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Potential value of dynamic MR in predicting short-term effects of (chemo-) radiation therapy on cervical cancers

Kun CAO ; Xiaopeng ZHANG ; Jie LI ; Ming WANG ; Jun SHAN ; Lei TANC ; Yingshi SUN

Chinese Journal of Radiology.2009;43(11):1160-1164. doi:10.3760/cma.j.issn.1005-1201.2009.11.011

Objective To investigate the potential value of MR dynamic contrast enhanced imaging (DCE)in predicting short-term effects of(chemo-)radiation therapy on cervical cancers in vivo.Methods Thirty-two patients pathologically diagnosed as cervical cancers received MR-DCE scan before therapy.The following scans were taken at the 2nd to 3rd week after the radiation or(and)chemotherapy initiated,to calculate early size change.The fourth scan was performed within one month after the therapy to judge residues.DCE derived parameters include mean time to enhancement(MTE),positive enhancement integral (PEI),time to peak(TTP),maximum slope of increase(MSI)and maximum slope of decrease(MSD).Size and DCE parameters were compared and analyzed by Mann-Whitney test and Spearman teat Results There are 20 cases in non-residue group and 12 cases in residue group.In non-residue group,the maximal lengths in both horizontal and craniocaudal directions[(47.45±13.76)mm and(38.75±10.69)mm]were smaller than that in residue group [(61.08±13.73)mm and(53.67±16.05)mm],with statistical significance(Z=-2.455 and-2.650 respectively,P＜0.05).PEI in low-enhance areas of non-residue group(0.62±0.25)was significantly higher than that in residue group(0.39±0.14)(Z=-2.919,P＜0.05).At early time after radiation started,length changing rate and volume changing rate had medium to strong negative correlations with MSI in hish-enhance areas(r=-0.577 and-0.723 respectively,P＜0.05).Conclusions For cervical cancers,those with larger lengths and lower PEI in low-enhanced areas tend to have tumor residue when radiation therapy completed.Those low MSI in high-enhance areas tend to shrink quickly.It is suggested that volume and parameters of DCE before(chemo-)radiation therapy have the potential in predicting short-term therapeutic effect.

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A study of proton MR spectroscopy in patients with minimal hepatic encephalopathy

Mei LI ; Lizhong WU ; Xiaolong DING ; Jie XU ; Qiang DAI ; Zhijun BAO ; Xing HU

Chinese Journal of Radiology.2009;43(11):1125-1130. doi:10.3760/cma.j.issn.1005-1201.2009.11.001

Objective To evaluate changes of regional cerebral metabolism by proton MR spectroscopy (~1H-MRS) in patients with minimal hepatic encephalopathy (MHE) and to correlate these changes with the neuropsychological test. Methods Fifty-four patients with cirrhosis including nine patients with hepatic encephalopathy (HE),23 patients with MHE,22 patients without HE and 13 controls underwent neuropsychological tests and ~1H-MRS scanning. The volumes of interest included occipital gray matter and left parietal white matter regions. Ratio of spectral peak areas of N-acetylaspartate (NAA),choline (Cho),myo-inositol (mI),and glutamine/glutamate (Glx) relative to creatine (Cr) were acquired. Statistical analysis was conducted using independent t test and one-way analysis of variance. The results of different groups were compared by using the nonparametric Mann-Whitney U test with Bonferroni correction. Correlations among the ~1H-MRS ratios, the grade of HE, neuropsychological test and ammonia data were calculated with Spearman correlation test. Results The ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr of the occipital gray matter and left parietal white matter regions in patients with cirrhosis are 1.55±0.12,0.48±0.10,0.42±0.14,2.52±0.48 and 1.73±0.17,0.75±0.16,0.42±0.16,2.75±0.59respectively,and they are 1.53±0.10,0.48±0.09,0.51±0.11,2.20±0.39 and 1.69±0.15,0.82±0.14,0.53±0.12,2.40±0.40 in patients without HE,1.58±0.13,0.48±0.08,0.38±0.13,2.62±0.39 and 1.78±0.18,0.74±0.14,0.38±0.15,2.84±0.58 in patients with MHE,1.54±0.12,0.50±0.13,0.29±0.07,3.04±0.31 and 1.70±0.19,0.62±0.16,0.29±0.07,3.37±0.38 inpatients with HE.Compared with controls, decreased mI/Cr and Cho/Cr ratios and elevated Glx/Cr ratios were found in patients with cirrhosis (t=3.196,9.394,-6.527,P＜0.01,occipital gray matter. t=5.592,9.717,-6.681,P＜0.01,left parietal white matter＝ and in subgroup of patients without HE, with MHE and HE (F=5.097,25.896,20.204,P＜0.01,occipital gray matter.F=16.435,28.660,21.283,P＜0.01,left parietal white matter).Significant difference in these metabolic alterations was also found among the different groups of cirrhosis especially the ratios of Glx/Cr in occipital gray matter and left parietal white matter (P＜0.0084).The ratios of mI/Cr also significantly altered between patients without HE and with MHE (P＜0.0084).There was a significant negative correlation between the ratios of Cho/Cr,mI/Cr and the grade of HE (P＜0.01＝ and a significant positive correlation between the ratios of Glx/Cr and the grade of HE (r=0.709,P＜0.01,occipital gray matter; r=0.720,P＜0.01,left parietal white matter＝.NCT-A and DST of controls is (49±8) s and 39±6.They are (134±37),(83±26),(64±22) second and 15±2,25±9,35±8 in patients with HE,MHE and without HE respectively.The metabolic alterations of Cho/Cr,mI/Cr,Glx/Cr correlated significantly with neurepsychological tests in all subjects (P＜0.01＝.There was a significant positive and a negative correlation between the ratios of Glx/Cr and the data of NCT-A and DST respectively (r=0.570,-0.642,occipital gray matter; r=0.541,-0.632,left parietal white matter).The metabolic alterations of Glx/Cr had no correlation with ammonia data as well as other metabolic alterations.Conclusions ~1H-MRS study shows cerebral metabolic alterations of gray and white matter in patients with cirrhosis,especially the reduction in mI/Cr ratio and increase in Glx/Cr ratio. These changes correlate well with the neuropsychological tests and may be useful in predicting the presence of MHE.

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Diagnostic value of apparent diffusion coefficient value in prediction of grade for neuroepithelial tumors

Zhiye CHEN ; Lin MA

Chinese Journal of Radiology.2009;43(11):1135-1138. doi:10.3760/cma.j.issn.1005-1201.2009.11.003

Objective To investigate the predictive value of ADC value in grading of neuroepithelial tumors. Methods The clinical data and images of 70 patients with neuroepithelial tumors pathologically proven were collected and analyzed restrospectively. All the patients were classified into low(WHOⅠ or Ⅱ)and high(WHO Ⅲ or Ⅳ)grade groups which included 40 and 30 cases respectively accroding to the 2007 WHO classification of tumours of the central nervous system. All the patients underwent plain and contrast-enhanced MR scan and DWI before surgery. The minimum ADC(MinADC)value was measured postoperatively on ADC maps. The Ki-67 labeling index(Ki-67 LI)of tumor tissue was determined by immunohistochemistry.MinADC values for two groups were analyzed using student t test, while the age and Ki-67 LI for the two groups was analyzed using Mann-Whitney test(P＜0.05 considered to be significant＝.Also the MinADC valHe and Ki-67 LI were analyzed with Pearson correlation. The receiver operating characteristic analysis was used for evaluation for grading neuroepithelial tumors of the patients using MinADC. Results The mean MinADC value[(1.08±0.31)×10~(-3) mm~2/s]of the low grade group was significantly higher than that[(0.74±0.18)×10~(-3) mm~2/s]of the high grade group(t=5.42,P＜0.05＝,and the Ki-67 LI of the low grade group[0-50%,median 4%]was significantly lower than that[0-75%,median 25%]of the high grade group(U=325.50,P＜0.05＝.There was a negative correlation between MinADC value and Ki-67 LI(r=-0.30,P＜0.05＝.The area under the ROC curve was 0.85,and the cutoff MinADC value of 0.86×10~(-3) mm~2/s for the differentiation between high and low grade neuroepithelial tumors provided the best combination of sensitivity(90.0%)and specificity(77.5%)(receiver operatingcharacteristic analysis).Conclusion MinADC value is helpful for prediction of neuroepithelial tumor grade.

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The capability of high field MRI in demonstrating post-mortem fetal brains at different gestational age

Zhonghe ZHANG ; Shuwei LIU ; Xiangtao LIN ; Gaojun TENG ; Taifei YU ; Fang FANF ; Bin ZHAO ; Fengchao ZANG ; Hequn GENG

Chinese Journal of Radiology.2009;43(11):1131-1134. doi:10.3760/cma.j.issn.1005-1201.2009.11.002

Objective To study the capability of high field MRI in demonstrating the post-mortem fetal brains at different gestational age(GA).Methods One hundred and eight post-mortem fetal brains of 14-40 weeks GA were evaluated by 3.0 T MRI. Eleven brains of 14 to 27 weeks GA with good 3.0 T MRI images were chosen and scanned by 7.0 T MRI. The developing sulci, layered structures of fetal cerebral cortex and basal nuclei were evaluated on MRI of different Tesla(3.0 T and 7.0 T)and their results analyzed. Results On T_1 WI of 3.0 T MRI, the layered structures of fetal cerebral cortex were present at 14 weeks GA, the sulci were more accurately identified after 16 weeks GA. The basal nuclei were clearly distinguishable after 20 weeks GA. and these structures were better visualized as the GA increased. On T_2WI of 7.0 T MRI, the sulei, layered structures of fetal cerebral cortex and basal nuclei were shown more clearly at the same GA when compared to 3.0 T, especially the sulci at the early developmental stages. Conclusions T_1 WI of 3.0 T MRI could show the developing structures of post-mortem fetal brain well, but the T_2 WI of 7.0 T MRI were comparatively better.

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The value of MR cholangiography in preoperative evaluation of biliary anatomy of living liver donors

Zhefeng YU ; Min ZHOU ; Zhiyi PENG

Chinese Journal of Radiology.2009;43(11):1152-1155. doi:10.3760/cma.j.issn.1005-1201.2009.11.008

Objective To determine the value of MR cholangiography(MRC)in the preoperative evaluation of biliary anatomy of living liver donors.Methods Fifty eight consecutive donors underwent MRC examinations and living liver transplantation.MRC was performed on a 1.5 T scanner with breath-hold rapid acquisition of T_2WI slab and breathing-gating 3D FSE T_2WI.Images of MRC and IOC were compared and classified according to the modified Huang's classification.Results Thity four(58.6%)liver donors showed normal biliary anatomy on IOC,and 24(41.4%)donors revealed variant bile anatomy.MRC correctly depicted biliary anatomy in 91.4%(53/58)donors.The sensitivity,specificity,positive predictive value and negative predictive value of MRC in distinguishing normal and difierent types of variant biliary anatomy were 83.3%(20/24),100%(34/34),100%(20/20),89.5%(34/38)respectively.Conclusion MRC can accurately assess the biliary anatomy in living liver donors and may guide the preoperative planning of liver transplant.

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Initial experience of evaluation of coronary artery with 320-slice row CT system in high pre-test probability population without heart rate(rhythm)control

Gang SUN ; Guoying LI ; Min LI ; Juan DING ; Shenghui LI ; Li LI ; Shifang ZHU ; Changling LIN ; Xiaofeng ZOU

Chinese Journal of Radiology.2009;43(11):1142-1147. doi:10.3760/cma.j.issn.1005-1201.2009.11.005

Objective To investigate the accuracy of 320-slice row CT system for the detection of coronary artery disease(CAD)in high pre-test probability population without heart rate/rhythm control.Methods Thirty patients with a high pre-test probability of CAD underwent 320-slice row CT without preceding heart rate/rhythm control.Invasive coronary angigraphy(ICA)served as the standard reference.Data sets were evaluated by 2 observers in consensus with respect to stenoses≥50% decreased diameter.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and Youden index were analyzed;the impact of heart rate and calcification on image quality as well as diagnostic accuracy were also analyzed by Chi-square test Results Mean heart rate during scanning was 73.7±15.4 beats per min(bpm),and median(QR)of Agatston score of segment was 45.6(181).On a per-segment analysis,overall sensitivity was 96.1%(74/77,95%CI:89.03%-99.19%),specificity was 98.3% (337/343,95%CI:96.23%-99.36%),PPV was 92.5% (74/80,95%CI:84.39%-97.20%),NPV of 99.1% (337/340,95%CI:97.44%-99.82%)and the Youden index was 0.94.In both heart-rate subgroups(242 in heart rate＜70 bpm group,169 in heart ratet≥70 bpm group),diagnostic accuracy for the assessment of coronary artery stenosis was similar(P＜0.05).The accuracy and the quality score of the subgroup Agatston score≥100 were lower than that of the subgroup Agatston score＜100;however,the difiercnce of results between 320-slice row CT and ICA was not significant(P＜0.05).Conclusion 320-detector row CT can reliably detect coronary artery stenoses in a high pre-test probability population without heart rate/rhythm control.

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Correlation of diagnostic imaging and autopsy findings of eight patients with acquired immune deficiency syndrome

Hongjun LI ; Yuzhong ZHANG ; Jingliang CHENG

Chinese Journal of Radiology.2009;43(11):1196-1200. doi:10.3760/cma.j.issn.1005-1201.2009.11.020

Objective To investigate the imaging findings with pathologic correlation in patients with acquired immune deficiency syndrome(AIDS).Methods Imaging findings,autopsy and pathological data were retrospectively analyzed in eight patients with AIDS.Routine CT scanning of different body parts was performed during their hospitalization.CT scanning was performed from the skull to the pelvis immediately following their death.After routine formalin fixing,7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy.Tissues were obtained from each sections and organs for pathological examinations.Results The autopsy data showed parasitic infections(5 cases),bacterial infections (3 cases),fungal infections(2 cases),virus infections(2 cases),lymphoma(1 case)and cerebrovascular diseases(1 case)in eight patients with AIDS.The CT scanning demonstrated symmetrical ground glass liked shadows with pulmonary hilus as the center in 5 cases of pulmonary PCP infection; pulmonary patchy shadows,scattering distribution of nodular shadows,extensive military nodular shadows with even distribution and tuberculous pleurisy; cloudy shadows for 2 cases of fungi infection with multiple foci of chronic inflammation;pulmonary net-like parenchymal changes for 2 cases of pulmonary CMV infection;thickened intestinal wall and narrowed intestinal lumen for 1 case of intestinal tumor; low density shadows of brain tissue for 1 case of CMV encephalitis and MRI findings of high T_1 and high T_2 signals as well as MRA findings of broken vascular channels in liquefied areas of brain tissues; patchy low density areas inside a cyst of brain for one case of brain toxoplasmosis infection:multiple small patchy low density areas in cerebral basal ganglia for one case of brain cryptococcus infection.Conclusions In AIDS patients,infection and tumor may occur in various organs resulting in complex symptoms,which makes it more complicated and difficult to make accurate diagnosis.A correlative study of imaging findings and pathological manifestation of AIDS patients at autopsy could be helpful for clinical diagnosis.

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Image analysis of Budd-Chiari syndrome in Henan province of China

Xinwei HAN ; Pengxu DING ; Shicheng QIN ; Bingyan LIU ; Xin ZHAO ; Dongzhi ZHAI

Chinese Journal of Radiology.2009;43(11):1187-1190. doi:10.3760/cma.j.issn.1005-1201.2009.11.018

Objective To investigate the distribution of the obstructive lesion of hepatic vein and inferior cava vein in patients with Budd-Chiari syndrome in Henan Province of China.Methods A total of 231 cases with Budd-Chiari syndrome were diagnosed by combination of three imaging techniques which either included colour Dopple ultrasound,multislice CT and vasography or colour Dopple ultrasound,MR angiography and vasography.All the hepatic veins,accessory hepatic veins and inferior vena cavae were imaged and their obstructions were detected and analysed.Results Out of the 231 patients there were 5 cases(2.2%)with simple obstruction of inferior vena cava with normal hepatic branches.Thirty-three cases(14.3%)had simple hepatic vein obstruction with normal inferior vena cava.The remaining 193(83.5%)cases had vein obstruction both in hepatic vein and inferior vena cava.Conclusion The most frequent form of Budd-Chiari symdrome in Henan province of China is the complex obstruction of inferior vena cava and heptic vein,and simple obstruction of inferior vena cava occurs the least.

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Diagnostic X-ray of post-traumatic osteolysis of bone

Qiande QIU ; Jiajun XU ; Da LIN ; Xuming LIU

Chinese Journal of Radiology.2009;43(11):1183-1186. doi:10.3760/cma.j.issn.1005-1201.2009.11.017

Objective To study the X-ray findings of post-traumatic osteolysis and to improve the knowledge of that disease.Methods X-ray features of 7 cases of post-traumatic osteolysis confirmed by clinical findings and pathology were reviewed retrospectively.There were 5 females and 2 males.from 9-56 years(mean 34 years)of age.Three patients had traffic accidents and 4 had trauma unrelated to traffic accidents.Osteolysis occurred from 3 to 18 months after trauma(1 case at 18 months,2 cases at 10 months,2 cases at 6 months and 2 cases at 3 months).Results There were 2 pubis fractures,1 distal tibiofibular shaft fracture,1 femoral neck fracture,1 humeral upper end commiuuted fracture,1 shoulder joint dislocation.and 1 soft tissue swelling around the wrist.The X-ray findings are:3 massive osteolysis,3 plaque flake osteolysis and 1 cystic osteolysis.There were no hardening of bony edge at the site of osteolysis in all 7 cases,clear margin in 5 cases and ill-defined margin in 2 cases,no residual bone in osteolytic area in 4 cases and residual bone in octeolytic area in 3 cases,no periosteal reaction and thickerning of bony cortex in osteolytic area in all 7 Cascs,bone repair in 2 cases and no bone repair in 5 cases.Histopathological findings showed:extensive capillary hyperplasia and fibrous tissue hyperplasia;hyperemia and swelling of synvium,proliferation of granulation tissue,osteonecrosis,increased osteoclast activity,some inflammatory cells,no evidence of neoplastic cells in the involved area.Conclusions Posttraumatic osteolysis is closely related to trauma.X-ray findings include massive osteolysis,plaque-like osteolysis,and irregular cystic changes.Early dignosis may be a challenging task.

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MRI findings of achilles tendon rupture

Xuezhe ZHANG

Chinese Journal of Radiology.2009;43(11):1180-1182. doi:10.3760/cma.j.issn.1005-1201.2009.11.016

Objective To evaluate the MRI findings of achilles tendon rupture. Methods The MRI data of 7 patients with achilles tendon rupture were retrospectively analysed. All 7 patients were male with the age ranging from 34 to 71 years. Routine MR scanning was performed in axial and sagittal planes, including T_1WI,T_2WI and a fat suppression MRI(SPIR).Results Among 7 patients, complete achilles tendon rupture was seen in 6 cases, partial achilles tendon rupture 1 case. The site of tendon disruption were 2.6-11.0 cm(mean 5.4 cm)proximal to the insertion in the calcaneus. The MRI findings of a partial or complete rupure of the achilles tendon included enlarged and thickened achilles tendon (7 cases),wavy lax achilles tendon(2 cases),discontinuity of some or all of its fibers and intratendinous regions of increased signal intensity(7 cases).In the cases of complete tendon rupture,the size of the tendinous gap varied from 3.0-8.0 mm,which was filled with blood and appeared as edema of increase signal intensity on T_2WI and SPIR.In all 7 patients, MR scanning showed medium signal intensity(7 cases)on T_1WI,or medium signal intensity(1 cases),medium-high signal intensity(3 cases),hish signal intensity(3 cases)on T_2WI,and medium-high singnal intensity(2 eases),high signal intensity(5 cases)on fat suppression MRI. The preachilles fat pad showed obscure in 6 cases of complete achilles tendon rupture. Conclusion MRI is an excellent method for revealing achilles tendon rupture and confirming the diagnosis.

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