Analysis of imaging features of mucinous breast carcinoma / 中国医师进修杂志

Objective:To investigate the characteristic of mammography, magnetic resonance imaging (MRI), ultrasonography and pathology of mucinous breast carcinoma (MBC); and to study the differential diagnosis value of the three methods in pure MBC (PMBC) and mixed MBC (MMBC).Methods:One hundred and three lesions in 100 MBC patients confirmed by surgery and pathology in the Affiliated Cancer Hospital of Fudan University from January 2011 to January 2018 were retrospectively analyzed. According to the 2013 version of the breast imaging report and data system (BI-RADS) criteria, the three imaging findings of lesions were described, evaluated and classified. According to pathological results the lesions were divided into two groups, PMBC and MMBC, and their imaging features and differences were analyzed.Results:On mammography, most of the mammary glands were c-types (55/76, 72%), and the lesions were mostly masses (71/76, 93%), most of which were round, oval, high-density masses with circumscribed, microlobulated or indistinct margins. Suspected malignant calcification was showed in 21% (16/76) of these lesions. Eight patients had ipsilateral axillary lymphadenopathy. On MRI, most lesions showed masses (69/72, 96%). Sixty-seven lesions (31/72, 43%; 36/72, 50%) showed equal and high signals on T 1WI, and 54 lesions (54/72, 75%) showed higher signals on T 2WI. The margins were mostly irregular and burrs (53/69, 77%). Masses enhancement was dominated by heterogeneous enhancement (32/69, 46%) and rim enhancement (33/69, 48%). The patter of time-signal intensity was dominated by progressive curves (41/72, 57%) and platform curves (24/72, 33%). The lesions had heterogeneous high signal on DWI. The ADC signal was slightly higher than normal gland. Seven patients were accompanied with thickening of the skin and nipple retraction. Eight patients had ipsilateral axillary lymphadenopathy. One patient had multiple lung metastases. On ultrasonography, most lesions showed irregular masses, heterogeneous hypoechoic, well-defined margins, posterior echo enhancement (75/97, 77%). Color Doppler imaging showed vascularity in 65% (63/97) of these lesions. Nine patients had ipsilateral axillary lymphadenopathy. There was significant difference in margins between PMBC and MMBC ( P < 0.05) on MRI and ultrasonography. It showed significant difference in vascularity between 2 groups ( P < 0.05) on MRI. Conclusions:MBC has some typical features in mammography, MRI and ultrasonography. Realizing its features can improve the diagnostic accuracy of MBC, and it also can contribute to the differential diagnosis of PMBC and MMBC.

Elevated serum uric acid is an independent risk factor for the loss of renal function / 中华肾脏病杂志

Objective To investigate the relationship between serum uric acid level and renal function decline by retrospective cohort study.Methods Through the physical examination system of the First People's Hospital of Foshan,the physical examination data from 2015 to 2018 of a public institution in Foshan city were obtained.The gender,age,blood cell analysis,liver function,serum creatinine,uric acid,fasting blood glucose were obtained.The change of eGFR (△eGFR=eGFR2018-eGFR2015) was analyzed.Results A total of 2505 subjects were followed up for four years.The subjects were divided into △eGFR ≥0 group and △eGFR ＜ 0 group.There were 845 subjects in △eGFR ≥0 group,and 1660 subjects in △eGFR ＜ 0 group.Compared with that in △eGFR ＜ 0 group,the base-level of uric acid in △eGFR ≥ 0 group was higher [(349.48±87.62) μmol/L vs (325.72±82.58) μmol/L,t=6.669,P ＜ 0.001],but the rate of uric acid decline was greater [-15.00(-53.50,17.00) μmol/L vs 15.50(-18.00,49.00) μmol/L,Z=-13.470,P ＜ 0.001].According to the levels of uric acid in 2015 and 2018,then the subjects were divided into four groups,normal to normal group (N-N,1551 cases),normal change into high uric acid group (N-H,299 cases),high uric acid drop to normal group (H-N,238 cases),and high to high uric acid group (H-H,417 cases).The △eGFR was-1.58(-4.17,1.01) ml · min-1 · (1.73 m2) 1 in N-N group,and-3.60(-7.24,-0.98) ml · min-1 · (1.73 m2)-1 in N-H group,-0.20(-3.14,3.27) ml· min-1· (1.73 m2)-1 in H-N group,-0.96(-4.07,1.93) ml· min-1· (1.73 m2)-1 in H-H group,respectively.The △eGFR decreased most significantly in N-H group than the other three groups (x2=103.130,P ＜ 0.001).Multivariate logistic regression analysis showed that elevated uric acid was an independent risk factor for eGFR decline (OR=1.739,95％CI 1.587-1.906,P ＜ 0.001),while elevated indirect bilirubin (OR=0.968,95％CI 0.943-0.993,P=0.013),elevated red blood cells (OR=0.815,95％ CI 0.680-0.976,P=0.026) were independent protective factors for eGFR decline.Conclusion Elevated uric acid is an independent risk factor for the decline of renal function.Good control of hyperuricemia is beneficial to the protection of renal function.

Digital breast tomosynthesis in diagnosis of dense breast lesions / 浙江大学学报·医学版

OBJECTIVE@#To evaluate the value of digital breast tomosynthesis (DBT) in diagnosis of dense breast lesions.@*METHODS@#Clinical and pathological data of 163 patients (58 benign lesions, 122 malignant lesions, and 180 lesions in total) with breast lesions undergoing surgical treatment in Shaoxing Central Hospital from January 2017 to December 2018 were retrospectively analyzed. The lesions were classified into non-homogeneous dense gland type and extremely dense gland type according to BI-RADS creterion. Breast MRI and DBT examinations were performed before the surgery. ROC curve was generated and the diagnostic efficacy of two examination methods for dense breast lesions was evaluated with pathological results as the gold standard. The detection rate, diagnostic accuracy of benign and malignant breast lesions were compared between two methods using chi-square test. The accuracy of lesion size preoperatively evaluated by MRI and DBT was analyzed by Pearson correlation.@*RESULTS@#The detection rate and diagnostic accuracy for benign breast lesions by MRI were higher than those by DBT (91.4% vs. 75.9%, =5.098, 0.05 and 94.3% vs. 91.8%, =0.569, >0.05). The areas under the ROC curves of MRI, DBT based on BI-RADS classification were 0.910 and 0.832, respectively (=1.860, >0.05). The sensitivities of MRI, DBT to breast lesions were 93.3% and 86.7%, and the specificities were 68.3% and 79.1%. DBT and MRI measurements were positively correlated with pathological measurements (=0.887 and 0.949, all <0.01).@*CONCLUSIONS@#DBT can effectively diagnose benign and malignant breast lesions under dense gland background, and it has similar diagnostic efficacy with MRI for breast malignant lesions.

Diagnostic performance of contrast-enhanced spectral mammography / 中华放射学杂志

Objective To assess the value of contrast enhanced mammography (CESM) in the detection of breast cancer. Methods A total of 145 patients who were suspected of breast abnormalities by clinical examination or ultrasound were prospectively collected. All patients underwent bilateral breast CESM and MRI examinations. Breast CESM and MRI examination were completed in the same week. The pathological specimens were analyzed and the maximum diameters of pathological lesions were measured. The lesions were observed on low energy(LE), CESM and MRI images, and then the maximum diameters of lesions on the above images were measured. Using pathology results as the gold standard, the diagnostic efficacy of LE, CESM and MRI were analyzed by ROC curve, and Z test was used to compare the areas under the ROC curves among different imaging methods. Bland-Altman method was used to analyze the consistency of the maximum diameters of the lesions obtained with different imaging methods. Results One hundred and fifty three lesions were found in 145 patients, in which 36 were benign and 117 were malignant. The LE, CESM and MRI showed 140, 151 and 149 lesions respectively, and the qualitative diagnostic errors were 25, 8 and 11, respectively. The areas under ROC curves of LE, CESM and MRI were 0.87, 0.96 and 0.97 respectively. There was significant difference of the area under ROC curve between CESM and LE, so did the MRI and LE (P<0.05), but there was not significant difference between CESM and MRI (P=0.51). The sensitivity, specificity and accuracy in the diagnosis of malignant breast lesions were 88.98%, 65.71% and 83.66% for LE, while they were 95.80%, 91.18% and 94.77% for CESM, 94.17%, 87.88%and 92.81%for MRI. The average difference of diameters between LE, CESM, MRI and pathologic size was-1.7, 1.1 and 0.3 mm, respectively, with 95%consistency interval range of-18.6 to 15.1,-9.8 to 12.1,-10.6 to 11.2 mm, respectively. There was best consistency between the pathological size and the size on MRI. Conclusion CESM can significantly improve the diagnostic efficacy of breast lesions, which is comparable with MRI.

The comparison of the diagnostic value of mammography,ultrasonography and MRI for breast non-mass enhancement lesions / 实用放射学杂志

Objective To compare the diagnostic efficacy of digital mammography,ultrasonography and MRI for breast non-mass enhancement (NME).Methods The digital mammography,ultrasonography and MRI data of 1 1 6 patients with 123 NME lesions on MRI were analyzed retrospectively.Results 99 lesions were malignant and 24 lesions were benign according to the pathologiacl result.The sensitivity of digital mammography,ultrasonography and MRI was 72.73%,65.66%,and 84.85%,respectively;The specificity was 66.67%,79.1 7%,and 79.1 7%,respectively;The accuracy was 71.54%,68.29%,and 83.74%,respectively;The positive pretictive value was 90.00%,92.86%,and 94.88%,respectively;The negative pretictive value was 37.21%,35.85%,and 55.88%,respectively.The sensitivity,specificity,accuracy,positive pretictive value and negative pretictive value of MRI were obviously higher than those of digital mammography and ultrasonography (P <0.05).The difference between the combinations and MRI alone were no statistically significant.Conclusion MRI have better diagnostic value,and could be used as the first choice examination for breast NME lesions.

MRI-guided breast lesion localization and lesion analysis / 中华放射学杂志

Objective To analyze the indications,techniques of MR-guided localization and the imaging features of breast lesion.Methods Hook wire localization was performed in 43 patients whose lesions were only detected by MRI,based on a 1.5 T MR scanner and a special MR biopsy positioning frame.The feasibility of operation and accuracy of localization were explored.Lesion features and pathologic findings were analyzed using Fisher exact test.Results A total of 37 patients (86.0％) with 38 lesions underwent MR-guided localization.Of the 6 patients canceled,the lesions were not obvious in 4 patients,and the positioning was difficult in 2 cases.Of the 38 lesions,17 were masses,20 were non-mass enhancement lesions,and one lesion was undetermined enhancement.There were 11 (28.9％) malignant lesions.The distribution of internal enhancement pattern was different between benign and malignant non-mass lesions (P =0.028),while the other morphological features between benign and malignant were not significantly different (P ＞ 0.05).Conclusions MR-guided localization provides an accurate and safe method for localizing the suspicious lesions on MRI.The morphological findings of these lesions are not characteristic for the differentiation of benign and malignant lesions.

A preliminary study of murine walker-256 tumor hypoxia detected by blood oxygen level dependent-MR / 中华放射学杂志

Objective To establish Walker-256 transplantation tumor model in SD Rats.To study of R2 * signal changes on murine Walker-256 tumor after inhaling Carbogen by blood oxygen level dependent (BOLD)-MR,and to explore the feasibility of BOLD-MRI on detecting tumor hypoxia.Methods Walker-256 tumor cell implanted subcutaneously in right lower abdomen of 95 female SD rats.MR was performed on the tumor-forming rats when the maximum diameter of tumor reached 1-3 cm,using a 3.0 T MR scanner equipped with a 3 inch animal surface coil BOLD-MRI was done by using a multiecho SPGR sequence during inhaling air and at 10 minute after inhaling Carbogen,respectively.All images were transferred to GE ADW 4.3 workstation,then a baseline R2* (R2 * a) and R2 * (R2 * b) after inhaling Carbogen of tumor was calculated using R2 Star analysis software and △R2 * was calculated through △R2 * =R2 * b-R2 * a,meanwhile the volume of tumor were calculated as well.The difference of R2 * signal preand post-inhaling of Carbogen was compared with a paired t test,Pearson correlation was calculated between R2 * a,△R2 * and the volume of tumor,respectively.The correlation between △R2 * and R2 * a was also assessed by Pearson correlation.Results Sixty-eight of ninety-five female SD rats formed the tumor (71.6％).The volume of tumor was from 352 to 13 173 mm3.Mean △R2* decreased significantly (-2.26 ±3.90) s-1 from (41.18 ±22.29) s-1 during breathing air to(38.91 ±21.35) s-1 10 min after inhaling Carbogen (t =4.01,P ＜ 0.01).△R2 * was inversely correlated with R2 * (r =-0.32,P ＜ 0.05).The △R2 * was well correlated with volume of tumor (r =0.35,P ＜ 0.05),but R2 * a was not correlated with volume of tumor(r =-0.03,P ＞ 0.05).Conclusions BOLD-MRI can detect the R2 * signal change of murine Walker-256 tumor pre-and post-inhaling of Carbogen.The R2 * signal showed significant decrease after inhaling Carbogen,however,the individual variation was remarkable.

Distribution of involved regional lymph nodes in recurrent and locally advanced breast cancer and its impact on target definition / 中华放射肿瘤学杂志

Objective The frequency and the anatomic distribution of involved regional nodes in recurrent and locally advanced breast cancer were analyzed, in order to evaluate the rational of conventional regional node radiation technique and provide evidence for target definition of breast cancer . Methods Patients with recurrent or locally advanced breast cancer who were treated in our hospital from August 2003 to December 2009 were included in this study. 111 patients had contrast enhanced chest CT images of the whole regional nodes before treatment. The regional nodes were categorized into 8 anatomical substructures including medial and lateral supraclavicular nodes ( SC-M, SC-L), axilla nodes ( ALN )- Ⅰ , Ⅱ , Ⅲ,infraclavicular nodes (IFN), Rotter's nodes (RN) and internal mammary nodes (IMN). The frequency of involvement and anatomical distribution of the involved nodes on CT images were analyzed. Results A total of 111 patients were enrolled this study and 199 anatomical substructures with involved nodes were identified. The frequency of involvement were :SC-M 33, SC-L 21, ALN- Ⅰ 30, ALN-Ⅱ 25, ALN-Ⅲ + IFN 35, RN 27, IMN 28. Supraclavicular region and axilla were the most frequently involved area (72. 3% ).The average depth of the SC-M and SC-L nodes was 33.48 mm ± 10. 57 mm and 45.62 mm ±20. 45 mm,and 51.5% and 71.4% of the SC-M and SC-L nodes were located more than 3 cm deep from the skin. The axilla nodes were located cranial and caudal to the axillary vein in 5 and 20 locally advanced breast cancer patients and in 64 and 28 patients who received prior axillary dissection. The majority of involved IMN was located within the first 3 intercostal spaces (26/28). The average distance between the center of involved IMN and chest skin was 24. 23 mm ± 10. 28 mm. The average distance between the center of involved IMN and midline of the body was 29. 38 mm ±6. 7 mm. The center of involved IMN was 6.19 mm ±5.73 mm lateral and 5.73 mm ± 4. 56 mm posterior to the internal mammary vessels. Conclusions Conventional field design is unlikely to provide sufficient dose to the entire risk region because of individual differences.Individualized treatment planning based on CT would become feasible with increasing knowledge of natural risk of nodal involvement.

Basic principles and clinical applications of dynamic contrast-enhanced MRI in prostate cancer / 中国医学影像技术

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) enables non-invasive imaging characterization of tissue vascularity with small molecular weight gadolinium chelates. Depending on this technique, tissue blood perfusion, microvessel permeability and extracellular leakage space can be obtained. The basic principles of two dynamic MRI techniques (T2*W and T1W DCE-MRI) and their applications in prostate cancer of DCE-MRI including diagnosis, differential diagnosis, formulation of treatment plan, evaluation of therapeutic reaction, detection of lesion recurrent were reviewed in this article.