Maximum Longitudinal Diameter Research Articles

Quantitative differentiation of non-invasive bladder urothelial carcinoma and inverted papilloma based on CT urography

PurposeTo investigate the value of CT urography (CTU) indicators in the quantitative differential diagnosis of bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB).Material and methodsThe clinical and preoperative CTU imaging data of continuous 103 patients with histologically confirmed BUC or IPB were retrospectively analyzed. The imaging data included 6 qualitative indicators and 7 quantitative measures. The recorded clinical information and imaging features were subjected to univariate and multivariate logistic regression analysis to find independent risk factors for BUC, and a combined multi-indicator prediction model was constructed, and the prediction model was visualized using nomogram. ROC curve analysis was used to calculate and compare the predictive efficacy of independent risk factors and nomogram.ResultsJunction smoothness, maximum longitudinal diameter, tumor-wall interface and arterial reinforcement rate were independent risk factors for distinguishing BUC from IPB. The AUC of the combined model was 0.934 (sensitivity = 0.808, specificity = 0.920, accuracy = 0.835), and its diagnostic efficiency was higher than that of junction smoothness (AUC=0.667, sensitivity = 0.654, specificity = 0.680, accuracy = 0.660), maximum longitudinal diameter (AUC=0.757, sensitivity = 0.833, specificity = 0.604, accuracy = 0.786), tumor-wall interface (AUC=0.888, sensitivity = 0.755, specificity = 0.808, accuracy = 0.816) and Arterial reinforcement rate (AUC=0.786, sensitivity = 0.936, specificity = 0.640, accuracy = 0.864).ConclusionAbove qualitative and quantitative indicators based on CTU and the combination of them may be helpful to the differential diagnosis of BUC and IPB, thus better assisting in clinical decision-making.Key points1. Bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB) exhibit similar clinical symptoms and imaging presentations.2. The diagnostic value of CT urography (CTU) in distinguishing between BUC and IPB has not been documented.3. BUC and IPB differ in lesion size, growth pattern and blood supply.4. The diagnostic efficiency is optimized by integrating multiple independent risk factors into the prediction model.

A retrospective study of 3D measurement and analysis applied in the morphological evaluation of achalasia cardia.

Achalasia cardia (AC) is defined as a disorder of esophageal motility whose diagnostic gold standard depends on high-resolution manometry (HRM). The invasiveness of HRM can cause difficulties in diagnosis, treatment, and follow-up for patients with AC. Thus, we aimed to investigate the function of 3D reconstruction and measurement to prove the wide application of this alternative non-invasive approach for AC. A total of 126 patients with AC and 40 healthy subjects in Tianjin Medical University General Hospital from January 2018 to October 2022 were enrolled in this retrospective study. Chest CT images of these subjects were used to reconstruct the 3D models of the esophagus, stomach, spine, left crus, and right crus. Measurements of esophagus length, volume of esophagus, gastroesophageal insertion angle (His angle), max thickness of esophageal wall, esophagus maximum transverse and longitudinal diameter, esophagus-spine angle, and spine-lower esophageal sphincter (LES) angle were applied based on the models. Retrocardiac esophagus length, volume of esophagus, max thickness of esophageal wall, esophagus maximum transverse and longitudinal diameter, thoracic esophagus-spine angle, and spine-LES angle in the AC group were higher than those in the control group (all P values <0.05). Among the three subtypes of AC, thoracic esophagus length, intra-abdominal LES length, volume of esophagus, His angle, esophagus maximum transverse and longitudinal diameter, and thoracic esophagus-spine angle all presented statistical differences (all P values <0.05). Correlation analysis revealed that manometric types were positively associated with His angle [r=0.196; 95% confidence interval (CI): 0.009, 0.372; P=0.028] but negatively associated with volume of esophagus (r=-0.480; 95% CI: -0.639, -0.310; P<0.001), esophagus maximum transverse diameter (r=-0.551; 95% CI: -0.679, -0.400; P<0.001), esophagus maximum longitudinal diameter (r=-0.518; 95% CI: -0.649, -0.366; P<0.001), and thoracic esophagus-spine angle (r=-0.324; 95% CI: -0.479, -0.157; P<0.001). This study successfully presented the differences in esophageal length, volume, thickness, and angles between healthy subjects and different AC subtypes on the basis of 3D reconstruction and measurement. Thus, 3D model and measurement can be regarded as a good support for further research and make a valuable contribution to developing non-invasive approaches for AC management.

Volume Index Measured Using Magnetic Resonance Imaging for Diagnosing Cervical Cancer Tumors

Diagnosis of cervical cancer with tumor diameter <2 cm using magnetic resonance imaging alone has not been investigated. Moreover, whether tumor volume can be used for diagnosing the true tumor diameter remains unknown. Here, we investigated the utility of early cervical cancer volume index in diagnosing cervical cancer with a tumor diameter of <2 cm, which can be treated using more conservative surgery. This single-center retrospective study analyzed women who underwent radical hysterectomy for cervical cancer with a tumor diameter of <2 cm and clinical stages IA2, IB1, IB2, IB3, and IIA1 at our institute between January 2009 and April 2022. The volume index, defined as the product of the maximum longitudinal diameter along the uterine axis, maximum anteroposterior diameter (thickness) on a sagittal section image, and maximum horizontal diameter on a horizontal section image, was evaluated using either T2-weighted magnetic resonance imaging or gadolinium-enhanced T1-weighted imaging. The receiver operating characteristic curve for the volume index was also calculated. The sensitivity and specificity of magnetic resonance imaging for measuring the tumor diameter were 0.92 and 0.84, respectively. The calculated cut-off value was 2.60, whereas the volume index area under the curve was 0.955, with a sensitivity of 0.92 and specificity of 0.93. Considering the specificity and low incidence of false-negative results, the volume index can be used for preoperative diagnosis of pT1B1 cervical cancer, which can be treated with more conservative surgery.

Diagnostic Value of Dual-Energy CT Virtual Non-Calcium and Rho/Z Images for Bone Marrow Infiltration in Primary Malignant Bone Tumors

We investigated the diagnostic performance of dual-energy CT (DECT) virtual non-calcium (VNCa) and Rho/Z images for bone marrow infiltration of primary malignant bone tumors (PMBTs). We retrospectively analyzed 65 patients with PMBT who underwent DECT and MRI within 2 weeks. DECT was used to evaluate the presence and extent of marrow involvement surrounding PMBTs using the SCT, VNCa, and Rho/Z images. MRI was used as the reference standard for measurements. CT values of normal and involved bone marrow areas were measured on VNCa images, and Zeff values were measured on Rho/Z images. The statistical methods used were the 2*C chi-square test, ANOVA test, paired samples t test, and diagnostic performance of the different variables were evaluated using receiver operating characteristic curves. VNCa and Rho/Z images showed higher accuracy (91%, 92% vs. 67%) and sensitivity (90%, 92% vs. 69%) than SCT images for diagnosing bone marrow infiltration in patients with PMBT. The maximum longitudinal diameter of tumor involvement measurements was statistically different between VNCa and SCT, Rho/Z and SCT, MRI, and SCT (all p < 0.05, p=0.047, p=0.049, and p=0.023, respectively). The maximum transverse diameter was statistically significant between SCT and MRI, VNCa and MRI, Rho/Z and MRI (all p < 0.05, and p=0.015, and p=0.044, and p=0.047, respectively). The HU or Zeff values based on the area of interest of VNCa and Rho/Z images differed significantly between the normal and infiltrated bone marrow area (p < 0.001). Receiver operating characteristic curve analysis revealed area under the curves of 0.995 and 0.988, respectively, with cut-off values of -31.57 HU and 7.8, and the sensitivity of both was 96.9%. DECT-VNCa and Rho/Z images have good diagnostic value when evaluating bone marrow infiltration in PMBTs.

Image-guided, surgical robot-assisted percutaneous puncture of the foramen ovale and foramina stylomastoideum: a cadaveric study.

Image-guided, surgical robot-assisted percutaneous puncture of the foramen ovale and foramina stylomastoideum: a cadaveric study.

Diffraction of low-frequency waves on elastic thin-walled shells of rotation

Asymptotic and functional relations connecting the characteristics of scattered near and far fields with elastic and spectral characteristics of thin-walled elongated elastic shells described by the Love theory were found. The study was carried out by the method of two-scale expansions. For the near scattered field, recurrent systems of boundary value problems for Laplace and Poisson equations were obtained, the solutions of which were found explicitly. The radiation patterns of the scattered field were obtained using the theory of wave potentials for the Helmholtz equation. Asymptotic formulas for the potential densities of simple and double layers were found. This made it possible to present the asymptotics of the scattered field directivity diagram in the form of parametric integrals that depend on the angles of incidence and observation, frequency, surface shape, and material characteristics of the shell. The asymptotic method was effective for strongly elongated shells when the ratio of the maximum longitudinal diameter to the maximum diameter of rotation is more than ten. For such highly elongated bodies, the use of various difference and iterative schemes is problematic due to the difficulties of triangulating the shell surface. Numerical implementations of calculations of directional diagrams of a spheroidal steel shell in water at different angles of incidence of plane waves in a wide frequency range are given. The numerical calculations performed in this work are not tied to a specific frequency, since the geometric dimensions are given in wavelengths. Calculations have shown that the radiation pattern for elongated bodies begins to differ from the spherically symmetrical one at values kl &gt; 4. When the wave size of the shell increases, the lobes of the directional diagram appear. The lobes direction depends on the above parameters. The number of lobes, their direction and power can be changed by using special distributions of the shell surface impedances.

Submucosal tunneling endoscopic resection for large symptomatic submucosal tumors of the esophagus: A clinical analysis of 24 cases

Studies evaluating submucosal tunneling endoscopic resection (STER) for the treatment of upper gastrointestinal submucosal tumors (SMTs) have recently increased. However, the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus have not been well investigated. The aim of the present study was to evaluate the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus. A total of 24 patients with large symptomatic SMTs in the esophagus who underwent STER in our hospitals between January 2015 and May 2018 were included in the study. The tumors were confirmed to be of muscularis propria layer origin. Treatment outcomes, complications, and follow-up results were retrospectively analyzed. All 24 lesions were resected en bloc with STER. The mean maximum transverse diameter of the lesions was 4.7 (3.5-6.5) cm. The mean maximum longitudinal diameter of the lesions was 2.1 (1.5-3.0) cm. The mean duration from mucosal incision to complete mucosal closure was 65 (50-115) min. Postoperative pathological diagnosis confirmed 18 cases with leiomyomas, 4 cases with stromal tumors, and 2 cases with schwannomas. There were no major complications. There were no residual lesions or disease recurrence during follow-up. STER is safe and effective for the treatment of large symptomatic SMTs of muscularis propria layer origin in the esophagus.

Feasibility Analysis and Clinical Applicability of a Modified Type V Resection Method for Malignant Bone Tumors of the Proximal Humerus

Objective: The purpose of this study was to explore the feasibility and clinical applicability of a modified type V resection method for malignant bone tumors of the proximal humerus. Methods: The relevant anatomic MRI data from 30 normal adult shoulder joints were measured to analyze the feasibility of the modified type V resection method for malignant bone tumors of the proximal humerus. Sixteen patients with malignant bone tumors of the proximal humerus were treated with modified radical resection between March 2012 and April 2017. Recurrence of tumor was evaluated after surgery, and shoulder function was assessed according to the Enneking skeletal muscle tumor function scoring system. Results: Radiographic results showed that the modified type V resection method was feasible, and within the allowable range of the maximum longitudinal diameter (<29.8 mm) and depth (<4 mm). Surgery was successfully completed in all 16 cases, and pathological examination suggested that the purposes for radical resection had been achieved. All patients were followed up over 3–49 months (mean, 15.6 months). One patient had local recurrence at 12 months after surgery, and we performed upper limb amputation. The remaining 15 patients had good prosthesis survival. At the final follow-up, shoulder joint function had recovered compared with preoperative levels, with a mean Enneking score of 25.8 points (range, 24–27 points). Conclusion: Modified type V resection may be feasible for treating tumors of the proximal humerus, maintaining good early shoulder function.

Determine the Role of FSH Receptor Binding Inhibitor in Regulating Ovarian Follicles Development and Expression of FSHR and ERα in Mice.

Mice of FRBI-1, FRBI-2, and FRBI-3 groups were intramuscularly injected with 20, 30, and 40mg/kg, respectively, for five consecutive days. Ovarian weights of three FRBI groups were reduced in comparison with FSH group. Ovarian cortex thicknesses (OCT) of the FRBI-3 group were less than that of the FSH group (P<0.05). As compared to FSH group, there were fewer numbers of secondary follicles (SFs) and mature follicles (MF) on the ovaries of FRBI-treated mice numbers of primary follicles (PFs) and SFs also decreased. In FRBI-3 mice, we found that the primordial follicles (POF) were scarcer, the follicles developed poorly, and granulosa cells became apoptosis. SF numbers of FRBI-2 and FRBI-3 groups were less than that of the FSH group on day 20 (P<0.05). Maximum longitudinal diameter (MLD) and transverse diameter (MTD) of three FRBI groups became decreased during the experiment. MLD and MTD of the FRBI-3 group were smaller than FSH group. Levels of FSHR mRNA and protein were less than that of CG and FSH group (P<0.05). ERα protein levels of FRBI group and serum concentrations of FSH and estradiol (E2) in the FRBI-treated mice were decreased when compared to CG and FSH group. In conclusion, FSH treatment could increase the numbers of SF and MF, enhance follicle development, reduce the numbers of SF and MF, and depress the follicular development of mice. Furthermore, FRBI declined the mRNA and protein levels of ERα and FSHR in the ovaries and dropped serum concentrations of FSH and E2 of mice.

Interplay Between RV Function and CRT, Which One Affects the Other?

Background: Cardiac resynchronization therapy (CRT) is an established treatment of heart failure with reduced EF (HFrEF) and wide QRS complex. Nearly 30% of candidates are non-responders. One of the suggested mechanisms of inadequate response is the reduced baseline RV function; also the effect of CRT on right ventricular systolic function has not been well studied. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response. Methods: 30 patients with a mean age of 51.9 ± 9.2 years including 9 (30%) females, with advanced HF (EF 120 ms, or non-LBBB > 150 ms, with NYHA class III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD1 basal), maximum mid (RVD2 mid) transverse, maximum longitudinal (RVD3 long) diameters, TAPSE, fractional area change (FAC), right ventricle index of myocardial performance(RIMP) and tricuspid lateral annular systolic velocity (S’), were done before CRT implantation and at the end of the follow up period (6 months). Patients presenting with reduction of LVESV of >15% were considered responders. Results: 20 (67%) cases were responders. Both groups were similar regarding demographic, clinical, ECG, and echocardiographic criteria at baseline however, the RA volume and RV transverse diameters were smaller and systolic function parameters were significantly better in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters together with significant improvement in RV systolic function, in contrast to non-responders group who showed more RV dilatation and more decline of RV systolic function, compared to baseline readings(with P value 40 % has 85% sensitivity and 90 % specificity (P value= 0.004). TAPSE of >20 mm has 85% sensitivity and 80 % specificity (P value=0.002), S' of >10 cm/s % has 85% sensitivity and 70 % specificity (P value=0.001) and RIMP of <0.52 has 85% sensitivity and 70 % specificity (P value=0.003) in predicting CRT response. Conclusions: CRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.

Assessment of right ventriclular systolic function prior to cardiac resynchronization therapy: Does it make any difference?

BackgroundCardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure (HF). Nearly 30% of candidates are inadequate responders. The benefit of patients with right sided heart failure from CRT is still a matter of debate. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response. Methods94 patients with a mean age of 53.7±14.6 years including 19 (20%) females, with advanced HF (EF<35%, LBBB>120ms, or non-LBBB>150ms, with NYHA –III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD basal), maximum mid (RVD mid) transverse, maximum longitudinal (RVD long) diameters, TAPSE, fractional area change (FAC), and tricuspid lateral annular systolic velocity (S′), in addition to RV global longitudinal strain (RVGLS) measured by speckle tracking echocardiography, were done before CRT implantation and at the end of the follow up period (5.9±1.2 months). Patients presenting with reductions of LVESV of >15% were termed volumetric responders for further statistical analysis. Results63 (67%) cases were volumetric responders. Both groups were matched regarding demographic, clinical, ECG, and echocardiographic criteria apart from the RV significantly smaller transverse diameters and significantly better systolic function parameters in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters (33.6±7.1 vs 40.7±8.6, 21.4±4.9 vs 27±6.1, 68.3±10.8 vs 81.2±15, respectively), p<0.01, together with significant improvement in RV systolic performance: FAC (47.7±7.3 vs 40.9±6.4), TAPSE (25.2±4.6 vs 22.1±4.9), S′ (15.3±2.3 vs 12.8±2.3), and GLS (26.1±2.1 vs 18.5±1.6), P<0.01, compared to baseline readings. S' and GLS were the only independent predictors of CRT response by multivariate analysis. S′>9cm/s, and GLS >12.45% had 100% sensitivity and 70%, 99.7% specificity, respectively for prediction of response to CRT. ConclusionsCRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.

Diagnosis of mitral valve cleft using real-time 3-dimensional echocardiography.

Mitral valve cleft (MVC) is the most common cause of congenital mitral insufficiency, and MVC may occur alone or in association with other congenital heart lesions. Direct suture and valvuloplasty are the major and effective treatments for mitral regurgitation (MR) caused by MVC. Therefore, it is important to determine the location and magnitude of the pathological damage due to MVC when selecting a surgical procedure for treatment. This study explored the application value of transthoracic real-time 3-dimensional (3D) echocardiography (RT-3DE) in the diagnosis of MVC. From October 2012 to June 2016, 19 consecutive patients with MVC diagnosed by 2-dimensional (2D) echocardiography in our hospital were selected for this study. Full-volume RT-3DE was performed on all patients. The 3D-imaging data were cropped and rotated in 3 views (horizontal, sagittal, and coronal) with 6 directions to observe the position and shape of the MVC and the spatial position between the cleft and its surrounding structures. The maximum longitudinal diameter and the maximum width of the cleft were measured. The origin of the mitral regurgitant jet and the severity of MR were evaluated, and these RT-3DE data were compared with the intraoperative findings. Of the 19 patients studied, 4 patients had isolated cleft mitral valve, and cleft mitral valves combined with other congenital heart lesions were detected in 15 patients. The clefts of 6 patients were located in the A2 segment, the clefts of 4 patients were located in the A1 segment, the clefts of 4 patients were located in the A3 segment, the clefts of 4 patients were located in the A2-A3 segment, and the cleft of 1 patient was located in the P2 segment. Regarding the shape of the cleft, 13 patients had V-shaped clefts, and the others had C- or S-shaped clefts. The severity of the MR at presentation was mild in 2 patients, moderate in 9 and severe in 8. Two of the patients with mild MR did not undergo surgery, while the remaining 17 patients did undergo surgery. Surgical treatment involved direct suture in 11 cases, reconstruction with ring annuloplasty in 3 cases and replacement in 3 cases. The diagnoses of MVC were confirmed by intraoperative findings. RT-3DE successfully captured full-volume 3D images of the 19 patients, which directly displayed the 3D structure of MVC with multiple views such as the position, shape, longitudinal diameter and width of the MVC, and the spatial position between the chordae tendineae surrounding the MVC and the aortic valve. The maximum longitudinal diameter of the valve leaflet cleft measured by RT-3DE and direct measurements during surgery were 12.02±2.12 and 13.01±2.45 mm, respectively, and the difference between these measurements was not statistically significant (P>0.05). Our results indicate that RT-3DE can provide more direct, accurate and abundant information. RT-3DE is a simple and fast imaging technique, and the detailed 3D images obtained can be used to confirm the diagnosis of MVC. RT-3DE is considered to be an important preoperative test that provides more comprehensive information for selecting a subsequent procedure for treatment.

FEASIBILITY AND SHORT-TERM EFFECTIVENESS ANALYSIS OF MODIFIED RADICAL RESECTION AND RECONSTRUCTION SURGERY FOR MALIGNANT PROXIMAL HUMERUS TUMOR

To explore the feasibility and short-term effectiveness of the modified radical resection and reconstruction in the treatment of malignant proximal humerus tumor. The relevant anatomic data from 30 normal adult shoulder joint MRI were measured to analyze the feasibility of modified radical resection and reconstruction surgery in the treatment of malignant proximal humerus tumor. Five patients with malignant proximal humerus tumor were treated by using the modified radical resection and reconstruction surgery between March 2012 and January 2016. There were 1 male and 4 females, aged from 9 to 69 years (median, 46 years). There were 4 cases of osteosarcoma (Enneking IIA in 2 cases and Enneking IIB in 2 cases) and 1 case of metastatic carcinoma (moderately differentiated adenocarcinoma). The disease duration was 7 to 12 months (mean, 9 months). Recurrence of tumor was observed after operation, and the shoulder function was assessed according to Enneking skeletal muscle tumor function scoring system. Radiographic results showed that modified radical resection and reconstruction surgery was feasible, which was in allowable range of the maximum longitudinal diameter (<29.8 mm) and depth (<4 mm). The operation was successfully completed in all 5 cases, and pathological examination suggested that purposes of radical resection had achieved. All patients were followed up 3 to 49 months (mean, 15.6 months). One patient had local recurrence at 12 months after operation, and a shoulder joint amputation was performed; the other 4 patients had good prosthesis survival. At last follow-up, the function of the shoulder joint was obviously recovered when compared with preoperative function; Enneking's skeletal muscle tumor function score was 25.8 points (range, 24 to 27 points). Modified radical resection and reconstruction surgery is feasible for the treatment of proximal humerus tumor, and it can maintain a good early shoulder function.

Interobserver reproducibility of cervical lymph node measurements at CT in patients with head and neck squamous cell carcinoma

To determine the interobserver reproducibility of measuring cervical lymph nodes at computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to investigate the influence of finding extracapsular spread (ECS) at CT on measurement reliability. The institutional review board approved the study protocol, and informed consent was obtained. A total of 146 patients with 224 suspicious lymph nodes underwent CT before treatment. Two observers independently measured the diameters (minimal axial, maximum axial, and maximum longitudinal diameter) and assessed the ECS using CT. The greatest diameter was defined as the largest among the three measured diameters. Interobserver variability was determined by the within-subject coefficient of variation, and interobserver agreement was determined by the intraclass correlation coefficient (ICC). The within-subject coefficients of variation were 7.8%, 7.6%, and 11.4% for the minimal axial, maximum axial, and greatest diameters, respectively. The ICC values for interobserver agreement were excellent for all diameter measurements (i.e., ICC >0.9). Minimum and maximum axial diameter measurements were statistically more reliable than the greatest diameter measurement (p=0.008 and p=0.0001, respectively). The presence of ECS on CT does not significantly affect the reliability of lymph node diameter measurements (p>0.05). Lymph node diameter measurement on CT is a highly reproducible and robust method. Additionally, imaging features of ECS do not affect reliability. Therefore, the measurement of lymph node diameter can be confidently performed in daily clinical practice or clinical trials.

Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review.

BackgroundTo evaluate the role of computed tomography (CT) and positron emission tomography (PET)/CT in patients with thymic cancer and thymoma at initial staging.MethodsWe retrospectively reviewed CT and PET/CT scans of 26 patients with a thymic cancer (n = 9) or thymoma (n = 17). Chest CT findings documented were qualitative and quantitative. Both qualitative and semiquantitative data were recovered by PET/CT. The comparisons among histological entities, outcome, and qualitative data from CT and PET/CT were made by non-parametric analysis.ResultsPET/CT resulted positive in 15/17 patients with thymoma. CT was available in 5/9 (56%) patients with thymic cancer and in 3/17 with thymoma. All quantitative CT parameters were significantly higher in patients with thymic cancer than thymoma (maximum axial diameter: 45 vs. 20 mm, maximum longitudinal diameter: 69 vs. 21 mm and volume: 77.91 vs. 4.52 mL; all P < 0.05). Conversely, only metabolic tumor volume (MTV) and total lesion glycolysis were significantly different in patients with thymic cancer than thymoma (126.53 vs. 6.03 cm3 and 246.05 vs. 20.32, respectively; both P < 0.05). After a median follow-up time of 17.45 months, four recurrences of disease occurred: three in patients with thymic cancer and one with a type B2 thymoma. CT volume in patients with recurrent disease was 102.19 mL versus a median value of 62.5 mL in six disease-free patients. MTV was higher in the recurrent than disease-free patient subset (143.3 vs. 81.13 cm3), although not statistically significant (P = 0.075).ConclusionOur preliminary results demonstrated that both morphological and metabolic volume could be useful from a diagnostic and prognostic point of view in thymic cancer and thymoma patients. A large multi-center clinical trial experience for confirming the findings of this study seems mandatory.

Positional relationships of abdominal aorta landmarks for angiography: observations from the intravascular space

To clarify the positional relationships of abdominal aorta (Ao) landmarks by way of observations from the intravascular space to facilitate angiography. A total of 95 donated Japanese cadavers were observed. We excluded 32 cadavers with anatomical variation at the celiac trunk (CT) or superior mesenteric artery (SMA), with flexure exceeding 5° in the aorta located cranially to the renal artery (RA), and with flexure exceeding 60° in the aorta located caudal to the RA. The maximum longitudinal diameter of the left (Lt.) RA was measured and the Ao was incised by frontal section to acquire photographs of the intravascular space. The inner diameter of the Ao at the Lt. RA level was investigated. The distances between the inferior borders of the CT, SMA, and Lt. RA were also used as the hypotenuse of a right-angled triangle. Lines parallel to the longitudinal diameter of the Ao and those parallel to the transverse diameter of the right-angled triangle were measured by a computer, and expressed as relative distance indexes using the transverse diameter of the aorta at the Lt. RA level as a reference point. The angle between the transverse axis of the Ao and the line connecting the CT to the SMA was also investigated. The mean diameter of the aorta was 20.6±2.0mm. The indexes between each blood vessel (longitudinal/transverse) were as follows: Lt. RA to CT 1.69/0.41, Lt. RA to SMA 0.86/0.51, and CT to SMA 0.82/0.13. The mean angle between the transverse axis of the Ao and CT to SMA was 81.9°±9.5°. These indexes should contribute to improving skills for workers new to angiography, and may reduce patient risk.

Clinical significance of tumor volume in endometrial cancer: A Japan–Korea cooperative study

ObjectiveThe aim of this study was to elucidate the significance of tumor volume as a risk factor for predicting lymph node metastasis. MethodsWe applied the tumor volume index to the data that were collected for 327 Korean patients with endometrial cancer who underwent preoperative assessment including magnetic resonance imaging (MRI) and subsequent surgery including systematic lymphadenectomy. The volume index, which we previously reported in the literature, was defined as the product of maximum longitudinal diameter along the uterine axis, maximum anteroposterior diameter in a sagittal section image, and maximum horizontal diameter in a horizontal section image according to MRI data, from 425 Japanese women with endometrial cancer. Relationships between lymph node metastasis and results of preoperative examinations including volume index were analyzed by logistic regression analysis. ResultsThe prevalence of affected lymph nodes was 14.2%. Multivariate analysis showed that high-grade histology assessed by endometrial biopsy [odds ratio (OR); 2.9, 95% confidence interval (CI): 1.4–6.4], volume index (OR; 2.4, 95% CI: 1.1–5.3), node enlargement assessed by MRI (OR; 4.2, 95% CI: 1.4–13.2), and high serum cancer antigen (CA)125 level (OR; 3.6, 95% CI: 1.6–8.1) were significantly and independently related to lymph node metastasis. When volume index was excluded from the analysis, myoinvasion assessed by MRI was an independent risk factor for lymph node metastasis as well as high-grade histology, node enlargement, and high serum CA125 level. ConclusionVolume index is compatible with myometrial invasion as a factor for predicting lymph node metastasis in endometrial cancer.

Tumor volume successively reflects the state of disease progression in endometrial cancer

ObjectiveThis study aimed to clarify the clinical significance of tumor volume in endometrial cancer. MethodsA total of 667 patients with endometrial cancer who underwent preoperative MRI and surgical treatment including lymphadenectomy were enrolled. As the surrogate marker of actual tumor volume, the volume index was defined as the product of the maximum longitudinal diameter along the uterine axis, the maximum intersecting anteroposterior diameter of the sagittal section image, and the maximum horizontal diameter of the horizontal section image from the MRI data. The volume index was divided into five categories: Group 1 (<8), Group 2 (8 to <27), Group 3 (27 to <64), Group 4 (64 to <125), and Group 5 (125 or more). The relationships between various clinicopathologic factors and volume index were investigated, and Cox regression analysis was conducted to assess the significance of volume index with respect to prognosis. ResultsHigh-risk clinicopathologic findings increased with tumor volume. The lymph node metastasis rate was 3% in Group 1, 9% in Group 2, 17% in Group 3, 25% in Group 4, and 53% in Group 5. Cox regression analysis showed that the volume index (≥36) was a prognostic factor (hazard ratio: 2.0, 95% confidence interval: 1.3–3.1) independent of older age (≥58years), high-risk histological grade/subtype, deep myoinvasion, lymph node metastasis, and type of surgery. ConclusionTumor volume successively reflects the state of disease progression in endometrial cancer. The volume index can give information on both the staged prognosis and surgical management.

Positional relationships among the celiac trunk, superior mesenteric artery, and renal artery observed from the intravascular space

To clarify the positional relationships among the celiac trunk (CT), the superior mesenteric artery (SMA), and the renal artery (RA) observed from the intravascular space to facilitate angiography. After excluding six cadavers in which anatomic variation was found in the CT or SMA and four cadavers in which a curvature of 5° or more was observed in the aorta from 30 Japanese donor cadavers, we used the abdominal aortas of the remaining 20 cadavers as specimens. We made an incision in the maximum longitudinal diameter of the left RA (Lt. RA) and acquired an image of the intravascular space using a digital camera. The distance between the inferior borders of each vessel was used as the hypotenuse of a right-angled triangle. Lines parallel to the longitudinal diameter of the aorta and those parallel to the transverse diameter of the right-angled triangle were measured by a computer and expressed as relative distance indexes using the transverse diameter of the aorta at the Lt. RA level as a reference point. The transverse diameter of the aorta was 20.1±2.9mm, and the relative distance indexes for longitudinal/transverse lines between each vessel were 1.61/0.35 between Lt. RA and CT, 0.84/0.48 between Lt. RA and SMA, and 0.78/0.13 between CT and SMA. The angle between the transverse axis of the abdominal aorta and the linear line connecting CT and SMA was 80.2°±9.4°. The branching point of CT in relation to SMA was located at the upper left in 80% (n=16), on the same line in 15% (n=3), and at the upper right in 5% (n=1) of the subjects. The relative distance indexes determined in this study will facilitate navigation during catheter insertion, particularly for those with little angiography experience, and thus reduce patient risk.

Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism

This study evaluated the relationship between ultrasonographic (US) parameters of parathyroid glands (PTGs) in haemodialysis patients (HDP) and degree of secondary hyperparathyroidism (SHPT), therapeutic responsiveness and type of PTG hyperplasia (diffuse or nodular). In 85 HDP, we evaluated the following US parameters of all and of the largest PTGs: number, maximum longitudinal diameter (MLD), structural (hypoechoic, heterogeneous, nodular) and vascular (nonhypovascular, intermediate, hypervascular) echo-pattern scores. Sixty-nine HDP underwent medical therapy (vitamin D, 39; vitamin D/cinacalcet, 30) and 16 underwent parathyroidectomy. The 69 HDP were classified as responders [median intact parathyroid hormone (iPTH) ≤300 pg/ml during follow-up) or nonresponders (iPTH >300 pg/ml). Number, MLD and structural and vascular echo patterns of PTGs were significantly correlated with iPTH and calcium concentrations. In the 41 (59%) responders, number (0-1), MLD (<10 mm) and structural and vascular scores (1-2) of the largest PTG were significantly lower than in nonresponders. Receiver operating curve (ROC) curve analysis showed high sensitivity and specificity (90% and 73%, respectively) of the MLD (<10mm) of the largest PTG in the predicting therapeutic outcome. US and histological MLD are significantly correlated and predict the type of hyperplasia. US parameters of PTGs are correlated to the degree of SHPT and type of hyperplasia and predict responsiveness to medical therapy.