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 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 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 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 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 efficacy and safety of treating liver cancer using 131I-anti-CD147-monoclonal-antibody (131I-anti- CD147-McAb) by transcatheter hepatic arterial infusion (TAI) in a rabbit liver cancer model. Methods Forty-five rabbit models were randomly divided into three groups evenly. Transcatheter hepatic artery infusion under general anesthesia were performed in all three groups. Group A:control group, saline. Group B:pure 131I solution. Group C: 131I-anti-CD147-McAb solution. About 2 ml blood sample was obtained from all rabbits for liver, kidney,and thyroid function at pre-TAI and post-TAI 1 day, 3 days ,7 days, 14 days, 21 days. The rabbits were scanned by single photon emission computed tomographic (SPECT) to monitor radionuclide bio-distribution and tumor size on 1 day, 7 days, 14 days, 21days after procedures in group B and C. On 14 days after procedure, five rabbits were randomly selected to be sacrificed in each group for pathological and immunological investigations. The remaining rabbits continued to be fed, and survival rates were measured. Results The TAI and SPECT-CT/CT procedures were successfully performed in all rabbits. Test results showed that AST and ALT levels tended to increase transiently 1 day after TAI (P<0.05). The liver function returned to pre-operative levels (P> 0.05) 7 days after TAI. FT3 and FT4 mean values of rabbits in group B and C continued to decline 7 days after TAI, while thyroid stimulating hormone (TSH) showed corresponding increase (P<0.05). WBC mean value of rabbits in group B and C declined slightly after procedures (P>0.05). SPEC-CT imaging of rabbits shows that most of the radionuclide was gathered in the gastrointestinal tract and thyroid in Group B, however, radionuclide was mainly concentrated in the tumor lesions in Group C. Fourteen days after procedures, radionuclide imaging of all rabbits disappeared in group B and C. The VX2 liver tumors increased rapidly after treatment in group A and B;but the tumors gradually reduced their size in group C. At 14 days after TAI: The proportion of tumor necrosis in group C was significantly greater than that in groups A and B (P<0.05). The microvessel density (MVD) number of residual tumor in group C was less than groups A or B (P<0.05).TUNEL analysis suggested that more apoptosis bodies was displayed in the residual tumor tissue in group C than that in groups A and B, but the expression of MMP-2 and vessel endothelial grouth factor (VEGF) was significantly reduced in group C than group A and group B. Median survival time of the rabbits in groups A, B, C was 22 days, 26 days and 54 days respectively. Survival time of the rabbits in group C was significantly prolonged than other two groups (P<0.01). Conclusions Radioimmunotherapy with 131I-anti-CD147-McAb by TAI can inhibit the growth and metastasis of liver cancer, and prolong the survival of experimental animals. The method is effective and safe in this animal study.

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.

Objective To explore the value of high-resolution MRI(HR-MRI) on clinical application in the differential diagnosis between Moyamoya disease(MMD) and atherosclerosis-related Moyamoya syndrome (A-MMS). Methods Seventeen cases of patients with MMD and 18 cases of patients with A-MMS in our hospital from January 2014 to September 2015 were prospectively enrolled in the study. Record the clinical data and the proximal middle cerebral artery (M1 portion) performance on HR-MRI, the max-vessel area, the min-vessel area, the max-lumen area, the min-lumen area, the wall max-thickness, the styles of M1 portion thickening (eccentric or concentric), whether the wall was enhanced or not, and analysis the recorded data statistically, t test and χ2 test were used for the statistical analysis. Results The wall max-thickness of MMD group was (0.94 ± 0.17) mm, which was smaller than that in A-MMS group (1.23 ± 0.42) mm, there was statistic significance (t=-2.977, P=0.006). The cases of M1 portion non-enhancement was 15, slight enhancement 2, strong enhancement 0 in MMD group, and non-enhancement 5, slight enhancement 5, strong enhancement 8 in the A-MMS group, the difference was significant statistically (χ2=9.794, P=0.001). The cases of M1 portion concentric thickening was 16, 9 cases in the A-MMS group, there was statistic difference between them (χ2=6.317, P=0.012). Wall concentric thickening diagnose the MMD with a sensitivity of 94.1% (16/17), specificity of 50.0% (9/18), accuracy of 71.4%(25/35). Wall strong enhancement appear in the A-MMS with a sensitivity of 44.4%(8/18), specificity of 100%(17/17), accuracy of 71.4%(25/35).With a cut-off the maximum wall thickness of 1.2 mm could be used to noninvasively differential diagnose the MMD and A-MMS with a sensitivity of 55.6%(10/18), specificity of 88.2%(15/17), accuracy of 71.4%(25/35). Conclusion HR-MRI is a good tool for the differential diagnosis between MMD and A-MMS.

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.