Tigroid Enhancement: A Characteristic Enhancement Pattern of the Cerebellar Hemisphere on MRI With Intracranial Dural Arteriovenous Fistulas.

PURPOSE: This study aims to investigate a characteristic cerebellar hemisphere enhancement pattern on magnetic resonance imaging (MRI) that could aid in early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS: Pretreatment MR images of 57 patients with intracranial DAVFs between January 1, 2017, and February 28, 2023, were retrospectively analyzed. A total of 128 patients with confirmed alternative cerebellar lesions during the same period were included as a control group. All patients underwent enhanced MRI with a 3.0T scanner. The presence or absence of parallel enhanced linear striations on the surface of the cerebellar lesions was documented. Statistically significant differences were determined by the Fisher exact test. RESULTS: Cerebellar lesions were identified in 4 intracranial DAVF patients (7.0%). All 4 patients were male, with an average age of 64 years (range: 58-76 years). The pretreatment MR images of all 4 DAVF patients with cerebellar lesions demonstrated the characteristic tigroid enhancement pattern. Tortuous flow voids were present in the MR images of 3 of the 4 patients. Tigroid enhancement pattern was not observed in the remaining 53 intracranial DAVF patients and all control patients. The differences in the incidence of the pattern were significant (p=0.01). CONCLUSION: A characteristic tigroid enhancement pattern of the cerebellar hemisphere on MRI may aid in the early and specific diagnosis of intracranial DAVFs, allowing timely treatment and improving outcomes. CLINICAL IMPACT: The identification of a characteristic tigroid enhancement pattern on MRI for cerebellar hemisphere lesions holds significant promise for clinical practice. This pattern serves as a distinctive marker aiding in the early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). Clinicians can now utilize this innovative finding to expedite diagnostic workflows, enabling timely intervention and management strategies. The incorporation of this novel imaging feature enhances diagnostic accuracy, potentially reducing misdiagnosis rates and preventing delays in treatment initiation. Ultimately, this advancement may lead to improved patient outcomes and quality of care in neurosurgical and neuroradiological practice.

Comprehensive analysis to identify GNG7 as a prognostic biomarker in lung adenocarcinoma correlating with immune infiltrates.

Background: G Protein Subunit Gamma 7 (GNG7), an important regulator of cell proliferation and cell apoptosis, has been reported to be downregulated in a variety of tumors including lung adenocarcinoma (LUAD). However, the correlation between low expression of GNG7 and prognosis of LUAD as well as the immune infiltrates of LUAD remains unclear. Methods: The samples were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). R software was performed for statistical analysis. GNG7 expression and its prognostic value in LUAD were assessed through statistically analyzing the data from different databases. A nomogram was constructed to predict the impact of GNG7 on prognosis. Gene set enrichment analysis (GSEA) and single-sample gene set enrichment analyses GSEA (ssGSEA) were employed to determine the potential signal pathways and evaluated the immune cell infiltration regulated by GNG7. The prognostic significance of GNG7 expression associated with immune cell infiltration was investigated using the Tumor Immune Estimation Resource 2.0 (TIMER2.0) and the Kaplan-Meier plotter database. The UALCAN, cBio Cancer Genomics Portal (cBioPortal) and MethSurv database were used to analyze the correlation between the methylation of GNG7 and its mRNA expression as well as prognostic significance. Results: GNG7 was demonstrated to be down-regulated in LUAD and its low expression was associated with poor prognosis. A clinical reliable prognostic-predictive model was constructed. Pathway enrichment showed that GNG7 was highly related to the B cell receptor signaling pathway. Further analysis showed that GNG7 was positively associated with B cell infiltration and low levels of B cell infiltration tended to associate with worse prognosis in patients with low GNG7 expression. Moreover, methylation analysis suggested hypermethylation may contribute to the low expression of GNG7 in LUAD. Conclusion: Decreased expression of GNG7 at least partly caused by hypermethylation of the GNG7 promoter is closely associated with poor prognosis and tumor immune cell infiltration (especially B cells) in LUAD. These results suggest that GNG7 may be a promising prognostic biomarker and a potential immunotherapeutic target for LUAD, which provides new insights into immunotherapy for LUAD.

IgG4-related disease: a case report with duration of more than 16 years and review of literature.

INTRODUCTION: IgG4-related disease was first reported in 2001 and was officially named in 2010. It is now considered as a systemic disease that might affect any organ system. The characteristic pathological changes of IgG4-related disease are extensive infiltration of IgG4-positive plasma cells. IgG4-related disease is a kind of benign lesions, but there has not been well-defined standard treatment so far. Patients usually respond well to corticosteroids. The prognosis of IgG4-related disease is perhaps good as long as early detection and treatment. CASE DESCRIPTION: We report one case of IgG4-related disease with a 16-years anamnesis with multi-pseudotumor masses. He was diagnosed with chronic kidney disease with wide interstitial renal fibrosis. And he received glucocorticoids therapy. After 2 month therapy, the serum creatinine, erythrocyte sedimentation rate, and serum IgG4 decreased significantly. The discussion includes presentation, clinical course, diagnosis, and prognosis of IgG4-related disease. The case and discussion highlight the importance of diagnosis and the good prognosis of IgG4-related diseases. DISCUSSION AND EVALUATION: Our case highlights the importance of diagnosis and the good prognosis of IgG4-related diseases. IgG4-related disease is a systemic fibro-inflammatory immune-mediated disorder and now recognized in almost every major organs. Characteristics of the disease is multiple lymph nodes and the response to glucocorticoids therapy is well. In such case, he had a history of 16 years with multi-pseudotumor masses and misdiagnosed for 16 years, if the doctors were not awareness of higher serum immunoglobulin G4 (IgG4) than normal, the correct diagnosis may be missed or delayed. Consequently, appropriate treatment for IgG4-related disease would also be delayed or not provided and likely result in increased morbidity and mortality. CONCLUSIONS: IgG4-related disease is a systemic fibro-inflammatory immune-mediated disorder and progresses slowly. In the present patient the course of IgG4-related disease appears to be benign. The prognosis of IgG4-related disease depend on early diagnosis and treatment.

[Value of 3T magnetic resonance dynamic contrast-enhanced and diffusion-weighted imaging in differential diagnosis of musculoskeletal tumors].

OBJECTIVE: To evaluate the value of magnetic resonance dynamic contrast-enhanced (MR-DCE) and magnetic resonance diffusion-weighted imaging (MR-DWI) in the differentiation of benign and malignant musculoskeletal tumors. METHODS: Sixty-three patients with pathologically confirmed musculoskeletal tumors were examined with MR-DCE and MR-DWI. Using single shot spin echo planar imaging sequence and different b values of 400, 600, 800 and 1000 s/mm(2), we obtained the apparent diffusion coefficient (ADC) of the lesions. ADC values were measured before and after MR-DCE, with a b value of 600 s/mm(2). The 3D fast acquired multiple phase enhanced fast spoiled gradient recalled echo sequence was obtained for multi-slice of the entire lesion. The time-signal intensity curve (TIC), dynamic contrast-enhanced parameters, maximum slope of increase (MSI), positive enhancement integral, signal enhancement ratio, and time to peak (T(peak)) were also recorded. RESULTS: ADC showed no significant difference between benign and malignant tumors when the b value was 400, 600, 800, or 1000 s/mm(2), and it was not significantly different between benign and malignant tumors in both pre-MR-DCE and post-MR-DCE with b value of 600 s/mm(2). TIC were classified into four types type1 showed rapid progression and gradual drainage; type2 showed rapid progression but had no or slight progression; type 3 showed gradual progression; and type 4 had no or slight progression. Most lesions of type1 or type2 were malignant, whereas most lesions of type 3 or type 4 were benign. When using type1 and type 2 as the standards of malignancy, the diagnostic sensitivity and specificity was 87.23% and 50.00%, respectively. The types of TIC showed significant difference between benign and malignant musculoskeletal tumors(χ(2)=17.009,P=0.001). When using MSI 366.62 ± 174.84 as the standard of malignancy, the diagnostic sensitivity and specificity was 86.78% and 78.67%, respectively. When using T(peak)≤70s as the standard of malignancy, the diagnostic sensitivity and specificity was 82.89%and 85.78%, respectively. Positive enhancement integral and signal enhancement ratio showed no significant difference between benign and malignant musculoskeletal tumors. CONCLUSIONS: TIC, MSI and T(peak) of MR-DCE are valuable in differentiating benign from malignant musculoskeletal tumors. T(peak) has the highest diagnostic specificity, and TIC has the highest diagnostic sensitivity. The mean ADC value are no significant difference between benign and malignant tumors.

[Diagnosis of solid-pseudopapillary tumor of the pancreas and the value of post-processing in the surgery by spiral CT].

OBJECTIVE: To study the CT manifestations of the solid-pseudopapillary tumor of the pancreas (SPTP) and to explore the value of post-processing in the surgery. METHODS: Clinical and CT features of 14 patients with SPTP proved pathologically were retrospectively analyzed. RESULTS: (1) 13 tumors were composed of different proportions of solid and cystic parts and 1 tumor was composed of solid part only. The solid portions demonstrated slight enhancement in the arterial phase and marked enhancement in the portal venous phase on post-contrast CT. The cystic portions appeared hypo-attenuation on both pre- and post-contrast CT images. Tumors were encapsulated and the capsule enhanced markedly with well-defined margins on post-contrast images. (2) Dilatation of the common bile duct or pancreatic duct wasn't seen in all of the cases and 1 case with the right adrenal ganglioneuroma. (3) 5 tumors located in the head of the pancreas, 3 of which with the superior mesenteric vein compression and displacement, in 2 cases the vessels were partially encapsulated by tumor. 6 tumors located in the tail of the pancreas, 3 of them with splenic hilum compression and multiple splenic vein tortuosity and dilatation, the veins drained into superior mesenteric vein anteriorly and posteriorly of the tumor. Splenic vein compression and posterior displacement occurred in 2 cases. In one case, there was no clear margin between the tumor and the splenic hilum. CONCLUSION: The SPTP has characteristic CT findings and correct diagnosis could be made by combining clinical features. The relationship of the lesions and surrounding structures could be revealed by the post-processing and was helpful for the operation.

Preoperative evaluation of venous systems with computed tomography venography in parasagittal meningiomas.

OBJECTIVE: Parasagittal meningiomas (PSM) may pose a difficult surgical challenge because venous patency and collateral anastomoses have to be clearly defined for correct surgical planning. The aim of this study was to study the diagnostic accuracy of computed tomography venography (CTV) in assessing the superior sagittal sinus (SSS) obstruction and venous collaterals. METHODS: Twenty-four patients undergoing surgery for meningiomas located adjacent to the SSS were prospectively evaluated. All the patients underwent both conventional computed tomography examination and CTV. Computed tomography venography was evaluated by 2 expert neuroradiologists to assess (1) patency of the sinus (patent/occluded), (2) the extent of occlusion (in centimeters), and (3) the number of collateral anastomoses close to the insertion of the meningioma. Computed tomography venography assessment was compared with surgery. All patients were operated on, and intraoperative findings were taken as the criterion standard. RESULTS: Computed tomography venography showed the sinus to be occluded in 6 cases. Computed tomography venography data were confirmed by surgery, showing 6 patients to have have an occlusion of the SSS. The CTV sensitivity was thus 100%. Computed tomography venography depicted 83% of collateral venous anastomoses close to the meningioma as subsequently confirmed by surgery. CONCLUSIONS: In the preoperative planning for patients with meningiomas located close to the SSS, CTV can provide additional and more reliable information concerning venous infiltration and the presence of collateral anastomoses compared with noncontrast computed tomography.

[Multi-slice helical CT perfusion imaging in evaluating intracranial neoplasms and tumor-like lesions].

OBJECTIVE: To investigate the clinical value of CT perfusion in diagnosing and assessing intracranial neoplasms and tumor-like lesions. METHODS: 16-slice helical CT perfusion imaging was performed in 56 patients who were clinically suspected to have intracranial neoplasm or tumor-like lesion. With a GE-Light Speed 16-slice helical CT scanner, routine plain-CT scanning was performed to localize the central slice of the lesion. Perfusion imaging was then carried out using cine scan technique to maintain a slice thickness of 5-10 mm, a total dose of 50-70 ml of contrast-medium at an injection flow rate of 3-5 ml/s, a delay time of 7 s and a total scan time of 50 s. The images were processed using perfusion software in an ADW 4.0 workstation, meanwhile, time-density curves (TDC) of different kinds of lesions were also produced and analyzed. RESULTS: The pathological types in this series included: 29 gliomas (12 low-grade and 17 high-grade), 2 ependemomas, 2 hemangioblastomas, 1 medulloblastoma, 2 metastatic tumors, 1 lymphoma, 5 meningiomas, 2 schwannomas, 1 germinoma, 1 teratoma in the pineal region, 6 cavernous hemangiomas, 2 inflammatory granulomas, 1 tuberculoma, and 1 hyperplasia of the choroid plexus. TDC of high-grade glioma, low-grade glioma and meningioma was different from each other. The cerebral blood flow (CBF), cerebral blood volume (CBV), particularly, the permeability surface (PS) value of glioma was found to increase significantly with the escalation of tumor differentiation grade. In PS map, margin of the tumor could be clearly showed, which was very useful when hemorrhaging within the tumor occurred. CBF in meningioma was lower than that in high-grade glioma, but there was no statistical difference in CBV, MTT and PS between these two types of tumor. The features of intracranial cavernous hemangioma such as significant prolongation of MTT, different TDCs, and zero perfused areas were diverse on CTP image, which was helpful in differentiating it from the other lesions. The germinoma and teratoma had rather low CBF and CBV value, but a remarkably high PS value, furthermore, they showed a rapid escalated TDC with a slowly and continuously elevated platform. The perfusion features of schwannoma was concordant with its pathological findings. However, no visible specific feature of inflammatory lesion was found on CTP image in this series. CONCLUSION: Multi-slice helical CT perfusion imaging may be helpful in revealing histopathological features and hemodynamic changes as well as differential diagnosis of intracranial neoplasms and tumor-like lesions. When combined with other image and clinical information, CTP can play an important role in pre-operative diagnosis and treatment planning for intracranial neoplasms and tumor-like lesions.

[Malignant tumor with false negative 18F-FDG PET image].

OBJECTIVE: To investigate the FDG uptake characteristics, the factors affecting 18F-FDG uptake and the extra CT diagnostic value of 18F-FDG PET/CT scan in the malignant tumor with false negative 18F-FDG PET image. METHODS: The data of PET/CT image in 17 patients with various kinds of cancers were reviewed and analyzed by visual observation and semi-quantity analysis ( SUV). The results were compared with the CT and histopathological diagnosis, respectively. RESULTS: Of 6 well-differentiated HCC patients confirmed by histopathological diagnosis, one had two lesions in the right lobe of the liver. One of these two lesions showed low FDG uptake on 18F-FDG PET scan and low density on CT scan. The other one was not shown on either 18F-FDG PET or plain CT scan. But on enhanced CT scan, these two lesions were found to be inhomogeneous with high density at arterial phase. The false negative 18F-FDG PET images of one gastric signet ring cell carcinoma in the gastric fundus with right adnexa metastasis, 3 renal cell carcinoma, one greater omentum and peritoneal metastatic adenocarcinoma and one well-differentiated prostate cancer were caused by normal physical uptake in the digestive tract or FDG retention in the urinary system due to normal excretion. The size of three metastases was smaller than or equal to 1 cm in diameter, however, two primary lesions of these metastases showed high FDG uptake and only one was negative on either 18F-FDG PET or CT scan. In this series, 68.8% of the primary tumors and 66.7% of metastases were found to show abnormal density on CT scan, and 31. 2% of the primary tumors and 33. 3% of metastases were not detectable on either PET or CT images. CONCLUSION: False negative 18F-FDG PET in malignant tumor may be correlated with the pathologic type, differentiation degree and the lesion size. Combining CT information with PET or paying attention to the scan methods during 8 F-FDG PET examination may reduce the rate of false negative 18F-FDG PET diagnosis in various kinds of malignant tumors.