Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level

Five years have passed since the Japan Narrow Band Imaging Expert Team (JNET) classification was proposed in 2014. However, the diagnostic performance of this classification has not yet been established. We conducted a retrospective study and a systematic search of Medical Literature Analysis and Retrieval System On-Line. There were three retrospective single center studies about the diagnostic performance of this classification. In order to clarify this issue, we reviewed our study and three previous studies. This review revealed the diagnostic performance in regards to three important differentiations.(1) Neoplasia from non-neoplasia;(2) malignant neoplasia from benign neoplasia;and (3) deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in the differentiation D-SMC from other neoplasia was 99.8%-100.0%. This classification would enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery. This article is the first review about the diagnostic performance of the JNET classification. Previous reports about the diagnostic performance have all been retrospective single center studies. A large-scale prospective multicenter evaluation study is awaited for the validation.

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT).METHODS: A total of 20 patients with pathologically-confirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired. Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM). Finally, the findings and diagnoses were compared with the pathologic results.RESULTS: The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P<0.05). The combined-type IPMNs had a higher rate of malignancy than the other two types of IPMNs (P<0.05). Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P<0.05). Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.CONCLUSION: MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors.

Diagnostic Accuracy and Complication Rates of Fusion Images Created Using Real-Time Ultrasound with CT for Identification of Peripheral Lung Lesions in Patients Undergoing Biopsy

Background: Fusion image improves lesion detectability and can be an effective tool for percutaneous ultrasound (US)-guide procedure. We describe the clinical benefit of US-guided lung biopsy using fusion image. Purpose: To retrospectively compare the diagnostic accuracy and complication rates of US-guided lung biopsy with B-mode alone and those of a fusion image created using real-time US and computed tomography (CT). Materials and Methods: Between September, 2013 and September, 2016, 50 peripheral lung lesions in 50 patients (40 males, 10 females;median, 74 years old) were performed by US-guided percutaneous cutting needle biopsy using the B-mode alone or fusion image. Final diagnoses were based on surgical outcomes or clinical follow-up results for at least 12 months after biopsy. To assess prebiopsy characteristics, all lesions were divided into two groups: group 1 (identification on B-mode) and group 2 (identification on fusion image). Results: Of 50 peripheral lesions, 40 lesions (80%) were detected by means of B-mode alone (group 1), and 10 lesions (20%) were identified by fusion image (group 2). The diagnostic accuracy of group 1 was 90% (36/40 lesions), and the diagnostic accuracy of group 2 was 100% (10/10 lesions). Nodule type and the size of the lesions showed significant group wise differences (p Conclusion: Fusion images created using real-time US and CT may be useful for identification of the minimal size of potential target lung lesions and may be more suitable for improved yields with US-guided lung biopsy.

A Controlled Study on Comparing Differences in CT Perfusion Imaging between Rabbits inoculated with VX2 Lung Tumor and Patients with Squamous Cell Carcinoma of the Lung

OBJECTIVE By analysis and evaluation of the perfusion images and perfusion parameters of the rabbits with VX2 lung tumor, the association between the perfusion parameters and tumor angiogenesis of patients with squamous cell carcinoma of the lung has been studied in order to establish a non-invasive and effective way to detect tumor blood supply, which is be able to exhibit hemodynamic data in tumors during cancer treatments. METHODS Fifteen Netherlands rabbits inoculated with VX2 lung tumor （rabbit group） and 25 patients with squamous cell carcinoma of the lung （patient group） received a multi-slice spiral CT perfusion imaging test using the Netherlands PHILIPS Brilliance 16-slice spiral CT and a U.S. MEDRAD binocular highpressure syringe. Image postprocessing was done using the special perfusion software and EBW 4.0 Workstation. Perfusion volume （PV）, peak enhanced increment （PEI）, transit time peak （TTP）, and blood volume （BV） were measured and analyzed. RESULTS In the rabbit group, the values of the PV, PEI, TTP, and BV of the tumor margin were （53.89 ± 13.38） mL/（min.mL）, （45.71 ± 15.52） Hu, （39.29 ± 10.10） sec, and （31.45 ± 18.19） mL/100 g, respectively; these values of the tumor center were （36.57 ± 14.17） mL/（min.mL）, （28.64 ± 11.74） Hu, （39.00 ＋ 9.78） sec, and （19.76 ± 13.95） mL/100 g, respectively; the values of the muscles were （12.45± 4.38） mL/（min.mL）, （10.98 ± 5.03） Hu, （38.86 ± 10.04） sec, and （5.38 ±2.87） mL/100 g, respectively. The values of the relative perfusion volume （RPV）, relative peak enhanced increment （RPEI）, and relative blood volume （RBV） of the tumor margin were 4.38 ± 1.45, 3.96± 1.45, 9.99 ± 11.7, respectively; these values of the tumor center were 2.14 ± 1.08, 1.83±1.45, 4.17 ±3.39, respectively. The values of the PV, PEL BV of the tumor margin vs. the values of the muscles developed t-values, which were 15.028, 10.79, and 5.88, respectively （P ≤ 0.01）, with statistical significance; the values of the PV, PEI, BV of the tumor center vs. the values of the muscles produced t-values, which were 8.67, 7.49, and 4.55, respectively （P 〈 0.01）, with statistical significance. The values of the TTP of the tumor margin vs. TTP values of the muscles, and the TTP values of the tumor center vs. TTP values of the muscles developed t-values, which were 1.7 and 0.806, respectively （P ≥ 0.05）, without statistical significance. In the patient group, the values of the PV, PE, TTP, and BV of the tumor margin were （88.95 ± 30.89） mL/（min.mL）, （61.87 ± 27.31） Hu, （37.72 ± 12.53） sec, and （18.38 ± 7.2） mL/100 g, respectively; these values of the tumor center were （39.77 ± 18.29） mL/（min.mL）, （14.57 ± 8.1） Hu, （35.64 ± 12.41） sec, and （11.22 ± 6.02） mL/100 g, respectively; these values of the muscles were （12.45 ± 6.5） mL/（min.mL）, （6.14 ± 2.66） Hu, （35.68± 12.35） sec, and （2.23 ± 1.11） mL/100 g, respectively. The values of the RPV, RPEI, and RBV of the tumor margin were 8.05 ± 5.04, 8.87 ± 4.32, and 12.16 ± 8.49, respectively; these values of the tumor center were 2.39 ± 1.68, 2.97 ± 2.1, 3.53 ± 2.82, respectively. The values of the PV, PEI, BV of the tumor margin in the patient group vs. the values of the muscles produced t-values, which were 13.8, 10.85, and 12.22, respectively （P 〈 0.01）, with significant differences; these values of the tumor center vs. the values of the muscles developed t-values, which were 9.158, 6.26, 8.654, respectively （P 〈 0.01）, with significant differences. The TTP value of the tumor margin vs. that of the muscles produced t-value, which was 0.371, and the TTP value of the tumor center vs. that of the muscles developed t-value, which was 1 （P 〉 0.05）, without statistical difference. CONCLUSION CT perfusion imaging technics demonstrates directly dynamic changes of blood flow to tumors, which assists in identifying tumor growth and necrosis, therefore, this research provides an evidence-based guidelines for the treatment of human lung squamous cell carcinoma and has far-reaching clinical significance.

Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

AIM To establish the ability of magnetic resonance(MR) and computer tomography(CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors(Pan NET) in a caseload of a tertiary referral center.METHODS Patients submitted to surgery for Pan NET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination(MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman(BA) and Mountain-Plot(MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok(PB) regression analysis was used to check the agreement between MR and CT.RESULTS Our study population consisted of 292 patients. Seventy-nine(27.1%) were functioning Pan NET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning-Pan NET, respectively. Limits of agreement(LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-Pan NET, no statistical significance was found in the size estimation rate of MR and CT(P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.CONCLUSION MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of Pan NET.

Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis:A retrospective casecontrol study

BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC.METHODS This study was conducted as a single-center,retrospective case-control study.Twenty-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern classifications.The results were compared with the pathological diagnoses to evaluate the diagnostic performance.Inter-and intra-observer agreements were calculated.RESULTS In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive carcinoma.In the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high specificity.The interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,respectively.The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and 0.567,respectively.CONCLUSION The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN.Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.

Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.

Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.

Application of GLAD-PCR Assay for Study on DNA Methylation in Regulatory Regions of Some Tumor-Suppressor Genes in Lung Cancer

Hypermethylation of the gene regulatory regions are common for many cancer diseases. In this work we applied GLAD-PCR assay for identificating of the aberrantly methylated RCGY sites in the regulatory regions of some downregulated genes in tissue samples of lung cancer(LC). This list includes EFEMP1, EPHA5, HOXA5, HOXA9, LHX1, MYF6, NID2, OTX1, PAX9, RARB, RASSF1 A, RXRG, SIX6, SKOR1 and TERT genes. The results of DNA samples from 40 cancer and 25 normal lung tissues showed a good diagnostic potential of selected RCGY sites in regulatory regions of MYF6, SIX6, RXRG, LHX1, RASSF1 A and TERT genes with relatively high sensitivity(80.0 %) and specificity(88.0 %) of LC detection in tumor DNA.

Role of positron emission tomography-computed tomography in non-small cell lung cancer

Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography(PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A 59-year-old G2P2 woman,with chronic pelvic pain,underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm×34 mm×36 mm,with irregular borders,heterogeneous echogenicity,no color Doppler vascularization and without acoustic shadowing.Normal ovarian tissue was visualized in contact with the lesion,and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe.Ascites,peritoneal metastases or other alterations were not observed.With the international ovarian tumor analysis ADNEX model,the lesion was classified as a malignant tumor(the risk of malignancy was 27.1%,corresponding to Ovarian-Adnexal Reporting Data System category 4).Magnetic resonance imaging confirmed the presence of a right adnexal mass,apparently an ovarian tumor measuring 65 mm×35 mm,without signs of invasive or metastatic disease.During explorative laparotomy,normal morphology of the internal reproductive organs was noted.A solid mobile lesion involved the entire appendix.Appendectomy was performed.Inspection of the abdominal cavity revealed no signs of malignant dissemination.Histopathologically,the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm(LAMN).CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature(benign vs malignant)and origin(gynecological vs nongynecological)of the lesion.Radiologists,gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific.The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.

CT检查影像特征对小细胞肺癌的诊断价值

目的 探讨CT检查影像特征对小细胞肺癌的诊断价值。方法 选取26例小细胞肺癌(SCLC)患者,作为SCLC组,采用倾向匹配法按1∶2的比例对性别、年龄进行匹配,共选取52例非小细胞肺癌(NSCLC)患者,作为NSCLC组。比较两组患者的CT影像特征,将差异有统计学意义的CT影像特征纳入多因素Logistic回归分析,分析SCLC的影响因素;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估CT影像特征对SCLC的诊断价值。结果 两组患者分型、病灶形态、支气管闭塞和/或肺不张、肺门纵隔淋巴结情况、血管受累情况比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,周围型肺癌、有支气管闭塞和/或肺不张均为SCLC的独立保护因素(P﹤0.05),肿瘤形态不规则、肺门纵隔淋巴结肿大、有血管受累均为SCLC的独立危险因素(P﹤0.05)。ROC曲线显示,病灶形态、血管受累情况对SCLC具有中等诊断价值,肺门纵隔淋巴结肿大情况、分型、支气管闭塞和/或肺不张情况对SCLC具有较低诊断价值,联合模型诊断SCLC的AUC为0.989(95%CI:0.893~0.997),具有较高诊断价值,均高于各指标单独检测(P﹤0.05)。结论 CT检查见中央型、病灶形态不规则、有肺门纵隔淋巴结肿大、血管受累任意一项可提示为SCLC,上述指标联合检查对SCLC的诊断价值较高。

基于脑MRI的机器学习预测非小细胞肺癌T790M突变

目的:本研究基于脑部T_(1)C和T_(2)W MRI建立人工智能模型,预测肺癌脑转移患者在靶向治疗中的耐药性T790M突变。方法:本研究收集80例肺癌脑转移患者(2017年6月—2019年12月)的T_(1)C和T_(2)W MRI影像和临床数据进行回顾性分析(患者按照2∶1的比例分成训练集和测试集)。采用无监督k-means算法将肿瘤区域划分为高亮度区域和低亮度区域,提取不同区域的影像组学图像特征构建模型,评估每个模型的诊断效果。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(Area under curve,AUC)、特异性和敏感性作为模型评价指标,分析模型的潜在临床应用价值。结果:对T_(1)C和T_(2)W MRI和临床特征融合的统计计算表明,本研究建立的模型对T790M突变具有良好的预测能力,在训练集和测试集上的AUC分别为0.899和0.818。结论:本研究建立的计算机模型可以有效预测肺癌脑转移患者T790M突变,具有潜在的临床辅助诊断价值。

血清miR-4646-5p、miR-3654联合传统肺癌肿瘤标志物在云南宣威肺癌诊断中的应用研究

背景与目的宣威肺癌近年来发病率持续增加,还具有全年龄段高发、女性肺癌死亡率高等特点。因此寻找更多稳定的生物标志物用于宣威肺癌的诊断具有巨大的临床应用前景。本研究旨在探究4个微小RNA(microRNA,miRNA)各自及联合传统肺癌肿瘤标志物在宣威肺癌检测和诊断中的临床应用价值。方法通过检测4个miRNA和5种传统肺癌肿瘤标志物在45例宣威肺癌患者和健康体检者血清中的表达量,采用逻辑回归模型综合评估4个miRNA在宣威肺癌诊断中的灵敏度、特异度和诊断效能等相关统计学指标。结果单个血清miRNA中miR-4646-5P、miR-3654在宣威肺癌组中的相对表达水平与对照组存在显著差异(P<0.05),miR-3654用于诊断的效果最好,灵敏度、特异度和曲线下面积分别为86.7%、82.2%、0.847。miR-3654联合miR-4646-5p、癌胚抗原(carcinoembryonic antigen,CEA)诊断宣威肺癌的效能最高,曲线下面积为0.901,灵敏度为73.3%,特异度为93.3%,阳性预测值为91.7%。结论血清miR-3654在4个miRNA中对宣威肺癌诊断效果最好,并且联合miR-4646-5p、CEA能有效提高其对宣威肺癌的诊断价值,有望作为有价值的宣威肺癌筛查指标。

表观扩散系数鉴别肺癌脑转移瘤组织学分型及其与Ki-67增殖指数的相关性

目的探讨表观扩散系数(apparent diffusion coefficient,ADC)鉴别诊断肺癌脑转移瘤组织学分型的价值及其与Ki-67增殖指数之间的关系。材料与方法回顾性分析经手术病理证实的20例小细胞肺癌脑转移瘤和41例非小细胞肺癌脑转移瘤患者的资料,并测定其Ki-67增殖指数。在ADC图上测量肿瘤实性部分的最小ADC值(the minimum ADC,ADCmin)、平均ADC值(the mean ADC,ADCmean)及对侧正常脑白质ADC值,并计算相对ADCmin(relative ADCmin,rADCmin)及相对ADCmean(relative ADCmean,rADCmean)。对比分析二者ADC值的差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值的鉴别诊断价值,并计算ADC值与Ki-67增殖指数之间的相关性。结果小细胞肺癌脑转移瘤组的ADCmin、ADCmean、rADCmin及rADCmean值均小于非小细胞肺癌脑转移瘤组,组间差异均具有统计学意义(P<0.05)。各ADC值均能对小细胞肺癌脑转移瘤及非小细胞肺癌脑转移瘤进行有效鉴别,其中rADCmean值的鉴别诊断效能最好,曲线下面积(area under the curve,AUC)为0.950[95%置信区间(confidence interval,CI):0.907~0.994],最佳截断值为0.955,相应的敏感度和特异度分别为96.23%、83.87%,准确度为91.67%。小细胞肺癌脑转移瘤组的Ki-67增殖指数大于非小细胞肺癌脑转移瘤组,组间差异具有统计学意义(P<0.05)。61例肺癌脑转移瘤患者的ADCmin、ADCmean、rADCmin及rADCmean值均与Ki-67增殖指数呈不同程度的负相关(r=-0.506、r=-0.480、r=-0.569、r=-0.541)。结论ADC值可以对肺癌脑转移瘤的组织学分型进行鉴别诊断,并可以预测Ki-67增殖指数的表达水平。

心脏钙化无定形肿瘤1例

患者男,44岁,胸痛12 h伴晕厥2次,数分钟后自主苏醒,未经特殊治疗;既往尿毒症病史4年,长期接受腹膜透析和血液透析治疗,肌酐控制差;高血压11年,血压最高165/90 mmHg,规律服用降压药但控制效果欠佳;冠心病3年;糖尿病病史14年;无特殊家族史。查体:体温36.6℃,脉搏100次/分,呼吸22次/分,血压146/86 mmHg,心率100次/分,律齐,未闻及杂音;双下肢水肿。

奥曲肽修饰的壳聚糖纳米递送分子信标成像肺癌研究

目的 探究通过奥曲肽(OCT)修饰的壳聚糖(CS)miR-155分子信标(miR-155-MB)纳米(CS-miR-155-MB-OCT)识别miR-155并成像肺癌细胞用于肺癌早期诊断。方法 通过尾静脉注射A549肺癌细胞建立肺移植瘤裸鼠模型;通过鼻腔滴入Cre腺病毒,分别在滴入腺病毒后的4、6、8、12周处死小鼠建立LSL K-ras G12D转基因小鼠肺部的非典型增生、腺瘤、原位癌、肺腺癌的不同病变时期肺腺癌模型;取肺组织行HE染色观察。免疫组化染色检测肺移植瘤组织及不同病变时期转基因小鼠肺组织生长抑素受体2(SSTR2)的表达;实时荧光定量PCR检测不同病变时期转基因小鼠肺组织miR-155的表达。在肺移植瘤裸鼠模型中,尾静脉注射CS-miR-155-MB或CS-miR-155-MB-OCT;转基因小鼠模型中,尾静脉注射CS-miR-155-MB-OCT;活体成像仪检测肺移植瘤裸鼠及转基因小鼠不同病变时期肺部荧光信号;制作肺组织冰冻切片,激光共聚焦扫描显微镜(CLSM)检测荧光信号来源。结果 HE染色显示成功构建了肺移植瘤裸鼠模型及转基因小鼠肺部的非典型增生、腺瘤、原位癌、肺腺癌的不同病变时期肺癌模型。肺移植瘤及不同病变时期病变组织均表达SSTR2。转基因小鼠模型中,随着疾病进展,miR-155表达逐渐升高(P<0.05)。在肺移植瘤裸鼠模型中,CS-miR-155-MB-OCT组肺部荧光信号强于CS-miR-155-MB组(P<0.05);转基因小鼠模型中,随着肺癌的进展,荧光信号逐渐增强(P<0.05);将肺组织再次成像后发现荧光信号来自肺部,CLSM发现荧光信号来自肿瘤细胞及部分正常肺泡上皮细胞。结论 CS-miR-155-MB-OCT能够根据产生的荧光强度变化动态反映肺癌的发生发展,从而为肺癌的早期诊断提供新技术。

外阴巨大血管肌纤维母细胞瘤磁共振成像误诊为脂肪肉瘤一例

外阴血管肌纤维母细胞瘤(angiomyofibroblastoma,AMF)是一种育龄期女性罕见的良性肿瘤,起源于女性的外阴或阴道。脂肪肉瘤好发于围绝经期及绝经后女性的躯干、四肢等部位。报道1例外阴巨大AMF磁共振成像(magnetic resonance imaging,MRI)误诊为脂肪肉瘤的病例,该患者因发现外阴肿物3年,增大1年入院,术前MRI诊断为脂肪肉瘤,而术前活检诊断为AMF,行外阴肿物切除术+外阴成形术,术后病理检查诊断AMF,术后随访9个月未见复发。临床医生应加强疾病的鉴别诊断,通过结合术前组织病理学及其相关影像学检查可提高AMF的诊断准确率,为临床提供准确的手术指导信息。

肺癌MUSE-DWI与ss-EPI DWI成像质量的对比研究

目的:探讨多重灵敏度编码扩散加权成像(MUSE-DWI)与常规扩散加权成像(ss-EPI DWI)在肺癌成像质量的对比。方法:连续性收集44例于扬州大学附属医院行胸部磁共振检查的肺癌患者,获取患者ss-EPI DWI和MUSE-DWI图像。由两名观察者分别对两种DWI序列的图像质量进行主观视觉定性评估,评估指标包括病灶辨识度、图像伪影、形变程度及整体图像质量;客观评估方面,计算并比较信噪比(SNR)、对比噪声比(CNR)、表观扩散系数(ADC)及最大横纵经。结果:MUSE-DWI序列在病灶辨识度、图像伪影、形变程度及整体图像质量方面优于传统ss-EPI DWI,差异有统计学意义(P<0.001)。MUSE-DWI序列显示肺癌病灶的SNR、CNR高于ss-EPI DWI,差异有统计学意义(P<0.001,P<0.05),两组间扫描肺癌的最大纵径差异有统计学意义(P<0.001),两组间病灶ADC值及病灶最大横径差异无统计学意义。结论:与常规单次激发平面回波扩散加权成像相比,MUSE-MRI可以提升肺癌图像质量,减少肺部DWI图像中的伪影和几何形变,提高病灶的SNR和CNR,在不影响ADC值测量的情况下提高解剖细节及病灶边界的清晰度。

常规磁共振成像联合弥散加权成像诊断直肠癌术前分期的准确性及漏诊误诊原因

目的 针对常规磁共振成像(MRI)联合弥散加权成像(DWI)诊断直肠癌术前分期的准确性及漏诊、误诊的原因进行探讨。方法 回顾性选取我院收治的58例直肠癌患者作为研究对象,选取时间为2020年1月至2023年2月。所有患者均接受常规MRI序列联合DWI检查、病理检查,金标准为病理检查结果。比较所有患者经术前常规MRI联合DWI、病理检查对肿瘤侵犯的深度(T分期)、淋巴结转移情况(N分期)的检出结果;统计术前常规MRI联合DWI成像检查T、N分期的诊断效能,并对相关影像学图片进行分析。结果 病理结果显示,58例直肠癌患者中T1分期13例,T2分期16例,T3分期19例,T4分期10例;N0分期24例,N1分期18例,N2a分期7例,N2b分期9例。常规MRI联合DWI成像检查结果显示,58例直肠癌患者中T1分期10例,T2分期15例,T3分期17例,T4分期16例;N0分期22例,N1分期20例,N2a分期8例,N2b分期8例,其结果均与病理结果较为接近;患者术前应用常规MRI联合DWI成像检查T分期、N分期总体的特异度、灵敏度、准确度均较高。结论 临床可根据常规MRI联合DWI诊断结果及影像学特点综合评估直肠癌患者术前肿瘤分期。