2015年 · 第49卷第07期

In recent years, the prevalence of breast cancer has been on the rise globally. Although the prevalence of breast cancer in China is still lower than that in European and American countries, the prevalence of women in big cities is increasing year by year and showing a trend of younger and younger. Breast cancer has become a major public health problem in today's society^[1,2]。 Compared with the continuous increase in the prevalence of breast cancer, the mortality rate shows a downward trend. This is due to the improvement of breast cancer treatment, and the other key factor lies in the early detection, diagnosis and treatment of breast cancer. In the early detection and diagnosis of breast cancer, routine imaging methods (including X-ray, ultrasound and MRI) have their own advantages and limitations. Combining various imaging examination methods for combined diagnosis, so that their advantages are complementary, can obviously improve the sensitivity and accuracy of breast lesion detection, and play an important role in early diagnosis of breast cancer. But despite this, the sensitivity and specificity for the diagnosis of certain types of breast cancer are still not high. In recent years, imaging workers have collaborated with personnel engaged in basic research and equipment research and development in related fields and scientific research institutes, and successively developed some new imaging technologies and equipment, and some imaging technologies have gradually developed from clinical trial stage to clinical application stage. Among them, there are imaging methods based on anatomical and morphological changes, imaging methods based on tissue metabolic function changes, and more cutting-edge molecular imaging technologies. Some imaging methods have multiple functions. These technologies are playing an important role in the diagnosis, treatment and basic research of breast cancer.

Liver cancer is one of the most common malignant tumors of the digestive system, with more than 1 million new liver cancer patients worldwide every year^[1]。 The preferred treatment for liver cancer is surgery, but the total surgical resection rate is only 20% ~30%^[2]At present, the main treatment for liver cancer is the combined application of various non-surgical treatment methods. Radiotherapy is a common method for the treatment of liver cancer. Because the tolerance of normal liver tissue to radiation limits the increase of liver cancer irradiation, conventional external radiotherapy is not effective for liver cancer. In recent years, radioactivity¹²⁵I seed implantation is widely used in the treatment of liver cancer, and some scholars have confirmed that under the guidance of CT¹²⁵Intertissue implantation of I particles induces apoptosis in rabbit VX2 tumor cells^[3]。 However, because the seed implantation process is manual operation, there will inevitably be radiation hot and cold spots^[4]It is difficult to achieve full conformal radiotherapy. At the same time, after seed implantation, the tumor size will shrink, resulting in the marginalization of the particles originally located in the tumor body, resulting in radiation damage to normal liver tissue sensitive to surrounding radiation.

Currarino syndrome is a general term for anorectal malformation, sacral agenesis and presacral mass. It belongs to a type of caudal degenerative syndrome. It is a rare congenital malformation that can occur with other malformations. Anorectal malformations can be manifested as congenital anal atresia, anal stenosis or anal ectopia, etc. Sacral hypoplasia can manifest as a complete or partial absence of the sacrum, or only as a split vertebra deformity or absence of the coccyx; Presacral masses can be manifested as real masses such as teratomas, enterogenic cysts, lipomas, dermoid cysts, etc., or pseudo masses such as presacral meningocele, etc. Most of the previous literature were case reports^[1,2]。 The author retrospectively analyzed the clinical data and imaging manifestations of 8 children with Currarino syndrome confirmed by clinical and pathological, and discussed its etiology, pathogenesis, clinical characteristics and imaging manifestations, so as to increase the understanding of this disease and improve the accuracy of diagnosis.

A 53-year-old female was admitted to the Department of Neurology of our hospital on April 16, 2014 due to headache accompanied by left limb weakness for more than 8 days and fever for 5 days. 8 days ago, the patient had headache with weak left limb muscle strength and swelling pain mainly in the headrest region without obvious trigger, which persisted without relief and was not treated. After 3 days, he developed fever and went to the local county hospital. CT examination showed right parietal lobe lesions, considering cerebral infarction, and the symptoms were not relieved after treatment. Since the onset of the disease, there have been no symptoms such as dizziness, nausea and vomiting, diplopia, choking, hoarseness, palpitation and shortness of breath, limb twitching and incontinence. Physical examination: clear consciousness, slightly poor spirit, fluent speech, no nystagmus, bilateral pupils responsive to light, symmetrical frontal lines, shallow nasolabial folds on the left side, right tongue extension, soft neck, no resistance, left upper limb muscle strength grade 0, left lower limb muscle strength grade 3, low muscle tone, right limb muscle strength grade 5, normal muscle tone. After admission, the neurology department gave dehydration, inhibited cerebral edema, nourished nerves and symptomatic treatment.

The patient was a 20-year-old male, unmarried and childless. He had been diagnosed with Kartagener syndrome (KS) in a foreign hospital due to repeated cough, expectoration and asthma for 19 years. He wanted to undergo lung transplantation and went to the doctor on March 29, 2013. The patient had cough, expectoration and asthma 6 days after birth, and then repeated attacks. He was treated as bronchiectasis in the local hospital, and the improvement was not obvious. In November 2012, his condition recurred again, and he was diagnosed with KS in the General Hospital of the Chinese People's Liberation Army. He was treated with puncture and drainage of both maxillary sinuses, and lung transplantation was recommended. The patient still has cough, yellow and white sticky sputum, and obvious asthma after exercise. He went to our hospital for lung transplantation evaluation. Physical examination: The respiratory sounds of both lungs were low, without obvious dry and wet rales, visceral inversion, and the apical pulsation point was located 0.5 cm within the midline of the right clavicle of the fifth intercostal bone. The pulsation range was normal. Imaging manifestations: Abdominal B-ultrasound showed visceral inversion and multiple polypoid lesions in gallbladder wall; Cardiac ultrasound showed visceral atrial transposition, mirror dextrocardia, main pulmonary artery and right pulmonary artery widening; Chest CT and its localization showed dextrocardiac position, bronchiectasis with infection in both lungs, mirror transposition of heart, large blood vessels, liver, stomach and spleen (Figure 1，Figure 2）； Paranasal sinus CT showed bilateral maxillary sinusitis (Figure 3）； Bronchoscopy showed bilateral bronchial structural inversion; Hematological examination showed that the patient had hepatitis B and hepatitis C; Pulmonary function tests showed extremely severe obstructive ventilatory dysfunction, severe decrease in pulmonary diffusion function, and forced expiratory volume (FEV1) at the first second was 0.50 L. Combined with the clinical symptoms and imaging findings of the patient, KS was diagnosed. After evaluation by the lung transplantation department, the patient had indications for lung transplantation, no surgical contraindications, and was discharged waiting for the transplanted lung source. The patient was readmitted on 27-Dec-2013 and underwent continuous double lung transplantation on 28-Jan-2014. Postoperatively, bronchoscopy was performed on February 25, 2014: bilateral bronchial anastomosis was covered with a large amount of white sticky sputum, bronchial mucosa was congested and edema, easily bleeding at touch, and mild granulation hyperplasia. Multiple sputum cultures suggestive of Acinetobacter baumannii infection. Chest CT showed bronchiectasis with infection in both lungs and visceral inversion (Figure 4）。 After treatment, the patient was discharged from the hospital in a stable condition, and was re-examined once in May and July 2014. At present, the patient has no pus, odorous phlegm, cold sweat, headache, and sleep. Reexamination of chest CT showed mild bronchiectasis in the lower lobes of both lungs and visceral inversion. 8 May 2014 Pulmonary function test revealed restrictive ventilatory dysfunction, decreased pulmonary diffuse function, FEV1 1.47 L.

From 15 to 17 October 2014, an international conference on "Rational Application of CT in individual health assessment (IHA) of Asymptomatic Persons", sponsored by WHO and co-organized by the German Federal Office for Radiation Protection, was held in Munich, Germany. WHO issued a global initiative on radiation safety in medical institutions, advocating the safe and effective use of ionizing radiation by medical institutions in the medical field. The initiative includes radiation risk assessment, risk management and risk communication, aiming at supporting the implementation of international basic safety standards for ionizing radiation protection and radiation source safety in medical institutions, and forming a consensus on IHA of asymptomatic people. Experts at the meeting exchanged the application of CT in IHA of asymptomatic people in various countries and regions. There are many studies on lung cancer, colorectal cancer and coronary heart disease IHA in asymptomatic people in European and American countries, and relevant schemes have been formulated. The author summarizes the relevant reports, expert suggestions and consensus of this conference for the benefit of domestic readers.

From November 30 to December 5, 2014, the 100th Annual Meeting of the Radiological Society of North America (RSNA) was held in Chicago, USA. The theme of this meeting was "A century of transforming medicine". Its connotation is the century-old history of RSNA, which has witnessed the progress of medical imaging technology and promoted the reform and development of clinical medicine. More than 56,000 medical radiologists from more than 130 countries attended the event. The session included 225 knowledge updating courses, 81 multidisciplinary cooperative courses, 2 703 academic presentations and 2 151 educational exhibitions. There were 301 (11%) academic presentations on cardiovascular imaging, ranking fourth after the nervous system, digestive system, and musculoskeletal system. The highlights of scientific research in the field of cardiovascular CT and MR imaging at this conference are as follows.