Objective To compare the lymph node dissection of left chest single incision and neck-right chest-abdomen incision in esophageal cancer surgery,and to explore the reasonable range of lymph node dissection in esophageal cancer surgery.Methods We retrospectively analyzed the clinical data of 72 patients with esophageal cancer radical surgery.According to the surgical approach,the patients were divided into left chest single-incision group (32 cases) and three-incision group (40 cases).The surgery time,number of lymph node resected,drainage tube time,length of hospital stay,lymph node dissection status and incidence of postoperative complications were analyzed.Results In left chest single-incision group and three-incision group,the operative time [(225.44 ± 11.98) min vs (265.42 + 13.15) min],lymph node dissection number[(8.031 ± 1.153) vs (11.821 ± 1.138)],length of stay [(13.212 ± 1.294) d vs(15.691 ± 1.404) d] and other aspects had statistically significant differences (t =24.201,25.302,14.010,all P ＜ 0.05).There were no significant differences between two groups in the chest tube indwelling time and the incidence of postoperative complications (P ＞ 0.05).Conclusion Both surgical radical resection of esophageal cancer have their own characteristics in terms of surgical difficulty,risks,efficacy and complications.In clinical,these must be carefully evaluated in patients with lesions and body affordability flexibility to choose the surgical approach in order to achieve the best therapeutic effect.

Objective To establish Walker-256 transplantation tumor model in SD Rats.To study of R2 * signal changes on murine Walker-256 tumor after inhaling Carbogen by blood oxygen level dependent (BOLD)-MR,and to explore the feasibility of BOLD-MRI on detecting tumor hypoxia.Methods Walker-256 tumor cell implanted subcutaneously in right lower abdomen of 95 female SD rats.MR was performed on the tumor-forming rats when the maximum diameter of tumor reached 1-3 cm,using a 3.0 T MR scanner equipped with a 3 inch animal surface coil BOLD-MRI was done by using a multiecho SPGR sequence during inhaling air and at 10 minute after inhaling Carbogen,respectively.All images were transferred to GE ADW 4.3 workstation,then a baseline R2* (R2 * a) and R2 * (R2 * b) after inhaling Carbogen of tumor was calculated using R2 Star analysis software and △R2 * was calculated through △R2 * =R2 * b-R2 * a,meanwhile the volume of tumor were calculated as well.The difference of R2 * signal preand post-inhaling of Carbogen was compared with a paired t test,Pearson correlation was calculated between R2 * a,△R2 * and the volume of tumor,respectively.The correlation between △R2 * and R2 * a was also assessed by Pearson correlation.Results Sixty-eight of ninety-five female SD rats formed the tumor (71.6％).The volume of tumor was from 352 to 13 173 mm3.Mean △R2* decreased significantly (-2.26 ±3.90) s-1 from (41.18 ±22.29) s-1 during breathing air to(38.91 ±21.35) s-1 10 min after inhaling Carbogen (t =4.01,P ＜ 0.01).△R2 * was inversely correlated with R2 * (r =-0.32,P ＜ 0.05).The △R2 * was well correlated with volume of tumor (r =0.35,P ＜ 0.05),but R2 * a was not correlated with volume of tumor(r =-0.03,P ＞ 0.05).Conclusions BOLD-MRI can detect the R2 * signal change of murine Walker-256 tumor pre-and post-inhaling of Carbogen.The R2 * signal showed significant decrease after inhaling Carbogen,however,the individual variation was remarkable.

Background and purpose: Ductal carcinoma in situ (DCIS), is precursor lesions of invasive breast cancer, belongs to non-systemic ductal lesions, which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods:All the cases were surgico-pathologically conifrmed. Twenty-four patients were DCIS, 9 patients were DCIS-MI, and 20 patients were BIDP. The MRI charateristics of DCIS, DCIS-MI and BIDP were analyzed and compared. Results:DCIS and DCIS-MI’s performance in the form of MRI is dififcult to differentiate (P<0.05). Compared with BIDP, the ductal and segmental enhancement, typeⅢtime-signal intensity curve (TIC), and the red pseudo-color image were associated with the DCIS. The local area enhancement, typeⅡTIC, and no-red pseudo-color image were associated with BIDP. Conclusion:MRI is a useful for differentiate between DCIS and BIDP, but is dififcult for DCIS and DCIS-MI.

Objective To analyze the imaging manifestations of primary non-Hodgkin lymphoma of skeletal muscle and improve the recognition of this rare disease.Methods Five cases of primary non-Hodgkin lymphoma of skeletal muscle proved pathologically underwent imaging exam,including MRI and CT in 3 cases,only MRI in 1 case,only CT in 1 case,X-ray in 2 cases and bone scintigraphy in 2 cases.Results Diffuse enlargements of involved muscle with presentation of overall configuration were observed in all five cases.All 4 cases manifested as homogeneous soft masses,which is isoattenuating to normal muscle on unenhanced CT images.After intravenous injection of contrast media,the masses enhanced homogeneously and slightly(2 cases)or moderately(1 case)on CT images.The lesions were homogenous and had isointense or slightly low signal intensity compared with that of uninvolved muscle on T1-weighted images and high signal intensity on T2-weighted images.After intravenous injection of contrast media,all 2 cases enhanced homogeneously and moderately with the enhanced signal intensity of involved muscle greatly higher than that of uninvolved muscle on MR images.Two cases of X-ray plain showed no destruction of bone and 2 cases of bone scintigraphy exams showed increased radiotracer uptake of involved muscle with no infiltration of bone marrow.Conclusion There are several characteristics on the imaging of primary non-Hodgkin lymphoma of skeletal muscle.MRI is the optimal imaging method for the diagnosis of this disease.

Background and purpose:With the widespread use of screening of prostate-specific antigen (PSA) levels, prostate cancers at organ-conifned stage are increasing in newly diagnosed cases. However, some defects remain in conventional monoexponential diffusion-weighted imaging (DWI) for differentiating organ-conifned prostate cancer from benign lesions. Therefore, the aim of this study was to obtain biexponential apparent diffusion parameters of prostate organ-conifned cancer, chronic prostatitis in peripheral zone (PZ) and normal PZ tissue, and to compare with monoexponential apparent diffusion coeffcient (ADC) for differentiating prostate cancer from prostatitis lesions. Methods:Sixteen patients with pathologically confirmed prostate organ-confined cancer in PZ, 14 with prostatitis underwent conventional (b-factors 0, 1 000 s/mm2) and 10b-factors (0-3 000 s/mm2) diffusion-weighted imaging (DWI).The monoexponential ADC value and biexponential parameters fast ADC (ADCf), fraction of ADCf (f), slow ADC (ADCs) value for prostate cancer, prostatitis and normal tissues were calculated and compared. Receiver operating characteristic analysis was performed for those parameters.Results:Biexponential and monoexponential parameters were obtained for 18 prostate cancers, 18 prostatitis and 37 normal PZ tissues. The ADC value of prostate cancer tissues was remarkably lower [(0.83±0.11)×10-3 mm2/s] than that of other tissues (P<0.01), while the ADC value of prostatitis [(1.45±0.19)×10-3 mm2/s] was lower than that of PZ [(1.67±0.31)×10-3 mm2/s] (P<0.01). Prostate cancer tissues had low-er ADCf [(1.54±0.23)×10-3 mm2/s],f [(45.8±5.4)%] and ADCs [(0.52±0.15)×10-3mm2/s] than the other tissues (P<0.01). The ADCf,f and ADCs were higher in PZ [(3.90±0.40)×10-3, (67.3±8.2)% and (1.51±0.36)×10-3 mm2/s] than prostatitis [(3.06±0.49)×10-3, (47.9±3.9)% and (0.91±0.29)×10-3 mm2/s) (P<0.01). The area under the curve (AUC) of ADCf and ADC were similar in differentiating cancer and prostatitis (0.96vs 0.94) (P>0.01), but the AUC off and ADCs in differ-entiating cancer from prostatitis (0.83 and 0.80) were signiifcantly lower than that of ADC (P<0.01).Conclusion:The biexponential DWI provided additional tissue characterization parameters for different prostate tissues. ADCf yielded comparable accuracy with ADC in identiifcation of prostate organ-conifned cancer. The biexponential parameter could further improve the diagnostic effcacy.

Background and purpose:Neoadjuvant chemotherapy to breast cancer has become a mature treat-ment method. The purpose of this study was to evaluate the dynamic contrast-enhanced MRI in assessing the response to neoadjuvant chemotherapy (NAC).Methods:Twenty-four female patients with breast carcinoma (24 were all inva-sive ductal carcinoma) underwent dynamic contrast-enhanced MRI (DCE-MRI) before, after the second and ifnal cycle of NAC. For each patient and each MRI examination, the maximum diameter of tumor, volume transfer constant (Ktrans), exchange rate constant (Kep), and extravascular extracellular volume fraction (Ve) were compared. According to the method of response evaluation criteria in solid tumor (RECIST), the results of neoadjuvant chemotherapy were divided into responder and non-responder.Results:All 24 patients were unilateral and single breast cancer; there were 17 cases of responders and 7 cases of non-responders according to RECIST criteria. For 17 cases of responders, both the average values ofKtrans andKepwere signiifcantly descended after neoadjuvant chemotherapy (allP<0.05).Conclusion:The quantitative parameters ofKtrans andKep can evaluate objectively and veridically the response to neoadjuvant chemother-apy for breast cancer in dynamic contrast-enhanced MRI.

Objective To analyze the indications,techniques of MR-guided localization and the imaging features of breast lesion.Methods Hook wire localization was performed in 43 patients whose lesions were only detected by MRI,based on a 1.5 T MR scanner and a special MR biopsy positioning frame.The feasibility of operation and accuracy of localization were explored.Lesion features and pathologic findings were analyzed using Fisher exact test.Results A total of 37 patients (86.0％) with 38 lesions underwent MR-guided localization.Of the 6 patients canceled,the lesions were not obvious in 4 patients,and the positioning was difficult in 2 cases.Of the 38 lesions,17 were masses,20 were non-mass enhancement lesions,and one lesion was undetermined enhancement.There were 11 (28.9％) malignant lesions.The distribution of internal enhancement pattern was different between benign and malignant non-mass lesions (P =0.028),while the other morphological features between benign and malignant were not significantly different (P ＞ 0.05).Conclusions MR-guided localization provides an accurate and safe method for localizing the suspicious lesions on MRI.The morphological findings of these lesions are not characteristic for the differentiation of benign and malignant lesions.

Objective To evaluate the value of quantitative 3T dynamic contrast enhanced MRI in the diagnosis of breast lesions. Methods One-hundred and eighteen patients suspected of breast lesions underwent MRI examination. A 3.0 T MR scanner was used to obtain the quantitative MR pharmacokinetic parameters: Ktrans( volume transfer constant), Kep (exchange rate constant) and Ve (extravascular extracellular volume fraction). The mean Ktrans, Kep and Ve of malignant, benign and normal glandular tissues were calculated and compared each other using LSD method. Independent sample t test was used between invasive ductal carcinoma and ductal carcinoma in situ (microinvasion included). Finally, the areas under the ROC curve (AUC) of Ktrans, Kep and Ve between malignant and benign lesions were compared. Results The mean Ktrans, Kep and Ve of malignant lesions (n=87) were (1.010±0.580) min-1, (1.634 ± 1.481) min-1 and (0.735 ±0.273); the mean Ktrans, Kep and Ve of benign lesions (n=23) were (0.331±0.192) min - 1, (0.417±0.324) min - 1 and (0.847±0.291); and the mean Ktrans, Kep and Ve of normal glandular tissues (n =83) were (0.051 ±0.028) min-1, (0.133±0.125) min-1 and (0.597±0.354), respectively. There were significant differences between normal glandular tissues and benign lesions, normal glandular tissues and malignant lesions, benign and malignant lesions in Ktrans (t=9.681, 11.189, 5. 590, respectively, P ＜ 0. 01 ), normal glandular tissues and malignant lesions, benign and malignant lesions in Kep(t =5. 287, 3. 874, P＜0. 05). There were a statistic differences between normal glandular tissues and benign lesions, normal glandular tissues and malignant lesions in Ve(t =2. 932, 2. 562 ,P ＜0. 05). There were no significant differences between normal glandular tissues and benign lesions in Kep, benign and malignant lesions in Ve ( t = 0. 760, 0. 832, P ＞ 0.05 ),invasive ductal carcinoma and ductal carcinoma in situ (microinvasion included) in Ktrans, Kep and Ve(t =0.834,0.075,0.454,P＞0.05). The areas under the ROC curve (AUC) of Ktrans, Kep and Ve between malignant and benign lesions were 0. 934, 0. 941 and 0. 659. The sensitivity of Ktrans, Kep and Ve were 77.01% ,91.95% ,56. 32% and the specificity of Ktrans, Kep and Ve were 95. 65%, 86. 96%, 78.26% for the differential diagnosis of breast lesions if taken the maximum Youden's index as cut-off. Conclusion The differential diagnosis of benign and malignant breast lesions by Ktrans, Kep is applicable.

ObjectiveTo study the MR Imaging features of breast phyllodes tumor (PT),and to correlate it with pathological results.MethodClinical and MRI findings were retrospectively reviewed in twenty-seven women with 28 PTs lesions confirmed by surgical pathology.Statistical analyses were one-way ANOVA for size analysis,Fisher exact test for analysis of MR appearances and Spearman correlation to study the relationship between MRI findings and BI-RADS categories.Results( 1 ) The histologic findings were benign,borderline and malignant PTs in 14.3％ (4/28),53.6％ (15/28) and 32.1％ (9/28) of lesions,respectively.(2) The mean maximum-diameter were (6.4 ± 3.9) cm,(5.7 ± 2.2) cm in borderline type and (4.8 ± 1.8)cm in benign type respectively.The results showed differences in lesion's size among the three type (F = 287.541,P =0.000),especially between malignant and benign type (P = 0.033 ).(3)Internal non-enhanced septations and silt-like changes on enhanced images,as well as time-signal curve on MRI correlated significantly with the histological grade ( P ＜ 0.05 ).( 4 ) If the category BI-RADS ≥ 4a was considered to be a suspicious sign for malignant lesion,the diagnostic accuracy of MRI would be 96.4％ (27/28),and the BI-RADS category of the MRI could reflect the PT's histological grade with a low correlation coefficient ( r = 0.382,P = 0.045 ).Conclusion The findings of PT on MRI have some characteristics,with tumor size and several MRI features correlating with the histological grade of breast PT.

dneys, renal hilars and adjacent blood vessels. Conclusions Most of the adrenal lymphoma manifested as large soft tissue masses with shght contrast enhancement. The larger lesions were likely to invade the ipsilateral kidney and adjacent blood vessels.