Publications by authors named "Jin-Wei Qiang"

68 Publications

Radiologic Imaging Modalities for Colorectal Cancer.

Dig Dis Sci 2021 Jul 30. Epub 2021 Jul 30.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Rd., Jinshan District, Shanghai, 201508, China.

Background: Studies reported various diagnostic value of radiologic imaging modalities for diagnosis and management of colorectal cancer (CRC).

Aims: To summary the diagnosis and management of CRC using computed tomography colonography (CTC), magnetic resonance colonography (MRC), and positron emission tomography (PET)/computed tomography (CT).

Methods: Comprehensive literature searches were conducted in PubMed, EmBase, and the Cochrane library for studies published before April 2021. The diagnostic performance of CTC, MRC, and PET/CT for CRC was summarized.

Results: A total of 54 studies (17 studies for CTC, 8 studies for MRC, and 29 studies for PET/CT) were selected for final analysis. The sensitivity and specificity for CTC ranged from 27 to 100%, 88 to 100%, respectively, and the pooled sensitivity and specificity for CTC were 0.97 (95% CI 0.88-0.99) and 0.99 (95% CI 0.99-1.00). The sensitivity and specificity for MRC ranged from 48 to 100%, 60 to 100%, respectively, and the pooled sensitivity and specificity for MRC were 0.98 (95% C: 0.77-1.00) and 0.94 (95% CI 0.84-0.98). The sensitivity and specificity for PET/CT ranged from 84 to 100%, 33 to 100%, respectively, and the pooled sensitivity and specificity for PET/CT were 0.94 (95% CI 0.92-0.96) and 0.94 (95% CI 0.90-0.97). The area under the receiver operating characteristic curve for CTC, MRC, and PET/CT was 1.00 (95% CI 0.99-1.00), 0.99 (95% CI 0.98-1.00), and 0.97 (0.95% CI 0.95-0.98), respectively.

Conclusions: This study suggested both CTC and MRC with relative higher diagnostic value for diagnosing CRC, while PET/CT with higher diagnostic value in detecting local recurrence for patients with CRC.
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http://dx.doi.org/10.1007/s10620-021-07166-0DOI Listing
July 2021

Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients.

Am J Trop Med Hyg 2021 Jul 19. Epub 2021 Jul 19.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.

To evaluate percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal bleeding (UGIB) in patients with chronic hepatic schistosomiasis japonicum (CHS), 29 CHS patients (20 males and 9 females) complicated with UGIB were selected as the investigation subjects. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the degrees of varices before and after PTSVE were evaluated by abdominal computed tomography (CT). Results showed that 26 CHS patients (89.6%) were successfully treated with PTSVE. Three cases (10.3%) failed, and two experienced intraperitoneal bleeding within 1 week after PTSVE. The abdominal CT showed a significant decrease of the varices stage in coronary (P < 0.001), esophageal (P = 0.006), and paraesophageal (P = 0.013) varices, but slightly increased perisplenic varices within 1 month of the intervention (P = 0.014). PTSVE may be a safe and effective procedure for the treatment of UGIB in CHS patients, particularly suitable for those with a widened hepatic fissure and exposed hepatic portal vein trunk and an enlarged spleen.
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http://dx.doi.org/10.4269/ajtmh.21-0304DOI Listing
July 2021

Development of MRI-Based Radiomics Model to Predict the Risk of Recurrence in Patients With Advanced High-Grade Serous Ovarian Carcinoma.

AJR Am J Roentgenol 2021 09 14;217(3):664-675. Epub 2021 Jul 14.

Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Rd, Shanghai 200032, China.

The purpose of our study was to develop a radiomics model based on preoperative MRI and clinical information for predicting recurrence-free survival (RFS) in patients with advanced high-grade serous ovarian carcinoma (HGSOC). This retrospective study enrolled 117 patients with HGSOC, including 90 patients with recurrence and 27 without recurrence; 1046 radiomics features were extracted from T2-weighted images and contrast-enhanced T1-weighted images using a manual segmentation method. L1 regularization-based least absolute shrinkage and selection operator (LASSO) regression was performed to select features, and the synthetic minority oversampling technique (SMOTE) was used to balance our dataset. A support vector machine (SVM) classifier was used to build the classification model. To validate the performance of the proposed models, we applied a leave-one-out cross-validation method to train and test the classifier. Cox proportional hazards regression, Harrell concordance index (C-index), and Kaplan-Meier plots analysis were used to evaluate the associations between radiomics signatures and RFS. The fusion radiomics-based model yielded a significantly higher AUC value of 0.85 in evaluating RFS than the model using contrast-enhanced T1-weighted imaging features alone or T2-weighted imaging features alone (AUC = 0.79 and 0.74 and = .02 and .01, respectively). Kaplan-Meier survival curves showed significant differences between high and low recurrence risk in patients with HGSOC by different models. The fusion model combining radiomics features and clinical information showed higher performance than the clinical model (C-index = 0.62 and 0.60, respectively). The proposed MRI-based radiomics signatures may provide a potential way to develop a prediction model and can help identify patients with advanced HGSOC who have a high risk of recurrence.
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http://dx.doi.org/10.2214/AJR.20.23195DOI Listing
September 2021

Contrast-enhanced CT longitudinal tail sign as a marker of positive resection margins in adenoid cystic carcinoma of the central airway.

J Thorac Dis 2021 May;13(5):2803-2811

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.

Background: Due to submucosal infiltration's biological nature along the airway, adenoid cystic carcinoma (ACC) frequently leaves positive surgical margins. This study evaluated the clinicopathologic, and computed tomography (CT) features for predicting surgical margin status in central airway ACC.

Methods: We retrospectively analyzed the files of 71 patients with ACC of the central airway proven by histopathology and surgery who had presented between January 2010 and December 2018. All patients were classified into positive and negative surgical margin groups according to margin status. Univariate analysis and multivariable logistic regression models were then performed to compare demography, histopathology, and CT characteristics between ACC patients with positive and negative margins.

Results: After surgical resection, 59 (83.1%) patients had positive margins, and 12 (16.9%) had negative margins. The contrast-enhanced CT (CECT) longitudinal tail sign (LTS) was identified in 55 of 59 (93.2%) patients with positive margins and was the only feature that had a significant association with positive margins (odds ratio 41.250, 95% CI: 7.886-215.767; P<0.001). Moreover, positive margins in upper or/and lower directions were associated with the LTS in corresponding directions (P<0.001).

Conclusions: Most central airway ACC patients exhibited positive margins following surgery. The appearance of the LTS on CECT was significantly associated with positive margins and could help preoperatively predict the submucosal invasion of ACC.
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http://dx.doi.org/10.21037/jtd-20-2929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182504PMC
May 2021

CT diagnosis and prognosis prediction of tracheal adenoid cystic carcinoma.

Eur J Radiol 2021 Jul 30;140:109746. Epub 2021 Apr 30.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China. Electronic address:

Purpose: To evaluate computed tomography (CT) features and establish a predictive model for the clinical diagnosis and prognosis of tracheal adenoid cystic carcinoma (ACC).

Method: From January 2010 to December 2018, 82 patients with tracheal tumors, including 46 patients with ACC confirmed by surgery and histopathology, were enrolled in this study. These patients' clinicopathologic information, CT features and survival outcomes were recorded and analyzed. Independent predictors of diagnosis and prognosis of tracheal ACC were determined by both univariate and multivariate analyses.

Results: Compared with tracheal non-ACC patients, univariate analysis showed that ACC patients were more likely to have extensive longitudinal length (p < 0.001) and to appear as annular wall thickening (p = 0.001), transmural growth (p = 0.036), poorly defined border (p = 0.003) and mild enhancement (p = 0.001). Multivariate logistic analysis showed that longitudinal length and enhancement degree were independent predictors of tracheal ACC. The 3-year and 5-year disease-free survival (DFS) were 75.7 % and 64.5 %, respectively. Longitudinal length (≥ 34 mm), transverse length (≥ 20 mm) and transmural growth were associated with poor DFS in univariate analysis. After multivariate adjustment, only transverse length (≥ 20 mm) was an adverse prognostic factor for DFS (hazard ratio = 4.594, 95 % confidence interval = 1.240-17.017; p = 0.022).

Conclusions: CT longitudinal length and enhancement degree of tumors showed satisfactory discrimination for tracheal ACC. Excessive CT transverse length might be an unfavorable indicator for ACC recurrence and could be helpful for predicting the survival outcomes of ACC at the initial diagnosis.
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http://dx.doi.org/10.1016/j.ejrad.2021.109746DOI Listing
July 2021

Optimization of 7,12-dimethylbenz(a)anthracene-induced rat epithelial ovarian tumors.

Oncol Lett 2021 Mar 14;21(3):206. Epub 2021 Jan 14.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China.

Ovarian carcinoma is the second most common malignant tumor of the female reproductive system and an notable cause of cancer death. The detection and diagnosis of early ovarian carcinomas are still clinical challenges, which calls for imaging studies using early ovarian carcinoma animal models. The present study aimed to optimize the 7,12-dimethylbenz(a)anthracene (DMBA)-induced model of rat ovarian tumors by investigating the delivery methods, induction dose and time of DMBA exposure, and explored the morphological features of tumors using MRI. Three schemes were performed. In scheme one the ovary was covered with absorbable hemostatic gauze loaded with a high concentration of liquid DMBA. For this scheme, 150 Sprague-Dawley rats were divided into three groups depending on the DMBA dose (1.0, 2.0 and 3.0 mg). In scheme two DMBA solution was injected under the ovarian capsule. For this scheme, 159 rats were divided into 0.5, 1.0 and 1.5 mg DMBA groups. In scheme three the ovary was covered with absorbable gauze loaded with a high concentration of solid DMBA. For this scheme 161 rats were divided into 1.0, 2.0 and 3.0 mg DMBA groups. Each group of the three schemes was further subdivided into 60-, 90-, 120-, 150- and 180-day groups. In scheme two, the tumor formation rate was 75.6% (99/131), which was the highest in the 1.5 mg group (86.4%, 38/44) and reached 100% (10/10) on day 120. The induced tumors were serous in 93.9% (93/99) of tumors. Borderline ovarian tumors accounted for 19.2% (19/99) of all tumors, and ovarian cancer accounted for 46.5% (46/99). The mean maximum diameter (MMD) of borderline ovarian tumors was 10.29±3.41 mm, and that of ovarian cancer was 15.19±7.10 mm. MMD of the solid components increased with increasing malignancy. Cystic, cystic-solid and solid tumors were observed. The ovarian subcapsular injection of 1.5 mg DMBA was the best scheme for the rat ovarian tumor model. The present model is ideal for investigating the occurrence, development and imaging of ovarian tumors.
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http://dx.doi.org/10.3892/ol.2021.12467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816358PMC
March 2021

Use of relative CT values to evaluate the invasiveness of pulmonary subsolid nodules in patients with emphysema.

Quant Imaging Med Surg 2021 Jan;11(1):204-214

Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.

Background: Lung cancer is a major cause of death, and adenocarcinoma is the most common histologic subtype. Precise diagnosis and treatment of invasive adenocarcinoma (IAC) can substantially improve the survival of patients. However, early-stage adenocarcinomas frequently appear as subsolid nodules (SSN) on computed tomography (CT), and the optimal cut-off CT value for differentiating the invasiveness of SSNs in emphysematous patients is unclear.

Methods: High-resolution CT targeted scans of 187 pulmonary SSNs in 175 patients with emphysema as confirmed by surgery and histology were retrospectively reviewed. The mean CT value, the relative CT (rCT) values of 1 (nodule CT value - lung CT value), and 2 (nodule CT value/lung CT value), and the size of the SSNs were measured and calculated. The differentiating performance of the CT values between pre-invasive and invasive tumors was evaluated using a receiver operating characteristic (ROC) curve.

Results: Significant differences were found in the rCT values of 1 and 2 among pure ground-glass nodules (GGNs) with different levels of invasiveness, in the rCT values of 1 and 2 for the ground-glass component (GGC) and the mean CT value of the solid component (SC) of part-solid nodules (PSNs) between minimally invasive adenocarcinoma (MIA) and IAC (all P<<0.05). The size was significantly different among pure GGNs with different invasiveness (P<0.05). The cut-off rCT values of 1, 2 and nodule size for differentiating between pre-invasive and invasive pure GGNs were 293.82 [sensitivity 58.0%, specificity 94.7%; area under the curve (AUC) 0.783], 0.68 (sensitivity 89.5%, specificity 58.0%, AUC 0.742) and 1.10 cm (sensitivity 74.0%, specificity 79.0%, AUC 0.796), respectively. The AUCs of combining rCT values 1 and 2 with the size of nodule were 0.795 (sensitivity 62.5%, specificity 89.5%) and 0.845 (sensitivity 71.6%, specificity 89.5%) respectively. There were no significant differences in the mean CT values between pure GGNs with different levels of invasiveness and between the GGC of PSNs of MIA and IAC.

Conclusions: In patients with emphysema, the rCT values are more useful than the mean CT values for differentiating between SSNs with different invasiveness and can be valuable for patient management.
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http://dx.doi.org/10.21037/qims-19-998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719921PMC
January 2021

Radiologists with MRI-based radiomics aids to predict the pelvic lymph node metastasis in endometrial cancer: a multicenter study.

Eur Radiol 2021 Jan 4;31(1):411-422. Epub 2020 Aug 4.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China.

Objective: To construct a MRI radiomics model and help radiologists to improve the assessments of pelvic lymph node metastasis (PLNM) in endometrial cancer (EC) preoperatively.

Methods: During January 2014 and May 2019, 622 EC patients (age 56.6 ± 8.8 years; range 27-85 years) from five different centers (A to E) were divided into training set, validation set 1 (351 cases from center A), and validation set 2 (271 cases from centers B-E). The radiomics features were extracted basing on T2WI, DWI, ADC, and CE-T1WI images, and most related radiomics features were selected using the random forest classifier to build a radiomics model. The ROC curve was used to evaluate the performance of training set and validation sets, radiologists based on MRI findings alone, and with the aid of the radiomics model. The clinical decisive curve (CDC), net reclassification index (NRI), and total integrated discrimination index (IDI) were used to assess the clinical benefit of using the radiomics model.

Results: The AUC values were 0.935 for the training set, 0.909 and 0.885 for validation sets 1 and 2, 0.623 and 0.643 for the radiologists 1 and 2 alone, and 0.814 and 0.842 for the radiomics-aided radiologists 1 and 2, respectively. The AUC, CDC, NRI, and IDI showed higher diagnostic performance and clinical net benefits for the radiomics-aided radiologists than for the radiologists alone.

Conclusions: The MRI-based radiomics model could be used to assess the status of pelvic lymph node and help radiologists improve their performance in predicting PLNM in EC.

Key Points: • A total of 358 radiomics features were extracted. The 37 most important features were selected using the random forest classifier. • The reclassification measures of discrimination confirmed that the radiomics-aided radiologists performed better than the radiologists alone, with an NRI of 1.26 and an IDI of 0.21 for radiologist 1 and an NRI of 1.37 and an IDI of 0.24 for radiologist 2.
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http://dx.doi.org/10.1007/s00330-020-07099-8DOI Listing
January 2021

Preoperative Assessment for High-Risk Endometrial Cancer by Developing an MRI- and Clinical-Based Radiomics Nomogram: A Multicenter Study.

J Magn Reson Imaging 2020 12 18;52(6):1872-1882. Epub 2020 Jul 18.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.

Background: High- and low-risk endometrial cancer (EC) differ in whether lymphadenectomy is performed. Assessment of high-risk EC is essential for planning surgery appropriately.

Purpose: To develop a radiomics nomogram for high-risk EC prediction preoperatively.

Study Type: Retrospective.

Population: In all, 717 histopathologically confirmed EC patients (mean age, 56 years ± 9) divided into a primary group (394 patients from Center A), validation groups 1 and 2 (146 patients from Center B and 177 patients from Centers C-E).

Field Strength/sequence: 1.5/3T scanners; T -weighted imaging, diffusion-weighted imaging, apparent diffusion coefficient, and contrast enhancement sequences.

Assessment: A radiomics nomogram was generated by combining the selected radiomics features and clinical parameters (metabolic syndrome, cancer antigen 125, age, tumor grade following curettage, and tumor size). The area under the curve (AUC) of the receiver operator characteristic was used to evaluate the predictive performance of the radiomics nomogram for high-risk EC. The surgical procedure suggested by the nomogram was compared with the actual procedure performed for the patients. Net benefit of the radiomics nomogram was evaluated by a clinical decision curve (CDC), net reclassification index (NRI), and integrated discrimination improvement (IDI).

Statistical Tests: Binary least absolute shrinkage and selection operator (LASSO) logistic regression, linear regression, and multivariate binary logistic regression were used to select radiomics features and clinical parameters.

Results: The AUC for prediction of high-risk EC for the radiomics nomogram in the primary group, validation groups 1 and 2 were 0.896 (95% confidence interval [CI]: 0.866-0.926), 0.877 (95% CI: 0.825-0.930), and 0.919 (95% CI: 0.879-0.960), respectively. The nomogram achieved good net benefit by CDC analysis for high-risk EC. NRIs were 1.17, 1.28, and 1.51, and IDIs were 0.41, 0.60, and 0.61 in the primary group, validation groups 1 and 2, respectively.

Data Conclusion: The radiomics nomogram exhibited good performance in the individual prediction of high-risk EC, and might be used for surgical management of EC.

Level Of Evidence: 4 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1872-1882.
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http://dx.doi.org/10.1002/jmri.27289DOI Listing
December 2020

Perfusion-based functional magnetic resonance imaging for differentiating serous borderline ovarian tumors from early serous ovarian cancers in a rat model.

Acta Radiol 2021 Jan 10;62(1):129-138. Epub 2020 Apr 10.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.

Background: Differentiation of borderline tumors from early ovarian cancer has recently received increasing attention, since borderline tumors often affect young women of childbearing age who desire to preserve fertility. However, previous studies have demonstrated that non-enhanced magnetic resonance imaging (MRI) sequences cannot sufficiently differentiate these tumors.

Purpose: To investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in differentiating serous borderline ovarian tumors (SBOT) from early serous ovarian cancers (eSOCA).

Material And Methods: Twenty SBOT and 20 eSOCA rat models were performed with DCE-MRI and IVIM-DWI at 3.0-T MR scanner. Qualitative and quantitative parameters of DCE-MRI were acquired and compared between two groups and correlated with the microvessel density (MVD). The receiver operating characteristic (ROC) curve analyses were conducted to determine their differentiating performances.

Results: SBOTs presented significantly lower values of the initial area under the enhancement curve (iAUC), volume transfer constant (K), and extracellular extravascular volume fraction (v) (<0.05) and a significantly higher value of true diffusion (D) (=0.001) compared with eSOCAs. The diagnostic effectiveness of v combined with D was significantly better than that of v or K alone (≤0.039).

Conclusion: DCE-MRI may represent a promising tool for differentiating SBOTs from eSOCAs and may not be replaced by IVIM-DWI. Combining DCE-MRI with DWI may improve the diagnostic performance of ovarian tumors.
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http://dx.doi.org/10.1177/0284185120913711DOI Listing
January 2021

Prediction of Platinum-based Chemotherapy Response in Advanced High-grade Serous Ovarian Cancer: ADC Histogram Analysis of Primary Tumors.

Acad Radiol 2021 03 13;28(3):e77-e85. Epub 2020 Feb 13.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, PR China. Electronic address:

Rationale And Objectives: To investigate the feasibility of apparent diffusion coefficient (ADC) histogram analysis of primary advanced high-grade serous ovarian cancer (HGSOC) to predict patient response to platinum-based chemotherapy.

Materials And Methods: A total of 70 patients with 102 advanced stage HGSOCs (International Federation of Gynecology and Obstetrics (FIGO) stages III-IV) who received standard treatment of primary debulking surgery followed by the first line of platinum-based chemotherapy were retrospectively enrolled. Patients were grouped as platinum-resistant and platinum-sensitive according to whether relapse occurred within 6 months. Clinical characteristics, including age, pretherapy CA125 level, International Federation of Gynecology and Obstetrics stage, residual tumor, and histogram parameters derived from whole tumor and solid component such as ADC; 10th, 20th, 25th, 30th, 40th, 50th, 60th, 70th, 75th, 80th, 90th percentiles; skewness and kurtosis, were compared between platinum-resistant and platinum-sensitive groups.

Results: No significantly different clinical characteristics were observed between platinum-sensitive and platinum-resistant patients. There were no significant differences in any whole-tumor histogram-derived parameters between the two groups. Significantly higher ADC and percentiles and significantly lower skewness and kurtosis from the solid-component histogram parameters were observed in the platinum-sensitive group when compared with the platinum-resistant group. ADC, skewness and kurtosis showed moderate prediction performances, with areas under the curve of 0.667, 0.733 and 0.616, respectively. Skewness was an independent risk factor for platinum resistance.

Conclusion: Pretreatment ADC histogram analysis of primary tumors has the potential to allow prediction of response to platinum-based chemotherapy in patients with advanced HGSOC.
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http://dx.doi.org/10.1016/j.acra.2020.01.024DOI Listing
March 2021

Whole solid tumor volume histogram parameters for predicting the recurrence in patients with epithelial ovarian carcinoma: a feasibility study on quantitative DCE-MRI.

Acta Radiol 2020 Sep 19;61(9):1266-1276. Epub 2020 Jan 19.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China.

Background: Preoperative prediction of the recurrence of epithelial ovarian carcinoma (EOC) can guide the clinical treatment and improve the prognosis. However, there are still no reliable predictive biomarkers.

Purpose: To evaluate whether whole solid tumor volume histogram parameters measured from quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict the recurrence in patients with EOC.

Material And Methods: We followed up 56 patients with surgical and histopathologically diagnosed EOC who underwent quantitative DCE-MRI scans. The differences of the histogram parameters between patients with and without recurrence were compared. Mann-Whitney U test, Pearson's Chi-squared test, or Fisher's exact test, and receiver operating characteristic (ROC) curves were used for statistical analysis.

Results: All histogram parameters of K, k, and v were not significantly different between EOC patients with and without recurrence (>0.05). For 30 patients with high-grade serous ovarian carcinoma (HGSOC), the histogram parameters of K (mean and 5th, 10th, 25th, 50th, 75th percentiles) and k (mean and 50th percentile) in 12 patients with recurrence were significantly lower than those in 18 patients without recurrence (all <0.05). ROC curves showed that the 5th percentile of K had the largest area under the curve (AUC) of 0.792 for predicting the recurrence in patients with HGSOC. When the threshold value was ≤0.0263/min, the sensitivity, specificity, and accuracy were 100%, 66.7%, and 80%, respectively.

Conclusion: Instead of predicting the recurrence of EOC, whole solid tumor volume quantitative DCE-MRI histogram parameters could predict the recurrence of HGSOC and may be potential biomarkers for the prediction of HGSOC recurrence.
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http://dx.doi.org/10.1177/0284185119898654DOI Listing
September 2020

Value of normalized apparent diffusion coefficients in differentiating between borderline and malignant epithelial ovarian tumors.

Eur J Radiol 2019 Sep 26;118:44-50. Epub 2019 Jun 26.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, PR China. Electronic address:

Purpose: To compare the diagnostic performance of normalized apparent diffusion coefficients (nADCs) of different references with that of ADCs at differentb factors in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs).

Method: This retrospective study included 53 BEOTs and 148 MEOTs. Conventional magnetic resonance and diffusion-weighted imaging withb factors of 800 and 1000s/mm were performed. ADC was measured three times at solid components of tumors, gluteus maximus muscle (GMM), iliopsoas muscle (IM) and urine and then averaged. ADC, nADCs were then obtained. Differences and the diagnostic performance of ADC and nADCs between BEOTs and MEOTs with different b factors were compared.

Results: ADC, nADCs regardless of b factors were significantly higher in BEOTs than MEOTs. The diagnostic performance of nADC regardless of b factors was significantly larger than that of nADC and nADC. There was no significant difference in the diagnostic performance between ADC and nADC regardless of b factors. A significantly lower ADC and a larger diagnostic performance for ADC was found with a b factor of 1000s/mm than 800 s/mm. There were no significant differences in nADC of BEOTs or MEOTs or in the diagnostic performance of nADC with b factors between 800 and 1000s/mm.

Conclusions: ADC and nADCs were both capable of differentiating BEOTs from MEOTs. nADC was the best of all nADCs and was superior to ADC because of its stable performance in differentiating BEOTs from MEOTs, regardless of b factors.
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http://dx.doi.org/10.1016/j.ejrad.2019.06.020DOI Listing
September 2019

The diagnostic performance of ADC value for tumor grade, deep myometrial invasion and lymphovascular space invasion in endometrial cancer: a meta-analysis.

Acta Radiol 2019 May 1:284185119841988. Epub 2019 May 1.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.

Background: Disputes exist regarding whether the apparent diffusion coefficient (ADC) can differentiate the tumor grade, deep myometrial invasion and lymphovascular space invasion (LVSI) in endometrial cancer. The aim of this review was to assess the diagnostic performance of the ADC value in endometrial cancer.

Material And Methods: The PubMed, Web of Science, Embase and Cochrane Library databases were searched for studies that used the ADC value to assess tumor grade, deep myometrial invasion and LVSI in endometrial cancer. We used forest plots to analyze the heterogeneity and generate the pooled sensitivity (SEN) and specificity (SPE). We used summary receiver operating characteristic (SROC) curves to work out the area under the SROC curve (AUC). Likelihood ratios (LRs) were also obtained.

Results: Of the 460 identified studies, 11 studies met our inclusion criteria and were included. Overall, nine studies (491 patients) aimed at differentiating high tumor grade had a pooled SEN, SPE and AUC of 77%, 73% and 81%, respectively; three studies (181 patients) for differentiating deep myometrial invasion had a pooled SEN, SPE and AUC of 71%, 67% and 77%, respectively; and two studies (106 patients) for differentiating LVSI had a pooled SEN and SPE of 66% and 74%, respectively. The positive and negative LRs were 2.77 and 0.35 for the tumor grade, 2.08 and 0.45 for deep myometrial invasion, and 2.48 and 0.45 for LVSI.

Conclusion: This meta-analysis showed that the ADC value had a moderate diagnostic performance for the tumor grade, deep myometrial invasion and LVSI in endometrial cancer.
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http://dx.doi.org/10.1177/0284185119841988DOI Listing
May 2019

Dynamic contrast enhanced‑magnetic resonance imaging for the early evaluation of the response to docetaxel in rats with epithelial ovarian cancer.

Oncol Rep 2019 Jun 17;41(6):3335-3346. Epub 2019 Apr 17.

Department of Radiology, Zhongshan Hospital, Medical Center of Fudan University, Shanghai 200032, P.R. China.

Dynamic contrast enhanced‑magnetic resonance imaging (DCE‑MRI) contributes to the early detection and prediction of responses to chemotherapy in cancer. The aim of the present study was to investigate the feasibility of quantitative DCE‑MRI parameters for noninvasively predicting the early response to DTX in epithelial ovarian cancer (EOC). In the present study, using 7,12‑dimethylbenz (A) anthracene, orthotopic EOC was induced in Sprague Dawley rats. Rats with EOC were treated with docetaxel (DTX) on day 0. DCE‑MRI was applied on days 0, 3, 7, 14 and 21. On day 21, the treated tumor types were categorized into sensitive and insensitive groups according to their change in size. Quantitative DCE‑MRI parameters were used to assess the early response to therapy. The experiment was performed again, the treatment group was divided into sensitive and insensitive groups according to their initially obtained cut-off values, and histopathological analyses were performed. Comparing the sensitive group with the insensitive group, there were significant differences in the percentage change in the volume transfer constant (Ktrans), rate constant (kep) and initial area under the curve (IAUC) from day 3 and tumor size from day 14. During the early stages of treatment (on day 3), the percentage change of Ktrans combined with kep produced an AUC of 1, and a sensitivity and specificity of 100 and 100%, respectively, using a cut-off value of a 17.59% reduction in Ktrans and kep. From day 7, there were significant differences in the quantitative index percentage change in angiogenesis in the sensitive group compared with the insensitive group. The percentage change in Ktrans, kep and IAUC were positively correlated with the percentage of change in tumor size and angiogenesis, and negatively correlated with the percentage of change in necrosis. The results of the present study indicated that quantitative DCE‑MRI parameters were superior to imaging tumor size for the early detection and prediction of the response to DTX chemotherapy in EOC.
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http://dx.doi.org/10.3892/or.2019.7124DOI Listing
June 2019

A rat model of serous borderline ovarian tumors induced by 7,12-dimethylbenz[a]anthracene.

Exp Anim 2019 Aug 14;68(3):257-265. Epub 2019 Feb 14.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China.

Serous borderline ovarian tumors (SBOTs) behave between benign cystadenomas and carcinomas, and the effective detection and clinical management of SBOTs remain clinical challenges. Because it is difficult to isolate and enrich borderline tumor cells, a borderline animal model is in need. 7,12-dimethylbenz[a]anthracene (DMBA) is capable of inducing the initiation, promotion, and progression of serous ovarian tumors. This study aims to investigate the proper dosage and induction time of DMBA for rat models of SBOTs, and explore their morphological features demonstrated by magnetic resonance (MR) imaging and molecular genetic characteristics. Rats were randomly divided into six groups (1 mg/70 D, 2 mg/70 D, 3 mg/70 D, 2 mg/50 D, 2 mg/90 D, and 2 mg/110 D). The 3 mg/70 D group induced the most SBOTs (50.0%, 12/24). The micropapillary projections were shown on MR imaging, which was the characteristic of SBOTs. The Cyclin D1 characterizing an early pathogenetic event strongly expressed in induced serous benign tumors (SBTs). The immunoreactivity staining scores of P53 expression significantly increased from SBTs, SBOTs to serous ovarian carcinomas (SCAs), which elucidate that P53 might be a promising biomarker to grade serous ovarian tumors. Based on morphological and molecular genetic similarities, this rodent SBOT model was suitable for investigating the pathogenesis of serous ovarian tumors and developing an early detection strategy.
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http://dx.doi.org/10.1538/expanim.18-0103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699968PMC
August 2019

The value of MR-detectable ipsilateral ovaries in characterizing the origin and malignancy of an adnexal tumors.

Eur J Radiol 2018 Dec 26;109:62-67. Epub 2018 Oct 26.

Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, China. Electronic address:

Objective: To investigate the magnetic resonance (MR) imaging morphological relationship between adnexal tumors and the ipsilateral ovaries to characterize the origin and malignancy of tumors.

Material And Methods: Clinical and MR imaging data of 496 adnexal tumors confirmed by histology (ovary tumors, n = 400, non-ovarian tumors, n = 96; benign tumors, n = 183, borderline tumors, n = 120, and malignant tumors, n = 193) were retrospectively analyzed. The presence and shape of the ipsilateral ovaries within the context of adnexal tumors of different origins, malignancies and configurations were evaluated. The relationships between the presence of the ipsilateral ovary and patient age, menstrual status and tumor size were also analyzed.

Result: The ipsilateral ovary was detected on MRI in 23% (90/400) of ovarian tumors and in 45% (43/96) of non-ovarian tumors (p < 0.001). A normal ovoid morphology of the ipsilateral ovary was found in only 7% (26/400) of ovarian tumors and in 26% (25/96) of non-ovarian tumors (p < 0.001). The ipsilateral ovary was detectable in 38% (69/183) of benign tumors, 35% (42/120) of borderline tumors, and 11% (22/193) of malignant tumors (p <  0.001); in 24% (24/101) of cystic tumors, 27% (49/179) of mixed cystic-solid tumors and 28% (60/216) of solid tumors (p = 0.737); and in 40% (120/303) of adnexal tumors in premenopausal patients and 7% (13/193) of adnexal tumors in postmenopausal patients (p < 0.001).

Conclusion: Detection of the ipsilateral ovary contributes to the localization and characterization of adnexal tumors. The ipsilateral ovary can be detected more frequently in non-ovarian tumors and in benign or borderline ovarian tumors.
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http://dx.doi.org/10.1016/j.ejrad.2018.10.027DOI Listing
December 2018

Diffusion-weighted imaging and diffusion kurtosis imaging for early evaluation of the response to docetaxel in rat epithelial ovarian cancer.

J Transl Med 2018 12 5;16(1):340. Epub 2018 Dec 5.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.

Background: To investigate diffusion-weighted magnetic imaging (DWI) and diffusion kurtosis magnetic imaging (DKI) for the early detection of the response to docetaxel (DTX) chemotherapy in rat epithelial ovarian cancer (EOC).

Methods: 7,12-Dimethylbenz[A]anthracene was applied to induce orthotopic EOC in Sprague-Dawley rats. Rats with EOC were treated with DTX on day 0 (treatment group) or were left untreated (control group). DWI and DKI were performed on days 0, 3, 7, 14 and 21 after treatment. On day 21, the tumors were categorized into the sensitive and insensitive groups according to the size change. The cutoff values of the DWI and DKI parameters for the early response were determined. The experiment was repeated, and the treatment group was divided into the sensitive and insensitive groups according to the initially obtained cutoff values. The DWI and DKI parameters were correlated with tumor size, proliferation, apoptosis and tumor necrosis.

Results: In the sensitive vs. insensitive or control group, significant differences were found in the Δ% of the DWI and DKI parameters (ADC, D and K) from day 3 and in tumor size from day 14. Early on day 7, the Δ% of K had an AUC of 1 and sensitivity and specificity values of 100% and 100%, respectively, to detect the response to DTX using a cutoff value of 19.03% reduction in K. From day 7, significant differences were found in the Δ% of Ki-67 and CA125 in the sensitive vs. control group and from day 14 in the sensitive vs. insensitive group. From day 14, there were significant differences in the Δ% of Bcl-2, apoptosis and tumor necrosis in the sensitive vs. control or insensitive group. The Δ% values of ADC and D were negatively correlated with the Δ% values of tumor size, Ki-67, CA125 and Bcl-2 and were positively correlated with the Δ% values of apoptosis and tumor necrosis. The Δ% of K was positively correlated with the Δ% values of tumor size, Ki-67, CA125 and Bcl-2 and was negatively correlated with the Δ% values of apoptosis and tumor necrosis.

Conclusions: DWI and DKI parameters, especially K, are superior for imaging tumor size for the early detection of the response to DTX chemotherapy in induced rat EOC.
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http://dx.doi.org/10.1186/s12967-018-1714-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282389PMC
December 2018

Role of proton MR spectroscopy in the differentiation of borderline from malignant epithelial ovarian tumors: A preliminary study.

J Magn Reson Imaging 2019 06 24;49(6):1684-1693. Epub 2018 Oct 24.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.

Background: Due to the overlapping imaging appearances between borderline and malignant epithelial ovarian tumors (EOTs), borderline EOTs often represent a diagnostic challenge on conventional MRI. Proton magnetic resonance spectroscopy ( H-MRS) might have potential to differentiate borderline from malignant tumors.

Purpose: To investigate the ability of H-MRS to differentiate borderline from malignant EOTs.

Study Type: Prospective.

Population: In all, 278 patients with adnexal masses.

Field Strength/sequence: 1.5 T Siemens Avanto MRI system and H-MRS using a point-resolved spectroscopy sequence (PRESS).

Assessment: Resonance peak integrals of the most common metabolites were analyzed and compared between the two groups.

Statistical Tests: The ratios of metabolites between borderline and malignant EOTs were compared with the Mann-Whitney U-test. A receiver operating characteristic (ROC) curve was used to determine their differential diagnosis performances.

Results: In the solid components of borderline and malignant EOTs, the mean Cho/Cr, NAA/Cr, and NAA/Cho ratios were 4.4 ± 1.1 and 9.9 ± 2.8; 10.4 ± 3.0 and 2.2 ± 1.0; and 2.4 ± 0.7 and 0.3 ± 0.1, respectively (all P < 0.001). The sensitivity, specificity, and area under the curve (AUC) were 91%, 100%, and 0.98 for the Cho/Cr ratio; 100%, 98%, and 0.99 for the NAA/Cr ratio; and 100%, 100%, and 1.00 for the NAA/Cho ratio, respectively. In the cystic components, the mean Cho/Cr, NAA/Cr, and NAA/Cho ratios were 3.2 ± 0.8 and 5.1 ± 1.2; 9.1 ± 3.4 and 2.3 ± 1.4; and 2.9 ± 1.2 and 0.5 ± 0.4, respectively (all P < 0.001). The sensitivity, specificity, and AUC were 84%, 82%, and 0.89 for the Cho/Cr ratio; 94%, 97%, and 0.99 for the NAA/Cr ratio; and 94%, 97%, and 0.99 for the NAA/Cho ratio, respectively.

Data Conclusion: The NAA/Cho ratio is a reliable biomarker for differentiating borderline from malignant EOTs.

Level Of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1684-1693.
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http://dx.doi.org/10.1002/jmri.26541DOI Listing
June 2019

Apparent diffusion coefficients measured using different regions of interest in differentiating borderline from malignant ovarian tumors.

Acta Radiol 2019 Aug 18;60(8):1020-1027. Epub 2018 Oct 18.

1 Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China.

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http://dx.doi.org/10.1177/0284185118805272DOI Listing
August 2019

The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging.

J Ovarian Res 2018 Aug 30;11(1):73. Epub 2018 Aug 30.

Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.

Background: To investigate MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary (SCSTs) emphasizing on the value of diffusion-weighted (DW) magnetic resonance (MR) imaging.

Methods: This retrospective study included 29 benign SCSTs in 28 patients and 13 malignant SCSTs in 13 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. In addition, T2 signal intensity and contrast enhancement pattern were also assessed and compared between benign and malignant SCSTs.

Results: Both of the T2 hypointensity and mild enhancement were specific to benign SCSTs. The majority of malignant SCSTs showed high signal intensity on DW imaging, whereas most benign SCSTs showed low or moderate signal intensity (p = 0.000). Fibromas were the tumors with the lowest observed ADC value (0.470 × 10 mm/s). Sclerosing stromal tumors were the tumors with the highest observed ADC value (2.291 × 10 mm/s). ADC value of solid component was significantly lower in malignant SCSTs (0.825 ± 0.129 × 10 mm/s) than in benign SCSTs (1.343 ± 0.528 × 10 mm/s) when fibromas were excluded (p = 0.024). T2, DCE and DW imaging has a limited value on the differential diagnosis of the benign and malignant SCSTs with an accuracy of 69.0%,71.4% and 78.1% respectively. Combination of T2, DCE and DW imaging permitted the distinction with an accuracy of 88.0%.

Conclusions: It is more helpful for distinction of the benign and malignant SCSTs by combining of T2, DCE and DW imaging than using each of the three sequences independently.
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http://dx.doi.org/10.1186/s13048-018-0444-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116557PMC
August 2018

Quantitative dynamic contrast-enhanced MR imaging for differentiating benign, borderline, and malignant ovarian tumors.

Abdom Radiol (NY) 2018 11;43(11):3132-3141

Department of Pathology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, 200011, China.

Purpose: This study aimed to investigate the diagnostic performance of quantitative DCE-MRI for characterizing ovarian tumors.

Methods: We prospectively assessed the differences of quantitative DCE-MRI parameters (K, k, and v) among 15 benign, 28 borderline, and 66 malignant ovarian tumors; and between type I (n = 28) and type II (n = 29) of epithelial ovarian carcinomas (EOCs). DCE-MRI data were analyzed using whole solid tumor volume region of interest (ROI) method, and quantitative parameters were calculated based on a modified Tofts model. The non-parametric Kruskal-Wallis test, Mann-Whitney U test, Pearson's chi-square test, intraclass correlation coefficient (ICC), variance test, and receiver operating characteristic curves (ROC) were used for statistical analysis.

Results: The largest K and k values were observed in ovarian malignant tumors, followed by borderline and benign tumors (all P < 0.001). K was the better parameter for differentiating benign tumors from borderline and malignant tumors, with a sensitivity of 89.3% and 95.5%, a specificity of 86.7% and 100%, an accuracy of 88.4% and 96.3%, and an area under the curve (AUC) of 0.94 and 0.992, respectively, whereas K was better for differentiating borderline from malignant tumors with a sensitivity of 60.7%, a specificity of 78.8%, an accuracy of 73.4%, and an AUC of 0.743. In addition, a combination with k could further improve the sensitivity to 78.9%. The median K and k values were significantly higher in type II than in type I EOCs.

Conclusion: DCE-MRI with volume quantification is a technically feasible method, and can be used for the differentiation of ovarian tumors and for discriminating between type I and type II EOCs.
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http://dx.doi.org/10.1007/s00261-018-1569-1DOI Listing
November 2018

[Percutaneous transsplenic varices embolization in treatment of upper gastrointestinal hemorrhage of schistosomiasis cirrhosis].

Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2017 Mar;29(3):349-351

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China.

Objective: To evaluate the application value of percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal hemorrhage in patients with schistosomiasis cirrhosis.

Methods: Sixteen schistosomiasis cirrhosis patients (12 males and 4 females) with portal hypertension complicated with esophageal and upper gastrointestinal hemorrhage were selected as the investigation subjects, all the patients had been treated by esophageal vein ligation and sclerotherapy, but with bleeding again post-operation. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the patients received PTSVE were reexamined with abdominal CT one month post-operation, and the degrees of varices were compared before and after PTSVE.

Results: Fourteen cases (87.50%) were successfully treated with PTSVE. Two cases (12.50%) failed, and one case had an abdominal bleeding 1 week post-operation. The abdominal CT showed the degrees of esophageal varices ( < 0.001), esophageal vein ( < 0.001) and gastric varices ( < 0.001) were significantly decreased in the patients who received PTSVE one month after the operation.

Conclusions: PTSVE is a safe and effective method in the treatment of upper gastrointestinal hemorrhage in the patients with schistosomiasis cirrhosis. PTSVE is especially suitable for the patients with severe liver cirrhosis, significantly bordered liver split, and bared main portal vein and even the branches.
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http://dx.doi.org/10.16250/j.32.1374.2016257DOI Listing
March 2017

Utility of DWI with quantitative ADC values in ovarian tumors: a meta-analysis of diagnostic test performance.

Acta Radiol 2018 Nov 20;59(11):1386-1394. Epub 2018 Feb 20.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.

Background Diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) values are widely used in the differential diagnosis of ovarian tumors. Purpose To assess the diagnostic performance of quantitative ADC values in ovarian tumors. Material and Methods PubMed, Embase, the Cochrane Library, and local databases were searched for studies assessing ovarian tumors using quantitative ADC values. We quantitatively analyzed the diagnostic performances for two clinical problems: benign vs. malignant tumors and borderline vs. malignant tumors. We evaluated diagnostic performances by the pooled sensitivity and specificity values and by summary receiver operating characteristic (SROC) curves. Subgroup analyses were used to analyze study heterogeneity. Results From the 742 studies identified in the search results, 16 studies met our inclusion criteria. A total of ten studies evaluated malignant vs. benign ovarian tumors and six studies assessed malignant vs. borderline ovarian tumors. Regarding the diagnostic accuracy of quantitative ADC values for distinguishing between malignant and benign ovarian tumors, the pooled sensitivity and specificity values were 0.91 and 0.91, respectively. The area under the SROC curve (AUC) was 0.96. For differentiating borderline from malignant tumors, the pooled sensitivity and specificity values were 0.89 and 0.79, and the AUC was 0.91. The methodological quality of the included studies was moderate. Conclusion Quantitative ADC values could serve as useful preoperative markers for predicting the nature of ovarian tumors. Nevertheless, prospective trials focused on standardized imaging parameters are needed to evaluate the clinical value of quantitative ADC values in ovarian tumors.
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http://dx.doi.org/10.1177/0284185118759708DOI Listing
November 2018

MRI features and score for differentiating borderline from malignant epithelial ovarian tumors.

Eur J Radiol 2018 Jan 22;98:136-142. Epub 2017 Nov 22.

Department of Radiology, Xinhua Hospital, Shanghai Second Medical College, Shanghai Jiao Tong University, Shanghai, China.

Purpose: To identify the MRI features of borderline epithelial ovarian tumors (BEOTs) and to differentiate BEOTs from malignant epithelial ovarian tumors (MEOTs).

Materials And Methods: The clinical and MRI data of 89 patients with a BEOT and 109 patients with a MEOT proven by surgery and histopathology were retrospectively reviewed. MRI features, including bilaterality, size, shape, margin, cystic-solid interface, configuration, papillae or nodules, signal intensity, enhancement, presence of an ipsilateral ovary, peritoneal implants and ascites were analyzed and compared. Based on the odds ratio (OR) values, the significant risk features for BEOTs were scored as 3 (OR≈∞), 2 (5≤OR<∞) or 1 (OR<5).

Results: There were 89 BEOT patients with 113 tumors [mean size of (13±6.7)cm], with bilateral ovary involvement in 24 cases. There were 109 MEOT patients with 142 tumors [(9.3±4.2)cm] with bilateral ovary involvement in 33 cases. There were eight significant risk factors for BEOTs, including round or oval shape (OR=2.714), well-defined margins (OR=3.318), clear cystic-solid interfaces (OR=5.593), purely cystic (OR=15.206), predominantly cystic with papillae or nodules (OR=2.579), exophytic papillae or nodules (OR=5.351), branching papilla (OR≈∞) and the presence of an ipsilateral ovary (OR≈∞). Based on the scoring of the eight risk factors, a cut-off score of 3.5 yielded a differential sensitivity, specificity, and accuracy of 82%, 85% and 84%, respectively.

Conclusion: In contrast to MEOTs, BEOTs frequently had the following features on MRI: round or oval, with well-defined margins and clear cystic-solid interfaces, purely cystic or predominantly cystic with papillae or nodules, branching or exophytic papillae, with the presence of an ipsilateral ovary. MRI can reveal the distinct morphological features of BEOTs and MEOTs and facilitate their discrimination.
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http://dx.doi.org/10.1016/j.ejrad.2017.11.014DOI Listing
January 2018

Liver fibrosis detection and staging: a comparative study of T1ρ MR imaging and 2D real-time shear-wave elastography.

Abdom Radiol (NY) 2018 07;43(7):1713-1722

Philips Healthcare, No. 218 Tianmu Road, Shanghai, China.

Purpose: To compare the results of T1ρ MR imaging and 2D real-time shear-wave elastography (SWE) for liver fibrosis detection and staging.

Methods: Twenty-nine rabbit models of CCl-induced liver fibrosis were established and six untreated rabbits served as controls. T1ρ MR imaging and 2D real-time SWE examination were performed at 2, 4, 6, 8, 10, and 12 weeks. T1ρ values and liver stiffness (LS) values were measured. Fibrosis was staged according to the METAVIR scoring system. Correlation test was performed among T1ρ values, LS values, and fibrosis stage. Receiver operating characteristic (ROC) analysis was performed for assessing diagnostic performance of T1ρ and SWE in detection of no fibrosis (F0), substantial fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4).

Results: There was moderate positive correlation between fibrosis stage and T1ρ values (r = 0.566; 95% CI 0.291-0.754; P < 0.0001), and LS value (r = 0.726; 95% CI 0.521-0.851; P = 0.003). T1ρ values showed moderate positive correlations with LS values [r = 0.693; 95% confidence interval (CI) 0.472-0.832; P < 0.0001]. Areas Under ROC (AUROCs) were 0.861 (95% CI 0.705-0.953) for SWE and 0.856 (95% CI 0.698-0.950) for T1ρ (P = 0.940), 0.906 (95% CI 0.762-0.978) for SWE and 0.849 (95% CI 0.691-0.946) for T1ρ (P = 0.414), 0.870 (95% CI 0.716-0.958) for SWE and 0.799 (95% CI 0.632-0.913) for T1ρ (P = 0.422), and 0.846 (95% CI 0.687-0.944) for SWE and 0.692 (95% CI 0.517-0.835) for T1ρ (P = 0.137), when diagnosing liver fibrosis with ≥ F1, ≥ F2, ≥ F3, and F4, respectively. There was moderate positive correlation between inflammatory activity and T1ρ values (r = 0.520; 95% CI 0.158-0.807; P = 0.013).

Conclusion: T1ρ imaging has potential for liver fibrosis detection and staging with good diagnostic capability similar to that of ultrasonography elastography.
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http://dx.doi.org/10.1007/s00261-017-1381-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061497PMC
July 2018

The value of DCE-MRI in assessing histopathological and molecular biological features in induced rat epithelial ovarian carcinomas.

J Ovarian Res 2017 Sep 26;10(1):65. Epub 2017 Sep 26.

Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.

Background: To investigate dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) for assessing histopathological and molecular biological features in induced rat epithelial ovarian carcinomas (EOCs).

Methods: 7,12-dimethylbenz[A]anthracene (DMBA) was applied to induce EOCs in situ in 46 SD rats. Conventional MRI and DCE-MRI were performed to evaluate the morphology and perfusion features of the tumors, including the time-signal intensity curve (TIC), volume transfer constant (K), rate constant (K), extravascular extracellular space volume ratio (V) and initial area under the curve (IAUC). DCE-MRI parameters were correlated with histological grade, microvascular density (MVD), vascular endothelial growth factor (VEGF) and fraction of Ki67-positive cells and the serum level of cancer antigen 125 (CA125).

Results: Thirty-five of the 46 rats developed EOCs. DCE-MRI showed type III TIC more frequently than type II (29/35 vs. 6/35, p < 0.001) in EOCs. The two types of TIC of tumors had significant differences in the histological grade, MVD, expression of VEGF and Ki67, and the serum level of CA125 (all p < 0.01). K, K and IAUC values showed significant differences in different histological grades in overall and pairwise comparisons except for IAUC in grade 2 vs. grade 3 (all p < 0.01). There was no significant difference in V values among the three grade groups (p > 0.05). K, K and IAUC values were positively correlated with MVD, VEGF and Ki67 expression (all p < 0.01). V was not significantly correlated with MVD, VEGF expression, Ki67 expression and the CA125 level (all p > 0.05).

Conclusions: TIC types and perfusion parameters of DCE-MRI can reflect tumor grade, angiogenesis and cell proliferation to some extent, thereby helping treatment planning and predicting prognosis.
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http://dx.doi.org/10.1186/s13048-017-0362-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615469PMC
September 2017

Endometrial Stromal Sarcoma of the Uterus: Magnetic Resonance Imaging Findings Including Apparent Diffusion Coefficient Value and Its Correlation With Ki-67 Expression.

Int J Gynecol Cancer 2017 11;27(9):1877-1887

*Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai; †Department of Radiology, Nantong Cancer Hospital, Nantong University, Nantong, Jiangsu; and Departments of ‡Radiology, Obstetrics & Gynecology Hospital, §Pathology, Obstetrics & Gynecology Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Objective: This study aimed to investigate the conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) features of endometrial stromal sarcoma (ESS) including a preliminary investigation of the correlation between the apparent diffusion coefficient (ADC) value and Ki-67 expression.

Methods: The clinical and MRI data of 15 patients with ESS confirmed by surgery and pathology were analyzed retrospectively. The conventional MR morphological features, signal intensity on DWI, ADC value (n = 14), and clinicopathological marker Ki-67 (n = 13) were evaluated.

Results: Of 15 patients with ESS, 13 tumors were low-grade ESS (LGESS), and the remaining 2 were high-grade ESS (HGESS); 9 tumors were located in the myometrium, 5 were located in the endometrium and/or cervical canal, and 1 was located in extrauterine. Thirteen (87%) of 15 tumors showed a homo- or heterogeneous isointensity on T1-weighted imaging and a heterogeneous hyperintensity on T2-weighted imaging. The hypointense bands were observed in 11 tumors (73%) on T2-weighted imaging. The degenerations (cystic/necrosis/hemorrhage) were observed in 7 LGESS tumors and 2 HGESS tumors. The DWI hyperintensity was observed in 13 tumors (93%) and isointensity in remaining 1. The mean ADC value of the solid components in 14 ESSs was (1.05 ± 0.20) × 10mm/s. The contrast-enhanced MRI showed an obvious enhancement in 14 tumors (93%) (heterogeneous in 7 LGESSs and 2 HGESSs; homogeneous in 5 LGESSs). The ADC value was inversely correlated with the Ki-67 expression (r = -0.613, P = 0.026).

Conclusions: Patients with ESS showed some characteristics on conventional MRI and DWI, and there was an inverse correlation between the ADC value and Ki-67 expression.
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http://dx.doi.org/10.1097/IGC.0000000000001114DOI Listing
November 2017

Multi-parametric MRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors.

Eur Radiol 2018 Jan 4;28(1):437-445. Epub 2017 Aug 4.

Department of Radiology, The General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, China.

Objective: To investigate the prediction of response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients.

Methods: Sixty-five patients underwent conventional MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The patients were divided into non- and residual tumour groups according to post-treatment MRI. Pretreatment MRI parameters and CPF between the two groups were compared and prognostic factors, optimal thresholds, and predictive performance for post-treatment residual tumour occurrence were estimated.

Results: The residual group showed a lower maximum slope of increase (MSI) and signal enhancement ratio (SER) in low-perfusion subregions, a higher apparent diffusion coefficient (ADC) value, and a higher stage than the non-residual tumour group (p < 0.001, p = 0.003, p < 0.001, and p < 0.001, respectively). MSI and ADC were independent prognostic factors. The combination of both measures improved the diagnostic performance compared with individual MRI parameters. A further combination of these two factors with CPF exhibited the highest predictive performance.

Conclusions: Pretreatment MSI and ADC were independent prognostic factors for cervical cancer. The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. The combination of multi-parametric MRI with CPF further improved the predictive performance.

Key Points: • Pretreatment MSI and ADC were independent prognostic factors for post-treatment residual tumours. • The residual groups showed lower MSI , higher ADC and higher stage. • The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. • The combination of multi-parametric MRI with CPF exhibited the highest predictive performance.
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http://dx.doi.org/10.1007/s00330-017-4989-3DOI Listing
January 2018

Oral administration of trace element magnesium significantly improving the cognition and locomotion in hepatic encephalopathy rats.

Sci Rep 2017 05 12;7(1):1817. Epub 2017 May 12.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China.

The therapeutic effects of iron, zinc and magnesium trace elements, as well as rifaximin were investigated and compared in HE rats. In this study, HE rats were treated with either ferrous sulfate (HE-Fe, 30 mg/kg/day), zinc sulfate (HE-Zn, 30 mg/kg/day), magnesium sulfate (HE-Mg, 50 mg/kg/day) or rifaximin (HE-Rf, 50 mg/kg/day), which was mixed with water and administered orally for 61 days. The Morris water maze (MWM) and open-field tests were used to evaluate cognitive and locomotor function. The blood ammonia levels before and after administration of the glutamine challenge test, manganese concentration and glutamine synthetase (GS) activity were measured. Significantly longer MWM escape latencies, less locomotor activity, higher blood ammonia levels, higher brain manganese concentrations and higher GS activity were observed in HE rats. However, HE-Mg and HE-Rf rats had significantly shorter MWM escape latencies, increased locomotor activity, lower blood ammonia, lower brain manganese concentrations and lower GS activity. Partial improvements were observed in HE-Fe and HE-Zn rats. The results indicated that oral administration of magnesium can significantly improve the cognitive and locomotor functions in HE rats by reducing the brain manganese concentration and regulating GS activity.
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http://dx.doi.org/10.1038/s41598-017-02101-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431966PMC
May 2017
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