Objective To explore the improvement of traditional incision in thoracotomy and the application of subaxillary vertical small incision in lung operations. Methods We carried out a retrospective analysis on documents of 680 cases of subaxillary vertical small incision pneumonectomy conducted in this hospital between December 1996 and June 2003. Results The length of incision was 8~13 cm (mean, 11 2 cm). The time for thoracotomy was 4 5~10 min (mean, 6 min) and the operation time was 50~ 170 min (mean, 135 min). The intraoperative blood loss was 100~1200 ml (mean, 350 ml), the postoperative drainage volume was 120~800 ml (mean, 300 ml), and the perioperative blood transfusion, 0~1400 ml (mean, 300 ml). Postoperative pain classification results revealed that 585 cases of grade 1, 60 cases of grade 2 and 35 cases of grade 3 severity were observed. The postoperative hospital stay was 10~21 days (mean, 14 days). No surgical death occurred. Conclusions Subaxillary vertical small incision can be simply made. It offers minimal invasion, less blood loss, mild postoperative pain, quick recovery and good cosmetic results, being a viable option in most operations of pneumonectomy.

Objective To investigate the correlation between middle cerebral artery (MCA) atherosclerotic plaques and single subcortical infarction (SSI) using high-resolution magnetic resonance imaging (HR-MRI).Methods The patients with SSI received HR-MRI examinations at the ipsilateral MCA horizontal segment stenosis from January 2012 to November 2014 were analyzed prospectively.They were divided into proximal SSI (pSSI) and distal SSI (dSSI).The longitudinal and transverse diameters and volume of different types of infarction pattern as well as the degree of luminal stenosis of MCA deep perforating parent artery,plaque distribution,plaque enhancement or not,white matter lesions,and general information of both groups were documented respectively.Results A total of 78 patients with SSI were enrolled,including 40 (51％) in the pSSI group and 38 (49％) in the dSSI group.The proportions of Fazekas scale grade 3 white matter lesions (63.5％vs.40.0％;x2 =4.183,P=0.041) and deep white matter lesions (50.0％ vs.15.0％;x2 =10.961,P =0.001) in the dSSI group were significantly higher than those in the pSSI group.The proportions of MCA plaque in the opening (35.0％ vs.13.2％;x2=3.930,P=0.047),plaque enhancement (87.5％ vs.30.0％;x2 =25.447,P ＜ 0.001) and posterosuperior wall plaques (42.5％ vs.21.4％;x2 =9.491,P ＜ 0.001) and the degree of luminal stenosis (60.38％ ± 10.20％ vs.45.00％ ±6.44％;t =3.625,P =0.031) in the pSSI group were all significantly higher than those in the dSSI group.In addition,the longitudinal and transverse diameters and volume of the infarcts in the pSSI group were significantly larger than those in the dSSI group (all P ＜ 0.001).Multivariate logistic regression analysis showed that MCA enhanced plaques on the lesionipsilateral sides (odds ratio[OR] 11.764,95％ confidence interval[CI] 2.081-66.511;P =0.005) and posterosuperior wall plaques (OR 6.131,95％ CI 1.012-23.339;P =0.037) were independently associated with pSSI,while deep white matter lesions (OR 0.280,95％ CI 0.203-0.648;P=0.012) was independently associated with dSSI.Conclusions The atherosclerotic plaques of MCA deep perforating parent artery are common in both the pSSI group and the dSSI group.pSSI is mainly associated with the location of atherosclerotic plaques of deep perforating parent artery and enhanced plaques,while dSSI is mainly associated with deep perforating artery vasculopathy.

Objective To discuss the diagnosis and surgical management of pulmonary sclerosing hemangioma(PSH).Methods Clinical records of 33 cases of PSH(34 lesions) in this hospital from 1987 to 2002 were reviewed.There were 6 male cases and 27 female cases,with a mean age of 41.3 years(range,24~57 years).Twenty-three cases had an initial symptom of bloody sputum,while 10 cases were disclosed by physical examinations.Image findings revealed solitary mass of the lung in all the cases,in 5 of which a "crescent sign" was presented.Results Preoperatively,28 cases were diagnosed as having pulmonary benign tumors(including 5 cases of suspected sclerosing hemangioma),1 case was clarified as having PSH by percutaneous needle aspiration cytology,and 4 cases were misdiagnosed as having lung cancer. All the patients received surgical treatment,including 21 cases of unilateral pulmonary lobectomy,1 case of bilateral lobectomy,5 cases of segmentectomy,4 cases of wedge resection(including 1 case of bilateral thoracoscopic wedge resection),and 2 cases of tumor excision.The operation time was 45~210 min(mean,90 min),and the blood loss was 100~600 ml(mean,230 ml).No peri-operative deaths were encountered.Follow-up surveys in 33 cases for(3~)10 years(mean,5.5 years) found no recurrence.Conclusions In middle-aged women,if the sign of bloody sputum develops,and image findings indicate the solitary mass of the lung,especially with a "crescent sign",a diagnosis of PSH is possible.Percutaneous needle aspiration cytology is helpful to make a confirmative diagnosis in some patients.It is advisable to manage the disease surgically.

Objective To investigate the feasibility of short-segment percutaneous pedicle screw non-fusion fixation plus electro-acupuncture for the treatment of single thoracolumbar fracture.Methods Forty-three patients with single thoracolumbar fracture were treated with short-segment percutaneous pedicle screw fixation without fusion,and then were given electro-acupuncture on points such as Jiaji (EX-B2),Huantiao (GB30),and Zhibian (BL54) after the operation.Before and after operation and during the follow-up,X-ray images of the spine at positive position and lateral position were taken for the measurement of vertebral anterior and posterior diameter ratio and the vetebral kyphosis Cobb's angle.Lumbago visual analogue scale (VAS) scores and Oswestry scores for lumbago function disorder were used for the evaluation of clinical efficacy.Results (1) All of the 43 patients were followed-up,and the follow-up period lasted for 10-27 months.(2) After the operation and at the end of follow-up,vertebral anterior and posterior diameter ratio and Cobb's angle were much improved (P ＜ 0.01compared with those before the operation),and the two indexes at the end of follow-up were improved as compared with those after the operation (P ＜ 0.05).(3) One week after the operation and at the end of follow-up,VAS scores and Oswestry scores were obviously improved as compared with those before treatment (P ＜ 0.01),and the two kinds of scores at the end of follow-up were also improved as compared with those after the operation (P ＜0.01).Conclusion Short-segment percutaneous pedicle screw fixation without fusion plus electro-acupuncture at points such as Jiaji is effective for the treatment of single thoracolumbar fracture by relieving pain in the waist and back,which ensures the satisfactory effect of operation.

Objective To investgate the value of various parameters obtained from monoexponential, biexponential, and stretched exponential diffusion?weighted imaging models in the differential diagnosis of breast lesions. Methods A retrospective study performed in 54 patients with pathologically confirmed malignant tumors(n=30), benign lesions(n=34) and normal fibroglandular tissues (n=30). All patients underwent T1WI, T2WI, dynamic enhancement and diffusion weighted MRI with multi?b values at a 3.0 T magnetic resonance imaging unit. All parameters were measured at a workstation. ADC was calculated by using monoexponential analysis(b=0, 800 s/mm2). Slow apparent diffusion coefficient (ADC?slow), fast apparent diffusion coefficient (ADC?fast), and perfusion fraction (f) were calculated using the biexponential model. Distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) were obtained from diffusion?weighted images using the stretched exponential model. All parameters were statistically compared among normal fibroglandular tissues, benign lesions and malignant tumors using Kruskal?Wallis rank sum test. Mann?Whitney U test were used for further comparisons between specific group pairs. ADC values were compared with ADC?slow and DDC for different groups by paired Wilcoxon test. Correlations between ADC?value, ADC?slow and DDC were assessed by using Spearman rank correlation coefficient. Receiver operating characteristic curve was used to analyze and compare the ability of these parameters in differentiation of benign and malignant breast lesions. Results The ADC, ADC?slow, f, DDC and α values were significantly different among the normal fibroglandular tissues, benign tumors and malignant tumors (P<0.05). Further differential comparisons of the four parameters between each pair showed that the ADC, ADC?slow, f, DDC and α values were significantly lower in malignant tumors than both in normal fibroglandular tissues and benign tumors(P<0.016 7). The ADC values of normal fibroglandular tissues, benign tumors and malignant tumors were significantly higher than ADC?slow and DDC (P<0.05). The f and DDC had higher area under the receiver operating characteristic curve (0.688 and 0.657 respectively). The optimal cutoff values for ADC, ADC?slow, f, DDC and α were 1.235 × 10-3mm2/s, 0.428 × 10-3mm2/s, 57.8%, 1.175 × 10-3mm2/s and 0.721, respectively. Theαvalue showed higher specificity (65.5%) and the f value had higher sensitivity (82.9%). Conclusion The parameters derived from biexponential and stretched exponential DWI could be helpful for differentiation between benign and malignant breast tumors.

Objective To improve the recognition to synovial sarcoma in spine by discussing the imaging features of the disease.Methods The clinical and imaging data of 4 cases (2 cases of male,2 cases of female) with synovial sarcoma in spine were analyzed retrospectively, which were confirmed by surgery and pathology,the imaging features and surgical pathology were mainly analyzed.Results All the 4 patients underwent conventional CT and MRI examination,3 of which underwent CT and MRI contrast enhancement examination.On CT plain scan,2 cases showed equal density,2 showed slightly high density.After enhancement,3 cases showed inhomogeneous enhancement.On T1WI,2 cases showed low signal intensity,2 showed iso-signal intensity.On T2WI,1 case showed high signal intensity,1 showed slightly high signal intensity,and 2 showed mixed high signal intensity.On Fat suppression sequence image,2 cases showed hyperintensity,1 had mixed hyperintensity,and 1 had slightly hyperintensity.On DWI,4 cases showed obviously hyperintensity.On T1WI enhancement,1 case had significant enhancement,2 showed inhomogeneous enhancement.Conclusion The CT and MRI manifestation of synovial sarcoma in spine has certain characteristics.Combined with clinical manifestations, CT and MRI are significantly helpful to improve the cognition and diagnosis of synovial sarcoma in spine.

Objective To explore the value of the apparent diffusion coefficient (ADC)of MRI diffusion-weighted (DW)in diag-nosing pathologic stage and histologic grade of bladder cancer.Methods 42 patients with confirmed bladder cancer underwent pelvic MRI examination including T2 WI and diffusion-weighted imaging (b values of 0 and 1 000 s/mm2 )Based on pathologic results,42 cases of bladder cancer were divided into three groups of Ta-T1 stage (non-muscle invasive),T2 stage (muscle invasive)and T3-T4 stage (around the bladder and other organizations invasive).Of 42 bladder cancers,36 urothelial carcinomas were divided into papillary urothelial neoplasm with low malignant potential (PUNLMP),low grade urothelial carcinoma and high grade urothelial carcinoma group.Tumor diameter and ADC were measured on DW imaging,and compared among different groups.Results The mean size of high grade tumors (4.52 ± 1.61)cm was significantly larger than that of PUNLMP (2.28 ± 0.51)cm and low grade tumors (1.69 ± 0.53)cm.The mean ADC of high grade tumors (0.83 ± 0.27)×10-3 mm2/s was significantly lower than that of PUNLMP (1.46 ± 0.30)×10-3 mm2/s and low grade tumors (1.17±0.11)×10-3 mm2/s (P<0.01).T3-T4 stage tumors showed significantly lower ADC (0.82±0.21)×10-3 mm2/s than T2 (1.01 ± 0.09)×10 -3 mm2/s and Ta-T1 stage tumors (1.24 ± 0.13)×10 -3 mm2/s (P <0.01).Conclusion DW ima-ging combined with conventional MR sequences is useful for displaying morphology of bladder cancer.DW imaging and ADC are use-ful in evaluation of pathologic stage and histologic grade of bladder cancer.

Objective To evaluate the utility of susceptibility weighted imaging (SWI)in the evaluation of traumatic brain injury (TBI)severities.Methods 20 mild TBI patients,20 moderate TBI patients and 20 severe TBI patients were collected.The involving brain regions,numbers and areas of hemorrhagic lesions detected by SWI were analyzed and the differences of each group were com-pared.The correlation analysis between Glasgow coma scale(GCS)scores and each above parameters were underwent.Results The differences of involving regions’number,lesions’number,lesions’area were statistically significant(P <0.05 ).Severe TBI group got the maximum number of involving regions,lesions,and the largest areas,followed by moderate group and mild group.The GCS were highly negatively correlated with the number of involving regions,number of lesions,areas of lesions detected by SWI.In descending order of relevance:GCS with areas detected by SWI(r=-0.982,P=0.000),the number of lesions detected by SWI(r=-0.941,P=0.000),the number of involving regions detected by SWI(r=-0.900,P=0.000).Conclusion The clinical applications of SWI in diagnosing TBI and evalua-ting the TBI severity is of great significance.

Objective To investigate MR findings and analysis of misdiagnosis of atypical invasive pituitary adenoma.Methods The MR findings of twenty cases of atypical invasive pituity adenomas confirmed by pathology were reviewed ,which were misdiag-nosed as chordomas or meningiomas.Results All the twenty cases showed iso-or slightly hypo-signal on T1 WI,iso-or slightly hy-per-signal on T2 WI;Enhanced scan displayed heterogeneous enhancement.The dynamic enhancement curve showed rapid enhance-ment phase.The bilateral cavernous sinuswere infringed in nine cases,in which the pituity and pituity stalk were not well seen. Among the twenty cases,twelve cases with suprasellar and anterior cranial fossa extension were misdiagnosed as meningiomas;eight cases with clival destruction were misdiagnosed as chordomas.Conclusion The MR features of atypical invasive pituity adenomas are various.In order to avoid misdiagnosis,a comprehensive analysis should be based on a variety of signs.

Objective To investigate the application value of DWI based on biexponential signal decay model with extended b-fac-tor range in differential diagnosis of benign and malignant breast lesions.Methods A total of 57 patients with breast tumor under-went DWI based on the biexponential model with 12 b-factors (0,10,20,50,100,200,400,600,800,1000,1 200 and 1 500 s/mm2 ), including benign lesions in 1 9 patients (24 breast tumors,defined as benign group)and malignant ones in 38 (47 tumors,defined as malignant group ).The values of slow apparent diffusion coefficient,fast apparent diffusion coefficient and fraction of fast ADC of le-sions were measured at a workstation (Advantage Windows 4.5).Differences in these parameters between the benign and malignant groups were compared.Results The ADCslow,ADCfast and ffast were(1.434±0.291)×10 -3 mm2/s,(2.744±0.050)×10 -3 mm2/s and (0.677±0.130)% in benign group,and (0.614±0.196)×10 -3 mm2/s,(2.692±0.068)×10 -3 mm2/s and (0.446±0.112)% in malig-nant one,respectively.The statistical differences in ADCslow and ffast were found between two groups (P <0.05),whereas no difference in ADCfast was found.Conclusion Biexponential signal decay model of DWI with extended b-factor range can provide helpful tissue characterization parameters for the differential diagnosis of benign and malignant breast lesions.