18F-FDG与18F-FLT PET/CT延迟显像对肺结节诊断效能的评价

目的 通过对多中心、前瞻性研究中接受了18F-脱氧葡萄糖(FDG)与18F-脱氧胸腺嘧啶核苷(FLT)延迟显像病例的分析,探讨18F-FDG与18F-FLT延迟显像对肺结节诊断的效能.方法 6个PET/CT中心,从2006年1月至2007年6月,按照统一标准,采用同机型、同一扫描条件,开展了肺结节样病变18F-FLT和18F-FDG PET/CT显像的多中心临床研究.在经确诊的55例病例中,25例患者进行了18F-FLT显像和延迟显像,34例患者进行了18F-FDG延迟显像.按常规计算延迟显像时病灶最大标准摄取值(SUVmax)及与早期显像时SUVmax相比的变化率(△SUVmax).对照临床确诊结果分析其诊断效能.采用SPSS11.0软件进行统计学处理.结果 18F-FDG延迟显像患者中,6例肺癌中5例、12例结核中9例、16例炎症或其他良性结节中9例的SUVmax较早期相升高.18F-FLT延迟显像组中,7例肺癌中3例、8例结核中3例和10例其他良性病灶中2例的SUVmax上升.经分组统计分析,不同疾病组间18F-FDG延迟显像SUVmax和△SUVmax差异无统计学意义;18F-FLT延迟显像SUVmax和△SUVmax组间差异也无统计学意义.无论18F-FDG还是18F-FLT,延迟显像的诊断效能均不如早期相.无论早期还是延迟显像,单独18F-FDG或18F-FLT显像的诊断效能均不如二者联合应用.结论 18F-FDG和18F-FLT延迟显像的SUVmax变化规律性不强,不宜单独应用于肺结节的鉴别诊断.     

Menghini针在经皮肺活检中的应用

本文介绍了44例经皮肺活检的经验,40例诊断正确,占90.9%;气胸发生率6.8%,作者认为 Menghini 针具有操作简单,无气栓发生,更换注射器方便等优点。同时对导向的选用及穿剌方法的改进也做了介绍。     

电视纵隔镜手术在肺癌分期中的应用价值

背景与目的　随着新辅助治疗方案的提出,以及人们逐渐认识到CT和PET等检查在肺癌分期中的局限性,纵隔镜手术在肺癌分期中的价值日益受到人们的重视。本研究旨在探讨电视纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值。方法　回顾性总结2001年9月至2004年6月60例经电视纵隔镜检查的肺癌患者的临床资料,其中颈部电视纵隔镜手术52例,胸骨旁电视纵隔镜手术2 例,颈部加胸骨旁电视纵隔镜手术6例。术前所有患者胸部CT均发现纵隔淋巴结肿大(直径大于1.0 cm)。结果　本组60 例患者,经电视纵隔镜检查证实纵隔淋巴结转移(阳性)者42例,未见纵隔淋巴结转移(阴性)者18例。纵隔淋巴结阳性者放弃手术,予以化疗;阴性者中转开胸行肺叶切除或肺楔形切除加纵隔淋巴结清扫,术后病理证实17 例纵隔淋巴结未见转移,1例隆凸后淋巴结可见癌转移(电视纵隔镜检查假阴性)。电视纵隔镜手术敏感性、特异性和准确性分别为97.7%、100%和98.3%。本组术中发生无名动脉撕裂1 例,并发症发生率为1.7%(1/60)。无围手术期死亡。结论　电视纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法。     

Die traumatische Pneumatocele — Ein Fallbericht

Zusammenfassung Die posttraumatische Pneumatocele ist eine seltene intrapulmonale Veränderung nach stumpfem Thoraxtrauma. Anhand eines gut dokumentierten Falles wird diese seltene Form der Lungenkontusion dargestellt und die klinisch bedeutsame Differentialdiagnose diskutiert.

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Traumatic pneumatocele — a case report

Summary The posttraumatic pneumatocele is a rare intrapulmonary lesion following blunt thoracic injury. By means of a well documented case report this rare form of lung contusion is demonstrated and the clinically important differential diagnosis is discussed.

     

Mortality rates in the Federal Republic of Germany following previous occupational exposure to asbestos dust

Summary In 1972, a procedure was introduced by the Industrial Injuries Insurance Institutes (Berufsgenossenschaften) of the Federal Republic of Germany, which is to be used by the special occupational health service for employees exposed to asbestos dust. Since 1 January 1972, occupational health examinations are performed when exposure to asbestos dust has been of at least 3 years' duration.On 1 January 1977, a prospective cohort study was started with employees formerly exposed to asbestos dust whilst working for companies manufacturing or using asbestos. Data on these persons are collected in the Central Register of Employees Exposed to Asbestos Dust of the Industrial Injuries Insurance Institutes. A total of 3,070 male and female employees in whom asbestos exposure terminated after 1 January 1972 formed subcohort I of the study. For comparison, 665 persons whose exposure terminated before 1 January 1972 served as subcohort II. In addition to several other inclusion criteria, each individual's permission was required before personal data could be evaluated.Of the subjects in the two subcohorts, 185 and 71, respectively, had died by 31 December 1982. Tumours were more frequently than this cause of death is expected in the general population. In addition to a high incidence of mesothelioma, the standard mortality rate was especially increased for lung cancer.The proportional mortality rates of about 40% for tumours of all sites (with about 17% lung cancer and 8% mesothelioma) especially in subcohort II, seemed to be comparable to the international figures for epidemiological mortality.Supported by the Central Office of the Industrial Injuries Insurance Institutes, Bonn, Contract no.638.31:376.3-4104.Presented as a Short Communication at the XXI International Congress on Occupational Health, Dublin, September 9–14, 1984.     

犬双肺序贯性移植的研究

目的探讨犬双肺序贯性移植时供肺的采取及受体移植手术技巧。方法犬16条,体重差异<5%的随机配对作为供受体进行双肺序贯移植实验共8次,移植右肺钳夹左房时采用了‘v’钳夹技术,并检测左肺及右肺术后0.5、1、2 h各进行血气分析、肺水含量及电镜下超微结构,了解术后肺功能。结果移植右肺时采取的‘v’型钳夹术良好地解决了钳夹左房时因回心血量受阻而引起的心功能不全。术后检测结果表明移植后肺功能良好。结论掌握了犬双肺序贯性移植的全过程,"V"形双阻断钳夹左心房技术提高了犬肺移植的成功率。     

PET/CT在评价及观察大鼠肺癌放疗效果中的应用

Objective The aim of this study was to understand the role of PET/CT in monitoring the therapeutic effect of radiotherapy (RT) on lung cancer with Wistar rats. Methods Thirty Wistar in-bred strain rats (6-8 weeks, weighed 180-280 g, female, ordinary) were made into Lewis pulmonary tumor model rats. 18F-fluorodeoxyglucose (FDG) PET/CT was performed when tumor reached 1.5-2.0 cm in greatest diameter (4-6 weeks) as a baseline. In order to get the optimal time point of PET/CT for moni-toring RT effect in rat cancer model, PET/CT was performed at the 3rd day, 1st, 2nd, 3rd, and 4th week after giving single dose of 5 Gy to each rat. Standardized uptake values (SUV) from FDG PET were measured and rats were sacrificed at different time point for validation. Besides, the expressions of glucose transport1 (Glut1) in tumor tissue were studied using immunohistochemistry. The level of tumor cell apoptosis, degra-dation, and necrosis were observed. SPSS 11.0 software was used for data analyses. Results A negative correlation of SUV uptake and time after RT and negative correlation of Glut1 expression and time after RT were observed in rat tumors, respectively. Positive correlation of SUV uptake and Glut1 expression in rat tumors was observed (Spearman rank correlation test, rs = 0.97, P < 0.01). Before RT, the SUV in rat tumor was 1.28 ± 0.31 and was decrease to 1. 00 ± 0.23 at the 3rd day and 0.18 ± 0. 10 at the 4th week after RT (F=15. 126, P<0.05). Before RT, the Glut1 in rat tumor was 0.2558 ±0.03 and was decrease to 0. 2320 ± 0. 01 at the 3rd day and 0. 1320±0.04 at the 4th week after RT. The amounts of tumor cell apopto-sis, degradation, and necrosis increased with time after RT. Conclusion Though FDG PET could monitor the therapeutic effect at the 3rd day after giving single dose of RT to rat lung tumor model, the optimal time was the the 4th week after treatment.     

CT的分叶征表现在肺内孤立结节影像诊断中的价值

目的探讨CT的分叶征表现在肺内孤立结节影像诊断的价值以及CT多平面重组（MPR）对此征检出的意义。方法观察病理证实的周围型小肺癌137例及良性肺内结节45例，将结节的边缘分为4型。对28例肺癌、22例良性结节行MPR，考察其显示分叶征的作用。引入可能性比值（likelihood ratios，LR）以量化良恶性病变在形态学上存在重叠的表现。结果Ⅰ型边缘结节对良性病变的特异性为83．3％（20／24），敏感性为44．4％（20／45）。Ⅳ型边缘结节对周围型小肺癌的特异性为97．6％（83／85），敏感性为60．7％（83／137）。表明Ⅰ型边缘是良性病变的特点；而Ⅳ型边缘是恶性病变的特征。Ⅳ型边缘的结节恶性病变在MPR重组图像上的检出率为64．3％（18／28），与横断面扫描差异有统计学意义（P〈0．01）。结论分叶征对肺内孤立结节的诊断有价值，MPR配合横断面薄层图像有助于提高该征的检出率。     

多层螺旋CT血管成像在支气管动脉灌注化疗前的定位价值

目的探讨多层螺旋CT血管成像(MSCTA)在支气管动脉(BA)灌注化疗前的定位价值。方法分析15例经支气管动脉介入治疗前的的肺癌病例,中央型13例,周围型2例。15例均行螺旋CT增强扫描,后传至工作站利用多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等后处理技术观察支气管动脉。结果13例中央型肺癌均由肿瘤性支气管动脉供血,重建图像清晰显示肿瘤性支气管动脉的起点、分支情况及走行特点;其中2例右侧肿瘤性支气管动脉与肋间动脉共干。2例周围型肺癌中有1例由肿瘤性支气管动脉供血,1例找不到明确发自支气管动脉的供血血管。结论多层螺旋CT血管成像能够显示肺癌特别是中央型肺癌的肿瘤性支气管动脉并能为经支气管动脉灌注化疗提供准确定位。