The value of intravoxel incoherent motion diffusion-weighted imaging in predicting perineural invasion for resectable gastric cancer: a prospective study.

AIM: To investigate the potential of intravoxel incoherent motion (IVIM) diffusion-weighted imaging to predict perineural invasion (PNI) preoperatively in resectable gastric cancer (GC). MATERIALS AND METHODS: This study prospectively recruited 85 surgically resected GC patients (58 men, 27 women) aged 60.87 ± 10.17 (39-81) years, who underwent IVIM sequence within 1 week before surgery. According to histopathological PNI diagnoses, patients were divided into PNI positive and negative groups. Conventional apparent diffusion coefficient (ADC) and the IVIM parameters, including true diffusion coefficient (D), pseudodiffusion coefficient (D∗), and pseudodiffusion fraction (f), were compared between the two groups. Morphological MRI features were also analysed. Multivariate logistic regression was used to screen independent predictors of PNI. Receiver-operating characteristic curve analyses were preformed to evaluate the efficacy. Spearman's correlation test was performed to analyse the relationship between MRI parameters and PNI. RESULTS: Tumour thickness and f in PNI-positive group were higher, whereas the ADC, D were lower than those in PNI-negative group (p<0.05). These four parameters correlated with PNI (p<0.05). The D, f, and tumour thickness were independent predictors of PNI. The area under the curve of ADC, D, f, thickness, and the combined parameter (D + f + thickness) were 0.648, 0.745, 0.698, 0.725, and 0.869, respectively. The combined parameter demonstrated higher efficacy than any other parameters (p<0.05). CONCLUSION: The ADC, D, and f can effectively distinguish PNI status in GC. The D, f, and thickness were independent predictors of PNI.

[Study on the current situation and influencing factors of job involvement for employed nurses in military hospital].

Objective: To investigate the current situation of job involvement of nurses in military hospitals in Henan Province and analyze the influencing factors, so as to provide reference for improving the level of job involvement of military nurses. Methods: In February 2022, the employed nurses of 4 military hospitals in Henan Province were investigated by convenient sampling method. A total of 663 questionnaires were collected, including 632 valid questionnaires, with an effective recovery rate of 95.32%. The self-designed questionnaire was used to investigate the basic information of nurses, the Job Involvement Scale was used to investigate the job involvement of nurses, the Emotional Labor Scale for Nurses was used to investigate nurses' emotions, and the Work-Family Conflict Scale was used to investigate the work-family conflict of nurses. Independent sample t-test and univariate analysis of variance were used to compare the job involvement of military employed nurses with different demographic characteristics, Pearson correlation analysis was used to explore the correlation between emotional labor, work-family conflict and job involvement, and hierarchical regression analysis was used to explore the impact of relevant variables on the job involvement of military employed nurses. Results: The total average score of job involvement of military employed nurses was (3.68±1.13), and the scores of vitality, dedication and focus were (3.64±1.15), (3.74±1.25) and (3.67±1.21) respectively. The total score of emotional labor of nurses was 33-80 (62.95±8.12), with an average score of (3.93±0.51). The total score of work-family conflict was 18-94 (55.16±13.53), with an average score of (3.06±0.75). Professional emotional regulation, patient-centered emotional inhibition and standardized emotional play were positively related to the job involvement (r=0.46, 0.41, 0.22, P<0.01). Time-based conflict, stress-based conflict and behavior-based conflict had negative correlation with the job involvement (r=-0.12, -0.23, -0.20, P<0.01). In hierarchical regression analysis, after controlling demographic variables, emotional labor and work-family conflict accounted for 17.2% and 4.2% of the variation of job involvement. Conclusion: The job involvement of military employed nurses tends to be at a moderate level. Emotional labor and work-family conflict can significantly affect their job involvement.

[Correlation analysis of Ki67, Ck19 with clinicopathological features and apparent diffusion coefficient value of hepatocellular carcinoma].

Objective: To investigate the expression of cell proliferating nuclear antigen (Ki67) and cytokeratin 19 (Ck19) in hepatocellular carcinoma (HCC), and correlation with the clinicopathological features and apparent diffusion coefficient (ADC) value of hepatocellular carcinoma. Methods: The data of 203 newly diagnosed HCC patients in the Affiliated Cancer Hospital of Zhengzhou University from January 2014 to October 2019 were retrospectively collected, and the expression of Ki67 and Ck19 and ADC values in all patients were analyzed. The relationship between Ki67 and Ck19 and the clinical pathological characteristics of the patient, and calculate the difference and correlation with the ADC value was analyzed. Results: There were statistically significant differences in tumor vascular tumor thrombus, alpha-fetoprotein (AFP), postoperative tumor recurrence, lymph node metastasis, and HCC differentiation between Ki67 positive and negative groups (χ²=5.156, 12.741, 29.925, 3.963, 77.408, all P<0.05),and negatively correlated with ADC value (r=-0.214, P=0.002). The average ADC value of HCC in the low Ki67 group was significantly higher than that of the high Ki67 group (1 089±280 vs 1 009±212, P<0.05). There were statistically significant differences in tumor vascular tumor thrombus, AFP, postoperative tumor recurrence, and lymph node metastasis between Ck19 positive and negative groups (χ²=9.058, 27.034, 4.053, 14.187, all P<0.05), but not correlated with ADC value (r=0.062, P=0.380). The expression differences of Ki67 and Ck19 in different HCC recurrence time groups were statistically significant (P<0.05). Conclusion: The positive expression of Ki67 and Ck19 in HCC was associated with the prognosis and recurrence of HCC. CK19 was not correlated with the ADC value, while Ki67 was negatively correlated with the ADC value, indicating that ADC value could provide certain imaging information for the biological characteristics of preoperative HCC.

[Value of readout-segmented echo-planar diffusion imaging on 3.0 T MRI for predicting the early efficacy of concurrent radiochemotherapy of advanced stage nasopharyngeal carcinoma patients].

Objective: To discuss the value of RESOLVE for predicting early therapeutic effect of concourrent radiochemotherapy in advanced stage nasopharngeal carcinoma patients. Methods: Sixty-eight patients with nasopharyngeal carcinoma were confirmed by pathology in Henan Cancer Hospital from June 2014 to January 2016.All patients underwent RESLOVE(b value=800 s/mm(2)) with a 3.0 T MRI scanner.The ADC value and the area of the tumor was measured before treatment and 2 weeks after treatment independently performed by two radiologists with 5 years experiences and the agreement evaluation was performed using ANOVA analysis.The correlation among pretreatment ADC value, pathology type, gender, tumor area and the tumor regression rate were analyzed using Spearman rank correlation test.The difference between pretreatment ADC value was compared in CR group and non-CR group by independent sample t test.ROC curve was drawn and the maximum Youden index value was the cutoff calculating the ADC value and predicting the sensitivity, specificity and area under the curve. Results: (1)The agreement between 2 radiologist was excellent. The ICC values of the ADC and the area of the tumor before treatment and the area of the tumor after treatment were 0.89, 0.92 and 0.95, respectively. (2)The pretreatment ADC values of the CR group and the non-CR group were (0.877±0.103)×10(-3) mm(2)/s and (0.779±0.078)×10(-3) mm(2)/s, respectively. There was statistical difference t value=2.874, P value=0.005.(3)ROC curve showed that the sensitivity and specificity of the pretreatment ADC value in predicting CR was 85.2% and 71.0%, with the cut-off value of 0.792×10(-3) mm(2)/s, and the area under curve was 0.778.(4)There was apparently correlation beween the pretreatment ADC value and the tumor regression rate(r=0.333, P=0.006). There was no correlation among pretreatment ADC value, pathology type, gender and tumor area (P>0.05). Conclusion: There is important value using the pretreatment ADC value measured by RESOLVE for predicting the early effect of concurrent radiochemotherapy in advanced stage nasopharngeal carcinoma patients.

[A comparison between 3.0 T MRI and histopathology for preoperative T staging of potentially resectable esophageal cancer].

Objective: To explore the value of 3.0 T MRI using multiple sequences (star VIBE+ BLADE) in evaluating the preoperative T staging for potentially resectable esophageal cancer (EC). Methods: Between April 2015 and March 2016, a total of 66 consecutive patients with endoscopically proven resectable EC underwent 3.0T MRI in the Affiliated Cancer Hospital of Zhengzhou University.Two independent readers were assigned a T staging on MRI according to the 7th edition of UICC-AJCC TNM Classification, the results of preoperative T staging were compared and analyzed with post-operative pathologic confirmation. Results: The MRI T staging of two readers were highly consistent with histopathological findings, and the sensitivity, specificity and accuracy of preoperative T staging MR imaging were also very high. Conclusion: 3.0 T MRI using multiple sequences is with high accuracy for patients of potentially resectable EC in T staging. The staging accuracy of T1, T2 and T3 is better than that of T4a. 3.0T MRI using multiple sequences could be used as a noninvasive imaging method for pre-operative T staging of EC.

[Using 3.0 T MR to dynamically observe ablated lung tumors after percutaneous cryotherapy therapy].

Objective: To initially explore MRI features and its changing trends including of lung tumors after Argon-Helium cryoablation therapy, and enhance the recognition of MR findings of lung tumors postcryoablation. Methods: Twenty-three cases of patients with twenty six nodules of pulmonary malignance who received Argon-Helium cryoablation therapy in Henan Cancer Hospital from July 2014 to January 2016 were enrolled.All patients underwent unenhanced and dynamic contrast-enhanced MRI scans at pre-and 1-day, 1-week, 1-, 3-, 6-, 12-month postcryoablation. Two radiologists independently reviewed MRI images, signal intensity in the ablated zone on T1WI and T2WI were assessed by a 5-point scale.The changing trends of size and signal intensity with time were showed by time-maximum diameter and time-score curve.Time-signal intensity curves based on dynamic enhanced sequence were also performed. Results: Typical MRI findings includes: heterogeneous signal intensity on both T1WI and T2WI at 1-day postcryoablation(26/26, 100%). Hyper-intense on T1WI(22/26, 84.6%) and T2WI(17/26, 65.4%) with a hypo-intense rim at 1-week postcryoablation.Decreasing signal intensity on T1WI(17/26, 65.4%) and increasing signal intensity on T2WI(22/26, 84.6%) at 1-month.Signal intensity declined to the level of muscle on both T1WI(18/26, 69.2%) and T2WI(19/26, 73.1%) at 3-month, nineteen ablated zone turned into patchy shape(19/26, 73.1%). The maximum diameter was largest at 1-day and gradually shrunk with time. The mean score value toped at 1-week and gradually decreased. A straight line type without definite enhancement was found from 1-day to 1-month postcryoablation, an inflow curve with a mild delayed enhancement was seen from 3- to 12- month. Totally 4 recurrence (4/26, 15.4%) all occurred at 3-month and were lack of a complete hypo-intense rim at 1-week postcryoablation. Conclusion: MRI findings of lung tumors postcryoablation are characteristic, a complete hypo-intense rim at 1-week is helpful to determine further recurrence, 1-week to 3-month is an important period to observe significant change of the ablation zone, MRI is valuable in identifying the ablation zone and can reflect its evolution with time.

Additional diffusion-weighted imaging in the detection of new, very small hepatocellular carcinoma lesions after interventional therapy compared with conventional 3 T MRI alone.

AIM: To evaluate the added value of diffusion-weighted imaging (DWI) combined with conventional magnetic resonance imaging (MRI) in the detection of new, very small hepatocellular carcinoma lesions (≤1 cm) in patients with hepatocellular carcinoma following interventional therapy compared to conventional MRI alone. MATERIALS AND METHODS: After interventional therapy, 45 patients with hepatocellular carcinoma underwent conventional MRI and DWI with a b-value of 0 and 700 s/mm(2). Twenty-one new, small hepatocellular carcinoma lesions were confirmed in 16 patients at follow-up MRI. Two observers independently retrospectively analysed the two imaging sets in random order. The diagnostic performance using each imaging set was evaluated by received operating characteristic curve analysis. RESULTS: Twenty-one new, very small hepatocellular carcinoma lesions found in 16 patients was confirmed as the final result. The area under the receiver operating characteristic curve of the DWI/conventional MRI combination (observer 1, 0.952; observer 2, 0.976) and conventional MRI images alone (observer 1, 0.905; observer 2, 0.905) were statistically significant. The kappa value of the DWI/conventional MRI combination was 0.884, and that of conventional MRI was 0.722. Among the 21 lesions, 100% (21/21) of the lesions were both recognized by two independent reviewers on DWI, while only 76% (16/21) and 71% (15/21) of the lesions were regarded as very small hepatocellular carcinomas on conventional MRI. CONCLUSION: Due to the higher detection rate of new subcentimetre lesions in hepatocellular carcinoma patients following interventional therapy, DWI could be considered complementary to conventional MRI in the diagnosis of hepatocellular carcinoma.