Objective
To investigate the value of contrast enhanced ultrasonography(CEUS) in the diagnosis of hepatic epithelioid hemangioendothelioma(HEHE).
Methods
The images of CEUS had been retrospectively evaluated in 21 lesions of HEHE which were confirmed by pathology. The perfusion patterns and time of enhancement were observed,including time to begin enhancement,time to peak enhancement,the washout time and the appearance of internal structures.
Results
The mean time of begin enhancement,time to peak,time to isoechogenity and hypoechogenity were (17.4±5.2)s,(22.0±7.2) s,(23.9±4.6)s and (42.2±13.7)s,respectively. During the arterial phase,8 lesions showed diffuse enhancement,7 lesions showed rim-like enhancement and 6 lesions showed branch enhancement. The inner margin in 6 lesions showed speculate enhancement. The central portion of the tumors was not enhanced in part lesions of 8 cases. As to time of peak enhancement,compared to the normal hepatic parenchyma,hypoenhancement,isoenhancement and hyperenhancement were observed in 10 lesions,6 lesions and 5 lesions respectively. Synchronous enhancement was observed in 11 lesions on CEUS,rapid enhancement was observed in 8 lesions and slow enhancement was observed in 2 lesions. Twenty-one lesions manifested hypoechoic mass in portal phase and delayed phase. The boundary of lesions was unclear on conventional ultrasound and became distinct after contrast injection in 21 lesions.
Conclusions
CEUS is useful for the diagnosis of HEHE.
Key words:
Contrast-enhanced ultrasound; Liver neoplasms; Hemangioendothelioma,epithelioid
Objective
To analyze the imaging characteristics of contrast-enhanced ultrasound(CEUS) and dynamic contrast enhanced magnetic resonance imaging (CEMRI) for diagnosis of hepatic epithelioid hemangioendothelioma, and to increase the accuracy of diagnostic imaging.
Methods
The imaging characteristics of CEUS and dynamic CEMRI in 11 patients with hepatic epithelioid hemangioendothelioma confirmed by surgical pathology or fine needle aspiration biopsy were retrospectively analyzed.
Results
On conventional ultrasound, 14 lesions in 11 patients showed hypoechoic. The peripheral blood flow was detected in most patients by color Doppler flow imaging and the average resistant index was 0.62±0.05. During the arterial phase, 6 lesions showed diffuse enhancement, 6 lesions showed annular enhancement and 2 lesions showed branch enhancement.As to time of peak enhancement, compared to the normal hepatic parenchyma, hypoenhancement, isoenhancement and hyperenhancement were observed in 1 lesion, 7 lesions and 6 lesions respectively. Synchronous enhancement was observed in 8 lesions on contrast-enhanced ultrasound, rapid enhancement was observed in 5 lesions and slow enhancement was observed in 1 lesion and all lesions decreased quickly in portal phase and delayed phase. On CEMRI, all lesions showed low signal on TIWI, high signal on T2WI and DWI. There were 5 lesions showed obvious annular constant enhancement and 1 lesion showed obvious annular progressive enhancement. Progressive peripheral enhancement and fully filling in delayed phase were found in 4 lesions.While progressive peripheral enhancement and incompletely filling in delayed phase were found in 3 lesions. One lesion displayed constant enhancement and incompletely filling in delayed phase. Halo sign , lollipopsign , capsular retraction sign and vessel sign were appeared in 6, 7, 8 and 8 patients respectively.
Conclusions
Both contrast-enhanced ultrasound and CEMRI have characteristic manifestations for the diagnosis of hepatic epithelioid hemangioendothelioma and cominbing them would be great significance to improve the preoperative diagnostic accuracy.
Key words:
Contrast-enhanced ultrasound; Contrast-enhanced magnetic resonance imaging; Liver neoplasms; Hemangioendothelioma, epithelioid
e14090 Background: Preoperative chemoradiation followed by surgery is the current recommended treatment for locally advanced rectal cancer. We aim to review our community cancer center experience with this approach, with attention to feasibility, toxicity, EUS staging accuracy, and elderly patient tolerance. Methods: A chart review was performed on all consecutive patients treated in cancer center between 08/01/2005 and 12/31/2009, with T3 or Any T, N+ disease. Results: 47 patients were treated with multidisciplinary evaluation, and EUS staging. 6 patients had surgery first due to bleeding (2), obstruction (1) and patient preference (3), while 41 patients underwent neoadjuvant treatment. The median radiation dose was 50.4 Gy in 28 fractions of 1.8 Gy daily; 14 (34%) and 25 (60.9%) patients received continuous infusion (CIV) 5-FU and capecitabine chemotherapy respectively. There were 29 males, 12 females; with ages from 35 to 86, median = 63 years, 10 (24.3%) patients were more than 75 years old. All 41 patients went on to surgery. Pathological CR was seen in 10 patients (24.3%). 4 patients (9.7%) were upstaged from N- by EUS to pN+ disease. Adjuvant chemotherapy with capecitabine or FOLFOX or 5-FU was administered in 38 (92%) patients, while 3 patients declined treatment. Toxicity and treatment intensity by age groups is described in the Table. Median follow was 11 months and all patients are alive with 2 (4.87% ) local recurrences. Conclusions: Neoadjuvant chemoradiation with CIV 5-FU or capecitabine with EUS staging and multimodality planning is feasible in the community setting, producing 24.3% pCR rate consistent with randomized trial data. 92% of patients, particularly 70% of elderly patients, were able to complete trimodality treatment. Definitive EUS under staging is seen in only 4 (9.7%) cases. Neoadjuvant chemoradiation of locally advanced rectal cancer should be a standard practice in the community. N Hematologic Skin GI Any grade 3 Delay/dose reduction in chemotherapy Delay/dose reduction in radiation Refusal of adjuvant treatment Group A <75y 31 11 (35.4%) 27 (87%) 24 (77%) 4 (12.9%) 6 0 0 Group B > 75 10 3 (30%) 9 (90%) 8 (80%) 3 (30%) 1 2 3 No significant financial relationships to disclose.
The aim of this study was to determine the reliability of magnetic resonance imaging (MRI) in the assessment of facet tropism and facet arthrosis of spondylolisthesis levels in degenerative cervical spondylolisthesis as compared to computed tomography (CT).The discrepancies in the interpretation of CT and MRI data in the evaluation of facet tropism and arthrosis have given rise to questions regarding the reliability of comparisons of the two techniques.Using a 4-point scale, 3 blinded readers independently graded the severity of facet tropism and facet arthrosis of 79 cervical facet joints on axial T2-weighted and sagittal T1 and T2-weighted turbo spin echo images as well as the corresponding axial CT scans.All results were subjected to the kappa coefficient statistic for strength of agreement.In the assessment of the severity of facet arthrosis, intermethod agreement (weighted κ) between CT scanning with a moderate inter-rater reliability (range κ = 0.43-0.57)and MRI with fair inter-rater reliability (range κ = 0.23-0.38)4103
Growing evidence has shown that gut microbiome composition is associated with breast cancer (BC), but the causality remains unknown. We aimed to investigate the link between BC prognosis and the gut microbiome at various oestrogen receptor (ER) statuses.We performed a genome-wide association study (GWAS) to analyse the gut microbiome of BC patients, the dataset for which was collected by the Breast Cancer Association Consortium (BCAC). The analysis was executed mainly via inverse variance weighting (IVW); the Mendelian randomization (MR) results were verified by heterogeneity tests, sensitivity analysis, and pleiotropy analysis.Our findings identified nine causal relationships between the gut microbiome and total BC cases, with ten and nine causal relationships between the gut microbiome and ER-negative (ER-) and ER-positive (ER+) BC, respectively. The family Ruminococcaceae and genus Parabacteroides were most apparent among the three categories. Moreover, the genus Desulfovibrio was expressed in ER- BC and total BC, whereas the genera Sellimonas, Adlercreutzia and Rikenellaceae appeared in the relationship between ER + BC and total BC.Our MR inquiry confirmed that the gut microbiota is causally related to BC. This further explains the link between specific bacteria for prognosis of BC at different ER statuses. Considering that potential weak instrument bias impacts the findings and that the results are limited to European females due to data constraints, further validation is crucial.
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Microvascular invasion (MVI) is considered the major risk factor for postoperative recurrence and metastasis in HCC. The diagnosis of MVI relies on the postoperative pathological assessment of the tumor tissues. Seeking non-invasive methods and biomarkers for evaluation of MVI before surgery has important clinical implications for guiding surgical treatment and improving patients' survival. Recent studies have reported the applications of radiomics technique in prediction of MVI in HCC and showed promising results. Herein we summarized the research progress in CT- or MRI-based radiomics models for prediction of MVI in HCC to provide helpful thinking for further research in this field.肝细胞癌是全球最常见的恶性肿瘤之一，微血管侵犯（MVI）是术后复发及转移的重要原因。MVI的诊断依靠术后肿瘤的病理学检查，术前寻求无创评估MVI的方法及生物标志物，对指导手术治疗和提高患者生存具有重要临床意义。近年来不少研究报道了利用影像组学预测肝细胞癌MVI，结果表明该技术在本领域具有一定的应用前景。现总结了近年来基于CT或MRI图像影像组学模型预测MVI研究结果，以期为该领域的进一步研究提供有益的思考。.
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