ObjectiveWe report a special case to explain seizure semiology and epileptogenic network of seizure arising from ventral motor cortex, and to explore Focal cortical dycplasia (FCD) features on MR of epileptic patients with DEPDC5 mutation.MethodsA drug-resistant focal epilepsy patient with DEPDC5 mutation was underwent a detailed presurgical evaluation. The epileptogenic area(EA) was localized with SEEG and removed later by surgery. Related literatures were thoroughly reviewed.ResultsSubtle FCD of ventral branch of inferior precentral sulcus(IPv) on MR(1.5T) was noticed. With SEEG recording, seizure onset zone was detected on IPv with the probable lesion, early spreading to anterior insula, central operculum and ventral precentral gyrus. According to the architectures of ventral motor trend, seizure semiology with evolution from contralateral dystonia to ipsilateral chorea movement could be better comprehended. Seizure was controlled after totally resection on the sites of IPv, anterior insula, and central operculum. Pathological change was FCD type I. Other literatures reported that DEPDC5 mutation related FCD may be located in motor system, and seizure onset could also be in anterior insula cortex besides motor cortex in other SEEG cases.ConclusionsEarly contralateral dystonia and chorea movement could be definite figures of seizure arising from inferior precentral sulcus; DEPDC5 mutation maybe a clue to find subtle FCD in motor cortex.
【Abstract】ObjectiveTo investigate the diagnostic value of a fast gradient-echo (GRE) three-dimensional contrastenhanced volumetric interpolated breath-hold examination (3D-VIBE) MR sequence in evaluating focal liver lesions. MethodsConventional spin-echo T2W, 2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic（early arterial, late arterial and portal venous phases） acquisitions were prospectively performed for 51 consecutive patients suspected of having focal liver lesions on CT or ultrasound imaging. Native T2W and 2D GRE T1W were acquired first, then 3D-VIBE fast scanning at early arterial, late arterial and portal venous phases respectively. The SNR and CNR of the liver lesions on plain scan and the enhancement patterns on contrast-enhanced 3D-VIBE images were carefully observed with correlation of the clinical and surgical pathological findings. ResultsThere exited certain differences in SNR, CNR, and the enhancement patterns of different kinds of focal hepatic lesions in plain scan and Gd-enhanced multi-phasic 3D-VIBE acquisitions. Conclusion3D-VIBE MR sequence is helpful in the detection and characterization of focal liver lesions.
摘要:目的: 分析肝脏局灶性结节增生(FNH)的MRI表现和病理特点,探讨两者的相关性,提高FNH诊断的准确率。 方法 :回顾性分析23例(共28个病灶)经手术切除病理证实为FNH的MRI平扫及增强表现,与其病理特点进行对照。 结果 :25个病灶在平扫T1WI上呈等或稍低信号,T2WI上呈等或稍高信号,3个病灶在平扫T1WI及T2WI上均呈稍高信号,增强后所有28病灶动脉期可见明显强化,门脉期及延迟期呈稍高、等或稍低信号,其中12个病灶可见中心纤维瘢痕延迟强化。FNH组织病理上表现为富血供的实质性肿块,肿物内部组织较均匀,没有异型细胞,中心可见纤维瘢痕。 结论 :肝脏MRI平扫及增强检查能很好的反映FNH的组织病理及血供特点,能为FNH的诊断及鉴别诊断提供可靠证据。Abstract: Objective: To analyze the MRI manifestations and pathology characteristic of hepatic focal nodular hyperplasia(FNH),and to investigate their correlation. Methods : A retrospective analysis was made on the unenhanced and dynamic enhanced MR images of 23 patients (totally 28 lesions) with surgical and pathological proved FNH. Results :25 FNH lesions demonstrated isointensity or slightly hypointense on unenhanced T1WI,and isointensity or slightly hyperintense on unenhanced T2WI,3 FNH demonstrated hyperintense on both unenhanced T1WI and T2WI. 28 FNHs were markediyhyperintense in the arterial phase of dynamic contrast enhanced MRI, and isointense or slightly hyperintense in the portal and delayed phase．The seals were shown in 12 lesions, and enhanced in delayed phase．FNH is solid mass with vast blood supply,its inside structure is homogemeous. Typical seal can be found by microscopic examination．〖WTHZ〗Conclusion : MRI could disclose the pathologic features of FNH and its blood supply and improve the accuracy 0f its diagnosis．
【Abstract】ObjectiveTo investigate the diagnostic value of the enhancement patterns for characterizing various focal hepatic lesions （FHL）. MethodsForty-seven patients (50 lesions) were included into the study. The morphologic features and the dynamic enhancement patterns of FHL were observed in the early arterial phase, late arterial phase and portal venous phase.The degree of FHL enhancement was analyzed by calculating the contrasttonoise ratio. Results70％ of the HCCs presented “fast-filling and rapid-washout” feature; 67％ of the cholangiocarcinomas showed slight enhancement in arterial phase, and 33.3％ had delayed enhancement on portal venous phase; All hemangiomas presented peripheral nodular enhancement in arterial phase, which then demonstrating centropedal “push-on” enhancement in portal venous phase; Hepatic abscesses mainly presented a slightly enhanced rim around the lesion with fibrous septa inside and an edematous zone outside. ConclusionThe enhancement pattern and the dynamic evolution of FHL enhancement had a great diagnostic value for different FHL by using MRI 3D-VIBE sequence.
Drug-resistant epilepsy (DRE) not only have disruption of the patients by seizure, but also influence the quality of life, cognitive function and social association, as well as development delay even retrogression for children. Epilepsy surgery is the only curative treatment currently available for focal lesional pharmacoresistant epilepsy, five years complete seizure freedom rates was around 60% after surgery. The criterion of surgical intervention at present is achievement for the diagnosis of DRE, thereafter consideration of early epilepsy surgery, but these maybe a long-term duration. Recent advance in examine methods and surgical techniques have improved the surgical treatment of epilepsy, to such patient with focal lesional structure abnormality, before the DRE emergence, under the discussion of the multidisciplinary team. Children under 3 years old, the brain have greater neural plasticity, early surgical treatment is expected at allow the healthy brain to recover and develop the language function and quality of life. Numerous cause may pose abstracts to the delay of surgical intervention: (1) diagnosis delay; (2) patient himself and their familiar recognize that there have same risk of surgical treatment; (3) the primary doctor firmly believe that epilepsy surgery is the ultimate methods; (4) special problems of the patient, such including: age, comorbidity, and the location of symptom, EEG as well as imaging non-conformation.
Objective To analyze the relationship between the epidermal growth factor receptor(EGFR) gene mutation and malignant pulmonary focal ground-glass lesion (fGGL). Methods We retrospectively collected the clinical data of 86 patients with surgical treatment in the department of cardiothoracic surgery of Changzheng Hospital from August 2012 to February 2015. There were 26 males and 60 females with a mean age of 56.14±10.55 years. We analyzed the relationship between the EGFR gene mutation and the related clinical data. Results Postoperative pathology showed atypical adenomatous hyperplasia (AAH) combined with focal adenocarcinoma in situ (AIS) or AIS in 10 patients, minimally invasive adenocarcinoma (MIA) in 15, and lepidic predominant adenocarcinoma (LPA) in 61. The EGFR gene mutation reports showed the exon 19 19-del mutation in 14 patients, exon 21 L858R mutation in 27, and exon 21 L861Q mutation in 2. There was no difference between the mutation of EGFR gene and clinical factors except age and smoking (P>0.05). Till June 30, 2015, all patients were alive and follow-up was 440.48±186.61 days. Conclusion The EGFR gene in patients with malignant pulmonary fGGL shows a higher mutation rate, which provides important clinical reference data for the basic research and the clinical treatment.
Objective To evaluate the sensitivity and accuracy of SPIO-enhanced MR Imaging in the detection of focal hepatic lesions. Methods We searched MEDLINE (1966 to 2004), EMBSAE (1984 to 2004), The Cochrane Library (Issue 1, 2004), CBMdisc (Jan.1978 to Jul. 2004), CMCC (1994 to 2004), “Radiology”, “AJR” and “European Radiology” database. Data from pharmaceutical companies and our research were also added. Related journals published from 1985 to 2003 were handsearched. Participants were clinically suspected of focal hepatic lesions. The quality of studies was assessed, and descriptive systematic review was applied to evaluate the detection sensitivity and accuracy of the imaging modality. Results Ten studies (418 patients with 1 037 focal hepatic lesions) were included. Because the data of sensitivity and specificity could not be extracted from any of the 10 included studies, it was impossible to do the meta-analysis using SROC curve. The sensitivity of SPIO-enhanced MRI ranged from 66% to 100%; accuracy ranged from 76% to 97%. Conclusions At present, there is no evidence to ascertain that SPIO-enhanced MRI has a considerably high accuracy in the detection of focal hepatic lesions. More studies with good methodology are needed.