Objective To access the value of the combination of axial image,MPR,and VE in theevaluation of laryngeal carcinoma involvement.Methods Twenty patients with laryngeal carcinoma or hypopharyngeal carcinoma were prospectively studied by helical CT,and MPR and VE were subsequently done on the Voxel Q workstation.The axial images findings and the combined image findings of axial image,MPR,and VE were compared with the pathological results by suing a predetermined checklist of 17 regions according to the TNM classification of malignant tumors(UICC and AJCC).the results were studied in a blind way. Results In the evaluation of the neoplastic invasion of ventricular fold,vocal cord,the anterior commissure,subglottic region,thyroid cartilage,and tissue beyond the larynx,the combined image were better than axial image in sensitivity(100% vs 92.4%,P=0.064),specificity(98.5% vs 89.5%,P=0.028),and accuracy(99.2% vs 90.8%,P=0.003).Neoplastic invasion of the arytenoid cartilage was present in 6 patients.The sensitivity and the specificity was 83.3% and 100% respectively when using the criteria of the arytenoid cartilage sclerosing combined with distortion,erosion or lysis.The specificity was only 57.1% when using the criteria of arytenoid cartilage sclerosing for judging parameter.The result was identical when assessing the arytenoid cartilage,PGS,and PES between the two groups.Conclusion Axial image combined with subsequent MPR and VE could improve the diagnosis in the evaluation of the neoplastic invasion of ventricular fold,vocal cord,the anterior commissure, subglottic region,thyroid cartilage,and tissue beyond the larynx.

Objective To study the CT manifestations of metastatic lymph node of thyroid carcinoma. Methods CT appearances of metastatic lymph node of thyroid carcinoma proved by surgery and pathology in 108 patients were reviewed. Results Of these 108 cases, metastatic lymph nodes were located at superoir and middle internal jugular chain(n=76), inferior internal jugular chain and super clavicular region(n=86), tracheoesophageal groove(n=52), and superior mediastinum(n=17). Of 84 thyroid papillary carcinoma patients, the attenuation of metastatic lymph nodes were similar to that of normal thyroid gland(n=16), with cystic formations (n=24), intracystic high attenuation papillary-like nodules (n=18), and fine granular calcifications (n=11). Of 24 follicular carcinoma, medullary carcinoma, and clear cell carcinoma patients, 17 cases had significant homogeneous or heterogeneous enhanced nodes, and the attenuation was the same as primary or recurrent thyroid tumors. Conclusion For thyroid carcinoma, the most common locations of metastatic lymph nodes were internal jugular chain, tracheoesophageal groove, and superior mediastinum regions. Marked enhancement similar to normal thyroid gland, cystic formations with intracystic high attenuation papillary-like nodules, and fine discrete granular calcifications were the characteristic manifestations of metastatic lymph node of papillary carcinoma. Marked homogeneous or heterogeneous enhancement after contrast administration and the same attenuation as the primary or recurrent thyroid tumor were found in follicular carcinoma, medullary carcinoma, and clear cell carcinoma metastases.

Objective To explore the significance and correlation between MCP-1 and cardiovascular complication of diabetes. Methods 65 patients with diabetes and 64 patents with IGT and 60 healthy persons as control group are chosen from a population of 1231residents at Jiangnan community in Guangzhou city. Ultrasonic inspection of carotid artery was applied to the intimae media thickness (IMT),and the levels of-MCP-1 were detected by Elisa. Result There was significant difference in the levels of MCP-1 among the normal control group, IGT group and DM group (P=0.000).The levels of MCP-1 in IGT complicated with AS patients were significantly higher than that in IGT alone patients. The levels of MCP-1 in DM complicated with AS patients were significantly higher than that in DM alone patients. The levels of MCP-1 were positively correlated with IMT in these patients. A forward LR Logistic regression analysis showed that IMT was a dependent variable, gender, MCP-1 and age are independently correlated with IMT. Conclusion MCP-1 is correlated with diabetes and its cardiovascular complication and it may be served as the target of therapy.

Objective To evaluate the value of MR and CT examinations in the diagnosis of nasopharyngeal carcinoma (NPC) and compare 2008 staging system with 1992 staging system and 2002 UICC staging system for NPC. Methods MR and CT images of seventy-six cases with NPC were studied. According to 2008 staging system and taking MR as a standard, differences between these two examinations were evaluated under the new NPC staging system, and three staging system were compared by MR findings. Results MR was inconsistent with CT in eveluating invasion of medial pterygoid muscle(22,24 cases), lateral pterygoid muscle( 15, 11 cases), skull base(35, 32 cases) and intracranial fossa( 11,6 cases), but no statistical diffence existed ( P ＞ 0. 05 ). There were statistical difference ( P ＜ 0. 05 )between MR and CT in determining invasion of parapharyngeal space( 50, 61 cases), retropharyngeal lymph node metastasis(48, 23 cases), stage T1 (18, 11 cases), T2 (15, 22 cases), N0 (18, 24 cases) and N1(33, 27 cases) with differences of 11 cases, 25 cases, 7 cases, 7 cases, 6 cases and 6cases respectively.For invasion of parapharyngeal space, CT showed 11 cases more than MR while 5 cases were comfirmed as compression by local tumor and 6 cases were proved as retropharyngeal lymph node metastasis according to MR. For retropharyngeal lymph node metastasis, MR presented 25 cases more than CT. These two reasons above mainly caused the differences of T-staging and N-staging. For 2008 staging system, when compared with 1992 staging system, there were 9 cases upstaging and 1 case downstaging in T classification, 16 cases upstaging in N classification, and 15 cases upstaging and 1 case downstaging in clinical classification; and when compared with 2002 UICC staging system, there were 7 cases, 10 cases and 12 cases upstaging in T,N, and clinical staging respectively. Conclusions Compared with MR examination which was regarded as standard by 2008 staging system of NPC, there were some differences in demonstrating invasion of parapharyngeal space and retropharyngeal lymph node metastasis by CT. Compared to 1992 staging system and 2002 UICC staging system, 2008 staging system mainly made T and N classification of tumor upstage,resulting in upstaging in clinical classification.

Objective To explore the capability of diffusion weighed imaging (DWI) in differentiating malignant cervical lymph nodes from benign ones in nasopharyngeal carcinoma (NPC) patients, and to assess the appropriate b value in 3.0T MR DWI. Methods Conventional MR and DWI scan were performed in 50 patients with histopathologically proven NPC and 20 healthy volunteers with GE 3.0T MR scanner, and neurovascular array 8 channels head and neck unite coil. DWI was performed with single shot spin-echo echo-planar imaging (SE-EPI) sequence at 4 different b values (600, 800, 1000,1200 s/mm~2). The apparent diffusion coefficient (ADC) values between metastatic lymph nodes of NPC patients and benign nodes of volunteers were compared. Results The mean ADC value (×10~(-3) mm~2/s) of metastatic cervical lymph nodes of NPC at different b value (600, 800, 1000, 1200 s/mm~2) was 0.808±0.112, 0.769±0.098, 0.732±0.095 and 0.696±0.083, respectively; the mean ADC value (×10~(-3) mm~2/s) of lymph nodes of volunteers was 0.993±0.172, 0.967±0.165, 0.903±0.157 and 0.855±0.122, respectively (P<0.05). When b value was 800 s/mm~2, and ROC cut-off point was 0.873×10~(-3) mm~2/s, the diagnostic sensitivity, specificity and accuracy was 88.41%, 69.43%, and 75.22%, respectively. Both the satisfying images and the accurate measurement were acquired. Conclusion As a rapid and sensitive new MR technique, DWI can offer help in discriminating benign and malignant cervical lymph nodes in NPC patients.

Objective To investigate the value of DWI before treatment on predicting sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma.Methods Seventy patients with nasopharyngeal carcinoma proved by nasopharyngoscope and biopsy pathology conducted DWI before concurrent chemoradiation and reexamined on receiving dose of 50 Gy.The mean, maximum and minimum ADC value of tumor were measured on DWI and maximum area of tumor before and during treatment ( on dose of 50 Gy) was delineated to calculate the tumor regression rate ( RS0-50 ).The patients were classified into three groups according to the RS0-50 as sensitive, moderate, and resistant therapeutic effect.Patients were classified into different groups according to the pathologic type and clinical stage respectively .Spearman correlation analysis was used between RS 0-50 and ADC values of all tumors , different pathologic types and clinical stages , respectively.ROC was used to evaluate the cutoff and value of ADC which had highest correlation to RS0-50 on predicting therapeutic effect.Results DWI of 3 patients were excluded due to obvious swallow artifact which influenced the measurement , and finally 67 patients were included in this study, with pathological type of nonkeratinized differentiated undifferentiated carcinoma in 49 cases, nonkeratinized undifferentiated carcinoma in 18 cases, clinical T1 stage in 7 cases, T2 in 14 cases, T3 in 17 cases and T4 in 29 cases.During treatment , there were 13 cases with sensitive therapeutic effect , 42 cases with moderate therapeutic effect and 12 cases with resistant therapeutic effect.RS0-50 [ ( 65.6 ± 3.1) %] showed mildly and moderately negative correlation to mean ADC [(1.06 ±0.19) ×10 -3 mm2/s] and maximum ADC [(1.29 ±0.33) ×10 -3 mm2/s] respectively ( r =-0.276, P =0.024 and r =-0.434, P=0.001, respectively).ROC showed when setting threshold at maximum ADC value of lower than 1.06 ×10 -3 mm2/s for predicting sensitive therapeutic effect , the specificity , sensitivity , and accuracy was 69.2%(9/13), 88.9%(48/54) and 85.1% (57/67), respectively, and when setting threshold at maximum ADC value of higher than and equal to 1.30 ×10 -3 mm2/s for predicting resistant therapeutic effect, the specificity, sensitivity, and accuracy was 75.0% (9/12), 65.5% (36/55) and 67.2%(45/67), respectively.Conclusion Pretreatment maximum ADC value were able to predict the tumor regression rate and sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma .

Objective To investigate the charateristics and prognostic value of computed tomography (CT) of retropharyngeal lymphadenopathy (RLN) in nasopharyngeal carcinoma (NPC).Methods From 1991 to 2006, CT images were analyzed for 588 patients with histologically proven NPC treated with radiation therapy in our hospital.The survival rate was evaluated by Kaplan-Meier method.Results RLN metastases were presented in 392 patients, with unilateral side in 254 patients and bilateral sides in 138 patients.The 5-year distant metastasis-free survival (DMFS) rate of patients with and without RLN metastasis was 66.6% and78.6%(χ2 = 10.78,P=0.005) ,with 69.7% and 62.2%(χ2 =2.31,P=0.129) for patients with unilateral and bilateral sides involvement.The DMFS rate was similar between the mild and moderate enhancement of RLN (67.6% and 58.9% ,χ2=2.77,P =0.096).The survival rate of RLN with homogeneous density was better than heterogeneous density (71.5%, 53.3% and 32.5%,respectively, χ2= 10.51, P = 0.001, χ2= 24.28, P = 0.000).The survival rate of patients with well boarded RLN was better than those with ill boarded RLN and obviously adjacent tissue involvement (65.5%, 51.8%and 50.0% , χ2 =8.20,P=0.004, χ2 =5.31 ,P=0.021).Conclusions The prognosis is poor with RLN metastasis, lymph node enhancement, heterogeneous density in nodes and ill boarded RLN.

Objective To evaluate the diagnostic value of MR in carotid artery involvement using surgery and pathology as gold standard.Methods 37 patients with suspected neck masses underwent MR scan.One radiologist unaware of the pathological results measured the nine indexes as following:axial surrounding angle(AXA),long axis angle(LAA),the adjacent length of tumor long axis(LLA),the tumor long axis length(TLAL),the ratio of the adjacent length of tumor long axis and the tumor long axis length (LLA/TLAL),the perivascular fatty gap,vascular displacement,vascular deformation and magnetic resonance angiography(MRA) evaluation of artery involvement.The comparison of diagnostic value used ROC curve,sensitivity,specificity and accuracy.The cat-egorical data used Fisher orχ2 test,and measurement data used t test.Results Four indexes (AXA,LAA,LLA/TLAL and MRA) had significantly statistical value for evaluating the arterial invasion.The AUC of AXA,LAA,LLA/TLAL were 0.910,0.775 and 0.766 (P <0.05),respectively.Using 145°,61°,0.553 and MRA to indicate invasion for diagnostic value,the sensitivity and spe-cificity of those four indexes were 100.0% and 89.2%,66.7% and 89.2%,100.0% and 59.5%,33.3% and 100.0%,respective-ly.Conclusion The four indexes including AXA,LAA,LLA/TLAL and MRA evaluation of artery involvement have statistic value but with poor stability.MRA had limited diagnostic value although it’s beneficial to observe the carotid artery.

Objective To evaluate the feasibility of applying spectral CT material suppressed iodine (MSI) imaging as virtual plain CT scan to replace traditional non-contrast (TNC) CT in head and neck neoplasms. Methods A total of 52 patients with initial diagnosis of head and neck neoplasms underwent TNC CT scanning and spectrum mode enhanced scanning in the head and neck with spectral CT. With GSI Volume Viewer software from GE AW4.6 workstation, the enhanced scanning data were processed and MSI images were acquired. The CT values of different tissues (fat, erector spinae, cervical vertebrae, thyroid, and brain parenchyma) and the enhancement rate in erector spinae, carotid sinus were compared between MSI and TNC images. Image quality was objectively evaluated in noise and SNR for MSI and TNC images, while the subjective evaluation included the visibility of lesions, subjective acceptance rate, diagnostic efficacy (with/without lesions or lesion calcification, necrosis). Radiation dose including volume CT dose index (CTDIvol) and effective dose (ED) was compared between MSI and TNC. Results (1) CT values of erector spinae on MSI and TNC imaging were(52 ± 6)and(52 ± 7)HU respectively, and the difference between the two image modes was not significant(t=0.39,P>0.05). CT values on MSI and TNC Imaging were[-74 (-86,-59)HU]and[-79(-73,-61)HU]for fat (Z=-2.71, P<0.05),[139(121,196)HU]and[282 (237,336) HU,Z=-5.46]for vertebrae (Z=-5.46, P<0.05),[57(48,61)HU]and[96(74,110) HU]for thyroid (Z=-4.85, P<0.05),[35(32,39)HU]and[35(32,39)HU]for brain parenchyma (Z=-4.74, P<0.05) respectively. (2) There was no significant difference in enhancement rate of erector spinae between MSI and TNC imaging 1.15(1.07,1.20) and 1.14(1.03,1.26) respectively, Z=-5.50, P>0.05). The difference of carotid sinus enhancement rate was significant 5.75(4.70,6.73) and 4.37(3.91,5.61) respectively, Z=-5.50, P<0.05). (3) The noise of MSI[10.61(8.34,13.57) HU)]was higher than that of TNC [9.32(7.40,11.42) HU](Z=-2.52,P<0.05), and the SNR of MSI [-6.59(-8.59—-4.25)] was lower than that of TNC[-7.94(-10.25,-5.51)] (Z=-2.73,P<0.05). (4) Median scores of subjective imaging quality evaluation were 4(3.00,4.75) and 4(3.00,4.00) in MSI and TNC images respectively, and the difference was not significant(Z=-0.45,P>0.05).Unacceptable and acceptable cases in imaging quality of MSI were 3 and 49 respectively, while those were 2 and 50 in TNC group. Subjective acceptance rate between MST and TNC images was not significantly different(?2=0.01,P>0.05). (5) Diagnostic performance evaluation showed that the consistency of two observers was good in detecting lesions, necrosis and calcification between MSI and TNC image, with K value 0.93, 0.83 and 0.90 respectively (P<0.05). (6) Radiation doses between pure energy spectrum enhanced mode and conventional pre plus post contrast enhanced mode were compared. And differences of CTDIvol[11.78(10.98,17.30) mGy]and[23.89 (22.42, 29.98) mGy] respectively],ED [1.89(1.63,2.29) mSv]and[3.77(3.21,4.16 ) mSv] respectively] were significant(Z=-6.28, P<0.05). Pure energy spectrum enhanced mode reduced 39.07% of CTDIvol and 45.75%of ED respectively. Conclusions MSI imaging can be a potential substitute for TNC imaging. And it has clinical values in the diagnosis of head and neck neoplasms.

Objective To predict the response of induction chemotherapy in advanced nasopharyngeal carcinoma (NPC)by using pretreat-ment apparent diffusion coefficient (ADC)values.Methods 35 patients with advanced NPC underwent DWI examination prior to 2-week in-duction chemotherapy.The patients were divided into CR (complete response)group,PR (partial response)one and SD (stable disease)one according to the tumor response of treatment.The effective responders included CR and PR groups.The patients were divided into children-adolescents(below 20 years)group and adults one according to the age,into non-keratinizing undifferentiated carcinoma group and non-kera-tinizing differentiated carcinoma one according to the pathological type,and also into T2,T3 and T4 groups according to the T-staging (UICC2010).Statistical analysis was used to compare the pretreatment ADC values between different groups.Results The average pre-treatment ADC values of CR,PR,responders and SD groups were (0.70±0.06)×10 -3 mm2/s,(0.72±0.04)×10 -3 mm2/s,(0.71± 0.04)×10 -3 mm2/s and (0.85±0.02)×10 -3 mm2/s respectively.The average pretreatment ADC value of the SD group was signif-icantly higher than that of PR group and responders,and the differences were significant (P <0.05).The average pretreatment ADC value of children-adolescents and adults groups were (0.73±0.07)×10 -3 mm2/s and (0.75 ±0.07)× 10 -3 mm2/s,which showed no significant differences.The average pretreatment ADC value of non-keratinizing undifferentiated carcinoma and non-keratinizing dif-ferentiated carcinoma groups were (0.76 ±0.08)×10 -3 mm2/s and (0.74±0.06)×10 -3 mm2/s,which showed no significant differ-ences.The average pretreatment ADC values of T2,T3 and T4 groups were (0.78±0.05)×10 -3 mm2/s,(0.77 ±0.07)×10 -3 mm2/s and (0.75±0.08)×10 -3 mm2/s.Although there were no significant differences between T2,T3 and T4 groups,a trend towards lower ADC was observed with increasing tumor T-staging.Conclusion Pretreatment ADC value is a valuable quantitative parameter,and it can be used for predicting induction chemotherapy response in advanced naso-pharyngeal carcinoma.