Purpose To investigate the CT and MRI features of papillary tumor of the pineal region(PTPR).Materials and Methods A total of seven cases pathologically diagnosed as PTPR in Nanfang Hospital,Southern Medical University from August 2009 to December 2022 were retrospectively analyzed,including patients'clinical and imaging data.Seven patients underwent MRI plain and enhanced scan,and five patients underwent CT scan at the same time.Results Supratentorial hydrocephalus was found in seven cases.The boundary of the tumor was clear,with a maximum diameter of about 1.8-5.9 cm,with an average of(2.8±1.5)cm.The tumors appeared as round in four cases and irregular masses in three cases.MRI showed mixed intensity on T1WI and inhomogeneous slight hyperintensity on T2WI of most cases,in which four lesions showed small patchy hyperintensity on T1WI.Four cases underwent diffusion weighted imaging,and three cases showed limited diffusion.Six PTPR lesions showed cystic degeneration,and three lesions had hemorrhage.On contrast-enhanced scans,most of the tumors demonstrated inhomogeneous moderate to obvious enhancement.The solid components of the lesions showed slightly high density on CT both in five cases,and calcification was present in three cases.Conclusion The imaging findings of PTPR have some characteristics,mostly with well-defined round or irregular masses,the tumor is prone to cystic degeneration,and the hyperintensity on T1WI is one of the characteristic images of the disease.

Objective To investigate the effectiveness of optimized flow sensitive black blood(FSBB)imaging in detecting the number of branches and measuring the depth of lenticulostriate arteries(LSAs)in patients with acute ischemic stroke.Methods The ima-ging and clinical data of 39 patients with acute ischemic stroke who underwent vascular recanalization under digital subtraction angi-ography(DSA)were prospectively collected.All patients received 3.0T MR FSBB imaging within 48-96 hours postoperatively.The number and depth of LSAs branches on the affected side were observed,measured and recorded by the post-processing workstations for both FSBB and DSA images.The difference and correlation of the number and average depth of LSAs branches detected by FSBB and DSA were analyzed.The consistency of the average depth of LSAs branches detected by FSBB and DSA was evaluated.Results There was no statistically significant difference in the number and depth of bilateral LSAs branches detected by FSBB and DSA(P＞0.05).FSBB and DSA showed strong positive correlations in detecting the number and depth of LSAs branches(r=0.786,0.704;P＜0.05).The number of average depth difference of bilateral LSAs branches detected by FSBB and DSA exceeded the limit of agreement(LoA)was 3,accounting for 4.92％(＜5％).Conclusion Optimized FSBB imaging can be used to assess the detection of the number and depth measurement of LSAs branches in patients with acute ischemic stroke,showing good consistency with DSA.It provides valua-ble imaging evidence for the morphological assessment of LSAs in clinical practice.

Object:To explore the feasibility of using artificial intelligence for quality control of echocardiographic images.Methods:Retrospectively，5 000 two-dimensional echocardiographic video images within the period from 2021 to 2023 were randomly retrieved from the echocardiography database of Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School，Nanjing University. Among these selected images，1 559 of them were apical views. The physician team formulated the scoring rules，which specifically included four scoring criteria：gain，scaling ratio，cardiac axis angle，and structure. Subsequently，the data were labeled with view classification and image quality scores. The labeled data were further partitioned into the training set（ n = 643），the validation set（ n = 276），and the test set（ n = 640）. The training and validation sets were utilized for constructing the models for view classification and quality assessment，while the test set was employed to verify the models' effectiveness. The view classification module was implemented using the SlowFast model，and the quality assessment module involved algorithms such as ResNet，Video Swin Transformer，SSD，and U-Net. Results:The average accuracy，precision，recall rate and F1 score of the classification model in identifying each apical view were 0.987 1，0.983 0，0.987 1 and 0.984 9 respectively，and the inference time was（333.4 ± 105.4）ms. The average accuracies of the quality assessment module in terms of gain，scaling ratio，cardiac axis angle and display of main structures were 0.915 1，0.928 2，0.938 7 and 0.965 6 respectively，and the overall scoring accuracy was 0.912 7.Conclusions:The echocardiogram quality control system developed in this research can effectively classify and evaluate the quality of two-dimensional images of the apical views in echocardiograms. Moreover，it guarantees the objectivity，timeliness and high-efficiency of quality control，which has reference value for the establishment of the echocardiogram quality control system.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Permanent left superior vena cava aneurysm is a rare mediastinal venous lesion，the majority of the literature is in the form of case reports. In this article，a 50-year-old female with an incidental permanent left superior vena cava aneurysm discovered on echocardiography in Nanjing Gulou Hospital，and the right heart contrast-enhanced echocardiographic played an important role in the process of clear diagnosis. The patient was observed without intervention. No complications were attributable to the permanent left superior vena cava aneurysm during follow-up.

Purpose To investigate the CT and MRI features of papillary tumor of the pineal region(PTPR).Materials and Methods A total of seven cases pathologically diagnosed as PTPR in Nanfang Hospital,Southern Medical University from August 2009 to December 2022 were retrospectively analyzed,including patients'clinical and imaging data.Seven patients underwent MRI plain and enhanced scan,and five patients underwent CT scan at the same time.Results Supratentorial hydrocephalus was found in seven cases.The boundary of the tumor was clear,with a maximum diameter of about 1.8-5.9 cm,with an average of(2.8±1.5)cm.The tumors appeared as round in four cases and irregular masses in three cases.MRI showed mixed intensity on T1WI and inhomogeneous slight hyperintensity on T2WI of most cases,in which four lesions showed small patchy hyperintensity on T1WI.Four cases underwent diffusion weighted imaging,and three cases showed limited diffusion.Six PTPR lesions showed cystic degeneration,and three lesions had hemorrhage.On contrast-enhanced scans,most of the tumors demonstrated inhomogeneous moderate to obvious enhancement.The solid components of the lesions showed slightly high density on CT both in five cases,and calcification was present in three cases.Conclusion The imaging findings of PTPR have some characteristics,mostly with well-defined round or irregular masses,the tumor is prone to cystic degeneration,and the hyperintensity on T1WI is one of the characteristic images of the disease.

Objective To investigate the effectiveness of optimized flow sensitive black blood(FSBB)imaging in detecting the number of branches and measuring the depth of lenticulostriate arteries(LSAs)in patients with acute ischemic stroke.Methods The ima-ging and clinical data of 39 patients with acute ischemic stroke who underwent vascular recanalization under digital subtraction angi-ography(DSA)were prospectively collected.All patients received 3.0T MR FSBB imaging within 48-96 hours postoperatively.The number and depth of LSAs branches on the affected side were observed,measured and recorded by the post-processing workstations for both FSBB and DSA images.The difference and correlation of the number and average depth of LSAs branches detected by FSBB and DSA were analyzed.The consistency of the average depth of LSAs branches detected by FSBB and DSA was evaluated.Results There was no statistically significant difference in the number and depth of bilateral LSAs branches detected by FSBB and DSA(P＞0.05).FSBB and DSA showed strong positive correlations in detecting the number and depth of LSAs branches(r=0.786,0.704;P＜0.05).The number of average depth difference of bilateral LSAs branches detected by FSBB and DSA exceeded the limit of agreement(LoA)was 3,accounting for 4.92％(＜5％).Conclusion Optimized FSBB imaging can be used to assess the detection of the number and depth measurement of LSAs branches in patients with acute ischemic stroke,showing good consistency with DSA.It provides valua-ble imaging evidence for the morphological assessment of LSAs in clinical practice.

Stiff person syndrome (SPS) is a rare neuro-immune disorder characterized by exaggerated startle responses and muscle spasms in response to minor stimuli. SPS is often misdiagnosed as panic disorder or agoraphobia. This paper reported a case of a patient with SPS presenting symptoms similar to panic attack. The patient had been misdiagnosed as dystonia, anxiety disorder and panic attack. The patient was finally correctly diagnosed through multiple disciplinary team discussions. This study integrates a comprehensive understanding of symptomatology and patient-reported experiences with targeted neurological evaluations and supplementary diagnostic tools to improve the accuracy of etiological diagnoses. This study aims to enhance the ability of psychiatrists to recognize somatic diseases presenting with psychiatric symptoms and to improve clinical diagnostic and treatment levels.

Object:To explore the feasibility of using artificial intelligence for quality control of echocardiographic images.Methods:Retrospectively，5 000 two-dimensional echocardiographic video images within the period from 2021 to 2023 were randomly retrieved from the echocardiography database of Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School，Nanjing University. Among these selected images，1 559 of them were apical views. The physician team formulated the scoring rules，which specifically included four scoring criteria：gain，scaling ratio，cardiac axis angle，and structure. Subsequently，the data were labeled with view classification and image quality scores. The labeled data were further partitioned into the training set（ n = 643），the validation set（ n = 276），and the test set（ n = 640）. The training and validation sets were utilized for constructing the models for view classification and quality assessment，while the test set was employed to verify the models' effectiveness. The view classification module was implemented using the SlowFast model，and the quality assessment module involved algorithms such as ResNet，Video Swin Transformer，SSD，and U-Net. Results:The average accuracy，precision，recall rate and F1 score of the classification model in identifying each apical view were 0.987 1，0.983 0，0.987 1 and 0.984 9 respectively，and the inference time was（333.4 ± 105.4）ms. The average accuracies of the quality assessment module in terms of gain，scaling ratio，cardiac axis angle and display of main structures were 0.915 1，0.928 2，0.938 7 and 0.965 6 respectively，and the overall scoring accuracy was 0.912 7.Conclusions:The echocardiogram quality control system developed in this research can effectively classify and evaluate the quality of two-dimensional images of the apical views in echocardiograms. Moreover，it guarantees the objectivity，timeliness and high-efficiency of quality control，which has reference value for the establishment of the echocardiogram quality control system.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.