ObjectiveTo compare the effectiveness of T2 weighted image (T2WI) and some compounded MRI techniques, including T2WI combined with magnetic resonance spectroscopy (T2WI+MRS), T2WI combined with diffusion weighted imaging (T2WI+DWI) and T2WI combined with dynamic contrast-enhancement [T2WI+(DCE-MRI)] respectively, with 1.5 T MR scanner in diagnosing prostate cancer through a blinding method. MethodsBetween March 2011 and April 2013, two observers diagnosed 59 cases with a blinding method. The research direction of radiologist A was to diagnose prostate cancer. The observers diagnosed and scored the cases with T2WI, T2WI+(DCE-MRI), T2WI+MRS, T2WI+DWI and compositive method respectively. The data were statistically analyzed with receiver operating characteristic (ROC) curve. ResultsAccording to the ROC curve, both observers got the sequence of area under curve (AUC) as T2WI+DWI > T2WI+(DCE-MRI) > T2WI+MRS > T2WI. On the basis of the result from observer A, the AUC from each technique was similar. The AUC of T2+DWI was slightly bigger than others. The specificity of single T2WI was the lowest; the sensitivity of T2WI was slightly higher. The AUC of the compositive method was marginally larger than T2WI+DWI. According to the result from observer B, the AUC of T2WI+DWI was obviously larger than the others. The AUC of single T2WI was much smaller than the other techniques. The single T2WI method had the lowest sensitivity and the highest specificity. The AUC of T2WI+DWI was slightly larger than the compositive method. The AUC of T2WI+(DCE-MRI), T2WI+MRS, single T2WI methods from observer A was obviously higher than those from the score of observer B. The AUC of T2WI+DWI from the two observers was similar. ConclusionThe method of combined T2WI and functional imaging sequences can improve the diagnosing specificity when a 1.5 T MR scanner is used. T2WI+DWI is the best method in diagnosing prostate cancer with least influence from the experience of observers in this research. The compositive method can improve the diagnosis of prostate cancer effectively, but when there are contradictions between different methods, the T2WI+DWI should be considered as a key factor.
【摘要】 目的 探讨MRI动态增强扫描在子宫内膜癌手术前诊断中的价值。 方法 回顾分析2008年2月-2010年3月38例经手术病理证实为子宫内膜癌患者的动态增强MRI检查资料，判断内膜癌子宫肌层和宫颈浸润情况，与病理结果对照，计算T2WI及动态增强序列诊断肌层及宫颈浸润的敏感度、特异度、准确度等，分析两种序列诊断准确度有无差异；计算内膜癌组织与子宫肌层在动态增强各期的对比信噪比，并分析其在各期间有无差异。 结果 动态增强序列诊断内膜癌肌层和宫颈受侵的敏感度、特异度、阳性预测值、阴性预测值分别为96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；动态增强序列诊断内膜癌深肌层浸润的准确度为94.7%，显著高于T2WI诊断深肌层浸润的准确度78.9%（Plt;0.05）；平衡期内膜癌组织与子宫肌层的对比信噪比显著高于动脉期和静脉期（Plt;0.01）。 结论 MRI动态增强扫描能够在手术前准确的判断内膜癌肌层及宫颈浸润，有助于子宫内膜癌治疗方式的选择。【Abstract】 Objective To investigate the role of dynamic-enhanced MRI in the diagnosis of endometrial carcinoma. Methods Thirty-eight patients with endometrial carcinoma confirmed by surgicopathology undergone dynamic-enhanced MRI scans were analyzed retrospectively. The invasion in myometrium and uterine cervix were analyzed. The tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging were calculated. MR imaging findings were compared with pathologic findings. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration were calculated. Results Respective sensitivity, specificity, and positive and negative predictive values in assessing myometrial infiltration were 968%,85.7%,96.8%,85.7%;those for cervical infiltration were 85.7%,91.7%,85.7%,91.7%,respectively. The diagnostic accuracy (94.7%) of dynamic imaging in depicting deep myometrial infiltration were significantly higher than that of T2WI (78.9%) (Plt;0.05).There was a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and venous phases (Plt;0.01). Conclusion Dynamic-enhanced MRI is highly accurate in preoperative diagnosis of endometrial carcinoma, which will benefit for the treat of endometrial carcinoma.
Objective To investigate the application of the dynamic contrast enhanced MRI (DCE-MRI ) combined with magnetic resonance spectroscopy (MRS) in the diagnosis of prostate cancer. Method A total of 60 patients with prostate cancer and 60 patients with benign prostatic hyperplasia diagnoses in Sichuan Cancer Hospital from January 2011 to January 2014 were included as prostate cancer group and proliferative group respectively. Sixty healthy individuals during the same period were included as the control group. We used Siemens Avanto 1.5 T high field superconducting MRI for DCE-MRI scan and MRS scan. After the MRS scan was finished, we used the workstation spectroscopy tab spectral analysis. Eventually we got the crest lines of prostate metabolites choline (Cho), creatine (Cr) and citrate (Cit). Then we calculated Cho/Cit, (Cho+Cr)/Cit and their average. Results Comparing the signal value in 21 seconds, 1 minute, 2 minutes of DCE-MRI, the differences among the three groups were statistically significant (P<0.05). Comparing the results of spectral analysis, the differences among the three groups were statistically significant (P<0.05). The sensitivity was 89.67%, the specificity was 95.45% and the accuracy was 94.34% when using DCE-MRI combined with MRS. Conclusion DCE-MRI combined with MRS greatly improves the sensitivity, specificity and accuracy of the diagnosis of prostate cancer; it has a great application value in the diagnosis of prostate cancer.
To solve the problem that the method based on tumor morphology or overall average parameters of tumor cannot conduct the early evaluation of tumor treatment response, we proposed a voxel-wise method. The voxel-wise method uses the method combining rigid and elastic registration algorithm to align the tumor area before and after treatment on the images which are acquired by the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). We calculated voxel-wise volume transport constant (Ktrans) using pharmacokinetic model, and designed a threshold d to get the volume fraction of voxels which Ktrans increased significantly (F+), Ktrans decreased significantly (F-) or had no significant change (F0). Linear regression analysis was performed to get the correlation between volume fractions and pathological tumor cell necrosis rate (TCNR). We then determined the ability of volume fractions to evaluate treatment response at early stage by receiver operating characteristic (ROC) curve analysis. We performed experiments on 10 patients with soft tissue sarcomas. The results indicated that F- had significant negative correlation with TCNR (R2=0.832 8, P=0.0002), F0 has significant positively correlation with TCNR (R2=0.788 4, P=0.0006). In addition, F-(AUC=0.905,P=0.053), F0 (AUC=0.857,P=0.087) had a good ability in early tumor treatment response evaluation. Therefore, F- and F0 can be used as effective imaging biomarkers for early evaluation of tumor treatment.
ObjectiveTo evaluate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with multislice computed tomography (MSCT) in the evaluation of neoadjuvant chemotherapy (NACT) for breast cancer. MethodsThe clinical, imaging, and pathological data of breast cancer patients who received NACT in the Affiliated Hospital of Southwest Medical University from February 2019 to August 2021 were retrospectively collected. Based on the results of postoperative pathological examination, the patients were assigned into significant remission (Miller-Payne grade Ⅰ–Ⅲ) and non-significant remission (Miller-Payne grade Ⅳ–Ⅴ). The variables with statistical significance by univariate analysis or factors with clinical significance judged based on professional knowledge were included to conduct the logistic regression multivariate analysis to screen the risk factors affecting the degree of pathological remission after NACT. Then, the screened risk factors were used to establish a prediction model for the degree of pathological remission of breast cancer after NACT, and the efficacy of this model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve. ResultsAccording to the inclusion and exclusion criteria, a total of 211 breast cancer patients who received NACT were collected, including 116 patients with significant remission and 95 patients with non-significant remission. Logistic regression multivariate analysis results showed that the human epidermal growth factor receptor 2 positive, lower early enhancement rate after NACT, lower arterial stage net increment after NACT, and lower CT value of arterial phase of lesions would increase the probability of significant remission in patients with breast cancer after NACT (P<0.05). The area under the ROC curve of the model for predicting the degree of pathological remission of breast cancer after NACT was 0.984, the specificity was 93.7%, and the sensitivity was 95.7%. The calibration curve showed that the model result fit well with the actual result, and the DCA result showed that it had a high clinical net benefit value. ConclusionFrom the results of this study, DCE-MRI combined with MSCT enhanced scanning has a good predictive value for pathological remission degree after NACT for breast cancer, which can provide clinical guidance for further treatment.
ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.
【摘要】 目的 探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusion weighted imaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheter arterial chemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。 方法 2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3~7 d及治疗后1~2个月、3~6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparent diffusion coefficient，ADC）值，与数字减影血管造影（digital substraction angiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。〖HTH〗结果 对肿瘤残余及复发的显示，动态增强扫描灵敏度为90.0%，特异度为96.9%；DWI灵敏度为96.7%，特异度为93.8%；动态增强扫描与DWI相结合的灵感度为100.0%，特异度为99.5%；DSA灵敏度和特异度分别为96.7%、100.0%。TACE治疗前所有肿瘤实质的ADC值为（1.134±0.014）×10-3 mm2/s；TACE治疗后3~7 d ADC值为（1.162±0.016）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0.015）×10-3 mm2/s，3~6个月后随访病灶ADC值为（1.179±0.017）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积不完全或无明显沉积病灶ADC值为（1.147±0.016）×10-3 mm2/s，3~6个月后随访病灶实质平均ADC值（1.142±0.012）×10-3 mm2/s。 结论 将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均 ADC值的动态测量、观察可及早判断肿瘤复发的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.
ObjectiveTo explore the value of magnetic resonance diffusion weighted imaging (DWI) in preoperative Bismuth-Corlette classification of hilar cholangiocarcinoma (HCCA). MethodsA total of 53 HCCA patients confirmed by postoperative pathology were retrospectively included. The accuracy of two sequence combinations, namely dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) + magnetic resonance cholangiopancreatography (MRCP) and DCE-MRI + MRCP + DWI, in evaluating the longitudinally involved bile duct segments and Bismuth-Corlette classification of HCCA was compared. Additionally, the correlation between apparent diffusion coefficient (ADC) values and tumor Bismuth-Corlette classification as well as degree of differentiation was analyzed. ResultsThere were 318 bile duct segments in 53 HCCA patients. The accuracy rate of DCE-MRI + MRCP was 93.7% (298/318), the sensitivity was 91.5% (161/176), and the specificity was 96.5% (137/142). The accuracy rate of DCE-MRI + MRCP + DWI was 96.5% (307/318), the sensitivity was 96.0% (169/176), and the specificity was 97.2% (138/142). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) of DCE-MRI + MRCP + DWI was 0.966 [95%CI (0.940, 0.983), P＜0.001], and its diagnostic efficacy was superior to that of DCE-MRI + MRCP [AUC=0.940, 95%CI (0.908, 0.963), P＜0.001]. The DeLong test indicated a statistically significant difference in AUC between the two sequences (Z=2.633, P＜0.01). The accuracy rates of preoperative Bismuth-Corlette classification of HCCA evaluated by DCE-MRI + MRCP and DCE-MRI + MRCP + DWI were 86.8% (46/53) and 94.3% (50/53), respectively. After adding the DWI sequence, the consistency between Bismuth-Corlette classification results and surgical pathological classification results (Kappa=0.922, P<0.001) was higher than that of DCE-MRI + MRCP sequence (Kappa=0.820, P<0.001), with a statistically significant difference (χ2=160.370, P<0.001). In addition, the ADC value of HCCA was negatively correlated with tumordegree of differentiation (rs=–0.524, P<0.001), but had no significant correlation with its Bismuth-Corlette classification (rs=–0.058, P=0.682). ConclusionsDCE-MRI + MRCP + DWI sequence can effectively improve the accuracy in preoperative evaluation of the involvement of bile duct segments and Bismuth-Corlette classification of HCCA, which provides guidance for precise preoperative surgical planning in clinical practice. In addition, the ADC value can provide additional information required for non-invasive preoperative prediction of the prognosis of HCCA patients.