BACKGROUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(i.e.cholangiocarcinoma or metastasis)is highly challenging and definitive diagnosis still relies on histologic...BACKGROUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(i.e.cholangiocarcinoma or metastasis)is highly challenging and definitive diagnosis still relies on histological exam.The patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical features.Dynamic contrast-enhanced ultrasound(DCEUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor perfusion.AIM To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver nodules.METHODS A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological diagnosis.In accordance with the study protocol,a qualitative and quantitative analysis of the evidence was planned.RESULTS Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic cholangiocarcinoma.CONCLUSION DCEUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early treatment.This quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.展开更多
目的探讨动态对比增强MRI(dynamic contrast-enhancement MRI,DCE-MRI)瘤周血管特征结合瘤内血流动力学参数在乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)4类肿瘤中的鉴别诊断价值。材料与方法回顾性分...目的探讨动态对比增强MRI(dynamic contrast-enhancement MRI,DCE-MRI)瘤周血管特征结合瘤内血流动力学参数在乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)4类肿瘤中的鉴别诊断价值。材料与方法回顾性分析2018年8月至2023年3月于大连医科大学附属第一医院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的女性病例102例,其中良性组43例,恶性组59例。记录患者年龄、病灶最大径(dmax)、乳腺DCE-MRI基本影像学特征、瘤周血管特征及瘤内血流动力学参数值。通过单因素和多因素logistic回归分析比较两组间多参数的差异,利用受试者工作特征(receiver operating characteristic,ROC)曲线以及曲线下面积(area under the curve,AUC)分析瘤周血管特征指标与瘤内参数值联合应用对BI-RADS 4类乳腺良恶性两组肿瘤鉴别的诊断效能。应用DeLong检验对AUC进行比较。结果乳腺良性组和恶性组病例在年龄、dmax、背景实质强化(background parenchymal enhancement,BPE)、纤维腺体组织量(fibroglandular tissue,FGT)、瘤周相邻血管征(adjacent vascular sign,AVS)数目、瘤周血管最大径、患侧瘤周与健侧同一象限血管直径差值(△d)、瘤周血管出现期相以及瘤内容积转移常数(volume transfer constant,K^(trans))、速率常数(flux rate constant,K_(ep))、最大增强斜率(maximum slope of increase,MSI)和时间-信号强度曲线(time-signal intensity curve,TIC)类型的差异均具有统计学意义(P<0.05),而病变位置、信号增强率(signal enhancement ratio,SER)和血管外细胞外间隙容积比(volume fraction of extravascular extra vascular space,V_(e))差异无统计学意义(P>0.05)。通过多因素logistic回归分析结果显示,△d、dmax、MSI和K^(trans)为区分两组间的独立影响因素,其中优势比最大的是MSI值(AUC为0.923)。将瘤周血管特征△d分别与dmax、MSI和K^(trans)进行两者联合模型比较,以△d与MSI联合模型的诊断效能最高(AUC为0.933,敏感度和特异度分别为93.2%和83.7%),且△d联合MSI与△d联合K^(trans)比较的差异具有统计学意义(P=0.001);其他联合指标在两两比较时差异无统计学意义(P>0.05),联合模型高于单独MSI模型的诊断效能。结论瘤周血管特征指标(△d)联合瘤内半定量(MSI)血流动力学参数对评价BI-RADS 4类乳腺肿瘤具有较好的鉴别诊断价值。展开更多
目的研究动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数与局部进展期宫颈癌临床病理特征及同步放化疗疗效的关系。方法选取河南科技大学第一附属医院2017年1月~2022年12月收治的68例...目的研究动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数与局部进展期宫颈癌临床病理特征及同步放化疗疗效的关系。方法选取河南科技大学第一附属医院2017年1月~2022年12月收治的68例局部进展期宫颈癌患者,接受DCE-MRI扫描,分析宫颈癌患者DCE-MRI定量参数[容量转移常数(volume transfer constant,K^(trans))、速率常数(rate constant,K_(ep))、细胞外间隙容积分数(extracellular space volume fraction,V_(e))]与临床病理特征关系;宫颈癌患者均接受同步放化疗,根据放化疗情况,将68例局部进展期宫颈癌患者分为有效组(n=39)与无效组(n=29),对比两组治疗前DCE-MRI定量参数,采用多因素Logistic回归分析探究疗效影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析DEC-MRI定量参数对患者疗效预测价值。结果鳞癌患者K^(trans)值较腺癌高(P<0.05);低分化患者K^(trans)、K_(ep)值较中高分化患者高(P<0.05);临床分期≥Ⅲa期患者K^(trans)、K_(ep)、V_(e)值均较<Ⅲa期高(P<0.05);不同肿瘤直径、是否淋巴结转移、是否脉管浸润患者之间DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值比较无明显差异(P>0.05)。有效组治疗前DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值均高于无效组(P<0.05)。多因素Logistic回归分析显示,临床分期≥Ⅲa期、K^(trans)、K_(ep)、V_(e)值均是影响局部进展期宫颈癌疗效的危险因素(P<0.05)。K^(trans)、K_(ep)、V_(e)值及三者联合预测疗效的ROC曲线下面积分别为0.962、0.950、0.860、0.997。结论DCE-MRI定量参数与局部进展期宫颈癌患者临床病理特征有一定关系,可作为患者同步放化疗疗效预测指标。展开更多
<strong>Background: </strong>Dynamic contrast-enhanced MR imaging (DCE-MR) is becoming a widely accepted complementary method for diagnosing breast cancer and other cancers in adults. It is useful to predi...<strong>Background: </strong>Dynamic contrast-enhanced MR imaging (DCE-MR) is becoming a widely accepted complementary method for diagnosing breast cancer and other cancers in adults. It is useful to predict tumor response to anticancer therapy and monitor the tumor response to the therapy. This form of imaging techniques has not been adequately explored in pediatric oncology patients. <strong>Objective:</strong> To determine the potential role of dynamic contrast-enhanced MR imaging (DCE-MR) in the diagnosis and treatment response monitoring of childhood and young adult extra-cranial tumors in routine clinical setting.<strong> Methods:</strong> Children with suspected extra-cranial solid tumors, including newly diagnosed or follow-up cases of confirmed tumors, were recruited. DCE-MR was performed with intravenous injection of 0.1 mmol/kg contrast. The enhancement time curves were plotted and the enhancement patterns were categorized into type 1, 2 and 3 curves. Enhancement curve patterns and maximal enhancement intensity were compared with types of tumor in newly diagnosed cases. The preoperative percentiles of inactive area on the colour map were compared with the necrotic areas on histologic sections of the resected specimens in follow-up cases. Pearson Chi-square test and Unpaired two-sample t-test were used for statistical analysis. <strong>Results: </strong>There were 36 patients, involving 28 malignant and 8 benign cases. There were 14 type 3 curves, (all of them were malignant tumors), 6 type 2 curves and 16 type 1 curves. All the benign cases (n = 8) demonstrated type 1 curve (accuracy & negative predictive value = 100%). All the malignant cases after treatment showed type 2 or 1 curve. For those cases with operation done afterwards, the extent of tumor necrosis was correlated closely with pathology findings (accuracy = 93.3%). <strong>Conclusion:</strong> Type 1 curve was a good predictor of benign lesion. DEC-MR may have a role to play in the monitoring of the progress of treatment and extent of tumor necrosis.展开更多
文摘BACKGROUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(i.e.cholangiocarcinoma or metastasis)is highly challenging and definitive diagnosis still relies on histological exam.The patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical features.Dynamic contrast-enhanced ultrasound(DCEUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor perfusion.AIM To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver nodules.METHODS A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological diagnosis.In accordance with the study protocol,a qualitative and quantitative analysis of the evidence was planned.RESULTS Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic cholangiocarcinoma.CONCLUSION DCEUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early treatment.This quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.
文摘目的探讨动态对比增强MRI(dynamic contrast-enhancement MRI,DCE-MRI)瘤周血管特征结合瘤内血流动力学参数在乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)4类肿瘤中的鉴别诊断价值。材料与方法回顾性分析2018年8月至2023年3月于大连医科大学附属第一医院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的女性病例102例,其中良性组43例,恶性组59例。记录患者年龄、病灶最大径(dmax)、乳腺DCE-MRI基本影像学特征、瘤周血管特征及瘤内血流动力学参数值。通过单因素和多因素logistic回归分析比较两组间多参数的差异,利用受试者工作特征(receiver operating characteristic,ROC)曲线以及曲线下面积(area under the curve,AUC)分析瘤周血管特征指标与瘤内参数值联合应用对BI-RADS 4类乳腺良恶性两组肿瘤鉴别的诊断效能。应用DeLong检验对AUC进行比较。结果乳腺良性组和恶性组病例在年龄、dmax、背景实质强化(background parenchymal enhancement,BPE)、纤维腺体组织量(fibroglandular tissue,FGT)、瘤周相邻血管征(adjacent vascular sign,AVS)数目、瘤周血管最大径、患侧瘤周与健侧同一象限血管直径差值(△d)、瘤周血管出现期相以及瘤内容积转移常数(volume transfer constant,K^(trans))、速率常数(flux rate constant,K_(ep))、最大增强斜率(maximum slope of increase,MSI)和时间-信号强度曲线(time-signal intensity curve,TIC)类型的差异均具有统计学意义(P<0.05),而病变位置、信号增强率(signal enhancement ratio,SER)和血管外细胞外间隙容积比(volume fraction of extravascular extra vascular space,V_(e))差异无统计学意义(P>0.05)。通过多因素logistic回归分析结果显示,△d、dmax、MSI和K^(trans)为区分两组间的独立影响因素,其中优势比最大的是MSI值(AUC为0.923)。将瘤周血管特征△d分别与dmax、MSI和K^(trans)进行两者联合模型比较,以△d与MSI联合模型的诊断效能最高(AUC为0.933,敏感度和特异度分别为93.2%和83.7%),且△d联合MSI与△d联合K^(trans)比较的差异具有统计学意义(P=0.001);其他联合指标在两两比较时差异无统计学意义(P>0.05),联合模型高于单独MSI模型的诊断效能。结论瘤周血管特征指标(△d)联合瘤内半定量(MSI)血流动力学参数对评价BI-RADS 4类乳腺肿瘤具有较好的鉴别诊断价值。
文摘目的研究动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数与局部进展期宫颈癌临床病理特征及同步放化疗疗效的关系。方法选取河南科技大学第一附属医院2017年1月~2022年12月收治的68例局部进展期宫颈癌患者,接受DCE-MRI扫描,分析宫颈癌患者DCE-MRI定量参数[容量转移常数(volume transfer constant,K^(trans))、速率常数(rate constant,K_(ep))、细胞外间隙容积分数(extracellular space volume fraction,V_(e))]与临床病理特征关系;宫颈癌患者均接受同步放化疗,根据放化疗情况,将68例局部进展期宫颈癌患者分为有效组(n=39)与无效组(n=29),对比两组治疗前DCE-MRI定量参数,采用多因素Logistic回归分析探究疗效影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析DEC-MRI定量参数对患者疗效预测价值。结果鳞癌患者K^(trans)值较腺癌高(P<0.05);低分化患者K^(trans)、K_(ep)值较中高分化患者高(P<0.05);临床分期≥Ⅲa期患者K^(trans)、K_(ep)、V_(e)值均较<Ⅲa期高(P<0.05);不同肿瘤直径、是否淋巴结转移、是否脉管浸润患者之间DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值比较无明显差异(P>0.05)。有效组治疗前DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值均高于无效组(P<0.05)。多因素Logistic回归分析显示,临床分期≥Ⅲa期、K^(trans)、K_(ep)、V_(e)值均是影响局部进展期宫颈癌疗效的危险因素(P<0.05)。K^(trans)、K_(ep)、V_(e)值及三者联合预测疗效的ROC曲线下面积分别为0.962、0.950、0.860、0.997。结论DCE-MRI定量参数与局部进展期宫颈癌患者临床病理特征有一定关系,可作为患者同步放化疗疗效预测指标。
文摘<strong>Background: </strong>Dynamic contrast-enhanced MR imaging (DCE-MR) is becoming a widely accepted complementary method for diagnosing breast cancer and other cancers in adults. It is useful to predict tumor response to anticancer therapy and monitor the tumor response to the therapy. This form of imaging techniques has not been adequately explored in pediatric oncology patients. <strong>Objective:</strong> To determine the potential role of dynamic contrast-enhanced MR imaging (DCE-MR) in the diagnosis and treatment response monitoring of childhood and young adult extra-cranial tumors in routine clinical setting.<strong> Methods:</strong> Children with suspected extra-cranial solid tumors, including newly diagnosed or follow-up cases of confirmed tumors, were recruited. DCE-MR was performed with intravenous injection of 0.1 mmol/kg contrast. The enhancement time curves were plotted and the enhancement patterns were categorized into type 1, 2 and 3 curves. Enhancement curve patterns and maximal enhancement intensity were compared with types of tumor in newly diagnosed cases. The preoperative percentiles of inactive area on the colour map were compared with the necrotic areas on histologic sections of the resected specimens in follow-up cases. Pearson Chi-square test and Unpaired two-sample t-test were used for statistical analysis. <strong>Results: </strong>There were 36 patients, involving 28 malignant and 8 benign cases. There were 14 type 3 curves, (all of them were malignant tumors), 6 type 2 curves and 16 type 1 curves. All the benign cases (n = 8) demonstrated type 1 curve (accuracy & negative predictive value = 100%). All the malignant cases after treatment showed type 2 or 1 curve. For those cases with operation done afterwards, the extent of tumor necrosis was correlated closely with pathology findings (accuracy = 93.3%). <strong>Conclusion:</strong> Type 1 curve was a good predictor of benign lesion. DEC-MR may have a role to play in the monitoring of the progress of treatment and extent of tumor necrosis.
