Objective:To compare the diagnostic efficacy of ultrasound and MRI in fibro-adipose vascular anomaly (FAVA).Methods:The clinical data of patients with suspected FAVA who underwent ultrasound and MRI examinations at Henan Provincial People’s Hospital from January 2011 to October 2021 were retrospectively analyzed. The imaging findings from ultrasound and MRI were analyzed, and then compared with the pathological findings. To evaluate the diagnostic efficacy of ultrasound and MRI in diagnosing FAVA by assessing sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate. Paired χ2 test (McNemar test) was used to compare the coincidence rate of ultrasound and MRI, as well as their combined diagnosis. A significance level of P < 0.05 was considered statistically significant. Results:A total of 50 patients were included in the study, comprising 24 males and 26 females, with their ages ranging from 1 to 50 years and an average age of (16.2 ± 10.5) years. Pathology confirmed 43 FAVA patients and 7 non-FAVA patients. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of ultrasound in the diagnosis of FAVA were 83.7%, 71.4%, 94.7%, 41.7%, and 82.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of MRI in the diagnosis of FAVA were 69.8%, 85.7%, 96.8%, 31.6%, and 72.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of FAVA were 90.7%, 71.4%, 95.1%, 55.6%, and 88.0%, respectively. The diagnostic accuracy of ultrasound was higher than that of MRI, but the difference was not statistically significant ( χ2 = 1.41, P = 0.235). The coincidence rate of combined diagnosis was higher than that of ultrasound ( χ2= 0.71, P = 0.401) and MRI ( χ2= 4.00, P = 0.039), with a statistically significant difference. Conclusion:Both ultrasound and MRI are highly valuable in diagnosing FAVA. The combined usage of ultrasound and MRI can enhance the accuracy of preoperative FAVA diagnosis.

Objective:To compare the diagnostic efficacy of ultrasound and MRI in fibro-adipose vascular anomaly (FAVA).Methods:The clinical data of patients with suspected FAVA who underwent ultrasound and MRI examinations at Henan Provincial People’s Hospital from January 2011 to October 2021 were retrospectively analyzed. The imaging findings from ultrasound and MRI were analyzed, and then compared with the pathological findings. To evaluate the diagnostic efficacy of ultrasound and MRI in diagnosing FAVA by assessing sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate. Paired χ2 test (McNemar test) was used to compare the coincidence rate of ultrasound and MRI, as well as their combined diagnosis. A significance level of P < 0.05 was considered statistically significant. Results:A total of 50 patients were included in the study, comprising 24 males and 26 females, with their ages ranging from 1 to 50 years and an average age of (16.2 ± 10.5) years. Pathology confirmed 43 FAVA patients and 7 non-FAVA patients. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of ultrasound in the diagnosis of FAVA were 83.7%, 71.4%, 94.7%, 41.7%, and 82.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of MRI in the diagnosis of FAVA were 69.8%, 85.7%, 96.8%, 31.6%, and 72.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of FAVA were 90.7%, 71.4%, 95.1%, 55.6%, and 88.0%, respectively. The diagnostic accuracy of ultrasound was higher than that of MRI, but the difference was not statistically significant ( χ2 = 1.41, P = 0.235). The coincidence rate of combined diagnosis was higher than that of ultrasound ( χ2= 0.71, P = 0.401) and MRI ( χ2= 4.00, P = 0.039), with a statistically significant difference. Conclusion:Both ultrasound and MRI are highly valuable in diagnosing FAVA. The combined usage of ultrasound and MRI can enhance the accuracy of preoperative FAVA diagnosis.

Purpose To identify hemangioma(HE)and Kaposiform hemangioendothelioma(KHE)by constructing two ultrasonography-based radiomics models to evaluate the application value of two models in distinguishing HE from KHE,and to compare the diagnostic efficiency of two models.Materials and Methods A total of 90 lesions of subcutaneous HE or KHE confirmed clinically or pathologically from Henan Provincial People's Hospital from August 2020 to May 2022,were retrospectively analyzed.Imaging features were extracted by using Pyradiomics and screened out by the least absolute shrinkage and selection operator algorithm.Support vector machine and random forest were used to construct the radiomics models.Then the diagnostic efficacy of different models was compared.Results Based on the selected 10 radiomics features,the area under the curve,accuracy,sensitivity,specificity,positive and negative prediction the training group and validation group of the support vector machine model were 0.902(95%CI 0.887-0.917),92.1%,85.0%,92.3%,90.9%,93.5%and 0.827(95%CI 0.787-0.856),85.2%,70.0%,94.1%,90.9%,85.0%,respectively;and those in the training group and validation group of the random forest model were 0.960(95%CI 0.938-0.983),98.4%,96.4%,97.8%,98.1%,97.2%and 0.742(95%CI 0.699-0.785),77.8%,57.1%,82.3%,79.6%,62.5%,respectively.The area under the curve between two models in the training group and validation group was statistically significant(Z=-3.306,-2.009;P<0.05).Conclusion Ultrasonography-based radiomics can distinguish HE from KHE,support vector machine model shows more stable diagnostic performance in small sample data.

Ubiquitin-Protein Ligases/metabolism* ; Proteolysis ; Biological Products ; Ligands

Objective:To investigate the MRI features of fibro-adipose vascular anomaly (FAVA).Methods:The clinical, pathological and MRI data of the FAVA patients confirmed clinically and pathologically in Henan Provincial People’s Hospital from January 2016 to June 2021 were retrospectively analyzed, including 17 females and 13 males, aged 4-53 (18.5±12.8) years.Through the analysis of the MRI images of FAVA performance, including the lesion area, shape, signal, the degree of reinforcement, inner structure, outer structure and other image characteristics, summarize the MRI features.Results:The lesions located at the lower leg (12 cases), thigh (12 cases), upper arm (4 cases), forearm (1 case) and trunk (1 case). Twenty-four case of lower limbs. All cases involved the muscular layer, including 21 cases of superficial muscle layer, 7 cases of deep muscle layer, and 2 cases of both. Twenty-three cases of superficial muscle layer. Most of the affected muscles were quadriceps femoris and gastrocnemius. Morphology: all lesions were intramuscular solid masses growing parallel to the long axis of the muscle. There were 11 cases of focal type, 11 cases of locally infiltrating type, and 8 cases of diffuse type. MRI findings: all lesions showed mixed signal. On T1WI, 28 cases showed cloud-like, band-like and patchy high signal on the background of medium and high signal. On T2WI-FS, all the 30 cases showed low to medium signal areas on the background of high signal, which were dendrimer, ribbon and cloud-like. The lesions showed moderate to obvious heterogeneous progressive enhancement. Twenty-seven lesions had different shapes of vascular shadow, and 28 lesions had drainage vein shadow adjacent to the lesions, 24 of which were located at the proximal end of the lesions. Fascial tail sign was found at the periphery of the lesions in 26 cases, of which 23 cases were located at the upper and lower ends of the lesions.Conclusion:FAVA is a complex vascular malformation with unclear pathological classification. MRI usually shows a solid mass in the superficial muscle layer of the lower limbs parallel to the long axis of the muscle, with cloud-like, band-like, and patchy hyperintensity on the background of high signal on T1WI, and dendritic, band-like, and cloud-like hypointensity on the background of high signal on T2WI-FS, which is helpful for the diagnosis of FAVA. Combined with the data of fascial tail sign, draining vein and clinical manifestations, the diagnosis of FAVA can be confirmed to a certain extent, which can provide reference and basis for clinical decision making.

Objective:To investigate the MRI features of fibro-adipose vascular anomaly (FAVA).Methods:The clinical, pathological and MRI data of the FAVA patients confirmed clinically and pathologically in Henan Provincial People’s Hospital from January 2016 to June 2021 were retrospectively analyzed, including 17 females and 13 males, aged 4-53 (18.5±12.8) years.Through the analysis of the MRI images of FAVA performance, including the lesion area, shape, signal, the degree of reinforcement, inner structure, outer structure and other image characteristics, summarize the MRI features.Results:The lesions located at the lower leg (12 cases), thigh (12 cases), upper arm (4 cases), forearm (1 case) and trunk (1 case). Twenty-four case of lower limbs. All cases involved the muscular layer, including 21 cases of superficial muscle layer, 7 cases of deep muscle layer, and 2 cases of both. Twenty-three cases of superficial muscle layer. Most of the affected muscles were quadriceps femoris and gastrocnemius. Morphology: all lesions were intramuscular solid masses growing parallel to the long axis of the muscle. There were 11 cases of focal type, 11 cases of locally infiltrating type, and 8 cases of diffuse type. MRI findings: all lesions showed mixed signal. On T1WI, 28 cases showed cloud-like, band-like and patchy high signal on the background of medium and high signal. On T2WI-FS, all the 30 cases showed low to medium signal areas on the background of high signal, which were dendrimer, ribbon and cloud-like. The lesions showed moderate to obvious heterogeneous progressive enhancement. Twenty-seven lesions had different shapes of vascular shadow, and 28 lesions had drainage vein shadow adjacent to the lesions, 24 of which were located at the proximal end of the lesions. Fascial tail sign was found at the periphery of the lesions in 26 cases, of which 23 cases were located at the upper and lower ends of the lesions.Conclusion:FAVA is a complex vascular malformation with unclear pathological classification. MRI usually shows a solid mass in the superficial muscle layer of the lower limbs parallel to the long axis of the muscle, with cloud-like, band-like, and patchy hyperintensity on the background of high signal on T1WI, and dendritic, band-like, and cloud-like hypointensity on the background of high signal on T2WI-FS, which is helpful for the diagnosis of FAVA. Combined with the data of fascial tail sign, draining vein and clinical manifestations, the diagnosis of FAVA can be confirmed to a certain extent, which can provide reference and basis for clinical decision making.

Objective:To investigate the MRI and pathological features of intramuscular fibro-adipose vascular anomaly (FAVA).Methods:The clinical and imaging data of 44 patients with intramuscular FAVA confirmed by pathology from December 2012 to March 2021 in Henan Province People′s Hospital were retrospectively analyzed. Twenty-five females and 19 males were included, with the age of (15±6), from 5 to 29 years old. The clinical and MRI features including the type, location, boundary, signal intensity, enhancement mode and degree, and the vascular flow voids in the lesion were summarized and compared with pathological results.Results:The thigh and calf muscles were involved in 1 patient simultaneously, and 1 site was involved in 43 patients, including 20 calf muscles, 15 thigh muscles, 5 forearm muscles, 1 upper arm muscle, 1 gluteal muscle, and 1 shoulder muscle. The gastrocnemius muscle of lower leg was most commonly involved (13/44), followed by soleus muscle (10/44) and quadriceps femoris muscle (9/44). All the lesions were solid on MRI, including 24 cases of focal mass type, 15 cases of diffuse infiltration type and 5 cases of local infiltration type. The long axis of all the lesions were consistent with the long axis of the muscles. All lesions showed inhomogeneously moderate hyperintensity on T 1WI and T 2WI, and significantly hyperintensity on fat suppression T 2WI. All lesions showed tortuous and dilated abnormal vessels, of which 18 cases showed vascular flow voids. Thrombosis was found in 10 cases. On contrast-enhanced imaging, the lesions showed moderate to obvious inhomogeneous enhancement. Pathologically, the diseased skeletal muscle was infiltrated by fibrous tissue, fat components, irregular abnormal veins and vessels, which led to inhomogeneous MRI signals. Among the 7 patients who underwent human PIK3CA gene mutation detection, and 6 were mutant. Conclusions:Intramuscular FAVA has certain characteristics in clinic, MRI imaging and histopathology, and its MRI signal characteristics can reflect its complex pathological components.

Objective:To investigate the differential performance of ultrasound between fibro-adipose vascular anomaly (FAVA) and venous malformations(VMs).Methods:From January 2015 to December 2020, the patients diagnosed with lower extremity FAVA by pathology in Henan Provincial People’s Hospital were enrolled as FAVA group. The patients diagnosed with lower extremity VMs by pathology were enrolled as the control group. The clinical and ultrasound imaging data were retrospectively analyzed. Through the single factor analysis of the two groups’data, the ultrasonic imaging indicators which may be valuable for distinguishing FAVA from VMs were screened. Further, the indicators valuable for differential diagnosis were determined by multi-factor Logistic regression analysis, and a multi-factor joint diagnosis model was constructed. The diagnostic efficiency of the joint diagnosis model was evaluated by the receiver operator characteristic curve (ROC curve), sensitivity, and specificity of the subjects.Results:A total of 20 patients with FAVA were involved, including 11 males and 9 females. The mean age was (18.1±12.2) years. Forty-six patients with VMs were involved, including 20 males and 26 females. The mean age was (19.9±13.6) years. Results of the single-factor analysis were differences in the lesion echo, fascial tail, blood flow, extrusion test, and posterior echo enhance characteristics between groups ( P<0.05). Multivariate analysis showed significant differences between groups in three aspects: fascial tail, extrusion test, and posterior echo enhancement ( P=0.001, 0.008, 0.007). The sensitivity and specificity of the multi-factor combined diagnosis model were 90.0% (95% CI: 68.3%-98.8%) and 93.5%(95% CI: 82.1%-98.6%), indicating high diagnostic efficiency. The ROC(AUC) area was 0.964(95% CI: 0.886-0.994), indicating high diagnostic efficiency. Conclusions:The ultrasonic imaging features of FAVA and VMs were different. The combined diagnosis of the fascial tail, compression test, and posterior echo enhancement has a higher auxiliary diagnostic value.

Objective:To investigate the differential performance of ultrasound between fibro-adipose vascular anomaly (FAVA) and venous malformations(VMs).Methods:From January 2015 to December 2020, the patients diagnosed with lower extremity FAVA by pathology in Henan Provincial People’s Hospital were enrolled as FAVA group. The patients diagnosed with lower extremity VMs by pathology were enrolled as the control group. The clinical and ultrasound imaging data were retrospectively analyzed. Through the single factor analysis of the two groups’data, the ultrasonic imaging indicators which may be valuable for distinguishing FAVA from VMs were screened. Further, the indicators valuable for differential diagnosis were determined by multi-factor Logistic regression analysis, and a multi-factor joint diagnosis model was constructed. The diagnostic efficiency of the joint diagnosis model was evaluated by the receiver operator characteristic curve (ROC curve), sensitivity, and specificity of the subjects.Results:A total of 20 patients with FAVA were involved, including 11 males and 9 females. The mean age was (18.1±12.2) years. Forty-six patients with VMs were involved, including 20 males and 26 females. The mean age was (19.9±13.6) years. Results of the single-factor analysis were differences in the lesion echo, fascial tail, blood flow, extrusion test, and posterior echo enhance characteristics between groups ( P<0.05). Multivariate analysis showed significant differences between groups in three aspects: fascial tail, extrusion test, and posterior echo enhancement ( P=0.001, 0.008, 0.007). The sensitivity and specificity of the multi-factor combined diagnosis model were 90.0% (95% CI: 68.3%-98.8%) and 93.5%(95% CI: 82.1%-98.6%), indicating high diagnostic efficiency. The ROC(AUC) area was 0.964(95% CI: 0.886-0.994), indicating high diagnostic efficiency. Conclusions:The ultrasonic imaging features of FAVA and VMs were different. The combined diagnosis of the fascial tail, compression test, and posterior echo enhancement has a higher auxiliary diagnostic value.

Objective:To strengthen the consciousness of postoperative rehabilitation exercise for focal intramuscular venous malformations and to explore the necessity of postoperative rehabilitation exercise for patients with focal intramuscular venous malformations.Methods:A retrospective analysis of patients with focal intramuscular venous malformations. From June 2017 to April 2018, 19 patients with focal intramuscular venous malformation were treated in the Hemangioma & Vascular Malformation Treatment Center of Henan Provincial People’s Hospital. All patients complained of pain and discomfort. According to the location of the lesion and the anatomical relationship between the lesion and the surrounding tissues, the operation method was selected. The rehabilitation physicians and surgeons worked out the rehabilitation plan together to carry out rehabilitation exercise treatment. The VAS scores before and after operation were compared to evaluate the effect of symptom relief and postoperative functional recovery.Results:A total of 19 patients were enrolled, including 11 females and 8 males, with an average age of 17.7 years (range, 3-44 years). The patients were followed up for 6 months to 1 year. The comparison of postoperative MRI and preoperative MRI showed that the lesions were completely removed. The VAS score of all patients was lower than that at admission. The preoperative VAS was 4.84±2.32 and the postoperative VAS was 2.16±1.17, P<0.01, indicating that the preoperative and postoperative VAS score had changed, and the VAS score had decreased. After rehabilitation exercise, all patients’ body functions were improved, joint stability, muscle strength and walking ability were restored to normal life. The preoperative joint function score was 10.47±3.29, and the postoperative joint function score was 14.46±3.50, P<0.01, indicating that the preoperative and postoperative joint function score had changed, and all the joint function scores had improved. Patients’ satisfaction was achieved. Conclusions:Postoperative rehabilitation guidance can effectively prevent postoperative limb dysfunction and accelerate the recovery of body function.