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Objective To investigate the diagnostic performance of ADC value for predicting proliferation and invasiveness of cervical squamous cell carcinoma (SCC).Methods Totally 96 patients with pathologically confirmed SCC underwent preoperative conventional MRI and DWI.Mini-ADC value,mean-ADC value and mini-ADC ratio (mini-ADC/meam ADC) were measured and compared for various patient groups divided based on Ki-67 labeling index and clinicopathological characteristics.Results The mini-ADC values were significantly lower in patients with high Ki-67 expression,tumor size ≥4 cm,high FIGO staging,low pathological grade,depth of cervical stromal infiltrating ≥ 1/2,parametrial involvement,lymphovascular invasion (LVI),lymph node metastasis and perineural invasion (PNI,all P＜ 0.05).Compared with mean-ADC value and mini-ADC ratio,mini-ADC value exhibited the most effective diagnostic performance in predicting clinicopathological characteristics with the highest areas under the ROC curve and efficacy.Mini-ADC value showed negative correlation with Ki-67 index (r=-0.48,P＜0.001) as well as other clinicopathological characteristics,including tumor size,FIGO staging,pathological grading,depth of cervical stromal infiltrating,parametrial involvement,LVI,lymph node metastasis and PNI (r=-0.36,-0.34,-0.27,-0.40,-0.33,-0.60,-0.61,-0.41,respectively,all P＜0.05).Conclusion Mini-ADC value can effectively reflect the proliferation and invasiveness of cervical SCC.
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Objective To evaluate the application value of percutaneous transsplenic varices embolization(PTSVE)in the treatment of upper gastrointestinal hemorrhage in patients with schistosomiasis cirrhosis. Methods Sixteen schistosomiasis cir-rhosis patients(12 males and 4 females)with portal hypertension complicated with esophageal and upper gastrointestinal hemor-rhage were selected as the investigation subjects,all the patients had been treated by esophageal vein ligation and sclerothera-py,but with bleeding again post-operation. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition,the patients received PTSVE were reexamined with abdominal CT one month post-operation,and the degrees of varices were compared before and after PTSVE. Results Four-teen cases(87.50%)were successfully treated with PTSVE. Two cases(12.50%)failed,and one case had an abdominal bleed-ing 1 week post-operation. The abdominal CT showed the degrees of esophageal varices(P < 0.001),esophageal vein(P <0.001)and gastric varices(P < 0.001)were significantly decreased in the patients who received PTSVE one month after the op-eration. Conclusions PTSVE is a safe and effective method in the treatment of upper gastrointestinal hemorrhage in the pa-tients with schistosomiasis cirrhosis. PTSVE is especially suitable for the patients with severe liver cirrhosis,significantly bor-dered liver split,and bared main portal vein and even the branches.
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Objective To evaluate the changes of endometrial microcirculation between pre-and postmenopause with magnetic resonance dynamic contrast-enhanced perfusion weighted imaging (MR DCE-PWI)and intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI).Methods Thirty-three patients with normal endometrium (premenopause in 21 and postmenopause in 12)confirmed by pathology underwent DCE-PWI,IVIM-DWI and conventional MRI.Quantitative parameters of DCE-PWI and IVIM-DWI in the endometrium were analyzed and compared between pre-and postmenopause groups.Results The DCE-PWI parameters were significantly higher in premenopause group than those in postmenopause one with significant differences in Ktrans (0.161±0.081)min-1 vs (0.097±0.054)min-1 , Kep (0.285±0.145)min-1 vs (0.184±0.119)min-1 and IAUC60 (20.854±10.695)mmol·kg-1 ·s vs (10.481±6.253)mmol·kg-1 ·s. No significant differences were found between the two groups in IVIM-DWI parameters including D,D* and f values.Conclusion DCE-PWI,rather than IVIM-DWI,can be used to quantitatively evaluate the changes of endometrial microcirculation between pre-and postmenopause.
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Objective To investigate the value of susceptibility?weighted imaging (SWI) for characterization of small hepatocellular carcinoma (sHCC) in cirrhotic livers. Methods Two hundred seventy?two patients suspiciousof HCC underwent conventional MR imaging and susceptibility?weighted imaging (SWI). Two hundred and five patients were excluded due to either size larger than 3.0 cm, no cirrhosis or HCC. Finally, a total of 84 hepatocellular nodules in 67 patients were included in this prospective study. There were 22 DNs in 12 cases, 8 DNs with HCC foci in 7 cases, and 54 overt HCCs in 48 cases. Two abdominal radiologists independently evaluated signal intensity and enhancing pattern using conventional MRI set and conventional MRI combining with SWI set. A five?point scale was performed to evaluate diagnostic confidence of HCC. Kappa analysis was performed to assess interobserver agreement of the two sets by two readers.The diagnostic performance and confidence level were compared for each image set,ROC was used to evaluate the diagnostic efficiency.Results Good interobserver agreement was identified with a Kappa value of 0.923 for conventional MRI set and 0.865 for conventional MRI combining with SWI set, respectively. The diagnostic sensitivity, specificity, accuracy, and area under the alternative?free response ROC (Az) were 80.6% and 80.6%, 81.8% and 77.3%, 81.0% and 79.8%, 0.804 and 0.782 using conventional MRI set, and 93.5%and 85.5%, 90.9%and 86.4%, 92.9%and 85.7%, 0.898 and 0.859 using conventional MRI combining with SWI set for reader 1 and reader 2, respectively.The diagnostic confidence level of conventional MRI combining with SWI set for diagnosis of HCC with less than 2 cm in size(n=36) was significantly higher than that of conventional MRI (reader 1, 3.86±0.47 vs 3.40±0.91;reader 2, 3.85±0.57 vs 3.41±0.92;t values were 3.733 and 2.468, P were 0.001 and 0.018).Conclusion SWI can provide additional valuable information and improve diagnostic performance for characterization of sHCC in cirrhotic livers.
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Objective To investigate the ability of proton magnetic resonance spectroscopy (1H-MRS) for differentiating benign from malignant solid adnexal tumors. Methods One-hundred and six patients (114 tumors) with surgically and histologically proven solid adnexal tumors (44 benign, 70 malignant) underwent conventional MR imaging and 1H-MRS. Single-voxel spectroscopy was performed using the point resolved spectroscopy localization technique with a voxel size of 2.0 cm × 2.0 cm × 2.0 cm. Resonance peak integrals of choline (Cho), N-acetyl aspartate (NAA), creatine (Cr), lactate (Lac), and lipid (Lip) were analyzed and the Cho/Cr, NAA/Cr, Lac/Cr and Lip/Cr ratios were recorded and compared between benign and malignant tumors using independent two-sample t test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of Cho/Cr ratio for differentiating benign from malignant tumors. Results A Cho peak was detected in all 114 tumors, NAA peak in 112 tumors (43 benign and 69 malignant), Lip peak in 70 tumors (21 benign and 49 malignant), and Lac peak in 16 tumors (7 benign and 9 malignant). The Cho/Cr and Lip/Cr ratios were 4.8±2.5, 6.4±4.0 in benign versus 9.6 ± 3.3, 10.5 ± 4.6 in malignant solid adnexal tumors, respectively, with a statistically significant difference (t values were-8.826 and-2.915,P malignant solid adnexal tumors, with no statistically significant difference (t=-1.523,P>0.05). When the Cho/Cr threshold was 7.2 for differentiating between benign and malignant tumors, the sensitivity, specificity, accuracy were 80.0%(56/70),88.6%(39/44) and 83.3%(95/114) respectively. Conclusions The 1H-MRS patterns of benign and malignant solid adnexal tumors differ. The Cho/Cr ratio can help clinicians differentiate benign from malignant tumors.
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Objective To establish a mouse model of early lung adenocarcinoma to serve the imaging studies of early lung adenocarcinoma .Methods Two-hundred and ten 4-week old SPF female Kunming mice were randomly divided into 5 experimental groups (40 mice per group) and 1 control group (10 mice).The mice of experimental groups were subcutaneously injected with a dose of 0.2 ml 1-methyl-3-nitro-1-nitroso-guanidine ( MNNG) solution in concentration of 2.0 mg/mL weekly for 1, 2, 4, 8, 12 weeks (group A-E), respectively, while the mice of control group was subcutane-ously injected with 0.2 mL saline weekly for 12 weeks.Ten mice were randomly sacrificed from each experimental group at the 60th, 80th, 100th and 120th days after initial injection ( group A60 , group A80 , group A100 , group A120; group B60 ,……and so on) , and the bilateral lungs were dissected .The tumor occurrence rate , number and size of lung tumors were observedandrecorded.Results 1.Thetumoroccurrencerateandnumberoflungtumorswerepositivelyproportionalto the time and dose of MNNG injection .No tumor was found in any group at the 60th day.2.At the 80th day, the tumor oc-currence rate in the groups A, B, C, D and E was 0, 10%, 30%, 40%and 50%, respectively.The number of tumors in each group was 0, 4, 42, 60 and 81, respectively.The number of tumors smaller than 0.5 mm in diameter was 0, 4, 25, 31 and 40, respectively.3.At the 100th day, the tumor occurrence rate was 20%, 40%, 100%, 100%and 100%, re-spectively.The number of tumors was 6, 19, 187, 223 and 301, respectively, and the number of tumors smaller than 0.5 mm in diameter was 5, 16, 132, 124 and 123, respectively.4.At the 120th day, the tumor occurrence rate was 30%, 50%, 100%, 100%and 100%, respectively.The number of tumors was 30, 124, 302, 351 and 362 per group, respec-tively.The number of tumors smaller than 0.5 mm in diameter was 21, 98, 123, 140 and 108, respectively.The induced lung adenocarcinomas were confirmed by pathology .Conclusions MNNG solution 0.2 mL (2.0 mg/mL) subcutaneously injected weekly for 4 weeks can produce 100%occurrence rate of lung adenocarcinoma in mice and most tumors are smaller than 0.5 mm in diameter at 100th day after initial injection .It is a most suitable model for imaging studies of mouse early lung adenocarcinoma .
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Objective To investigate the value of ultrasound-diffuse optical tomography(US-DOT) in evaluation of the response to neoadjuvant chemotherapy (NCT) in patients with breast cancer.Methods Fifty women with breast cancer confirmed by biopsy-pathology scheduled to undergo NCT were enrolled.US-DOT was performed and the total hemoglobin concentration(HbT) prior to and at the end of NCT.According to the response to treatment in solid tumors,patients were divided into complete response(CR) group,partial response (PR) group,stable disease (SD) group and progressive disease (PD) group.The analysis of variance compared the differences of HbT before and after NCT in each group; Pearson correlation analyzed the relationship between the relative HbT variation and the tumor size changes;Mixedeffects model analyzed the relationship between HbT and tumor size.Results After NCT,CR group had 8 cases,PR group 30 cases,SD group 12 cases and no PD cases.Before and after NCT,the mean relative variations of HbT before and after NCT were-0.525 ± 0.222,-0.328 ± 0.180 and-0.173 ± 0.167 in CR,PR and SD groups,respectively.The differences of HbT before and after NCT were statistically significant in each group (P ＜0.05).There was significant difference among tumor diameter and HbT in CR group and PR group (P ＜0.001);while in the SD group,there was no difference among tumor diameter and HbT (P ＞ 0.05).The change of HbT after NCT showed positive correlation with the change in tumor size (r =0.6).Mixed-effects model also showed that HbT change was associated with tumor size.Conclusions USDOT marker HbT is closely related to tumor size of breast cancer before and after NCT and may be applied to evaluate the response of breast cancer to NCT.
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Objective To investigate imaging characteristics of multistep hepatocarcinogenesis in cirrhotic livers on susceptibility-weighted imaging (SWI).Methods Seventy-three patients with 83 nodules in cirrhotic livers underwent hepatic MR imaging with SWI.Two radiologists reviewed MR images by consensus.Imaging characteristics of dysplastic nodules (DN),DN with malignant foci and hepatocellular carcinoma (HCC) were evaluated.Prussian blue staining was performed for semiquantification of hepatic iron content and above cirrhosis-associated nodules.Results Positive iron staining of background liver parenchyma was found in 69 of 73 patients and 4 HCC patients showed iron-negative staining of background liver parenchyma.Nine DNs appeared as hypointensity or isointensity with pathologically confirmed similar (n =7) or slightly decreased (n =2) iron deposition compared with background liver parenchyma.SWI detected 14 of 15 DNs with malignant foci.Seven patients appeared as homogeneous hyperintensity and 1 patient appeared as heterogeneous hyperintensity due to intratumoral hemorrhages.The remaining 6 patients demonstrated as nodule-in-nodule appearance with iron deposition in all background nodules,iron deposition with grade 1 in one internal HCC foci,and iron-free in 5 internal HCC foci.The remaining 50 patients with hepatic iron deposition had 55 HCC lesions.Three HCC lesions had iron deposition with grade 1 to 2 and the remaining 52 HCC lesions were pathologically iron-resistant.HCC appeared as hyperintensity compared with siderotic surrounding liver parenchyma.However,HCCs with diameter larger than 3 cm usually demonstrated heterogeneous hyperintensity due to intratumoral hemorrhage.Conclusions SWI could accurately demonstrate dynamic iron depletion on multistep hepatocarcinogenesis in cirrhotic livers.On SWI images,DNs appear as hypointensity due to siderosis and malignant nodules appear as hyperintensity due to iron depletion.
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Objective To investigate the value of multi-slice CT (MSCT) in diagnosing early acute appendicitis (AA).Methods From June 2008 to June 2011,abdomen MSCT images of 41 patients with acute simple appendicitis confirmed by surgery and pathology were evaluated retrospectively. Thirty-six patients with clinically confirmed normal appendix served as the control groups with 18 patients in complicated-normal-appendix (CNA) group and 18 patients in noncomplicated-normal-appendix (NCNA)group. The appendix was reconstructed by using multiplanar reformation (MPR) and curved planar reformation (CPR) techniques. The differences between early AA and normal appendix in appendiceal diameter,thickness of the appendiceal wall, maximum depth of the intraluminal appendiceal fluid (MDIAF), abnormal enhancement of the appendiceal wall, appendicolith and the periappendiceal abnormalities were evaluated and compared by using analysis of variance,R test and Chi-square test.Results The mean thickness of the appendiceal wall was (2.88 ±0.62),(2.58 -±0.50) and (2.73 ±0.53) mm in early AA,CNA and NCNA groups respectively,with no statistically significant difference among them ( F =1.73,P=0.19).The nean appendiceal diameter was (11.37 ± 1.94),(7.03 -±0.89),(6.75 ±0.63) mm,and median MDIAF was 4.05 (2.65-8.50),1.68 (0-.40),0 (0-1.90) mm in early AA,CNA and NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups ( Z =7.02,7.24 ; P =0.00 ).The abnormal enhancement of appendiceal wall was found in 61.1％ (11/18) of early AA,16.7％ (3/18) of CNA and 11.1％ (2/18) of NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups (x2 =12.83,P =0.00). Using a cutoff value of 7.8 mm of the appendiceal diameter and 2.6 mm of MDIAF for the early AA,the sensitivity,specificity and accuracy were 97.6％ (40/41),91.7％ (33/36) and 94.8％ (73/77),and 100.0％ (36/36),88.9％ (32/36) and 94.4％ (68/72),respectively.Conclusions MSCT is particularly useful for the diagnosis of early AA. When appendiceal diameter is greater than 7.8 mm,and MDIAF greater than 2.6mm,early AA can be diagnosed with confidence.
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Objective To investigate MRI features for differentiating borderline from benign mucinous cystadenoma ( MC )of the ovary.Methods Twenty three patients with 23 benign MCs and 19 patients with 20 borderline mucinous cystadenomas (BMC)proven by surgery and pathology underwent MRI,with 23 benign MCs and 20 BMC. MRI features of tumor were evaluated and compared between two groups including location,shape,size,loculation,signal intensity of the fluid,thickness of septa and wall,and vegetations.The findings were correlated with those of pathology.The loculation,the signal intensity of the intracystic content,the thickness of the septation and the wall,and the vegetations between the benign MCs and the BMCs were compared using the Chi-square test.ResultsHomogenous low signal on T1WI and homogenous high signal on T2WI were the main signal patterns of benign MC seen more commonly in benign MC (18/23 and 17/23,respectively) than in BMC (5/20 and 8/20,respectively) (x2 =12.1979,5.0553 ;P ＜0.05).The honeycomb loculi,high signal on T1 WI,low signal on T2WI,thickened septa or wall ( ≥5 mm),and vegetations ( ≥5 mm) were significantly more common in BMC( 10/20,9/20,8/20,10/20 and 14/20,respectively)than in benign MC(4/23,3/23,1/23,1/23 and 1/23,respectively) (x2 =5.1804,5.4300,8.2163,11.7113 and 20.2990,P ＜ 0.05 ),with the sensitivity and specificity for characterizing BMC of 50.0％ and 82.6％,45.0％ and 87.0％,40.0％ and 95.7％,50.0％ and 95.7％,and 70.0％ and 95.7％,respectively.When one of honeycomb loculi with low signal on T2WI,thickened septa or wall ( ≥5 mm),and vegetations ( ≥5 mm) were found,the sensitivity,specificity and accuracy for characterizing BMC were 90.0％,91.3％ and 90.7％ respectively. Conclusion MRI is accurate for demonstrating morphological features of ovarian MC which well correlated to pathological characteristics,and for differentiating BMC from benign MC,thus helpful for making surgery strategy.
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Objective To evaluate mesenteric muhidetector row CT angiography (MDCTA) in the diagnosis of acute mesenteric ischemia (AMI).Methods In this study,43 cases of AMI proven by clinical criteria,or operation and pathology underwent whole abdomen MDCT precontrast,arterial phase and venous phase scan with 0.6 mm collimation.The mesenteric arteries and veins were reconstructed by using volume rendering (VR),maximum intensity projection (MIP),thin slab maximum intensity projection (TSMIP) techniques,and abnormal CT angiography findings as well as abnormal bowel and mesentery were analyzed.Results It was found that AMI was caused by superior mesenteric artery (SMA) embolism (n =4),SMA thrombosis (n = 6),mesenteric and portal venous thrombosis (n = 13),SMA dissection (n =5),strangulated bowel obstruction (n = 10) and vasculitis (n = 5).MDCTA showed clearly the position,shape,severity and extent of the vascular occlusion,narrow and dissection.It could also demonstrate the abnormal course and direction of the vessels including vascular gathering,shift,tortuosity,retortion,and twist.Furthermore,the pathogenesis of various conditions including atherosclerotic plaque,emboli,thrombosis,dissection,tumorous invasion,strangulated bowel obstruction and vasculitis could be identified by MDCTA.Conclusion MDCTA can clearly demonstrate direct signs leading to AMI,and identify AMI and its etiology at early stage,with the combination with its indirect findings.
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Objective To study the initial and the follow-up manifestations of infants with Langerhans’ cell histiocytosis (LCH) and evaluate the relationship between X-ray manifestations and clinical prognosis. Methods The radiological manifestations were analysed in 22 cases of LCH proved by clinical features, laboratory data, and pathology. According to Lavin’s Grade, the 22 cases were classified as Grade I (9 cases), Grade II (9 cases), and Grade III (4 cases). Plain radiography was performed in all cases during the initial and the follow-up,including cranial bones, chest, long bones, and spine. CT was performed in 12 cases. Results Of the 22 cases, there were 7 cases which lesions were limited to bones. 5 of them were demonstrated with ossification and remodeling of the involved bone after chemotherapy.The remaining 15 cases were associated with multi-systemic involvements, only 4 of which improved after chemotherapy. Among these 15 cases, 7 had lung involvement, only 2 of which had gotten better. Hypothalamus/pituitary axis was affected in 1 case. Conclusion The extension of the bone involvement can reflect LCH clinical prognosis. However,the lung involvement of LCH, which mainly presented with interstitial lesion, is not sensitive for the evaluation of clinical situation.LCH with limited bone destructions have a better prognosis than those with the multi-systemic involvements.
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Objective To improve the diagnostic accuracy by analyzing the CT manifestations of ovarian cystadenoma .Methods The CT images of 57 patients with 62 ovarian cystadenomas proved by surgery and pathology were studied retrospectively . Results Of 62 ovarian cystadenomas, 26 cases with 31 tumors were serous,another 31 cases were mucinous . Unilocular and multilocular forms were seen respectively in 19(61.3%)and 12(38.7% ) of 31 serous cystadenomas, and in 3(9.7%)and 28(90.3%) of 31 mucinous cystadenomas.22 (71.0%) tumors were benign, and 9(29.0%)were of borderline and/or malignant transformation in 31 serous cystadenomas.23 (74.2%) tumors were benign, and 8 (25.8%) were of borderline and/or malignant transformation in 31 cases of mucinous cystadenomas.Benign cystadenomas were frequently round or oval cysts with thin regular wall and septa.Borderline or malignant transformation cystadenomas demonstrated predominately thick irregular wall or septa with projections.The overall preoperative accuracy of characterization was 48.4% in serous and 77.4% in mucinous cystadenomas.Conclusion Multilocular cystadenomas have the typical CT manifestations and CT is a high valuable procedure for imaging them, whereas unilocular cystadenomas, having similar CT findings with some other benign cystic lesions, are lack of enough characteristic features for CT correct characterization.
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Objective To improve the diagnostic accuracy of ovarian endometrioma and to discriminate it from other adnexal masses by analyzing its CT manifestations. Methods The CT images of 57 patients with 77 ovarian endometriomas proved by surgery and pathology were studied retrospectively.Results The cysts ranged in diameter from 2 to 14 cm with the mean size of 6.2 cm?5.1 cm. The margins of the cyst were sharp in 39 and ill defined in 38 endometriomas. Thin and thickened walls were found respectively in 40 and 37 of 77 endometriomas. Unilocular, bilocular and multilocular forms were seen respectively in 29(37.7%), 23(29.9%) and 25(32.5%) of 77 endometriomas. Gourd and sister forms were present respectively in 15 and 8 of 23 bilocular cysts, and sister loculi, outer son loculi, inner son loculi, and mixed forms in 10, 9, 1 and 5 of 25 multilocular endometriomas. The density of the cyst fluid varied from 11～65 HU with the mean of 28.5 HU. New hemorrhage inside cyst was found in 6 cysts. Slight or intermediate enhancement of the cyst wall of endometriomas in 42, and significant enhancement in 35 were demonstrated. 54 cysts, 13 cystadenomas with 18 lesions and 4 malignant tumors with 5 lesions were diagnosed by preoperatively by CT. The accurate rate of CT characterization was 71.4%. Conclusion The certain morphologic characteristics of the ovarian endometrioma can be showed by CT in higher extent. It is critical to familiar with these characteristics to improve the diagnostic accuracy, and to avoid misdiagnosis.