BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To ...BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.展开更多
BACKGROUND China ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality.Early screening,diagnosis,and timely determination of the optimal treatment plan can help ensure clinical efficacy and ...BACKGROUND China ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality.Early screening,diagnosis,and timely determination of the optimal treatment plan can help ensure clinical efficacy and prognosis.AIM To investigate the relationship between quantitative magnetic resonance imaging parameters,apparent diffusion coefficient value,pathological immunohistochemical status,and patient prognosis.METHODS A total of 108 patients with breast cancer(breast cancer group)and 110 patients with benign breast tumors(benign group)confirmed by pathological examination at our Hospital from September 2013 to August 2016 were selected.All patients had undergone preoperative magnetic resonance imaging(MRI)examinations,and the quantitative parameters of MRI and apparent diffusion coefficient(ADC)values for the two groups were compared.The MRI quantitative parameters and ADC values of patients with different estrogen receptor(ER),progesterone receptor,and human epidermal growth factor receptor-2 expression were statistically analyzed.The relationship between the quantitative parameters of MRI and ADC values and patient recurrence was analyzed using receiver operating curves.RESULTS The measured values of the quantitative parameters of MRI-Ktrans,Kep,and Ve in the breast cancer group were higher than those in the benign group;the ADC value in the breast cancer group was lower than that in the benign group,and the difference was statistically significant(P<0.05).The Ktrans,Ve,and ADC values in patients with ER-positive breast cancer were significantly lower than those in patients with negative ER expression(P<0.05).After 5 years of follow-up,22 patients with breast cancer experienced postoperative recurrence.The Kep,Ve,and ADC values of the recurrence group were significantly lower than those of the non-recurrence group,and the difference was statistically significant(P<0.05).CONCLUSION MRI quantitative parameters and ADC are related to the expression of breast cancer-related immunological receptor factors and have certain clinical value in assessing postoperative recurrence in patients.展开更多
BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To...BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To investigate the value of TA on apparent diffusion coefficient(ADC)maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.METHODS This was a case-control study of 59 patients with pT3 rectal adenocarcinoma,who underwent diffusion-weighted imaging(DWI)between October 2016 and December 2018.The inclusion criteria were:(1)Proven pT3 rectal adenocarcinoma;(2)Primary MRI including high-resolution T2-weighted image(T2WI)and DWI;and(3)Availability of pathological reports for surgical specimens.The exclusion criteria were:(1)Poor image quality;(2)Preoperative chemoradiation therapy;and(3)A different pathological type.First-order(ADC values,skewness,kurtosis,and uniformity)and second-order(energy,entropy,inertia,and correlation)texture features were derived from whole-lesion ADC maps.Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.RESULTS The final study population consisted of 59 patients(34 men and 25 women),with a median age of 66 years(range,41-85 years).Thirty patients had pT3a,24 had pT3b,and five had pT3c.Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas,only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors.Among the ADC second-order textural differences,energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas.For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors,the areas under the curves(AUCs)of skewness,energy,and entropy were 0.686,0.657,and 0.747,respectively.Logistic regression analysis of all three features yielded a greater AUC(0.775)in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors(69.0%sensitivity and 83.3%specificity).CONCLUSION TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.展开更多
Objective:To investigate the differences of apparent diffusion coefficient and transverse relaxation rate(R_(2)^(*))in magnetic resonance imaging(MRI)between micro hepatocellular carcinoma and nodules of cirrhosis.Met...Objective:To investigate the differences of apparent diffusion coefficient and transverse relaxation rate(R_(2)^(*))in magnetic resonance imaging(MRI)between micro hepatocellular carcinoma and nodules of cirrhosis.Method:The clinical data of 68 patients with micro hepatocellular carcinoma(76 lesions)and 45 patients with nodular cirrhosis(48 lesions)were retrospectively analyzed.Diffusion weighted imaging and R_(2)^(*)imaging were performed on all patients.The differences of apparent diffusion coefficient and R_(2)^(*)values in patients with micro hepatocellular carcinoma and nodular cirrhosis were compared.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of apparent diffusion coefficient values and R_(2)^(*)values for microhepatocellular carcinoma.Result:Compared with nodules of cirrhosis,the mean apparent diffusion coefficient and R_(2)^(*)value of micro-hepatocellular carcinoma were significantly decreased(P<0.05).The diagnosis threshold of apparent diffusion coefficient is at 1.35×10^(-3)mm^(2)/s,and the sensitivity for the diagnosis of micro-hepatocellular carcinoma was 80.88%,and the specificity was 91.11%,and the corresponding area under the ROC curve was 0.88;The diagnostic threshold for R_(2)^(*)value was at 53.96 Hz,and the sensitivity for the diagnosis of small hepatocellular carcinoma was 91.18%,and the specificity was 77.78%,and the corresponding area under the ROC curve was 0.84.Conclusion:MRI apparent diffusion coefficient value and R_(2)^(*)value can be used to differentiate and diagnose micro hepatocellular carcinoma and nodules of cirrhosis,in which the apparent diffusion coefficient of nodules of cirrhosis was less than 1.35×10^(-3)mm^(2)/s,R_(2)^(*)values were lower than 53.96 Hz may indicate the occurrence of nodular canceration.展开更多
With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed...With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy(14 moderate cases and 8 severe cases) underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.展开更多
AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Six...AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.展开更多
Aim: To investigate the diagnostic efficiency of apparent diffusion coefficient value (ADC) in differentiating benign from malignant breast lesions at 3.0 T diffusion-weighted imaging with different pair of b value. M...Aim: To investigate the diagnostic efficiency of apparent diffusion coefficient value (ADC) in differentiating benign from malignant breast lesions at 3.0 T diffusion-weighted imaging with different pair of b value. Methods: Total 110 patients with 107 lesions (44 benign and 63 malignant) were selected for our study with five different b-values 0, 400, 800, 1200 and 1600 s/mm<sup>2</sup>. ADC values were calculated using different pairs of b values. The cut-off ADC values and diagnostic efficiency were evaluated by receiver operating characteristic analysis. Comparison of Mean ADC value for breast lesions was determined by using independent sample t test. ROC curves were used for diagnostic efficiency of ADC using different pairs of b values. Results: With increase of b value, mean ADC value decreases. The mean ADC values for benign were 1.73 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 400, 1.57 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 800, 1.43 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1200 and 1.30 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1600 s/mm<sup>2</sup>. The mean ADC values for the malignant breast lesion were 1.21 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 400, 1.06 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 800, 0.94 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1200 and 0.86 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1600 s/mm<sup>2</sup>. ADC diagnostic efficiency for benign and malignant lesion for all the pair of b value combination was significant (p > 0.05). The sensitivity, specificity, PPV, NPV and accuracy were 80.95%, 90.9%, 92.72%, 76.92%, 85.04% for b 0 and 400;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 800;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1200;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1600 s/mm<sup>2</sup> respectively. Conclusion: DWI is effective in differentiating benign and malignant breast lesion at 3.0 Tesla using ADC with higher b value combination.展开更多
BACKGROUND Acute fibroid complications are rare.However,failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic,even deadly,complications.Pyomyoma is a rare but potent...BACKGROUND Acute fibroid complications are rare.However,failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic,even deadly,complications.Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct,hematogenous,or lymphatic dissemination.Even though the diagnosis is established through clinical and laboratory findings,imaging is an important complementary method to support the suspected diagnosis.CASE SUMMARY Herein,we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings.The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics.After a week of persistent pain,she developed sepsis without any identifiable foci.Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration,and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient’s clinical features.We decided to perform myomectomy(which is an infrequently performed surgical treatment due to the procedure’s intrinsic implic-ations)due to the patient’s desire to preserve fertility.Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis,while the tissue culture showed gram-negative cocci bacteria,which were successfully treated using antibiotic therapy.The patient’s health status improved after several days.CONCLUSION The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures.Nonetheless,magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.展开更多
Some in vitro experiments have shown that erythropoietin(EPO) increases resistance to apoptosis and facilitates neuronal survival following cerebral ischemia.However,results from in vivo studies are rarely reported.Pe...Some in vitro experiments have shown that erythropoietin(EPO) increases resistance to apoptosis and facilitates neuronal survival following cerebral ischemia.However,results from in vivo studies are rarely reported.Perfusion-weighted imaging(PWI) and diffusion-weighted imaging(DWI) have been applied successfully to distinguish acute cerebral ischemic necrosis and penumbra in living animals; therefore,we hypothesized that PWI and DWI could be used to provide imaging evidence in vivo for the conclusion that EPO could reduce apoptosis in brain areas injured by cerebral ischemia/reperfusion.To validate this hypothesis,we established a rat model of focal cerebral ischemia/reperfusion injury,and treated with intra-cerebroventricular injection of EPO(5,000 U/kg) 20 minutes before injury.Brain tissue in the ischemic injury zone was sampled using MRI-guided localization.The relative area of abnormal tissue,changes in PWI and DWI in the ischemic injury zone,and the number of apoptotic cells based on Td T-mediated d UTP-biotin nick end-labeling(TUNEL) were assessed.Our findings demonstrate that EPO reduces the relative area of abnormally high signal in PWI and DWI,increases cerebral blood volume,and decreases the number of apoptotic cells positive for TUNEL in the area injured by cerebral ischemia/reperfusion.The experiment provides imaging evidence in vivo for EPO treating cerebral ischemia/reperfusion injury.展开更多
Objective:The primary aim of this study was to assess the efficacy of whole-body diffusion-weighted imaging(WB-DWI)in detecting tumour recurrence and metastasis of gastrointestinal cancers by comparison with 18F-2-flu...Objective:The primary aim of this study was to assess the efficacy of whole-body diffusion-weighted imaging(WB-DWI)in detecting tumour recurrence and metastasis of gastrointestinal cancers by comparison with 18F-2-fluoro-2-deoxy-Dglucose positron emission tomography or computed tomography(18F-FDG-PET/CT).A secondary aim was to evaluate the change of apparent diffusion coefficient(ADC)value between metastases and normal tissues.Methods:Twenty-eight previously confirmed gastrointestinal cancer patients with suspected tumour recurrence or metastasis were recruited.WB-DWI and PET/CT images were evaluated by two radiologists and a nuclear medicine physician.Agreement between WB-DWI and PET/CT for detective efficacy was compared using kappa statistics.Additionally,diagnostic accuracy,sensitivity,specificity,negative predictive value(NPV),and positive predictive value(PPV)were also statistically analysed.ADC values between metastatic and normal tissues were compared.Results:There was no statistically significant difference(P>0.05)in the overall diagnostic performances of PET/CT(accuracy 98.9%;sensitivity 95.2%;specificity 99.8%;PPV 98.9%;NPV 98.9%)and WB-DWI(accuracy 95.9%;sensitivity 81.7%;specificity 99.1%;PPV 95.0%;NPV 96.1%).WB-DWI showed agreement with PET/CT(j=0.877)for detecting recurrence and distant metastases.A statistically significant difference in ADC value was observed between tissues of normal healthy volunteers and metastases in lymph nodes,liver and bones(P<0.05).Conclusions:WB-DWI is reliable in detecting tumour recurrence and metastasis of colorectal cancer and offers the same diagnostic performance as 18F-PET/CT without ionizing radiation.The quantitative value of ADC provides extra information to determine cancer metastasis.展开更多
Objective:This study aimed to determine whether the apparent diffusion coefficients(ADCs)determined by diffusion-weighted imaging(DWI)of magnetic resonance imaging(MRI)could facilitate the malignancy grading of variou...Objective:This study aimed to determine whether the apparent diffusion coefficients(ADCs)determined by diffusion-weighted imaging(DWI)of magnetic resonance imaging(MRI)could facilitate the malignancy grading of various gliomas.Methods:Sixty patients with a primary cerebral glioma underwent diffusion-weighted and gadolinium-enhanced(Gd)T1-weighted MRI using a 1.5-T MRI scanner.Scoring was performed based on signal intensities on DWI and Gd images.The mean and minimum ADC values were calculated,and Ki-67 staining was performed for each histological sample to evaluate their tumor proliferative potential.Then,the DWI,Gd,and combined scores were analyzed and compared with the Ki-67 staining index and malignant grade.The relationships among the mean and minimum ADC values,Ki-67staining index,and malignant grade were also evaluated.Results:The minimum ADC was inversely correlated with the Ki-67staining index,with a low minimum ADC suggestive of tumor malignancy.The qualitative evaluation of the D score of water molecule diffusion on DWI accurately reflected the pathological grades of gliomas,with an effectiveness that was at least as good as the quantitative analysis using the minimum ADC.The diagnostic value of Gd images in determining glioma malignancy grades was inferior to that of DWI.Conclusion:Both DWI and gadolinium-enhanced images of MRI should be considered essential for the diagnosis of tumor malignancy.展开更多
文摘BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.
基金Supported by Baoding Science and Technology Support Plan Project,No.17ZF211.
文摘BACKGROUND China ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality.Early screening,diagnosis,and timely determination of the optimal treatment plan can help ensure clinical efficacy and prognosis.AIM To investigate the relationship between quantitative magnetic resonance imaging parameters,apparent diffusion coefficient value,pathological immunohistochemical status,and patient prognosis.METHODS A total of 108 patients with breast cancer(breast cancer group)and 110 patients with benign breast tumors(benign group)confirmed by pathological examination at our Hospital from September 2013 to August 2016 were selected.All patients had undergone preoperative magnetic resonance imaging(MRI)examinations,and the quantitative parameters of MRI and apparent diffusion coefficient(ADC)values for the two groups were compared.The MRI quantitative parameters and ADC values of patients with different estrogen receptor(ER),progesterone receptor,and human epidermal growth factor receptor-2 expression were statistically analyzed.The relationship between the quantitative parameters of MRI and ADC values and patient recurrence was analyzed using receiver operating curves.RESULTS The measured values of the quantitative parameters of MRI-Ktrans,Kep,and Ve in the breast cancer group were higher than those in the benign group;the ADC value in the breast cancer group was lower than that in the benign group,and the difference was statistically significant(P<0.05).The Ktrans,Ve,and ADC values in patients with ER-positive breast cancer were significantly lower than those in patients with negative ER expression(P<0.05).After 5 years of follow-up,22 patients with breast cancer experienced postoperative recurrence.The Kep,Ve,and ADC values of the recurrence group were significantly lower than those of the non-recurrence group,and the difference was statistically significant(P<0.05).CONCLUSION MRI quantitative parameters and ADC are related to the expression of breast cancer-related immunological receptor factors and have certain clinical value in assessing postoperative recurrence in patients.
基金Jiangsu Provincial Medical Youth Talent,No.QNRC2016212Suzhou Clinical Special Disease Diagnosis and Treatment Program,No.LCZX201823+2 种基金Suzhou GuSu Medical Talent Project,No.GSWS2019077The Science and Technology Bureau of Changshu,No.CS201624(to Lu ZH)Jiangsu Committee of Health,No.H2018071(to Xia KJ).
文摘BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To investigate the value of TA on apparent diffusion coefficient(ADC)maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.METHODS This was a case-control study of 59 patients with pT3 rectal adenocarcinoma,who underwent diffusion-weighted imaging(DWI)between October 2016 and December 2018.The inclusion criteria were:(1)Proven pT3 rectal adenocarcinoma;(2)Primary MRI including high-resolution T2-weighted image(T2WI)and DWI;and(3)Availability of pathological reports for surgical specimens.The exclusion criteria were:(1)Poor image quality;(2)Preoperative chemoradiation therapy;and(3)A different pathological type.First-order(ADC values,skewness,kurtosis,and uniformity)and second-order(energy,entropy,inertia,and correlation)texture features were derived from whole-lesion ADC maps.Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.RESULTS The final study population consisted of 59 patients(34 men and 25 women),with a median age of 66 years(range,41-85 years).Thirty patients had pT3a,24 had pT3b,and five had pT3c.Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas,only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors.Among the ADC second-order textural differences,energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas.For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors,the areas under the curves(AUCs)of skewness,energy,and entropy were 0.686,0.657,and 0.747,respectively.Logistic regression analysis of all three features yielded a greater AUC(0.775)in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors(69.0%sensitivity and 83.3%specificity).CONCLUSION TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.
文摘Objective:To investigate the differences of apparent diffusion coefficient and transverse relaxation rate(R_(2)^(*))in magnetic resonance imaging(MRI)between micro hepatocellular carcinoma and nodules of cirrhosis.Method:The clinical data of 68 patients with micro hepatocellular carcinoma(76 lesions)and 45 patients with nodular cirrhosis(48 lesions)were retrospectively analyzed.Diffusion weighted imaging and R_(2)^(*)imaging were performed on all patients.The differences of apparent diffusion coefficient and R_(2)^(*)values in patients with micro hepatocellular carcinoma and nodular cirrhosis were compared.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of apparent diffusion coefficient values and R_(2)^(*)values for microhepatocellular carcinoma.Result:Compared with nodules of cirrhosis,the mean apparent diffusion coefficient and R_(2)^(*)value of micro-hepatocellular carcinoma were significantly decreased(P<0.05).The diagnosis threshold of apparent diffusion coefficient is at 1.35×10^(-3)mm^(2)/s,and the sensitivity for the diagnosis of micro-hepatocellular carcinoma was 80.88%,and the specificity was 91.11%,and the corresponding area under the ROC curve was 0.88;The diagnostic threshold for R_(2)^(*)value was at 53.96 Hz,and the sensitivity for the diagnosis of small hepatocellular carcinoma was 91.18%,and the specificity was 77.78%,and the corresponding area under the ROC curve was 0.84.Conclusion:MRI apparent diffusion coefficient value and R_(2)^(*)value can be used to differentiate and diagnose micro hepatocellular carcinoma and nodules of cirrhosis,in which the apparent diffusion coefficient of nodules of cirrhosis was less than 1.35×10^(-3)mm^(2)/s,R_(2)^(*)values were lower than 53.96 Hz may indicate the occurrence of nodular canceration.
基金supported by a grant from the Clinical Medicine Science and Technology Projects in Jiangsu Province of China,No.BL2014037a grant from the Changzhou City Science and Technology Support Plan in China,No.CE20165027+1 种基金a grant from the Changzhou Health Development Planning Commission Major Projects in China,No.ZD201515the Changzhou High-Level Health Personnel Training Project Funding
文摘With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy(14 moderate cases and 8 severe cases) underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.
基金Supported by National Institutes of Health R01 CA126809
文摘AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.
文摘Aim: To investigate the diagnostic efficiency of apparent diffusion coefficient value (ADC) in differentiating benign from malignant breast lesions at 3.0 T diffusion-weighted imaging with different pair of b value. Methods: Total 110 patients with 107 lesions (44 benign and 63 malignant) were selected for our study with five different b-values 0, 400, 800, 1200 and 1600 s/mm<sup>2</sup>. ADC values were calculated using different pairs of b values. The cut-off ADC values and diagnostic efficiency were evaluated by receiver operating characteristic analysis. Comparison of Mean ADC value for breast lesions was determined by using independent sample t test. ROC curves were used for diagnostic efficiency of ADC using different pairs of b values. Results: With increase of b value, mean ADC value decreases. The mean ADC values for benign were 1.73 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 400, 1.57 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 800, 1.43 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1200 and 1.30 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1600 s/mm<sup>2</sup>. The mean ADC values for the malignant breast lesion were 1.21 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 400, 1.06 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 800, 0.94 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1200 and 0.86 × 10<sup>-3</sup> mm<sup>2</sup>/s for b 0 and 1600 s/mm<sup>2</sup>. ADC diagnostic efficiency for benign and malignant lesion for all the pair of b value combination was significant (p > 0.05). The sensitivity, specificity, PPV, NPV and accuracy were 80.95%, 90.9%, 92.72%, 76.92%, 85.04% for b 0 and 400;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 800;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1200;84.12%, 90.9%, 92.98%, 80%, 86.91% for b 0 and 1600 s/mm<sup>2</sup> respectively. Conclusion: DWI is effective in differentiating benign and malignant breast lesion at 3.0 Tesla using ADC with higher b value combination.
文摘BACKGROUND Acute fibroid complications are rare.However,failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic,even deadly,complications.Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct,hematogenous,or lymphatic dissemination.Even though the diagnosis is established through clinical and laboratory findings,imaging is an important complementary method to support the suspected diagnosis.CASE SUMMARY Herein,we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings.The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics.After a week of persistent pain,she developed sepsis without any identifiable foci.Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration,and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient’s clinical features.We decided to perform myomectomy(which is an infrequently performed surgical treatment due to the procedure’s intrinsic implic-ations)due to the patient’s desire to preserve fertility.Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis,while the tissue culture showed gram-negative cocci bacteria,which were successfully treated using antibiotic therapy.The patient’s health status improved after several days.CONCLUSION The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures.Nonetheless,magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.
文摘Some in vitro experiments have shown that erythropoietin(EPO) increases resistance to apoptosis and facilitates neuronal survival following cerebral ischemia.However,results from in vivo studies are rarely reported.Perfusion-weighted imaging(PWI) and diffusion-weighted imaging(DWI) have been applied successfully to distinguish acute cerebral ischemic necrosis and penumbra in living animals; therefore,we hypothesized that PWI and DWI could be used to provide imaging evidence in vivo for the conclusion that EPO could reduce apoptosis in brain areas injured by cerebral ischemia/reperfusion.To validate this hypothesis,we established a rat model of focal cerebral ischemia/reperfusion injury,and treated with intra-cerebroventricular injection of EPO(5,000 U/kg) 20 minutes before injury.Brain tissue in the ischemic injury zone was sampled using MRI-guided localization.The relative area of abnormal tissue,changes in PWI and DWI in the ischemic injury zone,and the number of apoptotic cells based on Td T-mediated d UTP-biotin nick end-labeling(TUNEL) were assessed.Our findings demonstrate that EPO reduces the relative area of abnormally high signal in PWI and DWI,increases cerebral blood volume,and decreases the number of apoptotic cells positive for TUNEL in the area injured by cerebral ischemia/reperfusion.The experiment provides imaging evidence in vivo for EPO treating cerebral ischemia/reperfusion injury.
文摘Objective:The primary aim of this study was to assess the efficacy of whole-body diffusion-weighted imaging(WB-DWI)in detecting tumour recurrence and metastasis of gastrointestinal cancers by comparison with 18F-2-fluoro-2-deoxy-Dglucose positron emission tomography or computed tomography(18F-FDG-PET/CT).A secondary aim was to evaluate the change of apparent diffusion coefficient(ADC)value between metastases and normal tissues.Methods:Twenty-eight previously confirmed gastrointestinal cancer patients with suspected tumour recurrence or metastasis were recruited.WB-DWI and PET/CT images were evaluated by two radiologists and a nuclear medicine physician.Agreement between WB-DWI and PET/CT for detective efficacy was compared using kappa statistics.Additionally,diagnostic accuracy,sensitivity,specificity,negative predictive value(NPV),and positive predictive value(PPV)were also statistically analysed.ADC values between metastatic and normal tissues were compared.Results:There was no statistically significant difference(P>0.05)in the overall diagnostic performances of PET/CT(accuracy 98.9%;sensitivity 95.2%;specificity 99.8%;PPV 98.9%;NPV 98.9%)and WB-DWI(accuracy 95.9%;sensitivity 81.7%;specificity 99.1%;PPV 95.0%;NPV 96.1%).WB-DWI showed agreement with PET/CT(j=0.877)for detecting recurrence and distant metastases.A statistically significant difference in ADC value was observed between tissues of normal healthy volunteers and metastases in lymph nodes,liver and bones(P<0.05).Conclusions:WB-DWI is reliable in detecting tumour recurrence and metastasis of colorectal cancer and offers the same diagnostic performance as 18F-PET/CT without ionizing radiation.The quantitative value of ADC provides extra information to determine cancer metastasis.
文摘Objective:This study aimed to determine whether the apparent diffusion coefficients(ADCs)determined by diffusion-weighted imaging(DWI)of magnetic resonance imaging(MRI)could facilitate the malignancy grading of various gliomas.Methods:Sixty patients with a primary cerebral glioma underwent diffusion-weighted and gadolinium-enhanced(Gd)T1-weighted MRI using a 1.5-T MRI scanner.Scoring was performed based on signal intensities on DWI and Gd images.The mean and minimum ADC values were calculated,and Ki-67 staining was performed for each histological sample to evaluate their tumor proliferative potential.Then,the DWI,Gd,and combined scores were analyzed and compared with the Ki-67 staining index and malignant grade.The relationships among the mean and minimum ADC values,Ki-67staining index,and malignant grade were also evaluated.Results:The minimum ADC was inversely correlated with the Ki-67staining index,with a low minimum ADC suggestive of tumor malignancy.The qualitative evaluation of the D score of water molecule diffusion on DWI accurately reflected the pathological grades of gliomas,with an effectiveness that was at least as good as the quantitative analysis using the minimum ADC.The diagnostic value of Gd images in determining glioma malignancy grades was inferior to that of DWI.Conclusion:Both DWI and gadolinium-enhanced images of MRI should be considered essential for the diagnosis of tumor malignancy.
