Prospective analysis of the prognostic value of prenatal MRI measurement of cystic volume ratio in fetal congenital cystic adenomatoid malformation.

BACKGROUND: The cystic volume ratio (CVR) has been used to predict the prognosis of fetal lung disease, but most of them are reported on ultrasound. The purpose of this study was to investigate the prognostic value of prenatal magnetic resonance imaging (MRI) measurement of CVR in fetal congenital cystic adenomatoid malformation (CCAM). METHODS: To collect follow-up data on postnatally confirmed CCAM fetuses. According to the size of CVR, they were divided into a CVR ≥1.26 group and a CVR <1.26 group. The lesions were divided into macrocystic (diameter ≥5 mm) and microcystic (diameter <5 mm) types according to the size of cysts in the lesions. The collected contents also included the location of the lesions, prenatal symptoms, postpartum clinical prognosis, and pregnancy outcomes. RESULTS: In all, 51 cases were collected. Of these, 11 were placed into the CVR ≥1.26 group, and 40 were placed into the CVR <1.26 group; meanwhile 34 were classified as macrocystic lesions and 17 as microcystic lesions; 7 cases involved a terminated pregnancy. In the CVR ≥1.26 group, 81.82% (9/11) and 36.36% (4/11) had displacement of large vessels/heart and increased amniotic fluid, respectively; meanwhile, in the CVR <1.26 group, these phenomena occurred in 35.00% (14/40) and 2.50% (1/40) of cases (P=0.006, 0.010). Additionally, 83.33% (5/6) of live infants in the CVR ≥1.26 group had dyspnea, a significantly higher proportion than the 21.05% (8/38) in the CVR <1.26 group (P=0.011). Moreover, 45.45% (5/11) of the cases in the CVR ≥1.26 group were terminated pregnancies, a significantly higher proportion than the 5.26% (2/38) in the CVR <1.26 group (P=0.001). Finally, the CVR of macrocystic lesions was 0.55 (0.34-1.31), which was significantly greater than the 0.34 (0.17-0.57) of microcystic lesions (P=0.022). Logistical regression analysis identified that CVR is an independent factor associated with the postpartum prognosis of CCAM. CONCLUSIONS: Prenatal symptoms and postpartum prognosis were worse than CVR <1.26 when fetal CVR ≥1.26 measured by prenatal MRI; and the measurement of CVR of CCAM through prenatal MRI has considerable practical value in prenatal consultation, evaluation, and postpartum treatment.

The value of prenatal magnetic resonance imaging and postnatal follow-up using Gesell Developmental Schedules score for mild-to-moderate simple bilateral fetal ventriculomegaly.

OBJECTIVE: To investigate the relationship of mild-to-moderate simple bilateral fetal ventriculomegaly with postnatal neurological development. METHODS: Cases of simple lateral ventricular dilatation (273) were divided into bilateral mild dilatation (10.0-12.0 mm, 62), bilateral moderate dilatation (12.1-15.0 mm, 29), unilateral mild dilatation (133), and unilateral moderate dilatation (49) groups. The control group comprised 50 normal fetuses. Neurological development was assessed using Gesell Developmental Schedules (GDS) at postnatal 3, 6, 12, and 18 months. RESULTS: At postnatal 6, 12, and 18 months, the GDS score was higher for bilateral than for unilateral dilatation (p < .05). At postnatal 3 and 6 months, the GDS score was higher for the bilateral dilatation groups than for the control group (p < .05). At postnatal 6, 12, and 18 months, the GDS score was higher for the bilateral moderate dilatation group than for the unilateral moderate dilatation group (p < .05). Further, at postnatal 3, 6, 12, and 18 months, the GDS score was higher for the bilateral moderate dilatation group than for the control group (p < .05). CONCLUSION: At postnatal month 6, the GDS evaluation results of the bilateral dilatation groups were significantly inferior compared to those of the unilateral dilatation group.

Usefulness of prenatal magnetic resonance imaging in differential diagnosis of fetal congenital cystic adenomatoid malformation and bronchopulmonary sequestration.

BACKGROUND: Congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS) are the most common lung diseases in fetuses. There are differences in the prognosis and treatment of CCAM and BPS, and the clinical diagnosis and treatment plan is usually prepared prior to birth. Therefore, it is quite necessary to make a clear diagnosis before delivery. CCAM and BPS have similar imaging features, and the differentiation mainly relies on the difference in supply vessels. However, it is hard to distinguish them due to invisible supplying vessels on some images. AIM: To explore the application value of magnetic resonance imaging (MRI) in the differential diagnosis of fetal CCAM and BPS. METHODS: Data analysis for 32 fetuses with CCAM and 14 with BPS diagnosed by prenatal MRI at Huzhou Maternal and Child Health Care Hospital and Anhui Provincial Children's Hospital from January 2017 to January 2020 was performed to observe the source blood vessels of lesions and their direction. Pathological confirmation was completed through CT examination and/or operations after birth. RESULTS: After birth, 31 cases after birth were confirmed to be CCAM, and 15 were confirmed to be BPS. The CCAM group consisted of 21 macrocystic cases and 10 microcystic cases. In 18 cases, blood vessels were visible in lesions. Blood supply of the pulmonary artery could be traced in eight cases, and in 10 cases, only vessels running from the midline to the lateral down direction were observed. No lesions were found in four macrocystic cases and one microcystic case with CCAM through CT after birth; two were misdiagnosed by MRI, and three were misdiagnosed by prenatal ultrasonography. The BPS group consisted of 12 intralobar cases and three extralobar cases. Blood vessels were visible in lesions of nine cases, in four of which, the systemic circulation blood supply could be traced, and in five of which, only vessels running from the midline to the lateral up direction were observed. Three were misdiagnosed by MRI, and four were misdiagnosed by prenatal ultrasonography. CONCLUSION: CCAM and BPS can be clearly diagnosed based on the origin of blood vessels, and correct diagnosis can be made according to the difference in the direction of the blood vessels, but it is hard distinguish microcystic CCAM and BPS without supplying vessels. In some CCAM cases, mainly the macrocystic ones, the lesions may disappear after birth.

[Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children: a randomized controlled trial].

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children. METHODS: A total of 80 children with pneumonia of phlegm-heat blocking lung type were randomized into an observation group (40 cases, 1 case dropped off) and a control group (40 cases). In the control group, routine anti-infection and symptomatic and supportive treatment were given. On the basis of the treatment in the control group, acupuncture was applied at Sifeng (EX-UE 10) in the observation group, once every 2 days, 4 times were required. Before and after treatment, the score of clinical symptoms and signs and level of serum hypersensitive C-reactive protein (hs-CRP) were observed in the two groups. The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays were recorded, and the clinical therapeutic effect was evaluated in the two groups. RESULTS: After treatment, the scores of clinical symptoms and signs and levels of serum hs-CRP were reduced in the two groups (P<0.01), and the changes of scores of fever, cough and lung moist rale, secondary symptom score, total score of clinical symptoms and signs and level of serum hs-CRP in the observation group were larger than those in the control group (P<0.05, P<0.01). The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays in the observation group were shorter than those in the control group (P<0.05). The total effective rate was 87.2% (34/39) in the observation group, which was superior to 65.0% (26/40) in the control group (P<0.05). CONCLUSION: Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment can relieve clinical symptoms, shorten duration of antibacterial drugs and hospital stays for children with pneumonia of phlegm-heat blocking lung type.

Analysis of magnetic resonance imaging features of ovarian thecoma.

To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy.Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5 cm and <5 cm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance.The ≥5 cm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The <5 cm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (P = .007, .000).Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.

Clinical value of prenatal MRI for diagnosis of isolated ventriculomegaly and prediction of early postnatal developmental outcomes.

OBJECTIVE: To investigate the relationship of ventriculomegaly (VM) with postnatal neurological development. METHODS: Fetuses with isolated VM on MRI (n = 160; VM group) were separated into three subgroups according to lateral ventricle width: subgroup A (10.0-12.0 mm; n = 113), subgroup B (12.1-15.0 mm; n = 37), and subgroup C (>15.0 mm; n = 10). Fifty normal fetuses formed a control group. Post-delivery changes in ventricular width and neurological development were assessed with MRI/ultrasonography and the Gesell Development Schedules (GDS), respectively, at 3, 6, 12, and 18 months. RESULTS: GDS scores of subgroup A and subgroup B did not differ from that of the controls at 3 and 6 months. Subgroup B scores differed significantly from the control scores at 12 and 18 months. Subgroup C scores differed from the control scores at all-time points (all P < 0.05). In the VM group, GDS scores at 12 and 18 months were significantly different from the scores at 3 months, and the score at 18 months was significantly different from the score at 6 months (P < 0.05 for all). CONCLUSION: The milder the VM, the more likely it was to disappear or improve in the postnatal period. However, specific postnatal rehabilitation should be considered when fetal ventricular width is greater than 12.1 mm.

[Clinical value of prenatal MRI in the diagnosis and differential diagnosis of fetal bronchopulmonary sequestration].

OBJECTIVE: To investigate the clinical value of prenatal MRI in the diagnosis and differential diagnosis of congenital bronchopulmonary sequestration (BPS). METHODS: From January 2009 to December 2014, 16 fetuses with BPS were diagnosed by fetal MRI in Huzhou Maternity and Child Care Hospital and Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine. The clinical data of these cases were analyzed retrospectively. All were singleton pregnancy, and MRI was carried out within 24-48 hours after routine prenatal ultrasound. All the neonates underwent postnatal enhanced CT scan or surgical biopsy after birth, and the results were compared to prenatal MRI diagnosis. RESULTS: (1) With prenatal MRI, 16 cases were diagnosed BPS. The lesions located in left lung in 10 cases, and right lung in 6 cases. As the scope of the lesion, 3 cases located in the whole left lung, 6 cases limited to the left lower lobe, and 1 case was subdiaphragmatic on the left side. 2 cases located in the whole right lung and 4 cases limited to the right lower lobe. One case complicated oligoamnios, and one had pleural effusion. Supplying vessels could be found in 14 cases. (2) When the postnatal results were compared with prenatal MRI, 15 cases were comfirmed as BPS (15/16), including 10 intralobar cases 5 extralobar cases. One that was diagnosed as BPS by prenatal MRI was confirmed to be congenital cystic adenomatoid malformation (CCAM) by pathology. The accuracy of prenatal MRI diagnosis of BPS was 15/16. Prenatal ultrasound missed one case and misdiagnosed two cases, as one was mistakened as CCAM and the other as cystic teratoma. CONCLUSION: Prenatal MRI has good clinical value in the diagnosis and differential diagnosis of fetal BPS.

Validation of the Chinese version of EORTC QLQ-BM22 in patients with bone metastases.

PURPOSE: Our aim is to test the validity, reliability, and acceptability of the Chinese version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Bone Metastases 22 (EORTC QLQ-BM22) module to assess health-related quality of life (HRQOL) in patients with bone metastases in China. METHODS: Patients with histological confirmation of malignancy and bone metastases from Tianjin Cancer Institution and Hospital from June 2013 to April 2014 were enrolled in this study. All patients self-administered the EORTC QLQ-BM22 and the EORTC QLQ-C30. The Karnofsky Performance Scale (KPS) was performed to evaluate scores. The reliability and validity tests of the questionnaires were based on Cronbach's α coefficients, Pearson correlation test, and Wilcoxon rank sum nonparametric test. RESULTS: Internal consistency reliabilities of all the four scales were acceptable. Scales measuring similar HRQOL aspects were found to correlate with one another between EORTC QLQ-BM22 and EORTC QLQ-C30, but differences still existed. Significant differences were demonstrated in the scores of all four subscales of the QLQ-BM22 between the two KPS subgroups (KPS ≤ 80; KPS > 80). Meanwhile, the compliance for item completion of the QLQ-BM22 was satisfactory. CONCLUSIONS: The Chinese version of EORTC QLQ-BM22 is a reliable and valid instrument, which is appropriate for measuring the HRQOL of patients with bone metastases in China.

Cross-cultural verification of the EORTC QLQ-C15-PAL questionnaire in mainland China.

BACKGROUND: Simplified by European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30), EORTC Quality-of-Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL) is specifically applied to evaluating palliative care patients' quality of life. AIM: This study examined cross-cultural adaptability and validity of QLQ-C15-PAL for evaluating quality of life of palliative care patients with advanced cancer in mainland China. PARTICIPANTS AND DESIGN: From May to October 2013, 243 palliative care patients in Tianjin Cancer Hospital completed the EORTC QLQ-C30. We extracted QLQ-C15-PAL data for analysis. Physicians completed the Eastern Cooperative Oncology Group Performance Status score and mental state assessment for each patient. RESULTS: A total of 243 patients completed the study. The compliance rate was high, with missing rate for each item ranging from 0% to 2.1%. In addition to emotional function, the remaining dimensions demonstrated a high reliability (Cronbach's alpha > 0.7). Whether we divided patients into two groups according to their Eastern Cooperative Oncology Group Performance Status or divided patients into three groups according to mental status, both sets of results showed significant differences in QLQ-C15-PAL subscale scores (p < 0.05), indicating that the QLQ-C15-PAL scale could be used to distinguish between the aforementioned subgroups. Overall quality of life was moderately correlated with fatigue (r = -0.406) but weakly correlated with other subscales. The proportion of variance (R(2)) ranged from 0.848 to 0.903, which showed that QLQ-C15-PAL subscale scores explained between 84.8% and 90.3% of the original QLQ-C30 score distribution. CONCLUSION: The Chinese version of the EORTC QLQ-C15-PAL questionnaire has high reliability and validity and is therefore suitable for clinical use in China to determine health-related quality of life in Chinese patients with advanced cancer.

Validation of EORTC IN-PATSAT32 for Chinese cancer patients.

PURPOSE: The aim of this study is to test the psychometric properties and acceptability of the European Organization for Research and Treatment of Cancer (EORTC) inpatient satisfaction with care questionnaire 32 (IN-PATSAT32) for evaluating Chinese cancer patients and to analyze the influence of age, educational level, diagnostic time, and tumor stage on patient satisfaction. METHODS: Three hundred two cancer inpatients in Tianjin Cancer Institution and Hospital from June 2013 to December 2013 were recruited for this study. All participants self-administered the EORTC IN-PATSAT32 and EORTC quality of life questionnaire-core 30 (QLQ-C30). Psychometric evaluation of the validity, reliability, acceptability, as well as the influence of age, educational level, diagnostic time, and tumor stage on patient satisfaction, was conducted. RESULTS: A favorable internal consistency reliability was confirmed, as the Cronbach's α coefficients were >0.80 for all scales in the EORTC IN-PATSAT32, ranging from 0.849 to 0.944. Multi-trait scaling analysis showed that all item-scale correlation coefficients met the standard of convergent validity, and 79.3 % met the standard of discriminant validity. Weak correlations were found between the scales and single items of the EORTC IN-PATSAT32 and EORTC QLQ-C30, proving the validity of EORTC IN-PATSAT32. None of the EORTC IN-PATSAT32 scales were able to discriminate between patients across age categories, while significant influences of educational level on doctors' and nurses' conduct, as well as influences of diagnostic time and tumor stage on nurses' conduct, and information provision scales were discovered. The questionnaire was easily understood with a satisfactory acceptability. CONCLUSIONS: The EORTC IN-PATSAT32 appears to be a reliable, valid, and acceptable instrument to use on cancer patients and is appropriate for measuring the patient satisfaction of Chinese patients.