Testicular Puncture and Aspiration as an Intraoperative Adjunct in Pediatric Testicular Torsion: A Case Report with Long-Term Follow-Up

To study the correlation between the MRI apparent diffusion coefficient (ADC) value and histological grade and molecular biology of breast invasive ductal carcinoma (IDC). This retrospective study included 125 patients with IDC verified by pathology from February 2010 to February 2013. Conventional MRI and diffusion-weighted imaging (DWI) examination were performed using a 3.0T scanner with diffusion factor of 0 and 800 s/mm(2). The region of interest (ROI) was drawn on the largest lesion and/or its two adjacent slices. The ADC value of the whole tumor was calculated as the mean ADC value. The correlation between mean ADCs and histological grade and biological factors was analyzed. The mean ADC of pathological grade I, II and III IDC was (1.152 ± 0.072)×10(-3) mm(2)/s, (1.102 ± 0.101)×10(-3) mm(2)/s, and (1.035 ± 0.107)×10(-3) mm(2)/s, respectively. There was a statistically significant difference among them (P = 0.003). Statistically a significant difference was observed between grade III and I (P = 0.034), grade III and II (P = 0.006), but not between grade I and II (P = 0.741). A significant correlation was observed between ADC value and pathological grade (r = -0.342, P < 0.001). The median ADC values were significantly higher in the ER-negative than in the ER-positive cases [(1.130 ± 0.115)×10(-3) mm(2)/s vs. (1.060 ± 0.089) ×10(-3) mm(2)/s, P < 0.001)], in PR-negative than in PR-positive cases [(1.121 ± 0.106)×10(-3) mm(2)/s vs. (1.055 ± 0.096) ×10(-3) mm(2)/s, P < 0.001)], and in Ki-67-negative than in Ki-67-positive cases [(1.153 ± 0.090)×10(-3) mm(2)/s vs. (1.063 ± 0.101) ×10(-3) mm(2)/s, P < 0.001]. A statistically significant correlation was observed between ADC value and expressions of ER, PR, and Ki-67 (r = -0.311, r = -0.317, r = -0.414, P < 0.001). ADC value of breast invasive ductal carcinoma is correlated with histological grade, and expression of ER, PR and Ki-67.

Pilot Feasibility Study of Transscrotal Near Infrared Spectroscopy in the Evaluation of Adult Acute Scrotum

IntroductionImproving the early prediction of neoadjuvant chemotherapy (NAC) efficacy in breast cancer can lead to an improved prediction of the final prognosis of patients, which would be useful for promoting individualized treatment. This study aimed to explore the value of the combination of dynamic contrast-enhanced (DCE)-MRI parameters and apparent diffusion coefficient (ADC) values in the early prediction of pathological complete response (pCR) to NAC for breast cancer.MethodsA total of 119 (range, 28−69 years) patients with biopsy-proven breast cancer who received two cycles of NAC before breast surgery were retrospectively enrolled from our hospital database. Patients were divided into pCR and non pCR groups according to their pathological responses; a total of 24 patients achieved pCR, while 95 did not. The quantitative (Ktrans; Kep; Ve; IAUC) and semiquantitative parameters (W-in; W-out; TTP) of DCE-MRI that were significantly different between groups were combined with ADC values to explore their value in the early prediction of pCR to NAC for breast cancer. The independent T test was performed to compare the differences in DCE-MRI parameters and ADC values between the two groups. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC), sensitivity and specificity were calculated to evaluate the performance of the prediction.ResultsThe Ktrans, Kep, IAUC, ADC, W-in and TTP values were significantly different between the pCR and non pCR groups after NAC. The AUC (0.845) and specificity (95.79%) of the combined Ktrans, Kep, IAUC and ADC values were both higher than those of the individual parameters. The combination of W-in, TTP and ADC values had the highest AUC value (0.886) in predicting pCR, with a sensitivity and specificity of 87.5% and 82.11%, respectively.ConclusionsThe results suggested that the combination of ADC values and quantitative and semiquantitative DCE-MRI parameters, especially the combination of W-in, TTP, and ADC values, may improve the early prediction of pCR in breast cancer.

The aim of this study was to assess the value of different 1.5 T MRI apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (EADC) values in diagnosing the stages of liver cirrhosis. Sprague-Dawley (SD) rats were randomly divided into the experimental group and the control group. The experimental group was injected with thioacetamide intraperitoneally 3 times per week. After routine MR scanning, diffusion-weighted imaging (DWI) was processed by spin echo-echo planar imaging (SE-EPI) to generate the ADC value and EADC image. The liver ADC and EADC values of rats were measured in the control and experimental groups, followed by Masson staining and hematoxylin and eosin staining. Furthermore, immunohistochemistry was performed to detect Ki-67 and PCNA expression in liver tissues. In the control group, the differences in ADC and EADC values between the liver fibrosis and cirrhosis group were different. The ADC values of the liver fibrosis stage I-II, III-IV, and cirrhosis rats in the experimental group were lower than the control group, while the EADC values were higher than the control group. The ADC values of the liver fibrosis stage III-IV group and cirrhosis nodules group were lower than the control group. There were significant differences in EADC values between the cirrhotic nodule groups and the control group. DWI-ADC values showed a negative correlation between SD rat liver fibrosis and cirrhosis pathology classification.

Accurately predicting the hepatocellular carcinoma (HCC) grade may facilitate the rational selection of treatment strategies. The diagnostic efficacy of the combination of Gadolinium ethoxybenzy diethylenetriamine pentaacetic (Gd-EOB-DTPA) enhancement T1 mapping and apparent diffusion coefficient (ADC) values in predicting HCC grade needs further validation. This study aimed to assess the capacity of Gd-EOB-DTPA-enhanced T1 mapping and ADC values, both individually and in combination, to discriminate between different grades of HCC. From July 2017 to February 2020, 96 patients (male, 83; mean age, 53.67 years; age range, 29-71 years) clinically diagnosed with HCC were included in the present study. All patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI, including T1 mapping sequence) before surgery or biopsy. All the patients were categorized into 3 groups according to the pathological results (including 24 cases of well-differentiated HCCs, 59 cases of moderately differentiated HCCs, 13 cases of and poorly differentiated HCCs). The mean Gd-EOB-DTPA enhanced T1 values (&#916;T1=[(T1pre-T1post)/T1pre]×100%) and ADC values between different grading groups of HCC were calculated and compared. The area under the characteristics curve (AUC), the diagnostic threshold, sensitivity, and specificity of &#916;T1 and ADC for differential diagnosis were analyzed. Mean &#916;T1 was 58% for well-differentiated HCCs, 50% for moderately-differentiated HCCs, and 43% for poorly-differentiated HCCs. &#916;T1 showed statistical differences between the groups (P<0.001). The mean ADC values of the 3 groups were 1.11×10-3 mm2/s, 0.91×10-3 mm2/s, and 0.80×10-3mm2/s, respectively. ADC showed statistical differences between the groups (P<0.001). In discriminating well- differentiated group from the moderately differentiated group, the AUC of &#916;T1 was 0.751 (95% CI: 0.642, 0.859), the AUC of ADC was 0.782 (95% CI: 0.671, 0.894), the AUC of combined model was 0.811 (95% CI: 0.709, 0.914). In discriminating the poorly differentiated group from the moderately differentiated group, the AUC of &#916;T1 was 0.768 (95% CI: 0.634, 0.902), the AUC of ADC was 0.754 (95% CI: 0.603, 0.904), and the AUC of the combined model was 0.841 (95% CI: 0.729, 0.953). Gd-EOB-DTPA enhanced T1 mapping, and ADC values have complementary effects on the sensitivity and specificity for identifying different HCC grades. A combined model of Gd-EOB-DTPA-enhanced MRI T1 mapping and ADC values could improve diagnostic performance for predicting HCC grades.</p>.

Background:Scrotal exploration is considered the procedure of choice for acute scrotum.Objectives:We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area. Patients and Methods:We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.Results:A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.Conclusions:Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.

To evaluate diffusion alterations after hepatic radiofrequency (RF) ablation using a navigator respiratory-triggered diffusion-weighted imaging (NRT-DWI) sequence with regard to potential diagnostic information for detection of local tumor progression (LTP). One hundred forty-eight consecutive follow-up magnetic resonance (MR) examinations of 54 patients after hepatic RF ablation were reviewed. Apparent diffusion coefficient (ADC) values of ablation zones and liver parenchyma were assessed using a single-shot echoplanar imaging sequence with the NRT technique. ADC values of ablation zones and adjacent signal alterations identified in NRT-DWI were analyzed with regard to LTP. Mean ADC values of ablation zones (119.9 +/- 30.5 x 10(-5) mm(2)/sec) and liver (106.3 +/- 21.2 x 10(-5) mm(2)/sec) differed significantly (P = 0.0003). No evident changes in ablations' ADC values over time could be identified. ADC values obtained from the entire ablation zone did not significantly differ regarding the presence of LTP. In 58 examinations, hyperintense areas in the periphery of the ablation zone were detected on the NRT-DWI. Corresponding ADC values were significantly lower in patients with LTP (102.1 +/- 22.4 versus 130.8 +/- 47.6 x 10(-5) mm(2)/sec; P = 0.0124). NRT-DWI is useful in the follow-up imaging after RF ablation. ADC-based evaluation of signal alterations adjacent to the ablation zone may contribute to the identification of LTP and nontumoral posttreatment tissue changes.

Normal cranial bone marrow MR imaging pattern with age-related ADC value distribution

Magnetic resonance imaging is useful in evaluating acute spinal cord injury. Apparent diffusion coefficient (ADC) values obtained by diffusion-weighted imaging can differentiate cytotoxic edema from vasogenic edema through microscopic motion of water protons. To determine whether ADC values in the cervical spinal cord match neurological grades and thus predict functional recovery in patients suffering from cervical spinal cord injury. Diffusion-weighted images were obtained using 15 axial slices covering the cervical spinal cord from 16 consecutive patients. ADC values were determined for both gray and white matter. All patients were treated surgically. Patient neurological status was evaluated preoperatively and postoperatively with the Frankel classification and neurosurgical cervical spine scale. One patient had complete spinal cord injury and showed no recovery. Using 15 patients with incomplete injury, we analyzed correlations between preoperative ADC values and neurological grading, degree of postoperative recovery, or cavity formation in follow-up magnetic resonance images. For comparison, ADC values of 11 healthy volunteers were also calculated. There was significant correlation between ADC values and degree of postoperative recovery (P = .02). ADC values of patients showing cavity formation were significantly lower than those of patients without cavity formation (0.70 vs 0.96 × 10⁻³ mm²/s; P = .01). The cutoff ADC value of 0.80 × 10⁻³ mm²/s resulted in 75% sensitivity and 81.8% specificity for predicting cavity formation. Low ADC values in acute spinal cord injury may indicate postoperative cavity formation in the injured spinal cord and predict poor functional recovery.

Contest: The criteria for Pancreatic Autoimune Pancreatitis (AIP) diagnosis include pancreatic imaging, serological and histopathological findings, other organs involvement and response to steroid treatment. Case report: Two cases, the first of focal AIP (FAIP), the second of diffuse AIP (DAIP) associated to renal and abdominal aorta involvement respectively, underwent 3.0-Tesla Magnetic Resonance Imaging (3.0-T MRI) with Diffusion Weighted Imaging (DWI) before and after 1 month of corticosteroid treatment. In both cases Computed Tomography, performed for sudden onset of jaundice and pancreatic-like abdominal pain, had previously shown enlargement of pancreatic head and of all pancreatic gland respectively. Endoscopic ultrasound-guided fine-needle aspiration biopsy of both pancreatic lesions had revealed no malignancy. 3.0-T MRI demonstrated a solid mass in enlarged pancreatic head in the first case, an enlargement of all pancreatic gland in the second case, both hypoenhancing in pancreatic phase of contrast enhanced MRI, with moderate delayed enhancement at venous and late phases. Two wedge shaped regions of decreased enhancement of left kidney and a soft-tissue cuffing around the abdominal aorta were observed in first and second case respectively. At DWI, all pancreatic, renal and aortic lesions showed a high signal intensity from restricted diffusion at high b value (b = 1,000 sec/mm 2 ) images and low apparent diffusion coefficient (ADC) values, compared to the normal ADC value. 3.0-T MRI after treatment, compared to pre-treatment examination, showed marked reduction in size of pancreatic, renal lesions and soft-tissue cuffing aortic lumen. 3.0-T MR DWI revealed an increase of ADC values in all pancreatic, renal and aortic lesions. Conclusion: We emphasize the role of 3.0-T MRI DWI findings and ADC map values on diagnosis of AIP tanks to evaluating the response to short period of steroid treatment of pancreatic and extra pancreatic lesions.

The utility of perfusion MRI in distinguishing between pilocytic astrocytoma (PA) and medulloblastoma (MB) is unclear. This study aimed to evaluate the diagnostic and prognostic performance of dynamic susceptibility contrast (DSC)-MRI parameters and apparent diffusion coefficient (ADC) values between PA and MB. Between January 2012 and August 2021, 49 (median, 7 years [range, 1-28 years]; 28 females) and 35 (median, 8 years [1-24 years]; 12 females) patients with pathologically confirmed PA and MB, respectively, were included. The normalized relative cerebral blood volume and flow (nrCBV and nrCBF) and mean and minimal normalized ADC (nADCmean and nADCmin) values were calculated using volume-of-interest analyses. Diagnostic performance and Pearson's correlation with progression-free survival were also evaluated. The MB group showed a significantly higher nrCBV and nrCBF (nrCBV: 1.69 [0.93-4.23] vs. 0.95 [range, 0.37-2.28], p = .0032; nrCBF: 1.62 [0.93-3.16] vs. 1.07 [0.46-2.26], p = .0084) and significantly lower nADCmean and nADCmin (nADCmean: 0.97 [0.70-1.68] vs. 2.21 [1.44-2.80], p < .001; nADCmin: 0.50 [0.19-0.89] vs. 1.42 [0.89-2.20], p < .001) than the PA group. All parameters exhibited good diagnostic ability (accuracy >0.80) with nADCmin achieving the highest score (accuracy = 1). A moderate correlation was found between nADCmean and progression-free survival for MB (r = 0.44, p = .0084). DSC-MRI parameters and ADC values were useful for distinguishing between PA and MB. A lower ADC indicated an unfavorable MB prognosis, but the DSC-MRI parameters did not correlate with progression-free survival in either group.

Quantitative interpretation using ADC values for subjective MRI classification of neonatal hypoxic-ischemic encephalopathy.

Cerebral sinovenous thrombosis (CSVT) after closed head injury is an uncommon but potentially serious complication. The aim of this study was to determine whether diffusion weighted imaging (DWI) provide predictive information regarding prognosis. We retrospectively reviewed a series of 11 patients with CSVT after closed head injury. Each patient underwent computed tomography and magnetic resonance imaging within 24 hours of onset of symptoms, including DWI, magnetic resonance venography, and conventional sequences. Apparent diffusion coefficient (ADC) values were measured in seven regions of interest in 7 of 11 patients using DWI. Follow-up imaging and clinical outcome were assessed 6 months or later after initial presentation. The most affected sinus was the posterior portion of the superior sagittal sinus. There was a mean time interval of 4.1 days between subsequent venous stroke and the initial insult. Brain edema improved in 6 of 11 patients on follow-up imaging. Six of 11 patients recovered successfully, although high or mixed DWI intensity associated with moderately decreased ADC (0.53-0.57 x 10(-3) mm2/s). Two other patients with hematomas developed venous infarction, despite mixed DWI with heterogeneous ADC value (0.55-1.11 x 10(-3) mm2/s). The other three patients, with high DWI and strongly decreased ADC values (0.26-0.27 x 10(-3) mm2/s), developed severe brain atrophy after superior sagittal sinus thrombosis. The prospective cutoff point of ADC value may be higher in CSVT after head injury with traumatic hematoma. The territory of venous infarction was found to be larger in infants after treatment failure. In infants, CSVT can demonstrate initially cytotoxic brain edema, which is reversible with anticoagulation therapy.

The Liver Imaging Reporting and Data System (LI-RADS) is a widely utilized tool for classifying liver lesions, particularly in patients at risk for hepatocellular carcinoma (HCC). This study aims to assess the efficacy of LI-RADS in distinguishing between HCC and benign liver nodules by leveraging dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) features and apparent diffusion coefficient (ADC) values derived from MRI. Between October 2023 and March 2024, 43 patients with suspected HCC underwent MRI evaluation, including DCE-MRI and DWI sequences. The diagnostic performance of various MRI sequences was analyzed, focusing on their ability to differentiate HCC from benign lesions. The diagnostic efficacy of DCE-MRI and ADC in differentiation was evaluated using statistical analyses, such as t-tests and receiver operating characteristic (ROC) curve analysis. SPSS VER 16 was used to analyze the collected data. The study findings reveal that the DCE-MRI arterial phase demonstrated perfect diagnostic accuracy with an area under the curve (AUC) of 1.00, achieving 100% sensitivity and specificity. T2-weighted imaging also exhibited diagnostic solid performance, with an AUC of 0.801, while ADC values from DWI sequences showed limited efficacy in differentiating HCC from benign lesions (AUC=0.512). These findings indicate that DCE-MRI significantly enhances the accuracy of LI-RADS in classifying HCC versus benign liver nodules. This study highlights the importance of incorporating advanced imaging features into LI-RADS to improve the diagnostic precision of liver lesion evaluation in clinical practice.

Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes