2018年 · 第52卷第12期

Since the Food and Drug Administration (FDA) approved the first gadolinium contrast agent (gadopentetate meglumine) for official use in 1988, more than 300 million people have used gadolinium contrast agent for MR examination clinically. Due to its high benefit-risk ratio, the annual use still shows a significant upward trend^[1]。 In 2006 and 2014, due to the discovery of nephrogenic systemic fibrosis (NSF) and cerebral gadolinium deposition phenomena^[2,3]The safety of gadolinium contrast agents has attracted much attention. At present, the problem of gadolinium deposition in the brain is still a hot spot in the industry, which continuously triggers our thinking about the clinical safety application of gadolinium contrast agent.

The patient was a 66-year-old male. In November 2017, an abdominal CT examination in a local hospital due to "lumbar disc herniation" revealed "pelvic cyst" without obvious discomfort. The patient underwent prostatocentesis 18 years ago with unknown procedure. Laboratory tests: Serum prostate specific antigen (PSA) was 0.67 ng/ml (normal reference value 0-4.0 ng/ml), free PSA was 0.24 ng/ml (normal reference value 0-0.93 ng/ml), CA724 was 27.09 U/ml (0.00-6.90 U/ml), and there were no abnormalities in blood, urine and stool routine.

The patient was a 44-year-old female. Intermittent nausea, vomiting with acid reflux and heartburn for more than 1 year. Endoscopic ultrasound examination in our hospital showed submucosal bulge of gastric antrum and hypoechoic lesions of submucosa. Laboratory tests: Helicobacter pylori antibody was positive, stool routine showed occult blood, tumor markers, blood biochemistry and other results were not obviously abnormal.

The patient was a 48-year-old female. Physical examination found pelvic mass for more than 4 months. Specialist examination: A mass the size of a duck egg can be palpable in the right rear of the uterus, which is soft in texture, clear in boundaries, without mobility and tenderness; There were no abnormalities in bilateral attachments; The right inguinal lymph node is slightly swollen and tender. Previous cholecystectomy. Laboratory tests: HPV 43 positive; Blood routine, biochemical examination, liver and kidney function were normal; Carcinoembryonic antigen, alpha-fetoprotein and carbohydrate antigens CA125 and CA199 were all negative.

intraductal papillary mucinous neoplasm (IPMN) is a borderline neoplasm of pancreatic duct epithelial origin. Foreign data show that IPMN is the most common cystic tumor of pancreas^[1], accounting for about 50% of asymptomatic cystic lesions of the pancreas^[2]。 The latest domestic statistics show that IPMN is the third most common pancreatic cystic tumor, but malignant transformation is the most common^[3]。 The author reported a patient who was followed up by imaging for 14 years before diagnosis, and recorded the process of tumor growth, development and evolution.

primary bladder extraskeletal osteosareoma (PBEOS) is very rare. Less than 50 cases have been reported at home and abroad, and no bulk cases have been reported. Now, one case of PBEOS confirmed by pathology is reported, and its clinical features and imaging features are preliminarily discussed in combination with the literature.

In clinical MRI, about 30% of the examinations require the use of MR contrast agent to improve the image contrast in order to show the lesions more clearly^[1]。 1983 Weinmann et al.^[2]Gadolopentetate meglumine (Gd-DTPA) was used in clinical trials for the first time, and gradually became the most widely used contrast agent in clinical practice. But in 2006, Grobner^[3]It is suggested that Gd-DTPA may cause nephrogenic systemic fibrosis (NSF) in patients, which causes discussion on the safety of Gd-DTPA. Until 2014, Kanda et al.^[4]It was reported for the first time that Gd-DTPA may cause the deposition of gadolinium contrast agent in the brain after repeated use, which once again triggered heated discussion on the safety of Gd-DTPA among domestic and foreign scholars. At present, foreign scholars have carried out more research and made some progress. The author summarizes the research status and progress in this field in recent years as follows.

Pulmonary nodules are one of the early manifestations of lung cancer, and correct diagnosis can help improve the survival rate of patients with early lung cancer. The clinical diagnosis of pulmonary nodules is mainly based on pathological puncture biopsy, bronchoscopy and imaging examination. Among them, imaging examination is the most commonly used and is also the focus and hotspot of clinical research^[1,2,3,4]。 According to the imaging characteristics of pulmonary nodules, the pulmonary nodules can be divided into solid nodules and ground glass nodules according to the content of solid components (ground glass opacity nodules, GGN)^[5]。 Differential diagnosis of benign and malignant GGN has been a difficult clinical problem. In recent years, with the rapid development of artificial intelligence and machine learning technologies, it has become a trend to use computer technology to intelligently assist clinical diagnosis, among which GGN is the most relevant research, and many research results have gradually entered clinical trials. Although scholars at home and abroad have carried out a lot of research on GGN, it is still insufficient, and the accuracy and specificity have not yet met the clinical needs. Based on this, the author mainly reviews the latest advances in intelligent assisted diagnosis of benign and malignant pulmonary GGN, aiming to provide some reference for technicians and clinical medical staff engaged in related research.