Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data / 中医杂志

ObjectiveTo evaluate the effectiveness and consistency of three commonly used early colorectal cancer screening models for advanced colorectal adenoma as a noninvasive means， and to assess the predictive value of traditional Chinese medicine （TCM） tongue images in the models. MethodsPatients diagnosed with colorectal adenoma who underwent colonoscopy and pathological examination were selected as the study participants. Basic clinical data and tongue image were collected. The prediction models of Asia-Pacific colorectal screening （APCS） model， its revision （M-APCS） and colorectal neoplasia predict （CNP） model were applied to compare the predictive effects of the three models on advanced stage adenomas of the colon， the differences in clinical data and traditional Chinese medicine tongue characteristics among patients with different degrees of adenomas， and the similarities and differences in tongue characteristics among the models. The discriminative ability of the three risk models was evaluated using the area under the curve （AUC） and receiver operating characteristic （ROC） curves. The calibration was assessed using the Kuder-Richardson coefficient and the Hosmer-Lemeshow test for consistency analysis. ResultsA total of 227 patients with adenoma were analyzed， including 104 patients （45.82%） with advanced adenoma. In the detection of advanced adenoma， those with greasy coating （70 cases， 67.3%） were higher than those without greasy coating （34 cases， 32.7%， P＜0.05）. After multivariate analysis， the odds ratio （OR） value of non-greasy coating was 0.371 （0.204~0.673， P＜0.01）， indicating that non-greasy coating was a protective factor for advanced adenomas. Among the three risk models， the detection rate of advanced adenoma in the high-risk group with APCS was the highest （63.3%）， which was 1.49 times and 2.04 times that of the medium-risk group （42.6%） and the low-risk group （31.1%， P＜0.01）. The detection rate of advanced adenomas in high-risk groups of M-APCS and CNP was slightly higher than that in moderate or low risk groups （P＞0.05）. The proportion of yellow and greasy coating in high-risk group was higher than that in the medium-risk or low-risk group （P＜0.05）. For the ability to distinguish advanced and non-advanced adenomas， the AUC of APCS was 0.629 （95% CI： 0.556~0.702） and was higher than that of M-APCS （0.591） and CNP （0.586）. In calibration evaluation， Cronbach's alpha was 0.919 （＞0.7）， which indicated that the three models were consistent. In the correlation matrix， the correlation coefficients between APCS model and M-APCS model， and CNP model were 0.794 and 0.717， respectively， and the correlation coefficients between M-APCS model and CNP model were 0.873， Hosmer-Lemeshow χ2 =2.552， P＞0.05， which suggested that the three models had good calibration ability. ConclusionAll three models demonstrate the efficiency to identify advanced colorectal adenoma， and their calibration ability is considered to be good. Among the three models， the APCS exhibits the highest recognition efficiency， however， the recognition accuracy of the APCS model needs improvement. The presence of a greasy coating is identified as one of the potential predictors of advanced adenoma. Consequently， it can be considered for inclusion in the risk model of advanced colorectal adenoma to enhance the accuracy.

The value of synthetic MRI combined with diffusion weighted imaging in differential diagnosis of benign and malignant breast lesions / 中华放射学杂志

Objective:To evaluate the value of synthetic MRI combined with DWI in the diagnosis of benign and malignant breast lesions.Methods:The data of 184 consecutive patients with suspected breast lesions in Yunnan Cancer Hospital from July to September 2019 were prospectively analyzed. All patients were randomly assigned to training group ( n=110) and validation group ( n=74), and underwent conventional MRI and synthetic MRI respectively before and after contrast injection. At the maximum slice of the lesion, the ROI was drawn along the edge and recorded as "tumor". In the solid area with the most obvious tumor enhancement, the second ROI was drawn and recorded as "local". At the same time, ADC values (ADC local and ADC tumor) and relaxation time values (T local and T tumor) were measured. T and T + represented the relaxation time value of the ROI pre-and post-contrast scanning. ΔT% represented the relative change rate in T value between pre-and post-contrast scanning.The rank sum test was used to test the quantitative parameters of benign and malignant breast lesions in the training group and the validation group, and the variables with P<0.05 were included in the binary logistic regression analysis to screen the independent variables and establish the prediction model. The area under ROC curve was used to evaluate the discrimination of parameters and models. The clinical applicability of model was analyzed by decision curve analysis (DCA). Results:In the training group, univariate analysis showed that there were significant differences in T 1tumor, T 1+tumor, ΔT 1% tumor, T 2local, T 2+local, T 2tumor and T 2+tumor, ADC local, ADC tumor between benign and malignant breast lesions ( P<0.05). Multivariate logistic regression analysis showed that T 1+tumor, ΔT 1% tumor, T 2tumor, ADC local, ADC tumor were independent variables in the diagnosis of breast cancer. The relaxation time model (model A: T 1+tumor, ΔT 1% tumor, T 2tumor) and ADC model (model B: ADC local, ADC tumor) established by combining the above variables had the same diagnostic efficiency (AUC=0.905, 0.914, Z=-1.874, P=0.062), and the multi-parameter combination model (model C: T 1+tumor, ΔT 1% tumor, T 2tumor, ADC local, ADC tumor) had the highest diagnostic efficiency (AUC=0.965). DCA analysis showed that when the threshold probability ranges between 21%-99% (training cohort) and 15%-99% (validation cohort), the net benefit of model C was better than model A and B. Conclusion:The multi-parameter combined prediction model established based on the relaxation time value and ADC can identify breast cancer efficiently and can be used as an auxiliary diagnostic tool.

The value of MRI in the differential diagnosis of intraductal papilloma and invasive ductal carcinoma / 实用放射学杂志

Objective To investigate the MRI features and characteristics of irregular intraductal papilloma (IDP)and invasive ductal carcinoma (IDC),and to improve the diagnostic accuracy of MRI.Methods This study retrospectively included 3 3 patients with IDP and IDC confirmed by surgery and pathology,and analyzed MRI findings including lesion size,boundary,internal components,plain signal intensity,enhancement mode,ADC value and TIC curve χ.2 test,t test and rank-sum test were performed.Results Compared with the two groups,lesion boundary (P＜0.001),size (P＜0.001 ),ADC value (P＜0.001 ),enhancement mode (P＝0.001 ),TIC curve peak time (P＜0.001),slope (P＜0.001)and peak enhancement rate (P＜0.001)were statistically significant (P＜0.05);lesion (P＝0.159), internal components (P＝0.778),T2 WI signal (P＝0.438)and curve type (P＝0.406)were no statistically difference.Conclusion The irregular mass type IDP and IDC have similar MRI findings,the edge of the lesion,the ADC value,the enhancement mode,and the peak time,slope and peak enhancement rate of the curve are important for the identification of the two diseases.

Research progresses of breast background parenchymal enhancement of MRI / 中国医学影像技术

Breast background parenchymal enhancement (BPE) is a special form of breast dynamic contrast enhanced MRI.The diagnosis and research of breast diseases which shows BPE is becoming more and more important.The relationship between BPE and the risk factors of breast cancer is one of the focuses in breast MRI.In this review,the definition and typical manifestations of BPE,the relationship between BPE and fibroglandular tissue,and the influence factors of BPE in the breast MRI were reviewed.

Value of prediction model for BI-RADS imaging features in nonpalpable calcified breast lesions / 实用放射学杂志

Objective To improve the diagnostic accuracy of nonpalpable calcified breast lesions by establishing a Logistic multivariate prediction model to assess the probability of benign/malignant breast lesions.The proposed model is based on the clinical and BI-RADS-X-ray imaging features of patients with nonpalpable calcified breast lesions.Methods A total of 147 nonpalpable calcified breast lesions were analyzed retrospectively.Firstly, based on the personal experience,the X-ray imaging data of lesions were analyzed to obtain the BI-RADS categorization, and the ROC curve was plotted by comparison with pathology.Then the univariate and multivariate analysis was performed on the clinical and X-ray imaging features of pathology to select the independent factors related to benign/malignant features.Further,a Logistic regression model was built,the suitable cut-off point was determined, and the ROC curve was obtained.Finally,the comparisons of the diagnostic accuracy of breast lesions were made between the method using the BI-RADS categorization and the method using the Logistic regression model.Results The AUC of the BI-RADS method was 0.867 9.The univariate analysis showed that there exist statistical differences among clinical features of patients(age,location,and quadrant),as well as the BI-RADS-X-ray imaging features (distribution,morphological and gland density).Also,by using the multivariate Logistic regression equation,the statistical differences among age,quadrant and morphological difference can be observed.The AUC using the built Logistic regression model was 0.906 3.Conclusion The diagnostic accuracy of breast lesions using the Logistic model is higher than that using the BI-RADS categorization method.Therefore, the proposed model is valuable for obtaining accurate diagnosis of breast lesions.

Assessment of Locally Advanced Breast Cancer Response to Neoadjuvant Chemotherapy with Diffusion weighted MRI / 昆明医科大学学报

Objective To assess the value of diffusion weighted imaging (DWI) in monitoring therapy effect of neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer.Methods The prospective study included 26 lesions in 24 patients with LABC undergoing NAC.MRI was conducted before chemotherapy,after the first cycle of chemotherapyand after all cycles,including conventional MRI and DWI.All patients were confirmed by pre-treatment fine needle aspiration biopsy (FNAB),and postoperative histopathological prout.All lesions were divided into two groups of pathological complete response (pCR) and non-pCR.We evaluated ADC value and its changes in pathological complete response difference between the groups and complete remission in each testing point.Results Before chemotherapy and after the first cycle of chemotherapy,the ADCmean andADCmin had no statistically significant difference hetween pathologic complete response group and non-complete remission.After the whole chemotherapy,both of them had statistically significant difference;pathological complete response (pCR) and non-pCR early ADCmin value rate were (16.78 ± 22.70) ％ and (12.37 ± 10.09) ％respectively.No statistically significant difference was seen (P =0.53).Preoperative ADCmin value rates were (91.41 ± 45.83) ％ and (29.74 ± 22.96) ％ respectively,which were statistically significant (P =0.00) Conclusion ADC which is measured from DWI can be used to assess early response to NAC in breast cancer lesion,but cannat predict pCR or non-pCR for all cycles of chemotherapy on the first cycle.

The MRI diagnosis of the breast fibroadenoma with a washout type of the time signal intesity curve / 实用放射学杂志

Objective To investigate the MRI findings of the breast fibroadenoma which has a washout type of time signal intensity curve (TIC)for the purpose of improving imaging diagnosis.Methods The MRI findings of 20 cases of the breast fibroadenoma with a washout TIC and 20 cases of breast carcinoma verified by histopathology were analyzed retrospectively.Morphological features,internal signal, ADC value and dynamic enhancement performance of the two groups were compared with each other.Results The shapes of the breast fibroadenomas were more commonly ovoid or round (18/20),and the margins were circumscribed(16/20),Most of the fibroadenomas were high intensity in T2 WI with the non-contrast enhanced separations (9/20).The average minimum ADC value was (1.412±0.332)×10-3 mm2/s,and higher than that of breast cancer (0.888 ±0.1 60)×10 -3 mm2/s with the significant difference (P 0.05 ). Conclusion The breast fibroadenoma with washout TIC has a similar performance with the breast cancer in TIC and the early enhancement rate, however,the clear edge,higher T2 WI signal intensity,the non-contrast enhanced internal separations and higher ADC values are helpful to the diagnosis of breast fibroadenoma with washout TIC.

The application of manganese-enhanced MRI in stereotaxic techniques of rat visual nuclei / 实用放射学杂志

Objective To explore the value of manganese-enhanced MRI in locating the rat visual nuclei.Methods The visual nuclei of thirty-six rats were located by 3 different ways including individual MEMRI locating (group A,n= 1 6),anatomical atlas locating (group B,n=1 6)and direct puncture by using the data obtained in MEMRI (group C,n=4).After unilateral intra-vitreal injection of MnCL2 (30 mmol/L×3 μL)in group A,the brain MRI was performed 24 h later.The location coordinate of lateral geniculate nucleus (LGN) and superior colliculus (SC)were recorded individually.The nuclei injections (3% fluorogold solution,1 μL)were performed by using different location coordinate in groups A and B.The rat’s retinas were examined under fluorescence microscope 5 days later,and the results were compared between the two groups.After brain nucleus puncture injection (30 mmol/L MnCL2 solution,0.5 μL),MRI was performed 1 h later in group C.Results The success rate was 93.8% (1 5/1 6)in group A,and 65.5% (10/1 6)in group B.The difference between groups was statistically significant (P<0.05).All the injection locations of C group were agreed with atlas.Conclusion MEMRI in the visual nucleus stereotactic can improve the accuracy of location.

Clinical results of recombinant human endostatin combined with chemoradiotherapy for locally advanced nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the short-term efficacy and observe the tolerability and safety of recombinant human endostatin combined with induction chemotherapy followed by chemoradiotherapy for locally advanced nasopharyngeal carcinoma.</p><p><b>METHODS</b>Fifty-three patients with locally advanced nasopharyngeal carcinoma, who received recombinant human endostatin combined with induction chemotherapy followed by chemoradiotherapy, treated in our department from December 2011 to March 2013 were included in the study group of this study. Another 48 patients, who received induction chemotherapy followed by chemoradiotherapy alone in the same period, were chosen as a control group. The short-term outcome, overall survival (OS), progression-free survival (PFS), and acute side effects of the two groups were compared.</p><p><b>RESULTS</b>The complete remission rates of nasopharyngeal tumor in the study and control groups were 77.4% and 72.9%, respectively (P=0.154). The complete remission rates of patients with and without cervical lymph node metastasis were 75.5% and 62.6%, respectively, showing a significant difference (P=0.037). The 2-year OS, PFS, and DMFS rates for the study group were 82.3%, 77.2%, and 82.2%, respectively, versus 87.2%, 84.3% and 84.2% for the control group, showing a non-significant differences between the two groups (P=0.938, P=0.551, and P=0.725).</p><p><b>CONCLUSIONS</b>The short-term results of recombinant human endostatin (Endostar) combined with induction chemotherapy followed by concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma are slightly better than that of induction chemotherapy followed by concurrent chemoradiotherapy alone, with tolerable treatment-related toxicity and no more side effects.</p>

Study of 3D 1 H-MRS combined DWI in evaluating the response to neoadjuvant chemotherapy of breast cancer / 实用放射学杂志

Objective To determine whether tChoI and ADC and their changes could be applied to predict pathologic response be-fore,during and after NAC of locally advanced breast.To assess the diagnostic performance of each parameter.Methods The tChoI and ADC and their changes in 22 women who underwent MRI before,during and after the NAC were analyzed prospectively.All pa-tients were divided into major histological response group and non-major histological response group by methods of Miller and Payne system according to the final pathologic response.Pre-and post-treatment measurements and changes in tChoI and ADC values in MHR versus NMHR were analyzed using Mann-Whitney U test.ROC curve analysis was performed to assess the diagnostic per-formance of each parameter and also to identify which parameter could be used to predict the pathologic response to NAC and find the optimal cut off value for MHR prediction.Results After NAC,14 patients showed MHR and 8 showed NMHR.After NAC,all the parameters and their changes were significantly different between the MHR and NMHR groups,the change rate of all parameters af-ter NAC can actively diagnosis the MHR according ROC(AUC>0.5).Using 0.913 ×10 -3 mm2/s of ADCmin after NAC as the cut off value,prediction of MHR with sensitivity and specificity was 85.7% and 100%,respectively.Using 81.25% of the change rate of tCho I after NAC as the cut off value,prediction of MHR with sensitivity and specificity was 71.4% and 100%,respectively(AUC=0.881,P =0.008).The △ADCmin 2% and △tChoI2% are better than △ADCmean 2%.Conclusion Application of 3D 1 H-MRS and DWI can predict pathologic response and may provide more detailed and accurate evidence for subsequent treatment.

Diagnostic value of quantitative parameters of dynamic contrast-enhanced MRI in the evaluation of different pathological grades of cervical squamous cell carcinoma / 中华放射学杂志

Objective To investigate the value of dynamic contrast-enhanced MRI parameters in the diagnosis of cervical squamous cell carcinoma. Methods A retrospective analysis of dynamic contrast enhanced MRI in 55 patients with pathologically diagnosed cervical squamous cell carcinoma without prior treatment. They were divided into three groups based on grade of differentiation: well differentiated ( 6 patients),moderately differentiated(28 patients)and poorly differentiated group(21 patients). Capacity volume transfer constant (Ktrans),exchange rate constant(Kep) and extravascular extracellular volume fraction (Ve) were measured in each group of patients, and comparing the correlation with ANOVA, DCE-MRI parameters and grading of squamous differentiation using Spearman rank correlation analysis. Results Ktrans of the poorly, moderately and well differentiated cervical squamous cell carcinoma were (2.42±0.58),(1.71± 0.78),(1.27±0.78)/min respectively, Kep were (4.17±1.23),(3.08±1.58),(2.55±0.87)/min respectively, Ve were 0.60 ± 0.12,0.60 ± 0.19,0.43 ± 0.17 respectively. Statistical difference of Ktransand Kep were found among the subgroups of different pathological grading.(F values were 7.518 and 4.234,P all0.05). Statistical difference of Ktransand Kep were seen in multiple comparisons, between the groups of poorly and moderately differentiated groups poorly and well differentiated groups (P all 0.05). There were moderate negative correlation between Ktrans,Kep and the pathological degree (r=-0.531 and -0.446, P=0.001 and 0.002), Ve had no correlation between pathological grade (r= -0.220, P = 0.141).Conclusion DCE-MRI parameters Ktrans and Kep reveal perfusion characteristics in different pathological grades of cervical squamous cell carcinoma.

The value of BI-RADS in the 3D wire guide localization biopsy of non-palpable breast lesions / 实用放射学杂志

Objective To investigate the diagnostic value and therapeutic implication of breast imaging reporting and data system (BI-RADS)in non-palpable breast lesions detected by imaging.Methods 21 7 patients,who were found clinical non-palpable suspi-cious lesions in breast by X-ray examination,were enrolled in our study.All patients underwent general mammography (including craniocaudal view and mediolateral oblique view)and mammographic spot view in some patients,then were biopsied using 3D wire guided location biopsy.The predictive value of BI-RADS was analyzed by compare the imaging diagnosis with pathological results. Results Of the 21 7 cases,98 cases were diagnosed of grade Ⅲ,81 cases of grade Ⅳ and 38 cases of grade Ⅴ using BI-RADS.All cases were confirmed by surgery.All lesions were excised completely according to the preoperative 3D wire guided location biopsy. 75 lesions were malignant (34.6%,75/21 7),including 39 cases of carcinoma in situ (52.0%,39/75);142 lesions were benign.1 1 cases of grade Ⅲ,29 cases of grade Ⅳ and 35 cases of grade Ⅴ were malignant.The positive predictive value of BI-RADS for gradeⅢ,grade Ⅳ and grade Ⅴ was 1 1.2% (1 1/98),35.8% (29/81)and 92.1% (35/38)respectively.The positive predictive value of BI-RADS Ⅳ for premenopausal and postmenopausal women was 24.5% (13/53)and 57.1% (1 6/28).Conclusion BI-RADS can improve the resection rate and biopsy rate of non-palpable breast lesions by 3D wire guided location biopsy,and the detection rate of early breast cancer.

The preliminary study of the suitable b value in diffusion weighted imaging of lung cancer with 1.5T MR / 实用放射学杂志

Objective To determine reasonable b values in diffusion weighted imaging of lung cancer with 1.5T MR.Methods 30 patients with lung cancer received DWI of the chest using a single shot EPI-SE pulse sequence with different b values(500 s/mm2 , 600 s/mm2 ,800 s/mm2 ,1 000 s/mm2 ),and the ADC values of the lesion were measured.The image quality of each group of DWI and ADC were analyzed and compared.Results The images of DWI and ADC of 30 patients were all captured clearly,and ADC val-ues of lesions were measured too.As b values increasing from 500 s/mm2 to 1 000 s/mm2 ,SNR of lung tissue and lesion decreased gradually.When b value was 600 s/mm2 ,the ADC value was highest,and then decreased gradually.When b value was500 s/mm2 , the reference rang of ADC value was stable too.Conclusion When b value is 600 s/mm2 ,the image quality of DWI and ADC map of lung cancer is satisfying with SNR and CNR,and this would provide accuracy information for lesion changing.

PhaseⅡclinical trial of induction chrono-chemotherapy followed by concurrent chemoradiation in loco-regionally advanced nasopharyngeal carcinoma / 中国肿瘤临床

Objective:The present study aimed to investigate the short-term efficacy and adverse effects of induction chrono-che-motherapy including docetaxe1 (TXT), cisplatin (DDP), and 5 fluorouraci1 (5-FU) followed by concomitant chemoradiotherapy in lo-co-regionally advanced nasopharyngeal carcinoma (NPC). Methods:Newly diagnosed locally advanced (Ⅲ~Ⅳb) NPC patients were enrolled in this study. All patients received three cycles of TPF regimen. The TPF chemotherapy regimen was administered as follows:TXT, 75 mg/m2, i.v. infusion, d1; DDP, 75 mg/m2, bolus infusion from 10:00 to 22:00, d1-5; and 5-FU 750 mg/m2/d bolus infusion from 22:00 to 10:00, d1-5, with 21 days each cycle, followed by concomitant IMRT and chemotherapy (paclitaxel 135 mg/m2 i.v. infu-sion, with 21 days each cycle and a total of 2 courses). Acute and late toxicities were graded according to the Common Terminology Cri-teria for Adverse Events v3.0 scoring criteria. Tumor response was evaluated using 2000 Response Evaluation Criteria in Solid Tumors criteria. Results:The CR and PR rates of induction chemotherapy were 23.8%and 68.6%, respectively;whereas the CR and PR rates of the combined modality treatment were 64.8%and 31.4%, respectively. Two-year overall survival rate was 91.4%, two-year progres-sion free survival rate was 87.0%, and two-year distant metastasis-free survival rate was 88.4%. The main side effects from induction chemotherapy include an over grade 3 granulocytopenia of 28.6%. Major toxicity from concurrent chemo-radiotherapy was oral mucosi-tis (81.0%);grade 3 to 4 oral mucositis was 16%. No treatment-related deaths occurred in this study. Conclusion:Induction chrono-che-motherapy using TPF followed by concurrent chemoradiotherapy of paclitaxel is a well-tolerated treatment with short-term efficacy and severity for locally advanced NPC. Further follow-up is required to assess the late effects and long-term efficacy.

Clinical and CT Manifestations of Cystitis Glandularis / 实用放射学杂志

Objective To investigate the clinical features and CT findings of cystitis glandularis.Methods The cystoscopic findings,clinical data and CT findings in 12 cases of cystitis glandularis patiens confirmed by cystoscopy and pathology were analyzed retrospectively with literatures review. Results The clinical symptoms included hematuria (8 cases),symptoms of urinary tract infection(3 cases) and dysuria(1 case).The lesions predominataly located at the trigone, neck of the bladder and around the entrances of the ureter.CT showed normality in 3 cases,bladder wall locally thickening in 7 cases( the ranges were 1.6～ 5.5 cm),extensive bladder wall thickening in 1 case. The lesions were isodensity on plain CT images and slightly enhanced after administration of contrast medium, the CT value increased 13.1 HU averagely.Conclusion Cystitis glandularis is of certain CT characteristics,however,no abnormalities are found by CT that can not be ruled out cystitis glandularis.