A pilot study of gray matter volume and function changes in patients after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To explore the structural and functional alterations of related brain regions in patients after cardiopulmonary resuscitation (CPR) by brain magnetic resonance imaging (MRI).Methods:A single-center, observational, cross-sectional study design was used. Patients who had brain MRI scans during hospitalization between July 2020 and July 2021 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University and had good neurologic outcomes were consecutive enrolled in this study. The healthy control (HC) group consisted of age- and sex-matched volunteers. The demographic and clinical data were recorded. The modified Rankin Scale (mRS) was used to check the recovery and degree of continued disabilities when patients performed MRI. Montreal cognitive assessment (MoCA) was used to assess cognitive functions. The analyses of voxel-based morphometry (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) were conducted. After data preprocessing, comparison of gray matter volume (GMV) and fALFF values between the case group and HC group were carried out, and the information of different brain regions was obtained. Partial correlation analyses were performed to evaluate the correlation between the image parameters of different clusters and clinical parameters.Results:Totally 13 patients were enrolled in this study and 13 were in the HC group. All patients achieved good neurologic outcome; mRS was 3 in 1 case, 2 in 3 cases, and 1 in 5 cases during MEI examination. The case group showed significantly lower MoCA score compared with the HC group ( P<0.001). There were significantly decreased GMVs in the right inferior frontal gyrus, superior temporal gyrus, left superior temporal gyrus, and transverse temporal gyrus in the case group. The patients showed significantly decreased fALFF values in the left postcentral gyrus and precentral gyrus, while increased fALFF values in the right putamen than the HC group (voxel-level P<0.001 and cluster-level P<0.05 with GRF correction). In addition, mean fALFF value in the right putamen was negatively correlated with MoCA score in the case group ( r=-0.710, P=0.021). Conclusions:Patients after CPR may have GMVs and neuronal spontaneous activity changes in some brain regions, and VBM and fALFF methods can be used to objectively evaluate the impaired brain functional activity in patients after successful CPR.

Analysis of TUBB4A gene variant in a patient with adolescent-onset hypomyelinating leukodystrophy with atrophy of basal ganglia and cerebellum / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical characteristics and genetic etiology of a patient with adolescent-onset hypomyelinated leukodystrophy with atrophy of basal ganglia and cerebellum (H-ABC).@*METHODS@#A patient who was diagnosed with H-ABC in March 2018 at the First Affiliated Hospital of Nanjing Medical University was selected as the study subject. Clinical data was collected. Peripheral venous blood samples of the patient and his parents were collected. The patient was subjected to whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing.@*RESULTS@#The patient, a 31-year-old male, had manifested with developmental retardation, cognitive decline and abnormal gait. WES revealed that he has harbored a heterozygous c.286G>A variant of the TUBB4A gene. Sanger sequencing confirmed that neither of his parents has carried the same variant. Analysis with SIFT online software indicated the amino acid encoded by this variant is highly conserved among various species. This variant has been recorded by the Human Gene Mutation Database (HGMD) with a low population frequency. The 3D structure constructed by PyMOL software showed that the variant has a harmful effect on the structure and function of the protein. According to the guidelines formulated by the American College of Medical Genetics and Genomics (ACMG), the variant was rated as likely pathogenic.@*CONCLUSION@#The c.286G>A (p.Gly96Arg) variant of the TUBB4A gene probably underlay the hypomyelinating leukodystrophy with atrophy of basal ganglia and cerebellum in this patient. Above finding has enriched the spectrum of TUBB4A gene variants and enabled early definitive diagnosis of this disorder.

Integrating magnetization transfer imaging and fat suppression T 2WI for predicting the clinical activity of Graves ophthalmopathy / 中华放射学杂志

Objective:To investigate the value of magnetization transfer imaging (MTI) and fat suppression T 2WI (FS-T 2WI) in predicting the clinical activity of Graves ophthalmopathy (GO). Methods:From October 2020 to July 2021, 64 GO patients were prospectively enrolled in the First Affiliated Hospital of Nanjing Medical University. According to the clinical activity score (CAS), the patients were divided into active group (CAS≥3, 39 patients and 78 eyes) and inactive group (CAS<3, 25 patients and 50 eyes). The coronal MTI and FS-T 2WI were scanned for pre-treatment assessment. Magnetization transfer ratio (MTR) of extraocular muscles, and signal intensity ratio (SIR) between extraocular muscles and temporalis were measured, respectively. The independent-sample t-test was used to compare the MTR and SIR between two groups. The correlations between MRI parameters and CAS were analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curve was performed to evaluate the value of each and combined parameters for predicting the clinical activity of GO. The DeLong test was used to compare the area under the curve (AUC). Results:The MTR of active group and inactive group were 0.45±0.04 and 0.51±0.04, respectively, the difference was statistically significant ( t=7.62, P<0.001). The SIR were 3.4±0.6 and 2.6±0.5, respectively, and the difference was also statistically significant ( t=-8.20, P<0.001). MTR was negatively correlated with CAS ( r=-0.46, P<0.001), while SIR was positively correlated with CAS ( r=0.63, P<0.001). The AUC of MTR, SIR and the combination of MTR and SIR for predicting the clinical activity of GO were 0.840, 0.845 and 0.905, respectively. The combination of MTR and SIR showed higher performance than MTR or SIR alone, and the differences were statistically significant ( Z=2.61, P=0.009; Z=2.15, P=0.032). Conclusions:The quantitative parameters of MTI and FS-T 2WI, namely MTR and SIR, can be used to evaluate the clinical activity of GO. Integrating MTI and FS-T 2WI can improve the diagnostic efficiency.

Radiomics based on arterial-venous mixed images derived from dual-energy CT data in diagnosis of lymph nodes metastasis of papillary thyroid cancer / 中华放射学杂志

Objective:To explore the diagnostic value of radiomics based on arterial-venous mixed images derived from dual-energy CT (DECT) data in diagnosis of cervical lymph nodes (LNs) metastasis of papillary thyroid cancer (PTC).Methods:From June 2017 to December 2018, eighty-four patients with preoperatively DECT scanning and pathologically confirmed PTC (129 non-metastatic LNs and 97 metastatic LNs) in the First Affiliated Hospital of Nanjing Medical University were included in this study. The clinical and imaging data of all patients were retrospectively analyzed. The training cohort consisted of 62 PTC cases with 156 LNs (91 non-metastatic LNs and 65 metastatic LNs). An independent validation cohort consisted of 22 PTC patients with 70 LNs (38 non-metastatic LNs and 32 metastatic LNs). Semi-automatic LNs segmentation was conducted on arterial-venous mixed images derived from DECT using Syngo.via Frontier Radiomics software. Totally 1 226 radiomics features were extracted from arterial-venous mixed images for each LN. The least absolute shrinkage and selection operator (LASSO) regression was applied for radiomics features selection and signature building. The logistic regression modeling was used to construct diagnostic models based on the CT image features of LNs (model 1), the radiomics signature (model 2) and the combination of the CT image features and radiomics signature (model 3). An intuitive nomogram was plotted for model 3. The ROC curve analyses and area under the curve (AUC) were performed to evaluate the diagnostic efficiency of the three models, with the performances compared using the Delong test.Results:Model 1 was developed with LNs shape, degree of enhancement, pattern of enhancement, calcification and extra nodal extension. Three arterial phase radiomics features were selected and used to establish radiomics signature using LASSO regression (model 2). Model 3 was developed with LNs size, shape, degree of enhancement and radiomics signature. In both the training and validation cohort, model 3 showed the best diagnostic performance (AUC=0.965, 0.933), followed by model 2 (AUC=0.947, 0.910), and both these two models significantly outperformed model 1 (AUC=0.850, 0.846) (training cohort, Z=4.066 and 3.758, P both<0.001; validation cohort, Z=2.871 and 1.998, P=0.017 and 0.042) respectively. Conclusion:The radiomics model based on arterial-venous mixed images derived from DECT data can realize effective diagnosis of LNs metastasis in patients with PTC; and the combination model of radiomics signature with CT image features can further improve the diagnostic accuracy.

Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA / 中华急诊医学杂志

Objective To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery(MCA)occlusion.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018.According to the ASPECTS collateral circulation score,the patients were divided into two groups: good collateral group(n=31)and poor collateral group(n=18).The benefits and risks after thrombolysis in the two groups were compared,including 24-h NIHSS score,30-day mortality,90-day modified rankin scale(mRS)score,and the incidence of symptomatic cerebral hemorrhage.Statistical analysis was performed using t test,corrected x2 test,or Fisher's exact test.Results The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group(4.6±5.6 vs 12.5±8.4,P=O.OO; 1.7±1.7 vs 3.1±1.5,P＜0.05).The incidence of NIHSS score improved by ≥50％and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis(77.4％vs 27.8％,P＜0.05; 80.6％vs 27.8％,P=O.OO); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group(9.7％vs 50.0％,P＜0.05).There was no significant difference in mortality between the two groups after 30 days of thrombolysis(P＞0.05),but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group(11.1％vs 0％).Conclusion For patients with acute MCA infarction and receiving vascular recanalization therapy,patients with good collateral circulation can achieve good clinical outcomes,restore better recent neurological function,and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.

Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA / 中华急诊医学杂志

Objective@#To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion.@*Methods@#This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test.@*Results@#The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P<0.05). The incidence of NIHSS score improved by ≥50% and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis (77.4% vs 27.8%, P<0.05; 80.6% vs 27.8%, P=0.00); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group (9.7% vs 50.0%, P<0.05). There was no significant difference in mortality between the two groups after 30 days of thrombolysis (P>0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%).@*Conclusion@#For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.

ClinicalvalueofRESOLVE-DWIinthediagnosisandstagingofthyroid-associatedophthalmopathy / 实用放射学杂志

Objective Toinvestigatetheclinicalvalueofreadoutsegmentationoflongvariableecho-trainsdiffusion-weightedimaging (RESOLVE-DWI)inthediagnosisandstagingofthyroid-associatedophthalmopathy(TAO).Methods Atotalof30consecutivepatientswith TAOand30healthycontrols(HCs)whounderwentRESOLVE-DWIwereenrolledinourstudy.ADCvaluesofextraocularmuscles (superiorrectus,inferiorrectus,medialrectusandlateralrectus)were measuredandcomparedbetween TAOsand HCs,active TAOsandinactiveTAOs,orinactiveTAOsandHCs.ROCanalysiswasperformedtoevaluatethediagnosticvalueofsignificantparametersfor discriminatingactivefrominactiveTAOs.Results TheADCvaluesofallextraocularmusclesinTAOsweresignificantlyhigherthan thoseinHCs(P<0.05).Meanwhile,alltheextraocularmusclesinactiveTAOsshowedsignificantlyhigherADCvaluesthanthose ininactiveTAOs(P<0.05),exceptlateralrectus(P=0.267).WhilstnosignificantdifferenceswerefoundontheADCvaluesofall extraocularmusclesbetweeninactiveTAOsandHCs(P>0.05).ROCanalysisresultsindicatedthattheADCvalueofmedialrectus showedtheoptimalstagingefficacy(cutoffvalue,1.40×10-3 mm2/s;AUC,0.766;sensitivity,92.1%;specificity,59.1%).Conclusion RESOLVE-DWIanditsderivedADCvaluesofextraocularmusclescanassistinthediagnosisofTAO.TheADCvalueofmedial rectushastheoptimalefficacyontheevaluationofitsclinicalactivity.

Multivariate analysis of short-term prognostic factors in recanalization therapy for acute cerebral ischemia / 中华急诊医学杂志

Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher's exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95％CI: 1.013-6.937)and poor collateral circulation (OR=3.160, 95％CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9％ vs.10.5％, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9％ vs. 10.5％, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3％ vs. 37.8％, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral.

Quantitative analysis of dynamic contrast-enhanced MRI in conjunction with diffusion weighted imaging for differentiating benign and malignant orbital lymphoproliferative disorder / 中华放射学杂志

Objective To evaluate the value of quantitative analysis of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) for differentiating malignant from benign orbital lymphoproliferative disorder(OLPD). Methods Forty-three patients with OLPDs(20 patients with benign OLPDs and 23 patients with orbital lymphoma) confirmed by histopathology or clinical follow-up were enrolled in this retrospective study.Quantitative parameters of DCE-MRI including volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and mean apparent diffusion coefficient(ADC)values were obtained. χ2test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic ability of each parameter and its combination. Results Malignant group showed significantly lower mean ADC values and higher Kepvalues than benign group [ADC:(0.674±0.126)×10-3mm2/s vs(1.030±0.304)×10-3mm2/s,P<0.001;Kep:(1.299±0.566)/min vs(0.787± 0.311)/min, P= 0.001], while no significant differences was found on Ktrans(P= 0.637) and Ve(P= 0.023). ROC analyses results indicated that,a sensitivity of 95.7%,specificity of 80.0% and area under curve(AUC) of 0.896 could be obtained,when using ADC=0.809×10-3mm2/s as the cut-off value.Setting the Kepvalue of 0.863/min as the cut-off value, a sensitivity of 91.3%, specificity of 75.0% and AUC of 0.848 could be obtained. When combination of mean ADC and Kepwas used, optimal diagnostic performance could be obtained (AUC, 0.926;sensitivity, 91.3%;specificity, 90.0%). Conclusion Mean ADC values and Kepare significant variables in predicting malignant OLPDs. Combination of DWI and DCE-MRI can further improve the diagnostic capability in differentiating malignant from benign OLPDs.

Effect of collateral circulation on prognoses of patients with acute cerebral ischemia after thrombolysis / 中华急诊医学杂志

Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.

Comparison study of readout-segmented EPI and single-shot EPI in DWI of orbit in healthy adults / 中国医学影像技术

Objective To explore the feasibility of the applicatoin of readout-segmented echo-planar imaging (RS-EPI) at 3.0T MR of the orbit DWI and compared with single-shot echo-planar imaging (SS-EPI).Methods Forty-two volunteers underwent both standard SS-EPI and RS-EPI DWI of the orbit at a 3.0T MR unit.Two sets of DWI images were independently qualitatively scored in the number of distinguishable normal structures,fat suppression,ghosting artifact and overall image quality.SNR of the vitreous body,geometric distortion ratio (GDR) in both anterior-posterior (AP) and right-left (RL) direction,and ADC value of the vitreous body and pons were also quantitatively calculated and compared between two sets of DWI images.The statistical analysis was performed.Results For qualitative assessment,the RS-EPI was superior to SS-EPI on the number of distinguishable normal structures (P=0.009 0),ghosting artifact (P＜0.000 1),and overall image quality (P＜0.000 1),while no significant difference was found on fat suppression (P=0.753 9).For quantitative assessment,RS-EPI had significantly lower GDR than the SS-EPI in both AP and RL direction (P=0.001 4,0.001 7).The SNR in RS-EPI was significantly lower than that of SS-EPI (P=0.004 0).Meanwhile,there was no significant difference of ADC on vitreous body and pons between RS-EPI and SS-EPI (P=0.143 8,0.126 2).Conclusion The RS-EPI can provide better image quality than SS-EPI protocol in orbital DWI at 3.0T MR imaging.

The prognostic value of gray-white matter ratio on brain computed tomography in comatose adult survivors from cardiac arrest / 中华急诊医学杂志

Objective To evaluate the correlation between the gray-white matter ratio (GWR) and the outcomes of comatose adult survivors from cardiac arrest (CA) in Chinese.Methods Sixty-one CA patients checked with CT scans within 72 hours of resuscitation from January 2011 to January 2016 were included in this single-center retrospective study.Gray and white matter density (Hounsfield units) were measured,and the GWRs were calculated according to previous studies.The prognostic values of the GWRs in predicting poor outcomes (Cerebral Performance Category 3-5) were analyzed.Results The density values of gray matter were significantly higher in the good outcome group than those in the poor one.All GWRs were significantly higher in the good outcome group (P ＜ 0.05).A GWR (basal ganglia) ＜ 1.18 predicted poor outcomes with a sensitivity and specificity of 50.0％ and 88.2％,respectively (P =0.012).Conclusions Low GWRs,determined from brain CT scans in comatose CA patients after resuscitation,were associated with poor neurological outcomes.GWR determination from brain CT can be a useful indicator for outcome prediction aiding in an optimal clinical decision process in comatose survivors from CA.

The value of conventional MRI combined with diffusion weighted imaging in the differential diagnosis of orbital lymphoproliferative disorders / 中华放射学杂志

Objective To investigate the diagnostic value of conventional MRI combined with DWI in the differential diagnosis of orbital lymphoproliferative disorders (LPD). Methods As a retrospective study, 42 patients were enrolled, including 23 orbital lymphoma and 19 benign orbital LPD confirmed pathologically or clinically. These patients underwent conventional MR, DWI and contrast?enhanced MRI examination of orbit. Qualitative MR imaging features [location, margin, patient ratio of involved quadrants (≥2), signal intensity,“flow void sign”, sinusitis] and quantitative features [ADC and contrast enhanced ratio of the lesion to temporal muscle (CER)] were evaluated. Chi?square test and t test were used for the analysis of qualitative and quantitative features between lymphoma and benign orbital LPD groups, respectively. Multivariate Logistic regression analysis was employed to identify the significant variable for predicting malignant LPD. ROC analysis was used to evaluate the ability of the diagnostic models established based on identified variables. Results “Flow void sign”(9 lymphomas and 17 benign LPDs) and sinusitis (5 lymphomas and 13 benign LPDs) were statistically significant (P0.05). Both ADC [(0.79±0.09)×10?3 mm2/s of lymphoma, (1.29±0.35)×10?3 mm2/s of benign LPD] and CER (1.43±0.17 of lymphoma, 1.79±0.31 of benign LPD) between the two groups had significant difference (t=-6.630, -8.257;P<0.01). Multivariate logistic regression analysis showed that ADC value, CER and“flow void sign”were significant variables for predicting malignant orbital LPD (P<0.05). ROC curve showed that ADC value was the most significant single variable in differentiating orbital LPD [threshold value, 0.74 × 10- 3 mm2/s; areas under ROC curve (AUC), 0.97; sensitivity, 87.0%; specificity, 94.7%]. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD (AUC, 0.90;sensitivity, 78.3%;specificity, 100.0%, accuracy 88.1%). Conclusions ADC, CER and“flow void sign”on T2WI were significant variables for predicting malignant orbital LPD. ADC value was the most significant single variable. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD.

Value of conventional and functional MR in the diagnosis of orbital mucosa-associated lymphoid tissue lymphoma / 实用放射学杂志

Objective To evaluate the role of conventional and functional MR in the diagnosis of orbital mucosa-associated lymphoid tissue lymphoma (MALToma).Methods Twenty-two patients with pathologically confirmed orbital MALToma were enrolled in our study.The number,location,morphology,involvement of surrounding structure and imaging features were evaluated.Apparent diffusion coefficient (ADC) values derived from diffusion weighted imaging and time-intensity curve (TIC)pattern derived from dynamic contrast enhanced MRI were assessed. Results Orbital MALToma occurred unilaterally in 1 7 cases and bilaterally in 5 cases.Anterior orbit preseptal region was involved most frequently (20 cases),followed by intraconal(19 cases),extraxonal (17 cases)and lacrimal fossa (12 cases)regions.Most cases showed as homogeneously iso-intensity on both T1 and T2 weighted images.Mean ADC value of the lesions was (0.61 ± 0.08)× 10 -3 mm2/s.A washout-type TIC pattern was observed in 1 5 cases,while plateau pattern was found in 7 cases.Conclusion Conventional MRI can assist in describing the extent,while the functional MRI can quantitatively reflect the histo-pathological features of orbital MALToma.Combination of conventional and functional MRI can help the diagnosis of orbital MALToma.

Diagnostic and staging value of orbital structures quantitative measurement with 3T magnetic resonance imaging in Graves’ophthalmopathy / 实用放射学杂志

Objective To evaluate the diagnostic and staging value of orbital structures quantitative measurement with 3T mag-netic resonance imaging in patients with Graves’ophthalmopathy (GO).Methods Twenty-three GO patients (patient group)and eighteen healthy volunteers (contrast group)were enrolled.Quantitative measurement of orbital structures including exophthalmos values,fatty tissue thickness of the inner side of eye balls,cross-sectional areas of extraocular muscles and signal intensity ratios of extraocular muscles to the ipsilateral temporal muscles (SIR values),and they were compared between two groups.Correlations be-tween the quantitative values and clinical active score (CAS)were accessed.Receiver operating characteristic (ROC)analysis was performed to evaluate the most relevant quantitative parameter and its diagnostic value in discriminating active from inactive GO pa-tients.Results There were significant differences between the GO group and contrast group regarding to all the quantitative parame-ters (P <0.05).Strong correlation was found between SIR values and CAS (r =0.730,P <0.001 ).Significant difference of SIR was found between patients with active GO and inactive GO (P =0.002),and a cut off value of 3.25 might be the critical threshold value,with diagnostic sensitivity of 81.8% and specificity of 83.3% respectively.Conclusion Quantitative measurement of orbital structures with 3T MR imaging could provide assistant in diagnosing and staging of GO.

Correlation between epidermal growth factor receptorgene mutation and CT or positron emission tomography-CT image characteristics in lung adenocarcinomas / 中华放射学杂志

Objective To evaluate the diagnostic value of CT and PET-CT characteristics in predicting the presence of epidermal growth factor receptor(EGFR) gene mutations in lung adenocarcinomas. Methods One hundred and sixty-eight lung adenocarcinomas cases confirmed by pathology were enrolled in our study. They were divided into EGFR gene mutations group (89 cases) and wild types group (79cases) according to whether EGFR gene mutation occurred. All patients underwent CT examination. Seventy-five patients underwent PET-CT examination, including 37 gene mutationsand 38 wild types.The demographic (the patients' age, the gender and smoking history), CT characteristics(lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram, ground glass opacity/tumor ratio(G/T) and the maximum diameter of tumor(Dmax)) and PET-CT characteristics(the maximum standardized uptake value, (SUVmax))between these two groups were retrospectively compared. The independent sample t test was used to analyze the difference between these two groups regarding the patients' age,Dmax,SUVmax. The χ2 test was used to demonstrate the difference between these two groups regarding the gender, smoking history and CT features including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram and G/T.The trend analysis between SUVmax and EGFR gene mutations was performed by usingχ2 test for trend.Results No significant difference was found regarding partial CT characteristics of lesions including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram (P>0.05),however, the Dmax of EGFR gene mutations group and wild types group were(2.53±1.39),(3.00±1.77)cm, respectively. The amount of G/T>50%in EGFR gene mutations group and wild types group was 21 and 5, respectively. Significant differences were found regarding the G/T and Dmax(χ2=9.538, P50%as diagnostic criterion. Receiver operating characteristic (ROC) results indicated Dmax=1.85 cm was the optimal value in predicting EGFR gene mutations, with the sensitivity and specificity of 76% and 42%, respectively. Meanwhile, SUVmax=6.85 was the optimal value, with the sensitivity and specificity of 71% and 73%, respectively. Moreover,χ2 test for trend showed that an obvious trend was found to associate SUVmax with the incidence of EGFR gene mutations (χ2=15.755, P<0.05). Conclusion SUVmax may be helpful in predicting EGFR gene mutations in lung adenocarcinomas with relatively high diagnostic value.