogram parameters of dynamic contrast-enhanced MRI (DCE-MRI) in the diagnosis of cellular leiomyoma. Methods Seventy one patients with leiomyomas confirmed by pathology who underwent preoperative DCE-MRI were enrolled in this retrospective study. Quantitative perfusion histogram parameters (including median, mean, skewness, kurtosis, energy, entropy) were measured for each patient. Leiomyoma was divided into degeneration, ordinary and cellular types according to pathology. One-way analysis of variance and Least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. ROC curves were drawn to evaluate the diagnostic efficiency of different parameters. Results Among the three groups,the values of Ktrans(median, mean, kurtosis, energy, entropy), Kep(median, mean, skewness, kurtosis, entropy), Ve(median, mean, skewness, kurtosis) and Vp(median, mean, skewness, kurtosis, energy, entropy) had statistical difference (all P<0.05). The values of Ktrans, Kep, Vp (median, mean) and Ktrans (entropy) of the cellular group were higher than those of the degeneration and ordinary groups. While the values of Ktrans (kurtosis, energy) and Kep (skewness) of the cellular group were lower than the other two groups;then the value of Kep (kurtosis) of the cellular group was lower than the ordinary group and the value of Kep (entropy) of the cellular group was higher than the ordinary group;and the values of Ve (median, mean, kurtosis) and Vp (entropy) of the cellular group were higher than those of the ordinary group. The values of Ve (skewness) and Vp (skewness, kurtosis and energy) of the cellular group were lower than those of degeneration group. ROC curves found that when Ktrans(median)was 0.994/min, its sensitivity was 100.0％, the specificity was 73.8％, and the area under ROC was 0.905;when Ktrans(mean) was 1.170/min, its sensitivity was 90.0％, the specificity was 85.2％, the area under ROC was 0.921. And the areas under ROC of Ktrans (kurtosis, energy, entropy), Kep (median, mean, skewness, kurtosis, entropy), Ve (median, mean, skewness), Vp (median, mean, skewness) were also high (ranging from 0.711 to 0.872). Conclusion Histogram analysis of DCE-MRI quantitative perfusion is applicable for identification of cellular leiomyoma.

CT and MRI findings of liver primary undifferentiated pleomorphic sarcoma / 中国医学影像技术

Objective To investigate CT and MRI characteristics of liver primary undifferentiated pleomorphic sarcoma (UPS).Methods Data of 8 cases of pathologically confirmed liver UPS were analyzed retrospectively.Results The tumors located in right liver (n=6),left liver (n=1) or caudate lobe (n=1).Irregular shape and ill-defined boundary were found in 6 cases,while regular shape and well-defined boundary were found in the other 2 cases.The lesions in 7cases showed heterogeneous density,and demonstrated homogeneous density in 1 case.Slight heterogeneous enhancement in arterial phase and progressive enhancement in portal phase were observed in all 8 cases,while continuous enhancement was observed in 6 cases.Tumor thrombi in inferior vena or portal vein were observed in 4 cases.Conclusion CT and MRI manifestations of primary liver UPS are characteristic in certain degree,therefore being helpful to the diagnosis of this disease.

Analysis of clinical prognosis and the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization in patients with hepatocellular carcinoma / 中华肿瘤杂志

Objective@#To evaluate the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization, and to analyze the clinical prognosis of hepatocellular carcinoma patients.@*Methods@#From January18, 2012 to December18, 2014, 21 patients underwent TACE for HCC were retrospectively reviewed, including patients′ clinical and pathological data. The clinical outcome and relevant factors for bile duct injury were analyzed.@*Results@#A total of 21 patients were identified with bile duct injury at our single institution. All patients received 48 TACE treatments, including proper hepatic artery (14), left hepatic artery (3), the right hepatic artery (10), left and right hepatic artery (9) and tumor artery branches (12). Thirty-five bile duct injury occurred in 21 patients: 7 cases was close to the tumor, 2 distant to the tumor, 7 at right liver, 2 left liver, 11 both lobes of liver and 6 hepatic hilar. After medical conservative treatment and biliary tract inside and outside drainage, liver function of 10 cases were improved. In four patients with hepatic bile duct stricture and biloma, the effect of drainage was not obvious, which subsequently caused biliary complications such as infection, gallbladder and common bile duct stones. Three patients with liver cirrhosis at decompensation stage developed complications, and one of them died of hepatic encephalopathy. Four patients experienced tumor recurrence during the follow-up period.@*Conclusions@#The location of bile duct injury after transcatheter arterial chemoembolization is quite consistent with the level of hepatic arterial embolization. There may be some blood vessels mainly involved in blood supply of biliary duct. Complete embolism of these vessels may lead to bile duct injuries. Biliary drainage is ineffective in patients with hilar bile duct stricture, and can lead to complications of biliary tract later on.

Correlation between the CT features and malignancy risk of small (≤5 cm) gastric stromal tumors / 中华肿瘤杂志

Objective@#To evaluate the correlation between computed tomography (CT) features and malignancy risk category of small (≤5 cm) gastric stromal tumors (GST), in order to provide an image reference for preoperative assessment and intraoperative pathological diagnosis.@*Methods@#Eighty-three patients with surgically and pathologically proven GST (≤5 cm) between January 2011 and November 2015 were recruited, and their clinical, pathological and CT data were retrospectively analyzed. According to the pathological results and malignancy risk category, the patients were divided into 2 groups, the benign biological behavior group (very low and low risk) and malignant biological behavior group (intermediate and high risk). The clinical, pathological and CT imaging findings of the two groups were analyzed. Based on the tumor diameter, the receiver operating characteristic curve (ROC) was applied to evaluate the sensitivity, specificity and the best cut-off point for distinguishing the malignancy risk between the two groups.@*Results@#The lobulation and ulceration of the tumors presented statistically significant difference for the malignancy risk between the two groups (χ2=6.273 and 4.163, respectively; all P<0.05), but there was no significant difference in the sex, clinical symptoms, serum ferritin, tumor site, growth pattern, cystis degeneration and calcification (all P>0.05). No statistically significant differences were detected for the tumor CT value, arterial CT value, venous CT value, degrees of enhancement in arterial phase (DEAP), enhancement in portal venous phase (DEPP), and patient′s age for distinguishing the malignancy risk between the two groups (all P>0.05). On the other hand, significant differences were found in the maximum diameter (Dmax) of tumor and the minimum diameter (Dmin) of tumor (t=-3.256 and -3.466, respectively; all P<0.05). When the cut-off point of Dmax was 1.6 cm, the area under the ROC curve, sensitivity and specificity were 0.704, 92.3% and 75.4%, respectively. When the cut-off point of Dmin was 1.5 cm, the area under the ROC curve, sensitivity and specificity were 0.713, 88.5% and 71.9%, respectively.@*Conclusion@#CT features of the GST (≤5 cm) may predict, before surgery, the malignancy risk of small gastric stromal tumors, and provide the an image reference for preoperative assessment and intraoperative pathological diagnosis of the disease.

Value of CT imaging in the differentiation of gastric leiomyomas from gastric stromal tumors / 中华肿瘤杂志

Objective@#To explore the application value of CT imaging in differentiating gastric stromal tumors (GST) from gastric leiomyomas (GLMs).@*Methods@#CT images of patients with GST (n=65) or GLMs (n=13, maximum diameter of tumor ≤5 cm) proved by surgery and pathology were retrospectively analyzed. The tumor size, location, contour, growth pattern, degree and pattern of enhancement, calcification, necrosis, surface ulceration, lymph nodes, and patient clinical data were evaluated by two independent reviewers. Receiver operating characteristic (ROC) curves were employed to assess the measurement and calculation parameters in the differentiation of GST and GLMs.@*Results@#Between the GST and GLMs groups, there was no statistically significant difference in the contour, growth pattern, calcification, surface ulceration, and patient's sex (P>0.05). CT values of in plain scans, degree of enhancement in arterial phase (DE1), size, location and pattern of enhancement were found to be different between GST and GLMs (P<0.05). When the cutoff value of the maximum tumor diameter was 3.2 cm, the area under ROC curve, sensitivity and specificity were 0.707, 92.3%(12/13) and 60.6%(40/66), respectively. When the cutoff value of age was 59 years, the area under ROC curve, sensitivity and specificity were 0.773, 92.3% (12/13) and 46.2% (30/65), respectively. Taking the cutoff value of 10.9 HU as the degree of enhancement in arterial phase (DE1), the area under ROC curve, sensitivity and specificity were 0.774, 84.6% (11/13) and 77.3% (51/66), respectively. Using a cutoff value of 30.3 HU, the sensitivity, specificity, and the area under ROC curve were 84.6% (11/13), 65.2% (43/66), and 0.731, respectively.@*Conclusions@#CT examination in addition to clinical data can be very helpful for the differential diagnosis of GLMs from GSTs in maximum diameter ≤5 cm.

Series review of radioembolization with yttrium-90 microspheres (Part Ⅱ) : pre-treatment evaluation and post-treatment follow-up for patients with hepatic malignancy receiving yttrium-90 microspheres embolization / 介入放射学杂志

Yttrium-90 (90Y) radioembolization therapy can directly deliver a high dose of radiation to the tumor being targeted,which has been demonstrated to be effective in treating patients with hepatic malignancy.Compared with transarterial chemoembolization,90Yradioembolization is less frequently associated with toxicities such as abdominal pain,fever,nausea,and vomiting.However,the efficacy and safety of 90Y radioembolization therapy are largely reliant on careful preprocedural evaluation and diligent follow-up.This review discusses the details of essential preprocedural work-up and postprocedural follow-up for patients treated with 90Y radioembolization.

Research progress of quantitative perfusion parameters of dynamic contrast-enhanced MRI in diagnosis and efficacy evaluation of uterine tumors / 中华全科医师杂志

The quantitative parameters based on dynamic contrast-enhanced MRI (DCE-MRI)scan,simulate the distribution of contrast inside and outside of the blood vessels through a variety of tracer kinetic models.The DCE-MRI perfusion parameters now are widely applied in clinical management of uterine tumors,to analyze the microcirculation characteristics in tumor and to guide the diagnosis,tumor grading and efficacy evaluation.

Characteristics of yttrium-90 microsphere, techniques and radiation safety of radioembolization procedure.A series review of radioembolization with yttrium-90 microspheres (part Ⅰ) / 介入放射学杂志

Radioembolization with yttrium-90 (90Y) microspheres is a locoregional procedure during which either resin or glass microspheres loaded with β-emitting 90Y are selectively injected into a hepatic artery.The microspheres are trapped in downstream vasculatures,at which point they deliver a cytotoxic dose of radiation to the target tumor.The safety and efficacy of this method have been demonstrated in studies of survival outcomes in patients with nonresectable hepatic malignancies.In this first part of a series of reviews on radioembolization with 90Y microspheres,we cover the basic characteristics of 90Y and 90Y microspheres,techniques for the radioembolization procedure,and methods for ensuring radiation safety and protection.

MRI characteristics of primary dilated cardiomyopathy and isolated left ventricular non-compaction / 中国医学影像技术

Objective To explore the MRI characterisitics of primary dilated cardiomyopathy and isolated left ventricular non-compaction.Methods The patients who were diagnosed as primary dilated cardiomyopathy (n=18) and isolated left ventricular non-compaction (n=10) were enrolled,and the MRI was performed.The thickness of non-compaction myocardium (NC),compaction myocardium (C) in end-diastole,the feature of movement of myocardium,the number of non-compaction segment,the fraction shortening of non-compaction and the distribution were compared.Results Totally 823 segments were analyzed in primary dilated cardiomyopathy,in which 124 segments were non-compaction myocardium;397 segments were analyzed in isolated left ventricular non-compaction,in which 115 segments were non-compaction myocardium.The NC,NC/C,NC/(NC+C),and the fraction shortening of the isolated left ventricular non-compaction patients were higher than those of primary dilated cardiomyopathy patients (all P＜0.05).The features of distribution showed that the apical segment was mostly involved,and the basal segment was less involved or hardly involved.The anterior and lateral segments were more involved in the free wall,the septal was less involved.Conclusion The MRI characteristics of primary dilated cardiomyopathy and isolated left ventricular non-compaction are different,especially in the distribution,non compacted segments,NC and NC/C,which is important for diagnosis and differential diagnosis of the two diseases.

Application of dynamic-contrast enhanced magnetic resonance pharmacokinetic models in differential diagnosis of cellular uterine leiomyoma / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the application of the dynamic-contrast enhanced magnetic resonance imaging(DCE-MRI)pharmacokinetics models in differential diagnosis of cellular uterine leiomyoma.</p><p><b>METHODS</b>Sixty four patients with uterine leiomyoma confirmed by surgery and pathology were enrolled in the study between September 2015 and September 2016, including 30 cases of classical leiomyoma, 13 cases of cellular leiomyoma and 21 cases of degenerative leiomyoma. All patients underwent DCE-MRI before surgery. Reference region (RR) model, extended tofts (ET) model and exchange (EC) model were used to quantitatively analyze DCE-MRI data, and their differences among different pathological types of uterine leiomyoma were observed. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of the quantitative perfusion parameters in differential diagnosis of cellular uterine leiomyoma.</p><p><b>RESULTS</b>The values of K(transfer constant), K(efflux rate constant) in RR model, K, K, V(blood plasma volume ratio) in ET model and V(plasma volume ratio), F(plasma flow)in EC model of cellular uterine leiomyoma were higher than those of classical type(<0.05 or<0.01). The values of K, Kin RR model,K,K, V,Vin ET model and V,V,Fin EC model of cellular uterine leiomyoma were higher than those of degenerative uterine leiomyoma(<0.05 or<0.01). There were no significant differences in other quantitative perfusion parameters among three types of uterine leiomyoma (all>0.05). ROC curves revealed that the Kof the ET model was more effective in diagnosing cellular uterine leiomyoma, the area under the curve (AUC) was 0.929, and the sensitivity and specificity were 92.3% and 83.7%, respectively; meanwhile, the AUCs of Fof the EC model, Kof the RR model and Kof the ET model in diagnosis of cellular uterine leiomyoma were 0.867, 0.849 and 0.837, the sensitivities were 91.7%, 84.6% and 92.3%, and the specificities were 78.0%, 76.0% and 73.5%, respectively.</p><p><b>CONCLUSIONS</b>Three pharmacokinetics models can be used in the differentiation of cellular uterine leiomyoma from other types of uterine leiomyoma. Kof the ET model has higher sensitivity and specificity in differential diagnosis of cellular uterine leiomyoma.</p>

Value of dynamic contrast-enhanced MRI parameters of Extended Tofts and Exchange model in the differential diagnosis of hepatocellular carcinoma and hepatic metastases / 中华放射学杂志

Objective To analyze the value of dynamic contrast-enhanced MRI(DCE-MRI) parameters of Extended Tofts and Exchange model in the differential diagnosis of hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Methods A retrospective analysis of 40 pathologically confirmed cases was conducted , including 25 cases of HCC and 15 cases of hepatic metastases of colorectal cancer,all patients underwent DCE-MRI. Applying liver double blood supplement model , and respectively using Extended Tofts two-compartment model and Exchange model liver microvascular permeability parameters [volume transfer constant of the contrast agent(Ktrans), efflux rate from extracellular extravascular space to plasma(Kep), extravascular extracellular volume fraction(Ve)and blood plasma space volume fraction (Vp)] and the perfusion parameter hepatic arterial perfusion index(HPI) in the lesion parenchyma of HCC and metastases were calculated. We used t test to compare the differences of the parameters measured from the two types of tumors , statistically significant parameters between HCC and metastases were screened which compared with the gold standard of pathological findings in order to draw the ROC curves to evaluate the diagnostic efficacy of different model parameters, using χ2 test compared the diagnostic accuracy of optimal parameters between the two models. Results By using Extended Tofts and Exchange model , Ktrans value of HCC were (0.661 ± 0.402)/min and (0.604 ± 0.316)/min respectively, Ktrans value of hepatic metastases were (0.196±0.175)/min and (0.179±0.135)/min respectively;Vp value of HCC were (0.334±0.217) and (0.294± 0.098), Vp value of hepatic metastases were (0.089 ± 0.015) and (0.089 ± 0.022),respectively; HPI value of HCC were (0.680±0.281) and (0.769±0.245) , HPI value of hepatic metastases were (0.326±0.216), (0.373± 0.298), respectively. There were significant differences between HCC and hepatic metastases in Ktrans, Vp and HPI values in both models(P0.05).Drawn ROC curves of Ktrans, Vp, HPI , the Ktrans value (area under the curve of 0.869) among Extended Tofts model parameters was selected as optimal parameter to identify HCC and hepatic metastases; the HPI value (area under the curve of 0.845) among Exchange model parameters was selected as optimal parameter to differentiate these two types of tumors.The diagnostic accordance rate of Extended Tofts model and Exchange model were 80.0%(32/40), 82.5%(33/40), respectively ; There was no significant difference between them(χ2=0.082,P=0.775). Conclusions Parameters including Ktrans, Vp, HPI of the Extended Tofts model and Exchange model in DCE-MRI perfusion can be used to identify HCC and hepatic metastases of colorectal cancer. Among these parameters, Ktrans of Extended Tofts model and HPI of Exchange model have higher diagnostic value in differentiating HCC and hepatic metastases of colorectal cancer.

Evaluation of intraductal papillary mucinous neoplasms of the pancreas on MDCT and MRI / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The purpose of our study was to evaluate the predictive factors of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT and MRI.</p><p><b>METHODS</b>Preoperative MDCT or/and MRI of 27 consecutive patients (19 men, 8 women, mean age 61.3 years) who had undergone surgical resection and had a pathological diagnosis of IPMN were retrospectively assessed. The type of ductal involvement, solid appearance of the lesion, location, tumor size of branch duct type and combined type lesions, maximum diameter of the tumor, caliber of the main pancreatic duct and the extent of the common bile duct dilatation were assessed on CT and MRI and correlated with the pathological findings of the invasive carcinoma. Two abdominal radiologists reviewed all the images, and when discrepancies of the findings were found, the consensus was reached by discussion.</p><p><b>RESULTS</b>Pathological analysis revealed carcinoma in situ in two patients and invasive carcinoma in 19 patients arising from the IPMN. The type of ductal involvement (P = 0.038), a solid mass (P = 0.003) and the common bile duct dilatation ( ≥ 15 mm, P = 0.004) were correlated with the presence of associated invasive carcinoma. For the finding of solid and cystic mass in predicting invasive IPMN, the sensitivity was 66.7% (8/12) and specificity was 100.0% (8/8), and for bile duct diameter ≥ 15 mm, the sensitivity was 47.4% (9/19) and specificity was 100.0% (8/8). However, no association was found between the location of the lesion and associated invasive carcinoma. The caliber of the main pancreatic duct of patients with associated invasive carcinoma was significantly larger than that in the cases without invasive carcinoma (8.07 ± 2.23 mm vs. 4.86 ± 1.86 mm, P = 0.002). When using the main pancreatic duct dilatation ≥ 4 mm as the threshold, the sensitivity and specificity in predicting invasive IPMN were 94.7% (18/19) and 37.5% (3/8), respectively. For the branch duct type and combined type, the size of the tumor with associated invasive carcinoma was significantly larger than these without invasive carcinoma (41.35 ± 12.58) mm vs. (23.76 ± 8.06) mm (P = 0.003). When the maximum diameter was ≥ 40 mm, the sensitivity and specificity in predicting invasive IPMN were 50.0% (6/12) and 87.5% (7/8), respectively.</p><p><b>CONCLUSIONS</b>The findings of CT and MRI are helpful to predict invasive carcinoma associated with IPMN, which may play an important role in the preoperative evaluation, surgical planning and predicting the prognosis of IPMN.</p>

Recent advances on bile duct injury after transcatheter arterial chemoembolization for hepatic malignancy / 中华肝胆外科杂志

Transcatheter arterial chemoembolization (TACE) has been widely applied in palliative treatment of unresectable primary and metastatic liver cancer,and its efficiency and safety also have been widely acknowledged.However,there is a wide range of related complications,such as upper gastrointestinal hemorrhage,liver failure,pulmonary embolism,embolic cholecystitis and so on.As a serious complication of TACE,bile duct injury has been reported intermittently since the introduction of hepatic arterial embolization therapy.However,the exact pathogenesis,predisposing factors and clinical implications of the injuries remain to be clarified.As we find,by far there is no literature review about the bile duct injury after TACE for liver malignant tumors both at home and abroad.Thus the purpose of our study was to discuss such current issue of bile duct injury,and 26 articles have been included and analyzed.

Comparison of test bolus and bolus tracking techniques for dual-energy CT lung perfusion scan / 中华放射学杂志

Objective To compare the test bolus technique with the bolus tracking technique for dual-energy CT pulmonary angiography in patients suspected of pulmonary embolism (PE).Methods A total of 60 patients were randomized into 2 groups:bolus tracking technique group (group B,n =30) and test bolus technique group (group T,n =30).A standard dual-energy CT pulmonary angiography (CTPA)was performed after injection of 60 ml contrast medium followed by 35ml saline chaser at a speed of 4 mL/s.Attenuation profiles of different vascular segments (the subclavian vein,superior vena cava,left atrium,pulmonary trunk,S1 and S10 pulmonary artery) and enhancement value of lung parenchyma were measured to evaluate the timing techniques.The overall image quality of CTPA and pulmonary perfusion were analyzed by two radiologists.SPSS 19.0,Student t test,ANOVA test,Chi-Square test,Mann-Whitney U test and Kappa test were used for the statistic analysis.Results The attenuation of the subclavian vein [(1042 ± 639),(2200 ± 724) HU,F =43.196,P =0.001],superior vena cava [(529 ± 237),(904 ± 329)HU,F=25.654,P=0.001],pulmonary trunk [(325 ±112),(383±69)HU,F=5.94,P=0.018],S1 pulmonary artery [(320 ± 118),(385 ±73) HU,F =6.549,P =0.013],S10 pulmonary artery [(307 ± 78),(360 ± 82) HU,F =6.658,P =0.012] in group B were lower than those in group T,while the attenuation of the left atrium in group B was higher than that in group T [(270 ± 53),(219 ± 57)HU,F=12.823,P =0.001].The percentage of pulmonary arteries exceeding optimal attenuation (＞ 250 HU) in groups B was lower than that in group T [n =21 (70.0％),n =29 (96.7％),x2 =5.88,P ＜ 0.05].The enhancement value of pulmonary parenchyma in group B was lower than that in group T (the right lung (29±8)vs(34±8) HU,t=-2.401,P=0.020; the left lung (30±7)vs(36±9)HU,t=-2.493,P=0.016; total (30 ±7)vs(35 ±8) HU,t =-2.495,P =0.016).The image quality of CTPA in group B was poorer than that in group T (U =619.5,P ＜ 0.05,Kappa =0.708),while the artifacts of lung perfusion image in group B was less than that in group T (U =162.5,P ＜ 0.05,Kappa =0.796).Conclusion The test bolus technique has a better image quality of CT pulmonary angiography and a higher lung perfusion blood volume compared with the bolus tracking technique by using 60 ml contrast medium and 35ml saline.