Objective To analyze the characteristics of MR amide proton transfer(APT)imaging and enhancement signals in benign and malignant muscular soft tissue tumors and to explore the value of MR APT imaging,contrast enhancement techniques,and their combined application in the differential diagnosis of benign and malignant muscular soft tissue tumors.Methods A retrospective analysis was conducted on 34 patients with muscular soft tissue tumors confirmed by pathology,including 13 malignant and 21 benign.All patients underwent both MR with contrast enhancement and APT imaging examinations before surgery.APT values were obtained through post-processing on an image workstation.The enhancement signal characteristics and APT values were compared between benign and malignant muscular soft tissue tumors.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of the two techniques alone and in combination for differentiating between benign and malignant muscular soft tissue tumors.Results There were significant differences in enhancement signal characteristics on MR and APT values between benign and malignant muscular soft tissue tumors(P<0.05).The enhancement signal of malignant tumors was more heterogeneous,with higher enhancement degree than benign tumors;the APT value of benign tumors was(2.20±0.93)%,and the APT value of malignant tumors was(3.52±0.83)%,the ROC curve analysis determined a cutoff APT value of 2.82%for malignant tumors,with a diagnostic specificity of 90.5%and sensitivity of 76.9%.The area under the curve(AUC)for MR with contrast enhancement,APT imaging,and the combination of the two techniques were 0.694,0.857 and 0.894,respectively.No significant differences were found in the diagnostic efficacy between MR with contrast enhancement and APT imaging(Z=1.587,P=0.112 6)or between APT imaging and the combination of the two tech-niques(Z=1.217,P=0.223 4),but there was significant difference between MR with contrast enhancement and the combination of the two techniques(Z=2.428,P=0.015 2).Moreover,the combination of the two techniques showed the overall highest diag-nostic efficacy.Conclusion The combined application of MR APT imaging and contrast enhancement techniques is more beneficial for the qualitative diagnosis of muscular soft tissue tumors.

Objective To analyze the characteristics of MR amide proton transfer(APT)imaging and enhancement signals in benign and malignant muscular soft tissue tumors and to explore the value of MR APT imaging,contrast enhancement techniques,and their combined application in the differential diagnosis of benign and malignant muscular soft tissue tumors.Methods A retrospective analysis was conducted on 34 patients with muscular soft tissue tumors confirmed by pathology,including 13 malignant and 21 benign.All patients underwent both MR with contrast enhancement and APT imaging examinations before surgery.APT values were obtained through post-processing on an image workstation.The enhancement signal characteristics and APT values were compared between benign and malignant muscular soft tissue tumors.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of the two techniques alone and in combination for differentiating between benign and malignant muscular soft tissue tumors.Results There were significant differences in enhancement signal characteristics on MR and APT values between benign and malignant muscular soft tissue tumors(P<0.05).The enhancement signal of malignant tumors was more heterogeneous,with higher enhancement degree than benign tumors;the APT value of benign tumors was(2.20±0.93)%,and the APT value of malignant tumors was(3.52±0.83)%,the ROC curve analysis determined a cutoff APT value of 2.82%for malignant tumors,with a diagnostic specificity of 90.5%and sensitivity of 76.9%.The area under the curve(AUC)for MR with contrast enhancement,APT imaging,and the combination of the two techniques were 0.694,0.857 and 0.894,respectively.No significant differences were found in the diagnostic efficacy between MR with contrast enhancement and APT imaging(Z=1.587,P=0.112 6)or between APT imaging and the combination of the two tech-niques(Z=1.217,P=0.223 4),but there was significant difference between MR with contrast enhancement and the combination of the two techniques(Z=2.428,P=0.015 2).Moreover,the combination of the two techniques showed the overall highest diag-nostic efficacy.Conclusion The combined application of MR APT imaging and contrast enhancement techniques is more beneficial for the qualitative diagnosis of muscular soft tissue tumors.

Objective To analyze the difference of rotator cuff muscle group fat content by MR proton density fat fraction(PDFF)tech-nology,and to explore the correlation between these variations and the severity grading of supraspinatus tendon injury.Methods Ninety-three patients with supraspinatus tendon injury were retrospectively selected and divided into the tendinitis group(grade Ⅰ),the partial tear group(grade Ⅱ),and the complete tear group(grade Ⅲ).The fat fraction(FF)values of the three groups of rotator cuff mus-cle group were measured using the PDFF technology,and the differences in FF values among the rotator cuff muscle group in the three groups were compared.The risk factors of the grading of supraspinatus tendon injury and the correlation between FF values and the severity grading of supraspinatus tendon injury were analyzed.Results The differences in the FF values of the supraspinatus and infraspinatus muscles among the three groups were statistically significant(P＜0.01).The FF values of both the supraspinatus and infraspinatus muscles were identified as significant factors associated with the severity grading of supraspinatus tendon injury.Further-more,the FF values of the supraspinatus and infraspinatus muscles were positively correlated with the severity grading of supraspina-tus tendon injury(r=0.576,P＜0.01;r=0.510,P＜0.01).Conclusion MR PDFF technology can effectively evaluate the extent of fat infiltration in the rotator cuff muscle group after supraspinatus tendon injury.Specifically,the FF values of the supraspinatus and infraspinatus muscles serve as reliable quantitative indicators for classifying supraspinatus tendon injury.

Objective:To investigate the clinical manifestations of medically refractory hereditary movement disorders in children and the efficacy of deep brain stimulation (DBS).Methods:A case series study.The clinical and follow-up data of 20 children with medically refractory hereditary movement disorders who underwent DBS treatment at the Neurology and Functional Neurosurgery Departments of Beijing Children′s Hospital, Capital Medical University, from July 2018 to April 2024, were retrospectively analyzed.The severity of movement disorder symptoms and surgical effects were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale Movement(BFMDRS-M) or the Unified Parkinson′s Disease Rating Scale Ⅲ(UPDRS Ⅲ).Results:There were 12 males and 8 females among the 20 children, with an onset age ranging from 4 months to 12 years and 5 months.Fourteen patients had hereditary dystonia, which is related to KMT2B in 11 patients, TOR1A in 2 patients and SGCE in 1 patient.Two patients had choreoathetosis, which is related to ADCY5-related familial movement disorders.Two patients had early-onset Parkinson′s disease, which is related to ATP6AP2 in 1 patient and VPS13C in 1 patient.Two patients had neurodevelopmental disorders with involuntary movements, which is related to GNAO1 in 1 patient, and the other patient was idiopathic.All the children were given oral Levodopa, Benzhexol, Baclofen, Tiapride Hydrochloride, Clonazepam alone or in combination.Three children showed obvious dyskinesia after Levodopa treatment.The symptoms of movement disorders in all children exhibited little to no improvement.Levetiracetam and Zonisamide had unstable effects in the treatment of myoclonia.DBS surgery was performed on all the patients aged from 3 to 16 years.Electrodes were successfully inserted into bilateral globus pallidus internus in 14 cases and bilateral subthalamic nuclei in 4 cases.The target was unknown in 2 cases.No surgery-related complications were observed.The patients were followed up for 3 months to 6 years, and the last follow-up age of the patients ranged from 5 years and 7 months to 22 years and 1 month.The rate of improvement in BFMDRS-M score was 37%-100% in 16 patients and >70% in 7 patients with hereditary dystonia.The rate of improvement in UPDRS Ⅲ score was 23% in 1 patient with VPS13C-related early-onset Parkinson′s disease. Conclusions:Childhood medically refractory hereditary movement disorders are a case series that exhibits significant phenotypic and genotypic heterogeneity.DBS surgery demonstrates significant efficacy for KMT2B-, TOR1A-, and SGCE-related hereditary movement disorders.

Objective To analyze the difference of rotator cuff muscle group fat content by MR proton density fat fraction(PDFF)tech-nology,and to explore the correlation between these variations and the severity grading of supraspinatus tendon injury.Methods Ninety-three patients with supraspinatus tendon injury were retrospectively selected and divided into the tendinitis group(grade Ⅰ),the partial tear group(grade Ⅱ),and the complete tear group(grade Ⅲ).The fat fraction(FF)values of the three groups of rotator cuff mus-cle group were measured using the PDFF technology,and the differences in FF values among the rotator cuff muscle group in the three groups were compared.The risk factors of the grading of supraspinatus tendon injury and the correlation between FF values and the severity grading of supraspinatus tendon injury were analyzed.Results The differences in the FF values of the supraspinatus and infraspinatus muscles among the three groups were statistically significant(P＜0.01).The FF values of both the supraspinatus and infraspinatus muscles were identified as significant factors associated with the severity grading of supraspinatus tendon injury.Further-more,the FF values of the supraspinatus and infraspinatus muscles were positively correlated with the severity grading of supraspina-tus tendon injury(r=0.576,P＜0.01;r=0.510,P＜0.01).Conclusion MR PDFF technology can effectively evaluate the extent of fat infiltration in the rotator cuff muscle group after supraspinatus tendon injury.Specifically,the FF values of the supraspinatus and infraspinatus muscles serve as reliable quantitative indicators for classifying supraspinatus tendon injury.

Objective:To investigate the clinical manifestations of medically refractory hereditary movement disorders in children and the efficacy of deep brain stimulation (DBS).Methods:A case series study.The clinical and follow-up data of 20 children with medically refractory hereditary movement disorders who underwent DBS treatment at the Neurology and Functional Neurosurgery Departments of Beijing Children′s Hospital, Capital Medical University, from July 2018 to April 2024, were retrospectively analyzed.The severity of movement disorder symptoms and surgical effects were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale Movement(BFMDRS-M) or the Unified Parkinson′s Disease Rating Scale Ⅲ(UPDRS Ⅲ).Results:There were 12 males and 8 females among the 20 children, with an onset age ranging from 4 months to 12 years and 5 months.Fourteen patients had hereditary dystonia, which is related to KMT2B in 11 patients, TOR1A in 2 patients and SGCE in 1 patient.Two patients had choreoathetosis, which is related to ADCY5-related familial movement disorders.Two patients had early-onset Parkinson′s disease, which is related to ATP6AP2 in 1 patient and VPS13C in 1 patient.Two patients had neurodevelopmental disorders with involuntary movements, which is related to GNAO1 in 1 patient, and the other patient was idiopathic.All the children were given oral Levodopa, Benzhexol, Baclofen, Tiapride Hydrochloride, Clonazepam alone or in combination.Three children showed obvious dyskinesia after Levodopa treatment.The symptoms of movement disorders in all children exhibited little to no improvement.Levetiracetam and Zonisamide had unstable effects in the treatment of myoclonia.DBS surgery was performed on all the patients aged from 3 to 16 years.Electrodes were successfully inserted into bilateral globus pallidus internus in 14 cases and bilateral subthalamic nuclei in 4 cases.The target was unknown in 2 cases.No surgery-related complications were observed.The patients were followed up for 3 months to 6 years, and the last follow-up age of the patients ranged from 5 years and 7 months to 22 years and 1 month.The rate of improvement in BFMDRS-M score was 37%-100% in 16 patients and >70% in 7 patients with hereditary dystonia.The rate of improvement in UPDRS Ⅲ score was 23% in 1 patient with VPS13C-related early-onset Parkinson′s disease. Conclusions:Childhood medically refractory hereditary movement disorders are a case series that exhibits significant phenotypic and genotypic heterogeneity.DBS surgery demonstrates significant efficacy for KMT2B-, TOR1A-, and SGCE-related hereditary movement disorders.

Objective:To evaluate the efficacy of SedLine Brain Function Monitor-guided total intravenous anesthesia for children undergoing hypospadias surgery.Methods:This was a randomized controlled trial. A total of 161 children, aged 1-10 yr, with American Society of Anesthesiologists Physical Status classification ⅠorⅡ, scheduled for elective hypospadias surgery, were divided into SedLine group (S group, n=83) and control group (C group, n=78) using a random number table method. In group S, 95% spectral edge frequency (SEF 95) was maintained at 14-18 Hz, and the patient state index (PSI) was maintained at 25-50 during surgery. In group C, mean arterial pressure was maintained at 60-80 mmHg, and heart rate was maintained at 80-110 beats/min during surgery. PSI and SEF 95 were recorded before induction (T 1), at 0, 5 and 10 min after intubation (T 2-4), at the beginning of surgery (T 5), at 30 min and 1 h after surgery (T 6, 7), and at the end of surgery (T 8). The anesthetic duration, operation time, time from withdrawal to extubation, postanesthesia care unit duration, consumption of propofol and remifentanil, intraoperative adverse events, 5-point Likert scale scores, and emergence delirium scores were recorded. Results:Compared to C group, the total anesthesia time, time from withdrawal to extubation and postanesthesia care unit duration were significantly shortened, the consumption of propofol for both induction and maintenance was reduced, the PSI at T 5-8, SEFL 95 at T 2-6, and SEFR 95 at T 2-8 were increased, and the incidence of intraoperative body movement and incidence of emergence agitation were decreased in S group ( P<0.05). Conclusions:SedLine Brain Function Monitor-guided total intravenous anesthesia provides better efficacy when used for the children undergoing hypospadias surgery.