2017年 · 第51卷第08期

spinal dural arteriovenous fistulas (SDAVF) are the most common spinal vascular malformations^[1,2,3]。 Due to the lack of specificity, the clinical manifestations are often easily confused with common myelitis, demyelinating lesions, tumors and arachnoid cysts^[2,4]。 The gold standard for diagnosis of SDAVF is spinal cord selective arteriography (DSA)^[5]However, it has the disadvantages of strict indication requirements, many steps, long examination time, large radiation dose and trauma, easy missed diagnosis, etc., and requires selective angiography of 42 supplied spinal arteries one by one according to the range of lesions. If spinal cord angiography can be performed by magnetic resonance angiography (MRA) before operation, the location, extent and fistula of spinal cord vascular malformation can be judged and evaluated, which can guide spinal cord DSA or surgical operation, so as to achieve the purpose of accurate diagnosis and treatment. The author summarized and analyzed the spinal cord MRA data of 16 patients diagnosed with SDAVF, and compared the DSA and the surgical fistula site to evaluate the significance of spinal cord MRA in the judgment of fistula position.

Male, 21 years old. He came to our hospital on January 8, 2014 due to headache and dizziness for 1 month and aggravation for 2 days. Physical examination: normal development, clear consciousness, autonomous position, pathological reflex not drawn out.

A 28-year-old male was admitted for "sudden severe pain in the head and neck with nausea for 3 d, progressive decrease in chest sensation with weakness in both lower limbs for 2 d". Physical examination: neck rigidity, deep and shallow sensation below chest 2 disappeared, muscle strength of both upper limbs was grade 4, and muscle strength of both lower limbs was grade 0. The bilateral radial artery pulsed strongly, the femoral artery pulsed weakly, and the dorsal pedis artery pulsed untouched. Laboratory tests: antinuclear antibody, complement, rheumatoid factor, immunoglobulin, etc. were all negative. Cardiac ultrasound: hypertrophy of left ventricular wall with ejection fraction of 64%. Cervicothoracic MRI: Subdural hematoma at cervical 6 to thoracic 6 vertebral body level with spinal cord edema (Figure 1）。 Aortic CTA: Severe local stenosis of the thoracic aorta with extensive collateral formation (Figure 2,Figure 3,Figure 4）。 DSA: No abnormalities in the blood vessels of the head. The anterior spinal artery forms a fenestration structure at the level of the cervical 7 vertebral body, and an aneurysm can be seen at the beginning of fenestration (Figure 5）。 In addition, bilateral subclavian arteries emit tortuous and thick internal thoracic arteries. Anterior spinal aneurysm rupture and bleeding due to aortic coarctation were considered, followed by DSA aneurysm embolization (Figure 6) and spinal canal incision for subdural hematoma evacuation.

Female, 26 years old, presented on 11 Apr 2014 due to hemoptysis for 2 d. The patient developed hemoptysis without obvious trigger 2 days ago, which was dark red, without chest tightness, asthma, fever, night sweats, palpitations, chest and back pain and other symptoms. Physical examination: bilateral supraclavicular and cervical lymph nodes were not enlarged; The thorax was symmetrical without deformity, the bilateral respiratory motility was symmetrical, the respiratory sounds of both lungs were clear, and dry and wet rales were not heard; There was no bulge in the precordial area, strong heart sounds, heart rate 70 beats/min, homogeneous rhythm, and no pathological murmur was heard in the auscultation area of each valve.

Male, 42 years old. In August 2016, a physical examination found a right lower mediastinal mass, and I was seen in our hospital one month later. The patient complained that there were no symptoms such as cough, chest tightness and shortness of breath at ordinary times; Physical examination: bilateral thoracic symmetry, no dry and wet rales were heard in both lungs after auscultation; Heart rhythm, no murmur. Laboratory tests were normal.

Pulmonary nodules and masses are common lung diseases, and they are also the key and difficult problems in the diagnosis of lung diseases, which have attracted much attention of clinicians. At present, the application of chest X-ray, CT, MRI and PET-CT in pulmonary nodules and masses is still deficient^[1,2]Although CT is the main examination method of such diseases, its differential diagnosis of pulmonary nodules and masses mainly depends on morphological changes, and there are many phenomena of "different diseases with the same shadow, same disease with different shadow", which brings certain difficulties to the diagnosis. The development of energy spectrum CT provides multiple parameter information for the diagnosis and differential diagnosis of pulmonary nodules and masses, which makes up for the shortcomings of traditional CT quantitative evaluation. The author reviews the characteristics of CT energy spectrum imaging and its application in pulmonary nodules and masses.

Breast cancer is the most common malignant tumor in women in China, and its prevalence is increasing year by year^[1]。 Mammography is currently the preferred screening method for breast diseases^[2]Intramammary masses and fine calcifications can be shown, but the diagnostic sensitivity for dense breast is low^[3,4]。 DWI can observe the diffusion movement changes of living water molecules, and ADC value can help to differentiate benign and malignant breast lesions^[5,6,7]。 However, in living tissues, the intensity of tissue signal does not decay linear exponentially with b value. At low b value, the attenuation of DWI signal is related to microcirculation perfusion, and the ADC value cannot truly reflect the diffusion characteristics of water molecules in voxels^[8,9]。 intravoxel incoherent motion (IVIM) is a functional imaging method that can reflect the effects of water diffusion and microcirculation perfusion in voxels. Based on the biexponential model theory, it has more advantages than traditional DWI. The author mainly reviews the application progress of IVIM in breast tumors.

International Alliance Against Cancer and American Cancer Federation (UICC/AJCC) gastric cancer TNM staging is an internationally accepted gastric cancer staging system. It is an important basis and reference standard for clinical formulation of gastric cancer treatment plan and evaluation of prognosis. It is updated every 4 to 6 years according to clinical diagnosis and treatment progress^[1,2]。 In October 2016, version 8 of the new staging system was released^[3]Among them, the biggest change in gastric cancer is that on the basis of the previous version of single pathological staging (pTNM), two new systems, clinical staging (cTNM) and post-neoadjuvant therapy staging (ypTNM), were divided, and their application scope and specifications were preliminarily defined, and a new pattern of coexistence of three staging systems was constructed. Its purpose is to better adapt to the needs of individualized precision medicine in oncology clinics and the promotion of multidisciplinary team (MDT).

World Health Organization (WHO) following the 2014 Munich Conference, Germany^[1]In September 2016, a meeting was held in Seoul, South Korea to continue the discussion on the rational application of CT in individual health assessment (IHA). Thirty-one experts from 23 countries and regions exchanged the development status and supervision mechanism of IHA in asymptomatic people in different regions, focusing on the principle of radiation rationalization of IHA in radiology (mainly CT). WHO launches a global initiative on radiation safety, requiring radiological inspections to achieve maximum benefit with minimum risk^[2]。 The new International and European Basic Safety Standards (BSS) clearly set out the Safety requirements for medical radiation, that is, rationalization of means and optimization of protection, including the imaging requirements for asymptomatic people^[3,4]。 The asymptomatic population undergoes radiological examination in order to detect the disease early, and the potential radiation risk has to be considered. At present, the international screening of asymptomatic people mainly focuses on coronary heart disease, lung cancer, colorectal cancer and polyps^[5,6], breast screening has become mature^[7,8]Screening age, technical requirements and inspection specifications can refer to the consensus of domestic experts^{[8,9,10,11,12]}。 According to the relevant reports and expert consensus of this conference, and combined with the literature, the author makes a comprehensive introduction to the current situation and implementation problems of IHA, risk communication education and training, guidelines and clinical audit, ethics and IHA supervision mechanism, etc. for the benefit of readers.