1
|
Zhou Q, Huang X, Xue C, Zhou J. Correlation of clinical and computed tomography features of thymic epithelial tumours with World Health Organization classification and Masaoka-Koga staging. Eur J Cardiothorac Surg 2021; 61:742-748. [PMID: 34329409 DOI: 10.1093/ejcts/ezab349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to investigate the correlation of clinical and computed tomography (CT) features of thymic epithelial tumours (TET) with the World Health Organization classification and the Masaoka-Koga staging system. METHODS Clinical and CT imaging data from 159 patients surgically and pathologically diagnosed with TET (82 men, 77 women; mean [± standard deviation] age, 52.08 ± 11.76 years) were retrospectively collected and reviewed. CT features were evaluated by radiologists. Tumour size, morphology, margin, density, calcification, cystic necrosis, density of the fat layer around the tumour, invasion of surrounding tissues, mediastinal lymph node enlargement, pleural/pericardial effusion, metastasis, plain CT scans and enhanced CT values were analysed. RESULTS Of the 159 patients with TET, 76 had low-risk thymoma, 55 had high-risk thymoma and 28 had thymic carcinomas. Age, maximum tumour diameter, myasthenia gravis, morphology, edges, density, fat around the lesion, mediastinal vascular, pericardial and lung tissue invasion, pleural/pericardial effusion, metastasis and arterial phase CT values were statistically different among the 3 groups (P < 0.05). Multivariate regression analysis revealed that edges, fat around the lesion, mediastinal vascular invasion and pericardial effusion were most relevant to TET classification. The 159 patients with TET were categorized into the non-invasion group (stage I; n = 58); the invasion of surrounding fat (stage II; n = 46); and the invasion of surrounding structures and metastasis group (stages III and IV; n = 55). Tumour diameter, morphology, margins, density, cystic degeneration and necrosis, invasion of surrounding fat and structure, pleural and pericardial effusion and lymph node enlargement were statistically different among the 3 groups (P < 0.05). Multivariate regression analysis revealed that edges, fat around the lesion, mediastinal vascular invasion and pleura invasion were the most relevant CT signs in relation to TET staging. CONCLUSIONS Analysis of clinical and CT features before surgery may facilitate the preliminary classification and stage diagnosis of TET.
Collapse
Affiliation(s)
- Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China.,Second Clinical School, Lanzhou University, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Gansu, China
| | - Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China.,Second Clinical School, Lanzhou University, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Gansu, China
| | - Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China.,Second Clinical School, Lanzhou University, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Gansu, China
| |
Collapse
|
2
|
Ackman JB, Chung JH, Walker CM, Bang TJ, Carter BW, Hobbs SB, Kandathil A, Lanuti M, Madan R, Moore WH, Shah SD, Verde F, Kanne JP. ACR Appropriateness Criteria® Imaging of Mediastinal Masses. J Am Coll Radiol 2021; 18:S37-S51. [PMID: 33958117 DOI: 10.1016/j.jacr.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | | | - Tami J Bang
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen B Hobbs
- University of Kentucky, Lexington, Kentucky, Councilor, ACR Kentucky Chapter, Vice Chair, Informatics and Integrated Clinical Operations, University of Kentucky
| | | | - Michael Lanuti
- Massachusetts General Hospital, Boston, Massachusetts, The Society of Thoracic Surgeons, Director, Thoracic Oncology, Division of Thoracic Surgery, Massachusetts General Hospital
| | - Rachna Madan
- Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- University of Chicago, Chicago, Illinois, Primary care physician. Associate Chief Medical Information Officer, University of Chicago Medicine
| | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland, Director, Diagnostic Imaging, Johns Hopkins Bayview Medical Center
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
3
|
Zhou Q, Ke X, Man J, Zhang B, Wang F, Zhou J. Predicting Masaoka-Koga Clinical Stage of Thymic Epithelial Tumors Using Preoperative Spectral Computed Tomography Imaging. Front Oncol 2021; 11:631649. [PMID: 33842338 PMCID: PMC8029982 DOI: 10.3389/fonc.2021.631649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the utility of spectral computed tomography (CT) parameters for the prediction of the preoperative Masaoka-Koga stage of thymic epithelial tumors (TETs). Materials and Methods Fifty-four patients with TETs, aged from 37 to 73 years old, an average age of 55.56 ± 9.79 years, were included in the study.According to the Masaoka-Koga staging method, there were 19 cases of stage I, 15 cases of stage II, 8 cases of stage III, and 12 cases of stage IV disease. All patients underwent dual-phase enhanced energy spectral CT scans. Regions of interest (ROIs) were defined in sections of the lesion with homogeneous density, the thoracic aorta at the same level as the lesion, the outer fat layer of the lesion, and the anterior chest wall fat layer. The single-energy CT value at 40-140 keV, iodine concentration, and energy spectrum curve of all lesion and thoracic aorta were obtained. The energy spectrum CT parameters of the lesions, extracapsular fat of the lesions, and anterior chest wall fat in stage I and stage II were obtained. The energy spectrum CT parameters of the lesions, enlarged lymph nodes and intravascular emboli in the 3 groups were obtained. The slope of the energy spectrum curve and the normalized iodine concentration were calculated. Results In stage I lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the lesion and those of the fat outside the lesion and the anterior chest wall in the arteriovenous phase (P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was the opposite of that of the extracapsular fat. In stage II lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the anterior chest wall and those of the lesion and the fat outside the lesion in the arteriovenous phase(P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was consistent with that of the extracapsular fat. Distinction between stage I and II tumors be evaluated by comparing the energy spectrum curves of the mass and the extracapsular fat of the mass. The accuracy rate of is 79.4%. For stages III and IV, there was no significant difference in the slope of the energy spectrum curve of the tumor parenchyma, metastatic lymph node, and intravascular embolism (P>0.05). The energy spectrum curve of the tumor parenchyma was consistent with that of the enlarged lymph nodes and intravascular emboli. The two radiologists have strong consistency in evaluating TETs Masaoka-Koga staging, The Kappa coefficient is 0.873,(95%CI:0.768-0.978). Conclusion Spectral CT parameters, especially the energy spectrum curve and slope, are valuable for preoperative TET and can be used in preoperative staging prediction.
Collapse
Affiliation(s)
- Qing Zhou
- Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Xiaoai Ke
- Lanzhou University Second Hospital, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Jiangwei Man
- Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Zhang
- Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Furong Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Junlin Zhou
- Lanzhou University Second Hospital, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| |
Collapse
|
4
|
Mussi E, Mussa F, Santarelli C, Scagnet M, Uccheddu F, Furferi R, Volpe Y, Genitori L. Current Practice in Preoperative Virtual and Physical Simulation in Neurosurgery. Bioengineering (Basel) 2020; 7:bioengineering7010007. [PMID: 31947718 PMCID: PMC7175342 DOI: 10.3390/bioengineering7010007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 01/17/2023] Open
Abstract
In brain tumor surgery, an appropriate and careful surgical planning process is crucial for surgeons and can determine the success or failure of the surgery. A deep comprehension of spatial relationships between tumor borders and surrounding healthy tissues enables accurate surgical planning that leads to the identification of the optimal and patient-specific surgical strategy. A physical replica of the region of interest is a valuable aid for preoperative planning and simulation, allowing the physician to directly handle the patient’s anatomy and easily study the volumes involved in the surgery. In the literature, different anatomical models, produced with 3D technologies, are reported and several methodologies were proposed. Many of them share the idea that the employment of 3D printing technologies to produce anatomical models can be introduced into standard clinical practice since 3D printing is now considered to be a mature technology. Therefore, the main aim of the paper is to take into account the literature best practices and to describe the current workflow and methodology used to standardize the pre-operative virtual and physical simulation in neurosurgery. The main aim is also to introduce these practices and standards to neurosurgeons and clinical engineers interested in learning and implementing cost-effective in-house preoperative surgical planning processes. To assess the validity of the proposed scheme, four clinical cases of preoperative planning of brain cancer surgery are reported and discussed. Our preliminary results showed that the proposed methodology can be applied effectively in the neurosurgical clinical practice both in terms of affordability and in terms of simulation realism and efficacy.
Collapse
Affiliation(s)
- Elisa Mussi
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
- Correspondence: ; Tel.: + 39-055-2758703
| | - Federico Mussa
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
| | - Chiara Santarelli
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Mirko Scagnet
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Rocco Furferi
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Lorenzo Genitori
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
| |
Collapse
|
5
|
Meng Y, Sun J, Qu N, Zhang G, Yu T, Piao H. Application of Radiomics for Personalized Treatment of Cancer Patients. Cancer Manag Res 2019; 11:10851-10858. [PMID: 31920394 PMCID: PMC6941598 DOI: 10.2147/cmar.s232473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022] Open
Abstract
Radiomics is a novel concept that relies on obtaining image data from examinations such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). With the appropriate algorithm, the extracted results have broad applicability and potential for a massive positive impact in radiology. For example, clinicians can verify treatment efficiency, predict the location of tumor metastasis, correlate results with a histopathological examination, or more accurately define the type of cancer. Combining radiomics with other testing techniques allows every patient to have a personalized treatment plan that is essential for advanced examination and treatment. This article explains the process of radiomics, including data collection mechanisms, combined use with genomics, and artificial intelligence and immunology techniques, which may solve many of the challenges faced by doctors in diagnosing and treating their patients.
Collapse
Affiliation(s)
- Yiming Meng
- Central Laboratory, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| | - Jing Sun
- Central Laboratory, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| | - Na Qu
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| | - Guirong Zhang
- Central Laboratory, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| | - Tao Yu
- Department of Medical Image, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| | - Haozhe Piao
- Central Laboratory, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China.,Department of Neurosurgery, Cancer Hospital of China Medical University, Liaoning Province Cancer Hospital, Shenyang 110042, People's Republic of China
| |
Collapse
|
6
|
Li F, Ismail M, Elsner A, Uluk D, Bauer G, Meisel A, Rueckert JC. Surgical Techniques for Myasthenia Gravis. Thorac Surg Clin 2019; 29:177-186. [DOI: 10.1016/j.thorsurg.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
7
|
Comacchio GM, Marulli G, Mammana M, Natale G, Schiavon M, Rea F. Surgical Decision Making. Thorac Surg Clin 2019; 29:203-213. [DOI: 10.1016/j.thorsurg.2018.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Tassi V, Vannucci J, Ceccarelli S, Gili A, Matricardi A, Avenia N, Puma F. Stage-related outcome for thymic epithelial tumours. BMC Surg 2019; 18:114. [PMID: 31074388 PMCID: PMC7402578 DOI: 10.1186/s12893-018-0434-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Thymic epithelial tumours (TETs) are characterized by a wide variety of biological behaviors. Radical resection and stage are strong prognostic factors. Aim of this study is to review our Single Center Experience. METHODS One hundred and seventy-seven patients observed in the period from January 2000 to December 2016 were included in the study. Data regarding clinicopathologic features, treatment, and survival were collected. Stage-related clinical standpoints and therapeutic options were also evaluated. RESULTS Non-surgical treatment was primarily performed in 15 (8.47%), unresectable disease was intraoperatively found in 12 cases (7.4%). The analysis of 150 patients undergoing curative surgery revealed 70 stage I TET (46.66%), 49 stage II (32.66%), 19 stage III (12.66%), 6 stage IVa (4%) and 6 stage IVb (4%) at the first hospital admission. Histology identified 12 A thymoma (8%), 38 AB (25.33%), 24 B1 (16%), 50 B2 (33.33%), 19 B3 (12.66%) and 7 carcinomas (4.66%). The mean follow up time was 84.14 months (sd = 61.68 months). Disease relapse occurred in 13 patients (8.78%) at a mean period of 78.85 months (sd = 60.87 months) after surgery. Exitus due to thymoma happened in 6 cases (4.05%) after a mean survival of 56.02 months (sd = 25.17 months). The 5-year overall survival rate was 0.94 (95%CI 0.88-0.97) and the 5-year disease-free survival rate was 0.90 (95%CI 0.83-0.94). The 5-year overall survival rates were 96.1% (95% CI, 89.9-98.5%) for the early stages and 87.4% (95% CI, 65.6-95.8%) for the advanced stages (p = 0.670). The 5-year disease-free survival rates resulted being 98.8% (95% CI, 92.3-99.8%) for the early stages and 59.8% (95% CI, 37.8-76.2%) for the advanced stages (p < 0.001). CONCLUSIONS Advanced stage TETs are characterized by higher mortality and recurrence rates. Although technically demanding, surgery, as part of multimodality therapy, could prolong survival. Iterative surgical treatment of recurrences is a viable option for selected patients. TRIAL REGISTRATION The study was approved by the Institutional Review Board of Perugia and Terni University Hospitals [Code T1003] and was retrospectively registered.
Collapse
Affiliation(s)
- Valentina Tassi
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.
| | - Alessio Gili
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Alberto Matricardi
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Nicola Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Department of Surgical and Biomedical Sciences, University of Perugia Medical School, Terni, Italy
| | - Francesco Puma
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| |
Collapse
|
9
|
Zhang H, Zhang P, Yu TL. Comparative study of computed tomography of normal and lymphoid follicular hyperplasia thymus in myasthenia gravis patients. Exp Ther Med 2018; 17:512-518. [PMID: 30651830 DOI: 10.3892/etm.2018.6948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/18/2018] [Indexed: 01/10/2023] Open
Abstract
The aim of the present study was to evaluate the thymuses of non-thymomatous myasthenia gravis (MG) patients by computed tomography (CT) for differentiating lymphoid follicular hyperplasia (LFH) thymus from normal/involuted thymus in order to assist surgeons in determining whether a non-thymomatous MG patient requires an operation. In the present retrospective review over 10 years, 80 patients who received CT scan and thymectomy at the Affiliated General Hospital of Tianjin Medial University (Tianjin, China) were included. According to the pathological records, 54 of the cases initially detected on CT were confirmed as LFH thymus. Thymic measurements, including anteroposterior and transverse dimensions, width (the longest axis of the lobe on a transverse scan) and thickness (the largest dimension perpendicular to the long axis of the lobe) and CT attenuation of the thymus region, adipose tissue and chest wall musculature in each CT slice were included to assess differences between the LFH group and the normal/involuted thymus group. Although a negative association between patient age and the CT attenuation of the thymus region was identified (r=-0.779, P<0.05, Pearson's correlation test), the LFH thymus group featured nodular changes on CT, while no such changes were observed in the normal/involuted thymus group. The mean age of disease onset in the LFH thymus group was significantly lower than that in the normal thymus group (40.2±17.3 vs. 59.2±9.3 years). Furthermore, significant differences in CT attenuation were identified between the LFH group and the normal/involuted thymus group [-41.21±54.42 vs. -108.23±8.72 Hounsfield units (HU) on unenhanced CT; -25.57±58.65 vs.-117.40±6.22 HU on contrast-enhanced CT]. In the LFH group, the difference in mean CT attenuation between the thymus region and adipose tissue was significant, while no significant difference was observed in the normal/involuted thymus group. In conclusion, CT may be used to distinguish LFH thymus from normal/involuted thymus in MG patients.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Cardiac and Thoracic Surgery, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Peng Zhang
- Department of Cardiac and Thoracic Surgery, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Tie-Lian Yu
- Department of Radiology, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| |
Collapse
|