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Background To investigate the diagnostic value of arterial spin labeling (ASL) and intravoxel incoherent motion (IVIM) imaging in distinguishing nasopharyngeal carcinoma (NPC) in T1 stage from healthy controls (HC). Methods Forty-five newly diagnosed NPC patients in the T1 stage and thirty-one healthy volunteers who underwent MR examinations for both 3D pseudo-continuous ASL (pCASL) and IVIM were enrolled in this study. The Mann-Whitney test was used to compare the mean values of blood flow (BF) derived from pCASL and IVIM derived parameters, including apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f) between NPC tumor and benign nasopharyngeal mucosa of HC. Receiver Operating Characteristic (ROC) was performed to determine diagnostic cutoff and efficiency. The correlation coefficients among parameters were investigated using Spearman’s test. Results The NPC in the T1 stage showed higher mean BF, lower ADC, D, and f compared to benign nasopharyngeal mucosa (P < 0.001) with the area under curve of ROC of 0.742–0.996 (highest by BF). BF cutoff was set at > 36 mL/100 g/min; the corresponding sensitivity, specificity, and accuracy in differentiating NPC stage T1 from benign nasopharyngeal mucosa were 95.56% (43/45), 100% (31/31) and 97.37% (74/76), respectively. BF demonstrated moderate negative correlation with D* on HC (ρ [Spearman correlation coefficients] = − 0.426, P = 0.017). Conclusions ASL and IVIM could reflect the difference in perfusion and diffusion between tumor and benign nasopharyngeal mucosa, indicating a potential for accessing early diagnosis of NPC. Notably, BF, with a specificity of 100%, demonstrated better performance compared to IVIM in distinguishing malignant lesions from healthy tissue.

BackgroundMost hypopharyngeal cancers (HPCs) develop lymph node metastasis (LNM) at initial diagnosis. Understanding the pattern of LNM in HPC could help both surgeons and radiologists make decisions in the management of cervical lymph nodes.MethodsA total of 244 newly diagnosed HPC patients between January 2010 and December 2018 were recruited from three specialized cancer hospitals in mainland China. All patients received pre-treatment magnetic resonance imaging (MRI), and definitive radiotherapy with or without concurrent chemotherapy. We reassessed the features of the primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes at each level. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Univariate and multivariate analyses were used to determine the risk factors for bilateral and regional lymph node metastasis.ResultsThe cohort consisted of 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), and 2 post-cricoid cancers (PCC). A total of 176 patients (72.1%) presented with MRI-detectable LNMs. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9%, and 16.4%, respectively. Based on the prevalence of LNM at each level, we hypothesize that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II and III (61.0% and 55.4%), Level IV and RPLN (15.9% and 11.3%), and Level V and VI (1.5% and 3.1%). For PWCs, lymphatic drainage is carried out at two stations: Level II, III, and RPLN (48.9%, 40.4%, and 34.0%) and Level IV-VI (6.4%, 0%, and 2.1%). According to univariate and multivariate analyses, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338) and RPLN metastasis (P = 0.017, HR = 2.880 95%CI, 1.209-6.862). However, pyriform sinus invasion was less likely to present with bilateral LNM (P = 0.027, HR = 0.311, 95%CI, 0.111-0.875) and RPLN metastasis (P = 0.028, HR = 0.346, 95%CI, 0.134-0.891).Conclusions and RelevanceThe primary tumor site and extent of invasion are related to the pattern of lymph node metastasis. That is, the metastasis would drainage station by station along different directions.

BackgroundTo assess the prevalence, risk factors and prognostic significance of retropharyngeal lymph node (RPLN) metastasis diagnosed by magnetic resonance imaging (MRI) in patients with hypopharyngeal squamous cell carcinoma (HPSCC).Methods259 patients from three cancer institutions in China from Jan 2010 to Dec 2018 were analyzed, retrospectively. All the patients had been given pre-treatment magnetic resonance imaging (MRI) of head and neck and were then treated with definitive radiotherapy with or without chemotherapy. Pretreatment diagnostic MRIs were reviewed by a dedicated head and neck radiologist, for the presence or absence of radiographically positive RPLN, cervical LN and tumor invasion.Demographic variables were analysed by descriptive statistics using SPSS 20.0. Predictors of the presence of RPLN and its prognostic significance were examined.ResultsRPLN metastasis was discovered in 44 patients (17%). Logistic analysis showed that posterior pharyngeal wall (PPW) primary tumor; PPW invasion; N2-3; multiple cervical lymph node (LN) involvement (>2 LNs) were associated with RPLN metastasis, with metastasis rates 37%, 30%, 31% and 33% respectively. Patients with RPLN metastasis had a significantly reduced 5-year overall survival (OS) and disease-free survival (DFS) compared to the non-RPLN metastasis group (OS 28% vs. 48%, p=0.001; DFS 25% vs. 41%, p=0.040).ConclusionsRPLN metastasis was not uncommon in HPSCC patients. Risk factors were: PPW primary tumor, PPW invasion and cervical LN status. RPLN metastasis is a poor prognosticator for survival.

To evaluate whether the DCE-MRI derived parameters integrated into clinical and conventional imaging variables may improve the prediction of tumor recurrence for locally advanced cervical cancer (LACC) patients following concurrent chemoradiotherapy (CCRT). Between March 2014 and November 2019, 79 consecutive LACC patients who underwent pelvic MRI examinations with DCE-MRI sequence before treatment were prospectively enrolled. The primary outcome was disease-free survival (DFS). DCE-MRI derived parameters, conventional imaging, and clinical factors were collected. Univariate and multivariate Cox hazard regression analyses were performed to evaluate these parameters in the prediction of DFS. The independent and prognostic interested variables were combined to build a prediction model compared with the clinical International Federation of Gynecological (FIGO) staging system. Lymph node metastasis (LNM) and the mean value of ve (ve_mean) were independently associated with tumor recurrence (all p

To prospectively assess the incremental value of intravoxel incoherent motion (IVIM) DWI in determining whether the adenocarcinoma originated from the uterine corpus or cervix. Eighty consecutive uterine adenocarcinomas from the cervix or endometrium confirmed by histopathology underwent IVIM DWI acquisition on a 3.0T MR scanner before treatment. Five morphologic features were analyzed using Fisher exact test; IVIM DWI-derived parameters, including apparent diffusion coefficient (ADC), true coefficient diffusivity (D), perfusion-related diffusivity (D*), and perfusion fraction (f) were compared using two-sample independent t-test or Mann–Whitney U test. Logistic regression analysis was used to develop different diagnosis model. The ROCs of these variables and diagnostic models were compared to evaluate the diagnostic efficiency. Among single morphologic features, tumor location yielded the highest AUC of 0.891 in distinguishing endometrial adenocarcinoma (EAC) from cervical adenocarcinoma (CAC). Among single IVIM DWI-derived parameters, f values showed the best diagnostic performance (AUC: 0.837) at the optimal cut-off value of 0.261. Additionally, the combined diagnostic model, which consisted of tumor location, ADC and f showed the largest AUC of 0.967 with the highest sensitivity of 88.14%, highest specificity of 100.00%, and highest accuracy of 91.25%. IVIM DWI-derived parameters add additional diagnostic value to conventional morphologic features. A combined diagnosis model is a promising imaging tool for predicting the origin of uterine adenocarcinoma, further contributing to therapeutic decision-making.

To evaluate the diagnostic potential of diffusion kurtosis imaging (DKI) functional maps with whole-tumor texture analysis in differentiating cervical cancer (CC) subtype and grade. Seventy-six patients with CC were enrolled. First-order texture features of the whole tumor were extracted from DKI and DWI functional maps, including apparent kurtosis coefficient averaged over all directions (MK), kurtosis along the axial direction (Ka), kurtosis along the radial direction (Kr), mean diffusivity (MD), fractional anisotropy (FA), and ADC maps, respectively. The Mann-Whitney U test and ROC curve were used to select the most representative texture features. Models based on each individual and combined functional maps were established using multivariate logistic regression analysis. Conventional parameters—the average values of ADC and DKI parameters derived from the conventional ROI method—were also evaluated. The combined model based on Ka, Kr, MD, and FA maps yielded the best diagnostic performance in discrimination of cervical squamous cell cancer (SCC) and cervical adenocarcinoma (CAC) with the highest AUC (0.932). Among individual functional map derived models, Kr map–derived model showed the best performance when differentiating tumor subtypes (AUC = 0.828). MK_90th percentile was useful for distinguishing high-grade and low-grade in SCC tumors with an AUC of 0.701. The average values of MD, FA, and ADC were significantly different between SCC and CAC, but no conventional parameters were useful for tumor grading. The whole-tumor texture analysis applied to DKI functional maps can be used for differential diagnosis of cervical cancer subtypes and grading SCC. • The whole-tumor texture analysis applied to DKI functional maps allows accurate differential diagnosis of CC subtype and grade. • The combined model derived from multiple functional maps performs significantly better than the single models when differentiating tumor subtypes. • MK_90th percentile was useful for distinguishing poorly and well-/moderately differentiated SCC tumors with an AUC of 0.701.

Purpose To investigate mono-exponential, bi-exponential, and stretched-exponential models of diffusion-weighted imaging (DWI) for evaluation of prognosis-related risk factors of endometrial cancer (EC). Method Sixty-one consecutive patients with EC who preoperatively underwent pelvic MRI with multiple b value DWI between September 2016 and May 2018 were enrolled. The apparent-diffusion-coefficient (ADC), bi-exponential model parameters (D, D* and f) and stretched-exponential model parameters (DDC and α) were measured and compared to analyze the following prognosis-related risk factors confirmed by pathology: histological grade, depth of myometrial invasion, cervical stromal infiltration (CSI) and lymphovascular invasion (LVSI). A stepwise multilvariate logistic regression and the receiver operating characteristic (ROC) curves were performed for further statistical analysis. Results Lower ADC, D, f, and DDC were observed in tumor with high grade compared with a low-grade group, and the largest area under curve (AUC) was obtained when combining f and DDC values. ADC, D, f, DDC, and α were significantly different in patients with deep myometrial invasion (DMI) compared to those without DMI; the combination of f, DDC and α showed the highest AUC. Significantly different ADC and f were found between patients’ presence and absence CSI; the f values showed the highest diagnostic performance with an AUC of 0.825. Regarding the LVSI, ADC, D*, f, and DDC were significantly lower in tumors with LVSI compared to those without LVSI; the combination of f and DDC showed the largest AUC. Conclusion Multiple mathematical DWI models are a useful approach for the prediction of prognosis-related risk factors in EC.

Purpose To investigate the application of multi-b-value DWI parameters for the assessment of risk stratification in early-stage endometrial cancer (EC). Material and methods Fifty-three patients with early-stage EC who preoperatively underwent multi-b-value DWI with 13 b values (from 0 to 2000s/mm²) were included in this study. Multi-b-value DWI derived parameters, including apparent diffusion coefficient (ADC), true diffusivity (D), perfusion-related diffusivity (D*) and perfusion fraction (f) were measured independently by two radiologists. In addition, binary logical regression model was used to calculate predicative probability of combined parameters indicating statistical significance in differentiating risk stratification of early-stage endometrial cancer. Receiver operating characteristic analysis was performed for all single and combined parameters. Results The ADC and D values were significantly lower in intermedium-risk compared with low-risk (P = 0.000 and 0.011), as well as high-risk compared with low-risk of early-stage EC (P = 0.001 and 0.013), while f values only showed significant differences between low-risk and intermedium-risk groups (P = 0.011). Among the single parameters, the ADC values had the highest area under the ROC curve (AUC) in the identification of the low-risk of early-stage EC (AUC=0.892). Moreover, the combination of ADC and f value had the best diagnostic performance with the AUC of 0.912, the sensitivity of 81.1% and the specificity of 87.5%. Conclusion The multi-b-value DWI parameters provide valuable imaging biomarkers for the assessment of risk stratification in early-stage endometrial cancer. This approach might facilitate the selection of the optimal therapeutic approach and lead to the greater personalization of cancer care.

Purpose This prospective study aimed to investigate the value of kinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating uterine endometrioid adenocarcinoma (EAC) from adenocarcinoma of cervix (AdC). Methods Seventy-five newly diagnosed patients with distinctive pathology underwent DCE-MRI. Observers independently calculated the tumor diameters and DCE-MRI parameters using both population and individual-based arterial input function (AIF). Inter-observer consistency was evaluated, and a comparative analysis between EAC (n = 47) and AdC (n = 28) was performed. Regression analysis was used to select parameters that best distinguished EAC from AdC, and to generate predictive models. Receiver operating characteristic curve (ROC) was applied to calculate the diagnostic efficiency of single parameter and the predictive models. Results Inter-observer consistency was excellent (intra-class correlation [ICC] = 0.902−0.981), especially when calculated via population AIF with relatively higher ICC and smaller SD on Bland-Altman plot. Tumor diameters were not correlated with tumor types. All the DCE-MRI parameters were lower in EAC compared to AdC, except Kep by population AIF and TTP by both sets of AIFs. The statistical parameters were Ve, Maxslop, and Maxconc by population AIF, and Maxslop and Ktrans by individual AIF included in the predictive models, respectively. The two predictive models with combined parameters showed improved diagnostic efficiency in differentiating these two diseases compared with a single parameter. Conclusion DCE-MRI can quantitatively evaluate the perfusion difference between EAC and AdC, thus improving the identification of uterine adenocarcinoma with uncertain biopsy pathology.

88 Background: Splenic enlargement has been reported in patients treated with oxaliplatin. However, the characteristics of oxaliplatin-induced splenomegaly were not well studied. Here we evaluated the change of splenic volume and its clinical significance in patients treated by oxaliplatin-based regimen. Methods: Patients with stage II-IV primary colon cancer treated with oxaliplatin and capecitabine in China National Cancer Center from January 2016 to December 2017 were screened for this retrospective study. Those with complete laboratory tests and computed tomographic data before, during and up to 1.5 years after the chemotherapy were selected. The splenic size was measured by AWVolumeshare5. Splenomegaly was defined as an over 30% increase of splenic size from baseline. Recovery of splenomegaly was defined as the splenic size fell back to a 0.9 to1.1-fold range of baseline. Results: Out of a total of 144 patients, 102 (70.8%) had over 30% increase, 72 (50.0%) had over 50% increase, and 22 (15.3%) had over 100% increase in splenic size after oxaliplatin-based regimen. Among the 102 splenomegaly patients, 5 (4.9%) develop splenomegaly within 3 chemotherapy cycles, 53 (53.0%) within 6 cycles, 73 (71.6%) within 9 cycles, and 102 (100.0%) within 3 months after the last administration of oxaliplatin. Compared to the group without splenomegaly, patients with splenomegaly received more cycles of oxaliplatin administrations (median 8 vs 6, p < 0.001) and greater dose intensity (total dose per square meter) (median 822.8mg/m2 vs 629.3mg/m2, p < 0.001). Patients with splenomegaly had higher incidence of thrombocytopenia (61.7% vs 38.1%, p = 0.009) and are more likely to undergo oxaliplatin dose reduction due to thrombocytopenia (21.6% vs 7.1%, p = 0.038). The recovery rates of splenic size within 0.5, 1 and 1.5 years after the end of oxaliplatin treatment were 23.2%, 50.6% and 74.3%, respectively. Conclusions: Splenomegaly are common in patients treated with oxaliplatin-based chemotherapy, and most would recover in 1.5 years after completion of therapy. Patients with splenomegaly are prone to experience thrombocytopenia and oxaliplatin dose reduction. Further studies are needed to reveal the mechanism how oxaliplatin induce splenomegaly.

Purpose This prospective study aimed to investigate the correlation between two perfusion methods: arterial spin labeling (ASL) and dynamic contrast enhanced (DCE) technique in patients with nasopharyngeal carcinoma (NPC) and to optimize ASL protocol. Materials and methods Forty-five newly diagnosed NPC patients underwent MR examinations with both 3D pseudo-continuous ASL (pCASL) and DCE-MRI sequences. Tumor blood flow (TBF) derived in pCASL with three post-labeling delay (PLD) times (i.e. 1.0 s, 1.5 s, and 2.0 s) and DCE derived parameters including MaxSlop, contrast enhancement ratio (CER), Initial area under the gadolinium curve (IAUGC), Ktrans, Kep and Ve were measured by two independent observers, and their correlation coefficients were investigated using Spearman test. Results Inter-observer reproducibility (ICC = 0.931–0.998) was observed to be excellent. Positive correlations between mean, maximum and minimum value of TBFs with different PLDs and DCE-MRI parameters (except Ve) were respectively observed (r = 0.308–0.688, P = 0.000–0.040). Conclusion pCASL may be an alternative method for DCE-MRI in assessing the perfusion level in NPC in the future.

Leptomeningeal metastasis (LM) is a devastating complication of solid tumors. A retrospective study was carried out to evaluate the outcome and prognostic factors of LM. Patients with LM were identified through MRI from January 2008 to August 2011. 46 patients were included. 32 had NSCLC, five had breast cancer and nine had other cancers. Treatment included radiotherapy in 49 %, intrathecal chemotherapy in 12 %, and systemic chemotherapy in 61 % of the patients. The median survival was 4.4 (range, 0-45) months. KPS score, radiotherapy and systemic treatment were significantly associated with survival. Eighteen (58 %) of NSCLC patients received EGFR-TKI therapy, with a median survival of 13 months. EGFR-TKI therapy was identified as an independent prognostic factor for survival in the NSCLC subgroup. The prognosis remains poor in patients with LM from solid tumors. KPS ≥ 70, systemic treatment and radiotherapy represent positive prognostic factors. EGFR-TKI therapy improves outcomes of LM in selected NSCLC patients.

To investigate the potential of various metrics derived from mono-exponential model (MEM), bi-exponential model (BEM) and stretched exponential model (SEM)-based diffusion-weighted imaging (DWI) in diagnosing and differentiating the pathological subtypes and grades of uterine cervical carcinoma. 71 newly diagnosed patients with cervical carcinoma (50 cases of squamous cell carcinoma [SCC] and 21 cases of adenocarcinoma [AC]) and 32 healthy volunteers received DWI with multiple b values. The apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), water molecular diffusion heterogeneity index (alpha), and distributed diffusion coefficient (DDC) were calculated and compared between tumour and normal cervix, among different pathological subtypes and grades. All of the parameters were significantly lower in cervical carcinoma than normal cervical stroma except alpha. SCC showed lower ADC, D, f and DDC values and higher D* value than AC; D and DDC values of SCC and ADC and D values of AC were lower in the poorly differentiated group than those in the well–moderately differentiated group. Compared with MEM, diffusion parameters from BEM and SEM may offer additional information in cervical carcinoma diagnosis, predicting pathological tumour subtypes and grades, while f and D showed promising significance. • DWI-derived parameters by different models are related but provide diversified information. • Commonly used ADC by MEM of DWI overestimates the tissue water diffusivity. • DWI processed by BEM could separate blood perfusion from true diffusion effects. • The derived diffusion-related and perfusion-related parameters by BEM are superior to ADC.

Tumor extent assessment of nasopharyngeal carcinoma (NPC) is critical for delineating the radiotherapeutic target region. We aimed to investigate the use of the fusion images of fat suppressed T2WI (T2WI-FS) with arterial spin labeling (ASL) in measuring the volume of NPC. Two observers measured the volume of 21 untreated NPC using T2WI-FS, T2WI-FS/ASL (with PLD = 1.0, 1.5 and 2.0 s) fusion images and enhanced T1WI separately. Correlation and consistency were used to compare 1) measurements using T2WI-FS/ASL and T2WI-FS alone, taking enhanced T1WI images as a benchmark; 2) measurements between observers. Significant correlations existed between different series (r: 0.896~0.973). Measurements from the two observers using T2WI-FS/ASL had relatively higher intra-class correlation (ICC) (0.980~0.997) and lower within-subject coefficients of variation (wsCV) (14.76%~22.96%) when compared to using T2WI-FS alone (ICC: 0.978, 0.951, wsCV: 21.61%, 24.21%), while the T2WI-FS/ASL 1.0 s exhibited the best performance. Remarkably high ICC value (0.981~0.996) and relatively low wsCV (9.95%~17.91%) were obtained for the two observers using same series. Compared to those obtained using T2WI-FS alone, measurements made using T2WI-FS/ASL were more consistent with those made using enhanced T1WI. The T2WI-FS/ASL fusion images has the potential to be an alternative to enhanced T1WI, when contrast administration can not be performed.

Purpose To compare contrast-enhanced isotropic 3D-GRE-T1WI sequence vs. conventional non-isotropic sequence in terms of image quality, estimated signal-to-noise ratio (eSNR), relative tumor contrast and performance of cervical cancer staging. Methods This retrospective study was approved by the institutional review board, and informed consent was waived. Seventy-one patients (47 ± 9.4 years), with pathologically-confirmed cervical cancer underwent axial contrast-enhanced 1mm3 isotropic 3D-GRE-T1WI sequence (herein referred to Isotropy), and 3-mm-thick non-isotropic sagittal and coronal sequences. Image quality score, eSNR and relative contrast between tumor to myometrium, gluteal muscle, and fat respectively, were compared between 3-mm-thick reconstructed images from Isotropy and directly scanned non-isotropic images by paired t-test. Difference in tumor staging obtained from Isotropy and combined Three-planes including reconstructed axial images, directly scanned sagittal and coronal sequence were compared by McNemar test. Results Both sequences showed similar image quality. Reconstructed images demonstrated higher eSNR, equal or lower relative tumor contrast compared with non-isotropic images. Compared with performing diagnosis on Three-planes, both reviewers showed higher accuracy when diagnosing vaginal invasion on Isotropy (p = 0.039 and 0.003, respectively). Conclusion Compared with non-isotropic sequence, 3.0T MR isotropic 3D-GRE-T1WI sequence exhibited better eSNR, providing more reliable clinical information for preoperative staging of cervical cancer.

The current report presents an extremely rare case of a 41-year-old female with advanced gastric cancer who developed scalp metastasis during the period of systemic chemotherapy. The patient did not exhibit any rash or plaque at the initial physical examination. Following the 11th cycle of chemotherapy, the patient complained of pain on the scalp and a pink lesion was identified in the parietal region on physical examination, which increased in size and became darker and ulcerated. Pathological biopsy of the lesion and cranial magnetic resonance imaging confirmed the diagnosis of scalp metastasis. The patient succumbed to the disease one month later. The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found. The present report discusses the common clinical presentations of these four cases in combination with the current case.

To test the feasibility of apparent diffusion coefficient (ADC) value obtained with 3.0 T diffusion-weighted imaging (DWI) in the characterization of renal cell carcinomas (RCC) with different pathological subtypes and grades.A total of 137 patients who were diagnosed with RCC and underwent DWI were included in this study. The diagnosis was confirmed by pathological examination of surgical specimens. Images of DWI were obtained with b values of 0 and 800 s/mm2. The ADC values in the solid area of tumors and in the corresponding regions of contralateral normal renal parenchyma were measured and analyzed statistically.The mean ADC value was significantly lower in RCC (1.381±0.444×10(-3) mm2/s) than in normal renal parenchyma (2.232±0.221×10(-3) mm2/s) (P0.001). The ADC value was also statistically different between clear cell RCC (CCRCC) and non-CCRCC, and between different grades of CCRCC except grade I vs II and grade III vs IV.ADC measurement on 3.0 T DWI provides useful information in diagnostic work-up of RCC in terms of differentiation of RCC and normal renal parenchyma, and characterization of RCC with different pathological subtypes and grades.