Diagnostic accuracy of magnetic resonance imaging (MRI) in the assessment of tumor invasion depth in oral/oropharyngeal cancer

The purpose of the present study was to evaluate the diagnostic value of MRI for measuring invasion depth in oral/oropharyngeal carcinoma. We retrospectively reviewed pathologic specimens and MRI findings of 114 patients who were diagnosed with squamous cell carcinoma of the oral cavity and oropharynx. Invasion depths were evaluated in pathologic specimens and by MRI. The mean histologic and MRI invasion depths were 13.57 ± 8.476 and 15.24 ± 10.700 mm, respectively. The overall Pearson's correlation coefficient for histologic and MRI (T1W-MRI) invasion depths was 0.825, which was statistically significant (P<0.001). Pearson's correlation coefficients for histologic and MRI invasion depths in oral tongue, tongue base, and tonsil cancers were 0.949, 0.941, and 0.578, respectively. The MRI invasion depth was significantly different according to nodal status in cancers of the oral tongue (P=0.001(?)) and tongue base (P=0.003(?)). With MRI, the invasion depth cutoff values for determining positive nodes were 9.5 and 14.5mm in cancers of the oral tongue and tongue base, respectively. Preoperative MRI is an accurate method for measuring tumor invasion depth in oral tongue and tongue base cancers. Furthermore, it has predictive value for nodal metastasis in the oral tongue and tongue base.     

Diagnosis of cancer with magnetic resonance imaging (MRI)

Following a brief review of the history of magnetic resonance imaging (MRI), advantages and disadvantages of MRI are discussed in the diagnosis of malignant tumors of the various parts of the body. The advantages include high contrast resolution, no artifacts from the bones, and arbitrary imaging planes obtainable in multiple slices, whereas disadvantages include no signals from calcifications and prolonged imaging time. The roles of MRI were discussed in relation to detection of early cancers, extent of the lesions, histologic diagnosis and monitoring of treatments. Early diagnosis of tumors is successful in the central nervous system, whereas it is not accomplished in other parts of the body. Extent of the tumors or staging of the tumors can be accomplished to excellent advantage, but signal intensity is often not useful for differential diagnosis.     

Role of magnetic resonance imaging (MRI) in early cervical cancer

The aim of this study was to prospectively determine if invasive carcinoma of the cervix can be ruled out by negative magnetic resonance image (MRI) findings. Eligible patients were those who were scheduled to undergo either hysterectomy or conization because of invasive or non-invasive lesions of the cervix. T2-weighted and T1-dynamic enhancement images were reviewed by two radiologists who had no information on these patients except for the preoperative diagnosis. Clinical information regarding location of the disease was not given. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist who was not provided with MRI information. The correlation between MRI and histological findings was analyzed in terms of depth of invasion. Seventy cases were entered and 66 were evaluable. Sensitivities of T2 and dynamic MRI for invasive and non-invasive disease by radiologist 1 were 0.8824 and 0.8235, respectively, and those by radiologist 2 were 0.6296 and 0.7647, respectively. Specificities were 0.8776 and 0.8571, respectively, for radiologist 1 and 0.8974 and 0.8367, respectively, for radiologist 2. When sensitivities and specificities were calculated for prediction of non-invasive plus microinvasive lesions < or = 5 mm vs. invasive lesions > 5 mm, specificities of T2 and dynamic MRI became 1.0000 for both radiologists. Negative findings on T2 and/or dynamic MRI indicated non-invasive or early invasive cervical diseases < or = 5 mm. The dynamic technique provided only limited additional value in the detection of early invasive cervical carcinoma.     

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

Background

As mastectomy rates increase and overall survival for early breast cancer improves, a better understanding of the long-term consequences of mastectomy is needed. We sought to explore the correlation of specific mastectomy type with the Female Sexual Function Index (FSFI), body image satisfaction, and the reconstructed breast’s role in intimacy.

Methods

This study is a secondary analysis of a cross-sectional survey including a retrospective chart review. Patients at least one year from primary surgery were invited to complete the survey between 2012 and 2014. Baseline characteristics and survey responses were compared between three mastectomy groups: total/modified radical (TMRM), skin-sparing (SSM), and nipple-sparing (NSM). All patients underwent reconstruction.

Results

Of 453 invited, 268 (59%) completed the survey. Sixty underwent mastectomy with reconstruction: 16 (27%) TMRM, 36 (60%) SSM, and 8 (13%) NSM. There were no significant differences in median total FSFI scores between groups, yet median FSFI scores for the NSM group indicated sexual dysfunction. After adjusting for receipt of chemotherapy and/or radiation, NSM had the lowest median desire score. There was a trend for the NSM group to be the least satisfied with postoperative appearance, but also more likely to report that the chest was “often” caressed during intimacy. However, nearly 40% of the NSM group reported that caress of the reconstructed breast was unpleasant.

Conclusion

NSM offers patients the greatest opportunity for preservation of their native skin envelope and potentially enhanced cosmetic outcome, but our results did not demonstrate superior sexual function or body image outcomes in this group. By highlighting surgical consequences of mastectomy preoperatively, surgeons may better set realistic patient expectations regarding both aesthetic and functional outcomes after breast cancer surgery. With clearer expectations, patients will have a better opportunity for improved surgical decision-making.

     

磁共振成像在子宫内膜癌的诊断及分期中的作用研究

目的:探讨MRI在子宫内膜癌的诊断、分期中的作用.方法:回顾性研究273例经术后病理检查明确诊断的子宫内膜癌患者,根据其术前MRI表现,以FIG02009新分期方法结合病理分期结果进行评估.结果:273例患者中Ⅰa期136例,Ⅰb期46例,Ⅱ期51例,Ⅲa期8例,Ⅲb期7例,Ⅲcl期8例,Ⅲ2期4例,Ⅳa期6例,Ⅳb期7例,MRI对子宫内膜癌分期正确率为93.4％,与病理分期比较无显著统计学差异(P＞0.05).结论:MRI对子宫内膜癌的诊断及分期具有较高准确性,在临床治疗方式及预后评估中具有重要意义.     

MRI分期在早中期前列腺癌放疗中应用

背景与目的：前列腺癌是老年男性常见恶性肿瘤，部分早中期患者不能耐受或拒绝手术转而行放射治疗，在常规放疗过程中部分患者亦出现了不能耐受放疗反应，MRI作为一种显示前列腺及周围组织病变程度的影像设备，可应用于前列腺癌临床分期。本研究通过MRI确定MRI（TNM分期），对早中期的前列腺癌进行改良放射治疗，以探讨其在早中期前列腺癌放疔中的临床应用价值。方法：1998年1月-2003年1月共63例通过MRI确定分期为T1-2N0M0期，拒行根治术的前列腺癌患者，随机分为传统（方法）放疗组和改良放疗组，各予传统盆腔大野或改良盆腔野放疗4000—4500cGY，再各予前列腺精囊五野适形放疗2500—3000cGY。结果：中位生存时间传统放疗组和改良放疗组分别为82个月和76．3个月（P=0．673），5年生存率83．97％和79．64％；中位无PSA复发生存时间传统放疗组59个月，改良放疗组60个月（P=0．859），5年无PSA复发生存率分别为42．37％和49．01％。而急慢性消化道反应及急慢性泌尿生殖道反应传统放疗组显著多于改良放疗组差异有显著性。结论：通过MRI确定分期为T1-2N0M0期以前的早中期前列腺患者传统放疗组与改良放疗组在局控率及生存率差异无显著性，但在近期及远期毒副反应方面，改良放疗组显著少于传统放疗组。     

Tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) for uterine cervical cancer treated with irradiation

PURPOSE: To evaluate the prognostic value of tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) in patients with uterine cervical cancer treated with radiation therapy. METHODS AND MATERIALS: Forty-four patients with intact uterine cervical squamous carcinoma treated with a combination of external irradiation and high-dose-rate intracavitary therapy were analyzed. Actuarial disease-free survival (DFS), pelvic control rate (PC), and distant metastasis-free rate (DMF) were analyzed by tumor diameter, volume, and pelvic node status assessed by pretreatment MRI. RESULTS: Anteroposterior (AP) and lateral (RL) tumor diameter significantly affected DFS. The 2-year DFS was 74% for patients with < 40 mm in AP diameter tumor, and 24% for > or = 40 mm tumor (p = 0.02). Whereas PC was not influenced, DMF was significantly affected by AP tumor diameter. Tumor volume did not significantly affect any endpoints. Patients with enlarged pelvic nodes had significantly poorer outcome compared to those with none on PC, DMF, and DFS. The 2-year DFS was 78% for node-negative, and 10% for node-positive patients (p = 0.0001). CONCLUSION: AP tumor diameter and pelvic lymph node status assessed by MRI were the significant prognostic factors in uterine cervical cancer treated with irradiation. Prognostic value of tumor volume should be reassessed prospectively with an appropriate imaging technique. AP tumor diameter predominantly affected the incidence of distant metastasis, and lymph node status affected both pelvic control and distant metastasis.     

多参数磁共振成像对乳腺良恶性病变的诊断价值

目的 探讨扩散加权成像(DWI)、T2加权成像(T2WI)和动态对比增强(DCE)-MRI对乳腺癌的诊断价值.方法 对136例患者的169个乳腺病变进行分析,所有患者同时接受了DCE-MRI和DWI(b值为1000 s/mm2)检查.按检查方法分为三组,第一组DCE-MRI,第二组DWI-T2WI,第三组DCE-MRI...     

Shoulder impingement syndrome: Diagnostic accuracy of magnetic resonance imaging and radiographic signs

Shoulder impingement syndrome is commonly encountered in orthopaedics. In a blinded retrospective study, magnetic resonance imaging and roentgenographic signs in 41 patients with clinical signs of impingement syndrome were compared with 40 control patients. Statistically significant differences between the groups included the absence of subacromial fat, as well as the presence of a supraspinatus tear, subacromial osteophytes, and a decreased coracohumeral distance. Other signs reported to occur in patients with impingement syndrome did not vary significantly in the population studied.     

Magnetic resonance spectroscopy imaging (MRSI) and brain functional magnetic resonance imaging (fMRI) for radiotherapy treatment planning of glioma

Conventional radiotherapy of glioma is ineffective due to uncertainties in target delineation, inadequate radiation dose, and difficulties in identifying radio-resistant high-grade tumor for dose escalation. Magnetic resonance spectroscopy imaging (MRSI) and functional magnetic resonance imaging (fMRI) provide information on altered metabolic activity of tumor cells and functionally critical brain tissues, which are not available from anatomical imaging. In this paper, we review the pathological and physiological information that might be derived from MRSI and fMRI to better delineate the treatment volume and critical organs for glioma radiotherapy. Technical difficulties for incorporating MRSI and fMRI into radiotherapy treatment planning process are discussed and potential solutions are presented. A fusion protocol is used to illustrate the feasibility of registering MRSI and fMRI with simulation CT for one glioma case. An IMRT (intensity-modulated radiotherapy) dose painting plan for this case is also presented using the fused MRSI and fMRI to delineate the clinical target volumes and Broca's area.     

The value of magnetic resonance imaging in treatment planning of nasopharyngeal carcinoma

Seven patients with AJCC Stage T4 nasopharyngeal carcinoma underwent both computed tomographic (CT) and magnetic resonance (MR) examinations prior to radiation therapy treatment planning. Lateral tumor extension into the infratemporal fossa was visualized by MR as less extensive in three cases than suggested by CT, as was inferior extension into the parapharyngeal soft tissues in three cases. MR clarified uncertainties on CT regarding involvement of the pontine cistern in three patients and of the cavernous sinus in two patients. Posterior extension of tumor was underestimated by CT in four of six cases shown by MR to involve the clivus. MR appeared superior in evaluating the presence of parenchymal brain involvement in three cases. The margins of the final boost treatment fields dictated by MR findings differed measurably from those derived from CT in six of seven cases. These findings lend support for greater utilization of MR in treatment planning of nasopharyngeal carcinoma.     

甲状腺癌的MRI诊断

背景与目的：MRI现已成为诊断甲状腺病变的重要手段,国外有关甲状腺癌的MRI研究已有较多报道,而国内报道甚少。本研究旨在通过分析甲状腺癌的MRI表现及组织病理学特点,探讨MRI在甲状腺癌诊断中的价值。方法：回顾性分析31例甲状腺癌患者的术前MRI表现,并与术后病理检查结果对比。结果：3l例甲状腺癌患者中20例MRI信号不均匀,病理学显示肿瘤出现不同程度坏死、出血或囊变;22例肿瘤形态不规则、呈分叶状;22例肿瘤边缘模糊,其中10例可见瘤周不完整包膜样低信号影,病理检查发现肿瘤已侵犯并突破假包膜;19例肿瘤侵犯周围组织器官,19例出现颈部淋巴结转移。结论：瘤周不完整包膜样低信号影是甲状腺癌的MRI特征性表现;肿瘤边缘模糊、形状不规则及信号不均匀是诊断甲状腺癌的重要指征;MRI能够较好的显示小病灶、病灶形态改变及肿瘤侵犯的范围。     

Diagnostic accuracy and prognostic impact of restaging by magnetic resonance imaging after preoperative chemoradiotherapy in patients with rectal cancer

BackgroundThe prognostic role of restaging rectal magnetic resonance imaging (MRI) in patients with preoperative CRT has not been established. The goal of this study was to evaluate the diagnostic accuracy and prognostic role of radiological staging by rectal MRI after preoperative chemoradiation (CRT) in patients with rectal cancer.MethodsA total of 231 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from January 2008 to December 2009 were prospectively enrolled. The diagnostic accuracy and prognostic significance of post-CRT radiological staging by MRI was evaluated.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of radiological diagnosis of good responders (ypTNM stage 0–I) were 32%, 90%, 65%, and 69%, respectively. The overall accuracy of MRI restating for good responders was 68%. The 5-year disease-free survival rates of patients with radiological and pathological TNM stage 0, stage I, and stage II–III were 100%, 94%, and 76%, respectively (P = 0.037), and 97%, 87%, and 73%, respectively (P = 0.007). On multivariate analysis, post-CRT radiological staging by MRI was an independent prognostic factor for disease-free survival.ConclusionRadiological staging by MRI after preoperative CRT may be an independent predictor of survival in patients with rectal cancer.     

Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast

Aims

The role of magnetic resonance imaging (MRI) in the local staging of breast cancer is currently uncertain. The purpose of this prospective study is to evaluate the accuracy of preoperative MRI compared to conventional imaging in detecting breast cancer and the effect of preoperative MRI on the surgical treatment in a subgroup of women with dense breasts, young age, invasive lobular cancer (ILC) or multiple lesions.

Methods

Between January 2006 and October 2007, 91 patients with newly diagnosed breast cancer underwent preoperative clinical breast examination, mammography, bilateral breast ultrasonography and high-resolution breast MRI. All patients had histologically verified breast cancer. The imaging techniques were compared using the final pathological report as gold standard.

Results

The sensitivity of MRI for the main lesion was 98.9%, while for multiple lesions sensitivity was 90.7% and specificity 85.4%. After preoperative MRI, 13 patients (14.3%) underwent additional fine needle/core biopsies, 9 of whom had specimen positive for cancer. Preoperative MRI changed the surgical plan in 26 patients: in 19.8% of the cases breast conservative surgery was converted to mastectomy and in 7.7% of the patients a wider excision was performed. At a mean follow-up of 48 months, 2 local recurrences occurred (local failure rate = 2.5%).

Conclusions

Enhanced sensitivity of breast MRI may change the surgical approach, by increasing mastectomy rate or suggesting the need of wider local excision. MRI can play an important role in preoperative planning if used in selected patients with high risk of multifocal/multicentric lesions. However, the histologic confirmation of all suspicious findings detected by MRI is mandatory prior to definite surgery.     

高分辨率磁共振在局部进展期直肠癌中的应用

高分辨率磁共振(HRMRI)已成为多学科团队评估局部进展期直肠癌不可或缺的影像学方法.HRMRI可以对肿瘤进行准确的术前分期,同时准确评估相关不良预后因素,如环周切缘、脉管浸润等.HRMRI可以选择合适的直肠癌患者行新辅助治疗,对仅需单纯手术的患者可以避免过度治疗,从而提高局部进展期直肠癌患者的预后及生命质量.     

磁共振成像联合剪切波弹性成像技术在甲状腺微小乳头状癌诊断中的应用价值

目的探讨磁共振成像(MRI)联合剪切波弹性成像技术(SWE)对甲状腺微小乳头状癌(PTMC)的诊断价值,为PTMC的临床诊疗提供参考依据。方法根据术后病理学检查结果的不同将139例甲状腺结节患者分为74例PTMC患者和65例甲状腺良性病变患者。所有患者术前均进行了MRI和SWE检查。以病理结果为“金标准”,分析MRI、SWE单独及联合检查对PTMC及PTMC伴甲状腺外侵犯(ETE)的诊断价值。结果MRI、SWE单独及联合诊断PTMC的Kappa值依次为0.798、0.826、0.913,提示MRI、SWE联合诊断与病理结果的一致性最佳,但不同诊断方式的灵敏度、特异度、准确度、阳性预测值和阴性预测值比较,差异均无统计学意义(P﹥0.05)。MRI、SWE单独及联合诊断PTMC伴ETE的Kappa值依次为0.676、0.513、0.918,提示MRI、SWE联合诊断与病理结果的一致性最佳,且MRI、SWE联合诊断的灵敏度、特异度、准确度、阳性预测值和阴性预测值均高于任一方式单独诊断的结果(P﹤0.05)。结论MRI、SWE在PTMC的诊断中均具有良好的诊断价值,但二者联合诊断的效能更优,与病理检查结果的一致性较高,更利于PTMC及PTMC伴ETE的检出,值得临床重视。     

磁共振扩散加权成像和动态增强成像对结直肠癌术后局部复发诊断价值Meta分析

目的 探讨磁共振扩散加权成像(diffusion weighted imaging magnetic resonance,MR-DWI)和磁共振动态增强成像(dynamic contrast-enhanced magnetic resonance,MR-DCE)对术后局部复发结直肠癌的诊断价值.方法 计算机检索1990-01-2014-03 PubMed、Cochrane Database Systematic Reviews、EM-base和中国知网(CNKI)检索平台中,MR对手术后局部复发结直肠癌诊断价值的研究文献.文献质量使用QUADAS系统进行严格评价,纳入文献中所提取的诊断数据用Meta-disc 1.40软件进行Meta分析,分别合并磁共振T2加权(T2 weighted magnetic resonance,MR-T2 WI)成像、MR-DWI成像和MR-DCE成像诊断术后局部复发结直肠癌的敏感性、特异性、阴性似然比、阳性似然比及诊断比值比,采用拟合受试者工作特征曲线(summary receiver operating characteristic curve,SROC)分析不同方式MR对术后局部复发结直肠癌的诊断价值.结果 从607篇相关文献中最终纳入9篇文献,共577例患者,合计648个病变.Meta分析结果显示,MR诊断术后局部复发结直肠癌的汇总敏感性和汇总特异性的95％CI分别为89％和86％,汇总阳性似然比(positive likelihood ratio,PLR)和汇总阴性似然比(negative likelihood ratio,NLR)的95％CI分别为5.92和0.15,诊断比值比(diagnostic odds ratio,DOR)为47.46,MR在SROC下的面积为0.933 8.Meta回归分析提示,MR成像方式是产生非阈值效应异质性的主要原因,亚组分析表明,DCE成像的汇总敏感性、汇总特异性、汇总PLR、汇总NLR和汇总DOR等参数均与常规T2 WI成像基本相当,差异无统计学意义,P＞0.05.DWI成像的汇总敏感性、汇总特异性、汇总PLR、汇总NLR和汇总DOR等参数均较T2 WI成像为优,P＜0.05.T2 WI成像、DCE成像及DWI成像在SROC下的面积分别为0.9178、0.8971和0.9742,DWI成像诊断直肠癌局部复发的SROC最靠近左上角,曲线下面积最大,总体准确度明显高于T2 WI成像.结论 MR可以准确地诊断术后局部复发结直肠癌,与常规T2 WI成像相比较,DWI成像提高了诊断结直肠癌局部复发的敏感性与特异性,有着更好的诊断效能,可以考虑作为直肠癌术后评价的常规序列.