Objective:To investigate the computed tomography (CT) features of primary hepatic fibrosarcoma (PHF).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 patients with PHF who were admitted to 2 medical centers from January 2010 to December 2019, including 3 cases of Yueqing People's Hospital of Zhejiang and 5 cases of Wenzhou People's Hospital of Zhejiang were collected. There were 5 males and 3 females, aged 50 years(range, 39?60 years). All patients underwent abdominal CT plain and enhanced examination, and surgical procedures were selected based on patients' will and individual situations. Surgical tumor specimens were given pathological examination and immunohistochemical staining. Observation indicators: (1) imaging features of CT examination; (2) treatment and pathological examinations; (3) follow-up. Follow-up was performed by outpatient examination or hospitalization to detect survival of patients and tumor recurrence up to December 2020. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of CT examination: 8 patients received preoperative CT examinations, 3 cases of which were diagnosed as malignancies, 3 cases were diagnosed as hepatic space-occupying lesions, 2 cases were diagnosed as intrahepatic cholangiocarcinoma. ① Tumor location and general status: 8 patients had single tumor, of which 6 cases had tumor located in the right lobe of the liver and 2 cases had tumor located in the left lobe of the liver. The tumor was in oval shape in 5 patients and in circular in 3 patients. The maximum diameter of tumor in 8 patients was 9.3 cm(range, 4.0?15.0 cm). There were 1 case with tumor maximum diameter ≤5.0 cm, 4 cases with tumor maximum diameter as 5.1?10.0 cm, 3 cases with tumor maximum diameter >10.0 cm. ② CT plain scan showed uniform low density in 2 cases and uneven low density in 6 cases and the CT value of 8 cases was 40 HU(range, 29?43 HU). The tumor showed expansive growth with clear boundary in 6 cases, and invasive growth with unclear boundary in 2 cases. Five cases had intratumoral necrosis and cystic transformation, 2 cases had intratumoral strip hemorrhage, and 1 case of intratumoral calcification. There was 1 case with hilar lymph node metastasis. ③ Enhanced CT scan showed 8 cases with uneven enhancement in arterial phase, 8 cases with uneven tumor density in portal vein phase, 8 cases with intratumoral enhancement slowly withdrew in delayed phase and the density lower than liver parenchyma. (2) Treatment and pathological examinations: ① 8 patients under-went surgical resection, without intrahepatic or hilar metastasis. ② The results of postoperative pathological examination showed 2 cases with grade Ⅰ tumor differentiation (low potential malignancy), 5 cases with grade Ⅱ and Ⅲ tumor differentiation (moderate potential malignancy), 1 case with grade Ⅳ tumor differentiation (high potential malignancy). ③ Immuno-histochemical staining showed that 8 cases were positive for vimentin, CD10, p53 and negative for smooth muscle actin, keratin19, epithelial membrane antigen, endotheliocyte 34. All 8 patients were diagnosed as PHF. (3) Follow-up: all 8 patients were followed up for 7 to 128 months, with a median follow-up time of 53 months. The overall survival time of 8 patients was 15 to 122 months, and the median overall survival time was 45 months. One patient died of tumor recurrence and distant metastasis at 17 months after surgery, and the survival time of 7 patients was >28 months.Conclusions:CT plain scan of PHF showed uneven low-density masses. After enhancement, the arterial phase shows the tumor ring or peripheral nodular uneven enhancement, the intratumoral strip-shaped enhanced blood vessels. The portal vein phase shows the tumor-like small patches or grid-like continuous enhancement. The delayed phase is characterized by the slow withdrawal of intratumoral enhancement.

Objective To investigate the correlation between subacromial space and acromial shoulder impingement syndrome (SIS).Methods The clinical and imaging data of 40 patients with SIS were collected and retrospectively reviewed.The shape of acromion and tears of rotator cuff of all patients were classified.A cromion-Humerus (A-H) distance was measured.Results Among 40 patients,there were 9 cases of type Ⅰ,12 cases of type Ⅱ,19 cases of type Ⅲ.32 patients had subacromial space narrowing.7 cases had calcification in the supraspinatus tendon and 10 patients had acromioclavicular joint ostcoarthritis.There were 17 cases of type Ⅰ,15 cases of type Ⅱ,18 cases of type Ⅲ of tears of rotator cuff.6 patients had subacromial bursa thickening,5 patients had subacromial-deltoid sac fluid and 10 patients had the joint capsule fluid.2 patients had jointlabrum avulsion,3 patients had the supraspinatus muscle atrophy and 4 patients had Bankart Lesion.There was no significant difference was found in A-H distance measured with X-ray and MRI(P =0.137 0).There was positive correlation between the A-H distance and class of rotator cuff(r =0.545,P =0.000 1).Conclusion There exists some correlation between subacromial space and SIS.The diagnosis and class of SIS can be assessed according to narrowing range of subacromial space.

目的 探讨儿童纵隔神经母细胞瘤(NB)和神经节母细胞瘤(GNB) CT特点与病理类型相关性.方法 对9例儿童纵隔NB和3例儿童GNB CT表现与病理进行回顾性分析.结果 12例均位于后纵隔,其中右上纵隔1例,右中上纵隔2例,右中下纵隔2例,右下纵隔1例,左中纵隔2例,左中下纵隔2例,左下纵隔1例,双侧中下纵隔1例.肿块大小2.0 cm×2.3 cm ～ 12.6 cm ×4.0 cm,平均6.3 cm×4.3 cm.CT平扫:NB 9例,局限清楚3例,不清楚6例;密度均匀2例,不均匀7例;肿块内见斑点状或条片状钙化8例;邻近胸膜增厚3例,合并胸腔积液3例;邻近气管受压4例,心脏受压4例,肺动脉受压2例,降主动脉受压1例,胸椎受侵1例,多条肋骨侵袭性破坏2例;肿瘤越过中线向对侧生长4例,包绕主动脉4例,肿瘤向椎间孔生长3例,沿脊柱旁凸入上腹部1例;骨转移7例,纵隔淋巴结肿大5例,颈部淋巴结肿大4例,肝转移1例,脑转移1例.GNB 3例,密度较均匀,局限均较清楚;伴胸膜增厚2例,胸腔积液1例,气管受压1例,肋骨受压1例,肿瘤向椎间孔生长1例.CT增强9例,其中7例NB中呈轻度强化1例,中度强化4例,明显强化2例,不均匀强化6例,均匀强化1例,肿块内见点状血管影3例,肿块内呈囊状改变7例;2例GNB呈轻度均匀强化.结论 儿童患者CT检查发现后纵隔肿块,伴钙化、周围组织受侵或受压、远处转移者,应考虑NB或GNB可能.CT表现与肿瘤细胞成分密切相关,肿瘤生长特点与肿瘤分化程度密切相关.

Objective To evaluate the correlation between MRI imaging indexes and subacromial impingement syndrome ( SIS) .Methods We retrospectively analyzed the clinical and MRI imaging data of 40 cases diagnosed SIS from May 2009 to A-pril 2013, And 40 healthy volunteers were selected as the control group.Acromion index ( AI), Acromiohumeral distance (AHD), the acromion morphology were observed and their Constant scores were assessed.Results AI in SIS group was signifi-cantly higher than that of the control group (P<0.05), while AHD and Constant scores in the SIS group were significantly lower than that of the control group (P<0.05).Acromion species distribution in SIS group was nine cases of type I, 12 cases of type II, and 19 cases of type III, showing no significant difference with the control group (P<0.05).Spearman correlation analysis showed that, SIS group acromion morphology and Constant score were no significant correlation (r=-0.092, P>0.05).AI and AHD in SIS group with Constant score then showed a positive correlation between (rAI=0.221, P<0.05; rAHD=0.406, P<0.05).Conclusion AI and AHD showed correlation with SIS, and clinical conditions can be changed according to the diagno-sis and classification of the SIS.

Objective To study the CT features of pulmonary primary lymphoma in order to improve the understanding of this disease .Methods CT findings of 21 cases with lung primary lymphoma confirmed by pathology were retmspective-ly analyzed .Results 21patients were non-hodgkin lymphoma ,of which 16 cases were mucosaassociated lymphoid tissue lymphoma ,4 were high grade malignant Diffuse large B-cell lymphoma ,1 case was T cell lymphoma .8 cases were mass or nodular type ,7 cases were pneumonic-type ,and 6 cases were consolidation-type .14 cases showed air bronchogram ,4 ca-ses showed perifocal interlobular septal thickening ,2 cases showed cross lobe growing ,and 5 cases showed merger pleural effusion .Conclusion Pulmonary primary lymphoma shows the diversity with multidetector-row CT .The distribution of interstitial lung masses or the clearly edge lesion with bronchial wall thickening ,and peripheral lobular septal thickening , may be pulmonary lymphoma ,especially anti-infection treatment is invalid .

Objective To study the value of diffusion weighted imaging (DWI) in the differentiation of benign and malig-nant bile duct carcinoma and liver space -occupying lesions .Methods Using DWI technique ,we tried to differentiate the bile duct carcinoma ,benign or malignant liver space-occupying lesions in patients with liver disorders ,to explore the role of DWI in qualitative diagnosis of bile duct carcinoma and the other space-occupying lesions in the liver ,and to identify the characteristics of other diseases .Results ADC values of hepatocellular carcinoma (HCC) ,liver metastases ,and bile duct cancer were no significant difference .However ,the ADC values of liver hemangioma ,liver cyst and normal liver tissue were statistically significant higher than that of bile duct carcinoma .ADC values of duct carcinoma were no significant difference compared with these of malignant lesions ,whereas ,ADC values of the bile duct carcinoma were markedly low-er ,with statistically significant difference .Conclusion DWI sequence ,which has high speed ,can differentiate the be-nign ,malignant bile duct carcinoma ,and liver space-occupying lesions via image characteristics and the quantitative analy-sis of ADC value .Therefore ,DWI can provide quantitative diagnostic information and can be used as a supplement for the upper abdomen scan check sequence ,which should be taken as one of routine MRI sequences .

Objective To investigate CT features of pediatric mediastinal neuroblastoma.Methods The CT performance of pediatric mediastinal neuroblastoma confirmed by clinical and pathology in 17 cases were retrospectively analyzed.The tumor growth pattern,size,density,degree of enhancement,invasion to the surrounding tissues and metastatic characteristics were observed,and the results were compared with pathological analysis.Results Among the 17 cases,2 were at the right posterior upper mediastinum,3 at posterior right middle and upper mediastinum,3 at the posterior right middle and lower mediastinum,1 at the posterior right lower mediastinum,3 at the posterior left middle mediastinum,3 at the posterior left middle and lower mediastinum,1 at the posterior left lower mediastinum,and 1 at bilateral posterior middle and lower mediastinum.The average tumor size was 6.3 ×4.3 cm,ranging from 2.3 ×2.0 cm ～ 12.6 ×4.0 cm.CT plain scan showed 8 cases with clear boundary and 9 case without clear boundary.13 cases were with inhomogeneous density and 4 cases with homogeneous density.8 calcification of grainy or strip was found in the tumor.10 cases were with pleural thickening and 5 cases with pleural effusion.6 cases were with tracheal or main bronchial compression,4 with cardiac compression,7 with pulmonary artery compression,and 1 with descending aorta compression were found.6 cases were with tumors crossing the midline,5 with intervertebral foramen growth,3 wrapped around the aorta,3 with rib attack damage,2 with rib compression deformation,2 with thoracic invasion,and 1 into the upper abdomen.10 cases were with mediastinal lymph nodes enlargement,10 with bone metastasis,4 with cervical lymph nodes enlargement,1 with liver metastasis,and 1 with cerebral metastasis.Enhanced CT scan was performed in 14 cases:11with inhomogeneous enhancement,and 3 with homogeneous enhancement.The average CT value of the 3 mild enhancement was 36 HU,ranging from 20 to 56 HU.The average CT value of the 8 moderate enhancement was 53 HU,ranging from 36 to74 HU.The average CT value of the 3 marked enhancement 72 HU,ranging from 56 to 88 HU.7 punctate vessels and 6 polycystic changes were found in the tumors.Conclusions Mediastinal neuroblastoma in children are with certain characteristics.CT findings with clinical manifestations can make a definite diagnosis.

目的探讨肝脓肿的螺旋GT表现特征,着重讨论动态增强扫描表现.方法回顾性分析32例已证实的肝脓肿的CT平扫,动态增强扫描资料.结果增强扫描表现为:(1)高灌注异常:非病变肝组织一过性不均匀强化.(2)边缘强化:肝脓肿灶周环状或不规则强化.(3)分隔状强化:肝脓肿整个病灶呈蜂窝状,簇状,分隔状持续强化.结论螺旋CT平扫和动态增强扫描对肝脓肿的定性诊断和鉴别诊断有很大帮助.