Hepatic fat quantification of magnetic resonance imaging whole-liver segmentation for assessing the severity of nonalcoholic fatty liver disease: comparison with a region of interest sampling method.

BACKGROUND: Accurate and early assessment of the hepatic fat content is crucial for patients with nonalcoholic fatty liver disease (NAFLD). For years, magnetic resonance imaging (MRI) has been considered the optimal noninvasive method for the assessment of fat accumulation. To avoid time-consuming manual placement of multiple regions of interest (ROI), the use of whole-liver segmentation has been proposed to measure liver fat, mainly for heterogeneous fat deposition. However, it remains uncertain whether the hepatic mean fat fraction (FF) obtained by whole-liver segmentation with the inclusion of intrahepatic vasculature is consistent with the traditional ROI sampling method. In this study, we assessed the accuracy of hepatic mean FF obtained by whole-liver segmentation in patients of NAFLD with different severities using the ROI sampling method as a reference standard. METHODS: Hepatic FFs were measured by whole-liver segmentation and the ROI sampling method (reference standard) using MRI scanning with the iterative decomposition of water and fat with echo an asymmetry at least-square estimation-iron quantification (IDEAL-IQ) sequence. SPSS version 25.0 software was used to analyze the correlation and consistency of data between the two methods. RESULTS: There was a strong correlation in hepatic FF between whole-liver segmentation and the ROI sampling method in healthy, mild, and moderate steatosis patients (r = 0.943, 0.990, and 0.961, respectively). Bland-Altman analysis showed a small bias of +0.50±0.27 and +0.05±0.30, which indicated a small overestimation when using whole-liver segmentation in healthy subjects and mild NAFLD patients. The 95% limits of agreement ranged from +1.02 to -0.03, and from +0.65 to -0.55, respectively. However, a small bias of -0.96±0.77 was also evident, which indicated a small underestimation when using whole-liver segmentation in moderate NAFLD patients. The 95% limits of agreement ranged from +0.56 to -2.48. CONCLUSIONS: Due to inclusion of the intrahepatic vasculature, whole-liver segmentation has some effects on hepatic FF assessment in patients with different NAFLD severities; yet, it does not significantly affect the assessment of whole-liver FF in MRI FF maps.

Potential value of the PixelShine deep learning algorithm for increasing quality of 70 kVp+ASiR-V reconstruction pelvic arterial phase CT images.

OBJECTIVE: To investigate the effect of a deep learning-based denoising algorithm, PixelShine (PS), on the quality of 70 kVp pelvic arterial phase CT images. MATERIALS AND METHODS: A retrospective analysis was performed on arterial phase pelvic CT images from 33 patients (body-mass index ≤ 20 kg/m2) obtained with a GE Revolution CT (70 kVp tube voltage; adaptive statistical iterative reconstruction-Veo-filtered back projection, 50% blending) and designated group A. Group B images were then obtained by applying PS to group A image datasets. Subjective image quality was evaluated by two radiologists with a 5-point scoring system; the scores of the groups were compared. Image signal was assessed using CT values of the urinary bladder. CT and standard deviation (SD) values of the gluteus maximus were measured, and SD values of the gluteus maximus were used to represent image noise. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the bladder were calculated. Image noise, SNR, and CNR of two groups were compared using paired t-tests. RESULTS: The subjective visual image quality scores of groups A and B, respectively, were 3.11 ± 0.30 vs. 3.82 ± 0.57; image noise was 15.79 ± 2.05 Hounsfield units (HU) vs. 11.06 ± 2.22 HU; SNRs of bladder were 0.50 ± 0.23 vs. 0.79 ± 0.39; and CNRs of bladder were 3.72 ± 0.85 vs. 5.14 ± 1.27. Group B showed better subjective image quality, lower image noise, and improved SNR and CNR, compared to group A; these differences were statistically significant (P < 0.05). The noise of group B was approximately 30% lower than that of group A; the SNR and CNR values of group B were improved by approximately 58% and 38%, respectively. CONCLUSION: Using 70 kVp +ASiR-V, PS can improve the image quality of pelvic arterial phase CT images, significantly reduce the image noise, and improve the SNR and CNR.

Primary malignant mixed Müllerian tumors of the fallopian tube with cervix metastasis: A rare case report and literature review.

RATIONALE: Primary malignant mixed mullerian tumors of the fallopian tube is very rare and has only 1 case in the current literature with cervix metastasis. PATIENT CONCERNS: We reported a 49-year-old woman sufferring from primary malignant mixed mullerian tumors of the fallopian tube with cervix metastasis, and the imaging examination found a strip of solid mass in the right fallopian tube and a nodular mass in cervical canal, which were both hyperintense on T2 weighted image (T2WI) and diffusion weighted image (DWI) and continuous moderate enhancement on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DIAGNOSES: The diagnosis was confirmed according to the specific anatomical location and pathological examination which was proved as primary malignant mixed mullerian tumors of the fallopian tube with cervix metastasis. INTERVENTIONS: The patient underwent radical hysterctomy, bilateral adnexectomy, pelvic lymph node dissection, omentum majus excision and intravenous chemotherapy. OUTCOMES: Her posttreatment condition was good. LESSONS: Primary malignant mixed mullerian tumors of the fallopian tube can be located by magnetic resonance image examination, which may also offer several diagnostic tips according to changes in signal and enhancement. When combined with pathological findings, qualitative diagnosis can be determined. Surgery and adjuvant chemotherapy are considered as effective methods. Our paper discussed its epidemiology, clinical symptoms, pathologic characters, therapeutic method as well as magnetic resonance imaging findings suggesting the diagnosis and differential diagnosis, including precontrast scan, contrast scan and diffusion weighted image and provided magnetic resonance imaging characteristics of primary malignant mixed mullerian tumors of the fallopian tube described in other literatures.

Reproductive toxicity of brazilein in ICR mice / 中国天然药物

Brazilein is an active small molecular compound extracted from Caesalpinia sappan L. with favorable pharmacological properties on immune system, cardiovascular system, and nervous system. C. sappan has been used as a traditional medicine in China for hundreds of years for various diseases. However, the general reproductive toxicity of brazilein is still unknown. The purpose of the present study was to thoroughly evaluate the general reproductive toxicity of brazilein in ICR mice to support the future drug development and modernization of this potent traditional Chinese medicine. The results showed that, although no apparent toxicity on the reproducibility of the male was observed, brazilein might cause considerable risks to the fetuses and females as indicated by the ratios of dead fetuses and reabsorptions. In conclusion, our results from the present study provided some useful insights about the safety profile of brazilein, suggesting that brazilein should be used with caution in pregnant women.

Diagnostic Significance of Diffusion-Weighted MRI in Renal Cancer.

BACKGROUND: This study aimed to investigate whether diffusion-weighted imaging (DWI) could contribute to the discrimination between benign and malignant renal cancer. METHODS: We searched the PubMed electronic database for eligible studies. STATA 12.0 software was used for statistical analysis. The SMD and 95% CI were calculated. RESULTS: Decreased ADC signal was seen in all renal cancer patients (cancer tissue versus normal tissue: SMD = 1.63 and 95% CI = 0.96~2.29, P < 0.001; cancer tissue versus benign tissue: SMD = 2.22 and 95% CI = 1.53~2.90 and P < 0.001, resp.). MRI machine type-stratified analysis showed that decreased ADC signal was found by all included MRI machine types in cancer tissues compared with benign cancer tissues (all P < 0.05). The ADC values of renal cancer patients were significantly lower than those of normal controls for all included P values (all P < 0.05), and there was a decreased ADC signal at b-500, b-600, b-1000, b-500, and 1000 gradients compared with benign cancer tissues (all P < 0.05). CONCLUSION: Our study concluded that decreased ADC signal presented in DWI may be essential for the differential diagnosis of renal cancer.

Apparent diffusion coefficient measurement by diffusion weighted magnetic resonance imaging is a useful tool in differentiating renal tumors.

BACKGROUND: To determine the clinical value of apparent diffusion coefficient (ADC) measurement by diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating renal tumors. METHODS: Electronic databases were searched using combinations of keywords and free words relating to renal tumor, ADC and DW-MRI. Based on carefully selected inclusion and exclusion criteria, relevant case-control studies were identified and the related clinical data was acquired. Statistical analyses were performed using STATA 12.0 (Stata Corporation, College station, TX). RESULTS: Sixteen case-control studies were ultimately included in the present meta-analysis. These 16 high quality studies contained a combined total of 438 normal renal tissues and 832 renal tumor lesions (597 malignant and 235 benign). The results revealed that ADC values of malignant renal tumor tissues were markedly lower than normal renal tissues and benign renal tumor tissues. ADC values of benign renal tumor tissues were also significantly lower than normal renal tissue. CONCLUSIONS: ADC measurement by DW-MRI provided clinically useful information on the internal structure of renal tumors and could be an important radiographic index for differentiation of malignant renal tumors from benign renal tumors.

Virtual non-contrast computer tomography (CT) with spectral CT as an alternative to conventional unenhanced CT in the assessment of gastric cancer.

OBJECTIVE: The purpose of this study was to evaluate computed tomography (CT) virtual non-contrast (VNC) spectral imaging for gastric carcinoma. MATERIALS AND METHODS: Fifty-two patients with histologically proven gastric carcinomas underwent gemstone spectral imaging (GSI) including non-contrast and contrast-enhanced hepatic arterial, portal venous, and equilibrium phase acquisitions prior to surgery. VNC arterial phase (VNCa), VNC venous phase (VNCv), and VNC equilibrium phase (VNCe) images were obtained by subtracting iodine from iodine/water images. Images were analyzed with respect to image quality, gastric carcinoma-intragastric water contrast-to-noise ratio (CNR), gastric carcinoma-perigastric fat CNR, serosal invasion, and enlarged lymph nodes around the lesions. RESULTS: Carcinoma-water CNR values were significantly higher in VNCa, VNCv, and VNCe images than in normal CT images (2.72, 2.60, 2.61, respectively, vs 2.35, p≤0.008). Carcinoma- perigastric fat CNR values were significantly lower in VNCa, VNCv, and VNCe images than in normal CT images (7.63, 7.49, 7.32, respectively, vs 8.48, p<0.001). There were no significant differences of carcinoma-water CNR and carcinoma-perigastric fat CNR among VNCa, VNCv, and VNCe images. There was no difference in the determination of invasion or enlarged lymph nodes between normal CT and VNCa images. CONCLUSIONS: VNC arterial phase images may be a surrogate for conventional non-contrast CT images in gastric carcinoma evaluation.

Application of computed tomography virtual noncontrast spectral imaging in evaluation of hepatic metastases: a preliminary study.

OBJECTIVE: The objective was to qualitatively and quantitatively evaluate hepatic metastases using computed tomography (CT) virtual noncontrast (VNC) spectral imaging in a retrospective analysis. METHODS: Forty hepatic metastases patients underwent CT scans including the conventional true noncontrast (TNC) and the tri-phasic contrast-enhanced dual energy spectral scans in the hepatic arterial, portal venous, and equilibrium phases. The tri-phasic spectral CT images were used to obtain three groups of VNC images including in the arterial (VNCa), venous (VNCv), and equilibrium (VNCe) phase by the material decomposition process using water and iodine as a base material pair. The image quality and the contrast-to-noise ratio (CNR) of metastasis of the four groups were compared with ANOVA analysis. The metastasis detection rates with the four nonenhanced image groups were calculated and compared using the Chi-square test. RESULTS: There were no significant differences in image quality among TNC, VNCa and VNCv images (P > 0.05). The quality of VNCe images was significantly worse than that of other three groups (P < 0.05). The mean CNR of metastasis in the TNC and VNCs images was 1.86, 2.42, 1.92, and 1.94, respectively; the mean CNR of metastasis in VNCa images was significantly higher than that in other three groups (P < 0.05), while no statistically significant difference was observed among VNCv, VNCe and TNC images (P > 0.05). The metastasis detection rate of the four nonenhanced groups with no statistically significant difference (P > 0.05). CONCLUSIONS: The quality of VNCa and VNCv images is identical to that of TNC images, and the metastasis detection rate in VNC images is similar to that in TNC images. VNC images obtained from arterial phase show metastases more clearly. Thus, VNCa imaging may be a surrogate to TNC imaging in hepatic metastasis diagnosis.

Use of enhanced T2 star-weighted angiography (ESWAN) and R2* values to distinguish ovarian cysts due to endometriosis from other causes.

PURPOSE: To evaluate the feasibility of enhanced T2 star-weighted angiography (ESWAN) in differentiating endometrial from non-endometrial cysts. METHODS: Forty-nine patients with 60 histopathologically proven ovarian cystic lesions underwent pelvic MRI including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), liver acquisition with volume acceleration, and ESWAN. Ovarian cystic lesions were divided into endometrial cysts (group 1; n = 28), pyosalpinx and hydrosalpinx (group 2; n = 13), and ovarian cystic and cystic-solid tumors (group 3; n = 19). R2* (effective transverse relaxation rate) values were measured and pairwise comparison of the R2* values among the three groups was made using Kruskal-Wallis test. Receiver operating characteristic curves were used to calculate cutoff values and performance of R2* values for distinguishing among groups. T1WI signal intensity and R2* value were also compared using area under curve values. RESULTS: R2* values for group 1 were statistically higher than groups 2 and 3 (15.37, 1.40, and 1.79 Hz, respectively; P < 0.001). The cutoff value for R2* was 7.43 Hz with a sensitivity, specificity, PPV, NPV, and accuracy of 96.43, 87.50, 87.10, 96.55, and 91.67%, respectively. There was no significant difference between the R2* value and T1WI in diagnosing endometrial cysts. CONCLUSIONS: The R2* value provides an effective way to discriminate endometrial cysts from other ovarian cystic lesions.

Understanding differences between Rheum palmatum and R. franzenbachii from perspective of chemistry, efficacy and toxicity / 中国中药杂志

Rheum franzenbachii (called Tudahuang in local) has some similarities with R. palmatum (rhubarb) collected by "China Pharmacopoeia" and is often used as a substitute of rhubarb. Can Tudahuang simply replace rhubarb in the application or whether is there difference between Tudahuang and rhubarb, and what is the difference it is important to verify the difference and understand its proper application in the field of clinical practice. In this paper, we discussed the differences of the two herbs from the views of chemistry, efficacy and toxicity based on the author's previous research work as well as literatures, by using the major role of the rhubarb "diarrhea" as the basic point. The analysis result showed that the role of diarrhea Tudahuang was much weaker than that of rhubarb. The reason lies in the difference between the contents of combined anthraquinones component. While acute toxicity in mice of Tudahuang is stronger than that of rhubarb. Thus, Tudahuang should not simply replace rhubarb in practice.