1.The value of amide proton transfer weighted imaging combined with human epidermal growth factor receptor 2 status in predicting pathological complete response after neoadjuvant chemotherapy in breast cancer
Mingzhe XU ; Dongqiu SHAN ; Jinrong QU ; Chunmiao XU ; Renzhi ZHANG ; Yue WU ; Jing LI ; Zhiwei SHEN ; Xuejun CHEN
Chinese Journal of Radiology 2025;59(3):313-320
Objective:To explore the value of amide proton transfer weighted imaging (APTWI) combined with human epidermal growth factor receptor 2 (HER2) expression in predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer.Methods:The study was a cross-sectional study. Clinicopathological [estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 status, and molecular subtypes] and imaging data were retrospectively analyzed in 100 female patients who had invasive ductal carcinoma of the breast confirmed pathologically by preoperative puncture in the Henan Cancer Hospital from May 2023 to May 2024. All patients underwent MRI, including enhanced MRI, APTWI, and diffusion-weighted imaging (DWI) before NAC. The reference enhanced MRI images were segmented into lesions using the threshold extraction method, and the three-dimensional region of interest within the tumor was automatically outlined by the software and replicated in the amide proton transfer map generated by APTWI and the apparent diffuse coefficient (ADC) map generated by DWI. The magnetization transfer ratio asymmetry (MTRasym) value and the ADC value were measured, respectively. Tumor response to NAC was assessed using the Miller-Payne grading system, where Grade 5 indicated pCR and Grades 1-4 were classified as non-pCR. Independent sample t-tests and χ2 tests were used to compare clinical pathological and imaging parameters between pCR and non-pCR patients. Statistically significant variables were included in multivariate logistic regression to identify independent predictors of pCR. The diagnostic performance of individual and combined indicators for pCR was evaluated using receiver operating characteristic curves and the area under the curve (AUC). DeLong′s test was used to compare AUCs. Results:There were 39 pCR and 61 non-pCR patients. Significant differences were observed between the pCR and non-pCR patients in molecular subtypes, ER, PR, HER2, and Ki-67 statuses ( P<0.05). Pre-treatment MTRasym values were significantly higher in the pCR patients compared to the non-pCR patients ( P=0.005), whereas ADC values showed no statistical difference ( P=0.372). Multivariate logistic regression analysis showed HER2 positivity ( OR=5.87, 95% CI 1.99-17.30, P=0.001) and MTRasym values>2.61% (OR=4.39, 95% CI 1.37-14.08, P=0.013) was independent predictors of pCR after NAC. HER2 positivity combined with MTRasym value>2.61% predicted pCR after NAC in breast cancer with AUC of 0.819, which was superior to HER2 positivity and MTRasym value alone in predicting efficacy ( Z=3.91, P<0.001; Z=2.63, P=0.009). Conclusions:The MTRasym value of pre-treatment APTWI is valuable in predicting pCR after NAC in breast cancer. APTWI combined with HER2 expression status can further enhance the predictive efficacy.
2.Radiomics models based on fluid attenuated inversion recovery and contrast enhanced MRI for noninvasive prediction of isocitrate dehydrogenase mutation status in glioma
Qian'ang MA ; Jun LU ; Qi YAO ; Yafeng DONG ; Xuejun CHEN ; Jinrong QU
Journal of Practical Radiology 2025;41(6):915-919
Objective To investigate the value of MRI radiomics for the preoperative noninvasive prediction of isocitrate dehydrogenase(IDH)mutation status in glioma.Methods Totally,306 glioma patients were retrospectively selected.All patients were randomly assigned into training group(n=214)and validation group(n=92)at a ratio of 7∶3.Region of interest(ROI)was manually delineated by two radiologists independently on the fluid attenuated inversion recovery(FLAIR)and contrast enhanced(CE)MRI images for obtaining whole volume of interest(VOI)of lesion.A total of 851 radiomics features were extracted from the VOI,respectively.The least absolute shrinkage and selection operator(LASSO)method was used for features dimension reduction combing 10-fold cross validation.Three Radiomics score(Radscore)were calculated by linear combination of retained features and their corresponding coefficients.The optimal Radscore and clinical characteristics were incorporated to perform logistic regression analysis for establishing the IDH mutation status noninvasive prediction model.A nomogram was plotted for realizing the visualization of model.The receiver operating characteristic(ROC)curve was plotted to evaluate the prediction performance of model.The calibration and clinical utility of the model were evaluated by calibration curve and decision curve.Results The area under the curve(AUC)of Radscore-combined based on combination of two sequences was 0.856 in the training group,which was superior to the Radscore-CE(AUC=0.821),Radscore-FLAIR(AUC=0.766)from single sequence,with consistent result in the validation group.The addition of clinical characteristics to the model improved predictive value with AUC,sensitivity and specificity of 0.898,79.59%,90.52%in the training group.Conclusion The radiomics model based on FLAIR and CE MRI contributes to preoperative noninvasive prediction of IDH mutation status in glioma.The combination of multi-sequence and the addition of clinical characteristics can improve the prediction performance.
3.Radiomics models based on fluid attenuated inversion recovery and contrast enhanced MRI for noninvasive prediction of isocitrate dehydrogenase mutation status in glioma
Qian'ang MA ; Jun LU ; Qi YAO ; Yafeng DONG ; Xuejun CHEN ; Jinrong QU
Journal of Practical Radiology 2025;41(6):915-919
Objective To investigate the value of MRI radiomics for the preoperative noninvasive prediction of isocitrate dehydrogenase(IDH)mutation status in glioma.Methods Totally,306 glioma patients were retrospectively selected.All patients were randomly assigned into training group(n=214)and validation group(n=92)at a ratio of 7∶3.Region of interest(ROI)was manually delineated by two radiologists independently on the fluid attenuated inversion recovery(FLAIR)and contrast enhanced(CE)MRI images for obtaining whole volume of interest(VOI)of lesion.A total of 851 radiomics features were extracted from the VOI,respectively.The least absolute shrinkage and selection operator(LASSO)method was used for features dimension reduction combing 10-fold cross validation.Three Radiomics score(Radscore)were calculated by linear combination of retained features and their corresponding coefficients.The optimal Radscore and clinical characteristics were incorporated to perform logistic regression analysis for establishing the IDH mutation status noninvasive prediction model.A nomogram was plotted for realizing the visualization of model.The receiver operating characteristic(ROC)curve was plotted to evaluate the prediction performance of model.The calibration and clinical utility of the model were evaluated by calibration curve and decision curve.Results The area under the curve(AUC)of Radscore-combined based on combination of two sequences was 0.856 in the training group,which was superior to the Radscore-CE(AUC=0.821),Radscore-FLAIR(AUC=0.766)from single sequence,with consistent result in the validation group.The addition of clinical characteristics to the model improved predictive value with AUC,sensitivity and specificity of 0.898,79.59%,90.52%in the training group.Conclusion The radiomics model based on FLAIR and CE MRI contributes to preoperative noninvasive prediction of IDH mutation status in glioma.The combination of multi-sequence and the addition of clinical characteristics can improve the prediction performance.
4.The value of amide proton transfer weighted imaging combined with human epidermal growth factor receptor 2 status in predicting pathological complete response after neoadjuvant chemotherapy in breast cancer
Mingzhe XU ; Dongqiu SHAN ; Jinrong QU ; Chunmiao XU ; Renzhi ZHANG ; Yue WU ; Jing LI ; Zhiwei SHEN ; Xuejun CHEN
Chinese Journal of Radiology 2025;59(3):313-320
Objective:To explore the value of amide proton transfer weighted imaging (APTWI) combined with human epidermal growth factor receptor 2 (HER2) expression in predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer.Methods:The study was a cross-sectional study. Clinicopathological [estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 status, and molecular subtypes] and imaging data were retrospectively analyzed in 100 female patients who had invasive ductal carcinoma of the breast confirmed pathologically by preoperative puncture in the Henan Cancer Hospital from May 2023 to May 2024. All patients underwent MRI, including enhanced MRI, APTWI, and diffusion-weighted imaging (DWI) before NAC. The reference enhanced MRI images were segmented into lesions using the threshold extraction method, and the three-dimensional region of interest within the tumor was automatically outlined by the software and replicated in the amide proton transfer map generated by APTWI and the apparent diffuse coefficient (ADC) map generated by DWI. The magnetization transfer ratio asymmetry (MTRasym) value and the ADC value were measured, respectively. Tumor response to NAC was assessed using the Miller-Payne grading system, where Grade 5 indicated pCR and Grades 1-4 were classified as non-pCR. Independent sample t-tests and χ2 tests were used to compare clinical pathological and imaging parameters between pCR and non-pCR patients. Statistically significant variables were included in multivariate logistic regression to identify independent predictors of pCR. The diagnostic performance of individual and combined indicators for pCR was evaluated using receiver operating characteristic curves and the area under the curve (AUC). DeLong′s test was used to compare AUCs. Results:There were 39 pCR and 61 non-pCR patients. Significant differences were observed between the pCR and non-pCR patients in molecular subtypes, ER, PR, HER2, and Ki-67 statuses ( P<0.05). Pre-treatment MTRasym values were significantly higher in the pCR patients compared to the non-pCR patients ( P=0.005), whereas ADC values showed no statistical difference ( P=0.372). Multivariate logistic regression analysis showed HER2 positivity ( OR=5.87, 95% CI 1.99-17.30, P=0.001) and MTRasym values>2.61% (OR=4.39, 95% CI 1.37-14.08, P=0.013) was independent predictors of pCR after NAC. HER2 positivity combined with MTRasym value>2.61% predicted pCR after NAC in breast cancer with AUC of 0.819, which was superior to HER2 positivity and MTRasym value alone in predicting efficacy ( Z=3.91, P<0.001; Z=2.63, P=0.009). Conclusions:The MTRasym value of pre-treatment APTWI is valuable in predicting pCR after NAC in breast cancer. APTWI combined with HER2 expression status can further enhance the predictive efficacy.
5.Value of spectral CT based iodine concentration for the preoperative prediction of vascular invasion in gastric cancer
Jing LI ; Yi WANG ; Yingying WEI ; Guanglong CHEN ; Qiuxia LIAO ; Jianbo GAO ; Jinrong QU
Chinese Journal of Radiology 2023;57(2):181-186
Objective:To investigate the value of spectral CT based iodine concentration (IC) parameters for preoperative prediction of lymphovascular invasion (LVI) in gastric cancer.Methods:Between January 2021 and November 2021, 266 patients diagnosed as gastric adenocarcinomas by endoscopy and undergoing gastrectomy at the Affiliated Cancer Hospital of Zhengzhou University were recruited prospectively. They were divided into LVI and non-LVI groups according to pathological reports. Triple phase contrasted enhanced CT scans, including arterial phase (AP), venous phase (VP) and delayed phase (DP) were performed on a spectral CT platform within one week before surgery. The IC of gastric cancer lesions at three enhanced phases were measured based on iodine maps, and the normalized IC (nIC) was calculated. The thickness of the tumor was measured. Clinicopathological features were collected, including ulceration, pathological tumor staging (pT), pathological node staging (pN), histodifferentiation, Lauren subtype, perineural invasion (PNI), positive node numbers and positive node ratio. Student′s t tes t or Mann-Whitney U test were used to compare the differences of continuous variables between the two groups, while Chi-square test or Fisher′s exact test was used for categorical data. Multivariable logistic regression analysis was used to screen independent risk factors of LVI, and to build a combined parameter based on risk factors. The receiver operating characteristic curve analysis was performed to determine the predictive efficacy of IC parameters and the combined parameter for LVI. DeLong′s test was used to compare the differences among different area under the curve (AUC). Results:There were statistical differences in tumor thickness, ulceration, pT, pN, histodifferentiation, positive node numbers, positive node ratio, Lauren subtype and PNI between LVI and non-LVI groups ( P<0.05). The values of IC VP, IC DP, nIC VP, nIC DP in LVI group were statistically higher than those in non-LVI group ( t=3.77, 4.23, 4.25, 6.12, all P<0.001), with the AUC (95%CI) of 0.674 (0.610-0.738), 0.677 (0.614-0.741), 0.731 (0.671-0.792), 0.700 (0.636-0.764) for predicting LVI, respectively. Multivariable logistic regression analysis revealed that tumor thickness (OR=1.148, 95%CI 1.085-1.237, P<0.001) and nIC VP (OR=209.904, 95%CI 14.874-644.362, P<0.001) were independent predictors for LVI, the combined parameter incorporating these two factors yielded an AUC (95%CI) of 0.790 (0.736-0.937), which was statistically higher than any single parameter of IC VP, IC DP, nIC VP and nIC DP ( Z=3.07, 3.29, 2.10, 2.60, P=0.002, 0.001, 0.036, 0.009). Conclusion:The IC and nIC values of gastric cancer lesions derived from the VP and DP on spectral CT can effectively predict LVI status in gastric adenocarcinomas, and the combination of nIC VP and tumor thickness can further improve the predictive efficacy.
6.Application value of intravoxel incoherent motion imaging in preoperative evaluating the perineural invasion of esophageal squamous cell carcinoma: a prospective study
Tao SONG ; Shuang LU ; Hongkai ZHANG ; Wen FENG ; Hailiang LI ; Yufeng BA ; Jinrong QU
Chinese Journal of Digestive Surgery 2022;21(8):1104-1111
Objective:To investigate the application value of intravoxel incoherent motion (IVIM) imaging in preoperative evaluating perineural invasion (PNI) of esophageal squamous cell carcinoma (ESCC).Methods:The prospective study was conducted. The clinicopathological data of 63 ESCC patients who underwent IVIM imaging before surgery in the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital from January 2016 to April 2019 were selected. Patients underwent routine magnetic resonance imaging scan and IVIM sequence examination. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*) and pseudodiffusion fraction (f) values were measured. Observation indicators: (1) situations of enrolled patients; (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The interclass correlation coefficient (ICC) was used to evaluate cosistency of results. The receiver operating characrteristic curve was used to evaluate diagnostic efficiency. Results:(1) Situations of enrolled patients. A total of 63 patients were selected for eligibility. There were 41 males and 22 females, aged 60(range, 43?74)years. Of the 63 ESCC patients, 17 cases had PNI and 46 cases had no PNI. Cases with well differentiated tumor, moderate differentiated tumor or low differentiated tumor, cases in stage T1, T2, T3, T4 of infiltra-tion depth, cases with or without lymph node metastasis were 0, 6, 11, 0, 3, 13, 1, 15, 2 in patients with PNI, versus 6, 24, 16, 1, 22, 23, 0, 12, 34 in patients without PNI, showing significant differences between them ( Z=?2.32, ?2.49, χ2=19.58, P<0.05). (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. The ADC, D, D*, f values were (2.21±0.33)×10 ?3 mm 2/s, (1.46±0.31)×10 ?3 mm 2/s, 32.50 (15.55,46.75)×10 ?3 mm 2/s, (0.34±0.09)×10 ?3 mm 2/s in patients with PNI, versus (2.45±0.45)×10 ?3 mm 2/s, (1.72±0.38)×10 ?3 mm 2/s, 34.85(23.43,51.20)×10 ?3 mm 2/s, (0.42±0.13)×10 ?3 mm 2/s in patients without PNI, showing significant differences in the ADC, D and f values between them ( t=?2.03, ?2.52, ?2.34, P<0.05) and no significant difference in the D* value between them ( Z=?0.84, P>0.05). The cosistency of ADC, D, D* and f values in the 63 ESCC patients measured by 2 radiologists was good, with the ICC as 0.96, 0.92, 0.89 and 0.95. The receiver operating characrteristic curve demons-trated the best cut-off value of ADC, D and f values were 2.50×10 ?3 mm 2/s, 1.68×10 ?3 mm 2/s and 0.41, with the areas under the curve as 0.67 (95% confidence interval as 0.54?0.79), 0.70 (95% confidence interval as 0.58?0.81) and 0.69 (95% confidence interval as 0.57?0.80), respectively. The combina-tion of D and f value for diagnosing PNI of ESCC had the area under the curve as 0.74 (95% confidence interval as 0.62?0.84), with the cut-off value as 0.20, sensitivity and specificity as 94.1% and 56.5%. Conclusions:IVIM parameters D and f values can evaluate and predict the PNI of ESCC preopera-tively. The combination of D and f values can further improve the diagnostic efficiency.
7.Application of intravoxel incoherent motion in preoperative evaluation of the angiolymphatic invasion of esophageal squamous cell carcinoma
Tao SONG ; Yingshu WANG ; Lanwei GUO ; Hongkai ZHANG ; Wen FENG ; Shuang LU ; Hailiang LI ; Yufeng BA ; Jinrong QU
Chinese Journal of Radiology 2021;55(10):1065-1070
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.
8.MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction
Xijie ZHANG ; Pengfei MA ; Xiang LI ; Jinrong QU ; Hongkai ZHANG ; Jun LU ; Junli ZHANG ; Yanghui CAO ; Chenyu LIU ; Sen LI ; Zhi LI ; Yuzhou ZHAO
Chinese Journal of General Surgery 2021;36(4):277-280
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.
9.Predictive value of intravoxel incoherent motion imaging for pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma
Tao SONG ; Jinrong QU ; Hongkai ZHANG ; Jianjun QIN ; Wen FENG ; Yan ZHAO ; Hailiang LI
Chinese Journal of Digestive Surgery 2019;18(6):594-600
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.
10.Correlation between quantitative parameters of dynamic contrast?enhanced MRI after neoadjuvant chemotherapy and pathological grades in esophageal squamous cell carcinoma
Yanan LU ; Hongkai ZHANG ; Zhaoqi WANG ; Ling MA ; Yan ZHAO ; Pengrui GAO ; Yingshu WANG ; Zhengyan JIA ; Shuang LU ; Hailiang LI ; Jianjun QIN ; Jinrong QU
Chinese Journal of Radiology 2019;53(7):573-578
Objective To investigate the correlation between quantitative parameters of dynamic contrast?enhanced MRI (DCE?MRI) after neoadjuvant chemotherapy and pathological grades in esophageal squamous cell carcinoma. Methods Fifty?six patients with esophageal squamous cell carcinoma who were confirmed by esophagoscope and received neoadjuvant chemotherapy before operation between September 2015 and December 2017 in the Affiliated Cancer Hospital of Zhengzhou University were prospectively analyzed, and MRI examination was performed within one week before operation. All patients underwent routine chest MRI and DCE?MRI scanning, and quantitative parameters of DCE?MRI, including volume transfer constant (Ktrans),exchange rate constant (Kep) and extravascular extracellular volume fraction (Ve) were measured. Pathological grading was assessed as highly differentiated, moderately differentiated, poorly differentiated,and undifferentiated. Intraclass correlation coefficient (ICC) was calculated from the results of two radiologists. Kruskal?Wallis H test was used to compare the differences of quantitative parameters between different pathological grade groups of DCE?MRI,and Mann?Whitney U test was utilized to compare the intraclass differences among pathological grades. Spearman rank correlation analysis was performed for evaluating the correlation between DCE?MRI parameters and pathological grade of esophageal squamous cell carcinoma. The receiver operating characteristic (ROC) curves were used to evaluate the diagnosis accuracy of different DCE?MRI parameters in pathological grade of esophageal squamous cell carcinoma after neoadjuvant chemotherapy. Results The 56 patients were divided into four groups according to pathological findings: well differentiated group (n=8), moderately differentiated group (n=39), poorly differentiated group (n=9) and undifferentiated group (n=0). The differences of Ktransmean,Ktrans75%,Kepmax, Kepmean,Kep75% between different pathological grading groups were statistically significant (all P<0.05),and these parameters showed positive correlation significantly with pathological grading (r values were 0.778, 0.632, 0.594, 0.725, 0.489 respectively, all P<0.05). The ROC curve area of Ktransmean, Ktrans75% in the diagnosis of pathological grade for esophageal squamous cell carcinoma was 0.750,0.856,respectively. The diagnostic efficiency of Ktrans75% was the best with the diagnostic threshold of 0.693/min,sensitivity of 87.5%, specificity of 78.5%, respectively. Conclusion The quantitative parameters of DCE?MRI after neoadjuvant chemotherapy in esophageal squamous cell carcinoma have the potential value for predicting pathological grade.

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