Objective To explore the values of apparent diffusion coefficients (ADC) in staging the lesions of multiple sclerosis (MS) through analysing the differences of ADC in different types of lesions.Methods 137 lesions identified in 29 patients with MS,were characterized by their enhancement pattern on contrast-enhanced T1-weighted MR images and whether they were changing in appearance, size or signal.The lesions were classified into four groups:homogeneously enhancing lesions (HELs), ring-enhancing lesions (RELs), active nonenhancing lesions (ANELs), and inactive nonenhancing lesions (INELs).The mean ADC values for each type of lesions were calculated and compared.Results The ADC values for HELs, RELs, ANELs and INELs were (91.09±13.63)× 10 5 · m2 · s-1, (105.66±9.92) × 10-5 · m2 · s-1, (136.80±20.31) × 10-5 · m2 · s-1 and (127.46±13.65) ×10-5 · m2 · s-1.There were significant differences between the ADC values of any two groups in the four groups except the ADC values between ANELs and INELs.Conclusion ADC values are useful to differentiate each type of lesion,which can help stage the lesions of MS.

Objective:To analyze the magnetic resonance imaging (MRI) features of diffuse midline gliomas with H3K27M mutation, and to quantitatively analyze the changes of apparent diffusion coefficient (ADC).Methods:The MRI images of 14 cases of diffuse midline gliomas with H3K27M mutation were retrospectively analyzed in the Affiliated Hospital of Qingdao University from April 2017 to November 2019. The location, edge, signal, peritumoral edema and enhancement characteristics of the lesions were observed, and the changes of ADC values were analyzed.Results:The tumors were located in thalamus in four cases, pons in six cases, medulla oblongata in two cases and spinal cord in two cases. In seven cases, the tumor was confined to the midline region, of which six cases had clear boundary, seven cases were located in the midline area, but infiltrated into the non midline area at the same time, and six cases had unclear boundary. Basilar artery entrapment was found in all six patients located in pons. Multiple large cystic changes were found in five cases, multiple small cysts in four cases and no cystic changes in five cases. Cystic changes were found in all seven cases of tumors involving the non midline region, of which six cases were located only in the non midline region, and only two of the seven tumors localized in the midline region had small cysts. Hemorrhage was found in four cases. Five cases showed mild heterogeneous enhancement, six cases showed moderate heterogeneous enhancement, two cases showed obvious enhancement, and one case showed no enhancement. There was no edema around the tumor in nine cases and mild edema in five cases. The average edema index was 1.13. The average ADC value of tumor parenchyma in 12 patients was (7.83±0.88)×10 -4 mm 2/s, which was 15.6% lower than that of the contralateral side [(9.28±0.69)×10 -4 mm 2/s, t=-6.336, P<0.05]. Conclusions:Diffuse midline gliomas with H3K27M mutation have a younger onset age and are more likely to occur in thalamus, brainstem and spinal cord. Most of the tumors have no peritumoral edema or mild peritumoral edema. The tumors confined to the midline region are regular in shape and clear in boundary. The masses involving the non midline area are prone to cystic necrosis. Diffuse midline gliomas with H3K27M mutation in pons are prone to basilar artery entrapment. ADC value can provide a quantitative basis for preoperative tumor grading.

Objective To investigate the value of intravoxel incoherent motion DWI (IVIM-DWI) in differential diagnosis of high-grade gliomas and brain metastases.Methods Conventional MRI,contrast-enhanced MRI and IVIM-DWI were performed before surgery or chemoradiotherapy in 24 patients with high-grade gliomas and 28 patients with brain metastases.The diffusion constant (D),pseudodiffusion coefficient of perfusion (D*) and the perfusion fraction (f) in the parenchyma and peritumoral edema region within 1 cm and the normal centrum semiovale in the opposite side were measured,then the relative values of all parameters in each region (rD*,rD,rf) were calculated.Independent sample t test was used to analyze the parameters.ROC curve analysis of the parameters statistically different between high grade gliomas and brain metastases were performed,and the diagnostic efficacies were evaluated.Results The D* and rD* values of tumor parenchyma and in peritumoral edema within 1 cm of high-grade gliomas were higher than those of brain metastases (all P＜0.05).The f and rf values of tumor parenchyma and in peritumoral edema within 1 cm of highgrade gliomas were lower than those of brain metastases (all P＜0.01).The AUC of D* value in peritumoral edema within 1 cm was the highest,but there was no statistically different between any two AUC except the rD* value of peritumoral edema within 1 cm (P =0.033).Conclusion IVIM-DWI can distinguish the differences of diffusion and perfusion information in parenchyma and edema area between high-grade gliomas and brain metastases,therefore providing the basis for differential diagnosis of them.

Objective To compare the safety and efficacy of stent-assisted coil and non-stent-assisted coil for the treatment of ruptured posterior communicating artery aneurysms.Methods A total of 121 consecutive patients with ruptured posterior communicating artery aneurysm treated at the Department of Neurosurgery,Heze Municipal Hospital between June 2014 and June 2017 were enrolled retrospectively.They divided into either a stent group (n =63) or non-stent group (n =58) according to whether they used stent treatment or not.The two groups were compared,and their clinical data,surgical related complications,the degree of embolism immediately after aneurysm surgery,and the follow-up results of clinical and imaging were analyzed.Results Interventional embolization therapy was successfully performed in all the patients.(1) The proportion of wide-necked aneurysms of the stent group was higher than that of the non-stent group.There was significant difference (92.1％ [58/63] vs.8.6％ [5/58],x2 =84.249,P ＜ 0.01).There were no significant differences in age,aneurysm size,sex,and HuntHess grade (all P ＞ 0.05).(2) The incidences of intraoperative aneurysm rupture of the stent group and non-stent group were 4.8％ (3/63) and 3.4％ (2/58) respectively.There was no significant difference (x2 =0.132,P =0.717).The incidence of thromboembolie complication was 12.7％ (8/63) and 5.2％ (3/58)respectively.There was no significant difference (x2 =2.070,P =0.150).In the stent group,1 patient disabled and 1 died,and in the non-stent group,there were no cases with surgical related disability,and 1 died.(3) The comparison of immediate results after procedure between the stent group and non-stent group:there were no significant differences in the complete embolic rate (39.7％ [25/63] vs.37.9％[22/58],x2 =0.039),aneurysm neck residual rate (25.4％ [16/63] vs.39.7％ [23/58],x2 =2.811],and residual rate of aneurysm (34.9％ [22/63] vs.22.4％ [13/58],x2 =2.298,all P ＞ 0.05).(4) The recurrence rate of aneurysms (4.3％ [2/46]) of the stent group was lower than that of the non-stent group (31.8％ [14/44]).There was significant difference between the two groups (x2 =112.610,P =0.01).No rebleeding occurred in all aneurysms after procedure.Conclusion Compared with the non-stent-assisted coil embolization,the stent assisted embolization of ruptured posterior communicating artery aneurysms in acute phase may reduce the recurrence rate of aneurysms and without significantly increasing the incidence of surgery-related complications.

Objective:To investigate the effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume benign prostatic hyperplasia (BPH).Methods:The case data of 120 patients diagnosed with small volume BPH in the Yan′an University Affiliated Hospital from June 2020 to June 2022 were retrospectively analyzed, and they were divided into improved group and conventional group according to different treatment methods, with 60 cases in each group. Patients in the improved group were treated with 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip, and patients in the conventional group were treated with 980 nm semiconductor laser vaporization of prostate. The sexual function of the patients was evaluated by the international erectile function index-5(IIEF-5) score, erectile hardness score (EHS) and retrograde ejaculation before surgery and 1, 3, 6, and 12 months after surgery. International prostate symptom scale (IPSS), quality of life (QOL) score, the maximum urine flow rate (Qmax) and postvoid residual urine (PVR) were used to evaluate urinary control function. The incidence of urinary incontinence, bladder neck contracture and other complications were compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups. The count data were expressed as cases and percentage, and Chi-square test was used for comparison between groups. Results:There was no significant difference in PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score between two groups ( P>0.05). In terms of PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score at 1, 3, 6 and 12 months after surgery, all these parameters were significantly improved compared with the preoperative, the differences were statistically significant ( P< 0.05). However, there was no significant difference between the two groups ( P> 0.05). There was no significant difference in IIEF-5 score and EHS score between the two groups during postoperative follow-up and before and after operation ( P> 0.05). The incidence of retrograde ejaculation rate in the improved group was lower than that in the conventional group during the follow-up 1, 3, 6 months after surgery, and the difference was statistically significant ( P<0.05). In the follow-up 1, 3 months after surgery, the incidence of stress urinary incontinence in the improved group was lower than that in the conventional group, the differences were statistically significant ( P< 0.05). At follow-up 6, 12 months after surgery, the rates of stress urinary incontinence were similar between the two groups, and the difference was not statistically significant ( P> 0.05). In the follow-up 12 months after surgery, there were 2 cases (3.33%) of bladder and neck contracture in the improved group, and 8 cases (13.33%) in the conventional group, the difference was statistically significant ( P<0.05). Conclusions:The effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume BPH patients is similar to that of conventional vaporization, and the operation time is short. At the same time, the proximal 1 cm tissue of the verticulae and the integrity of the bladder neck are preserved, and the internal and external sphincter of the urethra are protected, thus improving the immediate postoperative urinary control rate and the incidence of retrograde ejaculation in small volume BPH patients.