ABSTRACT
Objective:To study the magnetic resonance imaging (MRI) features of hepatocellular adenomas (HCA).Methods:The MRI images of 36 patients who were diagnosed to have HCA by pathology at Wenzhou Chinese Medicine Hospital and Wenzhou People’s Hospital between January 2013 to May 2018 were reviewed retrospectively. There were 14 males and 22 females, age ranged from 27 to 85 (46±4) years. The location, size, morphology, signal intensity and enhancement modes of tumors were observed.Results:For plain scans of MRI: among 36 patients, the lesions of 10, 23 and 3 patients respectively were located in the left, right and both left and right hemilivers. The lesions of 15, 12 and 9 patients were round-like, oval-like and nodular shape, respectively. The maximum diameter ranged from 2.0 to 11.0 (4.8±2.6) cm. T 1 weighted imaging (T 1WI) of 21, 11, and 4 patients showed low signal, iso-signal, and slightly high signal, respectively. T 2 weighted imaging (T 2WI ) of 33, and 3 patients showed high, or slightly high signal and iso-signal, respectively. T 2WI on fat-suppression of 32 and 4 patients showed high, or slightly high signal and iso-signal, respectively. Diffusion weighted imaging (DWI) of 24, and 12 patients showed high or slightly high signal and iso-signal, respectively. T 2WI of 11 patients showed a high signal ring while the center had a relatively low signal, called the " atoll" sign. Of the 36 patients, 30 had a peritumoral low-signal pseudo-envelope, 11 had intratumoral necrosis, and 8 had intratumoral hemorrhage. On dynamic contrast enhancement scanning: the arterial phase of 22 and 14 patients showed uniform enhancement and uneven enhancement, respectively, while 16 lesions showed significant enhancement, in 15 patients moderate enhancement, and in 5 patients mild enhancement. In the portal venous phase of 7, 12 and 17 patients, the tumor signals were higher, equal and lower than the liver parenchyma signal, respectively. In the delayed phase of 1, 18 and 17 patients, the tumor signals were higher, equal and lower than the liver parenchyma, respectively. In the portal vein and delayed phase, 30 and 6 patients, the pseudocapsules showed mildly enhanced and no enhancement, respectively. Conclusion:HCA is mostly round or oval, T 1WI low signal, T 2WI, T 2WI fat suppression and DWI showed high or slightly high signal. Significant enhancement of arterial phase enhancement, mild enhancement of portal phase and delayed phase, a " atoll sign" and a peritumoral pseudocapsule are helpful for diagnosis.
ABSTRACT
Objective:To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods:The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results:Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T 1 weighted imaging (T 1WI), high signal on T 2 weighted imaging (T 2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T 1WI, high signal on T 2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T 1WI, high signal on T 2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" . Conclusion:MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other; a " target sign" on T 2WI; a capsule " shriveled sign " ; and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.
ABSTRACT
Objective:To investigate the CT features of primary hepatic lymphoma in order to improve the accuracy of diagnosis.Methods:The clinical data, CT and pathological findings of 11 patients with primary hepatic lymphoma confirmed by surgery and pathology in Wenzhou Medical University Affiliated Yueqing Hospital, Wenzhou People′s Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical College from September 2008 to September 2018 were retrospectively analyzed.Results:Among the 11 patients, the tumors were located in the right liver in 7 cases, in the left liver in 2 cases, and in the left and right lobe of the liver in 2 cases; there were 27 tumors with the largest diameter of 1.7 to 12.6 cm; the tumors were round in 3 cases, oval in 5 cases and irregular in 3 cases; the tumor boundary was clear in 8 cases and unclear in 3 cases. CT scan showed low density in 6 cases, slightly low density in 3 cases and equal density in 2 cases; the density was uniform in 7 cases and inhomogeneous in 4 cases; CT value was 26 to 47 (38 ± 5) HU; there were 2 cases of splenic metastasis, 1 case of rib metastasis and 1 case of abdominal and retroperitoneal lymph node enlargement. CT enhanced scan showed no obvious enhancement in 1 case; in arterial phase, mild to moderate enhancement was seen in 10 cases, including 8 cases of continuous circular enhancement at the edge of the lesions in portal venous phase and delayed phase, and 2 cases with nodular enhancement; the CT value of arterial phase was 30 to 68 (53.8 ± 11.6) HU, that of portal venous phase was 52 to 69 (64.3 ± 9.3) HU, and that of delayed phase was 43 to 64 (56.4 ± 6.0) HU. Eight cases were completely resected, and 6 cases recurred after operation. Five cases survived for 3 years and 2 cases survived for 5 years; 3 cases were not completely resected, and all of them recurred after operation. One case survived for 3 years and no patient survived for 5 years. Among them,. Pathological diagnosis was diffuse large B-cell lymphoma in 10 cases and T-cell lymphoma in 1 case.Conclusions:CT examination of primary hepatic lymphoma has important value in the localization, qualitative and auxiliary clinical diagnosis of the tumor.
ABSTRACT
Objective:To investigate the computed tomography (CT) features of gastric neuroendocrine neoplasm (GNEN).Methods:The retrospective and descriptive method was conducted. The clinicopathological data of 30 GNEN patients who were admitted to two domestic medical centers (13 cases in Wenzhou Hospital of Traditional Chinese Medicine and 17 cases in Wenzhou People′s Hospital) from January 2010 to December 2018 were collected. There were 23 males and 7 females, aged (62±4)years, with a range from 27 to 78 years. The patients underwent abdominal CT plain scan and dynamic enhancement scan. Two associate chief radiologists with more than 20 years of work experience observed and analyzed all the images respectively. Observation indicators: (1) CT examination; (2) treatment and postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect the survival of patients up to December 2018. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Results:(1) CT examination: of the 30 patients, 14 had the tumor located in the fundus of stomach, 10 had the the tumor located in the body of stomach, and 6 had the tumor located in the antrum. The tumor was elliptical in 18 cases and irregular in 12 cases. There were 15 cases of endogenous type, 13 cases of exogenous type, and 2 cases of intramural type. Patients with G1 neuroendocrine tumor had the maximum diameter of (6.8±1.6)cm, of which 4 cases had the maximum diameter less than 5.0 cm and 4 cases had the maximum diameter of 5.0 to 10.0 cm. Patients with G2 neuroendocrine tumor had the maximum diameter of (8.3±2.7)cm, of which 1 case had the maximum diameter less than 5.0 cm, 4 cases had the maximum diameter of 5.0 to 10.0 cm, and 2 cases had the maximum diameter greater than 10.0 cm. Patients with G3 neuroendocrine carcinoma had the maximum diameter of (17.8±2.2)cm, of which 6 cases had the maximum diameter of 5.0 to 10.0 cm and 9 cases had the maximum diameter more than 10.0 cm. The tumor showed swelling growth in 14 cases and invasive growth in 16 cases. The tumor boundary was clear in 14 cases and unclear in 16 cases. CT plain scan showed homogeneous tumor density in 10 cases and heterogeneous density in 20 cases. Nine patients had iso-density in the tumor parenchymal part, and the CT value was (34.0±3.5)HU. In the 18 cases of low density, the CT value was (16.6±1.4)HU. In the 3 cases of high density, the CT value was (45.3±3.6)HU. Of the 30 patients, 21 cases had small punctate or small round necrotic cyst lesions in the tumor, 10 cases had mesenteric lymph node, peritoneum, liver metastasis and adjacent omentum invasion; 17 cases had abdominal effusion. In the CT enhancement examination, 12 cases showed mild enhancement, and the CT value was (56.5±6.3)HU; 15 cases showed moderate enhancement, and the CT value was (66.0±5.4)HU; 3 cases showed significant enhancement, and the CT value was (76.6±5.8)HU. Seven cases showed homogeneous enhancement and 23 cases had heterogeneous enhancement. There were 8 cases with tortuous vessels. (2) Treatment and postoperative pathological examination: of the 30 patients, 10 cases with mesenteric lymph nodes, peritoneum, liver metastasis and adjacent omentum invasion underwent radical total gastrectomy; 14 cases without surrounding tissue invasion or metastasis underwent radical subtotal gastrectomy; 6 cases with tumor diameter less than 4.0 cm and without surrounding tissue invasion or metastasis underwent endoscopic resection. All the 30 patients were confirmed GNEN by postoperative pathological examination, including 8 cases of G1 neuroendocrine tumor, 7 cases of G2 neuroendocrine tumor, and 15 cases of G3 neuroendocrine carcinoma. Results of immunohistochemical staining showed that 30 patients were positive for synaptophysin, 23 were positive for chromogranin A, and 9 were positive for cytokeratin. (3) Follow-up: all the 30 patients were followed up for 10-80 months, with a median follow-up time of 39 months. The 5-year survival rate of 30 patients was 43.3% (13/30). The 5-year survival rates were 6/8, 3/7 and 4/15 of patients with G1 neuroendocrine tumor, G2 neuroendocrine carcinoma, and G3 neuroendocrine carcinoma.Conclusions:GNEN has the main manifestation as abdominal pain, with G3 as pathological classification, which is common in fundus and body of stomach. The CT findings of GNEN are characterized by swelling or infiltrating growth and round or irregular low-density masses. Tumors are prone to cystic transformation, and showed the mildly to moderately heterogeneous enhancement.
ABSTRACT
Objective@#To investigate the clinical and imaging features of primary peripheral primitive neuroectodermal tumors (pPNETs) of bone.@*Methods@#Clinical and X-ray, CT and MRI findings of 6 cases of primary bone pPNETs in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang, Yueqing People′s Hospital of Zhejiang, and Wenzhou People′s Hospital of Zhejiang were retrospectively analyzed.@*Results@#There were 4 males and 2 females, aged from 2 to 38 years, with an average age of (18.5 ± 12.0) years old. Local pain was found in all cases, including 4 cases with mass, with an average survival of (22.2 ± 16.9) months. Iliac bone tumor was found in 2 cases, sacrum in 2 cases, scapula in 1 case and femur in 1 case. Digital radiography(DR) examination was performed in 4 cases:4 cases showed osteolytic destruction, including 1 case with mild swelling changes, 1 case with laminar periosteal reaction and radial bone needle, and 3 cases with soft tissue mass. CT examination was done in 4 cases, and there were 4 cases of osteolytic destruction accompanied by soft tissue mass without periosteal reaction. Among them, 1 case had irregular sclerosis at the edge of bone destruction and 2 cases had fine calcification in soft tissue mass. MRI examination in 4 cases:there were 3 cases with equal signal on T1WI and 1 case with moderate to high signal on T1WI, 3 cases with inhomogeneous medium and high signal on T2WI and STIR, and 1 case with homogeneous high signal on T1WI, and 4 cases with soft tissue masses and peritumoral edema.@*Conclusions@#Bone pPNETs is characterized by osteolytic destruction with soft tissue masses, periosteal reaction with or without periosteal reaction, and intratumoral calcification. Imaging examination is helpful to understand the extent of lesions, formulation of therapeutic measures and evaluation of therapeutic effect.
ABSTRACT
investigate the clinical and imaging features of primary peripheral primitive neuroectodermal tumors (pPNETs) of bone. Methods Clinical and X-ray, CT and MRI findings of 6 cases of primary bone pPNETs in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang, Yueqing People′s Hospital of Zhejiang, and Wenzhou People′s Hospital of Zhejiang were retrospectively analyzed. Results There were 4 males and 2 females, aged from 2 to 38 years, with an average age of (18.5 ± 12.0) years old. Local pain was found in all cases, including 4 cases with mass, with an average survival of (22.2 ± 16.9) months. Iliac bone tumor was found in 2 cases, sacrum in 2 cases, scapula in 1 case and femur in 1 case. Digital radiography(DR) examination was performed in 4 cases:4 cases showed osteolytic destruction, including 1 case with mild swelling changes, 1 case with laminar periosteal reaction and radial bone needle, and 3 cases with soft tissue mass. CT examination was done in 4 cases, and there were 4 cases of osteolytic destruction accompanied by soft tissue mass without periosteal reaction. Among them, 1 case had irregular sclerosis at the edge of bone destruction and 2 cases had fine calcification in soft tissue mass. MRI examination in 4 cases:there were 3 cases with equal signal on T1WI and 1 case with moderate to high signal on T1WI, 3 cases with inhomogeneous medium and high signal on T2WI and STIR, and 1 case with homogeneous high signal on T1WI, and 4 cases with soft tissue masses and peritumoral edema. Conclusions Bone pPNETs is characterized by osteolytic destruction with soft tissue masses, periosteal reaction with or w ithout periosteal reaction, and intratumor al calcification. Im aging exam ination is helpful to under stand the extent of lesions, formulation of therapeutic measures and evaluation of therapeutic effect.
ABSTRACT
Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.
ABSTRACT
Objective To study the medical imaging findings and the pathological features of hepatic inflammatory myofibroblastic tumor (HIMT) using CT,MRI and histopathology.Methods The CT and MRI findings of 31 patients with HIMT which were confirmed by histopathology on surgically resected specimen were analyzed retrospectively.The location,size,shape,edge,density or signal,and contrast enhancement of these tumors were analyzed.Results The tumors were located in the right liver in 26 patients,in the left liver in 5 patients,and under the hepatic capsule in 27 patients.The tumors were solitary in 28 patients and multiple in 3 patients.The maximum diameter of the tumor ranged from 2.1 cm to 12.5 cm.The average diameter was (3.6 ± 1.2) cm.The tumors were round or oval in 21 patients and irregular in 10 patients.19 patients underwent CT examination and all tumors showed low density,with a CT value which ranged from 5 to 35HU.The average value was (27.6 ±5.3) HU.The density of tumors was homogeneous in 6 patients and inhomogeneous in 13 patients,and among these 13 patients,3 were alveolate.Twenty-one patients underwent MRI scan and all showed a low signal on T1WI,12 patients showed an equal signal and 9 patients showed a slightly higher signal on T2WI.In 6 patients the signals were homogeneous and in 15 patients they were inhomogeneous.On CT and MRI enhanced scans the whole tumor was enhanced in 12 patients,the edge was enhanced in 9 patients,the septum was enhanced in 8 patients and no enhancement was observed in 2 patients.Pathological examination under microscopy observed the presence of proliferation of spindle cells,chronic inflammatory cells which included the proliferation of lymphocytes,plasma cells and collagen fiber formation.The spindle cells had the characteristics of fibroblasts and myofibroblast cells.Immunohistochemical examination showed the wave type protein (Vimentin) was positive in 23 patients,the smooth muscle actin (SMA) was positive in 18 patients,the muscle actin (MSA) and the specificity of junction protein (Desmin) were positive in 12 patients,CD68 was positive in 4 patients,and the ALK,S-100 protein,CDll7 and CD35 were all negative.Conclusions The radiological features of CT and MRI plain scan varied.The patterns of contrast enhancement included full tumor filling,marginal enhancement,compartment enhancement,and no enhancement.The enhanced features varied from mild to moderate enhancement in the arterial phase,further enhancement in the portal phase and mild enhancement in the delayed phase.
ABSTRACT
Objective To study the medical imaging findings and the pathological features of hepatic inflammatory myofibroblastic tumor (HIMT) using CT,MRI and histopathology.Methods The CT and MRI findings of 31 patients with HIMT which were confirmed by histopathology on surgically resected specimen were analyzed retrospectively.The location,size,shape,edge,density or signal,and contrast enhancement of these tumors were analyzed.Results The tumors were located in the right liver in 26 patients,in the left liver in 5 patients,and under the hepatic capsule in 27 patients.The tumors were solitary in 28 patients and multiple in 3 patients.The maximum diameter of the tumor ranged from 2.1 cm to 12.5 cm.The average diameter was (3.6 ± 1.2) cm.The tumors were round or oval in 21 patients and irregular in 10 patients.19 patients underwent CT examination and all tumors showed low density,with a CT value which ranged from 5 to 35HU.The average value was (27.6 ±5.3) HU.The density of tumors was homogeneous in 6 patients and inhomogeneous in 13 patients,and among these 13 patients,3 were alveolate.Twenty-one patients underwent MRI scan and all showed a low signal on T1WI,12 patients showed an equal signal and 9 patients showed a slightly higher signal on T2WI.In 6 patients the signals were homogeneous and in 15 patients they were inhomogeneous.On CT and MRI enhanced scans the whole tumor was enhanced in 12 patients,the edge was enhanced in 9 patients,the septum was enhanced in 8 patients and no enhancement was observed in 2 patients.Pathological examination under microscopy observed the presence of proliferation of spindle cells,chronic inflammatory cells which included the proliferation of lymphocytes,plasma cells and collagen fiber formation.The spindle cells had the characteristics of fibroblasts and myofibroblast cells.Immunohistochemical examination showed the wave type protein (Vimentin) was positive in 23 patients,the smooth muscle actin (SMA) was positive in 18 patients,the muscle actin (MSA) and the specificity of junction protein (Desmin) were positive in 12 patients,CD68 was positive in 4 patients,and the ALK,S-100 protein,CDll7 and CD35 were all negative.Conclusions The radiological features of CT and MRI plain scan varied.The patterns of contrast enhancement included full tumor filling,marginal enhancement,compartment enhancement,and no enhancement.The enhanced features varied from mild to moderate enhancement in the arterial phase,further enhancement in the portal phase and mild enhancement in the delayed phase.
ABSTRACT
Objective To explore the value of MRI in differentiation diagnosis of benign ovarian mucin-ous cystadenoma ( MC) and borderline mucous cystadenoma ( BMC).Methods MRI data of 23 cases of benign MC and 14 cases of BMC, confirmed by surgery and pathology, were retrospectively analyzed, including tumor lo-cation, shape, size, loculation, signal intensity of cyst fluid, cyst wall, cyst septum and nodules, and they were compared with pathological results.Results Single loculus benign cystadenoma nodules showed isointensity T2 WI signal, low T1 WI signal, and low DWI signal.Single loculus borderline cystadenoma nodules showed high T2 WI signal, low T1 WI signal, and high DWI signal.Signs such as honeycomb loculi of multilocular cystadeno-ma, cyst fluid of high T1 WI signal, cyst fluid of low T2 W1 signal, cyst wall and irregularly thickened cyst septum ( >3 mm) were more seen in BMC (7/11, 6/11 and 7/11) than in MC (5/18, 4/18 and 5/18);5 cases were with cyst sediments (MC=4, BMC=1), showing moderate T2WI signals, and high T1WI signals.Broken fish-ing net gathering was only restricted to MC (5/18) with characteristics.Benign multilocular cystadenoma nodules showed low DWI signal,and borderline multilocular cystadenoma nodules showed high DWI signal.Conclusion MRI can well display pathological characteristics of ovarian MC, which has practical value for the differentiation and diagnosis of MC and BMC and can provide the reference for clinical surgery.