Objective:To explore the predictive value of a radiomics model based on preoperative contrast enhanced MRI in the assessment of the isocitrate dedydrogenase 1 (IDH 1) genotype in high-grade glioma.Methods:A retrospective analysis was performed on a dataset including 182 patients with high-grade glioma confirmed by surgical pathology between December 2012 and January 2018 in the Affiliated Hospital of Qingdao University. There were 79 patients with IDH1-mutant glioma (45 cases with WHO grade Ⅲ, 34 with WHO grade Ⅳ) and 103 with IDH 1 wild-type glioma (33 cases with WHO grade Ⅲ, 70 cases with WHO grade Ⅳ). All patients had complete preoperative brain contrast enhanced MRI.The cases were divided into a training dataset and a validation dataset at a ratio of 7∶3 using stratified random sampling. Radiomic features were initially extracted using A.K (Analysis Kit, GE healthcare) software, and were selected and excluded using Kruskal-Wallis and Spearman analyses. Using R softwear " GLM" function, the Lasso-logistic model was finally conducted to obtain the optimized subset of the feature to build the radiomics model, and the model was then tested with cross-validation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of the model in differentiating IDH1-mutant type and wild-type gliomas.Results:The radiomics model showed good performance in IDH genotype differentiation in both the training dataset (AUC 0.870, 95% CI: 0.754 to 0.855, accuracy rate 79.8%, sensitivity 85.5%, specificity 75.4%, positive predictive value 0.734, negative predictive value 0.867) and the validation dataset (AUC 0.860, 95% CI: 0.690 to 0.913, accuracy rate 78.9%, sensitivity 91.3%, specificity 69.0%, positive predictive value 0.700, negative predictive value 0.909).Conclusion:The radiomics model based on the preoperative enhanced MR can provide a way to predict the IDH1 genotype in high-grade gliomas.

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 By analyzing the clinical manifestations and pathologic features of Erdheim-Chester's disease (ECD) to improve the recognition of the disease.Methods The clinical characteristics,diagnosis and treatment of a young male with ECD were reported and the related literature was reviewed.Results A previously healthy young male patient with bilateral exophthalmos,blurred vision of right eye,polyuria and hypertension without obvious causes for nine months were admitted into our hospital.He developed low back pain two months ago.Thoracic vertebra Magnetic resonance imaging (MRI) showed multiple nodules extending from the 2th-7th thoracic vertebrae intra-medullary.MRI of the brain showed multiple masseswith abnormal intensities within the retro-ocular intraconal muscle cone,sellar and cavernous sinus,maxillary sinus.Biopsy specimens from the right orbital lesion demonstrated proliferation of fibrous connective tissue and fat tissue infiltrating with lymphocytes,plasma cells,eosinophils,foam cells,spindle cells,and multinucleated giant cells accompanied by fat necrosis.Immunohistochemistry showed infiltrated lymphocytes stained positive for CD68,CD20,CD3,LCA and negative for CD1a,S-100 protein and langerin.The clinical symptoms of exophthalmos and low back pain relieved after treated with methylprednisolone and interferon-α.Conclusion Understanding the characteristics of ECD can help to make the correct diagnosis and treatment.

Objective To evaluate the manifestations and diagnostic value of CT enterography (CTE) in primary intestinal T-cell lymphoma (PITCL).Methods Eighteen patients with PITCL confirmed by pathology were reviewed retrospec tively.The characteristics of lesion site,amount of foci,pattern and degree of contrast enhancement,lymphadenopathy,involvement of other organs and complications were recorded.Results In all of the 18 patients with PITCL,multiple lesions were seen in 13 cases (13/18,72.22％),and solitary involvement was seen in 5 cases (5/18,27.78％).Twelve ca ses were located at jejunum/ileum,3 of them were also involved in the colon.Five cases were located only in the colon,and 1 in the duodenum.Six cases were complicated with intestinal perforation.The patients were categorized into 6 types according to the CT manifestation:infiltration type (n=7),diffuse jejunum mucosa ileum metaplasia type (n =3),luminal aneurismal dilatation type (n =3),polypoid mass type (n =2),mesentery type (n=1),mixed type (n =2).Conclusion CTE can clearly display the imaging of PITCL and it has high value for the diagnosis of PITCL.

Objective To discuss the value of dynamic contrast-enhanced MRI (DCE-MRI)in differential diagnosis of high-grade gliomas (HGG)and metastasis.Methods 27 cases of HGG and 46 cases of metastasis were enrolled.All patients took contrast MRI and DCE-MRI before operation.Using the pharmacokinetic model of Extended Tofts Linear to quantitative analyze the data,volume transfer constant (Ktrans ),extracellular extravascular volume fraction (Ve )and blood plasma fraction (Vp )of the lesion's solid components and perilesional edam were obtained.Ktrans value,Ve value and Vp value were compared to judge whether there were significant differences between the two kinds of tumors.Results The values of the Ktrans ,Ve and Vp in parenchyma of HGG and metastasis were not statistically significant (P >0.05).The values of Ktrans and Ve in peritumoral edema of HGG were significantly higher than that of metastasis (P <0.05);Vp values in the peritumoral edema of HGG were lower than that of metastasis,but the difference was not statistically significant (P >0.05). Conclusion DCE-MRI can effectively distinguish HGG from metastasis through quantitative analysis of the perilesional edema.

Objective To evaluate the value of localization diagnosis of 1H-magnetic resonance spectroscopy (MRS) in the patients with structural MRI-negative temporal lobe epilepsy (TLE) based on the results of localization diagnosis of electroencephalogram (EEG) in patients with TLE without lesion.Methods Thirty-three patients with MRI-negative TLE and 33 age-and sex-matched healthy control subjects underwent MRS and took the side localized by scalp/video EEG as standard,to evaluate the value of N-acetyl-L-aspartic acid (NAA)/creatine (Cr),NAA/(Cr + choline (Cho)) in the localization diagnosis of TLE.Results There was no significant difference in NAA/Cr,Cho/Cr and NAA/(Cr + Cho) in bilateral hippocampi of 33 healthy controls,and the mean values of them in bilateral hippocampi were regarded as normal values.The NAA/Cr and NAA/(Cr + Cho) ratios were significantly decreased in both sides of the hippocampi ipsilateral and contralateral to the seizure side.Taking NAA/Cr and NAA/(Cr +Cho) as an index to localize respectively and comparing with the localization diagnosis of EEG,spectral anomalies were found in 28 cases and 29 cases respectively,and the abnormal rate reached 85％ and 88％.The localization diagnosis of 17 and 18 cases was consistent with the EEG,the rate being 52％ and 55％ respectively,but 12％ (4/33) and 18％ (6/33) were opposite.There were 36％ (12/33) and 27％ (9/33) cases who could not be localized.The localization diagnosis results by NAA/Cr and NAA/(Cr +Cho) were not significantly different.Conclusions The existence of mirror-image foci may be the main reason of the failure of localization diagnosis.1H-MRS has higher value for localization of TLE foci,and combining 1H-MRS with other techniques can further improve the accuracy and reliability of localizing the epileptic foci in patients with TLE.Compared with EEG in the diagnosis of TLE,there are no significant differences in the localization diagnosis of TLE by NAA/Cr and NAA/(Cr + Cho),which can all be the standard indices of localization diagnosis.

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 discuss the method, therapeutic effect and safety of CT-guided 125I radioactive seed implantation for the treatment of cervical lymph node metastasis. Methods CT-guided 125I radioactive seed implantation was performed in 32 patients with pathologically proved cervical lymph node metastasis Results The local effective control rates of the cervical lymph node metastasis at one, 3, 6 and 12 months after the treatment were 81.3%(26/32), 84.4%(27/32), 93.7%(30/32) and 87.5%(28/32) respectively. Conclusion For the treatment of cervical lymph node metastasis, CT-guided 125I radioactive seed implantation is technically simple and clinically safe with reliable curative effect; this treatment is very effective in improving local tumor control rate.

Objective To investigate the diagnostic value of CT and MRI in basal ganglia germinoma.Methods The clinical and imaging data in 1 7 patients with basal ganglia germinoma proved pathologically or clinically were analyzed retrospectively.Results All patients were male with an age rang from 8 to 18 years old and a mean age of 10.8 years.The most common symptom was hemi-paresis.Imaging features of the lesion were as follows:① usually irregular shape(11/17,64.7%)and cystic degeneration (10/17, 58.8%)without space-occupying effect and surrounding edema (12/17,70.6%);② isointensity on conventional MRI,hyperintensi-ty on DWI and hyperdensity on CT;15 patients (15/17,88.2%)with one or more than one appearances including multiple lesions, the lesion extending into surrounding structures and Waller degeneration.Conclusion Some clinical and imaging features of the basal ganglia germinoma are characteristic,and CT and MRI shows higher diagnostic value for the disease.

Objective To explore the features of leukoencephalopathy with cerebral calcifications and cysts (LCC) in clinic, radiology and pathology in order to improve skills in diagnosis. Methods Two female patients had CT and/or MRI scan, and case 2 had contrast enhancement MRI scan additionally. Both cases had blood biochemistry examinations including calcium, phosphorus and alkaline phosphatase et al. Case 2 had lumbar puncture and cerebrospinal fluid test. The major cystic lesion was surgically removed in both patients and offered a histopathological examination. Results CT scan reveaed diffuse calcifications in the bilateral basal ganglia, white matter of frontal lobe and/or dentate nuclei of cerebellum in both cases, and major cystic lesion in right frontal lobe (case 1) and the left parietal lobe (case 2). The rim of enhancement was observed in cystic lesion on MRI. Histopatbological examination revealed angiomatous rearrangements of the microvessels with fibroid, hyaline degeneration and haemosiderin deposits, brain tissue associated with areas of demyelinization, some Rosenthal fibers, gliosis, calcium deposits and hemorrhage, fibrinoid necrosis occurs in partial vessels associated with thrombogenesis and stenosis as changes in arteriolitis. Blood biochemistry examination showed normal. Cerebrospinal fluid test in case 2 showed increased intracranial pressure(350 mm H_2O,I mm H_2O =0. 0098 kPa). Conclusions The onset of LCC varies and occurs from early infancy to adult. The asymmetrical calcification is characteristic in LCC. Hemorrhage could be involved in the pathogenesis of cystic formation. LCC is characterized by a cerebral obliterative microangiopathy, both demyelinization and the edematous changes could probably result in white matter abnormalities on neuroimaging.