Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.

Objective:To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods:A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022. Before surgery, Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch. Based on the shape and size of the wound, a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella, and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched. The skin flap was transplanted to the recipient site of the limbs, and after reasonable combination, the wound was covered. An oval hole of suitable size was cut on the side of the receiving artery. The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it, while the accompanying veins of the two were still anastomosed end-to-end. The incision was directly sutured in the donor area. Follow up and observation were conducted for the survival status, appearance, color, texture, wound healing, scar condition, and limb function of the skin flap after surgery.Results:A total of 18 patients were included, including 12 males and 6 females, age range: 41-60 years old, with an average of 48.5 years old. There were 8 cases of hands and wrists, 4 cases of forearms, 4 cases of calves, and 2 cases of feet. The wound was large and irregular, or with multiple defects, all accompanied by bone or tendon exposure, with a wound area of 5 cm × 13 cm to 17 cm × 28 cm. The area of the lobulated skin flap harvested during the operation ranged from 3 cm × 9 cm to 24 cm × 10 cm. The combined flap area was 6 cm × 14 cm to 18 cm × 30 cm. All 18 flaps survived successfully, with one case experiencing arterial crisis, which was resolved through arterial re-anastomosis. No significant contracture was observed during the 3 months to 4 years of follow-up, and the appearance of the flaps was satisfactory. The donor sites in all 18 cases healed primarily. Only linear scars remain, with no impact on limb function.Conclusion:The lobulated anterolateral thigh flap with a single perforating branch can not only effectively repair the extensive irregular or multiple defects in limbs, but also facilitate direct primary closure of the donor site and reduce donor site morbidity. Additionally, end-to-side arterial anastomosis can reduce the risk of injury to the recipient’s main vessels, lower the difficulty of vascular anastomosis, and ensure a high flap survival rate.

Objective:To investigate the magnetic resonance imaging (MRI) features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis.Method:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 8 patients with DSRCT of the abdomen and pelvis, including 3 cases admitted in Yueqing People's Hospital and 5 cases admitted in Wenzhou People's Hospital, from January 2008 to June 2022 were collected. There were 5 males and 3 females, aged (43±5)years. All patients underwent MRI plain and enhanced scanning. Observa-tion indicators: (1) imaging features of DSRCT of the abdomen and pelvis; (2) treatment and pathological examination characteristics of DSRCT of the abdomen and pelvis; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of DSRCT of the abdomen and pelvis. ① Tumor location. Of the 8 patients, there were 6 cases with tumors located respectively at the lower edge of the liver in the right quarter costal region, the medial side of the ileocecal region in the right iliac region, the medial side of the caecum in the right iliac region, the gastro-pancreatic space in the left quarter costal region, the mesenteric space in the left iliac region and the right side of pelvic bladder, and 2 cases with tumors located at retroperitoneal space of left quarter rib region. ② Tumor size. There were 13 lesions in the 8 patients, and the maximum diameter of tumor was 9.1 (range, 3.5?20.0)cm. Of the 8 patients, there were 5 cases with single tumor and 3 cases with multiple tumors. ③ Tumor shape and boundary. Of the 8 patients, there were 4 cases with tumor in expansive growth and 4 cases with tumor in invasive growth. There were 5 cases with tumor of intratumoral necrosis and cystic degene-ration, 4 cases with tumor of intratumoral hemorrhage, 4 cases with tumor of intratumoral spot calcification, 3 cases with tumor of peritumoral tissue exudation. One patient may combined with multiple imaging manifestations. ④ Imaging characteristics of MRI plain scanning. Of the 8 patients, there were 4 cases with tumor of homogeneous hypointensity signal and 4 cases with tumor of hypointensity mixed with speckled hyperintensity (with hemorrhage) in T1 weighted imaging of MRI plain scanning. There were 3 cases with tumor of homogeneous hyperintensity and 5 cases with tumor of high signal at the edge, patchy and spot-shaped in the center in T2 weighted imaging of MRI plain scanning. There were 5 cases with tumor of high, equal and low confounding signals and 3 cases with tumor of high and low signals in T2 weighted imaging fat suppression sequence of MRI plain scanning. There were 3 cases with tumor of uniform high signals and 5 cases with tumor of high, equal and low mixed signals in diffusion weighted imaging of MRI plain scanning. ⑤ Imaging characteristics of MRI enhanced scanning. All 8 patients had tumor of heterogeneous enhancement in MRI enhanced scanning, including 2 cases with significant enhancement in arterial phase, continuous enhancement in portal phase, slightly reduced enhancement in delayed phase, 4 cases with moderate enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase, 2 cases with mild enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase. Of the 8 patients, there were 3 cases with tumor of annular enhancement with intratumoral strip or grid signals and 3 cases with tumor of peritumoral blood vessels increased and thickened signals. ⑥ Tumor invasion and metastasis. Of the 8 patients, there were 4 cases with tumor invaded bowel, 2 cases with tumor invaded surrounding tissues, 1 case with tumor invaded left kidney, spleen and pancreatic tail, 1 case with tumor invaded distal of left ureter. There were 5 cases with abdominal, retroperitoneal and inguinal lymph nodes enlargement, 4 cases with multiple nodular thickening of peritoneum and ascites, 2 cases with tumor liver and lung metastasis and 1 case with tumor rib, femur and sacrum metastasis. One patient may combined with multiple tumor metastasis. (2) Treatment and patholo-gical examination characteristics of DSRCT of the abdomen and pelvis. Of the 8 patients, 3 patients underwent complete resection as clear tumor boundary, 3 patients underwent tumor partial resection as tight adhesion between tumor and surrounding blood vessels, 2 cases underwent tumor tissue pathological examination as extensive metastasis of peritoneum, omentum, mesentery and surrounding intestine. All 8 patients were diagnosed as DSRCT by microscopic examination, electron microscopic examination, immunohistochemical staining and cytogenetic examination. (3) Follow-up. All 8 patients underwent postoperative follow-up and died during the follow-up.Conclusion:MRI features of abdominal and pelvic DSRCT include single or multiple lobulated masses with unclear boundaries, invading the omentum, mesentery, peritoneum and adjacent tissues in most cases, mixed signals and heterogeneous mild to moderate enhancement in enhanced scanning.

Objective:To explore the imaging features of hyperostosis frontalis interna (HFI).Methods:One hundred patients with clinically diagnosed HFI were enrolled from Department of Radiology, Yueqing People's Hospital and Department of Imaging, Wenzhou People's Hospital from January 2011 to December 2022. MRI alone was performed in 45 patients; MRI+DR was performed in 14, and MRI+CT was performed in 41. The imaging features of these patients were analyzed retrospectively.Results:In these 100 patients, 20 were with external hyperplasia, 51 with internal hyperplasia, and 29 with intermediate hyperplasia. External hyperplasia manifested as proliferating towards the diploe, enjoying clear boundary, uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and high density of the hyperplastic inner plate and diploe on CT and DR. Internal hyperplasia manifested as proliferating towards the cranial cavity, enjoying wavy or nodular inner edges, non-uniform low signals of hyperplastic inner plate on T1WI and T2WI, and high density of the hyperplastic inner plate on CT and DR. Intermediate hyperplasia manifested as proliferating simultaneously towards the cranial cavity and diploe, enjoying thin and blurred diploe, uniform or non-uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and non-uniform high density of the hyperplastic inner plate and diploe on CT and DR. Compressed and displaced brain parenchyma, reduced anterior cranial fossa volume, and narrowed subarachnoid space were noted in these 100 patients, including 47 patients with obvious frontal lobe brain tissue compression (depth of 3.0-17 mm, averaged [8.6±5.9] mm), 35 with lacunar cerebral infarction, 33 with subcortical arteriosclerotic encephalopathy, and 32 with varied degrees of cerebral atrophy.Conclusion:HFI is characterized by thickening and hardening of the bilateral frontal bone inner plates, with wavy, nodular or spindle-shaped inner edges, compressed brain tissues, and reduced anterior cranial fossa; these imaging features can help the definite diagnosis of HFI.

Objective:To evaluate the clinical results of using the free polyfoliate anterolateral thigh perforator flaps based on a single perforator in repair large soft tissue defects in extremities.Methods:Between March, 2014 and April, 2019, 9 patients with large soft tissue defects in extremities were repaired with the free polyfoliate anterolateral thigh perforator flaps based on a single perforator. One of the patients were repaired with bilateral free polyfoliate anterolateral thigh perforator flaps. Six defects on hand and wrist, 1 on forearm, 1 on shank and 1 on foot. The sizes of soft tissue defect ranged 5 cm×19 cm-17 cm×24 cm. All the wounds of donor site were closed primarily.Results:Seven flaps survived without vascular incidence. One flap developed artery crisis after surgery with the bilateral free polyfoliate anterolateral thigh perforator flaps. After emergency re-anastomosing, the flap survived successfully. Necrosis on one-leaf occurred in one flap, which was finally repaired by skin graft. The clinical results were satisfactory after 3-48 months of followed-up. The scars of the donor site were not obvious.Conclusion:The free polyfoliate anterolateral thigh perforator flaps can be designed with only one perforator. The flap can be changed into a variety of shapes based on the combination of the polyfoliate flaps in order to repair a large soft tissue defects in extremity. The polyfoliate flap has advantages of less donor site injury with a high survival rate.

Objective To investigate MSCT features of the intraductal papillary mucinous tumor of the pancreas.Methods The CT findings of 40 cases of intraductal papillary mucinous tumors confirmed by pathology were retrospectively analyzed,and the location,size,shape,edge and enhancement of the tumor were observed.Results Malignant (n=8):all of them were mainly pancreatic duct type,including 6 cases in the head of pancreas and 2 cases in the tail.All of them were multi-room,with 7 cases of cystic wall nodules and 7 cases of uneven septum thickening.The diameter of tumor cystic lesion was(41.0±0.5)mm on average,and the widest diameter of the dilated pancreatic duct was (6.9±1.0) mm.The cystic wall,wall nodule and interval were mild and moderate enhancement in the arterial phase,and continuous strengthening in the portal and delayed phases.Borderline(n=15):8 cases of main pancreatic duct type,1 case of branch pancreatic duct type,and 6 cases of mixed type.There were 10 cases in the head of the pancreas and 5 in the tail of the pancreas.There were 10 cases of multi room in the lesion,and the CT findings were composed of multiple clusters of small cystic lesions,with 3 cases of tuberous nodules on the cyst wall and 4 cases of irregular thickening of the cysts.5 cases were single room type,with capsule wall smooth and whole.The diameter of tumor cystic lesion was (28.0±0.5) mm on average,and the maximum diameter of the dilated pancreatic duct was (5.2±0.3) mm.The cystic wall and interval were mild and moderate enhancement in the arterial phase,and mild and continuous strengthening in the portal and delayed phases.Benign (n=17):1 case of main pancreatic duct type,10 cases of pancreatic duct type and 6 cases of mixed type;There were 12 cases in the head of the pancreas and 5 in the tail.All of them were single cystic type,and the cyst wall was smooth.The diameter of the tumor cystic lesion was (26±0.3) mm on average and the maximum diameter of the dilated pancreatic duct was (3.5±0.4) mm.There was no enhancement of the cystic wall in the arterial phase,mild enhancement in the portal phase,and mild continuous delayed phase in 2 cases,no enhancement in 15 cases.Conclusion MSCT expression of the intraductal papillary mucinous tumor of the pancreas has its characteristic features,which is helpful for the diagnosis and treatment of the disease.

Objective To investigate the MRI features of ovarian theca fibroma (OTF) and compare it with histopathology features in order to improve the accuracy of OTF diagnosis. Methods The clinical data of 33 patients with OTF which were confirmed by surgical pathology from January 2005 to December 2016 were analyzed retrospectively. The signal characteristics and intensities of MRI were compared with histopathology features. Results The lump largest diameter of 33 patients with OTF was 2.5 to 18.0 (6.65 ± 4.46) cm. The substantial lump was in 22 cases. T2WI and T2WI fat suppression imaging showed a low or equal mixed signal among which there was slightly high or high signal, and T1WI imaging showed relatively uniform low signal. The cystic and solid lump was in 11 cases, including 7 cases of solid lumps and 4 cases of cystic-solid lumps, T2WI and T2WI fat suppression imaging of solid area showed equal or low signal among which there were a small patchy high or slightly high signal, and T2WI and T2WI fat suppression of cystic areas showed high signal; T1WI of solid and cystic areas showed uniform low signal. Enhanced appearance: in the 33 cases of enhancement, the parenchyma part showed mild enhancement, of which 14 cases were equal enhancement, 19 cases were uneven enhancement. During the arterial phase, all of 33 cases showed mild enhancement; 15 cases were obviously enhanced and 18 cases were mildly enhanced in the portal vein phase; 21 cases remained enhanced and the enhanced intensity of 12 cases decreased in the delayed phase. Comparison of histopathology features with MRI features showed that there were a higher proportion of fibrous cells under the microscope in 22 cases of parenchymal tumor, in which the fat suppression image of T2WI and T2WI showed equal or low signal in parenchyma, and T1WI showed even low signal; and there were a higher proportion of tumor cells and less collagen fibers under the microscope in 11 cases of cystic-solid tumor, in which the T2WI showed a slightly equal and higher signal and T1WI showed low signal in parenchyma. Conclusions The MRI features have some characteristics, such as low and equal signal of T2WI in parenchyma, mild enhancement during arterial phase and continuous enhancement in portal vein and delayed phase, which is helpful for diagnosis of OTF.

Objective To explore the gray matter changes in aggressive patients with schizophrenia,and the relationship between the gray matter and aggression in patients.Methods Eighteen aggressive patients with schizophrenia (SZ1),18 age-and gender-matched un-aggressive patients with schizophrenia (SZ2) and 18 normal controls (NC) were enrolled in the study.Then a 3.0 T magnetic resonance imaging (MRI) scan was conducted for each participant.The voxel-based morphometry (VBM) approach and the Chinese version of Buss & Perry aggression questionnaire (B&P) were used to explore imaging data and to assess the aggression,respectively.Results Compared with NC,patients with schizophrenia showed changes in gray matter volume (GMV) in the frontal,temporal and the occipital lobes (P＜0.05,AlphaSim corrected).Compared with SZ2,SZ1 showed increased GMV in the right supramarginal gyrus,right postcentral gyms,bilateral insula and orbito-frontal gyri (P＜0.05,AlphaSim corrected).The GMV of the right insula,right postcentral gyms and right supramarginal grus were positively associated with B&P scores in patients with schizophrenia (P＜0.01,AlphaSim corrected),respectively.Conclusions These preliminary findings support that the aggression in schizophrenia is associated with GMV changes of brain regions in patients with schizophrenia.The right postcentral gyrus,the right insula and the right supramarginal gyrus may be involved in the neural mechanism of aggression in schizophrenia.

Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.

Objective To study the radiological features of dynamic enhanced multi-slice spiral CT (MSCT) and CTA in pure hepatic arterio-venous fistula (AVF).Methods The radiological features of MSCT imaging and CTA of 100 patients with pure hepatic AVF were retrospectively analyzed.Results Positive signs on the arterial phase were detected in 100 patients with pure hepatic AVF.In 89 patients,they were the peripheral type and in 11 patients they were the central type.There were 128 lesions in the 100 patients.In the peripheral type,the features were (1) in the arterial phase,the lesions appeared as a wedged or a patchy enhancement area at the edge of the liver,showing a halo sign in 68 patients.In 56 patients,the PV was shown also in the early arterial phase;(2) in the arterial phase,arailway track sign was shown in 21 patients as a result of a portal vein branch showing right next to a hepatic arterial branch.In the central type and in the arterial phase,the main portal vein (or the hepatic vein) and the left/right branches of the PV (or the HV) were shown.Conclusion MSCT and CTA were useful in the diagnosis of pure hepatic AVF.