Objective To summarize the computed tomography (CT) characteristics of primary hepatic angiosarcoma (PHA).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 9 PHA patients who were admitted to the Wenzhou Chinese Medicine Hospital (3 patients),Second Affiliated Hospital of Wenzhou Medical College (3 patients) and Wenzhou People's Hospital (3 patients) between January 2006 and June 2017 were collected.All 9 patients were fasting 8 hours before CT examination,and received screen scans without abdominal pressure.Scanning area was from dome of diaphragm to lower pole of the kidneys.Two associate senior doctors made images analysis.After preoperative examinations,patients selected whether or not to undergo treatment,resection,liver transplantation or chemotherapy + targeted therapy of monoclonal antibodies.Observation indicators:(1) plain scan appearances of CT;(2) enhanced scan appearances of CT;(3) results of pathological examinations;(4) follow-up and survival situations.Follow-up using outpatient,inpatient and imaging examinations was performed to detect tumor recurrence and stable condition up to December 2017.Results (1) Plain scan appearances of CT:9 patients showed solitary tumor,and tumors were respectively located in the left lobe (3 cases) and right lobe (6 cases) of the liver,including 5 with round tumors,3 with oval tumors and 1 with patchy tumor.The maximum diameter of tumor was 5.8-16.0 cm,with an average of 10.8 cm,including maximum diameter ＞ 6.0 cm in 8 patients.Tumors of 9 patients showed low-density shadow,and CT value was 32-46 HU,with an average of 41 HU,including homogeneous density in 3 patients and heterogeneous density in 6 patients;clear tumor boundary in 6 patients and unclear tumor boundary in 3 patients;tumor necrosis and cystolization in 4 patients,slightly strip-shaped high-density shadow in the center of tumor in 4 patients,and small patch-shaped intratunoral calcification in 1 patient.(2) Enhanced scan appearances of CT:① Arterial phase:tumors of 9 patients showed mild and moderate heterogeneous enhancements,with CT value of 63-76 HU and an average of 68 HU,including small patch-shaped or nodular enhancement in 3 patients and punetate or flocculent enhancement in the center of tumor in 6 patients.Tumors of 4 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma.Tumors of 5 patients showed mild enhancements,and tumor density was equal to or slightly less than that of normal liver parenehyma.② Portal vein phase:tumors of 9 patients showed mild and moderate,continuous and progressive enhancements,with a heterogeneous density,CT value of 56-71 HU and an average of 63 HU,including extended enhancement region in 3 patients,with a fusion and filling trend;small patch-shaped or nodular and lattice network-shaped enhancements of center and periphery of tumor in 6 patients,showing center filling and enhancement features of hepatic angiosarcoma.Tumors of 2 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma;tumors of 7 patients showed mild enhancements and tumor density was equal to or slightly less than that of normal liver parenchyma.③ Delayed phase:tumor enhancements of 9 patients slowly seceded,with CT value of 50-60 HU and an average of 53 HU,including density decreasing of periphery of tumor in 3 patients;partial fusion and center filling of enhancements in 6 patients,without enhancement in necrotic area.Tumor density was slightly higher than that of normal liver parenchyma in 2 patients,equal to that of normal liver parenchyma in 1 patient,and slightly less than that of normal liver parenchyma in 6 patients.(3) Results of pathological examinations:① Pathological examinations:cut surface of tumors showed grayish yellow and drab gray,and parts of surface were fish flesh shape,with internal bleeding and necrosis.Tumors were found in diffuse hyperplasia under microscopy,tumor tissues were made up of irregular and mutual matching lacuna vasorum,with infiltrating growths along hepatic sinus gap;hepatic angiosarcoma cells were spindle,round or irregular;there were slightly eosinophilia cytoplasm and deep chromatin of the nucleus,long-shaped or irregular nucleus,and different sizes of nucleolus.② Immunohistochemical staining:CD31 and CD34 were strongly positive,vimentin and Nestine were positive,and CK19,actin and creatine kinase were negative.(4) Follow-up and survival situations:of 9 patients,3 without treatment respectively died at 3,6 and 7 months;2 had recurrence at 4 and 5 months after tumor resection,with angiosarcoma invading right renal capsule,diaphragm and right pleural hemorrhage induced to haemothorax,and survived respectively for 13 and 15 months;2 respectively died of systemic metastasis at 4 and 8 months after liver transplantation;2 underwent chemotherapy + targeted therapy of monoclonal antibodies,and survived for 12 months.Conclusions CT appearances of PHA have certain characteristics.The plain scans of CT show heterogeneous low-density shadow,and enhanced scans of CT show small patch,punctate or nodular-shaped,continuous and progressive enhancements,with a clear boundary between tumor and liver parenchyma.

Objective To investigate CT and MRI features of hepatoblastoma in adults.Methods CT and MRI findings of 8 cases of adult hepatoblastoma were retrospectively analyzed.Results (1) 75.0％ of the tumors was located in the right lobe of the liver and 25.0％ in the left lobe of the liver.(2) The maximum diameter of the tumor was averaged at (8.2±5.5)cm,and the maximum diameter of ＞ 5 cm was 62.5％.(3) Most tumors have a complete or incomplete false envelope,and the boundary is clear.(4) 75.0％ tumors were of necrocystic degeneration with calcification or bleeding in 25.0％ cases.(5) CT flat scan showing uniform low density or low density,MRI scanning T1WI was low signal,T2WI,T2WI fat suppression and DWI were high in parenchyma.(6) To strengthen substantial part in mild and moderate arterial uneven improved or ring slightly improved,portal venous phase continued mild reinforcement,delay slow exit accounted for 75.0％,reinforced psuedocapsule was mild.(7) The adjacent organs are under pressure deformation.(8) All patients underwent tumor resection and were followed up for 3 to 24 months.Conclusions CT and MRI characteristics of hepatblastoma in adult are specific and help improve the diagnostic accuracy of the disease.

Objective To explore the CT features of primary retroperitoneal liposarcoma.Methods A retrospective analysis of pathologically confirmed primary retroperitoneal liposarcoma was done.Results Tumors were located in left retroperitoneal space in 16 cases,in right retroperitoneal space in 10 cases,and in median retroperitoneal space in 3 cases.The maximum diameter ranged from 9-40 cm,with an average of (17 ±8) cm.Tumors were round in 8 cases,oval in 10 cases and irregular in 11 cases.The boundary of tumor was clear in 10 cases.CT plain scanning was mixed density in 20 cases,uniform density in 9 cases;Tumors of necrotic cysts in 11 cases,and with calcification in 9 cases;Enlarged intraperitoneal and retroperitoneal lymph nodes were found in 6 cases and intrahepatic metastases in 3 cases.The solid part was mild to moderate enhancement.Pathologically of the 29 cases,7 were dedifferentiated,4 were mucous,5 were polymorphic,1 1 were well differentiated and 2 were mixed.Conclusion The CT examination of primary retroperitoneal liposarcoma is of great value in locating tumor and judging the relationship between tumor and adjacent organs.

Objective     To discuss the key points of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery. Methods     We retrospectively collected and analyzed the data of 70 patients who underwent TAVI in the Department of Cardiovascular Surgery, West China Hospital from March 2014 to October 2015. There were 39 males and 31 females with an average age of 73.7±4.5 years. The perioperative preparation and anesthesia points of TAVI were summarized. Results     All of the 70 included patients were aged and at high risk severe comorbidities such as ischemic heart disease and stroke. The aortic stenosis and regurgitation occurred in 39 and 31 patients respectively. No patients died during the surgery. The total success rate was 95.7%. Conclusion     TAVI is a complex procedure for high risk patients and need more attention during anesthesia. The successful conduction of the procedure requires the whole team to prepare carefully and cooperate closely.