T2WI-based MRI radiomics for the prediction of preoperative extranodal extension and prognosis in resectable rectal cancer.

OBJECTIVE: To investigate whether T2-weighted imaging (T2WI)-based intratumoral and peritumoral radiomics can predict extranodal extension (ENE) and prognosis in patients with resectable rectal cancer. METHODS: One hundred sixty-seven patients with resectable rectal cancer including T3T4N + cases were prospectively included. Radiomics features were extracted from intratumoral, peritumoral 3 mm, and peritumoral-mesorectal fat on T2WI images. Least absolute shrinkage and selection operator regression were used for feature selection. A radiomics signature score (Radscore) was built with logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each Radscore. A clinical-radiomics nomogram was constructed by the most predictive radiomics signature and clinical risk factors. A prognostic model was constructed by Cox regression analysis to identify 3-year recurrence-free survival (RFS). RESULTS: Age, cT stage, and lymph node-irregular border and/or adjacent fat invasion were identified as independent clinical risk factors to construct a clinical model. The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and independent clinical risk factors achieved a better AUC than the clinical model in the training (0.799 vs. 0.736) and validation cohorts (0.723 vs. 0.667). Nomogram-based ENE (hazard ratio [HR] = 2.625, 95% CI = 1.233-5.586, p = 0.012) and extramural vascular invasion (EMVI) (HR = 2.523, 95% CI = 1.247-5.106, p = 0.010) were independent risk factors for predicting 3-year RFS. The prognostic model constructed by these two indicators showed good performance for predicting 3-year RFS in the training (AUC = 0.761) and validation cohorts (AUC = 0.710). CONCLUSION: The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and clinical risk factors could predict preoperative ENE. Combining nomogram-based ENE and MRI-reported EMVI may be useful in predicting 3-year RFS. CRITICAL RELEVANCE STATEMENT: A clinical-radiomics nomogram could help preoperative predict ENE, and a prognostic model constructed by the nomogram-based ENE and MRI-reported EMVI could predict 3-year RFS in patients with resectable rectal cancer. KEY POINTS: • Intratumoral and peritumoral 3 mm Radscore showed the most capability for predicting ENE. • Clinical-radiomics nomogram achieved the best predictive performance for predicting ENE. • Combining clinical-radiomics based-ENE and EMVI showed good performance for 3-year RFS.

Longitudinal course of hyperintensity on diffusion weighted imaging in adult-onset neuronal intranuclear inclusion disease patients.

Background: High signals on diffusion weighted imaging along the corticomedullary junction (CMJ) have demonstrated excellent diagnostic values for adult-onset neuronal intranuclear inclusion disease (NIID). However, the longitudinal course of diffusion weighted imaging high intensities in adult-onset NIID patients has rarely been investigated. Methods: We described four NIID cases that had been discovered using skin biopsy and NOTCH2NLC gene testing, after diffusion weighted imaging exhibiting the distinctive corticomedullary junction high signals. Then using complete MRI data from NIID patients, we analyzed the chronological diffusion weighted imaging alterations of those individuals that had been published in Pub Med. Results: We discussed 135 NIID cases with comprehensive MRI data, including our four cases, of whom 39 had follow-up outcomes. The following are the four primary diffusion weighted imaging dynamic change patterns: (1) high signal intensities in the corticomedullary junction were negative on diffusion weighted imaging even after an 11-year follow-up (7/39); (2) diffusion weighted imagings were initially negative but subsequently revealed typical findings (9/39); (3) high signal intensities vanished during follow-up (3/39); (4) diffusion weighted imagings were positive at first and developed in a step-by-step manner (20/39). We discovered that NIID lesions eventually damaged the deep white matter, which comprises the cerebral peduncles, brain stem, middle cerebellar peduncles, paravermal regions, and cerebellar white matter. Conclusion: The longitudinal dynamic changes in NIID of diffusion weighted imaging are highly complex. We find that there are four main patterns of dynamic changes on diffusion weighted imaging. Furthermore, as the disease progressed, NIID lesions eventually involved the deep white matter.

Computed tomography enterography-based multiregional radiomics model for differential diagnosis of Crohn's disease from intestinal tuberculosis.

PURPOSE: To build computed tomography enterography (CTE)-based multiregional radiomics model for distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB). MATERIALS AND METHODS: A total of 105 patients with CD and ITB who underwent CTE were retrospectively enrolled. Volume of interest segmentation were performed on CTE and radiomic features were obtained separately from the intestinal wall of lesion, the largest lymph node (LN), and region surrounding the lesion in the ileocecal region. The most valuable radiomic features was selected by the selection operator and least absolute shrinkage. We established nomogram combining clinical factors, endoscopy results, CTE features, and radiomic score through multivariate logistic regression analysis. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to evaluate the prediction performance. DeLong test was applied to compare the performance of the models. RESULTS: The clinical-radiomic combined model comprised of four variables including one radiomic signature from intestinal wall, one radiomic signature from LN, involved bowel segments on CTE, and longitudinal ulcer on endoscopy. The combined model showed good diagnostic performance with an area under the ROC curve (AUC) of 0.975 (95% CI 0.953-0.998) in the training cohort and 0.958 (95% CI 0.925-0.991) in the validation cohort. The combined model showed higher AUC than that of the clinical model in cross-validation set (0.958 vs. 0.878, P = 0.004). The DCA showed the highest benefit for the combined model. CONCLUSION: Clinical-radiomic combined model constructed by combining CTE-based radiomics from the intestinal wall of lesion and LN, endoscopy results, and CTE features can accurately distinguish CD from ITB.

Assessment of histologic prognostic factors of resectable rectal cancer: comparison of diagnostic performance using various apparent diffusion coefficient parameters.

This study is to investigate optimum apparent diffusion coefficient (ADC) parameter for predicting lymphovascular invasion (LVI), lymph node metastasis (LNM) and histology type in resectable rectal cancer. 58 consecutive patients with resectable rectal cancer were retrospectively identified. The minimum, maximum, average ADC and ADC difference value were obtained on ADC maps. Maximum ADC and ADC difference value increased with the appearance of LVI (r = 0.501 and 0.495, P < 0.001, respectively) and development of N category (r = 0.615 and 0.695, P < 0.001, respectively). ADC difference value tended to rise with lower tumor differentiation (r = - 0.269, P = 0.041). ADC difference value was an independent risk factor for predicting LVI (odds ratio = 1.323; P = 0.005) and LNM (odds ratio = 1.526; P = 0.005). Maximum ADC and ADC difference value could distinguish N0 from N1 category, N0 from N1-N2, N0-N1 from N2 (all P < 0.001). Only ADC difference value could distinguish histology type (P = 0.041). ADC difference value had higher area under the receiver operating characteristic curve than maximum ADC in identifying LVI (0.828 vs 0.797), N0 from N1 category (0.947 vs 0.847), N0 from N1-N2 (0.935 vs 0.874), and N0-N1 from N2 (0.814 vs 0.770). ADC difference value may be superior to the other ADC value parameters to predict LVI, N category and histology type of resectable rectal cancer.

DWI and T2-Weighted MRI Volumetry in Resectable Rectal Cancer: Correlation With Lymphovascular Invasion and Lymph Node Metastases.

OBJECTIVE. The purpose of this study was to assess whether MR volumetric data on DW and T2-weighted MR images are correlated with lymphovascular invasion and lymph node metastases in resectable rectal cancer. MATERIALS AND METHODS. This retrospective study consisted of 50 consecutive patients with rectal cancer who underwent radical surgery within 1 week of MRI. The gross tumor volume was determined on both diffusion-weighted and T2-weighted MR images and correlated with pathologic lymphovascular invasion and lymph node metastases using univariate, multivariate, and ROC curve analyses. RESULTS. Both gross tumor volume values showed correlations with lymphovascular invasion (r = 0.750 vs r = 0.710; p < 0.0001) and lymph node metastases (r = 0.780 vs r = 0.755; p < 0.0001). Both values were associated with lymphovascular invasion and lymph node metastases in univariate analysis (all p < 0.0001), whereas only the DWI-based value was an independent risk factor for lymphovascular invasion (odds ratio = 1.207; p = 0.005) and lymph node metastases (odds ratio = 1.420; p = 0.005) in multivariate analysis. Both values could distinguish between N0 and N1, N0 and N1-N2, and N0-N1 and N2 disease (all p < 0.0001) in the Mann-Whitney U test. The area under the ROC curve was higher for the DWI-based value in lymphovascular invasion (0.899 vs 0.877), N0 vs N1 (0.865 vs 0.827), N0 vs N1-N2 (0.934 vs 0.911), and N0-N1 vs N2 (0.932 vs 0.927). CONCLUSION. Tumor volumetry data correlated with both lymphovascular invasion and lymph node metastases in resectable rectal cancer. In particular, the DWI-based gross tumor volume showed the most potential for noninvasive preoperative evaluation of lymphovascular invasion and lymph node metastases.

In vivo evaluation of early renal damage in type 2 diabetic patients on 3.0 T MR diffusion tensor imaging.

AIM: To investigate the utility of renal diffusion tensor imaging (DTI) to detect early renal damage in patients with type 2 diabetes. METHODS: Twenty-six diabetic patients (12 with microalbuminuria (MAU), and 14 with normoalbuminuria) and fourteen healthy volunteers were prospectively included in this study. Renal DTI on 3.0 T MR was performed, and estimated glomerular filtration rate (eGFR) was recorded for each subject. Mean cortical and medullary fractional anisotropy (FA) values were calculated by placing multiple representative regions of interest. Mean FA values were statistically compared among groups. Correlations between FA values and eGFR were evaluated. RESULTS: Both cortical and medullary FA were significantly reduced in diabetic patients compared to healthy controls (0.403 ± 0.064 vs 0.463 ± 0.047, P = 0.004, and 0.556 ± 0.084 vs 0.645 ± 0.076, P = 0.002, respectively). Cortical FA was significantly lower in diabetic patients with NAU than healthy controls (0.412 ± 0.068 vs 0.463 ± 0.047, P = 0.02). Medullary FA in diabetic patients with NAU and healthy controls were similar (0.582 ± 0.096 vs 0.645 ± 0.076, P = 0.06). Both cortical FA and medullary FA correlated with eGFR (r = 0.382, P = 0.015 and r = 0.552, P = 0.000, respectively). CONCLUSION: FA of renal parenchyma on DTI might serve as a more sensitive biomarker of early diabetic nephropathy than MAU.

CT volumetry for gastric adenocarcinoma: association with lymphovascular invasion and T-stages.

PURPOSE: To determine whether gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict presence of lymphovascular invasion and T-stages. RESULTS: Gross tumor volume increased with the lymphovascular invasion (r = 0.426, P < 0.0001) and T stage (r = 0.656, P < 0.0001). Univariate analysis showed gross tumor volume could predict lymphovascular invasion (P < 0.0001). Multivariate analyses indicated gross tumor volume as an independent risk factor of lymphovascular invasion (P = 0.026, odds ratio = 2.284). The Mann-Whitney U test showed gross tumor volume could distinguish T2 from T3, T1 from T2-T4a, T1-T2 from T3-T4a and T1-T3 from T4a (P = 0.000). In the development cohort, gross tumor volume could predict lymphovascular invasion (cutoff, 15.92 cm3; AUC, 0.760), and distinguish T2 from T3 (cutoff, 10.09 cm3; AUC, 0.828), T1 from T2-T4a (cutoff, 8.20 cm3; AUC, 0.860), T1-T2 from T3-T4a (cutoff, 15.88 cm3; AUC, 0.883), and T1-T3 from T4a (cutoff, 21.53 cm3; AUC, 0.834). In validation cohort, gross tumor volume could predict presence of lymphovascular invasion (AUC, 0.742), and distinguish T2 from T3 (AUC, 0.861), T1 from T2-T4a (AUC, 0.859), T1-T2 from T3-T4a (AUC, 0.875), and T1-T3 from T4a (AUC, 0.773). MATERIALS AND METHODS: 360 consecutive patients with gastric adenocarcinoma were retrospectively identified. Gross tumor volume was evaluated on multidetector computed tomography images. Statistical analysis was performed to determine whether gross tumor volume could predict presence of lymphovascular invasion and T-stages. Cutoffs of gross tumor volume were first investigated in 212 patients and then validated in an independent 148 patients using area under the receiver operating characteristic curve (AUC) for predicting lymphovascular invasion and T-stages. CONCLUSIONS: Gross tumor volume of resectable gastric adenocarcinoma at multidetector computed tomography demonstrated capability in predicting lymphovascular invasion and distinguishing T-stages.

Clinical risk stratification of acute pulmonary embolism: comparing the usefulness of CTA obstruction score and pulmonary perfusion defect score with dual-energy CT.

To compare the ability of CT angiography (CTA) obstruction score and perfusion defect score on dual energy CT perfusion imaging (DEPI) for clinical risk stratification of patients with acute pulmonary embolism (PE). 55 patients diagnosed as acute PE either by CTA or DEPI were retrospectively enrolled. Patients were grouped into high-, intermediate-, and low-risk groups in accordance to the renewed guidelines of 2014. Consistency between DEPI and CTA in diagnosis of PE were assessed. Correlations between CT parameters and right-to-left ventricular (RV/LV) diameter ratio were evaluated. Difference of CTA obstruction score and perfusion defect score across three groups with different risks were analyzed. The consistent rate of DEPI with CTA was 75.4%, and the Kappa value was 0.412 (p = 0.000). 44.3% of partially obstructive PE showed on CTA did not lead to perfusion defect on DEPI. Perfusion defect score was significantly correlated with CTA obstruction score and with RV/LV (r = 0.622 and 0.599, respectively, p < 0.001), and CTA obstruction score had lower correlation with RV/LV (r = 0.403, p = 0.003). Perfusion defect score could distinguish low- from intermediate-risk groups (p = 0.011). However, CTA obstruction score could not distinguish the two groups (p = 0.149). DEPI had fine consistency with CTA to diagnose acute PE and offered additional information of physiologic changes. Comparing with CTA obstruction score, perfusion defect score could better correlate with right ventricular dysfunction, and could be a more promising biomarker for clinical risk stratification.

Can Diffusion-weighted Magnetic Resonance Imaging Predict Survival in Patients with Cervical Cancer? A Meta-Analysis.

OBJECTIVE: Although diffusion-weighted magnetic resonance imaging (DWI) has been widely used in the diagnosis of cervical cancer, whether it can predict disease recurrence or survival remains inconclusive. This study aimed to systematically evaluate whether DWI can serve as a reliable prognostic predictor in patients with cervical cancer. METHODS: PubMed, the MEDLINE database and the Cochrane Library were searched for DWI studies with >12 months of prognostic data in patients with cervical cancer. Endpoints included tumor recurrence and death. Methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. Combined estimates of hazard ratios (HRs) were derived. RESULTS: Nine studies involving a total of 796 patients (mean/median age from 45.0 years to 62.9 years) met the inclusion criteria. Methodological quality was relatively high. Eight of the nine studies employed apparent diffusion coefficient (ADC) as an indicator of DWI results. Using disease-free survival (DFS) as an outcome measure, nine studies yielded a combined HR of 1.55 (95% confidence interval (CI): 1.23-1.95), and seven studies that employed pretreatment DWI yielded a combined HR of 1.50 (95% CI: 1.03-2.19), which indicated that unfavorable DWI results were associated with an approximately 1.50-1.55-fold higher risk of tumor recurrence. The two studies investigating the impact of DWI results on overall survival (OS) reported HRs of 7.20 and 2.17, respectively. CONCLUSION: DWI may serve as a predictor of tumor recurrence in patients with cervical cancer as showed by meta-analysis, and the quantified ADC as a suitable candidate indicator.

Tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography: association with N categories.

OBJECTIVE: To determine whether the gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict the presence of regional lymph node metastasis and could determine N categories. MATERIALS AND METHODS: A total of 202 consecutive patients with gastric adenocarcinoma who had undergone gastrectomy 1 week after contrast-enhanced multidetector computed tomography were retrospectively identified. The gross tumor volume was evaluated on multidetector computed tomography images. Univariate and multivariate analyses were performed to determine whether the gross tumor volume could predict regional lymph node metastasis, and the Mann-Whitney U test was performed to compare the gross tumor volume among N categories. Additionally, a receiver operating characteristic analysis was performed to identify the accuracy of the gross tumor volume in differentiating N categories. RESULTS: The gross tumor volume could predict regional lymph node metastasis (p<0.0001) in the univariate analysis, and the multivariate analyses indicated that the gross tumor volume was an independent risk factor for regional lymph node metastasis (p=0.005, odds ratio=1.364). The Mann-Whitney U test showed that the gross tumor volume could distinguish N0 from the N1-N3 categories, N0-N1 from N2-N3, and N0-N2 from N3 (all p<0.0001). In the T1-T4a categories, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 12.3 cm3), N0-N1 from N2-N3 (cutoff, 16.6 cm3), and N0-N2 from N3 (cutoff, 24.6 cm3). In the T4a category, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 15.8 cm3), N0-N1 from N2-N3 (cutoff, 17.8 cm3), and N0-N2 from N3 (cutoff, 24 cm3). CONCLUSION: The gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict regional lymph node metastasis and N categories.

Tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography: association with N categories

OBJECTIVE: To determine whether the gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict the presence of regional lymph node metastasis and could determine N categories. MATERIALS AND METHODS: A total of 202 consecutive patients with gastric adenocarcinoma who had undergone gastrectomy 1 week after contrast-enhanced multidetector computed tomography were retrospectively identified. The gross tumor volume was evaluated on multidetector computed tomography images. Univariate and multivariate analyses were performed to determine whether the gross tumor volume could predict regional lymph node metastasis, and the Mann-Whitney U test was performed to compare the gross tumor volume among N categories. Additionally, a receiver operating characteristic analysis was performed to identify the accuracy of the gross tumor volume in differentiating N categories. RESULTS: The gross tumor volume could predict regional lymph node metastasis (p<0.0001) in the univariate analysis, and the multivariate analyses indicated that the gross tumor volume was an independent risk factor for regional lymph node metastasis (p=0.005, odds ratio=1.364). The Mann-Whitney U test showed that the gross tumor volume could distinguish N0 from the N1-N3 categories, N0-N1 from N2-N3, and N0-N2 from N3 (all p<0.0001). In the T1-T4a categories, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 12.3 cm3), N0-N1 from N2-N3 (cutoff, 16.6 cm3), and N0-N2 from N3 (cutoff, 24.6 cm3). In the T4a category, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 15.8 cm3), N0-N1 from N2-N3 (cutoff, 17.8 cm3), and N0-N2 from N3 (cutoff, 24 cm3). CONCLUSION: The gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict regional lymph node metastasis and N categories.

Functional assessment of transplanted kidneys with magnetic resonance imaging.

Kidney transplantation has emerged as the treatment of choice for many patients with end-stage renal disease, which is a significant cause of morbidity and mortality. Given the shortage of clinically available donor kidneys and the significant incidence of allograft dysfunction, a noninvasive and accurate assessment of the allograft renal function is critical for postoperative management. Prompt diagnosis of graft dysfunction facilitates clinical intervention of kidneys with salvageable function. New advances in magnetic resonance imaging (MRI) technology have enabled the calculation of various renal parameters that were previously not feasible to measure noninvasively. Diffusion-weighted imaging provides information on renal diffusion and perfusion simultaneously, with quantification by the apparent diffusion coefficient, the decrease of which reflects renal function impairment. Diffusion-tensor imaging accounts for the directionality of molecular motion and measures fractional anisotropy of the kidneys. Blood oxygen level-dependent MR evaluates intrarenal oxygen bioavailability, generating the parameter of R2* (reflecting the concentration of deoxyhemoglobin). A decrease in R2* could happen during acute rejection. MR nephro-urography/renography demonstrates structural data depicting urinary tract obstructions and functional data regarding the glomerular filtration and blood flow. MR angiography details the transplant vasculature and is particularly suitable for detecting vascular complications, with good correlation with digital subtraction angiography. Other functional MRI technologies, such as arterial spin labeling and MR spectroscopy, are showing additional promise. This review highlights MRI as a comprehensive modality to diagnose a variety of etiologies of graft dysfunction, including prerenal (e.g., renal vasculature), renal (intrinsic causes) and postrenal (e.g., obstruction of the collecting system) etiologies.

[Clinical value of MRI united-sequences examination in diagnosis and differentiation of morphological sub-type of hilar and extrahepatic big bile duct cholangiocarcinoma].

OBJECTIVE: To investigate MRI features and associated histological and pathological changes of hilar and extrahepatic big bile duct cholangiocarcinoma with different morphological sub-types, and its value in differentiating between nodular cholangiocarcinoma (NCC) and intraductal growing cholangiocarcinoma (IDCC). METHODS: Imaging data of 152 patients with pathologically confirmed hilar and extrahepatic big bile duct cholangiocarcinoma were reviewed, which included 86 periductal infiltrating cholangiocarcinoma (PDCC), 55 NCC, and 11 IDCC. Imaging features of the three morphological sub-types were compared. RESULTS: Each of the subtypes demonstrated its unique imaging features. Significant differences (P < 0.05) were found between NCC and IDCC in tumor shape, dynamic enhanced pattern, enhancement degree during equilibrium phase, multiplicity or singleness of tumor, changes in wall and lumen of bile duct at the tumor-bearing segment, dilatation of tumor upstream or downstream bile duct, and invasion of adjacent organs. CONCLUSION: Imaging features reveal tumor growth patterns of hilar and extrahepatic big bile duct cholangiocarcinoma. MRI united-sequences examination can accurately describe those imaging features for differentiation diagnosis.

[Clinical value of dual-source CT angiography in the diagnosis of postoperative aortic intramural hematoma in patients with endovascular stent-graft exclusion surgery].

OBJECTIVE: To determine the clinical value of dual-source CT angiography (DSCTA) in the diagnosis of postoperative aortic intramural hematoma (AIMH) in patients with endovascular stent-graft exclusion (EVE) surgery. METHODS: Between Oct 2008 and May 2013, thirty-six patients were diagnosed with AIMH by DSCTA, and 12 of these patients with type B underwent EVE. The 12 patients were followed up with DSCTA, which included imaging reconstruction (multi-plane reconstruction, MPR), maximum intensity projection (MIP) and volume rendering technique (VRT). The extent and type of AIMH, aortic ulcers and the outcomes and complications of AIMH were observed. RESULTS: The 36 cases of AIMH included 11 Stanford type A and 25 type B. No tearing intimal flap or contrast materials within the hematoma were observed. The maximum aortic diameter of the hematoma areas varied from 3.8 to 5.4 cm (average 4.3 cm) and the maximum thickness of the hematoma ranged from 0.5 cm to 1.3 cm (average 0.9 cm). The ratio between the minimum and the maximum diameter of the aortic lumen in the hematoma areas ranged from 0. 74 to 0. 98 (average 0.85). Aortic ulcers were revealed in 3 patients with type A AIMH and 8 patients with type B AIMH. Intimal tearing of distal abdominal aorta was found in 3 patients with type B AIMH. In the 12 patients underwent EVE surgery, hematoma shrank in all cases with 4 cases almost resolving and aortic ulcers in the area of stent-graft exclusion disappeared in 3 cases. The form of stent-graft appeared normal in 9 cases and slightly abnormal in 3 cases. Fluent main branches of aortic arch and none existence of stent endoleaking were observed. CONCLUSION: DSCTA with handy, effective and non-invasive advantages is one of the important imaging methods in the diagnosis of AIMH in patients with EVE surgery.

[The value of sixty-four slice spiral CT angiography in diagnosing and evaluating abdominal aortic aneurysm before operations].

OBJECTIVE: To assess the value of sixty-four slice spiral CT angiography (CTA) in diagnosing and evaluating abdominal aortic aneurysm (AAA) before operations. METHODS: Between Oct 2006 and Jan 2008, forty-three consecutive patients with suspected AAA underwent examinations by the sixty-four slice spiral CT angiography with 370 mg I/mL contrast material. Of these patients, 38 patients whose AAA imaging quality met the diagnostic criteria were enrolled in the study. Imaging reconstruction were made at the workstation, which included multi-plane reconstruction (MPR), maximum intensity projection (MIP) and volume rendering technique (VRT). The comprehensive observation and analysis focused on the type, location, size and extension of AAA. The classification of AAA was based on the relevant parameters that satisfied the requirement of endovascular stent-graft exclusion. RESULTS: (1) The aneurysms of all of the 38 patients were located at under the level of renal arteries, including six that were adjacent to renal arteries and 32 under renal arteries. (2) Among the 38 patients with AAA, 4 were type I , 3 were type II A, 4 were type II B, 21 were type II C, and 6 were type III. (3) The sixty-four slice spiral CT angiography clearly displayed the shape, locality and size of the aneurysms, the anatomic relations between the aneurismal bodies and the adjacent main branches of aorta, and the mural thrombus in all of the patients. Relevant parameters of AAA could be accurately measured by the CTA images. CONCLUSION: Sixty-four slice spiral CT angiography is a fast, non-invasive and effective instrument for diagnosing and evaluating AAA before operations.

[Preliminary study of tumor perfusion assessment with multidetector CT in carcinoma of esophagus and cardia].

OBJECTIVE: To investigate the clinical application of first-pass perfusion MDCT in the assessment of tumor angiogenesis in carcinoma of esophagus and cardia. METHODS: CT perfusion was performed with multi-detector row CT (MDCT) in 44 patients with carcinoma of esophagus and esophagogastric junction, who was diagnosed with pathological results and did not received any anti-tumor therapy. Twenty-one patients with peripheral lung cancer but normal esophagus were served as controls. Perfusion parameters were compared between normal and malignant esophagus, between adenocarcinoma and squamous cell carcinoma, as well as between tumors with metastases and those without metastases. RESULTS: Carcinoma of esophagus and esophagogastric junction showed higher blood flow, peak enhancement index, blood volume, and shorter time to peak compared with normal esophagus (P < 0.05). There were no statistically significant differences in perfusion parameters between adenocarcinoma and squamous cell carcinoma (P > 0.05), whereas tumors with metastases showed higher blood flow and shorter time to peak compared with those without metastases (P < 0.05). CONCLUSION: MDCT perfusion could assess tumor vascularity in carcinoma of esophagus and esophagogastric junction, and tumor vascularity or angiogenesis was not influenced by its histological type. However, high blood flow and short time-to-peak may be helpful to predict tumor metastases.

Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breath-hold examination magnetic resonance imaging sequence.

BACKGROUND: Early detection and accurate staging are crucial for planning treatment and improving survival rate of hilar cholangiocarcinomas. This study investigated the diagnostic value of a three dimensional, spoiled gradient echo, T1-weighted magnetic resonance (MR) imaging sequence (3D volumetric interpolated breath-hold examination, 3D-VIBE) in the preoperative evaluation of hilar cholangiocarcinoma. METHODS: Thirty-one patients with surgically and histologically confirmed hilar cholangiocarcinomas underwent preoperative MR imaging examination. Unenhanced two-dimensional T1- and T2-weighted images, 2D MR cholangiopancreatographs (MRCP), gadolinium enhanced 3D-VIBE images in the early arterial, late arterial and portal venous phases followed by 2D T1-weighted images in the equilibrium phase were acquired. Images from 3D-VIBE, 2D T1-weighted enhanced sequences and 2D MRCP were interpreted by two abdominal radiologists through consensus reading in blind manner, focussing on the assessment of the morphological type, the longitudinal extent of tumor infiltration in the bile ducts and the involvement of neighbouring blood vessels. The accuracy of 3D-VIBE and 2D T1-weighted enhanced sequences in assessing the tumor resectability was compared. RESULTS: All the 31 tumors were directly displayed and accurately classified on 3D-VIBE images whereas 8 periductal infiltrating tumors (8/31, 25.8%) were not depicted on 2D T1-weighted enhanced images. Using the Bismuth Corlette classification, 3D-VIBE was closer to MRCP in delineating the intraductal extent of tumor infiltration than 2D T1-weighted enhanced (28/31, 90.3%; 10/31, 32.3%; chi2 = 22.0, P < 0.05). Involvement of the hepatic artery, the portal venous trunk and their branches was shown more frequently on 3D VIBE than 2D T1-weighted enhanced images. The positive predictive value and accuracy of 3D-VIBE (84.2%; 90.3%) for assessing tumor resectability were higher than those of 2D T1-weighted enhanced images (64.0%; 71.0%, all P < 0.05). CONCLUSION: Gadolinium enhanced 3D-VIBE is better than 2D T1-weighted enhanced sequence in the preoperative assessment of the morphologicalal type, the intraductal infiltrating extent and the tumor resectability of hilar cholangiocarcinomas.

Addison's disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation.

PURPOSE: To describe CT morphology of untreated adrenal tuberculosis during the different stages of the natural history of the disease and to evaluate the diagnostic implications of CT features. MATERIALS AND METHODS: We retrospectively evaluated CT features in 42 patients with documented adrenal tuberculosis for the location, size, morphology, and enhancement patterns shown on CT images. The clinical duration were correlated with the CT features. RESULTS: Of the 42 patients with untreated adrenal tuberculosis, bilaterally enlarged adrenal glands were revealed in 38 cases (91%), unilaterally enlarged in 3 cases (7%), and normal size in 1 case (2%). Of the 41 cases (98%) with enlargement, mass-like enlargement was seen in 20 cases (49%) and enlargement with preserved contours in 21 cases (51%). Peripheral rim enhancement presented in 22 cases (52%) on contrast-enhanced CT. Non-enhanced CT scan revealed calcification in 21 cases (50%). As the duration of Addison's disease increased, the presence of calcification and contour preservation increased concomitantly (p<0.001), whereas peripheral rim enhancement and mass-like enlargement decreased concomitantly on CT images (p<0.001). CONCLUSION: CT may be helpful in diagnosing adrenal tuberculosis when clinically suspected, and CT features are correlated to the clinical duration of Addison's disease.

[The value of MRI 3D-VIBE systems applied to preoperative estimate of hepatic portal cholangiocarcinoma].

OBJECTIVE: To explore the diagnostic value of the system serial of three-dimensional spoiled gradient-echo T1-weighted MR imaging (three-dimensional volumetric interpolated breath-hold examination, 3D-VIBE) used to the preoperative assessment of hepatic portal cholangiocarcinoma. METHODS: 31 surgically confirmed patients with hepatic portal cholangiocarcinoma underwent the preoperative examination through MR imaging system serial that was including T2W, two dimension (2D) T1W plain scan, 2D magnetic resonance cholangiopancreatography (MRCP), and Gadolinium-enhanced 3D-VIBE triple-phase dynamic acquisitions followed by 2D T1W scanning at the equilibrium phase. Meanwhile, it was performed for focusing on assessing or judging the tumor morphological type, the longitudinal infiltration extent of the bile duct and the involvement of neighbor blood vessels. And the 3D-VIBE was compared with 2D T1W systems for assessing or judging the tumor resectability. RESULTS: (1) (3D-VIBE directly displayed the hepatic portal tumors and correctly classified the tumor morphological types in all patients, but 2D T1W systems missed to show 8 hepatic portal cholangiocarcinoma of periductal-infiltrating type (25. 8%); (2) According to Bismuth-Corlette classification, 3D-VIBE was closed to MRCP in accuracy (93.5%) for showing the longitudinal infiltration extent of tumor, but 2D T1W system serial underestimated (32.3%) the extent. (3) 3D-VIBE showed more involvement of the main trunk of hepatic artery, portal vein and their branches than 2D T1W systems did. (4) The positive predicting value and accuracy for assessing tumor resectability were 84.0% and 90.0% for 3D-VIBE system, as 64.0% and 71.0% for 2D T1W systems. CONCLUSION: 3D-VIBE system is superior to other MR imaging system serial in the preoperative assessment of the morphological type, the longitudinal infiltration extent and the tumor resectability of hepatic portal cholangiocarcinoma.