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Objective To summarize the radiological features of follicular dendritic cell tumor of spleen (FDCS).Methods The clinical, radiological and pathological data of 8 patients from November 2011 to November 2017 in 5 hospitals with FDCS confirmed by pathology were retrospectively analyzed. All patients underwent CT examinations including plan and enhanced CT. Three patients underwent additional MRI and two patients underwent PET‐CT examinations simultaneously. The imaging features such as location, number, shape, boundary, size, internal structure, density (or signal, 18F‐fluorodeoxyglucose uptake), enhancement model and the relationship with surrounding structures were observed and compared with pathological results. Results Of the 8 patients with FDCS, 7 were located in the spleen and 1 was located in the spleen of the ectopic spleen of the pancreas. Seven patients with splenic FDCS underwent splenectomy and 1 patient with pancreatic ectopic spleen FDCS underwent resection of the pancreas. Multiple lesions were detected in 1 case, while single in the others. Tumor was round or oval. The tumors were well‐circumscribed and presented as expansive growth. On unenhanced CT, the tumors showed a slightly lower density, and hemorrhage and necrosis could be detected in 6 lesions. Calcification was seen in 1 case, significant necrosis, and cystic change was presented in the pancreatic ectopic spleen FDCS. The solid part presented isointensity or slightly hypointensity on T1WI, and hyperointensity on T2WI. Cystic necrosis areas were hypointensitive on T1WI, and hyperointensitive on T2WI. Spoke‐like areas with hypointensity on T1WI and hyperointensity on T2WI were detected in the center of the solid part with the distribution among the substantial degenerative and necrotic regions. PET‐CT showed that the 18F‐fluorodeoxyglucose was uptaked obviously. The enhancement CT showed that at the arterial phase, the tumors were markedly enhanced and continuously enhanced at portal vein phase and balance phase. Multiple liver metastases were detected in 1 case with huge FDCS. One patient was followed up for 6 years, and gastric lymphoma was detected. The others were followed up for 6 to 53 months, there remained no transfer or recurrence.Conclusions The features of FDCS of spleen mainly manifest as solid or cystic mass with clear solitary sphenoma accompanied by scarring, calcification and hemorrhage. The enhancement mode is persistent enhancement. MRI and PET‐CT help to further reflect the tumor pathological basis and biological characteristics.
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Objective To evaluate preoperative apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (eADC) in diffusion weighted imaging (DWI) on microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods We retrospectively reviewed 43 HCC patients with DWI data confirmed by surgery and pathology.ADC and eADC values were measured both in neoplasm and hepatic tissue,the ratio of tumor to liver (T/L) on ADC and eADC was calculated.The correlation between MVI and ADC value,T/L of ADC value,eADC value and T/L of eADC value was analysed,the best cut-off value of variables was analysed by ROC curve,multi factor analysis was carried out by Logistic regression model.Results The ADC value,T/L of ADC,eADC value and T/L of eADC were (1.458 ± 0.444) × 10-3 mm2/s,0.787 ± 0.186,0.289 ± 0.144 and 1.383 (1.179,1.655),respectively.Among them,the positive MVI group were (1.232 ± 0.480) × 10-3 mm2/s,0.683 ± 0.229,0.323 ±0.123 and 1.630(1.387,2.066),respectively.The negative MVI group were(1.545 ±0.404) × 10-3mm2/s,0.844 ±0.149,0.277 ±0.152 and 1.303(1.176,1.545),respectively.There was significant difference in ADC value,T/L of ADC value and T/L of eADC value (t =2.164,2.654,z =-2.058,all P ＜0.05),the area under the ROC curve were (1.085 × 10-3) mm2/s,0.685 and 1.475 using MVI as a diagnostic standard.Multivariate analysis showed that T/L of ADC value was an independent factor affecting MVI of HCC (OR=0.002,95％CI:1.380E-5-0.311,P＜0.05).Conclusions The ADC value in HCC patients with positive MVI is lower than in HCC patients with negative MVI,T/L of eADC value is higher than in HCC patients with negative MVI,and T/L of ADC value is an independent factor predicticing MVI of HCC.
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Objective To explore CT,MRI and 18F-FDG PET/CT features of splenic lymphangioma.Methods A retrospective analysis of 18 pathology proved splenic lymphangioma cases was made,including their clinical,imaging characteristics and pathological findings.15 cases with plain and enhanced CT scan,6 cases with plain and enhanced MRI scan and 1 case with 18F-FDG PET/CT examination.Results (1) 13 cases were single lesion,4 cases were multiple lesions and 1 case was lymphangiomatosis.The largest diameter was 15.8 cm,minimum diameter was less than 1.0 cm.(2) On CT imaging:cystic watery density and equal density interval was showed in 12 cases,in 3 cases as solid and slightly were showed lower density.Calcification was showed in 3 cases.On enhanced CT,internal septa was slightly enhanced and progressive inhomogeneous enhancement was shown in 3 cases.(3) On MRI imaging:cystic content was manifested as low signal on T1WI and high or highlight signal on T2WI,and there was a difference between the lesion and the splenic tissue on DWI.(4) One case underwent PET/CT imaging:18F-FDG uptake was not increased.Conclusions Preoperative CT,MRI and 18F-FDG PET/CT help establish a tentative diagnosis of splenic lymphangioma while final diagnosis relies on pathological examination.
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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG)positron-emission temography/computed tomography (PET/CT) examination to predict microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods The retrospective cohort study was conducted.The clinicopathological data of 51 HCC patients who were admitted to Changhai Hospital of the Second Military Medical University (32 patients) and Universal Medical Imaging Diagnostic Center (19 patients) from January 2013 to October 2017 were collected.Of 51 patients receiving postoperative pathological examination,21 diagnosed with positive MVI and 30 diagnosed with negative MVI were respectively allocated into the positive and negative MVI groups.All the patients received preoperative 1s F-FDG PET/CT examination and underwent surgery after related examinations.Two imaging doctors independently read films and made a semi-quantitative analysis.Observation indicators:(1) results of 18F-FDG PET/CT examination;(2) multivariate analysis and diagnostic value affecting MVI of HCC;(3) treatment and follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients' survival up to November 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the independent-sample t test.Measurement data with skewed distribution were described as M (Qn),and comparisons between groups were analyzed using the independent-sample rank sum test.Comparisons of count data were analyzed using the chisquare test.Logistic regression analysis was performed in variables with statistical significance.The inclusion criteria was 0.05 and exclusion criteria was 0.10 according to Backward (LR) method for screening variables.Receiver Operating Characeristic (ROC) curve analysis was used to evaluate the diagnostic value using MVI as a diagnostic standard.Results (1) Results of 18F-FDG PET/CT examination:of 51 HCC patients,tumors located in the right lobe,left lobe and caudate lobe of the liver were respectively detected in 37,12 and 2 patients.CT examinations of 51 HCC patients:HCCs showed the hypodense shadow or slightly hypodense shadow in liver and were round-like,and some of the larger lesions were irregularly conglomerate,with a relatively clear tumor-liver boundary;tumor necrosis area showed patchy and irregular lower density,with small lesions around the port of tumors.Of 51 patients,34 were positive on PET and 17 were negative on PET,and some necrotic areas showed no uptake and located in the center of tumors.There was no abnormal 18 F-FDG uptake in other parts of the whole body.The maximum diameter of tumor was (6± 3)cm.The maximum standardized uptake value (SUVmax),and ratio of SUVmax of tumor to SUVmax of liver (SUVmax T/L) in all the lesions were 6.38±4.91 and 2.42±1.93,respectively.The mean standardized uptake value (SUVmean),metabolism of volume (MTV),total lesion of glycolysis (TLG) of 40 patients were 4.30± 2.46,43.82 cm3 (8.97 cm3,219.13 cm3) and 165.73 (28.26,794.50),respectively,and software could not automatically delineate lesions in other 11 patients due to low metabolism.Delayed imaging was found in 21 patients,and the delayed SUVmax and retention index (RI) were 7.22±6.26,19.66％ (-7.10％,50.84％),respectively.The cases with positive and negative on PET were 18,3 in the positive MVI group and 16,14 in the negative MVI group,respectively,with a statistically significant difference between groups (x2=5.829,P＜0.05).The maximum diameter of tumor in the positive MVI group and negative MVI group was respectively (7.7±2.9)cm and (5.2±3.1)cm,with a statistically significant difference between groups (t=-2.930,P＜0.05).(2) Multivariate analysis and diagnostic value affecting MVI of HCC:the results of multivariate analysis showed that maximum diameter of tumor was an independent factor affecting MVI of HCC (OR=1.276,95％ confidence interval:1.028-1.585,P＜0.05).The area under the ROC curve of the maximum diameter of tumor was 0.723 using MVI as a diagnostic standard.The sensitivity,specificity and Youden index were respectively 90.5％,50.0％ and 0.405,with 4.55 cm as the critical value.(3) Treatment and followup:all 51 patients underwent tumor resection.Twenty-two patients were followed up for 25 months (range,12-46 months).The 1-and 2-year overall survival rates were 81.8％ (18/22) and 63.6％ (14/22),respectively.The 1-and 2-year tumor-free survival rates were 59.1％ (13/22) and 45.5％ (10/22),respectively.Conclusion The positive rate on PET of 18F-FDG PET/CT examination in HCC patients with positive MVI is higher than that in HCC patients with negative MVI,and the maximum diameter of tumor is an independent factor predicting MVI of HCC,with a certainly reference value.
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Objective To summarize the computed tomography (CT),magnetic resonance imaging (MRI) and fluorine-18 fluorodeoxy glucose (18 F-FDG) positron emission tomography (PET)/CT features of abdominal non-organi lymphangioma.Methods The retrospective cross-sectional study was conducted.The clinical data of 16 patients with abdominal non-organi lymphangioma who were admitted to the Affiliated Hospital of Ningbo University (11 patients) and the Changhai Hospital Affiliated to the Second Military Medical University (5 patients) between January 2009 and December 2015 were collected.All the patients received CT,MRI and 18F-FDG PET/CT examinations.Observation indicators:(1) imaging examinations;(2) imaging features of CT and MRI;(3) imaging features of PET/CT;(4) treatment and follow-up.Operations were applied to patients based on agreements of patients and families after finishing preoperative examinations,and postoperative pathological examinations were also performed.Follow-up using outpatient examination and telephone interview was performed once every 6-12 months postoperatively up to July 2016.Results (1) Imaging examinations:of 16 patients,12 underwent plan and contrast-enhanced CT scans,5 underwent plan and contrast-enhanced MRI scans,2 underwent plan MRI scans and 1 underwent 18 F-FDG PET/CT scan.One patient underwent simultaneously CT,MRI and 18 F-FDG PET/CT examinations and 2 patients underwent simultaneously CT and MRI examinations.(2) Imaging features of CT and MRI:① Classification of lymphangioma:unilocular cyst,plurilocular cyst and lymphangiomatosis were detected in 6,9 and 1 patients,respectively.② Lymphangioma location:9 of lymphangioma located in the single regions (6 with unilocular cyst and 3 with plurilocular cyst),7of lymphangioma involved multiple regions (6 with unilocular cyst and 1 with lymphangiomatosis).③ Lymphangioma diameter:lesion diameter was 4-25 cm,with an average of 12 cm,and diameter in 9 of lymphangioma was more than 10 cm.④ Lymphangioma shape:3 lymphangiomas were regular-shaped,showing round-like changes,and 13 lymphangiomas were irregular-shaped,showing'moulding'-like changes.⑤ Internal structure of lymphangioma:internal structures in 12 patients undergoing plain CT scans presented as liquid low density,with homogeneous density and-10-19 HU of CT value.MRI scans in 7 patients showed low signal on T1WI and high signal on T2WI,with homogeneous signals.No bleeding was found inside the abdominal non-organi lymphangiomas of 16 patients.The fluid-fluid level was detected in 1 patient with lymphangioma due to bleeding in pathological changes of liver.The septa and wall thickness was less than 2 mm in 15 patients with lymphangiomas,and was more than 3 mm in 1 plurilocular cyst lymphangioma,showing a equal density and isointensities on T1WI and T2WI.There was no nodule and calcification in 16 patients.⑥ Lymphangioma boundary:15 patients had clear boundary of lymphangioma and 1 had an unclear boundary of lymphangioma.⑦ Extrusion of adjacent organs:lymphangiomas in 10 patients were local concave,showing arc-shaped impression and hilar depression,lymphangiomas in 4 patients showed surrounding blood vessels,and fat density or signal inside lymphangioma was found in 2 patients.There were no surrounding intestine and lymph node enlargement in 16 patients.⑧ Lymphangioma reinforcement:of 14 patients with contrast-enhanced scans,septa and wall of lymphangiomas demostrated slight enhancement in 13 patients and moderate enhancement in 1 patient,and all contents showed no enhancement.(3) Imaging features of 18F-FDG PET/CT:inhomogeneous uptake of FDG was manifested in 1 plurilocular cyst lymphangioma,metabolic activity of the lesion was slightly higher than liver,SUVmax=3.71.(4) Treatment and follow-up:14 patients underwent single resection of lymphangioma (6 with unilocular cyst and 8 with plurilocular cyst);1 patient with plurilocular cyst lymphangioma underwent resection of lymphangioma,descending part of duodenum,pancreatic head and ascending colon;1 patient with lymphangioma underwent splenectomy due to smaller lesion.Sixteen patients were confirmed with lymphangioma by postoperative pathological examinations.Of 16 patients,13 were followed up for 6-31 months,with a median time of 15 months.During the follow-up,12 patients had no recurrence,with satisfactory outcomes,and 1 with recurrence of lymphangioma underwent multiple cervical and thoracic resections under right arm and sclerotherapy.Conclusion Abdominal non-organi lymphangioma has some imaging characteristics,it usually manifests as a larger mass with plurilocular cyst,moulding,liquid density/signal,thin septa and wall and clearly boundary.Plurilocular cyst lymphangioma has uptake of 18F-FDG.
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Objective To investigate and summarize the MRI characteristics of splenic sclerosing angiomatoid nodular transformation (SANT).Methods A retrospective analysis of 5 SANT cases were analyzed,in terms of their MRI characteristics and pathological findings.Results MRI findings of SANT included:T1WI presents iso-signal or slightly low signal,all displayed lesions were detected as low signal compared with spleen,but higher than muscle signal on T2 WI,and with speck dots or starlike low signal in the central area,without necrosis and cystic change.The signal was significantly differentiated compared with the spleen on DWI.On chemical shift imaging,2 cases were showed slightly higher signal on out phase,the others without signal change.On enhanced scan,4 cases had edge obvious enhancement on arterial phase,inward filling enhancement,and the signal was higher than the spleen,1 case without arterial phase enhancement,but with mild concentric delayed enhancement.All of the speck dots and starlike areas decreased with time delay,with certain degree enhancement on delayed phase.Conclusions There were some MRI features of SANT,preoperative MRI can prompt diagnosis,but final diagnosis depends on pathology.
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Objective To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of intestinal-type and pancreaticobiliary-type invasive adenocarcinomas of the ampullary region (IAARs) and investigate the value of the differential diagnosis.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 33 patients with IAAR who were admitted to the Lanzhou University Second Hospital (20 patients) and Affiliated Hospital of Ningbo University (13 patients) between September 2013 and August 2015 were collected.The patients underwent plain and enhanced scans of CT and MRI.(1) Observation indictors included tumor size,shape,growth pattern,boundary,internal structure,density and/or signal,style and/or degree of contrast enhancement,changes of bile and/or pancreatic duct,invasion and metastasis.(2) The clinical and imaging features of intestinal-type and pancreaticobiliary-type IAARs were compared.(3) Operation was performed after preoperative examinations,and patients received the postoperative pathological examination and immunohistochemistry.Measurement data with normal distribution were presented as x-±s.Comparison between groups was evaluated with an independent sample t test,and count data were analyzed using the chi-square test.Results (1) Of 33 patients with IAAR,19 received plain scan of CT,including 17 receiving simultaneous enhanced scan of CT.Fourteen patients [9 receiving diffussion-weighted imaging (DWI) sequence of MRI] received plain scan of MRI,including 12 receiving simultaneous enhanced scan of MRI.The maximum diameter of IAAR in 33 patients was (2.8 ± 1.4)cm.Fourteen tumors were round-like or oval shape and 19 tumors were irregular shape.The intracavity type,extracavity type and mixed type of tumors were detected in 24,6 and 3 patients,respectively.There were clear boundary of tumors in 17 patients and fuzzy boundary of tumors in 16 patients.Tumors of 5 patients had appeared necrotic and/or cystic,no hemorrhage or calcification was found in tumors of 33 patients.Density and signal of tumors were homogeneous in 18 patients and inhomogeneous in 15 patients.Of 29 patients receiving enhanced scan of CT or MRI,homogeneous enhancement and inhomogeneous enhancement were respectively detected in 14 and 15 patients,and mild enhancement,moderate enhancement and no enhancement were respectively detected in 15,14 and 0 patients.Tumors of 9 patients in DWI showed slightly high or high signal.Thirty patients had secondary bile duct dilatation (3 with mild dilatation,6 with moderate dilatation and 21 with severe dilatation),and 3 patients had no changes of bile duct.Twenty-six patients had secondary pancreatic duct dilatation and 7 had no changes of pancreatic duct.Sixteen patients had tumor invasion to pancreatic tissues and 7 had lymph node metastases.(2) Of 33 patients with IAAR,19 had intestinal-type IAAR (8 males and 11 females) and 14 had pancreaticobiliary-type IAAR (11 males and 3 females).There was statistically significant difference in the gender between the 2 types of IAAR (x2=4.388,P ＜ 0.05).The intracavity type,extracavity type and mixed type of tumors,clear boundary and fuzzy boundary of tumors,homogeneous and inhomogeneous density and/or signal of tumors,with and without tumor invasion to pancreatic tissues were respectively detected in 17,0,2,13,6,14,5,6,13 patients with intestinal-type IAAR and 7,6,1,4,10,4,10,10,4 patients with pancreaticobiliary-type IAAR,with statistically significant differences between the 2 types of IAAR (x2=9.971,5.125,6.617,5.125,P ＜ 0.05).(3) All the patients underwent surgery and received comprehensive diagnosis and tumor classification after pathological examination and immunohistochemistry.Conclusion There are certain characteristics of CT and MRI in intestinal-type and pancreaticobiliary-type IAARs,and gender,tumor growth pattern,boundary,density and/or signal,tumor invasion to pancreatic tissues have certain reference values for the differential diagnosis of intestinal-type and pancreaticobiliary-type IAARs.