PROPELLER DUO DWI序列+常规MRI在直肠癌术前T分期中的应用价值

目的研究螺旋桨采集技术扩散加权成像(PROPELLER DUO DWI)+核磁共振成像(MRI)诊断直肠癌术前T分期的应用价值。方法选取我院2018年6月至2020年6月直肠癌患者65例,均进行MRI及DWI扫描检查,以病理学诊断结果为“金标准”。比较常规MRI与常规MRI+DWI诊断直肠癌T分期的结果及准确率。结果65例直肠癌患者常规MRI诊断T1~T2期33例,T3期22例,T4期10例。MRI+PROPELLER DUO DWI诊断T1~T2期37例,T3期21例,T4期7例。MRI+PROPELLER DUO DWI诊断总准确率为92.3%(60/65),高于MRI[80.0%(52/65,P<0.05)]。结论与MRI常规序列比较,PROPELLER DUODWI技术+常规MRI在直肠癌患者术前T分期诊断中准确率更高,有助于临床治疗方案的制定。     

Imaging update on soft tissue sarcoma

Soft tissue sarcomas (STS) are rare tumours presenting as soft tissue lumps. Ultrasound is often the primary modality for the initial assessment, with MRI the mainstay for lesion characterisation. PET/CT along with other emerging MRI sequences are used in certain situations as an adjunct and problem solving tool in STS staging and assessment of disease recurrence. Recent advances include the promise of whole body MRI, hybrid PET/MRI, diffusion weighted imaging, dynamic contrast enhanced MRI and advances in artificial intelligence. This article discusses current concepts in extremity STS imaging and highlights recent advances.     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

Colorectal cancer:Current imaging methods and future perspectives for the diagnosis,staging and therapeutic response evaluation

In the last 10 years the mortality rate of colorectal cancer(CRC)has decreased by more than 20%due to the rising developments in diagnostic techniques and optimization of surgical,neoadjuvant and palliative therapies.Diagnostic methods currently used in the evaluation of CRC are heterogeneous and can vary within the countries and the institutions.This article aims to discuss in depth currently applied imaging modalities such as virtual computed tomography colonoscopy,endorectal ultrasound,computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of CRC.Special focus is put on the potential of recent diagnostic developments as diffusion weighted imaging MRI,MRI biomarkers(dynamic enhanced MRI),positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose(FDG-PET)combined with computed tomography(PET/CT)and new hepatobiliary MRI contrast agents.The precise role,advantage and disadvantages of these modalities are evaluated controversially in local staging,metastatic spread and treatment monitoring of CRC.Finally,the authors will touch upon the future perspectives in functional imaging evaluating the role of integrated FDG-PET/CT with perfusion CT,MRI spectroscopy of primary CRC and hepatic transit time analysis using contrast enhanced ultrasound and MRI in the detection of liver metastases.Validation of these newer imaging techniques may lead to significant improvements in the management of patients with colorectal cancer.     

Persistent Enhancement on Contrast-Enhanced Ultrasound Studies of Severe Crohn's Disease: Stuck Bubbles?

A small population of patients with severe Crohn's disease (CD) exhibit atypical lack of intensity decline on intestinal contrast-enhanced ultrasound. From a retrospective CD cohort examined with contrast-enhanced ultrasound, 104 patients were identified. Twenty study patients with severe active disease exhibited high peak enhancement (>23 dB) and minimal decline. From the same cohort, 84 control patients also exhibited high peak enhancement >23dB, but with typical intensity decline. Patient outcomes were assessed. Time–intensity curve analysis revealed a significantly higher (p < 0.0001) area under the curve (44.7 ± 1.5 dB·s), washout time and intensities at 60s and 120s in the study population compared with controls (40.0 ± 1.1 dB·s). Study patients had a worse overall outcome with surgery in 30% versus 10% (p?=?0.027) during follow-up. Heightened enhancement with lack of decline on contrast-enhanced ultrasound suggests microbubbles are stuck within the inflamed bowel wall for an extended period. This observation occurs in patients with severe disease and a bad outcome.     

B-Mode Ultrasound Combined with Color Doppler and Strain Elastography in the Diagnosis of Non-mass Breast Lesions: A Prospective Study

Non-mass breast lesions on ultrasound (US) are areas without an associated mass. The purpose of this study was to evaluate whether combining B-mode US with color Doppler US and strain elastography (SE) improves US differentiation between benign and malignant non-mass breast lesions and the decision for biopsy. In this prospective study, three different radiologists analyzed the US images of 77 non-mass lesions independently and recorded Breast Imaging Reporting and Data System (BI-RADS) categories for four data sets. The image characteristics and BI-RADS categories of the four data sets were analyzed by another radiologist. The final diagnosis was made on the basis of pathologic findings. Values for area under the receiver operating curve (AUC), sensitivity, specificity and accuracy were compared among the data sets. The AUC of B-mode US combined with both color Doppler US and SE was greater than that of B-mode US alone (0.666 vs. 0.828) (p = 0.011). The specificity of making the decision for biopsy increased from 6.5% to 38.7% when B-mode US was combined with color Doppler and SE, without a statistically significant change in sensitivity (p < 0.001). Combined use of color Doppler and SE could improve the diagnostic value of B-mode US in distinguishing benign from malignant non-mass breast lesions and the specificity of making the decision for biopsy of non-mass breast lesions.