Assessment of thoracic aorta in different cardiac phases in patients with non-aorta diseases using cardiac CT.

The aim was to evaluate the thoracic aorta in different cardiac phases to obtain the correct cardiac phase for measuring the maximum diameter required to predict aortic disease. Cardiac CT was performed on 97 patients for suspected coronary artery disease. The average diameter of ascending (AAD) and descending aorta (DAD) in the plane of pulmonary bifurcation, in the plane of the sinus junction (AAD [STJ] and DAD [STJ]), descending aorta in the plane of the diaphragm (DAD [Dia]), the diameter of the main pulmonary artery (MPAD), distance from the sternum to the spine (S-SD), and distance from the sternum to the ascending aorta (S-AAD) were assessed at 20 different time points in the cardiac cycle. Differences in aortic diameter in different cardiac phases and the correlation between aortic diameter and traditional risk factors were analyzed by the general linear mixed model. The diameter of the thoracic aorta reached the minimum at the phase of 95-0%, and reached the maximum at 30-35%. The maximum values of AAD, AAD (STJ), DAD, DAD (STJ), and DAD (Dia) were 32.51 ± 3.35 mm, 28.86 ± 3.01 mm, 23.46 ± 2.88 mm, 21.85 ± 2.58 mm, and 21.09 ± 2.66 mm, respectively. The maximum values of MPAD/AAD and DAD/AAD (STJ) were 0.8140 ± 0.1029, 0.7623 ± 0.0799, respectively. The diameter of the thoracic aorta varies with the cardiac phase. Analyzing the changes in aortic diameter, which can be done using cardiac CT, could provide a more accurate clinical measurement for predicting aortic disease.

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports.

BACKGROUND: Pseudogout is a benign joint lesion caused by the deposition of calcium pyro-phosphate dihydrate crystals, but it is invasive. Pseudogout of the temporo-mandibular joint (TMJ) is uncommon, and it rarely invades the skull base or penetrates into the middle cranial fossa. The disease has no characteristic clinical manifestations and is easily misdiagnosed. CASE SUMMARY: We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa. A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region. Another patient, a 52-year-old man with a mass in the left TMJ for 6 years, was admitted to the hospital. Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area. Both patients underwent excision of the lesion. The lesion was pathologically diagnosed as tophaceous pseudogout. The symptoms in these patients were relieved after surgery. CONCLUSION: Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction. A pathological examination is the gold standard for diagnosing this disease. Surgical treatment is currently the recommended treatment, and the prognosis is good after surgery.

Cause of postprandial vomiting - a giant retroperitoneal ganglioneuroma enclosing large blood vessels: A case report.

BACKGROUND: Ganglioneuroma (GN) is a rare neurogenic tumor that accounts for about 0.1%-0.5% of all tumors of the nervous system. It originates from neural crest cells. GN has no specific clinical symptoms or laboratory findings, which leaves it easily overlooked and misdiagnosed as other tumors. Retroperitoneal GN with very large volume and vascular penetration is extremely rare. CASE SUMMARY: We present the imaging and pathological findings of a giant retroperitoneal GN in a child. A 4-year-old boy had suffered from postprandial vomiting for more than 6 mo with no precipitating factors. Abdominal computerized tomographic examination showed a giant cystic mass in the retroperitoneal area. After injection of contrast agent, the mass showed heterogeneous enhancement. Surgery with local excision of the mass was performed to address the embedded abdominal blood vessels, and the histopathological and immunohistochemical diagnosis of the mass was GN. Postprandial vomiting was relieved, and no complications occurred after the operation. CONCLUSION: In the diagnosis of giant retroperitoneal hypodense masses in children, GN should be considered if the mass presents delayed enhancement, punctate calcification, and vascular embedding but no invasion. Pathology is the golden standard for the diagnosis of GN, and surgical excision is the optimal treatment for GN.

Imaging Analysis of Ganglioneuroma and Quantitative Analysis of Paraspinal Ganglioneuroma.

BACKGROUND This study evaluated the imaging features of ganglioneuroma (GN) and assessed the diagnostic value of the enhancement rate (ER) of CT for GN. MATERIAL AND METHODS We retrospectively reviewed records of 49 patients with histopathologically confirmed GN who underwent preoperative contrast-enhanced CT or MRI between 2010 and 2018. The independent samples t test and chi-square test were used. Receiver operating characteristic (ROC) curves were generated to analyze the diagnostic sensitivity (SE) and specificity (SP). Positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS The CT values were 32.59±3.61 Hounsfield units (HU) for plain scans, 38.87±5.09 HU for the arterial phase, and 54.26±8.14 HU for the venous phase, and the incidence of calcification and cysts was 32.6% and 10.2%, respectively. There was no significant difference in CT results and clinical parameters between mediastinal ganglioneuroma (MGN) and retroperitoneal ganglioneuroma (RGN) (p>0.05). The area under the curves (AUCs) for the arterial enhancement rate (AER), venous enhancement rate (VER), and AER/VER combined index in diagnosing GN were 0.735, 0.980, and 0.990, respectively. The VER of 0.2819 exhibited the SE and SP at 92.9% and 92.9%, respectively, to characterize the GN, whereas the AER of 0.1779 had SE and SP of 52.4% and 90.5%, respectively. The SE and SP for the combined index were 88.1% and 100%, respectively. The GN showed hypointensity on T1WI, hyperintense, or slightly high signal on T2WI with the linear hypointensity, and hyperintense on DWI. CONCLUSIONS A hypodense mass was observed for GN on plain scan and presented delayed enhancement on contrast enhancement. VER or AER/VER combination is more accurate than AER for the diagnosis of paravertebral GN.

Angiomatoid Fibrous Histiocytoma Mimicking Eosinophilic Granuloma in a Pediatric Patient.

BACKGROUND: Angiomatoid fibrous histiocytoma (AFH) is a rare low-grade malignant tumor mainly occurring in soft tissues, and its incidence in the bones is extremely rare. Although most of the existing reports focus on the pathological features of AFH, only a few describe its imaging features. To our knowledge, this is the first case of AFH in the skull, and it is distinguished from eosinophilic granuloma based on imaging results. CASE DESCRIPTION: A boy aged 10 years presented with a painless mass of parietal bone after trauma. Cranial computed tomography angiography showed local bone defects near the sagittal suture of the left parietal bone and a soft tissue mass with relatively uniform density in the same area. The signals of this mass were heterogeneous in all sequences of magnetic resonance imaging and presented septal enhancement after the injection of contrast agent. The patient underwent complete resection of the mass, and the histopathological and immunohistochemical diagnosis of the mass was AFH. No complications occurred after the operation and no recurrence occurred during the follow-up. CONCLUSIONS: To our knowledge, this is the first AFH that occured in the skull, and the main imaging manifestations of AFH are bone destruction with soft tissue mass. The characteristic features of AFH are its fibrillar component that showed low signal on T2-weighted imaging and septal or peripheral enhancement, and no dead bone in the mass.

Cortical morphologic changes in recent-onset, drug-naïve idiopathic generalized epilepsy.

PURPOSE: Only a few studies have investigated the brain morphology abnormalities in structural MRI in patients with drug-naïve idiopathic generalized epilepsy (IGE) and mainly focused on brain volume changes. In the present study, we aimed to investigate the changes in three morphologic measurement differences including cortical thickness, cortical volume, and surface area using FreeSurfer in a pediatric cohort of recent-onset, drug-naïve IGE. METHODS: Forty-five recent-onset, drug-naïve patients diagnosed with IGE and 32 demographically matched healthy controls were recruited. All participants underwent structural MRI scans with a 3.0 T MR system. FreeSurfer, an automated cortical surface reconstruction toolbox, was applied to compare the cortical morphology between patients and controls. The brain regions with significant group differences after multiple comparison correction were extracted in common space for each patient, and then correlated with their clinical characteristics (including onset age, duration of epilepsy, and mini-mental state examination (MMSE)) using partial correlation analysis with age, sex and intracranial volume as covariates. RESULTS: Compared with controls, IGE patients showed decreased cortical thickness in the left rostral middle frontal gyrus, decreased cortical volume in the right cuneus and left superior frontal gyrus that extended to the precentral gyrus, and decreased surface area in the right cuneus and right inferior parietal gyrus. None of these regions showed significant relationships with clinical measurements in the patient group. CONCLUSION: Our findings suggest that cortical thickness, cortical volume, and surface area changes occurred in the early stage of IGE. These findings provide structural neuroimaging evidence underlying the pathology of IGE.

A meta-analysis study of the association between EGFR rs2252586 mutation and the risk of glioma.

Several studies reported the association between Epidermal growth factor receptor (EGFR) rs2252586 mutation and glioma susceptibility. However, the results of these studies were inconsistent. A computer-based search using EMBASE and PubMed databases was conducted. Odds ratios (OR) and 95% confidence interval (CI) were used to assess the strength of association between EGFR rs2252586 mutation and glioma susceptibility. The EGFR rs2252586 mutation was significantly associated with an increased risk of glioma (OR=1.16; 95%CI, 1.11-1.21; P<0.00001). When stratified by tumor subtype, the significantly elevated risk was observed in glioblastoma (OR=1.15; 95%CI, 1.04-1.26; P=0.007) but not in oligodendroglioma (OR=1.19; 95%CI, 0.97-1.46; P=0.10). When we excluded the studies with small sample size (case number < 1000), a significant association between EGFR rs2252586 mutation and glioma susceptibility remained (OR=1.16; 95%CI, 1.09-1.22; P<0.00001). In conclusion, this meta-analysis found that EGFR rs2252586 mutation was significantly associated with glioma risk.

Chronic hepatitis B: correlation of abnormal features on T2-weighted imaging and dynamic contrast-enhanced imaging with hepatic histopathology.

OBJECTIVES: To investigate the correlations between abnormal features on liver magnetic resonance (MR) T2-weighted imaging (T2WI) and dynamic contrast-enhanced (DCE) imaging and the pathological findings in chronic hepatitis B. MATERIALS AND METHODS: Sixty-seven patients with chronic hepatitis B and 18 normal controls who were undergone an abdominal MR imaging were analyzed retrospectively. Patchy hyperintensities, linear and reticular hyperintensities in liver and periportal edema on T2WI and abnormal intrahepatic enhancement signals on DCE imaging were noted. The correlations between the abnormal features detected on hepatic T2WI and DCE imaging, and the levels of inflammatory activity and fibrosis were determined. RESULTS: Logistic regression analysis showed increased patchy hyperintensities (B = 1.869, P = 0.001) on T2WI and patchy enhancement (B = 1.596, P = 0.004) at the arterial phase along with increased inflammatory activity. However, linear and reticular hyperintensities (B = 2.356, P = 0.000) on T2WI, and meshwork enhancement (B = 2.191, P = 0.000) at the equilibrium phase, all correlated with fibrosis. Moreover, periportal edema mainly correlated with the inflammatory activities (B = 2.635, P = 0.001). CONCLUSIONS: In chronic hepatitis B patients, patchy hyperintensities on T2WI, periportal edema, and patchy enhancement at the arterial phase can predict moderate-to-severe inflammatory activities, whereas intrahepatic linear and reticular hyperintensities on T2WI, and meshwork enhancement at the equilibrium phase can predict moderate-to-severe fibrosis.

Diffusion-weighted magnetic resonance imaging for the detection of metastatic lymph nodes in patients with lung cancer: A meta-analysis.

The aim of the present meta-analysis was to evaluate the diagnostic value of diffusion-weighted imaging (DWI) in differentiating metastatic from non-metastatic lymph nodes in patients with lung cancer. A systematic literature search was performed to identify eligible original studies. The quality of included studies was assessed using 'quality assessment of diagnostic accuracy studies' (QUADAS-2). Meta-analysis was performed to pool sensitivity and specificity, to calculate the positive likelihood ratio (PLR), the negative likelihood ratio (NLR) and the diagnostic odds ratio (DOR), and to construct the summary receiver operating characteristic (SROC) curve. The homogeneity, threshold effect and publication bias were also investigated. Meta-regression analysis was performed to identify the sources of heterogeneity. A total of 10 studies with 11 datasets met the inclusion criteria, which comprised 796 patients with a total of 2,433 lymph nodes. The pooled diagnostic sensitivity was 0.78 [95% confidence interval (CI): 0.74-0.81] and the pooled diagnostic specificity was 0.88 (95% CI: 0.86-0.89). The PLR, NLR, and DOR were 7.11 (95% CI: 4.39-11.52), 0.24 (95% CI: 0.18-0.33), and 31.14 (95% CI: 17.32-55.98), respectively. The area under the SROC curve was 0.90. No publication bias was found (bias=-0.15, P=0.887). Notable heterogeneity was, however, observed, and patient selection, type of lung cancer, number of enrolled lymph nodes, reference standard, B-value and the type of scanner were the sources of heterogeneity (P<0.05). No significant threshold effect was identified (P=0.537). In conclusion, DWI has been revealed to be a valuable magnetic resonance imaging (MRI) modality, with good diagnostic performance for distinguishing metastatic from non-metastatic lymph nodes in patients with lung cancer. Therefore, DWI may be a useful supplement to conventional MRI techniques.

Angiomyolipoma of the rib: A rare case report.

Angiomyolipoma is a benign mesenchymal tumor, most commonly arising from the kidney. With the exception of the liver, extrarenal angiomyolipoma is an infrequent entity that may be misdiagnosed as other tumors. Angiomyolipoma occurring in the skeleton is an extremely rare occurrence and often difficult to differentiate from other bone diseases. We herein present a case of angiomyolipoma in the rib of a 44-year-old male patient, a highly unusual location for this type of tumor. Angiomyolipoma of the skeleton usually exhibits an infiltrative tendency. Although this clinical entity is rare, angiomyolipoma should be considered in the differential diagnosis of skeletal lesions, particularly in patients presenting with imaging findings of fat within the lesions.

Diagnostic accuracy of computed tomography perfusion in patients with acute stroke: A meta-analysis.

PURPOSE: The purpose of this meta-analysis was to evaluate the sensitivity and specificity of computed tomography perfusion (CTP) in diagnosing acute ischemic stroke in patients presenting to the emergency department with stroke-like symptoms. METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until November 5, 2014 using the following terms: magnetic resonance imaging/MRI, computed tomography/CT, and stroke. Randomized controlled trials, retrospective, and case-controlled studies were included which evaluated patients who presented for emergency assessment of stroke-like systems. Diffusion weighted imaging (DWI) was used as reference standard. Only studies published in English or Chinese were included. Quality assessment and sensitivity analysis were performed to evaluate that strength of the data. RESULTS: The analysis included six studies with a total of 1429 patients. The pooled overall sensitivity for CTP indicated it had reasonable sensitivity (55.7%) and high specificity (92%). Subgroup analysis indicated that of the different CTP modes, MTT and CBF had higher sensitivities (48.6% and 47.3%, respectively) than CBV (26.3%). CBF and CBV had higher specificity (91.0% and 95.4%, respectively) compared with MTT (86.6%). CONCLUSION: All three CTP modes had adequate sensitivity but very high specificity, and among the three CTP modes, CBF had the best diagnostic characteristics.

Chronic hepatitis B: Enlarged perihepatic lymph nodes correlated with hepatic histopathology.

AIM: To assess the value of enlarged perihepatic lymph nodes in determining hepatic histopathology for chronic hepatitis B (CHB) by magnetic resonance imaging (MRI). METHODS: Sixty-seven patients who were clinically and histologically diagnosed with CHB and 18 healthy subjects without history of liver disease underwent abdominal MRI. Histological diagnosis and hepatic inflammation (grade 0-4) and fibrosis (stage 0-4) were assessed by a simplified system for scoring in chronic viral hepatitis. The major imaging protocol included an axial breath-hold fat suppressed fast spoiled gradient echo T2-weighted imaging (T2WI), axial breath-trigger fat suppressed fast recovery fast spin echo T2WI, and axial and coronal fast imaging employing steady-state acquisition. Perihepatic lymph nodes larger than 5 mm in shortest diameter were noted. RESULTS: The numbers and size indexes of lymph nodes greater than 5 mm in shortest diameter in hepatic hilum suggested inflammatory activity for subjects with grade 2 or higher, with a high accuracy of diagnosis (the area under the curves > 0.9, P < 0.001). The numbers of lymph nodes were 2 or more with a sensitivity of 87.27%, a specificity of 90.00%, an accuracy of 88.24%, a positive predictive value of 94.12%, and a negative predictive value of 79.41% in patients with grade 2 or higher, and the size indexes were no less than 180 mm(2) with a sensitivity of 83.64%, a specificity of 100%, an accuracy of 89.41%, a positive predictive value of 100%, and a negative predictive value of 76.92%. The numbers and size indexes of lymph nodes were not correlated with hepatic fibrosis. The signal intensity indexes of lymph nodes were no significant correlation with histological grading or staging of liver. CONCLUSION: The numbers and size indexes of enlarged perihepatic lymph nodes for patients with CHB suggest inflammatory activity for subjects with grade 2 or higher.

Oedema of gallbladder wall: correlation with chronic hepatitis B on MR imaging.

PURPOSE: The aim of this study was to characterise gallbladder wall oedema and correlate it with chronic hepatitis B (CHB) on magnetic resonance (MR) imaging. MATERIALS AND METHODS: Sixty-seven patients who were clinically and histologically diagnosed with CHB and 18 healthy individuals without any history of liver disease underwent abdominal MR imaging. Hepatic inflammation (grade 0-4) and fibrosis (stage 0-4) for patients were assessed histologically. Gallbladder wall oedema was noted. RESULTS: Twelve patients showed gallbladder wall oedema on MR imaging, including six with grade 3 and six with grade 4 disease. There was a statistically significant difference for the presence of gallbladder wall oedema among groups with grade 0-4 (p=0.000), but not between groups with grades 3 and 4 (p=0.729). Gallbladder wall oedema was related to moderate-severe inflammatory activity (p<0.05), alanine transaminase (ALT) (p=0.012) and aspartate aminotransferase (AST) (p=0.027) levels but not to fibrosis or other laboratory data, including serum quantitative DNA for hepatitis B virus (HBV), with the p=0.105-0.846. Sensitivity and specificity for the diagnosis of hepatic moderate-severe inflammation using gallbladder wall oedema were 33.33% and 100%, respectively. CONCLUSIONS: Gallbladder wall oedema for patients with CHB can be specifically demonstrated on MR imaging and is correlated with hepatic moderate-severe inflammatory activity, elevated ALT and AST levels but not with fibrosis or other laboratory data, including viremia.