目的:采用静息态功能磁共振(fMRI)技术和区域一致性(ReHo)算法,探讨创伤后应激障碍(PTSD)军人脑局部功能变化情况.方法:选择基于《中国精神障碍分类与诊断标准(第3版)》、经精神科医师确诊的PTSD军人17例为观察组,另选择年龄、性别和受教育年限相匹配的非PTSD军人志愿者19例为对照组.两组均行MRI检查,扫描序列包括常规T1WI、T2WI、液体衰减反转恢复(FLAIR)成像,静息态fMRI成像(8 min,重复时间2 s)和全脑3D高分辨率T1成像;图像预处理步骤包括时间校正、头动校正、空间标准化、平滑、去除协变量、去线性漂移和滤波等.采用基于秩和的非参数数据驱动方法(肯德尔和谐系数,KCC)测量体素与邻近体素时间序列的相似性,计算并比较两组全脑标准化ReHo值,探讨两组脑局部活动一致性的差异.结果:两组MRI扫描均未发现明显病灶;fMRI扫描头动包括平移和转动,均湿示组间差异不显著(P值分别为0.56和0.29).两组全脑标准化ReHo值比较,差异显著(P＜0.05);采用AlphaSim进行多重比较校正,根据该分布,结合基于体素的P值＜0.05和簇体素量＞29,得出校正后P值＜0.05.与对照组比较,观察组ReHo值减低的脑区包括右侧海马/海马旁回、左侧尾状核、左侧额巾回、左侧颞上回、右侧壳核;ReHo值增高的脑区包括右侧楔叶/楔前叶、右侧颞中回、左侧中央后回、右侧中央后回.结论:PTSD军人脑局部活动一致性发生改变,静息态fMRI技术辅助诊断有助于进一步了解PTSD军人认知损伤的神经机制.

We investigated the value of CT texture analysis (CTTA) in predicting prognosis of unresectable pancreatic cancer.

To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease.

PURPOSE:To explore the regional spontaneous neural activity and functional connectivity alterations of adjustment disorder (AD) in new recruits with in vivo resting-state functional MR (rs-fMRI).MATERIALS AND METHODS:Resting-state fMRI was performed in 31 recruits with AD and in 31 control recruits. Regional homogeneity (ReHo) was used to detect the regional synchronizing features of neuronal activations. Correlative analysis was performed to investigate the relationship between the Symptom Check List-90 (SCL-90) score and ReHo in regions with significant group differences. Regions with significant correlation were then defined as regions of interest (ROIs), and seed-ROI based whole-brain functional connectivity was performed.RESULTS:Compared with the controls, patients with AD had significantly lower ReHo in the left posterior cerebellar lobe, bilateral medial orbitofrontal cortex, bilateral caudate and left middle temporal gyrus, whereas regions with enhanced ReHo were confined to bilateral posterior cingulate gyrus/precuneus. Only the left posterior cerebellar lobe showed significant correlation between ReHo and the SCL-90 score, and was defined as the seed ROI. Decreased functional connectivity was found between the ROI and bilateral supplementary motor area.CONCLUSION:This study reveals abnormalities in recruits with AD in baseline brain function activities, which could further improve our understanding of the neural substrates of cognitive impairment in AD.

An area of rapid advancement in abdominal MRI is diffusion-weighted imaging (DWI). By measuring diffusion properties of water molecules, DWI is capable of non-invasively probing tissue properties and physiology at cellular and macromolecular level. The integration of DWI as part of abdominal MRI exam allows better lesion characterization and therefore more accurate initial diagnosis and treatment monitoring. One of the most technical challenging, but also most useful abdominal DWI applications is in liver and therefore requires special attention and careful optimization. In this article, the latest technical developments of DWI and its liver applications are reviewed with the explanations of the technical principles, recommendations of the imaging parameters, and examples of clinical applications. More advanced DWI techniques, including Intra-Voxel Incoherent Motion (IVIM) diffusion imaging, anomalous diffusion imaging, and Diffusion Kurtosis Imaging (DKI) are discussed.

Objective To investigate the diagnostic value of ADC histogram obtained from MR DW imaging for stage ⅠB cervical cancer. Methods Seventy three patients diagnosed by cervical smear screening as cervical cancer without priortreatment were included prospectively in the patient group, and staged according to the international federation of gynecology and obstetrics (FIGO) staging system. Forty three patients with uterine leiomyoma detected by gynecologic examination, ultrasonography or CT and with negative result of cervical smear screening who were scheduled for hysterectomy were included prospectively in the control group. The patients of both groups underwent routine pelvic MR sequences, dynamic contrast enhanced imaging and DWI before hysterectomy. ADC histograms of the entire tumor and cervix volume were generated by post-processing software. Features of ADC histogram for the 2 groups were observed. Histogram parameters such as mean ADC (ADCmean), median ADC (ADCmedian), the 25th percentile of ADC (ADC_25th), the 75th percentile of ADC (ADC_75th), skewness and kurtosis were recorded. Student's t test or Mann-Whitney U test depending on homogeneity of variance was employed for the comparison of those parameters. ROC analysis was employed for assessing the diagnostic performance of ADC histogram in distinguishing the 2 groups. Results Thirty five patients in the patient group were staged as FIGO IB. Five patients in the control group ended up with pathologic findings of cervical intraepithelial neoplasia grade 3. Therefore 38 patients in the control group were investigated. ADC histograms of the patient group were mostly skewed positively, while the curves were largely skewed negatively. ADCmean, ADCmedian, ADC_25th, ADC_75th, skewness and kurtosis for the IB stage patient group were (1.10±0.21)×10-3mm2/s, (1.05±0.21)× 10-3 mm2/s, (0.90 ± 0.19) × 10-3mm2/s, (1.26 ± 0.23) × 10-3mm2/s, 0.83 (median) and 1.25 (median) respectively. ADCmean, ADCmedian, ADC_25th, ADC_75th, skewness and kurtosis for the control group were (1.62 ± 0.25)×10-3mm2/s, (1.64±0.24)×10-3mm2/s, (1.42±0.24)×10-3mm2/s, (1.84±0.27)×10-3mm2/s,-0.11(median) and 0.29 (median) respectively. All parameters showed statistically different (t values were -9.693,- 11.117, -10.255, and -9.988 for ADCmean, ADCmedian, ADC_25th and ADC_75th respectively;Z values were -6.360 and -4.445 for skewness and kurtosis respectively; P< 0.01). ROC analysis indicated that ADCmedian had the highest diagnostic accuracy for differentiating the 2 groups, with the area under the curve being 0.97, a cutoff value of 1.21×10-3mm2/s, and a sensitivity of 95.6%and a specificity of 89.3%. Conclusion ADC histogram of DWI may be valuable for diagnosing stage IB cervical cancer by distinguishing stage IB cervical cancer from normal cervix or cervical benign lesions.

OBJECTIVE:To determine if transit time for excretion of gadoxetate into major bile ducts and duodenum correlates with clinical models of hepatocellular function.METHODS:This retrospective research was approved by the Institutional Review Board with waiver of informed consent. Search of the radiology database from January 1, 2013 to March 4, 2014 revealed 84 patients with chronic liver disease (65 males, mean age 47 years). Eighteen control subjects with no known liver disease or risk factors were also enrolled for analysis (9 males, mean age 43 years). MRI was performed with hepatobiliary phases at 10, 15, 20, and 25 min after injection of 0.025 mmol/kg of gadoxetate (Primovist, Bayer HealthCare, Shanghai, China). The time of excreted contrast appearing in the biliary tree and in the duodenum was recorded. Linear trend analysis was performed to determine the relationship between excretion time and hepatic function.RESULTS:The patient cohort was stratified by Child-Pugh classification (A, B, and C with n = 53, 27, and 4, respectively). Arrival of gadoxetate in the gall bladder at 10-min hepatobiliary phase was seen in 87% of control group and 45% of Child-Pugh A group (p = 0.02). There was no difference between these groups for later hepatobiliary phases. The arrival of biliary contrast in the right hepatic duct, common bile duct, and gall bladder were significantly earlier in the Child-Pugh A group compared to the Child-Pugh B/C group at all hepatobiliary phases after 10 min (p < 0.05). Linear trend analysis showed that biliary transit times were significantly delayed with worsening liver function (p = 0.01). There was no difference in entry time of gadoxetate into the duodenum between the normal, Child-Pugh A, and Child-Pugh B/C groups.CONCLUSIONS:The transit time for gadoxetate to appear in extrahepatic duct is a reasonable indicator of liver function, and may be included in radiology reports. The appearance in the duodenum, however, may depend on factors other than liver function, such as the physiology of the gallbladder and sphincter of Oddi.

OBJECTIVE:The purpose of this study was to investigate the application of histogram analysis of apparent diffusion coefficient (ADC) in characterizing pathologic features of cervical cancer and benign cervical lesions.SUBJECTS AND METHODS:This prospective study was approved by the institutional review board, and written informed consent was obtained. Seventy-three patients with cervical cancer (33-69 years old; 35 patients with International Federation of Gynecology and Obstetrics stage IB cervical cancer) and 38 patients (38-61 years old) with normal cervix or cervical benign lesions (control group) were enrolled. All patients underwent 3-T diffusion-weighted imaging (DWI) with b values of 0 and 800 s/mm(2). ADC values of the entire tumor in the patient group and the whole cervix volume in the control group were assessed. Mean ADC, median ADC, 25th and 75th percentiles of ADC, skewness, and kurtosis were calculated. Histogram parameters were compared between different pathologic features, as well as between stage IB cervical cancer and control groups.RESULTS:Mean ADC, median ADC, and 25th percentile of ADC were significantly higher for adenocarcinoma (p = 0.021, 0.006, and 0.004, respectively), and skewness was significantly higher for squamous cell carcinoma (p = 0.011). Median ADC was statistically significantly higher for well or moderately differentiated tumors (p = 0.044), and skewness was statistically significantly higher for poorly differentiated tumors (p = 0.004). No statistically significant difference of ADC histogram was observed between lymphovascular space invasion subgroups. All histogram parameters differed significantly between stage IB cervical cancer and control groups (p < 0.05).CONCLUSION:Distribution of ADCs characterized by histogram analysis may help to distinguish early-stage cervical cancer from normal cervix or cervical benign lesions and may be useful for evaluating the different pathologic features of cervical cancer.

Background: Recently a considerable number of promising clinical trials have been designed to perform infusion of stem cells by pancreatic arterial intervention to improve the endocrine function of the pancreas for better diabetes control. It is necessary to investigate the pancreatic body and tail (PBT) arterial system for human islets located mostly in the PBT and identify the predominant artery or arteries. However, the arterial system in the PBT is complicated and variable. In this study we comprehensively investigated the anatomical characteristics of arteries feeding the PBT. Research Design and Methods: One hundred two patients with diabetes underwent 64-slice computed tomography angiography (CTA) and digital subtraction angiography (DSA). The target artery was catheterized, and DSA was performed to show the PBT. All images were documented for later analysis. Results: DSA demonstrated that the feeding arteries for the PBT included the dorsal pancreatic artery (DPA) alone (n = 51 [50%]), combined DPA and great pancreatic artery (GPA) (n = 22 [21.6%]), GPA alone (n = 16 [15.7%]), and transverse pancreatic artery (TPA) (n = 11 [10.8%]). DPA was observed to originate from the initial segment of the splenic artery (n = 34 [46.6%]), common hepatic artery (n = 17 [23.3%]), or superior mesenteric artery (n = 14 [19.2%]). The GPA was mostly from the middle (n = 36 [94.7%]), and only two were found to originate from the initial segment of the splenic artery. The TPA (n = 11) was from either the pancreatoduodenal artery (n = 5 [54.5%]) or the gastroduodenal artery (n = 4 [36.4%]). In most case, the predominant artery of the PBT (95.1%, 97 of 102) could be revealed by 64-slice CTA. Conclusions: The origins and identities of the predominant artery in the PBT are variable. DSA is superior to CTA for preoperative imaging in arterial intervention therapy.

Objective: The objective of this study was to compare the diagnostic performance of diffusion-weighted (DW) imaging with that of dynamic contrast-enhanced (DCE) imaging in the evaluation of tumor extent in patients with stage IB cervical cancer.Methods: This retrospective study was approved by the institutional review board. Between June 2010 and March 2012, 46 consecutive patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB who underwent preoperative DCE, DW (b = 0 and 800 s/mm(2)), and T1- and T2-weighted imaging were included in this study. Two radiologists independently evaluated the extent of cervical cancer and made a diagnosis of tumor stage according to the revised FIGO staging system. The staging accuracy by DCE and DW for readers 1 and 2 was compared with the McNemar test, and kappa statistics were used for reader agreement.Results: No statistical difference between the diagnostic performance of staging with DCE and with DW was observed in reader 1 (P = 1.000) or in reader 2 (P = 0.109). Interobserver agreement between the 2 readers for staging was both substantial with DCE (kappa = 0.750, P < 0.001) and with DW (kappa = 0.683, P < 0.001).Conclusions: The diagnostic performance of DW in distinguishing the subdivision of stage IB cervical cancer was not statistically different from that of DCE. Diffusion-weighted imaging may be preferable to DCE for the preoperative evaluation of stage IB cervical cancer.

Purpose: It has been demonstrated that the information in one image modality can be used to significantly help the reconstruction of another image modality. Here we develop and evaluate a novel Maximum a Posteriori (MAP) approach to apply anatomical information in MRI or x‐ray CT image to facilitate the estimate of Proton CT (pCT) image. Method: To incorporate anatomical information of MRI or x‐ray CT into the reconstruction of pCT images through priors based on information theoretic similarity measures, we formulate a MAP optimization problem, which includes a least‐square data‐fitting term to account for the noise in the measurement and a penalty term to maximize the joint density of feature vectors extracted from the pCT image and anatomical image. We defined feature vectors that emphasize prominent boundaries in anatomical and functional images, and attach less importance to detail and noise that is less likely to be correlated in the two images. We use a non‐parametric, FFT‐based Parzen window approach to speed up the computation of the density function of the feature vector, the joint density of feature vector, and the gradients of joint entropy. The optimization problem is solved using conjugate gradient and Armijo‐backtracking line search. We performed realistic simulations using anthropomorphic phantom to validate our approach and compare its performance to MAP approach with a quadratic smoothness penalty function (without anatomic information from x‐ray). Results: The Preliminary results demonstrate the proposed MAP approach with MRI or x‐ray CT as prior can achieve better contrast recovery and biasvariance trade‐off curves compared with MAP approach without anatomical prior. Conclusions: The proposed MAP approach can achieve superior image quality by using anatomical information in the MRI/x‐ray CT image. In the future we will investigate how much data reduction we can achieve using the proposed method while maintain the same image quality.

INTRODUCTION:The aim of this study is to evaluate the diagnostic performance of multidetector CT angiography (CTA) in depicting bronchial and non-bronchial systemic arteries in patients with haemoptysis and to assess whether this modality helps determine the feasibility of angiographic embolisation.MATERIALS AND METHODS:Fifty-two patients with haemoptysis between January 2010 and July 2011 underwent both preoperative multidetector CTA and digital subtraction angiography (DSA) imaging. Diagnostic performance of CTA in depicting arteries causing haemoptysis was assessed on a per-patient and a per-artery basis. The feasibility of the endovascular treatment evaluated by CTA was analysed. Sensitivity, specificity, and positive and negative predictive values for those analyses were determined.RESULTS:Fifty patients were included in the artery-presence-number analysis. In the per-patient analysis, neither CTA (P = 0.25) nor DSA (P = 1.00) showed statistical difference in the detection of arteries causing haemoptysis. The sensitivity, specificity, and positive and negative predictive values were 94%, 100%, 100%, and 40%, respectively, for the presence of pathologic arteries evaluated by CTA, and 98%, 100%, 100%, and 67%, respectively, for DSA. On the per-artery basis, CTA correctly identified 97% (107/110). Fifty-two patients were included in the feasibility analysis. The performance of CTA in predicting the feasibility of angiographic embolisation was not statistically different from the treatment performed (P = 1.00). The sensitivity, specificity, and positive and negative predictive values were 96%, 80%, 98% and 67%, respectively, for CTA.CONCLUSIONS:Multidetector CTA is an accurate imaging method in depicting the presence and number of arteries causing haemoptysis. This modality is also useful for determining the feasibility of angiographic embolisation for haemoptysis.

Objective To investigate the clinical value of 64-section CT angiography(CTA) in detecting the origin of dorsal pancreatic artery(DPA).Methods Ninety-seven consecutive patients with diabetes received transcatheter infusion of autologous bone marrow-derived stem cell transplantation into DPA.Abdominal CTA was performed in 42 patients before angiography.Celiac trunk,splenic,common hepatic and superior mesenteric arteries were reconstructed in order to locate the origin and traveling course of DPA.A routine angiography of both celiac and superior mesenteric arteries was performed for the demonstration of DPA.Further angiography of splenic and gastroduodenal arteries was carried out if necessary.Taking DSA images as the reference standard,the sensitivity,specificity and accuracy of CTA for DPA detection were calculated.Results DPA was the main supply artery of pancreas in 85.7% patients(36/42).CTA demonstrated the origin of DPA in 35 cases,although one of which was confirmed to be misjudged(false positive).In seven cases CTA could not demonstrate DPA,and DSA proved that 2 of them was misjudged(false negative).The sensitivity,specificity and accuracy of CTA for DPA detection were 94.4%,83.3% and 92.9%,respectively.Conclusion 64-section CTA can accurately detect the origin of main supply artery of pancreas,which is of great value in guiding the interventional procedure for pancreatic diseases.

Small cell lung cancer is commonly regarded as an old age related disease. Although the brain is a common site of metastasis for this type of lung cancer, the first manifestation is rarely shown from the metastasis site. In this paper, we report a rare case of 19-year-old female patient with small cell lung cancer whose initial presentation was a solitary brain metastasis. The patient was admitted to our hospital for the recurrence of brain tumor, and the histological diagnosis after operation showed small cell lung cancer. Three months later, she suffered from dry cough and was diagnosed as small cell lung cancer by trans-bronchial biopsy. Due to the identical cell types and immunohistochemical phenotypes, the brain tumor was retrospectively diagnosed as metastasis of small lung cancer by two neurological pathologists. She is the youngest female with brain metastasis as the first manifestation of small cell lung cancer reported so far internationally as to our knowledge. Second-hand smoking was possibly one of the risk factors.

PURPOSE:To investigate the diagnostic performance of 64-section CTA in the detection of dorsal pancreatic artery before interventional therapy for patients with diabetes. MATERIALS AND METHODS:The study was approved by the institutional ethics committee; written informed consent was obtained. Forty-two consecutive patients with diabetes received an experimental treatment of autologous bone marrow-derived stem cell transplantation by means of infusion into the dorsal pancreatic artery. All cases underwent abdominal CTA before angiography of pancreatic arteries in order to locate the origin and course of dorsal pancreatic artery. Angiography of coeliac artery, splenic artery, common hepatic artery and superior mesenteric artery were performed both in CTA and DSA. Superselective catheterization of dorsal pancreatic artery was carried out for the infusion of stem cell. Sensitivity, specificity and accuracy for the detection of dorsal pancreatic artery with CTA were calculated using DSA images as the reference standard. RESULTS:Thirty-five and thirty-six dorsal pancreatic arteries were detected by CTA and DSA respectively. Dorsal pancreatic artery was not visualized in either CTA or DSA in 5 patients. The sensitivity, specificity and accuracy for CTA were 94.4%, 83.3% and 92.9%. CONCLUSION:64-section CTA is accurate for the detection of dorsal pancreatic artery. It may be useful for the facilitation of superselective arterial infusion of stem cells to pancreas.

病例资料患者,男,37岁.12年前体检行胸部X线检查发现纵隔占位.平时无咳嗽、咳痰、咯血、胸闷、心悸等.吸烟史10余年,10支/日,偶有饮酒.实验室检查未见明显异常.影像学表现:胸部CT示右心缘一团块状软组织密度影,密度均匀,边界清楚,大小约7.2cm×7.8 cm.平扫CT值约54 HU,增强扫描动脉期CT值约65 HU(图2、3),延迟期CT值约96 HU(图4),各期CT值均与肝脏相似.

Objective To explore the features of time-signal curve of MRI dynamic enhancement of nasopharyngeal carcinoma before and after intensity modulated radiotherapy(IMRT).Methods 326 patients with newly diagnosed nasopharyngeal carcinoma were included.Dynamical contrast enhanced MR imaging was performed before and after IMRT.The features of time-signal curve of lesions before and after intensity modulated radiotherapy were analyzed.Results The typical curve before IMRT was a rapidly ascending-rapidly descending one or a rapidly ascending-platform one.That of post-treatment was of slowly ascending or slowly ascending-platform.Conclusion Treatment with IMRT can not only shrink the size of tumor and treat the local invasion or lymph nodes metastasis,but also inhibit the angiogenesis in nasopharyngeal carcinoma.

BACKGROUND: Conventional neuroimaging diagnosis does not assist with the monitoring or evaluation of basal nuclei ischemic and hemorrhagic stroke, or motor functional recovery. Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography have all been used to observe features of cerebral white matter fibrous structures. In addition, diffusion tensor tractography is the only non-invasive imaging method to display the corticospinal tract in vivo.OBJECTIVE: To evaluate the impairment degree of corticospinal tract induced by basal nuclei ischemic and hemorrhagic stroke through the use of magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography, and to analyze the correlation to muscular strength.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Medical Imaging, Neurology and Neurosurgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between November 2002 and June 2008.PARTICIPANTS: A total of 15 patients with acute or subacute cerebral ischemic stroke and nine with hemorrhagic stroke in the basal nuclei were selected.METHODS: Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography results and data were analyzed. Fractional anisotropy and directionally encoded color maps were obtained. Three-dimensional tractography of bilateral corticospinal tract was created, and corticospinal tract integrity was graded. Fractional anisotropy of infarct region and corresponding contralateral normal regions were measured, and hematoma volume in hemorrhagic stroke patients was determined. Hand motor function ability was evaluated using Brunstorm criteria.MAIN OUTCOME MEASURES: Fractional anisotropy of infarct region and corresponding contralateral normal regions; hematoma volume in hemorrhagic stroke patients; correlation between muscular strength and corticospinal tract impairment degree in ischemic stroke and hemorrhagic stroke patients before and after treatment.RESULTS: In ischemic stroke patients, the fractional anisotropy value was significantly lower in the infarct area of white matter than in the normal hemisphere (P < 0.01). The impairment degree of corticospinal tract negatively correlated with muscular strength of the corresponding hand (r=-0.97, P < 0.01). The hematoma volume of hemorrhagic stroke patients significantly negatively correlated with Spearman test results for muscular strength of the corresponding hand (r=-0.88, P < 0.01).CONCLUSION: Corticospinal tract impairment severity negatively correlated with muscular strength and motor functional recovery, which suggested that diffusion tensor imaging and diffusion tensor tractography could be used to evaluate corticospinal tract motor function.

Purpose: To characterize and evaluate functional and anatomic changes of visual pathway lesions during hyperbaric oxygen (HBO) treatment with blood-oxygenation-level-dependent functional MRI (BOLD-fMRI) and diffusion tensor imaging (DTI).Materials and Methods: Sixteen patients with visual pathway lesions received HBO treatment. Both BOLD-fMRI and DTI were performed before and after the treatment, while 12 healthy subjects were also studied with 2 examinations as control. The t-tests were used for the comparison of number of activated voxels (AVs) and fractional anisotropy (FA) between the two groups, and within the patient group before and after HBO treatment. Visual acuity of the patient group before and after the treatment was compared using Wilcoxon signed-rank test.Results: Before the treatment, both AVs (P < 0.01) and FA (P < 0.05) in the bilateral cortexes of occipital lobes were significantly less in the patient group than in the control group. After the treatment, both AVs (P < 0.05) and FA (P < 0.05) were significantly increased. Moreover. The FA of 6 patients with lesions in the optical nerve was greater than the FA of the other 10 patients with lesions in the optic radiation (P < 0.05).Conclusion: BOLD-fMRI combined with DTI was useful for the characterization and evaluation of anatomic and functional changes of visual pathway lesions and their development during HBO treatment.