Myxoinflammatory fibroblastic sarcoma of the liver: Case report and literature review.

RATIONALE: Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade malignant soft tissue sarcoma that primarily affects the distal extremities in adults, with the highest incidence in patients in their 40s and 50s. It has a high local recurrence rate and a low metastasis rate. Although MIFSs have been documented in other sites, an MIFS in the liver is highly unusual. Herein, we present a case of a patient with hepatic MIFS. PATIENT CONCERNS: The patient was a 58-year-old Chinese man with abdominal pain as the primary symptom. Abdominal computed tomography and magnetic resonance imaging revealed a mass in the right posterior lobe of the liver. The patient underwent surgical excision, and the excised specimen was identified as MIFS. Three years later, the patient returned to our hospital for abdominal pain. Computed tomography and magnetic resonance imaging revealed a mass in liver segments 2/3/4. DIAGNOSIS: Postoperative pathological examination of the tumor revealed the recurrence of MIFS. INTERVENTIONS: The patient underwent surgical resection of the MIFS. OUTCOMES: The patient received multiple pirarubicin-based chemotherapy treatments and an ALK inhibitor (anlotinib) within 6 months after surgery, but the tumor recurred. LESSONS: MIFS can not only occur in the proximal limbs, trunk, head, and neck but can also affect the abdominal organs. Surgical resection remains the primary treatment option for MIFS in the absence of any contraindications. Because the recurrence rate of MIFS is high, meticulous long-term monitoring is required.

Application Study of Brain Structure and Functional Magnetic Resonance Imaging in Patients with Systemic Lupus Erythematosus and Cognitive Dysfunction.

Objective: This study was aimed to investigate the application value of brain magnetic resonance imaging (MRI) technique, including arterial spin labeling (ASL) and diffusion tensor imaging (DTI) in patients with systemic lupus erythematosus (SLE) and cognitive dysfunction (CDF). Methods: A total of 50 patients with SLE admitted to the hospital from September 2020 to December 2022 were selected and divided into the group with CDF (n = 21) and the group without CDF (n = 29) according to the score of Montreal Cognitive Assessment Scale (MoCA). Additionally, 10 healthy individuals who underwent physical examinations during the same period were recruited as controls. After the conventional MRI, DTI and ASL data of all subjects were collected, statistical parametric mapping software combined with voxel morphology is applied for gray matter volume, white matter and gray matter cerebral blood flow (CBF) analysis among different groups. Results: There is a statistically significant difference in conventional MRI findings between the SLE group and the control group (P < .05). However, There was no significant difference in white matter fractional anisotropy (FA) values between the two groups (P > .05). The apparent diffusion coefficients (ADC) of the right precuneus and the right Brodmann's area 21 and 6 in SLE patients with CDF were significantly higher than SLE patients without CDF (P < .05). In comparison to the non-CDF group, the CDF group exhibited reduced gray matter volume, primarily in the anterior cingulate gyrus, left frontal lobe, and right insula (P < .05). Meanwhile, the white matter and gray matter cerebral blood flow (CBF) of SLE patients with CDF were significantly lower than those without CDF. (P < .05). Correlation analysis showed that the MoCA score was positively associated with the volume of gray matter in the right insula, bilateral frontal lobe, left temporal lobe, and cingulate gyrus (P < .05). Additionally, MoCA score was also found to be positively associated with the CBF of white matter and gray matter (P < .05). Conclusions: Alterations in gray matter volume and CBF in SLE patients are closely associated with combined CDF and can be observed by DTI and ASL techniques.

Epidemiological studies of accessory cardiac bronchus and a new variant.

Accessory cardiac bronchus (ACB) is a rare tracheobronchial branching abnormality which originates from the medial wall of the intermediate or main bronchus and is directed to the heart. Three types of ACB have been recognized: type (a) is similar to a short diverticulum, type (b) is a long bronchus ventilating a small undeveloped lobule, and type (c) is an intermediate type with a long diverticulum but no bronchial or alveolar arborization. Herein, we report 40 consecutive cases of ACB detected in 10,287 routine spiral computed tomography (CT) examinations of the chest. The frequency of the anomaly was 0.39%. The study included 17 females and 23 males (female to male ratio 1:1.35). A total of 24 cases belonged to type (a), 14 cases were type (b), and 2 cases were type (c). The mean largest diameter of ACB was 7.9 (range, 4.0 to 12.0) mm and the mean length was 7.5 (range, 3.0 to 18.0) mm. The mean ratio of the largest diameter to length was 1.1, the ratio for (a) was often greater than 1, and the ratios of (b) and (c) were often less than 1. The ACB originated from the intermediate bronchus in 29 cases, which accounted for the largest proportion. The ACB originated from the basal bronchus of the lower lobe in 11 cases (6 cases from the right lower lobe and 5 from the left), which has never been reported before and may be a new variant.

Diagnostic accuracy of dual-energy computed tomography (DECT) to detect non-traumatic bone marrow edema: A systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) for detecting bone marrow edema (BME) in non-traumatic patients. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Library databases was performed up to October 1, 2021 for relevant original studies. Study details were extracted by two independent reviewers. A bivariate mixed-effects regression model was used to assess comprehensive diagnostic performance, and a subgroup analysis was performed to evaluate sources of variability. The risk of bias was evaluated with the QUADAS-2 tool. RESULTS: Ten studies involving 2463 regions, including hands, ankles, hips, and sacroiliac joints, were evaluated in this meta-analysis. Summary sensitivity, specificity, and area under the receiver operating characteristic curve values for BME were 88.4% (95% confidence interval (CI) 82.4%-92.5%), 96.1% (95% CI 94.4%-97.3%), and 0.98 (95% CI 96%-99%), respectively. The subgroup analysis showed that studies using a thicker slice (≥1 mm) had a higher sensitivity, and studies with older patients (≥60 years), fewer included patients (<40), and bones other than the pelvis had a higher specificity. Studies presented a generally low or unclear risk for bias and applicability concerns. CONCLUSIONS: DECT has an excellent diagnostic performance for detecting BME in non-traumatic patients and may provide an alternative to magnetic resonance imaging (MRI) for the detection of non-traumatic BME in the future, especially when MRI is unavailable or contraindicated.

Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography.

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH). METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant. RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9--39.4) HU and -97.9 (-91.3--104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH. CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.

Application of MSI in MRI-negative focal cortical dysplasia patients with epilepsy.

BACKGROUND: Focal cortical dysplasia (FCD) is the most common cause of intractable epilepsy in children and adolescent. PURPOSE: To evaluate the application value of magnetic source imaging (MSI) in treatment of magnetic resonance imaging (MRI)-negative FCD patients with epilepsy. METHODS: MSI characteristics of 17 cases of MRI-negative focal cortical dysplasia patients with epilepsy were retrospectively analyzed. All patients were treated by surgery. RESULTS: In 17 patients, there were 3 cases of FCD Ia, 7 cases of FCDIb, 3 cases of FCDIIa and 4 cases of FCDIIb. FCD was located at temporal lobe in 8 cases, occipital lobe in 3 cases, frontal lobe in 2 cases and two lobes in 4 cases. In follow-up, 14 patients obtained satisfied curative effect. 1 patient was improved significantly and 2 patients were fine. The concordance between MSI and electrocorticogram in localizing epileptogenic foci was 65%. CONCLUSION: MSI is a new prospective noninvasive functional neuroimaging technique for identifying and delineating epileptogenic foci in MRI-negative FCD patients.

Application of high frequency color Doppler ultrasound in the monitoring of rheumatoid arthritis treatment.

The aim of the present study was to explore the use of high frequency color Doppler ultrasound to measure synovial thickness and blood flow to assess the therapeutic value of the recombinant human tumor necrosis factor (TNF) II receptor antibody fusion protein in rheumatoid arthritis (RA) treatment. A total of 36 clinically-diagnosed patients with RA were treated with methotrexate tablets or the recombinant TNF-receptor antibody fusion protein for 24 weeks. Joint synovial thickness and synovial blood flow integrity were monitored by high frequency color Doppler in the second metacarpophalangeal joint in one hand. The correlation of the erythrocyte sedimentation rate, C-reactive protein (CRP) and 28-joint disease activity score (DAS28) with the ultrasound parameters were analyzed. Metacarpophalangeal second joint 2 (MCP2) synovial thickness, wrist joint synovial thickness and MCP2 synovial blood flow, prior and subsequent to the treatment, have a high correlation with DAS28 (P<0.05), and the MCP2 synovial blood flow integral has a strong correlation with CRP. Evaluating the wrist joint synovial thickness and synovial integrity of the second metacarpophalangeal joint using high frequency ultrasound detection can effectively evaluate the disease status in patients with RA. This procedure is potentially valuable as a means of evaluating the curative effects of RA treatments.