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1.
Artigo em Inglês | MEDLINE | ID: mdl-32675402

RESUMO

OBJECTIVE: To explore the specific contrast-enhanced ultrasound (CEUS) features of hepatocellular adenomas (HCA) according to their pathological molecular classifications. METHODS & MATERIALS: In this retrospective study, fifty-three histopathologically proved HCA lesions (mean size, 39.7±24.9 mm) were included. Final histopathological diagnosis of HCA lesions were identified by surgical resection (n = 51) or biopsy (n = 2) specimens. CEUS imaging features were compared among four subgroups according to World Health Organization (WHO) 2019 pathological molecular classifications standards. Analysis of variance (ANOVA) were used for statistical analysis of continuous variables. Fisher's exact test were used for categorical variables. The sensitivity (SE), specificity (SP), and accuracy of CEUS feature in diagnosis of each HCA subtype were calculated and compared. RESULTS: Final histopathological diagnosis included HNF-1α inactivated HCAs (H-HCA, n = 12), ß-catenin activated HCAs (B-HCA, n = 8), inflammatory HCAs (I-HCA, n = 31), and unclassified HCAs (U-HCA, n = 2). During arterial phase of CEUS, all HCAs were hyper-enhanced, 66.6% (8/12) of H-HCAs and 50% (4/8) of B-HCAs displayed complete hyperenhancement, whereas 58.0% (18/31) of I-HCAs showed centripetal filling hyperenhancement pattern (P = 0.016). Hyper-enhanced subcapsular arteries could be detected in 64.5% (20/31) I-HCAs during early arterial phase. During portal venous and late phase, sustained hyper- or iso-enhancement were observed in 91.7% (11/12) of H-HCAs, while most of I-HCAs (61.3%, 19/31) and B-HCAs (7/8, 87.5%) were hypo-enhanced (P = 0.000). Central unenhanced areas were most commonly observed in I-HCAs (29.0%, 9/31) (P = 0.034). CONCLUSION: Depending on its unique imaging features including enhancement filling pattern, hyper-enhanced subcapsular artery and presence of washout, CEUS might provide helpful diagnostic information for preoperative prediction of various HCA molecular subtypes.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32538825

RESUMO

Duodenal neuroendocrine tumors are rare neoplasms arising from endocrine cells. Here we present a case of 32-year-old woman with Duodenal neuroendocrine tumors, report the imaging and contrast-enhanced Ultrasound (CEUS) features and review previous literatures of neuroendocrine tumors, which may be valuable for the differential diagnosis of duodenal neoplasms.

3.
Digestion ; : 1-7, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32516767

RESUMO

BACKGROUND: Early detection of hepatocellular carcinoma (HCC) is important. Advances in liver imaging techniques have facilitated the detection of HCC at an early stage. However, there is a controversial discussion on how to diagnose very small HCC by imaging. The aim of the current review is to present current published data on HCC ≤10 mm and discuss on how to best diagnose and treat such lesions. SUMMARY: It is still challenging, however, to accurately characterize HCC <10 mm. The accuracy of contrast-enhanced ultrasound may be critical for early treatment decisions for cancer patients, particularly when CECT and/or CEMRI are inconclusive. Key Messages: The characterization of focal liver lesions <10 mm is frequently delayed until a follow-up imaging procedure demonstrates growth or stability. A repetition of ultrasound examination after 3 months for new nodules <1 cm should be recommended.

4.
J Ultrasound Med ; 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32378794

RESUMO

OBJECTIVES: To explore the enhancement features of early hepatocellular carcinoma (HCC, including well-differentiated HCC and high-grade dysplastic nodules with a focus of HCC) and high-grade dysplastic nodules (HGDNs) on contrast-enhanced ultrasound (CEUS), correlated with the histopathologic findings. METHODS: This retrospective study enrolled 81 patients with 85 pathologically confirmed hepatic lesions (69 early HCCs and 16 HGDNs). All of the hepatic lesions were examined by CEUS with SonoVue (Bracco SpA, Milan, Italy) before surgery or biopsy. The enhancement features of early HCCs and HGDNs were evaluated and compared with histopathologic findings. RESULTS: Thirty-eight (55.1%) early HCCs showed arterial-phase hyperenhancement (APHE). The major enhancement pattern of early HCCs was APHE without portal venous/late-phase wash-out (20 of 69 [29.0%]). Eight (11.6%) early HCCs manifested APHE. Wash-out was observed in 30 (43.5%) early HCCs. Sixteen (23.2%) early HCCs showed very-late wash-out (>120 seconds). Wash-out was not observed in all HGDNs. Of the 16 HGDNs, arterial-phase isoenhancement without portal venous/late-phase wash-out was the major enhancement pattern (n = 7 [43.8%]). The degree of CD34 expression of sinusoidal endothelial cells was more diffuse in early HCCs than in HGDNs (56.5% versus 12.5%; P = .001). Arterial-phase enhancement patterns of early HCCs on CEUS were correlated with the degree of CD34 expression (P = .039). CONCLUSIONS: Enhancement patterns were significantly different between early HCCs and HGDNs on CEUS. Diffuse CD34 expression of sinusoidal endothelial cells in early HCC was correlated with APHE on CEUS.

5.
World J Gastroenterol ; 26(8): 839-849, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32148381

RESUMO

BACKGROUND: The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. AIM: To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. METHODS: This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. RESULTS: Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m2 and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m2 and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m2 and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m2 and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS (P < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. CONCLUSION: PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.

6.
Ultraschall Med ; 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32102105

RESUMO

PURPOSE: Fibrolamellar hepatocellular carcinoma (f-HCC) is a rare primary liver tumor. Imaging plays an important role in diagnosis. The aim of this retrospective study was to analyze contrast-enhanced ultrasound (CEUS) features of histologically proven f-HCC in comparison to benign focal nodular hyperplasia (FNH). MATERIALS & METHODS: 16 patients with histologically proven f-HCC lesions and 30 patients with FNH lesions were retrospectively reviewed regarding CEUS features to determine the malignant or benign nature of the focal liver lesions (FLL). Five radiologists assessed the CEUS enhancement pattern and came to a consensus using the EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) guideline criteria. RESULTS: Fibrolamellar hepatocellular carcinoma manifested as a single and huge FLL. On CEUS, f-HCC showed heterogeneous hyperenhancement in the arterial phase and hypoenhancement (16/16, 100 %) in the portal venous and late phases (PVLP) as a sign of malignancy. In contrast to the hypoenhancement of f-HCC in the PVLP, all patients with FNH showed hyperenhancement as the most distinctive feature (P < 0.01). 8 f-HCC lesions showed a central scar as an unenhanced area (8/16, 50.0 %), which could also be detected in 53.3 % (16/30) of FNH lesions (P > 0.05). CONCLUSION: By analyzing the hypoenhancement in the PVLP, CEUS imaging reliably diagnosed f-HCC as a malignant FLL. CEUS also showed differentiation between f-HCC and FNH lesions, showing similar non-enhanced central scars, whereas f-HCC lesions showed peripheral hyperenhancement in the arterial phase and early washout in the PVLP.

7.
Eur Radiol ; 30(5): 2973-2983, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31965257

RESUMO

OBJECTIVES: To propose a transfer learning (TL) radiomics model that efficiently combines the information from gray scale and elastogram ultrasound images for accurate liver fibrosis grading. METHODS: Totally 466 patients undergoing partial hepatectomy were enrolled, including 401 with chronic hepatitis B and 65 without fibrosis pathologically. All patients received elastography and got liver stiffness measurement (LSM) 2-3 days before surgery. We proposed a deep convolutional neural network by TL to analyze images of gray scale modality (GM) and elastogram modality (EM). The TL process was used for liver fibrosis classification by Inception-V3 network which pretrained on ImageNet. The diagnostic performance of TL and non-TL was compared. The value of single modalities, including GM and EM alone, and multimodalities, including GM + LSM and GM + EM, was evaluated and compared with that of LSM and serological indexes. Receiver operating characteristic curve analysis was performed to calculate the optimal area under the curve (AUC) for classifying fibrosis of S4, ≥ S3, and ≥ S2. RESULTS: TL in GM and EM demonstrated higher diagnostic accuracy than non-TL, with significantly higher AUCs (all p < .01). Single-modal GM and EM both performed better than LSM and serum indexes (all p < .001). Multimodal GM + EM was the most accurate prediction model (AUCs are 0.950, 0.932, and 0.930 for classifying S4, ≥ S3, and ≥ S2, respectively) compared with GM + LSM, GM and EM alone, LSM, and biomarkers (all p < .05). CONCLUSIONS: Liver fibrosis can be staged by a transfer learning modal based on the combination of gray scale and elastogram ultrasound images, with excellent performance. KEY POINTS: • Transfer learning consists in applying to a specific deep learning algorithm that pretrained on another relevant problem, expected to reduce the risk of overfitting due to insufficient medical images. • Liver fibrosis can be staged by transfer learning radiomics with excellent performance. • The most accurate prediction model of transfer learning by Inception-V3 network is the combination of gray scale and elastogram ultrasound images.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31985457

RESUMO

OBJECTIVES: To investigate the value of dynamic contrast enhanced ultrasound (D-CEUS) in monitoring the chemoradiotherapy (CRT) therapeutic response of local advanced pancreatic ductal adenocarcinoma (LAPC). PATIENTS AND METHODS: From October 2017 to December 2018, 11 patients diagnosed as LAPC were included (7 men, 4 women; mean age: 61.1±8.6 years). The algorithm of CRT was as following: the radiotherapy dose was 50.4 Gy/28Fx with S-1 40 mg bid orally taken in radiotherapy day. Conventional ultrasound scan and CEUS were performed before and 4 weeks after CRT. All ultrasound examinations were performed by an ACUSON Oxana 2 ultrasound equipment (Siemens Medical Solutions, Germany) with a C 6-1 convex array transducer (1-6 MHz). Time intensity curves (TICs) were generated in the region of interests (ROIs) both in LAPC lesions and in its surrounding pancreas parenchyma by SonoLiver software (TOMTEC Imaging Systems). Quantitative perfusion parameters including maximum intensity (MI), rise time (RT), mean transit time (mTT) and time to peak (TTP) were analyzed and compared before and after CRT. RESULTS: No significant difference could be found by conventional B mode ultrasound scan after CRT. TICs of CEUS showed lower ascending and descending slopes rate after CRT. Among all perfusion quantitative parameters, MI decreased significantly after CRT (42.1±18.8% vs 27.8±17.2%, P < 0.05). CONCLUSIONS: Depending on its unique advantages as non-radiation, effective and convenient, D-CEUS analysis and quantitative parameters, particularly MI, has potential application value in following up of the CRT treatment response in LAPC patients.

9.
Clin Hemorheol Microcirc ; 74(3): 315-325, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31524151

RESUMO

AIM: To investigate the value of contrast enhanced ultrasound with high resolution linear transducers (HF-CEUS) for differential diagnosis of focal fundal gallbladder (GB) wall thickening. METHODS: A total of 32 patients with incidentally detected focal fundal GB wall thickening were included. After conventional B mode ultrasound (BMUS) examinations, HF-CEUS were performed with a 7.5-12 MHz 9L4 linear transducer (S2000 HELX OXANA unit, Siemens). Two radiologists independently reviewed the HF-CEUS enhancement patterns to determine the differential features between malignancy and benignity with a five-point confidence scale. The diagnostic accuracy of BMUS and HF-CEUS for GB wall thickening was compared. The final gold standard was surgery with histological examination. RESULTS: Final diagnoses included GB adenocarcinoma (n = 16), adenomyomatosis (n = 12), Xanthogranulomatous (n = 2) and cholecystitis (n = 2). HF-CEUS features associated with GB adenocarcinoma including arterial phase inhomogeneous hyperenhancement, venous phase hypoenhancement and disruption of GB wall layer structure (P < 0.05). Two small (5 mm) liver metastasis were confirmed by HF-CEUS during the late phase liver sweep as hypoenhanced lesions. Nonenhanced Rokitansky-Aschoff sinuses were clearly observed in 83.3% focal adenomyomatosis. Overall sensitivity, specificity and accuracy for differentiation between malignant and benign focal fundal GB wall thickening of HF-CEUS and BMUS were 84.3% vs 53.1%, 90.6% vs 59.3% and 87.5% vs 56.2% (P < 0.005). CONCLUSIONS: CEUS performed with high frequency linear transducers could be a useful alternative in the differential diagnosis of focal fundal GB wall thickening on conventional ultrasound.

10.
Clin Hemorheol Microcirc ; 74(2): 167-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31306115

RESUMO

BACKGROUND AND AIM: To evaluate the benefits of contrast-enhanced ultrasound (CEUS) with high frequency transducers in characterization of focal gallbladder lesions (FGL). MATERIAL AND METHODS: From January 2017 to April 2019, 59 FGL detected by B mode ultrasound (BMUS) were examined, first with the low frequency convex transducer (1-5 MHz) and afterwards with high frequency transducer (7.5-12 MHz). High frequency dynamic CEUS were applied after bolus injection of 4.8 ml Sulphur hexafluoride microbubbles (SonoVue®, Milan). The BMUS and CEUS imaging features were recorded and compared. All lesions were confirmed by surgical resection and histopathologic results. RESULTS: The final diagnoses of 59 FGL included gallbladder adenocarcinoma (n = 15), gallbladder polyps (n = 11), gallbladder adenomas (n = 18), focal adenomyomatosis (n = 9), and gallbladder Ascariasis debris (n = 6). The mean diameter of FGL was 24.5±11.4 mm, and mean depth to the abdominal wall was 21.2±7.3 mm. While applying CEUS with high frequency transducer, specific diagnostic features, including arterial phase irregular intralesional vascularity (10/15, 66.7%), late phase hypoenhancement (12/15, 80%), destruction of gallbladder wall (8/15, 53.3%), infiltration to the adjacent liver (6/15, 40.0%) were significantly higher in malignant FGL. The overall sensitivity, specificity and diagnostic accuracy for the correct characterization of malignant FGL were significantly improved by CEUS with high frequency transducer (sensitivity 93.3%, specificity 88.5%, accuracy 100%). CONCLUSION: With its superior contrast resolution, CEUS performed with high frequency transducers is helpful to achieve better visualization of gallbladder fundus and make differential diagnosis of gallbladder lesions, which might greatly improve diagnostic confidence between malignant and benign FGL.

11.
Front Oncol ; 9: 1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31799183

RESUMO

Background: To evaluate the accuracy of radiomics algorithm based on original radio frequency (ORF) signals for prospective prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) lesions. Methods: In this prospective study, we enrolled 42 inpatients diagnosed with HCC from January 2018 to December 2018. All HCC lesions were proved by surgical resection and histopathology results, including 21 lesions with MVI. Ultrasound ORF data and grayscale ultrasound images of HCC lesions were collected before operation for further radiomics analysis. Three ultrasound feature maps were calculated using signal analysis and processing (SAP) technology in first feature extraction. The diagnostic accuracy of model based on ORF signals was compared with the model based on grayscale ultrasound images. Results: A total of 1,050 radiomics features were extracted from ORF signals of each HCC lesion. The performance of MVI prediction model based on ORF was better than those based on grayscale ultrasound images. The best area under curve, accuracy, sensitivity, and specificity of ultrasound radiomics in prediction of MVI were 95.01, 92.86, 85.71, and 100%, respectively. Conclusions: Radiomics algorithm based on ultrasound ORF data combined with SAP technology can effectively predict MVI, which has potential clinical application value for non-invasively preoperative prediction of MVI in HCC patients.

12.
Biomed Res Int ; 2019: 9296010, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886269

RESUMO

Objective: To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. Materials and Methods: Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. Results: Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[-3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. Conclusion: Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.


Assuntos
Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Câncer Papilífero da Tireoide/complicações , Neoplasias da Glândula Tireoide/complicações , Tireoidectomia/métodos , Ultrassonografia/métodos , Adulto , Idoso , Calcinose/patologia , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática/patologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pescoço/diagnóstico por imagem , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-31683473

RESUMO

OBJECTIVE: To evaluate the feasibility of vector flow imaging technique (V Flow) in measurement of wall shear stress (WSS) of common carotid arteries (CCA) in healthy adults and to provide the normal WSS values assessed by V Flow. METHODS & MATERIALS: This prospective study was approved by the Ethics Committee of our University. Eighty healthy adult volunteers were included (mean age 43.3 y, 47 females, 33 males). The volunteers were classified into three groups according to their age: group I (age 20 - 39 y), group II (age 40 - 59 y) and group III (age 60 - 80 y). Mindray Resona 8 ultrasound machine and a linear array transducer (3-9 MHz) was used, equipped with the updated V Flow function. Common carotid arteries of both sides were evaluated in three segments (initial segment, middle segment and near bifurcation segment). The WSS values of CCA were measured by two independent radiologists. The intraclass correlation coefficient (ICC) of observer reliability in WSS measurement was calculated. Inter-observer reproducibility was also evaluated with the 95% Bland-Altman limits of agreement (LOA). RESULTS: V Flow measurements were performed successfully in 79 volunteers (98.8 %, 79/80). The mean value of WSS in right CCA was (0.66±0.24) Pa, in left CCA was (0.66±0.18) Pa (P > 0.05). Mean WSS value had a moderately negative correlation with age group (P < 0.05). The mean WSS value of group I(mean±SD, 0.75±0.25 Pa) is larger than group II (mean±SD, 0.62±0.13 Pa) and group III (mean±SD, 0.49±0.11 Pa) (P < 0.05). The ICC of observer reliability of group I, II and III was 0.96 (95% confidence interval (95% CI) 0.92-0.98), 0.94 (95% CI 0.88-0.97), 0.93 (95% CI 0.76-0.98) respectively. The Bland-Altman plots showed that the 95% LOA were -0.17-0.12 (Pa) for group I, -0.09-0.13 (Pa) for group II and -0.08-0.10 (Pa) for group III. CONCLUSION: V Flow measurement is a simple, rapid and feasible imaging method for the WSS assessment of CCA in healthy volunteers, which will probably be an important tool for assessing CCA function.

14.
Med Sci Monit ; 25: 8694-8703, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31736477

RESUMO

BACKGROUND This study aimed to develop a nude mouse model of orthotopic liver transplantation of HCCLM3 human hepatocellular carcinoma (HCC) cell xenografts and the use of imaging and histology to evaluate tumor development and progression. MATERIAL AND METHODS HCCLM3 cells were injected subcutaneously into 25 healthy male athymic BALB/c (nu/nu) nude mice. The tumors that developed were transplanted into the liver of a new set of nude mice. After four weeks and six weeks, the mice were imaged using ultrasound (US), software-assisted contrast-enhanced ultrasound (CEUS), fluorodeoxyglucose-positron emission tomography (FDG-PET). Histology was performed on the liver and liver tumors, and included immunohistochemistry for vascular endothelial growth factor (VEGF), CD31, CD34, and alpha-smooth muscle actin (alpha-SMA). RESULTS The success rate for orthotopic tumor transplantation in the mouse liver was 90% (18/20). Liver tumors measured 11.8±2.6 mm in diameter and 525.9±250.8 mm3 in volume on the sixth week. CEUS showed rapid wash-in and washout in the liver tumors, and PET showed low tumor cell metabolism. Bone metastases were present in 45% (9/20) of mice in the sixth week. Immunohistochemistry showed positive expression for VEGF, CD31, CD34, and alpha-SMA. CONCLUSIONS The nude mouse orthotopic liver transplantation model of human HCC was shown to be a reliable model that has the potential for future research on the pathogenesis and progression of HCC and studies on drug development.


Assuntos
Transplante de Fígado/métodos , Transplante Heterólogo/métodos , Actinas/metabolismo , Animais , Antígenos CD34/metabolismo , Carcinoma Hepatocelular/patologia , Linhagem Celular Tumoral , Proliferação de Células , Modelos Animais de Doenças , Xenoenxertos , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
15.
Ann Transl Med ; 7(12): 256, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31355223

RESUMO

Background: Whether lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC) should be considered an independent prognostic factor for survival is controversial. The aim of this report was to investigate the prognostic value of LVI for patients with ESCC. Methods: Between October 2010 and July 2011, 152 ESCC patients were retrospectively reviewed. All of the patients underwent curative resection as their primary treatment. Clinicopathological features and overall survival (OS) rate were investigated. Kaplan-Meier curves were used to calculate the OS rate, and the prognostic factors were identified by Cox regression model. Results: Positive LVI was found in 49 (32.2%) patients. Patients with negative LVI had a significantly better 5-year OS rate than those with positive LVI (52.9% vs. 28.8%; P=0.000). The age, T stage, N stage, tumor differentiation, and LVI were demonstrated to be significant prognostic factors for OS through univariate analyses. LVI was confirmed as an independent prognostic factor for OS through multivariate survival analyses. Subgroup analyses revealed that LVI was associated with a decreased OS in node-negative patients, and no significant difference was observed in node-positive cases. Conclusions: Our study highlighted that LVI is an independent prognostic factor in patients with resectable ESCC. LVI may facilitate the stratification of patients with poor survival.

17.
Ann Thorac Surg ; 108(6): 1717-1723, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31039351

RESUMO

BACKGROUND: Nodal skip metastasis (NSM) is a prognostic factor in certain malignant tumors, but the clinical and prognostic implications of NSM in esophageal squamous cell carcinoma (ESCC) are still unclear. The study aimed to assess its risk factors and prognostic value in thoracic ESCC. METHODS: A retrospective study was conducted in patients with thoracic ESCC who underwent esophagectomy from March 2009 to March 2012 in the Department of Thoracic Surgery, West China Hospital, Sichuan University. The prognostic implications and risk factors of NSM were assessed in our study. RESULTS: The incidence of NSM in the entire cohort was 37.9%. Tumor location (P = .016), pT stage (P = .029), and pN stage (P < .001) were identified to be independent risk factors for NSM. The overall survival (OS) was similar between patients with and without NSM. The OS had no significant difference between pN1 patients with and without NSM, whereas the OS was significantly worse in pN2 patients with NSM than those without NSM (P = .001). The OS was similar between patients with NSM level 1 and NSM level 2, but the OS was significantly better in patients with NSM level 1 than NSM level 2 among patients with lower thoracic ESCC (P = .013). CONCLUSIONS: The effect of NSM on prognosis of thoracic ESCC may be mainly reflected in patients with pN2 stage. The prognostic value of NSM level for thoracic ESCC may be mainly reflected in patients with lower thoracic tumor.


Assuntos
Carcinoma de Células Escamosas do Esôfago/secundário , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Estadiamento de Neoplasias , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Carcinoma de Células Escamosas do Esôfago/epidemiologia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia , Feminino , Humanos , Incidência , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
19.
Clin Hemorheol Microcirc ; 72(4): 395-405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30909196

RESUMO

AIM: To investigate the specific findings and characteristics of real-time contrast-enhanced ultrasound (CEUS) in hypoechoic hepatic hemangioma. METHODS: A total of 101 lesions in 83 patients were included. Analysis was made of the relationship between tumor size and CEUS enhance patterns in arterial phase, portal phase and delayed phase, phase changes, echoic changes in perfusion regression stage and filling defect. RESULTS: CEUS showed a lesion detection rate of 92.7%. In regression stage, only 46.5% lesions were fully filled. Enhancement of the lesions was categorized into Pattern I, peripheral nodular enhancement and centripetal filling (68.3%); Pattern II, peripheral ring enhancement and centripetal filling (27.7%); and Pattern III, overall rapid enhancement (4.0%). The most common phase changes were "fast-in slow-out" (74.3%). More than half (61.4%) lesions were hyperechoic in regression stage. Among all the lesions, 4 (3.9%) lesions regressed to hypo-echo in portal phase and 2(2.0%) in delayed phase). The frequent enhancement in tumors >3.0 cm was of Pattern I or II, "fast-in slow-out" or "slow-in slow-out" phase change, and hyperechoic or isoechoic change in perfusion regression stage, but in those ≤3.0 cm, the enhancement was of Pattern III, "fast-in fast-out" phase change and hypoechoic change in perfusion regression stage. The differences were statistically significant (p < 0.05). The percentage of lesions with complete filling on CEUS in the larger hypoechoic hepatic hemangiomas was significantly lower than that of smaller ones (p < 0.01). CONCLUSIONS: CEUS has high diagnostic value in hypoechoic hepatic hemangiomas mainly characterized by peripheral nodular or ring enhancement, centripetal filling, and "fast-in slow-out" and "slow-in slow-out" phase changes.


Assuntos
Meios de Contraste/uso terapêutico , Hemangioma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Hemangioma/patologia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
J Ultrasound Med ; 38(9): 2379-2388, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30666662

RESUMO

OBJECTIVES: To find certain specifics of hepatic reactive lymphoid hyperplasia (HRLH) on contrast-enhanced ultrasound (CEUS) imaging as diagnostic imaging clues by retrospectively analyzing its enhancement features. METHODS: From June 2010 to June 2017, 18 histopathologically confirmed HRLH lesions in 18 patients were included in this retrospective study. The lesion's location, maximum diameter, shape, margin, echogenicity, and color flow signal on conventional ultrasound (US) imaging and enhancement pattern, presence of a feeding artery, and donutlike enhancement on CEUS imaging were observed and recorded. The lesion size on CEUS imaging at peak enhancement and that on conventional US imaging were compared and recorded. RESULTS: All of the lesions showed homogeneous hypoechogenicity with a regular well-defined margin on conventional US imaging, with a mean diameter ± SD of 14.3 ± 4.6 mm (range, 8-24 mm). On CEUS imaging, all of the lesions showed "quick-wash-in and quick-wash-out," which showed complete homogeneous hyperenhancement in the arterial phase and wash-out in the second half of the arterial phase or first half of the portal phase. In 83.3% (15 of 18) of the lesions, the lesion size that was enhanced at peak was enlarged compared with the hypoechoic area on conventional US imaging, and transient donutlike enhancement appeared when the lesion showed wash-out. In 55.6% (10 of 18) of cases, the feeding artery was detected. CONCLUSIONS: Enlarged complete homogeneous hyperenhancement in the arterial phase, consequently followed by quick wash-out of the lesion and the appearance of donutlike enhancement, may be the CEUS features of HRLH.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Hepatopatias/diagnóstico por imagem , Pseudolinfoma/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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