Objective To explore the diagnostic value of qualitative and quantitative analysis for wrist and hand changes of rheumatoid arthritis (RA) patients based on 3.0T MR images.Methods A total of 39 RA patients were enrolled and divided into 2 groups according to the course of the diseases,including 20 cases defined as early stage group (≤24 months) and 19 cases defined as middle-late stage group (＞24 months).MRI features such as joint synovitis,bone marrow edema,bone erosion,the tenosynovitis in wrists and hands were observed emphatically.Volumes of synovitis and bone marrow edema for all patients were quantified with the software developed by Kunming University of Science and Technology.Results Among the 78 sides of hands and wrists in 39 patients,the incidence rate of synovitis,bone marrow edema,bone erosion,tenosynovitis was 94.87％ (37/39),64.10％ (25/39),61.54％ (24/39) and 76.92％ (30/39),respectively.The highest incidence rate of synovitis,bone marrow edema and bone erosion was respectively found in the wrist (72/78,92.31 ％),carpus (48/78,61.54 ％) andtriangular bone (50/78,64.1 ％).There was no statistical significance difference of the occurrence of peritendinitis between the flexor tendons (74.36％ [58/78]) and extensor tendons (61.54％ [48/78];x2 =2.94,P=0.09).No statistical difference of the incidence rates of synovitis,bone marrow edema,bone erosion and tenosynovitis was found between the early stage group and middle-late stage group (all P＞0.05).There was no significant difference of synovitis and bone marrow edema volumes between the early stage group and the middle-late stage group (both P＞0.05) with MRI quantitative analysis.Conclusion 3.0T MRI can clearly demonstrate the pathological changes of the wrists and hands in RA patients.The quantitative analysis software can provide more accurate indicators for the assessment of disease severity.

Objective To investigate the conventional and functional MRI features of primary central nervous system lymphoma (PCNSL).Methods The conventional MRI,DWI,1H-MRS and PWI data of 21 patients with PCNSL confirmed pathologically were analyzed retrospectively.Results There were 39 lesions in 21 cases.The mean ADC value of the PC-NSL lesions and the contralateral hemisphere normal white matter was (0.78±0.14) × 10 a mm2/s and (0.89 + 0.21) × 10-3 mm2/s,respectively.The difference of ADC value between PCNSL lesions and the contralateral hemisphere normal white matter was statistically significant (t=1.24,P＜0.05).Compared with the normal brain white matter,the PCNSL lesions showed abnormally high Cho/Cr ratio (4.62±2.05 vs 0.83±0.25),high Cho/NAA ratio (6.86±2.36 vs 0.63± 0.34) and low NAA/Cr ratio (0.67±1.73 vs 0.63±.034) on 1H-MRS (all P＜0.05).PCNSL lesions showed relatively low perfusion on PWI.And the cerebral blood volume of PCNSL lesion was lower than that of the surrounding normal brain parenchyma.Conclusion MR DWI,1H-MRS and PWI can reflect the features of PCNSL from different profiles.Combined with routine MRI signs,the accuracy of diagnosis can be further improved.

Objective To discuss MRI and pathological features of intracranial hemangioblastoma.Methods MRIdata of 26 cases of hemangioblastoma confirmed with operation and pathology were analyzed retrospectively.Results There were 22 cases with single lesion and multiple lesions in 4 eases.And a total of 31 lesions located in the posterior cranial fossa,including 14 lesions in right cerebellar hemispheres,9 lesions in left cerebellar hemispheres,2 lesions in cerebellar inferior vermis,4 lesions in medulla oblongata,and 2 lesions in fourth ventricle.Ninteen lesions showed cystic nodular type,1 lesion was cystic type,11 lesions showed parenchymal type or partial parenchyma type.Cystic lesions showed long T1 and long T2 signal,T1WI of solid area showed slightly long T1 and slightly long T2 signal,of which 12 lesions were slightly shorter T1 signal.Solid areas significantly enhanced,cystic area had no enhancement,but cystic wall of 3 cystic nodular lesions were slightly enhanced.DWI of solid areas showed low signal.MRS showed the peak of Cho obviously increased,and the peaks of Cr and NAA obviously decreased or nearly disappeared,and the high peak of lipids and lactate were observed.Conclusion The conventional and functional MRI of intracranial hemangioblastoma have some characteristics,MRI has a great value in the diagnosis and localization of intracranial hemangioblastoma.

Objective To investigate the effectiveness and safety of TACE combined with radiofrequency ablation (RFA) and simple RFA in the treatment of hepatocellular carcinoma (HCC) with Meta-analysis.Methods The randomized controlled trials comparing of TACE combined with RFA and simple RFA in the treatment of HCC from January 2000 to November 2016 in Chinese and English literatures were included.Results A total of 12 articles were enrolled in this study.Meta-analyses showed that the 1-year,3-year overall survival rate and 1-year,3-year recurrence-free survival rate of TACE combined with RFA group were better than those of simple RFA group (all P＜0.05).And there was no significant difference between TACE combined with RFA group and simple RFA group in 5-year overall survival rate (P =0.07).There was no significant difference of the 1-year,3-year overall survival and 1-year and 3-year recurrence-free survival rate between TACE combined with RFA group and simple RFA group for tumor with maximum diameter ＜3 cm in HCC (all P＞ 0.05).There was no significant difference in the incidence of serious complication in both two groups (P=0.82).Conclusion The short-term and mid-term efficacy in the treatment of HCC using TACE combined with RFA is better than those using simple RFA,while the long-term efficacy of two kinds of therapy have no significant differences.

Objective To evaluate the therapeutic effects and safety of transcatheter arterial sclerosing embolization (TASE) combined with oral Propranolol in infantile huge hemangiomas.Methods A total of 76 infants with huge hemangioma were treated by TASE.All patients received oral Propranolol based on their weight.The follow-up and efficacy evaluation were performed from the last treatment.And the complications were analyzed.Results Seventy-six cases underwent 95 case-times of TASE totally.The success rate of puncture technique was 100％ (95/95).All patients were divided into 5 levels (0-Ⅳ levels) based on the curative effect of the follow-up,including 6 cases (6/76,7.90％) of level Ⅰ,19 cases (19/76,25.00％) of level Ⅱ,23 cases (23/76,30.26％) of level l,and 28 cases (28/76,36.84％) of level Ⅳ.The total effective rate was 100％ (76/76).There was no serious complications,and the curative effect was stable during the follow-up.Conclusion TASE combined with oral Propranolol in infantile huge hemangiomas is effective with less invasiveness and fewer complications.

Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.

Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.

Objective To explore the changes of hemodynamics in acute kidney injury (AKI) after acute severe Stanford type A aortic dissection.Methods Forty patients with acute Stanford A type aortic dissection were enrolled.Arterial peak systolic velocity (PSV),end diastolic velocity (EDV),pulsative index (PI),resistive index (RI),Serum creatinine (SCr) and urine volume were recorded and measured 1 day before operation,immediately after operation (enter the intensive care unit),6 h after operation,24 h after operation and 48 h after operation.Patients were divided into AKI group and non-AKI.group taking AKIN as a standard.Results Twenty-seven patients were in AKI group and 13 were in non-AKI group.The EDV,PI and RI had significantly differences between AKI group and non-AKI group at 6 h,24 h after operation.Correlation analysis showed that EDV negatively correlated with SCr (r=-0.508,P=0.001),while PI,RI positively correlated with SCr (r=0.411,0.443,P=0.009,0.005).Conclusion EDV,PI and RI in the interlobular arteries can be used to predict AKI early in the interosseous arteries,and the optimal time for ultrasonic measurement of renal arterial hemodynamics to predict is at 6 h and 24 h after operation.

Breast cancer is a common tumor in women.Early and timely diagnosis is crucial for treatment and prognosis.As a routine method of breast examination,ultrasonography plays an important role in diagnosis of breast diseases.Superb microvascular imaging (SMI) is a new ultrasonic blood flow imaging technique in recent years,which separates spectrum signals of low-speed flow from normal tissue motion by an adaptive algorithm.SMI can display the slow-speed flow more realistically,and has been used on breast,thyroid,liver and so on.SMI is obviously valuable in clinic.The principle and application progresses of SMI in diagnosis of breast diseases were reviewed in this article.

Thyroid nodule is one of the most common diseases in endocrine system.Most of them are benign.Surgery is considered as the traditional and classic way to treat thyroid nodules,meanwhile it can also cause damage to patients.Currently,laser ablation therapy is a kind of new method to treat benign thyroid nodules.The several aspects of laser ablation in thyroid nodules including basis,application,efficacy,procedure,safety and prospect were discussed in this review.