Objective To study the CT features of the sero-hepatic type of hepatic tuberculosis.Methods This is a retrospective,multi-center and cross-sectional study.17 patients with the sero-hepatic type of hepatic tuberculosis from the Yueqing People' s Hospital (n =5),Second Affiliated Hospital of Wenzhou Medical College (n =5),and Wenzhou People's Hospital (n =7) were studied.All these patients were fasted for 8 h prior to CT scanning.They underwent enhanced after conventional CT breathless scanning with no abdominal pressure.Results The CT scans displayed 41 lesions in these 17 patients with the sero-hepatic type of hepatic tuberculosis,including a solitary lesion in 13 patients and multiple lesions in 4 patients.The diameter of the lesions varied from 0.8 to 4.7 cm,with a mean ± S.D.of 2.38 ± 4.82 cm.The CT features showed a localized spindle-shaped focal lesion just underneath the liver capsule with resultant concave compression of the adjacent liver tissue (n =22),spotted calcifications in the center of the focal nodules (n =1);and aggregation of multiple low density nodular foci (n =19).Additional CT features included focal nodules surrounded by a small amount of liquid (n =15),compression of adjacent liver tissue (n =22),a small amount of ascites (n =8),and retroperitoneal lymph nodes enlargement (n =2).These nodules showed moderate (n =5) and slight enhancement in the arterial phase (n =36);moderate (n =32) and mild enhancement in the portal venous phase (n =9);and moderate (n =32) and mild enhancement in the parenchymal phase (n =9),respectively.The nodules showed ring-shaped (n =26),honeycomb or multiple ring-shaped enhancement (n =15).The enhanced ring-shaped wall thickness varied from 0.2 to 0.9 cm,with a thin wall (n =30) and a thick wall (n =11).The center of the focal nodule was a low density sac-shaped area,with no obvious contrast enhancement.The CT value was 21 to 39 hu.The infiltrative liver tissues which surrounded the focal nodules were shown as lamellar areas of obvious arterial enhancement,with equidensity in the portal vein phase and equilibrium phase.Conclusions CT showed characteristic features of the sero-hepatic type of hepatic tuberculosis.Clinical and laboratory findings could provide important supplementary information to make the diagnosis.

Objective To investigate the MRI characteristics of low grade fibromyxoid sarcoma (LGFMS).Methods The MRI imaging of 13 cases with operation and pathology proven low grade fibromyxoid sarcoma were retrospectively analyzed.Comparative study of the relationship between the signal,boundary,cystic,and the enhancement degree with tumor tissue components was performed.Results The tumors were located in thigh (n=7),lower leg (n=3),elbow,shoulder and upper arm (n=l for each).The average diameter of tumor was (7.01 ±2.89) cm (range from 2.5 to 12.0 cm).The tumors with maximal diameter larger than 5 cm were seen in 11 patients.All tumors had well-defined margin.Necrosis and cystic change was seen in 5 tumors,tumor compartment in 3 cases,intratumoral fluid fluid level in 2 cases,and peritumoral edema in 3 cases.T1WI showed hypointensity in 6 cases,iso-,hopointensity in 4 cases,isointensity with slightly hyperintensity in tumor center in 4 cases,heterogeneous intensity in 1 case.T2WI showed hyperintensity in 6 cases,central higher intensity in 4 cases,hyper-,iso-,hypo-intensity in 4 cases,and hyper-,hypo-intensity in 3 cases.T2WI with fat suppression sequence showed hyper-,iso-,hypo-intensity in 8 cases and high intensity solid part and much higher intensity in tumor center in 5 cases.Heterogeneous enhancement of the tumors was noted,including mild enhancement in 8 cases,moderate enhancement in 4 cases,and marked enhancement in one case.Pathological results showed that the tumors were gray and white or yellow,well-defined,and hard texture,in which 5 cases cystic degeneration with tremelloid material can be seen in 5 cases.Microscopy results showed alternating distribution of fibrous and myxoid areas.Nine cases had rosettes formation and characteristic arcuate vessels were seen in 2 tumors.Immunohistochemical results showed negative Vimentin,Desmin,and S-100 in 5 patients,while 3 patients were positive for SMA and CD34.Conclusions LGFMS has some characteristic MRI finding.Combination of MRI and the clinical findings can suggest the diagnosis of LGFMS,however,the final diagnosis depends on pathological examination.

Objective To investigate the ultrasonographic character of neonatal adrenal hemorrhage (NAH). Methods Forty-four hospitalized NAH were retrospectively analyzed. Doppler ultrasonography detected their shape and supply. Results Forty-one cases were diagnosed by ultrasonography in 44 cases of NAH,3 cases were misdiagnosed, accompanying with scrotal hematoma in 5 cases. Ultrasonography demonstrated mixed, anechoic, hyperechoic, hypoechoic adrenal mass, no color Doppler signal in all of NAH. Conclusions NAH can be diagnosed by color Doppler ultrasound in early stage and it is the first choice method.

Objective To investigate the value of CARE Dose 4D technique in decreasing radiation dose and improving image quality of multi-slice spiral CT in adult chest scanning.Methods 100patients of chest CT scanning were equally divided into study group and control group randomly.CARE Dose 4D Technique was used in study group.Effective mAs value,volume CT dose index (CTDIvol) and dose length product (DLP) were displayed automatically in machine while chest scanning; those values and actual mAs value of every image were recorded respectively.The image quality at apex of lung,lower edge of aorta arch,middle area of left atrium and base of lung on every image of 400 images was judged and classified as three level (excellent,good,poor) by two deputy chief physicians with double blind method,the image noise at corresponding parts was measured.Results While setting 80 mAs for quality reference mAs,the effective mAs value in study group most decreased 44 mAs than control group with an average decrease of 9.60( 12.0% ) ,CTDIvol with 4.75 mGy with an average decrease of 0.95 mC y( 11.0% ) ,DLP 99.50% in study group,with 98.0% in control group.But it was higher at apex of lung and base of lung,lower at middle area of left atrium,and similar at lower edge of aorta arch in study group than contrast group.The image noise were lower at apex of lung and base of lung in study group than control group (t =6.299 and 2.332,all P ＜ 0.05 ) ,higher at middle area of left atrium in study group than control group (t=3.078,P ＜0.05) and similar at lower edge of aorta arch in study group than control group (t =1.191,P ＞0.05).Conclusions CARE Dose 4D technique provides a function regulated mAs real-time on line,it not only raises utilization rate of radiation and decreases radiation dose,but also promises and increases image quality in chest CT scanning,and has some clinical significance.

Objective To investigate the cerebral CT appearances of toxic encephalopathy of tetramine and improve the recognition on this disease. Methods Four cases of toxic encephalopathy of tetramine were collected and their cerebral CT appearances were retrospectively analyzed. Results Cerebral CT appearances in acute phase (within 8 days): (1) cerebral edema in different degree. CT abnormalities consisted of cortical hypodensities and complete loss of gray-white matter differentiation. The CT value were in 11-13 HU, and to be watery density in serious case,(2)subarachnoid hemorrhage. It demonstrated the signs of poisoning hypoxic ischemic encephalopathy in chronic phase. Conclusion The cerebral CT appearances of toxic encephalopathy of tetramine had some character in acute phase and it can predict the serious degree of intoxication, but there was no characteristic findings in chronic phase.

Objective To investigate the characteristics and diagnostic value of multislice spiral CT (MSCT) of intestinal lipomas causing intussusception.Methods The MSCT findings of 25 cases with intestinal lipomas causing intussusception were retrospectively analyzed,the tumor location,size,shape,density,enhancement patterns and shape and length of intussusception were also observed retrospectively.Results Tumors were 1.2-6.5 cm in diameter,round or oval in shape (n =18),irregular shape (n =4),tubular shape (n =3) with uniform density (n =19),or uneven density (n =6).Under CT enhancement tumor capsule was moderately intensified.Intussusception included ileum-ileum type (n =7),jejunum-jejunum type (n =5),jejunum-ileum type (n =2),ileum-colon type (n =4),and colon-colon type (n =7).Intussusception was 5.0-5l.0 cm in length;presenting as concentric circles (n =12),round target sign (n =7),orbanana (n =6).Conclusion Intestinal liporna complicating secondary intussusception has definite MSCT characteristics which can help establish diagnosis.

Objective To investigate radiological features on computed tomography (CT) in the di agnosis of portal venous and intestinal wall gas in patients with ischemic bowel disease.Methods The clinic-pathological data of 17 patients with portal venous and intestinal gas associated with ischemic bowel diseases from Wenzhou People's Hospital (n =6),Yueqing People's Hospital (n =5),Shanghai Xuhui Dahua Hospital (n =3) and the Second Affiliated Hospital of Wenzhou Medical University (n =3) from January 2013 to October 2016 were analysed retrospectively.All the patients have been fasting for 8 h prior to CT scans.Enhanced CT study was performed following routine CT with no abdominal pressure for breath less scanting.Portal venous gas,intestinal wall gas,intestinal thickness and density,mesentery thickness,celiac effusion,and severity of intestinal wall enhancement were recorded.Results All the 17 patients ex perienced abdominal distension and pain.Additionally,nausea and vomiting was observed in 9 patients,di arrhea in 7,melena in 7,periumbilical tenderness in 11 and rebound tenderness in 8.CT scans of these 17 patients showed portal venous gas,including massiveprune-tree signs of hepatic vein and portal vein (n =11) and scanty gas shadows in distal hepatic vein (n =6).Intestinal gas sign was determined in all these patients (n =17),including single bubble shadow (n =8),multiple bubble shadow (n =7),and band-shaped bubble (n =2).Furthermore,CT study indicated extensive intestinal wall thickening with edema (n =13),predominate luminal extension of thinner bowels (n =4),scanty celiac effusion (n =3).Enhanced CT scans demonstrated 8 patients with decreased enhancement of intestinal wall and mesentery with diseases,target and halo signs observed in enhanced scans.Conclusions Portal venous and intestinal wall gas may demonstrate distinctive CT imaging.CT study could have superior sensitivity and spe cialty in clinical diagnoses of ischemic bowel diseases.

Objective To investigate CT features of pediatric mediastinal neuroblastoma.Methods The CT performance of pediatric mediastinal neuroblastoma confirmed by clinical and pathology in 17 cases were retrospectively analyzed.The tumor growth pattern,size,density,degree of enhancement,invasion to the surrounding tissues and metastatic characteristics were observed,and the results were compared with pathological analysis.Results Among the 17 cases,2 were at the right posterior upper mediastinum,3 at posterior right middle and upper mediastinum,3 at the posterior right middle and lower mediastinum,1 at the posterior right lower mediastinum,3 at the posterior left middle mediastinum,3 at the posterior left middle and lower mediastinum,1 at the posterior left lower mediastinum,and 1 at bilateral posterior middle and lower mediastinum.The average tumor size was 6.3 ×4.3 cm,ranging from 2.3 ×2.0 cm ～ 12.6 ×4.0 cm.CT plain scan showed 8 cases with clear boundary and 9 case without clear boundary.13 cases were with inhomogeneous density and 4 cases with homogeneous density.8 calcification of grainy or strip was found in the tumor.10 cases were with pleural thickening and 5 cases with pleural effusion.6 cases were with tracheal or main bronchial compression,4 with cardiac compression,7 with pulmonary artery compression,and 1 with descending aorta compression were found.6 cases were with tumors crossing the midline,5 with intervertebral foramen growth,3 wrapped around the aorta,3 with rib attack damage,2 with rib compression deformation,2 with thoracic invasion,and 1 into the upper abdomen.10 cases were with mediastinal lymph nodes enlargement,10 with bone metastasis,4 with cervical lymph nodes enlargement,1 with liver metastasis,and 1 with cerebral metastasis.Enhanced CT scan was performed in 14 cases:11with inhomogeneous enhancement,and 3 with homogeneous enhancement.The average CT value of the 3 mild enhancement was 36 HU,ranging from 20 to 56 HU.The average CT value of the 8 moderate enhancement was 53 HU,ranging from 36 to74 HU.The average CT value of the 3 marked enhancement 72 HU,ranging from 56 to 88 HU.7 punctate vessels and 6 polycystic changes were found in the tumors.Conclusions Mediastinal neuroblastoma in children are with certain characteristics.CT findings with clinical manifestations can make a definite diagnosis.

To investigate the CT appearances in early stage of clustering lung paragonimiasis,9 cases of two clustering lung paragonimiasis caused by eating raw stone-crab and laboratory examination were included in the study.Eight cases consulted by doctors in the hospital and their appearances were retrospectively analyzed.There were pleural effusion of varying degree (n=8) and random distribution sub-pleural pulmonary infiltrative lesions (n=7).The accompany appearances of the latter had lunar halo sign,characteristic tunnel sign (n=1) and peri-bronchitis (n=1).If CT detects pulmonary infiltrative lesions of random distribution within sub-pleura or tunnel sign,combining with the history of eating raw stone crabs and other freshwater fishes,with the rise of eosinophilic granulocytes in peripheral blood,the diagnosis of paragonimiasis should be suggested.

Objective To investigate the characteristics and diagnostic value of multi-slice spiral computed tomography (MSCT) examination of gastrointestinal lipoma.Methods The cross-sectional study was adopted.The clinicopathological data of 96 patients with gastrointestinal lipoma including 32 from the Second Hospital Affiliated to Wenzhou Medical University,30 from the First Hospital Affiliated to Wenzhou Medical University,17 from the Ruian People's Hospital of Zhejiang,11 from the Yueqing People's Hospital,3 from the Wenzhou Central Hospital and 3 from the Wenzhou People's Hospital from December 2006 to September 2015 were collected.All patients were fasted for 8 hours prior to the examination,and partial patients underwent enhanced scan after the conventional CT scanning with breathless scanning and no abdominal pressure.Coronal and sagittal images of gastrointestinal tract including the tumor were administrated with multiple planar reconstruction (MPR)techniques of Reformat software.Based on MPR images,the curves along the gastrointestinal tract were drawn,voxel distributed along the curve track were reconstructed,and curved planar reconstruction (CPR) images were obtained.The patients received operation or follow-up according to individual characteristics after examinations.The patients undergoing operation were followed up for detecting tumor recurrence and metastasis by CT examination and patients receiving follow-up were observed by endoscopy for detecting changes of tumor size and morphology up to June 2015.The analysis indexes included tumor location and size,performance of MSCT examination (tumor shape,density,margin,intussusceptions,enhanced MSCT examination),intraoperative findings,results of pathological examination and results of follow-up.Measurement data with normal distribution were presented as i ± s.Results All the 96 patients received MSCT plain scan and the 42 received enhanced MSCT scan.The CPR images in 30 patients were collected.(1) Tumor location and size:3 tumors were located in the stomach,16 in the duodenal,27 in the jejunum,23 in the ileal,2 in the ileocecus,9 in the sigmoid colon,9 in the ascending colon,3 in the descending colon,3 in the transverse colon and 1 in the appendix.The diameter of tumor was (3.8 ± 2.3) cm.(2) Performance of MSCT examination:of the 96 patients,round or oval tumors were detected in 68 patients,tubular tumors in 15 patients and lobulated tumors in 13 patients.Tumors showed homogeneous density in 67 patients and inhomogeneous density in 29 patients.The CT value of tumors was-110--53 HU with a median value of-80 HU.Tumors of the 96 patients had clear boundaries and smooth margins.Twenty-four patients were complicated with intussusceptions with nested length of (28 ±4)cm,including 10 cases of multiple concentric rings,7 cases of double-target sign and 7 cases of banana sign.Enhanced MSCT scan showed that capsule around tumors in the 96 patients demonstrated slightly intensified,tumor body demonstrated no enhancement and that angiolipoma in 10 patients had cable strip like enhancement in the tumors.(3) Intraoperative findings:of the 96 patients,59 patients underwent surgical resection with single tumor,24 patients were concomitant with intussusceptions,9 patients showed aphtha in the center of tumors and 1 patient had partial lipoma in the prepyloric region dropped into the duodenal.Thirty-seven patients received endoscopic examination,showing submucous nodular protrusive lesions of 1.7-3.5 cm.(4) Results of pathological examination:of 59 patients undergoing surgical resection,submucosal,subserous and intramural tumors were detected in 45,9 and 5 patients,respectively,with complete capsule and pedunculated or non-pedunculated.Of the 59 patients,tumors showed round or oval shape in 41 patients,tubular shape in 10 patients and lobulated shape in 8 patients.The section of tumors showed yellowish-white.Specimens from endoscopic and surgical resections were observed under microscopy,the tumors were composed of mature-differentiated adipocytes,different quantities of fibrous connective tissues,blood vessels and mucus ingredients.Tumor cells were round shape with hypochromatic cytoplast and became polygeal and vacuolated after squeezing,nucleus was compressed to peripheral area and cytoplasm was full of lipid droplets.The results of immunohistochemistry stain showed Vimentin,CD34,D2-40,CD68 were positive and AE1/3 and Calretinin were negative.All tumors were diagnosed as benign lipomas.Fifty-nine patients who underwent surgical resection were followed up for 0.5-5.0 years and 37 patients of which specimens were obstained by endoscopic resection were followed up for 1.0-2.0 years after the pathological diagnosis with no significant change.Conclusion The MSCT finding of the gastrointestinal lipoma has characteristic appearance,and MSCT examination can clearly show lipoma location,size,shape and properties,with a widespread application value.