Value of high resolution magnetic resonance imaging for preoperative evaluation of Denonvilliers fascia in patients with rectal cancer / 中华胃肠外科杂志

Objective: Total mesorectal excision (TME) is the gold standard for surgical treatment of mid-low rectal cancer, but the postoperative incidence of urination and sexual dysfunction is relatively high. Preserving the Denonvilliers fascia (DF) during TME can reduce the postoperative incidence of urination and sexual dysfunction. In this study, high resolution magnetic resonance imaging (MRI) was used to observe the imaging performance and display of DF, so as to determine the value of this technique in preoperative evaluation of the preservation of DF. Methods: A descriptive cohort study was carried out. Clinical data of patients with rectal cancer who underwent TME and received preoperative high-resolution MRI at department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University from August 2015 to June 2017 were retrospectively analyzed. The characteristics of DF were examined, and the shortest distance (d) between the anterior edge of tumor and DF was measured on high-resolution MRI. The distance d was compared between patients with stage T1-T2 and those with stage T3. Receiver operating characteristic (ROC) analysis was used to determine the predictive value of d for stage T1-T2 disease. Results: Thirty-two patients were enrolled in the study, including 27 males and 5 females with mean age of (62.9±8.9) years. DF was visualized in 96.9% (31/32) of cases on the T2WI sequence. The mean distance d in patients with stage T1-T2 disease (n=23) was (6.73±2.65) mm, and in those with stage T3 disease (n=9) was (1.30±1.15) mm (t=5.893, P<0.001). A cutoff of d >3 mm yielded specificity and positive predictive value for diagnosing stage T1-T2 disease of both 100%, sensitivity of 95.7% and negative predictive value of 90%. The optimum threshold of d was >3.05 mm, and Youden index was 0.957. Conclusions: High-resolution MRI can show the DF and accurately evaluate the relationship of DF with tumor in rectal cancer patients. Analysis on d value can provide an objective basis for the safe preservation of DF.

Hallazgos radiológicos en sistema nervioso central (SNC) del síndrome de MELAS: reporte de caso / Radiological findings of MELAS syndrome in central nervous system (CNS): case report

RESUMEN Presentamos el caso clínico de una paciente adulta joven con episodios recurrentes sugestivos de ataque cerebrovascular, con cambios radiológicos típicos de enfermedad de MELAS con confirmación genética de mutación en el gen A3243G.

SUMMARY A clinical case of a young adult patient with recurrent episodes suggestive of stroke, with typical radiological changes of MELAS disease with genetic confirmation of mutation in A3243G gene.

Anomalías quísticas congénitas de la vía biliar: aproximación diagnóstica mediante resonancia magnética / Congenital Cystic Biliary Ducts Diseases: Diagnostic Approach by Magnetic Resonance

Las enfermedades fibropoliquísticas hepáticas configuran un grupo de patologías bien diferenciadas que comparten en su etiología una malformación de la placa ductal y de la vía biliar durante el desarrollo intrauterino. La anomalía congénita encontrada depende del nivel donde el árbol biliar se ve afectado durante la embriogénesis. En este artículo se presenta el espectro de las anomalías congénitas de la vía biliar en pacientes evaluados mediante resonancia magnética (RM) y se describen los aspectos anatómicos y embriológicos, así como los hallazgos más relevantes de cada patología en los estudios por RM.

Fibropolycystic liver disease encompasses a unique group of entities that share in their etiology a malformation of the ductal plate and biliary ducts during intrauterine growth. The congenital abnormality found depends on the point where the biliary ducts are affected during embryogenesis. In our review, we describe the spectrum of congenital biliary abnormalities in patients studied with magnetic resonance imaging (MRI). Anatomical and embryological findings are described, as well as the most relevant MRI findings for each disease.

A comparative study of three-dimensional high-resolution MR imaging CPR and MRVE displayed in trigeminal neuralgia vascular responsibility / 实用放射学杂志

Objective To investigate the value of the three-dimensional high-resolution magnetic resonance imaging curve planar reformation(CPR)combined with virtual endoscopy reconstruction in vascular compression of trigeminal neuralgia.Methods 65 pa-tients with trigeminal neuralgia performed three-dimensional MR doubly excited balanced steady-state free precession sequence (3D-FIESTA-C),and CPR combined with virtual endoscopy reconstruction was used to evaluate the relationship of neurovascular anato-my.And 60 cases with microvascular decompression (MVD)surgery were analyzed.Results 65 cases of 3D-FIESTA-C CPR com-bined with MRVE showed responsibility vascular with a positive rate of 92.3% (60/65).60 cases of all patients with the results of surgery showed responsibility blood vessels and oppression parts with 3D-FIESTA-C CPR combined with MRVE,and it was found that the findings of oppression had a good consistency with MVD with the diagnose accordance rate of 95% (57/60).Conclusion Three-dimensional high-resolution magnetic resonance imaging CPR combined with virtual endoscopy reconstruction can be a new method to clearly and accurately show the anatomical relationship between blood vessels and nerves,which helps to improve the posi-tive rate of detection and to give operative guidance.

Cardiac Sarcoidosis Presenting With Complete Atrioventricular Block and Sustained Monomorphic Ventricular Tachycardia

Sarcoidosis is a rare but potentially fatal multisystem granulomatous disease of unknown etiology. While a number of clinical manifestations may develop, cardiac involvement (prior to or coincident with sarcoidosis of other organs) is an important prognostic factor. Recently, we encountered a patient with cardiac sarcoidosis who presented with complete atrioventricular (AV) block and sustained ventricular tachycardia. An implantable cardioverter-defibrillator was inserted as a precautionary measure for ventricular tachycardia and symptomatic complete AV block. 18F-fluoro-2-deoxyglucose positron emission tomography confirmed a dramatic response to high-dose steroid at four weeks, as demonstrated by a marked decrease in cardiac sarcoid activity from baseline status.

MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.

Lumbosacral Plexopathy, Complicating Rhabdomyolysis in a 57-Year-Old Man, Presented with Sudden Weakness in Both Legs

A 57-year-old man presented with weakness in both legs upon awakening after drinking. Magnetic resonance imaging (MRI) of the lumbar spine did not reveal any intraspinal abnormalities but MRI of the pelvis revealed lesions with abnormal intensities with heterogeneous contrast enhancement in both gluteal muscles. Serum creatine phosphokinase was markedly elevated. A diagnosis of lumbosacral plexopathy, complicating rhabdomyolysis was made. With supportive care he recovered well but mild weakness of the right ankle remained at 6 month-follow-up. Pelvic MRI is a helpful diagnostic tool in localizing rhabdomyolysis. Lumbosacral plexopathy should be included in the differential diagnosis of the such cases, presenting with sudden weakness of legs.

The MR Diagnosis of Giant Intracranial Aneurysms / 实用放射学杂志

Objective To analysis the imaging appearances of giant intracranial aneurysms(GIA).Methods Forty pathological proven GIA were included in this study.Results The MR appearances were variable depending on the present of thrombosis,the size and age of the thrombosis,and the secondary changes of the GIA.The typical flow void presented in majority patients.The flow artifacts were displayed across the residual lumen in the phase direction of MR image.The residual lumen showed dense contrast enhancement.The thrombosis was found in 26 GIAs with variable signal intensity from homogeneous hypo-or hyperintensity to onion or turbo like heterogeneous signal intensity without contrast enhancement.DSA studies displayed residual lumen of GIAs and fail to display totally thrombosis GIAs.Conclusion MR studies clearly show the residual lumen and thrombosis of GIAs.MR study is an important conjunctive tool of the DSA studies in diagnosis GIA.