Prognostic value of the standardized uptake value in esophageal cancer

OBJECTIVE: On PET, the level of tissue glycolysis can be quantified by the accumulation of fluorine-18-fluorodeoxyglucose expressed as the standardized uptake value (SUV). The aims of this study were to investigate the relation between SUV and the stage of disease and whether SUV can be used to predict resectability and survival in patients with esophageal cancer. CONCLUSION: SUV can be used to predict resectability; however, SUV is not an independent factor that can be used to assess survival in patients with esophageal cancer.     

Radiology's value chain

A diagnostic radiology value chain is constructed to define its main components, all of which are vulnerable to change, because digitization has caused disaggregation of the chain. Some components afford opportunities to improve productivity, some add value, while some face outsourcing to lower labor cost and to information technology substitutes, raising commoditization risks. Digital image information, because it can be competitive at smaller economies of scale, allows faster, differential rates of technological innovation of components, initiating a centralization-to-decentralization technology trend. Digitization, having triggered disaggregation of radiology's professional service model, may soon usher in an information business model. This means moving from a mind-set of "reading images" to an orientation of creating and organizing information for greater accuracy, faster speed, and lower cost in medical decision making. Information businesses view value chain investments differently than do small professional services. In the former model, producing a better business product will extend image interpretation beyond a radiologist's personal fund of knowledge to encompass expanding external imaging databases. A follow-on expansion with integration of image and molecular information into a report will offer new value in medical decision making. Improved interpretation plus new integration will enrich and diversify radiology's key service products, the report and consultation. A more robust, information-rich report derived from a "systems" and "computational" radiology approach will be facilitated by a transition from a professional service to an information business. Under health care reform, radiology will transition its emphasis from volume to greater value. Radiology's future brightens with the adoption of a philosophy of offering information rather than "reads" for decision making. Staunchly defending the status quo via turf wars is unlikely to constitute a forward-looking, competitive strategy.     

Programmatic accreditation's value

When the elements of educational quality, radiation safety and protection of student rights are considered, the value of JRCERT accreditation is apparent. Programs can be confident that the JRCERT Standards support their educational goals and objectives. Students can be confident that the education they receive will prepare them to function as entry-level professionals as determined by national standards. Radiation therapists and radiographers can be confident their coworkers were appropriately educated and are able to fulfill the responsibilities of these professional positions. Employers across the country can be confident that graduates possess fundamental skills regardless of the JRCERT-accredited program the graduate attended. Lastly, patients can be confident that their radiographic procedures are performed competently.     

乳腺DCE-MRI与ADC值及ADC差值的临床应用价值

目的 探讨动态增强磁共振成像(DCE-MRI)、扩散加权成像(DWI)对鉴别乳腺良恶性病变的临床应用价值.方法 对临床拟诊乳腺病变的60例患者行MR检查,将病灶形态学、早期增强率、时间-信号曲线(TIC)、表观扩散系数(ADC)值、病灶周围组织与病灶ADC的差值诊断结果进行比较分析.结果 早期增强率、TIC、ADC值、ADC差值受试者工作特征(ROC)曲线的曲线下面积(AUC)分别为0.741、0.808、0.882、0.959,早期增强率、ADC值、ADC差值最佳诊断阈值分别为163％、1.30×10-3mm2/s、0.47×10-3 mm2/s.形态学、早期增强率、Ⅲ型曲线、Ⅱ型及Ⅲ型曲线、ADC值、ADC差值鉴别诊断乳腺良恶性病变的敏感性分别为53.1％、59.4％、43.8％、90.6％、93.8％、96.9％,特异性分别为85.7％、82.1％、89.3％、57.1％、75.0％、82.1％,阳性预测值分别为81.0％、79.2％、82.4％、70.7％、81.1％、86.1％,阴性预测值分别为61.5％、63.9％、58.1％、84.2％、91.3％、95.8％,准确率分别为68.3％、70.0％、65.0％、75.0％、85.0％、90.0％.结论 DCE MRI与DWl对乳腺良恶性病变的鉴别诊断有重要作用,其中ADC差值诊断效能最高,需多种方法综合诊断互补不足,以提高诊断准确性.     

DWI及ADC值在肝脏弥漫性疾病诊断中的应用价值

目的:探讨肝脏常见弥漫性疾病的ADC值及DWI上信号强度与相应血供相关性。方法:共110例(19例肝硬化癌变结节、20例肝转移性肿瘤、35例海绵状血管瘤和36例肝囊肿)弥漫性肝占位进行磁共振扫描并计算感兴趣区ADC值、信号强度及增强率。结果:癌变结节与DN及正常肝组织间ADC值相比明显高于后两者,P<0.05。肝囊肿、海绵状血管瘤、肝硬化癌变结节及转移性肝癌在DWI上均为明显高信号。结论:DWI及ADC值对于鉴别弥漫分布的肝脏恶性实质肿块与肝硬化再生结节及良性富水肿块(血管瘤及囊肿)有重要的诊断价值,尤其是在弥漫分布的肝硬化再生结节中发现癌变结节,有其重大的临床意义。     

腰椎椎体CT值与骨密度值的相关性研究

骨质疏松症(osteoporosis,OP)是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病[1].由于骨质疏松所引起的骨折给患者带来极大的痛苦,也给社会造成了很大的负担.因此,如何早期预测骨质疏松、预防骨折、提高人们的生活质量,已成为目前亟待解决的重大课题.双能X线骨密度仪(DXA)是一种二维的测量方法,腰椎测量值受到骨质增生和附件的影响而不够精确;定量CT (QCT)需要专门的软件而无法普及;上述2种方法使得骨质疏松的检出率难以提高.MSCT是临床最常用的一种检查方法,影像科医师可方便快捷地测量每1例接受腰椎或腹部CT检查的患者腰椎椎体CT值.本文通过对腰椎椎体CT值与骨密度值进行相关性分析,从而评估椎体CT值对骨质疏松的诊断价值.     

Operational cost and value

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Our faithful Bell Helicopter 222U has begun to show its age. Although it has served us well as an air ambulance for more than 14 years, parts for this helicopter have become increasingly scarce and accordingly more expensive. Therefore, looking ahead to the day when it no longer makes economic sense to operate a BH222U, our program has invited several helicopter manufacturers to visit us and demonstrate the suitability of their aircraft for our program here in the high deserts and mountain ranges of central Oregon.     

肺最大通气量实测值占预计值百分比在围术期中评估价值研究

目的探讨肺最大通气量(MVV)实测值占预计值百分比(MVV%pred)在围术期的评估价值。方法选取61例行胸与上腹部手术后肺功能异常的患者,将50%≤MVV%pred<80%的患者纳入A组(33例),MVV%pred<50%的患者纳入B组(28例)。比较两组一秒用力呼气容积(FEV_1),用力肺活量(FVC),一氧化碳弥散量(DLco),5 Hz时呼吸阻力(R_5),MVV,残气量(RV),肺总量(TLC)及术后并发症发生概率。采用两种方法计算MVV估算值:方法一公式为MVV%pred=FEV_1×35/MVV预计值,方法二公式为MVV%pred=FEV_1×33+9/MVV预计值。结果与A组比较,B组FEV_1、MVV、FVC降低,R_5、RV、TLC升高,差异有统计学意义(P<0.05);两组DLco差异无统计学意义(P>0.05)。3种方法获得的MVV值中,实测值与方法一公式计算获得的估算值差异无统计学意义(P>0.05),而与方法二公式计算获得的估算值差异有统计学意义(P<0.05);方法一与方法二公式计算获得的预测值差异也有统计学意义(P<0.05)。A组患者术后并发症发生率为6.1%(2/33),明显低于B组的39.3%(11/28),差异有统计学意义(P<0.05)。结论 MVV%pred<50%的患者的肺通气功能减退与RV、TLC、气道阻力增高的程度明显高于50%≤MVV%pred<80%的患者,但两者弥散功能损害差异不明显。对不能配合完成MVV测试获得MVV%pred实测值的患者,可用公式MVV=FEV_1×35/MVV预计值计算获得的估算值对手术适应证进行评估。     

Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in endometrioid endometrial carcinoma

Purpose

To determine whether the relative metabolic activity of pelvic or para-aortic LN compared with that of primary tumor measured by preoperative [¹⁸F]FDG PET/CT scan has prognostic value in patients with endometrioid endometrial carcinoma.

Methods

We retrospectively reviewed patients with endometrioid endometrial carcinoma who underwent preoperative [¹⁸F]FDG PET/CT scans. Prognostic values of PET/CT-derived metabolic variables such as maximum standardized uptake value (SUV) of the primary endometrial carcinoma (SUV_Tumor) and LN (SUV_LN), and the LN-to-endometrial carcinoma SUV ratio (SUV_LN / SUV_Tumor) were assessed.

Results

Clinico-pathological data, imaging data, and treatment results were reviewed for 107 eligible patients. Median post-surgical follow-up was 23 months (range, 6–60), and 7 (6.5%) patients experienced recurrence. Regression analysis showed that SUV_LN / SUV_Tumor (P < 0.001), SUV_LN (P = 0.003), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.006), and tumor grade (P = 0.011) were risk factors of recurrence. Multivariate regression analysis revealed that FIGO stage (P = 0.034) was the independent risk factor of recurrence. SUV_LN / SUV_Tumor showed significant correlation with FIGO stage (P < 0.001), LN metastasis (P < 0.001), lymphovascular space invasion (P < 0.001), recurrence (P = 0.001), tumor grade (P < 0.001), and deep myometrial invasion of tumor (P = 0.022). Patient groups categorized by SUV_LN / SUV_Tumor showed significant difference in progression-free survival (Log-rank test, P = 0.001).

Conclusions

Preoperative SUV_LN / SUV_Tumor measured by [¹⁸F]FDG PET/CT was significantly associated with recurrence, and may become a novel prognostic factor in patients with endometrioid endometrial carcinoma.

     

颈部病变淋巴结实质区和坏死区表观扩散系数值的鉴别诊断价值

目的 探讨淋巴结实质区和坏死区的表观扩散系数(ADC)值对颈部淋巴结病变的鉴别诊断价值.方法 对36例颈部淋巴结转移癌、19例淋巴瘤和23例淋巴结结核患者进行扩散加权成像(DWI),测量并比较不同病变巾淋巴结实质区和坏死区的ADC值,评价两者对3种淋巴结病变的鉴别诊断能力.共对病理(114枚)和临床随访(63枚)证实的177枚淋巴结进行ADC值的测量和分析,其中转移癌性淋巴结84枚,淋巴瘤性淋巴结40枚,结核性淋巴结53枚.2组均数的比较采用独立样本t检验,2组以卜均数的比较采用单向方差分析(one-way ANOVA).结果 转移癌、淋巴瘤和结核的淋巴结实质区的ADC值分别为(0.93±0.16)、(0.64±0.13)和(1.01±0.11)×10-3mm2/s(F=82.928,P<0.01),淋巴结转移癌和结核中淋巴结坏死区的ADC值分别为(2.02±0.36)、(1.25±0.15)×10-3mm2/s(t=12.045,P<0.01).当淋巴结实质区的ADC值≤0.77×10-3mm2/s时,诊断为淋巴瘤的敏感度、特异度分别为83%和89%.当淋巴结坏死区的ADC值≥1.60×10-3mm2/s时,诊断为淋巴结转移癌的敏感度、特异度分别为88%、100%.结论 测量淋巴结的ADC值,尤其是坏死区的ADC值有助于淋巴结病变的鉴别诊断.     

The value of sports profiling

In his presidential presentation to the American Orthopedic Association in 1975, Inman said, "Man is a machine that moves . . . and expends energy." He was all too ahead of his time. Profiling, by recognizing that the body is a machine with links, studies the biophysical, biochemical, and biomechanical links of the body's systems. These studies, carried out on athletes and potential athletes of all ages, yield data with useful clinical and research applications. The continued use and study of profiling data will certainly enhance performance, increase enjoyment of athletes for years to come, and, we believe, prevent injury.     

Enteroclysis:Current clinical value

AIM: To retrospectively analyze changes in clinical indication, referring medical specialty and detected pathology for small bowel double-contrast examinations. METHODS: Two hundred and forty-one (n = 143 females; n = 98 males; 01.01.1990-31.12.1990) and 384 (n = 225 females; n = 159 males; 01.01.2004-31.12.2010) patients underwent enteroclysis, respectively. All exami- nations were performed in standardized double-contrast technique. After placement of a nasojejunal probe distal to the ligament of Treitz, radiopaque contrast media followed by Xray negative distending contrast media were administered. Following this standardized projections in all four abdominal quadrants were acquired. Depending on the detected pathology further documentation was carried out by focused imaging. Examination protocols were reviewed and compared concerning requesting unit, indication and final report. RESULTS: Two hundred and forty-one examinations in 1990 faced an average of 55 examinations per year from 2004-2010. There was an increase of examinations for gastroenterological (33.6% to 64.6%) andpediatric (0.4% to 7.8%) indications while internal (29.0% to 6.0% for inpatients and from 16.6% to 9.1% for outpatients) and surgical (12.4% to 7.3%) referrals significantly decreased. "Follow-up of Crohn’s disease" (33.1%) and "bleeding/tumor search" (15.1%) represented the most frequent clinical indications. A total of 34% (1990) and 53.4% (2004-2010) examinations yielded pathologic findings. In the period 01.01.2004 -31.12.2010 the largest proportion of pathological findings was found in patients with diagnosed Crohn’s disease (73.5%), followed by patients with abdominal pain (67.6% with history of surgery and 52.6% without history of surgery), chronic diarrhea (41.7%), suspected Crohn’s disease (39.5%) and search for gastrointestinal bleeding source/tumor (19.1%). The most common pathologies diagnosed by enteroclysis were "changes in Crohn’s disease" (25.0%) and "adhesions /strictures" (12.2%). CONCLUSION: "Crohn’s disease" represents the main indication for enteroclysis. The relative increase of pathologic findings reflects today’s well directed use of enteroclysis.     

Diagnostic value of vertebral phlebogram

Summary We believe that vertebro-basilar phlebograms contribute valuable information to the angiographic diagnosis of posterior fossa and centrencephalic tumours, as well as infra- and supra-tentorial herniations. Phlebograms are particularly useful for estimating the tumour site.

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Der diagnostische Wert des vertebro-basilären Phlebogramms

Zusammenfassung Das vertebro-basiläre Phlebogramm gibt eine wertvolle Information bei der angiographischen Diagnostik von Tumoren der hinteren Schädelgrube und bei einer ausgeprägten intracraniellen Raumforderung, die zu einer tentoriellen Herniation führt.

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La valeur diagnostique du phlébogramme du système vertébro-basilaire

Résumé A notre avis le phlébogramme du système vertébro-basilaire donne des importants reinsegnements pour le diagnostic angiographique des tumeurs de la fosse postérieure et des formations centro-encephaliques, ainsi que des hernies tentorielles inférieures et supérieures. II peut contribuer d'une facon significative à la valutation du siège de la tumeur, en représentant souvent le plus important aspect pathologique dans l'angiographie.

     

表观扩散系数在神经上皮肿瘤分级中的诊断价值

目的 评价ADC值在神经上皮肿瘤分级中的诊断价值.方法 回顾性分析70例经病理证实为神经上皮肿瘤患者的临床和影像资料,根据2007年WHO中枢神经系统分类标准,将所有患者分为低级别组40例(WHO Ⅰ或Ⅱ级)和高级别组30例(WHOⅢ或Ⅳ级).患者术前均行MR平扫、DWI及增强扫描,在ADC图上测量肿瘤组织的最小ADC值,术后利用免疫组织化学的方法确定Ki-67指数.两组间最小ADC值的比较采用成组t检验,年龄及Ki-67指数比较采用Mann-Whitney检验,最小ADC值与Ki-67指数的相关性采用Pearson相关性分析,应用ROC曲线来分析评价最小ADC值区分神经上皮肿瘤级别的能力.结果 低级别组平均最小ADC值[(1.08±0.31)× 10~(-3) mm~2/s]大于高级别组[(0.74±0.18)×10~(-3) mm~2/s],差异有统计学意义(t=5.42,P＜0.05＝.低级别组Ki-67指数[范围0～50%,中位数为4%]小于高级别组[范围0～75%,中位数为25%],差异有统计学意义(U=325.50,P＜0.05＝.最小ADC值与Ki-67指数呈负相关(r=-0.30,P＜0.05＝.ROC曲线下面积为0.85,区分高、低级别组肿瘤的最佳截断值为0.86×10~(-3) mm~2/s,此时,诊断高级别神经上皮肿瘤的敏感性为90.0%,特异性为77.5%.结论 最小ADC值有助于神经上皮肿瘤的分级判定.