AIM: To establish the quality standard for Compound Ruangan Granule(Radix Astragali, Radix et Rhizoma Salviae multiorrhizae,Ganoderma,Radix Paeoniae rubra,Radix Bupleuri) METHODS: The thin liquid chromatography was used to identify the four botanical drugs,the content of astragalosideIV in Compound Ruangan Granules was determined by HPLC-ELSD and the content of salvianolic acid B was determined by HPLC.(RESULTS:) The average content of astragalosideⅣ was 0.404 mg/g.The average recovery and relative standard deviation were 97.61% and 1.27%,respectively.The average content of salvianolic acid B was 5.76 mg/g.The average(recovery) and relative standard deviation were 98.64% and 0.90%,respectively.( CONCLUSION:) The method can be(adopted) as a standard for the quality control of Compound Ruangan Granules.

Objective To explore the way and the clinical value of chest coronal CT scan in children.Methods There were 16 patients with airway or pulmonary diseases proved by clinic underwent chest coronal scan,the ages ranged from 3 months to 5 years.Picker Ultra-Z spiral CT unit was applied,the aperture of the gantry was 70 cm,gantry's maximum tilted angle was 30?.The scanning parameter were :120 kV,200 mA,0.9 s,spiral pitch 1.5,thickness 2 mm,space 1.5 mm.Results The chest coronal images acquired in all cases were good.Tracheobronchial tree up to lobar bronchi were all displayed.Bronchial foreign body in 12 cases,bronchia tumor in 1 cases,lung hypogenesis in 1 case,lung inflammation in 8 cases,atelectasis in 5 cases and the local emphysema in 10 cases were demonstrated on CT images.Conclusion Children's chest coronal CT scan can show the whole tracheobronchial structure.It has high clinical applied values.

OBJECTIVETo analyze clinical and imaging features and genetic characteristics of Leigh syndrome with emergent pulmonary edema.

METHODThe clinical features and imaging data of 2 cases (1 male, 1 female) seen in Anhui Provincial Children's Hospital from 2012 to 2014 were analyzed and summarized. Venous blood samples were sent to Guangzhou Jinyu Medical Examination Center for genetic analysis. Peripheral blood DNA was extracted and amplified, then sent to a sequencing facility for presence of genetic mutation by comparing with the reference sequence (NC_012920.1).

RESULT(1) The first patient was a 7 months old boy. The second patient was a 7 months and 21 days old girl. They were presented with abnormal respiration and pulmonary hemorrhage required mechanical ventilation. The first patient had a similar attack after 4 months of his birth, whose psychomotor development was normal, and no abnormal neurological findings. The value of blood lactate was 1.58 mmol/L. The value of pyruvic acid was 0.25 mmol/L. The value of cerebrospinal fluid lactate was 6. 4 mmol/L, which was an abnormal increase. The second patient had abnormal nervous system development, which included motor development retardation and hypotonia. The value of blood lactate was 6. 8 mmol/L, pyruvic acid was 0.31 mmol/L. Cerebrospinal fluid lactate was 8.2 mmol/L. (2) Imaging data: chest X-ray revealed double lung effusion. Bilateral caudate nucleus and lentiform nucleus had high signal, and bilateral internal capsule forelimbs were affected in DWI sequence of head MRI. Hemispheres, basal ganglia, cerebral peduncle, cerebellum, pons, and splenium of corpus callosum had multiple abnormal signals in head MRI of the second patient. NAA peak showed significantly reduced lesion area in magnetic resonance blood-flow scanning, and Cho peak increased significantly, which were double lactate-peak. (3) Genetic testing: ATPase6 m.9185 t > C mutation was found in case 1 that was consistent with Leigh syndrome pathogenesis. Hybrid mutations (m. 10191 t > C) in mitochondrial DNA was found in case 2. Two cases with the diagnosis of Leigh syndrome was clear. They were given combined therapy, such as mechanical ventilation, limited fluid to alleviate lung exudation, coenzyme Q10, and L-carnitine. The illness of case 1 relapsed after discharge. But in case 2, there was no improvement. They both died after treatment was given up.

CONCLUSIONNeurological symptoms were common in Leigh syndrome, in which acute lung hemorrhage was rarely reported. Timely ventilator support can temporarily save lives, but fatality rate is high and prognosis is poor.

Brain ; pathology ; Carnitine ; therapeutic use ; DNA, Mitochondrial ; Female ; Genetic Testing ; Hemorrhage ; etiology ; Humans ; Infant ; Lactic Acid ; Leigh Disease ; complications ; genetics ; Lung Diseases ; etiology ; Magnetic Resonance Imaging ; Male ; Mutation ; Pyruvic Acid

Objective To investigate the CT manifestations of Meckel's diverticulum and its complications in children. Methods Retrospective analysis of Clinical and CT findings in 25 cases with pathologically proved Meckel's diverticulum. The unenhanced and contrast-enhanced CT were obtained in all patients. Results (1)The direct signs: the diverticulum cannot be shown in 5 cases; the diverticulums were found around the navel or in lower right abdomen in 20 cases. The blind-ending fluid-filled or gas-filled structures were found in 9 cases, with heterogeneous ring-enhancement. The tubercle-like structures were detected in 11 cases, which showed no enhancement in 4 cases, and homogeneous enhancement in 3 cases,and heterogeneous enhancement in 4 cases. (2) The indirect signs included intestine obstruction in 8 cases,swelling fat layer surrounding the diverticulum in 9 cases, free gas around the diverticulum in 3 cases,thickened mesentery in 8 cases, ascites in 4 cases, and intussusception due to inverted Meckel's diverticulum with "target sign" in 1 case. (3) CT classification: with diverticulitis or diverticular bleeding in 20 eases; with intestine obstruction or intussusception in 8 cases; bands-caused obstruction in 7 cases;intussusception in 1 case; with perforation in 3 cases. Conclusion Meckel's diverticulum and its complications have typical CT findings, and CT can clearly demonstrate diverticulum's shape, margin,internal components and surroundiug tissues.

Objective To retrospectively investigate the value of MR enterography(MRE) for detecting symptomatic Meckel diverticulum(MD) in pediatric patients.Methods We retrospectively selected 16 patients from our MR database patients who underwent MRE between June 2014 and September 2015.They were referred for MRE because of suspected MD after negative or inconclusive upper sonography or scintigraphy or for exclusion diagnosis.There were 13 males and 3 females,with a median age of 2.2 years of age ranging from 0.4 to 8.2 years old.The first symptom included unexplained gastrointestinal bleeding,abdominal pain,small-bowel obstruction,intussusception,vomiting and fever.Two experienced radiologists determined the diverticulum's location,shape,contents and peripheral structural abnormalities.Results MD were diagnosed by MRE in all children.A total of 13 MD and 3 intestinal duplication cysts were pathologically confirmed.The diverticulum's location included:the right lower quadrant in 2 cases,around the navel in 4 cases,the left lower quadrant in 4 cases,the middle quadrant in 2 cases and pelvic cavity in 1 case.The diverticulum's presented as a blind-ending fluid-filled or gas-filled structure in 11 cases and a solid-appearing mass in 2 cases.The wall of the diverticulum showed restricted diffusion,increased mural enhancement comparable with that of adjacent small bowel in 12 cases,and interruption of the wall continuity in 1 case.Hemorrhage in diverticulum appeared as hyperintensity on T1WI images and/or hypointensity on T2WI images in 2 cases.Extravasation of intravascular contrast medium into the gastrointestinal tract due to active bleeding from a Meckel diverticulum was detected in 2 cases.Peripheral structural abnormalities included soft-tissue stranding,adjacent mesenteric stranding and enhancement,free fluid,small-bowel obstruction and enlarged lymph nodes.Conclusion MRE may play an important role in the diagnosis of suspected symptomatic Meckel diverticula,particularly given its lack of ionizing radiation.

Objective To analyze the imaging characteristics of hepatic involvement in Langerhans cell histiocytosis(LCH) in children on MRCP, MRI and CT. Methods Twenty-nine children from three children hospitals in China, who were diagnosed as hepatic involvement by disseminated LCH during Aug 2008 and Jan 2015 were included in this study. Their MRCP (n=16), MRI (n=22), contrast?enhanced CT (n=15) data were retrospectively analyzed. The stenoses and dilatation of the intrahepatic bile ducts, the common hepatic bile duct and its first order branches and the common bile duct were evaluated on the MRCP image. The size and shape of the liver, the imaging characteristics of the periportal lesions in the Glisson sheath and hepatic parenchymal lesions were also evaluated on the cross?sectional images. Results MRCP indicated alternative stenoses/dilatation of the bile duct tree (n=16), stenoses of the common hepatic duct and its first?order branches (n=15), partialindistinctness of the common bile duct (n=2) and multiple cystic lesions along the biliary tree (n=5). On the cross?sectional images, the periportal lesions in the Glisson sheath were observed in 28 children. On MRI, the periportal lesions were shown in all the 22 children with MRI, presented as hypo-signal intensity on T1WI, hyper?signal intensity on T2WI (n=11) or mixed?signal intensity on T1WI and T2WI (n=11); On CT, the periportal lesions were found in 14 of the 15 children with CT, presenting as low density (n=13) and mixed density (n=1). Multiple nodular or cyst?like parenchymal lesions were observed in 21 patients including 18 patients on MRI and 5 patients on enhanced CT. Sixteen patients presented as hypo?intensity on T1WI, hyper?intensity on T2WI and low density on plain CT, and 5 patients with iso? or hypo?intensity on T1WI, hypo?intensity on T2WI,and milder enhancement relative to the adjacent parenchyma on contrast?enhanced CT. Conclusions The imaging characteristics of hepatic involvement by LCH include alternative stenoses and dilatation of the intrahepatic ducts, stenoses of the common hepatic bile duct and its first?order branches on MRCP, the periportal lesions in the Glisson sheath and hepatic parenchymal nodular or cyst?like lesions on cross?sectional images.

Objective To investigate the application value of magnetic resonance enterography (MRE) with multiple sequences in detection of children bowel intestinal diseases .Methods Retrospective analysis of 35 patients with bowel diseases confirmed by clini‐cal results ,surgery and pathology was performed .The patients underwent MRE with multiple sequences including T 1WI ,fat‐suppressed T2 WI ,diffusion weighted imaging (DWI) ,single‐shot fast spin‐echo (SSh‐TSE) sequence ,rapid balance fast field echo (B‐FFE) ,and unenhanced and enhanced fat‐suppressed (FFE‐IP‐SPAIR) scans .Results SSh‐TSE showed the whole intestinal distribution in 34 patients (34/35);DWI showed the lesions with high signal in 29 (29/35);T1WI and fat‐suppressed T2 WI showed hyperintensity on T2WI in 3 ,slight hypointensity on T1WI and T2WI in 2 ,and hyperintensity on T1WI and hypointensity on T2WI in 1 .Enhancement of lesion was found in 28 ,and unenhancement was in 2 .Conclusion MRE with multiple sequences with more information ,sensitivity and non‐ionizing radiation ,can be used as an important method in diagnosis of children intestinal diseases .

Objective To discuss the therapeutic effect of transcatheter arterial embolization using hardening agent combined with oral propranolol in treating giant hemangioma at maxillofacial region in infants. Methods During the period from October 2013 to December 2014 at Imaging Center of Anhui Provincial Children's Hospital, transcatheter arterial embolization using hardening agent combined with oral propranolol was employed in a total of 27 infants with giant hemangioma at maxillofacial region. The age of the infants ranged from 2 months to 22 months (mean 5.9 months) and the body weight was 4.5-10 kg with a mean of 6.32 kg. Angiography via femoral artery was performed, which was followed by super-selective catheterization of hemangioma-feeding artery, and then pingyangmycin lipiodol emulsion was injected into the hemangiomas with subsequent injection of PVA particles to obstruct the hemangioma-feeding artery. After the embolization treatment, the patient received oral propranolol for 3-6 months. Results All the infant patients were followed up for 3-6 months. Clinical examination and ultrasonography indicated that the hemangioma was cured in 20 infants (75%) and the therapeutic result was effective in 7 infants (25%). Skin necrosis at hemangiomas site was observed in 2 infants (7.5%), which was cured after symptomatic treatment. No serious complications such as pulmonary embolism, cerebral embolism occurred, and no recurrence was observed. Conclusion For the treatment of giant hemangioma at maxillofacial region in infants, transcatheter arterial embolization using hardening agent combined with oral propranolol is minimally invasive, quickly effective and highly safe;and this treatment leaves no scar formation in most cases. Therefore, this technique is worthy of clinical application.

Objective To analyze CT and MR features of malignant peripheral nerve sheath tumor (MPNST)of children. Methods Sixteen patients with histologically proven MPNST were retrospectively reviewed.There were 8 male and 8 female, ages from 0.3 to 11.0 years, and median age was 2.5 years. Sixteen cases were performed with CT plain scan, and eight cases with CT enhancement scans, and three with MR examination. The imaging data were analyzed by two highly experienced doctors and obtained agreements after mutual consultation. Results Among 16 cases, 3 cases were located at neck, 5 cases at waist and back,3 cases at abdominal and pelvic, 2 cases at foot, 1 case at left clavicle, 1 case at right mediastinum, 1 case at right orbit. Fifteen cases appeared as solid masses and 1 case showed a diffuse growth. CT plain scan showed 8 cases were solid-appearing masses and 7 cases were cystic-solid mass. Enhanced CT showed enhancement of solid component was moderate to marked and gradually delayed enhanced while cystic component had no any enhancement. One was located on the left side of the neck and appeared as diffuse growth. Two cases of solid mass type appeared as hypo-intensity on T1WI and hyper-intensity on T2WI, and obviously high signal intensity of cystic component on T2WI, and with significantly heterogeneous enhanced.One case with diffuse growth appeared as hypo-intensity on T1WI and slightly hyper-intensity on T2WI, and with significantly enhanced. Sixteen cases appeared as invasive growth, 11 caseswith multiple organic metastases and recurrences, and 4 cases with neurofibromatosis type I and scoliosis.Conclusion CT and MR appearances of MPNST have certain characteristic features, and can demonstrateaggressive performance and multiple organic metastases, which is helpful for definite diagnosis and treatment plan.

Objective To evaluate ultrasonography combined with magnetic resonance imaging(MRI) diagnosis value for fetal brain deformities.Methods The results of ultrasonography and MRI was analysied in 12 fetuses with deformities,which were compared to postnatal,autopsy or other hospital inspection results and evaluated the accuracy.Results In 8 cases,the diagnoses established by ultrasonography were correct.3 cases were misdiagnosed by ultrasonography,1 case was missed the diagnosis.In 11 cases,the diagnoses established by MRI were correct and 1 case was missed the diagnosis.Conclusion Ultrasonography must be choosed in diagnosising fetal skull brain deformities,MRI was supplement to ultrasonography in complicated pregnancies.The combination of ultrasonography and MRI have an important value in guiding pregnant women to determine whether or not to continue the pregnancy.