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Abstract Objective The incidence of traumatic brachial plexus injuries has been increasing considerably in Brazil, mainly due to the increase in the number of motorcycle accidents. The aim of the present study is to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of brachial plexus avulsion lesions, comparing it with the findings of physical and intraoperative examination. Methods A total of 16 patients with brachial plexus injury were prospectively evaluated and treated at the hand surgery outpatient clinic from our service. All patients underwent MRI of the brachial plexus, and the findings were inserted on a table, as well as the physical examination data, and part of the patients had the plexus evaluated intraoperatively. Results In the present study, the accuracy of MRI in the identification of root avulsion was 100%, with 100% sensitivity and specificity when comparing imaging with surgical findings. Conclusion Magnetic resonance imaging showed high sensitivity and specificity, confirmed by intraoperative findings, which allows considering this test as the gold standard in the diagnosis of avulsion in traumatic brachial plexus injuries.
Resumo Objetivo A incidência de lesões traumáticas do plexo braquial vem aumentando consideravelmente no Brasil, principalmente devido ao aumento do número de acidentes de motocicleta. O objetivo do presente estudo é avaliar a sensibilidade e a especificidade da ressonância magnética (RM) no diagnóstico das lesões por avulsão do plexo braquial, comparando com os achados do exame físico e do intraoperatório. Métodos Foram avaliados prospectivamente 16 pacientes com lesão do plexo braquial atendidos no ambulatório de cirurgia da mão de nosso serviço. Todos os pacientes foram submetidos ao exame de RM do plexo braquial e os achados foram inseridos em uma tabela, assim como os dados do exame físico, e parte dos pacientes teve o plexo avaliado intraoperatoriamente. Resultados No presente estudo, a acurácia da RM na identificação de avulsão de raízes foi de 100%, com 100% de sensibilidade e especificidade comparando-se achados da imagem e cirúrgicos. Conclusão A RM mostrou alta sensibilidade e especificidade, confirmadas por achados intraoperatórios, o que permite considerar este exame como padrão outro no diagnóstico de avulsão nas lesões traumáticas do plexo braquial.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brachial Plexus/surgery , Brachial Plexus/injuries , Brachial Plexus/diagnostic imaging , Magnetic Resonance Imaging , Diagnosis, Differential , Peripheral Nerve InjuriesABSTRACT
Introducción. El dolor abdominal agudo es una causa frecuente de consulta en los servicios de urgencias. Su incidencia es alrededor del 5%, de los cuales el 10%- 25% de los pacientes requieren tratamiento quirúrgico. Las neoplasias apendiculares primarias son infrecuentes, actualmente representan 1% de las neoplasias malignas de origen gastrointestinal. Existe un predominio en mujeres y se debe sospechar en pacientes con factores de riesgo. El objetivo es entender la importancia del diagnóstico oportuno en el abordaje del paciente con dolor abdominal agudo. Presentación del caso. Mujer con cuadro clínico de 5 días de dolor abdominal, con hallazgo en tomografía de abdomen de marcada dilatación quística del apéndice cecal con calcificaciones lineales y nodulares en la pared y su interior. Intraoperariamente, se realizó hemicolectomía derecha con resultado histológico de neoplasia mucinosa del apéndice (adenoma serrado) con pérdida de la muscularis mucosae, catalogándolo como adenocarcinoma de bajo grado. Discusión. Los tumores apendiculares representan el 1% de las neoplasias malignas de origen gastrointestinal, son un hallazgo incidental (0.7-1.4%) en los procedimientos de apendicectomía. El diagnóstico es histopatológico y el pronóstico se relaciona con la clasificación. Es importante conocer, identificar y sospechar esta patología dada su infrecuencia, con lo cual se puede mejorar el pronóstico en los pacientes. Conclusión. Los tumores apendiculares son infrecuentes, los cuales deben ser incluidos en el grupo de patologías causantes de dolor abdominal agudo.
Introduction. Acute abdominal pain is a frequent cause of consultation to emergency services. Its incidence is about 5%, of which 10%-25% of patients require surgical treatment. Primary appendiceal neoplasms are infrequent. They currently represent 1% of malignant neoplasms of gastrointestinal origin. They are predominant in women and must be suspected in patients with risk factors. The objective is to understand the importance of timely diagnosis in approaching patients with acute abdominal pain. Case report. A woman with clinical condition of 5 days of abdominal pain. Marked cystic dilation of the cecal appendix with linear and nodular calcifications on its wall and interior found in a tomography of the abdomen. Intraoperatively, a right hemicolectomy was performed with a histological result of mucinous neoplasm of the appendix (serrated adenoma) with loss of the muscularis mucosae, classifying it as a low grade adenocarcinoma. Discussion. Appendiceal tumors represent 1% of malignant neoplasms of gastrointestinal origin, with an incidental finding (0.7-1.4%) in appendectomy procedures. The diagnosis is histopathological, and prognosis is related to its classification. It is important to know, identify and suspect this pathology due to its infrequency, which can improve the patient's prognosis. Conclusion. Appendiceal tumors are infrequent and should be included in the group of pathologies that cause acute abdominal pain.
Introdução. A dor abdominal aguda é causa frequente de consulta nos serviços de emergência. Sua incidência é em torno de 5%, dos quais entre 10% e 25% dos pacientes necessitam de tratamento cirúrgico. As neoplasias primárias de apêndice são raras, representando atualmente 1% das neoplasias malignas de origem gastrointestinal. Há predominância em mulheres e deve-se suspeitar em pacientes com fatores de risco. O objetivo é compreender a importância do diagnóstico oportuno na abordagem de pacientes com dor abdominal aguda. Relato de caso. Mulher com quadro clínico de dor abdominal por 5 dias, com achado tomográfico de abdome de dilatação cística acentuada do apêndice cecal com calcificações lineares e nodulares na parede e seu interior. No intraoperatório foi realizada hemicolectomia direita com resultado histológico de neoplasia mucinosa de apêndice (adenoma serrilhado) com perda da muscularis mucosae, classificando-a como adenocarcinoma de baixo grau. Discussão. Os tumores apendiculares representam 1% das neoplasias malignas de origem gastrointestinal, sendo um achado incidental (0.7-1.4%) em procedimentos de apendicectomia. O diagnóstico é histopatológico e o prognóstico está relacionado à classificação. É importante conhecer, identificar e suspeitar desta patologia dada a sua infrequência, o que pode melhorar o prognóstico dos pacientes. Conclusão. Os tumores apendiculares são pouco frequentes e devem ser incluídos no grupo de patologias que causam dor abdominal aguda.
Subject(s)
Adenocarcinoma , Appendix , Abdominal Pain , Diagnosis, Differential , Intestinal NeoplasmsABSTRACT
Resumen ANTECEDENTES: La hemorragia puerperal tardía implica una importante morbilidad y mortalidad que requiere una actuación urgente. Su causa es muy variada y requiere una cuidadosa valoración que permita detenerla, sin complicaciones. CASO CLÍNICO: Paciente de 42 años que a las cinco semanas posteriores a una cesárea acudió a Urgencias debido a un sangrado puerperal abundante. Enseguida de un legrado y exhaustiva revisión en el quirófano en la ecografía se identificó un área parauterina anecogénica sugerente de dilatación aneurismática comunicada con la cavidad uterina. El diagnóstico se estableció con base en la angiografía y se confirmó luego de la embolización mediante radiología intervencionista, sin contratiempos, y resolución del cuadro. La paciente se dio de alta del hospital en los siguientes dos días, con posteriores revisiones que se reportaron normales. CONCLUSIONES: La patología vascular debe formar parte del diagnóstico diferencial del sangrado puerperal tardío y, si se diagnostica adecuadamente, puede facilitar el procedimiento terapéutico mediante radiología intervencionista y evitar, así, otros tratamientos más invasivos.
Abstract BACKGROUND: Late puerperal hemorrhage is a major morbidity and mortality that requires urgent action. Its cause is very varied and requires careful assessment to stop it without complications. CLINICAL CASE: A 42-year-old woman came to the emergency department five weeks after cesarean section for heavy puerperal bleeding. After curettage and thorough examination in the operating room, ultrasound identified an anechogenic parauterine area suggestive of aneurysmal dilatation in communication with the uterine cavity. The diagnosis was established based on angiography and confirmed after embolization by interventional radiology, without mishap, and resolution of the picture. The patient was discharged in two days, with subsequent revisions reported as normal. CONCLUSIONS: Vascular pathology should be part of the differential diagnosis of late puerperal hemorrhage and, if properly diagnosed, may facilitate the therapeutic procedure by interventional radiology and thus avoid other more invasive treatments.
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ABSTRACT Oral amyloidosis is a disease characterized by extracellular and irreversible deposition of amorphous and fibrillar proteins in the oral cavity, being strongly associated with Multiple Myeloma. The objective of this study is to report a case of a 62-year-old woman diagnosed with Multiple Myeloma who, approximately 2 years after starting treatment for the underlying disease, presented a lesion on the lateral border of the tongue with exophytic growth, pinkish color, vascularized, painless, measuring 3cm in its largest diameter. After histopathological analysis through incisional biopsy, a final diagnosis of amyloidosis was obtained. As a local treatment, we opted for complete excision of the lesion. The patient evolved to death due to Multiple Myeloma influenced by the diagnosis of systemic amyloidosis. Oral amyloidosis is usually associated with the systemic presentation of the disease, making it necessary to conduct a thorough investigation of other organs. Its diagnosis is important since the prognosis is directly related and can negatively influence survival rates and treatment of the underlying disease.
RESUMO A amiloidose oral é uma doença caracterizada pela deposição extracelular e irreversível de proteínas amorfas e fibrilares na cavidade bucal, sendo fortemente associada com Mieloma Múltiplo. O objetivo deste trabalho é relatar o caso de uma mulher com 62 anos de idade diagnosticada com Mieloma Múltiplo que, aproximadamente 2 anos após o início do tratamento para a doença de base, apresentou lesão em borda lateral de língua com crescimento exofítico, de coloração rósea, vascularizada, indolor, medindo 3 cm em seu maior diâmetro. Após análise histopatológica através de biópsia incisional, obteve-se diagnóstico final de amiloidose. Como tratamento local, optou-se pela exérese completa da lesão. A paciente evoluiu para óbito por consequência do Mieloma Múltiplo com complicações associadas à amiloidose sistêmica. A amiloidose oral geralmente está associada com a apresentação sistêmica da doença, tornando necessária uma investigação aprofundada nos demais órgãos. Seu diagnóstico é importante uma vez que pode influenciar diretamente no prognóstico e, consequentemente, negativamente nas taxas de sobrevida e no tratamento da doença de base.
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Objective:To investigate the key points of diagnosis and treatment of glycogen storage disease type Ⅱ(GSD Ⅱ).Methods:The clinical data of one child patient with GSD Ⅱ who received treatment in Hainan Children's Hospital on May 7, 2017 were retrospectively analyzed.Results:The child presented with atypical clinical manifestations, including pneumonia first, accompanied by muscle weakness and elevated muscle enzymes. Whole-genome sequencing showed that there were two heterozygous mutations in the acid alpha-glucosidase (GAA) gene, c.871C > T and c.1447G > A. The child was diagnosed with GSD Ⅱ.Conclusion:GSD Ⅱ has atypical clinical manifestations. It is easily misdiagnosed. Early whole-genome sequencing is helpful for the diagnosis of GSD Ⅱ.
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Objective:To explore the differences of clinical laboratory indicators between Kawasaki disease (KD) and systemic juvenile idiopathic arthritis (SJIA), providing objective evidence for diagnosis and differential diagnosis of these diseases.Methods:A total of 41 children patients with KD (KD group) and 33 children patients with SJIA (SJIA group) who received treatment in Huainan Maternal and Child Health Hospital between September 2017 and January 2022 were retrospectively analyzed. An additional 50 healthy children who concurrently received physical examination in the same hospital were included in the control group. Platelet count (PLT), white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP), serum procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), and serum ferritin (SF) levels were compared among groups before treatment.Results:One-way analysis of variance and pairwise q test were performed to compare laboratory indicators among KD, SJIA and control groups. CRP, ESR, SF and IL-6 levels in the KD group were significantly lower than those in the SJIA group [CRP: (57.80 ± 25.23) mg/L vs. (77.72 ± 45.64) mg/L; ESR: (67.02 ± 28.80) mm/h vs. (83.84 ± 47.64) mm/h; SF: (320.21 ± 182.53) μg/L vs. (945.58 ± 604.65) μg/L; IL-6: (50.35 ± 20.54) ng/L vs. (89.35 ± 45.54) ng/L, q = 4.34, 3.42, 11.51, 8.85, all P < 0.05]. IL-10 level in the KD group was significantly higher than that in the SJIA group [(18.52 ± 16.71) ng/L vs. (10.01 ± 3.24) ng/L, q = -5.25, P < 0.05]. WBC, CRP, ESR, PCT, PLT, IL-6, IL-10 and SF in the KD and SJIA groups were significantly higher than those in the control group (all P < 0.05). Conclusion:Detection of CRP, ESR, SF, IL-6, IL-10 in blood can provide objective evidence for the early diagnosis and differential diagnosis of KD and SJIA, thereby reducing the misjudgment of clinical diagnosis.
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Among all non-Hodgkin's lymphoma, primary ovarian Burkitt lymphoma (POBL) is a rare disease. Tumors can occur in one or both ovaries. The main symptoms of POBL are abdominal pain or a large abdominal mass. The differential diagnosis of POBL based on imaging characteristics and histopathological examination is the basis for further treatment of ovarian tumors from different sources. Although most patients with POBL have undergone surgical treatment after the discovery of ovarian masses, chemotherapy rather than surgery should be the main treatment method for them. Active chemotherapy combined with preventive central nervous system therapy leads to good prognosis. A variety of treatment schemes have been adopted, which greatly increase the survival rate of patients with POBL. In this review, we retrieved related literature and retrospectively reviewed the epidemiology, clinical manifestation, diagnosis and treatment of POBL. The purpose of this review is to draw clinicians' attention to the possibility of POBL when performing differential diagnosis of ovarian tumors.
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Objective:To investigate the clinicopathological features, immunophenotype and differential diagnosis of clear cell hidradenoma, and to analyze the origin of clear cell hidradenoma and the underlying mechanism.Methods:The clinical data of 23 cases of clear cell hidradenoma who underwent surgical resection in Suzhou Municipal Hospital between December 2017 and July 2021 were retrospectively analyzed. Clinical manifestation, imaging features, pathological features and prognosis of the 23 cases of clear cell hidradenoma were analyzed. Expression levels of epithelial membrane antigen, cytokeratin 20, cytokeratin 7, cytokeratin 14, carcinoembryonic antigen, and gross cystic disease fluid protein 15 were detected by immunohistochemical staining technique using the EnVision system. Periodic acid-Schiff (PAS) staining was performed to visualize glycogen.Results:Among the 23 cases, 8 were male and 14 were female, aged 14-94 years, with a median age of 55 years. The first symptom of clear cell hidradenoma was epidermal bulgels in 18 cases.Contrast ultrasonography showed a subcutaneous cystic solid echo mass with abundant blood flow in the solid part. The tumor histologically consisted of two types of cells: secretory epithelial cells or glandular epithelial cells and clear cells. Twenty cases had tumors with the features of benign clear cell hidradenoma. Two cases had atypical clear cell hidradenoma with atypia and mitosis. One case had malignant clear cell hidradenoma. Tumor cells were positive for epithelial membrane antigen, cytokeratin 7, cytokeratin 14, carcinoembryonic antigen, and gross cystic disease fluid protein 15 and they were Periodic acid-Schiff-positive. Twenty-three patients were followed up for 2-36 months, of which 4 were lost to follow-up and the rest had no recurrence of clear cell hidradenoma.Conclusion:Clear cell hidradenoma is rare and has a good prognosis. Malignant clear cell hidradenoma is rarer and has a poor prognosis. Diagnosis of clear cell hidradenoma is mainly based on comprehensive analysis of pathological features and immunophenotypes. Clear cell hidradenoma should be differentiated from metastatic clear cell carcinoma, spiral adenoma, cortical adenoma, and malignant melanoma.
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Objective:To explore the clinical and pathological characteristics of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS).Methods:The clinical and pathological data on 12 cases of confirmed ECIPAS in the First Affiliated Hospital of Naval Medical University and Huashan Hospital Affiliated to Fudan University from January 2011 to December 2020 were retrospectively analyzed. Patients′ sex, age, serum tumor markers, tumor size, tumor location and distant metastasis were recorded. Tissue expression of synaptophysin (Syn), chromogranin A(CgA), cytokeratin (CK) and CK5/6, estrogen receptor (ER), progesterone receptor (PR), proliferation index Ki-67 and tumor suppressor gene p53 were evaluated by immunohistochemistry.Results:All the patients were incidentally diagnosed during routine body examination. Among them, there were 4(33.3%) men and 8(66.7%) women. Patient's average age was 42 years old. All the lesions were located at the tail of the pancreas. 3 patients had elevated carbohydrate antigen 19-9(CA19-9). The ECIPAS were demonstrated as clear-boundary low or no echo on abdominal ultrasound, low-density mass on CT, and cystic and solid lesion on pancreas MRI, respectively. Eleven patients received resection of body and tail of pancreas and spleen, one patient received pancreatectomy with preservation of the spleen. The resected specimens from the 12 patients were showed as cystic and solid mass in the pancreatic tail with a maximal diameter ranging from 1.4 cm to 4.0 cm. Under microscopy, multi-cystic lesions covered with stratified squamous epithelial cells were observed. Immunohistochemistry showed that the squamous cell marker CK was expressed. In a follow-up period of 5 to 119 months, and no recurrence were diagnosed.Conclusions:ECIPAS is a rare lesion often occurring in tails of pancreas and the patients usually have no clinical symptoms. It is challenging to make a correct diagnosis by imaging, but this lesion has unique pathological manifestations and good prognosis.
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Objective:To analyze the diagnostic value of X-ray, CT and MRI multimodal images in the vertebral compression fractures caused by osteolytic metastases and osteoporosis.Methods:The basic clinical data and X-ray, CT, MRI imaging data of 102 patients with vertebral compression fractures from January 2019 to May 2021 in Jiangnan Hospital (Xiaoshan Traditional Chinese Medicine) Affiliated to Zhejiang University of Traditional Chinese Medicine were retrospectively analyzed. Among them, vertebral compression fractures caused by osteolytic metastases was in 47 cases, and vertebral compression fractures caused by osteoporosis was in 55 cases.Results:The age and osteoporosis rate in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: (61.95 ± 11.84) years old vs. (72.37 ± 12.55) years old and 4.3% (2/47) vs. 83.6% (46/55), the body mass index and pain visual analogue score were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: (22.58 ± 3.85) kg/m 2 vs. (18.11 ± 2.79) kg/m 2 and (8.31 ± 2.91) scores vs. (7.02 ± 2.72) scores, and there were statistical differences ( P<0.05); there was no statistical difference in gender composition ( P>0.05). The rates of vertebral body wedge shape and double concave shape in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 2.80% (3/107) vs. 60.82% (104/171) and 6.54% (7/107) vs. 29.82% (51/171), the rates of flat shape and posterior margin swelling were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 75.70% (81/107) vs. 9.36% (16/171) and 14.95% (16/107) vs. 0, and there were statistical differences ( P<0.01); the rates of pedicle involvement and soft tissue mass in patients with vertebral compression fractures caused by osteolytic metastases were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 68.09% (32/47) vs. 1.82% (1/55) and 46.81% (22/47) vs. 0, while the rate of linear image signal in vertebral body was significantly lower than that in patients with vertebral compression fractures caused by osteoporosis: 0 vs. 96.36% (53/47), and there were statistical difference ( P<0.01); there was statistical difference in MRI signals ( P<0.01), vertebral compression fractures caused by osteolytic metastases were mainly characterized by low T 1 high T 2 and low T 1 low T 2, while vertebral compression fractures caused by osteoporosis was mainly characterized by low T 1 high T 2; the rates of disc compression and widening in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 4.26%(2/47) vs. 34.55% (19/55) and 2.13%(1/47) vs. 18.18% (10/55), and there were statistical differences ( P<0.01 or <0.05). The accuracies of multimodal imaging in the diagnosis of vertebral compression fractures caused by osteolytic metastases and osteoporosis were significantly higher than those of X-ray, CT and MRI (89.4% vs. 51.1%, 72.3%, 83.0%; 90.9% vs. 52.7%, 60.0%, 78.2%), and there were statistical differences( P<0.05). Conclusions:Multimodal imaging is helpful to improve the diagnostic accuracy of vertebral compression fractures caused by osteolytic metastases and osteoporosis, to reduce the clinical misdiagnosis rate, with important reference value for the differential diagnosis of the two diseases.
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Objective:To investigate the diagnostic value of triglyceride/cystatin C (TG/Cys-C) ratio combined with diabetic retinopathy, diabetes course and systolic pressure in patients with diabetic kidney disease (DKD).Methods:Patients with type 2 diabetes and renal insufficiency, who underwent renal biopsy in four Grade A tertiary hospitals in Xuzhou from January 2013 to February 2021 were included in this retrospective study. Patients were divided into DKD group ( n=51) and non-DKD (NDKD) group ( n=49) based on renal biopsy results. Another 50 patients with type 2 diabetes mellitus without renal dysfunction were selected as control group. The first admission information and blood biochemical indexes were collected, and the TG/Cys-C ratio was calculated. The differences of clinical indexes between the DKD and NDKD groups were compared. The correlative factors of DKD in type 2 diabetes patients with renal dysfunction were analyzed by logistic regression. The ROC curve was used to evaluate the diagnostic value of TG/Cys-C ratio, diabetic retinopathy, duration of diabetes, systolic blood pressure and combined detection for DKD in patients with type 2 diabetes and renal dysfunction. Results:Among patients with type 2 diabetes with renal dysfunction, renal biopsy results showed that membranous nephropathy was the most common pathological type in NDKD group, accounting for 63.3% (31/49) of all NDKD patients. Compared with Type 2 diabetes mellitus without renal injury, type 2 diabetic patients with kidney injury had higher systolic blood pressure, higher total cholesterol, higher low-density lipoprotein, higher cystatin, higher creatinine, higher uric acid, higher fibrinogen level, more hypertension, more changes of urinary active sediment, lower hemoglobin, lower albumin, and the lower the glomerular filtration rate (all P<0.05). Compared with NDKD group, patients in DKD group had higher systolic and diastolic blood pressure, higher cystatin C and creatinine, more hypertension, more diabetic retinopathy, longer course of diabetes, lower concentration of hemoglobin, lower glomerular filtration rate, lower triglyceride and lower TG/Cys-C ratio (all P<0.05). Multivariate logistic regression analysis showed that TG/Cys-C ratio was associated with DKD in patients with type 2 diabetes mellitus and renal impairment ( OR=0.298, P=0.007), diabetic retinopathy ( OR=12.209, P=0.005), duration of diabetes ( OR=1.016, P=0.034) and systolic blood pressure ( OR=1.049, P=0.006) were independent risk factors for DKD in type 2 diabetic patients with renal dysfunction. The ROC curve showed that AUC of the TG/Cys-C ratio was 0.866 (the cot-off point was 2.06), and the sensitivity was 88.2% and the specificity was 71.4% for the diagnosis of DKD, and AUC of the TG/Cys-C ratio in combination with diabetic retinopathy, diabetes duration and systolic blood pressure was 0.952, and the sensitivity was 92.2% and the specificity was 89.8% for the diagnosis of DKD. Conclusion:TG/Cys-C ratio has significant clinical value in the diagnosis of DKD. Combined detection of TG/Cys-C ratio with diabetic retinopathy, course of diabetes and systolic blood pressure could further improve the diagnostic efficacy of DKD.
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Objective:To investigate the additional value of unenhanced computed tomography (CT) in the differential diagnosis of brain tumors and non-neoplastic lesions.Methods:A total of 237 cases [140 males and 97 females; (49±16) years old; including 48 cases of low-grade glioma, 134 cases of high-grade glioma, 38 cases of primary central nervous system lymphoma, 9 cases of medulloblastoma, 5 cases of germinoma, and 3 cases of central neurocytoma] of brain tumors (diffuse gliomas and non-glial tumors) diagnosed by biopsy or surgery and pathology in the Affiliated Hospital of Qingdao University from September 2016 to October 2020 were collected retrospectively. Sixty-six cases [46 males and 20 females; (42±13) years old; including 12 cases of abscesses, 5 cases of infarcts, 33 cases of demyelinating lesions, 11 cases of autoimmune encephalitis, and 5 cases of central nervous system vasculitis] of brain non-neoplastic lesions were confirmed by biopsy or clinic. All patients underwent routine magnetic resonance imaging (MRI) scan and unenhanced CT before the treatment. The images were reviewed by two neuroradiologists together blind to the final diagnosis with and without CT images respectively. The diagnostic results and reliability scores were recorded, and the accuracy of the two evaluations was compared.Results:CT hyperattenuation exhibited a higher specificity (95%) than conventional MRI scan (86%), and a lower diagnostic sensitivity (34% vs 86%). Compared to MRI alone, the combined modality of MRI and unenhanced CT significantly improved diagnostic accuracy (94% vs 86%). Additionally, the CT attenuation ratio of non-neoplastic lesions was significantly lower than that of neoplastic lesions [0.69 (0.61,0.78) and 1.14 (1.00,1.25), W=2 123, P<0.05]. The CT attenuation ratio in the non-glial origin tumor group was significantly higher than that in the diffuse glioma group [1.28 (1.18,1.41) and 1.13 (0.97,1.21), W=1 858, P<0.05]. There was no significant difference in grade Ⅲ and Ⅳ groups of diffuse glioma [1.11 (0.99,1.20) vs 1.16 (1.09,1.24), P>0.05 (Nemenyi test)]. However, both were significantly higher than that of grade Ⅱgroup of diffuse glioma [0.89 (0.76,1.07), P<0.05 (Nemenyi test)]. No significant difference was observed between astrocytic tumors and oligodendroglial tumors at the same grade. Conclusions:Hyperattenuation on unenhanced CT is highly specific for the diagnosis of brain tumors. Unenhanced CT plus MRI is more accurate for distinguishing the two entities in hypoattenuation lesion on unenhanced CT.
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Psychogenic non-epilepsy seizures (PNES) are defined as paroxysms with clinical symptoms similar to epilepsy without epileptiform discharges. It is often misdiagnosed as epilepsy. Misdiagnosis not only delays the time for patients with PNES to get correct diagnoses and treatments, but also may increase the risk of adverse effects from improper use of antiseizure medications. The diagnostic method of PNES is video electroencephalogram monitoring, but there is no consensus on the optimal duration of monitoring. At the same time, the use of diverse physiological signals, brain imaging, laboratory examination, and the application of machine learning provide new perceptions for the precise identification of PNES and epilepsy. This article reviewed the progress of precise differential diagnosis between PNES and epilepsy.
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Behcet′s disease is a chronic systemic vasculitis with unknown etiology that can involve multiple organs. Behcet′s disease with predominant gastrointestinal manifestations is diagnosed with intestinal Behcet′s disease. Severe complications such as gastrointestinal massive hemorrhage, perforation and obstruction may occur in intestinal Behcet′s disease. If not treated in time, they are associated with significant morbidity and mortality. Here, we will review the lesion distribution, clinical manifestations, diagnosis and disease activity of intestinal Behcet′s disease for better understanding of clinicians.
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Objective:To compare the diagnostic values of different diagnostic criteria of prostate specific membrane antigen (PSMA) PET/CT for primary prostate cancer (PCa).Methods:From May 2019 to May 2021, 2-(3-(1-carboxy-5-((6- 18F-fluoro-pyridine-3-carbonyl)-amino)-pentyl)-ureido)-pentanedioic acid ( 18F-DCFPyL) PET/CT images of 78 patients (age: (68.5±1.4) years) with clinically suspected PCa in Shanxi Bethune Hospital were retrospectively collected and blind diagnosed by the three criteria of SUV max, PSMA reporting and data system (PSMA-RADS) score and molecular imaging PSMA (miPSMA) score. The diagnostic efficacy for PCa, the correlation between the diagnostic results and disease risk, and the consistency of the diagnostic results of the three criteria were compared. Delong test, Spearman rank correlation analysis, and intra-class correlation coefficient (ICC) were used to analyze data. Results:The sensitivities of SUV max, PSMA-RADS score and miPSMA score for PCa were all 93.75%(60/64) and the specificities were 12/14, 10/14 and 12/14 respectively; AUCs of the three criteria were 0.951, 0.862 and 0.951, with no significant difference between SUV max and miPSMA score ( z=0.00, P=1.000), while there were significant differences between PSMA-RADS score and SUV max or miPSMA score ( z values: 2.71, 2.93, P values: 0.007, 0.030). There were positive correlations between the diagnostic results of the three criteria and the disease risk (International Society of Urological Pathology (ISUP) grading: rs values: 0.66, 0.62, 0.63, all P<0.001; D′Amico grouping: rs values: 0.67, 0.64, 0.67, all P<0.001). The diagnostic results of the three criteria were highly consistent (ICC=0.941, 95% CI: 0.903-0.967). Conclusion:The SUV max and miPSMA score have higher diagnostic efficiency and correlation of disease risk, which are more suitable for clinical application.
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Objective:To study the clinical features of intrahepatic biliary cystadenoma (BCA), with the aim to improve its treatment results.Methods:The clinical data and follow-up results of 86 patients with BCA treated at our department from March 2010 to January 2021 were retrospectively analyzed. Of 86 patients, there were 15 males and 71 females, with age of (48.4±13.1) years old. According to the surgical procedures carried out, 44 patients were divided into the minimally invasive group and 42 into the open group. Clinical data including imaging data, blood biochemistry, and tumor markers were collected. The follow-up data of these patients was collected in outpatient clinics or by telephone review.Results:Of 86 patients, 19(22.1%) patients had a monocystic lesion while 67(77.9%) patients had a multicystic lesion, 64 patients (74.4%) had intracapsular segregation, and 12(14.0%) patients had solid structures. Eighty-six patients with BCA were misdiagnosed as hepatic cysts in 9 patients (10.4%), hepatic echinococcosis in 2 patients (2.3%), biliary hamartoma in 1 patient (1.2%), and hepatic hemangioma in 1 patient (1.2%) before surgery. The tumor size [(6.5±3.2) vs. (9.0±4.0) cm], operative time [115(88, 185) vs. 195(160, 254) min], intraoperative blood loss [50(20, 162) vs. 300(200, 600) ml], and postoperative hospital stay [4(3, 6) vs. 8(7, 10) d] were significantly lower in the minimally invasive group than the open group. The differences were statistically significant ( P<0.05). In the 73 patients with complete follow-up, (median follow-up 63.5 months), 4 patients had developed tumor recurrence. Conclusion:Intrahepatic bile duct cystadenoma lacks specific clinical manifestations, and has a high rate of misdiagnosis and mistreatment. Early radical hepatectomy improved clinical outcomes.
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Objective:To study the clinical, imaging and pathological features of duodenal gangliocytic paraganglioma (DGP).Methods:The clinical, imaging and pathological data of patients with DGP treated at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2012 to October 2021 were retrospectively analyzed.Results:Of 8 patients with DGP, there were 7 males and 1 female, with a median age of 52 years (range 37 to 57 years). Five patients were asymptomatic and they were diagnosed on physical examination followed by investigations. Three patients presented with black stools. CT examination showed localized nodular thickening of the duodenum, with enhanced scanning showing obvious progressive contrast enhancement. Endoscopic ultrasonography showed a hypoechoic submucosal lesion in duodenal wall. Histologically, the neoplasm composed of three different cell types which included Schwann cells, epithelioid cells, and ganglioid cells. The Schwann cells expressed NF, NSE and S-100 proteins; the epithelioid cells expressed CK, NSE, Syn and CgA proteins; while the ganglioid cells expressed NSE, Syn, CgA and NF proteins. Endoscopic submucosal dissection was performed in 2 patients and surgical resection was performed in 6 patients.Conclusion:DGP is a rare benign neurogenic tumor which is most commonly found in the duodenum. It has a good prognosis. Imaging and endoscopic examinations demonstrated a submucosal mass. The main treatment are endoscopic resection and local surgical resection.
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Objective:To analyze the viscosity characteristics of liver tumors and investigate the clinical value of shear wave dispersion (SWD) in the differentiation of benign and malignant liver tumors.Methods:A total of 103 patients with focal liver lesions were prospectively collected in Zhongshan Hospital Affiliated to Fudan University from October 2020 to July 2021, including 80 cases with single lesion and 23 cases with multiple lesions, and only the largest lesion was observed in patients with multiple lesions. SWD values were measured within the tumor and in the liver parenchyma 2 cm away from the tumor, and were compared between benign tumor group and maligant tumor group. The ROC curves of SWD value, SWD ratio and their combination in differentiating benign and malignant liver tumors were plotted respectively, and the optimal diagnostic threshold, the sensitivity, specificity and accuracy of different diagnostic methods were analyzed.Results:Among the 103 patients, 35 were benign and 68 were malignant. The SWD value of liver benign tumor group was lower than that of liver malignant tumor group [(16.38±3.58)m·s -1·kHz -1 vs (18.59±3.12)m·s -1·kHz -1], the SWD value of liver parenchyma background in liver benign tumor group was lower than that in liver malignant tumor group [(10.88±3.37)m·s -1·kHz -1 vs (14.31±3.34)m·s -1·kHz -1], and the differences were statistically significant (all P<0.05). The SWD ratio of benign tumor to surrounding liver parenchyma was higher than that of malignant tumor group [1.57(1.25, 2.00) vs 1.27(1.06, 1.57)], and the difference was statistically significant ( P<0.05). When the SWD value >15.60 m·s -1·kHz -1 was used as the cut-off value, the area under ROC curve (AUC) was 0.72, the sensitivity was 88.2%, the specificity was 51.4%, and the accuracy was 75.7%. The sensitivity, specificity, accuracy and AUC were 58.8%, 74.2%, 63.1%, and 0.68, respectively, when the ratio of SWD value<1.32 was used as the cut-off value. SWD value combined with SWD ratio for the diagnosis of liver malignant tumor, the AUC was 0.88, the sensitivity was 82.3%, the specificity was 83.0%, and accuracy was 81.6%. The diagnostic efficacy of the two in combination for liver malignant tumor was superior to SWD value ( Z=2.678, P=0.007 4) and SWD value ratio ( Z=3.822, P=0.000 1). Conclusions:SWD imaging can reflect the viscosity information of liver tumors and surrounding liver parenchyma, and has potential clinical application value in the differentiation of benign and malignant tumors.
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Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.