Objective To assess the clinical efficacy of neoadjuvant chemotherapy （NAC） for breast invasive ductal carcinoma with MR diffusion weighted imaging. Methods Thirty patients with breast invasive ductal carcinoma underwent conventional MRI scanning and diffusion weighted imaging examination before and after preoperative neoadj-uvant chemotherapy. Two experienced radiologists independently analyzed and measured the maximum lesion diameter and apparent diffusion coefficient （ADC） values before and after treatment，respectively. Statistical analysis was performed for testing the tumor maximum diameter and ADC values change by using the paired t-test. Results After NAC treatment，the maximum tumor diameter of invasive ductal breast carcinoma sharply reduced〔（4.33±0.83） cm vs. （2.04±0.64） cm，P＜0.001〕. When b value was 1 000，the mean ADC values of breast massess were significantly changed after NAC treatment〔（1.89±0.15） ×10-3mm2/s vs. （1.14±0.31） ×10-3mm2/s， P＜0.05〕. Conclusion MR diffusion weighted imaging can non-invasively and accurately assess the NAC efficacy， which are helpful for making surgical strategies.
Objective To assess the radiation dose and image quality with low-dose multi-detector row CT urography （CTU） for the evaluation of children patients with ureteropelvic junction stenosis （UJS）. Methods In this prospective study， 30 children patients with UJS underwent CTU were classified half-randomly through exam numbers into 3 groups （115 mA， 100 mA， and 75 mA）. Consecutive acquisitions including CT dose index weighted （CTDIw） and dose long product （DLP） were obtained in each patient and compared for each group. Three experienced chest radio-logists were unaware of the CT technique reviewed CT images for overall image quality using a 3-grade scale （excellent， good， and worst）. The data were analyzed using a parametric analysis of variance test and Wilcoxon’s signed rank test. Results The CTDIws of 115 mA group， 100 mA group， and 75 mA group were （7.63±0.83） mGy， （6.29±0.51） mGy， and （4.72±0.18） mGy， respectively， the difference was significant among three groups （F=36.445， P=0.000）. The mean CTDIw reduction was 38.2% in the 75 mA group as compared with 115 mA group （P＜0.001）. The DLPs of 115 mA group， 100 mA group， and 75 mA group were （173.89±29.88） mGy•cm， （145.96±26.21） mGy•cm， and （102.78±12.72） mGy•cm， respectively， the difference was significant among three groups （F=13.955， P=0.000）. The mean radiation dose reduction was 40.9% （75 mA group versus 115 mA group， P＜0.001）. The assessment of image quality was no significant difference with the same protocol and post-processing technique （Wilcoxon’s signed rank test， P＞0.05）. There was a good agreement for image quality scoring among the three reviewers （Kappa=0.736）. Conclusion Low-dose multi-detector row CTU should be considered as a promising technique for the evaluation of children patients with UJS because it could decrease radiation dose and obtain acceptable image quality.
Objective To investigate the CT and pathological findings of adrenal myelolipoma， so as to improve the accuracy of diagnosis. Methods CT manifestations of twelve cases with pathological documented adrenal myeloli-pomas were retrospectively analyzed. Combined with pathological features， the location， size， shape， density， and surro-unding structures of adrenal myelolipomas were evaluated on CT image， respectively. Results Of 12 cases with adrenal myelolipomas， 9 cases arose from right adrenals， 2 cases from the left，and 1 case involved bilateral adrenal glands. CT features delineated the mixed density masses arising from adrenals， but majority components were fat densities. Pathological examination demonstrated the tumor was composed of mature fat cells and bone marrow cells. Compared with pathologic results， preoperative CT diagnosis was reliable for significant accuracy （11/12）. Conclusions Adrenal myelolipoma is rare. Combined with pathological characteristics clinical findings and laboratory tests， adrenal myelolipoma can be corr-ectly diagnosed with CT examination.
ObjectiveTo summarize the evolving concept and research progress on stability reconstruction in the surgical treatment of intertrochanteric fracture.MethodsRelated literature and author’s own experience concerning the surgical treatment of intertrochanteric fracture were reviewed and analyzed in terms of fracture pathoanatomy, stable and unstable pattern, adequate and in-adequate reduction, primary and secondary stability, postoperative stability evaluation, and early weight-bearing.ResultsIntertrochanteric fracture occur at the translational area of cervico-trochanteric junction, which has a nature tendency to varus instability. Fracture reduction quality is the paramount factor and is evaluated by two views, the anteroposterior and lateral Garden alignment and cortex apposition between the head-neck fragment and the femoral shaft. Rather than the posteromedial lesser trochanteric frag ment, the cortical support concept (positive, neutral, negative) emphasizes the reduction of anteromedial cortex to a nonanatomic positive apposition or an " anatomic” neutral apposition in intraoperative fluoroscopy. Postoperative radiographic stability score provides a quantitative assessment for early weight-bearing standing and walking. However, some fractures may lose cortical contact and buttress (negative) during the process of postoperative telescoping and secondary stability. Further studies are needed to elucidate the risk factors such as tilting, swing or rotation of the head-neck fragment, and propose new preventive methods.ConclusionStability reconstruction of intertrochanteric fracture requires adequate fracture reduction with Garden alignment and anteromedial cortical support apposition, and reliable sustainment by internal fixation implants. Early weight-bearing standing and walking is safe in patients with perfect postoperative stability score.
ObjectiveTo investigate the CT and pathological findings of adrenal leiomyosarcoma, so as to improve the accuracy of diagnosis.MethodsThe clinical data of patients with adrenal leiomyosarcoma who were confirmed with surgery and pathology in West China Hospital, Sichuan University between August 2009 and January 2019 were retrospectively analyzed. Patients without pre-operation CT examination were excluded. The CT imaging features of the disease, including the location, size, shape, enhanced features, surrounding structures and metastasis of adrenal leiomyosarcoma were evaluated on CT images, respectively.ResultsFinally 5 patients were included. All of them had left single lesion. Enhanced CT features delineated large masses with well-defined but irregular boundaries, multicentric necrosis involving both the center and edge, continuous increased enhancement of the non-necrotic area, and cross-section of neovascularization or needle-tip vessels in the tumors. Among the 5 patients, 2 had postoperative recurrence and 3 lost follow-up.ConclusionsPrimary adrenal leiomyosarcoma is rare. Adrenal leiomyosarcoma could be correctly diagnosed with CT enhanced examination, which are helpful for making surgical strategies.
Objective To investigate the mammographic appearance of breast phyllodes tumors and the relation- ship of mammographic appearance to clinicopathologic features， and to determine the differential characteristics and pathologic basis. Methods The clinical and imaging findings of 28 patients with surgically confirmed phyllodes tumorsfrom January 2010 to January 2013 were analyzed retrospectively. The radiological features were compared with path-ology. Results Seventeen benign， 8 intermediate， and 3 malignant phyllodes tumors were identified by the histopatho-logic review. Mammography demonstrated the tumors as a mass lesion in 26 cases and asymmetric opacity in 2 cases. The tumors were 2.8-10.2cm in diameter. The difference of rate of intermediate and malignant phyllodes tumors and benign phyllodes tumors was not statistically significant between ≥3cm and ＜3cm in diameter （Ρ＞0.05）. Although all the tumors showed lobulated margins except for 4 cases in the benign phyllodes tumors， it was not a significant finding（Ρ＞0.05）. However， poorly defined borders in the malignant and intermediate phyllodes tumors were more frequent than those in the benign phyllodes tumors （Ρ＜0.05）. Abnormal blood vessels were seen in 2 cases of benign phyllodes tumors and calcification was seen in 1 case of benign phyllodes tumors， while 10 tumors were surrounded by a clear halo， of them 8 were the benign phyllodes tumors and 2 were the intermediate and malignant phyllodes tumors （Ρ＞0.05）. Conclusions Mammographic features combined with clinical behavior can be helpful for early detection， but definite diagnosis and classification should be verified by histopathologic examination.
ObjectiveTo measure the rotation angle of the head-neck fragment of intertrochanteric fracture after cephalomedullary nail fixation by three-dimensional CT imaging, and to explore its clinical significance.MethodsThe clinical data of 68 patients with unstable intertrochanteric fracture of AO/Orthopaedic Trauma Association (AO-OTA) type 31-A2 treated with cephalomedullary nail fixation and with complete intraoperative fluoroscopy and postoperative three-dimensional CT imaging data between July 2016 and October 2018 were retrospectively analyzed. Among them, there were 21 males and 47 females, aged 68-93 years, with an average age of 81.8 years. There were 31 cases of AO/OTA type 31-A2.2 and 37 cases of 31-A2.3. Fracture reduction quality was evaluated according to Baumgaertner et al. and Chang et al. criteria. The anteromedial cortical contact or not of each patient was observed by three-dimensional CT imaging on T3DView software after operation. The rotation of head-neck fragments were divided into three types: non-rotation, flexion rotation, and hyperextension rotation. The rotation angles of each type were measured and the relationship between the rotation type of the head-neck fragments and the contact of the anteromedial cortex was analyzed.ResultsThe reduction and fixation of the small trochanter were not performed in 68 patients. According to Baumgaertner et al. criteria, the quality of fracture reduction was excellent in 15 cases (22.1%), acceptable in 50 cases (73.5%), and poor in 3 cases (4.4%). According to Chang et al. criteria, 31 cases were excellent (45.6%), 33 cases were acceptable (48.5%), and 4 cases were poor (5.9%). Thirty-nine cases (57.4%) received anteromedial cortical support and 29 cases (42.6%) did not receive cortical support. Three-dimensional CT imaging showed non-rotation in 12 cases (17.6%), flexion rotation in 39 cases (57.4%), and hyperextension rotation in 17 cases (25.0%). There were 7 cases (58.3%), 30 cases (76.9%), and 2 cases (11.8%) of cortical support in non-rotation group, flexion rotation group, and hyperextension rotation group, respectively. The rotation angles were (1.05±0.61), (13.96±6.17), (8.21±3.88)°, respectively. There were significant differences between groups (P<0.05).ConclusionIn the unstable intertrochanteric fracture after cephalomedullary nail fixation, the rotation of head-neck fragment exists in most patients, and the types of flexion rotation and non-rotation can easily obtain cortical support reduction.