Objective To compare the value of diffusion kurtosis imaging (DKI) mode and mono-exponential mode in predicting the response to neoadjuvant chemotherapy (NAC) for locally advanced breast carcinoma using DWI.Methods From January 1,2013 to December 31,2016,eighty patients with locally advanced breast carcinoma were enrolled into this prospective clinical study.The diagnosis was confirmed on the basis of histopathological results.The clinical stage stayed at Ⅱ or Ⅲ.The patients would receive breast-conserving surgery after NAC.All the patients underwent DWI examination by using both mono-exponential mode and DKI mode before chemotherapy was initiated.The parameters included ADC,mean diffusivity (MD) and mean kurtosis (MK).Within 1 to 3 days before or after MRI examination,the patients underwent aspiration biopsy,received 4 to 8 cycles of NAC and followed by surgery.According to histologic grading before NAC,the patients were classified into well-differentiated and poor-differentiated group.According to the comparison between pathological results acquired from biopsy before NAC and specimen acquired after surgery,the patients were classified into pathologic complete response (pCR) and pathologic non-complete response (non-pCR) according to treatment effect.The imaging parameters were compared between the pCR and the non-pCR group using t test.The predicting ability of two imaging modes was compared and analyzed with ROC analysis.The relationships between multiple imaging parameters,pathologic,clinical characteristics of tumor and treatment effect were analyzed using logistic multi-variate regression analysis,and further analyzed using Wald test.Results There were 30 cases of pCR and 50 cases of non-pCR.The ADC and MD values were lower in the pCR group than in the non-pCR group (P＜0.05).MK value was higher in the pCR group than in the non-pCR group (P＜0.05).ROC analysis showed that the area under ROC curve of ADC,MD and MK in predicting treatment effect were 0.732,0.866 and 0.683 respectively.Logistic regression analysis showed that,according to predicting ability,MD,ADC and MK successively were the independent predictors for the early response to chemotherapy.Conclusion Compared with mono-exponential mode,DKI mode can reflect the real micro-environment and water diffusion restriction within the tumor area more reliably and accurately,and is more suitable to serve as an imaging technique for predicting the response to NAC for locally advanced breast carcinoma.

With the wide application of Chinese herbal medicine around the world and the continuous perfection of adverse drug reaction monitoring system,herb-induced liver injury (HILI) has attracted more and more attention,but its actual incidence remains unknown.As is reported in the literature,its constituent ratio ranged from 20％ to 30％ and there are many clinical types,among which hepatocellular injury is the most common type.There are many causes of HILI,including pharmaceutical factors,factors associated with the human body,lack of preclinical evaluation,and unreasonable clinical application.Currently it is difficult to make a diagnosis of HILI,and tracing the source of Chinese herbal medicine may play an important role in the diagnosis of this disease.Liver injury induced by Chinese herbal medicine should be taken seriously and active diagnosis and effective prevention and treatment should be performed.

Objective: To investigate the prognostic value of quantitative parameters of dynamic contrast-enhangced MR (DCE-MR) on short-term efficacy of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma(HCC). Methods: 79 patients with HCC underwent non-enhanced MR imaging and DCE on a 3.0T MR scanner before and one month after TACE. The quantitative parameters were measured on the maximal tumor region, including maximal tumor diameter(MTD), ADC, K^trans, K_ep and V_e value before and after TACE. All patients were divided into stable group (36 patients) and progressive group (43 patients) based on follow-up. The quantitative data of the two groups before and after TACE was collected for analysis. Results: Among the 79 lesions in 79 patients, 21 were located in the left lobe of the liver, 53 in the right lobe of the liver and 5 in the junction area of the hepatic lobe. The maximum tumor diameter (MTD) was 2.2-9.9 cm, the median MTD was 5.1 cm. There were significant differences between progressive group and the stable group in MTD, K^trans, K_ep values of the tumor before TACE (P<0.05). One month after TACE, the MTD, K^trans, K_ep,ΔMTD, ΔK^trans and ΔK_ep values of the tumor in progressive group were statistically different with the stable group (P<0.05, respectively). For all the patients, the pre-TACE MTD, AFP, K^trans and K_ep values of tumors were statistically different with the post-TACE values (P<0.05). Conclusion The quantitative parameters (K^trans, K_ep,ΔK^trans and ΔK_ep values) of the DCE-MR could predict and evaluate the short-term efficacy of TACE on HCC.

OBJECTIVETo evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.

METHODSTo analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.

RESULTSThe lesions (benign=28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7). The tumors showed heterogeneous density on unenhanced CT (n=25). Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast. The enhancement patterns included whole enhancement (n=9), solid area enhancement (n=12), peripheral enhancement (n=1), and spotted enhancement (n=1). The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement. The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3). Besides that the morphology had statistical significance (P=0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.

CONCLUSIONSRetroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes. Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

Adrenal Gland Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; Diagnosis, Differential ; Humans ; Hypertension ; Image Enhancement ; Pheochromocytoma ; diagnostic imaging ; pathology ; Retroperitoneal Space ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.Methods To analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.Results The lesions ( benign =28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7).The tumors showed heterogeneous density on unenhanced CT (n=25).Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast.The enhancement patterns included whole enhancement ( n =9 ) , solid area enhancement ( n=12 ) , peripheral enhancement ( n=1 ) , and spotted enhancement ( n=1 ) .The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement.The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3).Besides that the morphology had statistical significance (P =0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.Conclusions Retroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes.Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

Objective To evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.Methods To analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.Results The lesions ( benign =28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7).The tumors showed heterogeneous density on unenhanced CT (n=25).Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast.The enhancement patterns included whole enhancement ( n =9 ) , solid area enhancement ( n=12 ) , peripheral enhancement ( n=1 ) , and spotted enhancement ( n=1 ) .The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement.The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3).Besides that the morphology had statistical significance (P =0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.Conclusions Retroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes.Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

BACKGROUNDBenign and malignant primary retroperitoneal tumors (RT) have different pathological manifestations, and overlapping imaging characteristics. This study aimed to evaluate the value of computed tomography (CT) for differentiating benign from malignant RT.

METHODSOne hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT. There were 38.1% (n = 74) benign lesions and 61.9% (n = 120) malignant lesions. Categorical variables were tested with a chi-square test or Fisher's exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.

RESULTSIn univariate analysis, the differences in ill-defined margins, irregular surfaces, long diameter >6.75 cm, short diameter >6.25 cm, and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2% and 91.9%, 70.0% and 62.2%, 68.8% and 60.7%, 59.7% and 74.2%, 87.5% and 35.1%, respectively. In multivariate analysis, a combination of all the above indexes was the best model for differentiating malignant tumors, resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2% and a specificity of 81.1% (P < 0.0001) when the score was 4. The differences in other findings including CT attenuation, number, and calcification had no statistical significance. The unique characteristics included the spotted enhancement (mottled high density) in schwannoma (P < 0.0001), adipose tissue in liposarcoma (P < 0.0001) and paravertebral location in neurogenic tumors (P < 0.0001).

CONCLUSIONSMore accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT. Some specific characteristics of CT can assist in preoperative planning.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Retroperitoneal Neoplasms ; diagnosis ; diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; methods ; Young Adult

Objective To investigate the short-term effects of intra-articular injection of hyaluronan on proprioception of the knee in gerontal patients with osteoarthritis (OA). Methods The 53 gerontal patients were included in this study. The study included treatment group (n=35) and the placebo group (n=18). Hyaluronan was intra-articularly injected into both knees of the subjects in treatment group, whereas physiological saline was intra-articularly injected in the placebo group. Proprioception test was performed, and Western Ontario and McMaster Universities(WOMAC) scales were used to evaluate pain and physical function. Results Statistical analysis was performed on 100 knees of 50 patients who completed the trial. Compared with the placebo group,the average absolute angular error (AAAE) value in the treatment group was detected to be statistically lower one week after the 4th injection (1.8±0.9 vs.2.9±1.1,t=2.42,P=0.02),and WOMAC was lower in the treatment group after one week (8.7±3.1 vs.11.5±4.0, t=0.73,P＜0.05). Conclusions Intra-articular injection of hyaluronan in gerontal patients with knee OA leads to a short-term increase in proprioception, and significant improvement in the functional conditions of patients.

Objective To observe the imaging features of primary hepatic endocrine carcinoma. Methods Three patients with primary hepatic endocrine carcinoma proven pathologically were retrospectively analyzed. Results Single liver lesion was detected in all 3 patients, 2 in right and 1 in left lobe of liver. The maximum diameter of the masses was 4.8 cm, 6.7 cm and 10.0 cm, respectively. The masses were all solid with different extent of low density. The solid part enhanced greatly in contrast enhanced CT scanning, while the non-solid part did not. The bigger lesions pushed the vascular to move aside in 2 patients. Enhanced and circuitous vascular was observed in 1 lesion. Slightly low signal was noticed on MR T1WI , while high signal was found on T2WI and DWI. Conclusion CT and MR can show specific features of primary hepatic endocrine carcinoma, i.e. usually single solid mass with various low densities inside and the solid part enhancing dramatically.