Objective:To investigate the imaging characteristics of small intestinal epithe-lioid angiosarcoma.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 male patients with small intestinal epithelioid angiosarcoma who were admitted to 3 medical centers, including Yantaishan Hospital of Yantai et al, from January 2013 to December 2023 were collected. The age of 5 patients was 54 (range, 36-73)years. All 5 patients underwent computer tomography (CT) plain scan and dynamic contrast-enhanced scan, with 1 patient also undergoing magnetic resonance imaging (MRI) plain scan. Observation indicators: (1) results of CT and MRI examination; (2) surgical conditions and postoperative pathological examination; (3) follow-up. Measurement data with skewed distribution were represented as M(range), and count data were described as absolute numbers. Results:(1) Results of CT and MRI examination. Of the 5 patients with small intestinal epithelioid angiosarcoma, two cases were primary small intestinal epithelioid angiosarcoma and the other three cases were metastatic small intestinal epithelioid angiosarcoma. None of the five patients exhibited metastasis to other solid organs, and no significant ascites or peritoneal metastases. ① In two cases of primary small intestinal epithelioid angiosarcoma, three tumors were identified, appearing as round soft tissue nodules on CT plain scan, primarily growing intraluminally. The CT value for tumors of those two cases on plain scan were 30, 35, 32 HU, respec-tively. During the arterial phase of enhanced CT scan, moderate enhancement was observed for tumors of those two cases, with CT value of 57, 72, 65 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those two cases, with CT value of 76, 86, 88 HU, respectively. During the delayed phase of enhanced CT scan, slightly decreased enhancement was observed for tumors of those two cases, with CT value of 74, 79, 72 HU, showing no significant necrosis or cystic changes within the tumors. ② In three cases of metastatic small intestinal epithelioid angiosarcoma, four tumors were identified with uneven thickening of the intestinal wall appeared on CT plain scan. The CT value for tumors of those three cases on plain scan were 39, 37, 38, 28 HU, respectively. During the arterial phase of enhanced CT scan, mild to moderate enhancement was observed for tumors of those three cases, with CT value of 57, 56, 52, 45 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those three cases, with CT value of 84, 88, 82, 77 HU, respectively. During the delayed phase of enhanced CT scan, further changes of increased or decreased enhancement was observed for tumors of those three cases, with CT value of 95, 78, 72, 70 HU. One case of those three patients had thickened intestinal wall with low signal on T1-weighted imaging, heterogeneous high signal on fat-suppressed T2-weighted imaging, significant high signal on diffusion-weighted imaging and low signal on apparent diffusion coefficient imaging on MRI scan. (2) Surgical conditions and post-operative pathological examination. All five cases underwent complete tumor resection. In two cases of primary epithelioid angiosarcoma with three small intestinal tumor foci, there were two tumors invading the serosa and one tumor invading the submucosa. All three metastatic epithelioid angio-sarcoma cases showed four tumors invasion through the serosa, with one case exhibiting mesenteric lymph node metastasis. Microscopic examination revealed hemorrhagic necrosis on the tumor mucosal surface, with tumor cells located in the submucosa or throughout the intestinal wall, displaying infiltrative growth patterns. The distribution was diffuse, with local networks forming irregularly sized vascular-like structures, containing red blood cells and forming blood sinuses and vascular networks. Tumor cells were arranged in solid sheets, strands, and nests, exhibiting spindle-shaped or epithelioid characteristics, with marked atypia, large nuclei, prominent nucleoli, and mitotic figures. Immunohistochemical analysis showed diffuse strong positivity for CD31, Fli-1, and Vim in all five patients. (3) Follow-up. All five patients were followed up postoperatively for 6(range, 3?48)months. During the follow-up period, four patients succumbed to widespread metastasis. One patient with metastatic small intestinal epithelioid angiosarcoma underwent six cycles of chemotherapy and remained in good condition four years post-surgery.Conclusion:The imaging characteristics of small intestinal epithelioid angiosarcoma include abnormal thickening or masses of the intestinal wall.

Objective:To investigate the imaging characteristics of small intestinal epithe-lioid angiosarcoma.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 male patients with small intestinal epithelioid angiosarcoma who were admitted to 3 medical centers, including Yantaishan Hospital of Yantai et al, from January 2013 to December 2023 were collected. The age of 5 patients was 54 (range, 36-73)years. All 5 patients underwent computer tomography (CT) plain scan and dynamic contrast-enhanced scan, with 1 patient also undergoing magnetic resonance imaging (MRI) plain scan. Observation indicators: (1) results of CT and MRI examination; (2) surgical conditions and postoperative pathological examination; (3) follow-up. Measurement data with skewed distribution were represented as M(range), and count data were described as absolute numbers. Results:(1) Results of CT and MRI examination. Of the 5 patients with small intestinal epithelioid angiosarcoma, two cases were primary small intestinal epithelioid angiosarcoma and the other three cases were metastatic small intestinal epithelioid angiosarcoma. None of the five patients exhibited metastasis to other solid organs, and no significant ascites or peritoneal metastases. ① In two cases of primary small intestinal epithelioid angiosarcoma, three tumors were identified, appearing as round soft tissue nodules on CT plain scan, primarily growing intraluminally. The CT value for tumors of those two cases on plain scan were 30, 35, 32 HU, respec-tively. During the arterial phase of enhanced CT scan, moderate enhancement was observed for tumors of those two cases, with CT value of 57, 72, 65 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those two cases, with CT value of 76, 86, 88 HU, respectively. During the delayed phase of enhanced CT scan, slightly decreased enhancement was observed for tumors of those two cases, with CT value of 74, 79, 72 HU, showing no significant necrosis or cystic changes within the tumors. ② In three cases of metastatic small intestinal epithelioid angiosarcoma, four tumors were identified with uneven thickening of the intestinal wall appeared on CT plain scan. The CT value for tumors of those three cases on plain scan were 39, 37, 38, 28 HU, respectively. During the arterial phase of enhanced CT scan, mild to moderate enhancement was observed for tumors of those three cases, with CT value of 57, 56, 52, 45 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those three cases, with CT value of 84, 88, 82, 77 HU, respectively. During the delayed phase of enhanced CT scan, further changes of increased or decreased enhancement was observed for tumors of those three cases, with CT value of 95, 78, 72, 70 HU. One case of those three patients had thickened intestinal wall with low signal on T1-weighted imaging, heterogeneous high signal on fat-suppressed T2-weighted imaging, significant high signal on diffusion-weighted imaging and low signal on apparent diffusion coefficient imaging on MRI scan. (2) Surgical conditions and post-operative pathological examination. All five cases underwent complete tumor resection. In two cases of primary epithelioid angiosarcoma with three small intestinal tumor foci, there were two tumors invading the serosa and one tumor invading the submucosa. All three metastatic epithelioid angio-sarcoma cases showed four tumors invasion through the serosa, with one case exhibiting mesenteric lymph node metastasis. Microscopic examination revealed hemorrhagic necrosis on the tumor mucosal surface, with tumor cells located in the submucosa or throughout the intestinal wall, displaying infiltrative growth patterns. The distribution was diffuse, with local networks forming irregularly sized vascular-like structures, containing red blood cells and forming blood sinuses and vascular networks. Tumor cells were arranged in solid sheets, strands, and nests, exhibiting spindle-shaped or epithelioid characteristics, with marked atypia, large nuclei, prominent nucleoli, and mitotic figures. Immunohistochemical analysis showed diffuse strong positivity for CD31, Fli-1, and Vim in all five patients. (3) Follow-up. All five patients were followed up postoperatively for 6(range, 3?48)months. During the follow-up period, four patients succumbed to widespread metastasis. One patient with metastatic small intestinal epithelioid angiosarcoma underwent six cycles of chemotherapy and remained in good condition four years post-surgery.Conclusion:The imaging characteristics of small intestinal epithelioid angiosarcoma include abnormal thickening or masses of the intestinal wall.

Objective To investigate the features of MSCT and multiple planar reformatting (MPR) technology in the diagnosis of urachal calculus,and also to improve knowledge and diagnosis of the disease.Methods Retrospective analysis was made on the images and clinical data of 19 cases of urachal calculus (male 12,female 7) by MSCT and MPR.Of the 19 cases,8 were confirmed by surgery and 11 were diagnosed by cystoscopy.MSCT and MPR were performed in all the cases,of which 9 cases underwent enhanced CT.Results In the 19 patients,there were 13 cases of multiple calculus and 6 cases of single calculus,with the affected sites mostly at the junction of bladder and urachus or at the urachus near the bladder.The calculi displayed circular or elliptic shape,with smooth edges and uniform density.CT values were over 400 HU and the diameter of the calculus was about 0.5-2.7 cm.Seven cases were accompanied with regional thickening of bladder wall,which was diagnosed by enhanced CT.In the 19 cases that underwent MPR,it was clearly seen that 16 cases had calculi in urachus and 3 cases had calculi on anterior wall of the bladder.Clear diagnosis could be made from the cross-sectional CT image,however,sagittal plane view or tilted sagittal plane view was more direct.Conclusions Urachal calculus often developed in urachal diverticulum on the basis of the primary disease,and CT manifestation was typical.Clear diagnosis could be made by MSCT combined with MPR.

Objective To investigate the features of MSCT and multiple planar reformatting (MPR) technology in the diagnosis of urachal calculus,and also to improve knowledge and diagnosis of the disease.Methods Retrospective analysis was made on the images and clinical data of 19 cases of urachal calculus (male 12,female 7) by MSCT and MPR.Of the 19 cases,8 were confirmed by surgery and 11 were diagnosed by cystoscopy.MSCT and MPR were performed in all the cases,of which 9 cases underwent enhanced CT.Results In the 19 patients,there were 13 cases of multiple calculus and 6 cases of single calculus,with the affected sites mostly at the junction of bladder and urachus or at the urachus near the bladder.The calculi displayed circular or elliptic shape,with smooth edges and uniform density.CT values were over 400 HU and the diameter of the calculus was about 0.5-2.7 cm.Seven cases were accompanied with regional thickening of bladder wall,which was diagnosed by enhanced CT.In the 19 cases that underwent MPR,it was clearly seen that 16 cases had calculi in urachus and 3 cases had calculi on anterior wall of the bladder.Clear diagnosis could be made from the cross-sectional CT image,however,sagittal plane view or tilted sagittal plane view was more direct.Conclusions Urachal calculus often developed in urachal diverticulum on the basis of the primary disease,and CT manifestation was typical.Clear diagnosis could be made by MSCT combined with MPR.

Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma,and investigate the key points of diagnosis and differentiation.Methods This was a retrospective descriptive study.The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August,2015 were collected.The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP).Observational indexes included:(1) imaging features:location,size,signal intensity and enhancement characteristics of the lesion;(2) treatment and prognosis:surgical treatment,pathological findings,results of immunohistochemical staining and clinical follow-up.After preoperative related examinations,the patient and relatives were willing to receive surgical therapy,and postoperative pathological examinations and immunohistochemical staining were conducted.The follow-up using outpatient examination was performed to detect the patient's recovery and clinical symptoms up to January 2016.Ultrasound and laboratory examinations [alanine transaminase (ALT),aspartate transaminase (AST),γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded.Results (1) Imaging features:pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct.The nodular was measured 1.2 cm × 0.9 cm at maximum cross-section.The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma,slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image.MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts.The width of common bile duct was 1.4 cm.After administration of contrast materials,the nodular showed avid enhancement and delay enhancement,which was mild enhancement at the artery phase,and gradual increase at the portal vein phase and the delay phase.The length of central stricture of the common bile duct was 1.3 cm.There was no abnormal enhancement in liver,spleen and pancreas.No retroperitoneal lymphadenopathy could be seen.The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts.(2) Treatment and prognosis:the patient received surgery for tumor resection and Roux-en-Y reconstruction.The removed gross specimen was a grey-white nodular measured 2.0 cm × 1.0 cm.The cute surface was grey-white and stiff.The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma.Normal biliary epithelial cells can be seen beside the nerve bundles.Immunohistochemical staining showed S-100 and Vimentin were positive.The index of Ki-67 was 5％.The patient was discharged at 14 days postoperatively with the good recovery.During postoperative 5-month follow-up,the patient had good recovery and jaundice seleras were disappeared.Ultrasound showed the bile ducts were not dilated.The results of laboratory examinations were normal.Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration.

Objective To summarize the imaging characteristics of the hepatic epithelioid hemangioendothelioma (EHE).Methods The clinical data of 6 patients with hepatic EHE who were admitted to the Yantaishan Hospital (3 patients), Zhangzhou Hospital of Traditional Chinese Medicine (2 patients) and Zhangqiu Hospital of Traditional Chinese Medicine (1 patient) between March 2007 and June 2014 were retrospectively analyzed.All the patients underwent plain scan and dynamic enhanced scan of computed tomography (CT), and the number,shape, size, location, density or signal, level and method of enhancement of the lesions were observed and analyzed.Six patients were followed up by outpatient imaging examination up to June 2014, and the changes of lesions were observed.Results Among the 6 patients, 1 solitary lesion and 5 multiple lesions were detected, and the total lesions were 125 including 1 patient with 75 lesions.The lesions were round or round-like and originated commonly from the right lobe of liver and hepatic subcapsular with a maximum diameter of 0.5-3.5 cm.Plain scan of CT showed that the lesions in 6 patients had low density with the clear boundary.MRI showed that low T1 WI signal and high or slightly high T2WI signal of the lesions were detected in 4 patients.Two patients had liver capsular retraction sign.The ring-like enhancement of 1 lesion and homogeneous enhancement of 5 lesions were found by dynamic enhanced scan of CT in 6 patients and enhanced scan of MRI in 4 patients.Enhanced signal in all the lesions was detected in the delayed phase.Veins into or through lesions were found in 3 lesions, with normal or narrowing vascular cavity.One patient had visible lollipop sign.Of the 6 patients, 5 were confirmed as with metastatic carcinoma of liver, and 1 was suggested as with cholangiocarcinoma.Six patients were diagnosed with hepatic EHE by pathological examination using hepatic biopsy technique.Among the 2 patients with hepatic EHE who didn't receive antineoplastic treatment after the diagnosis, 1 patient received CT examination at year 2 after first visit, which showed capsular retraction sign, and then was diagnosed as with secondary hepatic cirrhosis by MRI at 4 years after first visit.Another patient was diagnosed as with hepatic cirrhosis by CT examination at year 6.5 after first visit.One patient was diagnosed with tumor recurrence of hepatic left lobe by CT reexamination at postoperative year 4, and underwent ultrasound-guided radio frequency ablation (RFA) treatment based on no enlargement of tumor during 1-year follow-up, and then returned a normal condition after half year follow-up.Other 3 patients undergoing operation were followed up at postoperative year 1 , 4, 5 with no recurrence and metastasis.Conclusions Intrahepatic single or multiple nodules and delayed reinforcement by dynamic enhanced scan of CT and MRI are the typical imaging performances of hepatic EHE.There are certain characteristics in the liver the lollipop sign, capsular retraction sign and veins into or through the lesions.Mutual fusion and fibrosis of lesions leading ultimately to secondary liver cirrhosis may be characteristics of EHE growth.

Hepatic eosinophilic granuloma is a rare benign liver lesion,which results from granuloma formation due to chronic inflammation.Two patients were admitted to the Yantaishan Hospital and Yuhuangding Hospital from July 2008 to April 2012,respectively.The results of laboratory examination showed the elevation of peripheral blood eosinophils,and ultrasound examinations revealed low-echo masses in the liver and no blood flow was detected.The results of computed tomography showed hypoattenuation lesions with well-demarcated boundary.After intravenous administration of contrast angent,the lesions demostrated delayed heterogeneous enhancement with internal grid.The results of magnetic resonance imaging of 1 patient showed the lesion had slight hyper-intensity to the surrounding liver parenchyma on T1-weighted images,and slight high signal with low signal separation strip inside on fat-suppressed T2-weighted images.An obvious high signal was detected in diffusion weighted imaging.Familiarity with the imaging characteristics and combination of the elevation of peripheral eosinophil can help surgeons to make a suggestive diagnosis.

Primary hepatic malignant fibrous histiocytoma(PHMFH)remains extremely rare with less than 60 cases reported in literature.From October 1999 to May 2008,5 patients with PHMFH had been admitted to Yantai Cancer Hospital,Yantai Yuhuangding Hospital and the First Affiliated Hospital of Wenzhou Medical College,and the results of spiral CT were analyzed.Six tumors were detected,and the maximum diameter of the tumors was more than 8.5 cm.CT plain scanning revealed that all tumors were hypodense,4 patients with tumor necrosis and cystic degeneration,and the tumor in 1 patient wag with homogen density.Enhanced CT scanning showed marked enhancement of the solid component of tumor in 4 patients,slight enhancement in 1 patient,and a"fast in and fast out"sign in 5 patients.Hepatic bile ducts and portal vein were not involved.One patient was with portal lymph node metastasis and 1 with ioferior vena cava involvement.The characteristics of spiral CT imaging of PHMFH include tumor necrosis,cystis and invasion,as well as"fast in and fast out"sign,which could help to diagnose,although the ultimate diagnosis depends on histopathological examination.

Objective To improve the imaging recognition of the lymphangiomyomatosis.Methods The manifestations of 2 patients with lymphangiomyomatosis confirmed by pathological assessment were analyzed retrospectively and relevant literature were reviewed.Results Multiple,well-defined and thin-walled cysts were found on the chest HRCT.The size of the cystic airspace was different,and the wall of cysts ranged being fainted perceptible to near l mm in thickness.The retroperitoneal lymphangiomyomatosis were found in the 2 patients on CT images,and some lymphadens were confluence.The diameter of the largest lymphadens was 25 mm,no enhancement were found on contrast-enhanced CT scan.The right renal angioleiomyoma and retroperitoneal leiomyoma were presented in one patient,which were moderately homogeneous enhanced on contrast-enhanced CT scan.Conclusion Lymphangiomyomatosis is a rare lymphangial disease with smooth muscle abnormal hyperplasia.The diffuse cysts in bilateral lungs were its characteristic changes on CT images.Lymphangiomyomatosis can incorporate with renal angioleiomyoma,retroperitoneal leiomyoma and lymphangiomyomatosis.

Objective To evaluate CT manifestations and pathologic findings of thyroglossal cyst.Methods CT manifestations,clinical materials and pathological findings of 12 cases with thyroglossal defined by pathology were analysed.Results Of 12 cases,the the lesions were located at the center line of the neck in 8 cases and at left of the neck in 4 cases.The cysts were round or oblate in shape on CT scans.In 5 cases the walls of cyst were smooth and no enhanced;while in other 7 cases the cystic walls were coarse and enhanced evidently which there were infiltration of inflammatory cell microscopic examination.The nodules at cystic wall which were composed by blood vessel,striated muscle and connective tissue on pathology could be seen on CT scans while if these nodules were minor,they could hardly to be showed by CT.Conclusion CT can make a proper diagnosis of thyroglossal cyst.