2016年 · 第50卷第11期

Cerebral perfusion is an important physiological index to reflect brain function. Various MRI methods can provide abundant cerebral perfusion information, especially arterial spin labeling (ASL) technology which has been developed and applied in recent years. Compared with other perfusion imaging techniques, ASL technique has the advantages of being simple, non-invasive and can be repeated multiple times^[1]。 Because there are many kinds of imaging methods and parameters in ASL, which need to be properly set to achieve the optimum, it is necessary to provide standardized guidance on the application of this technology.

WHO on May 9, 2016 atActa NeuropatholThe journal published a new classification method of central nervous system tumors (referred to as 2016 CNS WHO Tumor Classification)^[1]。 The author will explain the influence of this new classification method on the diagnosis and treatment of central nervous system tumors from the perspective of imaging medicine. The 2016 CNS WHO tumor classification is a dual conceptual and practical improvement over the 2007 version classification. The new classification is the first time to define CNS tumors by adding molecular typing on the basis of conventional histological features, thus putting forward a new concept of classification and diagnosis of CNS tumors in the era of molecular pathology.

arterial spin labeling (ASL) is an MRI technique that uses blood water molecules as endogenous and freely diffusing tracers for cranial perfusion imaging. ASL technology has been proposed for more than 20 years^[1], has gone through multiple stages of development. With the continuous progress of ASL technology, especially the application of pseudo-continuous ASL (pCASL) sequence in recent years, its image quality, imaging range and imaging speed have been greatly improved, which has gradually attracted the attention of imaging and neuroscience workers, and has been more and more used in scientific research and clinical work.

primary adrenocortical carcinoma (PACC) is a highly malignant tumor that occurs in children and young people, with a prevalence of 0.5~2.0 per million, and is easily misdiagnosed clinically^[1,2]Even its pathological manifestations are easily confused with cortical adenomas^[3]。 The value of CT and MRI in the diagnosis of PACC, the DWI manifestations of PACC, and the pathological basis of the imaging manifestations of PACC are not clear. The purpose of the author was to explore the CT and MRI manifestations of PACC and their pathological basis.

transjugular intrahepatic portosystemic shunt (TIPS) has been widely used in the treatment of portal hypertension^[1,2]。 The shunt was established with bare stent in early TIPS, and the 1-year patency rate was less than 50%, which seriously affected the long-term efficacy after TIPS^[3]。 With the application of TIPS-specific Viatorr covered stents, shunt patency was significantly improved. Since Viatorr stent officially entered the Chinese market in October 2015, Fluency-covered stent was mostly used as an alternative to Viatorr stent in China before this. Unlike the Viatorr stent, the Fluency covered stent has no 2 cm bare area at the portal end. Therefore, in clinical TIPS, the combination of Fluency covered stent and bare stent to simulate Viatorr stent was attempted^[4,5]。 Through long-term follow-up of patients undergoing TIPS, the author aims to analyze the influence of different placement methods of covered stent and bare stent on the postoperative efficacy of patients in the medium and long term, and provide relevant reference for choosing appropriate stent placement methods during TIPS.

The world's earliest standardized training system for resident physicians was born in Johns Hopkins Medical School in the United States. After more than 100 years of development, the training system for resident physicians in the United States has formed a systematic, standardized and scientific system. Brigham and Women's Hospital in Boston's Longwood Medical District is one of the major teaching hospitals at Harvard Medical School and one of the larger hospitals in New England. The author has a certain understanding of the standardized training system of radiology residents in first-class hospitals in the United States through one year of visiting and scientific research work in this hospital. This paper introduces the medical education mode of American teaching hospitals represented by Brigham and Women's Hospital, and the forms and characteristics of standardized training of radiology residents, in order to provide reference for further standardization and improvement of standardized training of medical imaging residents in China.

Female, 60 years old. He was seen on March 18, 2015 due to headache for 7 d. The patient developed severe headache with nausea and vomiting without obvious trigger 7 days ago, without accompanying symptoms such as dizziness, fever, hearing impairment, convulsions and limb mobility impairment. No previous history of neurofibroma. MRI examination showed irregular cystic long T in the vermis of the cerebellum₁Hybrid length T₂Signal (Figure 1), DWI (b =1 000 s/mm²No significant diffusion restriction was observed on (Figure 2）； The medulla oblongata is compressed and thinned, and the fourth ventricle is compressed and lifted; No obvious supratentorial hydrocephalus was seen. After enhancement, the cyst wall of the lesion showed annular enhancement, and the wall nodules were significantly enhanced (Figure 3,Figure 4）。 The lesion size was approximately 32 mm ×25 mm ×37 mm. The tumor resection was performed under general anesthesia. During the operation, the tumor was filled with the fourth ventricle, irregular in shape, with an intact capsule, which was cystic-solid. The capsule contained grass-green clear cystic fluid, and the solid component was gray-red. Immunohistochemical staining: acidic calcium binding protein (S-100), Vimentin (Vimentin) (+), glial fibrillary acidic protein (GFAP), epithelial membrane antigen (EMA), progesterone receptor (PR) (-), CD34, Nestin (Focus +). Pathological diagnosis: Schwannoma of the fourth ventricle.

An 11-year-old female was admitted to the hospital with the main complaint of "pain in both hip and knee joints with restricted movement for 3 weeks". The patient developed pain in both hips after activity 3 weeks ago, accompanied by pain in both knee joints and weakness in both lower limbs, which was aggravated after activity, slightly relieved after rest, and the pain was obvious at night. Physical examination of orthopedic specialist showed tenderness and percussion pain in both hips and hips, pain radiating to both knee joints, muscle strength of both lower limbs grade 4, positive bilateral "4" sign, and no obvious abnormalities were found. Laboratory tests showed that blood alkaline phosphatase (ALP) was 1 058 U/L (reference value 0-300 U/L) and blood phosphorus (P) was 0.74 mmol/L (reference value 1.29-2.26 mmol/L).

A 43-year-old female was seen in the Department of Respiratory Medicine of our hospital on November 2, 2015 due to dyspnea with paroxysmal tingling. Six months ago, the patient developed shortness of breath and chest pain after a cold, without obvious fever, hemoptysis, hoarseness, choking and coughing after drinking water, and the symptoms improved after symptomatic treatment such as anti-inflammatory, phlegm-reducing, antispasmodic and asthmatic in another hospital. Specialist examination: bilateral thoracic symmetry, centered trachea. The breathing sounds of both lungs were clear, and no dry and wet rales and wheezing sounds were heard. Electronic bronchoscopy showed a globular neoplasm in the middle of the trachea, about 2.0 cm in diameter, with obvious congestion and slight roughness of the surface mucosa, and most of the tracheal lumen was blocked. No cancer cells and acid-fast bacilli were found on brush examination.

The patient was a 36-year-old female. Upper abdominal pain discomfort for 1 month, paroxysmal pain aggravated for 3 days. Past health, denying the history of metallurgical tours. Physical examination: mild tenderness in the upper abdomen, but no abnormalities. Laboratory tests: Treponema pallidum antibodies positive.

The patient was a 41-year-old male. The main reason for physical examination was B-ultrasound examination to find pancreatic space-occupying lesions. The patient had no obvious discomfort, and no abnormalities were found in physical examination and laboratory tests.

The patient was a 49-year-old male. Physical examination and ultrasound revealed pancreatic mass for 5 months. The patient had no obvious symptoms, and there were no abnormalities in physical examination and routine laboratory tests. Only CA199 increased up to 41.23 U/ml (normal reference value was 0-27 U/ml).

The patient was a 60-year-old male. Because of pain in the waist with both thighs and perineum for 5 months, an abdominal mass was found and admitted for 3 days. Physical examination: A pulsatile mass of 10.0 cm ×8.0 cm was palpable on the left side around the umbilicus, which was hard and without tenderness. There were no obvious abnormalities in laboratory tests.

The patient was a 46-year-old female. Fatigue accompanied by total abdominal distension and pain discomfort for 3 months, aggravated for 1 month. Physical examination: abdominal swelling, a huge mass palpable from the xiphoid process to the pelvic cavity, medium texture, fixed position, unclear boundary, edema of both lower limbs. Blood routine and blood biochemical examination showed no obvious abnormalities. Total abdominal CT plain scan + enhanced scan showed diffuse mass soft tissue density shadow in the abdominal cavity and compression changes in the adjacent intestinal structure (Figure 1）。 The enhancement scan mass was mildly delayed in enhancement, and patchy non-enhanced necrotic areas were visible in the tumor (Figure 2，Figure 3，Figure 4), the coronal and sagittal images show that the mass reaches the lower margin of the liver and goes down to the pelvic cavity (Figure 5,Figure 6）。 A puncture biopsy of the abdominal cavity was performed, and the postoperative pathological results (puncture tissue of the abdominal cavity) showed gastrointestinal stromal tumor. After 2 months of treatment with Gleevec, the symptoms of abdominal distension and pain improved. CT plain scan showed that the diffuse soft tissue mass in the abdominal cavity was significantly smaller than before, and the local density was not uniform (Figure 7）。