2015年 · 第49卷第08期

Glioma is the most common intracranial malignant tumor. Preoperative diagnosis is very important for the treatment and prognosis of glioma. PET-CT can reflect the anatomical and functional metabolic characteristics of the lesions, and is gradually applied to the evaluation of glioma.¹⁸F-deoxyglucose (FDG) imaging agent is the most widely used in clinic, but the vigorous glucose metabolism in inflammatory tissues leads to¹⁸Abnormally elevated F-FDG uptake is¹⁸The most common reasons for false positives on F-FDG PET-CT imaging^[1]。¹¹C-methionine (¹¹C-L-methionine,¹¹C-MET) and¹¹C-choline (¹¹C-choline,¹¹C-CHO) has been reported in recent years except¹⁸F-FDG is a new imaging agent commonly used for glioma imaging^[2,3]。 The occurrence and development of glioma are closely related to abnormal cell proliferation. Cell proliferation antigen (Ki-67) is a nuclear antigen associated with proliferating cells, which can effectively evaluate the proliferation activity of tumor cells^[4]。 In this study, C6 glioma and chronic inflammation model made by Wistar rats were used as experimental objects.¹¹C-MET,¹¹C-CHO PET-CT comparative study, and compared with pathological and immunohistochemical results to test¹¹C-MET,¹¹Differential diagnostic value of C-CHO in glioma and its efficacy to reflect cell proliferation.

Posterior circulation ischemic stroke caused by vertebrobasilar artery stenosis has a high disability and mortality rate, and the antithrombotic therapy is not effective. As a complementary therapy in addition to drug antithrombotic therapy, the clinical effect of stenting has been clinically confirmed. The results of recent drug-stent comparison studies show that the incidence of short-term endpoint events in stenting is much higher than that in the drug group, and the long-term results show that stenting does not bring more benefits than patients treated with drugs alone^[1,2]。 However, the study is controversial in terms of the experience of surgeons and enrolled cases^[3]Therefore, the results need further verification. In this study, the clinical data of single-center application of Wingspan stent in the treatment of symptomatic intracranial vertebrobasilar atherosclerotic stenosis were retrospectively analyzed to explore the safety and long-term clinical efficacy of drug combined with stenting in patients with vertebrobasilar stenosis in the Chinese population.

The child was a 1-year-old male. He was admitted to the hospital on September 21, 2013 due to vomiting and anorexia for 5 days, without fever, abdominal distension and other discomfort. Symptomatic treatment was given in the local hospital, but the symptoms did not improve significantly. CT examination of the head showed space-occupying lesions in the pineal region and the third ventricle, and obstructive hydrocephalus.

The patient, a 33-year-old female, was seen on 21 May 2014 due to headache for half a year and visual acuity decrease in her right eye for one month. Six months ago, the patient began to have headache without obvious trigger, especially on the left side, which was persistent, and menopause occurred. One month ago, his vision began to decline, especially in the right eye. Physical examination: bilateral pupils of equal size and round, 3 mm in diameter, sensitive to light reflection, normal muscle tone of limbs, meningeal irritation sign (-), decreased visual acuity in the right eye and normal visual acuity in the left eye. Laboratory Test: Cortisol<180 nmol/L, thyroid hormone and sex hormone were normal, and blood routine was normal.

A 13-year-old male was admitted to the hospital on 21 August 2012 with sudden limb twitches accompanied by loss of consciousness for 10 h. Two years ago, the child had repeated attacks of hand stiffness, lasting for 1 to 2 minutes each time, and no improvement was seen by self-supplementation of calcium. 10 h ago, there was no obvious trigger for numbness of upper limbs and hands with dizziness, convulsions, and fainting after amaurosis. After 10 minutes, he woke up and denied symptoms such as headache and vomiting. There were no abnormalities in blood routine, hemagglutination and electrolyte tests in the local hospital, and brain CT showed "brain space-occupying lesions". Physical examination on admission: superficial hypoesthesia on the right side of the body, muscle strength on the right side of the limb grade II.

hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant vascular dysplasia disease with rare imaging manifestations of neonatal liver involvement. 1 example is reported below.

Case 1 female, 53 years old. Intermittent vaginal bleeding for more than 1 month. MRI scan showed an irregular cervical mass, 69.0 mm ×46.2 mm ×50.9 mm. The lesion involved the lower part of the uterine body, the anterior fornix and the upper half of the anterior vaginal wall downward. The cervical fibrous matrix disappeared and infiltrated outward to the pelvic wall muscles. Mass T₁WI low signal, T₂WI signal confounding (Figure 1), mainly moderate signal, and a focal higher signal area can be seen inside. DWI is high signal (Figure 2), the ADC plot showed a significantly low signal (Figure 3), with an ADC value of 0.496×10^-3mm²/s, pelvic lymph nodes were enlarged and fused (Figure 4), in the shape of petals. The arterial phase of the enhanced scan was rapidly uneven and obviously enhanced, and the delayed phase continued to enhance (Figure 5,Figure 6）。 Bilateral ovarian invasion with signals consistent with cervical lesions. The postoperative pathological manifestations showed that the tumor cells were small, the nucleus was deeply stained, densely arranged, diffuse and flaky (Figure 7）。 Postoperative immunohistochemical results showed that neuron-specific enolase (NSE), CD56, synaptophysin (Syn), cytokeratin (CK), squamous epithelial upper basal cells (Ki-67) and chromaffin A (CgA) were all positive, suggesting small cell type neuroendocrine carcinoma. The patient developed mandibular metastasis after 6 months of follow-up.

The patient was a 72-year-old male. He was admitted to hospital in May 2011 due to a painless mass behind his right ear for 2 years. The patient accidentally discovered a mass behind the right ear 2 years ago, which was not taken seriously. The mass has increased slightly in the past 2 years, and a headache appeared 1 week ago and went to the stomatology department of our hospital. Physical examination: There was no obvious deformity of the head and face, the opening degree was 3 fingers, and there was no abnormality in the opening type. There was a bone mass behind the right ear, which was hard and inactive, and the boundary was still clear. Condylar activity remained without obvious tenderness. There were no abnormalities in blood routine and uric acid tests.

A 58-year-old female was seen with pruritus for 3 months and abnormal liver function found on physical examination for 1 week. Physical examination showed no significant abnormalities. Laboratory tests: alanine aminotransferase 104 U/L (normal reference value 5~40 U/L), aspartate aminotransferase 98 U/L (normal reference value 5~40 U/L), glutamyl transpeptidase 386 U/L (normal reference value 5~50 U/L), alkaline phosphatase 1 065 U/L (normal reference value 40~150 U/L), total bilirubin 37.8 μ mol/L (normal reference value 5.1~34.0 μ mol/L). There were no obvious abnormalities in other indicators.

The patient was a 45-year-old female. The main cause was fatigue and epigastric pain for 1 year. Previous history of iron deficiency anemia for 1 year and no history of hepatitis. Laboratory tests: hemoglobin 74 g/L (normal reference value 110~150 g/L), hematocrit 27% (normal reference value 37% ~47%), CA125 54.92 U/ml (normal reference value 0~35 U/ml), alpha-fetoprotein, carcinoembryonic antigen, CA153 and CA199 were not abnormal. Hepatitis B surface antibody was positive.

The patient was a 75-year-old female. The left breast nodule was found for 50 years and gradually increased for 2 years. Physical examination: A mass of about 6.0 cm ×7.0 cm was palpable in the inner upper quadrant of the left breast, which was hard in texture, irregular in shape, with clear borders, no tenderness, poor mobility, and no swollen lymph nodes were palpable under bilateral axillaries.

A 52-year-old male patient. Admission due to facial herpes for 3 weeks and anorexia for 2 weeks. Human immunodeficiency virus infection was found 2 months ago and has been treated with antiviral drugs, the details of which are unknown. Physical examination: Multiple herpes on the face, 10 cm ×8 cm mass palpable in the middle and upper abdomen, hard in texture, clear in border, poor mobility, and no obvious abnormalities. Thoracic and abdominal CT scans were performed with German Siemens 16-slice spiral CT instrument, which showed scattered small nodules in the lower lobes of both lungs; A 10.7 cm ×15.0 cm soft tissue density lesion was observed in the abdominal cavity, with irregular shape. Enhancement scan showed separated enhancement. The lesion surrounded the portal vein, renal veins, abdominal aortic trunk and its branch vessels, and no filling defect was observed in the vessels (Figure 1）； Multiple nodular low-density foci were observed in the liver and spleen (Figure 2), no obvious enhancement was seen after enhancement; No significant fluid accumulation was observed in the abdominal cavity. Pathological manifestations: Infiltration of inflammatory cells in the tissue, a large number of fungal spores, and hollow halo around the nucleus, most of which are located in the cytoplasm, and necrotic areas can be seen (Figure 3,Figure 4）。 Schiff iodate staining and hexamine silver staining were positive, and acid-fast staining was negative. Histoplasma infection was diagnosed.

high resolution magnetic resonance imaging (hrMRI) has the advantages of non-invasiveness and high resolution in the diagnosis of atherosclerotic lesions. Unlike traditional vascular examination techniques (DSA, CTA, MRA, etc.), which can only provide information on the degree of luminal stenosis, hrMRI takes the arterial wall as the imaging target, and can directly display the size, shape and composition of atherosclerotic plaques. According to the MRI technique, wall imaging can be divided into bright blood and black blood sequences. Bright blood sequence is mainly based on time leap method, which is a gradient echo sequence imaged by influx enhancement effect. However, due to the high blood signal in the lumen and the insufficient contrast level of soft tissue, the bright blood sequence is unfavorable to showing the wall structure near the lumen side (such as plaque fiber cap). Black blood sequence inhibits intraluminal flow blood signals, and multi-contrast sequences based on black blood sequence (such as T₁WI, T₂WI, proton density weighted imaging) is the main component of tube wall imaging at present. With the development of high-field MRI hardware and software technology, various new sequences emerge one after another, especially the methods of blood inhibition are constantly improved. How to quickly and effectively suppress the blood flow signal and improve the image resolution is a hot topic in the current hrMRI research. The author reviews the application status and progress of various blood inhibition methods in atherosclerotic wall HMRI and other new wall imaging techniques.