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Objective To prospectively evaluate the inter- and intraobserver agreement of apparent diffusion coefficient (ADC) measurements in free breathing, breath-hold, and respiratory triggered diffusion-weighted imaging (DWI) of lung cancer. Methods Twenty-two patients with lung cancer (tumor size >2cm) underwent DWIs (3.0T) in three imaging methods. Lesion ADCs were measured twice by both of the two independent observers and compared. Results No statistical significance was found among methods, though respiratory-triggered DWI tended to have higher ADCs than breath-hold DWI. Great inter- and intraobserver agreement was shown. Conclusion ADCs had good inter- and intraobserver agreement in all three DWI methods.

Purpose To assess the ability of diffusion-weighted imaging (DWI) for evaluating T stage and correlation with histological T stage of rectal cancer. Method The diagnostic accuracy, sensitivity, and specificity of T 2 WI and DWI combined with T 2 WI for T stage were evaluated. Mean tumor apparent diffusion coefficient (ADC) was compared with histological T stage. Result There were no significant differences in the diagnostic accuracy, sensitivity, and specificity no matter what kind of T stage was concerned. The difference between ADC values and histological T stage were significantly different. Conclusion DWI was useful for evaluating T stage of rectal cancer. The ADC may predict the histological grade.

Purpose Biomechanical properties can be used as biomarkers to diagnose tumors, monitor tumor development, and evaluate treatment efficacy. The purpose of this preliminary study is to characterize the biomechanical environment of two typical liver tumors, hemangiomas (HEMs) and hepatocellular carcinomas (HCCs), and to investigate the potential of using strain metrics as biomarkers for tumor diagnosis, based on a limited clinical dataset. Methods Magnetic resonance (MR) tagging was used to quantify the motion and deformation of the two types of liver tumors. Displacements of the tumors arising from a heartbeat were measured over one cardiac cycle. Local biomechanical conditions of the tumors were characterized by estimating two principal strains (e1 and e2 ) and an octahedral shear strain (esoct ) of the tumor and its peripheral region. Biomechanical conditions of the tumors were compared with those of the arbitrarily selected regions from healthy volunteers. Results We observed that the HCCs had significantly smaller strain values compared to their peripheral tissues. However, the HEMs did not have significantly different strains from those of the peripheral tissues, and were similar to healthy liver regions. The sensitivity of using e1 , e2 , and esoct to diagnose HCC were all 1, while the sensitivity of using e1 , e2 , and esoct to diagnose HEM were 0.67, 0.17, and 0.67, respectively. Conclusions Lagrangian strain metrics provide insight into the biomechanical conditions of certain liver tumors in the human body and may provide another perspective for tumor characterization and diagnosis.

Background The ischemia penumbra area is not easy to be detected accurately using noninvasive imaging methods. Objective We aim to assess the diagnostic value of susceptibility-weighted imaging (SWI) for ischemic penumbra in patients with acute ischemic stroke. Methods A retrospective analysis was carried out in 47 patients with ischemic stroke involving the middle cerebral artery. Mean transit time (MTT), time to peak, relative cerebral blood flow, and relative cerebral blood volume maps were created after image processing. Results No significant difference was found in the mismatch between the SWI and diffusion-weighted imaging (SWI-DWI) or in the MTT-DWI mismatch scores (P= 0.056, Kappa = 0.864). Conclusions SWI provides information comparable to PWI and, thus, could serve as a reliable magnetic resonance technique for assessing ischemic penumbrae.

Objective To explore the mismatched manifestation between regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) of astrocytomas. Methods Both conventional and perfusion CT were performed on 29 patients with pathologically confirmed astrocytomas (15 cases in Grades I–II, 14 cases in Grades III–IV). Time-density curves were plotted, cerebral blood flow and volume maps were generated, and the values between rCBF and rCBV in the same region of interest (ROI) were compared. Results Twelve low-grade astrocytomas showed low or medium values of both rCBF (46.95±22.92 ml ⋅ 100 g −1 ⋅ mm −1 ) and rCBV (5.74±3.61 ml ⋅ 100 g −1 ); 12 high-grade astrocytomas showed high values of both rCBF (95.44±42.58 ml ⋅ 100 g −1 ⋅ min −1 ) and rCBV (9.24±5.32 ml ⋅ 100g −1 ). These cases exhibited agreement between the values of rCBF and rCBV. However, the remaining five astrocytomas were mismatched, showing reduced rCBF value and increased rCBV value in the same ROI. The discrepancy may mislead to an inaccuracy of perfusion CT in grading gliomas. Conclusions The mismatched manifestation between rCBF and rCBV occasionally exists in some areas of astrocytomas. Hence, attention should be paid to assessments in preoperative grading of astrocytomas and in monitoring therapeutic effects.

Objective This study aimed to determine a contrast medium injection rate that ensures both accuracy for data and safety for operation by comparing hemodynamic parameters of brain CT perfusion imaging with varied injection rates. Methods Twenty-four healthy volunteers were divided into three groups based on contrast medium injection rates (4.5, 6.0, and 7.5 ml/s). For all subjects, CT perfusion scanning was started at 4 s after antecubital venous bolus of contrast media injection. A perfusion-analyzing software package was used to produce a time–density curve in the anterior cerebral artery and the superior sagittal sinus and calculate the regional cerebral blood flow (rCBF) in the gray matter and the white matter. The hemodynamic indices were compared among the three groups, and statistical analysis was carried out using the F test. Results The time for the arterial rise to reach the peak value for the 7.5-ml/s group was only 0.2 s ahead of the initiation time for the rise of the superior sagittal sinus. The differences of rCBF in the gray matter and the white matter among the three groups were statistically significant. rCBF in the gray matter and the white matter for the 7.5-ml/s group was 52.8 ml · min −1 100 g −1 · (±3.1) and 21.9 ml · min −1 · 100 g −1 (±2.4), respectively. Conclusions The use of the 7.5-ml/s injection rate can meet the prerequisite of the maximum slope model, and the resulting rCBF can be very close to that measured by positron emission tomography. Therefore, 7.5 ml/s was an ideal contrast medium injection rate.

To compare the value of liver acquisition with volume acceleration (LAVA) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing benign and malignant intraductal papillary mucinous neoplasms (IPMN) of the pancreas.The MR findings of 35 IPMN patients confirmed by pathology were analyzed retrospectively, and the sequences included T1WI, T2WI, LAVA, and MRCP. All patients were divided into two groups: the group of MRI enhancement (including T1WI, T2WI, and MRI enhancement) and the group of MRCP (including T1WI, T2WI, and MRCP). Two groups were evaluated by the receiver operating characteristic (ROC) curve.Totally 23 cases of intraductal papillary mucinous tumors and 12 cases of intraductal papillary mucinous carcinomas were diagnosed. Finally, 29 cases (29/35) of IPMN were diagnosed correctly in the group of MR enhancement, and 25 cases (25/35) diagnosed correctly in the group of MRCP. The differential diagnostic accuracy of the group of MRI enhancement (82.9%) was higher than that of the group of MRCP (71.4%), although the difference was not statistically significant (P=0.068). The sensitivity, specificity, positive predictive value, and the area under the ROC curve (AUC) of the group of MRI enhancement were 83.3%, 82.6%, 71.4%, and 0.850, and those of the group of MRCP were 75.0%, 69.6%, 52.3%, and 0.723. The AUC of the group of MRI enhancement was significantly larger than that of the group of MRCP (P=0.0465).MRI enhancement is more valuable than MRCP in the differential diagnosis of benign and malignant IPMN.

To report the results of a safety analysis from a phase II trial comparing administration of weekly paclitaxel plus S-1 (TS) versus paclitaxel plus 5-fluorouracil (5-FU)/calcium folinate (LV) (TLF) as first-line therapy for advanced gastric cancer.Patients (n = 240) with previously untreated advanced gastric cancer were randomly assigned to receive either TS or TLF in a 28-day cycle for six cycles.The clinical features of both sets of patients were similar, with the exception of the incidence of prior chemotherapy (P0·05). Most treatment-related adverse events occurred at similar rates in both treatment arms. However, patients receiving TS experienced an increase in all-grade especially grade 3/4 neutropenia, with an incidence of 43·7% in the TS arm and 16·3% in the TLF arm, respectively (P0·05). Other severe adverse events were infrequent and not significantly different between the groups.The safety and tolerance of weekly paclitaxel plus S-1 or 5-FU/LV is well in untreated advanced gastric cancer patients.

To evaluate the efficacy and safety of weekly paclitaxel combined with S-1 or fluorouracil in the first line treatment of advanced gastric carcinoma.Two hundred and forty patients with untreated advanced gastric carcinoma were randomized into two arms, patients in the experimental arm were given paclitaxel and S-1, while those in the control arm received paclitaxel and fluorouracil. The regimen of experimental arm was paclitaxel 60 mg/m(2) by intravenous infusion, day 1, 8, 15; S-1 80 - 120 mg/day given by oral administration, day 1 - 14. The regimen of control arm was fluorouracil 500 mg/m(2) by intravenous infusion continuously, day 1 - 5; CF 20 mg/m(2) by intravenous infusion, day 1 - 5. The regimens in both arms were repeated every 28 days. The efficacy and safety of both arms were assessed.Two hundred and twenty-eight patients were analyzed in the full analysis set, and 192 patients were analyzed in per-protocol set (experimental arm 100 patients, control arm 92 patients). The overall response rates of experimental and control arms were 50.0% and 28.3% (P = 0.002), and the disease control rates were 82.0% and 70.7% (P = 0.064), respectively. The primary endpoints of experimental arm were non-inferior to that of the control arm. The secondary endpoint of experimental arm in terms of median progression free survival was significantly better than that of control arm (5 months versus 4 months, P = 0.006). The experimental arm had a higher incidence of grade III-IV bone marrow suppression than the control arm, but the incidence of fever in both arms was not significantly different.Oral administration of S-1 is an alternative option of venous infusional fluorouracil. Weekly paclitaxel combined with S-1 is a safe regimen and has a promising efficacy.

Intravenous urography (IVU) combined with add-on CT (IVU-CT) can help to provide more diagnostic information for determining the localization and nature of ureteral abnormalities with less irradiation dose. This study aimed to determine the value of IVU-CT for diagnosis of ureteral diseases, where IVU is insufficient to determine the diagnosis.Two hundred and eighty patients underwent IVU for suspected ureteral disorders, which identified a definite diagnosis in 184 cases and was insufficient for definite diagnosis in 96 cases designated as indeterminate diagnosis. Subsequently 90 patients (six patients declined CT) with indeterminate diagnosis consented to undergo immediate or delayed helical CT scan. The CT data were transferred to the workstation for post-processing, and the cost and mean effective dose for each imaging method were calculated and compared indirectly.Of the 90 indeterminate diagnosis cases, diagnosis was determined in 86 cases by IVU-CT with a diagnostic accordance rate of 95.6%, while 184/280 (65.7%) had diagnosis determined by IVU alone. There was a significant difference between IVU and IVU-CT in the determination of the diagnosis of ureteral diseases (c(2) = 36.4, P0.05). The cost of IVU equals to 1/8 - 1/9 of that for CT urography (CTU), and the cost of IVU-CT is as much as 1/3 of CTU. CTU results in the highest mean effective dose, approximately nine times that for IVU and three times that for IVU-CT.IVU-CT provides valuable information for the localization and diagnosis of ureteral abnormalities and may be considered as an efficient, cost-effective and low-dose diagnostic technique in this setting.

Objective To retrospectively assess the diagnostic efficacy of dual-source CT angiography (DSCTA) in detecting and grading coronary stenosis. Methods Institutional review board approval and informed consent were obtained. One hundred ten patients were performed with both DSCTA and conventional coronary angiography (CCA) without heart rate or rhythm control in 1 week. Regarding CCA as the gold standard, the assessable rate of coronary arteries and diagnostic value of coronary stenosis using DSCTA were analyzed, respectively. The intermodality agreement between DSCTA and CCA in grading coronary stenosis was assessed using κ test. The value of DSCTA in diagnosing >50% coronary stenoses was also assessed. Results The overall assessable rate of DSCTA was 98.6% in detecting coronary arteries; there was no significant difference between assessable rates from different groups of heart rate ( χ 2 =0.45, P > .05). The efficacy of DSCTA was of 97.9% sensitivity, 97.3% specificity, 90.4% positive predictive value, and 99.4% negative predictive value for coronary stenosis; and 94.7% sensitivity, 96.8% specificity, 83.7% positive predictive value, and 99% negative predictive value for >50% stenoses. The intermodality agreement in diagnosing coronary stenosis was satisfactory ( k =0.87, u =58.46, P Conclusions As an effective noninvasive diagnostic tool, DSCTA yields a promising accuracy and reliability in assessing coronary stenosis. It may be recommended as a valuable screening tool for coronary artery disease, and a potential challenge to CCA as well.

Objective To investigate the improvement in postprocessing time and image quality of 3D negative-contrast CT cholangiography (nCTC) with minimum intensity projection (minIP). Methods Thirty-eight patients with suspected biliary obstruction who underwent portal phase helical CT were retrospectively studied. Three-dimensional nCTC was generated using 3D tools with manual cut function in three methods: one-slice, two-slice, and vari-slice cut slab, respectively. After adjusting the threshold level to about −20 HU, the erosion function with a value of one voxel was employed each time for further cleaning up hypodense interfering voxels such as fat and air that remained and the procedure was stopped before the biliary and pancreatic ducts were overeroded. Results Mean values of the total postprocessing time of the three manual cut methods for 3D nCTC were 57.8, 29.9, and 20.6 min, respectively. After the first erosion, interfering voxels were removed in more than half of the cases and they could be primarily eliminated following the second erosion. Meanwhile, the pancreaticobiliary ducts showed obvious erosion findings at the third erosion. Conclusions The vari-slice manual cut method was shown to be the most timesaving postprocessing method and the image quality for 3D nCTC can be improved when one to two frequencies of erosion are applied.

To evaluate the effect of herceptin(trastuzumab) plus adjuvant chemotherapy on the prognosis of patients with human epithelial growth factor receptor 2 (HER2) positive early-stage breast cancer by Meta-analysis.Search all of randomized clinical trials (RCTs) on herceptin plus adjuvant chemotherapy for HER2 positive early-stage breast cancer in MEDLINE, EMBase, Cochrane library, Clinical Trails, ASCO Conference data, CHKD, Wanfang Database, VIP information, scholar.google.com and SIGLE. A Meta-analysis was carried out by collecting information based on the inclusion and exclusion criteria from all papers available.The Meta-analysis included 4 trials. A total of 9116 patients were included in the analysis(4555 in the study group and 4561 in the control group). There were statistical differences between the study group(herceptin plus adjuvant chemotherapy) and the control group(adjuvant chemotherapy) in the disease-free survival rate [relative risk(RR)=1.08, 95% CI, 1.06-1.09, P0.001], the overall survival rate(RR=1.01, 95% CI, 1.01-1.02, P=0.0003), the distant recurrence rate(RR=0.49, 95% CI, 0.42-0.57, P0.001), and the cardiac events rate (RR=3.93,95% CI, 1.03-15.06, P=0.05).Herceptin plus adjuvant chemotherapy can improve the disease-free survival rate and the overall survival rate, decrease distant recurrence rate of patients with HER2 positive early-stage breast cancer, but may cause heart toxicity, especially when combined with anthracycline (doxorubicin).

To determine the short-term efficacy and security of whole body hyperthermia (WBH) combined with chemotherapy for advanced cancer.Different chemotherapy regimens were applied in 138 patients with advanced cancer. Among them, 68 patients (Group A) didn't receive any other therapies. The other 70 patients (Group B) received WBH together with chemotherapy. WBH was maintained at 40 degrees C approximately 42 degrees C for 50 approximately 60 min (once or twice every week and 4 times a cycle).In Group A, the rate of complete remission (CR) was 2.9%, partial remission (PR) was 36.8%, stable disease was 35.3%, progressive disease was 25.0%, the overall response rate (CR + PR) was 39.7%; while in Group B, the corresponding figures were 5.7%, 52.9%, 25.7%, 25.0%, and 58.6%, respectively. There was significant difference between the two groups (P0.05). The rates of III + IV gastrointestinal tract andmyelosuppression toxicities were 26.5% and 16.2% in Group A, while 27.1% and 18.6% in Group B. No significant difference was found.WBH combined with chemotherapy is efficient and safe for advanced cancer, and is worth generalizing extensively.