Magnetic resonance imaging features of choledochal traumatic neuroma / 中华消化外科杂志

Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma,and investigate the key points of diagnosis and differentiation.Methods This was a retrospective descriptive study.The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August,2015 were collected.The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP).Observational indexes included:(1) imaging features:location,size,signal intensity and enhancement characteristics of the lesion;(2) treatment and prognosis:surgical treatment,pathological findings,results of immunohistochemical staining and clinical follow-up.After preoperative related examinations,the patient and relatives were willing to receive surgical therapy,and postoperative pathological examinations and immunohistochemical staining were conducted.The follow-up using outpatient examination was performed to detect the patient's recovery and clinical symptoms up to January 2016.Ultrasound and laboratory examinations [alanine transaminase (ALT),aspartate transaminase (AST),γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded.Results (1) Imaging features:pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct.The nodular was measured 1.2 cm × 0.9 cm at maximum cross-section.The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma,slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image.MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts.The width of common bile duct was 1.4 cm.After administration of contrast materials,the nodular showed avid enhancement and delay enhancement,which was mild enhancement at the artery phase,and gradual increase at the portal vein phase and the delay phase.The length of central stricture of the common bile duct was 1.3 cm.There was no abnormal enhancement in liver,spleen and pancreas.No retroperitoneal lymphadenopathy could be seen.The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts.(2) Treatment and prognosis:the patient received surgery for tumor resection and Roux-en-Y reconstruction.The removed gross specimen was a grey-white nodular measured 2.0 cm × 1.0 cm.The cute surface was grey-white and stiff.The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma.Normal biliary epithelial cells can be seen beside the nerve bundles.Immunohistochemical staining showed S-100 and Vimentin were positive.The index of Ki-67 was 5％.The patient was discharged at 14 days postoperatively with the good recovery.During postoperative 5-month follow-up,the patient had good recovery and jaundice seleras were disappeared.Ultrasound showed the bile ducts were not dilated.The results of laboratory examinations were normal.Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration.

Imaging characteristics of hepatic epithelioid hemangioendothelioma / 中华消化外科杂志

Objective To summarize the imaging characteristics of the hepatic epithelioid hemangioendothelioma (EHE).Methods The clinical data of 6 patients with hepatic EHE who were admitted to the Yantaishan Hospital (3 patients), Zhangzhou Hospital of Traditional Chinese Medicine (2 patients) and Zhangqiu Hospital of Traditional Chinese Medicine (1 patient) between March 2007 and June 2014 were retrospectively analyzed.All the patients underwent plain scan and dynamic enhanced scan of computed tomography (CT), and the number,shape, size, location, density or signal, level and method of enhancement of the lesions were observed and analyzed.Six patients were followed up by outpatient imaging examination up to June 2014, and the changes of lesions were observed.Results Among the 6 patients, 1 solitary lesion and 5 multiple lesions were detected, and the total lesions were 125 including 1 patient with 75 lesions.The lesions were round or round-like and originated commonly from the right lobe of liver and hepatic subcapsular with a maximum diameter of 0.5-3.5 cm.Plain scan of CT showed that the lesions in 6 patients had low density with the clear boundary.MRI showed that low T1 WI signal and high or slightly high T2WI signal of the lesions were detected in 4 patients.Two patients had liver capsular retraction sign.The ring-like enhancement of 1 lesion and homogeneous enhancement of 5 lesions were found by dynamic enhanced scan of CT in 6 patients and enhanced scan of MRI in 4 patients.Enhanced signal in all the lesions was detected in the delayed phase.Veins into or through lesions were found in 3 lesions, with normal or narrowing vascular cavity.One patient had visible lollipop sign.Of the 6 patients, 5 were confirmed as with metastatic carcinoma of liver, and 1 was suggested as with cholangiocarcinoma.Six patients were diagnosed with hepatic EHE by pathological examination using hepatic biopsy technique.Among the 2 patients with hepatic EHE who didn't receive antineoplastic treatment after the diagnosis, 1 patient received CT examination at year 2 after first visit, which showed capsular retraction sign, and then was diagnosed as with secondary hepatic cirrhosis by MRI at 4 years after first visit.Another patient was diagnosed as with hepatic cirrhosis by CT examination at year 6.5 after first visit.One patient was diagnosed with tumor recurrence of hepatic left lobe by CT reexamination at postoperative year 4, and underwent ultrasound-guided radio frequency ablation (RFA) treatment based on no enlargement of tumor during 1-year follow-up, and then returned a normal condition after half year follow-up.Other 3 patients undergoing operation were followed up at postoperative year 1 , 4, 5 with no recurrence and metastasis.Conclusions Intrahepatic single or multiple nodules and delayed reinforcement by dynamic enhanced scan of CT and MRI are the typical imaging performances of hepatic EHE.There are certain characteristics in the liver the lollipop sign, capsular retraction sign and veins into or through the lesions.Mutual fusion and fibrosis of lesions leading ultimately to secondary liver cirrhosis may be characteristics of EHE growth.

Imaging characteristics of hepatic eosinophilic granuloma / 中华消化外科杂志

Hepatic eosinophilic granuloma is a rare benign liver lesion,which results from granuloma formation due to chronic inflammation.Two patients were admitted to the Yantaishan Hospital and Yuhuangding Hospital from July 2008 to April 2012,respectively.The results of laboratory examination showed the elevation of peripheral blood eosinophils,and ultrasound examinations revealed low-echo masses in the liver and no blood flow was detected.The results of computed tomography showed hypoattenuation lesions with well-demarcated boundary.After intravenous administration of contrast angent,the lesions demostrated delayed heterogeneous enhancement with internal grid.The results of magnetic resonance imaging of 1 patient showed the lesion had slight hyper-intensity to the surrounding liver parenchyma on T1-weighted images,and slight high signal with low signal separation strip inside on fat-suppressed T2-weighted images.An obvious high signal was detected in diffusion weighted imaging.Familiarity with the imaging characteristics and combination of the elevation of peripheral eosinophil can help surgeons to make a suggestive diagnosis.

Characteristics of spiral computed tomography imaging of primary hepatic malignant fibrous histiocytoma / 中华消化外科杂志

Primary hepatic malignant fibrous histiocytoma(PHMFH)remains extremely rare with less than 60 cases reported in literature.From October 1999 to May 2008,5 patients with PHMFH had been admitted to Yantai Cancer Hospital,Yantai Yuhuangding Hospital and the First Affiliated Hospital of Wenzhou Medical College,and the results of spiral CT were analyzed.Six tumors were detected,and the maximum diameter of the tumors was more than 8.5 cm.CT plain scanning revealed that all tumors were hypodense,4 patients with tumor necrosis and cystic degeneration,and the tumor in 1 patient wag with homogen density.Enhanced CT scanning showed marked enhancement of the solid component of tumor in 4 patients,slight enhancement in 1 patient,and a"fast in and fast out"sign in 5 patients.Hepatic bile ducts and portal vein were not involved.One patient was with portal lymph node metastasis and 1 with ioferior vena cava involvement.The characteristics of spiral CT imaging of PHMFH include tumor necrosis,cystis and invasion,as well as"fast in and fast out"sign,which could help to diagnose,although the ultimate diagnosis depends on histopathological examination.

CT Diagnosis of Thyroglossal Cyst(A Report of 12 Cases) / 实用放射学杂志

Objective To evaluate CT manifestations and pathologic findings of thyroglossal cyst.Methods CT manifestations,clinical materials and pathological findings of 12 cases with thyroglossal defined by pathology were analysed.Results Of 12 cases,the the lesions were located at the center line of the neck in 8 cases and at left of the neck in 4 cases.The cysts were round or oblate in shape on CT scans.In 5 cases the walls of cyst were smooth and no enhanced;while in other 7 cases the cystic walls were coarse and enhanced evidently which there were infiltration of inflammatory cell microscopic examination.The nodules at cystic wall which were composed by blood vessel,striated muscle and connective tissue on pathology could be seen on CT scans while if these nodules were minor,they could hardly to be showed by CT.Conclusion CT can make a proper diagnosis of thyroglossal cyst.

Imaging Diagnosis of the Lymphangiomyomatosis (A Report of 2 Cases) / 实用放射学杂志

Objective To improve the imaging recognition of the lymphangiomyomatosis.Methods The manifestations of 2 patients with lymphangiomyomatosis confirmed by pathological assessment were analyzed retrospectively and relevant literature were reviewed.Results Multiple,well-defined and thin-walled cysts were found on the chest HRCT.The size of the cystic airspace was different,and the wall of cysts ranged being fainted perceptible to near l mm in thickness.The retroperitoneal lymphangiomyomatosis were found in the 2 patients on CT images,and some lymphadens were confluence.The diameter of the largest lymphadens was 25 mm,no enhancement were found on contrast-enhanced CT scan.The right renal angioleiomyoma and retroperitoneal leiomyoma were presented in one patient,which were moderately homogeneous enhanced on contrast-enhanced CT scan.Conclusion Lymphangiomyomatosis is a rare lymphangial disease with smooth muscle abnormal hyperplasia.The diffuse cysts in bilateral lungs were its characteristic changes on CT images.Lymphangiomyomatosis can incorporate with renal angioleiomyoma,retroperitoneal leiomyoma and lymphangiomyomatosis.

MRI Diagnosis of Adrenal Myelolipoma(A Report of 13 Cases and Correlated with Pathology) / 实用放射学杂志

Objective To investigate the MRI manifestations and its pathologic foundation of adrenal myelolipoma.Methods MRI images of 13 patinets with adrenal myelolipoma confirmed by pathological assessment were analyzed retrospectively.MRI fingings were also studied in correlation with surgical pathology.Results The MRI diagnosis of adrenal myelolipoma in 13 patients were correct preoperative.Huge mass in the adrenal were found in 11 patients with T 1WI high signal intensity and mixed with conclamata and stripe low signal intensity.The high signal intensity was mature fatty tissue and the low signal intensity was myeloid tissue on pathologic examination.2 patients appeared as mixed signal intensity principle isointensity on T 1WI images,and the pathological findings was tumor hemorrhage.The high signal intensity changes to low signal intensity and slight higher than the signal of subcutaneous fatty tissue on T 1WI or T 1WI with fatty suppression.The low signal intensity of the myeloid tissue and the hemorrhage were high sinal intensity.No enhancement were found in all patients.Partly capsule enhancement were found in 2 patients with tumor hemorrhage and infection.The inferior cava vena was displaced to the anterior and internal side in all patients.Conclusion The characteristic manifestation of adrenal myelolipoma is high signal intensity change of the fatty tissue and no enhancement on contrast-enhanced MRI image.MRI could give correct diagnosis of the adrenal myelolipoma preoperative.