Imaging and pathological study of primary central nervous system lymphoma in special sites / 中华神经科杂志

Objective:To summarize the imaging and pathological features of primary central nervous system lymphoma in special sites, and analyze some misdiagnosed cases to provide help for clinical diagnosis.Methods:Thirty-nine patients with primary central nervous system lymphoma diagnosed by pathology from 2000 to 2019 in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The imaging and pathological features of primary central nervous system lymphoma in special sites were summarized, and the misdiagnosed cases in these special sites were analyzed.Results:Primary central nervous system lymphoma in special sites included one case of primary dural lymphoma, with thickening of dura mater and obvious enhancement; two cases with lesions in lateral ventricle, with homogeneous enhancement, involving ependyma and spreading to medulla oblongata; two cases with lesions in middle cerebellar peduncle, with patchy abnormal signals and no specific masses, mild to moderate enhancement after enhancement, and one misdiagnosed as demyelinating lesions; one case with lesions in the sellar region which obviously enhanced with a typical “dent sign”, misdiagnosed as invasive pituitary tumor. All the pathological findings indicated diffuse large B cell lymphoma.Conclusions:It is difficult to diagnose primary central nervous system lymphoma in special sites, which is easy to cause misdiagnosis. Understanding its imaging characteristics and pathology can help to diagnose the disease.

Value of dynamic enhanced multi-slice spiral computed tomography in the differentiation of benign and malignant intraductal papillary mucinous neoplasm of pancreas / 中华胰腺病杂志

Objective To analyze the value of dynamic enhanced multi-slice spiral computed tomography (MSCT) combined with two-dimensional (2D) curved reconstruction technique in the differentiation of benign and malignant intraductal papillary mucinous neoplasm (IPMN) of pancreas,and compare with magnetic resonance cholangiopancreatography(MRCP).Methods MSCT and MRCP data of a total of 50 patients with IPMNs confirmed by pathology after surgery was retrospectively reviewed.The benign and malignant IPMNs were differentiated based on the presence of mural nodules,main pancreatic duct (MPD) ≥ 10 mm,septum thickness ≥2 mm,calcification,surrounding vascular infiltration,enlarged peripancreatic lymph nodules,distant metastatic lesions and maximal branch duct type IPMN lesions ≥30 mm shown in the images.The sensitivity,specificity and accuracy were calculated and the receiver-operating-characteristics (ROC) analysis were drawn.Area under the curve (AUC) was calculated.Results Mural nodules in MSCT had a sensitivity,specificity,and accuracy of 77.1％ (27/35),80.0％ (12/15) and 78.0％ (39/50) for diagnosing malignant IPMN,respectively;which in MRCP were 77.1％ (27/35),86.7％ (13/15),and 80.0％ (40/50) in comparison.When MPD diameter ≥10 mm was used for diagnose malignancy,MSCT and MRCP had the sensitivity,specificity,and accuracy of 96.3％ (26/27),81.8％ (9/11),92.1％ (35/38),and 96.3％ (26/27),90.9％ (10/11),94.7％ (36/38),respectively.For thick septum ≥2 mm,MSCT and MRCP had the sensitivity,specificity,and accuracy of 4.8.6％ (17/35),93.3％ (14/15),62.0％(31/50),and 51.4％ (18/35),93.3％ (14/15),64.0％ (32/50),respectively.Out of 50 cases,calcifications were detected on MSCT in 6 patients,and 5 of them were pathologically diagnosed as malignant IPMN.MRCP failed to identify calcifications in any of these lesions.For MSCT,the AUC of MPD diameter ≥ 10 mm,mural nodules and thick septum ≥ 2 mm were 0.973 (P =0.000),0.825 (P =0.002) and 0.704(P =0.051),respectively.For MRCP,the AUC of the three factors above were 0.976(P =0.000),0.825(P =0.002),0.722 (P =0.034),respectively.For the predicting of IPMN malignancy,MSCT had an overall sensitivity,specificity,and accuracy of 94.3％ (33/35),73.3％ (11/15) and 88.0％ (44/50),respectively;in comparison,MRCP had values of 94.3％ (33/35),80.0％ (12/15) and 90.0％ (45/50),respectively.Conclusions Presence of mural nodules,MPD ≥10 mm and thick septum ≥2 mm on MSCT combined with 2D curved reconstruction or MRCP have a high value for predicting the malignancy of IPMN.The values of MSCT and MRCP were basically consistent in the differentiation of benign and malignant IPMN.MSCT can be used as the preferred examination for diagnosing IPMN in the primary hospitals without MR equipment.

Multi-slice CT imaging features of pancreatic neuroendocrine carcinoma / 中国医师进修杂志

Objective To investigate the multi-slice CT (MSCT) imaging features of pancreatic neuroendocrine carcinoma (PNEC). Methods A retrospective analysis of the MSCT and pathological findings of 10 PNEC patients confirmed by surgery and pathology was performed. Results Among the 10 patients, the tumor locating at pancreatic head was in 1 case, at pancreatic body was in 1 case, and at pancreatic tail was in 8 cases. The maximum diameter was 1.8-8.5 (4.7 ± 3.6) cm. The boundary between mass and normal pancreas was unclear, among which there was a circle-like shape in 4 cases, and irregular shape in 6 cases. The plain scan showed that there were cystic changes in the mass, including cystic lesion locating in the center of the lesion in 7 cases, and that locatingd in the periphery of the lesion in 3 cases. The plain CT value was (36.0 ± 8.3) HU. The enhancement scan showed that the circumference was mainly ring enhancement, the arterial phase CT values was (78.0 ± 6.7) HU, the portal venous phase CT values was (83.0 ± 8.2) HU, and the balanced phase CT values was (69.0 ± 9.1) HU. Under the microscope, found that the tumor were made up of small cells and large cells, the tumor tissue was invasive. The atypia of tumor cells was obvious, diffuse and distribution was diffuse, with necrosis. The nuclear division was more common. The immunohistochemical result showed that synaptophysin (Syn) positive was in 10 cases, neuron-specific enolase (NSE) positive was in 7 cases, chromogranin A (CgA) positive was in 7 cases, and CD56 positive was in 6 cases; the percentage of Ki-67 expression positive cell < 3% was in 3 cases, 3%-20% was in 4 cases, and ＞20% was in 3 cases. Conclusions The MSCT imaging findings of PNEC has certain characteristics, and multi-period dynamic contrast-enhanced scan is helpful for the diagnosis of pancreatic neuroendocrine carcinoma.

Sodium pyruvate protect occipital cortex of rats with repetitive and severe neonatal hypoglycemia detected by high resolution 1H nuclear magnetic resonance spectroscopy / 中华围产医学杂志

Objectives To investigate the occipital cortex metabolite alterations in repetitive and severe neonatal hypoglycemia rats treated with sodium pyruvate and to reveal the protective role of sodium pyruvate using high resolution 1H nuclear magnetic resonance spectroscopy.Methods Thirty-six 2-dayold Sprague-Dawley rats were randomly divided into hypoglycemia group and pyruvate group with 18 rats in each group.Rats in both groups received intraperitoneal injections of insulin (40 U/kg body weight) at 2,4 and 6 days of age to induce severe hypoglycemia (blood glucose value ≤ 1.4 mmol/L).In the hypoglycemia group,2.5 hours after insulin injection,intraperitoneal injection of 50％ glucose (2 ml/kg) was administered to terminate hypoglycemia,while in the pyruvate group,50％ glucose (2 ml/kg) and sodium pyruvate solution 2.5 ml/kg (500 mg/kg) were injected.Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay was used to observe the status of injured neurons in six neonatal rats,and metabolite changes in occipital cortex of the other 12 rats were detected by 1H nuclear magnetic resonance spectroscopy.The difference between the two groups was compared by independent-samples t test.Results Neonatal rats of both groups reached severe hypoglycemia level 2.5 hours after insulin injection.Compared with hypoglycemia group,pyruvate group had fewer injured neurons (45±5 vs 113 ± 12,t=0.782,P=0.013) and lower injured index in the occipital cortex (0.15 ± 0.03 vs 0.36 ± 0.06,t=l.143,P=0.020).Pyruvate group showed significant decreases in the concentration of taurine [(13.31 ± 2.06) vs (18.44 ± 3.86) mol/kg,t=8.231],glutamine[(1.50 ± 0.24) vs (2.02 ± 0.40) mol/kg,t=3.137],glutamate[(7.04 ± 0.95) vs (9.40 ± 1.73) mol/kg,t=6.449],aspartate[(1.51 ± 0.28) vs (2.15 ± 0.58) mol/kg,t=2.561] and creatine [(6.37±0.99) vs (8.46± 1.77) mol/kg,t =4.226] in the occipital cortex (all P'＜0.017).Conclusions Simultaneous use of glucose and sodium pyruvate to terminate hypoglycemia in repetitive and severe neonatal hypoglycemia rats can effectively alleviate severe hypoglycemia-induced occipital lobe damage via regulating excitatory amino acid neurotransmitters,energy metabolism and other metabolic pathways.

A comparative study on MRI appearance and pathological grading for pancreatic neuroendocrine tumors / 中华内分泌外科杂志

Objective To explore the value of conventional and functional MRI image parameter in preoperative grade of pancreatic neuroendocrine tumours (pNET).Methods Data of 35 cases of pNET were retrospectively analyzed,including tumor size,intensity of T1WI's and T2WI's signal,enhancement feature,and apparent diffusion coefficients (ADC)value.All kinds of tumors were classified into G1 to G3 according to WHO's classification in 2010.Results There were 40 pNETs (mean size(4.2±2.9)cm) among the 35 patients (20 male,and 15 female).By WHO's tumor grading,the number of patients from G1 to G3 was 18(45％),12(30％),and 10(25 ％),respectively.A higher grade was associated with larger tumor size (P＜0.05).Intensity of T1WI and T2WI signal has no significance for predicting tumor grade.Enhancement feature had statistical significance on tumor's grade (P＜0.05).ADC value decreased with the increase of tumor's grade,(2.23±0.80) × 10-3,(1.80±0.73) × 10-3,(0.92±0.24) ×10-3 mm2/s respectively for tumors from grade G1 to G3.Conclusion Enhancement features of MRI image and ADC value are conducive to preoperative grading of pNET.

The value of intravoxel incoherent motion diffusion-weighted MRI in differentiating benign breast lesions from malignant lesions / 中华内分泌外科杂志

Objective To study the diagnostic value of intravoxel incoherent motion (IVIM) diffusion-weighted MRI in differentiating benign from malignant breast lesions.Methods 50 female patients with lesions verified by pathology were included in this study,all of them underwent multi-b value (b=0-2000s/mm2) DWI scanning.Tissue diffusivity (D),pseudo-diffusivity (D*),perfusion fraction (f) and apparent diffusion coefficient (ADC) were acquired using IVIM model.The difference of these parameters in benign and malignant breast lesions was analyzed statistically.The diagnostic performance of these parameters was evaluated by ROC analysis.Results In benign lesions,D,D*,f and ADC value was (1.31±-0.47) ×10-3 mm2/s,(26.47±13.81) ×10-3 mm2/s,(17.35±3.78)％,(1.37±0.37)×10-3 mm2/s,respectively.In malignant lesions,D,D*,f and ADC value was(0.95±0.28)×10-3 mm2/s,(24.58±14.62)×10-3 mm2/s,(23.69±4.35)％,(1.03±0.14)×10-3 mm2/s,respectively.There were statistically significant differences between benign and malignant lesions in D,f and ADC value (t=3.203,-5.139,3.991,P＜0.05).There was no statisticaly significant difference in D* value (P＞0.05).ROC analysis showed that AUC of D value was 0.866,which was the highest one.AUC was increased to 0.934 by combining D with f value for diagnosis.Condusions The parameters acquired from IVIM model are useful to differentiate benign from malignant breast lesions.D value obtained from IVIM model may have relatively high sensitivity and specificity,D Combined with f value can obtain the best diagnostic performance.

One case of adult Kawasaki disease / 中南大学学报(医学版)

Kawasaki disease is far more frequent in children than in adults. The pathogenesis of Kawasaki disease is unknown, but it involves changes to the coronary artery and other diverse clinical manifestations. There are currently no specific laboratory diagnostic indexes, and especially since the disease is rare in adults, so it is extremely easy to misdiagnose or to overlook entirely. Our retrospective analysis of an diagnosis of and treatment for Kawasaki disease in an adult provides a guide to clinical doctors in terms of understanding Kawasaki disease, early diagnosis of it, and improved prognosis.

The establishment and meaning of the three-dimensional finite element model of pelvic floor levator ani muscle in an old healthy woman / 生物医学工程学杂志

This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis.

MRI Features in Children Surviving Premature Delivery with Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo study the characteristic findings on MRI in children surviving premature delivery with cerebral palsy.MethodsThe clinical data and MR imaging in 16 cases surviving premature delivery with cerebral palsy was retrospectively analyzed, compared with 16 healthy and age-matched controls.Results16 cases were final diagnosed as cerebral palsy with spstic diplegia. MRI features of children surviving premature delivery with cerebral palsy included abnormally high signal intensity in the periventricula white matter on T2WI, marked loss of periventricular deep white matter, ventriculomegaly with or without irregular ventricular outline and atrophy of the corpus callossum. These features were consistent with periventricular leukomalacia(PVL).ConclusionPVL was the characteristic findings on MRI in children surviving premature delivery with cerebral palsy. The characteristic findings of PVL was useful in determining the etiology and type of cerebral palsy in children.

MRI Features in Children with Cerebral Palsy Induced by Chronic Kernicterus / 中国康复理论与实践

@#Objective To study the characteristic findings on magnetic resonance imaging (MRI) in children with cerebral palsy (CP) induced by chronic kernicterus.Methods The MR imagings in 13 CP cases induced by chronic kernicterus were retrospectively studied, which were compared with 6 healthy and age-matched controls. 13 cases were finally diagnosed as dyskinetic cerebral palsy (athetoid subtype).Results In 13 cases, all showed symmetric high signals in the the globus pallidus on T2-weighted imaging. There were not apparent abnormality on T1-weighted imaging.Conclusion The bilateral high intensity signals in the globus pallidus on T2-weighted imaging are the characteristic findings on MRI in CP children induced by chronic kernicterus. Paying attention to the globus pallidus on MRI may be useful in determining the type of cerebral palsy.

Role of dynamic magnetic resonance imaging in the diagnosis of female stress urinary incontinence / 中华泌尿外科杂志

Objective To evaluate the application of dynamic magnetic resonance imaging in the diagnosis of female stress urinary incontinence(SUI). Methods Dynamic magnetic resonance imaging(DMRI)were performed on 30 healthy female volunteers and 35 female SUI patients.DMRI of the pelvic floor at rest and OR maximal strain were performed by using sagittal T2-weighted fast gradient sequences.The distance of Urethra-vesical junction to the pubococcygeal line,the posterior vesicourethral angle and angle of inclination of the urethral axis were measured at rest and on maximal strain position.The t-value exact test were used to analyze the data. Results At rest the Urethravesical junction laid above pubococcygeal line on both control and SUI groups.Mean distance from the Urethra-vesical junction to pubococcygeal line at rest had no difference between the two groups.On straining,the mean Urethra-vesical junction descent distance in the SUI group(-0.9±1.1cm)was significantly higher than in control group(-0.14±0.3 cm),(P＜0.001).On straining,the mean angle of urethral inclination in the SUI group(65±37°)was significantly bigger than in control groups (17±21°),(P＜0.05).The posterior vesicourethral angle in the SUI groups(156±36°)was significantly bigger than in control groups(113±28°),(P＜0.05). Conclusion Dynamic magnetic resonance imaging is a non-invasive.easily applied method in the diagnosis of SUI.

An initial analysis on the status quo of applying diagnosis test in imaging scientific study in China / 中华放射学杂志

Objective To analyze the status quo of applying diagnosis test in imaging scientific study in China, and to see whether reliable diagnosis can be provided to clinicians for accurate guidance of clinical management. Method We manually looked up diagnosis tests published in 1979～1999 "Chinese Journal of Radiology" that is quite influential in our country. Then we evaluated each of these diagnosis tests according to the International Standards. Results We totally searched 2 888 articles in which only 9% were diagnosis tests. Of these diagnosis tests, only 8.9% applied blind comparison with Gold Standard, 24% calculated sensitivity, specificity and accuracy in the same time. And only 0.5%?6% and 5.7% respectively calculated likelihood ratios, negative predictive value and positive predictive value. Conclusion In China, the quality and quantity of the diagnosis tests applied in the specialty of imaging scientific study is far from meeting the clinical demand. Improving methods of scientific study and carrying on more diagnosis tests of high quality are of important significance to improving the diagnostic level of imaging.

Lumbosacral MR Study in the Neurogenic Bladder / 实用放射学杂志

Objective To evaluate the lumbosacral features and diagnostic value of MRI in the neurogenic bladder .Methods Lumbosarcral MR scans were performed in 90 patients with neurogenic bladder.MRI images were reviewed and the abnormal appearances of lumbosacrum on MRI were analysed.Results Of 90 cases,61 cases showed abnormal appearances,the positive rate was 68% and 60 cases were accurately diagnosed by MRI(98.5%).These positive cases were mostly composed of follow three kinds of diseases:spinal deformations,tumors of spinal canal and lumber disc herniations.Conclusion MRI has significant value in lumbosacral examination of patients with neurogenic bladder.