Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

Treatment of MRA-DWI mismatched patients with mild ischemic stroke caused by middle cerebral artery M1 segment occlusion: comparison of endovascular treatment and intravenous thrombolytic therapy / 国际脑血管病杂志

Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.

Cerebral small vessel disease and cognitive impairment: the significance of structural and functional connectivity / 国际脑血管病杂志

Cerebral small vessel disease (CSVD) is the leading cause of cognitive decline in the elderly. Neuroimaging studies have shown that there are structural and functional connectivity abnormalities in patients with CSVD and are associated with cognitive impairment. Therefore, it is speculated that the changes of structural and functional connectivity may be an early imaging marker of CSVD-related cognitive impairment. This article reviews the significance of structural and functional connectivity in CSVD-related cognitive impairment.

Cerebral microinfarct / 国际脑血管病杂志

As a pattern of manifestation of cerebral small vessel disease,cerebral microinfarct(CMI) is a very common neuropathological change in old people. It is significantly correlated w ith cognitive decline and dementia. This article review s the meuropathology, neuroimaging and clinical significance of CMI.

MRI diagnosis of aggressive fibromatosis / 中华放射学杂志

ObjectiveTo analyze the MRI features of aggressive fibromatosis (AF) in order to improve its diagnostic accuracy.Method The clinical files and MRI appearances of 66 AF patients (primary 19 cases,recurrent 47 cases) were reviewed and compared with the postoperative pathological findings.ResultsThe median age of all patients was 31 years( range,11—60 years) with a male-to-female sex ratio of 1 ∶ 3.4.Eighty tumors were discovered.There were 5 superficial fibromatosis and 75 deep fibromatosis in which 2 lesions were intraabdominal,6 lesions in the abdominal wall and 67 lesions extraabdominal.The average long diameter of all lesions was ( 8.7 ± 5.4 ) cm,of superficial lesions ( 5.7 ±2.8) cm,of deep lesions ( 8.9 ± 5.5 ) cm.Of the 80 tumors,79 were displayed as space-occupying intramuscular lesions; 47(58.8％ ) were ovoid or lobulated and 22( 27.5％ ) were infiltrative in shape; 48 (60％) lesions had a well-defined margin,of which 4 formed a pseudocapsule as they enlarged by compressing normal tissue.To compare with the muscle signal intensity on MRI,75 lesions demonstrated isointensity,mild hyperintensity or hypointensity on T1 WI,heterogeneous high intensity on T2 WI,and avid heterogeneous enhancement after contrast administration.There was no necrosis or surrounding edema in all lesions.Tumors destroyed bone in 2 cases.ConclusionAggressive fibromatosis has characteristic features on MRI,and MRI is valuable in diagnosising AF and evaluating the extend of lesion and involvement of adjacent structures.

Magnetic resonance imaging appearance of neuromyelitis optica in spinal cord / 中华神经科杂志

Objective To investigate the characteristic MRI appearance of neuromyelitis optics (NMO) and muhip]e sclerosis (MS) in the spinal cord.Methods Twenty cases of MS and 23 cases of NMO were examined by MRL All image appearances were analyzed.Results The characteristic MRI appearance of NMO patients in the spinal cord was linear medullary lesion (LML), linear medullospinal lesion (LMSL), linear spinal lesion (LSL) and longitudinally extensive transverse myelitis (LETM), and spinal cord MRI with contiguous T2-weighted signal abnormality extending over 3 or more vertebral segments (23 cases), while in MS, spinal cord MRI with contiguous T2-weighted signal abnormality often extended less than 3 vertebral segments (only 12 cases, χ2 = 19.142, P < 0.01), and the distribution of spinal lesion usually was eccentric (17 cases, compared with NMO group, χ2 = 25.256, P < 0.01).Conclusions NMO is distinct from MS.In MRI, spinal lesion in NMO usually conforms to the distribution of aquaporin 4, while spinal lesion in MS always conforms to the demyelination.NMO has neuroimaging features that move it ever closer to distinct disease status.

Observation on cerebral microbleeds in patients with hypertension by magnetic resonance imaging / 中华神经科杂志

Objective To concentrate on the morbidity of cerebral microbleed (CMB) in patients with hypertension and to analyze the predilection and risk-factor of cerebral microbleed.Method Hypertensive patients were divided into the simple hypertention group, hypertention group with lacunar infarction and hypertention group with cerebral infarction.All of these 65 patients received examination of susceptibility-weighted imaging.Results Ninety-one focuses of cerebral microbleeds were found in these patients:58.2% of these focuses were in both basal ganglia and cerebral ganglion;35.2 percent were in cortex and subcortex;6.6 percent were in brainstem and cerebellum.The total morbidity of CMB was 33.8 percent, 52.4 percent in the group with lacunar infarction and 38.1 percent in the group with cerebral infarction, both were significantly higher than that of 8.7 percent in the simple hypertensive group (χ2= 8.08,P<0.01 andχ2=3.86, P<0.05).Conclusions The focus of CMB suggested the hemorrhagic tendency in endocranial capillary.CMB can be used as a routine exam for the hemorrhagic tendency in endocranial capillary.Synthetic analysis of risk-factor and the result of SWI help clinicians choose suitable treatment for each patient.

Pancreatic and renal involvement in von Hippel-Lindau disease: imaging findings / 中华放射学杂志

Objective To analyze the imaging features and to enhance the understanding of pancreatic and renal involvement in yon Hippel-Lindau disease (VHLD). Methods CT and MRI appearances and clinical data of six patients with pancreatic and renal involvement in VHLD were studied retrospectively.Six patients underwent CT scanning, and two of them also had MRI.Results Pancreatic cysts found in all six patients varied from several small cysts to cystic replacement of the entire gland.Calcifications were detected in four patients. Multiple bilateral renal lesions were detected in six patients.The renal lesions were classified as cystic, cystic with solid components and solid.Multiple combined renal lesions were found in five patients, and multiple simple cysts in one patient.Unilateral nephrectomy was performed in two patients, and the renal masses were diagnosed as clear cell carcinoma by pathology.Bile carcinoid was found in one patient, and retroperitoneal metastasis in another.Conclusion Multiple pancreatic cysts and/or multiple and bilateral combined renal lesions are highly suggestive of VHLD.

Endoscopic ultrasonography with combination of miniature probe and radial scanning in preoperative staging for rectal cancer / 中华消化内镜杂志

Objective To evaluate the specificity,sensitivity and accuracy of miniature probe combined with radial scanning endoscopic ultrasonography(EUS)in preoperative TN staging of rectal cancer,and to assess its value in the choice of therapeutic strategy.Methods A total of 60 patients with rectal cancer received EUS assessment before surgery.Diagnosis was made according to TNM standard and compared with those of MRI and postoperative pathological examination.The reference value of EUS for therapy selection was studied.Results According to EUS staging,there were 4 cases of TI,18 T2,30 T3 and 8 T4,among which 7 cases were over-staged and 4 others were under-staged.MRI staging showed 1 case of T1,18 T2,30 T3 and 10 T4,among which 14 were over-staged and 3 others were under-staged.The total accuracy of EUS in T staging and N staging was 81.67%(49/60)and 78.33%,respectively,with the sensitivity and specificity at 71.43%and 91.03%,respectively.Accuracy of MRI for T staging and N staging were 71.67%(43/60)and 83.33%,respectively,with the sensitivity and specificity as 85.71%and 86.96%.Conclusion EUS with combination of miniature probe and radial scanning is effective in preoperative TN staging of rectal cancer with easy manipulation and less pain.