Objective:To investigate the computed tomography (CT) features of primary liver leiomyosarcoma (PHLMS).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 10 patients with PHLMS who were admitted to 4 medical centers including 3 cases in Wenzhou Central Hospital, 3 cases in the Second Affiliated Hospital of Wenzhou Medical University, 2 cases in Wenzhou People's Hospital and 2 cases in Yueqing People's Hospital from January 2011 to December 2020 were collected. There were 5 males and 5 females, aged from 41 to 83 years, with a median age of 55 years. All 10 patients underwent abdominal CT examination. Observation indicators: (1) CT features; (2) treatment and pathological examination; (3) follow-up and survival. Follow-up using postoperative outpatient or inpatient examination to detect patient survival was conducted. Patients underwent imaging examination to detect tumor recurrence. Follow-up was up to December 2020. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) CT features: results of CT examination showed that each of the 10 patients had only one single tumor, including 3 cases with tumor on the left lobe of liver and 7 cases with tumor on the right lobe of liver. The tumor diameter of the 10 patients was 8.0 cm(range, 4.5-13.5 cm). Results of plain CT scan of 10 patients showed that 7 cases had tumor in expansive growth as round or oval, with clear boundaries and the tumor parenchyma showing low-density signals and patchy lower density area can be seen in the center, and 3 cases had tumor in infiltrative growth as patchy, with unclear boundaries and the tumor parenchyma showing iso-density signals. The CT scan value of 10 patients was 40 HU(range, 23-47 HU). Results of enhanced CT scan at arterial phase of the 7 cases with tumor in expansive growth showed that 3 cases undergoing tumor parenchyma with uneven mild enhancement signals, 3 cases undergoing tumor parenchyma with uneven moderate enhancement signals and 1 case undergoing tumor parenchyma with uneven significant enhancement signal. The CT scan value of 7 cases was 68 HU(range, 62-88 HU). Results of enhanced CT scan at arterial phase of the 3 cases with tumor in infiltrative growth showed that the peripheral region had high signal than the central region. The CT scan value of 3 cases was 73 HU(range, 67-90 HU). Results of enhanced CT scan at portal vein phase in the 7 cases with tumor in expansive growth showed that the tumor parenchyma showing continuous and progressive mild and moderate enhancement with uneven density, and the CT scan value was 63 HU(range, 55-78 HU). Of the 7 cases, 3 cases showed the enhancement range of tumor parenchyma with the trend of fusion and filling, and 4 cases showed small patchy or nodular enhancement and grid like enhancement in the center and periphery of the tumor. Results of enhanced CT scan at portal vein phase in the 3 cases with tumor in infiltrative growth showed that the enhancement withdrew, the density was uneven, and the CT scan value was 58 HU(range, 50-62 HU). Results of enhanced CT scan at delayed phase in 10 patients showed that the enhancement in the tumor withdrew slowly, and the CT scan value was 53 HU(range, 50-60 HU). Of the 10 patients, 4 cases showed decreased density of enhanced nodules around the tumor and 6 cases showed partially fused and filled to the center of tumor with no enhancement in the necrotic part. (2) Treatment and pathological examination: all 10 patients underwent completed tumor resection successfully, and no metastasis was found in liver or the hilar region. Results of postoperative pathological examination showed that each of the 10 patients had only one single visible tumor with tumor diameter of 8.0 cm(range, 4.5?13.5 cm). Of the 10 patients, 7 cases had tumor with complete or incomplete pseudocapsule with clear boundary and 3 cases had tumor without pseudocapsule and the boundary was unclear. All 10 patients had tumor with hard parenchyma and the section was mostly gray and fish like. Among them, patchy or punctate necrosis was seen in 7 cases, small patchy or punctate hemorrhage was seen in 3 cases, and small patchy calcification was seen in 2 cases. Microscopically, the tumor tissue was crisscross, the tumor cells were in spindle shaped, the nuclei were in round, oval, blunt at both ends or in thin rod like, with obvious heteromorphism, large and deeply staining, and obviously division. Immunohistochemical staining showed positive staining of smooth muscle actin, desmin and vimentin. (3) Follow-up and survival: all 10 patients were followed up postoperatively for 6 to 130 months, with a median follow-up time of 55 months. The overall survival time of 10 patients were 10 to 120 months, with a median overall survival time of 46 months. Of the 10 patients, 2 cases died of tumor recurrence and distant metastasis 10 and 11 months after operation, respectively and 8 cases survived >12 months.Conclusions:Results of plain CT scan of PHLMS show clear or unclear cysts and solid masses with uneven density. Results of enhancement CT scan of PHLMS show persistent uneven enhancement in tumor parenchyma and the surrounding area.

Objective:To explore the clinical value of magnetic resonance (MRI) multi-b-value scatter weighted imaging (DWI) combined with spectral imaging (MRS) in the diagnosis of prostate cancer.Methods:From November 2016 to August 2018, 33 patients with prostate cancer and 62 patients with benign prostatic lesions in the People's Hospital of Yongjia County were selected.DWI and MRS scans were performed and compared with pathological findings.Results:The DWI signal intensity of prostate cancer at the b value of 600s/mm 2, 1 000s/mm 2, 2 000s/mm 2 and 3 000s/mm 2 were significantly higher than those of benign prostatic lesions (all P<0.05). With the increase of b value, the sensitivity, specificity and accuracy of DWI in diagnosis of prostate cancer increased, under 3 000s/mm 2, the sensitivity, specificity and accuracy of DWI in the diagnosis of prostate cancer were 87.88%(29/33), 82.26% (51/62) and 84.21%(80/95), respectively.The sensitivity, specificity and accuracy of MRS in diagnosing prostate cancer were 69.70%(23/33), 79.03%(49/62) and 75.79%(72/95), respectively.The (choline+ creatine)/(citrate) (CC/C) value of prostate cancer (2.50±0.94) was significantly higher than that of benign prostatic lesions (0.93±0.23)( t=12.519, P<0.05). The sensitivity, specificity and accuracy of DWI at b value of 3 000s/mm 2 combined with MRS in the diagnosis of prostate cancer were 96.97%(32/33), 88.71%(55/62) and 91.58%(87/95), respectively. Conclusion:DWI combined with MRS has good application value in the diagnosis of prostate cancer.

Objective:To evaluate the imaging features of CT scan in patients with COVID-19.Methods:Clinical data of 56 patients with COVID-19 from January 17 to 19, 2020 admitted to Wenzhou Central Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively reviewed. The clinical manifestations, lung imaging characteristics and treatment outcomes of patients with different severity were analyzed with SAS software.Results:Fever (92.8%, 52/56), dry cough (75.0%, 42/56) and asthenia (58.9%, 33/56) were the first symptoms in most of the patients; some patients also had shortness of breath (25.0%, 14/56) and pharyngeal pain (10.7%, 6/56). Chest high-resolution CT scan showed that in 42 moderate patients, ground glass-like high-density shadows in the lung were observed in 30 cases (71.4%) ; localized plaque consolidation shadows and bronchial inflation signs were observed in 10 cases (23.8%). In 12 severe patients, 11 had high-density patches involving multiple lung lobes (≥3). In 2 critically ill patients the patches and stripes involving the entire lung were observed; and cord-like high-density shadow, local consolidation and fibrosis were also shown.Conclusion:The multiple ground-glass changes outside the lungs are early imaging manifestations of COVID-19 patients. The increase in pulmonary lobe consolidation and fibrosis may indicate the disease progression, and the degree of lung consolidation and fibrosis is closely related to the disease severity.

Objective: To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods: CT findings of 12 patients with primary mediastinal neuroendocrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pattern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results: Among the 12 cases, 4 cases were located in the anterior superior mediastinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of (6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, irregular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained calcification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the surrounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhancement. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclusion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

Objective To summarize the computed tomography (CT) characteristics of primary hepatic angiosarcoma (PHA).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 9 PHA patients who were admitted to the Wenzhou Chinese Medicine Hospital (3 patients),Second Affiliated Hospital of Wenzhou Medical College (3 patients) and Wenzhou People's Hospital (3 patients) between January 2006 and June 2017 were collected.All 9 patients were fasting 8 hours before CT examination,and received screen scans without abdominal pressure.Scanning area was from dome of diaphragm to lower pole of the kidneys.Two associate senior doctors made images analysis.After preoperative examinations,patients selected whether or not to undergo treatment,resection,liver transplantation or chemotherapy + targeted therapy of monoclonal antibodies.Observation indicators:(1) plain scan appearances of CT;(2) enhanced scan appearances of CT;(3) results of pathological examinations;(4) follow-up and survival situations.Follow-up using outpatient,inpatient and imaging examinations was performed to detect tumor recurrence and stable condition up to December 2017.Results (1) Plain scan appearances of CT:9 patients showed solitary tumor,and tumors were respectively located in the left lobe (3 cases) and right lobe (6 cases) of the liver,including 5 with round tumors,3 with oval tumors and 1 with patchy tumor.The maximum diameter of tumor was 5.8-16.0 cm,with an average of 10.8 cm,including maximum diameter ＞ 6.0 cm in 8 patients.Tumors of 9 patients showed low-density shadow,and CT value was 32-46 HU,with an average of 41 HU,including homogeneous density in 3 patients and heterogeneous density in 6 patients;clear tumor boundary in 6 patients and unclear tumor boundary in 3 patients;tumor necrosis and cystolization in 4 patients,slightly strip-shaped high-density shadow in the center of tumor in 4 patients,and small patch-shaped intratunoral calcification in 1 patient.(2) Enhanced scan appearances of CT:① Arterial phase:tumors of 9 patients showed mild and moderate heterogeneous enhancements,with CT value of 63-76 HU and an average of 68 HU,including small patch-shaped or nodular enhancement in 3 patients and punetate or flocculent enhancement in the center of tumor in 6 patients.Tumors of 4 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma.Tumors of 5 patients showed mild enhancements,and tumor density was equal to or slightly less than that of normal liver parenehyma.② Portal vein phase:tumors of 9 patients showed mild and moderate,continuous and progressive enhancements,with a heterogeneous density,CT value of 56-71 HU and an average of 63 HU,including extended enhancement region in 3 patients,with a fusion and filling trend;small patch-shaped or nodular and lattice network-shaped enhancements of center and periphery of tumor in 6 patients,showing center filling and enhancement features of hepatic angiosarcoma.Tumors of 2 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma;tumors of 7 patients showed mild enhancements and tumor density was equal to or slightly less than that of normal liver parenchyma.③ Delayed phase:tumor enhancements of 9 patients slowly seceded,with CT value of 50-60 HU and an average of 53 HU,including density decreasing of periphery of tumor in 3 patients;partial fusion and center filling of enhancements in 6 patients,without enhancement in necrotic area.Tumor density was slightly higher than that of normal liver parenchyma in 2 patients,equal to that of normal liver parenchyma in 1 patient,and slightly less than that of normal liver parenchyma in 6 patients.(3) Results of pathological examinations:① Pathological examinations:cut surface of tumors showed grayish yellow and drab gray,and parts of surface were fish flesh shape,with internal bleeding and necrosis.Tumors were found in diffuse hyperplasia under microscopy,tumor tissues were made up of irregular and mutual matching lacuna vasorum,with infiltrating growths along hepatic sinus gap;hepatic angiosarcoma cells were spindle,round or irregular;there were slightly eosinophilia cytoplasm and deep chromatin of the nucleus,long-shaped or irregular nucleus,and different sizes of nucleolus.② Immunohistochemical staining:CD31 and CD34 were strongly positive,vimentin and Nestine were positive,and CK19,actin and creatine kinase were negative.(4) Follow-up and survival situations:of 9 patients,3 without treatment respectively died at 3,6 and 7 months;2 had recurrence at 4 and 5 months after tumor resection,with angiosarcoma invading right renal capsule,diaphragm and right pleural hemorrhage induced to haemothorax,and survived respectively for 13 and 15 months;2 respectively died of systemic metastasis at 4 and 8 months after liver transplantation;2 underwent chemotherapy + targeted therapy of monoclonal antibodies,and survived for 12 months.Conclusions CT appearances of PHA have certain characteristics.The plain scans of CT show heterogeneous low-density shadow,and enhanced scans of CT show small patch,punctate or nodular-shaped,continuous and progressive enhancements,with a clear boundary between tumor and liver parenchyma.

Objective To investigate the CT features of early infection stage of thoracic and pulmonary paragonimiasis. Methods Medical records of 56 patients with thoracic and pulmonary paragonimiasis from January 2010 to June 2017 were collected, and the patients were diagnosed and treated at Yongjia County People's Hospital, and the results of laboratory examination and CT imaging features were analyzed retrospectively. Results The absolute value of eosinophils in peripheral blood of 56 patients was (5.61 ± 3.18) × 109/L, and the percentage of eosinophils was (35.90 ± 19.16)％, all of which increased to varying degrees. Forty-two patients had different degrees of pleural effusion and 52 cases with lung lesions. Lung lesions demonstrated one or several kinds of foci at the same time, randomly distributed in the lung field, mostly located in the sub-pleural lung tissue. There were 12 cases with pulmonary ground glass shadow, 4 cases with peribronchitis, 31 cases with pulmonary invasive lesions and 28 cases with pulmonary nodular/strip shadow. The size of most nodules were 0.5 - 1.0 cm, accompanied with halo sign. Conclusions The CT features of early infection stage of thoracic and pulmonary paragonimiasis are diverse. The size of 0.5 - 1.0 cm lung nodules with halo sign has certain characteristics in the diagnosis of paragonimiasis. Peribronchitis, infiltrative lesions, pleural effusion and increased peripheral blood eosinophil percentage can suggest diagnosis.

Objective To investigate the characteristics and diagnostic value of multislice spiral CT (MSCT) of intestinal lipomas causing intussusception.Methods The MSCT findings of 25 cases with intestinal lipomas causing intussusception were retrospectively analyzed,the tumor location,size,shape,density,enhancement patterns and shape and length of intussusception were also observed retrospectively.Results Tumors were 1.2-6.5 cm in diameter,round or oval in shape (n =18),irregular shape (n =4),tubular shape (n =3) with uniform density (n =19),or uneven density (n =6).Under CT enhancement tumor capsule was moderately intensified.Intussusception included ileum-ileum type (n =7),jejunum-jejunum type (n =5),jejunum-ileum type (n =2),ileum-colon type (n =4),and colon-colon type (n =7).Intussusception was 5.0-5l.0 cm in length;presenting as concentric circles (n =12),round target sign (n =7),orbanana (n =6).Conclusion Intestinal liporna complicating secondary intussusception has definite MSCT characteristics which can help establish diagnosis.

Objective To investigate radiological features on computed tomography (CT) in the di agnosis of portal venous and intestinal wall gas in patients with ischemic bowel disease.Methods The clinic-pathological data of 17 patients with portal venous and intestinal gas associated with ischemic bowel diseases from Wenzhou People's Hospital (n =6),Yueqing People's Hospital (n =5),Shanghai Xuhui Dahua Hospital (n =3) and the Second Affiliated Hospital of Wenzhou Medical University (n =3) from January 2013 to October 2016 were analysed retrospectively.All the patients have been fasting for 8 h prior to CT scans.Enhanced CT study was performed following routine CT with no abdominal pressure for breath less scanting.Portal venous gas,intestinal wall gas,intestinal thickness and density,mesentery thickness,celiac effusion,and severity of intestinal wall enhancement were recorded.Results All the 17 patients ex perienced abdominal distension and pain.Additionally,nausea and vomiting was observed in 9 patients,di arrhea in 7,melena in 7,periumbilical tenderness in 11 and rebound tenderness in 8.CT scans of these 17 patients showed portal venous gas,including massiveprune-tree signs of hepatic vein and portal vein (n =11) and scanty gas shadows in distal hepatic vein (n =6).Intestinal gas sign was determined in all these patients (n =17),including single bubble shadow (n =8),multiple bubble shadow (n =7),and band-shaped bubble (n =2).Furthermore,CT study indicated extensive intestinal wall thickening with edema (n =13),predominate luminal extension of thinner bowels (n =4),scanty celiac effusion (n =3).Enhanced CT scans demonstrated 8 patients with decreased enhancement of intestinal wall and mesentery with diseases,target and halo signs observed in enhanced scans.Conclusions Portal venous and intestinal wall gas may demonstrate distinctive CT imaging.CT study could have superior sensitivity and spe cialty in clinical diagnoses of ischemic bowel diseases.

To investigate the CT appearances in early stage of clustering lung paragonimiasis,9 cases of two clustering lung paragonimiasis caused by eating raw stone-crab and laboratory examination were included in the study.Eight cases consulted by doctors in the hospital and their appearances were retrospectively analyzed.There were pleural effusion of varying degree (n=8) and random distribution sub-pleural pulmonary infiltrative lesions (n=7).The accompany appearances of the latter had lunar halo sign,characteristic tunnel sign (n=1) and peri-bronchitis (n=1).If CT detects pulmonary infiltrative lesions of random distribution within sub-pleura or tunnel sign,combining with the history of eating raw stone crabs and other freshwater fishes,with the rise of eosinophilic granulocytes in peripheral blood,the diagnosis of paragonimiasis should be suggested.

Objective To investigate the characteristics and diagnostic value of multi-slice spiral computed tomography (MSCT) examination of gastrointestinal lipoma.Methods The cross-sectional study was adopted.The clinicopathological data of 96 patients with gastrointestinal lipoma including 32 from the Second Hospital Affiliated to Wenzhou Medical University,30 from the First Hospital Affiliated to Wenzhou Medical University,17 from the Ruian People's Hospital of Zhejiang,11 from the Yueqing People's Hospital,3 from the Wenzhou Central Hospital and 3 from the Wenzhou People's Hospital from December 2006 to September 2015 were collected.All patients were fasted for 8 hours prior to the examination,and partial patients underwent enhanced scan after the conventional CT scanning with breathless scanning and no abdominal pressure.Coronal and sagittal images of gastrointestinal tract including the tumor were administrated with multiple planar reconstruction (MPR)techniques of Reformat software.Based on MPR images,the curves along the gastrointestinal tract were drawn,voxel distributed along the curve track were reconstructed,and curved planar reconstruction (CPR) images were obtained.The patients received operation or follow-up according to individual characteristics after examinations.The patients undergoing operation were followed up for detecting tumor recurrence and metastasis by CT examination and patients receiving follow-up were observed by endoscopy for detecting changes of tumor size and morphology up to June 2015.The analysis indexes included tumor location and size,performance of MSCT examination (tumor shape,density,margin,intussusceptions,enhanced MSCT examination),intraoperative findings,results of pathological examination and results of follow-up.Measurement data with normal distribution were presented as i ± s.Results All the 96 patients received MSCT plain scan and the 42 received enhanced MSCT scan.The CPR images in 30 patients were collected.(1) Tumor location and size:3 tumors were located in the stomach,16 in the duodenal,27 in the jejunum,23 in the ileal,2 in the ileocecus,9 in the sigmoid colon,9 in the ascending colon,3 in the descending colon,3 in the transverse colon and 1 in the appendix.The diameter of tumor was (3.8 ± 2.3) cm.(2) Performance of MSCT examination:of the 96 patients,round or oval tumors were detected in 68 patients,tubular tumors in 15 patients and lobulated tumors in 13 patients.Tumors showed homogeneous density in 67 patients and inhomogeneous density in 29 patients.The CT value of tumors was-110--53 HU with a median value of-80 HU.Tumors of the 96 patients had clear boundaries and smooth margins.Twenty-four patients were complicated with intussusceptions with nested length of (28 ±4)cm,including 10 cases of multiple concentric rings,7 cases of double-target sign and 7 cases of banana sign.Enhanced MSCT scan showed that capsule around tumors in the 96 patients demonstrated slightly intensified,tumor body demonstrated no enhancement and that angiolipoma in 10 patients had cable strip like enhancement in the tumors.(3) Intraoperative findings:of the 96 patients,59 patients underwent surgical resection with single tumor,24 patients were concomitant with intussusceptions,9 patients showed aphtha in the center of tumors and 1 patient had partial lipoma in the prepyloric region dropped into the duodenal.Thirty-seven patients received endoscopic examination,showing submucous nodular protrusive lesions of 1.7-3.5 cm.(4) Results of pathological examination:of 59 patients undergoing surgical resection,submucosal,subserous and intramural tumors were detected in 45,9 and 5 patients,respectively,with complete capsule and pedunculated or non-pedunculated.Of the 59 patients,tumors showed round or oval shape in 41 patients,tubular shape in 10 patients and lobulated shape in 8 patients.The section of tumors showed yellowish-white.Specimens from endoscopic and surgical resections were observed under microscopy,the tumors were composed of mature-differentiated adipocytes,different quantities of fibrous connective tissues,blood vessels and mucus ingredients.Tumor cells were round shape with hypochromatic cytoplast and became polygeal and vacuolated after squeezing,nucleus was compressed to peripheral area and cytoplasm was full of lipid droplets.The results of immunohistochemistry stain showed Vimentin,CD34,D2-40,CD68 were positive and AE1/3 and Calretinin were negative.All tumors were diagnosed as benign lipomas.Fifty-nine patients who underwent surgical resection were followed up for 0.5-5.0 years and 37 patients of which specimens were obstained by endoscopic resection were followed up for 1.0-2.0 years after the pathological diagnosis with no significant change.Conclusion The MSCT finding of the gastrointestinal lipoma has characteristic appearance,and MSCT examination can clearly show lipoma location,size,shape and properties,with a widespread application value.