Objective: To evaluate left atrial volume and function in patients with paroxysmal atrial fibrillation (AF) combined with left atrial appendage thrombosis and patients with paroxysmal AF without left atrial appendage thrombosis by 3-dimensional speckle tracking imaging (3D-STI), and to explore the application value of this set of parameters in the evaluation of left atrial function in patients with paroxysmal AF. Materials and Methods: A total of 40 patients with paroxysmal AF admitted from December 2018 to December 2020 were selected as the observation group. All patients with paroxysmal AF in the observation group underwent transesophageal echocardiography. According to the presence of left atrial appendage thrombosis, the patients were divided into the AF without thrombosis group (24 cases) and the AF with thrombosis group (16 cases). Thirty normal people were selected as control group who were chosen as having no heart-related disease. The left atrial volume parameters (Left atrial maximum volume LAVmax, Left atrial minimum volume LAVmin, Left atrial volume before atrial contraction LAVpre-A, Left atrial stroke volume LAEV), left atrial ejection fraction (LAEF) and left atrial strain parameters (Left atrial reservoir longitudinal strain LASr, Left atrial conduit longitudinal strain LAScd, Left atrial contraction longitudinal strain LASct, Left atrial reservoir circumferential strain LASr-c, Left atrial conduit circumferential strain LAScd-c, Left atrial contraction circumferential strain LASct-c) of the 3 groups were measured by 3D-STI. Results: With the progression of paroxysmal AF, the left atrial volume increased, and the reservoir, conduit and contractile function were damaged. The left atrial volume continued to increase, and the reservoir, conduit and contractile function further decreased significantly in patients with AF combined with left atrial appendage thrombosis. LAEF was positively correlated with LASr and LASr_c. Conclusion: Real-time 3-dimensional spot tracking imaging (3D-STI) can evaluate the changes in left atrial volume and function in patients with paroxysmal AF, and has a certain reference value for clinical judgment of disease progression and prognosis.

Rationale: Angiomyolipoma is a mesenchymal tumor composed of blood vessels, smooth muscle, and mature adipose tissue. It is most commonly found in the kidney, and is rare outside the kidney, especially in the mediastinum. Only about 12 cases have been reported worldwide so far. Patient concerns: We report a young female patient who had been found with a left thoracic mass for 19 years. In the past 19 years, the patient had no chest pain, dyspnea and other symptoms, but this time she visited the doctor because of cough, and there were no other clinical signs. Diagnoses: The patient underwent computed tomography plain scan and enhanced scan after admission with imaging manifestations of a mixed density mass in the left chest cavity, calcification and fat density in the inside, and tortuous blood vessels after enhancement. Combined with imaging, the diagnosis was teratoma, not excluding hamartoma. Interventions: The patient underwent a central open thoracic giant mass resection. Outcomes: The postoperative pathology confirmed that it was angiomyolipoma originating from anterior mediastinum invasion of the left chest cavity, and no clear recurrence was seen after 1 year of postoperative follow-up. Lessons: Angiomyolipomas in the mediastinum are rare, especially those that invade the thorax. This article describes the clinical, imaging and pathological features of the patient in detail, which improves the understanding of the disease of clinical and imaging doctors, and provides a basis for the differential diagnosis of mediastinal lesions.

Purpose To compare noncontrast multiparametric MRI (mpMRI) and contrast-enhanced CT (CECT) for agreement with intraoperative peritoneal cancer index (PCI) and detection of key imaging features in pseudomyxoma peritonei (PMP). Materials and Methods This retrospective study included 40 patients with pathologically confirmed PMP who underwent cytoreductive surgery and preoperative mpMRI and CECT in 2024. Intraoperative PCI across 13 abdominopelvic regions served as the reference standard. Total PCI agreement was assessed using intraclass correlation coefficients (ICCs) and Bland–Altman 95% limits of agreement (LoA), with analyses stratified by PCI (≤ 20 vs > 20). Regional agreement and sensitivities for key imaging features were also compared. Results Forty patients (median age, 60 years; 25 women) were included. mpMRI showed greater agreement with intraoperative total PCI than CECT (ICC, 0.98 vs 0.90; difference, 0.08 [95% CI: 0.05, 0.15]), with narrower LoA (7.1 vs 19.1 points). Agreement remained greater with mpMRI for PCI ≤ 20 (ICC, 0.91 vs 0.58) and PCI > 20 (ICC, 0.95 vs 0.74). mpMRI showed higher regional agreement in 11 of 13 regions after multiple-comparison correction. mpMRI had higher sensitivity for mucinous ascites (100% vs 61%; P = 0.002) and intralesional septation (95% vs 37%; P = 0.002), whereas CECT had higher sensitivity for intralesional calcification (100% vs 0%; P = 0.021). Conclusion Noncontrast mpMRI showed greater agreement with intraoperative PCI than CECT and higher sensitivity for mucinous ascites and intralesional septation, whereas CECT better detected intralesional calcification.

Rationale: Meningeal melanocytosis is an exceedingly rare diffuse leptomeningeal melanocytic disorder that frequently mimics meningeal carcinomatosis or chronic infectious meningitis on conventional magnetic resonance imaging (MRI), posing substantial diagnostic challenges. This report aims to enhance clinical awareness of this condition and underscore the indispensable role of radiologic–pathologic correlation in achieving a definitive diagnosis. Patient concerns: A 19-year-old male presented with a 3-month history of progressive headache, nausea, vomiting, and one episode of generalized tonic-clonic seizure. Neuroimaging demonstrated diffuse linear leptomeningeal enhancement without restricted diffusion or conspicuous T1 shortening. Cerebrospinal fluid (CSF) analysis, bacterial and fungal cultures, next-generation sequencing (NGS), and positron emission tomography–computed tomography (PET-CT) were all non-diagnostic, and empirical anti-infective therapy failed to halt disease progression. Diagnoses: Following comprehensive exclusion of infectious, inflammatory, autoimmune, and neoplastic etiologies, stereotactic leptomeningeal biopsy was performed. Histopathology revealed diffuse proliferation of cytologically bland melanocytes within the leptomeninges; immunohistochemistry confirmed S-100, HMB45, and Melan-A positivity with a Ki-67 proliferative index of approximately 1% and wild-type BRAF V600E status, establishing a definitive diagnosis of meningeal melanocytosis. Interventions: The patient was treated with intravenous dexamethasone (10 mg/day) to manage cerebral edema and levetiracetam (500 mg twice daily) for seizure prophylaxis. Referral to a specialized neuro-oncology center was arranged for evaluation of definitive therapy, including potential whole-brain radiotherapy or intrathecal chemotherapy. Outcomes: Symptoms improved markedly following biopsy and initiation of corticosteroid therapy; headaches resolved, vomiting ceased, and no further seizures occurred during hospitalization. The patient was discharged neurologically intact on day 15 with a healed surgical wound, though long-term follow-up imaging was unavailable due to loss to specialized follow-up. Lessons: Meningeal melanocytosis may present without classic melanin-related T1 hyperintensity, rendering it indistinguishable from carcinomatosis on standard MRI sequences. When noninvasive investigations including CSF studies, NGS, and PET-CT are inconclusive, timely tissue biopsy is warranted. Incorporating susceptibility-weighted imaging and molecular testing for GNAQ/GNA11 mutations into the diagnostic workup may improve early and accurate identification of this rare condition.