[Objective]To evaluate the diagnostic value of quantitative diffusion kurtosis imaging(DKI)parameters in discriminating metastatic from non-metastatic regional lymph nodes in rectal cancer.[Methods]Totally 116 patients who underwent preoperative DKI scanning and radical rectal cancer surgery without neoadjuvant therapy between January 2015 and August 2016,and 285 lymph nodes,including metastatic lymph nodes(MLNs,n=104)and non-metastatic lymph nodes(NMLNs,n=181),were analyzed.The short-axis diameter(S),apparent diffusion coefficient(ADC),mean kurtosis coefficient(MK),and mean diffusion coefficient(MD)were compared between the two groups,with S=5.5 mm as a cutoff value.Receiver operating characteristic(ROC)curves were utilized to assess diagnostic efficiency and determine optimal cutoff values.[Results]Metastatic lymph nodes exhibited significantly higher S,ADC,and MD values(P＜0.05),but markedly lower MK values(P＜0.01)compared with non-metastatic lymph nodes.The optimal cutoff values for MK[area under the curve(AUC),sensitivity,specificity]in discriminating metastatic from non-metastatic lymph nodes were 1.150(0.634,80.77%,45.86%).Subgroup analysis revealed that when S≥5.5 mm,MK was lower in metastatic lymph nodes than in non-metastatic nodes(P=0.037),with optimal cutoff values(AUC,sensitivity,specificity)of 1.213(0.604,87.50%,36.51%).No significant differences were observed in S,ADC,or MD between the groups(P＞0.05).When S＜5.5 mm,metastatic lymph nodes showed higher ADC and MD but lower MK than non-metastatic nodes(P＜0.05).The optimal cutoff values(AUC,sensitivity,specificity)for MK in this subgroup were 1.108(0.655,81.25%,55.93%).No significant difference in S was observed(P=0.097).[Conclusion]The DKI quantitative parameter MK can effectively discriminate regional MLNs from NMLNs in rectal cancer.Combining S with MK may further enhance diagnostic accuracy.

[Objective]To evaluate the diagnostic value of quantitative diffusion kurtosis imaging(DKI)parameters in discriminating metastatic from non-metastatic regional lymph nodes in rectal cancer.[Methods]Totally 116 patients who underwent preoperative DKI scanning and radical rectal cancer surgery without neoadjuvant therapy between January 2015 and August 2016,and 285 lymph nodes,including metastatic lymph nodes(MLNs,n=104)and non-metastatic lymph nodes(NMLNs,n=181),were analyzed.The short-axis diameter(S),apparent diffusion coefficient(ADC),mean kurtosis coefficient(MK),and mean diffusion coefficient(MD)were compared between the two groups,with S=5.5 mm as a cutoff value.Receiver operating characteristic(ROC)curves were utilized to assess diagnostic efficiency and determine optimal cutoff values.[Results]Metastatic lymph nodes exhibited significantly higher S,ADC,and MD values(P＜0.05),but markedly lower MK values(P＜0.01)compared with non-metastatic lymph nodes.The optimal cutoff values for MK[area under the curve(AUC),sensitivity,specificity]in discriminating metastatic from non-metastatic lymph nodes were 1.150(0.634,80.77%,45.86%).Subgroup analysis revealed that when S≥5.5 mm,MK was lower in metastatic lymph nodes than in non-metastatic nodes(P=0.037),with optimal cutoff values(AUC,sensitivity,specificity)of 1.213(0.604,87.50%,36.51%).No significant differences were observed in S,ADC,or MD between the groups(P＞0.05).When S＜5.5 mm,metastatic lymph nodes showed higher ADC and MD but lower MK than non-metastatic nodes(P＜0.05).The optimal cutoff values(AUC,sensitivity,specificity)for MK in this subgroup were 1.108(0.655,81.25%,55.93%).No significant difference in S was observed(P=0.097).[Conclusion]The DKI quantitative parameter MK can effectively discriminate regional MLNs from NMLNs in rectal cancer.Combining S with MK may further enhance diagnostic accuracy.

Objective:To investigate the value of quantitative parameters derived from dual-layer spectral detector CT (SDCT) in characterizing regional lymph node (LN) status of colorectal cancer.Methods:From August 2019 to May 2020, 101 patients with colorectal cancer confirmed by pathology in the First Affiliated Hospital of Sun Yat-sen University were retrospectively collected. The largest regional LNs were matched with surgical pathology one by one and divided into metastatic LNs group (42 cases) and nonmetastatic LNs group (59 cases) according to pathological results. Based on preoperative venous phase contrast enhanced SDCT images he short-axis diameter (S) and the of the largest regional LN was measured, then its border and enhancement homogeneity were evaluated. Outlining the ROI along the edge of the LN on its widest cross section, the iodine density (ID) and effective atomic number (Z eff) were measured, then the normalized ID (nID) and normalized Z eff (nZ eff) were calculated. The χ 2 test, Fisher′s exact test, independent samples t-test or Mann-Whitney U test were used to compare the differences of each parameter between pathologically metastatic and nonmetastatic LNs and a logistic regression model was constructed. The ROC curves and area under the curve (AUC) were performed to evaluate the diagnostic performance of each parameter. DeLong test was used to compare the differences of each AUC. Results:The S, border, enhancement homogeneity, ID, Z eff, nID and nZ eff of LNs all showed significant differences between metastatic and nonmetastatic LNs (all P<0.001). The regression model constructed by S and Z eff of LNs had the highest value in differentiating metastatic and nonmetastatic LNs, with an AUC of 0.935, sensitivity and specificity of 85.7% and 89.8%, respectively. Its diagnostic value was higher than that of S, border, enhancement homogeneity (AUC 0.674-0.832, all P<0.05) and SDCT quantitative parameters (AUC 0.863-0.906, all P<0.05) of LNs. Conclusion:SDCT quantitative parameters facilitate the accurate diagnosis of regional metastatic LNs in patients with colorectal cancer, among which the multi-parameter regression model has the highest diagnostic value.

Objective To explore the repeatability and consistency of MR intravoxel incoherent motion (IVIM) parameters of rectal cancers.Methods Routine high resolution rectal MR and IVIM sequence were performed on 128 patients with pathologically proved rectal cancers before treatment.IVIM maps were generated from two sets of b-values (group A:0,5,10,20,30,40,60,80,100,150,200,400,600 and 1000 s/mm2;group B:0,5,10,20,30,40,60,80,100,150,200,400,600,1000,1500 and 2000 s/mm2),and IVIM parameters (D,D* and f) were measured.Then IVIM parameters were measured again by the same observer three months later.The intra-class correlation coefficient (ICC) and Bland-Altman graph analysis were performed to explore the repeatability and consistency of IVIM parameters.Results The differences of IVIM parameters (D,D* and f) derived from the two sets of b-values were statistically different (all P＜0.001).ICC and 95％ confidence interval (CI) of D,D* and f was 0.968 (0.955,0.977),0.780 (0.688,0.845) and 0.957 (0.934,0.970),respectively.Bland-Altman analysis showed that the 95 ％ limits of agreement of D,D* and f was (10.8％,22.4％),(14.8％,61.9％) and (-45.3％,-10.2％),respectively.There was significant difference of D* between twice measurement by the same observer (P=0.001);ICC and 95％CI of D,D* and f was 0.826(0.670,0.908),0.678 (0.392,0.830) and 0.910 (0.830,0.952),respectively.Furthermore,Bland-Altman analysis showed that the 95％ limits of agreement of D,D* and f were (-15.3％,12.4％),(-39.6％,61.2％) and (-22.6％,22.9％),respectively.Conclusion Under the two different sets of b-values,all IVIM parameters of rectal cancers demonstrate good consistency.In addition,D and f value show good repeatability.

OBJECTIVETo evaluate the diagnostic value of 3.0T high-resolution MRI in mesorectal lymph node metastasis of rectal cancer.

METHODSThe images and postoperative pathological data of patients with pathologically diagnosed rectal cancer who underwent prospective 3.0T two dimensional high-resolution MRI rectal examinations and surgery within two weeks after MRI examination at the First Affiliated Hospital, Sun Yat-sen University from November 2015 to November 2016 were retrospectively collected. Patients who received preoperative neoadjuvant therapy and those who did not undergo operation after MRI examination were excluded. The MRI sequences included high-resolution sagittal, coronal and oblique axial T2 weighted image (T2WI) (repetition time/echo time, 3000-4000 ms/77-87 ms; slice thickness/gap, 3 mm/0 mm; field of view, 18-22 cm). Two abdominal MRI radiologists independently assessed the morphology, margin, signal of all visible mesorectal nodes, measured their minor axes (three times for each radiologist) and gave estimation of the malignancy. The criteria of metastatic nodes on high-resolution MRI T2WI were nodes with irregular shape, ill-defined border and/or heterogeneous signal. The results of MRI diagnosis were compared with postoperative pathology. The sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of mesorectal nodes and nodes with different short-axis diameter ranges were calculated to evaluate the diagnostic efficiency of high-resolution MRI. Kappa statistics was used to evaluate the agreement for per node and for per patient between high-resolution MRI and pathological results. A Kappa value of 0-0.20 indicated poor agreement; 0.21-0.40 fair agreement; 0.41-0.60 moderate agreement; 0.61-0.80 good agreement; and 0.81-1.00 excellent agreement.

RESULTSA total of 81 patients were enrolled in the retrospective cohort study, including 50 males and 31 females with age of (59.3±11.1) years. Histopathology showed 1 case of well differentiated adenocarcinoma, 63 of moderately differentiated adenocarcinoma, 9 of moderately to poorly differentiated adenocarcinoma, 2 of poorly differentiated adenocarcinoma, 3 of mucinous adenocarcinoma and 3 of tubulovillous adenocarcinoma. Histopathological staging showed 2 cases in T1 stage, 20 in T2 stage, 45 in T3 stage and 14 in T4 stage; 34 in N0 stage, 40 in N1 stage and 7 in N2 stage; 76 in M0 stage and 5 in M1 stage. A total of 377 nodes were included in the node-by-node evaluation, of which 168 (44.6%) nodes were metastatic from 58.0% (47/81) patients. The median short-axis diameter was 5.4(2.4-18.6) mm in metastatic nodes, which was significantly larger than 3.8 (2.0-8.7) mm in non-metastatic nodes[Z=10.586, P=0.000]. The sensitivity, specificity, accuracy, PPV and NPV were 74.4% (125/168), 94.7% (198/209), 85.7% (323/377), 91.9% (125/136) and 82.2% (198/241), respectively. The Kappa values between high-resolution MRI and histopathological diagnosis for node-by-node and patient-by-patient were 0.71 and 0.70 respectively, indicating good agreements. Fourteen nodes >10 mm were all metastatic. The results of high-resolution MRI for nodal status were consistent with the results of histopathological diagnosis, and the sensitivity, accuracy and PPV were all 100.0%. Among 124 nodes with short-axis diameter of 5-10 mm, 95 (76.6%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 78.9% (75/95), 86.2% (25/29), 80.6% (100/124), 94.9% (75/79) and 55.6% (25/45), respectively. The agreement was fair (Kappa value 0.55) between high-resolution MRI and histopathological diagnosis. Among 239 nodes with short-axis diameter ≤5 mm, 59(24.7%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 61.0% (36/59), 96.1%(173/180), 87.4%(209/239), 83.7%(36/43) and 88.3%(173/196), respectively. The agreement was good (Kappa value 0.63) between high-resolution MRI and histopathological diagnosis.

CONCLUSIONRectal high-resolution MRI has good diagnostic value for estimating metastatic mesorectal nodes by evaluating the morphology, margin and signal of nodes.

Aged ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Prospective Studies ; Rectal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Sensitivity and Specificity

Objective To study the value of dual-phase enhanced multi-slice computed tomography (MSCT)scan in combination with the reconstruction technique for distinguishing gallbladder adenomyomatosis (GBA)from gallbladder cancer.Methods We ret-rospectively reviewed the CT features (including dual-phase and reconstructed images)of 36 patients with GBA (Group A,1 6 pa-tients)or gallbladder cancer (Group B,20 patients)proved by pathology.Fisher exact test was used to compare the CT findings be-tween the two groups.Results The occurrence rates of RAS,gallbladder wall smoothing,clear gallbladder border,uniform en-hancement of serous layer and thickening of the gallbladder wall were statistically significantly different between Group A and B. When using the Rokitansky-Aschoff sinuses as a parameter for the differential diagnosis of the two groups,the diagnostic accuracy reached to 92.85%.Conclusion Dual-phase enhanced MSCT scan in combination with the reconstruction technique is a valuable ima-ging technique for distinguishing GBA from gallbladder cancer.

AIM:To investigate the perfusion parameters using dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in rectal cancer patients so as to explore its potential value in estimating the microvascular condition including perfusion and permeability .METHODS:The data of 38 rectal cancer patients examined with DCE-MRI was ret-rospectively analyzed .The perfusion parameters of carcinoma and normal rectal wall in each case were calculated , inclu-ding volume transfer constant (Ktrans), rate constant of back flux (Kep), extravascular extracellular space fractional volume (Ve) and initial area under curve (iAUC).The mean values of tumor and normal rectal wall , mucinous and nonmucinous carcinoma, poorly and moderately-to-well differentiated carcinoma , case with or without lymph node metastasis were com-pared.RESULTS:All the parameters of rectal cancer were higher than normal rectal wall (P<0.01).No significant difference was found between poorly and moderately-to-well differentiated carcinoma in terms of K trans, Kep and Ve, neither was the case with or without lymph node metastasis .The cases with lymph node metastasis had lower iAUC than those with-out (P<0.05).CONCLUSION:Quantitative perfusion DCE-MRI answered the microvascular perfusion and permeability change of rectal cancer compared with normal rectal wall , besides it could be used to distinguish between mucinous and nonmucinous carcinoma , which demonstrated its value in the evaluation of rectal cancer .However , it should not be recom-mended to predict the degrees of tumor cell differentiation and lymph node metastasis just according to the perfusion param -eters.

Objective To evaluate the MR perfusion imaging in measuring the hemodynamics of liver.MethodsCT and MR perfusion imaging were performed in livers of 13 pigs.The hepatic artery perfusion(HAP),portal vein perfusion(PVP),total hepatic blood flow(THBF),portal vein perfusion index(PVI),distribution volume(DV)and mean transit time(MTT)were calculated and compared respectively.Hemodynamics of the liver from two kinds of imaging was compared by paked t-test,and the relativity was analyzed by Pearson correlation analysis.ResultsIn CT and MR perfusion imaging of the 13 pigs:the hepatic artery perfusion(HAP)were(37.7±7.38)and(35.80±7.31)ml-min-1·100ml-1.the portal vein perfusion(PVP)were(123.16 35.89)and(121.40±36.81)ml·min-1·100 ml-1.the total hepatic blood flow(THBF)were(160.88±37.05)and(157.21±38.71)ml·min-1·100 ml-1.the portal vein perfusion index(PVI)were(75.95±5.21)%and(76.63±5.24)%,the distilbution volume(DV)were(35.10±11.17)%and(41.03±10.06)%。The mean transit time(MTT)were(14.08±1.40)and(14.94±1.32)s.There were no statistical differences for HAP,PVP,THBF and PVI between CT and MR perfusion imaging(t=1.263,0.926,1.225,-1.115,P＞0.05).There were no statistical differences for DV and MTT(t=-3.345,-3.200,P＜0.01).Analysis of these two kinds of imaging showed the correlation coefficient of PVP,THBF and PVI were hishly related(r＞0.85,P＜0.01).Correlation coefficient of HAP,DV and M1T were moderately related(r＞0.70,P＜0.01).ConclusionsMR perfusion Call quantify the blood flow parameters of liver accurately.It is close to that of the CT perfusion imaging.

OBJECTIVETo assess a new intervention for reestablishing the second hepatic hilum by means of puncturing and stenting the liver tissue between the intrahepatic vena cava and a hepatic vein for the treatment of Budd-Chiari syndrome (BCS).

METHODSTwo patients with BCS, in which no second hepatic hilum structure was found in transhepatic venography, underwent an interventional procedure of canalizing and stenting the parenchyma tract between the intrahepatic vena cava and a hepatic vein. The procedures were performed in the percutaneous transhepatic and right jugular vein, respectively. A metallic stent with a 10 mm diameter was implanted to maintain tract patency.

RESULTSThe free hepatic vein pressure (FHVP) of both patients decreased from 37 mm Hg to 5 mm Hg and from 28 mm Hg to 4 mm Hg, respectively, after the procedure. The complication of hemorrhage due to puncture was observed in one patient. Both patients maintained hepatic improvements in 3-year follow-up. Both clinical conditions and laboratory values were significantly improved after the procedure. Furthermore, the stented canals (the reestablished second hepatic hilum) maintained patent with normal FHVP, which was confirmed by control venography.

CONCLUSIONThe new technique provides a simple, safe, effective, and relatively inexpensive treatment of Budd-Chiari syndrome. Long-lasting effectiveness is expected.

Adult ; Budd-Chiari Syndrome ; therapy ; Hepatic Veins ; Humans ; Male ; Middle Aged ; Stents ; Vena Cava, Inferior

Objective To probe the feasibility of single dose contrast enhanced magnetic resonance aortography(CEMRA) and evaluate its value in clinical application. Methods Transit time(TT) test and duration of peak enhancement of aorta(DPE) test in 28 healthy adults were performed. With 2 different injection rate of Gd DTPA at 2 ml/s and 3 ml/s, the TT,peak signal intensity of aorta(SPE),DPE and the interval between DPE and the time of injection(?T) were measured and compared. Two groups of healthy volunteers(each 10) underwent three diamentional fast imaging in static procession sequence (3D FISP) CEMRA with standard dosage of Gd DTPA with the injection rate at 2 ml/s and 3 ml/s respectively. The signal/noise ratio(SNR) of the source images and the image quality of CEMRA of both groups were compared. Fifteen patients with aortic disease did the same study as the voluteers with the injection rate only at 3 ml/s. Results With the injection rate of 2 ml/s and 3 ml/s,the TT,SPE,DPE,?T and the SNR of CEMRA in two groups were significantly different( P