Lian-Ming Wu

Renji Hospital, Shanghai, Shanghai Shi, China

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Publications (38)92.39 Total impact

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    ABSTRACT: Rationale and Objectives To assess the feasibility of quantitative T2* mapping at 3.0 T for prostate cancer detection and to investigate the use of T2* values to characterize tumor aggressiveness, with whole-mount step-section pathologic analysis as the reference standard. Materials and Methods Prostate multiecho T2* was performed in 55 consecutive patients with prostate cancer using a multishot fast-field echo sequence at 3.0 T magnetic resonance imaging. T2* mapping was obtained by exponentially fitting the multiecho T2* images pixel by pixel with different echo times for each slice. Generalized estimating equations were used to test the T2* value difference between normal and malignant prostate regions and the association between T2* value and tumor Gleason scores. Results The T2* values of the cancerous prostatic regions (mean: 42.51 ± 0.65 milliseconds) were significantly lower (P < .001) than those of the normal prostatic regions (mean: 74.87 ± 0.99 milliseconds). Adopting a threshold value of 59.27 milliseconds, T2* mapping resulted in 94.8% sensitivity and 77.3% specificity in the identification of prostate cancer. A lower mean T2* value was significantly associated with a higher tumor Gleason score (mean T2* values of 53.53, 43.75, 33.66, and 22.95 milliseconds were associated with Gleason score of 3 + 3, 3 + 4, 4 + 3, and ≥8, respectively P < .05). Conclusions From these preliminary data, quantitative T2* mapping seems to be a potential method in the characterization of prostate cancer. T2* mapping may provide additional quantitative information that significantly correlated with prostate cancer aggressiveness.
    Academic Radiology 08/2014; 21(8):1020–1026. DOI:10.1016/j.acra.2014.04.007
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    ABSTRACT: Purpose To evaluate the performance of computed tomographic urography (CTU), static-fluid magnetic resonance urography (static-fluid MRU) and combinations of CTU, static-fluid MRU and diffusion weighted imaging (DWI) in the diagnosis of upper urinary tract cancer. Material and Methods Between January 2010 and June 2011, patients with suspected UUT cancer underwent CTU, static-fluid MRU and DWI(b = 1000 s/mm2) within a 1-week period. The diagnostic performances of CTU, static-fluid MRU and combinations of CTU, static-fluid MRU and DWI for upper urinary tract cancer were prospectively evaluated. The ureteroscopic and histopathologic findings were compared with the imaging findings. Results Compared to static-fluid MRU alone(sensitivity: 76%/75%, reader 1/reader 2), combining DWI with MRI can increase the sensitivity (sensitivity: 84%/84%, p = 0.031/p = 0.016) of upper urinary tract cancer diagnosis. CTU had greater sensitivity (95%/94%) and accuracy(92/91%) than both static-fluid MRU (sensitivity: p < 0.001/p < 0.001 and accuracy: 83%/81%, p = 0.001/p < 0.001) and static-fluid MRU with DWI (sensitivity:p = 0.023/p = 0.039 and accuracy: 87%/85%, p = 0.042/p = 0.049) for the diagnosis of upper urinary tract cancers. Compared with CTU alone, CTU with DWI did not significantly increase sensitivity, specificity or accuracy. However, the diagnostic confidence was improved when the combined technique was used (p = 0.031/p = 0.024). Moreover, there was no significant change in sensitivity, specificity,accuracy or diagnostic confidence when static-fluid MRU was used in combination with CTU and DWI. Conclusion Although there is a potential role for static-fluid MRU and static-fluid MRU with DWI in urinary tract imaging, CTU is still the better choice for the diagnosis of upper urinary tract cancer. Combining DWI with CTU can help improve confidence in upper urinary tract cancer diagnoses.
    European journal of radiology 06/2014; DOI:10.1016/j.ejrad.2014.02.019
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    ABSTRACT: To investigate the potential value of histogram analysis of apparent diffusion coefficient (ADC) obtained at standard (700 s/mm(2)) and high (1500 s/mm(2)) b values on a 3.0-T scanner in the differentiation of bladder cancer from benign lesions and in assessing bladder tumors of different pathologic T stages and to evaluate the diagnostic performance of ADC-based histogram parameters. In all, 52 patients with bladder lesions, including benign lesions (n = 7) and malignant tumors (n = 45; T1 stage or less, 23; T2 stage, 7; T3 stage, 8; and T4 stage, 7), were retrospectively evaluated. Magnetic resonance examination at 3.0 T and diffusion-weighted imaging were performed. ADC maps were obtained at two b values (b = 700 and 1500 s/mm(2); ie, ADC-700 and ADC-1500). Parameters of histogram analysis included mean, kurtosis, skewness, and entropy. The correlations between these parameters and pathologic results were revealed. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic value of histogram parameters. Significant differences were found in mean ADC-700, mean ADC-1500, skewness ADC-1500, and kurtosis ADC-1500 between bladder cancer and benign lesions (P = .002-.032). There were also significant differences in mean ADC-700, mean ADC-1500, and kurtosis ADC-1500 among bladder tumors of different pathologic T stages (P = .000-.046). No significant differences were observed in other parameters. Mean ADC-1500 and kurtosis ADC-1500 were significantly correlated with T stage, respectively (ρ = -0.614, P < .001; ρ = 0.374, P = .011). ROC analysis showed that the combination of mean ADC-1500 and kurtosis ADC-1500 has the maximal area under the ROC curve (AUC, 0.894; P < .001) in the differentiation of benign lesions and malignant tumors, with a sensitivity of 77.78% and specificity of 100%. AUCs for differentiating low- and high-stage tumors were 0.840 for mean ADC-1500 (P < .001) and 0.696 for kurtosis ADC-1500 (P = .015). Histogram analysis of ADC-1500 at 3.0 T can be useful in evaluation of bladder lesions. A combination of mean ADC-1500 and kurtosis ADC-1500 may be more beneficial in the differentiation of benign and malignant lesions. Mean ADC-1500 was the most promising parameter for differentiating low- from high-stage bladder cancer.
    Academic radiology 05/2014; 21(8). DOI:10.1016/j.acra.2014.03.004
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    ABSTRACT: To quantitatively assess the imaging characteristics of sellar lesion in dual-energy computed tomography (CT) imaging for differentiation of sellar meningiomas and pituitary adenomas during the arterial phase (AP) and venous phase (VP). 51 patients with sellar/parasellar tumors (33 macroadenomas and 18 meningiomas) were examined with CT spectral imaging during the AP and the VP. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in Normalized iodine concentrations (NICs), HU curve slope (λHU), and mean CT values of lesions between the AP and VP were calculated. The two-sample t test was performed to compare quantitative parameters between sellar meningiomas and pituitary adenomas. NICs, λHU, and mean CT values in patients with sellar meningiomas differed significantly from those in patients with pituitary adenomas: Mean NICs were 43.52 mg/mL±1.35 versus 9.23 mg/mL ±2.44, respectively, during the AP and 52.13 mg/mL ±1.04 versus 24.37 mg/mL ±2.23 respectively, during the VP. λHU were -3.03±3.42 versus -0.53±0.23, respectively, during the AP and -2.96±0.41 versus -0.47±0.25, respectively, during the VP. Mean CT values were 193.63±2.08 versus 63.98±2.85, respectively, during the AP and 203.98±0.18 versus 77.66±0.91, respectively, during the VP. The combination of NIC and Mean CT value during VP had highest sensitivity (90.9%) and specificity (100%) among all phases. Quantitative dual-energy CT imaging has promising potential for diagnostic differentiation of sellar meningiomas and pituitary adenomas.
    PLoS ONE 03/2014; 9(3):e90658. DOI:10.1371/journal.pone.0090658
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    ABSTRACT: To evaluate the ability of diffusion-weighted magnetic resonance imaging (DWI) in differentiating malignant thyroid nodules from benign lesions with a meta-analysis. Articles in English and Chinese language relating to the accuracy of DWI for this utility were retrieved. Pooled estimation and subgroup analysis data were obtained by statistical analysis. A total of seven studies (17 subsets) with 358 patients, who fulfilled all of the inclusion criteria, were considered for the analysis. No publication bias was found (bias = 7.03, P > .05). Methodological quality was relatively high. DWI sensitivity was 0.91 (95% confidence interval [CI], 0.87-0.94) and specificity was 0.93 (95% CI, 0.86-0.96). Overall, positive likelihood ratio was 12.24 (95% CI, 6.47-23.20) and negative likelihood ratio was 0.99 (95% CI, 0.06-0.15). Diagnostic odds ratio was 123.78 (95% CI, 56.85-269.48). The area under the curve of the summary receiver operating characteristic was 0.94 (95% CI, 0.92-0.96). In patients with high pretest probabilities, DWI enabled confirmation of malignant thyroid lesion; in patients with low pretest probabilities, DWI enabled exclusion of malignant thyroid lesion. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 92% and 9% for positive and negative DWI results, respectively. A limited number of small studies suggests that quantitative DWI is a reliable diagnostic method for differentiation between benign and malignant thyroid lesions.
    Academic radiology 12/2013; 21(3). DOI:10.1016/j.acra.2013.10.008
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    ABSTRACT: PURPOSE To assess the feasibility of quantitative T2 star mapping at 3.0 T for prostate cancer detection and to investigate the use of T2 star values to characterize tumor aggressiveness, with whole mount step-section pathologic analysis as the reference standard. METHOD AND MATERIALS Prostate multi-echo T2 star was performed in Fifty-five consecutive patients with prostate cancer using a multishot fast field echo (mFFE) sequence at 3.0T MRI. T2 star mapping was obtained by exponentially fitting the multi-echo T2 star images pixel-by-pixel with different echo times for each slice. Generalized estimating equations were used to test the T2 star value difference between benign and malignant prostate regions and the association between T2 star value and tumor Gleason scores. RESULTS The T2 star values of the cancerous prostatic regions (mean: 42.51 + 0.65 ms) were significantly lower (P <0.001) than those of the benign prostatic regions (mean: 74.87+ 0.99 ms). Adopting a threshold value of 59.27 ms. T2 star mapping resulted in 94.8% sensitivity, 77.3% specificity in the identification of prostate cancer. A lower mean T2 star value was significantly associated with a higher tumor Gleason score (mean T2 star values of [53.53, 43.75, 33.66, and 22.95] ms were associated with Gleason score of 3 + 3, 3 + 4, 4 + 3, and 8 or higher, respectively p<0.05). CONCLUSION From these preliminary data quantitative T2 star mapping seems a potential method in the characterization of prostate cancer. T2 star mapping provided additional quantitative information that significantly correlated with prostate cancer aggressiveness. CLINICAL RELEVANCE/APPLICATION T2 star mapping seems a potential method in the characterization of prostate cancer.
    0 T for Detection and Assessment of Aggressiveness of Prostate Cancer. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Diffusion-weighted magnetic resonance imaging (DW-MRI) has been considered to be useful in diagnosing upper urinary tract (UUT) disease; however, the value of DW-MRI with different b values has not been reported. To evaluate the performance of using conventional MRI alone and in combination with DWI with different b values in diagnosing UUT cancer. Seventy patients with suspected UUT cancer underwent conventional MRI (T1-weighted and T2-weighted) and DW-MRI (b = 500 and 1500 s/mm(2)) on a 3 T-MRI scanner. The ureteroscopic and histopathologic findings were compared with the imaging findings. The utility of detecting UUT cancer using conventional MRI (set A), combined DW-MRI (b = 500 s/mm(2)) and conventional MRI (set B), and combined DW-MRI (b = 1500 s/mm(2)) and conventional MRI (set C) were independently evaluated by two readers. A total of 32 patients had verified cancer; 23 patients had benign UUT diseases, and 15 had no abnormality. Sets B and C had significantly improved diagnostic accuracy for UUT cancer compared with set A; the specificity in diagnosing UUT cancer was significantly improved when using set C compared with sets A and B. In patients without UUT obstructions, improved sensitivity and accuracy in diagnosis was achieved when using sets B and C compared with set A. Using DW-MRI in combination with conventional MRI provides increased diagnostic accuracy and sensitivity in patients without UUT obstruction. The combination of conventional MRI and DW-MRI with a higher b value (1500 s/mm(2)) improved the specificity in diagnosing UUT cancer compared to conventional sequences and DW-MRI with a lower b value (500 s/mm(2)).
    Acta Radiologica 10/2013; 55(7). DOI:10.1177/0284185113506576
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    ABSTRACT: PURPOSE: To assess diffusion-weighted magnetic resonance imaging (DWI-MRI) performed with apparent diffusion coefficient (ADC) values for the detection of cervical lymphadenopathy. MATERIALS AND METHODS: Studies evaluating DWI-MRI for the detection of cervical lymphadenopathy were systematically searched for in the MEDLINE, EMBASE, Cancerlit, and Cochrane Library and other database from January 1995 to November 2010. By node-based data analyses, Cochrane methodology was used for the results of this meta-analysis. RESULTS: Eight studies enrolling a total of 229 individuals were eligible for inclusion. Significant differences were found between malignant nodes and benign nodes of the mean ADC value (WMD [weighted-mean difference]: 1.19, 95% CI: [1.02, 1.35] × 10(-3) mm(2) /s, [P < 0.05]). In the secondary outcomes, significant differences were found between lymphomatous nodes and benign nodes (WMD: 1.33, 95% CI: [0.89, 1.77] × 10(-3) mm(2) /s), and nodes originating from highly or moderately differentiated cancer (WMD: 0.24, 95% CI: [0.21, 0.28] × 10(-3) mm(2) /s, [P < 0.05]), and nodes originating from poorly differentiated cancers (WMD: 0.10, 95% CI: [0.06, 0.14] × 10(-3) mm(2) /s, [P < 0.05]). CONCLUSION: DWI-MRI performed with ADC values shows significant differences among malignant nodes, lymphomatous nodes, and benign nodes in cervical lymphadenopathy. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 09/2013; 38(3). DOI:10.1002/jmri.24014
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    ABSTRACT: Gadoxetic acid is a recently developed hepatobiliary-specific contrast material used for magnetic resonance imaging (MRI) which enables highly sensitive detection of hepatocellular carcinoma (HCC). We performed a meta-analysis of all available studies of the diagnostic performance of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detection of HCC in patients with chronic liver disease. Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis. Across 10 studies of 570 patients, Gd-EOB-MRI sensitivity was 0.91 (95 % CI 0.77, 0.97) and specificity was 0.93 (95 % CI 0.85, 0.97). Overall, LR+ was 13.6 (95 % CI 5.6, 33.2), LR- was 0.10 (95 % CI 0.04, 0.27), and DOR was 140.36 (95 % CI 28, 696). Among patients with high pre-test probabilities, MRI enabled confirmation of HCC; among patients with low pre-test probabilities, MRI enabled exclusion of HCC. Worst-case-scenario (pre-test probability, 50 %) post-test probabilities were 93 and 9 % for positive and negative MRI results, respectively. In studies in which both Gd-EOB-MRI and contrast enhanced computed tomography (CE-CT) were performed, Gd-EOB-MRI was more sensitive than CE-CT (0.93 vs. 0.78; p < 0.05). Subgroup analysis suggested average lesion size (<2 vs. >2 cm) did not affect the diagnostic accuracy of the test (p > 0.05). A limited number of small studies suggest Gd-EOB-MRI has good diagnostic performance in the detection of HCC among patients with chronic liver disease. It is also confirmed to be a reliable tool for evaluation of small early-stage HCC.
    Digestive Diseases and Sciences 07/2013; 58(11). DOI:10.1007/s10620-013-2790-y
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    ABSTRACT: Breast cancer is the most common cancer in women worldwide. However, it remains a difficult diagnosis problem to differentiate between benign and malignant breast lesions, especially in small early breast lesions. To assess the diagnostic value of diffusion-weighted imaging (DWI) combined with T2-weighted imaging (T2WI) for small breast cancer characterization. Fifty-eight patients (65 lesions) with a lesion <2 cm in diameter underwent 3.0 Tesla breast magnetic resonance imaging (MRI) including DWI and histological analysis. Three observers with varying experience levels reviewed MRI. The probability of breast cancer in each lesion on MR images was recorded with a 5-point scale. Areas under the receiver-operating characteristic curve (AUCs) were compared by using the Z test; sensitivity and specificity were determined with the Z test after adjusting for data clustering. AUC of T2WI and DWI (Observer 1, 0.95; Observer 2, 0.91; Observer 3, 0.83) was greater than that of T2WI (Observer 1, 0.80; Observer 2, 0.74; Observer 3, 0.70) for all observers (P < 0.0001 in all comparisons). Sensitivity of T2WI and DWI (Observer 1, 90%; Observer 2, 93%; and Observer 3, 86%) was greater than that of T2WI alone (Observer 1, 76%; Observer 2, 83%; Observer 3, 79%) for all observers (P < 0.0001 in all comparisons). Specificity of T2WI and DWI was greater than that of T2WI alone for observer 1 (89% vs. 72%, P < 0.01) and observer 2 (94% vs. 78%, P < 0.001). DWI combined with T2WI can improve the diagnostic performance of MRI in small breast cancer characterization. It should be considered selectively in the preoperative evaluation of patients with small lesions of the breast.
    Acta Radiologica 07/2013; 55(1). DOI:10.1177/0284185113492458
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    ABSTRACT: RATIONALE AND OBJECTIVES: To prospectively assess the incremental value of diffusion-weighted imaging (DWI) combined with T2-weighted images (T2WI) in determining the T stage of bladder cancer by using pathologic findings as the reference standard. MATERIALS AND METHODS: This study is approved by the institutional review board; informed consent was waived. The study includes 362 patients (age range, 48-87 years; mean, 71 years) who underwent 3.0-T magnetic resonance imaging and histologic examination. Three observers with varying experience levels reviewed the T2WI data alone, DWI data alone, and combined T2WI and DWI data. Sensitivity, specificity, accuracy, and area under curve (AUC) were determined with the Z test after adjusting for data clustering. RESULTS: For differentiating Tis to T1 tumors from T2 to T4 tumors, the AUCs for T2WI and DWI (0.97 for observer 1 and 0.96 for observer 2) were greater than those for the DWI alone (0.92 for observer 1 and 0.90 for observer 2) (P < .05). Observer 3 had similar AUCs for T2WI and DWI compared to DWI alone. The accuracy of T2WI and DWI (observer 1, 98%; observer 2, 96%; observer 3, 92%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). The specificity of T2WI and DWI (observer 1, 100%; observer 2, 98%; observer 3, 93%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). Sensitivity was not improved even when T2WI and DWI were used. For differentiating Tis to T2 Tumors from T3 to T4 Tumors, the overall accuracy, specificity, and AUC for diagnosing T2 or higher stages were not significantly improved by combiningT2WI and DWI. CONCLUSIONS: T2WI combined with DWI can be a reliable sequence for preoperative evaluation of T stage urinary bladder cancer. It is particularly more useful in differentiating T1 or lower tumors from T2 or higher tumors compared to DWI alone.
    Academic radiology 06/2013; DOI:10.1016/j.acra.2013.02.012
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    ABSTRACT: OBJECTIVE: This meta-analysis aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in predicting responses in patients with locally advanced rectal cancer after preoperative neoadjuvant therapy. METHODS: Articles in English language relating to the accuracy of MRI for this utility were retrieved. Methodological quality was assessed by Quality Assessment of Diagnostic Accuracy Studies tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis. RESULTS: Fourteen studies involved 751 pathologically confirmed patients met the inclusion criteria. Methodological quality was relatively high. To predict histopathological response in locally advanced rectal cancer by MRI, the pooled sensitivity and specificity were 0.78 [95 % confidence intervals (CI), 0.65, 0.87] and 0.81 (95 % CI, 0.72, 0.87), respectively. Positive likelihood ratio and negative likelihood ratio were 4.1 (95 %CI, 2.9, 5.8) and 0.27 (95 % CI, 0.17, 0.43), respectively. Subgroup analysis showing that imaging was performed at 3.0 T MRI devices had higher pooled sensitivity (0.92, 95 % CI, 0.84, 1.00) than the subgroup of MRI with ≤1.5 T (0.68, 95 % CI, 0.53, 0.82) (p < 0.05).The sensitivity and specificity of T2-weighted imaging (T2WI) with diffusion-weighted imaging (DWI) were 0.92 (95 % CI, 0.81, 1.00) and 0.75 (95 % CI, 0.54, 0.95); those of T2WI alone were 0.64 (95 % CI, 0.47, 0.82) and 0.88 (95 % CI, 0.81, 0.94) (p > 0.05). CONCLUSION: This meta-analysis indicates that MRI is an accurate tool in predicting pathologic response after preoperative therapy in patients with locally advanced rectal cancer. It is suggested to perform MRI by 3.0 T devices, which might be sensitive to identify responder. The addition of DWI to T2WI showed a non-significant improvement in sensitivity, which deserves further investigation.
    International Journal of Colorectal Disease 03/2013; 28(9). DOI:10.1007/s00384-013-1676-y
  • Article: Reply.
    Lian-Ming Wu, Jian-Rong Xu, Jiani Hu
    American Journal of Roentgenology 02/2013; 200(2):W220-1.
  • Lian-Ming Wu, Jian-Rong Xu, Jiani Hu
    American Journal of Roentgenology 02/2013; 200(2):W220-W221. DOI:10.2214/AJR.12.9752
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    ABSTRACT: PurposeTo perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with hepatic metastases.Methods Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to February 2012. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression models.ResultsAcross 11 studies (537 patients), DW-MRI sensitivity was 0.87 (95% confidence interval (CI), 0.80, 0.91) and specificity was 0.90 (95% CI, 0.86, 0.93). Overall, LR+ was 8.52 (95% CI, 6.17, 11.77), LR– was 0.15 (95% CI, 0.10, 0.22) and DOR was 57.36 (95% CI, 38.29, 85.93). In studies in which both DW-MRI and contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DW-MRI performance with that of CE-MRI suggested no major differences against these two methods (p > 0.05). DW-MRI combined CE-MRI had higher sensitivity and specificity than DW-MRI alone (97% versus 86% and 91% versus 90%, respectively) (p < 0.05). The subgroup in which DW-MRI examinations were performed with a 3.0 Tesla (T) device had higher pooled specificity (0.91, 95% CI, 0.88–0.95) than the subgroup of DW-MRI with 1.5 T device (0.81, 95% CI, 0.67, 0.94) (p < 0.05). Average lesion size (⩽1.5 cm versus >1.5 cm) did not influence the diagnostic accuracy of the test (p > 0.05).Conclusion Our results demonstrate DW-MRI has good diagnostic performance in the overall evaluation of hepatic metastases and equivalent to CE-MRI. Combination of CE-MRI and DW-MRI can improve the diagnostic accuracy of magnetic resonance (MR) imaging. Our study further confirms that DW-MRI can accurately detect hepatic metastases regardless of the lesion size. It is suggested to perform DW-MRI by 3.0 T devices, which might have high specificity to identify liver metastases.
    European journal of cancer (Oxford, England: 1990) 02/2013; 49(3):572–584. DOI:10.1016/j.ejca.2012.08.021
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    ABSTRACT: GOALS:: To evaluate the overall diagnostic accuracy of magnetic resonance imaging (MRI) in assessing the activity of Crohn's disease (CD) in the small bowel. BACKGROUND:: Cross-sectional imaging techniques are playing an increasing role in the evaluation of suspected CD. Advantages of MRI include a lack of ionizing radiation, the ability to provide dynamic information regarding bowel distention and motility, improved soft-tissue contrast, and a relatively safe intravenous contrast agent profile. STUDY:: Two reviewers searched MEDLINE, EMBASE, and other electronic databases to identify studies in which MRI imaging was evaluated for assessing the activity of CD in the small bowel from January 2001 to September 2011. Bivariate random-effects meta-analytic methods were used to estimate summary, sensitivity, specificity, and receiver operating characteristic curves. RESULTS:: MRI had a pooled sensitivity of 0.87 [95% confidence interval (CI): 0.77, 0.93] and a pooled specificity of 0.91 (95% CI: 0.81, 0.96). Overall, likelihood ratio (LR)+ was 9.5 (95% CI: 4.4, 20.6) and LR- was 0.14 (95% CI: 0.08, 0.26). In patients with high pretest probabilities, MRI enabled confirmation of active CD; in patients with low pretest probabilities, MRI enabled exclusion of active CD. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 90% and 13% for positive and negative MRI results, respectively. CONCLUSIONS:: A limited number of small studies suggest that MRI has high sensitivity and specificity for diagnosis of active CD in the small bowel; MRI will likely also prove to be suitable as the primary modality for active CD imaging surveillance.
    Journal of clinical gastroenterology 01/2013; DOI:10.1097/MCG.0b013e31825d5034
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    ABSTRACT: PURPOSE To investigate the value of iodine-based material decomposition images with spectral CT imaging in characterizing and differentiating prostate cancer (PCa) from benign prostate hyperplasia (BPH), during the arterial phase (AP), venous phase (VP) and parenchymal phase (PP). METHOD AND MATERIALS This prospective study was institutional review board approved with written informed consent from patients. 28 male patients underwent CT examination with spectral imaging mode during AP, VP and PP. 10 patients had PCa and 18 had BPH. Iodine concentrations of the lesions were derived from iodine-based material-decomposition images and normalized to that of the obturator internus. The iodine concentration difference (ICD) between different phases [e.g. ICD(VP-AP), ICD(PP-VP)] were calculated. Lesion CT values at 75keV (corresponding to the conventional 120kVp) were also measured. The two independent-sample t-test was performed to quantitatively compare the parameters between PCa and BPH. Receiver operating characteristic (ROC) curve was generated to assist the establishment of the threshold for the normalized iodine concentration (NIC) in differentiating PCa and BPH. RESULTS 38 lesions (20 PCa and 18 BPH) were found in 28 patients. NIC for PCa patients differed significantly from those for BPH patients in all phases: (1.86±0.81 vs. 1.05±0.25 in AP, 3.53±1.50 vs. 1.85±0.50 in VP, and 2.58±0.59 vs. 1.79±0.50 in PP) (all p<0.05). ICD(PP-VP) for the PCa group (-0.95mg/ml±1.02) was also significantly different from ICD(PP-VP) for BPH (-0.06mg/ml±0.15) (P<0.05). ROC analysis indicated that NIC of 2.58 in VP provided 80% in sensitivity and 90% in specificity in differentiating PCa and BPH. On the other hand, there was no difference between the CT numbers for the two lesion types in any imaging phases (p>0.05). CONCLUSION Spectral CT imaging generated additional parameters than the CT numbers in conventional CT for the quantitative depiction of blood flow of prostatic lesions, and may be used to differentiate PCa from BPH with high accuracy. CLINICAL RELEVANCE/APPLICATION Iodine concentration obtained in the enhanced spectral CT may be used for the quantitative depiction of blood flow of prostatic lesions, and for differentiating PCa from BPH with high accuracy.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: BACKGROUND AND AIM: The purpose of this study was to perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS: Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis. RESULTS: Across 9 studies (476 patients), DWI sensitivity was 81% (95%CI: 67%-90%) and specificity was 89% (95% CI: 76%-95%). Overall, positive likelihood ratio was 7.11 (95%CI: 3.50, 14.48), negative likelihood ratio was 0.21 (95%CI: 0.12-0.37) and the diagnostic odds ratio (DOR) was 33.48 (95%CI: 16.67-67.25). The area under the curve of the summary receiver operator characteristic (ROC) was 0.92 (95% CI:0.89-0.94). In studies in which both DWI and conventional contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, The comparison of DWI performance with that of conventional CE-MRI suggested no major differences against these two methods (P>0.05).DWI combined CE-MRI had higher pooled sensitivity than DWI alone (93% vs. 73%) (p<0.05). CONCLUSION: DWI has good diagnostic performance in the detection of HCC in patients with chronic liver disease and equivalent to conventional CE-MRI. Combination of CE-MRI and DWI can improve the diagnostic accuracy of MR imaging. Further larger prospective studies are still needed to establish its value for detecting HCC in patients with chronic liver disease.
    Journal of Gastroenterology and Hepatology 11/2012; 28(2). DOI:10.1111/jgh.12054
  • Lian-Ming Wu, Jian-Rong Xu, Hai-Yan Gu, Jiani Hu
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    ABSTRACT: PURPOSE We performed a meta-analysis to compare the diagnostic capability of diffusion-weighted imaging (DW-MRI), 18F-FDG PET or combined FDG-PET/CT in predicting pathological response in patient with rectal cancer patients receiving neoadjuvant therapy. METHOD AND MATERIALS A comprehensive literature search of studies on human subjects was performed by one observer to identify articles about the diagnostic performance of DW-MRI,FDG PET or combined FDG-PET/CT for this utility through the MEDLINE, EMBASE databases, from January 2000 to January 2012. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR – ), and constructed summary receiver operating characteristiccurves using hierarchical regression models. Methodological quality was assessed by QUADAS tool. RESULTS 27 studies met the inclusion criteria and involved 1320 pathologically confirmed patients in total. Methodological quality was relatively high. DW-MRI sensitivity was 0.86 (95CI, 0.74, 0.92) and specificity was 0.71 (95% CI, 0.60, 0.80). Overall LR+ was 2.96 (95% CI, 2.06, 4.25), LR- was 0.20 (95% CI, 0.11, 0.38) and DOR was 14.65 (95% CI, 6.07, 35.39). 18F-FDG PET or combined FDG-PET/CT sensitivity was 0.81 (95CI, 0.74, 0.87) and specificity was 0.74 (95% CI, 0.64, 0.82). Overall LR+ was 3.10 (95% CI, 2.26, 4.26), LR- was 0.25 (95% CI, 0.18, 0.35) and DOR was 12.23 (95% CI, 7.28, 20.54). CONCLUSION Our study confirms DW-MRI has good performance in predicting pathological response to neoadjuvant therapy in rectal cancer patients but is equal to FDG PET or FDG-PET/CT. It has the potential to be a reliable alternative imaging method in this field. However, it is too early to call for broad application of DW-MRI in routine clinical practice. Further larger prospective directly comparative studies involving FDG PET or FDG-PET /CT would be required to determine the true value of DW-MRI in rectal cancer preoperative treatment screening. CLINICAL RELEVANCE/APPLICATION DW-MRI has a well-established role in the diagnosis of rectal cancer, it should not yet be used in routine clinical practice to guide neoadjuvant therapy decisions in patients with this dis
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: The aim of this study was to evaluate the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) in prostate cancer. The MEDLINE, Embase, CANCERLIT, and Cochrane Library databases were searched for studies published from January 2001 to August 2011 evaluating the diagnostic performance of DWI in detecting prostate carcinoma. Sensitivities and specificities were determined across studies, and summary receiver-operating characteristic curves were constructed using hierarchical regression models. Sixteen studies (18 subsets) with a total of 852 patients were included. Six studies (seven subsets) examining men with pathologically confirmed prostate cancer (260 patients) had pooled sensitivity and specificity of 0.88 (95% confidence interval [CI], 0.76-0.95) and 0.84 (95% CI, 0.76-0.90), respectively. Compared to patients at high risk for clinically relevant cancer, sensitivity was higher in low-risk patients (0.94 [95% CI, 0.89-0.97] vs 0.62 [95% CI, 0.54-0.70], P < .05), but specificity was lower (0.86 [95% CI, 0.72-0.94] vs 0.89 [95% CI, 0.83-0.93], P < .05). Ten studies (11 subsets) examining patients with suspected prostate cancer (592 patients) had pooled sensitivity and specificity of 0.76 (95% CI, 0.68-0.84) and 0.86 (95% CI, 0.79-0.91). Sensitivity was lower in high-risk patients (0.74 [95% CI, 0.57-0.87] vs 0.78 [95% CI, 0.70-0.84], P > .05), but specificity was higher (0.92 [95% CI, 0.89-0.94] vs 0.78 [95% CI, 0.70-0.84], P < .05). A limited number of small studies suggest that DWI could be a rule-in test for high-risk patients. Further prospective studies including larger populations are necessary to confirm the actual value of DWI in this field.
    Academic radiology 10/2012; 19(10):1215-24. DOI:10.1016/j.acra.2012.05.016

Publication Stats

289 Citations
92.39 Total Impact Points

Institutions

  • 2011–2014
    • Renji Hospital
      Shanghai, Shanghai Shi, China
  • 2010–2014
    • Shanghai Jiao Tong University
      • • School of Medicine
      • • Department of Radiology (Renji)
      Shanghai, Shanghai Shi, China