Medical imaging for the diagnosis,recurrence and metastasis evaluation of clear cell sarcoma

Clear cell sarcoma(CCS)of soft tissue is extremely rare,accounting for approximately 1%of all soft tissue tumours.It is very difficult to diagnose CCS based on clinical manifestations.Magnetic resonance imaging(MRI)provides highresolution images of soft tissues and pathological features such as mucus,necrosis,bleeding,and fat through high and low signals on T1 weighted image(T1WI)and T2 weighted image(T2WI).On the other hand,the paramagnetism of melanin in CCS shortens the relaxation time of T1 and T2,and high signal intensity on T1WI and low signal intensity on T2WI can be found.This is different from most other soft tissue sarcomas.At present,the treatment method for CCS is surgical resection.MRI can effectively display the tumour edge,extent of surrounding oedema,and extent of fat involvement,which is highly important for guiding surgical resection and predicting postoperative recurrence.As an invasive sarcoma,CCS has a high risk of metastasis.Regardless of the pathological condition of the resected tumour,MRI or computed tomography(CT)should be performed every 1-2 years to assess recurrence at the primary site and to screen for metastasis in the lungs,liver,and bones.If necessary,PET-CT can be performed to evaluate the overall condition of the patient.

Evaluation of Medical Prescribers’ Theoretical Knowledge on Medical Imaging in the Northern Region of Burkina Faso

Introduction: Medical imaging is a medical specialty that involves producing images of the human body and interpreting them for diagnostic, therapeutic purposes, and for monitoring the progress of pathologies. We aimed to assess the theoretical knowledge of doctors and interns in medical imaging in the northern region of Burkina Faso. Methodology: This was a descriptive cross-sectional survey based on a self-administered questionnaire. Prescribers knowledge was estimated based on scores derived from questionnaire responses. Results: We collected 106 questionnaires out of 163, i.e. a participation rate of 65.03%. The average knowledge score was 81.71% for the contribution of medical imaging to patient management. It was 60.02% for the indications/counter-indications of radiological examinations and 72.56% for the risks associated with exposure to radiation during these examinations. The score was 59.83% for the methods used to select the appropriate radiological examination. As regards the completeness of the clinical and biological information on the forms requesting imaging examinations, the score was 96.65%. Specialist doctors had the highest overall level of knowledge (74.68%). Conclusion: Improved technical facilities, good initial and in-service training, and interdisciplinary collaboration will help to ensure that imaging tests are properly prescribed, leading to better patient care.

Magnetic resonance imaging scanning susceptibility weighted imaging sequences in the diagnosis and prognostic evaluation of neonatal hypoxic-ischemic encephalopathy

BACKGROUND Magnetic resonance imaging(MRI)scanning with susceptibility weighted imaging(SWI)sequences plays a significant role in the diagnosis and prognostic evaluation of neonatal hypoxic-ischemic encephalopathy(HIE).AIM To observe the role of MRI multi-parameter quantitative indexes in the diagnosis of neonatal HIE.METHODS The imaging data from 23 cases of neonatal HIE admitted to the Imaging Department of Ganyu District People's Hospital of Lianyungang City and 23 neonates without HIE admitted during the same period were analyzed retrospectively from August,2021 to December,2023.The results of clinical judgment were compared with the results of computed tomography(CT)and MRI examinations.RESULTS The degree of cerebral edema(more than moderate),the number of damaged brain regions(>2),the number of cerebral hemorrhages(>2),and the percentage of small venous dilatation detected were higher in MRI than in CT examination,and the differences were statistically significant(P<0.05).The total area of the largest region of cerebral damage and of cerebral hemorrhage observed by MRI examination were significantly larger than those of CT examination(P<0.01).Multiparametric quantitative MRI combined with diffusion weighted imaging and SWI had higher sensitivity and accuracy than CT diagnosis,and the difference was statistically significant(P<0.05).The difference in the specificity of the two modes of diagnosis was not significant(P>0.05).CONCLUSION The use of MRI multi-parameter quantitative indexes can accurately diagnose and evaluate neonatal HIE.

Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

BACKGROUND Indentifying predictive factors for postoperative recurrence of hepatocellular carcinoma(HCC)has great significance for patient prognosis.AIM To explore the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)combined with clinical features in predicting early recurrence of HCC after resection.METHODS A total of 161 patients with pathologically confirmed HCC were enrolled.The patients were divided into early recurrence and non-early recurrence group based on the follow-up results.The clinical,laboratory,pathological results and Gd-EOB-DTPA enhanced MRI imaging features were analyzed.RESULTS Of 161 patients,73 had early recurrence and 88 were had non-early recurrence.Univariate analysis showed that patient age,gender,serum alpha-fetoprotein level,the Barcelona Clinic Liver Cancer stage,China liver cancer(CNLC)stage,microvascular invasion(MVI),pathological satellite focus,tumor size,tumor number,tumor boundary,tumor capsule,intratumoral necrosis,portal vein tumor thrombus,large vessel invasion,nonperipheral washout,peritumoral enhancement,hepatobiliary phase(HBP)/tumor signal intensity(SI)/peritumoral SI,HBP peritumoral low signal and peritumoral delay enhancement were significantly associated with early recurrence of HCC after operation.Multivariate logistic regression analysis showed that patient age,MVI,CNLC stage,tumor boundary and large vessel invasion were independent predictive factors.External data validation indicated that the area under the curve of the combined predictors was 0.861,suggesting that multivariate logistic regression was a reasonable predictive model for early recurrence of HCC.CONCLUSION Gd-EOB-DTPA enhanced MRI combined with clinical features would help predicting the early recurrence of HCC after operation.

Magnetic resonance imaging findings of radiation-induced breast angiosarcoma:A case report

BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.

Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

A Prediction Model for Detecting Dysthyroid Optic Neuropathy Based on Clinical Factors and Imaging Markers of the Optic Nerve and Cerebrospinal Fluid in the Optic Nerve Sheath

Objective This study aimed to develop and test a model for predicting dysthyroid optic neuropathy(DON)based on clinical factors and imaging markers of the optic nerve and cerebrospinal fluid(CSF)in the optic nerve sheath.Methods This retrospective study included patients with thyroid-associated ophthalmopathy(TAO)without DON and patients with TAO accompanied by DON at our hospital.The imaging markers of the optic nerve and CSF in the optic nerve sheath were measured on the water-fat images of each patient and,together with clinical factors,were screened by Least absolute shrinkage and selection operator.Subsequently,we constructed a prediction model using multivariate logistic regression.The accuracy of the model was verified using receiver operating characteristic curve analysis.Results In total,80 orbits from 44 DON patients and 90 orbits from 45 TAO patients were included in our study.Two variables(optic nerve subarachnoid space and the volume of the CSF in the optic nerve sheath)were found to be independent predictive factors and were included in the prediction model.In the development cohort,the mean area under the curve(AUC)was 0.994,with a sensitivity of 0.944,specificity of 0.967,and accuracy of 0.901.Moreover,in the validation cohort,the AUC was 0.960,the sensitivity was 0.889,the specificity was 0.893,and the accuracy was 0.890.Conclusions A combined model was developed using imaging data of the optic nerve and CSF in the optic nerve sheath,serving as a noninvasive potential tool to predict DON.

Relationship between pancreatic morphological changes and diabetes in autoimmune pancreatitis:Multimodal medical imaging assessment has important potential

Autoimmune pancreatitis(AIP)is a special type of chronic pancreatitis with cli-nical symptoms of obstructive jaundice and abdominal discomfort;this condition is caused by autoimmunity and marked by pancreatic fibrosis and dysfunction.Previous studies have revealed a close relationship between early pancreatic atrophy and the incidence rate of diabetes in type 1 AIP patients receiving steroid treatment.Shimada et al performed a long-term follow-up study and reported that the pancreatic volume(PV)of these patients initially exponentially decreased but then slowly decreased,which was considered to be an important factor related to diabetes;moreover,serum IgG4 levels were positively correlated with PV during follow-up.In this letter,regarding the original study presented by Shimada et al,we present our insights and discuss how multimodal medical imaging and arti-ficial intelligence can be used to better assess the relationship between pancreatic morphological changes and diabetes in patients with AIP.

Atlas of Elbow Soft Tissue Pathologies Using Magnetic Resonance Imaging at the Saint Camille Hospital in Ouagadougou and the Polyclinique Notre Dame de la Paix (Burkina Faso)

Introduction: The elbow is a superficial joint, particularly exposed to direct impact, forced movement, and overstrain. Our work aimed to study magnetic resonance imaging (MRI) pathologies of the soft tissues of the elbow through illustrative cases. Methodology: This was a retrospective and prospective cross-sectional study covering a period of one year, from June 2020 to June 2021, at the Saint Camille Hospital in Ouagadougou and the Polyclinique Notre Dame de la Paix. Results: In general, this study found that the pathologies diagnosed on MRI were lateral epicondylitis, subcutaneous type V elbow lipoma and liposarcoma, anteromedial cortical fracture of the radial cup, cortical detachment fracture of the lateral epicondylitis, medial epicondylitis, villonodular articular synovitis, simple dermo-hypodermatitis, sequellar fibrosis of the ulnar nerve, Workman's syndrome (median and ulnar nerves) and osteoarthritis of the elbow. Lateral epicondylitis was the most frequent pathology, and most patients consulted for elbow pain predominantly associated with pressure on the epicondyle, with relative functional impotence and, occasionally, elbow swelling. Conclusion: MRI, as a complement to ultrasound and radiography, remains the most informative examination for exploring soft-tissue pathologies of the elbow.

Document measurement and hot spot visualization analysis of Mimics medical imaging software based on Wanfang database

This paper is aim to carry out bibliometric,co-presence,and visual analyses of Chinese literature regarding Mimics software application,and to explore the software research status,research hotspots、dynamic frontiers.Select the Chinese documents of Mimics software application included in W anfang database from 1992 to 2019 and Using CiteSpace software for co presence analysis of the keywords and institutions,finally draw a visual map.In results,2654 effective articles adopted.

Contribution of Medical Imaging in the Diagnosis of Urinary Disorders in Children at the Charles de Gaulle University Hospital in Ouagadougou

Purpose: The purpose of our study, which focused on the contribution of medical imaging in the diagnosis of urinary tract diseases in children at the Charles de Gaulle University Hospital of Ouagadougou, was to study the role of medical imaging in the diagnosis of urinary tract diseases in patients aged 15 years or less at the CHUP-CDG. Patients and Methods: This was a descriptive cross-sectional study with the retrospective collection covering the period from January 1, 2009 to December 31, 2018, i.e., 10 years. We collected a total of 833 medical imaging examinations, performed in 735 patients. The mean age of the patients was 40 months, infants accounted for 37.69% of the cases. Male patients were more numerous with a sex ratio of 1.53. Results: Ultrasonography was performed in 652 patients or 78.27%, ASP RX in 128 patients or 10.88%. URC and UIV were used in 6.53% and 0.68% of patients, respectively. CT and MRI were not performed in our study. The most frequent clinical urinary signs were dysuria (58.13%) and hematuria (43.94%). Ultrasonography was the most requested examination (78.27%), followed by conventional radiography (15.37%). Urinary lithiasis was by far the most common urinary condition (46.86%), followed by urinary tract infections (32.19%) and malformative uropathies (14.93%), of which the posterior urethral valve was the most frequent. Imaging was also used to find other conditions associated with urinary tract diseases. Conclusion: Medical imaging plays a major role in the diagnosis and management of urinary tract diseases in children. It has limitations, that is why a formal meeting between clinicians and radiologists is necessary for a better choice of imaging techniques and efficient management of these conditions.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery

BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.

MRI and diffusion tensor imaging in assessing correlation of activation of cortical motor function and manifestations of corticospinal tract with muscle strength in patients with ischemic stroke

BACKGROUND： Ischemic stroke is often followed by the abnormalities of neurons and corticospinal tract, which can lead to corresponding clinical symptoms and signs. Recently, with the continuous perfection of high-field MRI instrument, it becomes possible to assess and investigate the cortical function and structural reconstruction following stroke by using MRI and diffusion tensor imaging （DTI）. OBJECTIVE： To observe the cortical motor function and changes of corticospinal tracts by using MRI and DTI in the patients with ischemic stroke at acute period, compare with the normal subjects, and assess the damage of corticospinal tract and muscle strength.DESIGN ： A case-control observation.SETTING： Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine inpatients （5 males and 4 females） with injury of motor function induced by acute ischemic stroke were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December in 2005, they aged 16-87 years with an average of 51 years old, and those with obvious conscious disturbances and severe cognitive disorders were excluded. At the same time, nine healthy right-handed physical examinees matched by age and gender with the patients were also selected, and they all had no nervous disease, epilepsy, mental diseases, cerebrovascular abnormalities and injury history, etc. All the subjects were informed with the detected items and agreed to participate in. METHODS： All the 9 patients with ischemic stroke at acute period and 9 healthy subjects were examined with MRI and DTI.① A block-based design was used in the MRI, the passive finger-to-finger exercise was used as the stimulative task, and the static condition was taken as the baseline task. The GE 1.5T MRI system was used, all the data were processed after off-line, and analyzed with the SPM2 software, the association between the activated area and local anatomy of brain was observed. ② The DTI image was processed with the dTV.Ⅱ.R1 software part of the anisotropic image and color anisotropic image were shown, and the three-dimensional white matter image of bilateral corticospinal tracts of the patients were reconstructed. ③ The muscle strength of the affected hand of the stroke patients was judged with the Brunnstorm standard. MAIN OUTCOME MEASURES： The manifestations of MRI, DTI and corticospinal tracts of the 9 stroke patients were mainly observed. RESULTS： All the 9 stroke patients and 9 healthy subjects were involved in the analysis of results. ① Results of MRI examination： The handed exercise of the healthy subjects mainly activated contralateral sensorimotor cortex, posterior parietal cortex and bilateral supplementary motor areas. For the exercise of ipsilateral hand of 7 stroke patients, contralateral sensorimotor cortex was weakly activated, but ipsilateral posterial parietal cortex was obviously activated, and the activation of cerebrum was observed in 3 of them. For the other two patients, bilateral sensorimotor cortexes were activated during the exercise of ipsilateral hand, and the ipsilateral activated area was greater than the controlateral one. The exercise of contralateral hand activated contralateral sensorimotor cortex, posterior parietal cortex and contralateral supplementary motor area, and no obvious ipsilateral activated area was observed.② Results of DTI examination： The anisotropic values of the infarcted area were obviously lower than those of the contralateral part （t=4.570, P 〈 0.01）. the anisotropic value of the infarcted area were obviously was obviously correlated with bilateral muscle strength （t=0.888, P 〈 0.05）. ③ Results of the examination for corticospinal tracts： The reconstruction of bilateral corticospinal tracts, contralateral anatomic form were generally identical with those of normal subjects, the consistency of each continuous form from anterior central gyrus downward to internal capsule to bridge of varolius and bulbus medullae. Because of the involvement of infarcted area to different extent, ipsilateral corticospinal tract was manifested by the interruption of succession and loss of consistency of anatomic structural form. The severity for the injury of corticospinal tract was markedly correlated with the muscle strength of the ipsilateral hand （r=0.888, P 〈 0.05）. CONCLUSION ： ① The MRI manifestations of stroke patients during the exercise of affected hand are different from those of normal subjects, suggesting that there is compensation and reconstruction of brain function.② DTI examination is good for the judgement of the correlation between the damaged severity of infarction and muscle strength.③The damaged severity of corticospinal tracts is correlated with muscle strength, and it can be used to judge the prognosis of rehabilitative treatment.

Gadoxetic acid-enhanced magnetic resonance imaging can predict the pathologic stage of solitary hepatocellular carcinoma

BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%). CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.

Relationship between traditional Chinese medicine syndrome differentiation and imaging characterization to the radiosensitivity of nasopharyngeal carcinoma

Background and Objective: Traditional Chinese medicine (TCM) is a well established and time-honored practice in China, employing syndrome differentiation as a basis for the treatment of disease. According to different TCM syndrome typing findings, combining modern medical methods with TCM approaches can improve the quality of life and comprehensive effect on patients with nasopharyngeal carcinoma (NPC). This study investigated the relationship between TCM syndrome typing and imaging characterization to radiosensitivity as to provide objective evidence for the integration of Chinese and modern medical approaches in the treatment of NPC. Methods: Prior to treatment, TCM syndrome typing, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 147 patients pathologically classified with NPC. The status of tumor remission was radiologically evaluated at accumulated doses of 20 Gy, 40 Gy and 60 Gy, and at 3 months after completion of radiotherapy. Statistical results were analyzed by the Friedman and K-W test procedures. Results: Prior to treatment, TCM syndrome typing of NPC included Lung Heat, Blood Stasis, Phlegm Congealment and Blood Stasis-Phlegm Congealment. Lung Heat typing accounted for the highest proportion at 34.7% (51/147), followed by Phlegm Congealment at 32.7% (48/147), Blood Stasis at 17.0% (25/147) and Blood Stasis-Phlegm Congealment at 15.7% (23/147). Radiological imaging demonstrated a higher incidence of cervical lymph node metastases in Phlegm Congealment and Blood Stasis-Phlegm Congealment types (P < 0.05), while Blood Stasis and Blood Stasis-Phlegm Congealment types were more prone to skull base invasion (P < 0.05). Residual tumor size was larger in Blood Stasis and Blood Stasis-Phlegm Congealment types than in Lung Heat and Phlegm Congealment types after 3 months of treatment (P < 0.05). Conclusions: Different radiological manifestations were observed in TCM syndrome typed NPC patients, with lesser radiosensitivity demonstrated in the Blood Stasis and the Blood Stasis-Phlegm Congealment types relative to the Lung Heat and Phlegm Congealment types.

Imaging of mixed epithelial and stromal tumor of the kidney: A case report and review of the literature

BACKGROUND Mixed epithelial and stromal tumors of the kidney (MESTKs) are a rare entity (about a hundred cases reported).They occur almost exclusively in postmenopausal women,with only seven cases reported in men.As this entity is very rare,little is known on its imaging features,especially magnetic resonance imaging (MRI) findings.In women,at MRI,the cystic component shows T1 hypointensity and T2 hyperintensity,while the solid component shows T1 hyperintensity and T2 hypointensity.CASE SUMMARY We report the computed tomography (CT) and MRI findings of MESTK in a 19- year-old male adolescent.To our knowledge,this case report is the first report of MRI findings of MESTK in male adolescents.The patient was admitted to Subei People's Hospital (Jiangsu Province,China) in July 2017 after a renal mass on the left side was detected by ultrasound during a clinical examination.Blood tests were all normal.Non-enhanced CT showed a round,well-circumscribed complex mass,approximately 45 mm × 40 mm in size.MRI revealed a clear wellcircumscribed mass with a mixed arrangement of solid and cystic components.On T2 weighted images,some hypointensities were found in the solid areas.After contrast enhancement,moderate or mild enhancement was found in the solid component,which increased with time.A radical left nephrectomy was performed.The pathology analysis revealed a mixed epithelial and stromal tumor.The patient had no imaging findings of recurrence or metastasis at 12 months following surgery.CONCLUSION The possibility of MESTK should be considered in male adolescents.MRI can provide useful information for the preoperative diagnosis.

Multimodality imaging and treatment of paranasal sinuses nuclear protein in testis carcinoma:A case report

BACKGROUND Nuclear protein in testis(NUT) carcinoma is a rare aggressive malignant epithelial cell tumor, previously known as NUT midline carcinoma(NMC), characterized by an acquired rearrangement of the gene encoding NUT on chromosome 15q14. Due to the lack of characteristic pathological features, it is often underdiagnosed and misdiagnosed. A variety of methods can be used to diagnose NMC, including immunohistochemistry, karyotyping, fluorescence in situ hybridization, reverse transcription-polymerase chain reaction, and next-generation sequencing. So far, there is no standard treatment plan for NMC and the prognosis is poor, related to its rapid progression, easy recurrence, and unsatisfactory treatment outcome.CASE SUMMARY A 58-year-old female came to our hospital with a complaint of eye swelling and pain for 8 d. The diagnosis of NMC was confirmed after postoperative pathology and genetic testing. The patient developed nausea and vomiting, headache, and loss of vision in both eyes to blindness after surgery. Magnetic resonance imaging(MRI) and positron emission tomography/computed tomography(PET/CT) performed after 1.5 mo postoperatively suggested tumor recurrence. The patient obtained remission after radiation therapy to some extent and after initial treatment with anti-angiogenic drugs and sonodynamic therapy(SDT), but cannot achieve long-term stability and eventually developed distant metastases, with an overall survival of only 17 mo.CONCLUSION For patients with rapidly progressing sinus tumors and poor response to initial treatment, the possibility of NMC should be considered and immunohistochemical staining with anti-NUT should be performed as soon as possible, combined with genetic testing if necessary. CT, MRI, and PET/CT imaging are essential for the staging, management, treatment response assessment and monitoring of NMC. This case is the first attempt to apply heat therapy and SDT in the treatment of NMC, unfortunately, the prognosis remained poor.

Correlation of magnetic resonance imaging quantitative parameters and apparent diffusion coefficient value with pathological breast cancer

BACKGROUND China ranks 120th worldwide for the incidence of breast cancer and 163rd for mortality.Early screening,diagnosis,and timely determination of the optimal treatment plan can help ensure clinical efficacy and prognosis.AIM To investigate the relationship between quantitative magnetic resonance imaging parameters,apparent diffusion coefficient value,pathological immunohistochemical status,and patient prognosis.METHODS A total of 108 patients with breast cancer(breast cancer group)and 110 patients with benign breast tumors(benign group)confirmed by pathological examination at our Hospital from September 2013 to August 2016 were selected.All patients had undergone preoperative magnetic resonance imaging(MRI)examinations,and the quantitative parameters of MRI and apparent diffusion coefficient(ADC)values for the two groups were compared.The MRI quantitative parameters and ADC values of patients with different estrogen receptor(ER),progesterone receptor,and human epidermal growth factor receptor-2 expression were statistically analyzed.The relationship between the quantitative parameters of MRI and ADC values and patient recurrence was analyzed using receiver operating curves.RESULTS The measured values of the quantitative parameters of MRI-Ktrans,Kep,and Ve in the breast cancer group were higher than those in the benign group;the ADC value in the breast cancer group was lower than that in the benign group,and the difference was statistically significant(P<0.05).The Ktrans,Ve,and ADC values in patients with ER-positive breast cancer were significantly lower than those in patients with negative ER expression(P<0.05).After 5 years of follow-up,22 patients with breast cancer experienced postoperative recurrence.The Kep,Ve,and ADC values of the recurrence group were significantly lower than those of the non-recurrence group,and the difference was statistically significant(P<0.05).CONCLUSION MRI quantitative parameters and ADC are related to the expression of breast cancer-related immunological receptor factors and have certain clinical value in assessing postoperative recurrence in patients.

Changes in brain function and anatomical structure following treatment of hyperbaric oxygen for visual pathway abnormalities in 16 cases Evaluation of functional magnetic resonance imaging combined with diffusion tensor imaging

BACKGROUND： There is a growing research focus on the combination of blood oxygenation level dependent functional magnetic resonance imaging （BOLD-fMRI） and diffusion tensor imaging （DTI） to evaluate visual cortical function and structural changes in the cerebrum, as well as morphological changes to the white matter fiber tracks, after visual pathway lesions. However, the combined application of BOLD-fMRI and DTI in treating of visual pathway abnormalities still requires further studies. OBJECTIVE： To observe and evaluate the effects of hyperbaric oxygen on visual pathway abnormalities, and to evaluate the characteristics of cerebral function and anatomic structural changes by using BOLD-fMRI combined with DTI technique. DESIGN： Case contrast observation. SETTING： Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS： Sixteen patients （9 males and 7 females, 15-77 years old） with lateral or bilateral visual disorder induced by visual pathway lesions were selected from the Department of Neurology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2006 to May 2007. These patients comprised the lesion group. Measures of interventional therapy： hyperbaric oxygen of two normal atmospheres for three courses （10 d/course） and routine internal medicine treatment. In addition, 12 healthy subjects of similar sex and age to the lesion group were regarded as the control group. The control group underwent routine ophthalmological and ocular fundus examinations; diagnostic results were normal. The experiment received confirmed consent from the local ethic committee, and all patients provided informed consent. METHODS： BOLD-fMRI and DTI manifestations in the lesion group were observed before and after hyperbaric oxygen intervention, and the results were compared with the control group. The subjects were positioned on their back, and BOLD-fMRI images were collected with the following GRE EPI sequence： TR = 2 000 ms, TE = 40 ms, layer thickness = 5 mm, and 20-layer successive scanning to cover the whole brain. While, DTI images were collected with SE EPI sequence of single excitation： TR=10 000 ms, TE = 112 ms, layer thickness = 4 mm, layer spacing = 0.5 mm, and a 30-layer successive scanning, matrix = 128×128. A diffusion gradient was applied at 13 directions, and one layer without diffusion weighted imaging was collected at b =1 000 s/mm^2. Numbers of activated voxels in cortical-activated regions, and fractional anisotropy in bilateral cerebral optical radiation regions, were calculated. Displacement, continuity, and destruction of fibrous tracts were analyzed. MAIN OUTCOME MEASURES： Results of BOLD-fMRI and DTI examinations. RESULTS： All 16 patients and 12 controls were included in the final analysis. ① Numbers of activated voxels through the use of BOLD-fMRI： prior to hyperbaric oxygen therapy, the number of activated voxels in the bilateral cortex of occipital lobe were significantly less in the lesion group than in the control group （t =3.23, P 〈 0.01）. In addition, the number of activated voxels significantly increased after treatment compared to before treatment （t = 2.46, P 〈 0.05）. ② Fractional anisotropy in optical radiation regions of bilateral cerebrum： fractional anisotropy in the lesion group was significantly less than the control group （t =2.89, P 〈 0.05）. In addition, fractional anisotropy after treatment was significantly higher than before treatment （t = 2.48, P 〈 0.05）. Moreover, fractional anisotropy of optical neuropathy was significantly higher in 6 patients in the lesion group than the occipital lobe optical central lesion （t = 2.35, P 〈 0.05）. CONCLUSION： BOLD-fMRI combined with DTI can indicate the occurrence, development, and therapeutic course of action for optical pathway lesions. The results acquired from these methods can provide information for function and structure, which can provide reliable verification in the treatment of cerebral function.