Le Fort型骨折的CT表现和分型

目的探讨Le Fort型骨折的CT表现及其分型。方法对62例Le Fort型骨折患者进行薄层螺旋CT扫描和三维重组分析。结果在62例中，Le FortⅠ型10例，Ⅱ型9例，Ⅲ型8例，复合型35例（其中Ⅰ＋Ⅱ型18例，I＋Ⅱ＋Ⅲ型7例，Ⅱ＋Ⅲ型10例）；55例同时伴发颌面部其他骨折。Le Fort型骨折在二维CT上表现为颌面部多发且杂乱的骨折，虽然在发现细小和深部结构的骨折方面优于三维CT成像，但难以作出Le Fort型骨折的诊断；三维CT成像能清晰立体地显示Le Fort型骨折的整体形状及走向，并可明确作出分型。结论三维CT成像是Le Fort型骨折最有效的诊断方法，对临床制定治疗方案具有指导意义，但是对细小骨折诊断不如二维CT。     

常规放疗结合后程立体定向放射治疗老年非小细胞肺癌患者的预后分析

目的观察老年非小细胞肺癌立体定向放疗疗效,并探讨其预后因子。方法128例老年非小细胞肺癌患者行常规放疗结合立体定向放疗,定期随访。结果全组患者1年生存率65.72%,单因素分析表明肿瘤体积、肿瘤剂量、卡氏评分影响近期结果,多因素分析仅肿瘤体积和肿瘤剂量为近期疗效预后因子,与生存期有关的预后因素为近期疗效、肿瘤剂量、临床分期。结论立体定向放疗可延长生存时间,对Ⅲ期患者,肿瘤剂量提高至72Gy是安全的。     

审慎诊治脉络膜恶性黑色素瘤

目的 探讨脉络膜恶性黑色素瘤的传统治疗、影像学临床特点及确诊符合率，以指导临床。方法 经临床确诊为脉络膜恶性黑色素瘤患者26例26眼，年龄41～73岁。术前视力0．2至光感。局部及全身检查除外肿瘤原发病灶及转移病灶。结果 26例行眼球摘除术，病理检查结果符合率为88．46％（23／26）。3例3眼病理检查结果为脉络膜出血。结论 审慎诊治脉络膜恶性黑色素瘤，提高确诊率，现代的包括手术在内的治疗方法应加以考虑。     

鼻咽癌常规放疗靶体积合理性的初步探讨

目的分析鼻咽癌常规放疗的局部控制情况和局部复发的剂量学模式,初步探讨照射靶体积确定的合理性.方法共476例初治鼻咽癌患者接受规范化单纯常规根治性放疗.全部病例均采用常规模拟定位,鼻咽靶体积为CT检查所见的原发病灶范围以及可能侵犯的亚临床病灶区域.利用Kaplan-Meier方法计算局部累积复发率;将鼻咽局部复发患者疗前和复发时局部病灶范围（Vnx和Vrecur）勾画于三维治疗计划系统,复制首程放疗的射野并按原处方剂量进行计算,根据剂量体积直方图进行剂量学评价：recurV95（95%处方剂量曲线包括的Vrecur）≥95%定义为野内复发,95%＞recurV95≥20%定义为野边缘复发,20%＞recurV95定义为野外复发.结果局部复发共52例,全组1、2、3、4年局部累积复发率分别为0.6%、3.9%、8.7%、11.5%.对42例局部复发的剂量学分析显示野内复发占多数（52%）,而大部分野边缘复发和全部野外复发均与射野设置不当、影像学阅片能力欠缺使首程放疗剂量不足有关.结论较好的局部控制率、复发的剂量学模式的分析结果提示该靶体积的设置比较合理.提高影像阅片能力,准确的射野设计,充分利用生物影像学工具,有针对性地提高照射剂量,有望进一步提高局部控制率.     

Vascular Centerline Extraction in 3D MR Angiograms for Phase Contrast MRI Blood Flow Measurement

The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignment between the vessels and the imaging plane. PC MRA imaging of blood flow is challenging when the flow in several vessels is to be evaluated with one acquisition. For this purpose, semi-automatic determination of the plane most perpendicular to several vessels is proposed based on centerlines extracted from 3D MRA. Arterial centerlines are extracted from 3D MRA based on iterative estimation-prediction, multi-scale analysis of image moments, and a second-order shape model. The optimal plane is determined by minimizing misalignment between its normal vector and the centerlines’ tangent vectors. The method was evaluated on a phantom and on 35 patients, by seeking the optimal plane for cerebral blood flow quantification simultaneously in internal carotids and vertebral arteries. In the phantom, difference of orientation and of height between known and calculated planes was 1.2° and 2.5 mm, respectively. In the patients, all but one centerline were correctly extracted and the misalignment of the plane was within 12° per artery. Semi-automatic centerline extraction simplifies and automates determination of the plane orthogonal to one vessel, thereby permitting automatic simultaneous minimization of the misalignment with several vessels in PC MRA.     

Self-expandable metallic stent for unresectable malignant strictures in the esophagus and cardia

Objective Self-expandable metallic stent (EMS) placement has been the first choice for dysphagia because of the certainty over its safety, low invasiveness, and immediate efficacy. However, there still remain some problems in relation to the EMS placement site and anticancer therapies before and after EMS placement. Methods: Consecutive 78 patients in whom EMS was placed due to the unresectable malignant stricture in the esophagus or cardia from July 1995 to August 2003 in our department were studied. Results: Gastroesophageal reflux was found in 5 of 8 patients after placement of conventional EMS for the stricture in the gastroesophageal junction. Meanwhile, acid and bile reflux into the esophagus were not detected by pH and bilirubin monitoring, respectively, in 6 patients after placement of the EMS with an anti-reflux mechanism for the stricture in the gastroesophageal junction. The median survival period of all patients after EMS placement was 123 days. The median survival period of 7 patients with radiotherapy only after EMS placement was 138 days and that of 17 patients with radiotherapy before EMS placement was 60 days, which was shorter than that of the former (p<0.05). On the other hand, the median survival period after hospital admission due to dysphagia of these 7 patients was longer than that of 17 patients with radiotherapy only before EMS placement, although, the difference was not significant. Conclusion: EMS with an antireflux mechanism is not commercially available in Japan and approval is urgently required. The indication of radiotherapy associated with EMS placement is to be studied further.     

Paediatric medulloblastoma: Patterns of care and radiotherapy quality assurance in Australia

The purpose of this study was to document how children in Australia with medulloblastoma are being treated and to evaluate the quality of radiotherapy (RT) delivered. The Radiotherapy Database of the Australian and New Zealand Children’s Haematology and Oncology Group was used to identify 46 children with medulloblastoma younger than the age of 15 years treated with radical intent by craniospinal irradiation between 1997 and 1999 inclusively. Twenty‐six patients had completely resected disease without evidence of disease spread. Of these, 16 patients received a craniospinal RT dose of <25 Gy in addition to chemotherapy. RT treatment immobilization methods varied, as did planning methods. RT dose to critical structures was recorded on treatment plans for only 15% of patients. The average systematic error in shield placement at the posterior orbit was 5.2 mm, and two‐thirds of patients were ‘overshielded’ at this site. Adequate coverage of the distal end of the thecal sac was achieved in fewer than 50% of on‐treatment verification films for 21 of 45 patients. With a reduction in RT dose to the craniospinal axis for paediatric medulloblastoma, greater attention is needed for patient immobilization, documentation of RT dose to critical structures and the placement and reproducibility of shielding.     

三维适形放疗联合肝动脉碘油栓塞化疗并热疗治疗原发性肝癌的疗效研究

目的:探讨原发性肝癌的肝动脉碘油栓塞化疗(TACE)、热疗、三维适形放疗(3DCRT)的综合治疗价值。方法:122例原发性肝癌患者进行前瞻性随机分组研究,综合治疗组64例,行TACE并3DCRT,结合热疗治疗。对照组58例3DCRT治疗,联合TACE。结果:1、2、3年生存率综合治疗组分别为85%、65%、39%,对照组分别为59%、30%、18%(P<0.05)两组毒副作用相似。结论:对于非手术切除的原发性肝癌患者,TA-CE,结合3DCRT并热疗,能明显提高疗效,而毒副作用不增加。     

新型加速器放疗网络的研制及其临床应用

目的研制新型加速器放疗网络。方法采用服务器-客户端模式．服务器采用SQL—Server2000为数据库服务软件，客户端使用VC＋＋6．0语言编写．通过RTP—Link以及DICOMRT和新型加速器连接传输病人治疗参数资料。结果成功研锚的新型加速器放疗网络包括病人资料管理模块、定位计划管理模块、定位图像预处理模块、靶区勾画模块、计划设计管理模块（包含MLC（多叶光栅）设计以及低熔点挡铅设计）和治疗参数输出（包括报表打印、连接加速器）。结论网络系统操作简单，适合新型全数字化加速器的常规放射治疗管理．是科室常规放疗治疗的质量保证（QA）和质量控制（QC）的有效工具。     

Validation of silver-stained nucleolar organizer regions for evaluation of invasive character of urinary bladder carcinoma in rats and mice

A series of 8 rat and 16 mouse invasive bladder carcinomas were investigated for the presence of silverstained nucleolar organizer regions (AgNORs) to clarify whether this parameter is applicable to the estimation of their invasive character. With regard to number of AgNORs per cell, neither rat nor mouse carcinomas showed any difference between invasive and noninvasive sites within the same tumor. However, the frequency of cancer cells bearing bizarre dots, irregular in size and shape, was significantly higher at sites of actual invasion. Quantitative data generated using an image analyzer revealed significantly lower values for NOR roundness and significantly larger NOR size in invasive sites than in noninvasive sites in all groups. Double staining for the proliferation marker proliferating cell nuclear antigen (PCNA) and AgNORs was performed on eight rat carcinomas and a close correlation between the two was confirmed. Thus the number of AgNORs in PCNA-positive cells was significantly greater than in PCNA-negative cells. Furthermore, a particularly strong correlation was observed for incidences of PCNA-positive cells and bizarre dots (P<0.01). The quantitative data also demonstrated significant differences in size and shape of dots. It is concluded that AgNORs have diagnostic value for the invasive character of bladder carcinomas.