Objective: To explore the application value of diffusion kurtosis imaging (DKI) in the differential diagnosis of rectal tumors and evaluating the prognostic factors associated with rectal adenocarcinoma. Methods: A total of 105 patients with rectal tumors admitted in the First Affiliated Hospital of Zhengzhou University from December 2018 to August 2020 were retrospectively analyzed. All patients underwent high-resolution magnetic resonance DKI scanning. The mean diffusivity (MD), mean kurtosis (MK) and apparent diffusion coefficient (ADC) were measured and the relationship of these parameters with pathological types and prognostic factors of rectal tumor were analyzed. The diagnostic efficacy of MD, MK, and ADC for positive circumferential resection margin (CRM) and extramural venous invasion (EMVI) of rectal adenocarcinoma was evaluated by the receiver operating characteristic (ROC) curve. Results: MD and ADC were only related to pathological type. The MD and ADC were (2.091±0.390)×10(-3) and (1.478±0.265)×10(-3) mm(2)/s in mucinous adenocarcinoma, higher than (1.136±0.182)×10(-3) and (0.767±0.077)×10(-3) mm(2)/s in unspecified adenocarcinoma and (1.617±0.697)×10(-3) and (0.940±0.179)×10(-3) mm(2)/s in tubulo-villous adenoma. The MD and ADC in unspecified adenocarcinoma were lower than those in tubule-villous adenoma (P<0.05). Nevertheless, MK was associated with pathological type, N stage, CRM and EMVI. The MK was 0.566±0.110 in mucinous adenocarcinoma, lower than 0.982±0.135 in unspecified adenocarcinoma and 0.827±0.121 in tubulo-villous adenoma. The MK in unspecified adenocarcinoma was higher than that in intubulo-villous adenoma. The MK was 0.984±0.107 in pN1-2, higher than 0.881±0.146 in pN0. The MK was 0.990±0.142 in positive CRM, higher than 0.862±0.114 in negative CRM. The MK was 0.996±0.140 in positive EMVI, higher than 0.832±0.100 in negative EMVI (P<0.05). The ROC curves showed that the AUCs of MD, MK and ADC in diagnosing positive CRM were 0.459, 0.653 and 0.408, respectively; with MK=1.006 as the optimal diagnostic threshold, the diagnostic sensitivity and specificity were 51.9% and 81.0%, respectively. The AUCs of MD, MK and ADC values in diagnosing positive EMVI were 0.510, 0.662 and 0.388, respectively; with MK=1.010 as the optimal diagnostic threshold, the diagnostic sensitivity and specificity were 50.9% and 87.5%, respectively. Conclusions: DKI quantitative parameter is helpful for discriminating rectal tubulo-villous adenoma, unspecified adenocarcinoma, and mucinous adenocarcinoma, and is helpful for predicting the prognosis of patients with rectal adenocarcinoma. High MK is associated with positive CRM and EMVI.
Humans ; Adenocarcinoma/diagnostic imaging* ; Adenocarcinoma, Mucinous/diagnostic imaging* ; Adenoma, Villous/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging/methods* ; Prognosis ; Rectal Neoplasms/pathology* ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo compare the difference in CT manifestations between primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma in order to improve radiologic diagnosis.

METHODSClinicopathological data and CT findings of 109 patients with colorectal mucinous adenocarcinoma and 46 patients with primary colorectal signet-ring cell carcinoma confirmed by surgery and pathology from March 2008 to February 2015 in the Tumor Hospital of Yunnan Province were retrospectively collected. Differences in age, gender, tumor location, length and thickness of the involved intestinal wall, thickening pattern of the intestinal wall, lesion density, calcification, contrast-enhanced form, peri-intestinal invasion, occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups.

RESULTSAmong 109 patients with colorectal mucinous adenocarcinoma, 68 were men and 41 were women with a mean age of (56.8±15.4) years. Among 46 patients with primary colorectal signet-ring cell carcinoma, 26 were men and 20 were women with a mean age of (42.9±15.6) years. Compared with mucinous adenocarcinoma group, signet-ring cell carcinoma group showed more concentric bowel-wall thickening[93.5%(43/46) vs. 81.6%(89/109), χ=9.19, P=0.030], higher lesion density [(42.0±3.0) Hu vs. (28.5±1.5) Hu, t=37.30, P=0.000], more marked enhancement [54.3%(25/46) vs. 12.8%(14/109), χ=35.21, P=0.000], less vast-low-density region in enhanced CT imaging[2.2%(1/46) vs. 45.0%(49/109), χ=73.31, P=0.000] and more severe peri-intestinal invasion [41.3% (19/46) vs. 17.4%(19/109), χ=10.25, P=0.006]. Calcification was found in 18.3%(20/109) of mucinous adenocarcinoma cases, but was not found in signet-ring cell carcinoma cases (χ=9.69, P=0.002). Target ring sign in contrast-enhanced scan was observed in 15.2%(7/46) of signet-ring cell carcinoma cases, while in none of mucinous adenocarcinoma cases (χ=17.37, P=0.000). There were no statistically significant differences in lesion location, length and thickness of the involved intestinal wall, occurrence of intestinal obstruction, lymph node metastasis, liver or peritoneum metastasis between two groups(all P>0.05).

CONCLUSIONSSignet-ring cell carcinoma is often found in younger patients, whose CT manifestation is characterized by the target ring sign in contrast-enhanced scan, while primary colorectal mucinous adenocarcinoma is often in older patients, whose CT manifestation is characterized by calcification in unenhanced scan and low density region in enhanced CT show.

Adenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Adult ; Age Factors ; Aged ; Calcinosis ; diagnostic imaging ; pathology ; Carcinoma, Signet Ring Cell ; diagnostic imaging ; pathology ; China ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

OBJECTIVETo evaluate the clinicopathological and CT features of mucinous cystic neoplasms (MCNs) of the pancreas and analyze the correlative risk factors for malignant pancreatic mucinous cystic neoplasms.

METHODSNinety-eight patients who underwent curative resection for mucinous cystic neoplasms of the pancreas at PLA General Hospital from April 1994 to January 2013 were included in this study. All clinicopathological data available were retrospectively analyzed. All patients were divided into benign tumors + premalignant lesion group (70 patients) and malignant tumor group (28 patients). Clinicopathological and CT features of the mucinous cystic neoplasms of the pancreas and risk factors of malignant pancreatic mucinous cystic neoplasms were analyzed.

RESULTSMucinous cystic neoplasms were seen mostly in perimenopausal women (71.4%, 70/98 cases,), and 51.0% (50/98 cases) of the patients had obvious clinical signs, mostly non-specific abdominal pain, but jaundice was present only in cases of malignant mucinous cystic neoplasms. Benign mucinous cystic neoplasms were mostly located in the distal pancreas (74.3%) and characterized with septa and thin cystic wall, while more malignant mucinous cystic neoplasms were located at the proximal pancreas (57.1%) and characterized with thick cystic wall and solid components. Univariate analysis showed that findings associated with malignancy gender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct were significantly correlated with malignant tumor development (P < 0.05 for all). The results of multiple logistic regression analysis showed that thick wall and solid components were independent prognostic factors for malignancy (OR = 31.417 and 34.976, P < 0.05 for both).

CONCLUSIONSGender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct are important diagnostic indices of malignant mucinous cystic tumors of the pancreas, while thick wall and solid components are independent risk factors of malignant pancreatic mucinous cystic neoplasms.

Adenocarcinoma, Mucinous ; diagnostic imaging ; Aged ; Female ; Humans ; Neoplasms, Glandular and Epithelial ; diagnostic imaging ; Pancreatic Neoplasms ; diagnostic imaging ; Radiography ; Retrospective Studies

BACKGROUNDThere are relatively few reports focusing on clinical and multi-slice CT (MSCT) imaging findings of mucinous tubular and spindle cell carcinoma (MTSCC). Our study aimed to characterize the clinical and MSCT imaging features of MTSCC.

METHODSThe imaging findings in 17 patients with MTSCC by MSCT were retrospectively studied. MSCT was undertaken to investigate tumor location, size, density, cystic or solid appearance, calcification, capsule sign, enhancement pattern, and retroperitoneal lymph node metastasis.

RESULTSTumors (mean diameter, (3.9 ± 1.7) cm) were solitary (17/17), solid (16/17) with cystic components (5/17), had no calcifications (14/17), had a poorly defined margin (14/17), were centered in the medulla (15/17), compressed the renal pelvis (7/17), and neither lymph node nor distant metastasis was found. The attenuation of MTSCC tumors was equal to that of the renal cortex or medulla on unenhanced CT (32.3 ± 2.6, 36.3 ± 4.6, 33.2 ± 3.9, respectively, P > 0.05), while tumor enhancement after administration of a contrast agent was lower than that of normal renal cortex and medulla during all phases (P < 0.05).

CONCLUSIONMTSCC tends to be a solitary, isodense mass with poorly defined margin arising from the renal medulla with enhancement less than the cortex and medulla during all phases.

Adenocarcinoma, Mucinous ; diagnosis ; diagnostic imaging ; Adult ; Carcinoma ; diagnosis ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Radiography

OBJECTIVETo explore the value of comprehensive application of CT and PET/CT in differential diagnosing mucinous and non-mucinous colorectal adenocarcinoma.

METHODSCT and PET/CT image data of 37 patients with mucinous adenocarcinoma and 50 patients with non-mucinous adenocarcinoma confirmed by pathology in our hospital from January 2010 to December 2012 were analyzed retrospectively. Differences of image were compared between two methods.

RESULTSOn CT, lesion density of pre-contrast, pro-contrast phase and enhancement degree were significantly lower in mucinous adenocarcinoma than those in non-mucinous adenocarcinoma(all P<0.01). Enhancement degree of hypointense area, hypointense area proportion of total lesion, and lymphatic or distant metastasis ratio were significantly higher in mucinous adenocarcinoma than those in non-mucinous adenocarcinoma(all P<0.05). On PET/CT, maximal SUV value of mucinous adenocarcinoma was significantly lower as compared to non-mucinous adenocarcinoma[(8.64±4.34) Bq/L vs. (12.38±5.96) Bq/L, P=0.015].

CONCLUSIONSCT combined with PET/CT provides better valuable information in differential diagnosing between mucinous and non-mucinous colorectal adenocarcinoma and clinical practice.

Adenocarcinoma ; diagnostic imaging ; Adenocarcinoma, Mucinous ; diagnostic imaging ; Colorectal Neoplasms ; diagnostic imaging ; Humans ; Multimodal Imaging ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo explore the dosimetric variance in forward intensity modulated radiotherapy (IMRT) based on 4D CT and 3D CT after breast conserving surgery.

METHODSSeventeen patients after breast conserving surgery underwent 3D CT simulation scans followed by respiration-synchronized 4D CT simulation scans at free breathing state. The treatment plan constructed using the end inspiration (EI) scan was then copied and applied to the end expiration (EE), and 3D scans and dose distribution were calculated separately. Dose-volume histograms (DVHs) parameters for the CTV, PTV, ipsilateral lung and heart were evaluated and compared.

RESULTSThe CTV volume difference was biggest between T0 and 3D CT, and the volume difference was 4.10 cm(3). Mean dose of PTV at EE was lower than that at EI (P = 0.019), but there were no statistically significant difference between 3D and EI, EE (all P > 0.05). The homogeneity index (HI) at EI, EE, 3D plans were 0.149, 0.159 and 0.164, respectively, and a significant difference was only between EI and EE (P = 0.039). The highest conformal index (CI) was at EI phase (P < 0.05), and there was no significant difference between EE and 3D (P = 0.758). The V(40) and V(50) of ipsilateral lung at EE phase were lower than that at EI (P < 0.05). There were no significant differences in all the indexes for heart (P > 0.05).

CONCLUSIONSThe breast deformation during respiration may be disregarded in whole breast IMRT. PTV dose distribution is significantly changed between EI and EE phases, and the differentiation of the lung high dose area between EI and EE phases may be induced by thorax expansion. 3D treatment planning is sufficient for whole breast forward IMRT, but 4D CT scans assisted by respiratory gating ensures more precise delivery of radiation dose.

Adenocarcinoma, Mucinous ; diagnostic imaging ; radiotherapy ; surgery ; Adult ; Breast Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnostic imaging ; radiotherapy ; surgery ; Dose Fractionation ; Female ; Four-Dimensional Computed Tomography ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Mastectomy, Segmental ; Middle Aged ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Respiration

OBJECTIVETo evaluate the impact of breast density on computer-aided detection (CAD) for breast cancer and the CAD false-positive rate of normal controls.

METHODSTwo hundred and seventy-one histologically proven breast malignant lesions (from Feb. 2008 to Dec. 2009) and 238 randomly selected normal cases were classified by mammographic density according to the American College of Radiology breast imaging reporting and data system (BI-RADS). Mammograms of BI-RADS 1 or BI-RADS 2 density were categorized as non-dense breasts, and those of BI-RADS 3 or BI-RADS 4 density were categorized as dense breasts. Full-field digital mammography (GEMS Senographe) were performed in all patients and controls with craniocaudal (CC) and mediolateral oblique (MLO) views. Then the image data were transferred to review workstation (SenoAdvantage), and the lesions were marked by Second Look Digital CAD system (version 7.2, iCAD). The differences of sensitivity and false-positive rate between dense and non-dense breasts were compared.

RESULTSOverall, the sensitivity of CAD in detection of cancers was 84.1% (228/271), there was a statistically significant difference in CAD of cancers in dense versus non-dense breasts (P = 0.015). The sensitivity of CAD in detection of mass cancers was 76.5% (186/243), in detection of calcification cancers was 79.1% (125/158), there was no statistically significant difference in CAD performance for the detection of mass cancers versus calcification cancers (P = 0.547). There was a significant difference in the CAD performance for the detection of mass cancer cases in non-dense versus dense breasts (P = 0.001), but no significant difference in the CAD for the detection of calcification cancers in non-dense versus dense breasts (P = 0.216). In the controls, the distribution of mass false-positive marks did not differ significantly between non-dense and dense breast tissue cases (P = 0.207), but the distribution of calcification false-positive marks differed significantly between non-dense and dense breast tissue cases (P = 0.001). There was a statistically significant difference of false-positive marks in non-dense versus dense breasts (P = 0.043).

CONCLUSIONSThe sensitivity of CAD in the detection of breast cancers is impacted by breast density. There is a statistically significant difference in the CAD performance for the detection of cancer cases in non-dense versus dense breasts. The false-positive rate of CAD is lower in dense versus non-dense breasts. It appears difficult for CAD in the early detection of breast cancer in the absence of microcalcifications, particularly in dense breasts.

Adenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Adult ; Aged ; Aged, 80 and over ; Breast ; pathology ; Breast Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; diagnostic imaging ; Carcinoma, Ductal, Breast ; diagnostic imaging ; pathology ; Carcinoma, Lobular ; diagnostic imaging ; pathology ; Carcinoma, Papillary ; diagnostic imaging ; pathology ; False Positive Reactions ; Female ; Humans ; Mammography ; methods ; Middle Aged ; Numerical Analysis, Computer-Assisted ; Radiographic Image Interpretation, Computer-Assisted

OBJECTIVEto evaluate the diagnostic accuracy of ultrasound-guided core needle biopsy of breast tumors.

METHODSsix hundred and sixty-seven cases of core needle biopsy of breast encountered during the period from January, 2004 to June, 2007 were retrieved from the archival file and retrospectively reviewed. The core needle biopsy diagnoses were correlated with the histologic findings of the subsequent surgical excision specimens. The discrepancies were further analyzed.

RESULTSthree hundred and eighty-two patients had core needle biopsy diagnosis followed by local excision, breast conservation surgery or mastectomy. Two hundred and eighty-one cases were confirmed to have malignancy in the surgical specimens. Review of the corresponding core needle biopsies showed 4 false-negative cases, no false-positive cases, 28 cases with underestimation and 2 cases with overestimation. The false-negative rate was 1.4% (4/281). The rate of underestimation for ductal carcinoma-in-situ was 6/11. The diagnostic accuracy of core needle biopsy was 94.7% (266/281).

CONCLUSIONin order to improve the diagnostic accuracy of core needle biopsy of breast tumors, recognition of the limitation of the procedure, application of immunohistochemistry and awareness of potentially rare entities are important.

Adenocarcinoma, Mucinous ; diagnostic imaging ; metabolism ; pathology ; surgery ; Biopsy, Needle ; methods ; Breast Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; CD56 Antigen ; metabolism ; Carcinoma, Ductal, Breast ; diagnostic imaging ; metabolism ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; diagnostic imaging ; metabolism ; pathology ; surgery ; False Negative Reactions ; Female ; Humans ; Keratin-5 ; metabolism ; Mastectomy ; methods ; Membrane Proteins ; metabolism ; Retrospective Studies ; Ultrasonography, Interventional ; methods ; Ultrasonography, Mammary

OBJECTIVEto investigate the pathologic basis of the difference between clinical response and pathologic response of breast carcinoma after neoadjuvant chemotherapy.

METHODStwo hundred and nine cases of breast cancer with neoadjuvant therapy were analyzed and clinical data were collected from June, 2005 to December, 2007. All patients had core needle biopsy taken before neoadjuvant chemotherapy and were operated within 4 weeks after neoadjuvant chemotherapy. Clinical examination, X-ray of breast and/or B ultrasonography of primary breast focus were taken before and after neoadjuvant chemotherapy. Clinical responses of breast primary focus were evaluated according to RECIST (response evaluation criteria in solid tumors) version 1.1.Pathologic responses of breast primary focus were evaluated according to Miller and Payne (MP) grading system. SPSS 15.0 software was used to statistical analysis.

RESULTS(1) Clinical responses basing on clinical examination showed complete response, partial response, stable disease and progressive response, in 33, 124, 41 and 11 cases respectively. (2) Eighty-seven cases had X-ray of breast taken before and after neoadjuvant chemotherapy. Clinical response basing on X-ray, showed complete response, partial response and stable disease in 8, 42 and 37 cases respectively. (3) Pathologic responses of breast primary focus were as MP1 (14 cases), MP2 (35 cases), MP3 (106 cases), MP4 (36 cases) and MP5 (18 cases). (4) The clinical response basing on clinical examination were related to the pathologic response (χ(2) = 33.668, P = 0.001); and the clinical response basing on X-ray of breast were also related to the pathologic response (χ(2) = 22.404, P = 0.004). (5) The pathologic basis of the difference between the pathologic response and the clinical response basing on X-ray of breast were: embolism of carcinoma, mucinous carcinoma, intraductal carcinoma with ossifying-type calcification, nodular fibrosis and others.

CONCLUSIONSthe clinical response may be related to the pathologic response. The difference between the two may be caused by pathologic changes. Some benign and malignant pathologic changes may contribute to the under-estimation of clinical response over pathologic response; whereas embolism of carcinoma may contribute to the over-estimation of clinical response over pathologic response.

Adenocarcinoma, Mucinous ; diagnostic imaging ; drug therapy ; pathology ; Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Lobular ; diagnostic imaging ; drug therapy ; pathology ; Disease Progression ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Radiography ; Remission Induction

OBJECTIVETo analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

METHODSTwelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 (33.3%) with adenoma and 8 (66.7%) with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites: main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation between ultrasonographic findings and histopathological results was analyzed.

RESULTSThere were 9 men and 3 women with a mean age of 60.1 +/- 9.6 years (range, 32-73). Of all the 12 patients with IPMN, 9 (75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CA19-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ultrasonography. The mean diameters of the lesions were 1.4 +/- 0.8 cm (range, 0.5-2.0) and 6.3 +/- 6.0 cm (range, 2.0-20.0) in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in adenomas and adenocarcinomas were 1.0 +/- 0.8 cm and 1.6 +/- 1.0 cm, respectively. Among the 4 adnomas, 3 (75.0%) cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 (62.5%) cases were classified as main duct type, and 3 (37.5%) as combined type. In 7 of the 8 adenocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.

CONCLUSIONSTransabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts. Some characteristics should be noticed as suggesting the possibility of malignancy: clinical symptoms of pancreatic insufficiency, large tumor size, and mural nodules with color Doppler flow signals. Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.

Adenocarcinoma, Mucinous ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; diagnostic imaging ; Carcinoma, Papillary ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Cyst ; diagnostic imaging ; Pancreatic Neoplasms ; diagnostic imaging ; Ultrasonography