BACKGROUND:MR elastography (MRE) has applications in breast cancer, but its optimal frequency and value in discriminating molecular subtypes remain unclear. PURPOSE:To identify the preferable breast MRE frequency and evaluate MRE parameters in the precision diagnosis of breast cancer. STUDY TYPE:Prospective. POPULATION:One hundred fifty-four female patients (mean age 50 ± 10.67 years) were enrolled, including five with bilateral cancer, yielding 159 lesions. FIELD STRENGTH/SEQUENCE:3.0 T, fast gradient-echo for DCE-MRI, single-shot EPI for DWI/ADC, SE-EPI for multifrequency MRE. ASSESSMENT:The image quality of 10 frequency MRE sets was assessed (including overall image quality, diagnostic confidence, artifact impact, and signal-to-noise ratio). Stiffness (c) and viscosity (φ) were measured at the optimal frequency and compared across clinicopathological subgroups. STATISTICAL TESTS:Independent-sample t-tests or one-way analysis of variance, Mann-Whitney U or Kruskal-Wallis H tests, Friedman test, χ2 tests. Spearman's rank correlation. Univariate and multivariate analyses. Receiver operating characteristic (ROC) curves, the area under the curve (AUC). p < 0.05 was considered statistically significant. RESULTS:The 40-70 Hz multifrequency band demonstrated significantly superior image quality compared with all other bands. Subgroup analyses showed that c and φ differed significantly between ER-positive and ER-negative groups (c values: 2.54 (2.17-2.86) vs. 2.80 (2.37-3.30) m/s; φ values: 1.17 ± 0.21 vs. 1.24 ± 0.22 radians) and across groups with different Ki-67 expression levels (c values: 2.54 ± 0.54 vs. 2.77 ± 0.57 m/s), T stage, molecular subtypes (c values: 2.55 (2.20-2.82) vs. 2.69 (2.20-2.96) vs. 2.94 (2.52-3.33) m/s), and enhancement patterns (c values: 2.34 ± 0.41 vs. 2.73 ± 0.58 m/s). Multivariable analysis identified c [OR: 5.37 (2.13-15.54)] and age group [OR: 0.27 (0.09-0.82)] as significant independent predictors of triple-negative breast cancer, and a predictive model incorporating these variables demonstrated an AUC of 0.739 in the training set and 0.700 in the validation set. DATA CONCLUSION:The 40-70 Hz multifrequency protocol may offer favorable image quality for breast MRE. MRE parameters, particularly stiffness, show potential for characterizing tissue biomechanical properties and could assist in distinguishing molecular subtypes. EVIDENCE LEVEL:1. STAGE OF TECHNICAL EFFICACY:Stage 2.

Purpose Reactive cutaneous capillary endothelial proliferation (RCCEP) is a common immune-related adverse event (irAE) associated with camrelizumab. We aimed to explore and describe benign vascular proliferative lesions occurring within breast tissue of triple-negative breast cancer (TNBC) patients undergoing neoadjuvant chemoimmunotherapy (NACI) with camrelizumab. Methods We conducted a retrospective single-center analysis of 106 TNBC patients treated between March 2021 and August 2023 (mean age 48.1 ± 11.2 years). The cohort included 60 patients receiving neoadjuvant chemotherapy (NAC) and 46 patients who underwent NACI with camrelizumab. Clinical data, pathological characteristics, and MRI findings at baseline and during each treatment cycle were analyzed for all participants. Post-treatment newly identified abnormal lesions within breast tissue were detected and characterized. Results Abnormal enhancement was observed in 30 patients (3 NAC vs. 27 NACI, P < 0.001). In the NACI group, abnormal enhancement included 3 cases of ring enhancement (3/27, 11.1 %), 2 cases of linear enhancement (2/27, 7.4 %), and 22 cases of mass enhancement (22/27, 81.5 %). These lesions typically emerged after the second treatment cycle, with few appearing after the fourth or sixth cycle. Most lesions (26/27, 96.3 %) regressed with continued treatment. In the NACI group, the development of new enhancement lesions was correlated with younger age (P = 0.007), premenopausal status (P = 0.014), a lack of peritumoral edema on baseline MRI (P = 0.007), and the presence of mass enhancements (P = 0.012). Conclusion TNBC patients treated with camrelizumab frequently develop benign vascular proliferative lesions in the breast tissue, primarily manifesting as mass enhancements on MRI that typically regress with continued treatment without requiring therapy discontinuation.

This study aims to investigate the imaging features of epidermoid cysts within intrapancreatic accessory spleen (ECIPAS) to benefit the differential diagnosis of pancreatic cystic lesions. We retrospectively reviewed the clinical, radiological and pathological data of 24 patients with pathologically confirmed ECIPAS. All cases underwent abdominal contrast-enhanced computed tomography (CE-CT) scans, with 4 cases further undergoing magnetic resonance cholangiopancreatography (MRCP). The imaging features of the lesions were analyzed. The majority of the patients were young to middle-aged with no apparent clinical symptoms. Over half of the masses exhibited circular, oval or unilocular architectures. On plain CT, the masses primarily displayed indistinct margins with an average diameter of 3.0 ± 1.1 cm. Nineteen lesions were situated in the pancreatic tail, 1 in the head, 1 in the head-body junction, and 3 in the body. In the arterial phases of enhanced CT scans, the lesions exhibited varying degrees of enhancement: slight enhancement (n = 11), significant enhancement (n = 5), and no discernible enhancement (n = 8) compared to pancreatic parenchyma. On MRCP scan, all four lesions showed hyperintense on T2-weighted imaging (T2WI). ECIPAS is a rare benign lesion, with nearly half exhibiting slightly uneven enhancement on contrast-enhanced CT scans. Usually, the solid-portion-enriched lesions show similar enhancement to that of the spleen, aiding in the precise preoperative diagnosis. ECIPAS can manifest in various locations within the pancreas, including the tail, head, and body. Patients may benefit from improved quality of life by avoiding unnecessary surgeries. * ECIPAS can occur not only in the pancreatic tail, but also in the pancreatic head and body. * On CE-CT scan, nearly half of ECIPAS show no marked reinforcement in arterial phase and exhibit spot-like or strip-like enhancement in venous phase while the cyst walls contain few solid portions. * Typically, the solid-portion-enriched cyst walls in ECIPAS show similar enhancement to spleen in both arterial and venous phases.

The development of multifunctional diagnostic and therapeutic integrated nanoplatforms has great potential for application in the comprehensive regulation of the tumor microenvironment. Here, a novel multifunctional nanoplatform based on MXene (MnO2/Fe3O4/Ti3C2OH/CMC nanocomposite) was developed for magnetic resonance imaging (MRI), photothermal therapy (PTT). In situ bimetallic modification of the MXene material by MnO2 and Fe3O4 allows enhanced MR imaging of the tumor areas in mice. The surface modification of the composite by carboxymethyl chitosan (CMC) can improve its biocompatibility and reduce the toxicity of the biomaterials. Under 808 nm laser irradiation, Ti3C2OH MXene material has excellent photothermal performance with SAR value of 978.12 W/g. Meanwhile, the excellent photothermal properties of Ti3C2OH MXene material under 808 nm laser, the effective inhibition of the growth of tumor-bearing mice by the MnO2/Fe3O4/Ti3C2OH/ CMC nanocomposite were achieved using PTT. In summary, this work not only develops a drug-loaded nanoplatform with good biocompatibility, but also designs a strategy to functionalize MXene for cancer MRI-PTT, thus broadening the medical applications of MXene imaging-hyperthermia use.

Background:Differentiation between breast phyllodes tumors (PTs) and fibroadenomas (FAs) remains a key clinical challenge, which is critical for formulating clinical treatment strategies. This study aimed to establish a fusion model based on mammography (MG) and magnetic resonance imaging (MRI) for the preoperative differentiation of PTs and FAs. Methods:The clinical data, MG images, and magnetic resonance (MR) images of patients with breast FAs treated in Fudan University Shanghai Cancer Center from October 2019 to December 2020, as well as patients with PTs treated from January 2011 to December 2020, were retrospectively collected. Univariate and multivariate logistic regression analyses were conducted to select independent factors and to construct a diagnostic model to differentiate PTs and FAs. The diagnostic performance of the model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results:A total of 147 patients with FAs and 138 patients with PTs were included in this study. Patient age, maximum diameter of mass, density on MG images, lobulation on MR images, and time-intensity curve (TIC) were independent factors contributing to the differential diagnosis. Finally, the fusion model showed satisfactory discrimination [area under the curve (AUC) 0.90, 95% confidence interval (CI): 0.86-0.94] and calibration. DCA indicated good clinical benefit, as indicated by most values being within threshold probabilities. Conclusions:Breast MG and MRI findings help differentiate between FAs and PTs preoperatively. The multimodal fusion model was clinically efficacious and thus useful for accurate clinical diagnosis and treatment.

This study aims to design and evaluate a two-dimensional Ti3C2-MXene contrast agent, codoped with iron and manganese, with the aim of achieving T1/T2 dual-mode magnetic resonance imaging contrast, and to investigate its effect on Chemical Exchange Saturation Transfer (CEST) contrast agents. Single-layer Ti3C2 was synthesized via the HCL/LiF etching technique, with the flake size subsequently tailored and the hydroxylated surface modified through a hydrothermal process. Fe3O4 nanoparticles and MnO2 nanosheets were integrated onto the two-dimensional Ti3C2-MXene surface using an in situ doping approach, and the final modification was achieved with carboxymethyl chitosan. Various characterization techniques were employed to assess the physical and chemical properties of the probe, which were then combined with a CEST contrast agent to investigate the mechanisms of multimodal magnetic resonance imaging and in vitro photothermal effects. Upon integrating the multi-modal molecular probe with Ioversol for imaging purposes, at a magnetic field strength of B1 = 1.25 μT and with a molecular probe concentration of 0.5 mg/mL, the CEST signal from Ioversol is almost entirely suppressed. This allows for the successful identification of a distinct concentration range where both contrast agents can coexist. In vitro photothermal studies on MXene codoped with iron and manganese have shown that the composite molecular probe exhibits excellent photothermal efficiency. The method combining complex nanoprobes with CEST contrast agents successfully achieved simultaneous imaging of both contrast agents. In vitro MRI experiments successfully obtained distinguishable concentration ranges for both, with changes in CEST signals reflecting the concentration variations of the complex molecular probes, which also exhibit good photothermal therapy (PTT) capabilities.

Objective To investigate the diagnostic value of diffusion kurtosis magnetic resonance imaging (DKI) and conventional diffusion-weighted imaging (DWI) for evaluating the response to first-line chemotherapy in unresectable pancreatic cancer. Materials and methods We retrospectively analyzed 21 patients with clinically and pathologically confirmed unresected pancreatic cancer who received palliative chemotherapy. Three-tesla MRI examinations containing DWI sequences with b values of 0, 100, 700, 1400, and 2100 s/mm 2 were performed before and after chemotherapy. Parameters included the apparent diffusion coefficient (ADC), mean diffusion coefficient (MD), and mean diffusional kurtosis (MK). The performances of the DWI and DKI parameters in distinguishing the response to chemotherapy were evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Overall survival (OS) was calculated from the date of first treatment to the date of death or the latest follow-up date. Results The ADC change and MD change were significantly higher in the responding group (PR group) than in the nonresponding group (non-PR group) (ADC change : 0.21 ± 0.05 vs. 0.11 ± 0.09, P = 0.02; MD change : 0.37 ± 0.24 vs. 0.10 ± 0.12, P = 0.002). No statistical significance was shown when comparing ADC pre , ADC post , MK pre , MK post , MK change , MD pre , and MD post between the PR and non-PR groups. The ROC curve analysis indicated that MD change (AUC = 0.898, cutoff value = 0.7143) performed better than ADC change (AUC = 0.806, cutoff value = 0.1369) in predicting the response to chemotherapy. Conclusion The ADC change and MD change demonstrated strong potential for evaluating the response to chemotherapy in unresectable pancreatic cancer. The MD change showed higher specificity in the classification of PR and non-PR than the ADC change . Other parameters, including ADC pre , ADC post , MK pre , MK post , MK change , MD pre , and MD post, are not suitable for response evaluation. The combined model SUM change demonstrated superior performance compared to the individual DWI and DKI models. Further experiments are needed to evaluate the potential of DWI and DKI parameters in predicting the prognosis of patients with unresectable pancreatic cancer.

Traditional T2 magnetic resonance imaging (MRI) contrast agents have defects inherent to negative contrast agents, while chemical exchange saturation transfer (CEST) contrast agents can quantify substances at trace concentrations. After reaching a certain concentration, iron-based contrast agents can "shut down" CEST signals. The application range of T2 contrast agents can be widened through a combination of CEST and T2 contrast agents, which has promising application prospects. The purpose of this study is to develop a T2 MRI negative contrast agent with a controllable size and to explore the feasibility of dual contrast enhancement by combining T2 with CEST contrast agents. The study was carried out in vitro with HCT-116 human colon cancer cells. A GE SIGNA Pioneer 3.0 T medical MRI scanner was used to acquire CEST images with different saturation radio-frequency powers (1.25/2.5/3.75/5 μT) by 2D spin echo-echo planar imaging (SE-EPI). Magnetic resonance image compilation (MAGiC) was acquired by a multidynamic multiecho 2D fast spin-echo sequence. The feasibility of this dual-contrast enhancement method was assessed by scanning electron microscopy, transmission electron microscopy, Fourier transform infrared spectroscopy, dynamic light scattering, ζ potential analysis, inductively coupled plasma, X-ray photoelectron spectroscopy, X-ray powder diffraction, vibrating-sample magnetometry, MRI, and a Cell Counting Kit-8 assay. The association between the transverse relaxation rate r2 and the pH of the iron-based contrast agents was analyzed by linear fitting, and the linear relationship between the CEST effect in different B1 fields and pH was analyzed by the ratio method. Fe3O4 nanoparticles (NPs) with a mean particle size of 82.6 ± 22.4 nm were prepared by a classical process, and their surface was successfully modified with -OH active functional groups. They exhibited self-aggregation in an acidic environment. The CEST effect was enhanced as the B1 field increased, and an in vitro pH map was successfully plotted using the ratio method. Fe3O4 NPs could stably serve as reference agents at different pH values. At a concentration of 30 μg/mL, Fe3O4 NPs "shut down" the CEST signals, but when the concentration of Fe3O4 NPs was less than 10 μg/mL, the two contrast agents coexisted. The prepared Fe3O4 NPs had almost no toxicity, and when their concentration rose to 200 μg/mL at pH 6.5 or 7.4, they did not reach the half-maximum inhibitory concentration (IC50). Fe3O4 magnetic NPs with a controllable size and no toxicity were successfully synthesized. By combining Fe3O4 NPs with a CEST contrast agent, the two contrast agents could be imaged simultaneously; at higher concentrations, the iron-based contrast agent "shut down" the CEST signal. An in vitro pH map was successfully plotted by the ratio method. CEST signal inhibition can be used to realize the pH mapping of solid tumors and the identification of tumor active components, thus providing a new imaging method for tumor efficacy evaluation.

BackgroundPreoperative pathological grading assessment is important for patients with breast phyllodes tumors (PTs).PurposeTo develop and validate a clinical–radiomics model based on multiparametric MRI and clinical information for the pretreatment differential diagnosis of PTs.Study TypeRetrospective.PopulationA total of 216 patients with PTs, 133 in the training cohort (55 benign PTs [BPTs] and 78 borderline/malignant PTs [BMPTs]) and 83 in the validation cohort (28 BPTs and 55 BMPTs).Field Strength/Sequence1.5 T and 3 T; T2‐weighted imaging (T2WI), precontrast T1‐weighted imaging (T1WI) and dynamic contrast‐enhanced T1‐weighted imaging (DCE‐T1WI).AssessmentA total of 3138 radiomics features were computed to decode the imaging phenotypes of PTs. To build the classification models, the following workflow was followed: minimum–maximum scaling normalization method, recursive feature elimination based on ridge regression (Ridge‐RFE), synthetic minority oversampling technique, and support vector machine classifier. We established several models based on the statistically significant features (Ridge‐RFE selected) of each sequence to distinguish BPTs from BMPTs, including precontrast T1WI model, DCE‐T1WI phase 1 model, T1WI feature fusion model, T2WI model, T1WI + T2WI model, clinical feature model, conventional MRI characteristics model, and combined clinical–radiomics model.Statistical TestsUnivariate analysis was utilized to compare variables between the BPT and BMPT groups. The receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic performance of these models.ResultsIn the training cohort, the clinical–radiomics model had excellent diagnostic efficiency, with an area under ROC (AUC) of 0.91 ± 0.02 (95% CI: 0.87–0.94). In the validation cohort, the AUCs were 0.79 ± 0.05 (95% CI: 0.70–0.87) for the combined model and 0.77 ± 0.05 (95% CI: 0.67–0.85) for the radiomics model.Data ConclusionCompared with conventional MRI characteristics, radiomics features extracted from multiparametric MRI are helpful for improving the accuracy of differentiating the pathological grades of PTs preoperatively. The model based on radiomics and clinical information is expected to become a potential noninvasive tool for the assessment of PTs grades.Evidence Level4Technical EfficacyStage 2

Although the probability of pancreatic cystic neoplasms (PCNs) being detected is raising year by year, their differential diagnosis and individualized treatment are still a challenge in clinical work. PCNs are tumors containing cystic components with different biological behaviors, and their clinical manifestations, epidemiology, imaging features, and malignant risks are different. Some are benign [e.g., serous cystic neoplasms (SCNs)], with a barely possible that turning into malignant, while others display a low or higher malignant risk [e.g., solid pseudopapillary neoplasms (SPNs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms (MCNs)]. PCN management should concentrate on preventing the progression of malignant tumors while preventing complications caused by unnecessary surgical intervention. Clinically, various advanced imaging equipment are usually combined to obtain a more reliable preoperative diagnosis. The challenge for clinicians and radiologists is how to accurately diagnose PCNs before surgery so that corresponding surgical methods and follow-up strategies can be developed or not, as appropriate. The objective of this review is to sum up the clinical features, imaging findings and management of the most common PCNs according to the classic literature and latest guidelines.

化学交换饱和转移（CEST）是一种基于不稳定自旋及可移动质子与水分子之间交换的一种新型MRI技术。当溶质与溶剂发生快速交换时，溶质信号会明显放大，因此毫摩尔至微摩尔的溶质质子浓度可被检测出来。代谢改变被认为是癌症的核心标志，监测体内代谢物变化可表征肿瘤微环境改变。这种非侵入性方法在阐明肿瘤生物学特征中发挥着重要作用。因此，本文主要从CEST MRI在代谢物检测及肿瘤领域应用研究方面的进展进行综述。

Abstract Background The role of serum high-density lipoprotein cholesterol (HDL-c) in tumorigenesis are observed in several endocrine-related cancers. However, its role in pancreatic neuroendocrine neoplasms (PNENs) has not been understood. In the current study, the relationship between HDL-c levels and malignant behavior in PNENs was explored. Methods One hundred ninety-seven patients with histopathology confirmed PNENs were included. PNENs were divided into three grades (G1, G2 and G3) as 2017 WHO classification based on ki67 index and mitosis count. The demographic data, clinical information, tumor morphological and pathological features (organs invasion, lymph node metastasis, vascular invasion and perineural invasion), and serum tumor biomarkers were collected. The relationships between HDL-c levels and malignant behaviors in PNENs were analyzed using logistic regression analysis. Models were also developed for the identification of high grade PNENs. Results The levels of serum HDL-c in G2/G3 tumor were significantly lower than that in G1 tumor (P = 0.031). However, no such difference was found between G3 and G1/G2. The proportions of low HDL-c (≤ 0.9 mmol/L) were higher in high-grade PNENs (G2/G3 or G3) than those in low-grade (G1 or G1/G2) (29.0 vs 15.2%, P = 0.032; 37.0 vs 20.5%, P = 0.023). The risk of G2/G3 tumors in patients with high serum HDL-c levels was decreased (odds ratio (OR) = 0.35, 95% confidence interval (CI): 0.12–0.99). Similarly, the risk of G3 PNENs increased in patients with low HDL-c levels (OR = 2.51, 95%CI:1.12–5.60). HDL-c level was also associated with a high ki67 index (> 55%) (OR = 0.10, 95%CI: 0.02–0.51) and neuroendocrine carcinoma G3 (OR = 0.21, 95%CI: 0.06–0.80). The area under the curve (AUC) of HDL-c + tumor size + age was 0.85 (95% CI: 0.79–0.91) in identifying G2/G3 PNENs, and HDL-c (> 0.9 mmol/L) + tumor size + age had an AUC of 0.77 (95% CI: 0.70–0.84) in identifying G3 PNENs. HDL-c level was associated with lymph node metastasis (OR = 0.24, 95%CI:0.08–0.99). Conclusion Serum HDL-c levels were significantly associated with malignant behaviors in PNENs, in particular to tumor grade and lymph node metastasis.

目的:探讨磁共振DWI联合T2WI对T2和T3期直肠癌的术前分期价值.方法:将在本院初诊、术前未进行放化疗且有完整的病理资料和明确的TNM分期诊断结果的213例直肠癌患者纳入本研究.所有患者在术前行直肠标准方案MRI检查(T1WI、高分辨小视野非抑脂FSE-T2WI、DWI及增强扫描).对DWI联合T2WI及单独使用T2WI对T2和T3期直肠癌的诊断效能(符合率、特异度、敏感度、阳性预测值及阴性预测值)进行分析和比较,并对两位阅片者诊断结果的一致性进行分析.结果:DWI联合T2 WI和单独使用T2 WI对T2期直肠癌的诊断符合率、敏感度、特异度、PPV和NPV分别为92.5％vs.84.0％、93.8％vs.56.9％、91.9％vs.95.9％、83.6％vs.86.0％和97.1％vs.83.5％;而在诊断T3期直肠癌时相应诊断结果分别为91.1％vs.79.3％、89.3％vs.85.5％、93.9％vs.69.5％、95.9％vs.81.8％和84.6％vs.75.0％.单独使用T2 WI对直肠癌术前T分期的诊断符合率为76.5％,而DWI联合T2 WI为89.2％,差异具有统计学意义(P<0.001).两位研究者分别基于DWI联合T2WI及单独T2WI进行术前分期时均获得了较好的组间一致性,Kappa值均为0.848.结论:DWI联合T2WI对T2和T3期直肠癌的术前分期诊断效能要优于单独使用T2WI.

OBJECTIVE:To explore the potential factors related to the pathological grade of breast phyllodes tumors (PTs) and to establish a nomogram to improve their differentiation ability.METHODS:Patients with PTs diagnosed by post-operative pathology who underwent pretreatment magnetic resonance imaging (MRI) from January 2015 to June 2020 were retrospectively reviewed. Traditional clinical features and MRI features evaluated according to the fifth BI-RADS were analyzed by statistical methods and introduced to a stepwise multivariate logistic regression analysis to develop a prediction model. Then, a nomogram was developed to graphically predict the probability of non-benign (borderline/malignant) PTs.RESULTS:Finally, 61 benign, 73 borderline and 48 malignant PTs were identified in 182 patients. Family history of tumor, diameter, lobulation, cystic component, signal on fat saturated T2 weighted imaging (FS T2WI), BI-RADS category and time-signal intensity curve (TIC) patterns were found to be significantly different between benign and non-benign PTs. The nomogram was finally developed based on five risk factors: family history of tumor, lobulation, cystic component, signal on FS T2WI and internal enhancement. The AUC of the nomogram was 0.795 (95% CI: 0.639, 0.835).CONCLUSION:Family history of tumor, lobulation, cystic components, signals on FS T2WI and internal enhancement are independent predictors of non-benign PTs. The prediction nomogram developed based on these features can be used as a supplemental tool to pre-operatively differentiate PTs grades.ADVANCES IN KNOWLEDGE:More sample size and characteristics were used to explore the factors related to the pathological grade of PTs and establish a predictive nomogram for the first time.

PURPOSE:The objective of this research was to validate the diagnostic value of three-dimensional texture parameters and clinical characteristics in the differentiation of colorectal signet-ring cell carcinoma (SRCC) and adenocarcinoma (AC).METHODS:We retrospectively analyzed data from 102 patients with SRCC or AC confirmed by pathology, including 51 SRCC (from January 2015 to July 2019) and 51 AC patients (from January 2019 to July 2019). CT findings and clinical data, including age, gender, clinical symptoms, serological biomarkers, tumor size, and tumor location, were compared between SRCC and AC. CT texture features were quantified on portal phase images using three-dimensional analysis. A list of texture parameters was generated with MaZda software for the classification of tumors. The texture features, clinical data and CT findings were statistically analyzed for the discrimination ability of SRCC and AC, and the potential predictive parameters that may be used to differentiate the two groups were subsequently tested using the least absolute shrinkage and selection operator (LASSO) and logistic regression analyses. The receiver operating characteristic curve (ROC) provided a range of values for establishing the cutoff value, as well as the sensitivity and specificity of prediction for each significant variable.RESULTS:SRCC occurred more often in men than AC did (80.39% vs 49.02%, P < 0.01). The patients were younger in the SRCC group than in the AC group, without a statistically significant difference (55.84 vs 59.20 years, P = 0.216). There were no significant differences in the clinical symptoms, tumor size, or tumor location between the two groups (P=0.505, P=0.19, P=0.843, respectively). The elevation of serological biomarker CA724 was more common in SRCC than in AC (P< 0.001). Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg were lower in the SRCC group than in the AC group during the portal phase, with the areas under curve (AUCs) of 0.892-0.929, sensitivity of 76.5-84.3% and specificity of 88.2-96.1%. In the differentiation between SRCC and AC, the 1-NN minimal classification error (MCR) was 29.41%.CONCLUSION:Three-dimensional texture parameters, including Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg, exhibited a favorable discriminatory ability to distinguish SRCC from AC.

*These authors contributed equally to this work Purpose: The objective of this research was to validate the diagnostic value of threedimensional texture parameters and clinical characteristics in the differentiation of colorectal signet-ring cell carcinoma (SRCC) and adenocarcinoma (AC). Methods: We retrospectively analyzed data from 102 patients with SRCC or AC confirmed by pathology, including 51 SRCC (from January 2015 to July 2019) and 51 AC patients (from January 2019 to July 2019). CT findings and clinical data, including age, gender, clinical symptoms, serological biomarkers, tumor size, and tumor location, were compared between SRCC and AC. CT texture features were quantified on portal phase images using three-dimensional analysis. A list of texture parameters was generated with MaZda software for the classification of tumors. The texture features, clinical data and CT findings were statistically analyzed for the discrimination ability of SRCC and AC, and the potential predictive parameters that may be used to differentiate the two groups were subsequently tested using the least absolute shrinkage and selection operator (LASSO) and logistic regression analyses. The receiver operating characteristic curve (ROC) provided a range of values for establishing the cutoff value, as well as the sensitivity and specificity of prediction for each significant variable. Results: SRCC occurred more often in men than AC did (80.39% vs 49.02%, P < 0.01). The patients were younger in the SRCC group than in the AC group, without a statistically significant difference (55.84 vs 59.20 years, P = 0.216). There were no significant differences in the clinical symptoms, tumor size, or tumor location between the two groups (P=0.505, P=0.19, P=0.843, respectively). The elevation of serological biomarker CA724 was more common in SRCC than in AC (P< 0.001). Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg were lower in the SRCC group than in the AC group during the portal phase, with the areas under curve (AUCs) of 0.892–0.929, sensitivity of 76.5–84.3% and specificity of 88.2–96.1%. In the differentiation between SRCC and AC, the 1-NN minimal classification error (MCR) was 29.41%. Conclusion: Three-dimensional texture parameters, including Perc.01%3D, Perc.10%3D and s(1,0,0) SumAverg, exhibited a favorable discriminatory ability to distinguish SRCC from AC.

Objectives Our goal was to investigate the correlation between histopathology and diffusion parameters by utilising the most repeatable region-of-interest (ROI) strategy for diffusion parameters in rectal cancer on a 3T scanner. Methods 113 patients underwent DKI-MR and 66 of these patients received surgery without neoadjuvant chemoradiotherapy. Two readers independently measured the parameters using three slice protocols including single slice, three slices and whole-tumour slice (WTS), combined with one of two ROIs, including outline and round ROI. ANOVA, Kruskal-Wallis, a paired sample t-test, interclass correlation coefficient (ICC), Bland-Altman, Student’s t-tests, receiver operating characteristic curves and z statistic were used for statistical analysis. Results There were no significant differences among the three slice protocols in ADC values ( p = 0.822, 0.987), K values ( p = 0.842, 0.859) and D values ( p = 0.917, 0.988) using round and outline ROI, respectively. The ADC and D values derived from outline ROIs were higher than those from round ROIs (all p < 0.001 for ADC, all p < 0.001 for D), while K values derived from outline ROIs were lower than those from round ROIs ( p < 0.001, p = 0.001, p < 0.001) using three slice protocols, respectively. The WTS-outline ROI resulted in the best intra- and inter-observer ICC. Utilising the WTS-outline ROI method, the AUC for assessment of well-differentiated tumours was 0.871 by K and 0.809 by ADC; and the AUC for T2 was 0.768 by K. Conclusions The most repeatable strategy was the WTS-outline ROI method. In addition to DWI, DKI also have diagnostic value for rectal cancer histopathological characteristics utilising the WTS-outline ROI on a 3T scanner. Key Points • DKI using a 3T scanner is feasible for assessing rectal cancer. • ROI and slice protocol show considerable influence on DKI parameters. • DKI parameters exhibit excellent repeatability using whole-tumour slice-outline ROI on 3T scanner. • DKI has considerable diagnostic value for the estimation of rectal cancer characteristics.

The purpose of the study was to determine whether the pre-treated MR texture features of colorectal liver metastases (CRLMs) are predictive of therapeutic response after chemotherapy.

Objective To assess the value of apparent diffusion coefficient (ADC) calculated using conventional diffusion-weighted imaging (DWI) in evaluating the response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Methods Between January 2014 and September 2015, 56 consecutive patients diagnosed with LARC (T3, T4, and / or lymph node positive) were prospectively enrolled and underwent pre- and post-neoadjuvant CRT MRI using a 3.0 T MRI scanner in Fudan University Shanghai Cancer Center. DWI sequences were performed with b values of 0, 700, 1 400, and 2 100 s/mm2, respectively. Regions of interest (ROI) were manually drawn on each cross-sectional area of the primary lesions, simultaneously avoiding the encircle distortion artifacts and macroscopically visible necrotic or cystic portions in the axial ADC map deriving from T2-weighted images. Then, the value of ADCpre, ADCpost, and ADCratiowere obtained.Pathological complete remission (pCR), tumor regression grade (TRG) and tumor downstaging (T-downstaging) were used as the evaluation criteria. Downstaging was determined by comparing the pretreatment and postoperative pathologic classifications. Patients with ypT0-2N0 (the "yp" prefix indicates final staging after CRT [y] and postoperative pathologic examination [p]) were defined as T-downstaging, those with TRG 0 or TRG 1 were classified as good responders, whereas the remaining patients with TRG 2-3 were classified as poor responders, and if no tumor cells were identified in the resected specimen and only fibrotic mass or acellular mucin pools were present, the type of response was considered as complete response (ypT0N0) and the patient was labeled as pCR. Results The ADCpostand ADCratiovalues in pCR patients were much higher than those in non-pCR patients (P<0.05), as well as in the evaluation criteria of TRG and T-downstaging (P<0.05). The optimal cutoff value for the identification of patients with pCR was ≤ 0.82×10-3mm2/s for ADCpre{during which its AUC was 0.583〔95%CI(0.44,0.71)〕, with 57.1%(8/14) sensitivity, 69.0%(29/42) specificity, and 66.1%(37/56) accuracy, respectively}, >1.17×10-3mm2/s for ADCpost{ during which its AUC was 0.823〔95%CI(0.70,0.91)〕 with 92.9%(13/14) sensitivity, 66.7%(28/42) specificity, and 73.2%(41/56)accuracy, respectively} and > 0.43 for ADCratio{ during which its AUC was 0.793〔95%CI(0.66,0.89)〕with 78.6%(11/14)sensitivity, 73.8%(31/42) specificity, and 75.0%(42/56)accuracy, respectively}. In addition, the optimal cutoff value for the identification of patients with TRG0-1 was ≤0.88×10-3mm2/s for ADCpre{ during which its AUC was 0.567〔95%CI(0.43,0.70)〕, with 77.3%(17/22) sensitivity, 50.0%(17/34)specificity, and 60.7%(34/56) accuracy, respectively}, >0.20×10-3mm2/s for ADCpost{ during which its AUC was 0.773〔95%CI(0.64,0.87)〕, with 72.7% (16/22) sensitivity, 79.4%(27/34) specificity, and 76.8%(43/56)accuracy, respectively} and >0.37 for ADCratio{ during which its AUC was 0.721〔95%CI(0.59,0.83)〕, with 68.2%(15/22)sensitivity, 70.6%(24/34) specificity, and 69.6% (39/56)accuracy, respectively}. Finally, the optimal cutoff value for the identification of patients with T-downstaging was≤0.82×10-3mm2/s for ADCpre{ during which its AUC was 0.545〔95%CI(0.41,0.68)〕, with 46.2%(12/26) sensitivity, 70.0%(21/30)specificity, and 58.9%(33/56)accuracy, respectively}, >1.23×10-3mm2/s for ADCpost{ during which its AUC was 0.747〔95%CI(0.61,0.85)〕, with 57.7%(15/26)sensitivity, 90.0%(27/30)specificity, and 75.0%(42/56) accuracy, respectively} and >0.59 for ADCratio{ during which its AUC was 0.682〔95%CI(0.54,0.80)〕, with 46.2%(12/26) sensitivity, 90.0%(27/30)specificity, and 69.6%(39/56)accuracy, respectively}. Conclusion The ADCpostand ADCratiohave high-level capabilities for identifying the response to neoadjuvant CRT in LARC patients.