Diagnostic value of magnetic resonance spectroscopy for intracranial space-occupying lesions / 中国辐射卫生

Objective To evaluate the value of magnetic resonance spectroscopy (MRS) in the diagnosis of intracranial space-occupying lesions. Methods A total of 126 patients with intracranial space-occupying lesions in the First Affiliated Hospital of Xinjiang Medical University from 2019 to 2022 were enrolled and subjected to brain magnetic resonance imaging (MRI) and MRS examinations. The performance of MRI alone and in combination with MRS was evaluated and compared for diagnosis of intracranial space-occupying lesions. Results Tuberculoma (19.05%) and high-grade glioma (15.87%) were the intracranial space-occupying lesions most commonly diagnosed by MRI in combination with MRS. Radiologists confirmed the diagnosis of intracranial space-occupying lesions in 23.81% patients depending on MRI alone, and in 75.40% patients depending on MRI combined with MRS, with a 2.17-fold improvement (χ2 = 67.07, P<0.01). The combination of MRI and MRS improved the accuracy of imaging diagnosis of intracranial space-occupying lesions in 70 (55.67%) patients compared with MRI alone. In addition, MRI in combination with MRS significantly improved the accuracy of differential diagnosis of high-grade glioma, low-grade glioma, cerebral infarct, tuberculoma, recurrent tumor, and radiation necrosis compared with MRI alone (P<0.01). Conclusion The efficacy of imaging diagnosis of intracranial space-occupying lesions can be improved by MRI in combination with MRS relative to MRI alone. The combined use of MRI and MRS may serve as a non-invasive tool for diagnosis of intracranial space-occupying lesions. In addition, the combination facilitates the differentiation between low- and high-grade gliomas, between high-grade glioma and tuberculoma, and between recurrent tumor and radiation necrosis.

The diagnostic value of left ventricular opacification in patients with suspected cardiac space occupying lesion / 中国医师杂志

Objective:To improve the contrast between the myocardium and the cardiac cavity by left ventricular opacification and to diagnosis the suspected cardiac space occupying.Methods:25 patients with suspected cardiac space occupying by two-dimensional echocardiography were selected into the observation group. All patients were limited by near-field artifacts and sound window, gas interference or unclear display of two-dimensional echocardiography due to obesity. After left ventricular opacification, the images were sorted and analyzed. 10 subjects without heart disease served as the normal control group. The left ventricular function measured by routine two-dimensional echocardiography and cardiography were compared in the observation group.Results:In the observation group, 25 patients had no discomfort during the contrast-enhanced, and the contrast-enhanced echocardiography was successful. Among them, 7 cases excluded the diagnosis of cardiac space occupying, 3 cases were judged to be caused by near-field artifacts, 3 cases were judged to be spontaneous intracardiac development, and 1 case was judged to be ventricular septal hypertrophic cardiomyopathy; 18 patients were diagnosed as intracardiac thrombus, and the smallest thrombus diagnosed was 7 mm×8 mm hypoechoic fresh thrombus at the apex of the heart after myocardial infarction. In the observation group, there was no significant difference between ejection fraction (EF) value measured by two-dimensional image echocardiography and cardiography ( P>0.05), but the ventricular end diastolic volume (EDV) and ventricular end systolic volume (ESV) of cardiography were larger than those of two-dimensional echocardiography ( P<0.05). At the same time, 6 of the 25 patients could clearly observe the vortex phenomenon in the cardiac cavity after angiography, indicating the hypercoagulable state of the cardiac cavity. All 10 cases in the control group were developed successfully, and there was no discomfort in the course of angiography. Conclusions:Left ventricular contrast echocardiography can improve the clarity of cardiac ultrasound images, accurately judge the presence or absence of cardiac space occupying, and more accurately judge the change of cardiac cavity size, so as to provide diagnostic information for cardiac space occupying.

Guideline for ultrasonic diagnosis of liver diseases / 中华肝脏病杂志

Ultrasound is a non-invasive, real-time, inexpensive, radiation-free and easily repeatable method, usually used for liver imaging. In recent years, new ultrasound examination techniques for liver diseases such as contrast-enhanced ultrasound and elastography have been rapidly developed, which can effectively identify intrahepatic space-occupying lesions, assess the degree of liver fibrosis and portal hypertension, and monitor the effects of treatment. Therefore, these technologies play an important diagnostic role in clinical liver diseases and have therapeutic interventional value. This guideline classifies the instrument set-up, patient preparation, and physician examination methods through multimodal ultrasound examinations (gray-scale ultrasound, color Doppler ultrasound, contrast-enhanced ultrasound, elastic ultrasound) for liver diseases. In addition, liver diseases multimodal ultrasound technology diagnostic criteria for diffuse hepatic lesions (inflammatory lesions, fibrosis, and sclerosis), multiple space-occupying lesions, and interventional procedures have been defined and standardized. Concurrently, we also recommend the ultrasound monitoring time interval and diagnostic report writing standard for liver diseases.

A rare cause of progressive neuropathy: Arachnoiditis ossificans

Arachnoiditis ossificans (AO) is a rare type of chronic arachnoiditis characterized by the presence of calcification or ossification of the spinal arachnoid which is usually associated with progressive neurological deficits. It is usually followed by prior history of trauma, surgery, infection, or myelography. Magnetic resonance imaging and computed tomography are the characteristics that are helpful in the diagnosis of most cases. Prognosis and treatment depends on the site and clinical presentation of the patients. We present a case of a young female who presented with a long-standing history of neurological symptoms and a intradural lesion mimicking a tumor.

Current situation and progression of radiofrequency ablation therapy for benign space occupying lesion of the liver / 中华肝胆外科杂志

Benign occupations of the liver (BOL) are a heterogeneous group of benign hepatic lesions,a minority of which may need active management.It's reported that radiofrequency ablation (RFA) can be used to treat BOL,such as hepatic haemangioma,focal nodular hyperplasia (FNH),hepatocellular adenoma,simple hepatic cyst,liver abscess and hepatic echinococcosis.RFA has exhibited a potentiality to replace resection as the first-line treatment option for hepatic haemangioma.For multiloculated intractable simple hepatic cyst or liver abscess,when patients are not suitable for or refuse surgical resection,RFA may be an alternative option for the resection;and it also has many advantages over resection,including effectiveness,safety,minimal invasiveness and repeatability in the treatment of FNH,hepatocellular adenoma,and hepatic echinococcosis.A review will be presented on the current situation and latest progression of RFA therapy for BOL in this article.

Application of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound in the diagnosis of uterine space-occupying lesion / 上海交通大学学报（医学版）

Objective·To evaluate the clinical value of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound in the diagnosis of uterine space-occupying lesion.Methods·A total of 75 patients with uterine space-occupying lesion were enrolled in this study from March 2015 to February 2016 at Hospital of Southwest Medical University.Patients received both two-dimensional ultrasound and four-dimensional color Doppler ultrasound to determine the location,number and nature of the lesions,as well as the clinical staging of malignant lesions,then the diagnostic accuracy was evaluated.Results·Among 75 patients,there were 26 cases with endometrial carcinoma,21 cases with hysteromyoma,16 cases with metropolypus,and 12 cases with uterine adenomyosis.The diagnostic accuracy of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound for the uterine space-occupying lesion was 88.0％,which was significantly higher than that of two-dimensional ultrasound (64.0％) (P＜0.05).What's more,the diagnostic accuracy of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound for the clinical staging of endometrial carcinoma was 88.5％,which was significantly higher than that of two-dimensional ultrasound (61.5％) (P＜0.05).Conclusion·Two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound is more effective to improve the diagnostic accuracy of uterine space occupying lesion and clinical staging of endometrial carcinoma in comparison with two-dimensional ultrasound,which will favor the clinical strategy for the treatment of uterine space-occupying lesion.

Secondary male hypogonadism induced by sellar space-occupying lesion: Clinical analysis of 22 cases / 中华男科学杂志

<p><b>Objective</b>To analyze the clinical characteristics of secondary male hypogonadism induced by sellar space-occupying lesion, explore its pathogenesis, and improve its diagnosis and treatment.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 22 cases of secondary male hypogonadism induced by sellar space-occupying lesion, reviewed related literature, and investigated the clinical manifestation, etiological factors, and treatment methods of the disease. Hypogonadism developed in 10 of the patients before surgery and radiotherapy (group A) and in the other 12 after it (group B). The patients received endocrine therapy with Andriol (n=7) or hCG (n=15).</p><p><b>RESULTS</b>The average diameter of the sellar space-occupying lesions was significantly longer in group A than in B (［2.35±0.71］ vs ［1.83±0.36］ cm, P<0.05) and the incidence rate of prolactinomas was markedly higher in the former than in the latter group (60% vs 0, P<0.01). The levels of lutein hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) were remarkably decreased in group B after surgery and radiotherapy (P<0.01). Compared with the parameters obtained before endocrine therapy, all the patients showed significant increases after intervention with Andriol or hCG in the T level (［0.78±0.40］ vs ［2.71±0.70］ ng/ml with Andriol; ［0.93±0.44］ vs ［3.07±0.67］ ng/ml with hCG) and IIEF-5 score (5.00±2.61 vs 14.50±3.62 with Andriol; 5.36±1.82 vs 15.07±3.27 with hCG) (all P<0.01). The testis volume increased and pubic hair began to grow in those with hypoevolutism. The patients treated with hCG showed a significantly increased testis volume (P<0.01) and sperm was detected in 7 of them, whose baseline testis volume was markedly larger than those that failed to produce sperm (［11.5±2.3］ vs ［7.5±2.3］ ml, P<0.01). Those treated with Andriol exhibited no significant difference in the testis volume before and after intervention and produced no sperm, either.</p><p><b>CONCLUSIONS</b>Hypothyroidism might be attributed to surgery- or radiotherapy-induced damage to the pituitary tissue, space-occupying effect of sellar lesion, and hyperprolactinemia. Both Andriol and hCG can improve the T level and erectile function, but the former does not help spermatogenesis.</p>

A Case Report of ‘Pseudo Tumor Cerebri’

Pseudo tumor cerebri is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. This case is being presented for the following points: raised ICT, bilateral CN VI palsy, bilateral papilledema (left > right), neck rigidity present without Kernig's and Brudginski signs. Keeping the history, Neurological findings, investigative results, point to the possibility of raised intracranial pressure with CN VI involvement. The final clinical diagnosis, to the above syndrome, points out to ‘Pseudo-tumor cerebri’.

Clinical application of hysteroscopic on intrauterine benign lesions treatment and its safety evaluation / 中国综合临床

Objective To investigate the hysteroscopy application on uterine cavitary benign and its safety.Methods Two hundred and ten patients with benign lesions in the uterine cavity from Jan 2010 to Jan 2013 were selected as our subjects.They were underwent hysteroscopy and electric section,including 72 cases with uterine polyps resection,70 cases with uterine fibroids resection,and 68 cases with pregnancy tissue residue removal surgery.The follow up periods were 4 months to 2 years and the therapy effects were recorded.Results Two hundred and ten patients were got one successful operation.Operation period was ranged from 11 to 39 minutes and average was 15 minutes.The intraoperation bleeding volumes was ranged from 5 to 70 ml and no intraoperation complications occurred.During the follow-up periods,94.1％ (191/203) patients were recovered to regular menstruation and dysmenorrhea improvement rate was 87.70％ (178/203) at 1 month after operation.At 6 months after operation,96.1％ (195/203) and 91.6％ (186/203) patient were with the regular menstruation and dysmenorrhea improvement.Two cases with uterine cavitypolyp were reoccurred after operation and cured by electron section.Conclusion Hysteroscopy in treatment of benign uterine lesions is showed the satisfactory curative effect in terms of keep uterus integrity with little injury,slight pain.It is proved to be as the prefer methods to treatment for benign uterine cavity lesions.

Clinical Significance of Ultrasonography for the Diagnosis of Nontraumatic Posterior Interosseous Nerve Palsy / The Japanese Journal of Rehabilitation Medicine

Objective : Causes of nontraumatic posterior interosseous nerve (PIN) palsy include space-occupying lesions, constrictions of the PIN, and supinator syndrome. The purpose of this study was to identify these causes using Ultrasonography (US). Methods : We performed US in seven cases (seven elbows) with palsy and examined the PIN and surrounding structures. Results : We identified the three causes by the following US findings : 1) A space-occupying lesion in two elbows. Both were low-echoic and diagnosed as ganglion. In these two cases, the PIN was elevated by the lesion and compressed against the arcade of Frohse. 2) A diffusely swollen PIN with constrictions was found in three cases. 3) A PIN showing a reduction in caliber beneath and a swelling (pseudoneuroma) proximal to the arcade of Frohse, compatible with supinator syndrome was also identified. Conclusion : US is useful for the diagnosis of nontraumatic PIN palsy.

Significance of history taking before autopsy: A case study.

Many cases are being reported before the Forensic Experts, in which it becomes difficult to find out the precise cause of death. A 73 year male was brought for autopsy examination at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand with suspicion of death due to brain tumor. The findings of autopsy examination was edema of brain matters and depressed area in right frontal lobe of brain with several stitches marks on right side of head. Detailed history from all the concerned persons were taken which reveals previously person was operated by neurosurgeon for space occupying lesion in cranial cavity. Histo-pathology examination of mass showed Koch’s lesion as tuberculoma en plaque a very rare presentation of tuberculosis which is very common in our country even in the era of 21st century. Case is being presented with brief discussion showing the need of early and prompt history taking including hospital records details before an autopsy examination. It may reveal important facts as well as helps the Forensic Experts to take the consideration of therapeutic artefacts during autopsy to find the exact cause of death.

Value of the new 5-sector approach for orbital imaging division in diagnosis of orbital space-occupying lesions / 第二军医大学学报

Objective: To discuss the diagnostic value of the new 5-sector approach for orbital imaging division in the diagnosis of orbital space-occupying lesions. Methods: We retrospectively analyzed the clinical and imaging data of 374 patients with orbital space-occupying lesions. The distribution of the lesions was analyzed according to the new 5-sector approach for orbital imaging division (globe compartment, optic nerve compartment, intraconal compartment, extraconal compartment and extra-periosteum compartment) and the distribution rule of the lesions were discussed. Results: Hemangioma was the most common lesion among our group, with an incidence of 34.75%(130/374); 79.23% (103/130) of the hemangiomas were distributed in the intraconal compartment. There was a distributional difference between the lymphoma and inflammatory pseudotumor(χ 2 = 13. 63, P=0.001), with the former mainly located in the extraconal compartment and the latter often in the mixed compartments. We also found that there were distributional differences for those lesions which had more than 10 sufferers in our study(χ2= 788.058, P=0.001). Significant differences were also noted in the distribution of both benign and malignant lesions in the intraconal, extraconal and mixed type compartment(χintra/extra2=66.53, P extraconal compartment (56.12%,78/139)> mixed type(36.96%, 17/46); for the malignant lesions, the incidence order was: mixed type(63. 04%,29/46)> extraconal compartment(43.88%,61/139)> intraconal compartment(0.82%,1/122). Conclusion: There are distributional differences in orbital space-occupying lesions under the new 5-sector approach for orbital imaging division, indicating that the new 5-sector approach is helpful in the diagnosis of orbital lesions.

Affecting factors for diagnosis of benign or malignant pancreatic cystic lesions / 中华肝胆外科杂志

Objective To determine the effecting factors for diagnosis of binign or malignant in cystic lesions of pancreas(CLP).Methods One hundred twenty-six patients undergoing operations for CLP or suspected CLP in this hospital from January 1984 to June 2008 were reviewed.Patients were divided into two groups according to lesion's histological features after operation.The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated.Results One hundred twenty-six patients underwent operations for suspected pancreatic cystic neoplasms.There were 89 benign and 37 malignant CLPs.The univariate analysis showed that gender, clinical symptoms(jaundice and weight loss), elevated serum CA199, and presence of one or more of three morphologic features such as solid component, nodule or septation were significantly different between benign and malignant cystic neoplasm of pancreas.The multivariate analysis indicated that imaging features and gender were independent predictors of malignancy.Conclusion In patients with suspected pancreatic cystic neoplasms, elevated serum CA199, clinical symptoms(jaundice and weight loss)and presence of suspicious morphologic features on imaging are predictors of malignant potential of CLP.Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.

A preliminary study of the movement of space-occupying pancreatic lesions and its influencing factors / 中华放射肿瘤学杂志

Objective To investigate the movement and its influencing factors of the space-occup ying pancreatic lesions and provide a reference for the safe margin between CTV and PTV in accurate radio therapy.Methods Gold fiducials were implanted into the lesions of 16 pancreatic carcinoma patients by percutaneous punctures under B-uhrasonographic guidance.The movements of these markers were measured under the X-ray simulator system in the x,y and z axial directions,respectively.The relevant influencing fac tors were analyzed.Results The motion amplitudes of pancreatic lesions were 0.1-0.3 (mean 0.16 ± 0.06) cm,0.1-0.4 (mean 0.25 ±0.12) em and 0.5-1.6 (mean 0.88±0.24) cm in the x,y and z axi al directions,respectively.The movements were not associated with the height,weight,age,tumor location or tumor size.Conclusions The motion of the space-occupying pancreatic lesions is mainly influenced by the respiration,especially with the maximal amplitude in the z axial direction.Therefore,the motion in the z axial direction should be given more consideration when determining the PTV margin.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS: Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.

Quiste hidatídico hepático a propósito de un caso

Se reporta el caso de paciente femenina de 51 años, con antecedente de contacto con animales domésticos, a la cual se le realizó diagnóstico de quiste hidatídico hepático, en base a estudios de imagen y paraclínicos compatibles por patrón ecográfico, con gran Lesión de Ocupación de Espacio (LOE) quística, multivesicular, de aspecto septado, en lóbulo hepático derecho, eosinofilia moderada y discreta elevación del perfil bioquímico hepático, con Elisa (IgG) para hidatidosis positivo, que manifestó buena respuesta a terapia farmacológica única con benzimidazoles (Albendazol) vía oral, con disminución progresiva de la lesión hasta su total desaparición, sin requerir tratamiento quirúrgico, en seguimiento actual de 13 meses. Se revisa la literatura de la enfermedad y manejo terapéutico de la misma.

We report the case of a 51 years old female patient, with a history of contact with domestic animals, to whom we diagnosed a Hepatic Hydatid Cyst, on the grounds of image studies and laboratory tests compatible with a spaceoccupying lesion, multivesicular cysts, in the right hepatic lobe; moderate eosinophilia, and a discreet elevation of the hepatic biochemical profile, with Elisa (IgG) positive for Hydatid Cyst disease. She showed a good response to single therapy with benzimidazole (Albendazole), given orally, with a progressive diminution of the lesion until its total disappearance, without requiring surgical treatment, at follow up for 13 months. We review the literature relative to this disease and its therapeutic options.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions / 대한정형외과학회잡지

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesion (SOL)s. MATERIALS AND METHODS: 14 patients (15 cases) that underwent surgery from 1992 to 2002 for CTS due to SOL were studied. The average age was 51 years. There were 6 men and 8 women. Mean follow up period was 16 months. In patients with swelling or tenderness on the area of wrist flexion creases, MRI and/or CT scan were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion were, in three cases tuberculosis tenosynovitis, nonspecific tenosynovitis in three cases, gout in one case, mass in four cases, and abnormal palmaris longus hypertrophy in one case. Bony lesions were, in one case Kienbock's disease (stage III), neglected volar dislocation of lunate in two cases. Following surgery, all cases showed alleviation of symptoms. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and if necessary, MRI and/or CT should be supplemented in order to rule out SOLs.

Surgical Treatment of Tarsal Tunnel Syndrome / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of tarsal tunnel syndrome. MATERIALS AND METHODS: Twenty-one patients with tarsal tunnel syndrome were followed for more than 1 year after operation. The mean age was 44 years, and the mean follow up period was 2 years and 9 months. Clinically preoperative and postoperative AOFAS ankle-hindfoot score and visual analogue scale for pain were analyzed. Radiologically the cause of disease was investigated, and the size of mass was measured, if possible. The duration of symptom, the presence of space occupying lesion (SOL), the effect of epineurolysis were statistically analyzed to see the relation with the operative results. RESULTS: Operative release of tarsal tunnel was done in all cases, and epineurolysis was done in 11 cases. The causes of the disease were 10 soft tissue masses, 7 talocalcaneal coalitions, 1 nonunion of medial talar process fracture, and 1 pes planovalgus, and 3 idiopathic cases. The masses were subdivided into 7 ganglions, 2 neurilemmomas, and 1 lipoma. There was 1 case of combined talocalcaneal coalition and ganglion. Clinically AOFAS ankle-hindfoot score was increased from 62.7 points preoperatively to 84.3 points postoperatively. Visual analogue scale was improved from 6.5 preoperatively to 2.2 postoperatively. Two cases were graded as unsatisfactory. One was severe pes planovalgus, and the other was idiopathic case. The duration of symptom and the epineurolysis were not related with the results. However the presence of space occupying lesion was significantly related with the good results. CONCLUSION: Early operative release of tarsal tunnel appears to be important for the improvement of symptom. However the prognosis is limited in case that there is no SOL.

Evaluation of the Renal Space-occupying Lesions with Sonography / 中华超声影像学杂志

In this paper 100 cases of renal space-occupying lesions which had been examined before operation by sonography and verified by surgery and pathology were analysed retrospectively. Results showed 99 cases of renal space-occupying lesions and 1 case of retroperitoneal tumor. There were 2 eas-es of false negative and 1 case of false positive for the localization by ultrasound.Nephromas were found to be 92.92%(92/99)totally.in which rnalignant and benign tumors were 86.96%(80/92)and 13.04%(12/92)respectively.5 cases of misdiagnosis and 2 cases of pitfall in qualitative analysis were iden-dried by pathology.The rate of accuracy was 92%(92/100).