Objective To discuss MSCT imaging features of adrenal ganglioneuroma ,and to sum up the key points of differential diagnosis .Methods The MSCT manifestations of 8 cases with adrenal ganglioneuroma confirmed by operation and pathology were analyzed combined with relevant literature .Results All adrenal ganglioneuromas were single ,5 cases of right adrenal gland ,3 cases of left adrenal gland ,most tumor density was uniform ,density of soft tissue in 7 cases,speckle calcification was seen in 2 cases.No enhanced or mild enhancement was found in the enhanced posterior artery ,the portal and delayed period showed mild continuous enhancement and line like separation enhancement and encapsulation enhancement .Low density of water samples in 1 case of CT plain scan ,no strengthe-ning at all stages .Conclusion Adrenal ganglioneuroma is rare , the dynamic enhanced performance of MSCT has some characteristics ,and it is beneficial to identify other adrenal tumors .

Objective ToevaluatetheimagedifferencesofCTinsubtypepapillaryrenalcellcarcinoma(PRCC).Methods Aretrospective analysisof30multiphaseCTenhancedimagesofPRCCconfirmedbyoperationandpathologyinourhospitalwasperformed,followed byacomparativestudyofCT multistageenhancedperformanceandpathology.Results typeⅠ16cases,typeⅡ14cases,ofwhich 11casesofⅡtypePRCC wereirregularorlobulated,and4casesoftypeⅠshowedlobulated,therewarestatisticallysignificant differencesbetweenthetwogroups(P＝0.003).Venoustumorthrombusin5casesoftypeⅡPRCC,4casesoftypeⅡPRCClymph nodemetastasis,perirenalinvasionin6casesofⅡtypePRCC,but1caseofⅠPRCChadvenousthrombus,perirenalinvasionin2 cases,nocaseoflymphnodemetastasis,therewereobviousdifferencesbetweenthetwogroups(P＝0.044,P＝0.022,P＝0.025). PRCCplainscanCTvalue,CTvalueofexcretoryperiod,CTvalueaddedinthesubstantiveperiod,CTincrementduringexcretionperiod, therewarenosignificantstatisticalsignificancebetweentypetwogroups(P＝0.893,P＝0.169,P＝0.559,P＝0.155).CTvalueof corticalphase,CTvalueinperenchymalphase,CTvalueincrementincarticalphasehadsignificantlydifferencesbetweentwogroups (P＝0.013,P＝0.046,P＝0.008).Conclusion Therearecertaindifferenceintumormorphology,outsideinvasionsignsandenhancement degreebetweentypeⅠandtypeⅡPRCCandⅡtypePRCCispronetoappearperirenalinvasion,tumorthrombusandlymphnode metastasis.CTscanningishelpfulindifferentialdiagnosisofsubtypesofPRCC.

Objective To explore the CT imaging features of renal mucinous tubular and spindle cell carcinoma(MTSCC).Methods The CT images of 9 cases patients with renal MTSCC confirmed by pathology were analyzed retrospectively,and their size,shape,density,degree of enhancement and enhancement mode were analyzed.Results There were 6 cases of left renal and 3 cases of right renal,with the largest diameter ranging from 1.6 cm to 7.7 cm.The shape of renal MTSCC was round in 4 cases,oblong in 3 cases,and fan-shaped in 2 cases.The long axis of the oblong tumor was parallel to the renal column,the central angle of the fan-shaped tumor was located in the renal medulla,and the arc was located under the renal capsule.Renal MTSCC was mainly located in the renal medulla.There were 6 cases of complete endophytic tumors,5 of which compressed the renal sinus.The tumor density was uniform in 5 cases,and the CT value of the solid component of the tumor was(32.43±4.82)HU,and the difference was not statistically significant compared with that of the renal parenchymal density(P=0.859).After enhancement,the solid component of the tumor showed mild uniform enhancement in the cortical phase,with a CT value of(41.71±6.74)HU.In the parenchymal phase and excretory phase,there was progressive enhancement,and the CT values were(58.23±9.42)HU and(61.81±9.49)HU,respectively.The CT value of each phase of tumor after enhancement was lower than that of renal medulla in the same period,and the differences were statisti-cally significant(P=0.001,P=0.005,P=0.002).Conclusion Renal MTSCC is mainly located in the renal medulla,which is easy to compress the renal sinus.It can be oblong or fan-shaped.Cystic,necrosis and calcification are rare.After enhancement,the tumor shows mild uniform enhancement in the cortical phase,progressive enhancement in the parenchymal phase and the excretory phase,and the CT value of each phase are lower than that of the renal medulla in the same period,which can suggest the diagnosis.

Objective To explore the diagnostic value of Likert score and EPE grade score based on multiparameter magnetic resonance imaging(mpMRI)for extracapsular extension in prostate cancer(PCa).Methods The MR imaging and histopathology data from 272 PCa patients were analyzed retrospectively.All patients underwent mpMRI examination within 2 months before radical prostatectomy.Two radiologists with over 10 years of experience assessed the mpMRI images according to the Likert score and EPE grade score,respectively,and compared with pathological findings.The consistency between the two radiologists was evaluated by weighted Kappa test.The statistical analysis was performed using MedCalc 20.0 software.The sensitivity,specificity and other indicators were calculated to analyze the optimal cut-off value of Likert score and EPE grade score for diagnosing extracapsular extension in PCa.The area under the curve(AUC)was used to compare the diagnostic performance of the two scoring systems for extracapsular extension in PCa.Results Among 272 PCa patients,there were 45 cases with extracapsular extension and 227 cases without extracapsular extension.The weighted Kappa coefficients were 0.730 and 0.820 for Likert score and EPE grade score,respectively,indicating good consistency.The optimal cut-off values for diagnosing extracapsular extension in PCa were Likert score 3 and EPE grade score 2.The sensitivity and specificity were 68.8%and 77.5%for Likert score 3,and 64.4%and 84.5%for EPE grade score 2,respectively.Both Likert score(AUC=0.780)and EPE grade score(AUC=0.797)had high accuracy in predicting extracapsular extension in PCa,with no significant difference(P>0.05).Conclusion Both Likert score and EPE grade score have good diagnostic performance in detecting extracapsular extension in PCa,which provides important diagnostic basis for clinical staging of PCa.

Objective:To investigate the influencing factors of refractory anastomotic stenosis after laparoscopic intersphincteric resection (Ls-ISR) for rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopatho-logical data of 495 patients who underwent Ls-ISR for rectal cancer in two medical centers, including 448 patients in Peking University First Hospital and 47 patients in Cancer Hospital Chinese Academy of Medical Sciences, from June 2012 to December 2021 were collected. There were 311 males and 184 females, aged 61 (range, 20-84)years. Observation indicators: (1) incidence of anastomotic stenosis; (2) influencing factors of refractory anastomotic stenosis after Ls-ISR; (3) construction and evaluation of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Follow-up was conducted using outpatient examination and telephone interview to detect the incidence of postoperative anastomotic leakage and anastomotic stenosis up to August 2022. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. Factors with P<0.10 in univariate analysis were included in multivariate analysis. The R software (3.6.3 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of nomogram prediction model. Results:(1) Incidence of anastomotic stenosis. All 495 patients underwent Ls-ISR successfully, without conversion to laparotomy, and all patients were followed up for 47(range, 8-116)months. During the follow-up period, there were 458 patients without anas-tomotic stenosis, and 37 patients with anastomotic stenosis. Of the 37 patients, there were 15 cases with grade A anastomotic stenosis, 3 cases with grade B anastomotic stenosis and 19 cases with grade C anastomotic stenosis, including 22 cases being identified as the refractory anastomotic stenosis. Fifteen patients with grade A anastomotic stenosis were relieved after anal dilation treat-ment. Three patients with grade B anastomotic stenosis were improved after balloon dilation and endoscopic treatment. Nineteen patients with grade C anastomotic stenosis underwent permanent stoma. During the follow-up period, there were 42 cases with anastomotic leakage including 17 cases combined with refractory anastomotic stenosis, and 453 cases without anastomotic leakage including 5 cases with refractory anastomotic stenosis. There was a significant difference in the refractory anastomotic stenosis between patients with and without anastomotic leakage ( χ2=131.181, P<0.05). (2) Influencing factors of refractory anastomotic stenosis after Ls-ISR. Results of multivariate analysis showed that neoadjuvant therapy, distance from tumor to anal margin ≤4 cm, clinic N+ stage were independent risk factors of refractory anastomotic stenosis after Ls-ISR ( hazard ratio=7.297, 3.898, 2.672, 95% confidence interval as 2.870-18.550, 1.050-14.465, 1.064-6.712, P<0.05). (3) Construction and evaluation of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Based on the results of multivariate analysis, neoadjuvant therapy, distance from tumor to anal margin and clinic N staging were included to constructed the nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Results of ROC curve showed the AUC of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR was 0.739 (95% confidence interval as 0.646-0.833). Conclusions:Neoadjuvant therapy, distance from tumor to anal margin ≤4 cm, clinic N+ stage are independent risk factors of refractory anastomotic stenosis after Ls-ISR. Nomogram prediction model based on these factors can predict the incidence of refractory anastomotic stenosis after Ls-ISR.