2016年 · 第50卷第01期

On January 20, 2015, President Barack Obama mentioned the "Precision Medicine Program" in his State of the Union address. He said: "I hope to eradicate polio, usher in a new era of human genomic medicine, provide timely and correct treatment; I hope to bring us closer to curing diseases such as cancer and diabetes, so that all of us can obtain individual genetic information to protect the health of ourselves and our families." Thus, the curtain of precision medicine was opened, and the concept of precision medicine has since attracted worldwide attention.

Hemodynamic changes caused by coronary artery disease, such as intracoronary pressure-flow gradient and blood flow reserve, are closely related to myocardial ischemia. Monitoring hemodynamic changes can guide revascularization, maximize the benefit of patients and avoid adverse outcomes, which is more clinically significant than simple morphological assessment. computational fluid dynamics (CFD) is an interdisciplinary subject combining computer technology and fluid physics. The three-dimensional data of coronary artery obtained by CT scan combined with CFD can deduce the hydrodynamic parameters of intracoronary blood flow, including the pressure distribution, shear force distribution and flow velocity distribution of blood flow, and add functional information on the basis of morphology, which provides a new method for non-invasive assessment of myocardial perfusion^[1]。 The main objective of this study is to explore the technical wiring for constructing an optimized three-dimensional coronary body shape based on high-resolution dual-source CT, combined with a computational fluid simulation process to assess the left coronary artery pressure gradient and shear force, blood flow velocity gradient distribution.

Currently, coronary CTA has become an important non-invasive imaging method for clinical diagnosis and screening of coronary heart disease^[1]。 The changes of heart rhythm and whether patients can hold their breath during scanning are the main factors that affect the image quality. Sudden premature contraction of patients during exposure often leads to incorrect recognition of ECG gating signal, which affects the image quality and even leads to examination failure. The results showed that retrospective ECG-gated scanning combined with electrocardiogram (ECG) editing could improve the quality of coronary CTA images in patients with arrhythmia^[2,3]However, it is not clear which technical method of ECG editing function works best. The author aims to explore four ECG editing techniques: disable Sync, delete Sync, insert Sync and shift R-peak^[4,5]Value of improving the quality of coronary CTA images in patients with premature contractions.

partial splenic embolization (PSE) is an effective method for the treatment of hypersplenism in patients with cirrhosis^[1,2,3]Its efficacy is closely related to the degree of splenic embolism^[1,2]。 However, as the degree of embolism increases, so does the risk of developing complications^[3]Especially in patients with severe liver decompensation, the risk of complications is higher^[4]。 How to balance the efficacy with the risk of complications and control the appropriate degree of splenic embolism has always been a difficult problem for PSE operators. In this study, the spleen volume was measured accurately by CT, the degree of splenic embolism was calculated, and the risk factors of PSE complications were discussed with clinical and laboratory indexes.

intramuscular myxoma (IM) is a rare benign soft tissue tumor with undetermined differentiation^[1]。 This tumor is similar to other myxoid soft tissue tumors such as myxoid liposarcoma, myxofibrosarcoma and para-articular myxoma in clinical manifestations and pathology, but intramuscular myxoma generally does not relapse or metastasize, so preoperative MRI diagnosis and differential diagnosis are particularly important. The author retrospectively analyzed the clinical data and MRI manifestations of 11 patients with intramuscular myxoma confirmed by pathology, aiming to further improve the understanding and diagnosis of this disease.

At present, three dimension (3D) 3D printing technology has been widely used in medical fields such as bone and joint surgery, neurosurgery, dentistry, plastic surgery and drug research and development, but it is just beginning in the cardiovascular field^[1]。 At the end of 2014, cardiac 3D printing began to appear at the American Heart Association (AHA) Annual Meeting, North American Radiology Annual Meeting (RSNA) and European Cardiovascular Imaging Annual Meeting (EACVI), which once became the highlight of the conference. Our center has been concerned about the development of cardiac 3D printing for a long time. Here, we briefly introduce the clinical application status and future development direction of new cardiac 3D printing technologies at home and abroad.

The patient was a 58-year-old male. The tumor in the right parotid gland area was found for more than 1.5 years, and it gradually increased for 1 month. 1.5 years ago, the patient accidentally discovered a jujube-sized mass at the right mandibular angle, which grew progressively, without pain and numbness, and was not treated. One month ago, I went to a local hospital. After taking oral traditional Chinese medicine (the specific medication is unknown), my self-sensed mass became smaller, and gradually increased to the size of a fist after stopping the medication. On April 20, 2015, I went to the First Hospital of Lanzhou University. Specialist physical examination: A mass about 7.0 cm ×5.0 cm ×4.5 cm in size protrudes from the ascending branch of the right mandibular angle, which is round, clear in boundary, hard in texture, mobile, no tenderness, no adhesion to the surrounding skin, low skin temperature, and no swelling of the neck and bilateral submandibular lymph nodes. Laboratory test: white blood cells 5.91×10⁹/L, positive for squamous cell carcinoma associated antigen, negative for alpha-fetoprotein, carcinoembryonic antigen, CA125, CA153, CA199 and CA724.

The patient was a 31-year-old female. Physical examination revealed a space-occupying lesion in the right side wall of the bladder. The patient had no significant emaciation, dysuria and macroscopic hematuria. Physical examination: There was tenderness in the bladder area, but there was no obvious abnormality. Laboratory tests: There were no abnormalities in blood, urine routine and serum biochemical tests.

The patient was a 62-year-old male. He was admitted to hospital due to pain in his left knee and left hip for 4 months and aggravated for half a month. In December 2013, the patient developed pain in the left knee and left hip without obvious trigger, which was acupuncture-like pain, accompanied by mild edema in the left knee and left foot. In April 2014, the pain in the left knee and left hip was aggravated, and it was obvious in the left knee. The patient suffered from a fall of his left knee joint due to a car accident in May 2011, and was treated with "left patella repair" in an external hospital.

Case 1: A 58-year-old male was admitted due to dyspnea after activity for 3 years and aggravated for 2 days. CT scan of the throat showed that the soft tissue density shadow was seen at the posterior cricoid cartilage of the subglottic area, with uneven internal density and a small amount of strip calcification locally, about 2.2 cm ×2.1 cm ×2.4 cm (Figure 1). The upper pole of the tumor was located at the level of the lower margin of thyroid cartilage, down to the lower margin of cricoid cartilage, and protruding into the laryngeal cavity to the left front. The laryngeal cavity was obviously narrowed, the left piriform fossa disappeared, and the adjacent cricoid cartilage was interrupted and destroyed (Figure 2). During the operation, the tumor invaded the cricoid cartilage, and chondrocytes were seen under the microscope, with different sizes, oval and round shapes, deeply stained nuclei, and obvious cell atypia. Binuclear tumor cells were seen, and there was mucinous degeneration in the chondroid matrix (Figure 3, HE ×40). Pathological diagnosis: well differentiated chondrosarcoma.

cardiac magnetic resonance (CMR) longitudinal relaxation time quantitative imaging (T₁mapping) technique is a non-invasive imaging method to assess the characteristics of myocardial tissue, which can directly quantify the T of myocardial tissue₁Value, which can be noninvasively evaluated for myocardial infarction, diffuse myocardial fibrosis, heart failure, myocardial amyloidosis and other diseases^[1,2]。 CMR T₁mapping is a new technique developed in recent years. It is based on inversion or saturation pulse sequence excitation, collects signals at different times in the process of longitudinal magnetization vector recovery, and then obtains the T of myocardial tissue after a series of data calculation and post-processing₁Value. The author CMR T₁The progress of mapping technology is reviewed.