Influence of hyperthermia on carotid blood flow using <Superscript>99m</Superscript>Tc-HMPAO

Hyperthermia can be the result of many causes such as environmental conditions, brain tumors and infectious diseases. Since hyperthermia is very common, its role in causing stroke through a decrease in cerebral blood flow needed further emphasis. The aim of this study was to record cerebral blood flow in vitro by using isolated rabbit carotid artery strips and in-vivo using radioactive isotope scanning during temperature elevation. The recording of isometric tension in rabbit carotid artery strips in organ baths, and the scintigraphic cerebral imaging of technetium-99m-hexamethyl-propyleneamineoxime (99mTc-HMPAO) using Gamma camera, were acquired at control and higher body temperature by 4°C. Blood pressure was measured through femoral artery and cerebral blood flow was measured through carotid artery. Elevating temperature by 4°C induced reproducible contraction. During hyperthermia, the carotid artery contraction leads to a decrease in cerebral blood flow although the blood pressure did not decrease. The uptake of 99mTc-HMPAO in the brain was significantly reduced. This decrease in cerebral perfusion is regionally dependent, which is more in the frontal area, the cerebral hemispheres than the cerebellum. The decrease was 36 ± 3, 37 ± 2, 22 ± 2%, respectively. Hyperthermia causes carotid artery contraction leading to decrease in cerebral blood flow, which was confirmed by 99mTc-HMPAO images. The decrease is regionally dependent. Since the blood pressure did not decrease by heating, the reduction in cerebral perfusion is mainly due to carotid contraction. The applied neck cooling may be considered as a promising therapeutic strategy for the hyperthermic patient to avoid brain damage. This can be achieved by external application of an ice-water-perfused neck collar.     

99m Tc 标记单克隆抗体Au14-1对荷宫颈癌小鼠的放射免疫显像研究

目的和方法：应用99mTc直接法标记抗小鼠宫颈癌（U14）单克隆抗体Au14-1,对荷瘤Km小鼠进行放射性分布和放射免疫显像的实验观察,探讨用99mTc－An14-1作宫颈癌导向诊断和导向治疗的可能性。结果：（1）99mTc－Au14-1注射后12h肿瘤灶已有放射性聚集,24h肿瘤组织的％ID／g值达8．79,呈明显特异性浓聚;（2）除肾脏外,各脏器的T／NT值在2．02~6．71之间,SPECT图像12h已见肿瘤显影,24h肿瘤影像更为清晰。结论：99TcTc－An14-1的体内分布与显像结果相一致,表明An14-1在体内具有良好的宫颈癌导向定位作用。     

Evaluation of biological response modifiers in the enhancement of tumor uptake of technetium-99m labeled macromolecules. A preliminary report.

Imaging tumors with radioactive monoclonal antibodies remains attractive but continues to be challenging. With the hypothesis that the use of biological response modifiers (BRMs) may augment the tumor uptake, technetium-99m(99mTc)-labeled tumor necrosis factor (TNF) and nuclear histone specific TNT-1-F(ab')2 were evaluated in tumor bearing mice given a single dose of interferon (IFN). Ukrain or pokeweed mitogen as BRMs. As early as 1.5 h post injection (p.i.) of the radioactive macromolecules, the absolute tumor uptake (% administered dose/g) of each agent was enhanced (e.g., TNF, control = 1.8 +/- 0.4, Ukrain = 3.2 +/- 0.5, P = 0.006) and tumor to muscle ratios were elevated (e.g., TNF, control a 4.1 +/- 2.2, interferon 8.3 +/- 2.7, P = 0.01). The absolute tumor uptake remained practically unchanged at 4 h p.i. Generally with BRMs, the blood clearance was rapid and tumor/blood ratios and tumor/muscle ratios were higher than in the control group, increasing to greater than 200% for IFN as a BRM. The early enhancement in tumor uptake of macromolecules, leading to excellent delineation of tumors by scintigraphy is highly encouraging and warrants further studies to explore the full potential of BRMs.     

升压联合化疗对大鼠脑胶质瘤形态学变化的影响

目的:通过体外细胞化疗和体内对大鼠胶质瘤升压联合化疗后, 观察体外细胞形态变化和体内肿瘤抑制作用, 观察变压联合化疗对胶质瘤的治疗效果。方法:采用胶质瘤体外培养、化疗。体内采用脑定位注射接种法, 复制大鼠脑胶质瘤动物模型。体内进行联合升压化疗。结果: 体外培养瘤细胞, 使用化疗药后, 可见细胞体积增大、胞质呈颗粒样变、胞内容物外溢等形态学变化;体内化疗后肿瘤体积变小, 瘤内可见坏死区等病理变化;升压化疗组肿瘤内血流增加、药物浓度增加;动物生存期延长。 结论:升压联合化疗对大鼠脑胶质瘤具有明显抑制作用, 可使动物生存期延长。     

Lactoferrin-conjugated superparamagnetic iron oxide nanoparticles as a specific MRI contrast agent for detection of brain glioma in vivo

A specific contrast agent for magnetic resonance imaging (MRI) is crucial to brain tumor patients for the surgical operation or the postoperative radiology. This study explored lactoferrin-conjugated superparamagnetic iron oxide nanoparticles (Lf-SPIONs) as an MRI contrast agent for the detection of brain gliomas in vivo. The hydrodynamic diameter of about 75 nm, saturation magnetization of 51 emu/g Fe and T(2) relaxivity of 75.6 mM(-1)S(-1) of the Lf-SPIONs suggested its applicability for MRI. Using a rat model of C6 glioma, Lf-SPIONs provided a better picture or more sensitivity to depict brain glioma on MR images than that of SPIONs. Significantly enhanced T(2)-weighted images of brain glioma were documented in vivo with Lf-SPIONs until 48 h after injection. Moreover, Lf-SPIONs were clearly observed around vascular region of the tumor slices after 48 h. High level expression of Lf receptors was confirmed in brain tumor tissues by RT-PCR and Western Blot compared to normal brain tissues. These findings suggested that Lf-SPIONs could be potentially employed as a sensitive and specific MRI contrast agent in the diagnosis of brain glioma.     

The pattern of function-related regional cerebral blood flow investigated by single photon emission tomography with 99mTc-HMPAO in patients with presenile Alzheimer's disease and Korsakoff's psychosis

Single photon emission tomography (SPET) with the lipophilic blood flow marker 99mTc-hexamethyl propyleneamine oxime (99mTc-HMPAO) has been used to determine regional uptake of radiolabel into brain regions of patients with presenile Alzheimer's disease and Korsakoff's psychosis, and age-matched controls. Using occipital cortical uptake as reference area, the pattern of relative regional cerebral blood flow (rCBF) was determined in other cortical areas and basal ganglia. In Alzheimer's disease, reduction in rCBF occurred most strikingly in posterior temporal and parietal areas. By contrast, in Korsakoff's psychosis, posterior temporal rCBF was maintained, although there was a trend to reduced tracer uptake in other cortical areas. These impairments of flow were correlated with impairments of neuropsychological function. In Alzheimer's disease, left posterior temporal and left parietal regions in particular showed rCBF to be strongly correlated with most aspects of cognitive function. In Korsakoff's psychosis, however, impaired flow in frontal regions was correlated with impaired performance on tests of memory and orientation. The findings in Alzheimer's disease show quantitative parallels with those from studies using Positron Emission Tomography (PET), and extend our understanding of the relationship between cognition and regional brain function in dementia. The findings in Korsakoff's psychosis offer the first direct evidence linking frontal lobe dysfunction with the cognitive impairment seen in the disorder.     

Striatal Dopaminergic Functioning in Patients with Sporadic and Hereditary Spastic Paraplegias with Parkinsonism

Sporadic spastic paraplegia (SSP) and hereditary spastic paraplegia (HSP) belong to a clinical and genetically heterogeneous group of disorders characterized by progressive spasticity and weakness in the lower extremities. The symptoms are associated with pyramidal tract dysfunction and degeneration of the corticospinal tracts. Parkinsonism is uncommon in SSP/HSP patients. However, both disorders are associated with damage to the nigrostriatal dopaminergic system. In the present study, the clinical features of patients with SSP/HSP were investigated, and nigrostriatal dopaminergic binding potential was assessed using dopamine transporter (DAT) single-photon emission computer tomography (SPECT). Nine patients with spastic paraplegia participated in the present study. The subjects underwent DAT SPECT using the agent [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3,2,1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato (3-)-N2,N20,S2,S20]oxo-[IR-(exo-exo)])-[⁹⁹mTc]technetium ([⁹⁹mTc]TRODAT-1). The [⁹⁹mTc]TRODAT-1 SPECT images of five patients appeared normal, whereas the images of four patients revealed reduced striatal ligand uptake. Among the four patients with reduced uptake, two had parkinsonism, and one exhibited periodic limb movements and restless leg syndrome. Our DAT SPECT imaging study shows that reduced DAT density may be observed in patients with parkinsonism. The results of the present study offer an explanation for the spectrum of spastic paraplegia symptoms and the progression of the disorder.     

Intratumoral injection of 188Re labeled cationic polyethylenimine conjugates: a preliminary report

188Re (Rhenium) is easily obtained from an in-house 188W/188Re generator that is similar to the current 99Mo/99mTc generator, making it very convenient for clinical use. This characteristic makes this radionuclide a promising candidate as a therapeutic agent. Polyethylenimine (PEI) is a cationic polymer and has been used as a gene delivery vector. Positively charged materials interact with cellular blood components, vascular endothelium, and plasma proteins. In this study, the authors investigated whether intratumoral injection of 188Re labeled transferrin (Tf)-PEI conjugates exert the effect of radionuclide therapy against the tumor cells. When the diameters of the Ramos lymphoma (human Burkitt's lymphoma) xenografted tumors reached approximately 1 cm, 3 kinds of 188Re bound compounds (HYNIC-PEI-Tf, HYNIC-PEI, 188Re perrhenate) were injected directly into the tumors. There were increases in the retention of 188Re inside the tumor when PEI was incorporated with 188Re compared to the use of free 188Re. The 188Re HYNIC-Tf-PEI showed the most retention inside the tumor (retention rate=approximately 97%). H&E stain of isolated tumor tissues showed that 188Re labeled HYNIC-PEI-Tf caused extensive tumor necrosis. These results support 188Re HYNIC-PEI-Tf as being a useful radiopharmaceutical agent to treat tumors when delivered by intratumoral injection.     

Capillary electrophoresis of 99mtechnetium radiopharmaceuticals

Diagnostically used 99mTc kit radiopharmaceuticals were analyzed using capillary zone electrophoresis with radioactivity detection: 99mTc-bis(bis(2-ethyloxyethyl)phosphino)ethane (99mTc-Myoview, 99mTc-Tetrofosmin), 99mTc-trans(1,2-bis(dehydro-2,2,5,5,-tetramethyl-3-furanone-4-methylene- amino)ethane)-tris(3-methoxy-1-propyl)phosphine) (99mTc-Technescan Q12, 99mTc-Furifosmin), 99mTc-methoxyisobutylisonitrile (99mTc-MIBI), 99mTc-L,L-ethylenecysteine diethylester dimer (99mTc-ECD), 99mTc-d,1-hexamethylene propyleneamine oxime (99mTc-HMPAO), 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA), 99mTc-ethylene hepatobiliary iminodiacetic acid (99mTc-EHIDA), 99mTc-L,L-ethylenecysteine dimer (99mTc-EC), 99mTc-mercaptoacetylglycylglycylglycine (99mTc-MAG3), 99mTc-dimercaptosuccinic acid (99mTc-DMSA), 99mTc-methylene diphosphonate (99mTc-MDP) and 99mNaTcO4. A pressure-driven capillary zone electrophoresis was employed to detect small anions of high electrophoretic mobility and cations within one run. Effective 99mTc complex charges could be determined by a neutral internal standard. All complexes showed the expected electrophoretic behaviours in view of their charges. Pure products were obtained for the majority of the studied complexes. In the case of 99mTc-Q12, 99mTc-EHIDA and 99mTc-MDP, complex mixtures were detected. The high potential of CE for the analysis of 99mTc radiopharmaceuticals could be shown.     

Discriminating vital tumor from necrotic tissue in human glioblastoma tissue samples by Raman spectroscopy

Vital and necrotic glioblastoma tissues were studied by Raman microspectroscopy to identify possibilities for the development of an in vivo Raman method for real-time intraoperative brain biopsy guidance. The histologic malignancy grade of gliomas depends on the presence of parameters such as endothelial proliferation and necrosis, which are often not evenly distributed within the tumor. Because tissue samples obtained by stereotactic surgery are relatively small, sampling errors may easily occur by missing these crucial features. Although necrosis is important for grading, specimens containing only necrosis are diagnostically useless. Raman microspectroscopic mapping experiments were performed on unfixed cryosections of glioblastoma, obtained from 20 patients. After spectral acquisition, a clustering analysis was performed, resulting in groups of similar spectra. Each cluster was assigned a color, and pseudo-color Raman maps of the tissue sections were constructed. After the Raman experiments, the tissue sections were stained for histopathologic analysis, enabling identification of the histologic origin of the Raman spectra and assignment of the Raman spectral clusters to either vital or necrotic tissue. A classification model for discrimination between vital and necrotic tumor tissue based on linear discriminant analysis was developed. The classification model was evaluated using independent Raman data obtained from nine other tissue sections and yielded 100% accuracy. Information about the biochemical differences between necrosis and vital tumor was obtained by the analysis of difference spectra. Necrotic tissue was found to consistently contain higher levels of cholesterol (-esters). This in vitro result indicates that Raman spectra contain the information to distinguish vital glioblastoma from necrosis and makes Raman spectroscopy a powerful candidate for guidance of stereotactic brain biopsy.     

Detection of medullary carcinoma of thyroid, with liver metastasis, using 99mTc DMSA(V) scintigraphy

A sixty year old female referred for thyroid and liver scintigraphy had a clinical history of progressive swelling in the neck with hepatomegaly. A large cold area was detected in the right thyroid lobe using 99mTc pertechnetate and in the right lobe of liver using 99mTc phytate. Subsequent whole body scan with 99mTC DMSA(V) showed avid tracer uptake in right lobe of thyroid and liver. Aspiration cytology of thyroid and liver showed medullary carcinoma of thyroid with its metastasis in liver. Histopathology following thyroidectomy confirmed the diagnosis. Thus 99mTc pentavalent DMSA contributes specificity to diagnose medullary carcinoma of thyroid and metastatic lesions.     

Migration of 99mTc-labelled syngeneic lymphocytes in the rat. Biological and theoretical models predict radiation damage and poor scintigraphic detectability

The possibility of obtaining useful scintigrams of secondary lymphoid organs after infusion of syngeneic lymphocytes labelled with technetium-99m (99mTc) was explored in a rat model. Thoracic duct lymphocyte (TDL) accumulation in various organs was measured with both 99mTc and 51Cr labelled cells, the latter processed with a method that has been shown not to damage lymphocytes. 99mTc labelled TDL did not localize properly in the lymph nodes and spleen. We could not visualize lymph nodes in scintigrams, neither could we demonstrate any difference between normal and hyperplastic spleens. Our conclusion is that radiation from the 99mTc label readily influences lymphocyte migration so that useful scintigraphy in rats and other small experimental animals becomes impossible. This was supported by results from culture experiments with 99mTc labelled, radiosensitive mouse haemopoietic progenitor cells. Theoretical considerations, including the calculations of lymphocyte self-irradiation and signal/noise ratios during scintigraphy of rat tissues, supported our conclusion that scintigraphy in small animals, to disclose the physiological migration of lymphocytes, may be impossible with the present sensitivity of gamma cameras.     

Fast Monte Carlo based joint iterative reconstruction for simultaneous 99mTc/ 123I SPECT imaging

Simultaneous 99mTC/ 123I SPECT allows the assessment of two physiological functions under identical conditions. The separation of these radionuclides is difficult, however, because their energies are close. Most energy-window-based scatter correction methods do not fully model either physical factors or patient-specific activity and attenuation distributions. We have developed a fast Monte Carlo (MC) simulation-based multiple-radionuclide and multiple-energy joint ordered-subset expectation-maximization (JOSEM) iterative reconstruction algorithm, MC-JOSEM. MC-JOSEM simultaneously corrects for scatter and cross talk as well as detector response within the reconstruction algorithm. We evaluated MC-JOSEM for simultaneous brain profusion (99mTc-HMPAO) and neurotransmission (123I-altropane) SPECT. MC simulations of 99mTc and 123I studies were generated separately and then combined to mimic simultaneous 99mTc/ 123I SPECT. All the details of photon transport through the brain, the collimator, and detector, including Compton and coherent scatter, septal penetration, and backscatter from components behind the crystal, were modeled. We reconstructed images from simultaneous dual-radionuclide projections in three ways. First, we reconstructed the photopeak-energy-window projections (with an asymmetric energy window for 1231) using the standard ordered-subsets expectation-maximization algorithm (NSC-OSEM). Second, we used standard OSEM to reconstruct 99mTc photopeak-energy-window projections, while including an estimate of scatter from a Compton-scatter energy window (SC-OSEM). Third, we jointly reconstructed both 99mTc and 123I images using projection data associated with two photo-peak energy windows and an intermediate-energy window using MC-JOSEM. For 15 iterations of reconstruction, the bias and standard deviation of 99mTc activity estimates in several brain structures were calculated for NSC-OSEM, SC-OSEM, and MC-JOSEM, using images reconstructed from primary (unscattered) photons as a reference. Similar calculations were performed for 123I images for NSC-OSEM and MC-JOSEM. For 123I images, dopamine binding potential (BP) at equilibrium and its signal-to-noise ratio (SNR) were also calculated. Our results demonstrate that MC-JOSEM performs better than NSC- and SC-OSEM for quantitation tasks. After 15 iterations of reconstruction, the relative bias of 99mTc activity estimates in the thalamus, striata, white matter, and gray matter volumes from MC-JOSEM ranged from -2.4% to 1.2%, while the same estimates for NSC-OSEM (SC-OSEM) ranged from 20.8% to 103.6% (7.2% to 41.9%). Similarly, the relative bias of 123I activity estimates from 15 iterations of MC-JOSEM in the striata and background ranged from -1.4% to 2.9%, while the same estimates for NSC-OSEM ranged from 1.6% to 10.0%. The relative standard deviation of 99mTc activity estimates from MC-JOSEM ranged from 1.1% to 4.8% versus 1.2% to 6.7% (1.2% to 5.9%) for NSC-OSEM (SC-OSEM). The relative standard deviation of 123I activity estimates using MC-JOSEM ranged from 1.1% to 1.9% versus 1.5% to 2.7% for NSC-OSEM. Using the 123I dopamine BP obtained from the reconstruction produced by primary photons as a reference, the result for MC-JOSEM was 50.5% closer to the reference than that of NSC-OSEM after 15 iterations. The SNR for dopamine BP was 23.6 for MC-JOSEM as compared to 18.3 for NSC-OSEM.     

Proportion of necrosis in transplanted murine adenocarcinomas and its relationship to tumor growth

Percentage of necrosis has been measured in 30 murine adenocarcinoma transplants of known volume. It was found that changes in necrotic proportion during the growth of these particular tumors agree with the concept of a core of necrosis surrounded by a viable shell of constant thickness. This means that viable and necrotic fractions were proportional to the surface area of the tumor, which is consistent with the frequently observed superficial distribution of nutrient-supplying arteries. According to this model a plot of 1n tumor volume versus necrotic fraction is sigmoid and, if tumor growth is directly related to viable fraction, such a plot is not compatible with popular mathematical growth equations. However, the equation of von Bertalanffy gives a reasonable fit to the data here for total tumor growth, suggesting that growth too was proportional to surface area and in accord with a surface-related viable fraction and blood supply. An appropriate physiological explanation is given of necrosis development resulting from a superficial nutrient supply.     

Bone extraction and blood clearance of diphosphonate in the dog.

The transcapillary extraction of diphosphonate, as [99mTc]EHDP, a substance used in bone scanning and for management of certain metabolic bone diseases, has been examined. The maximum instantaneous extraction for [99mTc]EHDP was 0.27 +/- 0.05 (mean +/- SD, N = 10) and the net extraction at 5 min was 0.18 +/- 0.05 (N = 10). The permeability ratio of [99mTc]EHDP to the freely diffusible compound, sucrose, using the formula PS = -Fs loge (1 - Emax), was 0.71. This is similar to the ratio of diffusion coefficients of EHDP to sucrose, which is estimated to be 0.78. These results suggest that the mechanism by which [99mTc]EHDP passes through the capillaries in bone is passive diffusion. Tissue level estimations of EHDP confirm a rapid blood clearance associated with an increase in the rate of urinary excretion; the level of [99mTc]EHDP in bone, however, remains constant. The fractional excretion of [99mTc]EHDP was 27.3 +/- 2.0% in control dogs and was unchanged by thyroparathyroidectomy and subsequent infusion of parathyroid hormone.     

Generalized five-dimensional dynamic and spectral factor analysis

We have generalized the spectral factor analysis and the factor analysis of dynamic sequences (FADS) in SPECT imaging to a five-dimensional general factor analysis model (5D-GFA), where the five dimensions are the three spatial dimensions, photon energy, and time. The generalized model yields a significant advantage in terms of the ratio of the number of equations to that of unknowns in the factor analysis problem in dynamic SPECT studies. We solved the 5D model using a least-squares approach. In addition to the traditional non-negativity constraints, we constrained the solution using a priori knowledge of both time and energy, assuming that primary factors (spectra) are Gaussian-shaped with full-width at half-maximum equal to gamma camera energy resolution. 5D-GFA was validated in a simultaneous pre-/post-synaptic dual isotope dynamic phantom study where 99mTc and 123I activities were used to model early Parkinson disease studies. 5D-GFA was also applied to simultaneous perfusion/dopamine transporter (DAT) dynamic SPECT in rhesus monkeys. In the striatal phantom, 5D-GFA yielded significantly more accurate and precise estimates of both primary 99mTc (bias=6.4 % +/- 4.3 %) and 1231 (-1.7% +/- 6.9%) time activity curves (TAC) compared to conventional FADS (biases = 15.5% +/- 10.6% in 99mTc and 8.3% +/- 12.7% in 123I, p < 0.05). Our technique was also validated in two primate dynamic dual isotope perfusion/DAT transporter studies. Biases of 99mTc-HMPAO and 123I-DAT activity estimates with respect to estimates obtained in the presence of only one radionuclide (sequential imaging) were significantly lower with 5D-GFA (9.4% +/- 4.3% for 99mTc-HMPAO and 8.7% +/-4.1% for 123I-DAT) compared to biases greater than 15% for volumes of interest (VOI) over the reconstructed volumes (p < 0.05). 5D-GFA is a novel and promising approach in dynamic SPECT imaging that can also be used in other modalities. It allows accurate and precise dynamic analysis while compensating for Compton scatter and cross-talk.     

术中超声在脑功能区胶质瘤切除术中的应用价值

目的 探讨术中超声(IOUS)在切除脑功能区胶质瘤中的临床价值。方法 回顾性队列研究。 纳入2018年12月—2020年6月蚌埠医学院第一附属医院神经外科62例脑功能区胶质瘤患者,其中男26例、女36例,年龄28~68岁;胶质瘤WHO分级Ⅰ级13例、Ⅱ级22例、Ⅲ级21例、Ⅳ级6例。62例患者均行肿瘤开颅显微切除术,根据是否应用IOUS分为两组:应用IOUS者31例纳入观察组,未应用IOUS者31例纳入对照组。比较两组患者临床基线资料;对比观察低级别(Ⅰ~Ⅱ级)与高级别(Ⅲ~Ⅳ级)脑胶质瘤患者的IOUS声像图表现;对术中暴露肿瘤时间、手术时间、肿瘤的切除程度、术后第5天患者脑水肿程度等围术期指标观察结果进行组间比较,并依据卡氏评分(KPS)评价两组患者术后3个月神经功能恢复情况。结果 两组患者性别、年龄,肿瘤的大小、位置、级别,肿瘤中心至硬脑膜的垂直距离,术前患者脑水肿程度和神经功能KPS评分等基线资料比较,差异均无统计学意义(P值均＞0.05)。观察组暴露肿瘤时间(23.1±3.7)min短于对照组的(37.3±4.3)min,肿瘤切除程度高于对照组,术后第5天脑水肿程度较对照组轻,术后3个月KPS(78.32±4.32)分高于对照组术后3个月KPS(74.22±2.38)分,组间差异均有统计学意义(P值均＜0.05);观察组与对照组手术时间分别为(187.4±17.8)min和(194.8±15.8)min,组间比较差异无统计学意义(P＞0.05)。低级别和高级别胶质瘤IOUS回声均较脑组织回声高,但前者边缘规整、内部较均匀并可见钙化的强回声,而后者边缘为模糊的的混合回声影、内部呈不均匀回声或无回声的坏死囊变区。结论 不同级别脑胶质瘤的IOUS声像图表现不同。IOUS应用于功能区胶质瘤开颅显微手术中,具有实时定位准确的优点,可提高肿瘤全切率,减轻术后脑水肿,保护及改善术后神经功能。     

瘤周区多体素磁共振波谱在脑肿瘤鉴别诊断中的应用

目的评价脑肿瘤周围区域多体素氢质子磁共振波谱(1H-MRS)在脑肿瘤诊断及鉴别诊断中的应用价值。方法搜集行常规MRI及多体素1H-MRS检查的脑肿瘤病变患者38例,包括胶质瘤15例、转移瘤9例、脑膜瘤14例(均为良性)。再根据WHO2000年分类标准,将脑胶质瘤分为低级别组(Ⅰ～Ⅱ级)8例,高级别组(Ⅲ～Ⅳ级)7例。所有患者检查前均未接受过化疗或放疗,没有脑外伤或/和脑手术史。常规扫描后增强前采用定点分辨磁共振波谱序列(PRESS)扫描,根据病灶的特征选定感兴趣区(ROI),ROI的大小既要包括肿瘤实质区、肿瘤周围区,也要尽可能涵盖对侧正常脑组织,又要避开骨骼、脑室、血管、坏死、囊变、出血、气体及钙化等区域。后处理应用MR机附带的波谱分析软件自动完成。计算脑胶质瘤、转移瘤及脑膜瘤实质区、周围区及对侧正常脑组织区代谢产物比值的平均值,进行组内、组间比较。P<0.05有统计学意义。结果多体素1H-MRS显示不同脑肿瘤的肿瘤实质区NAA/Cr、Cho/Cr和NAA/Cho平均值与对侧正常脑组织区比较有显著性差异(P<0.05);脑胶质瘤周围区与脑膜瘤、转移瘤的周围区以及高、低级别胶质瘤肿瘤周围区域多组代谢物比值具统计学差异(P<0.05)),高级别与低级别脑胶质瘤肿瘤周围区Glx/Cr的比值有显著性差异(P<0.05)。结论多体素1H-MRS技术可无创观察脑肿瘤患者脑代谢改变,有助于脑肿瘤的诊断、鉴别诊断、预测侵袭性病变的浸润范围以及脑胶质瘤的分级诊断等。     

Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.     

Glioma grading using apparent diffusion coefficient map: application of histogram analysis based on automatic segmentation

The accurate diagnosis of glioma subtypes is critical for appropriate treatment, but conventional histopathologic diagnosis often exhibits significant intra‐observer variability and sampling error. The aim of this study was to investigate whether histogram analysis using an automatically segmented region of interest (ROI), excluding cystic or necrotic portions, could improve the differentiation between low‐grade and high‐grade gliomas. Thirty‐two patients (nine low‐grade and 23 high‐grade gliomas) were included in this retrospective investigation. The outer boundaries of the entire tumors were manually drawn in each section of the contrast‐enhanced T₁‐weighted MR images. We excluded cystic or necrotic portions from the entire tumor volume. The histogram analyses were performed within the ROI on normalized apparent diffusion coefficient (ADC) maps. To evaluate the contribution of the proposed method to glioma grading, we compared the area under the receiver operating characteristic (ROC) curves. We found that an ROI excluding cystic or necrotic portions was more useful for glioma grading than was an entire tumor ROI. In the case of the fifth percentile values of the normalized ADC histogram, the area under the ROC curve for the tumor ROIs excluding cystic or necrotic portions was significantly higher than that for the entire tumor ROIs (p < 0.005). The automatic segmentation of a cystic or necrotic area probably improves the ability to differentiate between high‐ and low‐grade gliomas on an ADC map. Copyright © 2014 John Wiley & Sons, Ltd.