Objective To investigate the effect of Kang' ai injection and Shenqifuzheng injection on liver function of patients with advanced primary liver cancer after being performed transcatheter arterial chemomembolization (TACE).Methods 120 patients with advanced primary liver cancer were randomly divided into three groups:a control group,a Kang'ai injection group,and a Shenqifuzheng injection group,with 40 patients in each group.All three groups were treated with TACE,and after TACE the control group was treated with anti-infection,inhibiting-acid,protecting-liver function and Shuganning tablets,20 ml/day.On this basis,the Kang'ai injection group was additionally injected with Kang'ai injection,40ml/day,and Shenqifuzheng injection group was additionally injected with Shenqifuzheng injection,250ml/day.All three groups were treated for 15 days.Liver function was tested and compared at the 3rd day,the 7th day and 14th day after TACE in all three groups.Results At the 14th day after TACE,ALT,AST,TBiL,and TBA of the Kang' ai group and Senqifuzheng group [(40.35 ± 10.10) μmol/L、(37.52 ± 10.57) μmol/L、(40.13 ± 8.36) μmol/L、(45.19 ± 19.65) μmol/L in Senqifuzheng group; (40.11 ±7.31) μmol/L,(34.99±9.38) μmol/L,(32.15±6.58) μmol/L,(40.75 ± 6.79) μmol/L in Kang'ai group] were greatly improved than the control group [(61.28 ± 13.38) μmol/L,(57.53 ± 13.36) μmol/L,(68.69± 7.25) μmol/L,(67.75 ± 17.88) μmol/L],with statistical significance (P＜ 0.01).Conclusion Kang'ai injiection and Shenqifuzhcng injection both can reduce liver function damage caused by TACE,thus they can be used together with TACE for treating advanced primary liver cancer.

Objective To investigate introvoxel incoherent motion (IVIM) sequence features of cervical cancer and to analyze the difference between cervical cancer and normal cervix by using biexponential model parameters of IVIM sequence.Methods MR imaging data of 26 patients with cervical cancer confirmed by surgical pathology and 26 patients of normal cervical confirmed by clinical or MR examination were analyzed retrospectively.All patients underwent routine pelvic MRI sequences,including T1WI,T2WI,DWI (b =800 s/mm2) and IVIM sequence.The IVIM sequence was applied using a biexponential model with factors from 0 to 1200 s/mm2.The standard ADC,slow ADC,fast ADC and fraction of fast ADC values of cervical cancer and normal cervix groups were measured and analyzed by using t test.Diagnostic efficacy of these parameters in cervical cancer group was evaluated by using area under the curve.Results The standard ADC,slow ADC,fast ADC and fraction of fast ADC of cervical cancer group were (0.47 ± 0.09) × 10-3 mm2/s,(0.45 ± 0.09) × 10-3 mm2/s,(5.00 ± 1.68) × 10-3 mm2/s,0.30 ±0.06 and those of normal cervical group were (0.77 ± 0.15) × 10-3 mm2/s (0.61 ± 0.06) × 10-3 mm2/s,(4.29 ±0.57) × 10-3 mm2/s and 0.44 ± 0.04,respectively.The differences of standard ADC,slow ADC value and fraction of fast ADC value between two groups were statistically significant (t =8.841,7.540,10.591,P ＜0.01,respectively).There was no difference of fast ADC between the two groups (t =0.120,P ＞ 0.05).The area under the curve of fraction of fast ADC was the maximum,and it may be the most valuable parameter for the diagnosis of cervical cancer.Conclusions Cervical cancer group has characters on IVIM with lower standard ADC,slow ADC and fraction of fast ADC compared with the normal cervix group.IVIM sequence can reflect diffusion and perfusion of cervical cancer quantitatively.It may play a complementary role in the diagnosis and has some application prospects.

Objective To investigate the value of multi slice spiral computed tomography (MSCT) reconstruction technique for diagnosis and preoperative evaluation of pancreatic carcinoma.Methods The multi-phase enhanced CT images of thirty-five cases of pancreatic carcinoma proved histologically were analyzed retrospectively.The techniques of volume rendering (VR),multi-planar reconstruction (MPR) and curved planar reformation (CPR) were used to deal with the images,and the relation between the pancreatic tumor and its surrounding structures,vessels,bile duct were observed,then the evaluation of possible surgical resection was performed,then it was compared with operative results.Results Among the 35 patients,27 vessels invasion was showed in 9 patients,common bile duct invasion in 19 patients,pancreatic duct invasion in 12 patients,duodenum invasion in 7 patients,posterior wall of stomach in 2 patients was invaded; one patient had regional portal hypertension with splenomegaly,peri-pancreatic lymph nodes enlargement was detected in 14 patients,para-aortic lymph nodes enlargement was detected in 4 patients,and liver metastasis was found in 3 patients.According to CT evaluation,surgery could be performed in 21 cases,finally 19 patients underwent curative pancreatic cancer resection,and 2 patients underwent palliative surgery.According to CT evaluation,surgery could not be performed in 14 cases,and all of the patients underwent palliative surgery.The coincidence percentage of pre-operative evaluation and post-operative results of curative surgery,palliative surgery was 90％ and 88％.Conclusions MSCT reconstruction technique is useful for diagnosis of pancreatic carcinoma regional invasion and metastasis,and it can increase the accuracy of assessment of tumor resectability.

Objective To comparatively analyze the application of conventional echo planar imaging-diffusion weighted imaging (EPI-DWI) and readout-segmented echo-planar diffusion imaging (RESOLVE) in the diagnosis of nasopharyngeal carcinoma.Methods A total of 35 patients with nasopharyngeal carcinoma confirmed by pathology were included in this study.All patients underwent conventional EPI-DWI and RESLOVE (b=800 s/mm2) with a 3.0 T MRI scanner.ADC values of the tumors and normal nasopharyngeal tissues were calculated.Scoring (Five-point score) for imaging quality of conventional EPI-DWI and RESLOVE was independently performed by two radiologists with 5 years experiences and the agreement evaluation was performed using Kappa analysis.The numbers of cases with effectively ADC values,the ADC values of the same tissue in different sequences and the ADC values of the tumor and the normal muscle tissue in the same sequence were compared.The data was statistically analyzed by x2 test,paired sample t test and independent sample t test.Results The agreement between two radiologists was excellent.The Kappa value of the conventional EPI-DWI was 0.91 1(P＜0.01).The Kappa value of the RESOLVE was 0.827(P＜0.01).Four points or more accounted for 97.1％ (34/35) in the RESOLVE group,while only 2.9％ (7/35) images scored four points and most of them were less than four points in the conventional EPI-DWI group.The effectively ADC values can be measured in the conventional EPI-DWI,accounting for 54.3％ (19/35) cases.The ADC values could be measured in all cases of group (100.0％,35/35).The scores of imaging quality of RESOLVE were higher than those of conventional EPI-DWI,which were significantly different (x5=19.091,P＜0.001).The ADC values of the normal nasopharyngeal tissue were (1.65 ±0.13) × 10-3,(1.96±0.14) × 10-3 mm2/s and the ADC values of the tumor were (0.87±0.09) × 10-3,(0.83±0.10)× 10-3 mm2/s in the conventional EPI-DWI and the RESOLVE,respectively.The ADC values were significantly different between the tumors and the normal nasopharyngeal tissues (t=-23.284,-31.509,P＜0.05).The ADC values of the tumors were apparently lower than the normal nasopharyngeal tissues.There were no significant difference of the ADC values between the conventional EPI-DWI and the RESOLVE measuring the same tissue (t=-0.957,-0.921,P＞0.05).Conclusion Compared with conventional EPI-DWI,RESLOVE can provide a higher quality image and may be helpful to accurate diagnosis.

Objective To assess the diagnostic value of MR imaging in follow-up evaluation of patients with hepatocellular carcinomas ( HCC ) treated with radiofrequency ablation ( RFA ) and to compare it with that of multi-slice CT.Methods From December 2009 to September 2011,there were 48 patients (56 HCCs) treated with RFA after transcatheter arterial chemoembolization (TACE). MR imaging and multi-slice CT were performed for follow-up.Two radiologists independently reviewed these images,detection of residual or recurrent tumor were assessed on a five-point scale and compared with Kappa test and with the method of receiver operating characteristic (ROC) curve analysis.Sensitivity,specificity and accuracy were evaluated.Results The observer agreement rate for MR imaging was higher ( 0.925 ) than for multi-slice CT (0.701,P ＜ 0.05).The area under the ROC curve (AUC)of MR imaging( 0.987 and 0.971 by two radiologists respectively) was significantly higher than that of CT( 0.674 and 0.598 by two radiologists respectively),P ＜0.05. The sensitivity, specificity and accuracy of detection rate for MRI [100％(22/22),95.5％ (86/90) and 95.5％ ( 107/112),respectively] were significantly different with that for multi-slice CT [40.9％ ( 9/22 ),57.8％ ( 52/90 ) and 60.7％ ( 68/112 ),respectively]. Conclusion Diagnostic accuracy and detection rate of residual or recurrent tumor were found to be superior with MR imaging than with multi-slice CT.

Objective To analyze the value of conventional T2WI combining with breath-hold Cartesian VIBE sequence, and compared with Blade combining with breath-free radial VIBE sequences in pre-operative T staging of potentiallly resectable esophageal carcinoma. Methods Sixty-five cases of esophageal carcinoma were concluded prospectively. All patients had received pathological examination of gastroscope biopsy before MRI. Patients received MR examination, including T2WI, breath-hold VIBE, Blade, and breath-free radial VIBE sequences. Two radiologists with more than five years experiences in the diagnosis of chest, performed T staging in MRIby referring to the the 7th edition of UICC-AJCC TNM classification. The results of MRI T staging and the postoperative pathological T staging were analyzed byχ2 test. Results Sixty-five patients were included. Diagnostic coincidence rates of the preoperative T staging by using conventional T2WI combining with breath-hold Cartesian VIBE sequences and Blade combining with breath-free radial VIBE sequences were 51%(33/65) and 88%(57/65) ,with 32 and 8 cases overstaging or understaging respectively, and the statistical differences were significant(χ2=20.80, P<0.05). The former diagnostic accuracy of esophageal carcinoma in situ, muscularis violation and esophageal fiber membrane were 42%(8/19), 54%(14/26), 55%(11/20), and the latter were 89%(17/19), 88%(23/26), and 85%(17/20). Conclusions Diagnostic coincidence rate of the preoperative T staging by using Blade combining with breath-free radial VIBE sequences is much higher than conventional T2WI combining with breath-hold Cartesian VIBE sequences. Blade combining with breath-free radial VIBE sequences could be used as non-invasive imaging method in preoperative T staging of potentially resectable esophageal carcinoma.

Objective: To assess intravoxel incoherent motion(IVIM) in evaluating and predicting response to neoadjuvant chemotherapy(NAC) in esophageal squamous cell carcinoma(ESCC). Methods: Forty-seven patients with ESCC diagnosed by pathological findings on biopsy from September 2015 to March 2017 were prospectively collected. All patients were examined before and after NAC using routine MRI scan and IVIM. The standard apparent diffusion coefficient (ADC_standard), diffusion coefficient (D), perfusion coefficient (D^*) and perfusion score (f) were measured. The patients were divided into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) according to the 1.1 version of the response evaluation criteria in solid tumors (RECIST). Thirty-one patients underwent surgery after NAC, and the patients were divided into TRG 0-3 according to tumor regression grade (TRG). The differences of parameter values before and after NAC between different groups were analyzed using Student's t test (normal distribution) and Wilcoxon rank sum tests (non-normal distribution). The parameters with statistical significance were evaluated by the receiver operating characteristics (ROC) curves. Results: The ADC_standard values before and after NAC were (1.97±0.51) ×10^-3, (2.42±0.52)×10^-3 mm²/s. The D values before and after NAC were (1.30±0.30)×10^-3, (1.63±0.35)×10^-3 mm²/s. The ADC_standard and D values after NAC were significantly higher than those before NAC, and the differences were statistically significant (t=-6.35, -5.25 respectively, both P<0.01). There were no statistical differences on D^* and f between before and after NAC (P>0.05). The patients were divided into PR group (29 cases) and SD group (18 cases) after NAC, without CR and PD patients. The ADC_standard, D and f values of PR group were significantly lower than those of the SD group before NAC (t=-3.11, -2.53 and -2.10 respectively, all P<0.05). The ADC_standard, D, D^* and f values after NAC revealed no significant difference between PR and SD groups. Thirty-one patients received operation after NAC, which were divided into TRG 2 group (14 cases) and TRG 3 group (17 cases) according to TRG standard, without TRG 0 and TRG 1 patients. All the parameter values before NAC revealed no significant difference between TRG 2 and TRG 3 groups. The D values after NAC in TRG 2 and TRG 3 groups were (1.81±0.31)×10^-3, (1.46±0.39)×10^-3 mm²/s respectively, and the significant difference was found between two groups (t=2.76, P<0.05). The efficiency of efficacy evaluation for NAC was the highest at D value of 1.68×10^-3 mm²/s, with sensitivity and specificity being 85.7% and 70.6%, respectively. Conclusion IVIM can be used as a new imaging method to evaluate and predict the efficacy of NAC for ESCC, among which the parameter D was the most valuable.

Objective:To investigate the clinical significance of MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction.Methods:The clinical data of 73 patients with adenocarcinoma on the esophagogastric junction operated from Jul 2018 to Aug 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent MRI examination within one week before surgery. First, the T 2WI, diffusion-weighted imaging and dynamic enhanced images of each patient were carefully observed to define the tumor location, size, shape, signal and enhancement mode, then the distances between the upper edge of the tumor and the cardiac incisure on MRI dynamic enhancement were measured independently, and compared with the measured distance in surgical fresh specimens. Results:The mean location of tumor upper edge measured in MRI of 73 patients was (1.75±1.98)cm, while measured in the surgical specimen was (1.72±1.97)cm. There was no significant difference between the two groups ( t=0.572, P=0.569). The intraclass correlation efficient between the two groups was excellent (ICC=0.974, 95% CI: 0.959-0.984, P<0.01). Conclusion:The measurement result of tumor upper edge in MRI is basically consistent with that of surgical specimens. MRI can be used to locate the tumor upper edge for adenocarcinoma of esophagogastric junction before operation.

Objective:To explore the value of intravoxel incoherent motion (IVIM) DWI in preoperative prediction of angiolymphatic invasion in esophageal squamous cell carcinoma (ESCC).Methods:From April 2016 to April 2019, 63 ESCC patients who planned to undergo resection of esophageal cancer were prospectively collected at Henan Cancer Hospital.According to the postoperative pathological results, 63 patients were divided into angiolymphatic invasion group (30 cases) and no angiolymphatic invasion group (33 cases). All patients underwent IVIM sequence and routine MRI examination before operation. The ADC, true diffusion coefficient (D), pseudodiffusion coefficient (D *) and pseudodiffusion fraction (f) were measured. The differences of parameter values between ESCC with and without angiolymphatic invasion were analyzed using Student′s t test or Wilcoxon rank sum test.The logistic regression was used to analyze the significance of various parameters. For the parameters with statistical significance, the ROC curves were performed to evaluatethe diagnostic performance of parameters for identifying angiolymphatic invasion.The Z test was used to compare the area under the ROC curves(AUC) of parameters. Results:The difference of ADC, D and f values between angiolymphatic invasion group and no angiolymphatic invasion group were statistically signi?cant ( t=4.476, 5.033 and 5.712 respectively, all P<0.001). The D * values showed no statistically signi?cant di?erence ( Z=0.184, P=0.854). The logistic regression analysis showed that D (OR=9.042) and f (OR=26.221) were in correlation with angiolymphatic invasion. The ROC analyses demonstrated that the AUCs of ADC, D and f values in predicting angiolymphatic invasion of ESCC were 0.787, 0.822 and 0.853, respectively. D combined with f had highest AUC (0.917) in predicting the angiolymphatic invasion of ESCC, sensitivity and specificity were 93.3% and 75.8%. D combined with f showed better diagnostic performance than the D and the f value, and the difference were statistically significant ( Z=2.403, 2.289, P=0.016, 0.022). Conclusions:IVIM can be used as an effective functional imaging modality for preoperative evaluation and prediction of the angiolymphatic invasion of ESCC. D value combined with f value can further improve prediction performance of angiolymphatic invasion.

Objective To explore the predictive value of intravoxel incoherent motion (IVIM) imaging for the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma (ESCC).Methods The prospective study was conducted.The clinicopathological data of 33 patients with locally advanced ESCC who were admitted to Affiliated Hospital of Zhengzhou University from September 2015 to October 2017 were collected.Patients received magnetic resonance imaging (MRI) and IVIM imaging examination before and after neoadjuvant chemotherapy.Two radiologists read the imaging together,manually delineated the region of interest in the diffusion-weighted imaging,and the apparent diffusion coefficient (ADC),diffusion coefficient (D),perfusion coefficient (D*),and perfusion score of the tumor (f) were automatically measured.Patients underwent neoadjuvant chemotherapy with paclitaxel plus cisplatin,and underwent radical surgery for esophageal cancer after 2 cycles of chemotherapy.Observation indicators:(1) comparison of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with ESCC;(2) comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in patients with different tumor regression grade (TRG);(3) predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG.Measurement data with normal distribution were presented as Mean±SD,and comparison before and after neoadjuvant chemotherapy was done using the paired t test,and comparison between different TRG patients was done using the t test.Measurement data with skewed distribution were presented as M(P25,P75),and comparison before and after neoadjuvant chemotherapy and between different TRG patients were done using the Wilcoxon rank sum test.The receiver operating characteristic (ROC) curve was used to evaluate predictive value of IVIM imaging parameters.Results Thirty-three patients were screened for eligibility,including 26 males and 7 females,aged from 44 to 74 years,with an average age of 60 years.All the 33 patients were diagnosed as ESCC by pathological examination.(1) Comparison of IVIM parameters before and after neoadjuvant chemotherapy in patients with ESCC:33 patients with ESCC showed a significant difference in the ADC,D,and f value after neoadjuvant chemotherapy [ADC:(1.95±0.56) × 10-3 mm2/s vs.(2.54±0.50) × 10-3 mm2/s,t=-6.98;D:(1.26×10-3 mm2/s (0.81×10-3 mm2/s,2.44×10-3 mm2/s) vs.1.68×10-3 mm2/s (0.83×10-3 mm2/s,2.27×10-3 mm2/s),Z=-3.96;f:0.33％±0.14％ vs.0.42％±0.15％,t=-3.13,P＜ 0.05].(2) Comparison of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy in different TRG patients:of 33 patients,15 were in TRG 2 and 18 were in TRG 3.The ADC change value,ADC change rate,D change value,D change rate were (0.85±0.52)× 10-3 mm2/s,52.91％± 32.51％,0.64× 10-3 mm2/s (0.05× 10-3 mm2/s,1.41 × 10-3 mm2/s),48.20％ (3.03％,16.95％) of TRG 2 patients,and (0.38±0.35)×10-3 mm2/s,21.94％±19.08％,0.26×10-3 mm2/s (-1.43×10-3 mm2/s,0.81× 10-3 mm2/s),20.18％ (-58.61％,77.14％) of TRG 3 patients,respectively,with significant differences between two groups (t=3.09,3.41,Z=-3.04,-2.93,P＜0.05).(3) Predictive efficacy of change value and change rate of IVIM imaging parameters before and after neoadjuvant chemotherapy for TRG:ROC curve analysis showed that ADC change value exhibited an area under curve (AUC) of 0.798,a sensitivity of 66.7％ and a specificity of 94.4％ in predicting TRG,when 0.86× 10-3 mm2/s was used as the cut-off value.With 43.3％ as the cut-off value,ADC change rate had an AUC of 0.793,a sensitivity of 66.7％ and a specificity of 88.9％ in predicting TRG.With 0.35× 10-3 mm2/s as the cut-off value,D change value had an AUC of 0.809,a sensitivity of 73.3％ and a specificity of 77.8％ in predicting TRG.With 25.9％ as the cut-off value,D change rate had an AUC of 0.800,a sensitivity of 80.0％ and a specificity of 72.2％ in predicting TRG.Conclusions The change value and change rate of ADC and D values before and after neoadjuvant chemotherapy are potential predictors of pathologic response in ESCC.The significantly increased ADC and D values after neoadjuvant chemotherapy are prone to good pathologic response.The change value and change rate of D values show a better predictive value for pathologic response to neoadjuvant chemotherapy in ESCC compared with those of ADC values.