Intravoxel incoherent motion magnetic resonance imaging for diagnosis of cervical cancer and evaluation of response of uterine cervical cancer to radiochemotherapy: A pilot study

Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.

Preliminary clinical application of an adaptive iterative statistical reconstruction algorithm inhead and neck computed tomography angiography with low tube voltage and a low concentration of contrast medium

Objective To evaluate the feasibility of using a low concentration of contrast medium （Visipaque 270 mgl/mL）, low tube voltage, and an advanced image reconstruction algorithm in head and neck computed tomography angiography （CTA）. Methods Forty patients （22 men and 18 women; average age 48.7 ± 14.25 years; average body mass index 23.9 ± 3.7 kg/m^2） undergoing CTA for suspected vascular diseases were randomly assigned into two groups. Group A （n = 20） was administered 370 mgl/mL contrast medium, and group B （n = 20） was administered 270 mgl/mL contrast medium. Both groups were administered at a rate of 4.8 mL/s and an injection volume of 0.8 mL/kg. Images of group A were obtained with 120 kVp and filtered back projection （FBP） reconstruction, whereas images of group B were obtained with 80 kVp and 80% adaptive iterative statistical reconstruction algorithm （ASiR）. The CT values and standard deviations of intracranial arteries and image noise on the corona radiata were measured to calculate the contrast-to-noise ratio （CNR） and signal-to-noise ratio （SNR）. The beam-hardening artifacts （BHAs） around the skull base were calculated. Two readers evaluated the image quality with volume rendered images using scores from 1 to 5. The values between the two groups were statistically compared. Results The mean CT value of the intracranial arteries in group B was significantly higher than that in group A （P 〈 0.001）. The CNR and SNR values in group B were also statistically higher than those in group A （P 〈 0.001）. Image noise and BHAs were not significantly different between the two groups. The image quality score of VR images of in group B was significantly higher than that in group A （P = 0.001）. However, the quality scores of axial enhancement images in group B became significantly smaller than those in group A （P〈 0.001）. The CT dose index volume and dose-length product were decreased by 63.8% and 64%, respectively, in group B （P 〈 0.001 for both）. Conclusion Visipaque combined with 80 kVp and 80% ASiR provided similar image quality in intracranial CTA with 64% radiation dose reduction compared with the use of lopamidol, 120 kVp, and FBP reconstruc-tion.

Cine magnetic resonance imaging for quantitative assessment of healthy volunteers and patients with organic small bowel disease

Objective The aim of the study was to use dynamic magnetic resonance imaging （MRI） to compare quantitative parameters of small bowel motility between healthy volunteers and patients with small bowel diseases in order to investigate the characteristics of normal and impaired bowel peristalsis. Methods A total of 44 healthy volunteers （20 men, 24 women; mean age： 36 years; range： 20-61 years） and 42 patients （28 men, 14 women; mean age： 44 years; range： 15-72 years） with organic small bowel disease were recruited in our hospital （Tongji Hospital, Tongji Medical College, Huazhong University of Sci- ence and Technology, Wuhan, China） in this prospective study approved by the hospital institutional review board. Imaging was performed using a 3.0-T scanner 45 minutes after standardized oral administration of 1500 mL non-absorbable fluid （2.5% mannitol）. A serial coronal scan was performed at selected planes for two minutes without breath-hold. Time-caliber curves were plotted at two well-distended small bowel loops in both healthy and patient groups regardless of location. Luminal diameter （LD）, contraction period （CP）, frequency of contraction （FC）, and amplitude-diameter ratio （ADR） were measured based on the graph. Results The characteristics of abnormal peristaltic parameters were assessed in different patients and compared to normal curves from healthy volunteers. A total of 37 segments with abnormal motility were confirmed by two readers in consensus, based on curve patterns and the presence of a stationary phase. Compared to normal peristalsis in healthy volunteers, five different patterns of impaired peristalsis were identified： Ⅰ, consecutive; Ⅱ, slow; Ⅲ, giant type; Ⅳ, uncoordinated; and V, akinetic. Dilated LDs were de- tected in all instances of abnormal peristalsis （P 〈 0.05）. Increased frequency was found in type Ⅰ [（8.73 ± 1.15）/min], while decreased frequency was detected in type Ⅲ peristalsis [（0.67 ± 0.29）/min]. There were no significant differences in frequency between type Ⅱ [（3.19 ±0.43）/min] and normal peristalsis [（3.45± 0.57）/min]. Apart from typeⅠ [（8.70± 0.75）/min], increased FCs were found in all other abnormal patterns. In type Ⅱ peristalsis, the average ADR value was 0.82 ± 0.08, comparable to the ADR value in the healthy group （0.83 ± 0.13）. Conclusion MR cine is an effective method for differentiating normal and abnormal small bowel peristal- sis. Plotting time-caliber curves and measuring quantitative MR cine parameters such as LD, CP, FC, and ADR offers more precise information about small bowel motility.

Intestinal lymphangiectasia associated with chylothorax and multiple lower extremity arteriovenous malformation: A case report and literature review

Intestinal lymphangiectasia （IL） is an uncommon protein losing enteropathy, characterized by small intes- tinal mucosa or serosa lymphangiectasia and intestine lymph loss. Currently, IL is a very rare disease in children or adults, with typical clinical symptoms including hypoalbuminemia, absolute lymphocyte reduc- tion, ascites, edema, etc. We report a case of an adult with intestinal lymphatic ectasia accompanied by chylothorax and multiply arteriovenous malformations of the hip and lower extremity. CT and MRI revealed diffuse edema and thickening of the small intestine, accompanied by splenomegaly and pleural effusion. Extensive nodularity of lower ileum and the ileocecal region could be seen during intestinal endoscopy. Finally, small intestinal lamina propria lymphangiectasis was confirmed by pathological examination. To raise awareness of the disease, here we compare our case and those previously reported, and discuss the diaqnosis and manaqement of IL.

Acquired renal arteriovenous malformation:the diagnostic value of three-dimensional multidetector-row computed tomography

Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomogra- phy （MDCT） in detecting acquired renal arteriovenous malformation （RAVM） and to compare its perfor- mance with that of ultrasonography and digital subtraction angiography （DSA）. Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional （3D） reconstruc- tion. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation. Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter 〉 10 mm, and one with a maximum lesion diameter between 5 and 10 ram, were correctly diagnosed with MDCT angiog- raphy. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5-10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maxi- mum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively. Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.

New era, new concept, new idea

Nowadays,with the development of science and technology,the specialization of clinical medicine and refinement of treatment demand more accurate diagnoses,which is a new challenge for our radiologists.Improved methods are developed constantly as

The double intervention clinical value and application research of TACE with PAI on massive hepatocellular carcinoma

Objective： To study the efficacy of transcatheter arterial chemoembolization （TACE） combined with percutaneous acetic acid injection （PAI） on massive hepatocellular carcinoma （MHCC）. Methods： TACE was performed in 57 patients with MHCC, which were randomly divided into group A （n = 28） and group B （n = 29）. Patients in the group A received conventional TACE for the first time and then received low dose TACE （10 mg mitomycin C） for the repeated treatment, Re-examined CT scans after TACE for a week. Based on filled status of Lipiodol in the Lesions, PAl was underwent in the area of rarefaction or defect filled by Lipiodol. Patients in the group B received conventional TACE. Then The survival rate and masses variation and hepatic function and a-FP and side effects were observed. Results： The 1-, 2- and 3-year survival rate after TACE were 96.4%, 78.6% and 32.1% for group A, and 65.5%, 48.3% and 20.7% for group B. Masses diminution were found in all patients in group A, while 20 cases were found in group B, unchanged in 5 cases and enlarged in 4 cases. Conclusion： The efficacy of TACE combined with PAl are significantly better than that of TACE only, low dose TACE produces less hepatic damage and less side effect.