Robotic gastric cancer surgery had developed rapidly in recent years, and its clinical application had come a long way. More and more studies had demonstrated that the robotic gastric cancer surgery was a safe and feasible procedure, and showed the technical advantages in the lymph node dissection, bleeding control, precise surgery, and postoperative recovery over laparoscopic surgery. However, some limitations such as the high surgical costs, lack of high-quality evidence, insufficient intelligence limited the development of robotic gastric cancer surgery. In the future, with more high-quality evidence-based medicine research and the development of intelligent surgical robots, the robotic gastric cancer surgery will be further standardized and promoted. We believe that robotic gastric cancer surgery will become the mainstream of minimally invasive surgery for the treatment of gastric cancer.
Objective To explore a new rotation training mode suitable for residency standardized non-professional radiological trainees in radiology department, so as to improve the training quality. Methods The residency standardized non-professional radiological trainees who rotated in the Department of Radiology, West China Hospital, Sichuan University between June 2021 and January 2022 were retrospectively included as the research objects. According to the training mode, they were divided into traditional training mode group and innovative training mode group. The training results of the two groups were compared by taking process assessment, final examination and final score as evaluation indicators. Results Finally, 122 residents were included, including 45 in the traditional training model group and 77 in the innovative training model group. There was no significant difference in gender, major, identity and grade between the two groups (P>0.05). There was no significant difference between the two groups in the first film reading skill examination and their usual homework performance (P>0.05). The score of the second film reading skill examination [15 (14, 16) vs. 12 (11, 13)], the score of the final examination [34 (31, 36) vs. 29 (25, 31)] and the final score [80 (76, 83) vs. 71 (67, 74)] in the innovative training mode group were better than those in the traditional training mode group (P<0.05). Conclusion The innovative training mode of online teaching platform combined with offline teaching can improve the training effect of residency standardized non-professional radiological trainees in radiology department.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.
Hepatoid adenocarcinoma (HAC) of the pancreas is a rare, highly malignant tumor with poor prognosis. This article presents the CT and MR features of HAC of the pancreas, while also reviewing the relevant literatures to succinctly summarize the underlying pathophysiological mechanism, imaging diagnosis, and differential diagnosis. The objective is to enhance the understanding of HAC of the pancreas among clinicians and radiologists.
ObjectiveTo make a comprehensive review of the value of radiomics for prediction of therapeutic responses to neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).MethodRelevant literatures about the therapeutic response evaluation of LARC by using radiomics were collected to make an review.ResultRadiomics had good predictive value in terms of complete pathologic response (pCR) and treatment effectiveness of NCRT in patients with LARC.ConclusionRadiomics, a new imaging diagnostic technique, plays an important role in the prediction of the efficacy of NCRT in LARC.
目的 對邊緣性腦炎患者磁共振（MR）影像學表現進行探討，以明確急性邊緣性腦炎的特異性磁共振影像學征象，了解磁共振成像（MRI）在急性邊緣性腦炎患者診斷以及病情評價中的應用價值。 方法 通過對2008年12月-2010年1月間臨床收集的8例邊緣性腦炎患者進行MRI檢查，并回顧性分析不同序列磁共振影像學表現，總結MRI征象，評價MRI檢查在急性邊緣性腦炎的臨床診治中的作用。 結果 邊緣性腦炎患者顯示特異性的雙側邊緣系統腫脹及信號異常，呈T1WI低信號影；T2WI及FLAIR成像為高信號影像；增強掃描未見確切異常強化；FLAIR成像是檢測病變最敏感的序列。部分患者可見累及邊緣系統外結構。隨訪病例影像學改變可有明顯好轉。 結論 邊緣性腦炎特異性損傷邊緣系統，以雙側海馬為主，MRI影像可直觀反映邊緣性腦炎早期及隨訪期改變，能直接了解邊緣性腦炎顱內受累范圍、程度及治療后恢復情況等，可為其臨床及時診斷及治療評估提供有利信息。
目的 觀察蜂蜇傷致橫紋肌溶解的MRI表現，探討MRI對蜂蜇傷致橫紋肌溶解癥的診斷價值。 方法 收集2008年9月-2009年12月急診科及腎內科蜂蜇傷患者4例。對其行蜇傷部位MR增強掃描，對其中1例患者行遠離部位肢體掃描。總結MRI征象，評價MRI在蜂蜇傷所致橫紋肌溶解臨床診治中的作用。 結果 蜇傷部位顯示T1WI稍低，T2WI高信號影像，在T2WI加壓脂影像中顯示最為清晰，橫紋肌損傷有局部隨肌間隙擴散趨勢，但遠端無蜇傷肌肉受累。 結論 蜂蜇傷導致的橫紋肌溶解可在MRI影像上得到直觀反映。MRI具有良好的軟組織對比度，能及時反映橫紋肌受累范圍及程度、治療后恢復情況等，可為其臨床診治評估提供有利信息。
ObjectiveTo explore the value of a decision tree (DT) model based on CT for predicting pathological complete response (pCR) after neoadjuvant chemotherapy therapy (NACT) in patients with locally advanced rectal cancer (LARC).MethodsThe clinical data and DICOM images of CT examination of 244 patients who underwent radical surgery after the NACT from October 2016 to March 2019 in the Database from Colorectal Cancer (DACCA) in the West China Hospital were retrospectively analyzed. The ITK-SNAP software was used to select the largest level of tumor and sketch the region of interest. By using a random allocation software, 200 patients were allocated into the training set and 44 patients were allocated into the test set. The MATLAB software was used to read the CT images in DICOM format and extract and select radiomics features. Then these reduced-dimensions features were used to construct the prediction model. Finally, the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), sensitivity, and specificity values were used to evaluate the prediction model.ResultsAccording to the postoperative pathological tumor regression grade (TRG) classification, there were 28 cases in the pCR group (TRG0) and 216 cases in the non-pCR group (TRG1–TRG3). The outcomes of patients with LARC after NACT were highly correlated with 13 radiomics features based on CT (6 grayscale features: mean, variance, deviation, skewness, kurtosis, energy; 3 texture features: contrast, correlation, homogeneity; 4 shape features: perimeter, diameter, area, shape). The AUC value of DT model based on CT was 0.772 [95% CI (0.656, 0.888)] for predicting pCR after the NACT in the patients with LARC. The accuracy of prediction was higher for the non-PCR patients (97.2%), but lower for the pCR patients (57.1%).ConclusionsIn this preliminary study, the DT model based on CT shows a lower prediction efficiency in judging pCR patient with LARC before operation as compared with homogeneity researches, so a more accurate prediction model of pCR patient will be optimized through advancing algorithm, expanding data set, and digging up more radiomics features.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.