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.

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.

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.

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.

Correlation and predictive value of pathological complete response and ultrasound characteristic parameters in neoadjuvant chemotherapy for breast

BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy:A case report and review of literature

BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.

Thoracic spine infection caused by Pseudomonas fluorescens:A case report and review of literature

BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Waist subcutaneous soft tissue metastasis of rectal mucinous adenocarcinoma: A case report

BACKGROUND Rectal mucinous adenocarcinoma(MAC)is a rare pathological type of rectal can-cer with unique pathological features and a poor prognosis.It is difficult to diag-nose and treat early because of the lack of specific manifestations in some aspects of the disease.The common metastatic organs of rectal cancer are the liver and lung;however,rectal carcinoma with metastasis to subcutaneous soft tissue is a rare finding.CASE SUMMARY In this report,the clinical data,diagnosis and treatment process,and postope-rative pathological features of a patient with left waist subcutaneous soft tissue masses were retrospectively analyzed.The patient underwent surgical treatment after admission and recovered well after surgery.The final pathological diagnosis was rectal MAC with left waist subcutaneous soft tissue metastasis.CONCLUSION Subcutaneous soft tissue metastasis of rectal MAC is rare,and it can suggest that the tumor is disseminated,and it can appear even earlier than the primary ma-lignant tumor,which is occult and leads to a missed diagnosis and misdiagnosis clinically.When a subcutaneous soft tissue mass of unknown origin appears in a patient with rectal cancer,a ma-lignant tumor should be considered.

Contribution of Computed Tomography to the Diagnosis of Urinary Lithiasis in a West African University Hospital

Introduction: Urinary lithiasis is defining as a condition characterized by the formation of concretions in the kidneys or urinary excretory tract. We aimed to study professional practice in CT urinary lithiasis at CHUYO. Materials and method: This was a descriptive cross-sectional study with retrospective data collection covering 3 years from January 2017 to December 2019. Results: In general, it was noted that CT scans in our environment provide all the elements needed by urologists to diagnose urinary lithiasis and its impact on the urinary system. However, there are shortcomings, particularly in terms of the accuracy of the shape and density of the stones in the CT scan reports, which does not make it easier for urologists to decide on treatment. Conclusion: Computed tomography plays a major role in the diagnosis and therapeutic management of urinary lithiasis, and its use needs to be improved in our context.

Contribution and Relevance of Transfontanellar Ultrasound in Newborns in Ouagadougou: Multicentre Study on 1000 Cases

Objectives: To demonstrate the contribution and relevance of ETFs through the study of 1000 examination reports carried out in the medical imaging departments of the OUAGADOUGOU CHU. Material and method: Analytical descriptive study with retrospective collection, extended from 1st January 2020 to 1st January 2022. Results: Of the 1000 transfontanellar ultrasound reports, the mean age of patients was 7.61 +/ 7.5 days, with extremes of zero and 28 days. Sex was specified in 989 cases. Males accounted for 54.49% and females for 45.51%. 555 transfontanellar ultrasound were performed in 2020. 441 in 2021 and 4 in 2022. 61.9% of transfontanellar ultrasound were performed at the Bogodogo University Hospital, 205 at Charles de Gaulle and 176 at Tengandogo. Indications for transfontanellar ultrasound were dominated by neonatal distress (65.8%), followed by convulsions (10.2%) and prematurity (9.1%). Transfontanellar ultrasound was normal in 570 cases (57%) and abnormal in 430 cases (43%). Abnormalities were dominated by haemorrhage and ischaemic lesions in 66.28% (285) and 21.63% (93) of cases respectively. In the group of normal transfontanellar ultrasound, neonatal distress represented 59.65% of indications and prematurity 10.7% of indications. As for abnormal transfontanellar ultrasound, neonatal suffering accounted for 73.95% of indications and convulsions for 12.56%. The average age ofpatients with an abnormal transfontanellar ultrasound was 8.74 days +/ 7.89 days. The indication for investigations was relevant in 42.2% of cases and irrelevant in 57.8%;of the transfontanellar ultrasound with relevant indications, 0.71 were normal and 99.29 abnormal;of the transfontanellar ultrasound with irrelevant indications, the transfontanellar ultrasound was normal in 98.1% and abnormal in 1.9%. Conclusion: Transfontanellar ultrasound is an important part of ultrasound in current practice. Haemorrhage, anoxic-ischaemic lesions and hydrocephalus are the most frequent pathologies found by this technique in newborns. Whether or not the examinations were normal depended on the appropriateness of the prescription.

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.

Effect of CT-Guided Microwave Ablation Combined with TACE on Liver Function and Survival of Patients with Primary Liver Cancer

Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.

Ultrasound of the Rotator Cuff in Non-Fractured Shoulder Trauma: 30 Cases at the Yalgado Ouedraogo University Hospital of Ouagadougou (Burkina Faso)

Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.

Massive Epistaxis Revealing a Post-Traumatic Aneurysm of the Internal Carotid Artery: A Clinical Case and Review of the Literature

Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.

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.