CT features of calcified micro-gastric gastrointestinal stromal tumors: a case series.

BACKGROUND: Due to the lack of corresponding clinical symptoms, small calcified gastric gastrointestinal stromal tumors (GISTs) are often overlooked in clinical practice. Therefore, there is an unmet need to define the imaging features of calcified micro-gastric GISTs to facilitate diagnosis. This study retrospectively analyzed the computed tomography (CT) features of pathologically confirmed calcified micro-gastric GISTs. METHODS: The medical records (gastroscopy, pre-treatment gastric CT imaging [pre- and post-contrast scans], pathology) of patients with calcified gastric GISTs < 1 cm in diameter confirmed pathologically after endoscopic submucosal dissection, endoscopic submucosal excavation, or endoscopic full-thickness resection were retrospectively reviewed. RESULTS: Seven patients had 8 calcified gastric GISTs < 1 cm in diameter. Six patients hadsingle lesions, and 1patients had multiple lesions. Six patients had lesions in the gastric fundus, 1 patient had a lesion in the body of the stomach. Lesions had a mean diameter of 5.2 mm (range, 1.3 mm ~ 7 mm). Unenhanced CT scans showed spots and high-density nodular calcifications in 3 submucosal lesions, 2 lesions in the muscularis propria, and 3 subserosal lesions that protruded outside the stomach. Among the 8 lesions, only two had solid soft tissue components surrounding the calcification, with one of these two showing post contrast enhancement of the solid soft tissue component. CONCLUSIONS: Novel CT features of gastric GISTs included: commonly found in the gastric antrum, small size (< 1 cm in diameter), calcification, few solid soft tissue components, and no abnormal enhancement in most cases.

Plague in China 2014-All sporadic case report of pneumonic plague.

BACKGROUND: Yersinia pestis is the pathogen of the plague and caused three pandemics worldwide. Pneumonic plague is rarer than bubonic and septicemic plague. We report detailed clinical and pathogenic data for all the three sporadic cases of pneumonic plagues in China in 2014. CASE PRESENTATION: All the three patients are herders in Gansu province of China. They were all infected by Yersinia pestis and displayed in the form of pneumonic plague respectively without related. We tested patient specimens from the upper (nasopharyngeal swabs) or the lower (sputum) respiratory tract and whole blood, plasma, and serum specimens for Yersinia pestis. All patients had fever, cough and dyspnea, and for patient 2 and 3, unconscious. Respiratory symptoms were predominant with acute respiratory failure. The chest X-ray showed signs consistent with necrotizing inflammation with multiple lobar involvements. Despite emergency treatment, all patients died of refractory multiple organ failure within 24 h after admission to hospital. All the contacts were quarantined immediately and there were no secondary cases. CONCLUSIONS: Nowadays, the plague is epidemic in animals and can infect people who contact with the infected animals which may cause an epidemic in human. We think dogs maybe an intermediate vector for plague and as a source of risk for humans who are exposed to pet animals or who work professionally with canines. If a patient has been exposed to a risk factor and has fever and dyspnea, plague should be considered. People who had contact with a confirmed case should be isolated and investigated for F1 antigen analysis and receive post-exposure preventive treatment. A vaccination strategy might be useful for individuals who are occupationally exposed in areas where endemically infected reservoirs of plague-infected small mammals co-exist.

Diagnosis value preoperative localization of insulinoma by diffusion-weighted imaging: A pilot study.

Insulinoma is the most common functional neuroendocrine tumor that originates from the islet of beta cells. Insulinoma is usually an isolated benign tumor and small in size (<2 cm). Due to the small size of the lesion, it often leads to difficulty in clinical preoperative localization diagnosis. However, we have unexpectedly discovered that the diffusion-weighted-imaging (DWI) adds great value in the preoperative localization diagnosis of insulinoma in non-invasive examination technique.We verified using operative pathology data and retrospectively analyzed the clinical and imageology findings of 5 cases who reported to have an insulinoma. All the 5 cases underwent DWI examination, among non-contrast enhanced magnetic resonance imaging (MRI) in 1 case, contrast-enhanced MRI in 4 cases.Five cases of DWI showed a nodular high signal <1.3 cm with pancreatic tail in 3 cases, pancreatic neck, and pancreatic head in 1 case each, respectively. Non-contrast enhanced MRI showed suspicious abnormal signals in the tail of the pancreas were detected in 1 case. MRI enhanced scans presented 2 cases with abnormal enhancement in the arterial phase and 2 cases without abnormal enhancement in arterial phase. Also, 3 cases showed mild persistence enhanced in the portal venous phase and delayed phase. However, 1 case remained normal in the portal venous phase and the delay period.DWI examination has high clinical value in the localization diagnosis of insulinoma and thus it can be used as a routine examination for preoperative localization diagnosis.

Comparison of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening: a meta-analysis.

BACKGROUND: As a common and essential contrast medium at present, gadobenate dimeglumine has shown better performance than some other agents when applied to Breast Magnetic Resonance Imaging Screening (Breast MRI Screening). Nevertheless, reports on the diagnostic performance of these two mediums (gadobenate dimeglumine and gadopentetate dimeglumine) are not completely consistent. OBJECTIVE: To assess the diagnostic value of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening in patients suffering from breast cancer and to provide more convinced evidence to guide clinical practice in terms of appropriate contrast agents. DATA SOURCES AND REVIEW METHODS: Original articles in English and Chinese published before January 2013 were selected from available databases (The Cochrane Library, PUBMED, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Journal Full-text). The criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis. Then, the area under curve (AUC) of SROC and the spearman rank correlation of sensitivity against (1-specificity) were calculated. RESULTS: Total of 17 researches involving 1934 patients were included. The pooled sensitivity of gadobenate dimeglumine and gadopentetate dimeglumine were 0.99 (0.97, 1.00) and 0.93 (0.88, 1.00) respectively. The pooled specificity for these two contrast agents were 0.924 (0.902, 0.943) and 0.838 (0.817, 0.858) respectively, and the AUC of SROC curve were 0.9781 and 0.9215 respectively. CONCLUSIONS: Gadobenate dimeglumine can be regarded as a more effective and feasible contrast medium for Breast MRI Screening. At least 5% differences in diagnostic performance are usually considered as clinically relevant.