Identification of hub genes in calcific aortic valve disease.

Calcific aortic valve disease (CAVD) is a heart valve disorder characterized primarily by calcification of the aortic valve, resulting in stiffness and dysfunction of the valve. CAVD is prevalent among aging populations and is linked to factors such as hypertension, dyslipidemia, tobacco use, and genetic predisposition, and can result in becoming a growing economic and health burden. Once aortic valve calcification occurs, it will inevitably progress to aortic stenosis. At present, there are no medications available that have demonstrated effectiveness in managing or delaying the progression of the disease. In this study, we mined four publicly available microarray datasets (GSE12644 GSE51472, GSE77287, GSE233819) associated with CAVD from the GEO database with the aim of identifying hub genes associated with the occurrence of CAVD and searching for possible biological targets for the early prevention and diagnosis of CAVD. This study provides preliminary evidence for therapeutic and preventive targets for CAVD and may provide a solid foundation for subsequent biological studies.

Refining the 8th edition TNM classification for EBV related nasopharyngeal carcinoma.

The AJCC/UICC TNM classification describes anatomic extent of tumor progression and guides treatment decisions. Our comprehensive analysis of 8,834 newly diagnosed patients with non-metastatic Epstein-Barr virus related nasopharyngeal carcinoma (NPC) from six Chinese centers indicates certain limitations in the current staging system. The 8th edition of the AJCC/UICC TNM classification inadequately differentiates patient outcomes, particularly between T2 and T3 categories and within the N classification. We propose reclassifying cases of T3 NPC with early skull-base invasion as T2, and elevating N1-N2 cases with grade 3 image-identified extranodal extension (ENE) to N3. Additionally, we suggest combining T2N0 with T1N0 into a single stage IA. For de novo metastatic (M1) NPC, we propose subdivisions of M1a, defined by 1-3 metastatic lesions without liver involvement, and M1b, characterized by >3 metastatic lesions or liver involvement. This proposal better reflects responses of NPC patients to the up-to-date treatments and their evolving risk profiles.

Identification of key candidate genes and biological pathways in neuropathic pain.

BACKGROUND: Neuropathic pain is a common chronic pain, characterized by spontaneous pain and mechanical allodynia. The incidence of neuropathic pain is on the rise due to infections, higher rates of diabetes and stroke, and increased use of chemotherapy drugs in cancer patients. At present, due to its pathophysiological process and molecular mechanism remaining unclear, there is a lack of effective treatment and prevention methods in clinical practice. Now, we use bioinformatics technology to integrate and filter hub genes that may be related to the pathogenesis of neuropathic pain, and explore their possible molecular mechanism by functional annotation and pathway enrichment analysis. METHODS: The expression profiles of GSE24982, GSE2884, GSE2636 and GSE30691 were downloaded from the Gene Expression Omnibus（GEO）database, and these datasets include 93 neuropathic pain Rattus norvegicus and 59 shame controls. After the four datasets were all standardized by quantiles, the differentially expressed genes (DEGs) between NPP Rattus norvegicus and the shame controls were finally identified by the robust rank aggregation (RRA) analysis method. In order to reveal the possible underlying biological function of DEGs, the Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway enrichment analysis of DEGs were performed. In addition, a Protein-protein Interaction (PPI) network was also established. At the end of our study, a high throughput sequencing dataset GSE117526 was used to corroborate our calculation results. RESULTS: Through RRA analysis of the above four datasets GSE24982, GSE2884, GSE2636, and GSE30691, we finally obtained 231 DEGs, including 183 up-regulated genes and 47 down-regulated genes. Arranging 231 DEGs in descending order according to |log2 fold change (FC)|, we found that the top 20 key genes include 14 up-regulated genes and 6 down-regulated genes. The most down-regulated hub gene abnormal expressed in NPP was Egf17 (P-value = 0.008), Camk2n2 (P-value = 0.002), and Lep (P-value = 0.02), and the most up-regulated hub gene abnormal expressed in NPP was Nefm (P-value = 1.08E-06), Prx (P-value = 2.68E-07), and Stip1 (P-value = 4.40E-07). In GO functional annotation analysis results, regulation of ion transmembrane transport (GO:0034765; P-value = 1.45E-09) was the most remarkable enriched for biological process, synaptic membrane (GO:0097060; P-value = 2.95E-08) was the most significantly enriched for cellular component, channel activity (GO:0015267; P-value = 2.44E-06) was the most prominent enriched for molecular function. In KEGG pathway enrichment analysis results, the top three notable enrichment pathways were Neuroactive ligand-receptor interaction (rno04080; P-value = 3.46E-08), Calcium signaling pathway (rno04020; P-value = 5.37E-05), and Osteoclast differentiation (rno04380; P-value = 0.000459927). Cav1 and Lep appeared in the top 20 genes in both RRA analysis and PPI analysis, while Nefm appeared in RRA analysis and datasets GSE117526 validation analysis, so we finally identified these three genes as hub genes. CONCLUSIONS: Our research identified the hub genes and signal pathways of neuropathic pain, enriched the pathophysiological mechanism of neuropathic pain to some extent, and provided a possible basis for the targeted therapy of neuropathic pain.

Prognostic Modeling of Patients Undergoing Surgery Alone for Esophageal Squamous Cell Carcinoma: A Histopathological and Computed Tomography Based Quantitative Analysis.

OBJECTIVE: To evaluate the effectiveness of a novel computerized quantitative analysis based on histopathological and computed tomography (CT) images for predicting the postoperative prognosis of esophageal squamous cell carcinoma (ESCC) patients. METHODS: We retrospectively reviewed the medical records of 153 ESCC patients who underwent esophagectomy alone and quantitatively analyzed digital histological specimens and diagnostic CT images. We cut pathological images (6000 × 6000) into 50 × 50 patches; each patient had 14,400 patches. Cluster analysis was used to process these patches. We used the pathological clusters to all patches ratio (PCPR) of each case for pathological features and we obtained 20 PCPR quantitative features. Totally, 125 computerized quantitative (20 PCPR and 105 CT) features were extracted. We used a recursive feature elimination approach to select features. A Cox hazard model with L1 penalization was used for prognostic indexing. We compared the following prognostic models: Model A: clinical features; Model B: quantitative CT and clinical features; Model C: quantitative histopathological and clinical features; and Model D: combined information of clinical, CT, and histopathology. Indices of concordance (C-index) and leave-one-out cross-validation (LOOCV) were used to assess prognostic model accuracy. RESULTS: Five PCPR and eight CT features were treated as significant indicators in ESCC prognosis. C-indices adjusted for LOOCV were comparable among four models, 0.596 (Model A) vs. 0.658 (Model B) vs. 0.651 (Model C), and improved to 0.711with Model D combining information of clinical, CT, and histopathology (all p<0.05). Using Model D, we stratified patients into low- and high-risk groups. The 3-year overall survival rates of low- and high-risk patients were 38.0% and 25.0%, respectively (p<0.001). CONCLUSION: Quantitative prognostic modeling using a combination of clinical data, histopathological, and CT images can stratify ESCC patients with surgery alone into high-risk and low-risk groups.

Prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma: A retrospective study.

PURPOSE: To evaluate how prevertebral space involvement (PSI) and degree of tumor extension within the space affects prognosis in nasopharyngeal carcinoma (NPC). PARTICIPANTS AND METHODS: Data of patients with newly-diagnosed nonmetastatic NPC (n = 757) were retrospectively analyzed. Patients were separated into groups according to presence or absence of PSI and degree of tumor spread. Overall survival (OS), failure-free survival (FFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared between the groups. RESULTS: Prevalence of PSI, simple prevertebral muscle involvement (PMI), and behind prevertebral muscle involvement (BPMI) were 44.9% (340/757), 22.5% (170/757), and 22.5% (170/757), respectively. OS, FFS, LRFS, and DMFS for patients with and without PSI were 64% vs. 84.8%, 68% vs. 85.6%, 85.8% vs. 94.4%, and 78.5% vs. 92.8%, respectively (all P < 0.001). PSI was an independent predictor of OS, FFS, LRFS, and DMFS. OS, FFS, and DMFS for patients with simple PMI and with BPMI were 72.7% vs. 54.8% (P = 0.002), 75.8% vs. 59.8% (P = 0.003), and 85.5% vs. 71.2% (P = 0.002), respectively. Degree of PSI extension was related to OS, FFS, and DMFS. OS, FFS, LRFS, and DMFS were significantly poorer in patients with PSI in T2-3 stage than in patients without PSI in T3 stage (P < 0.05), but comparable to those in patients with T4 stage (P > 0.05). CONCLUSIONS: PSI predicts poor prognosis in NPC. Survival is poorer in patients with BPMI than in those with simple PMI. NPC with PSI should be classified as T4 stage.

Influence of tumor necrosis on treatment sensitivity and long-term survival in nasopharyngeal carcinoma.

PURPOSE: To assess the impact of tumor necrosis on treatment sensitivity and long-term survival in patients with nasopharyngeal carcinoma (NPC) treated using intensity-modulated radiation therapy (IMRT). PARTICIPANTS AND METHODS: In total, 757 patients with non-metastatic, histologically confirmed NPC were retrospectively examined. All patients were treated using IMRT; 93.7% patients with stage T3-T4/N1-N3 disease also received cisplatin-based chemotherapy. RESULTS: The incidence rates of tumor necrosis in primary tumor, retropharyngeal lymph nodes, neck lymph nodes, and total tumor were 2%, 17.7%, 21.5%, and 31.4%. Overall, 40.8% patients with necrosis of the total tumor achieved complete response (CR) and 54.7% patients without tumor necrosis achieved CR at the end of treatment (χ2 = 12.728, P < 0.001). The estimated 7-year overall survival (OS), failure-free survival (FFS), distant metastasis-free survival (DMFS), and loco-regional relapse-free survival (LRRFS) for patients with tumor necrosis and without tumor necrosis of the total tumor were 68.5% vs. 88.4%, 70.5% vs. 88.1%, 77.6% vs. 90.6%, and 85.9% vs. 91.3%, respectively (all P < 0.001). Multivariate analyses indicated that necrosis of the total tumor was an independent predictor of OS, FFS, DMFS, and LRRFS. The impact of lymph node necrosis on long-term survival was similar to that of necrosis of the total tumor. ROC curves verified that inclusion of lymph node necrosis improved the predictive value of the current N classification criteria (P = 0.006). CONCLUSIONS: Tumor necrosis served as a predictor of treatment sensitivity and poor prognosis for patients with NPC. Lymph node necrosis significantly improved the prognostic value of the current N classification criteria for NPC.

Correction to: Radiomics on multi-modalities MR sequences can subtype patients with non-metastatic nasopharyngeal carcinoma (NPC) into distinct survival subgroups.

The original version of this article, published on 14 March 2019, unfortunately contained a mistake.

Radiomics on multi-modalities MR sequences can subtype patients with non-metastatic nasopharyngeal carcinoma (NPC) into distinct survival subgroups.

OBJECTIVES: To explore and evaluate the feasibility of radiomics in stratifying nasopharyngeal carcinoma (NPC) into distinct survival subgroups through multi-modalities MRI. METHODS: A total of 658 patients (training cohort: 424; validation cohort: 234) with non-metastatic NPC were enrolled in the retrospective analysis. Each slice was considered as a sample and 4863 radiomics features on the tumor region were extracted from T1-weighted, T2-weighted, and contrast-enhanced T1-weighted MRI. Consensus clustering and manual aggregation were performed on the training cohort to generate a baseline model and classification reference used to train a support vector machine classifier. The risk of each patient was defined as the maximum risk among the slices. Each patient in the validation cohort was assigned to the risk model using the trained classifier. Harrell's concordance index (C-index) was used to measure the prognosis performance, and differences between subgroups were compared using the log-rank test. RESULTS: The training cohort was clustered into four groups with distinct survival patterns. Each patient was assigned to one of the four groups according to the estimated risk. Our method gave a performance (C-index = 0.827, p < .004 and C-index = 0.814, p < .002) better than the T-stage (C-index = 0.815, p = .002 and C-index = 0.803, p = .024), competitive to and more stable than the TNM staging system (C-index = 0.842, p = .003 and C-index = 0.765, p = .050) in the training cohort and the validation cohort. CONCLUSIONS: Through investigating a large one-institutional cohort, the quantitative multi-modalities MRI image phenotypes reveal distinct survival subtypes. KEY POINTS: • Radiomics phenotype of MRI revealed the subtype of nasopharyngeal carcinoma (NPC) patients with distinct survival patterns. • The slice-wise analysis method on MRI helps to stratify patients and provides superior prognostic performance over the TNM staging method. • Risk estimation using the highest risk among slices performed better than using the majority risk in prognosis.

Survival and Toxicities of IMRT Based on the RTOG Protocols in Patients with Nasopharyngeal Carcinoma from the Endemic Regions of China.

Background: This study evaluated the survival outcomes and toxicities of intensity-modulated radiation therapy (IMRT) based on the RTOG 0225/0615 RT protocols in patients with nasopharyngeal carcinoma (NPC) from a region of China where this tumor type is endemic. Methods: A total of 455 patients with non-metastatic, histologically-confirmed NPC were retrospectively reviewed. All patients were treated by IMRT using the RTOG 0225/0615 RT protocols; 91.1% (288/316) of patients with stage III-IVb NPC received concurrent chemotherapy +/- induction chemotherapy or adjuvant chemotherapy. Results: Estimated four-year overall survival (OS), failure free survival (FFS), local relapse free survival (LRFS), regional relapse free survival (RRFS) and distant metastasis free survival (DMFS) were 83.8%, 80.5%, 94.3%, 96.7% and 85.8%, respectively. T and N category were significant prognostic factors for OS, FFS, RRFS and DMFS; and T category, for LRFS. In-field failure was the major loco-regional failure pattern. During RT, 206 (45.3%) patients experienced acute grade 3-4 toxicities. The most common acute toxicity was mucositis; 124 (27.2%) patients experienced grade 3-4 mucositis; 46 (10.1%) experienced serious late toxicities. The most common late toxicity was MRI-detected radiation-induced temporal lobe necrosis (6.8%). Conclusions: The RTOG IMRT protocols are feasible for patients with NPC from the endemic regions of China.

Clinical presentation and CT/MRI findings of alveolar soft part sarcoma: a retrospective single-center analysis of 14 cases.

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a relatively rare malignant tumor and early diagnosis and appropriate treatment for ASPS are essential for a good prognosis. PURPOSE: To retrospectively review the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) findings of ASPS so as to improve the accuracy of imaging diagnosis. MATERIAL AND METHODS: Fourteen patients with pathologically proven ASPS were enrolled. Their clinical and imaging findings were retrospectively reviewed. RESULTS: The median age of the patients was 29 years (range, 13-37 years). Most tumors were located in the soft tissues of the trunk and lower limbs. The median maximal diameter of the masses was 91 mm. Thirteen masses presented with ovoid or irregular shapes. Eleven masses had less clear boundaries. Compared with the adjacent muscles, the masses were isodense or hypodense on CT, hypo-, iso-, or hyperintense on T1-weighted images, and heterogeneous hyperintense on T2-weighted images. Intense enhancement was seen after contrast agent administration, with prominent intra- or peri-tumoral feeders on CT or flow voids on MRI. By the end of the last follow-up, 13 patients had distant metastasis and three patients had local recurrence. CONCLUSION: ASPS should be included in the differential diagnosis when a bulky, heterogeneous soft tissue mass in the trunk and the lower limbs with intense enhancement after contrast administration and prominent intra- or peri-tumoral feeders on CT or flow voids on MRI is seen, particularly in young patients.

Is maximum primary tumor diameter still a prognostic factor in patients with nasopharyngeal carcinoma treated using intensity-modulated radiotherapy?

BACKGROUND: Intensity-modulated radiation therapy (IMRT) has represented a technical milestone that has facilitated the clinical implementation. The purpose of this study was to evaluate the prognostic value of maximum primary tumor diameter (MPTD) in patients with nasopharyngeal carcinoma (NPC) treated using IMRT. METHODS: Five-hundred and sixty-six patients with non-metastatic, histologically-confirmed NPC were retrospectively reviewed. MPTD was measured using magnetic resonance imaging (MRI). All patients were treated using IMRT; 87.5% (456/521) of patients with Stage T3-T4/N1-N3 disease also received cisplatin-based chemotherapy. Receiver operating characteristic (ROC) curves were used to identify the optimal MPTD cut-off point and examine the prognostic value of combining MPTD with the current T classification criteria. RESULTS: Median follow-up for all patients was 36 months (range, 1-52 months). The 3-year overall survival (OS), failure-free survival (FFS), distant metastasis-free survival (DMFS), and local relapse-free survival (LRFS) rates for patients with a MPTD ≤41 vs. >41 mm were 96.1% vs. 85.4%, 93.7% vs. 74.7%, 96.1% vs. 79.7%, and 98.1% vs. 92.9%, respectively (all P < 0.05). In multivariate analysis, MPTD was an independent prognostic factor for OS, FFS, DMFS and LRFS in all patients (all P < 0.05). Among stage T3-T4 patients, the 3-year OS, FFS, DMFS, and LRFS rates for patients with a MPTD ≤41 vs. >41 mm were 96.9% vs. 84.5%, 95.4% vs. 73.5%, 96.1% vs. 79.2%, and 99.3% vs. 92.6%, respectively (all P < 0.05). In multivariate analysis, MPTD was also an independent prognostic factor for OS, FFS and DMFS in stage T3-T4 patients (all P < 0.05), and the difference in LRFS was almost statistically significant (P = 0.05). ROC curves verified that inclusion of MPTD improved the predictive value of the current T classification criteria (P < 0.001). CONCLUSIONS: MPTD was an independent prognostic factor in patients with NPC treated using IMRT, and significantly improved the prognostic value of the current T classification criteria for NPC.

Reactive thymic hyperplasia following chemotherapy for children with lymphoma: computed tomography may be able to provide valuable information to avoid over-treatment.

OBJECTIVES: To analyse the clinical and computed tomography (CT) findings related to reactive thymic hyperplasia in order to improve the recognition of this phenomenon and avert over-treatment. METHODS: Fifty-two children with pathologically proven lymphoma developed reactive thymic hyperplasia following chemotherapy, which was confirmed with long-term review and follow-up. The clinical and CT findings of these 52 children were retrospectively analysed. RESULTS: The median follow-up period for the whole study group was 32.9 months. Fifty-one children survived free of disease; 23 of these had been with tumour invasion and the remaining 29 without. The median period from complete remission (CR) of the mediastinal lesions to the date of recurrent mediastinal masses was 8.6 months, which was not statistically significantly different from that of 9.5 months from commencement of treatment to the date of newly developed mediastinal masses (P = 0.495). The median maximal diameters of the recurrent and newly developed mediastinal masses were not significantly different (P = 0.091). All of the 52 cases presented with a single mediastinal mass; 42 masses (42/52, 81%) of those showed trapezoidal or triangular shapes and were well-circumscribed; 10 masses (10/52, 19%) manifested diffuse shapes and were ill-circumscribed. Forty-two masses (42/52, 81%) showed homogeneous density. All of the masses revealed mild enhancement after contrast administration. Forty-two masses (42/52, 81%) slightly displaced and 10 masses (10/52, 19%) partly surrounded adjacent vessels. After long-term follow-up, 42 masses (42/52, 81%) shrank naturally, and 10 (10/52, 19%) remained unchanged. CONCLUSIONS: Reactive thymic hyperplasia can, and often does, occur in children receiving regular chemotherapy for lymphoma, regardless of whether the tumour initially invades the mediastinum. Knowing the characteristic CT findings of this benign entity is helpful in differentiating it from residual or recurrent lymphoma and averting unnecessary treatment.

Nasopharyngeal carcinoma patients with retropharyngeal lymph node metastases: a minimum axial diameter of 6 mm is a more accurate prognostic predictor than 5 mm.

OBJECTIVE: The criteria for the diagnosis of metastatic retropharyngeal lymph nodes (RLNs) have not yet been resolved and are not included in the current edition of the American Joint Committee on Cancer (AJCC) staging system (seventh edition) for the staging of nasopharyngeal carcinoma (NPC). The aim of this study was to use MRI to identify an RLN size criterion that can accurately predict prognosis in patients with NPC. MATERIALS AND METHODS: Eight hundred seventeen patients with newly diagnosed localized NPC were identified. All of the patients underwent MRI before treatment with definitive radiation therapy. All the MRI studies and medical records were reviewed retrospectively. Overall survival (OS), distant metastasis-free survival (DMFS), and local relapse-free survival (LRFS) were assessed using SPSS software (version 17.0). RESULTS: RLN size cutoffs of ≥ 5 mm and of ≥ 6 mm were used. There was no significant difference in OS (p = 0.216), DMFS (p = 0.081), or LRFS (p = 0.067) in patients with RLNs ≥ 5 mm and in those with RLNs < 5 mm. When 6 mm was used as a size cutoff, significant differences in OS (p = 0.000) and DMFS (p = 0.001) were identified; there was no significant difference observed for LRFS (p = 0.380). CONCLUSION: A minimum axial RLN diameter of 6 mm was a more accurate prognostic predictor in NPC patients with RLN metastases than 5 mm.

Adrenal cortical adenoma with the maximal diameter greater than 5 cm: can they be differentiated from adrenal cortical carcinoma by CT?

To study the computed tomographic findings of adrenal adenoma with the maximal diameter greater than 5 cm and to discuss whether such tumor can be differentiated from adrenal carcinoma by CT examination. Fourteen consecutive patients with adrenal adenoma with the maximal diameter larger than 5 cm, proven pathologically, were enrolled. All patients underwent non-enhanced and contrast-enhanced CT examination. The CT findings, including size, shape, edge, density on non-enhanced CT and schedule of reinforcement after contrast administration for each lesion were retrospectively analyzed. CT data of 13 patients with adrenocortical carcinoma were also evaluated to determine whether differentiating characteristics existed. The maximal diameter of the 14 masses of adenoma ranged from 5.5 cm to 20 cm (mean, 10 cm). One mass showed lobulated, the rest 13 masses showed rounded or ovoid. Eleven and 3 masses appeared well-circumscribed and ill-circumscribed, respectively. All of 14 masses presented heterogeneous density on non-enhanced CT images with patchy low-attenuation foci or stippled calcification. All of 14 masses revealed moderately to markedly heterogeneous enhancement after contrast administration. None of 14 masses developed local invasion and distant metastasis. Except for recurrence, metastasis and venous tumor emboli which only occurred in the cases of adrenal carcinoma, no definite computed tomographic features could be found that enabled the identification of adenomas with the maximal diameter greater than 5 cm with adrenal carcinomas. The characteristic CT findings of adrenal adenoma with the maximal diameter greater than 5 cm include bulky, well-circumscribed, rounded or ovoid masses, heterogeneous attenuation with low-attenuation foci on non-enhanced CT images and heterogeneous enhancement after contrast administration. The differential diagnosis between such tumor and adrenal cortical carcinoma by CT examination is relatively difficult, such findings as recurrence, metastasis and venous tumor emboli may be of some significance.

Solid neuroendocrine breast carcinoma: mammographic and sonographic features in thirteen cases.

This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma (NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings. The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed. Imaging data were evaluated by two radiologists for a consensual diagnosis. All patients presented with one palpable mass; only 1 experienced occasional breast pain, and 5 complained of fluid discharge. In 7 patients, the masses were firm and mobile. Regional lymph node metastasis was noted in only 1 patient. For the 10 patients who underwent mammography, 6 had a mass, 1 had clustered small nodules with clustered punctuate microcalcifications, 2 had asymmetric focal density, and 1 had solitary punctuate calcification. Most of the masses had irregular shape with indistinct or microlobulated margins. For the 9 patients who underwent ultrasonography (US), 9 masses were depicted, all of which were hypoechoic, mostly with irregular shape and without acoustic phenomena. Different types of acoustic phenomena were also identified. One patient had developed distant metastases during follow-up. NEBC has a variety of presentations, but it is mostly observed on mammograms as a dense, irregular mass with indistinct or microlobulated margins. Sonographically, it typically presents as an irregular, heterogeneously hypoechoic mass with normal sound transmission. Histories of nipple discharge and calcification observed using imaging are not rare.

CT findings of primary non-teratomatous germ cell tumors of the mediastinum--a report of 15 cases.

OBJECTIVE: To analyze computed tomography (CT) features of primary non-teratomatous germ cell tumors of the mediastinum and to improve the diagnostic efficacy of CT for such tumor. METHODS: Fifteen patients with primary non-teratomatous germ cell tumors of the mediastinum, proven pathologically, were enrolled. All patients underwent non-enhanced and contrast-enhanced CT examinations. The CT features, including location, size, shape, edge, CT attenuation, involvement of adjacent structure and local or distant metastasis of each lesion were retrospectively analyzed. RESULTS: Each case showed single mass, a total of 15 masses. 11 masses arose within the left anterosuperior mediastinum and 4 masses arose within the right anterosuperior mediastinum. 10 masses appeared lobulated and ill-circumscribed, and 5 masses appeared rounded or oval and well-circumscribed. The maximal diameter of all the masses ranged from 5 cm to 16 cm (mean, 11 cm). 12 masses revealed heterogeneous attenuation on non-enhanced CT images with patchy low-attenuation foci and stippled calcification, and showed moderately heterogeneous enhancement after contrast administration. 3 masses of the patients with seminoma revealed homogeneous attenuation on non-enhanced CT images and showed lightly homogeneous enhancement after contrast administration. Pericardial effusion, pleural effusion and involvement of adjacent vascular structures were observed in 6, 5 and 10 cases, respectively. Pulmonary metastasis were observed in 3 cases. CONCLUSIONS: The characteristic CT findings of primary non-teratomatous germ cell tumors of the mediastinum include bulky, ill-circumscribed, lobulated masses, heterogeneous attenuation with low-attenuation foci and calcification on non-enhanced CT images and heterogeneous enhancement after contrast administration. Seminomas may show homogeneous attenuation and homogeneous enhancement after contrast administration. The tumor is apt to involve pericardium, pleura and adjacent vascular structure and develop distant metastasis. Primary non-teratomatous germ cell tumors should be considered when anterosuperior mediastinal masses are detected with these findings, especially in young males.

A novel one-step synthesis of Gd3+-incorporated mesoporous SiO2 nanoparticles for use as an efficient MRI contrast agent.

Molecular imaging has generated a demand for more sensitive contrast agents for magnetic resonance (MR) imaging. We synthesized, by a novel one-step method, Gd(3+) incorporated mesoporous SiO(2) nanoparticles, Gd(2)O(3)@SiO(2), for use as an efficient contrast agent. The prepared nanoparticles were also coated with poly(lactic-co-glycolic acid) (PLGA). The size, morphology, composition and Brunauer-Emmett-Teller specific surface area of the nanoparticles were evaluated. The Gd(2)O(3)@SiO(2) nanoparticles possess intragranular network morphology with a uniform size distribution and an average size of approximately 20-40 nm. The PLGA-coated nanoparticles were spherical or near-spherical in shape with a diameter of approximately 120 nm, a smooth surface, and neither aggregation nor adhesion tendencies. No free Gd ions were detected to dissociate from Gd(2)O(3)@SiO(2) even up to the limit (<0.03 mg/l) of the ICP equipment (IRIS Advantage). Our theoretical computation based on density functional theory (using DMol3, Materials Studio) revealed that the Gd(2)O(3) molecules are fully absorbed on the interface of mesoporous SiO(2) with a stable state of lower energy. Both Gd(2)O(3)@SiO(2) and PLGA-coated Gd(2)O(3)@SiO(2) samples have a larger T(1) relaxivitiy than commercial gadolinium diethylene triaminepentaacetate (Gd-DTPA). In vitro and in vivo MR images using the Gd(2)O(3)@SiO(2) nanoparticles were observed with a 1.5 T clinical MR scanner and compared with the images using Gd-DTPA. The Gd(2)O(3)@SiO(2) nanoparticles display a better magnetic property than commercial Gd-DTPA. In vivo MR imaging demonstrated that the nanoparticles were mainly distributed in the liver. Strong enhancement was also detected in nasopharyngeal carcinoma CNE-2 xenografted tumors. The Gd(2)O(3)@SiO(2) nanoparticles are not only potential candidates for highly efficient contrast agents for MR imaging, but also might be developed into potent targeted probes for in vivo molecular imaging of cancer.

[Quantitative evaluation of CT-MRI images of various tumors with expansive or infiltrative growth pattern].

OBJECTIVE: To investigate quantitatively the proliferation of tumors in characteristic of either expansive or infiltrative growth pattern. METHODS: The CT/MRI images of 34 tumor patients with 6 different pathological types were adopted to undergo quantitative evaluation of the growth pattern of these tumors. Three key parameters, fractal dimension (Df) of the border between the tumor and neighboring tissues, degree of heterogeneity (H), and clumsiness (C) inside the tumor, were computed numerically. RESULTS: The Df values of the infiltrative tumors were higher than those of the expansive tumors, thus revealing the more evident complexity and openness of the border of infiltrative tumor. Heterogeneity and clumsiness existed within both expansive and infiltrative tumors. The clumsiness derived from heterogeneity and they were correlated positively with each other. The growth coefficient of clumsiness of the expansive tumor was greater than that of the infiltrative tumor. CONCLUSION: The method to analyze the fractal dimension of tumor border, and degrees of heterogeneity and clumsiness within a tumor presented in this paper gives some enlightenment to the fundamental research in characterizing tumor growth and shows practical value in clinical diagnosis of tumor, and may be of benefit to the quantitative evaluation of radiological images and computer-aided diagnosis.

How does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography?

PURPOSE: To analyze the degree and pattern of influence of magnetic resonance imaging (MRI) on staging according to the 6th edition of the American Joint Committee on Cancer staging system compared with computed tomography (CT). METHODS AND MATERIALS: The MRI and CT scans and medical records of 420 consecutive patients with newly diagnosed nasopharyngeal carcinoma (NPC) were analyzed retrospectively. The tumors of all patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system. RESULTS: A significant difference (p <0.05) was found between CT and MRI in demonstrating involvement in the oropharynx (CT, 25.0% vs. MRI, 14.5%), prevertebral muscle (CT, 18.4% vs. MRI, 36.0%), parapharyngeal space (CT, 82.6% vs. MRI, 68.8%), skull base (CT, 31.0% vs. MRI, 52.6%), sphenoid sinus (CT, 13.6% vs. MRI, 16.7%), ethmoid sinus (CT, 7.1% vs. MRI, 3.3%), intracranial area (CT, 4.8% vs. MRI, 16.0%), and retropharyngeal lymph nodes (CT, 52.1% vs. MRI, 69.0%). The incidence of cervical lymph node metastasis and lymph node metastasis at each level was similar according to CT and MRI. MRI resulted in changes in 49.8% of T stage cases, 10.7% of N stage cases, and 38.6% of clinical stage cases. CONCLUSION: MRI demonstrated early primary tumor involvement more precisely and deep primary tumor infiltration more easily. The use of MRI caused dramatic changes in the results of the T stage and clinical staging and should be preferred to CT in staging NPC. Patients would benefit from changes in treatment strategies resulting from the use of MRI.

[Value of multislice spiral CT in preoperative staging of rectal carcinoma].

BACKGROUND & OBJECTIVE: Preoperative staging is important for optimal therapy planning and prognosis prediction of rectal carcinoma. The role of conventional computed tomography (CT) in preoperative staging of rectal carcinoma is controversial. This study was to evaluate the value of multislice spiral computed tomography (MSCT) in preoperative staging of rectal carcinoma. METHODS: From Mar. 2006 to Feb. 2007, 87 patients with pathologically proved rectal cancer underwent preoperative plain and enhanced MSCT. Two radiologists evaluated independently tumor location, size, the depth of tumor invasion into the rectal wall (T), the involvement of regional lymph nodes (N) and the presence of distant metastases (M) on CT images. TNM staging was made according to CT findings and compared with the pathologic results. The accuracy, sensitivity, and specificity were assessed. RESULTS: All the 87 cases of rectal carcinoma were detected clearly by MSCT. The accuracy was 81.6% for TNM staging, 94.3% for T staging, 82.8% for N staging, and 98.9% for M staging. The sensitivity was 90.5% for T1-2 staging, 91.3% for T3 staging, and 97.7% for T4 staging. The specificity was 98.5% for T1-2 staging, 94.2% for T3 staging, and 97.7% for T4 staging. The sensitivity was 92.9% for N0 staging, 72.0% for N1 staging, and 82.4% for N2 staging. The specificity was 88.9% for N0 staging, 88.5% for N1 staging, and 91.7% for N2 staging. Only 1 case of distant metastasis was missed due to the liver lesion of less than 5 mm. CONCLUSION: MSCT is an accurate technique for preoperative staging of rectal carcinoma, which can assess the extension to adjacent tissues and the presence of lymph node and distant metastases exactly.