Purpose To investigate CT and MRI manifestations of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions (abbreviation as Xp11.2 translocation renal cell carcinoma).Materials and Methods Eighteen cases of Xp11.2 translocation renal cell carcinoma confirmed by pathology were retrospectively analyzed.Ten patients underwent CT scans,2 of them had unenhanced CT and 8 of them had pre-and post-contrast CT scan.Fourteen cases underwent plain and multi-phase contrast MRI scan,including 2 cases with unenhanced CT and 4 cases with pre-and post-contrast CT scan.The location,size,shape,density/signal,blood supply and the enhancement of the Xpl 1.2 translocation renal cell carcinoma were analyzed.Results All of the 18 tumors located in the corticomedullary with 17 solid lesions and 1 cystic lesion.The mean maximum diameter of the tumor was (4.6±2.0) cm.Thirteen lesions were circular or oval and 5 were irregularly or lobulated lesions.Ten lesions showed slightly high or high density on unenhanced CT,and the average CT value was (50.6± 11.5) HU,in which 4 lesions showed calcification.Among 8 cases of enhanced CT,1 lesion showed abundant blood supply,while 7 lesions showed lack of blood supply.Fourteen cases of MRI scan exhibited various imaging features with short T1 and T2 signal,and the persistent enhancement in the medullary phase.The MRI findings were further divided into 3 types according to the signal intensity and blood supply except 1 cystic lesion:① 5 lesions predominantly with short T1 and T2 signal were lack of blood supply;② 4 lesions predominantly with slightly longer T1 and T2 signal were abundant blood supply;③ 4 lesions predominantly with equal T1 and T2 signal were relatively lack of blood supply.Conclusion The CT and MRI features of Xpl 1.2 translocation renal cell carcinoma had certain manifestations:slightly high or high density nodule or mass located in corticomedullary on pre-contrast CT scan,various signal intensity with short T1 and T2 signal on MRI,and the persistent enhancement in the medullary phase.These image features combined with clinical data are helpful for diagnosis.

Objective To explore imaging manifestations of hepatic epithelioid hemangioendothelioma (HEH). Methods CT and MR images in 14 patients with HEH proven by histopathology were retrospectively analyzed. Plain and two-phase contrast-enhanced CT scan were performed in 5 cases, non-contrast and multiphase contrast-enhanced MR scan were performed in 7 cases, CT and MRI were both performed in 2 cases. Characteristics of CT and MR T2WI images were classified and analyzed. All lesions were classified into three types:multiple, diffuse and solitary form. Results (1) Multiple form of HEH:228 lesions were found in 11 patients, including 178 lesions on MRI and 50 lesions on CT. On T2WI, three or two layered-target-signs with hyperintensity core were found in 79.2% (141/178) of the lesions. Three layer-target-sign included hyperintensity core, hypointensity rim and slightly high signal halo from the inside out. Two layer-target-sign included hyperintensity core and slightly high signal halo from the inside out. Characteristics of dynamic contrast-enhanced scan included peripheral two or three layered-rim-like enhancement in 66.3%( 118/178) of the lesions;peripheral, gradual rim-like enhancement with enhanced core in 27.0%( 48/178) of the lesions;heterogeneously mild enhancement in 2.2%( 4/178) of the lesions;centripetal enhancement in 4.5%( 8/178) of the lesions. Fifty lesions were found in CT, which showed low density nodules or masses with clear margins. Two-layered-black-target sign were found in 42 lesions in contrast-enhanced images, white-target sign were found in 3 cases, and centripetal enhancement was found in 5 cases. (2) Diffuse form of HEH:in one of the two cases of this type, the lesions could not be separated from normal liver parenchyma, gradual enhancements were found along with the vessels in the center of the lesions. (3) Solitary form of HEH: one case, the lesion showed heterogeneous density in non-contrast CT images and gradual enhancement in contrast-enhanced images. Conclusions We found some imaging characteristics of HEH. Two or three layered-target-sign on T2WI and black-target sign, white-target sign on contrast-enhanced images were unique imaging features of HEH.

Benign biliary stricture is a challenging problem in hepatobiliary surgery. Benign biliary stricture is associated with major portal vein variation, which is not be found in literatures. A male patient with benign biliary stricture was admitted to the Chinese PLA General Hospital in March, 2010.The stricture was located in the hilar confluence with intrahepatic biliary dilation and hepatolithiasis. The result of computed tomography showed that the hilar biliary confluence was compressed by the left portal vein and right anterior portal vein. The patient was cured after receiving gallbladder interposition, choledocholithotomy and T tube drainage. We suggested that the benign hilar biliary stricture due to portal vein variation may be named as biliary nut-craker syndrome.

Objective To investigate MRI features of metanephric adenoma(MA). Methods The retrospective analysis was performed on 6 adult patients that were scanned by regular, DWI and dynamic-enhancement MRI two weeks before surgery and diagnosed with MA pathologically after surgery. MRI features of lesions were observed. The signal intensities of lesions and contralateral normal renal cortex and medulla were respectively measured in plain scan, cortex, parenchyma and delayed phase. The enhancement magnitudes were calculated and the ADC values of lesions were measured. The differences of the signal intensity and enhancement magnitude were assessed by paired-sample t test among renal cotex, medulla and lesions. Results All lesions in MA were single and solid masses. Four cases occurred in the right kidney and two cases in the left kidney. The maximum diameters of the lesions ranged from 21 to 79 mm and the mean value was(41 ± 20)mm. Five cases were round or oval, while one case was irregular. The signal intensity in five cases was slightly lower in T2WI than the renal parenchyma, while one case was slightly higher than the renal parenchyma. The hyperintentsity of DWI and hypointensity of ADC were seen in all cases. The mean ADC value was(0.759 ± 0.211) × 10-3mm2/s. Hemorrhage were seen in two cases. Necrosis was present in one case and the capsules were seen in two cases. No scar, fat and swollen lymph nodes was seen in all cases . There was no statistical significance of the signal intensity between lesions measure in the plain scan and normal renal parenchyma(P>0.05). After adminstrating contrast materials, all lesions shown persistently mild to moderate enhancement . The siganl intensities of lesions measured in three phases after enhancement were signifcantly lower than those of the renal cortex(P<0.05). No significant differences of the signal intensity measured in cortex and medulla phase between lesions and normal renal medulla was present(P>0.05). But the signal intensities of leisons in delayed phases were significantly lower than thoseof renal medulla(P<0.05). Except from the difference of enhanced magnitude in cortex phase between lesions and normal medulla, significant differences were present between leisons and normal renal parenchyma(P<0.05). Conclusion MRI manifestations of MA show certain distinction, including, dominantly solid lesions, relatively lower signal intensity of lesions than that of renal cortex, slowly persistent enhancement, high signal on DWI and low signal on ADC.

Objective To discuss the MRI findings of hepatic epithelioid hemangioendothelioma (EHE).Methods MRI and clinical data of 8 EHE patients confirmed by pathology in PLA General Hospital were retrospectively analyzed.Results 8 patients included 3 male and 5 female.1 patient had single lesion and 7 patients had multiple lesions.A total of 162 lesions were detected and most of the lesions were in the peripheral liver.For T1WI,100 lesions (61.7％) showed slightly low signal,and 62 lesions (38.3％) showed lower signal intensity in the center of the lesion and appeared as "target sign".For T2WI,the center of 29 lesions (17.9％) showed two-loop "target sign",66 lesions (40.7％) showed three-loop "target sign",and 67 lesions (41.4％) showed slightly homogeneous higher signal.For DWI,116 lesions (71.6％) showed halo-like high signal and 46 lesions (28.4％) showed uniform high signal.For dynamic enhancement,the lesions showed slightly enhancement in the arterial phase,and persistent enhancement in portal venous phase,the center of 122 lesions (about 75.3％) showed enhancement and 40 lesions (24.7％) showed no enhancement in delayed phase.1 patient with hepatobiliary specific contrast was enhanced in hepatobiliary phase.“Hepatic capsule depression” was observed in 30 lesions.7 lesions appeared as “lollipop sign”,and were enveloped in 16 lesions.Conclusion MRI,DWI and dynamic contrastenhanced scanning of EHE in liver are characteristic,which is helpful for qualitative diagnosis before surgery.

Objective:To observe the changes of varicella zoster virus (VZV)-DNA load in aqueous humour samples in VZV-induced acute retinal necrosis (ARN) in the early stages of antiviral treatment.Methods:A retrospective observational clinical study. From April 2016 to April 2018, 24 patients with 24 eyes of VZV-induced ARN who were diagnosed by Department of Ophthalmology, Eye and ENT Hospital of Fudan University and received complete aqueous humor sampling were included in the study. Among them, there were 13 males with 13 eyes, 11 females with 11 eyes; 12 left eyes and 12 right eyes; the age was 52.0±9.5 years old (39-71 years old). The time from the onset of ocular symptoms to the diagnosis of ARN was 16.6±6.1 days (7-30 days). Best-corrected visual acuity (BCVA) and ultra-wide-field fundus imaging were performed in all affected eyes. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. All patients were given intravitreal injection of 40 mg/ml ganciclovir 0.1 ml (including 4 mg of ganciclovir), 2 times a week, until the active necrotizing retinal lesions subsided, at most after the diagnosis 4 weeks, with a maximum of 9 injections. The follow-up period was 12.8±5.6 months. The aqueous humor samples were collected at presentation and 4, 7, 14, 21, 28 days after the initiation of antiviral therapy, and the VZV-DNA load was detected by real-time quantitative polymerase chain reaction. A plateau phase and a logarithmic reduction phase of the DNA load changes were observed after antiviral treatment began. Wilcoxon rank sum test was used to compare and analyze the differences in BCVA between the eyes at baseline and last follow-up.Results:The mean viral load at presentation was 8.6×10 7±1.3×10 8 copies/ml. The initial plateau phase last for an average of 7.4±2.4 days. In the following logarithmic reduction phase, the mean slope of the decline in viral load was -0.13±0.04 log/day, and the expected time for half reduction of the initial viral load was 2.5±0.7 days. After 28 days antiviral treatment, the viral load decreased to 1.7×10 5±1.8×10 5 copies/ml. In the course of the disease, rhegmatogenous retinal detachment occurred in 16 eyes. Before treatment and at the last follow-up, the logMAR BCVA of the affected eye was 1.1±0.6 and 0.8±0.7, respectively. The results of correlation analysis showed that the logMAR BCVA at the last follow-up was correlated with the initial VZV-DNA load ( r=0.467, P=0.033). Conclusion:The VZV-DNA load in the aqueous humor of eyes with VZV-induced ARN is significantly decreased after antiviral treatment, which is closely related to the clinical process of ARN.