[The Value of MRI Texture Analysis in Identifying Intraductal Carcinoma of the Prostate Gland].

OBJECTIVE: To explore the value of a radiomics approach based on MRI texture analysis (TA) in identifying intraductal carcinoma of the prostate gland (IDCP). METHODS: MRI images of 56 patients with pathological proven prostate cancer were analyzed retrospectively, including 31 patients with pure prostate adenocarcinoma and 25 patients with IDCP component in the prostate adenocarcinoma lesions. After imaging features of lesions were analyzed, then enhanced arterial and venous phase images were imported into Omni-Kinetics software for the extraction the TA features of region of interests' lesion according to the T2-weighted imaging. In order to set up a regression prediction model which based on texture parameters and morphological features. Furthermore, the comparison of diagnostic accuracy of each TA regression models were assessed by operating characteristic curves (ROC). RESULTS: Among the imaging features of peripheral lesions, the incidence of surgical capsule invasion, prostatic capsule involvement, and seminal vesicle invasion in patients with IDCP was higher than that in patients with adenocarcinoma alone ( P<0.05). Among the imaging features of transitional zone lesions, patients with adenocarcinoma containing IDCP had a higher incience of imaging features as benign prostatic hyperplasia, extracapsular invasion of the prostate, seminal vesicles invasion, and vascular nerve bundles than that in pure adenocarcinoma group ( P<0.05). In order to differential diagnosis of simple adenocarcinoma and adenocarcinoma containing IDCP, 4 arterial phase texture features were used to build the regression model in the peripheral zone group, and the area under the curve ( AUC) of the TA model and combined model with or without seminal vesicles invasion were 0.890 and 0.938, respectively. In the transitional zone group, 2 arterial phase texture features and 2 venous phase features were used in TA regression model, and the AUC of texture model and the combined model with or without vascular nerve bundles were 0.844 and 0.901, respectively. CONCLUSION: The incidence of adenocarcinoma with IDCP is higher in high-grade invasive prostate cancer. It is wonderful that when compared with T2WI, enhanced sequential texture analysis is more valuable when using the radiomics approach based on MRI texture analysis in identifying IDCP in prostate cancer.

Spontaneous adrenal hematoma in pregnancy: A case report.

RATIONAL: Spontaneous adrenal hematoma in pregnancy is a very rare condition. Herein we present an additional rare case of unilateral spontaneous adrenal hematoma in a pregnant woman, aiming to share this experience and summarize the signal characteristics of simple adrenal hematoma in magnetic resonance imaging (MRI). PATIENT CONCERNS: A 28-year old pregnant woman was referred to our hospital with a vague paroxysmal left-side back pain at 17 weeks of gestation. DIAGNOSIS: MR scan of the abdomen revealed an 8.1 × 7.7 × 6.8 cm round mass in the left adrenal region, which showed a rim of acute hemorrhage signal. Due to the stable condition of the patient and fetus, she was admitted for observation. Repeat MR scan was performed a month later, and it showed a stable mass with marginal subacute bleeding signal. INTERVENTIONS: Laparoscope excision of the hematoma was performed. OUTCOMES: Simple adrenal hematoma was confirmed by pathological examinations. And the patient was discharged 3 days later with normal renal and adrenal functions. LESSONS: The most important characteristic of adrenal hematoma is the high-signal rim on T1-weighted MR images, and the clinicians should make individualized treatment plan for every patient encountered in the future who might have different clinical conditions.

Diagnostic Performance of Monoexponential DWI Versus Diffusion Kurtosis Imaging in Prostate Cancer: A Systematic Review and Meta-Analysis.

OBJECTIVE: We aimed to compare the diagnostic performance of monoexponential DWI and diffusion kurtosis imaging (DKI) for the detection of prostate cancer (PCa). MATERIALS AND METHODS: A systematic literature search was conducted for studies evaluating the diagnostic value of monoexponential DWI and DKI for PCa in the same patient cohorts with sufficient data to construct 2 × 2 contingency tables. Qualities of the included studies were assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data were extracted to calculate pooled sensitivities and specificities. We constructed summary ROC curves and calculated AUCs to determine the performances of DKI parameters (diffusion coefficient and kurtosis characterizing the deviation from the monoexponential decay) and apparent diffusion coefficient (ADC) values in diagnosing PCa. RESULTS: Five studies (463 patients) were included, with eight, nine, and 10 subsets of data available for analysis of ADC, diffusion, and kurtosis, respectively. Pooled sensitivities were 89% (95% CI, 80-94%) for ADC, 91% (95% CI, 84-95%) for diffusion, and 87% (95% CI, 83-91%) for kurtosis. Pooled specificities were 86% (95% CI, 80-90%) for ADC, 78% (95% CI, 71-84%) for diffusion, and 85% (95% CI, 81-89%) for kurtosis. According to the summary ROC analyses, the AUC was 0.93 (95% CI, 0.90-0.95) for ADC, 0.89 (95% CI, 0.86-0.92) for diffusion, and 0.93 (95% CI, 0.90-0.95) for kurtosis. There was no notable publication bias, but significant heterogeneity was observed. CONCLUSION: Monoexponential DWI and DKI showed comparable diagnostic accuracies for PCa. DKI is a potentially helpful method for the diagnosis of PCa. Therefore, on the basis of current evidence, we do not recommend including DKI in routine clinical assessment of PCa for the moment.

Lipo-prostaglandin E1 improves renal hypoxia evaluated by BOLD-MRI in patients with diabetic kidney disease.

OBJECTIVE: To evaluate the effect of lipo-PGE1 on renal hypoxia in patients with DKD by BOLD-MRI. MATERIALS AND METHODS: All patients were divided into DKD group and CKD-without-diabetes group. All patients received intravenous 10 µg lipo-PGE1 once daily for 14 days. BOLD-MRI was performed before and after lipo-PGE1 administration to acquire renal CR2* and MR2* values. RESULTS: Renal MR2* value in DKD group after lipo-PGE1 treatment were significantly decreased compared with the baseline. However, no significant differences in MR2* values were found in the CKD-without-diabetes group. CONCLUSIONS: Lipo-PGE1 was shown to improve kidney medullary oxygenation in patients with DKD.

Diagnostic value of renal perfusion in patients with chronic kidney disease using 3D arterial spin labeling.

PURPOSE: To evaluate the diagnostic value of 3D arterial spin labeling (ASL) for noninvasive quantification of renal blood flow (RBF) in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: CKD patients (n = 27) and healthy volunteers (n = 36) underwent renal 3T ASL magnetic resonance imaging, with inversion times from 1200 to 2000 msec for volunteers in the preliminary test, and 1800 to 2000 msec for volunteers and CKD patients in the formal experiments. The cortical RBFs were compared, and a correlation between RBF and estimated glomerular filtration rate (eGFR) was evaluated. RESULTS: For healthy volunteers, RBF values increased with TIs from 1200 to 1600 msec, but were almost constant at TIs from 1600 to 2000 msec. The cortical RBF values of CKD patients were lower than that of healthy volunteers at TIs from 1800 to 2000 msec. In addition, the CKD patients had lower cortical RBF values than the healthy volunteers (P < 0.01 for both), and their RBF values positively correlated with eGFR. CONCLUSION: 3D ASL is a potential noninvasive method for measuring renal perfusion that can provide valuable information for clinical CKD diagnosis. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:589-594.

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤ 4 cm) at 3.0T Magnetic Resonance Imaging.

BACKGROUND: The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤ 4 cm). METHODS: In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm 2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. RESULTS: The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10-3 mm 2 /s), ccRCCs ([1.53 ± 0.31] × 10-3 mm 2 /s) and the normal renal parenchyma ([2.22 ± 0.12] × 10-3 mm 2 /s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10-3 mm 2 /s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs. CONCLUSIONS: DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤ 4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.

Diffusion-weighted imaging of the kidneys and its relationship with residual renal function in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: The objective of our study was to prospectively evaluate renal diffusion as shown by diffusion-weighted imaging (DWI) and its relationship with the residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD) patients. SUBJECTS AND METHODS: Forty CAPD patients and 40 healthy volunteers were recruited, and all underwent conventional and fat-saturated echo-planar DWI with three b values (0, 300, 600 s/mm(2)). The renal parenchymal thickness and apparent diffusion coefficients (ADCs) were measured, and both were compared between the two groups. The relationships between ADC values and clinical indexes--which included RRF, serum creatinine value, cystatin C value, and urine output--were analyzed. RESULTS: Compared with the renal parenchymal thickness and ADC values in control subjects, these values in CAPD patients were significantly decreased (p < 0.0001). In CAPD patients, the ADC values were positively correlated with RRF (r = 0.447, p = 0.004). A mild linear correlation was also found between the ADC values and cystatin C value (r = -0.352, p = 0.026). CONCLUSION: The renal diffusion function as shown by DWI is impaired in CAPD patients and correlates with RRF.

Unicentric mesenteric Castleman's disease with littoral cell angioma, anemia, growth retardation and amenorrhea: A case report.

Castleman's disease (CD) is a rare lymphoproliferative disorder of unknown origin, and littoral cell angioma (LCA) is a rare vascular tumor of the spleen with an unknown etiology. The current study reports the case of a 28-year-old female who presented with anemia, growth retardation and amenorrhea. Physical examination revealed a mass in the mesentery, splenomegaly with multiple small nodules, hepatomegaly and an infantile uterus. Histopathological analysis of the resected mass and spleen confirmed the diagnosis of hyaline-vascular CD and LCA. The patient's anemia resolved, and menstruation and breast development also commenced following surgery. To the best of our knowledge, this is the first report of CD accompanied by littoral cell angioma, anemia, growth retardation and amenorrhea.

[The diagnostic value of conventional MRI in the differentiation of malignant tumor from benign lesion in prostatic peripheral zone].

OBJECTIVE: To evaluate the diagnostic capabilities of conventional MRI (T1WI, T2WI and Gd-enhancement T1WI) for differentiating prostate cancer from benign prostatic disorders in prostatic peripheral zone (PZ). METHODS: Respectively analyze the characteristics of conventional MRI in 46 cases of prostate cancer and 25 cases of benign prostatic disorders (with 28 lesions). Six indexes were initially screened by Chi2-test, and receiver operating characteristic curves (ROC) of these indexes were depicted, then Bayes discriminator was applied to discriminate all the lesions according to the indexes with statistic meaning. The discriminant function was evaluated with new sample validation. RESULTS: The indexes showing statistics meaning between prostate cancer and benign prostatic disorders were uniform low SI on T2WI, shape, pseudocapsule extension, prostate-capsule extension, size change of PZ with lesion and enhancement style. Furthermore, uniform low SI on T2WI, enhancement style and size change of PZ with lesion were consist of the function after discrimination, AUC of these 3 indexes were all above 0. 7, which were wider than that of the other 3 indexes. The discriminating accuracy rates of the new sample for benign prostatic disorders and prostate cancer were 83% and 77%. CONCLUSION: The importance of uniform low SI on T2WI, enhancement style and size change of PZ with lesion should be highlighted in the differentiation of prostate cancer and benign prostatic disorders in PZ.

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents.

In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm × 8 cm × 10 cm hematoma in the left psoas muscle. After aggressive supportive therapy [the administration of packed red blood cell transfusion, carbazochrome sodium sulfonate injection, and continuous venovenous hemofiltration (CVVH)], the patient's vital signs stabilized and her hemoglobin increased to 86 g/L. Repeat CT showed that the hematoma had been partially absorbed after two weeks. Eventually, the patient was discharged with stable vital signs. Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage, particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents.

[Distinguishing benign from malignant incidental adrenal lesions in enhanced CT imaging].

OBJECTIVE: To characterize the differences in radiologic features between benign and malignant adrenal lesions. METHODS: Enhanced multiple-slice spiral CT images of 99 patients with adrenal tumors were reviewed retrospectively, investigating into morphological features of different kinds of adrenal lesions with Wash-in Amplitude (WA, venous phase attenuation-unenhanced attenuation) and relative wash-in ratio (RWR, WA/artery phase attenuation). RESULTS: A combination of threshold in diameter = 3.2 cm, unenhanced attenuation = 24 HU, and RWR value = 0.879 produced 94.28% sensitivity and 98.43% specificity in diagnosing adenomas. CONCLUSION: Enhanced CT imaging improves diagnostic accuracy of incidental adrenal lesions.

Noninvasive evaluation of renal oxygenation in diabetic nephropathy by BOLD-MRI.

PURPOSE: To evaluate the renal oxygenation in type 2 diabetes by blood oxygenation level dependent magnetic resonance imaging (BOLD-MRI). MATERIALS AND METHODS: Forty-eight patients with type 2 diabetes and 67 healthy controls were recruited. All patients were further divided into four subgroups based on renal functional level. Bilateral renal cortical R2* (CR2*) and medullary R2* (MR2*) values were extracted and quantified on BOLD-MRI, then R2* ratio between medulla and cortex (MCR) was calculated. CR2*, MR2* and MCR were compared among the groups separately. The relationships were analyzed between R2* values and clinical index of renal function. RESULTS: Compared with controls, MR2* and CR2* in diabetes were significantly increased. The positive relationship was found between MR2* and estimated glomerular filtration rate (eGFR), and CR2* was negatively correlated with eGFR. Interestingly, the MCR increased in early stage of diabetes and decreased along with the aggravation of diabetic nephropathy (DN). CONCLUSION: BOLD-MRI can non-invasively detect and assess the renal hypoxia in diabetes. Our findings suggest that hypoxia in medulla is more apparent and earlier than in cortex. During the progression of DN, a reversion of corticomedullary oxygenation gradient can be detected, thus, MCR would be adopted to suppose the progression and prognosis of DN.

[Non-invasive assessment of renal oxygenation with BOLD MRI in patients with type 2 diabetes].

OBJECTIVE: To evaluate renal oxygenation in patients with type 2 diabetes using blood oxygenation level-dependent magnetic resonance imaging (BOLD MRI). METHODS: The R2* values of cortex and medulla as well as cortical thickness were measured in 25 patients with type 2 diabetes and 30 normal controls. The associations between R2* values and clinical parameters were analyzed. RESULTS: The medulla R2* value of the patients with diabetes was significantly higher than that of the normal controls. No significant difference in cortical thickness was found between the patients with diabetes and the normal controls. The medulla R2* value increased with eGFR in the patients with diabetes. CONCLUSION: BOLD MRI is a non-invasive and efficient method to assess the oxygenation in different regions of kidney. Abnormality of kidney in diabetic patients can be detected earlier by BOLD MRI than traditional imaging.

[Renal and non-renal tumors within the perirenal space in infants and children: multi-detector row CT characteristics].

OBJECTIVE: To determine the characteristics of Multi-detector Row CT (MDCT) image in distinguishing renal tumors from non-renal tumors within the perirenal space in infants and children. METHODS: Data from 40 patients with surgically and pathologically proved retroperitoneal neoplasms within the perirenal space were collected. Based on the pathological findings, the patients were divided into renal tumor group (n=14) and non-renal tumor group (n=26). The major clinical characteristics and CT characteristics of the two groups were compared. RESULTS: Incomplete renal contour with "crescent sign", "beak sign", "embedded kidney sign" and "prominent feeding artery sign" appeared in renal tumors more often than in non-renal tumors (P < 0.05). The sign of "renal displacement and renal axis rotation" and "extra-renal central plane of tumor" appeared more often in non-renal tumors than in renal tumors (P < 0.05). Large solid tumors with "pseudocapsule", "necrosis and cystic change", "vascularity", inferior vena cava tumor thrombus, and distant metastasis were more likely to be renal tumors than non-renal tumors (P < 0.05). Irregular mass with calcifications appeared more often in non-renal tumors than in renal tumors (P < 0.05). CONCLUSION: MDCT can detect the location, origin and histological feature of retroperitoneal neoplasms in infants and children. The MDCT characteristics can help differentiate renal and non-renal tumors within the perirenal space.

[Relationship between renal apparent diffusion coefficient and renal interstitial fibrosis: preliminary study].

OBJECTIVE: To explore the relationship between renal ADCs (apparent diffusion coefficient values) and renal interstitial fibrosis (RIF) grades. METHODS: Twenty four patients with chronic renal diseases and 48 healthy volunteers (control group) were examined with SS-EPI DWI at 3. OT MR. In chronic renal disease group, RIF of 14 patients who received renal biopsy was determined as grade I and II based on the tubuleinterstitial damage degree, while RIF of 10 patients with uremia, who did not receive biopsy but had nephrogenic renal atrophy, was categorized as grade III. RESULTS: With comparison of the study group and control group, ADCs of renal cortex were significantly different. In either grade II or III RIF, and ADCs of renal medulla showed difference in grade III RIF (P<0.05). Also, ADCs of both cortex and medulla displayed a decreasing trend as RIF grade increased (P<0.05). CONCLUSION: ADCs of renal cortex and medulla may reflect the grades of RIF. ADC of renal cortex might be more sensitive than that of renal medulla.

[A study of correlation between the blood supply types of PHcc on spiral CT and the level of VEGF expression in PHcc].

OBJECTIVE: To study the correlation between the blood supply types of primary hepatocellar carcinoma (PHcc) on Spiral CT and the level of vascular endothelial growth factor (VEGF) expression in PHcc for improvement in treatment strategies and prognostication. METHODS: Forty-five cases of PHcc identified by operation and pathology were investigated. Immunohistochemistry staining in SP was performed. The relationships between blood supply types of PHcc on Spiral CT during dual-phase scanning and the expression levels of VEGF in well-differentiated, moderately differentiated and poorly differentiated PHcc were analyzed. RESULTS: There were four blood supply types of PHcc on Spiral CT. Both the strong positive staining and the positive staining were most frequently seen in the hepatic artery blood supply type, and then were frequently in the double blood supply type, i. e. the hepatic arterial supply combining with the portal blood supply type. The positive staining results were rarely seen in the portal blood supply type and poor blood supply type (P<0.001). And with the escalation of the Edmonson- Steiner histological grades, the VEGF expression levels were shown to increase correspondingly (P < 0.05). CONCLUSION: We can ascertain the blood supply type of PHcc and infer the VEGF expression levels that reflect the PHcc angiogenesis condition and the histological grades by means of Spiral CT during dual- phase scanning. Hence this method is useful for the selection of PHcc treatment plans, including anti-angiogenesis and evaluating the prognosis.

[CT differentiation of renal angiomyolipoma and renal cell carcinoma].

OBJECTIVE: To improve the diagnosis of atypical renal angiomyolipoma (RAML) by use of CT to differentiate RAML from renal cell carcinoma (RCC). METHODS: We retrospectively analyzed the CT manifestations with dual-phase enhanced contrast study in 36 cases of RAML (with 57 lesions) and 46 cases of RCC. 25 lesions of RAML and all RCC were histologically confirmed. Maximum likehood estimator was employed to discriminate all the lesions according to a series of indexes with statistical meanings. RESULTS: Nine indexes were found to be significant and evident for separating RAML from RCC, namely "single or multiple", border, lobulation, protrusion rate, interface with cortex, angle with cortex, "levering-cortex-up" sign, characters of blood vessel in lesion and calcification. The accuracy rates of discrimination analysis for RAML and RCC were 93.0% and 89.1%, separately. CONCLUSION: The importance of 4 indexes, including protrusion rate, angle with cortex, "levering-cortex-up" sign and the traits of blood vessel, should be highlighted in the differentiation of RAML and RCC.