Objective:To compare the efficacies of MRI, X-ray mammography (XMG) and Ultrasound (US) in detecting and diagnosing breast ductal carcinoma in situ (DCIS).Methods:Two hundred and forty one consecutive patients with pathology-confirmed DCIS were retrospectively recruited from January 2011 to December 2017 in PLA General Hospital. The imaging examination modalities included MRI and/or XMG and/or US.The breast imaging reporting and data system (BI-RADS) categorizations by MRI, XMG and US were compared and their sensitivities of detecting DCIS were calculated. The causes of underestimation on MRI were interpreted with the information of XMG and US. Chi-square test was used to compare the differences.Results:The diagnostic sensitivity of XMG, US and MRI was 65.9% (29/44), 71.6% (101/141) and 91.2% (145/159), respectively, with statistical significant differences (χ2 =24.034, P<0.001). Breast density and lesion type would influence the sensitivity of XMG. And the sensitivity of US was decreased because of non-mass lesion. Of the 14 cases under-evaluated as BI-RADS category 1 to 3 on MRI, 5 were corrected by XMG and/or US to BI-RADS category 4. The cause of underestimation on MRI was the coexistence of DCIS with adenoma or other benign lesion. Conclusion:The retrospective comparison of MRI, XMG and US in this study showed that MRI had significant higher sensitivity in detecting breast DCIS, while the false negative rates of XMG and US were un-negligible.

Purpose To measure the longitudinal and transverse strain and displacement parameters of each segment of long axis myocardium on cardiac MRI film images of normal young volunteers using feature tracking technique (FT), and to analyze the regularity of left ventricular long axis strain and establish peak and time to peak (TTP) reference range concerning the longitudinal and transverse strain and displacement. Materials and Methods Cardiac film images of 29 healthy volunteers aged 24 to 34 were collected using Philips Multiva 1.5T MRI scanner, including three typical long axis planes of the left ventricular long axis, left ventricular outflow tract, and four-chamber view. The MRI film images were analyzed drawing on myocardial feature tracking software TOMTEC, and the peak value and TTP of longitudinal and transverse strain and displacement of the 16 AHA segments excluding apex cordis were obtained thereby. The regularity of each parameter concerning the plane, layer, and segment was summarized and analyzed. Results The TTP of longitudinal strain, longitudinal displacement and transverse strain were consistent among each myocardial segment, which was a constant indicator in (41.24±12.51) ％ RR interphase. The peak value of longitudinal displacement was represented by apex cordis (2.56±0.89) mm < middle (6.09±2.03) mm < cardiac base (8.07±2.05) mm, and the peak value of transverse displacement was manifested as apex cordis (4.57±1.18) mm < middle (5.65±0.84) mm < cardiac base (8.48 ±1.18) mm, which was consistent with cardiac geometric deformation visually observed. The longitudinal strain showed consistency on 2CH-3CH-4CH plane, whose peak reference value was (-22.46±13.19)％; while the peak value of transverse strain displayed no consistency on different planes. Conclusion The longitudinal strain of the left ventricular on different planes has consistent peak value and TTP, suggesting good reference value.

Objective To learn the endocardial strain patterns of the left ventricles on the short-axis views in normal youth volunteers using feature tracking techniques on cine cardiac MR imaging,and to build up the reference ranges of strain peak and time to peak (TTP) for endocardial strain analysis.Methods Twenty-nine normal youth volunteers aged from 24-34 years old were enrolled in the study in march 2015.The Cine MR imaging were acquired using balance FFE sequence with 24 phases for each cardiac cycle.The standard short-axis imaging planes were basal,mid-cavity and apical levels and divided into 16 segments.The peaks and TTPs of myocardial displacement and its velocity,radial and circumferential strain and strain rate and its velocity in each segment were calculated using feature tracking techniques.The data with normal distribution were analyzed by ANOVA and Student-Newman-Keuls (SNK) method,and Kruskal-Wallis and Wilcoxon rank sum test were used for the data without normal distribution.Results The peaks and TTPs of radial strain and strain rate differed in 16-segmental levels and basal,middle and apical plane levels and had no concordant reference ranges.The circumferential strain and strain rate were homogeneous at basal and middle plane levels [(-27.09 ±9.51)％,(1.94 ±0.98)/s,respectively].Their TTPs were homogenous [0.38 (0.08)RR,0.54 (0.08)RR,respectively],and there were no significant differences in planar-segments or inter-segment level.Except for middle level,the peaks of radial displacement and velocity differed in basal and apical levels and had no concordant reference ranges.But radial velocity TTPs were homogeneous in all 16 segments [0.21 (0.04)RR].Except for the radial strain rate,TTPs showed no significant difference between basal level and middle level.The measurements at apical level revealed high variance.No regular pattern could be found on individual peak and TTP curves of velocity and strain rate.Conclusion The peaks and TTPs of radial strain are different in segmental and planar levels without a concordant reference range.The peaks and TFPs of circumferential strain and the radial velocity rTTPs are homogeneous in middle and apical plane level and have homogeneous reference range.

The radiologist-technologist integration (RTI)training program involves radiologists′ participation in technologists′ scan and examination training and technologists′ participation in physicians′preparation of reports during their residency training.Based on the investigations in the PLA General Hospital, West China Hospital of Sichuan University, The SecondXiangyaHospitalofCentralSouthUniversity, International Hospital of Peking University, and The First Hospital of Qinhuangdao, the author evaluated the methods of and practice in RTItraining as well as the potential value of RTI and itsfacilitation of work quality.RTItraining has effectively enhanced the basic skills training of the residents, deepened their understanding of the imaging process, and promoted scientific research and clinical work.The RTI training program can cultivate the technologists′ abilities to identify lesions, design individual protocols, and achieve the targeted scan for diagnosis.Meanwhile, itmay contribute to the improvement of human resource management inthe radiology department and overall quality of radiological examinations.

Purpose A systematic analysis of the articles published in the Chinese Journal of Medical Imaging from year 2013 to 2015 was performed to investigate its features of acceptance and publication for future decision making.Methods The printed journal and retrieved data from the Chinese Hospital Knowledge Database was analyzed using biometrical index,including the number of the papers,subspecialties,publication types,medical imaging modalities,MeSH frequency,citation and download.Results From year 2013 to 2015,there were 770 papers published,21.4 articles per issue and 0.267 articles per page in average.The top three subspecialty were abdominal imaging,chest imaging and reviews/comments,accounting for 17.27％,9.61％,9.48％,respectively.The top three modalities were CT,ultrasound and MRI,accounting for 39.61％,38.31％,29.87％,respectively.The original research papers were 584,accounting for 75.84％.The frequent MeSH subjects were differential diagnosis,angiography,pathology,computer-assisted image processing and contrast agents.Totally,there were 2395 citations and averagely 3.11 citation for each paper.The top citation was 36.There were 71317 downloads and 92.62 for each paper in average,the top download was 499.Conclusions The publications and its density per page increased annually from 2013 to 2015.The subspecialty were fully covered,the papers focus on original researches and clinical applications.The publication theme could follow the tendency of the imaging technology and had good and steady effects in the field.

Objective To compare the difference of echocardiography and magnetic resonance imaging (MRI) in measurement of cardiac function in patients with dilated cardiomyopathy (DCM).Methods Totally 41 patients with DCM underwent echocardiography and MRI to measure cardiac function,the parameters included left ventricular end-diastolic volume (LVEDV),end systolic volume (LVESV),left ventricular ejection fraction (LVEF) and stroke volume (SV).The vertical long axis (VLA),horizontal long axis (HLA) and short axis (SA) of heart were measured by echocardiography.The differences of echocardiography and MRI were compared by linear regression and linear correlation.Results ①The value of LVEDV and LVESV obtained by the two methods:the value of LVEDV [(262.6 ± 117.0) ml] and LVESV [(196.4 ± 109.8) ml] obtained by MRI were higher than those of echocardiography [(211.4 ± 90.6),(216.5 ± 71.5),(219.1 ± 80.1) ml;(153.3 ± 76.1),(153.9 ± 54.1),(157.0 ± 61.1) ml,all P ＜ 0.05].②The value of SV and LVEF obtained by the two methods:the value of SV[(66.2 ± 21.3) ml] obtained by MRI was higher than that of echocardiography VLA [(58.1 ± 14.4) ml,P ＜ 0.05].The value of LVEF [(25.2 ±7.2)％] obtained by MRI was lower than those of echocardiography HLA and echocardiography SA [(28.9 ± 6.1)％,(28.3 ± 6.1)％,all P ＜ 0.05].③The value of LVEDV and LVESV obtained by echocardiography SA were associated with those obtained by MRI (r =0.785,0.653,all P ＜ 0.05).The value of LVEF obtained by echocardiography VLA was associated with it obtained by MRI (r =0.690,P ＜ 0.05).The value of SV obtained by echocardiography HLA and echocardiography SA were associated with those obtained by MRI (r =0.734,0.701,all P ＜ 0.05).Conclusion There are differences in accuracy and reliability using echocardiography and MRI when measuring dilated cardiomyopathy heart function,which must be treated differently.

PurposeTo explore the correlation between apparent diffusion coefficient (ADC) value on MR diffusion-weighted imaging (DWI) and prognostic factors in breast invasive ductal carcinomas.Materials and Methods 103 patients with pathology-proven invasive breast ductal carcinomas underwent DWI MR scan using b=1000 s/mm2. The minimum ADC values of the lesions were determined. Histopathological specimens were analyzed for tumor size, lymph node metastasis, pathological grade (traditional prognostic factors) and the expression of prognostic factors including Ki-67, ToPo-IIα, P53 and CyclinD1. The correlations between ADC values and these prognostic factors were evaluated.Results In 103 breast invasive ductal carcinomas, there was no significant relationship between tumor size, lymph node metastasis, pathological grade and mean ADC values (P>0.05). The correlations between mean ADC values and the biological prognostic factors were not significant (P>0.05). However, positive correlations were observed between pathological grade and the expression of Ki-67 as well as ToPo-IIα(P<0.05).Conclusion ADC values cannot serve as a prognostic factor for invasive ductal breast carcinomas. However, the expression of Ki-67 and ToPo-IIα in breast invasive ductal carcinomas may be important in evaluating prognosis of the tumor and guiding clinical therapy.

PurposeTo investigate a multi-parametric protocol for breast MRI examination and lesions assessment correlated to the American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) categorization, and to improve the management of the breast lesions.Materials and Methods 301 pathologically confirmed lesions on 278 patients were retrospectively included. The scan protocol used a dynamic contrast enhancement sequence (DCE) of 1 mm×1 mm×1 mm spatial resolution, 120 temporal resolution and a diffusion weighted imaging (DWI) of b=1000 s/mm2. The malignant morphological features on the early-enhanced images, type II or III time intensity curve and the apparent diffusion coefficient (ADC) value less than benign/malignant threshold was equally weighted. Each was given 1 point when present malignant features and treated different on mass and non-mass-like enhancement lesions. When the sum of score was ≥2 points, the lesion was categorized as BI-RADS 5. When the sum of score was 1 point, the lesion was categorized as BI-RADS 4. When the sum of score was <1 point, the lesion was categorized as BI-RADS 3. The other specific benign findings were categorized as BI-RADS 2. No abnormality on DWI, DCE, T2WI and T1WI was categorized as BI-RADS 1. The final categories were correlated to the pathological grades as benign (B), high risk (HR) and malignant (M).Results When grouped HR as malignant (M+HR), the area under curve (AUC) of the ROC was 0.860. When grouped HR as benign (B+HR), the AUC of the ROC was 0.876, and the optimized sensitivity, specificity and accuracy was 85.3%, 86.8% and 85.1%, respectively, which were better than the other grouping. If the management of HR lesions could be lumptoectomy or short-term follow-up, the positive predictive value (PPV) of BI-RADS 5 for excisable lesions (M+HR) was 93.2%, the PPV of BI-RADS 4 for excisable lesions (M+HR) was 46.9% and the biopsy was essential. The PPV of BI-RADS 3 and below for follow-up lesions (B+HR) was 90.4%.Conclusion A simple diagnosis algorithm was established, which equally weighted the DCE morphological feature, DCE-TIC and DWI-ADC. The diagnosis protocol was well consistent with BI-RADS categorization and could predict the benign, high risk and malignant lesions in pathology as well as the proper management.

OBJECTIVETo summarize the features of clinical manifestations, laboratory tests and imaging findings of patients with cardiac amyloidosis (CA).

METHODSA total of 60 CA patients (including 41 male and 19 female patients) from 4 centers admitted between May, 2012 and November, 2013 were included in the study. The demographic data, medical history, clinical manifestations, laboratory test data, ECG, cardiac ultrasound, and cardiac magnetic resonance (CMR) imaging of the patients were analyzed.

RESULTSTwo-thirds of the 60 CA patients, were middle-aged or elderly men, and 47% of the patients had AL-CA. The clinical manifestations included exertional dyspnea (73%), pedal edema (47%), hypotension (47%), and hypertrophy of the tongue (22%); abnormal laboratory test results included albuminuria (53%) and liver (15%) and kidney (28%) dysfunction; blood routine, urine and serum immunoglobulin quantification and immunofixation electrophoresis could help the screening of AL-CA. Kidney (53%) and liver (15%) involvement was common, and 86% of AL-CA patients had kidney involvement. Typical ECG characteristics included poor R wave progression (35%), low voltage in limb leads (33%), and a pseudo infarct Q wave (30%); the latter two were more frequent in AL-CA. The characteristics of ultrasound findings included left ventricle thickening (100%), left atrial enlargement (87%) and enhanced echo of the myocardial granules(92%), and diastolic dysfunction was obvious in all the CA patients regardless of the systolic function. The DT and E/e' of the mitral annulus could be used as an index to evaluate diastolic dysfunction in early stage of the disease. Left ventricular (LV) global subendocardial late gadolinium enhancement (LGE, 81%) accompanied by right ventricular (RV) and atrial LGE was the typical characteristic of CMR, and the range of LGE in the RV and the two atria was wider in AL-CA than in non-AL-CA. NT-proBNP (97%) and cardiac troponin (53%) in CA patients were both elevated, which helped in diagnosing and assessing the severity of cardiac involvement, according to which 50% of the patients were found to be at a high risk, 43% at an intermediate risk, and 7% at a low risk.

CONCLUSIONThe combination of the features of clinical, laboratory tests and imaging findings of CA have important diagnostic and prognostic value for CA.

Adult ; Aged ; Amyloidosis ; diagnosis ; pathology ; physiopathology ; Cardiomyopathies ; diagnosis ; pathology ; physiopathology ; Electrocardiography ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Magnetic Resonance Imaging ; Male ; Middle Aged

OBJECTIVETo analyze the endocardial, myocardial, and epicardial longitudinal systolic strain (LSsys) in the left ventricle (LV) segments and walls in patients with cardiac involvement due to primary amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM).

METHODSTwenty patients with biopsy-proven AL-CA, 20 with asymmetric HCM, and 20 age-matched healthy volunteers were analyzed for their clinical characteristics and underwent conventional echocardiography for evaluating LV wall thickness, left atrial and ventricle size, systolic and diastolic function and 2-dimensional velocity vector imaging for evaluating the endocardial, myocardial and epicardial LSsys of the LV segments and walls. AL-CA and HCM patients also underwent cardiac magnetic resonance to evaluate the late gadolinium enhancement (LGE) features.

RESULTSCompared with the control group, AL-CA and HCM groups, with similar clinical symptoms and physical signs, both showed increased LV wall thickness, left atrial diameter, E/A ratio, septal E/e' ratio and the prevalence of granular sparkling. LV segments and walls endocardial LSsys were significantly lower in AL-CA patients than in HCM patients and the control subjects. The endocardial-epicardial LSsys difference in all the left ventricle walls were significantly smaller in AL-CA group than in the control group, but this difference appeared variable in HCM group. The LGE also presented with different features in AL-CA and HCM: AL-CA group showed subendocardial LGE in almost all the LV walls, but HCM group showed patchy LGE with a regional, multifocal distribution.

CONCLUSIONAL-CA is characterized by a significantly reduced endocardial LSsys in the LV segments and an uniform decrease of the endocardial-epicardial LSsys difference in all the LV walls, but the changes in HCM appear variable, and 2-dimensional velocity vector imaging is therefore a useful modality to differentiate AL-CA from HCM.

Amyloidosis ; diagnosis ; Cardiomyopathy, Hypertrophic ; diagnosis ; Diagnosis, Differential ; Diastole ; Echocardiography ; Heart Ventricles ; physiopathology ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Systole