T1WI Signal Research Articles

Risk factors affecting long-term efficacy of ultrasound-guided high-intensity focused ultrasound treatment for multiple uterine fibroids

Objectives To investigate the long-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for multiple uterine fibroids and the factors associated with recurrence. Materials and methods Five hundred and forty-nine patients with multiple uterine fibroids treated with USgHIFU from June 2017 to June 2019 were retrospectively analyzed. The Pictorial Blood Loss Assessment Chart (PBAC) was used to assess menstrual blood loss. The patients were asked to undergo pre- and post-USgHIFU magnetic resonance imaging (MRI) and complete routine follow-up after USgHIFU. Cox regression analysis was used to investigate the risk factors associated with recurrence. Results The median number of fibroids per patient was 3 (interquartile range: 3–4), and a total of 1371 fibroids were treated. Among them, 446 patients completed 3 years follow-up. Recurrence, defined as PBAC score above or equal to 100 and/or the residual fibroid volume increased by 10%, was detected in 90 patients within 3 years after USgHIFU, with a cumulative recurrence rate of 20.2% (90/446). The multi-factor Cox analysis showed that age was a protective factor for recurrence. Younger patients have a greater chance of recurrence than older patients. Mixed hyperintensity of fibroids on T2WI and treatment intensity were risk factors for recurrence. Patients with hyperintense uterine fibroids and treated with lower treatment intensity were more likely to experience recurrence than other patients after USgHIFU. No major adverse effects occurred. Conclusions USgHIFU can be used to treat multiple uterine fibroids safely and effectively. The age, T2WI signal intensity and treatment intensity are factors related to recurrence.

A Novel DNA Aptamer Probe Recognizing Castration Resistant Prostate Cancer in vitro and in vivo Based on Cell-SELEX.

Early recognition of castration-resistant state is of significance for timely adjustment of treatment regimens and improvement of prognosis. This study aims to screen new aptamers CRda8 and CRda21 which recognize castration resistant prostate cancer (CRPC) cells with high affinity and specificity by SELEX technology. The enrichment of specific aptamer candidates was monitored by flow cytometric analysis. The affinity and specificity of aptamer candidates were evaluated by flow cytometry and immunofluorescence assay. MR imaging of CRda21-conjugated polyethylene glycol (PEG)-Fe3O4 nanoparticles to CRPC was further explored in vivo. Both aptamers showed high specificity to target cells with dissociation constants in the nanomolar range, and did not recognize other tested cells. The staining of clinical tissue sections with fluorescent dye labeled aptamers showed that sections from CRPC exhibited stronger fluorescence while sections from benign prostatic hyperplasia and androgen dependent prostate cancer did not exhibit notable fluorescence. In vivo MRI demonstrated that CRda21-conjugated PEG-Fe3O4 had good affinity to CRPC and produced strong T2WI signal intensity reduction distinguished from peritumoral tissue. The high affinity and specificity of CRda8 and CRda21 make the aptamer hold potential for early recognition of castration-resistant state and diagnosis of CRPC at the cellular level.

A Smart Responsive Nanotheranostic System for MRI of Tumor Response to Immunotherapy and Enhanced Synergism of Thermo‐Immunotherapy

AbstractThe challenges associated with the assessment of immune checkpoint inhibitor (ICI) therapy and low immunotherapy response observed in patients with poorly immunogenic tumors are addressed. A smart‐responsive nanoprobe MZF@Gd is synthetized based on magnetic resonance tuning (MRET). The nanoprobe is designed to be targeted and cleaved by granzyme B, a marker of cytotoxic T‐cell activation. MZF@Gd consisted of superparamagnetic Mn‐ and Zn‐doped ferrite magnetic nanoparticles (MZF‐MNPs) with a magnetocaloric effect and a paramagnetic contrast agent gadolinium‐diethylenetriamine penta‐acetic acid (Gd‐DTPA). These components are connected by the granzyme B substrate peptides. The activation of the T1WI signal through MRET, following the cleavage of the probe by granzyme B, enabled the accurate evaluation of the ICI therapeutic effect. Subsequently, an active‐targeting magnetothermally responsive nanotheranostic agent FA‐P(MZF@Gd/JQ1) is fabricated. This agent incorporated the MRET probe MZF@Gd, JQ‐1 (an inhibitor of PD‐L1), the thermosensitive copolymer PCL‐b‐P(MEO2MA‐co‐OEGMA), and folic acid on the surface. Nanotheranostic agents killed tumor cells through magnetocaloric effects, stimulated antitumor immunity, and regulated the drug release, thereby achieving a synergistic effect between hyperthermia and immunotherapy. Moreover, MZF@Gd released from the agent sensitively detected the presence of granzyme B at the tumor site, thereby enabling an effective assessment of therapeutic efficacy.

MR imaging findings of stage I intravenous leiomyomatosis: a retrospective single-center study in 19 cases.

The aim was to explore the magnetic resonance imaging (MRI) features of stage-I intravenous leiomyomatosis (IVL). From January 2019 to January 2023, clinical, pathological, and MRI data were collected from 19 cases confirmed by surgical pathology. Two radiologists retrospectively measured the tumor sizes, T1WIs, T2WIs, and ADC values and evaluated contrast-enhanced T1WIs, DWIs, complications and parauterine infiltrations. The number of tumor cells and the total nuclear area were measured. The percentage of tumor cell area out of the total area was used as the tumor cell density. Nineteen patients with stage-I IVL aged 33 to 66years (mean age: 46 ± 7.6years) were included in this study. All 19 cases were located in the myometrium or parametrium, with a mean diameter of 11.2 ± 4.8cm. Among these cases, 14 (73.6%) were associated with leiomyoma, and six (31.6%) involved the broad ligament. Isointensity was observed in the T1WIs of 12 cases (63.2%), while slight hypointensity was seen in five patients (26.3%). Isointensity was observed in the on T2WIs of four cases (21.1%), and iso- or slight hyperintensity was observed in 15 cases (78.9%). A significant difference was detected between the normalized T2WIs of IVL and myometrium (p < 0.001). A Pearson correlation test showed demonstrated a negative correlation between the ADC and tumor cell density values (r = -0.946, p < 0.001). Tortuous vessels were present in 17 cases (89.5%) within or next to the lesions, and multiple winding cord-like filling defects were seen in 11 cases (57.9%) within the tortuous vessels on the T2WIs. Identifying the characteristic MRI features of stage-I IVL helped improve the diagnostic accuracy achieves for this rare tumor. Stage-I IVL often presents as a large mass accompanied by leiomyoma, and it easily invades the broad ligament. TIWI signals exhibited isointensity, and T2WI signals contained iso- or slight hyperintensity. Tortuous vessels were present within or next to the lesions, and multiple winding cord-like filling defects were observed within the tortuous vessels on the T2WIs.

The value of dynamic contrast-enhanced MRI and diffusion-weighted sequence in the evaluation of endometrial lesions

Background/Aim: Endometrial abnormalities represent a diagnostic challenge due to overlapping imaging features with normal endometrium. Aim of this study was to assess accuracy of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI) in evaluation of endometrial lesions in comparison with T2 and to assess local staging validity and degree of myometrial invasion in malignancy. Methods: Forty patients with abnormal vaginal bleeding or sonographic thickened endometrial were recruited. MRI examination of pelvis was per-formed using 1.5 T scanner with a pelvic array coil. Conventional T1-and T2, dynamic contrast-enhanced (DCE) sequences and diffusion-weighted image (DWI) were performed. Results: Mean age of patients was 53.2 years and 60 % of patients COM-plained of post-menopausal bleeding. Irregular margin, type III enhancement curve, a high signal in T2WI and DWI and low signal of apparent diffusion coefficient (ADC) were significantly associated with malignancy. The optimum ADC threshold value for distinguishing benign from malignant endometrial lesions was 0.905 × 10 -3 mm 2 /S, with 95.5 % sensitivity and 92.9 % specificity. DWI was most sensitive to malignant endometrial lesions, followed by DCE (89.6 %, 98.4 %) and T2 (86.7 %, 91.4 %). DWI and DCE staging correlated with FIGO staging (p = 0.0001 and p = 0.019, respectively). DWI had the best sensitivity for myometrial invasion (95.6 %), followed by DCE (91.9 %) and T2WI (90.1 %). All three sequences had 89.7 % specificity. Conclusion: DWI and DCE MRI were superior to conventional MRI at distinguishing malignant from benign endometrial lesions and can improve myometrial invasion depth evaluation and therapy planning when COM-bined with morphological T2WI. ADC cutoff at a high b value improved MRI diagnostic sensitivity and specificity.

10053-MNG-1 STRATIFICATION OF TUMOR VOLUME GROWTH RATE USING RISK FACTORS IN SUPRATENTORIAL MENINGIOMAS

Abstract BACKGROUND The natural history of meningiomas is still unclear, and no guidelines have been established based on objective indices regarding the necessity and timing of therapeutic intervention. Objective: We attempted to provide statistics on the characteristics of tumor volume change, stratify tumor growth by risk factors, and generate a predictive tumor volume curve based on the statistics, with the aim of describing the natural history of meningiomas. METHODS 313 cases were included in the study, with the origin of meningioma being the circumflex and parasagittal sinus areas and the cerebral sickle region, and with multiple MRI scans performed at intervals of at least 3 months. Relative growth rate (RGR) and annual volume change (AVC) were calculated by tumor volume, and the patients were classified into three groups according to the combination of gender, age, and MRI T2WI signal intensity, and compared. RESULTS The median RGR and AVC of the entire cohort were 6.1% and 0.20 cm3/year, respectively, and there were significant differences between groups in gender (p=0.018) and MRI T2WI (p &amp;lt; 0.001) for RGR and tumor location (p=0.025) and initial tumor volume (p &amp;lt; 0.001)for AVC. The median RGR and AVC in the classification were 17.5% and 1.05 cm3/year for the very high growth group, 8.2% and 0.33 cm3/year for the high growth group, and 3.4% and 0.04 cm3/year for the low growth group, showing significant differences between the groups (p &amp;lt; 0.001). The predicted tumor volume curve showed an average 2.24-fold or 5.24 cm3 increase in volume over 5 years in the very high-growth group, while little tumor volume change was observed in the low-growth group. CONCLUSION The combination of growth risk factors allowed stratification of tumor growth and provided a predictive tumor volume curve for each county. The results may assist in the treatment of supratentorial meningiomas.

Comparison of Imaging Characteristics of Gangliogliomas between Child/Adolescent Group and Adult Group.

Ganglioglioma is a rare, slowly proliferating mixed glioneuronal tumor, with the highest incidence observed in children and young adults, but it can also occur in adults. This study aimed to compare the imaging characteristics of ganglioglioma in children/adolescents and adults to facilitate radiographic diagnosis. In this retrospective study, a total of 32 patients were included and divided into two groups: the child/adolescent group (age < 18 years, n=19) and the adult group (age ≥ 18 years, n=13). Various variables were analyzed, including maximum diameter, location, periphery, border, calcification, unenhanced CT attenuation, T1WI, T2WI/FLAIR, and DWI signal intensity, enhancement pattern, degree of enhancement, homogeneity of enhancement, solid/cystic component, peri-tumoral edema, intra-tumoral septa, peri-tumoral capsule, and intra-tumoral hemorrhage. Most gangliogliomas were situated in the peripheral regions, particularly in the temporal lobe. The majority exhibited hypointense/isointense signals on T1WI and hyperintense signals on T2WI/FLAIR and DWI, with predominantly heterogeneous nodular enhancement. Peri-tumoral edema was significantly less frequent in the child/adolescent group, while marked enhancement was significantly more common in the adult group. There was no significant difference in maximum diameter between the child/adolescent group and the adult group. Peri-tumoral edema was significantly less prevalent in the child/adolescent group, whereas marked enhancement was significantly more frequent in the adult group. To ensure accurate results, a larger case series should be conducted to validate our findings.

Acute and Chronic Kernicterus: MR Imaging Evolution of Globus Pallidus Signal Change during Childhood.

Despite its rarity in Western countries, kernicterus resulting from severe neonatal hyperbilirubinemia and its associated neurologic consequences still persists. Subtle MR imaging patterns may be overlooked, leading to diagnostic and prognostic uncertainties. The study systematically analyzes MR imaging pattern over time. A retrospective MR imaging study was conducted in Departments of Pediatric Neurology at the University Children's Hospitals in Leipzig, Germany, or Tübingen, Germany, between 2012 and 2022 in patients who presented beyond the neonatal period suspected of having chronic kernicterus. Eight patients with a total of 15 MR images were identified. The clinical diagnosis of kernicterus was confirmed in all cases on the basis of typical MR imaging findings: Bilateral, diffuse hyperintensity of the globus pallidus was observed in the neonatal period on T1WI (1 MR imaging, at 2 weeks), in infancy on T2WI (4 MR images, at 9-26 months). In children 2 years of age and older, bilateral hyperintensity on T2WI was limited to the borders of the globus pallidus (8 MR images, at 20 months -13 years). Notably, 2 children exhibited normal initial MR imaging findings at 2 months of age. Hence, MR imaging depiction of kernicterus pathology evolves with time, first evident on T1WI, subsequently on T2WI, with a "blind window" during early infancy. The T2WI signal change initially involves the entire globus pallidus and later is limited to the borders. Kernicterus had not been diagnosed in any except 2 patients by previous investigators. All patients presented with a characteristic clinical history and signs and an evolving MR imaging pattern. Nonetheless, the diagnosis of kernicterus was frequently missed. Abnormalities on later MR images appear to be underrecognized.

Intravoxel incoherent motion diffusion-weighted MRI for predicting the efficacy of high-intensity focused ultrasound ablation for uterine fibroids.

To evaluate the significance of magnetic resonance (MR) intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) quantitative parameters in predicting early efficacy of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids before treatment. 64 patients with 89 uterine fibroids undergoing HIFU ablation (51 sufficient ablations and 38 insufficient ablations) were enrolled in the study and completed MR imaging and IVIM-DWI before treatment. The IVIM-DWI parameters, including D (diffusion coefficient), D* (pseudo-diffusion coefficient), f (perfusion fraction) and relative blood flow (rBF) were calculated. The logistic regression (LR) model was constructed to analyze the predictors of efficacy. The receiver operating characteristic (ROC) curve was drawn to assess the model's performance. A nomograph was constructed to visualize the model. The D value of the sufficient ablation group (931.0(851.5-987.4) × 10-6 mm2/s) was significantly lower than that of the insufficient ablation group (1052.7(1019.6-1158.7) × 10-6 mm2/s) (p<0.001). However, differences in D*, f, and rBF values between the groups were not significant (p>0.05). The LR model was constructed with D value, fibroid position, ventral skin distance, T2WI signal intensity, and contrast enhanced degree. The area under the ROC curve, specificity, and sensitivity of the model were 0.858 (95% confidence interval: 0.781, 0.935), 0.686, and 0.947. The nomogram and calibration curves confirmed that the model had excellent performance. The IVIM-DWI quantitative parameters can be used to predict early effects of HIFU ablation on uterine fibroids. A high D value before treatment may indicate that the treatment will be less effective in the early stages.

MRI features of pituitary adenoma apoplexy and their relationship with hypoxia, proliferation, and pathology.

We aim to study the MRI features of pituitary adenoma (PA) apoplexy and their relationship with hypoxia, proliferation, and pathology. Sixty-seven patients with MRI signs of PA apoplexy were selected. According to the MRI signs, they were divided into the parenchymal group and the cystic group. The parenchymal group had a low signal area on T2WI without cyst >2 mm and this area was not significantly enhanced on the corresponding TW1 enhancement. The cystic group had a cyst >2 mm on T2WI, and the cyst showed liquid stratification on T2WI or high signal on T1WI. The relative T1WI (rT1WI) enhancement value and relative T2WI (rT2WI) value of non-apoplexy areas were measured. Protein levels of hypoxia-inducible factor-1 (HIF-1α), pyruvate dehydrogenase kinase 1 (PDK1), and Ki67 were detected with immunohistochemistry and Western blot. Nuclear morphology was observed with HE staining. The rT1WI enhancement average value, rT2WI average value, Ki67 protein expression level, and the number of abnormal nuclear morphology of non-apoplexy lesions in the parenchymal group were significantly lower than those in the cystic group. The protein expression levels of HIF-1α and PDK1 in the parenchymal group were significantly higher than those in the cystic group. HIF-1α protein was positively correlated with PDK1 but negatively correlated with Ki67. When there is PA apoplexy, the ischemia and hypoxia of the cystic group are lesser than those of the parenchymal group, but the proliferation is stronger.

Clinical and imaging features of Kaposiform hemangioendothelioma in infants

ObjectiveKaposiform hemangioendothelioma (KHE) is a locally aggressive tumor of vascular origin. This study investigated the clinical and imaging features of KHE to provide a reference for its early diagnosis. MethodsThe clinical and imaging findings of 27 clinically confirmed KHE cases (including 21 with focal lesions and 6 with diffuse lesions) between January 2016 and December 2021 were retrospectively analyzed. ResultsThe mean age of the 27 patients was 105 ± 80.27 days. Twenty-two (81.5%) of these patients had Kasabach–Merritt phenomenon. Most KHEs were located in the trunk and/or extremities (22/27). Ultrasonography showed heterogeneous echogenicity and/or striated hypoechoic bands with abundant or patchy blood flow within the tumor. On plain computed tomography (CT), they appeared as heterogeneous lesions isodense with the muscles, with a CT value of 29.58 ± 11.53 HU. In the arterial phase, the KHEs showed striated or lamellar heterogeneous enhancement, with a CT value of 153.91 ± 52.11 HU after enhancement. All KHEs showed uneven and high signal intensity on T2-weighted imaging, mixed high and low signal intensity on fat-saturated images, and no significant diffusion restriction on diffusion-weighted imaging. ConclusionKHEs can occur in various locations and present as highly infiltrative and heterogeneous masses that can invade the skin, adjacent muscles, and bones. A vascularized mass with purpuric skin changes, with uneven and high T2WI signal is highly suggestive of the diagnosis of KHE.

Magnetic resonance findings of Stewart-Treves Syndrome in primary limb lymphedema compared with pathology: A retrospective single-center study.

Stewart-Treves Syndrome in Primary Limb Lymphedema (STS-PLE) is an extremely rare malignant tumor. A retrospective analysis was conducted to elucidate the relationship between magnetic resonance imaging (MRI) findings and signs compared to pathology. Seven patients with STS-PLE were enrolled at Beijing Shijitan Hospital, Capital Medical University, from June 2008 to March 2022. All cases were examined by MRI. The surgical specimens were subjected to histopathological and immunohistochemical staining for CD31, CD34, D2-40, and Ki-67. There were two different types of MRI findings. One was mass shape (STS-PLE I type) in three male patients, and the other was the "trash ice" d sign (STS-PLE II type) observed in four female patients. The average duration of lymphedema (DL) of STS-PLE I type (18 months) was shorter than that of STS-PLE II type (31 months). The prognosis for the STS-PLE I type was worse than that for the STS-PLE II type. Regarding overall survival (OS), the STS-PLE I type (17.3 months) was three times shorter than that of the STS-PLE II type (54.5 months). For STS-PLE I type, the older the STS-PLE onset, the shorter the OS. However, there was no significant correlation in STS-PLE II type. MRI was compared to histological results to provide an explanation for the differences in MR signal changes, especially on T2WI. Against a background of dense tumor cells, the richer the lumen of immature vessels and clefts, the higher the T2WI MRI signal (taking muscle signal as the internal reference standard) and the worse the prognosis, and vice versa. We also found that younger patients with a lower Ki-67 index (<16%) had better OS, especially for the STS-PLE I type. Those with stronger positive expression of CD31 or CD34 had shorter OS. However, the expression of D2-40 was positive in nearly all cases, and seemed not to be associated with prognosis. In lymphedema, the richer the lumen of immature vessels and clefts based on dense tumor cells, the higher the T2WI signal on the MRI. In adolescent patients, the tumor often showed a "trash ice" sign (STS-PLE II-type) and prognosis was better than for the STS-PLE I type. While in middle-aged and older patients, tumors showed a mass shape (STS-PLE I type). The expression of immunohistochemical indicators (CD31, CD34, and KI-67) correlated with clinical prognosis, especially decreased Ki-67 expression. In this study, we determined it was possible to predict prognosis comparing MRI findings with pathological results.

Hepatic epithelioid angiomyolipoma: magnetic resonance imaging characteristics.

The aim of the study was to analyze MR imaging features of hepatic epithelioid angiomyolipoma (HEAML). This study included 113 patients with 122 pathologically confirmed HEAML who underwent enhanced MRI scanning before partial hepatectomy. MR images were retrospectively reviewed and correlated with pathological findings. The mean age of 113 patients was 48.12 ± 11.77years old, and the male to female ratio was 1:3.35 with 87 females (76.99%). 107 (94.69%) patients presented as single tumor, and 96 patients (84.96%) were asymptomatic. 122 HEAML lesions were diagnosed pathologically in 113 patients, with the average of 4.47 ± 3.26cm. 109 lesions (89.34%) and 108 lesions (88.52%) showed regular and well-defined boundary. On T1WI, 121 lesions (99.18%) mainly presented hypointensity. On T2WI, 118 lesions (96.72%) and 109 lesions (89.34%) mainly showed hyperintensity and heterogeneous signals. Most of the lesions (97.46%) showed hyperintensity on DWI. 118 lesions (96.72%) manifested as severe hyperenhancement and 106 lesions (86.89%) showed heterogeneity during the arterial phase. As for the lesion enhancement pattern, 73 lesions (59.84%) presented as persistent enhancement, 37 lesions (30.33%) as wash out, 8 lesions (6.56%) as degressive enhancement, and 4 lesions (3.28%) as poor blood supply. Additionally, 96 lesions (78.69%) with intra-tumor vessels and 85 lesions (69.67%) with outer rim were confirmed during the delayed phase. At enhanced MRI, hypointensity on T1WI, hyperintensity and heterogeneous signals on T2WI, hyperintensity on DWI, little or no fat component, heterogenous hyperenhancement, persistent enhancement, intra-tumor vessels, and outer rim would be helpful to diagnose HEAML.

Sacral injury and influencing factors after ultrasonic ablation of uterine fibroids ≤30 mm from the sacrum

To study sacral injuries and influencing factors after ultrasonic ablation of uterine fibroids no more than 30 mm from the sacrum. A total of 406 patients with uterine fibroids who underwent percutaneous ultrasound ablation were analyzed retrospectively. All patients underwent contrast-enhanced magnetic resonance imaging (MRI) scans before and after high-intensity focused ultrasound. The abnormal signal intensity (low signal intensity on T1WI and high signal intensity on T2WI) on the postoperative MRIs was indicative of a sacral injury. The patients were divided into a sacrum injury group and a sacrum non-injury group. The relationship between fibroid characteristics, ultrasound ablation parameters, and injury was analyzed using univariate and multivariate analyses. There were 139 cases of sacral injury (34.24%). When the distance from the fibroid's dorsal side to the sacrum was 0-10 mm, the risk assessment showed that the danger of sacral injury increased by 1.85 times and 3.03 times compared with that at a distance of 11-20 or 21-30 mm. Furthermore, the risk of sacral injury increased by 1.89 times and 3.23 times when the therapeutic dose (TD) of a fibroid was >500 KJ compared with that of a fibroid with TD= 250-500 KJ and <250 KJ. A distance of 10 mm or less and a TD of >500 KJ were significantly correlated with sacral injury. The distance from the fibroid's dorsal side to the sacrum and the TD were the main causes of injury to the sacrum. A distance of 10 mm or less and a TD of >500 KJ carried higher injury risks, while a distance of 21-30 mm and a TD of <250 KJ were the most appropriate circumstances to reduce the risk of sacral injury.

Chordoid gliomas of the third ventricle

Chordoid glioma is a rare slow-growing tumor of the central nervous system. Available world experience includes no more than 200 cases (lesion of the third ventricle in absolute majority of cases). Recognition and treatment of chordoid glioma are currently difficult problems due to small incidence of this disease. To describe clinical manifestations and surgical treatment of chordoid glioma of the third ventricle considering literature data and own experience. There were 12 patients (6 men and 6 women) with chordoid glioma between 2004 and 2023 (10 patients with lesion of the third ventricle, 1 - lateral ventricle, 1 - pineal region). Only patients with tumors of the third ventricle were analyzed. Total and subtotal resection was performed in 1 and 3 cases, respectively. Five patients underwent partial resection, 1 patient underwent biopsy. The follow-up data were available in 7 out of 10 patients (mean 25 months). Radiotherapy was performed in 4 patients (continued tumor growth in 2 cases). One patient died. Chordoid glioma is a benign tumor predominantly localized in the third ventricle. Preoperative MRI and CT in some cases make it possible to suspect chordoid glioma and differentiate this tumor from craniopharyngioma, meningioma and pituitary adenoma by such signs as isointense signal in T1WI, hyper- or isointense signal in T2WI, homogeneous contrast enhancement and edema of basal ganglia in T2 FLAIR images. The only effective treatment for chordoid glioma is surgery. Total resection is often impossible or extremely dangerous due to location of tumor, large size and invasion of the third ventricle. Postoperative mental disorders and diabetes insipidus, including severe hypernatremia, are common that requires mandatory monitoring of water and electrolyte balance.

MNG-3 STRATIFICATION OF TUMOR GROWTH BY RISK FACTORS AND PREDICTED TUMOR VOLUME CURVES FOR SUPRATENTORIAL MENINGIOMAS

Abstract Background The natural history of meningiomas is still unclear, and no guidelines have been established based on objective indices regarding the necessity and timing of therapeutic intervention.Objective: We attempted to provide statistics on the characteristics of tumor volume change, stratify tumor growth by risk factors, and generate a predictive tumor volume curve based on the statistics, with the aim of describing the natural history of meningiomas. Methods 313 cases were included in the study, with the origin of meningioma being the circumflex and parasagittal sinus areas and the cerebral sickle region, and with multiple MRI scans performed at intervals of at least 3 months. Relative growth rate (RGR) and annual volume change (AVC) were calculated by measuring tumor volume, and the patients were classified into three groups according to the combination of gender, age, and MRI T2WI signal intensity, and compared. Results The median RGR and AVC of the entire cohort were 6.1% and 0.20 cm3/year, respectively, and there were significant differences between groups in gender (p=0.018) and MRI T2WI (p &amp;lt; 0.001) for RGR and tumor location (p=0.025) and initial tumor volume (p &amp;lt; 0.001)for AVC. The median RGR and AVC in the classification were 17.5% and 1.05 cm3/year for the very high growth group, 8.2% and 0.33 cm3/year for the high growth group, and 3.4% and 0.04 cm3/year for the low growth group, showing significant differences between the groups (p &amp;lt; 0.001). The predicted tumor volume curve showed an average 2.24-fold or 5.24 cm3 increase in volume over 5 years in the very high-growth group, while little tumor volume change was observed in the low-growth group. Conclusion The combination of growth risk factors allowed stratification of tumor growth and provided a predictive tumor volume curve for each county. The results may assist in the treatment of meningiomas.

Lateral ventricle meningiomas in children: clinicopathological and neuroradiological features.

Lateral ventricle meningiomas (LVM) in children are very rare. The current research is mostly limited to adults, and there are very few related studies on children. The purpose of this study was to analyze the clinicopathological and imaging features of lateral ventricle meningiomas in children. A retrospective analysis of five children with pathologically confirmed lateral ventricle meningioma was performed, and we collected clinical data, including clinicopathological data, treatment prognosis data, and imaging features (including tumor location, signal intensity, enhancement degree, intratumoral cyst, calcification, peritumoral edema, and associated hydrocephalus). Among the 5 patients with LVM, 4 were male and 1 was female with an average age of 7.6years (range 2 to 12years). All CT scans showed slight hyperintensity or isodensity, and only 1 patient had calcification. Two patients demonstrated cyst changes. Four patients had varying degrees of peritumoral edema. The average tumor volume was 164.1 cm3 (1.4-314.9 cm3). All 5 patients with LVM were iso- or hypointense on T1WI. The T2WI signals had no obvious features. Four patients had a high signal on DWI (80%). The contrast-enhanced signals were mostly homogeneously strong (80%). MRI showed hydrocephalus in 3 patients. All patients underwent gross total resection, and they were followed up regularly after the operation. The average follow-up time was 47.4months. No recurrence was found in any of the children. All patients were pathologically confirmed to have meningiomas, and WHO grades were all grade I. Lateral ventricle meningiomas in children are very rare, and the imaging manifestations of the tumor have certain characteristics, but the clinical diagnosis is still difficult, and the diagnosis still requires pathological analysis.

Neuroimaging in Pediatric Patients with Juvenile Xanthogranuloma of the CNS.

Juvenile xanthogranuloma is a rare clonal, myeloid, neoplastic disorder. Typically, juvenile xanthogranuloma is a self-limited disorder of infancy, often presenting as a solitary red-brown or yellow skin papule/nodule. A small subset of patients present with extracutaneous, systemic juvenile xanthogranuloma, which may include the CNS. The goal of this retrospective study was to evaluate and categorize the neuroimaging findings in a representative cohort of pediatric patients with CNS juvenile xanthogranuloma. The brain and/or spine MR imaging data of 14 pediatric patients with pathology-proven juvenile xanthogranuloma were categorized and evaluated for the location; the signal intensity of xanthogranulomas on T1WI, T2WI, DWI, and a matching ADC map for the pattern and degree of contrast enhancement; and the presence of perilesional edema, cysts, or necrosis. Fourteen pediatric patients (8 girls, 6 boys; mean age, 84 months) were included in the study. Patients presented with a wide variety of different symptoms, including headache, seizure, ataxia, strabismus, hearing loss, facial paresis, and diabetes insipidus. Juvenile xanthogranuloma lesions were identified in a number of different sites, including supra- and infratentorial as well as intracranial and spinal leptomeningeal. Five patients were categorized into the neuroradiologic pattern unifocal CNS juvenile xanthogranuloma; 8, into multifocal CNS juvenile xanthogranuloma; and 1, into multifocal CNS juvenile xanthogranuloma with intracranial and spinal leptomeningeal disease. In most cases, xanthogranulomas were small-to-medium intra-axial masses with isointense signal on T1WI (compared with cortical GM), iso- or hyperintense signal on T2WI, had restricted diffusion and perilesional edema. Almost all xanthogranulomas showed avid contrast enhancement. However, we also identified less common patterns with large lesions, nonenhancing lesions, or leptomeningeal disease. Four cases had an additional CT available. On CT, all xanthogranulomas were homogeneously hyperdense (solid component) without evident calcifications. CNS juvenile xanthogranuloma may demonstrate heterogeneous neuroimaging appearances potentially mimicking other diseases, such as primary brain neoplasms, metastatic disease, lymphoma and leukemia, other histiocytic disorders, infections, or granulomatous diseases.

The Value of MRI Combined with AFP, AFP-L3, GP73, and DCP in the Diagnosis of Early Primary Liver Cancer.

Objective To investigate the diagnostic value of magnetic resonance imaging (MRI) combined with serum alpha-fetoprotein (AFP), alpha-fetoprotein (AFP-L3), Golgi protein 73 (GP73), and des-γ-carboxyprothrombin (DCP) on early-stage primary liver cancer (PHC). Methods A total of 122 patients who were treated in our hospital from January 2019 to May 2022 were included in this study, including 62 patients with early PHC (referred to as the observation group) and 60 patients with benign liver disease (referred to as the control group). MRI scans were performed on all participants, and MRI image features were compared. Subsequently, the differences in serum AFP, AFP-L3, GP73, and DCP concentrations of the two groups of patients were detected and compared. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of MRI and each of the above tumor markers in diagnosing early PHC. Results The proportion of low or slightly low signal on T1WI in the observation group was significantly greater than that in the control group, while the proportions of equisignal and high signal were lower than those in the control group. The proportion of high signal on T2WI and high signal on DWI in the observation group was higher than that in the control group, while the proportion of low or slightly low signal and equisignal was lower than that in the control group. Compared with the control group, the serum concentrations of AFP, AFP-L3, GP73, and DCP in the observation group were significantly increased (all P < 0.05). For the diagnosis of early-stage PHC patients, MRI combined with these four markers showed favorable diagnostic value compared with parameter alone (area under the ROC curve, sensitivity, and specificity were 0.943, 0.919, and 0.833, respectively). Conclusion MRI combined with serum AFP, AFP-L3, GP73, and DCP detection has good value in the diagnosis of early PHC patients, and can serve as an effective strategy to improve the early diagnosis rate of PHC.

MRI parameters for predicting the effect of ultrasound-guided high-intensity focused ultrasound in the ablation of uterine fibroids

To study the value of magnetic resonance imaging (MRI) parameters in predicting the efficacy of ultrasonic ablation of fibroids. A total of 91 patients were divided into groups based on non-perfused volume (NPV) ratio and blood supply type. The preoperative MRI parameters were measured and analysed. A correlation analysis between the MRI parameters and the NPV ratio was performed. Receiver operating characteristic (ROC) curves were used to analyse and determine the cut-off value of MRI parameters to predict the ablation rate of fibroids. The uterine fibroids group with an NPV ratio <80% and the group with an NPV ratio of ≥80% had significant differences in signal intensity (SI) at MRI T2-weighted imaging (WI), fibroid-to-rectus abdominis SI ratio (SIR) at T2WI, and blood supply type (p<0.05). There were no significant differences in fibroid volume, T2WI signal uniformity, and apparent diffusion coefficient (ADC) values. The ADC value and SI and SIR at MRI T2WI in the group with poor blood supply were lower than those in the group with a rich blood supply (p<0.05). SI at MRI T2WI correlated negatively with the NPV ratio. The cut-off values for SI and SIR at MRI T2WI of fibroids whose NPV ratio exceeds 80% were 220.58 and 1.315, respectively. SI at MRI T2WI and blood supply type could be predictors of the efficacy of ablation. Ultrasonic ablation of fibroids with MRI T2WI hyperintensity and a rich blood supply had poor efficacy.