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.

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.

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 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.

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.

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.

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.

Objective To develop a brachtherapy (BT) dose calculation program based on AAPM TG-43UI formula.With this program we can combine the dose result of external beam radiotherapy (EBRT) and BT together which is calculated by the different treatment planning TPS.Methods BT treatment data, such as source parameter, dwelling position and dwelling time, are retrieved from Nucletron Plato planning system and converted to ADAC planning system coordinate.The BT 3D dose distribution is re-calculated as well.Then the 3D dose distribution is exported to ADAC planning system.In that way, ADAC planning system can display either the EBRT dose or the BT dose and the combined dose can be calculated, displayed and evaluated as well.Results BT dose calculation result of our program which based on AAPM TG-43UI formula is identical with which of Plato (<0.1%).Furthermore, the BT dose can be transfer to the ADAC easily and the dose distributions of combined therapy can be merged in ADAC.Conclusions Our program can be used to combine the dose result of EBRT and BT from different TPS.

Objective To investigate the predictive value of peripheral blood eosinophil percentage (EOS％) and exhaled nitric oxide (FeNO) on the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) at stable stage.Methods A total of 78 patients with stable COPD during the outpatient clinic from January 2017 to December 2018 were enrolled.EOS％,FeNO,and pulmonary function indicators [forced vital capacity (FVC),forced expiratory volume in 1 sec (FEV1),peak expiratory flow (PEF)] were measured after ICS-free elution.The questionnaire was used to assess the severity of the symptoms.The above indicators were reviewed after 4 weeks of ICS treatment.According to the improvement of pulmonary function and chronic obstructive pulmonary disease assessment (CAT) improvement,the patients were divided into effective and ineffective groups.Pearson correlation analysis and receiver operating characteristic (ROC) curve were used to analyze the predictive value of EOS％ and FeNO for ICS.Results After ICS treatment,EOS％ and FeNO were lower,FVC,FEV1,and PEF were higher than before,and CAT score was lower than before (P ＜ 0.05).There was a positive correlation between EOS％ and FeNO levels before treatment and the FEV1 improvement (r =0.412,0.397,P ＜ 0.05),and no correlation with the improvement of FVC,PEF and CAT scores (P ＞ 0.05).The FeNO level in the effective group was higher than that in the ineffective group before and after ICS treatment,with statistically significant difference (P ＜ 0.05).The pre-treatment EOS％ level and post-treatment EOS％were not significantly different between the two groups (P ＞ 0.05);the area under the ROC curve for EOS％ prediction of ICS efficacy before treatment was 0.531 (P ＞0.05),with critical value 3.13％,the sensitivity 57.1％ and specificity 52.4％,respectively.The area under the ROC curve of FeNO for ICS treatment before treatment was 0.628 (P ＜ 0.05),with critical value 30.00％,sensitivity and specificity (64.6％ and 91.0％) respectively.Conclusions For patients with stable COPD,EOS％ and FeNO levels are positively correlated with the improvement of FEV1 after ICS treatment.Both of them can predict the efficacy of ICS to a certain extent,and FeNO has higher predictive value than EOS％,which can be applied to clinical practice.