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BACKGROUND AND OBJECTIVES: Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however, they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types. METHODS: We used the Clalit Health Services record (representing more than 5 million patients) to identify adults with LC and breast, pancreatic, or colon cancer (non-lung cancer, NLC) who underwent brain magnetic resonance diffusion (MRI) scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed, and CMIs were documented, as well as cardiovascular risk factors. RESULTS: Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI were found in 73/2056 (3.5%) MRI scans of LC group compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of NLC (p < 0.01). Cancer type (e.g. LC vs NLC) was the only associated factor with CMI incidence on multivariate analysis. After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients and 0.5 in NLC. DISCUSSION: CMIs are common findings in cancer patients, especially in LC patients and therefore might serve as a marker for occult brain ischemia, cognitive decline, and cancer-related stroke (CRS) risk.

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Isquemia Encefálica , Neoplasias Pulmonares , Accidente Cerebrovascular , Adulto , Humanos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Isquemia Encefálica/complicaciones , Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética

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Objective To explore the value of apparent diffusion coefficient(ADC)values of magnetic resonance diffusion weighted imaging(MR-DWI)in predicting the prognosis of primary hepatocellular carcinoma(HCC)treated by radiofrequency ablation(RFA).Methods A prospective study was conducted on 178 patients with HCC.All patients were treated with RFA and followed up for 1 year after treatment.MR-DWI was performed before RFA and one month after RFA,and the changes in ADC value were calculated.These changes of the cancer in patients with different clinicopathological parameters were compared.The factors affecting the prognosis of HCC patients with RFA,and the value of ADC value changes in predicting the prognosis were analyzed.Results The changes of ADC values in patients with high alpha-fetoprotein,Barcelona clinic live cancer(BCLC)stage C,and poorly differentiated were lower than those in patients with low alpha-fetoprotein,BCLC stage B,and moderately well-differentiated(P<0.05).Six cases were lost to follow-up,and 120 of the remaining 172 patients survived.Cox regression analysis showed that the changes in ADC value,tumor stage and degree of differentiation were independent factors affecting the prognosis of HCC patients with RFA(P<0.05).Receiver operating characteristic(ROC)curve results showed that the best cut-off point,sensitivity,specificity and area under the curve(AUC)of ADC value change in predicting the prognosis of HCC patients with RFA were 0.42×10-3 mm2/s,75.00%,78.33%and 0.801.There were 16 deaths in the high change group of ADC value(>0.42)and 36 deaths in the low change group(≤0.42).The overall survival curve of the high change group of ADC value was better than that of the low change group(P<0.05).Conclusion The change in ADC value of MR-DWI sequence before and after short-term RFA treatment in HCC patients is related to the patient's pathology and prognosis,with a good predictive effect.The low change in ADC value has a higher risk of poor prognosis.

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Introduction: To confirm the efficacy of magnetic resonance-diffusion weighted imaging (MR-DWI) in esophageal squamous cell carcinoma (ESCC) early pathological response prediction and assessment to neoadjuvant chemoradiotherapy (nCRT) using patient-derived xenografts (PDXs). Methods: PDX-bearing mice were randomly divided into two groups: the experimental group receiving cisplatin combined with radiotherapy, whereas the control group receiving normal saline. MRI scans were performed in treatment groups in the before, middle, and end of treatment. The correlations between tumor volumes, ADC values and tumor pathological response at different time nodes were explored. Then, expression of proliferation marker and apoptotic marker were detected using immunohistochemistry, and apoptosis rate was detected by TUNEL assay to further verify the results observed in the PDX models. Results: The ADC values of the experimental group were significantly higher than the control group in the both middle and end stage of treatment (all P< 0.001), however, significant difference was only observed in tumor volume at the end stage of treatment (P< 0.001). Furthermore, the △ADCmid-pre in our study may able to identify tumors with or without pCR to nCRT at an early stage, due to these changes were prior to the changes of tumor volume after treatment. Finally, TUNEL results also showed that the apoptosis rate of the experiment groups increased the most in the middle stage of treatment, especially the groups with pCR, but the highest apoptosis rate occurred in the end of the treatment. Further, the two PDX models with pCR exhibited the highest levels of apoptotic marker (Bax), and lowest levels of proliferation marker (PCNA and Ki-67) in the both middle and end stage of the treatment. Conclusions: ADC values could be used to determine the tumor's response to nCRT, especially in the middle stages of treatment and before the tumor tissue morphology changes, and further, the ADC values were consistent with the potential biomarkers reflecting histopathological changes. Therefore, we suggest that radiation oncologists could refer to the ADC values in the middle stages of treatment when predicting the tumor histopathological response to n CRT in patients with ESCC.

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(1) Background. The purpose of this study is to evaluate the diagnostic accuracy of a quantitative analysis of diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI of mucinous ovarian cancer (MOC). It also aims to differentiate between low grade serous carcinoma (LGSC), high-grade serous carcinoma (HGSC) and MOC in primary tumors. (2) Materials and Methods. Sixty-six patients with histologically confirmed primary epithelial ovarian cancer (EOC) were included in the study. Patients were divided into three groups: MOC, LGSC and HGSC. In the preoperative DWI and DCE MRI, selected parameters were measured: apparent diffusion coefficients (ADC), time to peak (TTP), and perfusion maximum enhancement (Perf. Max. En.). ROI comprised a small circle placed in the solid part of the primary tumor. The Shapiro-Wilk test was used to test whether the variable had a normal distribution. The Kruskal-Wallis ANOVA test was used to determine the p-value needed to compare the median values of interval variables. (3) Results. The highest median ADC values were found in MOC, followed by LGSC, and the lowest in HGSC. All differences were statistically significant (p < 0.000001). This was also confirmed by the ROC curve analysis for MOC and HGSC, showing that ADC had excellent diagnostic accuracy in differentiating between MOC and HGSC (p < 0.001). In the type I EOCs, i.e., MOC and LGSC, ADC has less differential value (p = 0.032), and TTP can be considered the most valuable parameter for diagnostic accuracy (p < 0.001). (4) Conclusions. DWI and DCE appear to be very good diagnostic tools in differentiating between serous carcinomas (LGSC, HGSC) and MOC. Significant differences in median ADC values between MOC and LGSC compared with those between MOC and HGSC indicate the usefulness of DWI in differentiating between less and more aggressive types of EOC, not only among the most common serous carcinomas. ROC curve analysis showed that ADC had excellent diagnostic accuracy in differentiating between MOC and HGSC. In contrast, TTP showed the greatest value for differentiating between LGSC and MOC.

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Background: Glioma is a common primary craniocerebral malignant tumor, due to the lack of specificity of imaging examination and clinical manifestations, its diagnostic accuracy is relatively low, which may result in misdiagnosis and missed diagnosis. The apparent diffusion coefficient (ADC) in magnetic resonance diffusion weighted imaging (DWI) can reflect the histological characteristics of gliomas, which can be widely applied to classify gliomas and evaluate the extent of metastasis of glioma. The present study aimed to assess the clinical value of magnetic resonance DWI in the pathological grading of glioma and its therapeutic application in clinical surgery. Methods: This article retrospectively analyzed the clinical data of 41 patients with glioma confirmed by surgical pathology results from January 1, 2019 to March 31, 2020 in the People's Hospital of Gaozhou. Among them, 16 patients had low-grade gliomas [World Health Organization (WHO) grade I-II] and 25 patients had high-grade gliomas (WHO grade III-IV). They were subjected to conventional T1WI and T2WI plain scans, along with DWI and enhanced scans before surgery. The ADC values of the glioma parenchyma, the peritumoral edema area, the surrounding white matter, and the contralateral normal white matter were measured. We selected some tumor tissues for pathological analysis as well, and conducted pathological grading according to WHO grading standards. Results: We compared and evaluated the ADC values of the observed areas for low-grade gliomas and high-grade gliomas. The ADC values of low-grade gliomas in the tumor parenchyma, peritumoral edema, and white matter around the edema area were significantly lower than those of high-grade gliomas, and the differences were statistically significant (P<0.05). The difference in ADC values of normal white matter between the two groups of patients was not statistically significant (P=0.125). Conclusions: DWI has prognostic predictive value in the preoperative differential diagnosis and pathological classification of gliomas. This advanced technology can verify the extent of glioma infiltration in the surrounding brain tissue. It can help clinicians formulate a safer and more effective therapeutic strategy by providing accurate information on prognostic evaluation before the successful surgical intervention of gliomas.

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Background. The aim of our study was to describe the selected parameters of diffusion-weighted imaging (DWI) and perfusion dynamic contrast enhancement (DCE) MRI in primary tumors in patients with serous epithelial ovarian cancer (EOC), as well as in disease course prognosis and treatment response, including bevacizumab maintenance therapy. Materials and Methods. In total, 55 patients with primary serous EOC were enrolled in the study. All patients underwent MR imaging using a 1.5 T clinical whole-body MR system in preoperative DWI and DCE MRI selected parameters: apparent diffusion coefficients (ADC), time to peek (TTP) and perfusion maximum enhancement (Perf. Max. En.) were measured. The data were compared with histopathological and immunochemistry results (with Ki67 and VEGF expression) and clinical outcomes. Results. Higher mean ADC values were found in low-grade EOC compared to high-grade EOC: 1151.27 vs. 894,918 (p < 0.0001). A negative correlation was found between ADC and Ki67 expression (p = 0.027), and between ADC and VEGF expression (p = 0.042). There was a negative correlation between TTP and PFS (p = 0.0019) and Perf. Max. En. and PSF (p = 0.003). In the Kaplan−Meier analysis (log rank), a longer PFS was found in patients with ADC values greater than the median; p = 0.046. The Kaplan−Meier analysis showed a longer PFS (p = 0.0126) in a group with TTP below the mean value for this parameter in patients who received maintenance treatment with bevacizumab. Conclusions. The described relationships between PFS and DCE and DWI allow us to hope to include these parameters in the group of EOC prognostic factors. This aspect seems to be of particular interest in the case of the association of PFS with DCE values in the group of patients treated with bevacizumab.

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OBJECTIVE: Imaging examination, tumor marker detection, bladder biopsy, and other methods are the common methods for the diagnosis of bladder cancer (BC). This study was aimed to assess the value of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the diagnosis of BC. MATERIALS AND METHODS: Fifty-nine patients with BC were recruited in our hospital from September 2012 to December 2015, who had CEUS and magnetic resonance diffusion-weighted imaging (MRI + DWI). All patients underwent surgical treatment and definite pathological stage. The series and parallel combined diagnosis methods were applied to calculate the diagnostic sensitivity, specificity, and accuracy through using quantitative apparent diffusion coefficient (ADC) and receiver operating characteristic curve. RESULTS: The accuracies of CEUS and MRI + DWI examination for T staging of BC were 74.6% and 76.3%, respectively. Compared with the single diagnostic methods, the two combined diagnosis accuracy was 91.5%, which was significantly improved in diagnosis accuracy (P < 0.05). The diagnostic accuracies of CEUS, MRI + DWI, and ADC for muscle invasion of BC were 81.4%, 83.1%, and 84.7%, respectively. The diagnostic accuracy of CEUS parallel combined with MRI + DWI (91.5%) was obviously enhanced, compared with that with the single diagnostic method. CONCLUSION: The accuracy of CEUS and MRI + DWI combined diagnosis was higher than that with the single diagnostic method. CEUS and MRI + DWI combined diagnosis was a feasible and effective method for the clinical diagnosis of BC.

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Medios de Contraste/metabolismo , Imagen por Resonancia Magnética/métodos , Ultrasonografía/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/metabolismo

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Objective: To discuss application of apparent diffusion coefficient (ADC) in diffusion weighted imaging (DWI) combined with serum alkaline phosphatase (ALP) and tumor specific growth factor (TSGF) in evaluating neoadjuvant chemotherapy for osteosarcoma. Methods: A total of 78 patients with osteosarcoma who were admitted to People's Hospital of Gansu from January 2016 to August 2018 were collected as study subjects. All the patients were treated with neoadjuvant chemotherapy. Before chemotherapy, at the end of 4 courses of chemotherapy, before and after surgery, MRI examination and detection of serum ALP and TSGF were performed. According to results of pathological examination, the 78 patients were divided into effective chemotherapy group (n=54) and ineffective chemotherapy group (n=24). ADC values, levels of serum ALP and TSGF, change rates of ADC values and levels of serum ALP and TSGF were compared between the two groups. The value of ADC value combined with serum ALP and TSGF in evaluating curative effect of neoadjuvant chemotherapy for osteosarcoma was analyzed with receiver operating characteristic curve (ROC). Results: After chemotherapy, ADC value in effective chemotherapy group increased significantly, while levels of serum ALP and TSGF decreased significantly (t=7.269, 18.778, 23.237, all P<0.05). Only after surgery, ADC value, levels of serum ALP and TSGF increased or decreased significantly in ineffective chemotherapy group (t=7.316, 15.083, 20.930, all P<0.05). Before and after chemotherapy, change rates of ADC values and levels of serum ALP and TSGF in effective chemotherapy group were all significantly higher than those in ineffective chemotherapy group (t=7.604, 5.482, 5.048, all P<0.05). ROC curve analysis showed that area under the curve (AUC) of ADC value combined with serum ALP and TSGF for evaluating curative effect of neoadjuvant chemotherapy was 0.912, which was higher than that of ADC value, ALP, TSGF, ADC value combined with ALP, ADC value combined with TSGF (0.847, 0.787, 0.701, 0.885, 0.876, respectively). Conclusion: ADC value combined with serum tumor markers ALP and TSGF is reliable in evaluating curative effect of neoadjuvant chemotherapy for osteosarcoma.

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Neoplasias Óseas , Osteosarcoma , Antígenos de Neoplasias , Biomarcadores de Tumor , Neoplasias Óseas/terapia , Imagen de Difusión por Resonancia Magnética , Humanos , Terapia Neoadyuvante , Proteínas de Neoplasias , Osteosarcoma/terapia , Curva ROC , Resultado del Tratamiento

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OBJECTIVE: Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation. METHODS: A retrospective analysis was performed based on prospectively collected data of patients included simultaneously in the magnetic resonance imaging (MRI) substudy of the International Carotid Stenting Study and Athero-Express biobank. Patients randomised for carotid endarterectomy (CEA) underwent surgery between 2003 and 2008. Brain MRI was performed one to seven days prior to CEA. Plaques were histologically examined for presence of IPH. The primary outcome parameter was presence of silent ipsilateral brain ischaemia on magnetic resonance diffusion weighted imaging (MR-DWI) appearing hypo or isointense on apparent diffusion coefficient. RESULTS: Fifty-three patients with symptomatic carotid stenosis meeting the study criteria were identified, of which 13 showed one or more recent ipsilateral DWI lesion on pre-operative scan. The median time between latest ipsilateral neurological event and revascularisation was 45 days (range 6-200) in DWI negative patients vs. 34 days (range 6-74, p = .16) in DWI positive patients. IPH was present in 24/40 (60.0%) DWI negative patients vs. 12/13 (92.3%) DWI positive patients (OR 8.00; 95% CI 0.95-67.7, p = .06). Multivariable logistic regression analysis correcting for age and type of index event revealed that IPH was independently associated with DWI lesions in the waiting period till surgery (OR 10.8; 95% CI 1.17-99.9, p = .04). CONCLUSION: Symptomatic patients with ipsilateral carotid stenosis and silent brain ischaemia on pre-operative MR-DWI, more often showed pathological evidence of IPH compared with those without ischaemic lesions. This identifies carotid IPH as a marker for patients at risk of silent brain ischaemia and possibly for future stroke and other arterial disease complications. Such patients may be more likely to benefit from CEA than those without evidence of ipsilateral carotid IPH.

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Isquemia Encefálica/diagnóstico por imagen , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Hemorragia/cirugía , Placa Aterosclerótica/complicaciones , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano , Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Arterias Carótidas/patología , Arterias Carótidas/cirugía , Estenosis Carotídea/etiología , Imagen de Difusión por Resonancia Magnética , Femenino , Hemorragia/etiología , Hemorragia/patología , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/patología , Placa Aterosclerótica/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Stents , Tiempo de Tratamiento , Resultado del Tratamiento

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PURPOSE: The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. MATERIALS AND METHODS: Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. RESULTS: Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger (P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10-3 mm2/s vs 1.026 ± 0.246 × 10-3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10-3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients (P < .001). CONCLUSION: The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.

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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Imagen de Difusión por Resonancia Magnética/métodos , Invasividad Neoplásica/diagnóstico por imagen , Invasividad Neoplásica/patología , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recto/irrigación sanguínea , Recto/diagnóstico por imagen , Estudios Retrospectivos

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OBJECTIVES: Peri-procedural ischaemic brain lesions on diffusion weighted imaging (DWI) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been related to a higher chance of recurrent cerebrovascular events. This systematic review provides an overview of patient characteristics associated with increased risk of new DWI lesions. METHODS: MEDLINE, EMBASE, and Cochrane library databases were systematically searched (update November 2018) for studies reporting post-procedural DWI lesions after CEA or CAS. Data derived from both procedures were analysed separately. Studies reporting predictive features that were present prior to intervention were assigned to 10 categories: age, gender, cardiovascular risk factors, symptomatology, plaque vulnerability, atherosclerotic burden, cerebrovascular haemodynamics, carotid/arch anatomy, inflammatory markers, and markers of coagulation. A semi-quantitative analysis was performed by plotting studies that found an association between the investigated features and DWI lesions against those that did not find an association. RESULTS: Forty-six studies (5018 patients) were included: 10 reported only CEA, 33 CAS, and three both interventions. 68.0% of 1873 CEA patients and 55.9% of 3145 CAS patients were symptomatic. The weighted prevalence of DWI lesions was 18.1% (95% CI 14.0-22.7%) in CEA patients compared with 40.5% (95% CI 35.4-45.7%) in CAS patients. Studies reporting on CEA patients predominantly found an increased risk in symptomatic patients (two of seven studies, including 848/1661 patients), those with impaired haemodynamics (five of five studies), and increased inflammatory markers (two of three studies). Studies reporting on CAS patients often found a positive association with age (10/26 studies), high plaque vulnerability (25/34 studies), or complex carotid/arch anatomy (three out of five studies). CONCLUSIONS: For patients undergoing CEA, symptomatic status, impeded cerebral haemodynamics, and increased inflammatory markers are associated with increased susceptibility to peri-operative DWI lesions. In CAS patients, higher age, plaque vulnerability and complex carotid/aortic arch anatomy were identified as risk factors. These clinical predictors may assist with decision making on patient selection for medical treatment, CEA or CAS.

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Isquemia Encefálica/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/terapia , Imagen de Difusión por Resonancia Magnética , Endarterectomía Carotidea/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Stents , Isquemia Encefálica/epidemiología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Toma de Decisiones Clínicas , Femenino , Humanos , Masculino , Selección de Paciente , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento

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Objective To explore the clinical value of magnetic resonance diffusion-weighted imaging ( MR-DWI ) in the early diagnosis of cervical lymph node recurrence after radiotherapy of nasopharyngeal carcinoma, aiming to provide reference for targeted diagnosis and treatment of these patients. Methods The MR-DWI features of 17 patients with recurrent cervical lymph nodes after radiotherapy from 2005 to 2016 were retrospectively analyzed. The results of diagnosis and treatment after lymph node recurrence were summarized. Results The recurrent lymph nodes of 17 patients showed a high signal or mixed signal on MR-DWI images. The sensitivity of MR-DWI and T2WI fat suppression sequence was 100% and 60%. Positron emission tomography-computed tomography ( PET-CT) or biopsy was performed to validate the diagnosis in patients with highly suspected single cervical recurrence. Besides, surgical treatment yielded better clinical prognosis. Conclusions MR-DWI is highly sensitive to recurrent cervical lymph nodes of nasopharyngeal carcinoma after radiotherapy, especially for the small lymph nodes of 5-10 mm in diameter, which are easily ignored. PET-CT examination should be performed, the nature of the lymph nodes should be confirmed by multi-modality imaging diagnosis, and timely operation has important clinical significance in improving the therapeutic effect and quality of life for patients with cervical lymphnode recurrence.

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PURPOSE: Primary fallopian tube carcinoma (PFTC) is the rarest form of female genital malignancy. The imaging applied for suspected adnexal masses includes transvaginal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), but the vast majority of PFTC is recognised intraoperatively. MATERIAL AND METHODS: The study group consisted of seven women with postoperatively histopathological diagnosis of PFTC. To recognise characteristic findings for PFTC, retrospective analysis of preoperative MRI was performed. All patients underwent MRI of the pelvis and abdomen using a 1.5T MR system. Based on the results of the above imaging, suspected adnexal masses were recognised. MRI protocol contained T2-weighted images, fat-suppressed T2-weighted, T2-TIRM, DW EPI, pre- and postcontrast dynamic 3D T1 GRE in transverse orientation, with diffusion weightings of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2. Regions of interest were outlined by a radiologist, who documented the character of adnexal masses on diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps. RESULTS: In all seven patients with PFTC unilateral tumour was found. On all DW images (with ß values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of solid parts of tumour were significantly higher than the mean signal intensities of normal ovarian tissue (p = 0.0001). There were no statistically significant differences between eight ß values applied for ADC calculations. CONCLUSIONS: Preoperative diagnostics of PFTC is difficult and mainly based on morphological features. Previous research did not show characteristics of PFTC in post-contrast dynamic imaging. In our material a clear increasing of signal intensity in DW imaging occurred independently of the ß value.

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OBJECTIVE: To evaluate the accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with ADC value combined with MDCT in evaluating recurrent cholesteatoma. PATIENTS: Thirty patients (20 females and 10 males), their age ranged from 10 to 40years, had undergone a tympanomastoid surgery for a cholesteatoma of the middle ear underwent MDCT and MR DWI examination before second- or third-look surgery from May 2015 to October 2016. RESULTS: CT showed partial opacification of the tympanomastoid cavity in 10 ears and complete opacification in 21 ears. CT detects 10 cases out of 20 cases of recurrent cholesteatoma with sensitivity 47.6%, specificity 100%, and NPP 47.6%. DWI depicted 21 out of 20 cases proved cholesteatoma patients (sensitivity 100%, specificity 90%, PPV 95.2% and P value is 0.001). All MRI of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity = 100%). The ADC of cholesteatoma group (21 ears) were ranged from 553 to 759 × 10-3 mm2/s and the ADCs of non cholesteatoma group (10 ears) was ranged from 1495.8 to 1766.8 × 10-3 mm2/s. Cut off value of cholesteatoma is ≤759 × 10-3 mm2/s. CONCLUSION: MR DWI with ADC combined with MDCT has high sensitivity, specificity, accuracy in detecting recurrent cholesteatoma.

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Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.

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Objective To determine the value of the apparent diffusion coefficient (ADC) of magnetic resonance diffusion-weighted imaging (MRDWI) combined with squamous cell carcinoma antigen (SCC) and carcinoembryonic antigen (CEA) in the evaluation of the efficacy and prognosis of concurrent chemoradiotherapy for cervical carcinoma.Methods A total of 80 patients with cervical squamous cell carcinoma confirmed by histology or cytology in our hospital from 2013 to 2016 were included in this study.Of the 80 patients, 39 were FIGO stage ⅡB, 7 were stage ⅢA, 26 were stage ⅢB, and 8 were stage ⅠVA.MRDWI examination and SCC and CEA measurements were first performed for the patients following group assignment, and the patients were then given extrapelvic radiotherapy (45-50 Gy)+platinum-based chemotherapy plus brachytherapy (20-25 Gy) based on their conditions.MRDWI, SCC, and CEA examinations were performed again after treatment to determine the changes in ADC, SCC, and CEA.In addition, ADC, SCC, and CEA were examined in the middle stage of treatment for 40 patients.Data were analyzed using the paired t-test or ANOVA.Results The overall response rate of the 80 patients after concurrent chemoradiotherapy was 100%.No disease progression was identified in any of the patients until the end of treatment, and the overall survival time of the patients was all above 6 months.Serum SCC and CEA were reduced after treatment (P=0.000,0.000), whereas the ADC value was increased after treatment (P=0.000).The increase in ACD following the decreases in SCC and CEA after treatment (P=0.000, 0.000) was indicative of increased efficacy of the concurrent chemotherapy and radiotherapy.Conclusions MRDWI combined with SCC and CEA is highly reliable for the evaluation of efficacy and prognosis of concurrent chemoradiotherapy for cervical cancer.

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Transcatheter arterial chemoembolization (TACE) has already been a mature and an effective treatment for advanced hepatocellular carcinoma (HCC).Clinically,it is very important to quickly and accurately evaluate the postoperative curative effect with minimally invasive technique so as to determine the next treatment options.At present,postoperative conventional CT and MRI are the main means to assess the curative effect of TACE,but it is a pity that after the treatment the functional changes of the tumor occur earlier than the morphological changes.In recent years,functional MRI techniques,such as diffusionweighted imaging (DWI),multi-b value DWI,dynamic contrast-enhanced (DCE) imaging,etc.have been more and more used for quantitative evaluation of the diffusion of water molecules and the blood microcirculation perfusion within the tumor tissue,and some progresses have been achieved in the evaluation of curative efficacy for tumor.This paper aims to make a comprehensive review about the research progress of the above mentioned functional imaging methods as well as their current application status in evaluation of the curative effect of TACE.

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PURPOSE: To investigate the changes to diffusion-weighted imaging (DWI) correlated with histopathology after neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC). MATERIALS AND METHODS: Thirty-three patients with LACC were examined with 3T magnetic resonance imaging (MRI) with DWI and apparent diffusion coefficient (ADC) maps. MRIs were performed for each patient at three timepoints: before the first NACT, 2 weeks after the first NACT, and 2 weeks after the second NACT. Uterine cervical specimens were collected at the same timepoints. Specimens were stained for tumor cell density, proliferating cell nuclear antigen (PCNA), and aquaporin 1 (AQP1). Treatment responses were classified as the effective group (complete and partial response) and the ineffective group (stable and progressive disease). RESULTS: The ADC value of the effective group after the first chemotherapy was higher than that before chemotherapy (P = 0.002), and expressions of three pathological indicators (tumor cell density, PCNA, and AQP1) significantly decreased after the first NACT compared with those prechemotherapy (P < 0.001). Changes of PCNA expression were negatively correlated with changes of ADC values after the first NACT in the effective group (r = -0.56, P = 0.03). Changes of cellular density were negatively correlated with changes of ADC values from the time of prechemotherapy to after the second NACT in the effective group (r = -0.51, P = 0.04). CONCLUSION: The ADC change after successful chemotherapy is closely related with cellular characteristics preceding size reduction. ADC may be used as an early imaging biomarker of NACT response in LACC.

Asunto(s)

Imagen de Difusión por Resonancia Magnética/métodos , Interpretación de Imagen Asistida por Computador/métodos , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/patología , Adulto , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante/métodos , Femenino , Humanos , Aumento de la Imagen/métodos , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento

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Objective To study the value of magnetic resonance diffusion weighted imaging (DWI)and dynamic enhanced imaging (DCE)in endometrial carcinoma staging.Methods 200 cases with endometrial carcinoma were selected,DWI and DCE were given before operation.The diagnostic value of two kinds of examination methods for the diagnosis of endometrial carcinoma in general and basic level was compared.Results The overall accuracy of muscle invasion of magnetic resonance DWI was 91.5%(183 /200),which was significantly higher than 77.5%(155 /200)of magnetic resonance DCE,the difference was statistically significant (χ2 =11.231,P <0.05 ).The accuracy,sensitivity and positive predictive value of the magnetic resonance DWI superficial and deep muscular layer were significantly higher than those of the magnetic resonance DCE (χ2 =9.283,8.231,9.021,8.927,8.142, 9.405,all P <0.05).Compared with pathological results,Kappa value of magnetic resonance DWI was 0.807,Kappa value of magnetic resonance DCE was 0.587.Conclusion Magnetic resonance DWI compared with magnetic reso-nance DCE,the accuracy and sensitivity of the infiltration of endometrial carcinoma was higher.

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OBJECTIVE: To detect the activity of tumor cells and tumor blood flow before and after the radiotherapy of implanted pulmonary VX-2 carcinoma in rabbit models by using magnetic resonance diffusion-weighted imaging (MR-DWI) and magnetic resonance perfusion weighted imaging (MR-PWI), and to evaluate the effectiveness and safety of the radiotherapy based on the changes in the MR-DWI and MR-PWI parameters at different treatment stages. METHODS: A total of 56 rabbit models with implanted pulmonary VX-2 carcinoma were established, and then equally divided into treatment group and control group. MR-DWI and MR-PWI were separately performed using a Philips Acheiva 1.5T MRI machine (Philips, Netherland). MRI image processing was performed using special perfusion software and the WORKSPACE advanced workstation for MRI. MR-DWI was applied for the observation of tumor signals and the measurement of apparent diffusion coefficient (ADC) values; whereas MR-PWI was used for the measurement of wash in rate (WIR), wash out rate (WOR), and maximum enhancement rate (MER). The radiation treatment was performed using Siemens PRIMUS linear accelerator. In the treatment group, the radiotherapy was performed 21 days later on a once weekly dosage of 1,000 cGy to yield a total dosage of 5,000 cGy. RESULTS: THE ADC PARAMETERS IN THE REGION OF INTEREST ON DWI WERE AS FOLLOWS: on the treatment day for the implanted pulmonary VX-2 carcinoma, the t values at the center and the edge of the lesions were 1.352 and 1.461 in the treatment group and control group (P>0.05). During weeks 0-1 after treatment, the t values at the center and the edge of the lesions were 1.336 and 1.137 (P>0.05). During weeks 1-2, the t values were 1.731 and 1.736 (P<0.05). During weeks 2-3, the t values were 1.742 and 1.749 (P<0.05). During weeks 3-4, the t values were 2.050 and 2.127 (P<0.05). During weeks 4-5, the t values were 2.764 and 2.985 (P<0.05). The ADC values in the treatment group were significantly higher than in the control group. After the radiotherapy (5,000 cGy), the tumors remarkably shrank, along with low signal on DWI, decreased signal on ADC map, and remarkably increased ADC values. As shown on PWI, on the treatment day for the implanted pulmonary VX-2 carcinoma, the t values of the WIR, WOR, and MER at the center of the lesions were 1.05, 1.31, and 1.33 in the treatment group and control group (P>0.05); in addition, the t values of the WIR, WOR, and MER at the edge of the lesions were 1.35, 1.07, and 1.51 (P>0.05). During weeks 0-1 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 1.821, 1.856, and 1.931 (P<0.05); in addition, the t values of the WIR, WOR, and MER at the edge of the lesions were 1.799, 2.016, and 2.137 (P<0.05). During weeks 1-1 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.574, 2.156, and 2.059 (P<0.05) and the t values of the WIR, WOR, and MER at the edge of the lesions were 1.869, 2.058, and 2.057 (P<0.05). During weeks 2-3 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.461, 2.098, and 2.739 (P<0.05) and the t values of the WIR, WOR, and MER at the edge of the lesions were 2.951, 2.625, and 2.154 (P<0.05). During weeks 3-4 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.584, 2.107, and 2.869 (P<0.05) and the t values of the WIR, WOR, and MER at the edge of the lesions were 2.057, 2.637, and 2.951 (P<0.05). During weeks 4-5 after treatment, the t values of the WIR, WOR, and MER at the center of the lesions were 2.894, 2.827, and 3.285 (P<0.05) and the t values of the WIR, WOR, and MER at the edge of the lesions were 3.45, 3.246, and 3.614 (P<0.05). After the radiotherapy (500 cGy), the tumors shrank on the T1WI, WIR, WOR, and MER; meanwhile, the PWI parameter gradually decreased and reached its minimum value. CONCLUSIONS: MR-DWI and MR-PWI can accurately and directly reflect the inactivation of tumor cells and the tumor hemodynamics in rabbit models with implanted pulmonary VX-2 carcinoma, and thus provide theoretical evidences for judging the clinical effectiveness of radiotherapy for the squamous cell carcinoma of the lung.