2015年 · 第49卷第05期

Lung cancer is the leading cause of malignancy-related death worldwide. It is well known that lung cancer will significantly improve its prognosis if it can be surgically removed at an early stage (especially stage I). Therefore, for many years, many medical or public health institutions at home and abroad have been committed to achieving early diagnosis and treatment of lung cancer through screening, and ultimately reducing the mortality rate. Large sample randomized controlled studies beginning in the 1960s and 1970s showed that^[1]Although X-ray chest radiography can detect more lung cancer and improve the surgical resection rate, it does not reduce the mortality rate of lung cancer. Therefore, X-ray chest radiography is not recommended as a lung cancer screening tool at present. In the 1990s, with the development of chest low-dose computed tomography (LDCT) technology, Japan, the United States and some countries in Europe successively launched LDCT lung cancer screening projects, which marked that lung cancer screening research entered the LDCT era, and became a research hotspot in the field of lung cancer screening in the past 20 years. Although there are still many problems in LDCT lung cancer screening, the role of LDCT in high-risk lung cancer groups has been basically recognized internationally.

The female reproductive system is the primary site of common malignant tumors. In China, the prevalence of cervical cancer, endometrial cancer and ovarian cancer are among the top 10 malignant tumors, which are 12.96/100,000, 8.77/100,000 and 7.95/100,000 respectively^[1]。 The choice of treatment mode and prognosis are not only related to the tissue type and pathological grade of tumor, but also closely related to the preoperative stage of tumor. Although cervical cancer and endometrial cancer are easy to obtain scraping histopathological results in clinic, due to the limited materials and heterogeneity of tumor tissue, it may affect the accuracy of judging pathological characteristics such as tumor differentiation (pathological grade) and tumor angiogenesis. Because it is difficult to obtain pathological evidence of ovarian cancer before operation, it is difficult to accurately judge the pathological type and stage. MRI can provide an important basis for the localization and qualitative diagnosis of tumor, and has great value in judging tumor stage before operation, evaluating and predicting curative effect after treatment, and monitoring tumor recurrence^{[2,3,4,5,6,7,8,9,10]}。 The author focuses on the value of MRI in the diagnosis, staging and efficacy evaluation of malignant tumors of female reproductive system.

Lung cancer is a malignant tumor with the highest prevalence and mortality in the world. Although some progress has been made in the treatment in recent years, the current 5-year survival rate of lung cancer is only 15% ~16%^[1,2,3]The prognosis remained unimproved. It is well known that the prognosis of lung cancer will improve significantly if surgical resection can be performed at an early stage, especially stage I. Therefore, for many years, domestic and foreign efforts have been made to achieve early diagnosis and treatment of lung cancer through screening, and ultimately reduce the mortality rate. Large sample randomized controlled studies from 1960s to 1970s have shown that although chest X-ray can detect more lung cancer and improve the surgical resection rate, it does not reduce the mortality rate of lung cancer. Therefore, chest X-ray is not recommended as a screening tool for lung cancer at present^{[4,5,6,7,8,9]}。 Since 1990s, with the development of chest low-dose computed tomography (LDCT) technology, lung cancer screening research has entered the era of LDCT, and has become the hot spot of lung cancer screening research in recent 20 years. In 2011, the results of a randomized controlled study of the National Lung Screening Trial (NLST) in the United States showed that compared with chest X-ray, the use of LDCT to screen people at high risk of Lung cancer can reduce the mortality rate of Lung cancer by 20%^[10]。 Based on the exciting benefits of NLST, many authoritative medical organizations in the United States have successively launched lung cancer screening guidelines, recommending LDCT lung cancer screening in high-risk groups. In recent years, more and more medical institutions in China have carried out or plan to carry out LDCT lung cancer screening, but there is still a lack of corresponding diagnosis and treatment standards in China, resulting in great differences in the understanding and diagnosis and treatment level of LDCT lung cancer screening, and irregular clinical practice. Therefore, the Cardiothoracic Group of Radiology Branch of Chinese Medical Association drafted this consensus with reference to the latest foreign lung cancer screening guidelines, combined with the experience of large-scale lung cancer screening projects abroad and the current actual situation in China.

Male, 39 years old. He was seen for more than 2 months because of slurred speech and weakness of right limb. Physical examination: The right nasolabial fold is slightly shallow, the corner of the mouth is skewed to the left, and the bulging cheeks leak to the right. There was no abnormality in muscle tone, and the muscle strength of the right limb was grade IV, and the muscle strength of the left limb was grade V. CT examination of the head in external hospital revealed left frontal cerebral infarction.

Female, 49 years old. Abnormal liver function for 18 years, anorexia, asthenia and jaundice for 3 months. Laboratory tests: aspartate aminotransferase 1 113 U/L (normal reference value 0~40 U/L), glutamyl transpeptidase 76 U/L (normal reference value 0~40 U/L), alkaline phosphatase 407 U/L (normal reference value 32~92 U/L), total bilirubin 139.9 μ mol/L (normal reference value 1.7~17.1 μ mol/L), direct bilirubin 114.5 μ mol/L (normal reference value 1.7~7.0 μ mol/L), indirect bilirubin 25.4 μ mol/L (normal reference value 1.7~13.7 μ mol/L), immunoglobulin M 5.26 g/L (normal reference value 0.48~2.12 g/L). Antinuclear antibody, anti-liver and kidney microsomal antibody-1 antibody, anti-mitochondrial antibody, and anti-mitochondrial antibody M2 were positive.

Female, 61 years old. A sudden severe headache with vomiting was seen for 1 h. Emergency head CT scan showed subarachnoid hemorrhage (Figure 1）。 After admission to hospital, symptomatic treatment was given. After 15 hours, whole brain angiography was performed through the right femoral artery approach, which showed a dissected aneurysm at the distal end of the opening of the right posterior inferior cerebellar artery in the V4 segment of the right vertebral artery (Figure 2), the initial segment of the right subclavian artery is extremely tortuous, and the opening of the right vertebral artery is narrow (Figure 3）。 Twelve hours after the examination, the patient complained of worsening headache. Physical examination showed that the right pupil was dilated, the light reflex disappeared, and the patient's consciousness level decreased. Re-examination of skull CT showed that the amount of subarachnoid hemorrhage increased compared with that at the emergency department. After the treatment of blood pressure control, dehydration, intracranial pressure reduction, anti-cerebral vasospasm, and improvement of brain metabolism, the patient's consciousness improved and vital signs were stable. Interventional therapy was performed on the 5th day after admission.

Male, 43 years old. Intermittent hemoptysis for 17 years, bronchiectasis and pulmonary bullae were found on chest CT. In March 2013, bronchial arteriography was performed through the femoral artery due to massive hemoptysis. Bilateral bronchial arteries were thickened and disordered, and right bronchial artery-pulmonary artery fistula was found. The bleeding gradually stopped after embolization of bilateral bronchial arteries with 710-1 000 μ m gelatin sponge particles, and there was no further hemoptysis after discharge. On 8-Sep-2014, the patient was admitted to hospital due to another large amount of blood for 2 h, and the total hemoptysis volume was about 100 ml. Scattered dry and wet rales can be heard during chest physical examination. Chest X-ray and CT examination showed emphysema, bilateral multiple bronchiectasis with infection, left lung insufficiency with multiple pulmonary bullae formation, and bilateral pleural hypertrophy. After admission, he was given medical treatment, but his symptoms did not improve, so he was transferred to our department for interventional treatment. The patient presented with hemoptysis and severe asthma at the time of transfer. The hemoptysis volume in 24 hours was about 600 ml, and the oxygen saturation of the fingers fluctuated about 90%.