The value of breast imaging reporting and data system classification combined with radiomics in differentiating benign from malignant breast lesions with different X-ray phenotypes / 中华放射学杂志

Objective:To evaluate the differential diagnostic efficacy of a predictive model of breast imaging reporting and data system (BI-RADS) classification combined with mammography radiomics classifier for various X-ray phenotype of breast lesions.Methods:A retrospective analysis was performed on 2 055 female patients who underwent mammography examination and were confirmed by pathology from May 2013 to August 2020 in Zhongda Hospital, Southeast University. Breast lesion was classified into mass or non-mass according to the fifth edition of BI-RADS. The mass was further divided into small mass (maximum diameter ≤ 2 cm) and large mass (maximum diameter>2 cm), the non-mass was further divided into asymmetric, calcification and structural distortions. By manually segmenting the region of interest of the lesion, the radiomics features were extracted and the model was constructed. Receiver operating characteristic curve and area under the curve (AUC) were used to assess the diagnostic efficacy of the BI-RADS classification, the radiomics model and the combined model for various phenotypes of breast lesions. Differences among the AUC were analyzed by the DeLong test.Results:The AUCs based on the BI-RADS classification, the radiomics model and the combined model were 0.924±0.006, 0.827±0.009 and 0.947±0.005 respectively. Compared with BI-RADS classification and the radiomics model, AUC of the combined model was the highest, and the differences were statistically significant ( Z=9.29, 14.94, P<0.001). For large mass, small mass and non-mass, combined model (AUC=0.958±0.007, 0.933±0.013, 0.939±0.008) showed the best performance when compared to the BI-RADS classification (AUC=0.937±0.010, 0.896±0.020, 0.916±0.011; Z=5.32, 3.90, 5.08, P<0.001) or the radiomics model (AUC=0.872±0.012, 0.851±0.021, 0.758±0.016; Z=7.86, 4.53, 12.13, P<0.001). The AUC of the combined model for benign and malignant asymmetric breast lesions (0.897±0.017) was higher than that of the BI-RADS classification (AUC=0.866±0.020, Z=4.27, P<0.001) and the radiomics model (AUC=0.633±0.029, Z=7.44, P<0.001); however, the AUC of the combined model for benign and malignant calcification and structural distortion of breast lesions (0.971±0.010, 0.811±0.057, respectively) was only higher than that of the radiomics model (AUC=0.827±0.021, 0.586±0.075, Z=7.40, 3.15, P<0.001), and there was no significant difference with the BI-RADS classification (AUC=0.959±0.012, 0.800±0.061, Z=1.87, 0.39, P>0.05). Conclusion:The combined model shows better differential diagnostic performance, which is valued in the clinical application.

Repeatability and consistency of diffusion-weighted imaging parameters for breast cancer with mass and non-mass / 中华放射学杂志

Objective@#To study the repeatability and consistency among different operators while different b-value DWI was used to detect mass and non-mass breast lesions.@*Methods@#Between December 2010 and October 2017, we collected 131 female patients (one hundred and thirty-three lesions) from Zhongda Hospital Southeast University, they were diagnosed as non-cystic lesion of the mammary gland by contrast enhancement MRI (DCE-MRI),were examined with DWI and confirmed by surgical pathology. There were 94 cases of mass lesion (96 lesions) and 37 cases of non-mass lesion (37 lesions). All patients were examined with DWI before surgery,80 patients were examined with b-value of 0, 400, 800 and 1 000 s/mm2, there were 51 tumor lesions and 29 non-tumor lesions;53 patients were examined with b-value of 0, 400, 800 and 1 200,1 600 s/mm2,there were 45 tumor lesions and 8 non-tumor lesions. Two radiologists with the same qualifications used double-blind reading to measure ADC values. Paired t test was used to compare the differences in measurement parameters between the two physicians. The repeatability of data between the two physicians was analyzed by intraclass correlation coefficient (ICC) and Cronbach α coefficients. The consistency of data between the two physicians was evaluated by Bland-Altman analysis.@*Results@#In different b values (0,400,800,1 200,1 600 s/mm2), the ADC value of non-mass type breast cancer and mass type breast cancer was no statistically significance between the two operators (P>0.05).The ICC of the ADC values of the non-mass breast lesion under the different b values measured by 2 physicians were 0.72, 0.78, 0.87, 0.76, 0.74, and the repeatability was good or very good; The Cronbach α coefficients are 0.83, 0.88, 0.93, 0.86, 0.85, and the reliability is high. The ICC of the ADC values of the mass breast lesion under the different b values measured by 2 physicians were 0.88,0.95,0.97,0.93,0.91, and the repeatability was very good. the Cronbach α coefficients were 0.94,0.97,0.99,0.96,0.95, and the reliability was high. The results of the Bland-Altman image analysis showed that the ADC values of non-mass and mass lesion detected by different operators in different b values have good consistency. In different b values, there were 97.3% (36/37), 94.6% (35/37), 93.1% (27/29),8/8 and 8/8 points within the 95% consistency limit of non-mass breast lesions; there were 97.9% (94/96), 94.8% (91/96), 92.2% (47/51), 95.6% (43/45), 93.3% (42/45) within the 95% consistency limit of mass breast lesions.@*Conclusion@#The ADC values were measured under different b values, and different operators had favarable repeatability and consistency for different lesions of different types of breast cancer.

Correlation of quantitative perfusion parameters on dynamic contrast-enhanced MRI with ;prognostic factors and subtypes of breast carcinoma / 中华放射学杂志

Objective To investigate whether correlation exists between quantitative perfusion parameters obtained from dynamic contrast?enhanced magnetic resonance imaging (DCE?MRI) and different prognostic factors or immunohistochemical subtypes of breast cancers. Methods A retrospective analysis of DCE?MRI was performed in 87 breast cancer patients with 91 pathology confirmed breast lesions. All the patients underwent the immunohistochemistry after the operation, 80 breast cancer patients with 84 breast lesions were divided into different subtypes based on the immunohistochemical profiles. All the patients underwent plain MRI and DCE?MRI. The volume transfer constant (Ktrans), rate constant (kep) and volume of EES per unit volume of tissue (Ve) value were calculated. Results of the immunohistochemistry and observation results of the the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor?2 (HER?2) were recorded. Subtypes were also categorized. The degree of the expression of Ki?67 was observed simultaneously. Among the 87 breast cancer patients (with 91 breast lesions), 68 were ER?positive,18 were ER?negative, 60 were PR?positive, 26 were PR?negative;30 were HER?2 positive and 58 were HER?2 negative. Eighty breast cancer patients (with 84 breast lesions) were divided into different subtypes:19 were Luminal A, 49 were Luminal B, 7 were HER?2 positive subtype and 9 were triple negative breast cancer (TNBC). The quantitative perfusion parameters with diffierent expression of the receptors were analyzed through Mann?Whitney U test, the correlation between the degree of the expression of Ki?67 and quantitative perfusion parameters was obtained with Spearman test. Furthermore, the distributions of the perfusion parameters between groups according to immunohistochemical subtype were compared using the Kruskal?Wallis test. Results Ktrans and kep value were higher in tumors with ER?negative and PR?negative than with ER?positive and PR?positive and difference was statistically different ( P0.05). The degree of the expression of Ki?67 was 5%to 90%the mean value was 33%, the median and interquartile range of Ktrans, kep and Ve value was 1.33/min (0.88/min), 2.63/min (2.34/min) and 0.51 (0.22) respectively. There was no significant correlations between the degree of the expression of Ki?67 and Ktrans and kep value (r value was 0.24 and 0.22 respectively, P value was 0.03 and 0.04 respectively), and the degree of the expression of Ki?67 was not associated with Ve (r=0.00, P=0.97). Ktrans value was lower in Luminal A and Luminal B than that in HER?2 positive subtype and TNBC, kep value was lower in Luminal A and Luminal B than that in TNBC, and Ve value in Luminal A, Luminal B and HER?2 positive subtype were higher than that in TNBC, kep value was lower in Luminal B than that in HER?2 positive subtype, statistically significance was seen among them (P<0.05).Triple?negative breast cancer showed the highest kep value (3.99/min) and the lowest Ve value (0.41) than the other subtypes. Conclusion The different subtypes of breast cancer may be predicted to some extent with quantitative perfusion parameters, and there is no correlation between quantitative perfusion parameters and the prognostic factors.

Signal intensity ratio and signal-to-noise ratio of breast lesions in 3.0 T MR diffusion weighted imaging with different b values / 中华放射学杂志

Objective To investigate the signal intensity ratio and signal-to-noise ratio of breast lesions in 3.0 T MR diffusion weighted imaging with different b values.Methods Ninety seven patients with 106 solid breast lesions (44 malignant,62 benign) confirmed by pathology were retrospectively analyzed.The patients were examined by 3.0 T MR DWI with different b values (b =0,400,800,1 000 s/mm2) before surgery.The signal-to-noise ratio (SNR) and signal intensity ratio (SIR) of benign and malignant lesions were observed and measured under different b values.One-way ANOVA and t test were used to analyze quantitative data.ROC curve was used to analyze the diagnostic efficiency of SIR under different b values.Results Under different b values,class A image was found in 92 cases,class B images was found in 5 cases.While b value were 0,400,800,1 000 s/mm2,SIR of benign lesions were 2.33 ± 1.36,2.25 ± 1.13,2.06 ± 0.84,2.02 ± 0.79 respectively,SIR of malignant lesions were 2.02 ± 0.79,2.27 ± 0.85,2.61±0.78,2.82 ± 1.01 respectively.While b value was 0 or 400 s/mm2,there was no significant differences for SIR between benign and malignant lesions (t value were 1.58,1.26 respectively; P value were 0.12,0.90 respectively),but there were statistically significances between benign and malignant lesions under b value 800 s/mm2 or 1 000 s/mm2 (t value were 3.41,4.29 respectively ;P ＜0.01).There was no differences in SIR for benign and malignant lesions under different b values respectively (F value is 1.21,2.22 respectively; P ＞0.05).While b value were 0,400,800,1 000 s/mm2,the diagnostic sensitivity and specificity of SIR for breast benign and malignant lesions were 56.8％ (25/44),56.8％ (25/44),75.0％ (33/44),77.3％ (34/44) and 51.6％ (32/62),54.8％ (34/62),66.1％ (41/62),66.1％ (41/62) respectively.While b value were 0,400,800,1 000 s/mm2,SNR were 170 ±93,145 ±72,84 ±41,70 ± 39 respectively.Different b values,there was statistically significant difference between groups (F =55.89,P ＜ 0.01) ; and there were significant differences between every two b values (P ＜ 0.05).Conclusion The higher b values (800 s/mm2 and 1 000 s/mm2) are superior to lower b values in the differential diagnosis of benign and malignant breast lesions using 3.0 T MR scanner.

Effects of self management education on quality of life and psychological pressure in parents of asthma children / 现代临床护理

Objective To explore the influence of self-management education on the quality of life of parents of asthma children. Methods Forty-eight parents of children with asthma underwent one-year intervention of self-management.The results were assessed on the basis of two kinds of questionnaires,the Generic Quality of Life Inventory-74(GQOLI-74)and a self-designed psychological pressure questionnaire.Results After intervention,the scores of person and family,economic burden,lifelong care,lack of sense of accomplishment and overprotection were diminished,compared to those before intervention(P<0.05).There were also significant differences between pre-and post-intervention in the four dimensions with 20 factors(P<0.05 or P<0.01).Conclusion The self-management education can ease parents' psychological pressure and increase their quality of life.

Effect of parental participation in the care to discharged children with metabolic syndrome / 现代临床护理

Objective To prove into the effect of parental involvement in nursing to discharged children with metabolic syndrome.Methods Forty-six children with metabolic syndrome were equally divided into the observation group and the control group according to the order of admittance.Both groups accepted health education,guide to lifestyle and so on.After leaving hospital,the observation group accepted parental involvement in nursing,while the control group accepted physical examination regularly.Then the lifestyles,physical indicators,blood pressure and biochemical indicators of both groups were compared.Results The lifestyle of the observation group was significantly greater than that of the control group(All P<0.01).The observation group had greater declines in waist,blood pressure,TC,TG and LDL-C and a greater increase in HDL-C than those of the control group.Conclusions Parental involvement in nursing can improve the lifestyle of children patients,which is good for the declines of their weigh and blood lipid.This treatment can achieve the goal of control and treatment of children metabolic syndrome.

Comparative study of ultrasonography-guided optical imaging system and full-field digital mammography in breast neoplasms / 中华放射学杂志

Objective To compare the diagnostic values of US-guided optical imaging system (OPTIMUS) and full-field digital mammography (FFDM) in breast neoplasms. Methods Sixty-four patients suspected of breast neoplasms underwent OPTIMUS and FFDM before surgery. All patients were proved histopathologically. The accuracy of diagnosis was compared with chi-square test. Results Sixty-five masses were delineated by OPTIMUS and FFDM. The diagnostic accuracy, sensitivity and specificity of OPTIMUS were 86. 2% ( 56/65 ), 87.0% ( 20/23 ) and 85.7% ( 36/42 ), respectively. The positive likelihood ratio was 6. 09 and the negative likelihood ratio was 0. 175. The diagnostic accuracy, sensitivity and specificity of FFDM were 73.8% (48/65), 82. 6% ( 19/23 ) and 71.4% (30/42), respectively. The positive likelihood ratio was 2. 892 and the negative likelihood ratio was 0. 243. There were no significant differences between OPTIMUS and FFDM ( x2 = 3. 077 ,P ＞ 0. 05). Conclusion OPTIMUS is similar and supplementary to FFDM for the diagnosis of breast neoplasms.

Atypical full-field digital mammographic findings of breast cancer / 中华放射学杂志

Objective To evaluate the diagnostic significance of full-field digital mammography (FFDM)for atypieal breast cancer findings.Methods Seven hundred-eighteen cases with breast cancer were examined using FFDM and atypical mammographic findings were found in 134 cases.Craniocaudal (CC)view and mediolateral oblique(MLO)view were conducted for each patient.Mediolateral view or spot view Was achieved if necessary.Preoperative localization Was conducted for the patients with nonpalpable breast cancer8.Results (1)The masses with well.circumscribed margin on mammography were more common in infiltrating duetal carcinoma(22/106),mucinous carcinoma(8/10),medullary carcinoma (5/6),and increased with age and reduction of the mass density.(2)Long spieulation,architectural distortion,patchy high density were mainly found in infiltrating ductal carcinoma and 30-40(24 cases),41-50(34 cases)years old patients.Long speculation wag mainly found in 30-40 years old patients (10/30).(3)Hish homogenous density and subcutaneous edema in the entire breast and mass-like area were most ffequendy found in infiltrating ductal carcinoma at 30-40(2 cases)and 41-50(5 cases)years old.High density and subcutaneous edema were only found in dense breast(8 cases).Conclusion The atypical findings of breast cancer in foil-field digital mammography are associated with the pathological type of cancer.patient age and the gland density of the breast.

Effect of low-power laser irradiation on hemodynamics of patients with geriatric coronary heart disease / 中国组织工程研究

BACKGROUND: It is reported that there is special physiological effect of Neiguan (Luo-connecting point, P6) acupuncture on the cardiovascular system. Instead of acupuncture, irradiation of the Neiguan point with He-Ne laser can improve the cardiac function of senile patients with coronary heart disease (CHD).OBJECTIVE: To study the effect of irradiation of Neiguan acupoint with He-Ne laser on the circulatory system of senile patients with coronary heart disease.DESIGN: Auto-control study.SETTING: Henan Provincial General Hospital of the Chinese People's Armed Police Force.PARTICIPANTS: Forty senile patients with coronary heart disease hospitalized in the General Hospital of Henan People's Armed Police Force for rehabilitation from 2000 to 2001 were selected. There were 28 males and 12 females, aged from 66 to 85 with the average age of 70. The course of their disease was from 2 years to 20 years. Among the patients, 15 were complicated with essential hypertension and 7 were with hyperlipemia.METHODS: He-Ne laser, with wavelength of 632.8 nm and power of 5 mw, was used to irradiate directly the Neiguan acupoint once a day, 15 minutes in each time and 20 times as a whole course. Indexes of hemodynamics were detected before the treatment, just after the first treatment and after the first course of treatment.MAIN OUTCOME MEASURES: ① Cardiac work total (CWT), left heart work effective (LWE) and left cardiac index (LCI); ② Left heart total pumping force (LTPF), left heart jetting pressure (JP), left heart effective pumping force (LEPF) and pressure of efflux (EPE); ③ Consumption myocardium oxygen (CMO) and coronary compliance (CMR); ④ Modulus of elasticity of the cardiac muscle (VE).RESULTS: All 40 senile patients with coronary heart disease entered the final analysis without any loss. ① Comparison between the first time of post-treatment and the pre-treatment: The data of CWT, LCI, and LWE were decreased [(534.086 ±90.923), (616.587 ±137.426) J/minute;(4.821±0.622), (5.469±1.144) L/minute.m2; (116.528±22.476), (136.603 ±30.796) J/minute, P ＜ 0.05 or P ＜ 0.01]. Parameter of CMO was decreased but parameter of CMR was increased [(22.783±4.174), (25.255±6.125) mL/minute,(180.108±31.210), (157.031±35.056) g/cm4s2, P ＜ 0.01]. ② Comparison between post-first course and pretreatment: Parameters of CWT were decreased [(489.291±118.434), (616.587±137.426) J/minute, P ＜ 0.05],those of CMO were also decreased but th ose of CMR were increased [(22.472±6.011), (25.255±6.125) mL/minute, (193.757±51.704),(157.031±35.056) g/cm4s2, P ＜ 0.01].CONCLUSION: The treatment of coronary heart disease with He-Ne laser beam instead of needling may induce heating effect, biological effect and electromagnetic field, which can excitated the physiological function of meridian in order to improve cardiac load and myocardial oxygen consumption, to increase the oxygen supply and the utilization rate of tissue, improve relaxation-contraction function of coronary artery and promote the blood supply and circulation of coronary artery.

Effect of dexamethasone by local treatment on cerebral edema and serum myelin basic protein after brain injury in rabbits / 中华创伤杂志(英文版)

OBJECTIVE: To explore the effect of dexamethason e by local treatment on cerebral edema and brain damage after brain injury. METHODS: Twenty-two rabbits were classified into 2 groups, Gro up A (the control group, n=11) and Group B (the treated gr oup, n=11). An rabbit brain contusion model was made by bo ne windowplasty by extradural hitting. Group B was treated by local infiltrating and spraying of dexamethasone at equidistance to lesions. Group A was given nor mal saline in the same way as Group B. The changes of moisture in brain tissues and serum myelin basic protein (MBP) were observed. RESULTS: The percentage of water content in damaged hemisphere in Group A and Group B was 81.75%plus minus0.56% and 79.45%plus minus0.52% respe ctively. There was a significant difference between the 2 groups (P<0.05). The normal level of MBP was 1.66 mug/Lplus minus0.71 mug/L, while the value of MBP in Group A and Group B were 5.98 mug/Lplus minus2.08 mug /L and 3.15 mug/Lplus minus1.09 mug/L separately. The level of MBP in Group A an d Group B were higher than normal level and there was also a significant differe nce between Group A and Group B (P<0.05). CONCLUSIONS: The results of our study showed that the brain moi sture and MBP in serum were increased after brain injury while reduced after tre atment with dexamethasone. It is demonstrated that local treatment of brain inju ry with dexamethasone has an obvious therapeutic effect on cerebral edema and se rum MBP.

Evaluation of image quality of CT virtual endoscopy / 中华放射学杂志

Objective To analyze and evaluate the image quality and the impact factors of CT virtual endoscopy (CTVE) in the application of various body parts. Methods CTVE images from 143 patients were classified into 2 types according to the chosen threshold: low attenuation lumen (including natural air filled and artificially air filled lumina) and high attenuation lumen. A 4 point scale was used to evaluate the differences of diagnostic confidence, artifacts, and overall image quality rating between both kinds of lumina. Results There was no statistically significant differences in diagnostic confidence of CTVE images among 3 kinds of lumina, but the image quality of CTVE of natural air filled lumen was better than that of artificially air filled lumen ( P 0.05). There was a significant difference in artifact rating of CTVE images among three kinds of lumina with the most artifacts seen on images of high attenuation lumen. Common artifacts observed on the CTVE images were attributed to patient motion artifacts such as respiration, inappropriate choice of spiral CT scanning parameters, and improper modification of thresholds. Conclusion The threshold setting was one of the most important factors impacting the image quality of CTVE images, and most artifacts seen on the CTVE images were easily recognized on the basis of their characteristic appearance, and did not influence the diagnostic information heavily.