Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature.

Peritoneal loose body (PLB) is a rare clinical entity. It is generally agreed that the most common origin of the loose bodies is appendix epiploica. We here report a case of PLB that looks like a "boiled egg," which was misdiagnosed preoperatively as a lesion of hepatic origin and was confirmed by operation and postoperative pathology. PLBs are rare entities, a good understanding of their specific imaging features can help prevent misdiagnosis, but sometimes an accurate preoperative diagnosis is still difficult to achieve. Exploratory laparoscopy is a recommended method for management of PLBs.

Idiopathic mesenteric phlebosclerosis associated with long-term oral intake of geniposide.

BACKGROUND: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain. AIM: To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP. METHODS: The detailed formula of herbal liquid prescriptions of all patients was studied, and the herbal ingredients were compared to identify the toxic agent as a possible etiological factor. Abdominal computed tomography (CT) and colonoscopy images were reviewed to determine the extent and severity of mesenteric phlebosclerosis and the presence of findings regarding colitis. The disease CT score was determined by the distribution of mesenteric vein calcification and colon wall thickening on CT images. The drinking index of medicinal liquor was calculated from the daily quantity and drinking years of Chinese medicinal liquor. Subsequently, Spearman's correlation analysis was conducted to evaluate the correlation between the drinking index and the CT disease score. RESULTS: The mean age of the 8 enrolled patients was 75.7 years and male predominance was found (all 8 patients were men). The patients had histories of 5-40 years of oral Chinese herbal liquids containing geniposide and exhibited typical imaging characteristics (e.g., threadlike calcifications along the colonic and mesenteric vessels or associated with a thickened colonic wall in CT images). Calcifications were confined to the right-side mesenteric vein in 6 of the 8 patients (75%) and involved the left-side mesenteric vein of 2 cases (25%) and the calcifications extended to the mesorectum in 1 of them. The thickening of colon wall mainly occurred in the right colon and the transverse colon. The median disease CT score was 4.88 (n = 7) and the median drinking index was 5680 (n = 7). After Spearman's correlation analysis, the median CT score of the disease showed a significant positive correlation with the median drinking index (r = 0.842, P < 0.05). CONCLUSION: Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.

Idiopathic mesenteric phlebosclerosis associated with use of Chinese herbal medicine: Two case reports.

RATIONALE: Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic colitis. It is more common in the Asian population people with Asian ancestry. Disease pathogenesis and etiology are not fully elucidated but may be associated with the long-term intake of toxins and other substances, including Chinese herbs. The disease has typical radiological and endoscopic features. Radiologic examination combined with endoscopy can lead to a conclusive diagnosis. PATIENT CONCERNS: We present 2 cases of IMP: in male patients aged 66 and 79 years. The first patient presented with diarrhea and abdominal pain, and the second patient presented with numbness of limbs and abdominal discomfort. These patients had a history of long-term use of Chinese herbal medicine (CHM). DIAGNOSIS: Both patients were diagnosed with IMP by endoscopy and radiology, and the diagnosis confirmed by biopsy in the first patient. INTERVENTIONS: The first patient was advised to stop using CHM. Both patients were given conservative treatment and were followed up regularly. OUTCOMES: Symptoms improved after conservative treatment. The patients had no obvious discomfort during the follow-up period. CONCLUSION: We suspect that the disease is induced by the long-term use of CHM, and dosage and duration of use may determine disease severity.

MRI-based Radiomics nomogram to detect primary rectal cancer with synchronous liver metastases.

Synchronous liver metastasis (SLM) remains a major challenge for rectal cancer. Early detection of SLM is a key factor to improve the survival rate of rectal cancer. In this radiomics study, we predicted the SLM based on the radiomics of primary rectal cancer. A total of 328 radiomics features were extracted from the T2WI images of 194 patients. The least absolute shrinkage and selection operator (LASSO) regression was used to reduce the feature dimension and to construct the radiomics signature. after LASSO, principal component analysis (PCA) was used to sort the features of the surplus characteristics, and selected the features of the total contribution of 85%. Then the prediction model was built by linear regression, and the decision curve analysis was used to judge the net benefit of LASSO and PCA. In addition, we used two independent cohorts for training (n = 135) and validation (n = 159). We found that the model based on LASSO dimensionality construction had the maximum net benefit (in the training set (AUC [95% confidence interval], 0.857 [0.787-0.912]) and in the validation set (0.834 [0.714-0.918]). The radiomics nomogram combined with clinical risk factors and LASSO features showed a good predictive performance in the training set (0.921 [0.862-0.961]) and validation set (0.912 [0.809-0.97]). Our study indicated that radiomics based on primary rectal cancer could provide a non-invasive way to predict the risk of SLM in clinical practice.

Prediction of efficacy of neoadjuvant chemoradiotherapy for rectal cancer: the value of texture analysis of magnetic resonance images.

PURPOSE: To explore the clinical feasibility of predicting the efficacy of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer on the basis of texture analysis (TA) of T2-weighted imaging (T2WI). METHODS: The cohort for this prospective study comprised 136 patients with rectal cancer to be treated with nCRT, all of whom underwent three MR scans (pre-, early, and post-nCRT). Treatment efficacy was assessed on the basis of the outcomes of pathologic complete response (pCR) and non-pCR as determined by postoperative pathological examination. Extraction and analysis of texture features in T2WI of defined tumor regions were performed by AK software. Pre- and early-nCRT texture features were selected as potential predictors of outcomes by logistic regression analysis, and a prediction model for pCR was developed. A receiver operating characteristic (ROC) curve was used to assess the predictive power of texture features in pre- and early-nCRT images. RESULTS: Univariate logistic regression analysis demonstrated that the pre-nCRT features of energy, entropy, and skewness, and early-nCRT features of variance, kurtosis, energy, and entropy were independent predictors of pCR. A prediction model incorporating these predictors was constructed by multivariate logistic regression, The AUCs of pre-nCRT, early, and combined models were 0.751, 0.831, and 0.873, respectively; the sensitivities 66, 71, and 75%, respectively; and the specificities 87.22, 86.11, and 91.67%, respectively. CONCLUSIONS: TA of T2WI images can predict the efficacy of nCRT for rectal cancer, possibly providing a new marker of tumor biological response in clinical practice.

[Application value of texture analysis of magnetic resonance images in prediction of neoadjuvant chemoradiotherapy efficacy for rectal cancer].

OBJECTIVE: To explore the application value of texture analysis of magnetic resonance images (MRI) in predicting the efficacy of neoadjuvant chemoradiotherapy(nCRT) for rectal cancer. METHODS: A total of 34 rectal cancer patients who were hospitalized at Zhejiang Provincial People's Hospital from February 2015 to April 2017 were prospectively enrolled and received 3.0T MRI examination at pre-nCRT (1 day before nCRT), early stage (at 10-day after nCRT) and middle stage (at 20-day after nCRT). INCLUSION CRITERIA: distance from tumor lower margin to anal edge was less than 12 cm under rectoscope; rectal cancer was confirmed by preoperative pathology; clinical stage was T3 or above; lymph node metastasis existed but without distant metastasis; functions of liver, kidney and heart present no contraindications of operation. EXCLUSION CRITERIA: unfinished nCRT, surgery and three examinations of MRI; image motion artifacts; lack of postoperative pathological results. All the patients underwent rectal cancer long-term three-dimensional radiotherapy and chemotherapy combined with nCRT (oxaliplatin plus capecitabine). The tumor regression grading (TRG) was divided into TRG 0 to 4 grade after nCRT, and TRG 4 was classified as pathological complete remission (pCR); TRG 2 to 3 was classified as partial remission (PR); the rest was no remission (NR). Extraction and analysis of texture features in T2-weighted MR-defined tumor region were performed using Omni Kinetics texture software. The texture values of each time point were statistically analyzed, and the differences of texture values and change differences between pCR and PR+NR, and NR and pCR+PR were compared respectively. Statistically significant texture values were screened and were used in receiver operating characteristic (ROC) curve to assess the prediction of the efficacy of nCRT. RESULTS: Of 34 patients, 21 were males and 13 were females with median age of 49.3 years. Nineteen (55.9%) patients were low rectal adenocarcinoma and 15 (44.1%) patients were middle rectal adenocarcinoma. Nine (26.5%) cases belonged to pCR, 13 (38.2%) belonged to PR, and 12 (35.3%) belonged to NR. Before nCRT, the entropy of tumor area in pCR patients was significantly higher than that in PR+NR patients (7.164±0.272 vs. 6.823±0.309, t=2.925, P=0.006). At the middle stage of nCRT, as compared with PR+NR patients for the texture features of tumor region, the variance (1566±281 vs. 2883±867, t=-4.435, P=0.000) and entropy(5.436±0.934 vs. 6.803±0.577, t=-4.118,P=0.002) of pCR patients were significantly lower; kurtosis(4.800±1.288 vs. 3.206±1.211, t=3.333, P=0.002) and energy (0.016±0.005 vs. 0.010±0.004, t=3.240, P=0.003) of pCR patients were significantly higher. As compared to pCR+PR patients, the kurtosis(2.461±0.931 vs. 4.264±1.205, t=-4.493, P=0.000) and energy (0.011±0.004 vs. 0.014±0.004, t=-3.453, P=0.000) of the NR patients were significantly lower. As for texture change values between early stage and middle stage, the entropy difference was significant between pCR and PR+NR, NR and pCR+PR (1.344±0.819 vs. 0.489±0.319, t=3.047, P=0.014; 0.446±0.213 vs. 0.917±0.677, t=-3.638, P=0.001, respectively). As for texture change values between pre-nCRT and middle stage, variance and entropy differences between pCR and PR+NR (1759±1226 vs. 977±842, t=2.113, P=0.042; 1.728±0.918 vs. 0.524±0.355, t=3.832, P=0.004), and the change values of entropy between NR and pCR+PR (0.475±0.349 vs. 1.044±0.860, t=-2.722, P=0.011) were statistically significant. The above indicators were included in the ROC curve. The results revealed that at the middle stage, entropy value >5.983 indicated the best efficacy for the diagnosis of pCR, with the area under the ROC curve (AUC) of 0.885, the sensitivity of 100%, and the specificity of 66.7%; the energy <0.010 indicated the best AUC for diagnosis of NR was 0.902, with the sensitivity of 91.7% and specificity of 81.8%. CONCLUSIONS: Texture analysis based on T2 weighted images can predict the efficacy of nCRT for rectal cancer. The middle stage of nCRT is the best time of prediction. The entropy and energy of this period are texture parameters having higher predictive ability.

[ß-catenin is involved in BMP9-induced differentiation of C3H10T1/2 cells into cardiomyocyte-like cells].

Objective To investigate the role of ß-catenin in the differentiation of C3H10T1/2 cells into cardiomyocyte-like cells induced by bone morphogenetic protein 9 (BMP9). Methods C3H10T1/2 cells were transfected with the recombinant adenovirus expressing BMP9 (Ad-BMP9) and differentiated into cardiomyocytes in vitro for up to 21 days. The activated level of ß-catenin in the cells after cultivated with Ad-BMP9 and different concentrations of ß-catenin specific inhibitor XAV-939 was detected by Western blotting. Real-time quantitative PCR (qRT-PCR) was performed to evaluate the expressions of cardiac specific gene myocyte enhancer factor 2C (MEF2C) and GATA binding protein 4 (GATA4) in the cells one week after induced by Ad-BMP9 and different concentrations of XAV-939. Three weeks after the transfection, the expressions of connexin 43 (Cx43) and cardiac troponin T (cTnT) were analyzed by Western blotting, and the location of Cx43 in the cells was observed by immunofluorescence technique. Results While the transfection was successful in 50% of the cells positive for BMP9, ß-catenin was excessively activated and their phosphorylation level remarkably increased. After XAV-939 inhibited the activity of ß-catenin, the expressions of MEF2C, GATA4, Cx43, cTnT in C3H10T1/2 cells induced by BMP9 were significantly suppressed. Conclusion The ß-catenin can be activated by BMP9 and the activation of ß-catenin plays an important role in the differentiation of C3H10T1/2 cells into cardiomyocyte-like cells induced by BMP9.

[Wnt3a combined with bone morphogenetic protein 9 induce C3H10T1/2 cells differentiation into cardiomyocyte-like cells in vitro].

OBJECTIVE: To investigate the effects of Wnt3a alone and combined with bone morphogenetic protein 9 (BMP9) on the differentiation of C3H10T1/2 cells into cardiomyocyte-like cells. METHODS: Recombinant adenovirus GFP, BMP9 and Wnt3a were amplified with human embryo kidney 293 cell line (HEK293 cells) and transferred into C3H10T1/2 cells. Three weeks after transfection, the cell morphology and the expression of green fluorescent protein in cells transfected with GFP, BMP9 and Wnt3a were observed by an inverted microscope and a fluorescence microscope. Flow cytometry was performed to detect cell transfection efficiency. The expressions of cardiac-specific proteins connexin 43 (Cx43), cardiac troponin T (cTnT) and genes GATA binding protein 4 (GATA4), myocyte enhancer factor 2C (MEF2C) were analyzed by Western blotting, immunofluorescence and real-time quantitative PCR (qRT-PCR). RESULTS: High-titer recombinant adenovirus was generated with HEK293 cells. The expressions of Cx43, cTnT, GATA4 and MEF2C were similar among Wnt3a group, GFP group and control group, but they significantly increased in cells when co-induced by Wnt3a and BMP9 for 3 weeks. The expressions of Cx43, cTnT, GATA4 and MEF2C showed no significant difference between BMP9 group and Wnt3a and BMP9 co-induction group. CONCLUSION: Wnt3a can not promote the differentiation of C3H10T1/2 cells into cardiomyocyte-like cells by itself, but co-induction by Wnt3a and BMP9 can promote the differentiation.

Primary pancreatic paraganglioma: a report of two cases and literature review.

Paraganglioma is a rare tumor of paraganglia, derived from neural crest cells in sympathetic or parasympathetic ganglions. Primary paraganglioma originating from the pancreas is rare. We report two patients with paraganglioma in the head of the pancreas, in whom computed tomography showed a sharply marginated, hypervascular tumor with cystic areas. Significant intratumoral vessels and early contrast filling of the draining veins from the mass were not found. Although the pancreatic paraganglioma was located at the pancreatic head, the bile ducts often revealed no dilation, and sometimes the main pancreatic duct was mildly dilated. These findings are helpful in differentiating pancreatic paraganglioma from other pancreatic neoplasms. It is often difficult to distinguish between nonfunctional pancreatic paragangliomas and pancreatic endocrine tumors. In many reports,pancreatic paragangliomas show the retroperitoneal extension of a paraganglioma into the pancreas rather than a true pancreatic neoplasm. In surgical treatment, we could select simple excision of the tumor rather than radical surgery.

The definition of the V zone for the safety space of functional surgery of the tongue.

OBJECTIVES/HYPOTHESIS: To define safety space for functional surgery of the tongue. STUDY DESIGN: Prospective nonrandomized study. METHODS: Computed tomographic angiography of the lingual artery was performed in 107 in-patients with obstructive sleep apnea syndrome and 17 controls. The safety space was ascertained according to the course of lingual artery. RESULTS: The course of the lingual artery, termed the Big Dipper bowl of the tongue, was similar in each group. The tissue above the lingual artery and the vacuity of the hypoglossal/lingual artery neurovascular bundle (HLNVB) formed a three-dimensional structure. The anterior part was named the V prozone. Its anterior border was the tangent plane of the deep lingual artery, its posterior border the circumvallate papilla, its width the interval of bilateral margins at the corresponding parts of the tongue, and its height the level of the middle lingual frenulum. The posterior portion between the bilateral dorsal arteries in the tongue base was named the V postzone. Its width was 31.42±3.82 mm when the tongue was in a resting position, and its height was the distance from the foramen cecum to the bottom of the epiglottic vallecula. The inferior part under the intrinsic lingual muscles was named the hypoglossal floor. It is a relatively restricted surgery zone. CONCLUSIONS: The V zone of the tongue without HLNVB travelling provides enough of safety space for functional surgery on the tongue.

An unusual case of pancreatic and gastric neoplasms (2010: 12b). Malignant GISTs originating from the pancreas and stomach.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract and are believed to originate from the neoplastic transformation of the interstitial cells of Cajal from their precursors. GIST can occur anywhere but mainly affects the stomach (60%), jejunum and ileum (30%), duodenum (4-5%), rectum (4%), colon, appendix and esophagus. Primary GISTs of the pancreas are very rare, with only five previous cases reported. This is an unusual case of multiple GISTs in the pancreas and stomach.

Small intestinal lipomas: diagnostic value of multi-slice CT enterography.

AIM: To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography (CT) enterography. METHODS: Fourteen cases (one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed. The location, size, clinical and radiological aspects were discussed. RESULTS: Twelve patients presented with abdominal pain, of whom three complained of paroxysmal colic. Melena or bloody stools was mentioned in five cases. One lesion was detected incidentally during routine physical examination. One lesion was found unexpectedly during the preoperational evaluation for cholecystitis. Examination of the abdomen revealed palpable masses in four cases. Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from -130 HU to -60 HU. On contrast enhancement CT scan, no striking enhancement was seen. CONCLUSION: The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations, while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.

Perivascular epithelioid cell tumor of the liver: a report of two cases and review of the literature.

Perivascular epithelioid cell tumor (PEComa) is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus, but very rare in the liver. To the best of our knowledge, less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver, retrospectively analyze their clinical and imaging features, and review the literature.

[Study on brain response to acupuncture by functional magnetic resonance imaging--observation on 14 healthy subjects].

OBJECTIVE: To observe the signal changes of brain functional area during needling Sanyinjiao (ST36), Zusanli (SP6) and Yanglingquan (GB34), the three acupoints in three different meridians, in human by functional magnetic resonance imaging (fMRI), in order to preliminary explore the neural mechanism of acupuncture. METHODS: Needling was complemented with 30 s of maneuver applying followed by 30 s of rest as a circle on an acupoint, and at the same time, fMRI was performed once 5 min and 12 s. Then the same program was repeated with the same mode on another acupoint, until ending the experiment. RESULTS: The commonly activated regions were postcentral gyrus and right inferior frontal gyrus when needling at ST36 and SP6, and the different activated areas included left inferior frontal gyrus, left insula, left inferior parietal lobule, left culmen, left middle temporal gyrus and left middle frontal gyrus, while no cortical signal enhanced region was found when needling at GB34. Signal weakened regions could be found when needling at all the three points, the commonly activated regions were bilateral parahippocampal, hippocampal, callosal gyrus, bilateral praecuneus and cerebellum. CONCLUSION: Brain response in special regions could be obtained by needling at different acupoints.

[Angiographic diagnosis of gastrointestinal stromal tumors].

OBJECTIVE: To investigate the angiographic feature and its diagnostic value in gastrointestinal stromal tumor (GIST). METHODS: Twelve patients with pathologically proved GIST underwent angiography using PUCK and DSA one week before operation. The origin, size, morphology and angiographic appearance of the lesion were retrospectively analyzed. RESULTS: It was found that two tumors originated from stomach, eight from jejunum, and two from ileum. Seven cases were benign but five malignant. Obviously thickened and enlarged feeding artery was detected in eight tumors, and early-developed vein was found in three. Two types of angiographic changes of GIST were observed: 1) twisted irregular neoplastic vessels with partially coarse and indistinct margin were found in four cases, which were all malignant; 2) ball-like neoplastic vessels with homogeneous stain in tumor were found in eight cases, seven of them were benign but one was malignant. CONCLUSION: Angiography may be helpful in localization and diagnosis as well as defining the size of GIST, and especially in patients with melena of unknown origin.

Imaging features of ciliated hepatic foregut cyst.

Ciliated hepatic foregut cyst (CHFC) is a very rare cystic lesion of the liver that is histologically similar to bronchogenic cyst. We report one case of CHFC that was hard to distinguish from solid-cystic neoplasm in imaging features. Magnetic resonance imaging was helpful in differentiating these cysts from other lesions.

Angiographic findings of gastrointestinal stromal tumor.

AIM: To discuss the angiographic features of gastrointestinal stromal tumor (GIST) and to evaluate their diagnostic role. METHODS: Twelve patients with pathologically proved GIST underwent angiography (DSA)1 wk before operation, using Puck and digital subtraction DSA. The origin, size, morphology and angiographic appearance of the lesions were reviewed. RESULTS: Two tumors arose from stomach, 8 from jejunum, and 2 from ileum. Seven cases were benign and 5 were malignant. Obviously thickened supplying arteries were detected in 8 tumors, and early-developed veins were found in 3. Two types of angiographic changes of GIST were observed. Four cases had twisted irregular neoplastic vessels with partially coarse and indistinct margins, which were all malignant. Eight cases had ball-like neoplastic vessels with uniform tumor staining, of which 7 were benign and 1 was malignant. CONCLUSION: Angiography facilitates localization and diagnosis of GIST, helps define their size, range and location, and is especially valuable to patients suffering from melena with unknown reasons.