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Objective:To analyze the risk factors of short-term recurrence of hepatocellular carcinoma (HCC) treated by transcatheter arterial chemoembolization combined with radiofrequency ablation (TACE-RFA), and to predict the short-term recurrence rate by establishing a nomogram model.Methods:The clinical data of patients with hepatocellular carcinoma treated with TACE-RFA at the PLA General Hospital from January 2010 to December 2019 were retrospectively analyzed. Of 125 patients who were included, there were 103 males and 22 females, aged (56.6±8.9) years old. Based on whether tumors had recurred within 12 months after treatment, the patients were divided into two groups: the recurrent group ( n=86) and the non-recurrent group ( n=39). The baseline conditions, tumor characteristics and preoperative laboratory examination resultss were collected and the patients were followed-up by outpatient reexaminations. Multivariate logistic regression analysis was used to study the risk factors of short-term recurrence. C-index, correction model and ROC curve were used to evaluate the model. Results:Multivariate logistics regression analysis showed that the neutrophil to lymphocyte ratio (NLR) >1.25 ( OR=2.87, P=0.048), albumin-γ-glutamyltransferase ratio (AGR)≤0.3 ( OR=3.40, P=0.043), incomplete tumor encapsulation ( OR=3.81, P=0.007) and maximum tumor diameter ( OR=1.98, P=0.003) were independent risk factors for short-term recurrence after TACE-RFA. Applying the above factors to construct the nomograph, the C-index was 0.767, the area under the curve was 0.77 (95% CI: 0.67-0.85), and the calibration curve had a good consistency. Conclusion:NLR>1.25, AGR≤0.3, incomplete tumor encapsulation and tumor maximum diameter were risk factors of short-term recurrence after TACE-RFA in patients with HCC. The nomogram model based on the above factors was of good value in predicting short-term recurrence after TACE-RFA.
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Unfortunately, most of HCC patients were diagnosed at the intermediate or advanced stage, losing the chance to receive the surgical intervention. Locoregional interventional treatment is one of the major therapeutic options for inoperable HCC treatment and prolongs the survival of the patients. Evaluation of the efficacy of the treatment is the important to determine the further therapy strategies. Currently, the evaluation of patients’ response is mainly based on CT and MR anatomic morphological images, but characteristics of tumor biology changes can be observed earlier than the morphological changes. In the recent years, with the development of diffusion weighted imaging (DWI), its value in clinical application has been continuously explored, and it has been increasingly used for quantitative evaluation the diffusion of water molecular and microcirculation perfusion of blood flow in tumor tissue, with some progress in evaluating the tumor response. This paper mainly reviewed the recent research findings of DWI on locoregional interventional treatment for HCC, thereby providing guidance on clinical practice.
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Objective:To study the predictive value of pretreatment apparent diffusion coefficient (ADC) on prognosis in patients with isolated large hepatocellular carcinoma(SLHCC) treated by combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA).Methods:A retrospective analysis was performed on 40 patients with SLHCC who were treated at the Department of Interventional Radiology, the First Medical Center of PLA General Hospital from December 2014 to July 2018, with combined TACE and RFA. There were 34 males and 6 females, with an average age of 55.9 years. All patients underwent enhanced abdominal MRI within 1 week before and 1 month after treatment. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy value of ADC. The survival curves were plotted by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate prognostic analyses were performed using the Cox proportional hazard models.Results:After treatment, there were 18 patients with complete response and 12 with partial response. The objective response rate was 75.0% (30/40). The area under ROC curve of ADC in predicting the effectiveness of TACE combined with RFA (complete response + partial response) was 0.86 (95% CI: 0.74-0.98). The optimal threshold was 1.32×10 -3 mm 2/s, the sensitivity was 0.63, and the specificity was 1.00. The progression-free survival rate and cumulative survival rate in the high ADC group (≥1.32×10 -3mm 2/s, n=19) were better than that in the low ADC group (<1.32×10 -3mm 2/s, n=21), with significant differences (both P<0.05). On multivariate analysis, ADC<1.32×10 -3mm 2/s ( HR=3.711, 95% CI: 1.705-8.074; P<0.05) was an independent risk factor for progression-free survival, while ADC < 1.32×10 -3mm 2/s ( HR=3.518, 95% CI: 1.016-12.185, P<0.05) was an independent risk factor for overall survival. Conclusion:Preoperative ADC was an independent risk factor for prognosis in patients with SLHCC undergoing TACE combined with RFA. It has value in prognostic prediction.
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Objective To investigate the value of the apparent diffusion coefficient (ADC)measurement in assessment of tumor grade and myometrial invasion of endometrial carcinoma (EC).Methods 80 EC patients and 28 cervical cancer patients with normal endometrium were studied retrospectively.1.5T conventional MRI and DWI (b=0,1 000 s/mm2)were performed,and ADC values were calculated by two radiologists.Statistical analyses were performed by using SPSS 19.0 and Medcalc software.Results The mean ADC values (×10-3mm2/s)were 0.851±0.131,0.752±0.099,0.681±0.089 for G1,G2 and G3 EC,respectively.Significant statistical differences were achieved for the three groups (G1 vs G2:P=0.005;G2 vs G3:P=0.03;G1 vs G3:P< 0.000 1).For the prediction of G3,the area under the curve (AUC)of 0.851 and the cut-off value of ≤0.742×10-3mm2/s were identified,with the sensitivity, specificity and accuracy of 88.24%,76.19% and 85%,respectively.Conclusion There are significant statistical differences between histologic grades of EC.ADC measurement may have the potential to select G3 EC patients.
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Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.
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Objective To assess the application of MRI in diagnosis of oblique vaginal septum syndrome (OVSS).Methods Clinical and imaging data of 41 patients with OVSS confirmed by surgery from March 2011 to November 2016 were retrospectively analyzed.Results The average age of patients was 20.5 year (10-46 years).The primary clinical symptoms were menorrhalgia (16 cases) and menorrhagia (13 cases).There were 12 cases of type Ⅰ,23 cases of type Ⅱ,5 cases of type Ⅲ and 1 case of type Ⅳamong 41 cases of OVSS.The resections for OVSS were performed in 35 cases.Forty two cases were diagnosed as OVSS by MRI scan,and 41 were confirmed by surgery,the accuracy of MRI diagnosis was 97.6％ (41/42).MRI showed uterus didelphys,hydrocolpos or hematocolpos with varying degrees,and revealed ipsilateral renal agenesis in all 41 cases.Conclusion MRI scan can accurately diagnose oblique vaginal septum syndrome and provide comprehensive information for clinical treatment.
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Magnetic resonance imaging (MRI) findings of 52 patients with septate uterus were retrospectively analyzed.There were 19 cases of complete septate uterus and 32 cases of partial septate uterus confirmed by hysteroscopy or hysteroscopy combined with laparoscopy,and 1 case without surgery.According to MRI findings,19 cases were diagnosed as complete septate uterus,32 cases as partial septate uterus and 1 case as intrauterine adhesion.The results indicated that MRIcan be used in diagnosis of septate uterus.
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0.05).DBP and DEHP obviously induced a decrease in organ body weight ratios of testis and epididymis and an increase in organ body weights ratios of liver.Obvious decrease in the sperm counts,spermatozoon survival rate and significant increase in the rate of the sperm deformation were observed.There was synergism between DBP and DEHP on the testis,epididymis and liver organ body weight ratio,as well as sperm counts,sperm survival and deformation rates.Pathological examination showed the seminiferous tubules were irregular shape,degenerative atrophy and interstitial substance broadening,and the seminiferous epithelium were degeneration.Epididymis epithelium was damaged and few of mature sperm was seen.Conclusion DBP combined with DEHP can cause obvious toxic effects on reproductive function in male rats.DBP and DEHP mixture can strongly affect the sperm quantity and quality.Also,some toxic effects to epididymis are observed.
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Objective To study the combined toxic effects of di-n-butyl phthalate(DBP)and di-2-ethylhexyl phthalate(DEHP)on sex hormone and lipid peroxidation in male rats.Methods According to 2?2 factorial analysis,thirty-two healthy and clean adult male SD rats were randomly divided into 4 groups,including a control group(given coin oil) and three experimental groups:DBP(1/20 LD50,1.0 g/kg,dissolved in coin oil),DEHP(1/20 LD50,1.7 g/kg,dissolved in coin oil) and DBP+DEHP(1.0 g/kg + 1.7 g/kg,dissolved in coin oil),8 rats in each group,through gavage,once a day,for 8 consecutive weeks.The spectrophotometric method was used to measure the activity of lipid peroxidation SOD,GSH and GSH-Px level in testis homogenate.The activities of ACP,AKP and ?-GT were assessed in testis homogenate.Radioimmunoassay was used to determine the testosterone,LH and FSH levels in the serum.Results There was synergism between DBP and DEHP on the SOD activity in testicle and testosterone level in serum,and there was antagonism between DBP and DEHP on the ?-GT and ACP activity in testicle,as well as the FSH level in serum.Conclusion DBP combined with DEHP can cause obvious toxic effects on reproductive function in male rats.The change of testosterone biosynthetic enzymes and the levels of T in serum and disordered physiologic balances of hypothalamic-pituitarytestis axis may be key factors contributing to the decrease of testosterone,then the decrease of reproductive function in male rats.