2015年 · 第49卷第04期

The only way to improve the efficiency of lung cancer treatment is early detection, early diagnosis and early treatment, and the way of early detection is lung cancer screening. How to carry out the correct screening, how to classify and diagnose the nodules found by screening, and what kind of advice and treatment to patients are related to the correct characterization of nodules and the correct choice and prognosis of subsequent treatment. Therefore, a new classification standard for lung adenocarcinoma was introduced in 2011^[1]； Following the introduction of guidelines for the management of solid pulmonary nodules by the Fleischner Society in 2005^[2]In 2012, the recommended treatment opinions for subsolid nodules in the lungs were launched^[3]； In 2013, the National Comprehensive Cancer Network (NCCN) launched lung Cancer screening guidelines^[4]； In 2014, the American College of Radiology (ACR) issued the first version of the Lung-RADS (Lung Imaging Reporting and Data System)^[5]； May 2014 Manos et al.^[6]A 6-Class Lung-RADS protocol for CT screening was published in the Journal of the Canadian Association of Radiologists. These are enough to show that relevant disciplines around the world attach importance to the prevention, diagnosis and treatment of lung cancer. How to correctly treat, understand, refer to and use these consensus and guidelines in combination with the actual situation in China, and form the relevant consensus of Chinese experts on lung cancer screening and nodule treatment, which plays an important role in promoting the level of lung cancer screening and early diagnosis in China.

In recent years, with the rapid development of medical imaging equipment and technology, especially the popularization and application of multi-slice spiral CT, the detection rate of pulmonary nodules has increased obviously, and quite a few pulmonary nodules are difficult to determine benign or malignant, which has become a difficult point in clinical diagnosis, decision-making, evaluation and treatment practice^[1,2,3]。 The Fleischner Society published guidelines for the management of solid pulmonary nodules in 2005^[4]In 2013, guidelines for the management of pulmonary subsolid nodules were issued^[5]。 In 2013, the American College of Chest Physicians (ACCP) released the latest 3rd edition of guidelines for the management of pulmonary nodules^[6]The evaluation of pulmonary nodules proposed in this guideline is all for nodules that cannot be identified as benign or malignant^[7]。 Based on this, the American College of Radiology (ACR) officially promulgated the first version of the Lung Imaging Reporting and Data System (Lung-RADS) on April 28, 2014, that is, Lung-RADS version 1.0^[8]In fact, it is a lung nodule imaging report and data system for people at high risk of lung cancer. In order to facilitate the understanding and reference of domestic peers, it is presently introduced and interpreted.

Throughout the development of multi-slice spiral CT, it can be roughly divided into two stages: increasing slices and energy imaging. In the first stage of more than 40 years, several mainstream equipment manufacturers have continuously updated their equipment along the direction of increasing the number of rows, and the number of detectors has increased from 4 rows, 16 rows and 64 rows to 320 rows. With the increase of the number of detector rows, the scanning speed has increased, and the success rate of heart scanning has increased. The energy imaging stage is the stage of CT equipment from anatomical imaging to functional imaging and qualitative and quantitative examination of substances, paying more attention to image quality, radiation dose and expanding clinical application scope. The development of multi-slice spiral CT technology mainly focuses on the following technical hotspots.

With the rapid development of MRI technology, it plays an increasingly important role in the field of medical imaging diagnosis and scientific research. Throughout the development of MRI technology, technology leads the progress of equipment, and equipment promotes the progress of technology. The two complement each other. The author discusses the new progress of MRI technology from the aspects of equipment hardware and technology development.

With the improvement of CT resolution, the reduction of radiation dose, the popularization of lung cancer screening and the enhancement of people's health care awareness, more and more asymptomatic pulmonary nodules are detected, the volume is smaller and smaller, and the density is lighter and lighter. Such nodules often lack characteristics and are difficult to diagnose, but often lead to anxiety in patients, and clinical management is diversified, randomized and irregular. A new pathological classification of lung adenocarcinoma was introduced by International Multidisciplinary in 2011^[1]The Fleischner Society also launched recommendations for the treatment of subsolid nodules in the lung at the end of 2012^[2,3]。 How to follow the guidelines, reach the consensus of Chinese experts in combination with national conditions, and correctly treat subsolid nodules is very important to reduce the burden on patients and society and improve the prognosis of patients.

low-grade fibromyxoid sarcoma (LGFMS) is a rare and late-recognized soft tissue tumor with no specific clinical manifestations and high misdiagnosis rate. There are few reports on its imaging manifestations in China, and the malignancy of LGFMS tumor cells is low, so it is easy to be misdiagnosed as some benign or borderline tumors in histology. Therefore, the author analyzed and summarized the MRI images of 5 patients with LGFMS, aiming to improve the understanding of this disease and explore the diagnostic value of MRI for this disease.

The prognosis of patients with ureter and hydronephrosis caused by mechanical obstruction of ureter caused by gynecological malignant tumor compression of ureter is poor, and the average survival time is 6~12 months^[1]。 Double J tube placement is a common method in patients with ureteral stricture caused by gynecological malignant tumors, but 50% ~67% of patients failed to implant double J tube under cystoscopy^[2]At this time, it is often necessary to perform DSA-guided percutaneous puncture of the renal pelvis and anterograde placement of double J tube. However, there are still a few patients with severe ureteral stenosis. The guide wire can pass through the stenosis, but the double J tube cannot enter the bladder through the stenosis. The author adopted DSA-guided percutaneous pelvic puncture with antegrade insertion of guide wire and transurethral bladder retrograde insertion of double J tube for treatment, and achieved satisfactory results. The following report aims to explore the feasibility and safety of this method.

The patient was a 15-year-old female. He was admitted to hospital in September 2013 with electroshock-like pain in the left temporal region, nausea and vomiting for half a month. Half a month ago, the patient developed left temporal shock-like pain without obvious trigger, paroxysmal, with jet-like vomiting. In the local hospital, the MRI of the skull showed a space-occupying lesion in the foramen magnum area of the posterior fossa of the skull. Now, I came to our hospital for further diagnosis and treatment. Admission physical examination: bilateral tendon reflex (+), finger-nose test, Babinsky sign, neck impedance test (-), muscle strength and muscle tone of limbs were normal.

The patient was a 69-year-old female. Due to swelling of the right maxilla and palate for more than 3 years, I saw the doctor on March 26, 2014. Physical examination: open mouth 3 fingers, open mouth type descent. The right maxilla and palate were swollen without tenderness, and the gums were congested, red and swollen. Multiple swollen lymph nodes, with a maximum of about 1.5 cm ×0.8 cm, can be palpable under both jaws and the neck, and can be moved.

A 4-year-old child came to our hospital on July 10, 2013 and was admitted to the hospital due to cough for 6 days and coughing up blood for 2 days. Six days ago, there was no obvious trigger for cough with phlegm, excessive cough in the morning, no shortness of breath, low fever at the beginning of the disease, and the fever subsided on the second day. In the past 2 days, cough was accompanied by coughing up blood, which was bright red in color and small in amount. Physical examination: body temperature 36.2℃, pulse 96 beats/min, blood pressure 110/74 mmHg (1 mm Hg =0.133 kPa). The breathing sound of the left lung was thick, the breathing sound of the right lung was low, and a small amount of wet rales could be heard during deep inhalation. The heart did not hear a murmur, and the heart rhythm was in harmony. Laboratory tests showed no obvious abnormalities.

A 41-year-old male was seen on July 23, 2014 due to pain in the right forearm with external rotation disorder and flexion of the little finger for more than half a year. Seven years ago, the patient had right forearm pain with mild limitation of movement due to trauma, and he felt recovery and improvement without treatment. Six months ago, the patient had the above symptoms again, and he didn't pay attention to them at first. Later, the symptoms gradually worsened, so he came to our hospital for treatment. Physical examination: An egg-sized hard mass can be seen in the middle of the dorsal side of the right forearm, with poor mobility, obvious tenderness in the affected area, slightly higher surrounding skin temperature, intact skin and no obvious swelling.