Object To evaluate the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) for the preoperative T staging of gastric cancer. MethodsThe databases such as the PubMed, Cochrane Database Systematic Reviews, EMbase, CNKI, and Wanfang Data were searched on computer from 1993 to 2012.The reviewers screened the trials according to inclusion and exclusion criteria strictly, extracted the data, and assessed the methodology quality.Meta-analysis were performed using the Metadisc 1.40 software, the pathology diagnosis as gold standard.The acquired pooled sensitivity, specificity, and summary receiver operating characteristic curve (SROC) were used to describe the value of MRI in T staging. ResultsEight case-control studies involving 302 patients with gastric cancer were included in the study.The pooled statistical results of Meta-analysis showed that:the pooled sensitivity and specificity of MRI for T1-stage gastric cancer were 85%(55%-98%) and 97%(91%-99%) respectively, and the area under the SROC curve (AUC) was 0.961.The pooled sensitivity and specificity of MRI for T2-stage gastric cancer were 73%(60%-84%) and 93%(89%-96%) respectively, and the AUC was 0.935.The pooled sensitivity and specificity of MRI for T3-stage gastric cancer were 87%(81%-92%) and 82%(74%-88%) respectively, and the AUC was 0.914.The pooled sensitivity and specificity of MRI for T4-stage gastric cancer were 75%(62%-86%) and 97%(94%-99%) respectively, and the AUC was 0.963. ConclusionMRI has the high consistency in preoperative T staging with pathology, and should be recommended as a preferred to increase the accuracy of preoperative staging, and improve the prognosis.
ObjectiveTo summarize clinical outcomes of mitral valve replacement (MVR) with modified anterior leaflet preservation technique,improve therapeutic effects and reduce postoperative mortality and morbidity. MethodsFrom May 2005 to December 2012,128 patients underwent MVR with modified anterior leaflet preservation technique (modified group) in Beijing Anzhen Hospital,among whom 14 patients received concomitant aortic valve replacement. There were 49 male and 79 female patients in the modified group with their age of 45.0±12.3 years. Another 128 patients who underwent routine MVR during the same period were also included in this study as the control group,including 55 male and 73 female patients with their age of 48.0±8.4 years. There was no statistical difference in preoperative clinical characteristics between the 2 groups (P>0.05). ResultsIn the modified group,there was no perioperative death. Postoperatively,6 patients received reexploration for bleeding,4 patients had low cardiac output syndrome,5 patients had pulmonary infection,1 patient received tracheostomy,and 3 patients had acute kidney failure (AKI). In the control group,5 patients died postoperatively including 3 patients with left ventricular rupture and 2 patients with severe low cardiac output syndrome. Postoperatively,5 patients received reexploration for bleeding,12 patients had low cardiac output syndrome,4 patients had pulmonary infection,and 6 patients had AKI. Echocardiography at 6th month during follow-up showed that left ventricular ejection fraction (LVEF) left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) of modified group patients were improved compared with control group patients. There was statistical difference in LVEF and LVESD between the 2 groups (P<0.05). There was no statistical difference in LVEDD between the 2 groups (P>0.05). LVEF,LVEDD and LVESD of modified group patients during follow-up were statistically different from preoperative values (P<0.05). LVEDD of control group patients during follow-up was statistically different from preoperative LVEDD (P<0.05). LVEF and LVESD of control group patients during follow-up was not statistically different from preoperative values (P>0.05). ConclusionMVR with modified anterior leaflet preservation technique is simple to perform with satisfactory short-term results. This technique is suitable for various types of mitral valve diseases especially degenerative mitral valve disease and infective endocarditis.
This study aims to detect early changes of kidney in patients with primary hypertension by 3.0 T functional magnetic resonance imaging (fMRI). 26 patients with primary hypertension (hypertension group) and 33 healthy volunteers (control group) underwent conventional and functional magnetic resonance scans, which included blood oxygen level-dependent (BOLD) MRI, diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). We measured renal cortical thickness (CT), parenchymal thickness (PT), and functional values of renal cortex and medulla including R2* value, apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value in each group, and then calculated the cortical/parenchymal thickness ratio (CPR). Compared with those in the control group, CT and CPR in hypertension group were larger (P<0.01), cortical and medullar R2* values increased (P<0.01) whereas medullar FA values decreased (P<0.05). It could be well concluded that noninvasive 3.0 T functional MRI would have important clinical significance in identifying early abnormalities of kidney in hypertension patients.