The value of MR amide proton transfer weighted imaging technique in predicting the pathological grade of brainstem glioma / 中华放射学杂志

Objective:To evaluate the clinical application value of MR amide proton transfer weighted imaging (APTWI) in predicting the pathological grade of brainstem glioma (BSG).Methods:The data of 41 BSG patients in Beijing Tiantan Hospital, Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed. According to the pathological results, 41 patients were classified into high-grade BSG (20 patients) and low-grade BSG (21 patients). Combined with conventional MR images, the signal intensity (%) of amide proton transfer (APT) in the parenchymal area of the tumor was obtained on APTWI images. χ 2 test or independent sample t-test was used to analyze the differences in gender distribution, age and APT signal intensity between patients with high and low grade BSG. Receiver operating characteristic (ROC) curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold; the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test. Results:There was no significant difference in age [(23±18) years, (20±17) years, t=0.97, P=0.340] and gender distribution (9/11, 9/12 for males/females, χ 2=0.02, P=0.890) between high-grade and low-grade BSG patients. The APT signal intensity of high-grade BSG [(3.9±0.9)%] was significantly higher than that of low-grade BSG [(2.8±0.9)%], and the difference had statistical significance ( t=4.16, P<0.001). The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836, and with 2.85% as the optimal diagnostic threshold of APT signal intensity, its sensitivity for the diagnosis of high-grade BSG was 90.0% and specificity was 71.4%. The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade (χ 2=13.33, P=0.101). Conclusion:APTWI can be applied in distinguishing high grade BSG from low grade BSG, and has clinical value in predicting glioma grading.

Establishment of WHO/ISUP grading prediction model for renal clear cell carcinoma based on CT radiomics / 中华泌尿外科杂志

Objective A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics.Methods The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Mfiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed.There were 70 males and 34 females,and the age was 61.2 ± 11.7 years.The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio.According to the WHO/ISUP pathological grading criteria of renal cancer in 2016,Ⅰ and Ⅱ were defined as low-grade group,Ⅲ and Ⅳ were defined as high-grade group.The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning.LASSO regression was used to reduce the radiomics feature dimensionality in the training group,and to establish radiomics risk scores.The binary logistic regression was used to build the prediction model,which was used in the validation group.Bootstrap method was used to validate the model of training and validation group.AUC,sensitivity and specificity were calculated respectively.Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree.Results After dimensionality reduction,the radiomics risk score of ccRCC was established.The low and high-level risk scores of the training group were-2.49 ± 1.73 and 1.23 ± 2.17,with significant difference (t =-7.785,P ＜ 0.01).The binary logistic regression multivariate analysis showed that the radiomics risk score was an independent risk factor in identifying low or high-grade ccRCC with odds ratio of (OR =3.576,95％ CI 1.964 ～ 6.513).The predictive model was Y =1/[1 + exp(-Z)],Z =1.274 × radiomics risk score + 0.072.The AUC of radiomics risk score in training group was 0.940 (95％ CI 0.883-0.998) with 95.5％ sensitivity and 88.2％ specificity after internal verification by Bootstrap method,and good Hosmer-Lemeshow goodness-of-fit test (x2 =4.463,P ＞ 0.05).The low and high-level risk scores of the Validation group were-2.27 ± 2.02 and 0.82 ± 2.08,with significant difference (t =-3.832,P ＜ 0.01).The AUC in validation group was 0.859(95％ CI 0.723-0.995) with 77.8％ sensitivity and 81.8％ specificity,and with good Hosmer-Lemeshow goodness-of-fit test (x2 =14.554,P =0.068) as well.Conclusions The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC.

Quantitative analysis of hepatocellular carcinomas pathological grading in non-contrast magnetic resonance images / 生物医学工程学杂志

In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: = 125; validation dataset, = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.

Establishment of WHO/ISUP grading prediction model for renal clear cell carcinoma based on CT radiomics / 中华泌尿外科杂志

Objective@#A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics.@*Methods@#The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed. There were 70 males and 34 females, and the age was 61.2±11.7 years. The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio. According to the WHO/ISUP pathological grading criteria of renal cancer in 2016, Ⅰ and Ⅱ were defined as low-grade group, Ⅲ and Ⅳ were defined as high-grade group. The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning. LASSO regression was used to reduce the radiomics feature dimensionality in the training group, and to establish radiomics risk scores. The binary logistic regression was used to build the prediction model, which was used in the validation group. Bootstrap method was used to validate the model of training and validation group. AUC, sensitivity and specificity were calculated respectively. Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree.@*Results@#After dimensionality reduction, the radiomics risk score of ccRCC was established. The low and high-level risk scores of the training group were -2.49±1.73 and 1.23±2.17, with significant difference (t=-7.785, P < 0.01). The binary logistic regression multivariate analysis showed that the radiomics risk score was an independent risk factor in identifying low or high-grade ccRCC with odds ratio of (OR=3.576, 95%CI 1.964~6.513). The predictive model was Y=1/[1+ exp(-Z)], Z=1.274×radiomics risk score+ 0.072. The AUC of radiomics risk score in training group was 0.940 (95%CI 0.883-0.998) with 95.5% sensitivity and 88.2% specificity after internal verification by Bootstrap method, and good Hosmer-Lemeshow goodness-of-fit test (χ2=4.463, P>0.05). The low and high-level risk scores of the Validation group were -2.27±2.02 and 0.82±2.08, with significant difference (t=-3.832, P<0.01). The AUC in validation group was 0.859(95%CI 0.723-0.995) with 77.8% sensitivity and 81.8% specificity, and with good Hosmer-Lemeshow goodness-of-fit test (χ2=14.554, P=0.068) as well.@*Conclusions@#The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC.

Correlation of quantitative parameters from dynamic contrast-enhanced MRI with pathological grades of esophageal squamous cell carcinoma / 中华放射学杂志

Objective To investigate the correlation between dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) quantitative parameters and pathological grading in esophageal squamous cell carcinoma(SCC). Methods Prospective analysis of esophageal squamous cell carcinoma confirmed by electronic gastrointestinal endoscopy was performed. Thirty nine patients who underwent radical resection of esophageal carcinoma with MRI examination one weeks before operation were included. All patients underwent routine chest MRI and DCE-MRI scans, and DCE-MRI quantitative parameters including volume transfer constant (Ktrans), exchange rate constant (Kep) and extravascular extracellular volume fraction(Ve)were measured.Pathological analysis of postoperative specimens,including pathological grading(highly differentiated,moderately differentiated,poorly differentiated,undifferentiated),gross tumor pathological type(ulcerative type,medullary type,fungating type,sclerotic type)and local infiltration degree (T staging) were performed. Kruskal-Wallis H test was used to compare the differences of quantitative parameters between different pathological T staging,gross tumor pathological types and pathological grades of DCE-MRI,and a Dunn-Bonferroni test for post hoc comparisons.Spearman rank correlation analysis was used to evaluate the correlation between DCE-MRI parameters and pathological grading of esophageal squamous cell carcinoma.The ROC curves was used to evaluate the efficiency of different parameters in the diagnosis of poorly differentiated esophageal squamous cell carcinoma. Result Among the thirty nine patients, they were divided into three group according to pathological findings: well differentiated (12 patients),moderately differentiated(15 patients)and poorly differentiated group(12 patients);ulcerative type (19 patients), fungating type(10 patients), medullary type(10 patients);T1, 2 stage(16 patients), T3 stage(14 patients), and T4 stage(9 patients). There was no significant difference in the value of Ktrans, Kepand Ve between different T staging groups and different tumor pathological types groups(all P>0.05).The differences of Ktrans, Kepand Vebetween different pathological grading groups were statistically significant (all P<0.05). There were positive correlation between Ktrans, Kep, Veand the pathological grading, rs value were 0.874, 0.672, 0.578 respectively, all P<0.01. The ROC curve area of Ktrans, Kepand Vein the diagnosis of poorly differentiated esophageal squamous cell carcinoma was 0.941,0.809 and 0.773 respectively.The diagnostic efficiency of Ktranswas the best.Conclusions The quantitative parameters of DCE-MRI are correlated with the pathological grading of esophageal squamous cell carcinoma. Ktrans, Kepand Vecan reflect the perfusion characteristics of esophageal squamous cell carcinoma.

Relationship between M2 microphage infiltration and the malignant degree of prostate cancer / 临床与实验病理学杂志

Purpose To investigate the relationship between M2 microphage infiltration and the pathological grading and staging of prostate cancer.Methods 58 patients who accepted the radical resection of prostate cancer were selected.After operation,pathologic specimens were hematoxylin eosin stained and immunohistochemical of SP stained to identify the pathological grading,staging,and M2 microphage infiltration.Then,Chi-squared test was used to analyze the relationship between M2 microphage infiltration and the pathological grading and staging of prostate cancer.Results There were 71.4％ high stage (≥T2c) cases and 60％ lymph node metastasis cases in M2 microphage infiltration group,which was significantly higher than those in non M2 microphage infiltration group.However,there was no relationship between M2 microphage infiltration and pathological grading.Conclusion M2 macrophage infiltration may participate in the prostate cancer cell growth and metastasis,whose pathophysiological mechanism needs further exploration.

Value of conventional MRI features in solitary cerebral glioma grading / 西安交通大学学报(医学版)

Objective To evaluate the value of conventional MRI in determining high-or low-grade solitary cerebral glioma.Methods We divided 218 patients with solitary cerebral glioma confirmed by surgical pathology into low-grade group (n =134)and high-grade group (n =84).MRI features include the following:in contact with subventricular zone (SVZ ), tumor heterogeneity, tumor boundary, necrosis, hemorrhage, crossing midline, occupying effect,peritumoral edema,volume of enhancement,and enhanced inhomogeneity.The t-test,chi-square test and logistic regression analysis were used to evaluate the differences in age,gender and magnetic resonance imaging between the high-and low-grade glioma groups.MRI findings were then correlated with grade of gliomas. Results There was a significant difference in age between the two groups (P <0.001).There was no significant difference in men and women between the two groups (P =0.864).Seven out of ten MRI findings were identified to be significantly different between high- and low-grade groups.They were SVZ contact (P = 0.011 ),tumor heterogeneity (P <0.001),cystic change and necrosis (P =0.037),degree of edema (P =0.017),occupying effect (P = 0.009 ),tumor boundary (P < 0.001 ),and volume of enhancement (P < 0.001 ).Moreover,the logistic regression analysis indicated that age,cystic change and necrosis,tumor boundary,and volume of enhancement were independently associated with high-grade gliomas. Conclusion Conventional MRI findings are useful in determining high-or low-grade gliomas.Presence of the following MRI features suggests high-grade gliomas:older age,notable cystic changes and necrosis,unclear tumor boundary,and significant enhancement.

Value of conventional MRI features in solitary cerebral glioma grading / 西安交通大学学报(医学版)

Objective To evaluate the value of conventional MRI in determining high-or low-grade solitary cerebral glioma.Methods We divided 218 patients with solitary cerebral glioma confirmed by surgical pathology into low-grade group (n =134)and high-grade group (n =84).MRI features include the following:in contact with subventricular zone (SVZ ), tumor heterogeneity, tumor boundary, necrosis, hemorrhage, crossing midline, occupying effect,peritumoral edema,volume of enhancement,and enhanced inhomogeneity.The t-test,chi-square test and logistic regression analysis were used to evaluate the differences in age,gender and magnetic resonance imaging between the high-and low-grade glioma groups.MRI findings were then correlated with grade of gliomas. Results There was a significant difference in age between the two groups (P <0.001).There was no significant difference in men and women between the two groups (P =0.864).Seven out of ten MRI findings were identified to be significantly different between high- and low-grade groups.They were SVZ contact (P = 0.011 ),tumor heterogeneity (P <0.001),cystic change and necrosis (P =0.037),degree of edema (P =0.017),occupying effect (P = 0.009 ),tumor boundary (P < 0.001 ),and volume of enhancement (P < 0.001 ).Moreover,the logistic regression analysis indicated that age,cystic change and necrosis,tumor boundary,and volume of enhancement were independently associated with high-grade gliomas. Conclusion Conventional MRI findings are useful in determining high-or low-grade gliomas.Presence of the following MRI features suggests high-grade gliomas:older age,notable cystic changes and necrosis,unclear tumor boundary,and significant enhancement.

Application of susceptibility weighted and perfusion weighted imaging techniques in diagnosis and grading of clear cell renal cell carcinomas / 第二军医大学学报

Objective To investigate whether the degree of intratumoral susceptibility signal intensity (ITSS) of susceptibility weighted imaging" (SWI) correlates with the transfer constant (Ktrans) of perfusion weighted imaging (PWI), and to assess their values in diagnosis and grading of clear cell renal cell carcinoma (ccRCC). Methods Thirty-six patients with pathologically confirmed ccRCC and Fuhrman grades (I W) underwent both 2D multi-breath-hold SWI and renal PWI examination. The degree of ITSS and the mean value of Ktrans were evaluated. Kruskal-Wallis test and one-way analysis of variance (ANOVA) were applied to compare the differences among the three groups (Fuhrman I, TJ and [TJ). Spearman correlation coefficient was used to determine the correlation between degree of ITSS and mean value of Ktrans. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy. Results The degrees of ITSS of Fuhrman grade I (8 patients), grade TJ (16 patients) and grade III (12 patients) were (1. 25 ± 0. 43), (1. 75 ± 0. 83) and (2. 20 ± 0. 75), with the Ktrans values being (0. 24 ± 0. 07)min-1, (0. 31 ± 0. 08)min-1 and (0. 34 ± 0. 07) min-1, respectively, statistical significances were found for both degrees of ITSS and Ktrans values among the three Fuhrman groups (χ2 = 6. 089, P< 0. 05, F=4. 116, P<0. 05). A positive correlation was found between the degree of ITSS and value of Ktrans (r = 0. 536, P< 0. 01). ITSS and value of KtransROC curve analysis was used to distinguish Fuhrman UJ vs T - II ccRCC, the optimal area under curves (AUCs), sensitivity and specificity were 0. 737, 80. 0%, 37. 5% and 0. 737, 90. 0%. 68. 8%, respectively. Conclusion Both the degree of ITSS and mean value of Ktrans can provide more pre-operative information of ccRCC, helping to make surgical plans and to predict the prognosis.

Clinical study on the corration of pathological classification of brainstem glioma with MRI ;imaging / 中国医学装备

Objective:To explore the corration of pathological classification of brainstem glioma with MRI imaging. Methods: The clinical data of 98 patients with BSG was retrospectively analyzed. of 98 patients, 66 cases were low level of brainstem gliomas, 32 cases were high level of brainstem gliomas. MRI images of different pathological grading of BSG were analyzed. Results:Glioma growth way was similar between the two groups and there was no statistical significance. But the proportion of basal artery circumvolutio, necrosis, growth across the midline of the high level group were significantly higher than the control group, there was a significant statistical significance (P2 cm in diameter was higher than the control group, and the difference was statistically significant (P<0.05). The improved forms of high level group were mainly wreath, wall nodules (P<0.01), and improved significantly stronger than the low level group (P<0.01). The main uniformity of high level group in show was characteristics with less uniformity (P<0.01). The MRI measuring minimum thickness was similar between the two groups and had no statistical significance. But MRI measuring thickness, the ratio and gap between maximum thickness and minimum thickness of high level group were bigger than the value of low level group, with statistically significant difference (P<0.001). Conclusion:MRI imaging and MRI enhanced characteristics of brainstem glioma may predict and judge the malignant degree and pathological grading of brainstem glioma.

Correlation between apparent diffusion coefficient value and pathological grading in pT1b clear cell renal cell carcinoma / 中华放射学杂志

Objective To evaluate the correlation of ADC values on 3.0 T MR with the pathological grades in pT1b clear cell renal cell carcinoma(CCRCC).Methods Conventional MR images,ADC values and Fuhrman pathological grading of pT1b CCRCC were performed in 30 patients.Grade Ⅰ and Ⅱ were defined as low-grade group; grade Ⅲ and IV were defined as high-grade group.The differences of ADC values among four different pathologic grades were compared with a one-way analysis of variance. The comparison of ADC values of two different grade groups was performed with t test,and the ROC curve was performed to evaluate the diagnostic efficacy of ADC value. Correlation between pathological gradings and ADC values was assessed with Spearman rank correlation analysis. Results ( 1 ) The mean ADC value of grading Ⅰ ( 10 patients ), Ⅱ ( 8 patients ),Ⅲ ( 7 patients ),IV ( 5 patients ) was ( 0.94 ± 0.11 ) ×10-3 mm2/s,(0.82 ±0.13) × 10-3 mm2/s,(0.68 ±0.09) × 10-3 mm2/s,(0.59 ±0.03) × 10-3 mm2/s,respectively.Significant differences of ADC values among the four grades were present (F =16.422,P =0.000 ).( 2 ) The mean ADC value of the low-grade group was significantly higher than that of the high-grade group(t =5.738,P =0.000).Sensitivity and specificity of diagnosing the low-grade group was 88.9％ and 83.3％ respectively.There was a negative correlation between pathological grading and ADC value ( r =-0.807,P ＜ 0.05). Conclusions The ADC values of pT1b CCRCC have close correlation with pathological gradings.They can be used to predict the degree of tumor malignancy preoperatively and guide surgical planning.

Comparison of WHO 2004 and WHO 1973 pathological grading system of non-muscle invasive urothelial neoplasms / 中华泌尿外科杂志

Objective To compare WHO 2004 and WHO 1973 pathological grading methods of non-muscle invasive urothelial neoplasms. Methods The clinical pathological features of 160 non-muscle invasive urothelial neoplasms patients, treated in our hospital from February, 1998 to Decem-ber, 2008, were re-graded according to WHO 2004 and WHO 1973 classification system. To evaluate recurrence and progression of all the patients during the follow up period, we used statistical method to analyses the differences between two classification system. Results There were 160 patients, ac-cording to WHO 1973 classification methods: 5 cases of papilloma, 52 cases of grade 1 tumors, 83 ca-ses of grade 2 and 20 cases of grade 3;By WHO 2004 classification method: 7 cases of papilloma, 31 cases of low-grade malignant potential of urothelial papilloma, 99 cases of low-grade papillary urotheli-al carcinoma and 23 cases of high-grade papillary urothelial carcinoma. There was no difference in re-currence among the grades of WHO 2004 and WHO 1973 pathological grading system (both P>0.05). Regarding the progress of non-muscle invasive papillary urothelial neoplasms, no significant difference was found among grades of WHO 1973 classification system(P>0.05)while difference exis-ted among grades of WHO 2004 pathological grading system (P<0.05), especially between papillary neoplasm of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas(HG-PUC) (P<0.01). Moreover, HGPUC grade had more progression rate (30.4%) than G_3 grade (15.0%). Conclusions Compare to G_3 grade, HGPUC grade was more easily to make progress in pa-tients,due to this grade include more high malignant papillary urothelial carcinomas. Therefore, it is necessary for urologists to use a more rigorously follow up and therapy method in connection with HG-PUC grade of new classification system.