High resolution diffusion-weighted imaging with readout segmentation of long variable echo-trains for determining myometrial invasion in endometrial carcinoma.

BACKGROUND: We assessed the image quality of endometrial cancer lesions by readout segmentation of long variable echo-trains (RESOLVE) diffusion-weighted imaging (DWI) compared with that by single-shot echo-planar imaging (SS-EPI) DWI, aimed to explore the value of RESOLVE DWI for determining myometrial invasion and clinical stage in endometrial cancer. MATERIALS AND METHODS: From April 2017 to March 2018, a total of 30 endometrial cancer patients (mean age 52.8 ± 9.0 years), who had undergone RESOLVE DWI and SS-EPI DWI, were included in the study. The image quality of endometrial carcinoma by two kinds of DWI scanning methods was compared qualitatively and quantitatively. The Spearman rank correlation test was used to assess the correlation of qualitative image quality scores between two readers. The accuracy of two DWI methods in detecting myometrial invasion and staging of endometrial carcinoma was calculated according to postoperative pathological results. The indexes were analyzed including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The qualitative score of RESOLVE DWI group was superior to SS-EPI DWI group in every aspect of five aspects (all P < 0.001). Interobserver agreement of depiction was good or excellent in two DWI sequences. Signal to noise ratio and contrast to noise ratio values in RESOLVE DWI group were both higher than those in SS-EPI DWI group (P<0.001). No statistical difference of apparent diffusion coefficient value was observed between two DWI groups (P = 0.261). The specificity, accuracy, PPV, and NPV of estimating myometrial invasion by RESOLVE DWI in three cases (intramucosal lesion, <50% superficial invasion and ≥ 50% deep invasion) were all higher than those by SS-EPI DWI for endometrial carcinoma. Especially RESOLVE DWI was valuable in judging <50% superficial invasion (95%CI:0.586, 0.970). No significant difference in accuracy staging was between the two DWI groups (P = 0.125). CONCLUSION: RESOLVE DWI can provide higher quality images of endometrial carcinoma than SS-EPI DWI. The high-quality images are helpful for precise assessment of myometrial invasion in endometrial cancer.

Successful treatment of multisite hemorrhage by several methods in brain metastasis of choriocarcinoma: A case report.

RATIONALE: Brain metastasis of choriocarcinoma is a highly malignant gestational trophoblastic neoplasia (GTN) and has a notoriously poor prognosis. Hemorrhagic choriocarcinoma lesions may lead to life-threatening conditions also. Treatment of brain metastases of choriocarcinoma with hemorrhage in multiple sites is very difficult in clinical practices. A patient has been successfully treated in our hospital, which provides as clinical references for this difficulty in treating brain metastases of choriocarcinoma with hemorrhage in multiple sites. PATIENT CONCERNS: A 28-year-old patient with gravida 2, para 0 was admitted in our hospital for amenorrhea, vaginal bleeding, and lower abdominal pain. DIAGNOSES: The patient was diagnosed as choriocarcinoma FIGO stage IV and the score of the Prognostic Scoring Index modified by the WHO was 15. INTERVENTIONS: The patient received multiagent chemotherapy (EMACO regimen) soon after the diagnosis of choriocarcinoma with brain metastasis. During the therapy, the patient was given 3 different methods of treatment for metastatic site hemorrhage. An emergency surgery was performed to control massive bleeding from the metastatic lesions of broad ligament. Blood transfusions were given to treat acute left pulmonary hemorrhage. Uterine artery embolization (UAE) was performed to treat increased uterine bleeding. OUTCOMES: The patient achieved remission after 9 cycles of chemotherapy. She has been followed up for 14 months with no signs of tumor recurrence. LESSONS: The diagnosis of choriocarcinoma may be difficult, especially in the setting with the limit of medical resources. The application of various diagnostic techniques such as x-ray, computed tomography, and magnetic resonance imaging is helpful for evaluating the patient's condition.

The roles of Fanconi anemia genes in the regulation of follicle development.

Fanconi anemia (FA) is a rare recessive autosomal or X-linked genetic disease caused by the mutations of the FA genes. The FA genes are involved in the homologous recombination repair processes of damaged interstrand crosslinks in DNA. Premature ovarian insufficiency (POI) is commonly observed in female FA patients and in mice of experimental FA models with serious deficiency of germ cells, suggesting that FA genes could play an important role(s) in follicle development in mammals. Studies have showed that FA genes play significant functions in promoting the proliferation of primordial germ cell, maintaining normal meiosis of the oocytes, participating in the gonadotropin regulation of oocytes and granular cell growth, and other aspects of regulation of follicular development. In this review, we summarize the roles and molecular mechanisms of FA genes in the development of mammalian follicle, which may provide some insights on the genetic basis for the etiology of POI.