2017年 · 第51卷第07期

The patient was a 10-year-old male. On August 2, 2016, a mass on the floor of the mouth was found, with surface erosion, slight pain, poor anti-inflammatory effect and rapid increase of lesions. On August 11th, he was diagnosed as a mesenchymal tumor by pathological biopsy in a local hospital, excluding tumors of lymphohematopoietic system. He went to our hospital on September 1, 2016. Stomatological examination: 2 ulcers on the right lateral edge of the tongue, about 15 mm ×10 mm and 20 mm ×20 mm, respectively, with oval shape covered with yellow pseudomembrane and obvious tenderness. The tongue is swollen and hard, with limited movement.

An 8-month-old male was admitted to the hospital on 21 June 2015 due to anorexia for 5 days, fever and unconsciousness for 12 hours. Family History: Only child, healthy parents, unrelated marriage. Physical examination on admission: body temperature 39.0℃, coma, decreased muscle strength and tone of limbs, bilateral Babinsky sign (+). Blood routine: white blood cells 17.97×10⁹/L [normal reference value (3.50~9.50) ×10⁹/L], blood ammonia: 152.1 μ mol/L (normal reference value 20.0~60.0 μ mol/L); Lumbar puncture: No obvious abnormalities were observed in routine cerebrospinal fluid. Cranial MR examination showed diffuse and symmetrical T in bilateral cerebral hemisphere cortex₁WI signal is reduced (Figure 1）; T₂WI signal increased and sulcus shallowness disappeared (Figure 2）。 DWI (Figure 3) showed increased gray matter and white matter signals and decreased ADC values in bilateral cerebral hemispheres. There were no obvious abnormal signals in bilateral caudate nucleus, lenticular nucleus, thalamus, hippocampus, brainstem and cerebellum. MRS (Figure 4) showed that the peak of inositol (mI), choline (Cho) and N-acetylaspartate (NAA) decreased, the peak of glutamine and glutamate complex (Glx) increased significantly, and the towering peak of lactate (Lac) was visible. The results of out-of-hospital blood tandem mass spectrometry analysis showed that the amino acids of glutamine, histidine, methionine and piperidine were increased, and citrulline was decreased. Results of urinary gas-mass spectrometry: increased excretion of uracil and orotic acid in urine. There was no obvious abnormality in the test results of fatty acyl carnitine. The comprehensive diagnosis was ornithine transcarbamylase deficiency (OTCD).

The 25-year-old female was seen on June 3, 2016 due to chest tightness and palpitation for more than 1 month. The patient denied a history of tuberous sclerosis. Physical examination: pulse 100 beats/min, heart rate 108 beats/min, arrhythmia, variable intensity of heart sounds, no murmur in each valve auscultation area. Laboratory tests: No obvious abnormalities were found in myocardial enzymes, atrial natriuretic peptide, complete set of hemagglutination and tumor markers. 24 h ambulatory electrocardiogram: ectopic rhythm; Persistent atrial fibrillation.

A 6-year-old male was found to have a soft tissue mass in his right thigh in July 2015. On August 15th, he underwent mass resection in the local hospital. On December 1st, he found that the soft tissue mass in the lower right thigh was enlarged and growing rapidly. He went to our hospital on January 5th, 2016. Physical examination: Both lower limbs are equal in length, and a large mass protruding from the skin surface can be seen in the lower section of the right thigh. The skin is intact, the local skin temperature is increased, the texture is soft, the mobility is poor, the curvature of the right knee joint is limited, the muscle strength and tension of the right lower limb are normal, the skin feels normal, the dorsal pedis artery is palpable, the peripheral blood flow is good, the Achilles tendon reflex and knee reflex of both lower limbs are normal, and the pathological signs are negative.

The patient was a 51-year-old female. The main cause of intermittent dull pain in the lower abdomen was aggravated for half a month and admitted to hospital for 3 days. Physical examination: tenderness in the middle and lower abdomen, accompanied by rebound pain and muscle tension, and active intestinal sounds.

The patient was a 53-year-old female. He was admitted to hospital on August 31, 2016 mainly due to red and swollen conjunctiva of his right eye, blurred vision and intracranial murmur for 1 month. Physical examination: right palpebral conjunctiva congestion, restricted ocular movement, slight pulsatile murmur can be heard in the right temporal and behind the ear, and spontaneous carotid-cavernous fistulae (CCF) confirmed by right carotid angiography.Figure 1，Figure 2，Figure 3]。 Due to the small fistula, a domestic covered stent [Willis stent of Minimally Invasive Medical Devices (Shanghai) Co., Ltd.] was applied after consultation to implement endovascular isolation of the carotid cavernous sinus segment. On 2 Sep 2016, under general anesthesia, a covered stent (4.0 mm ×13.0 mm) was positioned in the cavernous sinus segment of the right carotid artery through the right femoral artery approach, and the fistula disappeared after the stent was dilated and released at 6 atm (1 atm =101 kPa). The operation was successful (Figure 4，Figure 5，Figure 6), and no pulsatile murmur was heard during postoperative auscultation. However, on the second day after surgery, a slight intracranial murmur was smelled again. The patient's ocular symptoms did not improve significantly, dizziness accompanied by nausea and vomiting. Another DSA examination revealed that the covered stent was leaked. The stent adhesion was improved and endoleak disappeared with 4.5 mm ×8.0 cm balloon dilation 3 d after surgery (Figure 7，Figure 8）。 Two days after the second operation, the patient reported that intracranial murmur still existed. After reexamination of the internal carotid artery 5 days after the operation, there was no abnormality in the position of the covered stent. Vertebral artery angiography showed that the right cavernous sinus was developed through the basilar artery-persistent trigeminal artery (PTA) route, so the fistula and PTA were completely occluded by coil tamponade, and the fistula disappeared (Figure 9，Figure 10，Figure 11，Figure 12，Figure 13）。

The patient was a 70-year-old female. The main reason was to find a left axillary mass for 8 months and a right breast mass for 2 months. He was admitted to hospital on October 13, 2015. Physical examination: A mass with a maximum diameter of about 2 cm was palpable in the outer upper quadrant of the right breast, which was soft in texture, with clear boundaries and acceptable mobility. No clear mass was palpable in the left breast. An irregular mass with a maximum diameter of about 10 cm can be palpable in the left axillary, which is hard in texture, with unclear borders and poor mobility.

The patient was a 44-year-old male. The main cause was right lower abdominal pain with fever for 3 days. Physical examination showed no obvious abnormalities. Blood white blood cells were elevated in laboratory tests.

The patient was a 37-year-old male. In 1994, he underwent splenectomy and periesophageal devascularization due to liver cirrhosis, portal hypertension and upper gastrointestinal hemorrhage. In 2014, he experienced upper gastrointestinal hemorrhage again. Due to cavernous degeneration of the portal vein, he planned to perform transjugular intrahepatic portosystemic shunt (TIPS) without success, and performed superior mesenteric vein-inferior vena cava artificial vascular bypass. Two years after the operation, he was admitted to hospital again due to upper gastrointestinal hemorrhage for 3 days. Color ultrasound examination after admission showed that there was no obvious blood flow signal in the artificial blood vessel. Upper gastrointestinal angiography showed esophageal and gastric varices. MR venography (MRV) showed cavernous degeneration of the portal vein, artificial blood vessels between the inferior vena cava and superior mesenteric vein, and filling defects at the inferior vena cava anastomosis (Figure 1）。 Inferior vena cava angiography showed a filling defect of the inferior vena cava in the lower right posterior of the right renal vein, considering intimal hyperplasia around the anastomosis (Figure 2）。 Due to the insufficient support force, the loach guide wire and cobra catheter could not choose to enter the artificial blood vessel. Rups-100 (Cook, USA) system was introduced, and the long metal sheath was pushed up and fixed to the anastomosis. The loach guide wire was repeatedly explored to enter the artificial blood vessel and then enter the superior mesenteric vein through the artificial blood vessel (Figure 3）。 Catheter follow-up, with greater resistance when passing through artificial blood vessels. Intravenous angiography of superior mesenteric vein showed: vascular disorder of the portal vein system, unobstructed blood flow of superior mesenteric vein, which was blood flow into the liver, and no visualization was found in artificial blood vessels, so occlusion was considered (Figure 4）。 Replacement plus hard exchange guidewire, introduction of 8 mm ×6 cm Powerflex balloon (Cordis, USA) to dilate the anastomosis and artificial blood vessel (Figure 5), the artificial blood vessel was still not developed after repeated angiography, and a 10 mm ×8 cm Smart self-expanding internal stent (Cordis, USA) was implanted, and the stent covered the whole process of the artificial blood vessel. Repeated angiography showed patent blood flow from artificial blood vessels (Figure 6), the superior mesenteric vein is the hepatic blood flow. Postoperative routine double antiplatelet therapy. The ultrasound examination at 3 and 9 months postoperatively showed that the blood flow in the artificial vascular stent was unobstructed, and there were no symptoms of hematemesis and melena.

With the continuous development of science and technology, various omics represented by genomics emerge in an endless stream. In the aspect of imaging medicine, radiomics has officially joined the omics family. At the same time, we have also entered the era of big data, and all kinds of information have exploded, as have medical-related data. At the beginning of 2015, then-US President Barack Obama announced the launch of a new large-scale research and development project-the precision medicine program. According to the definition of the National Institutes of Health, precision medicine is an emerging method of disease treatment and prevention based on differences in individual genes, environment and lifestyle. The premise of precision medicine is accurate diagnosis, and the integration of imagomics and big data will surely open up a new world for precision imaging medicine. The author reviews the birth and integration of radiomics and big data, as well as their applications in the field of precision imaging medicine.