Assessment of Ki-67 expression levels in IDH-wildtype glioblastoma using logistic regression modelling of VASARI features.

To investigate the value of using VASARI signs preoperatively to assess Ki-67 proliferation index levels in patients with IDH-wildtype glioblastoma (GB).Pathological and imaging data of 154 patients with GB confirmed by surgical pathology were retrospectively analysed, and the level of Ki-67 proliferative index was assessed in tumour tissue samples from patients using immunohistochemistry (IHC) staining. Patients were divided into a high and low Ki-67 proliferation index expression group. Two radiologists analysed MRI images of patients with IDH-wildtype GB using the VASARI features system. VASARI parameters between the two groups were statistically analysed to identify characteristic parameters with significant differences and their predictive performance was determined using ROC curves.Among the obtained clinical and VASARI features of IDH-wildtype GB patients, the distribution of Maximum diameter, Proportion of necrosis and Hemorrhage was significantly different between the two groups (all p < 0.05). Multivariate logistic regression analysis showed that Maximum diameter and Hemorrhage were independent risk factors distinguishing the group with high and low expression of Ki-67 proliferative index. ROC curve analysis showed that the logistic regression model achieved an AUC value of 0.730 (95% CI: 0.639, 0.822), sensitivity of 0.628 and specificity of 0.756.Logistic regression modelling of preoperative VASARI features can be used as a reliable tool for predicting the level of Ki-67 proliferative index in IDH-wildtype GB patients, which can help in preoperative development of treatment and follow-up strategies for patients.

Differential diagnosis of chromophobe renal cell carcinoma and papillary renal cell carcinoma with dual-energy spectral computed tomography.

BACKGROUND: Computed tomography (CT) image features of chromophobe renal cell carcinoma (ChRCC) and papillary renal cell carcinoma (PRCC) are, occasionally, sometimes difficult to identify. However, spectral CT might provide quantitative parameters to differentiate them. PURPOSE: To differentiate between ChRCC and PRCC with quantitative parameters using spectral CT. MATERIAL AND METHODS: Forty cases of RCC confirmed with pathological tests were analyzed retrospectively (27 cases of PRCC and 13 cases of ChRCC). All patients underwent non-enhanced CT and dual-phase contrast-enhanced CT scans. For each lesion, the CT value of monochromatic images as well as iodine and water concentrations were measured, and the slope of spectrum curve was calculated. Data were analyzed using Student's t-test. Sensitivity and specificity of the quantitative parameters were analyzed using the receiver operating characteristic (ROC) curve. RESULTS: During the cortex phase (CP) and parenchyma phase (PP), the CT value and slope of spectrum curve of ChRCC were higher than those of PRCC, and significant differences were observed at low energy levels (40-70 keV). Normalized iodine concentration of ChRCC and that of PRCC was significantly different during CP and PP (P < 0.05). The water (iodine) concentrations of ChRCC and PRCC in CP and PP were not statistically different (P > 0.05). All the ROCs for parameters were above the reference line. CONCLUSION: Spectral CT may help increase the diagnostic accuracy of differentiating PRCC from ChRCC using a quantitative analysis.

Different Effects of Melatonin on X-Rays-Irradiated Cancer Cells in a Dose-Dependent Manner.

The purpose of this study is to investigate the effects of melatonin on the radiosensitivity of HeLa cells. Concentration from 10 to 1000 µM of melatonin was used on HeLa cells before X-rays irradiation (IR). The cellular inactivation effect was analyzed by clonogenic assay, and cell growth was measured by MTT assay at various concentrations. Ten micrometer melatonin promoted the cell-killing effects of IR, while 1000-µM melatonin prevented IR-induced cellular inactivation. Further analysis revealed that 1000-µM melatonin protected the cells from IR-induced reactive oxygen species damage, as the oxidative stress measured by fluorescent microscopy and fluorescence-activated cell sorting using 2,7-dichlorofluorescein diacetate staining. This is further confirmed by melatonin receptor agonist, which has no antioxidant capacity. A 10-µM melatonin, on the contrary, enhanced the cell-killing effects of IR by activating c-Jun NH2-terminal kinase (JNK) signaling. c-Jun NH2-terminal kinase signaling activation was indicated by Western blot of phosphorylated JNK. We used JNK inhibitor to further confirm the involvement of JNK signaling in the cell-killing enhancement of 10-µM melatonin administration. Our results suggest the importance of dose-dependent effects in melatonin application for radiotherapy.

Gastrointestinal stromal tumor risk classification: spectral CT quantitative parameters.

PURPOSE: To examine the value of spectral CT quantitative parameters in gastrointestinal stromal tumor (GIST) risk classification. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board. The requirement for informed consent was signed. The authors evaluated 86 patients (30 high risk, 22 medium risk, 28 low risk, and 6 very low risk; mean age: 59 years [range 19-83 years]) with pathologically confirmed GIST who underwent plain and triple-phase contrast-enhanced CT with spectral CT imaging mode from March 2015 through September 2017, with manual follow-up. Quantitative parameters including the CT value of 70 keV monochromatic images, the slope of spectral curves, and the normalized iodine concentration (NIC) and water (iodine) concentrations were measured and calculated, and conducted a power analysis of the above data. RESULTS: (1) The CT values at 70 keV of the high-risk group were higher than the intermediate and low groups in each of the enhanced phases (P ≤ 0.001), no significant differences in the intermediate-risk and low-risk groups were noted (P = 0.874, 0.871, 0.831, respectively). (2) The slope of the spectral curve of the high-risk group was higher than those of the intermediate and low groups in each of the enhanced phases (P ≤ 0.001), and there were no significant differences between the intermediate- and low-risk groups (P = 0.069, 0.466, 0.840, respectively). (3) The NIC of the high-risk group significantly differed from the lower risk groups (P ≤ 0.001). There was also no significant difference observed between the intermediate- and low-risk groups (P = 0.671, 0.457, 0.833, respectively). (4) The power analysis results show that only the low-risk group with delay period is 0.530, the rest groups are all greater than 0.999. CONCLUSION: Dual-energy spectral CT with quantitative analysis may help to increase the accuracy in differentiating the pathological risk classification of GIST between high risk and non-high risk, preoperatively. There were limitations for distinguishing the intermediate- and low-risk groups.

Clinical value of spectral CT imaging combined with AFP in identifying liver cancer and hepatic focal nodular hyperplasia.

PURPOSE: To investigate the clinical value of spectral computed tomography (CT) imaging combined with alpha-fetoprotein (AFP) in identifying liver cancer and hepatic focal nodular hyperplasia (FNH). METHODS: A total of 132 patients with local liver space-occupying lesions, including 68 patients with liver cancer, were randomly enrolled. All the patients underwent spectral CT imaging and AFP examinations. The corresponding specificity, sensitivity, accuracy rate, positive predictive value and negative predictive value of spectral CT imaging, AFP and combined detection were recorded, respectively, with pathological findings as the gold standards. SPSS 17.0 software was used for statistical analysis. P<0.05 suggested that the difference was statistically significant. RESULTS: The diagnostic rate of spectral CT imaging was 79.5% for liver cancer and 81.3% for hepatic FNH. In arterial phase and portal venous phase, the contrast-to-noise ratio (CNR) of liver cancer was remarkably lower than that of FNH, showing a statistically significant difference, and the difference was the greatest at 70-100 keV between the two kinds of lesions. The detection rate of AFP for liver cancer was 86.8%, and the exclusive diagnostic rate of AFP for hepatic FNH was 96.9%. AFP had the highest specificity (73.2%) in identifying liver cancer and hepatic FNH. The spectral CT imaging possessed the highest sensitivity (91.7%) in identifying liver cancer and hepatic FNH. Both the sensitivity (98.1%) and accuracy (89.1%) of spectral CT imaging combined with AFP were the highest in identifying liver cancer and hepatic FNH. CONCLUSION: The spectral CT imaging combined with AFP is conducive to improving the efficiency of differential diagnosis of liver cancer and hepatic FNH.

Correlations of TNM staging and lymph node metastasis of gastric cancer with MRI features and VEGF expression.

OBJECTIVE: To investigate the correlations of expression of vascular endothelial growth factor (VEGF) in gastric cancer tissues of patients and magnetic resonance imaging (MRI) features with clinical tumor-node-metastasis (TNM) staging and lymph node metastasis, and to analyze the diagnostic value of MRI features for preoperative TNM staging and lymph node metastasis of patients with gastric cancer, and the roles of VEGF in tumor development and metastasis. METHODS: A total of 120 gastric cancer patients treated in our hospital from May 2015 to July 2017 were selected as objects of study. The VEGF protein expressions in gastric cancer tissues of patients with different TNM staging and lymph node metastasis degrees were detected using immunohistochemical method, and the correlations of VEGF protein expression with TNM staging and lymph node metastasis were analyzed. Before operation, MRI was used to predict TNM staging and lymph node metastasis of all patients, and prediction results were compared with postoperative pathological diagnosis results. At the same time, the differences in lymph node apparent diffusion coefficient (ADC), long diameter and short diameter, relative ADC of primary lesion (rADCp) and relative ADC of muscle (rADCm) were compared and analyzed between lymph node metastasis group and non-lymph node metastasis group. RESULTS: The VEGF expression in patients with stage-N3 gastric cancer was about 7 times that in patients with stage-N0 gastric cancer, and it was increased with the increased degree of lymph node metastasis (p< 0.01). The VEGF expression in patients with distant metastasis of tumor cells was significantly higher than that in patients without distant metastasis (p< 0.01). The expression of VEGF in stage-T4 gastric cancer was about 10 times that in stage-Tis cancer, and the larger the infiltration depth of tumor cells was, the higher the expression level of VEGF would be (p< 0.01). The VEGF expression in gastric cancer tissues was positively correlated with the infiltration depth, lymph node metastasis and distant metastasis of tumor cells. Moreover, the prediction results of MRI for TNM staging and lymph node metastasis before operation were compared with postoperative pathological results, and it was found that there was better consistency (Kappa = 0.739). ADC, rADCp and rADCm in gastric cancer patients without lymph node metastasis were significantly higher than those in patients with lymph node metastasis, but the short diameter and long diameter were obviously shorter than those in patients with lymph node metastasis, and the differences were statistically significant (p< 0.05). CONCLUSION: The VEGF protein expression in gastric cancer tissues is positively correlated with TNM staging and lymph node metastasis in patients. The preoperative prediction results of MRI are well consistent with postoperative pathological results, and MRI features are correlated with lymph node metastasis in patients, which has an important guiding significance for the diagnosis and treatment of gastric cancer.

MRI features of intracranial anaplastic hemangiopericytoma.

Magnetic resonance imaging (MRI) features of intracranial anaplastic hemangiopericytoma (AHPC) were analyzed. The pathological examination showed that there was a great number of irregularly arranged tumor cells with nuclear atypia, and mitotic properties were commonly seen providing support for clinical staging, therapy and prognosis judgment. Eighteen cases of intracranial AHPC proved by operation and pathology were analyzed retrospectively. Both plain and enhanced MR scans were performed and the results were compared with pathology in all cases. In all 18 cases, the tumor was positioned in the cortex; in 12 cases, it was located in the frontal falx and in 3 cases, it was located in the parietal falx. In 2 cases, the tumor was located in the middle cranial fossa, and in 1 case, it was located in the cerebellar hemispheres. Thirteen of the 18 cases showed mixed hyper-iso signal intensity with cortical grey matter, and the other 5 cases were isointense in the cortical grey matter on T1-weighted images. Fifteen of the 18 cases showed heterogeneous hyper-iso signal intensity, and the other 3 cases were isointense on T2-weighted images. Fifteen of the 18 cases showed heterogeneous enhancement in contrast-enhanced T1-weighted images. Our data show that, because intracranial AHPC has specific features on MRI, it could be very useful for its clinical diagnosis.