The Correlation Between Computed Tomography Volumetry and Prognosis of Advanced Gastric Cancer Treated with Neoadjuvant Chemotherapy.

PURPOSE: To investigate the feasibility and utility of computer tomography (CT) volumetry in evaluating the tumor response to neoadjuvant chemotherapy (NAC) in advanced gastric cancer (AGC) patients. PATIENTS AND METHODS: One hundred and seventeen Patients with AGC who received NAC followed by R0 resection between January 2006 and December 2012 were included. Tumor volumes were quantified using OsiriX software. The volume reduction rate (VRR) was calculated as follows: VRR = [(pre-chemotherapy total volume) - (post-chemotherapy total volume)]/(pre-chemotherapy total volume) × 100%. The optimal cut-off VRR for differentiating favorable from unfavorable prognosis was determined by receiver operating characteristic (ROC) analysis. Overall survival was calculated using Kaplan-Meier analysis and values were compared using the Log-rank test. Multivariate analysis was determined by the Cox proportional regression model. RESULTS: The optimal cut-off VRR was 31.95% according to ROC analysis, with a sensitivity of 70.4% and a specificity of 71.7%. Based on the cut-off VRR, patients were divided into the VRR-High (VRR ≥ 31.95%, n = 63) and VRR-Low (VRR < 31.95%, n = 54) groups. The VRR-Low group exhibited a worse prognosis than that of the VRR-High group (HR, 2.85; 95% CI, 1.69-4.82, P < 0.001), with 3-year survival rates of 40.7% and 79.4%, and 5-year survival rates of 31.5% and 63.5%, respectively. CONCLUSION: CT volumetry is a feasible and reliable method for assessing the tumor response to NAC in patients with AGC.

Management of biochemical recurrence after radical prostatectomy for prostate cancer: A case report.

RATIONAL: How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Multiple disciplinary team (MDT) mechanism may propose an appropriate treatment plan for patients and can effectively improve patient prognosis and survival, reduce patient diagnosis and treatment waiting time, and greatly improve patient satisfaction. PATIENT CONCERNS: Here, we presented a case of a 77-year-old man with a persistently elevated serum level of prostate-specific antigen (PSA), who had a history of radical prostatectomy (RP) and of 9 years endocrine therapy. DIAGNOSES: Castration-resistant prostate cancer and locally recurrent prostate cancer. INTERVENTIONS: Androgen-deprivation therapy was first utilized 2 months after RP, due to the consideration of BCR on May 5, 2007. And during the next 9 years, he was treated with different endocrine agents but failed to maintain serum levels of PSA stable. Finally, the MDT suggested patient to perform salvage radiation therapy (SRT). Under MDT mechanism, we avoid secondary surgery, so as to reduce the patients' mental suffering and cost of patient care. OUTCOMES: EPIC26 scale assessment revealed leak-free urine, good urine control, no defecation abnormalities or blood in the stool, no breast tenderness and breast enlargement significantly improved. The patient now has no adjuvant therapy, including endocrine therapy. The patient achieved good prognosis through local RT. LESSONS: Pelvic SRT for patients with locally recurrent PCa may restore the same radical effect as RP. And more importantly, MDT mechanism plays an important role in making the most appropriate decisions for patients.

Trends in Treatment for Prostate Cancer in China: Preliminary Patterns of Care Study in a Single Institution.

Objectives: A Patterns of Care Study (PCS) was performed in the largest regional medical center in Zhejiang Province, China. The hospital information system (HIS) was used to evaluate patient characteristics and changes in initial treatment patterns for prostate cancer and to determine recent predominant trends in treatment plans for prostate cancer (PCa) in China. Methods: Men who were newly diagnosed with localized or locally advanced PCa for 2010-2011 and 2016-2017 were identified in the HIS database. Patient characteristics and temporal trends in initial management were assessed, and differences between groups were evaluated for significance using Chi-square and Mann-Whitney U tests. Results: In total, 1792 patients met the study criteria, including 505 and 1287 patients in the 2010-2011 and 2016-2017 samples, respectively. The average age of patients diagnosed in the 2010-2011 PCS survey was 70 years, decreasing to 68 years when the 2016-2017 patients were included (P<0.001). In the 2010-2011 sample, 50.69% of the patients had an initial prostate-specific antigen (PSA) level ≥20 ng/ml. In contrast, the initial PSA level was 4-19.99 ng/ml for 66.67% of the patients in the 2016-2017 sample (P<0.001). Based on National Comprehensive Cancer Network (NCCN) criteria, the percentages of patients in low- and intermediate-risk groups increased from 33.06% to 54.78%; conversely, the percentages in high-risk, very high-risk, and regional (N1) groups decreased to a certain extent (P<0.001). According to European Association of Urology (EAU) criteria, the percentages of patients in low- and intermediate-risk groups increased from 32.07% to 53.69%, yet the percentage in the high-risk group decreased (P<0.001). The use of radical prostatectomy (RP) and radiation therapy (RT) increased from 48.32% to 76.46% and 5.35% to 16.94%, particularly in high-risk and low-risk groups, respectively, whereas the rates of hormone therapy (HT) and active surveillance and observation (AS&O) decreased from 32.28% to 4.27% and from 16.04% to 2.33%, respectively (P<0.001). A similar pattern was observed when patients were stratified by EAU risk group. Conclusions: The results of this real-world study in the largest regional medical center in Zhejiang Province, China, indicate that the predominant characteristics of PCa patients and trends in initial management are changing rapidly. We found the following: (a) a trend toward a decreased age among newly diagnosed patients; (b) a trend toward lower initial PSA levels; (c) a downward trend in risk group classification; (d) a significant increase in the likelihood of receiving RP, particularly in the high-risk group; (e) an increase in the rate of RP, mostly due to use of the Da Vinci robotic system; (f) a significant increase in the likelihood of receiving RT, especially in the low-risk group; and (g) a decrease in HT and AS&O.

Clinical application of computed tomographic angiography in patients with renal arterial hemorrhage: Diagnostic accuracy and subsequent therapeutic outcome.

The aim of the present study was to determine the accuracy of multi-section computed tomographic angiography (CTA) for the diagnosis of renal arterial h=emorrhage in comparison with digital subtraction angiography (DSA) and the effect of diagnostic outcome on therapeutic patient management. A retrospective analysis was conducted of the records of all patients undergoing DSA for acute renal hemorrhage between August 2005 and June 2014. A total of 74 patients were identified in whom CTA was performed prior to the DSA. DSA detected a renal arterial lesion in 68 cases and no bleeding was demonstrated in 6 cases. CTA correctly identified the bleeding site in 59 of the 68 DSA-positive cases. There were 14 patients with negative CTA results that underwent DSA after 2-10 days because of persistent hematuria, and 9 of them were found to have positive DSA results. The sensitivity, specificity, positive predictive value and negative predictive value of CTA for the detection of arterial lesions in the context of acute renal hemorrhage were 0.868, 0.833, 0.983 and 0.357, respectively. All patients with bleeding sites identified by DSA underwent superselective embolization in a single session. Five patients underwent a secondly embolization for recurrent hemorrhage. These results indicate that CTA is an accurate technique for the detection of major arterial hemorrhage and supports its use in the initial examination of these patients.

Diagnostic Accuracy of Noncontrast CT in Detecting Acute Appendicitis: A Meta-analysis of Prospective Studies.

The aim of the study is to evaluate the diagnostic accuracy of noncontrast CT in detecting acute appendicitis. Prospective studies in which noncontrast CT was performed to evaluate acute appendicitis were found on PubMed, EMBASE, and Cochrane Library. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were assessed. The summary receiver-operating characteristic curve was conducted and the area under the curve was calculated. Seven original studies investigating a total of 845 patients were included in this meta-analysis. The pooled sensitivity and specificity were 0.90 (95% CI: 0.86-0.92) and 0.94 (95% CI: 0.92-0.97), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 12.90 (95% CI: 4.80-34.67), 0.09 (95% CI: 0.04-0.20), and 162.76 (95% CI: 31.05-853.26), respectively. The summary receiver-operating characteristic curve was symmetrical and the area under the curve was 0.97 (95% CI: 0.95-0.99). In conclusion, noncontrast CT has high diagnostic accuracy in detecting acute appendicitis, which is adequate for clinical decision making.

[Renal artery computed tomography angiography for the application of severe bleeding after PCNL].

OBJECTIVE: To evaluate the clinical values of computed tomography angiography (CTA) for severe hemorrhage after percutaneous nephrolithotomy (PCNL). METHODS: A total of 50 patients with bleeding after PCNL were enrolled. All patients underwent renal artery CTA. There were 34 males and 16 females with an average age of 45.7 years. Left (n = 31) and right (n = 19) sides were affected. The criteria of severe bleeding included a one-off amount of bleeding over 400 ml after PCNL or/and hemoglobin decreased 20 g/L after PCNL. RESULTS: Among them, CTA showed pseudoaneurysm (n = 24), arteriovenous fistula (n = 6), suspicious bleeding spot (n = 4) and no obvious bleeding spot (n = 16). And 24 pseudoaneurysm and 6 arterovenous fistula patients underwent digital subtraction angiography (DSA) immediately. The bleeding spots were successfully intervened and coil embolization treatment was performed. Three of 4 suspicious bleeding cases had rebleeding mini-pseudoaneurysms. The remaining one case of rebleeding was successfully controlled by conservative measures. CONCLUSION: Renal artery CTA is the first-line screening technique for severe bleeding after PCNL. But for arterial hemorrhage patients, DSA examination may be directly conducted.

[Interventional treatment of massive hemorrhage after percutaneous nephrolithotomy].

OBJECTIVE: To explore the diagnostic and therapeutic measures of massive hemorrhage after percutaneous nephrolithotomy (PCNL) unresponsive to conservative treatment. METHODS: The clinical data of 36 cases of massive hemorrhage occurring after PCNL from January 2010 to January 2014 at our hospital were analyzed. There were 21 males and 15 females with an average age of 46.7 years. There were left (n = 22) and right (n = 14) cases. Severe hemorrhage had an average onset of Days 3-4 (range, 1 to 7) after PCNL. Clinical manifestations included a drainage of fresh red blood liquids out of kidney fistula accompanied by red gross hematuria. Conservative measures were ineffective. RESULTS: On computed tomography angiography (CTA), pseudoaneurysm (n = 22) and arteriovenous fistula (n = 5) were found. Digital subtraction angiography (DSA) and coil embolization were successfully performed in 27 cases whose hemorrhage stopped in 1-3 days after embolization and kidney function returned to normal. Another 9 cases had no obvious hemorrhage on CTA. And venous hemorrhage was considered and conservative treatment succeeded. CONCLUSIONS: Renal arterial CTA is an ideal for assessing massive hemorrhage after PCNL unresponsive to conservative treatment. DSA and coil embolization are the preferred treatments.

[Clinicopathological characteristics and imaging features of pulmonary adenocarcinoma with micropapillary pattern].

OBJECTIVE: To explore the clinicopathological characteristics and imaging features of lung adenocarcinoma with a micropapillary pattern (MPP). METHODS: Eighty cases of pulmonary adenocarcinoma with a micropapillary pattern treated in our hospital from July 2011 to December 2012 were selected to retrospectively analyze their clinicopathological characteristics and imaging features. RESULTS: Among the 80 cases of lung adenocarcinoma with MPP, there were 38 cases of stage I (47.5%), 12 cases of stage II (15.0%), 25 cases of stage III (31.3%) and 5 cases of stage IV (6.2%). There were 14 cases of moderately differentiated (17.5%) and moderately/poorly differentiated (82.5%) tumors. Sixty-three cases had pleural involvement, vascular invasion, involving the bronchial wall, invasion of large vessels, nerve invasion, and lymph node metastasis (at least one of them) (78.8%). Immunohistochemical staining revealed that both positive rates of TTF-1 and CK7 were 100%, and that of pulmonary surfactant apolipoprotein-A (SPA) was 84.0%. Imaging examination revealed hilar or mediastinal lymph node enlargement in 15 cases (18.8%). but the pathology confirmed hilar or mediastinal lymph node metastasis in 36 cases (45.0%). Lung CT imaging showed that the majority of the cases were peripheral type, and only a few of central type, and most cases were solid lesions, with lobulation, spiculation, pleural indentation, and vascular convergence sign, while there were few ground-glass opacity sign and vacuole sign. CONCLUSIONS: Lung adenocarcinoma with MPP component often presents with early invasions of pleura, blood vessels, lymphatic vessels, and lymph nodes. Imaging manifestation of this cancer mainly shows as peripheral and solid lesions, often with lobulation, spiculation, pleural indentation, vascular convergence sign, but GGO and vacuole signs are unusual. Overexpression of TTF-1, CK7 and SPA, and elevated CEA level are associated with clinical staging of the disease.

Embolization of renal artery pseudoaneurysm following laparoscopic partial nephrectomy for central renal tumor: A report of two cases.

Laparoscopic partial nephrectomy has recently emerged as a minimally invasive treatment for small- to moderate-sized renal tumors. Renal artery pseudoaneurysms (RAPs) have been well-reported in patients with renal trauma or who have undergone percutaneous urological procedures, including biopsy, nephrostomy and percutaneous nephroureterolithotomy. However, RAP following laparoscopic partial nephrectomy for central renal tumor is a rare but serious, potentially life-threatening complication. In total, two patients underwent laparoscopic partial nephrectomy at The First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) for central renal tumors that had developed gross hematuria several weeks following the surgical procedures. The formation of RAPs was confirmed by contrast-enhanced computed tomography scans. Superselective embolizations of the renal artery branches were successfully performed to treat these two patients. In the current report, the etiology, diagnosis and management of RAPs are discussed.

[CT and MRI findings in patients with autoimmune pancreatitis].

OBJECTIVE: To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings in patients with autoimmune pancreatitis (AIP). METHODS: The imaging findings of pancreas and extra-pancreas in 24 patients with AIP were retrospectively reviewed. Among them, CT scan was performed in 18 patients, MRI in 11, and bGth CT and MRI in 10. RESULTS: The pancreas showed diffuse enlargement (25%, 6/24), focal enlargement (37. 5%, 9/24), combined enlargement (25%, 6/24) ,and no enlargement (12. 5%, 9/24). Unenhanced CT showed hypoattenuation in AIP area (n = 2) . After intravenous injection of contrast medium, 17 patients showed abnormal contrast enhancement in the affected pancreatic parenchyma, including hypoattenuation during the arterial phase (50%, 9/18) and hyper attenuation during the delayed phase (94. 4%, 17/18). Precontrast MRI showed abnormal signal intense (n =9), including hypointense on T1-weight images (T1 WI) (n = 7), hyperintense (n = 7) and hypointense (n = 2) on T2-weight images (TIWI). Enhanced MRI demonstrated abnormal contrast enhancement within lesions (n = 11), including hypoattenuation during the arterial phase (81. 8%, 9/11) and good enhancement during the delayed phase (100%, 11111). A capsule-like rim was seen around pancreas (37. 5%, 9/24), among which CT detected in 6 out of 18 patients and MRI found in 7 out of 11 patients.The main pancreatic duct lumen within lesions has no visualization (100%, 24/24) and upstream dilation of the main pancreatic duct (n = 8) , ranging from 2. 2 to 4. 5 mm(mean 3. 1 0. 47 mm) in diameter. Narrowing of the common bile duct was shown in 14 patients. Miscellaneous findings were: infiltration of extrapancreatic vein (n = 9) and artery (n = 1); mild fluid collection around pancreas (n = 2); pseudocysts (n = 3). Fourteen patients also presented one or more of the following extrapancreatic imaging findings: narrowing of the intra-hepatic bile duct or hilar duct (n = 5); thickening of gallbladder wall (n = 5); fibrosis in mesenteric (n = 2), in retroperitoneal (n = 2) and in ligamentum teres hepatis (n = 1); renal involvement (n = 3); peri-pancreatic or para-aortic lymphadenopathy (n = 10); and ulcerative colitis (n = 3). CONCLUSION: AIP display some characteristic CT and MRI imaging features: sausage-like change of the pancreas; capsule-like rims around lesions; delayed contrast enhancement in the affected pancreatic parenchyma; segment or diffuse pancreatic duct stenosis but mild upstream dilation and extrapancreatic organs involvement. CT and MRI findings combining with serological tests and pancreas biopsy can assist physicians to make accurate and timely diagnosis.

Isolated inverting papilloma of the sphenoid sinus: clinical presentations, imaging manifestations, and therapeutic strategies.

BACKGROUND: Isolated inverting papilloma (IP) of the sphenoid sinus is rare, with about 50 patients reported in the English-language literature. With its rarity, scientists have paid less attention to the clinical and radiographic characteristics of isolated IPs arising from the sphenoid sinus. METHODS: We describe the clinical presentation, imaging manifestations, and surgical methods of isolated IPs from the sphenoid sinus in 3 patients and review the English-language literature from 1970 to 2011. RESULTS: In total, 59 cases of isolated sphenoid sinus IPs (including our cases) have been reported, 40 patients with computed tomography or magnetic resonance imaging details. The most common presentation is headache. Lesions were found in the sphenoethmoidal recess in 26 cases. In 8 patients who underwent enhanced magnetic resonance imaging, the tumor was obviously intensified. We found 26 patients with bony destruction, and 8 lesions revealed the correct tumor origin. CONCLUSIONS: A polyp-like mass in the sphenoethmoidal recess strongly implied the diagnosis of an IP in the sphenoid sinus. Bony destruction on computed tomography is a common characteristic of this disease and had a close relationship with the original tumor site in our study. Malignant transformation of IPs in the sphenoid sinus is much scarcer.

Small intestinal lipomas: diagnostic value of multi-slice CT enterography.

AIM: To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography (CT) enterography. METHODS: Fourteen cases (one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed. The location, size, clinical and radiological aspects were discussed. RESULTS: Twelve patients presented with abdominal pain, of whom three complained of paroxysmal colic. Melena or bloody stools was mentioned in five cases. One lesion was detected incidentally during routine physical examination. One lesion was found unexpectedly during the preoperational evaluation for cholecystitis. Examination of the abdomen revealed palpable masses in four cases. Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from -130 HU to -60 HU. On contrast enhancement CT scan, no striking enhancement was seen. CONCLUSION: The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations, while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.

Diagnosis of obscure gastrointestinal hemorrhage with capsule endoscopy in combination with multiple-detector computed tomography.

AIM: To demonstrate the clinical efficacy of combination capsule endoscopy (CE) and multiple-detector computed tomography (MDCT) diagnostic imaging in the identification of gastrointestinal hemorrhages. METHODS: In the present study, 123 patients with gastrointestinal hemorrhages of obscure origin (GHOO) were examined with CE in combination with MDCT. The results were compared with findings of surgical pathology. RESULTS: Of the 123 patients, 57.72% (71/123) of the patients exhibited positive CE findings compared with 30.08% (37/123) on MDCT alone (P < 0.01). When used in combination, 65.85% (81/123) of patients scored positively. The detection rate due to the combination of diagnostic imaging was significantly higher than that of MDCT alone (P < 0.01), but was not significantly higher than that of CE alone (P > 0.05). Integrating the two diagnostic platforms improved the diagnosis of stromal tumors, hemangioma, Crohn's disease, vascular anomaly, Meckel's diverticulum, and ancylostomiasis. There was no significant difference in the positive detection rate between CE and MDCT when confirmed by surgical pathology. CONCLUSION: The contribution of CE is critical in the diagnosis of GHOO, given the fact that there is a significant difference in the detection rate between CE and MDCT, but there is no significant difference in the rate between CE plus MDCT and CE alone.

[A clinical study on the diagnostic value of capsule endoscopy and multiple-detector computer tomography in obscure gastrointestinal bleeding].

OBJECTIVE: To evaluate the diagnostic value of capsule endoscopy (CE) and multiple-detector computer tomography (MDCT) in obscure gastrointestinal bleeding. METHODS: The diagnostic value of CE was compared with that of MDCT in patients with obscure gastrointestinal bleeding. 60 patients (35 men, 25 women; mean age 53.8 years, range 17 - 84 years) with obscure gastrointestinal bleeding were enrolled in the study. All underwent gastroscopy and colonoscopy, but definite diagnosis was not made, then all of them underwent MDCT followed by CE. RESULTS: Natural excretion of the capsule occurred in 58 (96.7%) patients. CE identified positive findings in 36 (60.0%) patients and MDCT identified positive findings in 23 (38.3%) patients, P < 0.01. One patient was found to have 2 lesions simultaneously with CE. CE combined with MDCT identified positive findings in 40 (66.7%) patients. When this result was compared with that of CE, P > 0.05; whereas, compared with MDCT, P < 0.01. 28 patients underwent operations at last; the lesions accounting for bleeding all located in small intestine (16 in jejunum, 12 in ileum). CONCLUSIONS: Diagnostic yield of CE was higher than that of MDCT in patients of obscure gastrointestinal bleeding. Combining CE with MDCT did not increase the diagnostic yield in obscure gastrointestinal bleeding. However, MDCT showed more extraintestinal lesions, it is suggested that patients with obscure gastrointestinal bleeding be examined not only with CE but also MDCT.

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.