2018年 · 第52卷第09期

Angiosarcoma is a malignant tumor derived from mesenchymal cells differentiated from vascular endothelial cells. It occurs in the skin of head and neck, followed by soft tissues, breast, lung, liver, spleen and bone^[1,2]。 primary cardiac angiosarcomas (PCAS) are rare, and they are easily misdiagnosed and misdiagnosed because they have no specific clinical symptoms. The author analyzed and summarized the clinical data of 4 cases of PCAS diagnosed by pathology in our hospital, and combined with relevant literatures, explored the CT and PET-CT manifestations of cardiac angiosarcoma, so as to improve the understanding of the tumor by imaging physicians and clinicians.

Echinococcus granulosus hydatidosis is a common zoonotic parasitic disease, which is common in high altitude areas of western China. Infected people are caused by swallowing food containing tapeworm eggs. After tapeworm eggs enter the gastric cavity, the eggshell is dissolved by gastric acid and hatched into larvae. After Echinococcus granulosus hydatidosis invades the human body, about 70% stay in the liver and develop into cysts, followed by lung, kidney, spleen, brain and other parts^[1]Hydatid cysts occurring in the mammary gland are rare^[2]Occasional clinical onset, accounting for only 0.27%^[3]。 The purpose of the author was to investigate the X-ray and MRI manifestations of cystic hydatidosis of the breast.

cerebral venous sinus thrombosis (CVST) is a special type of cerebrovascular disease. It is rare to occur in the fetus. There are only more than 60 cases reported in foreign literature, and only one case diagnosed by ultrasound in China^[1]。 Because fetal CVST is potentially lethal or disabling, accurate prenatal diagnosis is important^[2,3]。 The author retrospectively analyzed the MRI manifestations of 3 cases of fetal CVST, aiming to explore the value of MRI in the diagnosis of fetal CVST.

A 2-year-old and 3-month-old child went to the gastroenterology department of a local hospital for 1 month because of retching and salivation without obvious trigger, but her symptoms did not improve after treatment. Twenty days ago, convulsions occurred, manifested as tilting the head back, turning the eyes up, foaming at the mouth, purple lips, no fever, 4 to 5 times a day, and the attacks were more frequent before going to bed, each time lasting for tens of seconds to 1 min, and could recover by itself. He was seen in our hospital in November 2016. Specialist examination: no neurological positive signs.

A 43-year-old male was admitted to the hospital on December 30, 2017 due to sudden right limb weakness with headache for 2 h. CT examination of the head showed brainstem hemorrhage. Has a history of "hypertension" for 4 years, and his blood pressure is not well controlled at ordinary times; The history of "chronic bronchitis" is more than 30 years. Physical examination: blood pressure 177/118 mmHg (1 mmHg =0.133 kpa), consciousness, unclear speech, shallow right nasolabial fold, right extension of tongue, right upper limb muscle strength grade 3, right lower limb muscle strength grade 4, left limb muscle strength grade 5, right Babinski sign positive, right finger-nose test cannot be completed, Kernig sign negative. In order to determine the cause of brainstem hemorrhage, CTA of the cephalic and carotid arteries was performed. Axial thin-slice CT showed a membranous structure in the lumen of the posterior wall of the initiation of the left internal carotid artery (Figure 1), sagittal reconstruction images showing a membranous protrusion in the posterior wall of the initiation of the internal carotid artery in the left carotid sinus (Figure 2), diagnosed as a left carotid web. After adjusting blood pressure, controlling cerebral edema, hemostasis and nerve nourishment, the patient improved and was discharged.

Female, 64 years old. The right nasal cavity mass was found for more than 1 year, accompanied by nasal congestion, runny nose, sneezing, loss of smell, occasional headache, which worsened in the past six months. The right nasal cavity mass was consciously enlarged, nasal congestion worsened, accompanied by choking and coughing at night, and was admitted to hospital on May 21, 2017. There were no abnormalities in the laboratory tests.

Male, 57 years old. He was admitted to the hospital on June 19, 2017 due to paroxysmal right limb weakness with slurred speech for 10 d and aggravated for 3 d. 3 years of previous history of hypertension and 20 years after internal fixation of right femoral fracture. Physical examination: clear and clear, visual acuity and visual field of both eyes normal, right lower limb muscle strength 5^－Grade, and the physical examination of Yu Neurology was negative. Head and neck CTA: Severe luminal stenosis at the initiation of the left internal carotid artery and moderate luminal stenosis at the initiation of the right internal carotid artery. Preoperative head CT showed lacunar infarction in the left basal ganglia region (Figure 1）。

Male, 37 years old. Due to intermittent chest tightness for 2 months and asthma after exertion for more than 10 days, he was admitted to the hospital on February 13, 2017. No abnormalities were found on admission physical examination. Electrocardiogram revealed sinus tachycardia with occasional premature atrial contractions. Chest DR showed slightly enlarged heart shadow and left pleural effusion. Then, the left pleural effusion puncture and catheter drainage was performed under the guidance of ultrasound, and a total of about 1 600 ml of red bloody fluid was drained. Laboratory test of pleural effusion showed: glucose 6.37 mmol/L (normal value 3.90~6.00 mmol/L), total protein 33.10 g/L, C-reactive protein 12.60 mg/L, tumor associated antigen (CA-125) 478.70 U/ml (normal value ≤35 U/ml), non-small cell lung cancer antigen 15.07 mg/L (normal value ≤3.3 mg/L), protein qualitative (+ +), mononuclear cell ratio 93.10%, pleural effusion culture showed positive Streptococcus viridis. Cardiac ultrasound showed a slightly hyperechoic size of 5.2 cm ×4.9 cm from the outside of the right atrium, which was closely related to the right atrium. Considering the space-occupying lesion of the right atrium (Figure 1）。 An enhanced CT scan of the chest showed that the medial pericardium occupied the right heart margin (Figure 2）。 PET-CT showed that the soft tissue density mass shadow radionuclide concentration was seen in the pericardium of the right margin of the heart, and the maximum standard uptake value was about 14.2, which was considered as malignant tumor; No abnormal concentration of nuclides at other sites was observed. CT-guided puncture biopsy was performed (Figure 3), pathologically and immunohistochemically consistent with angiosarcoma (Figure 4）。

Male, 30 years old, went to our hospital in January 2015 because his blood pressure rose for 6 months due to physical examination. Physical examination 6 months before the patient saw an increase in blood pressure, up to 200/120 mmHg (1 mmHg =0.133 kPa), without discomfort. He went to the local hospital and was given oral Baixintong, Betaloc, Ambonol and indapamide quadruple antihypertensive drugs, and his blood pressure was controlled at 140/80 mmHg. For further treatment, go to our hospital. Admission physical examination: No vascular murmur was heard in both kidney areas, blood pressure 160/95 mmHg, heart rate 74 beats/min. Blood biochemical indexes were normal, and renin was>30.56 ng·ml in both standing and recumbent positions^－1• h^－1(Normal 0~6.56 ng·ml^－1• h^－1), angiotensin and aldosterone values were normal; Ultrasonography of both kidneys showed stenosis of the right renal artery, CTA showed three branches of the right renal artery and an aneurysm in the middle branch, but none showed fenestration deformity (Figure 1）。 After communicating with the patient and family, it is proposed to perform right renal artery angiography with stent implantation or coil occlusion of the tumor-bearing artery.

Male, 26 years old, was admitted to hospital on April 24, 2017 due to cough and sputum for 3 weeks. The patient developed a cough without obvious cause 3 weeks ago, which was paroxysmal cough with expectoration, which was yellow-white purulent sputum, without fever and chills. 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 no dry or wet rales were 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. Blood laboratory test on April 26: D-dimer 13.76 mg/L (normal value 0-0.50 mg/L), fibrinogen 4.46 g/L (normal value 2.00-4.00 g/L), electrocardiogram showed reverse clock transposition. On May 3, blood oxygen saturation was 93% (normal value 80%-100%), thrombin source activity was 68%, D-dimer>20 mg/L, all microbiological and immunological tests were negative, and the patient died on May 8.

Female, 49 years old, headache, dizziness, blurred vision, polydipsia and polyuria for half a year, aggravated in the past half month, came to our hospital in July 2017. Physical examination: There were no positive pathological signs in neurological examination, no nausea, vomiting and incontinence. The visual acuity in both eyes decreased, 0.3 in the left eye and 0.8 in the right eye, and the temporal visual field defects in both eyes. Blood antidiuretic hormone 0.7 U/ml (normal 1.0-10.0 U/ml). Five pituitary tests showed no abnormalities. Blood routine suggests: white blood cells 12.70×10⁹/L [normal (4.00~10.00) ×10⁹/L], absolute neutrophil 11.57×10⁹/L [normal (1.80~6.30) ×10⁹/L].

lenticulostriate arteries (LSAs) are a type of perforator arteries, small arteries mainly emanating from and perpendicular to the middle cerebral artery (MCA). Because of the special shape and location of the lenticulostriate artery, and it is easy to cause hemorrhage in the basal ganglia area, it is also called "hemorrhagic artery"^[1]。 Acute infarction of lenticulostriate artery manifests as deep white matter hyperintensity on DWI, mainly lacunar infarction, but some patients have progressive motor deficit (i.e., neurological deterioration). How to display the lentistriate artery is a huge challenge for imaging, and there are a variety of imaging techniques available today, and these techniques play a huge role in the evaluation and diagnosis of the lentistriate artery. The author aims to summarize the origin, distribution and blood supply range of lenticulostriate artery, study the number, length, diameter and clinical significance of lenticulostriate artery in anatomy and imaging, and evaluate the imaging characteristics of lesions related to lenticulostriate artery.

hepatocellular carcinoma (HCC) is the most common pathological type of primary liver cancer, accounting for 85% to 90%. At present, countries and regions around the world are actively formulating clinical practice guidelines for HCC suitable for their own National conditions, mainly including the National Comprehensive Cancer Network (NCCN) guidelines, the American Association for the Study of Liver Diseases (AASLD) Guidelines, European Association for the Study of the Liver (EASL) Guidelines, Asian Pacific Association for the Study of the Liver (APASL) Guidelines, Japan Society of Hepatology (JSH) guidelines, Korean Liver Cancer Study Group (KLCSG) and National Cancer Center (NCC) guidelines, etc. In 2011, the Chinese Health and Family Planning Commission (formerly the Ministry of Health) promulgated the Standards for Diagnosis and Treatment of Primary Liver Cancer (hereinafter referred to as the Standards), which were revised and updated in 2017^[1,2]。 These guidelines and norms have been established by a multidisciplinary team of experts after thorough discussion in combination with the latest evidence-based medicine evidence, and are updated regularly, which has played a positive role in standardizing and guiding the clinical practice of HCC. Imaging examination is the main method of screening and diagnosis of HCC in high-risk groups. The incidence of HCC varies in different regions of the world, and the underlying liver disease background is also significantly different, resulting in large differences in screening protocols, examination techniques and diagnostic procedures^[3]。 The author aims to improve the diagnostic level of HCC by in-depth interpretation of the relevant contents of China's 2017 version of the specification and comparison with international diagnostic guidelines.