Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
Objective To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC). Methods A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed. Results Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.ConclusionsThe majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
Objective To observe the multimodal imaging characteristics of the eyes in patients with presumed tuberculous retinal vasculitis. Methods A retrospective case series study. A total of 15 patients (22 eyes) diagnosed with presumed tuberculous retinal vasculitis and receiving anti-tuberculosis treatment (ATT) effectively in Department of Ophthalmology, Subei People's Hospital Affiliated to Yangzhou University from January 2018 to April 2021 were included. Among them, there were 5 males and 10 females. Seven had bilateral involvement and 8 had unilateral involvement. The age was 49.3±11.1 years old. The best corrected visual acuity (BCVA), fundus colour photography, wide-angle fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) were performed in all patients. Indocyanine green angiography (ICGA) was performed in 7 eyes. The BCVA examination was performed with the international standard visual acuity chart, which was converted into the logarithm of minimal angel resolution vision (logMAR). Systemic tuberculosis-related examinations included chest CT, serum T-spot, purified protein derivative and other tuberculosis-related tests. All patients were treated with systemic anti-tuberculosis therapy. The follow-up time was ＞12 months. The multimodal imaging characteristics for affected eyes. Nonparametric test was used to compare BCVA before and after treatment. ResultsThe retinal vessels of all the affected eyes were tortuously dilated, including 3 eyes with vascular white scabbard, 5 eyes with scattered bleeding point at the retina inculding 3 eyes walking along the vessels. The lesions were mainly distributed in the middle and periphery of the retina, and some of them involved the posterior pole; 12 eyes (54.5%, 12/22) with simple retinal vasculitis and 10 eyes (45.5%, 10/22) with retinal vasculitis complicated with choroiditis. Tuberculous retinal vasculitis showed different degrees of retinal vascular leakage on FFA, mainly retinal vein and capillary leakage, not involving arteries; 16 eyes (72.7%, 16/22) of retinal vasculitis showed peripheral occlusive retinal vasculitis and 4 eyes (18.2%, 4/22) were associated with retinal neovascularization. In 10 eyes with choroiditis, there were multiple focal choroiditis lesions of different sizes under the retina. Of the 7 eyes examined by ICGA, the choroidal inflammatory lesions showed hypofluorescent dark dots (HDD) in 5 eyes (71.4%,5/7), showing HDDs of different sizes, most of which were distributed in the posterior pole and middle periphery. In 10 eyes with retinal vasculitis complicated with choroiditis after ATT, the accumulation of hyper-reflective substances above and below the retinal pigment epithelium layer of the retina was gradually absorbed, but not completely disappeared, and most of the disorders of retinal structure could not be recovered. The average logMAR visual acuity was 0.61±0.57 before treatment and 0.36±0.55 after treatment. The BCVA after treatment was significantly higher than that before treatment (Z=－3.102, P＜0.01). ConclusionsPeripheral occlusive retinal vasculitis is the most common manifestation of tuberculous retinal vasculitis in FFA, which may be accompanied by focal choroidal inflammatory lesions. Wide-angle FFA and ICGA are more important in the diagnosis of tuberculous retinal vasculitis. OCT can be used for monitoring the changes of inflammation.
ObjectiveTo investigate CT image features of ground glass opacity (GGO)-like 2019 novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease.MethodsWe retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January 17th and February 13th, 2020. These 71 GGO-like COVID-19 patients were as a COVID-19 group. And 80 GGO-like early-stage lung carcinoma patients who underwent resection were as a lung carcinoma group. Clinical features such as sex, age, symptoms including fever, cough, fatigue, myalgia and dyspnea, detailed exposure history, confirmatory test (SARS-CoV-2 quantitative RT-PCR) and pathologic diagnosis were analyzed.ResultsSignificantly different symptoms and exposure history between the two groups were detected (P<0.001). More lesions (61 patients at percentage of 85.92%, P<0.001), relative peripheral locations (69 patients at percentage of 97.18%, P<0.001) and larger opacities (65 patients at percentage of 91.55%, P<0.001) were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma. Similar features appeared in early-stage of COVID-19 and lung carcinoma, while pneumonia developed into more extensive and basal predominant lung consolidation. Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur.ConclusionConsidering these similar and unique features of GGO-like COVID-19 and early-stage lung carcinoma, it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases. We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.
Objective To explore the potential indicators of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC) patients and to develop a nomogram model. Methods The clinicopathologic features of PTMC patients in the SEER database from 2004 to 2015 and PTMC patients who were admitted to the Center for Thyroid and Breast Surgery of Xuanwu Hospital from 2019 to 2020 were retrospectively analyzed. The records of SEER database were divided into training set and internal verification set according to 7∶3. The patients data of Xuanwu Hospital were used as the external verification set. Logistic regression and Lasso regression were used to analyze the potential indicators for cervical lymph node metastasis. A nomogram was developed and whose predictive value was verified in the internal and external validation sets. According to the preoperative ultrasound imaging characteristics, the risk scores for PTMC patients were further calculated. The consistency between the scores based on pathologic and ultrasound imaging characteristics was verified. Results The logistic regression analysis results illustrated that male, age<55 years old, tumor size, multifocality, and extrathyroidal extension were associated with cervical lymph node metastasis in PTMC patients (P<0.001). The C index of the nomogram was 0.722, and the calibration curve exhibited to be a fairly good consistency with the perfect prediction in any set. The ROC curve of risk score based on ultrasound characteristics for predicting lymph node metastasis in PTMC patients was 0.701 [95%CI was (0.637 4, 0.765 6)], which was consistent with the risk score based on pathological characteristics (Kappa value was 0.607, P<0.001). Conclusions The nomogram model for predicting the lymph node metastasis of PTMC patients shows a good predictive value, and the risk score based on the preoperative ultrasound imaging characteristics has good consistency with the risk score based on pathological characteristics.
ObjectiveTo observe the multimodal imaging characteristics of combined hamatoma of the retina and retinal pigment epithelium (CHRRPE).MethodsA retrospective case study. From January 2013 to December 2017, 6 CHRRPE patients (6 eyes) diagnosed in Department of Ophthalmology, Sun Yat-sen Memorial Hospital were included in the study. There were 4 males and 2 females, with the mean age of 12.0±8.10 years. There were 5 eyes with BCVA ≤0.1, 1 eye with BCVA＞1.0. Corneal fluoroscopy showed 1 eye with an external oblique 15°, and the remaining eye had no abnormalities in the anterior segment. All eyes underwent fundus color photography, FAF, FFA, ICGA, OCT and color Doppler flow imaging (CDFI). The multimodal imaging characteristics were observed.ResultsAll the affected eyes CHRRPE were located in the posterior pole and showed mild elevation. Most of the retinal neuroepithelial layers had different degrees of hyperplasia, vascular tortuosity and retinal folds. Of the 6 eyes, 4 eyes (66.7%) involving the macula and optic disc, only 2 eyes (33.3%) involving the macula. OCT showed that the structure of the neuroepithelial layer was unclear and the signal intensity was uneven; it involved 2 eyes of the whole retina (33.3%) and only 4 eyes of the neuroepithelial layer (66.7%). FFA and ICGA showed that the choroidal background fluorescence of the early lesions was weakened, and the lesions showed slightly weak fluorescence; the late telangiectasia fluorescein was obviously leaked, and the lesions were stained with fluorescence. FAF mainly appears as weak autofluorescence with a small amount of strong autofluorescence. CDFI has no characteristic performance.ConclusionsCHRRPE is mainly a membrane-like hyperplasia without angiogenesis, involving the retinal neuroepithelial layer, and may also involve the entire retina. OCT is dominated by strong reflection; AF, FFA and ICGA are mainly weak fluorescence.
Objective To investigate the clinical features and multimodal imaging features of eyes with perifoveal exudative vascular anomalous complex (PEVAC). MethodsA retrospective case study. From February 2014 to November 2020, 7 eyes of 7 patients with PEVAC diagnosed by ophthalmology examination in Department of Ophthalmologyof Peking University People's Hospital were included in this study. There were 6 males and 1 female. The age was 60.1±9.1 years. All were monocular. The chief complaints of visual deformation and vision loss were 3 and 1 cases, respectively. All patients underwent best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA). BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. OCT angiography (OCTA) and indocyanine green angiography (ICGA) were performed in 4 and 2 eyes, respectively. Three eyes were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) combined with local laser photocoagulation. Two eyes were treated with laser photocoagulation alone. The follow-up time was 16.7±19.1 months. During follow-up, relevant examinations were performed with the same equipment and methods as at the initial diagnosis. The multimodal imaging characteristics and treatment response of the affected eyes were observed. ResultsThe baseline logMAR BCVA was 0.33±0.19 (0.20-0.80). All eyes showed isolated hemangiomatous lesions in the macular fovea with rigid retinal exudation, and 2 adjacent isolated hemangiomatous lesions were observed in 1 eye. FFA and ICGA examination showed that all eyes with macular hemangiomatous lesions showed clear boundary and strong fluorescence in the early stage. No other retinal or choroidal vascular abnormalities were observed. On OCT examination, circular lumen-like structures with strong reflective wall near the fovea were observed in the macular region of all eyes, accompanied by intraretinal cystic lumen. The macular central retinal thickness (CMT) was 326±125 (207-479) μm. In the four eyes examined by OCTA, blood flow signals were observed in the circular lumenoid structures with strong reflective walls adjacent to the fovea. Blood flow signals were observed in the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina in 3 eyes. SCP showed blood flow signal in 1 eye. In 4 eyes treated with intravitreal injection of anti-VEGF drugs, there was no significant improvement in the intraretinal capsule space after treatment. Subretinal fluid absorption, retinal cystoid edema persisted, and rigid exudation decreased in 1 eye. CMT decreased and BCVA increased in 5 eyes treated with laser photocoagulation or laser photocoagulation alone. At last follow-up, logMAR BCVA was 0.16±0.06 (0.10-0.20) and CMT was 212±34 (154-252) μm. Compared with baseline, the difference of BCVA was statistically significant (t=2.661, P=0.037). ConclusionsThe fundus of PEVAC patients is characterized by solitary or multiple solitary hemangiomatous lesions in the macular fovea. Round lumenoid structures with strong reflective walls, with or without intraretinal cystic lumen, rigid exudate, and subretinal fluid, in which blood flow signals can be seen in OCT.
ObjectiveTo observe the clinical and multimodel imaging characteristics of paracentral acute middle maculopathy (PAMM).MethodsRetrospective case series study. From January 2014 to August 2018, 12 eyes of 12 patients with PAMM diagnosed in Department of Ophthalmology, Peking University People’s Hospital, were included in this study. There were 9 males and 3 females, with the mean age of 57 years. All patients were referred for sudden impaired vision, with or without paracentral scotoma. The patients underwent BCVA, slit lamp examination, fundus photography, FFA and OCT. Simultaneously, OCT angiography (OCTA) was performed in 10 eyes, visual field was performed in 5 eyes, near infrared fundus photography was performed in 1 eye. Clinical and multimodal imaging findings were reviewed and analyzed.ResultsAmong 12 eyes, there were 5 eyes with BCVA 0.05-≤0.1, 4 eyes with BCVA 0.3-0.5, 3 eyes with BCVA 0.6-1.0. There were 1 eye with central rentinal artery obstruction (CRAO), 7 eyes with branch retinal artery obstruction (BRAO). Among them, BRAO with central retinal vein occlusion (CRVO) in 1 eye, with non-arteritic anterior ischemic optic neuropathy in 1 eye, with diabetic retinopathy in 1 eye; old BRAO in 3 eyes; pure BRAO in 1 eye. There were 4 eyes with pure CRVO, including 3 eyes with ischemic CRVO. All eyes demonstrated hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT. En face OCT highlighted the areas with hyperreflectivity corresponding to these lesions. OCTA demonstrated significant deep capillary dropout, abnormal morphology and enlargement of foveal avascular zone.ConclusionHyperreflective band-like lesions at the level of the inner nuclear layer on OCT and middle retinal perivascular hyperreflectivity on en face scan are characteristic in PAMM.
ObjectiveBy applying the mutual corroboration in the diagnosis, we aimed to improve the accuracy of preoperative imaging diagnosis, select the appropriate timing of operation and guide the follow-up time for patients with pulmonary nodules.MethodsClinical data of 1 368 patients with pulmonary nodules undergoing surgical treatment in our department from July 2016 to October 2019 were summarized. There were 531 males and 837 females at age of 44 (21-67) years. The intraoperative findings, images and pathology were classified and analyzed. The imaging pathology and pathological changes of pulmonary nodules were shown as a dynamic process through mutual collaboration and interaction.ResultsOf 1 368 patients with pulmonary nodules, 376 (27.5%) were pure ground-glass nodules, 729 (53.3%) were mixed ground-glass nodules and 263 (19.2%) were solid nodules. Among the pure ground-glass nodules, adenocarcinoma in situ (AIS) accounted for the highest proportion (156 patients), followed by microinvasive adenocarcinoma (MIA, 90 patients), atypical adenomatous hyperplasia (AAH, 85 patients), and benign tumors (20 patients). Among mixed ground-glass nodules, 495 patients were invasive adenocarcinoma (IA) and 207 patients of MIA. In solid nodules, patients were characterized by pathology of either IA (213 patients) or benign tumors (50 patients), and no patient was featured by AAH, AIS or MIA.ConclusionThe mutual collaboration and interaction can improve the accuracy of preoperative diagnosis of pulmonary nodules, and it supports the choice of operation timing and the judgment of follow-up time.