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Multiple primary malignant neoplasms (MPMNs) are rare malignant neoplasms that simultaneously or successively occur in the same patient as 2 or more primary malignancies. Currently, an increasing number of cases are being reported. In general, MPMNs more commonly occur as 2 solid tumors or 2 hematological malignancies. Cases of MPMN that involve a solid tumor and a hematological malignancy are rare. Here, we report a case of synchronous colorectal cancer (CRC) and multiple myeloma (MM) with chest wall involvement. After reviewing the literature, we believe that there may be a distinct syndrome involving CRC and MM. The patient in our case study suffered refractory anemia following surgery and 2 cycles of chemotherapy. Initially, the anemia was considered to be a common manifestation of CRC in this patient. Interestingly, although he received a blood transfusion, his hemoglobin levels remained low. He later developed hematuria, proteinuria, multiple osteoporosis in the costal bones, and thrombocytopenia. These new symptoms drew our attention, and we considered a diagnosis of synchronous primary CRC and MM, with the anemia as a symptom of MM. Based on the results of a bone marrow aspirate, MM was confirmed. Therefore, when CRC is associated with refractory anemia, we should not only assume that anemia is a classical symptom of CRC, a result of chronic blood loss, nutritional deficiencies, or myelosuppression due to chemotherapy, but we should also consider that it may reflect the possibility of a coexisting hematologic malignancy. As the treatment of these 2 malignancies is different, early diagnosis and treatment based on definitive diagnosis as early as possible will be beneficial to overall prognosis. [ABSTRACT FROM AUTHOR]

Purpose To assess the ability of diffusion-weighted imaging (DWI) for evaluating T stage and correlation with histological T stage of rectal cancer. Method The diagnostic accuracy, sensitivity, and specificity of T 2 WI and DWI combined with T 2 WI for T stage were evaluated. Mean tumor apparent diffusion coefficient (ADC) was compared with histological T stage. Result There were no significant differences in the diagnostic accuracy, sensitivity, and specificity no matter what kind of T stage was concerned. The difference between ADC values and histological T stage were significantly different. Conclusion DWI was useful for evaluating T stage of rectal cancer. The ADC may predict the histological grade. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the mismatched manifestation between regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) of astrocytomas. Methods: Both conventional and perfusion CT were performed on 29 patients with pathologically confirmed astrocytomas (15 cases in Grades I–II, 14 cases in Grades III–IV). Time-density curves were plotted, cerebral blood flow and volume maps were generated, and the values between rCBF and rCBV in the same region of interest (ROI) were compared. Results: Twelve low-grade astrocytomas showed low or medium values of both rCBF (46.95±22.92 ml ⋅ 100 g−1 ⋅ mm−1) and rCBV (5.74±3.61 ml ⋅ 100 g−1); 12 high-grade astrocytomas showed high values of both rCBF (95.44±42.58 ml ⋅ 100 g−1 ⋅ min−1) and rCBV (9.24±5.32 ml ⋅ 100g−1). These cases exhibited agreement between the values of rCBF and rCBV. However, the remaining five astrocytomas were mismatched, showing reduced rCBF value and increased rCBV value in the same ROI. The discrepancy may mislead to an inaccuracy of perfusion CT in grading gliomas. Conclusions: The mismatched manifestation between rCBF and rCBV occasionally exists in some areas of astrocytomas. Hence, attention should be paid to assessments in preoperative grading of astrocytomas and in monitoring therapeutic effects. [Copyright &y& Elsevier]

Abstract: Objective: This study aimed to determine a contrast medium injection rate that ensures both accuracy for data and safety for operation by comparing hemodynamic parameters of brain CT perfusion imaging with varied injection rates. Methods: Twenty-four healthy volunteers were divided into three groups based on contrast medium injection rates (4.5, 6.0, and 7.5 ml/s). For all subjects, CT perfusion scanning was started at 4 s after antecubital venous bolus of contrast media injection. A perfusion-analyzing software package was used to produce a time–density curve in the anterior cerebral artery and the superior sagittal sinus and calculate the regional cerebral blood flow (rCBF) in the gray matter and the white matter. The hemodynamic indices were compared among the three groups, and statistical analysis was carried out using the F test. Results: The time for the arterial rise to reach the peak value for the 7.5-ml/s group was only 0.2 s ahead of the initiation time for the rise of the superior sagittal sinus. The differences of rCBF in the gray matter and the white matter among the three groups were statistically significant. rCBF in the gray matter and the white matter for the 7.5-ml/s group was 52.8 ml · min−1 100 g−1 · (±3.1) and 21.9 ml · min−1 · 100 g−1 (±2.4), respectively. Conclusions: The use of the 7.5-ml/s injection rate can meet the prerequisite of the maximum slope model, and the resulting rCBF can be very close to that measured by positron emission tomography. Therefore, 7.5 ml/s was an ideal contrast medium injection rate. [Copyright &y& Elsevier]

Objective To prospectively evaluate the inter- and intraobserver agreement of apparent diffusion coefficient (ADC) measurements in free breathing, breath-hold, and respiratory triggered diffusion-weighted imaging (DWI) of lung cancer. Methods Twenty-two patients with lung cancer (tumor size > 2 cm) underwent DWIs (3.0 T) in three imaging methods. Lesion ADCs were measured twice by both of the two independent observers and compared. Results No statistical significance was found among methods, though respiratory-triggered DWI tended to have higher ADCs than breath-hold DWI. Great inter- and intraobserver agreement was shown. Conclusion ADCs had good inter- and intraobserver agreement in all three DWI methods. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the improvement in postprocessing time and image quality of 3D negative-contrast CT cholangiography (nCTC) with minimum intensity projection (minIP). Methods: Thirty-eight patients with suspected biliary obstruction who underwent portal phase helical CT were retrospectively studied. Three-dimensional nCTC was generated using 3D tools with manual cut function in three methods: one-slice, two-slice, and vari-slice cut slab, respectively. After adjusting the threshold level to about −20 HU, the erosion function with a value of one voxel was employed each time for further cleaning up hypodense interfering voxels such as fat and air that remained and the procedure was stopped before the biliary and pancreatic ducts were overeroded. Results: Mean values of the total postprocessing time of the three manual cut methods for 3D nCTC were 57.8, 29.9, and 20.6 min, respectively. After the first erosion, interfering voxels were removed in more than half of the cases and they could be primarily eliminated following the second erosion. Meanwhile, the pancreaticobiliary ducts showed obvious erosion findings at the third erosion. Conclusions: The vari-slice manual cut method was shown to be the most timesaving postprocessing method and the image quality for 3D nCTC can be improved when one to two frequencies of erosion are applied. [Copyright &y& Elsevier]

An electromagnetic actuator was designed for magnetic resonance elastography (MRE). The actuator is unique in that it is simple, portable, and capable of brain, abdomen, and phantom imagings. A custom-built control unit was used for controlling the vibration frequency and synchronizing the trigger signals. An actuation unit was built and mounted on the specifically designed clamp and holders for different imaging applications. MRE experiments with respect to gel phantoms, brain, and liver showed that the actuator could produce stable and consistent mechanical waves. Estimated shear modulus using local frequency estimate method demonstrated that the measurement results were in line with that from MRE studies using different actuation systems. The relatively easy setup procedure and simple design indicated that the actuator system had the potential to be applied in many different clinical studies. [ABSTRACT FROM AUTHOR]

• Intratumoral and peritumoral fat is distinct and changeable. • Subcutaneous and visceral adipose tissue are associated with cancer prognosis. • Imaging methods of fat quantification evolve. • Fat quantification techniques show great potential for clinical work on cancer. Recently, the study of the relationship between lipid metabolism and cancer has evolved. The characteristics of intratumoral and peritumoral fat are distinct and changeable during cancer development. Subcutaneous and visceral adipose tissue are also associated with cancer prognosis. In non-invasive imaging, fat quantification parameters such as controlled attenuation parameter, fat volume fraction, and proton density fat fraction from different imaging methods complement conventional images by providing concrete fat information. Therefore, measuring the changes of fat content for further understanding of cancer characteristics has been applied in both research and clinical settings. In this review, the authors summarize imaging advances in fat quantification and highlight their clinical applications in cancer precaution, auxiliary diagnosis and classification, therapy response monitoring, and prognosis. [ABSTRACT FROM AUTHOR]

Objective: To access the effect of iodinate contrast agent (ICA) on DNA double-stand breaks (DSBs) in human peripheral blood lymphocytes during computed tomography (CT) examinations.Materials and Methods: This present study was approved by the institutional ethics committee; written informed patient consent was obtained from 70 patients. A total of 48 patients underwent computed tomography urography (CTU), in which only one time CT scanning was examined after injecting ICA, and 22 patients received unenhanced whole abdominal CT, among them 10 patients were selected to get ICA injection immediately after irradiation. Blood samples were taken from all patients prior to and immediately after CT scan, as well as 8min after the injection of ICA. The lymphocytes in these blood samples were separated by using density-gradient centrifugation, fixed and immunostained with γH2AX antibody. The average number of phosphorylated histone H2AX (γH2AX) foci per lymphocyte was counted under a fluorescence microscopy. Differences in the number of γH2AX-foci were statistically analyzed using independent sample t test and one way ANOVA.Result: The three patient groups had no significant differences in the baseline foci numbers(P>0.05). The γH2AX-focus levels increased in both groups after CT scan. Patients who underwent CTU examinations had a greater DSBs level (mean±standard error of mean, 0.945±0.184 foci per cell) than those who received unenhanced whole abdominal CT scan (mean±standard error of mean, 0.700±0.112 foci per cell), increasing by about 37.9%; The ICA injected before CT scan itself had an effect on the DSBs, which increased DSBs level by approximately 90.3% (0.059±0.018vs 0.031±0.025, P<0.05), but no significant difference was found if added after irradiation, increasing DSBs level only by 3.2% approximately (0.711±0.091vs 0.689±0.108, P=0.499).Conclusion: The iodinated contrast agent itself can lead to an increase in the level of DSBs as assessed with γH2AX foci formation, and the application of ICA can amplify DNA damage induced by diagnostic x-ray procedures such as whole abdominal CT. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To retrospectively assess the diagnostic efficacy of dual-source CT angiography (DSCTA) in detecting and grading coronary stenosis. Methods: Institutional review board approval and informed consent were obtained. One hundred ten patients were performed with both DSCTA and conventional coronary angiography (CCA) without heart rate or rhythm control in 1 week. Regarding CCA as the gold standard, the assessable rate of coronary arteries and diagnostic value of coronary stenosis using DSCTA were analyzed, respectively. The intermodality agreement between DSCTA and CCA in grading coronary stenosis was assessed using κ test. The value of DSCTA in diagnosing >50% coronary stenoses was also assessed. Results: The overall assessable rate of DSCTA was 98.6% in detecting coronary arteries; there was no significant difference between assessable rates from different groups of heart rate (χ 2=0.45, P > .05). The efficacy of DSCTA was of 97.9% sensitivity, 97.3% specificity, 90.4% positive predictive value, and 99.4% negative predictive value for coronary stenosis; and 94.7% sensitivity, 96.8% specificity, 83.7% positive predictive value, and 99% negative predictive value for >50% stenoses. The intermodality agreement in diagnosing coronary stenosis was satisfactory (k=0.87, u=58.46, P<.01). Conclusions: As an effective noninvasive diagnostic tool, DSCTA yields a promising accuracy and reliability in assessing coronary stenosis. It may be recommended as a valuable screening tool for coronary artery disease, and a potential challenge to CCA as well. [Copyright &y& Elsevier]

Purpose: To evaluate the relationship between myocardial extracellular volume (ECV) fraction measured using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and risk of heart failure (HF) in patients without coronary artery disease (CAD), and to evaluate the relationship between ECV and left ventricular structure and function.Materials and Methods: Sixty consecutive HF patients without CAD and 60 consecutive participants without heart disease who underwent coronary CT angiography (CCTA) following LIE-DECT were included. ECV of the left ventricle was calculated from the iodine maps and hematocrit levels using the American Heart Association (AHA) 16-segment model. Cardiac structural and functional parameters were collected including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), interventricular septal thickness (IVST), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP).Results: ECV in HF patients without CAD (31.3 ± 4.0 %) was significantly higher than that in healthy subjects (27.1 ± 3.7 %) (P < 0.001). Multivariate linear analysis revealed that ECV was associated with age (β = 0.098, P = 0.010) and hypertension (β = 2.093, P = 0.011) in all participants. Binary logistic regression analysis showed that after adjusting for age, sex, body mass index (BMI), smoking, and drinking, ECV was a risk factor affecting the occurrence of HF in those without CAD (OR = 1.356, 95 %CI：1.178-1.561, P < 0.001). A positive correlation was found between ECV and NT-pro-BNP, LVEDV, LVESV, and LAV (r = 0.629, 0.329, 0.346, and 0.338, respectively; all P < 0.001) in all participants.Conclusions: ECV could be measured using LIE-DECT iodine maps. ECV elevation was a risk factor for HF without CAD and correlated with cardiac structure and function. [ABSTRACT FROM AUTHOR]