Q: After all the high-end imaging tests, why was the diagnosis still misdiagnosed and surgery performed? One day, a case of upper abdominal MR review for “peri-pancreatic lymph node tuberculosis” came to my attention. Since there was no detailed clinical information, I naturally had to ask the patient’s family about the medical history and treatment process. The patient’s family brought all the imaging data including CT, MRI, PET-CT, etc., which were done one year ago at a foreign hospital. They reported that one year ago, a physical examination revealed a pancreatic mass and a dissection was performed at a large hospital in Beijing. No postoperative treatment was given (not required). We reviewed the preoperative examination images brought by the patient and found multiple nodular masses in the pancreatic area partially containing calcification; PET-CT revealed significant uptake of this lymph node shadow (the lesion had uptake, which is the basis for the diagnosis of malignancy). According to the patient’s family, the doctors had different opinions during the preoperative multiple consultations, but most of them thought that both PET-CT had uptake and it should be malignant tumor. In fact, when diagnosing malignant tumors by PET-CT, there is one point that needs special attention: inflammatory lesions and tuberculosis foci also have uptake and are even less easily distinguished from malignant tumors. So how to differentiate them? Of course, on the one hand, it should be combined with other information on the clinical aspects of the patient, but as far as imaging examinations are concerned, reference should be made to the manifestations of other imaging examinations, for example, calcification in the lesion area on CT scan and significant inhomogeneous delayed enhancement in the lesion on MR scan in this case, etc. In particular, calcification manifested by CT is valuable evidence to support tuberculous foci. When we compared the MR images of the current review with the original preoperative images, the lesion around the pancreas did not show any significant changes, which indicates that the disease is a chronic process that does not require treatment, much less surgery, in the absence of any symptoms, signs, etc. In this case, the key to performing a dissection of the nodular foci with suspicion of malignancy is that no attention was paid to analyzing multiple examination data organically, while ignoring the important manifestations of CT and placing too much emphasis on the uptake of PET-CT and assigning it to malignancy across the board. In the face of so many imaging methods, it is necessary to be familiar with and understand the principles of disease examination and diagnosis as well as the imaging characteristics of different diseases (in practice, this is a difficult point for doctors, some of them often only know one but not the other). In order to reduce misdiagnosis, we need to analyze and synthesize the imaging data in detail, and grasp the characteristics of the imaging performance to make diagnosis. In this way, the value of high-end imaging examinations can be truly realized. Although all kinds of high-end imaging examinations are done, this is only the fulfillment of the examination method, as to whether the correct diagnosis of the disease depends on whether the analysis of these imaging information, analysis and diagnosis is correct, then it can be said to achieve the purpose of the examination. Of course, there are also diseases that are too difficult and complex, although all kinds of imaging examinations are done, it is difficult to interpret the location of the disease or clarify its nature, which belongs to the limits of imaging examinations. “Although this perception is common among patients or family members, it is one-sided. As a doctor, we should do everything possible to improve the quality of imaging examinations, select the right examination technique, analyze and synthesize the various characteristics of the obtained imaging information in a fine and comprehensive manner, and then make a correct diagnosis.