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Background and Purpose:Accurate differentiation of pancreatic ductal adenocarcinoma(PDAC)from mass-forming chronic pancreatitis(MFCP)is clinically significant.The application of dual-layer spectral detector CT(DLCT)in pancreas has been explored.This study aimed to investigate the value of DLCT in distinguishing resectable PDAC from MFCP.Methods:We retrospectively collected data of 33 patients with resectable PDAC and 19 patients with MFCP admitted to Fudan University Shanghai Cancer Center from September 1,2021 to May 31,2023.Prior to surgery,patients underwent enhanced DLCT scans,including arterial phase(AP),parenchymal phase(PP)and venous phase(VP).DLCT quantitative parameters,including attenuation enhancement fraction(AEF),lesion-to-parenchyma ratio(LPR)and iodine enhancement fraction(IEF)were calculated.Difference analysis was conducted using independent sample t-test or chi-square test.Univariate and multivariate analyses were performed using binary logistic regression.Receiver operating characteristic(ROC)curves were used for performance evaluation.P＜0.05 was considered statistically significant.Results:Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP,LPR40_VP,IEF_PP/VP,carbohydrate antigen 19-9(CA19-9)and double-duct sign(all P＜0.05).The spectral combined model composed of LPR40_VP and IEF_PP/VP exhibited the best discriminatory efficacy,surpassing CA19-9,double-duct sign and AEF_AP/PP(all P＜0.05).The combined model demonstrated an area under curve(AUC)of 0.841,sensitivity of 90%,specificity of 73%,and accuracy of 79%.Conclusion:DLCT has certain potential in differentiating resectable PDAC from MFCP.Spectral quantitative parameters can complement CA19-9 and outcome shortcomings of conventional CT in distinguishing resectable PDAC from MFCP.
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Objective:To investigate the value of nomogram constructed by CT-based radiomics for differentiating benign and malignant thyroid follicular neoplasms.Methods:Totally 200 post-surgery patients with pathologically confirmed thyroid follicular neoplasms in Fudan University Shanghai Cancer Center from January 2016 to December 2018 were retrospectively analyzed. Among the patients, 46 were follicular thyroid carcinoma (FTC) and 154 patients were follicular thyroid adenoma (FTA). The patients were randomly divided into a training set ( n=140) and validation set ( n=60) using a random number table. CT signs and radiomics features of each patient were analyzed within the LIFEx package. A predictive model was developed by the least absolute shrinkage and selection operator regression to build a nomogram based on selected parameters. The predictive effectiveness of differentiating benign and malignant thyroid follicular neoplasms was evaluated by the area under receiver operating characteristic curve (AUC). Calibration plots were formulated to evaluate the reliability and accuracy of the nomogram based on internal (training set) and external (validation set) validity. The clinical value of the nomogram was estimated through the decision curve analysis. Results:The prediction nomogram was built with 4 selected parameters, including grey level zone length matrix (GLZLM)-gray-level zone length matrix_zone length non-uniformity, GLZLM-gray-level zone length matrix_low gray-level zone emphasis, CONVENTIONAL_HUQ3, CONVENTIONAL_HUmean. In training and validation sets, the AUCs for differentiating FTC and FTA were 0.863 (95%CI 0.746-0.932), 0.792 (95%CI 0.658-0.917), accuracy were 87.9% and 75.0%, sensitivity were 67.9% and 66.7%, specificity were 91.1% and 90.5%, respectively. The calibration curves indicated good consistency between actual observation and prediction for differentiating the malignancy. Decision curve analysis demonstrated the nomogram was clinically useful.Conclusions:The CT radiomics mode shows the certain value and great potential to identify benign or malignant thyroid follicular neoplasms and the nomogram can accurately and intuitively predict the malignancy potential in patients with thyroid follicular neoplasms.
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Objective:To investigate the value of CT-radiomics based machine learning model in predicting the abundance of tumor infiltrating CD8 +T cells and the prognosis of pancreatic cancer patients. Methods:A total of 150 pancreatic cancer patients who underwent surgical excision and confirmed by pathology from Fudan University Shanghai Cancer Center between December 2011 and January 2017 were retrospectively enrolled. The patients were randomly divided into the training set ( n=105) and the validation set ( n=45) in a 7∶3 ratio with simple random sampling. The immunohistochemical method was used to assess the abundance of tumor infiltrating CD8 +T cells, and the patients were then divided into high infiltrating group ( n=75) and low infiltrating group ( n=75) according to the median. The prognosis between the 2 groups was evaluated using Kaplan-Meier method and log-rank test. Radiomic features were extracted from preoperative venous-phase enhanced CT images in the training set. The Wilcoxon test, the max-relevance and min-redundancy algorithm were used to select the optimal feature set. Three supervised machine learning models (decision tree, random forest and extra tree) were established based on the optimal feature set to predict the abundance of tumor infiltrating CD8 +T cells. Performance of above-mentioned models to predict the abundance of tumor infiltrating CD8 +T cells in pancreatic cancer was tested in the validation set. The evaluation parameters included area under the receiver operating characteristic curve (AUC), F1-score, accuracy, precision and recall. Results:The median overall survival time of patients in high infiltrating group and low infiltrating group were 875 days and 529 days, respectively (χ2=11.53, P<0.001). The optimal feature set consisted of 10 radiomic features in training set. In the validation set, the decision tree, random forest and extra tree model showed the AUC of 0.620, 0.704 and 0.745, respectively; corresponding to a F1-score of 0.457, 0.667 and 0.744, the accuracy of 57.8%, 68.9% and 75.6%, the precision of 66.7%, 73.7% and 80.0%, the recall of 34.8%, 60.9% and 69.6%. Conclusions:Pancreatic cancer patients with high tumor infiltrating CD8 +T cells have better prognosis than those with low tumor infiltrating CD8 +T cells. The radiomics-based extra tree model is valuable in predicting the CD8 +T cells infiltrating level in pancreatic cancer.
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Objective To discuss the influence of temperature-holding nursing in the anesthesia and stress state during the recovery period of general anesthesia for patients with thoracoscopic lung surgery. Methods 120 patients with thoracoscopic lung surgery underwent the general anesthesia from January 2017 to July 2018 in our hospital were selected and randomly assigned to two groups, 60 cases in each group. At the recovery period, the control group was treated with conventional nursing; the observation group was treated with conventional nursing and temperature-holding nursing. At each time period, the body temperature, stress response and postoperative rehabilitation conditions were probed. Results At the end of the operation 30 minutes, 60 minutes and the end of the operation, the body temperature of the observation group was (36.39 ± 0.34)°C, (36.50 ± 0.38)°C, (36.56 ± 0.38)°C, and the control group was (35.49 ± 0.31)°C, (35.63 ± 0.41) °C, (36.17 ± 0.52)°C, the difference between the two groups was statistically significant (t=15.15, 12.01, 4.69, P<0.05). NE was (279.3 ± 87.4)ng/L, (321.5 ± 110.6)ng/L, (363.5±108.2) ng/L at 30 min, 60 min, and end of surgery. E was (342.5±81.6)ng/L, (320.2± 59.4)ng/L, (169.4±54.2)ng/L at 30 min, 60 min, and end of surgery. NE in the control group were (244.8± 87.5)ng/L, (390.8±98.6)ng/L, (469.7±97.7)ng/L, and E was (129.5±39.6)ng/, (187.0±51.3) ng/L, (327.6 ± 68.9) ng/L, and he difference between the two groups was statistically significant (t=2.161~13.979, P<0.05).The operation time, the postoperative retention time of PACU, the complete recovery of consciousness and the time of removal of tracheal catheter in the observation group were (65.93±21.94) min, (32.85±3.22) min, (18.60±5.26) min, (24.19±6.73) min, respectively. The groups were (87.52±18.42) min, (50.06 ± 4.27) min, (26.54 ± 4.81) min, (32.40 ± 8.05) min, and the difference between the two groups was statistically significant (t=5.838~24.927, P<0.05). Conclusion The temperature-holding nursing can improve the recovery conditions and reduce the stress response for patients with thoracoscopic lung surgery. It is worthy of clinical promotion.
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Objective@#To discuss the influence of temperature-holding nursing in the anesthesia and stress state during the recovery period of general anesthesia for patients with thoracoscopic lung surgery.@*Methods@#120 patients with thoracoscopic lung surgery underwent the general anesthesia from January 2017 to July 2018 in our hospital were selected and randomly assigned to two groups, 60 cases in each group. At the recovery period, the control group was treated with conventional nursing; the observation group was treated with conventional nursing and temperature-holding nursing. At each time period, the body temperature, stress response and postoperative rehabilitation conditions were probed.@*Results@#At the end of the operation 30 minutes, 60 minutes and the end of the operation, the body temperature of the observation group was (36.39±0.34)°C, (36.50±0.38)°C, (36.56±0.38)°C, and the control group was (35.49±0.31)°C, (35.63±0.41) °C, (36.17±0.52)°C, the difference between the two groups was statistically significant (t=15.15, 12.01, 4.69, P<0.05). NE was (279.3±87.4)ng/L, (321.5±110.6)ng/L, (363.5±108.2) ng/L at 30 min, 60 min, and end of surgery. E was (342.5±81.6)ng/L, (320.2±59.4)ng/L, (169.4±54.2)ng/L at 30 min, 60 min, and end of surgery. NE in the control group were (244.8±87.5)ng/L, (390.8±98.6)ng/L, (469.7±97.7)ng/L, and E was (129.5±39.6)ng/, (187.0±51.3) ng/L, (327.6 ±68.9) ng/L, and he difference between the two groups was statistically significant (t=2.161~13.979, P <0.05).The operation time, the postoperative retention time of PACU, the complete recovery of consciousness and the time of removal of tracheal catheter in the observation group were (65.93±21.94) min, (32.85±3.22) min, (18.60±5.26) min, (24.19±6.73) min, respectively. The groups were (87.52±18.42) min, (50.06±4.27) min, (26.54±4.81) min, (32.40±8.05) min, and the difference between the two groups was statistically significant (t=5.838~24.927, P<0.05).@*Conclusion@#The temperature-holding nursing can improve the recovery conditions and reduce the stress response for patients with thoracoscopic lung surgery. It is worthy of clinical promotion.
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Objective To investigate the imaging features of epidermoid cyst within intrapancreatic accessory spleen (ECIPAS) to make benefits for differential diagnosis of pancreatic lesions. Methods We retrospectively reviewed the clinicalradiological and pathological data of 7 patients with pathologically confirmed ECIPAS. All the cases underwent plain and contrast enhanced CT scan, 2 cases underwent magnetic resonance cholangiopancreatography (MRCP), and 5 cases underwent ultrasonic examination. The imaging features of the lesions were analyzed. Results CT showed that 5 lesions were situated in the pancreatic tail while the other two located in the neck.The mean size of the lesions was (2.8± 1.2) cm,ranging from 1.5 to 4.8 cm. The cysts appeared multiocular in 2 cases. On plain CT, 2 cases showed well?defined low density foci, while 2 cases showed slightly high density. Calcification can be found in 2 cases. In 4 cases, the solid component surrounding the cyst displayed progressive enhancement on postcontrast CT. The enhancement was higher than the pancreatic parenchymaand similar to the spleen during both arterial and portal venous phases. On MRCP,no expansion was shown in pancreatic duct andit had no relationship with cyst in both 2 cases while slightly hypointensity could be found at the back and it pancreatic neck and body in 1 case. Five lesions were hypoechoic or anechoic and irregular?shaped on ultrasound. Conclusion ECIPAS is a rare benign lesion and the typical imaging manifestation is a cyst with surrounding solid component with enhancement similar to the spleen while higher than pancreas.
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Background and purpose:Primary thyroid lymphoma (PTL) is uncommon in clinic with quite different treatment from that of other malignant thyroid tumors. Therefore, to achieve complete understanding of PTL has crucial signiifcance. This study aimed to investigate the clinical and computed tomography (CT) characteristics of PTL.Methods:The clinical and imaging data from 22 patients with PTLs conifrmed by pathology were collected. The clinical symptoms of patients, the site, size, shape, margin, CT value and enhancement pattern, relation with surround-ing tissues of PTLs and cervical lymph nodes were summarized retrospectively.Results:All the 22 patients including 8 males and 14 females had an average age of 60 years (range: 39-77 years). Twelve PTLs rapidly progressed in short term and the rest expanded slowly. The tumors involved bilateral thyroid in 11 cases, unilateral thyroid in 8 cases and both right lobe and isthmus in the remaining 3 cases. The long and short ranges were (12-104) mm and (11-71) mm. The solitary, multiple and diffuse nodules distributed in 5, 5 and 12 patients, respectively. In axial plain CT scans, low density appeared in 15 patients, isodensity in 7 patients, calciifcation inside the lesion in 0 patient, and necrosis in 5 patients. Nineteen PTLs manifested slight or moderate enhancement, and 3 marked enhancement in contrast-enhanced axial CT images. Homogeneous density and mixed density were demonstrated in 13 and 9 cases, respectively. Trachea and esophagus was pushed in 17 and 5 cases, tumors were involved into superior mediastinum in 12 cases and enlarged lymph nodes were demonstrated in 8 cases.Conclusion:If a solid thyroidal mass in an old female patient rapidly pro-gresses in short term and CT scans show homogeneous and low density, slight or moderate enhancement, and diffusive swelling with compression and invasion of surrounding tissues, it has a high possibility of PTL.
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OBJECTIVE To describe the clinical, CT or MRI, pathological characteristics of desmoplastic fibroblastoma for helping the diagnosis and treatment. METHODS The clinical data of 4 cases with desmoplastic fibroblastoma were retrospectively analyzed. RESULTS The tumors of all 4 cases were found in the compartment of muscles, and can be removed by conservative excision. The 4 cases were followed up for 38, 7, 6, 3 months respectively, and no local recurrences were found. CONCLUSION Desmoplastic fibroblastoma is a benign fibroblastic neoplasm with distinctive clinical, CT or MRI imaging and pathological characteristics. Optimal management is conservative excision with functional preservation. Needle aspiration cytology and immunohistochemistry are of non-diagnostic value.
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Background and purpose:Parotid gland is rich in fat and has obvious contrast with bone and muscle in CT image.The preoperative examination of CT could help to evaluate the scale of tumor invasion and the relationship between tumor and normal tissues so that the proper therapy could be properly designed.The purpose of this study was to evaluate the roles of computer tomography(CT)in differential diagnosis of benign and malignant parotid tumors and to improve the diagnostic accuracy.Methods:CT images of 17 patients with benign parotid tumors and 15 patients with malignant parotid tumors proved by pathology were analyzed retrospectively.All patients underwent CT contrast-enhanced examination preoperatively.Images of all patients were retrospectively reviewed by two experienced radiologists in the diagnosis of head and neck tumors.Results:14 of 17 cases of benign tumors had round shapes and 9 of 15 cases of malignant tumors exhibited lobular or irregular masses(P
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Purpose:To investigate the detection ability of CT and MRI in skull base invasion in nasopharyngeal carcinoma. Methods:Sixty patients with nasopharyngeal carcinoma were examined by plain CT scan at axial sections and MRI of T_(1)WI at axial , coronal and sagittal sections and T_(2)WI at axial sections fast spin echo (FSE). Results:The overall positive rates of skull base invasion detected by CT and MRI were 16.7% and 53.3%(?~2 Test,P
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Purpose:To investigate the values of three newer contrast enhanced MRI sequences including gadolinium-enhanced FLAIR MRI(CE FLAIR), dynamic contrast-enhanced MRI (DCE MRI) and perfusion- weighted MRI(PWI) by comparing their advantages and disadvantages respectively in the diagnosis of intracranial tumors. Methods:43 patients with intracranial tumors underwent DCE MRI, CE FLAIR and PWI respectively. The gadolinium-enhanced FLAIR, dynamic enhanced MR and perfusion-weighted MR images were evaluated independently by two radiologists for the number of examinations with one or more enhancing lesions, the number and location of enhancing lesions per examination, the detectability for different lesions in different locations, size and extent of the lesions. Results:Perfusion-weighted MR images showed poor quality and could not give a diagnosis in 5 of 43 cases because of heavy susceptibility artifacts. There were 47 lesions in the 38 cases. However, 41 lesions were found on CE FLAIR MR images and 42 on DCE MRI and 45 on PWI. 3 lesions(2 located in the subcortical area and 1 in paraventricle) were only revealed on the CE FLAIR images. 4 lesions in the basal ganglia area were only found on dynamic enhanced images. 7 lesions in the cerebral hemisphere were only found on perfusion-weighted images. So there were significant differences in revealing lesions of different locations with the three MR modalities(P
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0.05). Four lesions were only revealed on CE FLAIR whereas 7 lesions were only found on postcontrast T_1WI. Enhancing lesions located in cerebral hemisphere or the forth ventricle was revealed much more on T_1WI than that on CE FLAIR. However, postcontrast fast FLAIR images may be useful in detecting superficial abnormalities and those located in sulcus or lateral ventricle. The enhancement degree of enhanced T_1WI was much more intense than that of CE FLAIR(P0.05) and statistical significance in GWC, CNR and CER(P
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Objective To observe the findings of 1H magnetic resonance spectroscopy ( 1H MRS) and explore its value for diagnosis of radiation induced-temporal lobe necrosis in nasopharyngeal carcinoma (NPC). Methods Thirteen patients with definite clinical diagnosis of radiation induced temporal lobe necrosis in NPC underwent 1H MRS. All 1H MRS examinations were performed on a Singa Horizont 1.5 T whole body MR system with point resolved spectroscopy (PRESS) and chemical-shift selective saturation (CHESS) (TR=2000?ms,TE=144 ?ms). The voxel (2?cm ? 2?cm ? 2?cm) was positioned in both of the lesion and the contralateral side of the temporal lobe as the control (except for bilateral lesions). 2THZ]Results The interval between radiation and the examination ranged from 32 to 172 months ( median, 42 months). Eighteen lesions were observed in 13 patients (5 patients with bilateral lesions). 1H MRS was performed on 17 lesions and 8 control temporal lobes. The mean values of NAA/ Cr in the lesions and the control temporal lobes were 1.33?0.28、1.78?0.34 respectively(t=3.22, P=0.005). Three lesions showed NAA、Cho and Cr peak absent (2 lesions with Lip peak ). Among 8 patients with the control temporal lobes 1H MRS examined, Cho/Cr decreased in 6 patients (75%). Four lesions showed Lip , Lac and MI, respectively. Conclusions The radiation-induced temporal lobe necrosis shows abnormal features on 1H MRS. Significant decrease of NAA/ Cr as well as Cho/Cr are observed in most patients. 1H MRS may play a role in the diagnosis of radiation induced temporal lobe necrosis.