Objective To study the radiological features of dynamic enhanced multi-slice spiral CT (MSCT) and CTA in pure hepatic arterio-venous fistula (AVF).Methods The radiological features of MSCT imaging and CTA of 100 patients with pure hepatic AVF were retrospectively analyzed.Results Positive signs on the arterial phase were detected in 100 patients with pure hepatic AVF.In 89 patients,they were the peripheral type and in 11 patients they were the central type.There were 128 lesions in the 100 patients.In the peripheral type,the features were (1) in the arterial phase,the lesions appeared as a wedged or a patchy enhancement area at the edge of the liver,showing a halo sign in 68 patients.In 56 patients,the PV was shown also in the early arterial phase;(2) in the arterial phase,arailway track sign was shown in 21 patients as a result of a portal vein branch showing right next to a hepatic arterial branch.In the central type and in the arterial phase,the main portal vein (or the hepatic vein) and the left/right branches of the PV (or the HV) were shown.Conclusion MSCT and CTA were useful in the diagnosis of pure hepatic AVF.

Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.

Esophageal submucosal hematoma is rarely seen in clinical practice and its clinical presentations are untypical.Gastroscopy might injure the esophageal mucosa and cause bleeding.Computed tomography had the advantages of quick examination and formation of imaging,as well as non-invasiveness,which is helpful for the diagnosis and differential diagnosis of the esophageal submucosal hematoma.The clinical data of 9 patients with esophageal submucosal hematoma who were admitted to the Yueqing People's Hospital,the First Affiliated Hospital of Wenzhou Medical University,the First Affiliated Hospital of the Zhengzhou University and the Third People's Hospital of Wenzhou from July 2005 to February 2014 were retrospectively analyzed.The features of computed tomography examination of esophageal submocosal hematoma include the range of the esophageal submucosal hematoma exceeds 2 parts of the esophagus,the rip of the esophageal mucosa begins and ends at the physiological narrowing of the esophagus,thickening of the esophageal wall,stricture of the esophagus,annular thickening and eccentric thickening of the esophageal wall,crescent,spot or gas shadows of the esophageal cavity,the density of the hematoma decreases as the time passed by.These features of computed tomography are of great importance for the diagnosis of esophageal submucosal hematoma.

Objective To explore the gray matter changes in aggressive patients with schizophrenia,and the relationship between the gray matter and aggression in patients.Methods Eighteen aggressive patients with schizophrenia (SZ1),18 age-and gender-matched un-aggressive patients with schizophrenia (SZ2) and 18 normal controls (NC) were enrolled in the study.Then a 3.0 T magnetic resonance imaging (MRI) scan was conducted for each participant.The voxel-based morphometry (VBM) approach and the Chinese version of Buss & Perry aggression questionnaire (B&P) were used to explore imaging data and to assess the aggression,respectively.Results Compared with NC,patients with schizophrenia showed changes in gray matter volume (GMV) in the frontal,temporal and the occipital lobes (P＜0.05,AlphaSim corrected).Compared with SZ2,SZ1 showed increased GMV in the right supramarginal gyrus,right postcentral gyms,bilateral insula and orbito-frontal gyri (P＜0.05,AlphaSim corrected).The GMV of the right insula,right postcentral gyms and right supramarginal grus were positively associated with B&P scores in patients with schizophrenia (P＜0.01,AlphaSim corrected),respectively.Conclusions These preliminary findings support that the aggression in schizophrenia is associated with GMV changes of brain regions in patients with schizophrenia.The right postcentral gyrus,the right insula and the right supramarginal gyrus may be involved in the neural mechanism of aggression in schizophrenia.

Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.

Objective To investigate the MRI features of ovarian theca fibroma (OTF) and compare it with histopathology features in order to improve the accuracy of OTF diagnosis. Methods The clinical data of 33 patients with OTF which were confirmed by surgical pathology from January 2005 to December 2016 were analyzed retrospectively. The signal characteristics and intensities of MRI were compared with histopathology features. Results The lump largest diameter of 33 patients with OTF was 2.5 to 18.0 (6.65 ± 4.46) cm. The substantial lump was in 22 cases. T2WI and T2WI fat suppression imaging showed a low or equal mixed signal among which there was slightly high or high signal, and T1WI imaging showed relatively uniform low signal. The cystic and solid lump was in 11 cases, including 7 cases of solid lumps and 4 cases of cystic-solid lumps, T2WI and T2WI fat suppression imaging of solid area showed equal or low signal among which there were a small patchy high or slightly high signal, and T2WI and T2WI fat suppression of cystic areas showed high signal; T1WI of solid and cystic areas showed uniform low signal. Enhanced appearance: in the 33 cases of enhancement, the parenchyma part showed mild enhancement, of which 14 cases were equal enhancement, 19 cases were uneven enhancement. During the arterial phase, all of 33 cases showed mild enhancement; 15 cases were obviously enhanced and 18 cases were mildly enhanced in the portal vein phase; 21 cases remained enhanced and the enhanced intensity of 12 cases decreased in the delayed phase. Comparison of histopathology features with MRI features showed that there were a higher proportion of fibrous cells under the microscope in 22 cases of parenchymal tumor, in which the fat suppression image of T2WI and T2WI showed equal or low signal in parenchyma, and T1WI showed even low signal; and there were a higher proportion of tumor cells and less collagen fibers under the microscope in 11 cases of cystic-solid tumor, in which the T2WI showed a slightly equal and higher signal and T1WI showed low signal in parenchyma. Conclusions The MRI features have some characteristics, such as low and equal signal of T2WI in parenchyma, mild enhancement during arterial phase and continuous enhancement in portal vein and delayed phase, which is helpful for diagnosis of OTF.

Objective To investigate MSCT features of the intraductal papillary mucinous tumor of the pancreas.Methods The CT findings of 40 cases of intraductal papillary mucinous tumors confirmed by pathology were retrospectively analyzed,and the location,size,shape,edge and enhancement of the tumor were observed.Results Malignant (n=8):all of them were mainly pancreatic duct type,including 6 cases in the head of pancreas and 2 cases in the tail.All of them were multi-room,with 7 cases of cystic wall nodules and 7 cases of uneven septum thickening.The diameter of tumor cystic lesion was(41.0±0.5)mm on average,and the widest diameter of the dilated pancreatic duct was (6.9±1.0) mm.The cystic wall,wall nodule and interval were mild and moderate enhancement in the arterial phase,and continuous strengthening in the portal and delayed phases.Borderline(n=15):8 cases of main pancreatic duct type,1 case of branch pancreatic duct type,and 6 cases of mixed type.There were 10 cases in the head of the pancreas and 5 in the tail of the pancreas.There were 10 cases of multi room in the lesion,and the CT findings were composed of multiple clusters of small cystic lesions,with 3 cases of tuberous nodules on the cyst wall and 4 cases of irregular thickening of the cysts.5 cases were single room type,with capsule wall smooth and whole.The diameter of tumor cystic lesion was (28.0±0.5) mm on average,and the maximum diameter of the dilated pancreatic duct was (5.2±0.3) mm.The cystic wall and interval were mild and moderate enhancement in the arterial phase,and mild and continuous strengthening in the portal and delayed phases.Benign (n=17):1 case of main pancreatic duct type,10 cases of pancreatic duct type and 6 cases of mixed type;There were 12 cases in the head of the pancreas and 5 in the tail.All of them were single cystic type,and the cyst wall was smooth.The diameter of the tumor cystic lesion was (26±0.3) mm on average and the maximum diameter of the dilated pancreatic duct was (3.5±0.4) mm.There was no enhancement of the cystic wall in the arterial phase,mild enhancement in the portal phase,and mild continuous delayed phase in 2 cases,no enhancement in 15 cases.Conclusion MSCT expression of the intraductal papillary mucinous tumor of the pancreas has its characteristic features,which is helpful for the diagnosis and treatment of the disease.

Objective:To evaluate the clinical results of using the free polyfoliate anterolateral thigh perforator flaps based on a single perforator in repair large soft tissue defects in extremities.Methods:Between March, 2014 and April, 2019, 9 patients with large soft tissue defects in extremities were repaired with the free polyfoliate anterolateral thigh perforator flaps based on a single perforator. One of the patients were repaired with bilateral free polyfoliate anterolateral thigh perforator flaps. Six defects on hand and wrist, 1 on forearm, 1 on shank and 1 on foot. The sizes of soft tissue defect ranged 5 cm×19 cm-17 cm×24 cm. All the wounds of donor site were closed primarily.Results:Seven flaps survived without vascular incidence. One flap developed artery crisis after surgery with the bilateral free polyfoliate anterolateral thigh perforator flaps. After emergency re-anastomosing, the flap survived successfully. Necrosis on one-leaf occurred in one flap, which was finally repaired by skin graft. The clinical results were satisfactory after 3-48 months of followed-up. The scars of the donor site were not obvious.Conclusion:The free polyfoliate anterolateral thigh perforator flaps can be designed with only one perforator. The flap can be changed into a variety of shapes based on the combination of the polyfoliate flaps in order to repair a large soft tissue defects in extremity. The polyfoliate flap has advantages of less donor site injury with a high survival rate.

Objective:To explore the imaging features of hyperostosis frontalis interna (HFI).Methods:One hundred patients with clinically diagnosed HFI were enrolled from Department of Radiology, Yueqing People's Hospital and Department of Imaging, Wenzhou People's Hospital from January 2011 to December 2022. MRI alone was performed in 45 patients; MRI+DR was performed in 14, and MRI+CT was performed in 41. The imaging features of these patients were analyzed retrospectively.Results:In these 100 patients, 20 were with external hyperplasia, 51 with internal hyperplasia, and 29 with intermediate hyperplasia. External hyperplasia manifested as proliferating towards the diploe, enjoying clear boundary, uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and high density of the hyperplastic inner plate and diploe on CT and DR. Internal hyperplasia manifested as proliferating towards the cranial cavity, enjoying wavy or nodular inner edges, non-uniform low signals of hyperplastic inner plate on T1WI and T2WI, and high density of the hyperplastic inner plate on CT and DR. Intermediate hyperplasia manifested as proliferating simultaneously towards the cranial cavity and diploe, enjoying thin and blurred diploe, uniform or non-uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and non-uniform high density of the hyperplastic inner plate and diploe on CT and DR. Compressed and displaced brain parenchyma, reduced anterior cranial fossa volume, and narrowed subarachnoid space were noted in these 100 patients, including 47 patients with obvious frontal lobe brain tissue compression (depth of 3.0-17 mm, averaged [8.6±5.9] mm), 35 with lacunar cerebral infarction, 33 with subcortical arteriosclerotic encephalopathy, and 32 with varied degrees of cerebral atrophy.Conclusion:HFI is characterized by thickening and hardening of the bilateral frontal bone inner plates, with wavy, nodular or spindle-shaped inner edges, compressed brain tissues, and reduced anterior cranial fossa; these imaging features can help the definite diagnosis of HFI.

Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.