2016年 · 第50卷第12期

Thyroid nodules are more common in clinic. 4% of the population can be palpable by physical examination, 50% of the population can be found by ultrasound examination, 50% of the population can be found by autopsy, and 5% of the thyroid nodules are malignant^[1,2,3,4]。 Thyroid malignant tumors include primary thyroid cancer, metastatic cancer and sarcoma, most of which are primary thyroid cancer. Malignant thyroid nodules mentioned in daily life and work mostly refer to primary thyroid cancer. According to the tissue composition, primary thyroid cancer is divided into papillary thyroid carcinoma (PTC), follicular cell carcinoma, medullary carcinoma and undifferentiated carcinoma, of which PTC accounts for 80% to 88%^[5,6]。 After surgical and¹³¹I treatment, the 5-year survival rate of thyroid cancer is 97%^[7]With a 10-year survival rate of 96%^[8], for low-risk PTC, 5-and 10-year survival rates can reach nearly 100%^[9,10]。 30% to 90% of PTC were accompanied by cervical lymph node metastasis at the time of diagnosis^[11]Lymph node metastasis is an important risk factor for local recurrence, and its harm is more serious than that of primary tumor. Therefore, according to clinical data and imaging characteristics, it is of great significance to identify a small number of primary thyroid cancer from a large number of benign nodules as soon as possible, and stage them, predict their aggressiveness and follow-up. At present, the main imaging examination methods for thyroid nodules include ultrasound, ultrasound-guided fine needle aspiration cytology (FNAC), CT, MRI and radionuclide examination, etc. These examination methods have their own advantages and disadvantages. It is very important to formulate a reasonable imaging examination process. Therefore, the Head and Neck Science Group of Radiology Branch of Chinese Medical Association and the editorial department of Chinese Journal of Radiology organized experts related to imaging department, nuclear medicine department, ultrasound department, internal medicine and surgery. After many discussions, this edition of thyroid nodule imaging examination process expert consensus was formed for the reference of the majority of clinical and imaging physicians, and it will be continuously improved and improved according to everyone's feedback in the future.

computed tomography (CT) is a revolution in the history of medical imaging since Roentgen discovered X-ray in 1895. Because of its advantages of high density resolution and spatial resolution, accurate localization and characterization of lesions, and intuitive and reliable imaging data for clinical practice, CT examination has become an indispensable diagnostic method in clinical medicine, and has been popularized to all levels of medical institutions in China. It is essential to standardize CT examination techniques to provide universally recognized quality images for clinical and diagnostic purposes. In order to standardize CT examination technology and better serve patients, relevant domestic experts drafted this edition of CT examination technology expert consensus based on relevant literature and clinical practice.

reversible cerebral vasoconstriction syndrome (RCVS) is a group of rare clinical and imaging syndromes, which was first developed by Call et al.^[1]Reports, and similar reports have been made since^[2,3]。 Due to the insufficient understanding of this syndrome, there are few relevant literatures at home and abroad. The clinical and imaging data of 3 patients with RCVS in our hospital were retrospectively analyzed, and combined with the literature analysis, aimed at improving the understanding and diagnosis of this disease.

congenital tuberculosis, also known as intrauterine infectious tuberculosis, refers to the mother suffering from tuberculosis during pregnancy, and Mycobacterium tuberculosis spreads vertically through the umbilical cord through the placenta, causing the fetus to be infected with tuberculosis in the uterus; Can also be caused by fetal inhalation or swallowing of amniotic fluid or birth canal secretions contaminated with M. tuberculosis during delivery^[1]。 As the incidence of pulmonary tuberculosis increases year by year, the number of pulmonary tuberculosis in women of childbearing age is also increasing, which leads to a significant increase in the incidence of congenital pulmonary tuberculosis. As a special group, the immune function of newborns is not perfect, so the imaging manifestations of newborns after tuberculosis infection are very different from those of adults and even children. Congenital pulmonary tuberculosis is mainly diagnosed by mothers with pulmonary tuberculosis, but 60% ~70% of mothers are asymptomatic, and the early clinical specificity of children is lacking, so early diagnosis is difficult^[2]。 The imaging features and clinical manifestations of 7 cases of congenital pulmonary tuberculosis were analyzed in order to provide help for clinical diagnosis and early treatment.

The patient was a 19-year-old female. Pain in the right upper abdomen for 2 days, and repeated multiple joint swelling and pain for 1 year. Physical examination: The liver is enlarged, and four horizontal fingers can be palpable under the right rib, which is tough, smooth on the surface and tender. Redness and swelling of the left interphalangeal joint, left ankle and both elbow joints. Laboratory tests: Hemoglobin slightly decreased, platelet count, fibrinogen, lactic acid, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total cholesterol, triglycerides, low-density lipoprotein, C-reactive protein, urinary transferrin, 24-h urinary albumin quantity were all increased.

The patient was a 51-year-old female. The main cause was buttock mass ulceration for 1 year. The patient had a buttock mass since birth. One year ago, a sinus tract appeared on the surface of the mass, and a small amount of white peptone-like liquid flowed out. Untreated, the mass gradually increased. Six months ago, there were three ulcers on the surface of the mass, with purulent secretions and new granulation tissue on the surface, which felt fluctuating when touched, and the ulcers continued to drain pus and did not heal. Laboratory tests: CRP was 53.2 mg/L (normal reference 0-5 mg/L) and CA125 was 43.32 U/ml (normal reference 0.01-35.00 U/ml).

The patient was a 64-year-old female. Multiple space-occupying lesions in both kidneys were found in B-ultrasound during physical examination in other hospitals for 1 week. CT plain scan and enhanced scan were performed, which showed multiple hamartomas in both kidneys, and a mass about 2 cm in diameter was seen on the lateral side of the middle pole of the left kidney, which was mildly enhanced. It was suspected to be left kidney cancer, and was admitted to our hospital on July 1, 2013. The patient had no obvious discomfort symptoms, no obvious abnormalities were found on physical examination, and no obvious abnormalities were found on laboratory examination.

Case 1 male, 65 years old. Dull pain under xiphoid process for 5 months, CT examination in other hospital showed space-occupying lesions in S8 segment of liver. Laboratory tests: Hepatitis B surface antigen, e antigen and core antibody were positive (major three positive), and the carcinoembryonic antigen (CEA) value was 10.9 ng/ml (normal reference value was 0~5 ng/ml). MRI examination: 2.5 cm ×1.8 cm nodules in the S8 segment of the liver with clear boundaries. T₂WI showed a slightly high signal (Figure 1）； T₁WI is low signal (Figure 2）； DWI visible diffusion is limited (Figure 3）； Dynamic enhancement scanning showed obvious early arterial enhancement, but slightly decreased in venous phase, but it was always higher than the surrounding liver parenchyma. Small cord-like and speckled low enhancement areas were seen in the center of the lesion (Figure 4）。 Surgical findings: The tumor was located in S8 segment with clear boundary, and the tumor resection of S8 segment of liver was performed. Postoperative pathology: A large number of lymphocytes and plasma cells infiltrated in the tissue, abnormal large cell strips growing in cord or nest shape, nuclear vacuolation, and mitotic images were easily seen (Figure 5）。 Immunohistochemistry: Ki67 40% positive (+), leukocyte common antigen (LCA), CD3, CD20, CA153, CD110 focal, CD34 vascular, CK19 partial positive (+), Hepatocyte specific antigen (Hepatocyte), alpha-fetoprotein (AFP), Epstein-Barr virus in situ hybridization (EBers) negative. Pathological diagnosis: lymphoepithelioma-like carcinoma (LELC), with little lymphocyte infiltration in the portal area of surrounding liver tissue.

epithelioid hemangio endothelioma (EHE) of the liver is a rare low-grade malignant vascular tumor. The author diagnosed a patient who refused to receive any anti-tumor treatment for many years after diagnosis. Through imaging examination and follow-up, the development and evolution of tumor natural growth were recorded, which is now reported as follows.

traumatic brain injury (TBI) is an important brain injury disease. It is the most common disease in neurosurgery and the main cause of disability and death in trauma patients. mild TBI (mTBI) was defined as the initial Glasgow score (GCS) score of 13 to 15, the duration of loss of consciousness (LOC) less than 30 min, the duration of alteration of consciousness (AOC) and the posttraumatic amnesia (PTA) less than 24 h after the patient's head was subjected to external violence, and the head CT findings were negative^[1]。 Approximately 80% of patients with mTBI who are clinically considered recovered develop cognitive dysfunction for some time after injury (approximately 3 months later), and these symptoms can persist for months or even years^[2,3]。

Hepatic fibrosis is a key link in the development of various chronic liver diseases to liver cirrhosis, which is the result of abnormal deposition of extracellular matrix in the liver during the injury-healing process^[1]。 Early diagnosis of liver fibrosis and evaluation of liver function have important clinical significance. Pathology is the gold standard for evaluating the staging of liver fibrosis, but it is invasive and has sampling errors, which is not conducive to long-term follow-up; Commonly used clinical serological indexes to evaluate liver function, such as Child-Turcotte-Pugh score, end-stage liver disease model score, indocyanine green test (ICG), etc., can only evaluate the overall liver function, but cannot evaluate locally and predict postoperative residual liver function. MRI can obtain the anatomical information of organs more intuitively and comprehensively than pathological and serological indexes. With the application of functional imaging sequences and the development of contrast agents, enhanced MRI can provide more abundant functional information, which has the potential to quantitatively evaluate liver fibrosis and liver function^[2,3]。 At present, the research on quantitative evaluation of liver fibrosis and liver function by enhanced MRI is still in the exploratory stage. The author reviews its research progress.

Objectively and accurately evaluating the efficacy of tumor therapy has important clinical significance^[1]In which imaging examination plays an important role. Quantitative tumor image analysis is a computer-aided medical image analysis method, which extracts quantitative imaging biological indexes (including tumor size and activity) from tumor images, and provides index data for evaluating clinical tumor treatment effect and clinical drug trials^[2,3]。 In clinical practice to evaluate the efficacy of tumor treatment, the gold standard for clinical trial endpoints is overall survival (OS). OS is considered to be the best and most reliable efficacy endpoint index in oncology clinical trials, which is accurate and easy to observe; However, it has that limitation that it takes a long time, must have an exact time of death, and it is difficult to determine the effect of the test drug on survival due to the effect of subsequent anti-tumor therapy^[4]。 Therefore, imaging-based efficacy evaluation criteria are widely used in clinical practice as an alternative clinical trial endpoint for OS^[4]。

Acta NeuropatholMagazine published online on May 9, 2016 Louis et al.^[1]An overview of the new WHO classification of central nervous system tumors. Although the classification of brain tumors still largely depends on histological examination, the genetic basis of some brain tumors has been elucidated in recent 20 years. In 2014, the International Joint Conference on Neuropathology, held in Haarlem, the Netherlands, established guidelines for adding molecular pathology findings to the diagnosis of brain tumors and adopted the process for the 2007 version of the CNS tumor classification revision. In 2016, based on the work of 117 researchers in 20 countries, WHO adopted the opinions of a number of neuropathology and neurooncology experts, and added molecular typing to most brain tumors for the first time on the basis of the 2007 edition. The 2016 WHO classification of central nervous system tumors also added some newly recognized tumors, deleted some tumor types or diagnostic terms, and revised the diagnosis, grading and classification of some tumors. Although this classification is officially only defined as the revised version of the 4th edition of 2007, due to significant progress, I would like to compile the 2016 WHO classification of central nervous system tumors, hoping to help everyone's study and work.