We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Purpose To perform MRI examination after the death of SD rat model due to cerebral infarction and to investigate the changing characteristics of cerebral infarction during postmortem examination. Materials and Methods Middle cerebral artery occlusion (MCAO) model was established on 21 SD rats by applying modified suture method. 13 to 56 h after modeling, 12 dead SD rats were collected for the experiment. The bodies were stored at an environment with a temperature of 10-15°C and relative humidity of 45%-55%. Head MRI was performed 12 h after modeling and at 8, 24, 48, 72 and 96 h after death respectively, and apparent diffusion coefficient (ADC) values of infarction and contralateral brain tissue were calculated. At each post-mortem time point, ADC values of bilateral cerebral hemispheres, ADC values of infarction and living infarction, and ADC values of non-infarcted brain and living non-infarcted zone were compared. Brain tissue was taken after scan for pathological diagnosis and compared with diagnostic results of postmortem MRI (pmMRI). Results The right cerebral signal of rats was abnormal 12 h after cerebral infarction and after death. Eight rats were found to have shifted cerebral middle-line structure to the left. ADC values of infarction at each time point after death were lower than that of non-infarction, the difference of which was statistically significant (P<0.05); ADC values of infarction were lower than that of living infarction, the difference of which was statistically significant (P<0.05); ADC value of non-infarcted area at each time point was lower than that of living non-infarcted area, the difference of which was statistically significant (P<0.05). Necrosis and disintegration of neurons, disintegration and liquefaction of glial fibers, infiltration of inflammatory cells and leakage of red blood cells were spotted in necrotic areas after receiving cerebral HE staining in rat. HE staining was consistent with the infarction zone indicated by pmMRI. Conclusion pmMRI can be used for the diagnosis of cerebral infarction via virtual necropsy.

Purpose To evaluate the feasibility of magnetic resonance T2 values in diagnosing hepatic fibrosis (HF).Materials and M1etdheds The models of HF were induced in rats by repetitive dosing of carbon tetrachloride.The stage of hepatic fibrosis (S),grade of inflammation (G) and degree of fatty liver (F) for the HF model animals and their normal controls were evaluated by pathology.The relationship between T2 values and liver fibrosis was analyzed by using multiple echo gradient spin echo sequences.Results According to the stage of hepatic fibrosis,the HF model rats were staged into S1-S4.The grade of inflammation of the HF model rats was G0 or G1,and the degree of fatty liver was F3 or F4,both of which had no statistical differences among the HF model rats at different fibrosis stages (P＞0.05).The T2 values for all rats including normal control rats in the stage of liver fibrosis from S0 to S4 were (38.27±1.45) ms,(42.08±2.63) ms,(45.93±3.61) ms,(50.23 ± 2.23) ms and (57.79± 5.40) ms,respectively,with a significant difference (F=31.903,P＜0.01).Except the T2 values had no significant difference between the S0 and S 1 stages (P＞0.05),the pairwise comparisons of the T2 values between the rest stages were statistically significant (P＜0.01).The T2 values were positively correlated with the stages of hepatic fibrosis (rs=0.921,P＜0.01).Conclusion The T2 value can quantitatively reflect the degree of hepatic fibrosis.

Purpose To investigate the features of 64-slice spiral computerized tomography (CT) on collateral circulation of pancreatic portal hypertension (PPH).Material and Methods the abdominal CT images of 52 patients with PPH confirmed by pathology the Affiliated Hospital of Southwest Medical University from August 2013 to May 2015 were analyzed retrospectively.The collateral circulations of portal vein were recorded.Results There were 21 (40.4％) patients with isolated splenic vein occlusion (ISVO),and 32 (59.6％) patients with non isolated splenic vein occlusion (NISVO) in the total 52 patients.There was no significant difference in the occurrence rate between ISVO and NISVO (x2=1.92,P＞0.05).The main collateral pathways of PPH were pathway Type Ⅰ (28 patients)and pathway Type Ⅲ (22 patients),and 2 patients belonged to pathway Type Ⅱ.The patients in pathway Type Ⅰ or Ⅲ were significantly more than patients in pathway Type Ⅱ(P＜0.01).There were 92.3％ (48/52) of patients with gastroepiploic varicosity,which is significantly higher than other varicose veins (P＜0.001).The significant difference was found between the patients (21.2％) with gastric fundus varicosity and the patients (1.9％)with inferior segment esophageal varices (x2=9.42,P＜0.01).The patients with gastric fundus varicosity and right superior colic varicosity in NISVO were more than those in ISVO (x2=4.15,7.44,P＜0.05).Conclusion For PPH patients,the valuable features of collateral circulation can be revealed by multi-slices CT.

Objective To evaluate early dynamic contrast enhancement CT on multiple organ failure in acute pancreatitis.Methods 333 cases of acute pancreatitis identified by clinical and early dynamic contrast enhancement CT were collected.Patients were divided into organ failure group(OF group,124 cases) and non-organ failure group (notn-OF group,209 cases).All variables including duration of hospitalization,need for intensive care unit,infection,need for operation,mortality and MCTSI,EPIC score were analyzed by U test and x2 test firstly.The variables with significance (P＜0.05) were analyzed by Stepwise Logistic regression further.Results On U test and x2 test,there were significant differences(P＜0.001) between two groups in duration of hospitalization,need for intensive care unit,infection,need for operation,mortality,MCTSI score and EPIC score and APFC + ANC＞ 100 mL,and bilateral pleural effusion/ pulmonary atelectasis.The Stepwise Logistic regression analysis demonstrated that increased MCTSI and EPIC score,APFC+ANC＞ 100 mL and bilateral pleural effusion/pulmonary atelectasis were 4 independent risk factors of multiple organ failure in acute pancreatitis.Conclusion Multiple organ failure in acute pancreatitis can be judged with early dynamic contrast enhancement CT for improved treatment.

Objective To evaluate the value of 18 F?NaF PET/CT and MRI in the diagnosis of skull?base bone invasion ( SBBI) in patients with nasopharyngeal carcinoma( NPC) . Methods Sixty?three NPC patients (45 males, 18 females;age range 23-72 years) were enrolled in this prospective study. Pa?tients underwent 18 F?NaF PET/CT and MRI to confirm whether the skull base was invaded. The reference standard was based on the follow?up imaging in 6 months. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two imaging modalities were calculated. χ2 test was used to analyze their difference. The SBBI foci and their distribution detected by the two imaging modalities were compared. Results Thirty?four NPC patients demonstrated SBBI in follow?up imaging. The diagnostic sen?sitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18 F?NaF PET/CT were 97.1%(33/34), 89.7%(26/29), 91.7%(33/36), 96.3%(26/27) and 93.7%(59/63), respective?ly. For MRI, the parameters were 91.2%(31/34), 86.2%(25/29), 88.6%(31/35), 89.3%(25/28) and 88.9%(56/63), respectively. The diagnostic efficiency of the two imaging modalities had no significant difference (χ2=0.162-1.062, all P>0.05) . 18 F?NaF PET/CT detected 133 lesions and MRI detected 97 le? sions, and the clivus was the most common site of SBBI. Conclusions 18 F?NaF PET/CT and MRI have similar diagnostic efficiency in detecting SBBI. 18 F?NaF PET/CT can detect more lesions than MRI do, and has potential advantage for detecting tiny bone lesions in skull base.

Purpose To investigate the chest CT features of lung injury caused by oral paraquat,and deepen the understanding of paraquat poisoning.Materials and Methods The chest CT features of 74 patients with lung injury caused by oral paraquat were analyzed retrospectively and comparatively.74 patients were divided into 3 groups according to toxic dose:28 cases in the low dose group (paraquat dose less than 10 ml),34 cases in the medium dose group (paraquat dose among 11 to 50 ml),and 12 cases in the large dose group (paraquat dose more than 50 ml).74 patients were also divided into 3 groups according to course of disease:The course of disease among 1 to 7 days were in the early period,8 to 14 days in the medium period,and 14 days later in the later period.The image features were summarized by comparing the chest CT features,with toxic dose,course of disease,and the scope of lung injury.Results Poisoned patient's chest CT features,related with toxic dose (P＜0.05),appeared from increased bronchovascular shadows,ground glass opacity,to effusion and consolidation,and to pulmonary fibrosis along with time.The effusion and consolidation majorly located in the lateral lungs,which showed a characteristic disease extent.Conclusion The chest CT features of lung injury,caused by oral paraquat,have a certain characteristic.It relates to toxic dose and course of disease,which has a certain guiding significance to clinical diagnosis and treatment.

Objective To explore the application value of ECG tube current modulation technology of dual source CT in coronary angiography,compared with retrospectively ECG-gated technique.Methods 200 patients were randomly divided into ECG tube current modulation group (Group A)and retrospectively ECG-gated group(Group B).In Group A,the main parameters were the exposure time windows of full dose,which were set according to different heart rates.χ2 test was adopted in the subjective score,and t test was used in the objective score and radiation dose.Results There was no statistical significance in image quality between the two groups(χ2 =2.125,tnoise =-0.557,P >0.05 );The effective dose (ED)of Group A and Group B were (3.30±0.40)mSv and(6.90±1.76)mSv,respectively.The difference was statistically significant (t ED =-1 9.954,P <0.05).The radiation dosage of Group A was 52% lower than that of Group B.Conclu-sion Compared with retrospectively ECG-gated technique,the ECG tube current modulation technique ensures the image quality, and at the same time it can significantly reduce the radiation dose,therefore,it can be used as a routine examination technique of cor-onary angiography.

Objective To investigate thickness of the hilar periportal space and caudate-right lobe ratio in the patients with chro-nic hepatitis B and liver cirrhosis after hepatitis B .Methods Eighty-four patients who were clinically and histologically diagnosed with chronic hepatitis B or cirrhosis and 18 healthy subjects without history of liver disease underwent abdominal MRI .The rela-tionship among liver fibrosis degree ,hilar periportal space and caudate-right lobe ratio were observed .Results There was signifi-cant correlation between the hilar periportal space and hepatic fibrosis for chronic hepatitis and cirrhosis (rs = 0 .546 ,P< 0 .01) . There was significant difference between S2 and S3 for thicknesses of the hilar periportal space(P<0 .01) ,and no significant differ-ence among S3 ,S4 and cirrhosis(P=0 .188) .A cutoff value of 9 mm for the hilar periportal space had a sensitivity of 85 .37% and a specificity of 76 .79% for a diagnosis of hepatic fibrosis with S3 or higher .There was no significant correlation between the caudate-right lobe ratio and hepatic fibrosis(rs = -0 .155 ,P=0 .119) .Conclusion Thicknesses of the hilar periportal space increase gradu-ally with hepatic fibrosis in patients with chronic hepatitis B and cirrhosis ,with a high sensitivity and specificity for a diagnosis of hepatic fibrosis with S3 or higher .

Objective To explore the localization diagnosis method of lumbar intervertebral foramen stenosis by multi-di-mensional MRI scans of lumbar nerve roots. Methods Twenty-one patients with lumbar intervertebral foramen stenosis were fol-lowed up from June 2006 to June 2011 postoperatively, 10 cases of male, 11 cases of female;36 to 65 years old, average 45.6 years. The medical history is six to thirty six months, an average of 9.4 years;5 cases have low back pain with unilateral leg pain and 16 cases showed unilateral leg pain only. The height of intervertebral space and foramen intervertebrale were measured on the X-rays of lumbar lateral position. Lumbar nerve roots MR imaging at the position of axial, coronal and sagittal scan were performed separately to the patients who were clinically suspected to suffer from lumbar intervertebral foramen stenosis. A definitive diagno-sis of the location of nerve root compression and structural changes surrounding the nerve root can be obtained. Surgical operation was performed to confirm the accuracy of the MRI imaging diagnosis. Results There were 9 cases of lumbar intervertebral fora-men stenosis caused by lumbar disc herniation. The other 12 cases are caused by zygapophyseal joint hyperplasia. All cases of lumbar intervertebral foramen stenosis located at the low back. By comparing MR images of lumbar intervertebral foramen stenosis with surgical procedure,the surgical observation of 21 patients completely coincided with the preoperative localization diagnosis, coincidence rate was 100%(21/21). After surgical treatment, 20 cases achieved a complete remission of leg pain and 1 case was not satisfactory. Conclusion MRI imaging at the position of axial, coronal and sagittal scan for lumbar nerve roots were useful to rigorous localization diagnosis of lumbar intervertebral foramen stenosis, and can provide accurate radiological evidence for sur-gery program.