消化管憩室肿瘤:附4例报告

目的：探讨消化管憩室伴发肿瘤的影像学特征。材料和方法：食管憩室伴发鳞癌2例、胃和小肠憩室伴发平滑肌肉瘤各1例。采用气－钡双对比造影4例及CT双期扫描1例。均经病理证实。结果：消化管憩室肿瘤中：4例病灶均位于憩室壁；壁部分受累2例，全部受累2例。4例均显示粘膜紊乱、中断，壁僵硬、充盈缺损。结论：消化管憩室区出现粘膜紊乱、中断、充盈缺损及邻近管腔僵硬是伴发肿瘤的影像学特征。     

Targeting Telomerase with an HLA Class II-Restricted TCR for Cancer Immunotherapy

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奥沙利铂联合大剂量亚叶酸钙与氟尿嘧啶治疗晚期胃癌

目的 探讨奥沙利铂联合大剂量亚叶酸钙与氟尿嘧啶治疗晚期胃癌的疗效及其安全性。方法 晚期胃癌患者45例，采用奥沙利铂联合大剂量亚叶酸钙及氟尿嘧啶治疗，疗程3周期。结果 部分缓解18例，无变化17例，进展10例，总有效率40．0％。中位疾病进展时间5个月，1年生存率58．7％。毒性反应主要为感觉神经毒性(54．3％)，其次为恶心、呕吐和腹泻；骨髓抑制毒性小。结论 奥沙利铂联合大剂量亚叶酸钙与氟尿嘧啶方案治疗晚期胃癌，疗效肯定，患者耐受性较好。     

采用组织芯片技术检测大肠癌组织中p16、cyclinDl和CDK4的表达

目的研究大肠癌组织中多肿瘤抑制蛋白(p16)、细胞周期蛋白(cyclinD1)及细胞周期蛋白依赖激酶(CDK4)的表达及其意义。方法采用组织芯片技术制作80例大肠癌组织芯片,同时用S-P免疫组织化学方法检测大肠癌组织芯片中p16、cyclinD1和CDK4的表达。结果80例大肠癌中p16、cyclinD1和CDK4的阳性率分别为40.0%、57.5%、47.5%。不同组织学类型、淋巴结转移状况的大肠癌中,p16、cyclinD1的表达无明显差异(P>0.05)。不同组织学类型、浸润程度及淋巴结转移状况的大肠癌中CDK4的表达均无明显差异(P>0.05)。结论p16表达、cyclinD1高表达与大肠癌的浸润程度密切相关,大肠癌中p16低表达与cyclinD1的高表达密切相关。p16低表达影响cyclinD1的高表达。应用组织芯片大规模高效检测临床组织样本是可行的,具有快速、方便经济、准确的特点。     

FDG PET for grading malignancy in thymic epithelial tumors: Significant differences in FDG uptake and expression of glucose transporter-1 and hexokinase II between low and high-risk tumors: Preliminary study

Purpose

To evaluate ¹⁸F-fluorodeoxyglucose (FDG) uptake to predict the malignant nature and analyze the correlation between FDG uptake and expression of glucose transporter 1 (Glut-1) and hexokinase II (HK-II) in thymic epithelial tumors.

Materials and methods

Eleven patients with a thymic epithelial tumor who underwent FDG PET/CT before therapy were reviewed. The thymic tumors were classified by the WHO histological classification and Masaoka clinical staging. Comparison of maximum standardized uptake value (SUV_max) of the lesion was made between the low-risk (Type A, AB and B1) and high-risk {Type B2, B3 and C (thymic cancer)} groups and among clinical stages. Expression of Glut-1 and HK-II was analyzed immunohistochemically.

Results

All 11 tumors showed FDG uptake visually. SUV_max was significantly higher in the high-risk group (n = 5, 5.24 ± 2.44) than the low-risk group (n = 6, 3.05 ± 0.55) (P = 0.008). Staining scores of both Glut-1 and HK-II were significantly higher in the high-risk group than in the low-risk group (Glut1: P = 0.034 and HK-II: P = 0.036). There were no significant differences in SUV_max (P = 0.11), Glut-1 (P = 0.35) and HK-II scores (P = 0.29) among clinical stages. SUV_max was significantly correlated to each of the staining scores of Glut-1 (ρ = 0.68, P = 0.031) and HK-II (ρ = 0.72, P = 0.024).

Conclusion

These preliminary results support the previously published view that SUV_max may be useful to predict the malignant nature of thymic epitherial tumors and suggest that the degree of FDG uptake in the thymic epitherial tumors is closely related to the amount of Glut-1 and HK-II in the tumor.     

彩色多普勒超声鉴别良恶性乳腺肿物的应用

目的 探讨彩色多普勒超声鉴别良恶性乳腺肿物的应用。 方法 95例乳腺病变住院患者，首先用二维超声明确肿块部位、形态、大小等一般情况，然后用彩色多普勒血流成像（CDFI）观察，记录血流分级，用频谱多普勒测量病灶内多处血管并记录最高的搏动指数（PI）、阻力指数（RI）和峰值流速等参数。 结果 （1）临床怀疑乳腺肿块95例，超声检出乳腺肿物93例；（2）良性组与恶性组肿物在Adle，分级存在显著性差异（P〈0.05）；（3）频谱分析显示两组间峰值流速、平均流速、PI、RI之间均存在显著性差异（P〈0．05），恶性组均高于良性组。 结论 （1）彩色多普勒超声检出乳腺肿物准确，简便；（2）综合分析和评价CDFI血流Adler分级、肿物内血流速度、PI、RI等指标有助于对乳腺良恶性肿物的鉴别。     

Dynamic contrast‐enhanced‐MRI of tumor hypoxia

Patients with highly hypoxic primary tumors show increased frequency of locoregional treatment failure and poor survival rates and may benefit from particularly aggressive treatment. The potential of gadolinium diethylene‐triamine penta‐acetic acid‐based dynamic contrast‐enhanced‐MRI in assessing tumor hypoxia was investigated in this preclinical study. Xenografted tumors of eight human melanoma lines were subjected to dynamic contrast‐enhanced‐MRI and measurement of the fraction of radiobiologically hypoxic cells and the fraction of pimonidazole‐positive hypoxic cells. Tumor images of K^trans (the volume transfer constant of gadolinium diethylene‐triamine penta‐acetic acid) and v_e (the fractional distribution volume of gadolinium diethylene‐triamine penta‐acetic acid) were produced by pharmacokinetic analysis of the dynamic contrast‐enhanced‐MRI data, and K^trans and v_e frequency distributions of the non‐necrotic tumor tissue were established and related to the extent of hypoxia. Tumors showing high K^trans values and high v_e values had low fractions of hypoxic cells, whereas tumors showing both low K^trans values and low v_e values had high hypoxic fractions. K^trans differentiated better between tumors with low and high hypoxic fractions than did v_e. This study supports the current attempts to establish dynamic contrast‐enhanced‐MRI as a method for assessing the extent of hypoxia in human tumors, and it provides guidelines for the clinical development of valid assays. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

An improved coverage and spatial resolution—using dual injection dynamic contrast‐enhanced (ICE‐DICE) MRI: A novel dynamic contrast‐enhanced technique for cerebral tumors

A new dual temporal resolution‐based, high spatial resolution, pharmacokinetic parametric mapping method is described ‐ improved coverage and spatial resolution using dual injection dynamic contrast‐enhanced (ICE‐DICE) MRI. In a dual‐bolus dynamic contrast‐enhanced‐MRI acquisition protocol, a high temporal resolution prebolus is followed by a high spatial resolution main bolus to allow high spatial resolution parametric mapping for cerebral tumors. The measured plasma concentration curves from the dual‐bolus data were used to reconstruct a high temporal resolution arterial input function. The new method reduces errors resulting from uncertainty in the temporal alignment of the arterial input function, tissue response function, and sampling grid. The technique provides high spatial resolution 3D pharmacokinetic maps (voxel size 1.0 × 1.0 × 2.0 mm³) with whole brain coverage and greater parameter accuracy than that was possible with the conventional single temporal resolution methods. High spatial resolution imaging of brain lesions is highly desirable for small lesions and to support investigation of heterogeneity within pathological tissue and peripheral invasion at the interface between diseased and normal brain. The new method has the potential to be used to improve dynamic contrast‐enhanced‐MRI techniques in general. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

超声显像对卵泡膜细胞瘤的诊断价值

目的 探讨超声检查在卵泡膜细胞瘤诊断中的价值.方法 回顾性分析14例卵泡膜细胞瘤的临床与声像图资料,并与手术病理结果作对照.结果 本组卵泡膜细胞瘤6例声像图呈实性肿物(6/14);8例呈囊实性肿物(8/14).结论 卵泡膜细胞瘤声像图不具特征性,单从声像图判断困难,还需结合临床综合分析进行鉴别.     

Pancreatic multicenter ultrasound study (PAMUS)

Aim

To describe the typical CEUS pattern of pancreatic lesions and to evaluate the diagnostic accuracy of Contrast-enhanced ultrasound (CEUS) in their characterization.

Materials and methods

All US and CEUS examinations of focal pancreatic masses performed in six centers during a period of five years were reviewed. Inclusion criteria were: focal pancreatic mass pathologically proved, visible at ultrasound (US) and studied with CEUS. All lesions were then evaluated for size, aspect and enhancement pattern. Sensitivity, specificity, positive and negative predictive values with 95% CIs were calculated to define diagnostic accuracy of CEUS in respect to pathology. Diagnostic confidence of US and CEUS, discerning between benign and malignant lesions, were represented by using ROC (receiver operating characteristics) curves. Agreement was evaluated by means of k statistics.

Results

1439 pancreatic lesions were included. At CEUS the lesions were divided into solid (89%) and cystic (12%) masses and classified into six and eight categories, respectively. Among the solid lesions, adenocarcinomas were characterized with an accuracy of 87.8%. Among the cystic lesions, cystic tumors were diagnosed with an accuracy of 97.1%. ROC curve area increased from 0.637 for US to 0.877 for CEUS (p < 0.0001). Inter-observer agreement was slightly higher for solid (k = 0.78) than cystic (k = 0.62) lesions. In none of the centers side effects were reported.

Conclusion

CEUS is accurate in the characterization of pancreatic lesions. CEUS should be considered as a complementary imaging method for pancreatic lesions characterization.