A suspected case of hemorrhagic fever with renal syndrome complicated with dengue fever in Longhua District, Shenzhen / 中华地方病学杂志

Objective:To investigate and analyze a suspected case of hemorrhagic fever with renal syndrome (HFRS) complicated with dengue fever (DF) in Longhua District of Shenzhen City, so as to improve the level of diagnosis and monitoring of such case.Methods:The morbidity and treatment data of this case were analyzed retrospectively, and the results of blood routine, urine routine, dengue virus and Hantavirus antibody, nucleic acid test and other laboratory tests were collected, the epidemiological analysis included the history of travel, mosquito bite and rodent contact was did.Results:This case was 25-year-old male presented with fever (maximum body temperature 39.4 ℃), chills and fatigue. On the 5th day, he developed oliguria. The clinical laboratory results showed that the platelet count decreased, the urine routine was detected, and the sediment tube type was 86.32 μl. The serum samples were tested, positive for dengue virus NS1 antigen and IgM antibody, negative for viral nucleic acid; positive for IgM antibody of Hantavirus, positive for Hantavirus nucleic acid. This case had a history of contact with mice without any protection, no obvious epidemiological history of DF, this patient might be a suspected case of HFRS with DF.Conclusions:This patient may be a suspected case of HFRS with DF. The infectious source of HFRS is suspected to be rats.

The diagnostic value of both mammography and MRI in combination with clinical features in high-risk breast lesions / 中华放射学杂志

Objective:To evaluate the value of mammography and MRI combined with clinical features in predicting upgrade to malignancy in high-risk breast lesions.Methods:Data from 230 patients who were diagnosed with high-risk breast lesions and underwent both mammography and MRI examinations before biopsy were analyzed retrospectively from Jan 2017 to Mar 2018 in Fudan University Shanghai Cancer Hospital. The imaging features of both mammography and MRI were analyzed, and the association between mammography, MRI and clinical features were evaluated using pathology as the gold standard. Independent t test and χ 2 test were used to compare the difference of clinical and imaging features between upgrade and non-upgrade groups, using receiver operating characteristic (ROC) curve to test the diagnostic value between mammography and MRI. Binary logistic regression was used to evaluate the correlation between upgrade and clinical, imaging findings. Results:Two hundred and thirty patients had 230 lesions, and 47 cases had atypia upgrade to malignancy during second surgery (upgrade rate was 20.4%). There were statistically significant differences in age, maximum diameter of lesion, and menopausal status between the upgraded and non-upgraded groups ( P<0.05). There was no statistically significant difference in mammographic features between two groups ( P>0.05), while there was statistically significant difference in breast MRI features and background parenchymal enhancement ( P<0.05). For the diagnostic value in predicting upgrade of high-risk lesions, MRI was better than mammography (the areas under ROC curve were 0.913 and 0.606, Z=6.919, P<0.01). Single factor analysis showed that age, lesion size, menopausal status, MRI negative and background parenchymal enhancement on MRI were significantly different for upgrade to malignancy ( P<0.05). Multiple factors analysis showed age and background parenchymal enhancement on MRI were independent factors for predicting upgrade ( P<0.01). Conclusion:For the upgrade to malignancy in high-risk lesions, the diagnostic value of MRI is better than mammography. The elder age and moderate or marked background parenchymal enhancement on MRI may serve as useful predictors of upgrade.

Association between both maternal and fetal angiotensinogen gene single nucleotide polymorphism and preeclampsia/eclampsia / 中华流行病学杂志

Objective@#To explore the association between preeclampsia/eclampsia and maternal and fetal angiotensinogen SNPs.@*Methods@#From January 2008 to October 2015, a case-parents/mother-control designed study was conducted among 347 preeclampsia/eclampsia cases and 700 controls to collect related information on their demographic characteristics and to detect the related angiotensinogen SNPs’ genotypes. Both log-linear and unconditional logistic regression methods were employed to investigate the genetic effects of maternal/fetal angiotensinogen SNPs on preeclampsia/eclampsia. Multivariate binary unconditional logistic regression model and covariance were used to analyze the relationship between BMI before pregnancy, weight gain during pregnancy and overweight and obesity in preschool children.@*Results@#Both fetal angiotensinogen rs3789679 GA and AA genotype were associated with the reduced risks of preeclampsia/eclampsia, with ORs as 0.73 (95%CI: 0.55-0.96) and 0.62 (95%CI: 0.39-0.98), respectively. For fetal angiotensinogen rs2493132, individuals that carrying the TT genotype, presented a positive association with the risk of preeclampsia/eclampsia, with OR as 1.60 (95%CI: 1.08-2.37). However, these associations were not statistically significant after the correction of the false discovery rate. It was observed that fetal rs3789679 could reduce the risk of preeclampsia/eclampsia (OR=0.73, 95%CI: 0.55-0.96) under the dominant model (GA+AA/GG) while fetal rs2493132 increased the risk of preeclampsia/eclampsia (OR=1.66, 95%CI: 1.13-2.44) under the recessive model (TT/CC+CT). Maternal rs5051 presented an association with preeclampsia/eclampsia (OR=1.33, 95%CI: 1.01-1.76) under the dominant model (TC+CC/TT).@*Conclusions@#Results from the dominant model showed that both fetal rs3789679 GA and AA genotype reduced the risk of preeclampsia/eclampsia and maternal rs5051 TC while CC genotype increased the risk of preeclampsia/eclampsia. Fetal rs2493132 TT genotype seemed to be associated with the risk of preeclampsia/eclampsia under the recessive model.

Evaluation of Salivary Gland Function Using Diffusion-Weighted Magnetic Resonance Imaging for Follow-Up of Radiation-Induced Xerostomia

OBJECTIVE: To investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia. MATERIALS AND METHODS: This study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia. RESULTS: The ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10−3 mm2/s and 1.32 ± 0.07 × 10−3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10−3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10−3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10−3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10−3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT. CONCLUSION: The ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.

A preliminary study of MRI background parenchymal enhancement in the early prediction for tumor response during neoadjuvant chemotherapy / 中华放射学杂志

Objective To retrospectively investigate the characteristics of background parenchymal enhancement(BPE)in the contralateral breast following neoadjuvant chemotherapy(NAC)and whether BPE could help predict tumor response in early stage of advanced breast cancer. Methods Data from 161 patients who were diagnosed with unilateral breast cancer and then underwent NAC before surgery were analyzed retrospectively from August 2014 to December 2016.All the patients underwent both bilateral breast MRI scan with contrast enhancement. Two experienced radiologists independently categorized the patients' levels of BPE into four categories (1=minimal, 2=mild, 3=moderate, 4=marked) at baseline and after the 2nd cycle of NAC. All the patients were divided in to pathologic complete response (pCR) group and non-pCR group according to the histopathologic tumour response.The status of estrogen receptor(ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were recorded before underwent NAC.The t test and Pearson chi-squared test were used to compare the baseline characteristics of the pCR and Non-pCR groups.The kappa test was used to test the inter-observer agreement.The Wilcoxon test was used to test for changes of BPE categories after NAC.The Mann-Whitney U test was used to test the difference of BPE between pre-and post-menopausal status. Associations were evaluated using Binary logistic regression models. Results Fifty nine patients achieved pCR, and 102 patients had residual disease (non-pCR). Age, tumor size, distribution of size, menopausal status and lymph node showed no significance between pCR and non-pCR groups(all P>0.05),while only ER/PR status and HER2 status had a significant difference (P>0.05 in both). Inter-observer agreement regarding BPE categorization was moderate and substantial before and after NAC(Kappa value 0.644 and 0.708).The level of BPE was higher in premenopausal than post-menopausal women both at baseline and after the 2nd cycle of NAC(P<0.01). Decreased BPE was observed in 106 cases(premenopausal 60 cases and postmenopausal 46 cases),and no change in BPE were observed in 55 cases (premenopausal 27 cases and postmenopausal 28 cases). A significant reduction in BPE was observed after the 2nd NAC cycle in the overall cases, pre-and post-menopausal cases (all P<0.01). Logistic model showed that hormonal receptor (HR) negative and HER-2 receptor at baseline and the change of BPE after NAC were the independent factors for predicting pCR. Conclusions Regardless of the menopausal status, BPE showed a reduction after NAC, and it can serve as an additional imaging biomarker of tumour response at an early stage of NAC.

A comparative study of diagnostic performance between digital breast tomosynthesis and conventional imaging methods / 中国癌症杂志

Background and purpose:Breast cancer is the most common malignancy in women. The new technology of mammography is helpful in breast cancer diagnosis. This study aimed to compare the efficacy of digital breast tomosynthesis (DBT) with conventional imaging methods in the diagnosis of benign and malignant breast lesions.Methods:During the period from Mar. 2015 to Dec. 2015, 227 patients with suspected lesions (by palpation or sonography) underwent further imaging exam in our hospital. The sonography, full-field digital mammography (FFDM), DBT and breast MRI were performed on all the patients. A double-blind assessment was carried out according to BI-RADS (version 2013) by experienced radiologists. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of all methods, referring to the pathological data as the golden standard; the difference in the efficiency of DBT from the other methods was determined byZ-test.Results:Thirty patients were excluded for the unsatisfactory images, and 205 lesions (132 malignant and 73 benign lesions) were detected in the remaining 197 patients. Area under the curve (AUC) of sonography, FFDM, DBT, DBT+FFDM and MRI based on the BI-RADS were 0.8308, 0.8592, 0.9167, 0.9198, and 0.9354, respectively. The AUC of DBT was significantly higher than those of sonography (Z=7.36,P=0.0067) and FFDM (Z=4.89,P=0.0271), while there was no significantly difference between DBT and MRI (Z=0.02,P=0.9002) or FFDM+DBT (Z=0.69,P=0.4048).Conclusion:DBT could significantly improve the diagnostic performance for breast lesions compared with sonography and FFDM, providing a comparable efficiency to MRI. As a new mammography technology, DBT has good clinical application prospect.

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

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

The differential diagnostic value of digital breast tomosynthesis in combination with synthesized two-dimensional images in breast disease / 中华放射学杂志

Objective To investigate the diagnostic value and characteristics of breast lesion in digital breast tomosynthesis (DBT) in combination with synthesized two-dimensional (2D) images. Methods The prospective study enrolled women older than 18 years with clinically suspected breast lesion.One hundred and sixty seven patients with 177 lesions confirmed by biopsy or surgery were included. All the patients underwent full-field digital mammography(FFDM)and DBT examinations,and synthesized 2D images(V-preview)were reconstructed from DBT.The images of FFDM,V-preview images and DBT plus FFDM, V-preview images were analyzed. The breast imaging reporting and data system (BI-RADS) and characteristic for predicting benign and malignant lesion were also evaluated.The average glandular dose for a single mammographic view between FFDM and DBT was recorded.The Nonparametric Z test was used to compare the differences among four different mammographic images in BI-RADS.The differential diagnostic performance among different mammography was evaluated by ROC analysis.Independent t test was used to compare the average glandular dose between FFDM and DBT.Results One hundred three benign lesions and 74 malignant lesions were confirmed. Compared with FFDM images alone or plus DBT,the diagnostic values of V-preview images alone/or plus DBT were not significantly different(Z=0.187 and 0.226,P=0.851 and 0.821), but compared with V-preview, the diagnostic values of V-preview images plus DBT revealed significant difference(Z=3.546,P<0.01).The area under ROC for V-preview plus DBT were 0.899,and the sensitivity,specificity,and accuracy were 90.5%,89.3%,and 89.3%,separately.For the average glandular dose, there was no significant difference between FFDM (1.48 ± 0.52) mGy and DBT (1.56 ± 0.39) mGy examination(t=1.714,P=0.087).Conclusion Synthesized 2D images from DBT,which may eliminate the need for FFDM,in combination with DBT can improve the diagnostic efficiency.

Log-linear model used in the hybrid design of case-parents triad/control-mother dyad / 中华流行病学杂志

This study introduced the application of a log-linear model in the hybrid design of case-parents triad/control-mother dyad.Data related to the association between cleft lip with palate (CLP) and methylenetetrahydrofolate reductase (MTHFR) gene A1298C diversity was analyzed.Log-linear model based on likelihood ratio tests (LRTs) was used to analyze the relationships between mother,offspring genotypes and CLP.Data from our study noticed that children of mothers carrying the CC genotype presented a lower risk of CLP,comparing with the children of mothers carrying the AA genotype,with S2=0.45 (95％CI:0.26-0.79).Offspring that carrying the AC genotype presented a lower risk of CLP,comparing with the offspring that carrying the AA genotype,with R1 =0.69 (95％CI:0.48-0.97).However,no other types of relationships were found.The power of hybrid design was greater than the case-parents study (0.86＞0.78).MTHFR A1298C polymorphism seemed to have played an important role in the etiology on both cleft lip and palate.Data from the hybrid design and the log-linear model could help researchers to explore the effects of genotypes from both mothers and the offspring.This study design would present stronger power than the regular case-parents studies thus suitable for studies on the etiology of diseases in early lives,as birth defects.

Log-linear model used in the hybrid design of case-parents triad/control-mother dyad / 中华流行病学杂志

This study introduced the application of a log-linear model in the hybrid design of case-parents triad/control-mother dyad.Data related to the association between cleft lip with palate (CLP) and methylenetetrahydrofolate reductase (MTHFR) gene A1298C diversity was analyzed.Log-linear model based on likelihood ratio tests (LRTs) was used to analyze the relationships between mother,offspring genotypes and CLP.Data from our study noticed that children of mothers carrying the CC genotype presented a lower risk of CLP,comparing with the children of mothers carrying the AA genotype,with S2=0.45 (95％CI:0.26-0.79).Offspring that carrying the AC genotype presented a lower risk of CLP,comparing with the offspring that carrying the AA genotype,with R1 =0.69 (95％CI:0.48-0.97).However,no other types of relationships were found.The power of hybrid design was greater than the case-parents study (0.86＞0.78).MTHFR A1298C polymorphism seemed to have played an important role in the etiology on both cleft lip and palate.Data from the hybrid design and the log-linear model could help researchers to explore the effects of genotypes from both mothers and the offspring.This study design would present stronger power than the regular case-parents studies thus suitable for studies on the etiology of diseases in early lives,as birth defects.

Role of the dynamic contrast-enhanced MRI in assessing the response to neoadjuvant chemotherapy of breast cancer / 中国癌症杂志

Background and purpose:Neoadjuvant chemotherapy to breast cancer has become a mature treat-ment method. The purpose of this study was to evaluate the dynamic contrast-enhanced MRI in assessing the response to neoadjuvant chemotherapy (NAC).Methods:Twenty-four female patients with breast carcinoma (24 were all inva-sive ductal carcinoma) underwent dynamic contrast-enhanced MRI (DCE-MRI) before, after the second and ifnal cycle of NAC. For each patient and each MRI examination, the maximum diameter of tumor, volume transfer constant (Ktrans), exchange rate constant (Kep), and extravascular extracellular volume fraction (Ve) were compared. According to the method of response evaluation criteria in solid tumor (RECIST), the results of neoadjuvant chemotherapy were divided into responder and non-responder.Results:All 24 patients were unilateral and single breast cancer; there were 17 cases of responders and 7 cases of non-responders according to RECIST criteria. For 17 cases of responders, both the average values ofKtrans andKepwere signiifcantly descended after neoadjuvant chemotherapy (allP<0.05).Conclusion:The quantitative parameters ofKtrans andKep can evaluate objectively and veridically the response to neoadjuvant chemother-apy for breast cancer in dynamic contrast-enhanced MRI.

The diagnostic ability of biexponential diffusion-weighted imaging (DWI) for organ-conifned prostate cancer in peripheral zone：compared to monoexponential DWI / 中国癌症杂志

Background and purpose:With the widespread use of screening of prostate-specific antigen (PSA) levels, prostate cancers at organ-conifned stage are increasing in newly diagnosed cases. However, some defects remain in conventional monoexponential diffusion-weighted imaging (DWI) for differentiating organ-conifned prostate cancer from benign lesions. Therefore, the aim of this study was to obtain biexponential apparent diffusion parameters of prostate organ-conifned cancer, chronic prostatitis in peripheral zone (PZ) and normal PZ tissue, and to compare with monoexponential apparent diffusion coeffcient (ADC) for differentiating prostate cancer from prostatitis lesions. Methods:Sixteen patients with pathologically confirmed prostate organ-confined cancer in PZ, 14 with prostatitis underwent conventional (b-factors 0, 1 000 s/mm2) and 10b-factors (0-3 000 s/mm2) diffusion-weighted imaging (DWI).The monoexponential ADC value and biexponential parameters fast ADC (ADCf), fraction of ADCf (f), slow ADC (ADCs) value for prostate cancer, prostatitis and normal tissues were calculated and compared. Receiver operating characteristic analysis was performed for those parameters.Results:Biexponential and monoexponential parameters were obtained for 18 prostate cancers, 18 prostatitis and 37 normal PZ tissues. The ADC value of prostate cancer tissues was remarkably lower [(0.83±0.11)×10-3 mm2/s] than that of other tissues (P0.01), but the AUC off and ADCs in differ-entiating cancer from prostatitis (0.83 and 0.80) were signiifcantly lower than that of ADC (P<0.01).Conclusion:The biexponential DWI provided additional tissue characterization parameters for different prostate tissues. ADCf yielded comparable accuracy with ADC in identiifcation of prostate organ-conifned cancer. The biexponential parameter could further improve the diagnostic effcacy.

The imaging features of rare stromal tumor / 中国癌症杂志

Background and purpose:Stromal tumor is one of the common gastrointestinal mesenchymal tumors. There is certain understanding about the typical cases. However, the diagnosis of those occurring in rare location or with rare imaging findings is often difficult. This research summarized this kind of cases,in order to increase the radiological knowledge of the disease.Methods:This study retrospectively analyzed clinical, radiological and pathological data from 550 patients who had stromal tumor conifrmed by pathology in our hospital. Those with incomplete data were eliminated. Forty-nine patients were selected for further study according to the typical imaging findings.Results:Among these 49 patients, 9 were pathologically confirmed to have extra-gastrointestinal stromal tumor, while 40 patients had gastrointestinal stromal tumor. Among the patients with gastrointestinal stromal tumor, 22 were found in rare locations, 12 in retroperitoneal space, 3 in omentum majus and mesenterium, 5 in esophagus, and 2 in prostate. Obvious cystic degeneration was found in 16 patients. Bulky calciifcation, such as lfake or annulus, was found in 7 patients. The analysis result of risk-stratiifcation showed 19 patients were conifrmed as high-grade among the patients with tumors found in rare locations, 15 as high grade among those with obvious cystic degeneration, and 7 as high-grade among those with extra-gastrointestinal stromal tumor.Conclusion:Rare stromal tumor often occurs in the locations, such as retroperitoneal space, omentum majus and mesenterium. Obvious cystic degeneration and bulky calciifcation can be seen. The risk-stratiifcation of these patients often showed high-grade. Comprehensively analyzing its clinical features and imaging ifndings can help improve the diagnostic accuracy.

Research progress and clinical applications of computed tomographic colonography in coloretal cancer / 中国癌症杂志

Computed tomography colonography (CTC) is a well-established technique for evaluation of colorectal cancer (CRC). Signiifcant advances have been made in the technique of CTC since its inception. Besides being an excellent tool for detection of CRC, it is minimally invasive, less time-consuming and well tolerated by patients. Furthermore, it has fewer complications than conventional colonoscopy (CC) or barium enema (BE). The application of new technologies, such as electronic cleansing (EC) and dual-energy CT (DECT), enriches the examination of CTC. In 2005, a standardized reporting scheme, CT colonography reporting and data system (C-RADS), was put forward by the working group on virtual colonoscopy. They proposed that the report should include lesion size, number, morphology, location, attenuation and recommendations for lesion surveillance. New research progress and clinical applications of CTC in CRC are reviewed in this article. In addition, the paper also brielfy touches upon technique, indications, contraindications, safety and risk of CTC.

Clinical application study on malignant metastatic diseases between DWIBS and PET/CT / 中国癌症杂志

Background and purpose: Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) can be used for magnetic resonance imaging systemic examination, especially in examing the metastatic lesions, lymph node and bone diseases, and the imaging result is similar with PET. This study aimed to evaluate the application value of magnetic resonance DWIBS and positron emission tomography with computed tomography (PET/CT) on malignant metastatic diseases. Methods: Thirty-six patients confirmed with malignant tumors accompanying metastasis by the pathology of operation or biopsy underwent both DWIBS imaging and PET/CT, chi-square test and Kappa test were used for comparing the detection results of metastasis by these 2 imaging methods. Results:Among the 36 malignant tumor patients with 238 metastatic lesions, 218 (91.6%, 218/238) lesions in DWIBS and 209 (87.8%, 209/238) lesions in PET/CT were detected, with 200 lesions detected by the two methods simultaneously, and the concordance rate was 88.7%(211/238);but there was no statistical signiifcance between this two methods (χ2=1.843, P=0.157). Kappa test showed a fair concordance rate between DWIBS and PET/CT (P=0.000).There were different significance between DWIBS and PET/CT in detecting metastatic lesions of brain and bone (P=0.005 and 0.031);But there was no signiifcant differences (P=0.309 and 1.000) in detecting metastatic lesions of lymph nodes and liver. Conclusion:DWIBS could detect metastatic lesions effectively, and there is ifne consistency with PET/CT. DWIBS is more sensitive than PET/CT in detecting metastatic lesions of brain and bone, so DWIBS could be chosed for screening metastatic lesions according to the characteristics of different primary tumors.

Application of DWI with various b values in diagnosis of clear cell renal cell carcinoma Fuhrman grades SHEN / 中国癌症杂志

Background and purpose:Renal cell carcinoma is the most common type of adult renal cancer, and the Fuhrman grading system is the most widely accepted independent indicator for the prognosis of kidney tumors. This study aimed to explore the correlation between the conventional diffusion weighted imaging (DWI) with various b values and Fuhrman grade of clear cell renal cancer, and assess the diagnostic efifciency of ADC values at different b values in differentiating Fuhrman low- and high-grade tumor. Methods:Thirty-three patients with pathologically proved clear cell renal cell cancer (CCRCC) and qualiifed images were included for the research. The diagnostic efif-ciency of ADC values at different b values for differentiating Fuhrman low-(1 and 2) and high-grade (3 and 4) tumor were also assessed and compared by receiver operator characteristic curve (ROC), and the optimum sensitivity, speciifc-ity and accuracy were selected using Youden index. Results:The 33 patients consist one tumor of Fuhrman grade 1, 14 of grade 2, 16 of grade 3 and 2 of grade 4. A negative correlation was found between the ADC0-800, ADC0-400-800, ADC0-600-1 200, ADC0-400-800-1 200 and ADCtotal with Fuhrman grade (r:-0.553,-0.511,-0.603,-0.645,-0.610, respectively), among these the ADC0-400-800-1200 showed the strongest correlation. The AUCs [area under the (receiver operator characteristic curve) ROC curve] of those parameters for differentiating the low-and high-grade tumor were 0.789, 0.757, 0.813, 0.844 and 0.835, among which the ADC0-400-800-1 200 reveal the best result, but the difference was not statistically signif-icant (P>0.05). The sensitivity of the ADC values were 86.7%, 73.3%, 60.0%, 86.7%and 86.7%;The speciifcity were 66.7%, 77.8, 72.2%, 77.8%and 72.2%. Conclusion:ADC0-800, ADC0-400-800, ADC0-600-1 200, ADC0-400-800-1 200 and ADCtotal re-vealed signiifcant correlation with the Fuhrman grade of clear cell renal cancer, and providing high diagnostic efifciency in differentiating Fuhrman low-and high-grade tumor.

Diagnostic value of digital breast tomosynthesis plus full-field digital mammography in breast disease / 中华放射学杂志

Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) in benign and malignant breast disease.Methods The prospective study enrolled 46 consenting women with a clinical suspicious of breast lesion confirmed by pathology. All the patients underwent DBT, FFDM and dedicated breast magnetic resonance image (DB-MRI) examinations before surgery or biopsy. To observe the manifestation of breast disease in different examinations according to breast imaging reporting and data system (BI-RADS), and to evaluate the visibility grade of disease between DBT plus FFDM and FFDM alone. Using receiving operating characteristic(ROC) and Z test to analysis the diagnostic efficiency of three examinations.Results Forty-six cases included 14 benign cases and 32 malignant cases. Compared with FFDM, 35 cases showed increased visibility in DBT plus FFDM, that the malignant lesion manifested mass with speculated and architectural distortion(23/27) and the benign lesion manifested mass with halo sign(6/8). Eleven cases didn't show increase visibility in both DBT plus FFDM and FFDM alone. The ration of BI-RADS 0 in FFDM was 23.9%(11/46), meanwhile in other two examination were 0. The ration of BI-RADS 3 in DBT plus FFDM was the lowest(6.5%, 3/46). When the lesion in DBT plus FFDM showed mass or speculated, in MRI showed similar morphology with mass or mass-like enhancement. According pathology as the gold standard, excluded 11 cases with BI-RADS 0 in FFDM, there was significant statistical difference between DBT plus FFDM and FFDM alone in 35 cases (Z=2.132, P=0.033) to differentiate benign and malignant breast disease, the area of ROC curve were respectively 0.955, 0.878. There is no statistical difference between DBT plus FFDM and MRI in 46 cases (Z=0.502, P=0.616), the area of ROC curve were respectively 0.887, 0.908.Conclusion DBT combined with FFDM can improve both detection of breast lesion and diagnostic efficiency, while the performance value between DBT and MRI are equal.

Value of MR diffusion-weighted imaging in diagnosis and outcome prediction for uterine cervical cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of diffusion weighted imaging (DWI) in uterine cervical cancer and the apparent diffusion coefficient (ADC) value in diagnosis and predicting treatment response.</p><p><b>METHODS</b>Twenty-eight patients with advanced primary cervical cancer confirmed by pathology and 10 cases of normal uterine cervix as control were recruited in this prospective clinical trial. To analyze the correlation between tumor volume measured in DWI and tumor maximum diameter measured according to the RECIST criteria. To compare the ADC value differences among the uterine cervical cancer, uterine myometrium, and normal uterine cervix. To compare the ADC values in 17 cancer patients before and after treatment.</p><p><b>RESULTS</b>The illustration of tumor boundary in DWI was superior to conventional T2WI and post-enhancement T1WI. The DWI with higher b value (2000 s/mm(2)) had a better signal-to-noise ratio. The tumor volume measured in DWI has good correlation with tumor maximum diameter according to RECIST criteria (r = 0.759, P < 0.01). When b = 800 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium, and normal uterine cervix were (9.85 ± 1.55)×10(-3) mm(2)/s, (14.20 ± 2.80)×10(-3) mm(2)/s, and (14.14 ± 0.45) ×10(-3) mm(2)/s. When b = 2000 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium and normal uterine cervix were (7.38 ± 0.98)×10(-3) mm(2)/s, (8.52 ± 2.38)×10(-3) mm(2)/s, and (8.60 ± 0.63)×10(-3) mm(2)/s, respectively. There were significant differences between the cervical cancer and normal cervix or uterine myometrium (P < 0.001 for both). When b = 800 s/mm(2), the ADC value was (9.85 ± 1.55)×110(-3) mm(2)/s before and (13.41 ± 2.93)×10(-3) mm(2)/s after treatment (P < 0.001). When b = 2000 s/mm(2), the ADC value was (7.38 ± 0.98)×10(-3) mm(2)/s before and (8.93 ± 1.92)×10(-3) mm(2)/s after treatment (P = 0.008). Univariate logistic regression analysis showed that 25% ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were significantly correlated to the treatment outcome of cervical cancer (P < 0.05 for all). Multivariate regression analysis showed that 25%ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were not significantly correlated to the treatment outcome of cervical cancer (P > 0.05 for all). The values of ROC curves were 25%ADC = 0.818, 50%ADC = 0.775, and 75%ADC = 0.716 (P > 0.05), however, the 25% ADC showed a relatively stronger statistical power.</p><p><b>CONCLUSIONS</b>DWI helps to confirm the morphology and exact target zone of the tumor for radiotherapy. DWI volume measurement is well correlated with RECIST criteria, particularly in volume measurement of irregular tumors. ADC value has a potential in quantitatively monitoring treatment response and predicting outcome of cervical cancers.</p>

MRI in the differential diagnosis of breast ductal cancer in situ / 中国癌症杂志

Background and purpose: Ductal carcinoma in situ (DCIS), is precursor lesions of invasive breast cancer, belongs to non-systemic ductal lesions, which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods:All the cases were surgico-pathologically conifrmed. Twenty-four patients were DCIS, 9 patients were DCIS-MI, and 20 patients were BIDP. The MRI charateristics of DCIS, DCIS-MI and BIDP were analyzed and compared. Results:DCIS and DCIS-MI’s performance in the form of MRI is dififcult to differentiate (P<0.05). Compared with BIDP, the ductal and segmental enhancement, typeⅢtime-signal intensity curve (TIC), and the red pseudo-color image were associated with the DCIS. The local area enhancement, typeⅡTIC, and no-red pseudo-color image were associated with BIDP. Conclusion:MRI is a useful for differentiate between DCIS and BIDP, but is dififcult for DCIS and DCIS-MI.

A control study between DWIBS and bone scintigraphy mapping in the diagnosis of bone metastatic diseases / 中国癌症杂志

Background and purpose:Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) can be used for MR imaging systemic examination, especially the lymph node and bone diseases can be clear, and the imaging result is similar with PET. The aim of this study was to compare the value of clinical application in the diagnosis of malignant metastatic osteopathic between DWIBS and bone scintigraphy mapping. Methods:Thirty-six specimens conifrmed with malignant tumors by the pathology of operation or biopsy underwent both DWIBS imaging and bone scintigraphy mapping, chi-square test was used for comparing the detection results of bone metastasis by this two imaging methods. Results:Thirty (165 positions in all) of 36 malignant tumor patients were conifrmed as having bone metastasis, compared that 26 patients (143 positions) with DWIBS method and 23 patients (132 positions) with bone scintigraphy mapping were detected, but there was no statistical signiifcance between this two imaging methods (χ2=1.002, P=0.506). The sensitivity, positive predictive value (PPV) and accuracy of the detection rate of bone metastasis were similar in DWIBS and bone scintigraphy, with 86.7%, 96.3%, 86.1%and 76.7%, 88.5%, 72.2%, respectively;but the speciifcity and negative predictive value (NPV) in DWIBS (83.3%and 55.6%) was higher than that of in bone scintigraphy (50.0%and 30.0%). The detection rates of different bone metastasis with DWIBS and bone scintigraphy were 86.7%(143/165) and 80.0%(132/165), and it was no signiifcant difference (χ2=2.640, P=0.104);DWIBS method was better than bone scintigraphy in the detection of osseous metastasis on pelvis and limbs long bone, and there was different signiifcant (χ2=6.783 and 7.636, P=0.023 and 0.016). Conclusion:DWIBS could detect bone metastatic lesions effectively, and there is ifne consistency with bone scintigraphy. Therefore, DWIBS is to hope to be extended and applicated clinically.