Synchronous rectal adenocarcinoma and intestinal mantle cell lymphoma: A case report.

BACKGROUND: Mantle cell lymphoma (MCL) of the gastrointestinal tract is a rare malignancy, accounting for about 0.2% of malignant colorectal tumors. MCL synchronous with rectal adenocarcinoma is extremely rare. We know of only a few cases reported in the literature. We describe the case of a patient with synchronous rectal adenocarcinoma and intestinal MCL. CASE SUMMARY: A 63-year-old man was admitted to our hospital due to abdominal pain and hematochezia over the past month. The patient was diagnosed with middle rectal cancer cT2N0M0 and underwent surgery. However, we found a large tumor in the small intestine during surgery. The patient underwent total mesorectal excision for rectal cancer and resectioning of the ileal segment containing the large mass. Pathology and immunohistochemistry revealed the presence of both rectal adenocarcinoma and pathognomonic MCL stage IIE presenting as multiple lymphomatous polyposis. The patient subsequently underwent RDHAP/RCHOP chemotherapy and was maintained with rituximab. A Positron Emission Tomography and Computed Tomography (PET/CT) scan showed that the disease responded well to treatment without tumor-increased metabolism in the gastrointestinal tract. CONCLUSION: Synchronous rectal adenocarcinoma and intestinal MCL presenting as multiple lymphomatous polyposis are extremely rare. MCL is often discovered fortuitously when rectal cancer is diagnosed. The coexistence of these tumors poses treatment challenges.

Knowledge, attitude, and perception regarding COVID-19-related prevention practice among residents in Vietnam: a cross-sectional study.

Background: Vietnam was one of the countries pursuing the goal of "Zero-COVID" and had effectively achieved it in the first three waves of the pandemic. However, the spread of the Delta variant was outbreak first in Vietnam in late April 2021, in which Ho Chi Minh City was the worst affected. This study surveyed the public's knowledge, attitude, perception, and practice (KAPP) toward COVID-19 during the rapid rise course of the outbreak in Ho Chi Minh City. Methods: This cross-sectional survey was conducted from 30th September to 16th November 2021, involving 963 residents across the city. We asked residents a series of 21 questions. The response rate was 76.6%. We set a priori level of significance at α = 0.05 for all statistical tests. Results: The residents' KAPP scores were 68.67% ± 17.16, 77.33% ± 18.71, 74.7% ± 26.25, and 72.31% ± 31, respectively. KAPP scores of the medical staff were higher than the non-medical group. Our study showed positive, medium-strong Pearson correlations between knowledge and practice (r = 0.337), attitude and practice (r = 0.405), and perception and practice (r = 0.671; p < 0.05). We found 16 rules to estimate the conditional probabilities among KAPP scores via the association rule mining method. Mainly, 94% confident probability of participants had {Knowledge=Good, Attitude=Good, Perception=Good}, as well as {Practice=Good} (in rule 9 with support of 17.6%). In opposition to around 86% to 90% of the times, participants had levels of {Perception=Fair, Practice=Poor} given with either {Attitude=Fair} or {Knowledge=Fair} (according to rules 1, 2, and rules 15, 16 with a support of 7-8%). Conclusion: In addition to the government's directives and policies, citizens' knowledge, attitude, perception, and practice are considered one of the critical preventive measures during the COVID-19 pandemic. The results affirmed the good internal relationship among K, A, P, and P scores creating a hierarchy of healthcare educational goals and health behavior among residents.

KRAS mutations and their associations with clinicopathological features and survival in Vietnamese non­polyp colon cancer patients.

The aim of the present study was to determine Kirsten Ras sarcoma virus (KRAS) mutations and the associations of KRAS mutations with clinicopathological features and treatment outcomes in Vietnamese non-polyp colon cancer (NPCC) patients. The data in the present study covered 194 patients with non-polyp colon cancers at stages II or III, according to the 8th edition of the American Joint Committee on Cancer staging system, in northern Vietnam from January 2016 to August 2020. All patients underwent radical surgery and adjuvant therapy with FOLFOX4 or XELOX. Subsequently, the recruited patients were followed-up with scheduled hospital exams for diagnosing recurrence. Genomic DNA samples were prepared from dissected tumors and specific sequences of the KRAS gene were amplified by polymerase chain reactions (PCR). The mutations at codons 12, 13, 59, 60, 61, 117 and 146 of the gene were determined. Possible associations of the KRAS mutations with clinicopathological properties and the survival of patients were analysed. The KRAS mutation rate was 47.9% in Vietnamese patients with NPCC, of those, mutations in exon 2 accounted for 91.4% of all detected mutations. The mutated-KRAS patients exhibited a significantly higher rate of anemia. Moreover, the KRAS mutation rate was higher in females (57.1%) than in males (39.8%). The KRAS mutation rate was also higher in patients with right colon cancers. Furthermore, KRAS mutations were an independent prognosis for poor disease-free survival (DFS) and overall survival (OS) in stage II patients. Among left-sided colon patients, mutated KRAS was a significant predictive factor for poor DFS but not for OS. The present study revealed a very high mutation rate of KRAS in Vietnamese patients with NPCC. The data of the present study indicated that the mutation status was associated with female patients and right-sided tumors. The KRAS mutations were a negative factor for the survival of patients with stage II NPCC and patients with left-sided colon cancer.

Ductal carcinoma in situ arises from microglandular adenosis and atypical microglandular adenosis in a young woman.

Microglandular adenosis (MGA) and atypical microglandular adenosis (AMGA) are intensely rare and distinctive forms of adenosis of the breast, usually occurring in middle-aged women. Carcinoma arising in MGA is an extremely rare subtype of breast carcinoma, and most reported cases are of invasive carcinoma. Ultrasound and magnetic resonance imaging are accurate imaging modalities for diagnosing these abnormalities. Our goal in this article was to report a rare instance of ductal carcinoma in situ (DCIS) arising from MGA and AMGA in a very young Vietnamese woman who presented with a palpable mass in her right breast for 1 month. During clinical examination and imaging, suspected lesions were found and categorized as BI-RADS 4a. The final histopathological findings confirmed DCIS arising from MGA/AMGA. In this patient, the disease was detected and managed early when the lesion was localized in the duct and there were no signs of invasive ductal carcinoma.

Safety and Efficacy of Liver Venous Deprivation Following Transarterial Chemoembolization Before Major Hepatectomy for Hepatocellular Carcinoma.

Objective: This study aimed to evaluate the safety and efficacy of liver venous deprivation (LVD) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: Between January 2021 and December 2022, HCC patients indicated for hepatectomy with initial insufficient future liver remnant (FLR) underwent LVD after TACE to induce preoperative liver hypertrophy. Results: Twenty-seven HCC patients with a median age of 55 years underwent LVD. No TACE or LVD procedure-associated complications occurred, except for 1 case presenting with grade A liver failure after LVD (then recovered after 7 days). The FLR volume was 29.3% (interquartile range [IQR] = 7.5) and 48.9% (IQR = 8.6) of the total liver volume before and after LVD, respectively (p < 0.001). The degree of hypertrophy and FLR hypertrophy rate were 14.8% (IQR = 8.4) and 55.2% (IQR = 36.7), respectively. All 27 patients demonstrated sufficient FLR after LVD (24 patients at three weeks post-LVD, one at six weeks, and two at ten weeks), but only 21 patients accepted surgery. Postoperative histopathology showed 16 patients with cirrhosis and five with mild fibrosis (F1, F2). One patient presented with severe intraoperative bleeding due to damage of left hepatic vein and developed grade C liver failure, then died on day 32 postoperation. Conclusion: LVD following TACE seems to be a safe, effective, and feasible method of inducing significant FLR regeneration in HCC, even in well-selected cirrhotic livers. Comparative studies with a large patient population and multicenter data are needed for further evaluation.

Diagnostic Performance of Magnetic Resonance Imaging in Discriminating Benign and Malignant Soft Tissue Tumors.

Objective: The study aimed to evaluate the role of magnetic resonance imaging (MRI) in differentiating between primary benign and malignant soft tissue tumors (STTs). Patients and Methods: The study was carried out on 110 patients with histopathological diagnoses of STTs. All patients underwent routine MRI before surgery/biopsy at Viet Duc University Hospital or Vietnam National Cancer Hospital, Hanoi, Vietnam, from January 2020 to October 2022. Data on preoperative MRI as well as the clinical features and pathological results of the patients were collected retrospectively. Univariate and multivariate linear regression were used to analyze the relationship between imaging, clinical parameters, and the ability to differentiate malignant from benign STTs. Results: Among 110 patients (59 men and 51 women), 66 had benign tumors and 44 had malignant tumors. The qualitative values that were significant in distinguishing between benign and malignant STTs were hypointensity on T1-weighted images (T1W; p<0.001), hypointensity on T2-weighted images (T2W; p=0.003), cysts (p=0.003)), necrosis (p<0.001), fibrosis (p=0.023), hemorrhage (p<0.001), lobulated margin (p<0.001), ill-defined border (p<0.001), peritumoral edema (p<0.001), vascular involvement (p<0.001), and heterogeneous enhancement (p<0.001). Regarding quantitative values, age (p=0.009), size (p<0.001), T1W signal quantification value (p=0.002), and T2W signal quantification value (p=0.007) showed statistically significant differences between benign and malignant tumors. Multivariate linear regression analysis showed that the combination of peritumoral edema and heterogeneous enhancement was the most valuable in the differential diagnosis of malignant tumors from benign tumors. Conclusion: MRI is valuable in discriminating between malignant and benign STTs. The presence of cysts, necrosis, hemorrhage, lobulated margin, ill-defined border, peritumoral edema, heterogeneous enhancement, vascular involvement, and T2W hypointensity is suggestive of malignant lesions, especially signs of peritumoral edema and heterogeneous enhancement. Advanced age and large tumor size are also suggestive of soft tissue sarcomas.

Effects of postoperative atrial fibrillation on cardiac surgery outcomes in Vietnam: a prospective multicenter study.

BACKGROUND: This study was designed to assess the impact of postoperative atrial fibrillation (POAF) on short- and long-term outcomes after cardiac surgery. METHODS: We prospectively assessed POAF concerning outcomes in 379 adult patients who had undergone cardiac surgery in two heart surgery centers with a follow-up period of one year for every patient. The effects of POAF on postoperative events were evaluated using Logistic regression, Cox regression (adjusted for propensity score), and Kaplan-Meier analysis. RESULTS: The incidence of POAF was 27.2%. Multivariable logistic regression analysis revealed POAF was associated with an increased risk of 6-month (OR = 5.36; CI: 1.51-18.94; p = 0.009), and 1-year mortality (OR = 4.56; CI: 1.29-16.04; p = 0.018) as well as Major Adverse Cardiocerebral Events (MACEs; acute MI, cardiac arrest, low cardiac output after surgery, third-degree atrioventricular block or stroke; OR = 3.02; CI: 1.29-7.05; p = 0.011), Intensive Care Unit (ICU) stay > 3 days (OR = 2.39; CI: 1.14-5.00; p = 0.021), and postoperative stay > 14 days (OR = 3.12; CI: 1.65-5.90; p < 0.001). Multivariable Cox regression analysis showed POAF as an independent predictor of mortality at one year (HR = 2.86; CI: 1.05-7.75; p = 0.038). Discharge plans including statin and beta-blocker had an independent association with a reduced mortality at one year (HR = 0.22; CI: 0.05-0.96; p = 0.045; HR = 0.16; CI: 0.03-0.87; p = 0.034, respectively). CONCLUSIONS: POAF is associated with an increased risk of morbidity, all-cause mortality, and hospital duration. Statins and beta-blockers that were included in discharge plans had an independent association with reduction in 1-year all-cause mortality.

Predictive Value of Preoperative Diffusion Tensor Imaging for Evaluating Postoperative Outcomes of Supratentorial Glioma in the Motor Function Area.

Objective: This study aimed to assess the predictive value of preoperative diffusion tensor imaging (DTI) data for surgical outcomes of patients with supratentorial glioma in the motor function area. Patients and Methods: This is a retrospective study of 43 patients receiving navigation-guided surgery for histopathologically demonstrated supratentorial glioma in the motor function area. All patients underwent preoperative 3 Tesla magnetic resonance imaging examinations with conventional and DTI sequences. Data on preoperative imaging and pre- and postoperative clinical characteristics of patients were retrospectively collected. Univariate and multivariate linear regressions were applied to analyze the relationships between preoperative parameters and pre- and postoperative muscle strength and the Karnofsky Performance Status (KPS) score. Results: Fourteen patients had low-grade gliomas and 29 had high-grade gliomas. Although the corticospinal tract (CST) score did not differ significantly between tumor grades, edema and deviation were common in low-grade gliomas (64.3%), while destroyed and infiltrated lesions were common in high-grade gliomas (58.6%). Muscle strength improved after surgery in the deviated tract group (40%) more than in the infiltrated tract group (33.3%). Two independent indices, preoperative muscle strength (p = 0.000) and glioma-to-CST distance (p = 0.001), were linearly related to postoperative muscle strength. The preoperative KPS score was the only indicator that affected the postoperative KPS score (p = 0.000). Conclusion: DTI should be considered in surgical management of supratentorial gliomas in the motor function area to determine the appropriate surgical strategy and predict the nature of the tumor and postoperative motor function.

Diagnosis of symmetric bilateral lateral ventricular subependymomas: A case report.

Subependymomas are rare benign tumors that are hypovascular and noninvasive. Subependymomas tend to present as solitary lesions in the fourth ventricle or the frontal horn of the lateral ventricle. When multiple lesions are present, determining the correct diagnosis between subependymoma and other intraventricular neoplasms can be challenging. The characterization of imaging features and enhancement patterns can help narrow down the list of potential differential diagnoses. In this article, we describe a case of bilateral subependymomas in the lateral ventricles in a 40-year-old Asian man, including the clinical features, imaging results from conventional magnetic resonance imaging, magnetic resonance spectroscopy, and magnetic resonance perfusion, histological outcomes, and the disease management approach.

Prognostic Significance of PD-L1 Expression and Standardized Uptake Values in the Primary Lesions of Stage IV Adenocarcinoma Lung Cancer.

Background: This study evaluated the prognostic ability of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with stage IV adenocarcinoma lung cancer to detect protein death-ligand 1 (PD-L1) expression levels. Methods: In total, 86 patients with stage IV adenocarcinoma lung cancer underwent 18F-FDG PET/CT imaging and PD-L1 expression evaluation before treatment from February 2019 to November 2020 at Bach Mai Hospital, Hanoi, Vietnam. The assessed patient characteristics in this study included sex, age, smoking status, epidermal growth factor receptor (EGFR) mutation, PD-L1 expression level, survival status, tumor, node, and metastasis (TNM) stage, and metastasis locations. Results: The average age was 62.23 ± 9.51 years, and men and women represented 67.4% and 32.6% of the population, respectively. The EGFR mutation rate was 36%. PD-L1 expression was negative (detected in <1% of the tumor) in 40.7% of cases and positive in 59.3% of cases (detected in 1-49% of the tumor in 32.6%; detected in ≥50% of the tumor in 26.7%). The mean maximum standardized uptake value (SUVmax) was 11.09 ± 3.94. SUVmax was significantly higher in PD-L1-positive tumors than in PD-L1-negative tumors (12.24 ± 4.01 and 9.43 ± 3.22, respectively; p = 0.001). Receiver operating characteristic curve analysis revealed an area under the curve of SUVmax was 0.681 (95% confidence interval 0.570-0.793, p = 0.004). Compared with PD-L1-negative cases, SUVmax was significantly different in all PD-L1-positive cases (p = 0.001), weakly PD-L1-positive cases (1-49%, p = 0.005), and strongly PD-L1-positive cases (≥50%, p = 0.003). PD-L1 expression levels were significantly associated with SUVmax (p = 0.001), tumor size (p = 0.022), and EGFR mutation status (p = 0.045). Conclusions: SUVmax in the primary lesions was able to predict PD-L1 expression and may play a role in predicting PD-L1 immunotherapy efficacy in patients with stage IV lung adenocarcinoma.

Mycotic Aneurysm with Iliac Artery-Colonic Fistula.

Although mycotic (infected) aneurysms are uncommon, they can affect any artery. The most frequently involved vessel is the aorta as well as femoral and cerebral arteries. A vascular-colonic fistula from infected aneurysms is even rarer, which remains a challenge for diagnosis and treatment. In this case report, we aimed to illustrate an 89-year-old man presenting initially with an aneurysm of the right common iliac artery. Forty days later, this lesion was infected and produced fresh blood in the rectum and sigmoid colon observed by colonoscopy. The final diagnosis of this case was a right common iliac artery aneurysm-colonic fistula due to infection. The patient was successfully diagnosed and treated with surgery at our hospital.

Association of anthelmintic treatment with malaria prevalence, incidence, and parasitemia: A systematic review and meta-analysis.

A chronic helminth infection can alter host immune response and affect malaria infection. We conducted a systematic review and meta-analysis to find the impact of anthelmintic treatment on malaria prevalence, incidence, and parasitemia. Nine and 12 electronic databases were searched on 28th July 2015 and 26th June 2020 for relevant studies. We performed meta-analysis for malaria prevalence, incidence, parasitemia, and a qualitative synthesis for other effects of anthelmintic treatment. Seventeen relevant papers were included. There was no association between anthelmintic treatment and malaria prevalence or change of parasitemia at the end of follow up period (pooled OR 0.93, 95% CI: 0.62, 1.38, p-value=0.71 and SMD -0.08, 95%CI: -0.24, 0.07, p-value=0.30 respectively) or at any defined time points in analysis. Pooled analysis of three studies demonstrated no association between malaria incidence and anthelmintic treatment (rate ratio 0.93, 95%CI: 0.80, 1.08, p-value=0.33). Our study encourages anthelmintic treatment in countries with high burden of co-infections as anthelmintic treatment is not associated with change in malaria prevalence, incidence, or parasitemia.

Diagnosis and management of calcaneal Yakes type IV AVM: Two case reports.

Peripheral arteriovenous malformations (AVMs) are rare, congenital anomalies resulting from developmental genetic defects of the vasculature and cause significant disturbances in daily activities. AVMs can affect any part of the body and are rarely observed in the calcaneal region. Here, we describe two cases of Yakes type IV calcaneal AVMs managed by ethanol sclerotherapy at our institute.

Correlations between dynamic contrast-enhanced magnetic resonance imaging parameters and histopathologic factors in breast cancer.

BACKGROUND: This study aimed to correlate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters with prognostic factors in breast cancer. METHODS: A retrospective analysis was performed in 45 patients who had breast DCE-MRI and were diagnosed with invasive ductal breast cancer following surgery. The following DCE-MRI parameters were calculated: percentage of initial peak enhancement (Epeak), time to initial peak enhancement (TTP), initial slope increase (IS), early signal enhancement ratio (ESER), and time-signal intensity curve (TIC) types. Correlations between Epeak, TTP, IS, ESER, and prognostic factors were determined using the Mann-Whitney U test and the Kruskal-Wallis test. The Chi-square test and Fisher's exact test were used to investigate the relationship between kinetic curve types and prognostic factors. RESULTS: Epeak and IS were significantly higher in the Ki-67 high-expression group than in the Ki-67 low-expression group (p = 0.031 and p = 0.012, respectively). ESER was significantly correlated with the histological type and Ki-67 expression level (p = 0.014 and p = 0.047, respectively). The TIC types were significantly correlated with the Ki-67 expression level (p = 0.009). Tumors with plateaus and washout curves were more likely to be associated with the Ki-67 high-expression group than tumors with a persistent curve (P = 0.027 and P = 0.038, respectively). TTP had no correlation with any prognostic factors (P > 0.05). CONCLUSIONS: This study showed that the DCE-MRI parameters of breast cancer were correlated with the expression of histopathological prognostic factors and might be useful for predicting prognosis.

First Reported Case of Anti-Ampa Receptor Encephalitis in a Vietnamese Adolescent.

INTRODUCTION: Autoimmune encephalitis refers to a group of diseases characterized by the presence of antibodies that directly attack receptors on the neuron surface and are associated with cognitive and behavioral disorders. Alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor autoimmune encephalitis is very rare and has been reported in only a few individual cases, with little clinical experience. CASE REPORT: We describe the clinical manifestation and disease course of the first diagnosed case of anti-AMPA receptor encephalitis at the Neurology Department of Children's Hospital 2 in November 2020. A previously healthy 10-year-old presented with symptoms over 2 periods. During each period, the patient presented with multiple focal seizures, a cognitive-behavioral disorder, and amnesia. The brain magnetic resonance imaging (MRI) results were persistently normal. Electroencephalography (EEG) recorded many focal spikes and spike waves. Antibodies against N-methyl D-aspartate (NMDA) were not detected. Antibodies against AMPA receptors were detected in the serum and cerebrospinal fluid using an indirect fluorescent antibody test. This patient was treated with immunotherapy, including methylprednisolone and intravenous immunoglobulin (IVIG), and antiepileptic drugs, such as oxcarbazepine, topiramate, and levetiracetam. The seizures were controlled, but the cognitive-behavioral disorder was only partially resolved. CONCLUSION: This case report contributes to the clinical understanding of anti-AMPA receptor encephalitis disease manifestation, the response to the immunotherapy, and relapse.

McCune-Albright syndrome onset with vaginal bleeding.

McCune-Albright syndrome (MAS), a rare genetic disorder, affects multiple organs and classically presents with the triad of polyostotic fibrous dysplasia (FD), skin hyperpigmentation (café-au-lait spots) and precocious puberty. Diagnosis occurs when patients manifest at least two of these three symptoms. We describe a 4-year-old girl who was admitted to our hospital due to recurrent vaginal bleeding, initially diagnosed as precocious puberty. On brain MRI, abnormalities in the maxillary and occipital bones were compatible with FD. Clinical examination after craniofacial bone lesions and clinical signs indicated MAS revealed abnormally pigmented macules on the neck and back, which were initially overlooked. No abnormal hormone tests were observed. Precocious puberty is the most common MAS-associated symptom that results in the admission to the hospital, whereas the clinical manifestation of FD in the first years of life is usually equivocal and probably has not been discovered by parents. Thus, comprehensive medical examinations are necessary to obtain a prompt and proper diagnosis.

Primary hepatic neuroendocrine tumor.

SUMMARY: Primary hepatic neuroendocrine tumor (PHNET) is a rare type of neuroendocrine tumor (NET) that is also a primary hepatic tumor. Patients are present with almost no specific clinical symptoms and typically present with negative test results and atypical imaging characteristics; therefore, the differentiation of PHNET from other types of primary hepatic masses can be very difficult. In this article, we describe a case of PHNET that mimicked a liver helminth infection in a 57-year-old man. The diagnosis of PHNET in this patient was challenging, and the final diagnosis was based on imaging, histopathology features, and long-term follow-up. LEARNING POINTS: An uncommon type of neuroendocrine tumor (NET) is a primary hepatic neuroendocrine tumor (PHNET). Primary hepatic neuroendocrine tumors are rare NET lesions found in the liver, characterized by non-specific clinical and imaging results, which can be easily confused with other liver lesions, including HCC and parasitic lesions. To have a conclusive diagnosis and classification, a mixture of many medical assessment techniques, such as imaging, gastrointestinal endoscopy, nuclear medicine, anatomy, including histopathology, and immunohistochemistry, is essential.

Medulloblastoma in the cerebellopontine angle mimicking a schwannoma.

The typical distinction between cerebellopontine angle (CPA) medulloblastoma and other primary CPA tumors was not fully known. While CPA medulloblastoma is very uncommon, it should be included in the differential diagnosis of patients with CPA tumors.

Correlations between apparent diffusion coefficient values and histopathologic factors in breast cancer.

BACKGROUND: Breast cancer is the most common malignancy dia-gnosed in women, and the incidence gradually increases. Magnetic resonance imaging (MRI) is become widely used to identify benign and malignant breast tumors. Objective: The aim of this study was to evaluate the relationships between apparent diffusion coefficient (ADC) values and histopathologic prognostic factors in breast cancer. METHODS: Forty-nine breast carcinoma patients were included evaluated for prognostic factors, including histological type, histo-logical grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Minimum (ADCmin) and mean (ADCmean) ADC values were compared among prognostic factor groups by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: Lower mean ADCmin and ADCmean values were observed for no special type (NST) than for invasive lobular carcinoma (ILC) type (0.81 ± 0.03 × 10-3 and 0.96 ± 0.03 × 10-3 mm2/s, P= 0.002 and 0.03, respectively). The mean ADCmin and ADCmean values for the high-level Ki-67 group were significantly lower than those for the low-level Ki-67 group (P = 0.001 and 0.008, respectively). No correlations were observed between ADC values and histological grades, ER, PR, HER2, and molecular subtypes. CONCLUSION: ADCmin and ADCmean values correlated with the pro-liferation marker Ki-67 and histological grade. ADC values can serve as noninvasive indicators of cell proliferation in breast cancer.

The performance of diffusion tensor imaging parameters for the distinction between medulloblastoma and pilocytic astrocytoma.

BACKGROUND: To evaluate the performance of diffusion tensor imaging (DTI) parameters for the distinction between pediatric medulloblastomas and pilocytic astrocytomas. METHODS: DTI was performed in 36 patients, who were divided into two groups: group 1 consisted of 26 patients with medulloblastoma, whereas group 2 consisted of 10 patients with pilocytic astrocytoma. The Mann-Whitney U test was utilized to compare the tumoral fractional anisotropy (tFA) and diffusivity (tMD) values and the tumor to parenchyma ratios for these values (rFA and rMD, respectively) between these two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were applied to compute the cut-off point, and then the area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS: The tFA and rFA values of group 1 were significantly lower than those of group 2 (p < 0.05). In contrast, the tMD and rMD values of group 1 were significantly higher than those of group 2 (p < 0.05). Among the FA parameters, a cut-off tFA value of 0.37 provided the best ability to discriminate between medulloblastomas and pilocytic astrocytomas, producing a sensitivity value of 84.6%, a specificity of 80%, and an AUC of 81.7%. The cut-off values for MD and rMD were determined to be 1.06 × 10-3 mm2/s and 1.33, respectively, and were determined to be the most efficacious parameters for the differential diagnosis between medulloblastoma and pilocytic astrocytoma, which generated sensitivity, specificity, and AUC values of 100%. CONCLUSIONS: DTI parameters can play pivotal roles in the discrimination between medulloblastoma and pilocytic astrocytoma.