Background:The preoperative diagnosis of gastric stromal tumor (GST) and gastric schwannoma (GS) is of great significance for the selection of surgical methods. However, their similar clinical and imaging findings make it challenging to distinguish between the two tumors, and thus misdiagnosis occurs frequently before surgery. This study aimed to investigate the value of clinical data and enhanced computed tomography (CT) features in the differential diagnosis of GST and GS by a multi-institution retrospective analysis, for large (≥5 cm) and small (<5 cm) tumors. Methods:This study involved 493 patients with GST and 102 patients with GS. The enhanced CT imaging data and clinical characteristics of the participants were analyzed, including the complete clinical and imaging data, and postoperative pathological diagnosis. The cut-off value of 5 cm of the tumor was used to divide the patients into two groups (large group: 164 GST and 13 GS; small group: 329 GST and 89 GS). The categorical variables were statistically analyzed using the chi-squared test, and the continuous variables were statistically analyzed using independent samples t-test or Mann-Whitney U test. The statistically significant variables for the two groups were analyzed using multivariate logistic regression and receiver operating characteristic curve analysis. Results:A total of 177 patients were divided into a large GST (GST-L) group (n=164) and a large GS (GS-L) group (n=13), and 418 patients were divided into a small GST (GST-S) group (n=329) and a small GS (GS-S) group (n=89). Multivariate logistic regression analysis showed that the lymph node and necrosis were independent risk factors in large groups. In the small groups, multivariate logistic regression analysis showed that sex, location, growth pattern, lymph node, and necrosis were independent risk factors. The area under the curve was 0.983 in the large groups [accuracy (ACC) =95.5, sensitivity (SEN) =0.923, specificity (SPE) =0.957], and 0.931 in the small groups (ACC =77.8, SEN =0.816, SPE =0.922). Conclusions:The two models have high diagnostic efficiency, and share significantly different features of lymph nodes and necrosis, whether in large or small groups, which may contribute to providing a precise reference for the planning of surgical methods.

Objective The risk category of gastric gastrointestinal stromal tumors (GISTs) are closely related to the surgical method, the scope of resection, and the need for preoperative chemotherapy. We aimed to develop and validate convolutional neural network (CNN) models based on preoperative venous-phase CT images to predict the risk category of gastric GISTs. Method A total of 425 patients pathologically diagnosed with gastric GISTs at the authors’ medical centers between January 2012 and July 2021 were split into a training set (154, 84, and 59 with very low/low, intermediate, and high-risk, respectively) and a validation set (67, 35, and 26, respectively). Three CNN models were constructed by obtaining the upper and lower 1, 4, and 7 layers of the maximum tumour mask slice based on venous-phase CT Images and models of CNN_layer3, CNN_layer9, and CNN_layer15 established, respectively. The area under the receiver operating characteristics curve (AUROC) and the Obuchowski index were calculated to compare the diagnostic performance of the CNN models. Results In the validation set, CNN_layer3, CNN_layer9, and CNN_layer15 had AUROCs of 0.89, 0.90, and 0.90, respectively, for low-risk gastric GISTs; 0.82, 0.83, and 0.83 for intermediate-risk gastric GISTs; and 0.86, 0.86, and 0.85 for high-risk gastric GISTs. In the validation dataset, CNN_layer3 (Obuchowski index, 0.871) provided similar performance than CNN_layer9 and CNN_layer15 (Obuchowski index, 0.875 and 0.873, respectively) in prediction of the gastric GIST risk category (All P >.05). Conclusions The CNN based on preoperative venous-phase CT images showed good performance for predicting the risk category of gastric GISTs.

Bronchial lipoma is a rare benign tumor of the lung, which is often misdiagnosed due to concomitant pulmonary diseases. In addition, the coexistence of endobronchial lipoma and lung cancer is extremely unusual. To date, no related computed tomography (CT) images have been reported. The patient was a 53-year-old man, who was admitted to our hospital with cough, yellow phlegm, and fever for 1 week. The CT image showed an irregular mass in the medial segment of the right middle lobe (B 4a ) with surrounding ground glass opacity, and another solid nodule in the right lower lobe (B 6b ). Unfortunately, after 2 weeks of anti-inflammatory treatment, the bronchial invasion of the B 4a nodule did not decrease significantly, so further bronchoscopy was carried out and tumor resection was performed using endoscopic mucosal resection with a ligation device (EMR-L). During the follow-up 4 months, it was found that the B 6b nodule was marked enlargement and then removed. The lesions of the B 4a and B 6b were confirmed as endobronchial lipoma and squamous cell carcinoma (T1aN0M0) by histopathology and immunohistochemical staining, respectively, and no postoperative radiotherapy or chemotherapy was performed. Regrettably, after 29 months of follow-up, we observed recurrence and slow enlargement of the lipoma in its original location, progressive emphysema in both lungs, and solitary chest wall metastasis from the B 6b squamous cell carcinoma that had been resected. Therefore, endobronchial endoscopy resection should be carefully selected for larger endobronchial lipoma. If it is accompanied by early squamous cell carcinoma (T1aN0M0), we still recommend active postoperative chemoradiotherapy.

目的 探讨脑深部髓质静脉(DMV)及血管周围间隙(PVS)评分评估脑白质高信号(WMH)严重程度的意义.方法 收集浙江省立同德医院2020年6月至2022年4月99例WMH患者影像及临床资料.DMV评分在磁敏感加权成像图像上进行,并将DMV区域分成双侧额部、顶部、枕部6个区域.对每个区域分别依据DMV显著程度及信号连续性进行评分,最后对6个区域评分进行相加,分值范围0～18分.PVS评分采用Semiquantitative量表(0～4分).WMH分为脑室旁WMH(PWMH)和深部WMH(DWMH),采用Fazekas量表进行严重程度评估.结果 PWMH及DWMH不同严重程度间DMV评分、PVS评分差异均有统计学意义(均P＜0.01).有序多分类logistic回归分析显示DMV评分及PVS评分是DWMH、PWMH严重程度的影响因素(均P＜0.05).结论 DMV评分、PVS评分是WMH严重程度的影响因素.

目的 探讨脑白质高信号(WMH)患者脑深部髓质静脉(DMV)评分危险因素方法 收集2020年1月至2022年4月WMH患者影像及临床资料.基底节区血管旁间隙(BPVS)在T2WI图像上按个数进行评分(0～4分).丘脑纹状体静脉(TSV)、大脑内静脉(ICV),透明隔静脉(SV)直径及DMV评分在SWI图像上评估.按DMV解剖区域分成双侧额部、顶部、枕部6个区域,并对每个区域分别进行评分(依据DMV程度及信号连续性进行评分:0～3分),最后对6个区域评分进行相加,分值范围0～18分.结果 117例WMH患者纳入研究,Spearman相关性分析DMV评分与年龄(r=0.425,P＜0.001),BPVS评分(r=0.278,P=0.002)及TSV直径(r=-0.230,P=0.012)相关.DMV评分与SV,ICV直径无相关(P＞0.05).结论 WMH患者DMV评分与年龄、BPVS评分及TSV直径相关.

目的:脑白质高信号(WMH)是脑小血管疾病重要影像标记物,发病率高,社会负担重.但其发病机制尚不清楚,本文旨在探索脑深静脉直径与WMH体积的关系.方法:收集我院2019年1月—2022年4月WMH患者的影像及临床资料.在T2 Flair图像上手动分割WMH,并计算WMH体积.在SWI相位图像上测量丘脑纹状体静脉(TSV),透明隔静脉(SV),大脑内静脉(ICV)的直径.分析TSV、SV、ICV的直径与WMH体积的关系.结果:共117例WMH患者纳入研究,WMH体积3011.22(2 146.72,4 752.33)mm3,TSV 直径 1.8(1.68,1.95)mm,SV 直径:1.65(1.55,1.76)mm,ICV 直径 1.77(1.6,1.91)mm.Spearman相关性及单因素线性回归分析TSV直径与WMH体积负相关(P＜0.05).经年龄、血管危险因素校正,线性回归分析示TSV直径与WMH体积独立相关(P＜0.05).结论:TSV直径与WMH体积负相关,TSV管腔变窄可能为WMH形成的重要机制之一,值得未来进一步研究.

To explore added value of diffusion-weighted imaging (DWI) as an adjunct to Kaiser score (KS) for differentiation of benign from malignant lesions on breast magnetic resonance imaging (MRI). Two hundred forty-six patients with 273 lesions (155 malignancies) were included in this retrospective study from January 2015 to December 2019. All lesions were proved by pathology. Two radiologists blind to pathological results evaluated lesions according to KS. Lesions with score > 4 were considered malignant. Four thresholds of ADC values −1.3 × 10−3mm2/s, 1.4 × 10−3mm2/s, 1.53 × 10−3mm2/s, and 1.6 × 10−3mm2/s were used to distinguish benign from malignant lesions. For combined diagnosis, a lesion with KS > 4 and ADC values below the preset cutoffs was considered as malignant; otherwise, it was benign. Sensitivity, specificity, and area under the curve (AUC) were compared between KS, DWI, and combined diagnosis. The AUC of KS was significantly higher than that of DWI alone (0.941 vs 0.901, p = 0.04). The sensitivity of KS (96.8%) and DWI (97.4 – 99.4%) was comparable (p > 0.05) while the specificity of KS (83.9%) was significantly higher than that of DWI (19.5–56.8%) (p < 0.05). Adding DWI as an adjunct to KS resulted in a 0–2.5% increase of specificity and a 0.1–1.3% decrease of sensitivity; however, the difference did not reach statistical significance (p > 0.05). KS showed higher diagnostic performance than DWI alone for discrimination of breast benign and malignant lesions. DWI showed no additional value to KS for characterizing breast lesions. • KS showed higher diagnostic performance than DWI alone for differentiation of benign from breast malignant lesions. • DWI alone showed a high sensitivity but a low specificity for characterizing breast lesions. • Diagnostic performance did not improve using DWI as an adjunct to KS.

To evaluate the diagnostic performance of biphasic contrast-enhanced CT in differentiation of lipid-poor adenomas from pheochromocytomas. 129 patients with 132 lipid-poor adenomas and 93 patients with 97 pheochromocytomas confirmed by pathology were included in this retrospective study. Patients underwent unenhanced abdominal CT scan followed by arterial and venous phase. Quantitative and qualitative imaging features were compared between the two groups using univariate analysis. Risk factors for pheochromocytomas were evaluated by multivariate logistic regression analysis and a diagnostic scoring model was established based on odd ratio (OR) of the risk factors. Pheochromocytomas were larger and showed cystic degeneration more frequently compared with lipid-poor adenomas (p < 0.01). No significant difference was found in peak enhancement phase between the two groups (p = 0.348). Attenuation values on unenhanced phase (CTU), arterial phase (CTA), and venous phase (CTV) of pheochromocytomas were significantly higher than that of lipid-poor adenomas while enhancement ratio on arterial and venous phase (ERA, ERV) of pheochromocytomas was significantly lower than that of lipid-poor adenomas (all p < 0.05). Multivariate analysis revealed lesion size > 29 mm (OR: 5.74; 95% CI 2.51–13.16; p < 0.001), CTA > 81 HU (OR: 2.54; 95% CI 1.04–6.17; p = 0.04), CTV > 97 HU (OR: 11.19; 95% CI 3.21–38.97; p < 0.001), ERV ≤ 1.5 (OR: 20.23; 95% CI 6.30–64.87; p < 0.001), and the presence of cystic degeneration (OR: 6.22, 95% CI 1.74–22.25; p = 0.005) were risk factors for pheochromocytomas. The diagnostic scoring model yielded an area under the curve (AUC) of 0.911. Biphasic contrast-enhanced CT showed good diagnostic performance in differentiation of lipid-poor adenomas from pheochromocytomas.

Abstract To retrospectively analyze the computed tomography (CT) findings and clinical manifestations of gastric calcifying fibrous tumor (CFTs). The features of 7 cases with pathologically proven gastric CFTs who had undergone CT were assessed, including tumor location, contour, growth, degree of enhancement, calcification and clinical data. In addition, the size and CT value of each lesion were measured. The mean values of these CT findings and clinical data were statistically analyzed only for continuous variables. Four patients were female and three were male (mean age: 33.3 years; range: 22 ∼ 47 years). Nonspecific clinical symptoms: abdominal pain and discomfort were observed in four cases and the CFTs were incidentally detected in the other three cases. Regarding tumor markers, lower ferritin levels were observed in three female patients. All of the gastric CFTs were solitary and mainly located inside the body; they were in round or oval shape and exhibited endophytic growth. Gastric CFTs are usually small sized and could contain confluent and coarse calcifications; cyst, necrosis, ulcer, bleeding and surrounding lymphadenopathy were not found in any of the cases. Unenhanced CT values of gastric CFTs were higher than those of same-transect soft tissue. Mild-to-moderate enhancement in the arterial phase and progressive enhancement in the portal venous phase were mainly noted. A gastric mass with a high unenhanced CT attenuation value, confluent and coarse calcifications and mild-to-moderate enhancement could prompt a diagnosis of gastric CFT. In addition, (1) being young- or middle-aged, (2) having relatively low ferritin levels, and (3) tumor located in the gastric body have critical reference value for diagnosis of gastric CFT.

Background The aim of the present study was to explore the brain active characteristics of patients with irritable bowel syndrome with diarrhea (IBS-D) using resting-state functional magnetic resonance imaging technology. Methods Thirteen IBS-D patients and fourteen healthy controls (HC) were enrolled. All subjects underwent head MRI examination during resting state. A voxel-based analysis of fractional amplitude of low frequency fluctuation (fALFF) maps between IBS-D and HC was performed using a two-sample t-test. The relationship between the fALFF values in abnormal brain regions and the scores of Symptom Severity Scale (IBS-SSS) were analyzed using Pearson correlation analysis. Results Compared with HC, IBS-D patients had lower fALFF values in the left medial superior frontal gyrus and higher fALFF values in the left hippocampus and right precuneus. There was a positive correlation between the duration scores of IBS-SSS and fALFF values in the right precuneus. Conclusion The altered fALFF values in the medial superior frontal gyri, left hippocampus and right precuneus revealed changes of intrinsic neuronal activity, further revealing the abnormality of gut-brain axis of IBS-D.

目的 探索大脑前动脉A1段优势供血与前交通动脉瘤(ACoA)发生、破裂出血的相关性.方法 回顾性分析48例ACoA患者及48例无ACoA患者(对照组)头颅CTA图像.观察是否存在大脑前动脉A1段优势供血(单侧发育不良或缺如),并测量ACoA瘤颈径,最大横径、最大高度及纵横径比值;观察ACoA是否破裂出血.分析ACoA组与对照组大脑前动脉A1段优势供血差异性;分析ACoA组大脑前动脉A1段优势供血与瘤颈径,最大横径、最大高度及纵横径比值及ACoA破裂出血的相关性.结果 大脑前动脉A1段优势供血与ACoA相关,且与ACoA纵横径比值相关(P<0.05);大脑前动脉A1段优势供血与ACoA破裂出血不相关(P>0.05).结论 大脑前动脉A1段优势供血与前交通动脉瘤形成相关,与前交通动脉瘤破裂出血不相关.

目的 探索大脑前动脉(ACA)A1段管径、分支血管角度与前交通动脉瘤(ACoA)的相关性.方法 选择2013年1月至2019年8月浙江省立同德医院经数字减影血管成像或CT血管成像(CTA)证实为ACA A1段优势供血的ACoA患者(ACoA组)和无ACoA的求诊者(对照组),各42例,分析两组受检者的头颅CTA图像,测量ACoA颈径、最大横径、最大垂直高度及纵横径比值.分析ACA A1段优势供血侧ACA A1段管径、分支血管角度,并分析其与ACoA的相关性.结果 ACoA组ACA A1段管径、分支血管角度均大于对照组,差异均有统计学意义(均P<0.05).ACA A1段管径与ACoA纵横径比值呈负相关(r=-0.508,P<0.05).ACA A1段管径、分支血管角度与ACoA颈径、最大横径、最大垂直高度,ACA A1段分支血管角度与ACoA纵横径比值均不相关(均P>0.05).ACoA组中ACA A1段管径与分支血管角度呈正相关(r=0.345,P<0.05).结论 ACA A1段管径、分支血管角度与ACoA形成相关.

Objective:To investigate the characteristics of multi-slice spiral CT images in lung cancer with cystic lesions and improve the accuracy of diagnosis.Methods:The clinical data of 27 cases of cystic lung cancer confirmed by pathological results of surgery or puncture who received treatment during 2012-2019 in Tongde Hospital of Zhejiang Province, China were collected. The clinical stages, pathological results and the characteristics of multi-slice spiral CT images were analyzed.Results:All 27 cases were diagnosed with peripheral lung cancer. Type VI peripheral lung cancer occurred in 12 (44.44%) cases, and adenocarcinoma in 17 (62.96%) cases. Stage Ia lung cancer occurred in 18 (66.67%) patients. Above 70% of CT images showed irregular cystic structure [70.37% (19/27)], polycystic structure [74.07% (20/27)], and vessels passing through the cysts [70.37% (19/27). Over 90% of CT images displayed unsmooth inner wall of the cysts [92.59% (25/27)] and fuzzy margin of the cysts [96.30% (26/27)].Conclusion:It is very difficult to diagnose lung cancer with cystic lesions. This kind of atypical lung cancer should be considered when the imaging features of peripheral lung cancer appear including thickened cystic wall, fuzzy cystic margin, vascular bundle sign and pleural indentation sign.

目的 探讨Kaiser评分对MRI乳腺影像报告与数据系统(BI-RADS)4类病灶的诊断价值.方法 选取2015年1月至2018年12月在浙江省立同德医院行乳腺MRI动态增强检查的女性患者152例(共158个病灶,其中6例患者有2个病灶),所有病灶经病理检查证实.2位影像科医师在不知道病理结果的情况下,按照Kaiser评分规则对每个强化病灶进行评分.以Kaiser评分≤4分为良性、>4分为恶性,以病理检查结果为金标准,计算Kaiser评分的灵敏度、特异度及AUC.结果 158个乳腺病灶中,良性84个,恶性74个,恶性率为46.8％.良性病灶Kaiser评分为2(1,3)分,明显低于恶性病灶的7(5,9)分(P<0.05).Kaiser评分诊断BI-RADS 4类乳腺病灶的灵敏度为0.946,特异度为0.893,AUC为0.941(95％CI:0.892～0.972).结论 Kaiser评分可以作为辅助决策手段用于MRI BI-RADS 4类病灶性质的诊断,减少不必要的活检.

目的 比较术前运用Hook-wire和医用胶两种定位方式行胸腔镜手术(VATS)切除孤立性肺小结节(SPN)的临床疗效.方法 选取2016年3月至2019年9月在浙江省立同德医院心胸外科同一医疗组行VATS的SPN患者共70例.所有患者均为单个结节定位,其中采用CT引导下Hook-wire定位者42例,医用胶定位者28例,观察和比较两组患者定位时间、定位成功率,气胸、出血、刺激性咳嗽等定位相关并发症发生率,同时记录比较两组患者VATS时间,统计两组术中冷冻切片病理检查结果.结果 所有患者均顺利完成术前CT引导下肺结节穿刺定位.两组患者定位时间比较差异无统计学意义(P>0.05);Hook-wire组定位成功率明显低于医用胶组,差异有统计学意义(P<0.05).Hook-wire组气胸和渗血的发生率均明显高于医用胶组,差异均有统计学意义(均P<0.05);医用胶定位组咳嗽的发生率明显高于Hook-wire组,差异有统计学意义(P<0.05).所有患者均顺利完成VATS,Hook-wire组VATS时间明显长于医用胶组,差异有统计学意义(P<0.05);而两组患者术中冷冻切片病理检查结果比较差异无统计学意义(P>0.05).结论 CT引导下Hook-wire或医用胶定位均可用于VATS切除SPN,安全性高,可简化VATS操作难度,缩短时间,医用胶相比Hook-wire定位成功率高、手术用时更短,相关并发症少,予以优先推荐.

目的:总结分析肾综合征出血热的临床特征及影像学表现,提高其早期诊断符合率.方法:回顾性分析78例确诊为肾综合征出血热患者的临床及影像资料,总结其临床及影像学特征.结果:肾综合征出血热患者最常见的临床表现为发热(72/78,92.31％)、少尿或无尿(65/78,83.33％)、呕吐腹泻(63/78,80.77％)、头痛腰痛腹痛(47/78,60.26％)、颜面部及颈胸部充血(49/78,62.82％),其他表现包括部分患者伴有全身散在出血点(22/78,28.21％)、颜面部或下肢水肿(19/78,24.36％)甚至休克(6/78,7.69％).实验室检查最常见异常为白细胞升高、血小板降低、转氨酶升高、尿素氮及肌酐升高、凝血时间延长、尿蛋白阳性;部分患者伴有淀粉酶升高、肌钙蛋白升高等.58例(74.36％)患者肾综合征出血热病毒IgM及IgG阳性.胸腹部CT最常见表现为肾肿胀(42/78,53.85％)、肾周筋膜增厚伴渗出(63/78,80.77％)、腹腔积液(56/78,71.79％)、胸腔积液及肺不张(54/78,69.23％),其他表现包括胰腺炎(31/78,39,74％)、心包积液(22/78,28.21％)、两肺感染(18/78,23.08％)、肝密度减低(11/78,14.10％)及肾包膜下出血(9/78,11.54％)等;头颅MRI表现为垂体信号异常(2/78,2.56％)、脑出血(1/78,1.28％)等.结论:肾综合征出血热患者最主要的临床特征为多器官损害,其临床特征复杂,诊断需结合患者的症状体征、实验室检查及影像学表现.通过影像学检查可了解病情的严重程度,以制定正确的治疗方案,为治疗赢得宝贵时间.

Our study aimed to explore the value of applying the CT-based radiomic nomogram for predicting recurrence and/or metastasis (RM) of gastric stromal tumors (GSTs). During the past ten years, a total of 236 patients with GST were analyzed retrospectively. According to the postoperative follow-up classification, the patients were divided into two groups, namely non-recurrence/metastasis group (non-RM) and RM group. All the cases were randomly divided into primary cohort and validation cohort according to the ratio of 7:3. Standardized CT images were segmented by radiologists using ITK-SNAP software manually. Texture features were extracted from all segmented lesions, then radiomic features were selected and the radiomic nomogram was built using least absolute shrinkage and selection operator (LASSO) method. The clinical features with the greatest correlation with RM of GST were selected by univariate analysis, and used as parameters to build the clinical feature model. Eventually, model of radiomic and clinical features were fitted to construct the clinical + radiomic feature model. The performance of each model was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). A total of 1223 features were extracted from all the segmentation regions of each case, and features were selected via the least absolute shrinkage and LASSO binary logistic regression model. After deletion of redundant features, four key features were obtained, which were used as the parameters to build a radiomic signature. The AUCs of radiomic nomogram in primary cohort and validation cohort were 0.816 and 0.946, respectively. The AUCs of clinical + radiomic feature model in primary cohort and validation cohort were 0.833 and 0.937, respectively. Using DeLong test, the differences of AUC values between radiomic nomogram and clinical + radiomic feature model in primary cohort (P = 0.840) and validation cohort (P = 0.857) were not statistically significant. To sum up, CT-based radiomic nomogram is of great potential in predicting the RM of GST non-invasively before operation.

Abstract To retrospectively analyze the computed tomography (CT) findings and clinical manifestations of gastric calcifying fibrous tumor (CFTs). The features of 7 cases with pathologically proven gastric CFTs who had undergone CT were assessed, including tumor location, contour, growth, degree of enhancement, calcification and clinical data. In addition, the size and CT value of each lesion were measured. The mean values of these CT findings and clinical data were statistically analyzed only for continuous variables. Four patients were female and three were male (mean age: 33.3 years; range: 22 ∼ 47 years). Nonspecific clinical symptoms: abdominal pain and discomfort were observed in four cases and the CFTs were incidentally detected in the other three cases. Regarding tumor markers, lower ferritin levels were observed in three female patients. All of the gastric CFTs were solitary and mainly located inside the body; they were in round or oval shape and exhibited endophytic growth. Gastric CFTs are usually small sized and could contain confluent and coarse calcifications; cyst, necrosis, ulcer, bleeding and surrounding lymphadenopathy were not found in any of the cases. Unenhanced CT values of gastric CFTs were higher than those of same-transect soft tissue. Mild-to-moderate enhancement in the arterial phase and progressive enhancement in the portal venous phase were mainly noted. A gastric mass with a high unenhanced CT attenuation value, confluent and coarse calcifications and mild-to-moderate enhancement could prompt a diagnosis of gastric CFT. In addition, (1) being young- or middle-aged, (2) having relatively low ferritin levels, and (3) tumor located in the gastric body have critical reference value for diagnosis of gastric CFT.

Abstract Rationale: Intrauterine devices (IUDs) are one of the most common and effective methods of contraception worldwide. Migration of an IUD to an extrauterine site is a rare complication. The aim of this study was to report an extremely rare case in which an IUD was found in an ovarian tumor. Patient concerns: A 63-year-old Chinese woman presented with vaginal bleeding and lower abdominal pain during hospitalization due to pneumonia. Preoperative imaging showed bilateral cystic masses in the adnexal region, and ring hyperdensity was found in the right ovarian mass. Endometrial thickening and multiple uterine leiomyomas were found on ultrasonography. Hysteroscopy showed partial septate uterus and a small endometrial polyp. Diagnosis: Bilateral ovarian cystadenomas with perforation of the IUD into the right ovarian tumor were considered based on preoperative imaging and the patient's medical history. Furthermore, early endometrial carcinoma was suspected. Interventions: The patient underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A stainless steel ring IUD was confirmed within the right ovarian tumor during the operation. Outcomes: The pathology results demonstrated bilateral ovarian serous cystadenofibromas with focal epithelial proliferation and endometrial atypical hyperplasia with malignant transformation. The patient has been followed up for 7 months, and there has been no recurrence at present. Lessons: The presence of an IUD within an ovarian tumor is extremely rare. This is the second reported case in the English literature describing an extrauterine IUD within an ovarian tumor. The correlation between ovarian cancer tumorigenesis and IUD translocation is unclear and requires further investigation.

目的:探讨儿童Joubert综合征临床表现、影像学特点以及基因学研究进展,以提高对本病的认识.方法:回顾性分析14例Joubert综合征的临床资料及影像学表现,其中男9例,女5例,年龄3个月～17岁,平均6岁.14例患儿均有不同程度的智力和运动发育滞后于同龄儿,肌张力减退,共济失调.所有病例均行MRI检查,其中2例胎儿期有MRI检查.结果:14例头颅MRI平扫均具有以下特征性表现:①小脑半球“中线裂征”:表现为小脑蚓部发育不全,双侧小脑半球间线样裂隙脑脊液信号;②“磨牙征”:表现为小脑上脚延长并增厚,脑干发育异常,轴位上双侧小脑上脚与中脑交接处呈“磨牙”改变;③四脑室扩大,呈“蝙蝠翼状”.其他还有脑室系统不同程度扩大7例,胼胝体完全缺如1例,腺垂体发育不良l例.2例有胎儿期MRI检查中1例误诊为Dandy-Walker综合征,1例诊断准确.结论:Joubert综合征有特征性的MRI表现,结合临床可以确诊;“磨牙征”是胎儿MRI检查诊断本病的基础影像学表现,对进一步探索致病基因、发现预防出生缺陷有着重要指导意义.