AIM:To investigate the diagnostic capability of breathhold diffusion-weighted imaging(DWI) for differentiation between malignant and benign hepatic lesions.METHODS:A total of 614 malignant liver lesions(132 hepatocell...AIM:To investigate the diagnostic capability of breathhold diffusion-weighted imaging(DWI) for differentiation between malignant and benign hepatic lesions.METHODS:A total of 614 malignant liver lesions(132 hepatocellular carcinomas,468 metastases and 14 intrahepatic cholangiocarcinomas) and 291 benign liver lesions(102 hemangiomas,158 cysts,24 focal nodular hyperplasia,1 angiomyolipoma and 6 hepatic adenomas) were included from seven studies(eight sets of data).RESULTS:The pooled sensitivity and specificity of breath-hold DWI were 0.93 [95% confidence interval(CI):0.91-0.95] and 0.87(95%CI:0.83-0.91),respectively.The positive likelihood ratio and negative likelihood ratio were 7.28(95%CI:4.51-11.76) and 0.09(95%CI:0.05-0.17),respectively.The P value for χ2 heterogeneity for all pooled estimates was < 0.05.From the fitted summary receiver operating characteristic curve,the area under the curve and Q * index were 0.96 and 0.91,respectively.Publication bias was not present(t = 0.49,P = 0.64).The meta-regression analysis indicated that evaluated covariates including magnetic resonance imaging modality,echo time,mean age,maximum b factor,and number of b factors were not sources of heterogeneity(all P > 0.05).CONCLUSION:Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions.The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.展开更多
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many...Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).展开更多
Objective: To compare image quality and apparent diffusion coefficients (ADC) of the normal pancreas parenchymas in breath-hold, respiratory-triggered and free-breathing diffusion weighted imaging (DWI) at 3.0-Tesla. ...Objective: To compare image quality and apparent diffusion coefficients (ADC) of the normal pancreas parenchymas in breath-hold, respiratory-triggered and free-breathing diffusion weighted imaging (DWI) at 3.0-Tesla. Methods: DWI of the pancreas was performed at 3.0-Tesla in 21 healthy volunteers with breath-hold, respiratory-triggered and free-breathing using b-values of 0 and 500 s/mm2. For all three sequences, two readers assigned an image quality score to images at b0 and b500, and two independent readers measured ADCs for the head, body and tail of pancreas. Image quality scores and ADCs of pancreas in the three DWIs were compared. Results: For b0, image quality scores was not significantly different among the three sequences (p = 0.103). For b500, image quality score was significantly lower in free-breathing DWI than breath-hold or respiratory-triggered DWI (p = 0.000), and not significantly different between breath-hold and respiratory-triggered DWI (p = 0.212). Mean ADCs differed significantly among the anatomical regions with the lowest values measured in the pancreatic tail both at breath-hold and respiratory-triggered DWIs whereas no significant difference was found at free-breathing DWI. Conclusion: Breath-hold or respiratory-triggered technique provided DW images of pancreas with acceptable quality at 3.0-Tesla. Breath-hold is the preferred DWI technique for ADC measurements of pancreas.展开更多
A technique for multiple deep-inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) for a lung tumor has been proposed with 10 MV flattening-filter-free beams and an image sensor measuring a distance ...A technique for multiple deep-inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) for a lung tumor has been proposed with 10 MV flattening-filter-free beams and an image sensor measuring a distance map to thorax surface. Planning CT images were acquired under a DIBH condition and a clinical target volume (CTV) was contoured. This procedure was repeated five times and an internal target volume (ITV) among the multiple DIBHs was created by integrating the five CTVs. A planning target volume (PTV) was defined by adding an isotropic margin of 5 mm to the ITV. Immediately before treatment, a 30-second half-arc cone-beam computer tomography (CBCT) imaging was performed under another DIBH condition, and the couch was repositioned so that tumor may be located inside the PTV contours. An infrared distance measurement device having laser diodes and an image sensor was attached to the couch, and a distance map to the patient thorax surface was recorded as a reference during still another DIBH condition. A half-arc segmented VMAT beams with two beam interrupts were delivered to the patient under multiple DIBHs, where the delivery time of each of the three segmented beams was 30 seconds. During the beam delivery, the distance map was monitored in real time to confirm that the distance to the thorax surface remained unchanged. In-treatment CBCT images suggested that the tumor position at the time of tumor registration was accurately reproduced during the DIBH VMAT delivery.展开更多
Purpose/Objectives: We aimed to report clinical effects on critical organ dose and cardiac toxicity from implementation of the deep inspiration breath-hold (DIBH) technique in post-operative extern-beam radiotherapy o...Purpose/Objectives: We aimed to report clinical effects on critical organ dose and cardiac toxicity from implementation of the deep inspiration breath-hold (DIBH) technique in post-operative extern-beam radiotherapy of patients with left-sided breast cancer, using longitudinal clinical data. Materials/Methods: We retrieved three groups of patients who received post-operative radiotherapy of left-sided breast cancer in our institution in recent years: Groups A and B consist of patients whose treatment did not include internal mammary nodes (IMN) and who were treated with the free breathing technique and with the DIBH technique, respectively, and Group C consists of patients whose radiotherapy included internal mammary nodes with the DIBH technique. Dose parameters for the heart and left lung were retrieved from the treatment plans. Radiation-induced cardiac risks were estimated using existing risk models. Results: The average heart dose was 2.65 ± 0.98 Gy, 1.10 ± 0.29 Gy, and 1.26 ± 0.25 Gy in Groups A, B, and C, respectively. The average heart volumes receiving at least 25 Gy were 7.10 ± 9.79 cc in Group A, 0.07 ± 0.22 cc in Group B, and 0.03 ± 0.08 cc in Group C. On average, the excessive risk of having ischemic heart disease was estimated to be 19.6%, 8.1%, and 9.3% in Groups A, B, and C, respectively. The mean left lung doses were 5.73 ± 1.86 Gy, 5.93 ± 1.55 Gy, and 9.13 ± 1.57 Gy in Groups A, B, and C, respectively. Conclusion: Implementation of the DIBH technique significantly lowered heart dose and decreased the ischemic heart disease risk in patients receiving post-operative radiotherapy for left-sided breast cancer, without significant increase in left lung dose.展开更多
The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatme...The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.展开更多
基金Supported by Grants from the Science Foundation of Guangdong Province for Doctorate Startup Project,No.S2012040006618the Postdoctoral Fund of Guangzhou University of Traditional Chinese Medicine,No.20120621
文摘AIM:To investigate the diagnostic capability of breathhold diffusion-weighted imaging(DWI) for differentiation between malignant and benign hepatic lesions.METHODS:A total of 614 malignant liver lesions(132 hepatocellular carcinomas,468 metastases and 14 intrahepatic cholangiocarcinomas) and 291 benign liver lesions(102 hemangiomas,158 cysts,24 focal nodular hyperplasia,1 angiomyolipoma and 6 hepatic adenomas) were included from seven studies(eight sets of data).RESULTS:The pooled sensitivity and specificity of breath-hold DWI were 0.93 [95% confidence interval(CI):0.91-0.95] and 0.87(95%CI:0.83-0.91),respectively.The positive likelihood ratio and negative likelihood ratio were 7.28(95%CI:4.51-11.76) and 0.09(95%CI:0.05-0.17),respectively.The P value for χ2 heterogeneity for all pooled estimates was < 0.05.From the fitted summary receiver operating characteristic curve,the area under the curve and Q * index were 0.96 and 0.91,respectively.Publication bias was not present(t = 0.49,P = 0.64).The meta-regression analysis indicated that evaluated covariates including magnetic resonance imaging modality,echo time,mean age,maximum b factor,and number of b factors were not sources of heterogeneity(all P > 0.05).CONCLUSION:Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions.The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.
文摘Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
文摘Objective: To compare image quality and apparent diffusion coefficients (ADC) of the normal pancreas parenchymas in breath-hold, respiratory-triggered and free-breathing diffusion weighted imaging (DWI) at 3.0-Tesla. Methods: DWI of the pancreas was performed at 3.0-Tesla in 21 healthy volunteers with breath-hold, respiratory-triggered and free-breathing using b-values of 0 and 500 s/mm2. For all three sequences, two readers assigned an image quality score to images at b0 and b500, and two independent readers measured ADCs for the head, body and tail of pancreas. Image quality scores and ADCs of pancreas in the three DWIs were compared. Results: For b0, image quality scores was not significantly different among the three sequences (p = 0.103). For b500, image quality score was significantly lower in free-breathing DWI than breath-hold or respiratory-triggered DWI (p = 0.000), and not significantly different between breath-hold and respiratory-triggered DWI (p = 0.212). Mean ADCs differed significantly among the anatomical regions with the lowest values measured in the pancreatic tail both at breath-hold and respiratory-triggered DWIs whereas no significant difference was found at free-breathing DWI. Conclusion: Breath-hold or respiratory-triggered technique provided DW images of pancreas with acceptable quality at 3.0-Tesla. Breath-hold is the preferred DWI technique for ADC measurements of pancreas.
文摘A technique for multiple deep-inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) for a lung tumor has been proposed with 10 MV flattening-filter-free beams and an image sensor measuring a distance map to thorax surface. Planning CT images were acquired under a DIBH condition and a clinical target volume (CTV) was contoured. This procedure was repeated five times and an internal target volume (ITV) among the multiple DIBHs was created by integrating the five CTVs. A planning target volume (PTV) was defined by adding an isotropic margin of 5 mm to the ITV. Immediately before treatment, a 30-second half-arc cone-beam computer tomography (CBCT) imaging was performed under another DIBH condition, and the couch was repositioned so that tumor may be located inside the PTV contours. An infrared distance measurement device having laser diodes and an image sensor was attached to the couch, and a distance map to the patient thorax surface was recorded as a reference during still another DIBH condition. A half-arc segmented VMAT beams with two beam interrupts were delivered to the patient under multiple DIBHs, where the delivery time of each of the three segmented beams was 30 seconds. During the beam delivery, the distance map was monitored in real time to confirm that the distance to the thorax surface remained unchanged. In-treatment CBCT images suggested that the tumor position at the time of tumor registration was accurately reproduced during the DIBH VMAT delivery.
文摘Purpose/Objectives: We aimed to report clinical effects on critical organ dose and cardiac toxicity from implementation of the deep inspiration breath-hold (DIBH) technique in post-operative extern-beam radiotherapy of patients with left-sided breast cancer, using longitudinal clinical data. Materials/Methods: We retrieved three groups of patients who received post-operative radiotherapy of left-sided breast cancer in our institution in recent years: Groups A and B consist of patients whose treatment did not include internal mammary nodes (IMN) and who were treated with the free breathing technique and with the DIBH technique, respectively, and Group C consists of patients whose radiotherapy included internal mammary nodes with the DIBH technique. Dose parameters for the heart and left lung were retrieved from the treatment plans. Radiation-induced cardiac risks were estimated using existing risk models. Results: The average heart dose was 2.65 ± 0.98 Gy, 1.10 ± 0.29 Gy, and 1.26 ± 0.25 Gy in Groups A, B, and C, respectively. The average heart volumes receiving at least 25 Gy were 7.10 ± 9.79 cc in Group A, 0.07 ± 0.22 cc in Group B, and 0.03 ± 0.08 cc in Group C. On average, the excessive risk of having ischemic heart disease was estimated to be 19.6%, 8.1%, and 9.3% in Groups A, B, and C, respectively. The mean left lung doses were 5.73 ± 1.86 Gy, 5.93 ± 1.55 Gy, and 9.13 ± 1.57 Gy in Groups A, B, and C, respectively. Conclusion: Implementation of the DIBH technique significantly lowered heart dose and decreased the ischemic heart disease risk in patients receiving post-operative radiotherapy for left-sided breast cancer, without significant increase in left lung dose.
文摘The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.
