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Objective:To investigate the diagnostic value of diffusion kurtosis imaging (DKI) quantitative parameters in lymph node metastasis of rectal cancer.Methods:The clinicopathological data of 79 patients with rectal cancers in Shanxi Province Cancer Hospital from November 2016 to March 2017 were retrospectively analyzed. All patients underwent routine magnetic resonance image (MRI) sequence and DKI sequence examinations before the operation. The tumor region of interest (ROI) was delineated by two radiologists. Matlab software was applied to calculate DKI quantitative parameters including apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) in two groups, respectively; and the consistency analysis was performed by using the interclass correlation coefficients (ICC). According to the results of postoperative pathology, all patients were divided into lymph node metastasis group and lymph node non-metastasis group; ADC, MD, MK of both groups were compared. The pathological diagnosis results were taken as the gold standard, receiver operating characteristic (ROC) curves of DKI quantitative parameters in the diagnosis of lymph node metastasis of rectal cancer were plotted, the area under the curve (AUC) was calculated, the optimal diagnostic threshold was determined based on the Yoden index, and the sensitivity and specificity were calculated.Results:The ICC of ADC, MD and MK calculated by two physicians were 0.934 (0.833-0.975), 0.963 (0.905-0.981) and 0.971 (0.949-0.991), respectively, showing a good inter-observer consistency. Among the 79 patients with rectal adenocarcinoma, 36 cases were in lymph node metastasis group and 43 cases were in lymph node non-metastasis group. MK value in lymph node metastasis group was higher than that in lymph node non-metastasis group, and the difference was statistically significant (0.97±0.08 vs. 0.89±0.09; t = -4.07, P < 0.001), while the ADC and MD values in lymph node metastasis group were lower than those in lymph node non-metastasis group, and the differences were not statistically significant (all P > 0.05). The AUC of MK value in the diagnosis of lymph node metastasis of rectal cancer was 0.735, and the corresponding sensitivity and specificity were 55.56% and 88.37%, respectively. Conclusions:DKI quantitative parameter MK has a certain diagnostic value in predicting lymph node metastasis of rectal cancer.
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Objective To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in combination with peripheral serum tumor markers in the diagnosis and therapeutic evaluation of small cell lung cancer (SCLC) brain metastases.Methods Retrospective analysis of 368 SCLC cases diagnosed by histopathology or cytology from February 2009 to February 2012 in Shanxi Provincial Cancer Hospital was made.All patients underwent pathological examination of progastrin-releasing peptide (ProGRP),neuron-specific enolase (NSE) and brain DWI,and measured the apparent diffusion coefficient (ADC) of DWI sequences of brain metastases.The difference between the positive rates of ProGRP and NSE in patients with or without brain metastases was compared by the X2 test,and the diagnostic efficiency of ProGRP,NSE,DWI and combined detection for brain metastases were analyzed.The Kruskal-Wallis H test was used to compare the changes of ADC value,ProGRP and NSE before and after brain irradiation therapy in brain metastases of SCLC.Pearson correlation analysis was made to evaluate the correlation between the changes of ADC value and the levels of ProGRP and NSE in SCLC patients with brain metastases before and after treatment.Results The median expression of serum ProGRP in 169 SCLC patients was 2 664.7 pg/ml (98.4-4 876.8 pg/ml),with a positive rate of 98.2 ％ (166/169).The median expression of NSE was 41.9 μg/L (9.4-264.3 μg/L),with a positive rate of 70.4 ％ (119/169).The median expression of serum ProGRP level was 514.3 pg/ml (3.9-2 899.3 pg/ml) in 199 SCLC patients without brain metastasis,the positive rate was 89.4 ％ (178/199).The median expression of NSE was 40.4 μg/L (0.3-176.1 μ,g/L),with a positive rate of 64.8 ％ (129/199).The difference of ProGRP level between the two groups was statistically significant (u =121.47,P ＜ 0.001),but there was no significant difference in NSE level (u =1.35,P =0.12).The sensitivities of ProGRP,NSE,DWI,ProGRP+DWI and NSE+DWI were 68.4 ％,41.2 ％,66.7 ％,92.2 ％,and 82.4 ％,and the specificities were 52.9 ％,35.3 ％,76.5 ％,94.1％,and 88.2 ％.The sensitivity and specificity of ProGRP+DWI and NSE+DWI were higher than those of single test,and the differences were statistically significant (all P ＜ 0.001).One hundred and fifty-six SCLC patients with brain metastases were treated with whole brain radiotherapy.Pearson correlation analysis showed that ADC values were negatively correlated with ProGRP and NSE levels (r =-0.945,P ＜ 0.001;r =-0.995,P ＜ 0.001).Conclusion DWI combined with ProGRP and NSE can provide objective evidence and clinical guidance for the diagnosis of SCLC brain metastases and the evaluation of whole brain radiotherapy.
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Objective@#To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery.@*Methods@#A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival.@*Results@#Among the 95 cases, 5 cases occured local recurrence, 21 cases developed, 3 cases including both locally recurrence and distant metastasis, 19 died and 47 had no recurrence or metastasis at the last of follow-up. Univariant analysis showed that MRI signs before chemoradiation, namely, mr circumferential resection margin, mr levator ani muscle invasion, mr lymphatic vessel invasion, mr tumor deposition and postoperative pathological parameters, yp circumferential resection margin, yp lymphatic vessel invasion were related to PFS (P<0.05). Multivariate analysis of Cox proportional hazard model showed that mr lymphatic vessel invasion and mr tumor deposition were independent factors for PFS (OR=2.774 and 3.029, P<0.05).@*Conclusions@#Lymphatic vessel invasion and tumor deposition on MRI are independent prognostic factors for progression free survival of locally advanced rectal cancer after neoadjuvant chemoradiotherapy and TME surgery. To some extent, MRI signs can assess local recurrence and distant metastasis in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and mesorectal excision.
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Objective@#To investigate the magnetic resonance imaging (MRI) findings and clinicopathological features of primary lesions in patients with occult breast cancer (OBC).@*Methods@#The imaging reports from the Breast Imaging Reporting and Data System in 2013 were retrospectively analyzed to investigate the morphology and the time signal intensity curve (TIC) of breast lesions in patients with OBC. The clinical and pathological characteristics of these patients were also included.@*Results@#A total of 34 patients were enrolled. Among these patients, 24 patients underwent modified radical mastectomy and 18 of them had primary breast carcinoma in pathological sections. MRI detected 17 cases of primary lesions, including six masse lesions with a diameter of 0.6-1.2 cm (average 0.9 cm), and 11 non-mass lesions with four linear distributions, three segmental distributions, three focal distributions, and one regions distribution. Five patients had TIC typeⅠprimary lesions, ten had TIC type Ⅱ primary lesions, and two had TIC type Ⅲ primary lesions. Among all 34 cases, 23 of them had complete results of immunohistochemistry: 11 estrogen receptor (ER) positive lesions (47.8%), tenprogesterone receptor (PR) positive lesions (43.5%), seven human epidermal growth factor receptor 2 (HER-2) positive lesions (30.4%), and 20high expression(>14%) of Ki-67 (87.0%). The proportion of type luminal A was 4.3%, type luminal B was 43.5%, triple negative breast cancer (TNBC) was 30.4%, and HER-2 over expression accounted for 21.7%.@*Conclusions@#The primary lesions of OBC usually manifested as small mass lesions, or focal, linear or segmental distribution of non-mass lesions. The positive rate of ER and PR was low, but the positive rate of HER-2 and the proliferation index of Ki-67 was high. Type luminal B is the most common molecular subtype.
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Objective To evaluate the value of 3.0T magnetic resonance multi-b value diffusion-weighted imaging (DWI) in evaluating the efficacy of chemotherapy for patients with central lung squamous cell carcinoma and atelectasis. Methods Twenty patients with lung squamous cell carcinoma were examined by magnetic resonance imaging (MRI) (including T1WI, T2WI and multi-b value DWI) before chemotherapy, 2 cycles of chemotherapy and 4 cycles of chemotherapy. The images, the tumor volume and changes of apparent diffusion coefficient (ADC) were analyzed. Results In the patients with central lung cancer and atelectasis, the tumor and atelectasis could be distinguished on MRI examination before radiotherapy. It was more easily identified on T2WI images after radiotherapy. In the 20 patients, the ADC values in the effective group (partial remission or complete remission) and the invalid group were increased, but the differences of ADC values in the effective group before chemotherapy, 2 cycles and 4 cycles of chemotherapy were statistically significant [b=800 s/mm2:(1.09 ± 0.52) × 10-6 mm2/s, (1.22 ± 0.59) × 10-6 mm2/s, (1.24 ± 0.52) × 10-6 mm2/s, F = 31.19, P < 0.001]. There was no significant difference in ADC values between before and after chemotherapy (b = 800 s/mm2: (1.10 ± 0.49) × 10-6 mm2/s, (1.16 ± 0.60) × 10-6 mm2/s, (1.20 ± 0.72) × 10-6 mm2/s, F=2.86, P=0.089]. When b=800 s/mm2, the ADC curve slope in the effective group was more stable, better linearity. Conclusions The MRI technique can accurately distinguish the tumor from atelectasis before and after chemotherapy. The change of ADC value after chemotherapy is earlier than that of morphological change. The change rate of b value can better evaluate the curative effect of chemotherapy.
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Objective To evaluate the clinical value of gemstone spectral imaging (GSI) in preliminary assessment of esophageal carcinoma pathology features.Methods 58 patients were analyzed which were diagnosed with histological pathology as esophageal carcinoma underwent GSI enhanced scans before surgery.The iodine concentrations (IC) in the lesions were measured on the iodine-water based material-decomposition images.The results of IC value were evaluated retrospectively with different pathological grading,locations and pathological morphology according to the final pathologic findings.Results 52 cases patients were squamous cell carcinoma and 6 patients were adenocarcinoma.The IC values were (14.75±4.24) mg/ml and (12.86±5.09) mg/ml.The IC value between the two different pathological types had not statistically difference (P =0.35).The IC of different pathological grading:Well differentiation was (20.08± 4.66)mg/ml,n =19.Medium was (14.13±3.39) mg/ml,n =25.Poor was(11.73±3.21) mg/ml,n =14.The IC values between pathological grading had significant difference(P =0.00).There were four different pathological morphology including m edullar (n =16),m ushroom type (n =21),ulcer (n =13) and narrow type (n =8).Their IC values respectively were (16.34±2.56) mg/ml,(18.70±3.03) mg/ml,(14.31±4.60) mg/ml and (11.18±2.09) mg/ml.The IC value between mushroom and narrow type had statistical difference (P =0.04).The Other types had no statistically difference (P =0.19).Conclusions The results of this study demonstrate that GSI has a certain ability of pathologic stage of esophageal cancer.The GSI has a certain clinical value in guiding treatment and judging prognosis of esophageal carcinoma.
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Objective To evaluate the diagnosis value of spiral CT in leiomyosarcoma of abdomen.Methods Both plain and enhanced CT fingdings in 12 cases with pathologic-proved leiomyosarcoma of abdomen were respectively analyzed.Results In all of 12 cases,1 case occurred in colon,1 case in rectum,1 case in small intestine,5 cases in mesentery,4 cases in retroperitoneum,CT positioning accuracy rate was 91.7 ％ (11/12).The volume was comparatively large,the average diameter was 6 cm.The density were uneven,nodosity or lamellar necrosis were found.Delay enhacement were occurred in lower density part in most part of cases (9/12).Conclusion The localization of spiral CT is comparatively accurate to the leiomyosarcoma of abdomen,some characteristics are found in CT image,but the final diagnosis depends on immunohistochemistry.
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Objective To observe the effects of swimming in cold water on the functioning and structure of the peripheral nerves of diabetic rats,and to compare the effects of seawater and fresh water. Methods Forty SD rats weighing ( 250 ± 20) g were randomly divided into a normal control group (A),a diabetic model group ( B ),a seawater swimming group (C) and a fresh water swimming group (D) with 10 rats in each group.The swimming training was carried on 5 times a week for 8 weeks.At the end of the 4th and 8th week of training,caudal nerve conduction velocity (CNCV) was measured.The nerve structure of the caudal nerves was observed at the end of the 8th week. Results By the 4th week,CNCV had slowed significantly in group B compared with group A,but not in groups C and group D.Compared with group B,CNCV had increased significantly in group C.There was no significant difference in CNCV between groups C and D.At the 8th week,compared with group A,CNCV had slowed in groups B and C.Compared with group B,CNCV was significantly faster in groups C and D.However,there was no significant difference between group C and group D with regard to CNCV.At the end of the 8th week demyelination was observed in the caudal nerves under a light microscope and an electron microscope in groups B,C and D,but the demyelination was milder in groups D and C. Conclusion Swimming in cold water can prevent or delay diabetic neuropathy in diabetic rats.There was no significant difference between seawater and fresh water swimming in terms of its effect on CNCV.
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Objective To evaluate the value of high resolution MR imaging (MRI) with diffusion weighted imaging (DWI) in the preoperative diagnosis of rectal cancer. Methods 55 patients with rectal cancer may underwent high resolution MRI examinations before surgical operation, and with DWI (b=600, 1000 s/mm2). The apparent diffusion coefficient (ADC) of the tumors were measured. The image findings were compared with pathology. Select 15 patients without rectal lesion, ADC value of the tumors and normal rectal wall were measured. Results High resolution MRI diagnosis rectal cancer sensitivity, specific degree and coincidence rate were 95.7% (45/47), 50.0% (4/8), 89.1% (49/55), high resolution MRI with DWI diagnosis colorectal cancer sensitivity, specific degree and coincidence rate were 100.0 % (47/47), 75.0 % (6/8), 96.4 % (53/55). The high resolution MRI tumor T-staging agreed with the histological stage that was 88.9% (40/45), the diagnosis of T2 stage was 87.5 % (14/16), the diagnosis of T3 stage was 89.6 % (26/29). The same b-valued under the ADC values of rectal cancer tumors and the normal rectal were different (P ＜0.05). No correlation can be pointed out between ADC and pathological classification of each tumor.Conclusion High resolution MRI with DWI for the rectal cancer preoperative diagnosis and T-staging has higher diagnostic accuracy, DWI can serve as an important supplement sequence of colorectal cancer diagnosis.
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Objective To discuss the value of MRI in the assessment of diagnosis and staging of cervical carcinoma. To compare MRI diagnosis value before surgery and pathology staging after surgery in uterine cervical carcinoma. Methods Pelvic MRI were performed in 50 patients with cervical carcinoma. The pathological type included 47 cases of squamous cell carcinoma, 2 cases of adenocarcinoma and 1 cases adeno-squamous carcinoma. The MRI scanning included axial SE T1WI, axial , sagittal and coronal FSE T2WI ,and axial , sagittal and coronal enhanced or dynamic contrast-enhanced MR. MR staging were compared with surgical pathologic staging after surgery in 38 patients. Results The accuracy of MR imaging in stage Ⅰ - ⅡA of cervical cancer were 82.35 %. These patients performed an operation of hysterectomy or subtotal hysterectomy surgery. The accuracy of MR imaging in stage ⅢA-ⅣB were 100 %. The accuracy of MRI in total stage were 84.21%. Conclusion MR imaging can show the local tumors and extension of the cervical cancer clearly on multiple planes and angles. Preoperative staging with high accuracy, MR1 is conducive to preoperative evaluation, surgical plan formulation and selection.