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Fifteen patients with Crohn′s disease (CD) in remission diagnosed at Shanghai Jing′an District Central Hospital from February 2018 to June 2019, and 26 matched healthy subjects were recruited. All participants underwent resting-state functional magnetic resonance imaging (fMRI) scans of hippocampus. The amplitude of low-frequency fluctuations (ALFF) was calculated to determine differences in the brain. Left hippocampus was selected as seeds for functional connectivity (FC) analysis, and the results were compared between two groups. The relationship between disease duration and ALFF/FC values in abnormal regions were analyzed with Pearson correlation. Compared with the controls, the ALFF of the left hippocampus (voxel size 32) of CD patients decreased [family-wise error correstion(FWE correction), cluster level P<0.05], and the ALFF of the left medial superior frontal gyrus (voxel size 126), left supplementary motor area (voxel size 126) and left anterior cingulate gyrus increased (voxel size 37) (FWE corrected, cluster level P<0.05). Using the left hippocampus as the seed point for the whole brain functional connectivity analysis, CD patients showed increased FC strength with the left superior temporal gyrus, left medial superior frontal gyrus, left inferior frontal gyrus (opercular part), and right supplementary motor area(FEW corrected, cluster level P<0.05). Correlation analysis did not show a significantly differences between ALFF/FC value of altered brain areas and the disease duration. It suggests that there are changes in spontaneous activities and functional connectivity in the left hippocampus in patients with CD.
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Objective To investigate muscle MRI characteristics of lower limbs in Chinese patients with dysferlinopathy. Methods Detailed clinical information of 42 patients with dysferlinopathy confirmed by Western blot or DYSF genetic test were studied retrospectively, including age, course, serum creatinine kinase (CK) and modified Gardner?Medwin and Walto score, and T1WI, STIR image. Each muscle was scored according to its fatty degeneration evaluated on T1WI (fat replacement score). The patients were divided into 3 groups:Miyoshi myopathy (MM), limb girdle muscle dystrophy 2B (LGMD 2B) and preclinical stage (asymptomatic hyperCKemia or exercise intolerance). The data including the scores of each muscle between MM and LGMD 2B were compared by ANOVA analysis and Chi square test. The relationship of fatty replacement score with course and GM?W score was analyzed by Spearman rank correlation analysis. Results Thirty nine patients underwent thigh MR scanning and 36 patients underwent leg MR scanning. At the thigh level, there is no specificity that the fatty replacement was found in both the anterior and posterior parts while the rectus femoris, sartorius and gracilis were rarely involved. At the leg level, the most severely involved muscle was the soleus, followed by gastrocnemius. It formed a sandwich?like pattern that the anterior part (anterior and posterior tibial muscle and peroneus longus muscle) and the posterior part (medial and lateral gastrocnemius) were less involved than the middle part (soleus). Of 42 patients, 14 cases were MM, and 24 were LGMD 2B. The fat replacement score of each muscle between two groups showed no significant differences (F=0.066 to 3.907,P all>0.05) except for the adductor muscle (F=5.239, P=0.028), semimembranosus (F=6.703, P=0.014) and semitendinosus (F=7.689, P=0.009). Of 4 pre?symptomatic cases, 3 showed edema of posterior part of leg on STIR, especially soleus. In all patients, the fat replacement score correlated positively with course (rs=0.732, P=0.000) and GM-W score (rs=0.485, P=0.001). Conclusions The MRI of Chinese patient with dysferlinopathy was characterized by the milder involvement of rectus femoris, sartorius and gracilis muscle in the thigh and a sandwich?like pattern in the leg, which is helpful for differential diagnosis of inflammatory Myopathy versus other types of muscular dystrophy.
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Objective To assess the effect of iDose4 in image quality and radiation dosage in CT angiography of craniocervical arteries.Methods Imaging data of 50 patients with 256-slice spiral CT angiography of craniocervical arteries were randomly divided into two groups:(A) 120 kV,250 mAs (25 patients),(B) iDose4 100 kV,180 mAs (25 patients).Dose length product (DLP) of the two groups were compared.Objective image noise was compared by two blinded readers,t test and nonparametric tests were used for statistical analysis.Results The overall image quality score of group A (3 points =1 patient,4 points =6 patients and 5 points =18 patients) and group B (4 points =5 patients and 5 points =20 patients) were shown.The image noise of group A (1 point =1 patient,2 points =5 patients and3 points =19 patients) and group B (2 points =4 patients,3 points =21 patients) were also evaluated.There was no statistical difference in revealing rate of image quality scores and objective noise between the two groups (Z =-0.334,-0.218,P ＞ 0.05).The estimated effective radiation dose was reduced by 56％ in group B than in group A.DLP was significantly lower in group B [(642.4 ±36.6) mGy · cm]than in group A [(1462.1 ± 64.3) mGy · cm].Conclusion Low dose contrast medium of CT angiography can display craniocervical arteries and the intracranial arteries very well with high image quality.
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Objective To study the multi-detector spiral CT (MDCT) features of pancreatic tuberculosis to improve the awareness and correct diagnosis. Methods Imaging features of MDCT were retrospectively reviewed on 9 cases with pancreatic tuberculosis that were diagnosed from 2003 to 2009, among them two patients underwent MDCT angiography, the features were compared with those of operative and pathological findings. Results One case of pancreatic cancer, 2 cases of cystadenocarcinoma and 1 case of pseudocyst, 2 cases of pancreatic cancer with retroperitoneal lymph node metastasis, 2 cases of lymphoma were diagnosed by MDCT, and all the lesions were diagnosed as pancreatic tuberculosis pathologically, and the misdiagnosis rate was 100%. Pancreatic tuberculosis often presented as pancreatic head mass, sometimes pancreatic body and tail were involved. MDCT showed isopycnic or low density solid-cyst mass, occasionally calcification was present, with slightly or moderate ring-like enhancement after contrast injection. There was no enlargement of the pancreatic duct. The retroperitoneal and adjacent lymph nodes were always enlarged with ring-like enhancement. Sometimes there was evidence of tuberculosis of other abdominal organs. Conclusions Ring-like enhanced lesions with ring-like enhanced lymph nodes without enlargement of pancreatic duct are characteristic MDCT features of pancreatic tuberculosis.
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Objective To improve the recognition of pituitary hyperplasia secondary to primary hypothyroidism by analyzing clinical and imaging data. Methods The clinical features, hormone data,imaging findings, and treatment were reviewed in 32 patients with pituitary hyperplasia secondary to primary hypothyroidism in Huashan Hospital from 1999 to 2008. Results Thirty-two patients, most juvenile,presented clinical and imaging features suggestive of functional primary pituitary adenoma. The dose of levothyroxine was increased to maintain the thyrotropin concentration at normal values. Following adequate thyroxine replacement, pituitary hyperplasia regressed on average within 6 months. Conclusions Pituitary hyperplasia secondary to primary hypothyroidism seems to be quite prevalent in children and adolescents.Complete regression will be achieved with thyroxine replacement therapy.
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Background and purpose: Primary intracranial epithelioid haemangioendothelioma (EH) was rare. This study was to discuss the clinical pathological features, radiographic findings, treatment and prognosis of primary intracranial EH combined with literature review. Methods: We reviewed a case of EH reported from our hospital, and comprehensively analyzed the related literature. Results: Based on our report and review of the literature, EH is rare and with borderline or uncertain behavior. The original tumors demonstrated specific image features. The tumor usually appeared as a small nest or cords composed of eosinophilic epithlioid or spindled cells.Immunohistochemical assay were positive for endothelial markers CD31, CD34 and FⅧ. EH may be treated with complete surgical resection whenever possible and is sensitive to radiation. The EH has a favorable prognosis. Conclusion: EH has variable malignant potential, and should be differentiated from meningioma. Total resection and close follow-up is recommended. Additional radiotherapy is advised for residual tumors.
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Objective To describe the hemodynamic characteristics of normal pancreas and pancreatic tumors by 64 slices helical CT perfusion imaging, to evaluate the role of CT perfusion in the diagnosis of pancreatic tumors. Methods Perfusion CT scan was performed in 149 patients, including 36 patients with normal pancreas, 105 patients with pancreatic tumors and 8 patients with duodenal papillary carcinoma. The parameters including blood flow (BF) ,blood volume (BV) and permeability surface area product (PS) were measured. Results The mean value of BF, BV and PS of normal pancreas were (135.24±48.36) ml· min-1·kg-1, (200.55±54.96)ml/kg and (49.75±24.27) ml·min-1·kg-1, respectively. Pancreatic carcinoma has a lower BF, BV and PS,whieh were 31.77±19.36 ml·min-1· kg-1, (66.84±39.49)ml/kg and (37.64±27.14) ml·min-1·kg-1, respectively. The aforementioned parameters in pancreatic cysts were close to zero. The parameters in pancreatic carcinoma were significantly lower than those in normal pancreas(P<0.05); the BF and BV in duodenal papillary carcinoma were significantly lower than those in normal pancreas(P<0.05), while the value of PS was not significantly different from that in normal pancreas; the aforementioned parameters in pancreatic cysts were significantly different from those in normal pancreas(P <0.01). Conclusions In perfu sion CT, normal pancreas was an organ with symmetrical BF,BV and PS. Pancreatic carcinoma was a tumor with low perfusion and decreased PS. Duodenal papillary carcinoma had decreased BF and BV with no significant change in PS. Pancreatic cyst had no blood perfusion. The 64 slice helical CT peffusion imaging was invaluable in differential diagnosis of pancreatic tumors.
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Objective To study the MRI signs of primary central nervous system lymphoma(PCNSL).Methods MRI features of PCNSL in 44 patients proven by pathology from January 2004 to September 2005 were analysed retrospectively.There were 29 men and 15 women,the age ranged from 12~76 years old with mean 53.Results The lesions localized at brain in 41 patients and spinal cord in 3.The lesions were multiple and single.The lesions were hypointense on T1WI and isointense or hyperintense on T2WI mostly.Nearlly all the lesions had parenchymatously massive or nodular enhancement,the minority has ring-like enhancement post contrast-enhanced scan.Conclusion PCNSL has certain MRI characteristic.The solitary or multiple lesions with obviously nodular enhancement,especial contact with cerebrospinal fluid space,the possibility of PCNSL diagnosis should be consider.
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Objective To study the imaging features and the cause of the cystic meningiomas so as to avoid the misdiagnosis and improve the understanding and knowledge. Methods CT and MRI features in 27 pathologically proved cystic meningiomas were analyzed. There were 10 men and 17 women, and the age ranged from 16 to 80 years with the average age of 49 years. Twenty-six patients were examined by using MRI (24 with enhanced scan), and 15 patients by CT (seven with enhanced scan). 15 patients were examined by both CT and MRI. The image features were analyzed according to Nauta and were compared with operative and pathological findings. Results The cystic meningiomas were mostly epithelial type, but fibrous type, angiomatous type, or papillary type may also be seen. Mostly, the locations were cerebral convexity, but tumors of the tentorium, alisphenoid, olfactory groove, and skull base were also seen. And all were sessile. On imaging, most tumors were parenchymatous with cystic parts, and marked enhancement of the parenchymatous part could be seen. Some were entirely cystic with parenchymatous nodule, the nodule enhanced markedly and the wall of the cyst may be or not be enhanced. Of the 27 cases, four cases were NautaⅠ, seven cases were NautaⅡ, one case was Nauta Ⅲ, and ten cases were Nauta Ⅳ. Three were both Nauta Ⅱand Ⅲ in 3 cases, Nauta Ⅱ, Ⅲ, and Ⅳ in 1 and both Nauta Ⅲ and Ⅳ in 1, respectively. Conclusion The cystic meningiomas have characteristic imaging features. CT and MRI, especially MRI, are valuable in the diagnosis.
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Objective To analyses the CT misdiagnostic causes of gallbladder carcinoma, in order to improve the diagnostic rate.Methods Fourty-three patients with the gallbladder carcinoma proved histologically were examined by computed tomography (CT), twenty-three of them were misdiagnosed.The misdiagnostic causes were analysed and compared CT images with operation.Results In the cases of misdiagnosis they were diagnosed as acute or chronic cholecystitis in 5; polyp in 1; bile duct carcinoma in porta hepatis in 2; cholangiocarcinoma in 1; neoplasm of distal part of common bile duct or ampulla in 3; carcinoma of head of pancreas in 5;cholangitis in 1; jaundice of obstruction in 2;tumefaction of gallbladder in 2;carcinoma of colon in 1. Conclusion To be aware of CT characters of gallbladder carcinoma and the way of metastasis is useful to avoid misdiagnosis of the gallbladder carcinoma and to improve the diagnostic rate.
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Objective To study the imaging features of the ventricular meningioma, in order to improve the understanding knowledge. Methods Compared with operative and pathological findings,the CT and MRI features of ventricular meningioma were analyzed in 22 patients (8 males and 14 females,range from 17~72 years old with average age 45 years).21 cases were examined by MRI(17 with enhanced scan),11 cases by CT(4 with enhanced scan).Results The ventricular meningioma were mostly fibrous type. Mostly, the locations were in the trigone of the lateral ventricle with regular shape. On imaging, the most were parenchymatous with markedly enhancement. Calcification may be found, but cystic changes and hemorrhage were very rare.Conclusion The ventricular meningiomas have characteristic imaging features. CT and MRI are valuable in diagnosis, especially MRI.