Objective:To investigate the magnetic resonance imaging (MRI) features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis.Method:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 8 patients with DSRCT of the abdomen and pelvis, including 3 cases admitted in Yueqing People's Hospital and 5 cases admitted in Wenzhou People's Hospital, from January 2008 to June 2022 were collected. There were 5 males and 3 females, aged (43±5)years. All patients underwent MRI plain and enhanced scanning. Observa-tion indicators: (1) imaging features of DSRCT of the abdomen and pelvis; (2) treatment and pathological examination characteristics of DSRCT of the abdomen and pelvis; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of DSRCT of the abdomen and pelvis. ① Tumor location. Of the 8 patients, there were 6 cases with tumors located respectively at the lower edge of the liver in the right quarter costal region, the medial side of the ileocecal region in the right iliac region, the medial side of the caecum in the right iliac region, the gastro-pancreatic space in the left quarter costal region, the mesenteric space in the left iliac region and the right side of pelvic bladder, and 2 cases with tumors located at retroperitoneal space of left quarter rib region. ② Tumor size. There were 13 lesions in the 8 patients, and the maximum diameter of tumor was 9.1 (range, 3.5?20.0)cm. Of the 8 patients, there were 5 cases with single tumor and 3 cases with multiple tumors. ③ Tumor shape and boundary. Of the 8 patients, there were 4 cases with tumor in expansive growth and 4 cases with tumor in invasive growth. There were 5 cases with tumor of intratumoral necrosis and cystic degene-ration, 4 cases with tumor of intratumoral hemorrhage, 4 cases with tumor of intratumoral spot calcification, 3 cases with tumor of peritumoral tissue exudation. One patient may combined with multiple imaging manifestations. ④ Imaging characteristics of MRI plain scanning. Of the 8 patients, there were 4 cases with tumor of homogeneous hypointensity signal and 4 cases with tumor of hypointensity mixed with speckled hyperintensity (with hemorrhage) in T1 weighted imaging of MRI plain scanning. There were 3 cases with tumor of homogeneous hyperintensity and 5 cases with tumor of high signal at the edge, patchy and spot-shaped in the center in T2 weighted imaging of MRI plain scanning. There were 5 cases with tumor of high, equal and low confounding signals and 3 cases with tumor of high and low signals in T2 weighted imaging fat suppression sequence of MRI plain scanning. There were 3 cases with tumor of uniform high signals and 5 cases with tumor of high, equal and low mixed signals in diffusion weighted imaging of MRI plain scanning. ⑤ Imaging characteristics of MRI enhanced scanning. All 8 patients had tumor of heterogeneous enhancement in MRI enhanced scanning, including 2 cases with significant enhancement in arterial phase, continuous enhancement in portal phase, slightly reduced enhancement in delayed phase, 4 cases with moderate enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase, 2 cases with mild enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase. Of the 8 patients, there were 3 cases with tumor of annular enhancement with intratumoral strip or grid signals and 3 cases with tumor of peritumoral blood vessels increased and thickened signals. ⑥ Tumor invasion and metastasis. Of the 8 patients, there were 4 cases with tumor invaded bowel, 2 cases with tumor invaded surrounding tissues, 1 case with tumor invaded left kidney, spleen and pancreatic tail, 1 case with tumor invaded distal of left ureter. There were 5 cases with abdominal, retroperitoneal and inguinal lymph nodes enlargement, 4 cases with multiple nodular thickening of peritoneum and ascites, 2 cases with tumor liver and lung metastasis and 1 case with tumor rib, femur and sacrum metastasis. One patient may combined with multiple tumor metastasis. (2) Treatment and patholo-gical examination characteristics of DSRCT of the abdomen and pelvis. Of the 8 patients, 3 patients underwent complete resection as clear tumor boundary, 3 patients underwent tumor partial resection as tight adhesion between tumor and surrounding blood vessels, 2 cases underwent tumor tissue pathological examination as extensive metastasis of peritoneum, omentum, mesentery and surrounding intestine. All 8 patients were diagnosed as DSRCT by microscopic examination, electron microscopic examination, immunohistochemical staining and cytogenetic examination. (3) Follow-up. All 8 patients underwent postoperative follow-up and died during the follow-up.Conclusion:MRI features of abdominal and pelvic DSRCT include single or multiple lobulated masses with unclear boundaries, invading the omentum, mesentery, peritoneum and adjacent tissues in most cases, mixed signals and heterogeneous mild to moderate enhancement in enhanced scanning.

Objective:To explore the value of a two-stitch continuous suture in single- lumen ileostomy.Methods:This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, n=60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, n=38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. Results:There were no significant differences in baseline data between the groups (all, P>0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; t=-17.874; P<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ 2=9.633, P=0.002;5.3% (2/38) vs. 28.3% (17/60), χ 2=7.923, P=0.005; and 2.6% (1/38) vs. 18.3% (11/60), P=0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all P>0.05). Conclusion:Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.

胃癌是一种常见的消化系统恶性肿瘤,病死率较高[1].胃癌的早期发现和准确的诊断对其治疗和预后具有重要意义,内窥镜、胃肠道钡餐造影是常用的检查方法,对胃癌病灶的检出有较大作用,但对病灶在胃壁浸润深度的观察以及周围淋巴结转移的发现有其局限性.近年来,多层螺旋CT及其成像系统已广泛应用于胃癌的诊断,不仅能够清楚显示病灶的部位、形态,还能判断肿瘤的浸润深度和转移情况.本研究旨在探讨64层螺旋CT双期动态增强扫描对胃癌病灶的诊断价值,报道如下.

Objective:To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma.Methods:A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019. There were 8 males and 8 females, with age ranging from 35 to 71 years (average 56.8 years). The site, size, shape, margin, density of signal, adjacent tissue changes and degree enhancement of tumor were analyzed.Results:Tumors in the liver in the 16 patients were all solitary, with 11 in the right and 5 in the left liver. The maximum diameter of tumor ranged from 3 to 16cm (average 8.5cm). On plain CT scanning ( n=16), the tumors were round or oval in 6, and lobulated or irregular in 10 patients. The margins of the tumors were clear in 10 and unclear in 6 patients. All tumors showed low density, with 15 tumors showing uneven density, with necrosis and liquefaction of different sizes in the center, while 1 tumor showing uniform density. On plain MRI scanning ( n=4), four tumors had clear margins, with necrosis and liquefaction seen in the center of the tumors. The solid part showed a slightly lower signal on T 1 weighted imaging and a slightly higher signal on T 2 weighted imaging. The liquefaction focus of central necrosis showed higher signal intensity on T 2 weighted imaging. Enhanced scanning ( n=12 on CT enhancement and n=4 on MRI enhancement), the margins of the tumors were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Strip septate and margin enhancement in the tumor were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 1 patient. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous phase. In the delayed phase, enhancement in the tumor decreased, but there was continuous enhancement of the margin and interval of the tumor in 1 patient. Conclusions:Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer. The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components. Large intrahepatic tumors showed necrotic cystic degeneration, moderate or significant persistent enhancement in striped septum and margin of tumor.

Objective:To investigate the computed tomography (CT) features of gastric neuroendocrine neoplasm (GNEN).Methods:The retrospective and descriptive method was conducted. The clinicopathological data of 30 GNEN patients who were admitted to two domestic medical centers (13 cases in Wenzhou Hospital of Traditional Chinese Medicine and 17 cases in Wenzhou People′s Hospital) from January 2010 to December 2018 were collected. There were 23 males and 7 females, aged (62±4)years, with a range from 27 to 78 years. The patients underwent abdominal CT plain scan and dynamic enhancement scan. Two associate chief radiologists with more than 20 years of work experience observed and analyzed all the images respectively. Observation indicators: (1) CT examination; (2) treatment and postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect the survival of patients up to December 2018. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Results:(1) CT examination: of the 30 patients, 14 had the tumor located in the fundus of stomach, 10 had the the tumor located in the body of stomach, and 6 had the tumor located in the antrum. The tumor was elliptical in 18 cases and irregular in 12 cases. There were 15 cases of endogenous type, 13 cases of exogenous type, and 2 cases of intramural type. Patients with G1 neuroendocrine tumor had the maximum diameter of (6.8±1.6)cm, of which 4 cases had the maximum diameter less than 5.0 cm and 4 cases had the maximum diameter of 5.0 to 10.0 cm. Patients with G2 neuroendocrine tumor had the maximum diameter of (8.3±2.7)cm, of which 1 case had the maximum diameter less than 5.0 cm, 4 cases had the maximum diameter of 5.0 to 10.0 cm, and 2 cases had the maximum diameter greater than 10.0 cm. Patients with G3 neuroendocrine carcinoma had the maximum diameter of (17.8±2.2)cm, of which 6 cases had the maximum diameter of 5.0 to 10.0 cm and 9 cases had the maximum diameter more than 10.0 cm. The tumor showed swelling growth in 14 cases and invasive growth in 16 cases. The tumor boundary was clear in 14 cases and unclear in 16 cases. CT plain scan showed homogeneous tumor density in 10 cases and heterogeneous density in 20 cases. Nine patients had iso-density in the tumor parenchymal part, and the CT value was (34.0±3.5)HU. In the 18 cases of low density, the CT value was (16.6±1.4)HU. In the 3 cases of high density, the CT value was (45.3±3.6)HU. Of the 30 patients, 21 cases had small punctate or small round necrotic cyst lesions in the tumor, 10 cases had mesenteric lymph node, peritoneum, liver metastasis and adjacent omentum invasion; 17 cases had abdominal effusion. In the CT enhancement examination, 12 cases showed mild enhancement, and the CT value was (56.5±6.3)HU; 15 cases showed moderate enhancement, and the CT value was (66.0±5.4)HU; 3 cases showed significant enhancement, and the CT value was (76.6±5.8)HU. Seven cases showed homogeneous enhancement and 23 cases had heterogeneous enhancement. There were 8 cases with tortuous vessels. (2) Treatment and postoperative pathological examination: of the 30 patients, 10 cases with mesenteric lymph nodes, peritoneum, liver metastasis and adjacent omentum invasion underwent radical total gastrectomy; 14 cases without surrounding tissue invasion or metastasis underwent radical subtotal gastrectomy; 6 cases with tumor diameter less than 4.0 cm and without surrounding tissue invasion or metastasis underwent endoscopic resection. All the 30 patients were confirmed GNEN by postoperative pathological examination, including 8 cases of G1 neuroendocrine tumor, 7 cases of G2 neuroendocrine tumor, and 15 cases of G3 neuroendocrine carcinoma. Results of immunohistochemical staining showed that 30 patients were positive for synaptophysin, 23 were positive for chromogranin A, and 9 were positive for cytokeratin. (3) Follow-up: all the 30 patients were followed up for 10-80 months, with a median follow-up time of 39 months. The 5-year survival rate of 30 patients was 43.3% (13/30). The 5-year survival rates were 6/8, 3/7 and 4/15 of patients with G1 neuroendocrine tumor, G2 neuroendocrine carcinoma, and G3 neuroendocrine carcinoma.Conclusions:GNEN has the main manifestation as abdominal pain, with G3 as pathological classification, which is common in fundus and body of stomach. The CT findings of GNEN are characterized by swelling or infiltrating growth and round or irregular low-density masses. Tumors are prone to cystic transformation, and showed the mildly to moderately heterogeneous enhancement.

目的:探讨联合入路翻页式腹腔镜辅助右半结肠癌根治术的有效性及安全性。方法:采用回顾性队列研究方法。选取2017年6月至2018年6月期间，于南方医科大学珠江医院普通外科行腹腔镜辅助右半结肠癌根治术的80例患者临床资料，所有患者均在术前经CT和电子结肠镜确诊为右半结肠癌。根据手术入路的不同，分为改良联合入路组（40例）和传统中间入路组（40例）。比较两组围手术期情况和随访情况。结果:两组基线资料的比较，差异均无统计学意义（均 P>0.05）。与传统中间入路组比较，改良联合入路组的手术时间较短[（162.8±21.2）min比（188.5±19.5）min， t=-5.658， P<0.001]，术中失血量较少[（40.9±20.1）ml比（81.0±27.3）ml， t=-7.491， P<0.001]，术后排气时间较短[（44.4±7.3）h对比（48.6±10.5）h， t=-2.077， P=0.041]。两组的术中淋巴结清扫数目、切除肠管长度以及术后并发症发生率、术后住院天数和总费用的差异无统计学意义（均 P>0.05）。全组患者中位随访6.2（2.1~12.2）个月，两组均未发现局部复发及死亡患者出现。 结论:联合入路翻页式腹腔镜辅助右半结肠癌安全可行，且具有手术难度低、缩短手术时间、减少术中出血以及加快术后康复的优势。

目的:观察ACS(急性冠状动脉综合征)患者社会支持程度对其死亡率及MACE(不良心血管事件)的影响.方法:纳入本院2017年4月-12月间诊疗ACS患者90例为研究对象,用简单随机化手段将其分为对照组 、实验组,每组45例,对应常规ACS对症治疗 、联合社会支持模式干预.比较两种干预模式下ACS患者社会支持度 、发生死亡和MACE概率等数据并以此归纳之间的联系性.结果:通过MSPSS量表对两组患者社会支持度情况进行评估,提示实验组患者高社会支持例数显著高于对照组且有统计学意义(P<0.05);分别于患者出院后的1、3、6、12个月通过随访掌握死亡和MACE事件,实验组患者显著低于对照组且有统计学意义(P<0.05).结论:对ACS患者应该重视社会支持程度,有利于提高其出院后生存质量,保障治疗的延续性和依从性.

目的:探讨髂骨原发性非霍奇金淋巴瘤的CT表现特征.方法:收集2010年1月至2018年12月经病理证实的18例髂骨原发性非霍奇金淋巴瘤患者的CT影像资料.男12例,女6例;年龄17～76岁,中位数46岁;均表现为患病部位疼痛,其中13例可触及软组织肿块、5例邻近髋关节活动受限、2例邻近骶髂关节疼痛.18例均行CT平扫,其中12例行增强扫描.分析病变的CT表现,探讨该病的CT表现特征.结果:①CT平扫结果.肿瘤位于髂骨体4例,髂骨翼14例;肿瘤累及邻近骶骨与骶髂关节3例,累及邻近髋关节2例.溶骨型11例,表现为骨髓腔内斑片状骨质破坏,骨皮质破坏明显,边缘清楚,未见骨膜反应,可见软组织肿块与髓腔相连;浸润型3例,表现为斑点状、虫蚀样骨质破坏,皮质不光整、毛糙,边缘模糊或有硬化区,与正常骨组织间分界不清;混合型4例,表现为小斑片状骨质破坏,周围骨质硬化明显.16例有明显软组织肿块,软组织肿块大于骨质破坏的范围,并包绕病骨;无明显软组织肿块2例.软组织肿块密度均稍低于周围肌肉组织,其中密度均匀10例、混杂密度8例;软组织肿块直径3.0～15.0 cm,中位数7.2 cm;平扫CT值15～58 HU,中位数35 HU;肿块内均未见瘤骨及钙化.18例肿块周围软组织均受压、移位,其中2例病灶边界不清,累及左侧髂腰肌、臀肌、输尿管及髂血管;2例盆腔内见多发肿大淋巴结.②CT增强扫描结果.动脉期软组织肿块呈轻度至显著不均匀强化,CT值32～116 HU,中位数55.5 HU;门静脉期和延迟期肿块呈持续不均匀强化,其中7例肿块较均匀强化、5例肿块周边强化而中心病灶坏死囊变区无强化.结论:髂骨原发性非霍奇金淋巴瘤的CT表现多为溶骨型或混合型骨质破坏,且多合并较大软组织肿块,骨膜反应少.

Objective To investigate the CT characteristics of primary pulmonary sarcomatoid carcinoma (PSC). Methods CT characteristics of 14 cases with primary pulmonary saromatoid cacinoma confirmed by surgical pathology were analyzed retrospectively. Results Among the 14 cases, the clinical manifestations were chest pain and cough in 6 cases, cough with blood-stained sputum in 5 cases, chest tightness and asthma in 2 cases, and no symptoms in 1 case. All the 14 cases had solitary masses in the lung. Carcinoma of 7 cases located in the upper lobe of the right lung, and carcinoma of 1 case located in the inferior lobe of the right lung. Carcinoma of 3 cases was located in the upper lobe of the left lung, and 3 cases were found in the inferior lobe of the left lung. Eleven cases had peripheral tumors and 3 cases had central tumors. CT plain scan revealed an isodense mass. There were 12 cases with uneven mass density and necrosis, and 2 cases had uniform mass density. The smooth margin was identified in 7 masses, and ill-defined margin and lobulation was shown in 7 masses. Cavity was observed in 1 mass, and speckled calcification was seen in 1 mass. Pleural invasion and thickening was in 5 cases, pneumothorax occurred in 1 case, and there was 1 case of liver metastasis. Enhancement scan showed patchy or annular enhancement around the mass, and the central enhancement of the mass was not obvious or uneven patchy enhancement. Conclusions The CT characteristics of primary pulmonary sarcomatoid carcinoma are solitary masses in the lung, especially if the mass is located in the periphery of the upper lobe of the right lung with uneven density, and enhancement scan shows patchy or annular enhancement around the mass.

investigate the CT and MRI features of adult rhabdomyosarcoma (RMS) of extremities. Methods A retrospective analysis was carried out on CT and MRI findings of 10 patients with rhabdomyosarcoma of extremities confirmed by surgery and pathology in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University. The site, size, shape, margin, density or signal, adjacent tissue changes and enhanced degree of the mass were observed. Results In the 10 cases, the mass was located in the thigh in 6 cases, in the calf in 3 cases, and in the upper arm in 1 case. The maximum diameter of the tumor was 2.9-22.5 (12.0 ± 7.2) cm. The masses were oval in 2 cases and irregular in 8 cases. The margins of the masses were clear in 2 cases and unclear in 8 cases. There was invasive destruction of adjacent bone in 3 cases, intratumoral necrotic cystic changes in 8 cases, intratumoral hemorrhage in 2 case, and lymph node metastasis in 3 cases. Four patients underwent plain CT scan: CT presented isodensity in 1 case and slightly lower density in 3 cases. The mass density was uniform in 1 case and uneven in 3 cases. CT value of the solid part of the mass was 27-47 (42 ± 6) HU in average. Three patients underwent enhanced CT scan: all the enhanced masses showed uneven enhancement, including 1 case of mild enhancement and 2 cases of moderate enhancement, with no enhancement of necrotic cystic lesion area and clear in lesion boundary. Nine patients underwent plain MRI scan: mass of 9 cases presented iso-signal or slightly lower signal on T1WI, including 4 cases with iso-signal and 5 cases with slightly lower signal. There were 7 cases of uneven signals and 2 cases of uniform signals. The mass presented high signal on T2WI, including 8 cases with uneven signals and 1 case with uniform signals, and the necrotic cystic lesion showed higher signal on T2WI. Seven patients underwent enhanced MRI scan: all the enhanced masses showed uneven enhancement, including significant enhancement in 5 cases, moderate enhancement in 2 cases, no enhancement in necrotic cystic lesion area, and "perivascular" phenomenon in 4 cases. Conclusions CT or MRI examination shows that the soft tissue tumor of the extremities presents low density on CT, equal or slightly low T1WI signal on MRI, and high signal on T2WI, with necrotic cystic lesion inside peripheral blood vessel density in the tumor, without calcification and significantly or moderately uneven enhancement should consider the possibility of RMS should be considered.

Objective To investigate the correlation between the rate of late gadolinium enhancement (LGE) and risk of sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients. Methods 45 HCM patients and 20 normal volunteers underwent cardiac cine MRI and late gadolinium enhancement. Then, we calculated their rate of LGE and analyzed the difference between the two groups of data; The HCM Risk-SCD was used to calculate the 5 year SCD risk score of HCM patients, and to analyze the correlation between LGE rate and 5-year SCD risk score. Results The LGE rate of HCM patients was significantly higher than that of normal controls (P<0.001). The LGE rate of HCM patients was positively correlated with the 5-year SCD risk score (P<0.0001). Conclusion LGE rate is positively correlated with SCD risk in HCM, and can be used as a quantitative index to evaluate the SCD risk in HCM patients.

Objective To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods CT findings of 12 patients with primary mediastinal neuroen-docrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pat-tern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results Among the 12 cases, 4 cases were located in the anterior superior medi-astinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of(6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, ir-regular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained cal-cification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the sur-rounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhance-ment. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclu-sion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

目的 MRI双回波稳态(We DESS)及T2-mapping序列在鉴别踝关节撞击综合征(AIS)关节软骨退变早期的价值.方法 回顾性分析收治的AIS患者30例,均给予MRI常规FS-T2WI序列、WeDESS及T2-mapping序列检查,比较3种扫描序列对关节软骨退变早期诊断的敏感度、特异度及准确度,同时比较软骨退变早期与未退变 T2-mapping序列T2值.结果 30例患者最终经经踝关节镜取组织行病理检查后发现关节软骨退变早期14例,未退变16例.We DESS、T2-mapping序列的敏感度、特异度及准确度明显高于FS-T2WI序列(均P＜0.05),但We DESS与T2-mapping序列诊断敏感度、特异度及准确度差异均无统计学意义(均P＞0.05).软骨退变早期患者平均T2值与未退变患者差异有统计学意义(P＜0.05).结论 WeDESS及T2-mapping序列对AIS关节软骨退变早期的鉴别有较高价值,且T2-mapping序列检查可进行定量评估,值得临床应用.

Objective To investigate the features of soft tissue myxofibrosarcoma (MFS)on MRI.Methods The MRI data of 15 cases with MFS confirmed by surgery and pathology were analyzed retrospectively.Results Of all the 1 5 cases,7 were located in the thigh,3 were located in the lower leg,2 were located in the forearm,1 was located in the shoulders,1 was located in the back and 1 was located in the buttocks.The average maximum diameter of all lesions was (9.43±3.1)cm.Fifteen cases showed isointensity with slightly hypointensed fiber septa on T1WI.The signal intensity of MFS on T2WI was mixed.Five cases of low-grade MFS with myxoid area showed slightly hyperintensity,with sporadic small nodular and striped fibrous septa which showed hypointensity on T2WI and inhomogeneous enhancement.In 5 cases of high-grade MFS,the solid part and the septa showed hypointensity on T2WI;the myxoid matrix area and the necrotic area showed hyperintensity on T2WI.The myxoid matrix part showed mild inhomogeneous enhancement with peritumoral enhancement of"tail sign".Among the 5 cases,the solid part of 4 cases showed middle to severe annular heterogeneous enhancement,while the solid part of the remaining 1 case showed nodular enhancement.Five cases of intermediate-grade MFS showed slightly hyperintensity or isointensity on T2WI,and nodules and fibrous septa showed hypointensity.The enhanced solid part and myxoid matrix area showed mild to moderate inhomogeneous enhancement,and there were 2 cases with"tail sign".Conclusion MRI features of soft tissue myxofibrosarcoma have some characteristics including isointensity on T1WI,mixed signal intensity on T2WI,heterogeneous enhancement and peritumoral enhancement of"tail sign".

Objective To explore the CT features of primary retroperitoneal liposarcoma.Methods A retrospective analysis of pathologically confirmed primary retroperitoneal liposarcoma was done.Results Tumors were located in left retroperitoneal space in 16 cases,in right retroperitoneal space in 10 cases,and in median retroperitoneal space in 3 cases.The maximum diameter ranged from 9-40 cm,with an average of (17 ±8) cm.Tumors were round in 8 cases,oval in 10 cases and irregular in 11 cases.The boundary of tumor was clear in 10 cases.CT plain scanning was mixed density in 20 cases,uniform density in 9 cases;Tumors of necrotic cysts in 11 cases,and with calcification in 9 cases;Enlarged intraperitoneal and retroperitoneal lymph nodes were found in 6 cases and intrahepatic metastases in 3 cases.The solid part was mild to moderate enhancement.Pathologically of the 29 cases,7 were dedifferentiated,4 were mucous,5 were polymorphic,1 1 were well differentiated and 2 were mixed.Conclusion The CT examination of primary retroperitoneal liposarcoma is of great value in locating tumor and judging the relationship between tumor and adjacent organs.

Objective To investigate the MRI features of ovarian theca fibroma (OTF) and compare it with histopathology features in order to improve the accuracy of OTF diagnosis. Methods The clinical data of 33 patients with OTF which were confirmed by surgical pathology from January 2005 to December 2016 were analyzed retrospectively. The signal characteristics and intensities of MRI were compared with histopathology features. Results The lump largest diameter of 33 patients with OTF was 2.5 to 18.0 (6.65 ± 4.46) cm. The substantial lump was in 22 cases. T2WI and T2WI fat suppression imaging showed a low or equal mixed signal among which there was slightly high or high signal, and T1WI imaging showed relatively uniform low signal. The cystic and solid lump was in 11 cases, including 7 cases of solid lumps and 4 cases of cystic-solid lumps, T2WI and T2WI fat suppression imaging of solid area showed equal or low signal among which there were a small patchy high or slightly high signal, and T2WI and T2WI fat suppression of cystic areas showed high signal; T1WI of solid and cystic areas showed uniform low signal. Enhanced appearance: in the 33 cases of enhancement, the parenchyma part showed mild enhancement, of which 14 cases were equal enhancement, 19 cases were uneven enhancement. During the arterial phase, all of 33 cases showed mild enhancement; 15 cases were obviously enhanced and 18 cases were mildly enhanced in the portal vein phase; 21 cases remained enhanced and the enhanced intensity of 12 cases decreased in the delayed phase. Comparison of histopathology features with MRI features showed that there were a higher proportion of fibrous cells under the microscope in 22 cases of parenchymal tumor, in which the fat suppression image of T2WI and T2WI showed equal or low signal in parenchyma, and T1WI showed even low signal; and there were a higher proportion of tumor cells and less collagen fibers under the microscope in 11 cases of cystic-solid tumor, in which the T2WI showed a slightly equal and higher signal and T1WI showed low signal in parenchyma. Conclusions The MRI features have some characteristics, such as low and equal signal of T2WI in parenchyma, mild enhancement during arterial phase and continuous enhancement in portal vein and delayed phase, which is helpful for diagnosis of OTF.

Objective To study the medical imaging findings and the pathological features of hepatic inflammatory myofibroblastic tumor (HIMT) using CT,MRI and histopathology.Methods The CT and MRI findings of 31 patients with HIMT which were confirmed by histopathology on surgically resected specimen were analyzed retrospectively.The location,size,shape,edge,density or signal,and contrast enhancement of these tumors were analyzed.Results The tumors were located in the right liver in 26 patients,in the left liver in 5 patients,and under the hepatic capsule in 27 patients.The tumors were solitary in 28 patients and multiple in 3 patients.The maximum diameter of the tumor ranged from 2.1 cm to 12.5 cm.The average diameter was (3.6 ± 1.2) cm.The tumors were round or oval in 21 patients and irregular in 10 patients.19 patients underwent CT examination and all tumors showed low density,with a CT value which ranged from 5 to 35HU.The average value was (27.6 ±5.3) HU.The density of tumors was homogeneous in 6 patients and inhomogeneous in 13 patients,and among these 13 patients,3 were alveolate.Twenty-one patients underwent MRI scan and all showed a low signal on T1WI,12 patients showed an equal signal and 9 patients showed a slightly higher signal on T2WI.In 6 patients the signals were homogeneous and in 15 patients they were inhomogeneous.On CT and MRI enhanced scans the whole tumor was enhanced in 12 patients,the edge was enhanced in 9 patients,the septum was enhanced in 8 patients and no enhancement was observed in 2 patients.Pathological examination under microscopy observed the presence of proliferation of spindle cells,chronic inflammatory cells which included the proliferation of lymphocytes,plasma cells and collagen fiber formation.The spindle cells had the characteristics of fibroblasts and myofibroblast cells.Immunohistochemical examination showed the wave type protein (Vimentin) was positive in 23 patients,the smooth muscle actin (SMA) was positive in 18 patients,the muscle actin (MSA) and the specificity of junction protein (Desmin) were positive in 12 patients,CD68 was positive in 4 patients,and the ALK,S-100 protein,CDll7 and CD35 were all negative.Conclusions The radiological features of CT and MRI plain scan varied.The patterns of contrast enhancement included full tumor filling,marginal enhancement,compartment enhancement,and no enhancement.The enhanced features varied from mild to moderate enhancement in the arterial phase,further enhancement in the portal phase and mild enhancement in the delayed phase.

Objective: To analyze the diagnostic value of MRI and ultrasonography in adherent placenta, and to investigate the advantages and disadvantages of two kinds of examination methods for this disease. Meth-ods: A total of 134 patients suspected as placenta implantation abnormality underwent MRI and ultrasonography. The diagnostic value of MRI and ultrasonography in adherent placenta were evaluated and compared with intra-operative and postoperative pathology as the diagnostic criteria. Results: In 134 cases who were all undergoing caesarean section, 43 cases were confirmed to be placenta implantation by the intraoperative and postoperative pathology diagnosis. Among them, 24 patients were as adhesion, 17 patients were as implanted and 2 patients were as penetrating. The sensitivity, specificity, correct index, misdiagnosis rate and missed diagnosis rate of ad-herent placenta diagnosis by MRI were 62.50%, 87.27%, 49.77%, 12.73% and 37.50%, respectively. The indexes above of diagnosis by ultrasound were 25.00%, 89.09%, 14.09%, 10.91% and 75.00%, respectively. There were significant differences between the sensitivity of MRI and ultrasonography (x2=6.875, P=0.009). Conclusion:Ultrasonography is of high specificity. Its position as the convenient and cheap screening test is irreplaceable. The sensitivity of MRI is higher than that of ultrasonography. And MRI should be regarded as a routine examination of suspected cases.

Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.

Objective To explore the correlations between the brain metabolites and the development quotient in the preterm infants, thus to provide a important informations for the early diagnosis and prediction of nervous system development delayed in the preterm infants .Methods Total of 45 cases with preterm and 30 cases with full-term underwent 1 H-MRS scan within 1 week of birth to collect their brain metabolite data , including the NAA/Cr, Cho/Cr, Lac/Cr, Glx/Cr and MI/Crr.The Gesell examina-tion was performed at postnatal 40~52 weeks.The values of the development quotient and its five functional areas were recorded . The correlations between the brain metabolites and the development quotient were analyzed by Multiple linear regression analysis . Results The value of NAA/Cr in the premature infant was lower than that of the full term infant , the difference was statistically significant ( t =-6.202, P <0.001).The values of Cho/Cr, Lac/Cr and Glx/Cr were higher than that of the full term infant , the difference was statistically significant ( P <0.001).The multiple linear regression analysis demonstrated that the develop-ment quotient had significant correlations with the values of NAA /Cr and Lac/Cr (determination coefficient was 0.418).Conclu-sion There was significant correlation between the brain metabolites ( NAA and Lac ) in the early 1 H-MRS and the Gesell devel-opmental quotient in the preterm infants suggests that the NAA and Lac may be an early predictive indicator in the nervous system development delayed in the preterm infants .