Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis:Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis. METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively, and were then compared to the corresponding histological pancreatic conditions. RESULTS: Pancreatic carcinomas demonstrated type-Ⅲ (n = 13) or Ⅳ (n = 20) TIC. Tumor-forming pancreatitis showed type-Ⅱ (n = 5) or Ⅲ (n = 3) TIC. All islet cell tumors revealed type-Ⅰ. The type-Ⅳ TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

Quantitative Assessment of Coronary Flow Reserve by the Variables of Time-Intensity Curve with Myocardial Contrast Echocardiography

The reliability and reliable indexes of q ua ntitative assessment of coronary flow reserve (CFR) by using time intensity cur ve (TIC) via myocardial contrast echocardiography were investigated. The TIC var iables were obtained by employing acoustic densitometry (AD) technique before an d after acetylcholine (Ach) injection in 12 dogs. Meanwhile, the correlation be tween these variables and CFR was analyzed. Among the variables derived from TIC , peak intensity (PI), area under the curve (AUC) and descending slope (DS) were increased significantly ( P <0.05) with the increase of coronary blood flow a fter Ach injection. Conversely, time to peak (TP), half time of descent (HT) , and mean transit time (MTT) were decreased remarkably ( P <0.0001). Th e P I and AUC ratios from post to pre Ach injection were strongly associated with CFR with the correlation coefficient (r) being 0.8366 and 0.8824, respectively. It is reliable by using the variables derived from TIC with myocardial contrast echocardiography to quantitatively evaluate regional myocardial CFR. The PI an d AUC ratios from post to pre Ach injection are the reliable indexes for quan titative assessment of CFR.

Straw return increases crop grain yields and K-use efficiency under a maize-rice cropping system

Straw return is an effective way to improve crop grain yield and potassium(K)use efficiency by increasing soil K content.However,the effects of straw return on soil K supplying capacity,replacement of K fertilizer,and K-use efficiency under maize(Zea mays L.)–rice(Oryza sativa L.)cropping systems are little studied.A two-year field experiment was conducted to determine the physiological determinants of K-use efficiency under straw return with four K fertilization rates.Sr33(straw returned plus 33%of K fertilizer applied)and Sr67(straw returned plus 67%of K fertilizer applied)increased annual crop yields by 1.5%and 3.2%and increased agronomic K-use efficiency by respectively 2.9 and 1.3-fold on average in the two years,compared with the conventional practice S0K100(no straw returned plus normal amounts of K fertilizer applied).The Sr33 and Sr67 treatments resulted in significantly greater equilibrium K concentration ratios(CR0 K)and specifically exchangeable K(KX)values according to quantity/intensity(Q/I)relationship analyses,indicating improvement of the potential soil K supply capacity.However,the Sr67 better maintained the soil exchangeable K level and K balance.The results suggested that K released from maize and rice straw can replace about half of chemical K fertilizer,depending on the available K content in maize–rice cropping system production.

Usefulness of dynamic contrast-enhanced MR imaging in the evaluation of pulmonary isolated lesions

Objective： The aim of our study was to investigate the value of dynamic contrast-enhanced MRI for evaluating differential diagnosis of pulmonary isolated lesions. Methods： Twenty-nine consecutive patients enrolled in this study, all of whom underwent DCE-MRI examinations and received a histologic and clinical diagnosis. Among these, lung tuberculoma 7 cases, harmatoma 3 cases, peripheral lung cancer 19 cases. DCE-MRI was acquired with 3D LAVA technique, total 18 phases were acquired, scanner time of per phase was 5-7″. After contrasting agent, twice successive scanning was acquired at 10″ and 50″. Then 1′30″, 2′, 2′30″, 3′, 3′30″, 4′, 5′, 6′, 7′, 8′, 9′, 10′, 11′, 12′ performed scanning. Region of interest was placed on the Maximum level in the tumors. According to Schaefer＇s standard, four types of time signal intensity curve （TIC） were classified, which were A, B, C and D. Compared the dynamic parameters between benign and malignant nodules. Results： Lung tuberculoma may display three curves： A type 1 case, ring-shaped enhancement 4 cases （periphery ring A type, central region D type）, D type 2 cases. Harmatoma may display three curves： A type 1 case, C type 2 case. Peripheral lung cancer may display A type. Except 2 cases D type lung tuberculoma, we compared curve data of 8 cases benign nodules （including tuberculoma Atype and periphery ring Atype, harmatoma Atype and C type） and lung cancer. SlEP%： benign nodules 0.7885 ±0.5543, lung cancer 1.2623 ±0.3059, P 〈 0.05; MER： benign nodules 1.0007 ± 0.4251, lung cancer 1.3694 ±0.2740, P 〈 0.05; washout： P 〉 0.05. Conclusion： Lung MR imaging is helpful to diagnosis and differential diagnosis of isolated benign and malignant nodules. SIEP% and MER could offer valuable information. The evolution of global tuberculosis may be from A type to ring-shaped ennoblement to D type. It was easy to do right diagnosis to lung tuberculoma with ring-shaped ennoblement and D type. Peripheral lung cancer commonly displayed A type and needed identification with acute inflammation. So, it is important to anti-inflammatory follow-up for a few A type nodules.

Effectiveness of dynamic contrast-enhanced magnetic resonance imaging in evaluating clinical responses to neoadjuvant chemotherapy in breast cancer

Background Use of neoadjuvant chemotherapy necessitates assessment of response to cytotoxic drugs.The aim of this research was to investigate the effectiveness of dynamic contrast-enhanced magnetic resonance imaging （MRI） for evaluating clinical responses to neoadjuvant chemotherapy in breast cancer patients.Methods We examined patients receiving neoadjuvant chemotherapy for primary breast cancer between October 2007and September 2008.Dynamic contrast-enhanced MRI was used to examine breast tumors prior to and after neoadjuvant chemotherapy.The MRI examination assessed tumors using Response Evaluation Criteria in Solid Tumors （RECIST）.The Miller-Payne grading system was used as a histopathological examination to assess the effect of the treatment.We examined the relationship between the results of RECIST and histopathological criteria.In addition,we used time-signal intensity curves （MRI T-SI） to further evaluate the effects of neoadjuvant chemotherapy on tumor response.Results MRI examination of patients completing four three-week anthracycline-taxanes chemotherapy treatment revealed that no patients had complete responses （CR）,58 patients had partial responses （PR）,29 patients had stable disease （SD）,and four with progressive disease （PD）.The effectiveness of neoadjuvant chemotherapy （CR ＋ PR） was 63.7% （58/91）.The postoperative histopathological evaluations revealed the following：seven G5 （pCR） cases （7.7%）,39G4 cases （42.9%）,16 G3 cases （17.6%）,23 G2 cases （25.3%）,and six G1 cases （6.6%）.The effectiveness （G5 ＋ G4 ＋G3） was 68.1% （62/91）.MRI T-SI standards classified 53 responding cases,29 stable cases,and nine progressing cases.These results indicated that the treatment was 58.2% effective （53/91） overall.Conclusions Dynamic contrast-enhanced MRI and histopathological standards were highly correlated.Importantly,MRI T-SI evaluation was found to be useful in assessing the clinical effectiveness of neoadjuvant chemotherapy.