Nomogram based on CT texture analysis and morphological characteristics for differentiating Borrmann Ⅳ type gastric cancer from gastric diffuse large B-cell lymphoma / 中华放射学杂志

Objective:To explore the value in differentiating Borrmann Ⅳ type gastric cancer (BT4-GC) from gastric diffuse large B-cell lymphoma (DLBCL) using a nomogram based on CT texture analysis (CTTA) and morphological characteristics.Methods:From June 2011 to December 2020, a total of 60 patients with BT4-GC and 24 patients with DLBCL were retrospectively collected in Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. Morphological characteristics were evaluated, including major location, long axis range, circumferential range, mucosal line status, and perigastric enlarged lymph nodes. CTTA parameters were calculated using venous CT images with a manual region of interest. The morphological characteristics and CTTA parameters between BT4-GC and DLBCL were compared by χ 2 test, Fisher exact test or Mann-Whitney U test. The multivariate binary logistic regression analysis was used to filter factors into the diagnostic model and construct a nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of CTTA parameters and the diagnostic model in differentiating BT4-GC from DLBCL. Results:For morphological characteristics, mucosal line status showed a significant difference between BT4-GC and DLBCL (χ 2=12.99, P<0.001). For CTTA parameters, 16 parameters showed significant differences between BT4-GC and DLBCL (all P<0.05). The area under the ROC curve (AUC) of 16 CTTA parameters in differentiating BT4-GC from DLBCL was 0.662-0.833. Percentile 90 showed the highest AUC of 0.833 (95%CI 0.736-0.906). The mucosal line status (OR 4.82, 95%CI 1.21-19.25, P=0.026) and percentile 90 (OR 1.09, 95%CI 1.04-1.15, P=0.001) were brought into the diagnostic model and constructed a nomogram. The AUC of the model in differentiating BT4-GC from DLBCL was 0.898 (95%CI 0.813-0.953), sensitivity was 0.833, and specificity was 0.817. Conclusions:The nomogram based on CTTA percentile 90 and morphological characteristics mucosal line status can effectively distinguish BT4-GC from DLBCL and shows high diagnostic efficacy.

Intravoxel incoherent motion magnetic resonance imaging for evaluation of the efficacy of concurrent chemoradiotherapy in treatment of cervical cancer / 中华放射肿瘤学杂志

Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging ( IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0?1 000 s/mm2), and contrast?enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer ( stage ≥Ⅱb ) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi?exponential model to generate three parameters, containing pure diffusion coefficient ( D ) , pseudodiffusion coefficient ( D?) , and perfusion fraction ( f ) . Apparent diffusion coefficient ( ADC ) was obtained using the mono?exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment ( 0?96 × 10-3 vs. 1?77 × 10-3 mm2/s, P=0?000;0?76 × 10-3 vs. 1.34± 0?12 × 10-3 mm2/s, P=0?000;0?14% vs. 0?24%, P=0?012). The above three values significantly increased after two weeks of treatment (all P=0?000) and kept increasing until the end of the treatment. In contrast, the D? value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.

Application value of spectral CT imaging in quantitative evaluation of Lauren classification of gastric cancer / 实用放射学杂志

Objective To explore the value of gemstone spectral imaging (GSI)in quantitative evaluation of Lauren classification of gastric cancer.Methods Fifty-two patients with gastric cancer confirmed by gastroscopy underwent contrast-enhanced spectral CT imaging preoperatively.The monoergic and iodine-based images were obtained by GSI Viewer software,CT value and iodine concentration (IC)of the lesions were measured,and normalized iodine concentration (NIC)was calculated.With the reference of postoperative pathology,data were analyzed by LSD method of one-way analysis of variance.Results The IC,NIC,spectrum curve slope of 40-70 keV,40-140 keV and 70-140 keV energy range of intestinal type,mixed type and diffuse type carcinoma in the arterial phase were 12.86±6.80 (100 μg/mL),0.13±0.06 ,2.50±1.26 ,0.99±0.51 ,0.34±0.20 ,18.54±6.49 (100 μg/mL),0.19±0.07, 3.56±1.24,1.42±0.50,0.50±0.18 and 24.52±9.68 (100 μg/mL),0.24±0.09,4.73±1.76,1.90±0.73,0.68±0.29,respectively. The values of intestinal type were all significantly lower than those of diffuse type (P <0.05).Comparison between intestinal-mixed type and mixed-diffuse type,the other parameters were no significant differences except IC between intestinal-mixed type (P=0.037).Conclusion The slope of spectrum curve,iodine concentration,and normalized iodine concentration could be helpful for preoperative evaluation of Lauren classification of gastric cancer.

Diagnostic value of magnetic resonance diffusion weighted imaging for metastatic lymph nodes in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer.</p><p><b>METHODS</b>Between December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis.</p><p><b>RESULTS</b>A total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52).</p><p><b>CONCLUSIONS</b>MR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.</p>

Preoperative T staging of gastric cancer: comparison between MR including diffusion weighted imaging and contrast enhanced CT scan / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer.</p><p><b>METHODS</b>Forty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated.</p><p><b>RESULTS</b>Overall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively).</p><p><b>CONCLUSION</b>MR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.</p>

Quantitative measurement of fatty liver by spectral imaging on gemstone CT:an experimental study on mice model / 实用放射学杂志

Objective To investigate the feasibility of quantitative measurement of fat concentration by CT spectral imaging in a mice model of fatty liver.Methods Twenty-four mice with different degrees of fatty liver underwent CT spectral imaging.CT values of liver parenchyma under mixed X-ray energy and 65 keV,fat concentration based on various basic material pairs (fat/water,fat/io-dine,fat/calcium)and spectral curves were obtained.Liver specimens were obtained to measure the concentration of triglyceride , and HE staining was performed.Correlations between various CT indexes and triglyceride concentration were analyzed.Results Correlation between fat concentration (fat/water pair)and triglyceride (r =0.91 5 )was better than that between CT values on 65 keV and triglyceride (r=-0.858),as well as polychromatic CT values (r=-0.81 6).All the P values were<0.001.Correlations between fat concentrations based on fat/iodine or fat/calcium pairs and triglyceride were relatively low (r=-0.726,-0.660).CT indexes on 1.25 mm slice thickness performed better than those on 2.5 mm.With fatty liver degree increased,the shape of spectral curve changed gradually.Conclusion Liver fat concentration can be measured by CT spectral imaging noninvasively,accurately and quantitatively in a mice model of fatty liver.

Clinical presentations and imaging features of a novel avian-origin influenza H7N9 / 中华放射学杂志

Objective To discuss the clinical presentations and imaging features of a novel avianorigin influenza (H7N9).Methods Anteroposterior chest radiographs and serial thin-section CT images in 5 patients with H7N9 were reviewed retrospectively by two radiologists,the predominant inaging patterns of lung abnormalities and clinical data were recorded and analyzed.Results The large consolidation of the right lung with air bronchograms was the most common radiographic appearance in all patients with H7N9 at admission,and the abnormalities were more severe in the bilateral lower lobes.Both lungs developed large,scattered consolidations and ground-glass opacities with the progression of disease.The lesions in the left lung were more rapidly absorbed than those in the right lung.Conclusion Influenza H7N9 has certain chest imaging characteristics in the onset,progression and recovery of disease.

Study on MR tracking of magnetically labeled swine mesenchymal stem cells after autologous transplantation into acute injured liver in vivo / 中华肝胆外科杂志

Objective To evaluate in vivo tracking of swine mesenchymal stem cells (MSCs) la-beled with super paramagnetic iron oxide (SPIO) in intraportal transplantation by a clinical 1.5T MR.Methods MSCs were isolated from swine and cultured as well as expanded, which were then incuba-ted with SPIO (Feridex I. V.). Prussian blue staining was performed for showing intracelluar irons.To establish a swine model of acute liver necrosis, 0.5 g/kg of D-galactosamine was administrated to 10 pigs. MSCs(labeled cells in six, unlabeled cells in four)were injected into liver via portal veins. MR imaging was performed with a clinical 1.5T MR immediately before and at 6 h, 3 d, 7 d, 14 d after transplantation, respectively. Results Prussian blue staining of SPIO labeled MSCs could be effec-tively labeled and the labeling efficiency was almost 100%. Signal intensity loss in liver by SPIO labe-ling on FFE sequence persisted until 14 days after transplantation. Histological analysis by Prussian blue staining showed homing of labeled MSCs in liver after 14 days, primarily distributing in hepatic sinusoids and liver parenchyma. Conclusion MSCs can be labeled with SPIO in vitro successfully.MRI can monitor magnetically labeled MSCs transplanted into liver.

Evaluation of MR lymphography with positive lymphotropic contrast agent in diagnosing lymph node lesions / 中华放射学杂志

Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.

MR diffusion weighted imaging with background signal suppression in breast cancer / 中华放射学杂志

Objective To explore the feasibility of echo planar imaging with short time inversion recovery(STIR-EPI)diffusion weighted imaging with background signal(DWIBS)suppression in breast cancer.Methods The diffusion weighted imaging(DWI)with background suppression(b=800 mm2/s)was performed in 26 patients with breast cancer.Apparent diffusion coefficient(ADC)of all lesions,vere measured and compared.3D maximum intensity projection(3D-MIP)and reverse black and white technique were used to show the lesions.DWI and DWIBS were performed and compared for the detection of breast cancer. Randomized blocks analysis of variance was used for the ADC values in different breast tissues.the ADC values in breast cancer and benign lesion were compared using t test.The paired chi square tes:was used for the detection rate of breast cancer in two different imaging methods.Results Most of the breast cancers were hyperintense on DWI(b:800 mm2/s).,rhe ADC value of caneer tissue was(0.93±0.25)×10-3mm2/s,tumor necrosis was(2.06±0.17)×10-3 mm2/s,normal breast tissue was (1.92±0.23)×10-3 mm2/s and metastatic lymph node was(1.10±0.14)× 10-3mm2/s and the differenees were statistically significant between two structures(P＜0.01).The signal of the tissue8 around the breast cancer was decreased on DWIBS with 3 D-MIP and reverse black and white technique and similar to positron emission tomography(PET).DWIBS sequence detected more breast cancers(92.3/)and metastatic lymph nodes(88.4/)than DWI sequence did(57.6/and 42.3/,respectively,X2:8.307,P＜0.05;X2=12.235,P＜0.05).The ADC values in breast cancer(1.09±0.17)×10-3mm2/s and benign lesion (2.15±0.53)×10-3 mm2/s had significant statistical differences(t=8.626,P＜0.05).conclusion Diffusion weighted MRI with background suppression can detect more lesions than DWI and can be potentially applied for the detection of the breast cancer eombining the ADC value.

The early diagnostic value of MRI in liver cirrhosis and portal hypertension / 医学研究生学报

Objective: To evaluate the diagnostic value of the special sequences and methods of MRI in liver cirrhosis and portal hypertension. Methods:100 cases of liver cirrhosis were examined by 3DT1W/FFE and SENSE-BABLANCE sequences and compared with normal livers. Results: ① 3DT1W/FFE imaging has clear advantage over conventional scan in detecting cirrhotic nodules. ② The peak of signal intensity ASD (average standard deviation) in normal livers and the minimum of signal intensity ASD in liver cirrhosis cases were found . If signal intensity standard deviation in liver was over 30, liver cirrhosis should be considered. ③ The degree of hypertension and the size of portal vein and its branches were evaluated by SENSE-BABLANCE sequences. Conclusion: MRI special sequences and methods play a significant role in the early diagnosis of liver cirrhosis and portal hypertension.

Application of balance technique in abdominal MRCP / 医学研究生学报

Objective: To discuss the application of BALANCE-FFE sequence in abdominal MRCP.Methods:100 patients of abdominal diseases were examined by BALANCE technique. Results: The signal of BALANCE-FFE sequence was high in abdominal MRCP examination, and BALANCE image of the coronal scan was excellent. Conclusion:The biliary tract had obviously high signal intensity acquired by BALANCE sequence. The gallstone and the stenosis could be seen. The tissue out of the bile duct, the head of pancrease and the lymph could also be seen. The BALANCE sequence could be used as a supplement of conventional MRCP.