颅内动脉超选择化疗药灌注的应用

恶性脑肿瘤患者在术后进行化疗，对加强疗效有一定作用。我院对4例恶性脑肿瘤术后患者，在X线电视导向下，经股动脉穿刺插管至颅内动脉，导管再超选择到达原肿瘤病灶供血管，灌注化疗药物，以达巩固增强疗效的目的。     

动脉灌注化疗的药物选择原则

动脉灌注化疗是治疗恶性肿瘤的一种有效的方法,在选择灌注化疗药物时应考虑以下用药原则。①选择肿瘤敏感型药物。②不同抗癌机制药物相配伍。③选择药物配伍的种类和药物之间的相互作用。④浓度依赖型药物为首选。⑤抗癌药物配伍应注意不良反应。⑥灌注的药物对癌细胞的杀伤作用是以原型起作用的。⑦注意给药的顺序和疗程间隔。⑧注意给药个体化 由于患者的机体状况不同、肿瘤的不均一性,个别对待是临床治疗的基本原则之一。⑨注意结合化疗药的药代谢动力学特点。⑩还应熟悉常用药物和常见肿瘤的化疗方案。     

经导管动脉灌注化疗药物应用原则--中国肿瘤介入专家共识北大核心CSCD

经导管动脉灌注化疗(TAI)是肿瘤介入治疗的重要手段之一,也是保证化疗在局部治疗中发挥最大抗癌效力的一个必要途径。TAI中药物选择既要遵循常规全身化疗基本原则,又要兼顾经导管区域性药物灌注特性。理论上静脉输注化疗药物均能经动脉灌注,但需经人体转化后才能起效的药物不适用于TAI。TAI是在肿瘤供血动脉内直接灌注药物,能克服部分静脉化疗无法通过的生理屏障,起到药物"首过效应",从而显著提高肿瘤局部药物浓度,提高疗效。TAI后化疗药物同样会沿血液循环到全身,同时也起到全身化疗作用。TAI也会产生不良反应,相比全身化疗程度要轻微,对人体免疫功能损害亦较轻。TAI虽然适用于各种中晚期恶性肿瘤,但也必须严格把握适应证和禁忌证,即在选择用药时应谨慎、合理,争取在获得最大有效作用的同时减少不良反应。选择TAI药物时应根据以下用药原则:选择肿瘤敏感药物,选择原型起作用药物,首选浓度依赖型药物,联合应用不同作用机制药物,尽量避免药物毒性作用相同或对同一脏器毒性累加的药物,不得应用相互拮抗或相互发生不良化学反应的药物及溶剂配伍,严格执行特殊药物使用说明,给予适当剂量的化疗药物,注意化疗药物应用先后顺序,重视非抗肿瘤药物与化疗药之间相互作用,以及药物稀释浓度与容量。     

超选择子宫动脉插管连续灌注化疗治疗子宫恶性肿瘤

目的：探讨超选择性子宫动脉插管连续灌注化疗(percutaneous transuterine arterial infusion chemotherapy,PTIC)治疗子宫内膜癌和宫颈癌的临床效果。资料与方法：PTIC治疗47例子宫恶性肿瘤（连续5天灌注化疗药物）。PTIC后47例患者均接受子宫切除根治术。有危险预后因素者接受放疗。结果：47例子宫动脉造影均可见肿瘤血管及肿瘤染色。化疗后复查者肿瘤血管和肿瘤染色均明显减少。12例子宫内膜癌和16例宫颈癌对PTIC有反应。术中发现肿瘤体积减小，手术时间缩短，术中出血量减少。结论：PTIC可使肿瘤体积减小、坏死，有效控制宫旁浸润和淋巴结转移。减小手术难度，缩短手术时间，减少术中出血量。     

心理干预对肝动脉介入灌注化疗患儿依从性的影响

单纯性肝动脉介入灌注化疗是一种经皮股动脉穿刺置入导管于肝动脉内,再注入化疗药物的方法。这种治疗方法将化疗药直接灌注到供应肝脏血液的动脉血管内,使肝脏局部的药物浓度较全身化疗时高10倍以上,而全身其他部位的药物浓度不同时升高,从而显著提高疗效,减少了副作用[1]。因此,加强对患儿的护理指导,提高治疗依从性,具有重要意义。本研究对我院收治的3名肝母细胞瘤患儿实施心理干预,进行全程护理督导,均采取局部麻醉方法,取得良好效果,现报道如下。1材料与方法1.1一般资料选择2005年5月~2006年3月确诊为肝母细胞瘤患儿,在我院行肝动脉介入…     

超选择动脉内溶栓治疗急性脑梗死患者的护理

脑梗死是神经系统的常见病、多发病，具有高致残率、高死亡率的特点。上世纪80年代初Chaise等用纤维蛋白溶剂，经动脉内灌注治疗因手术所致的血栓形成，后又发展为超选择动脉内局部溶栓，方法逐渐推广到脑血管病治疗领域。超选择动脉内溶栓能直接将药物注入血栓所在动脉或者血栓附近，达到高选择溶栓目的。其血管再通率达80％左右。     

胃癌选择性动脉灌注化疗的短期疗效研究

对24例经病理证实的胃癌采用外科术前选择性动脉灌注化疗,并选择10例作全身化疗作对照研究.分析发现经选择性动脉灌注化疗的病人药物副反应轻微,持续时间短,临床症状改善明显。术后病理显示其有效率为92%,杀伤原发癌灶和周围转移淋巴结内癌细胞的效果显著高于全身化疗.     

消化道大出血的介入应用

目的：探讨消化道大出血的介入诊断及治疗价值。资料与方法：对14例消化道出血病例进行血管造影，术中根据不同的出血原因和部位，分别采用动脉栓塞或缩血管药物、止血药物的灌注治疗。结果：动脉栓塞治疗4倒，即时止血率为100％；缩血管药物加止血药物灌注8例，即时止血率100％。1例24小时内再出血；2例进行血管造影明确诊断，行外科手术。治疗术后病人均无严重并发症。结论：消化道出血介入治疗，可明确诊断确定出血点，术中同时行动脉栓塞或缩血管药物、止血药物灌注治疗是安全有效的，为临床诊断及治疗提供了帮助；若复发出血，亦可为急诊病人争取时间。     

静脉滴注重组人血管内皮抑素联合动脉灌注化疗治疗晚期恶性肿瘤的临床观察

目的 探讨静脉滴注重组人血管内皮抑素联合动脉灌注化疗治疗晚期恶性肿瘤的疗效及安全性.方法 选取41例晚期恶性肿瘤患者人组研究,分为治疗组和对照组,均给予相应的肿瘤供血动脉灌注化疗,治疗组在灌注化疗后当天开始给予重组人血管内皮抑素静脉滴注治疗,连用14 d,间隔7 d为1个周期,对照组仅行动脉灌注化疗治疗,于2个治疗周期后比较疗效和生活质量评分,同时比较不良反应.结果 重组人血管内皮抑素治疗组治疗后疾病控制率、K氏评分显著升高,差异有统计学意义(P<0.05);有效率和不良反应与对照组差异无统计学意义(P>0.05).结论 采用静脉滴注重组人血管内皮抑素联合动脉灌注化疗治疗晚期恶性肿瘤,患者的疾病控制率和生活质量有明显的提高,而治疗相关不良反应不大,值得临床推广及进一步研究.     

化疗栓塞与化疗灌注在中晚期膀胱癌治疗中的对照研究

目的采用生存分析的方法对照研究化疗栓塞与化疗灌注在中、晚期膀胱癌中的治疗作用。资料与方法69例中、晚期膀胱癌患者分为两组,一组行双侧髂内动脉化疗灌注术,另一组行双侧髂内动脉化疗栓塞术。应用Cox比例风险模型对各个因素与术后膀胱癌的生存时间进行回归分析,筛选出主要的影响因素;应用Kaplan-Meier生存曲线分析两种治疗方法与生存时间的关系,并进行Log-Rank检验。结果69例手术均成功,双侧髂内动脉化疗栓塞术组生存时间为5~52个月,平均(26.52±3.29)个月;双侧髂内动脉化疗灌注术组生存时间为4~36个月,平均(13.41±1.69)个月。中晚期膀胱癌的死亡率与介入治疗的两种方法的相关性差异有统计学意义(P<0.05),其风险度为3.220,回归系数为1.169,证明双侧髂内动脉化疗栓塞术对于提高患者的生存时间具有更重要的意义。接受双侧髂内动脉化疗栓塞术的患者,生存时间明显高于接受双侧髂内动脉化疗灌注术的患者。结论应用化疗栓塞治疗较单纯化疗灌注治疗可明显提高患者的生存时间。     

Superselective intra-arterial chemotherapy for advanced maxillary sinus cancer: an evaluation of arterial perfusion with computed tomographic arteriography and of tumor response

OBJECTIVE: The purpose of our study was to elucidate the relationship between arterial perfusion in advanced maxillary sinus cancer which was opacified by superselective intra-arterial computed tomographic arteriography (IA-CTA) and the tumor response to intra-arterial chemotherapy. METHODS: Superselective IA-CTA was performed to identify the feeding arteries and their perfusion in advanced maxillary sinus cancer in 10 patients. Cisplatin was selectively infused into these feeding arteries, except for the internal carotid artery. RESULTS: The results were assessed in 9 of the 10 patients, and a complete response was achieved in 5 patients in whom either the entire tumor, or most of the tumor, was perfused by the branches of the external carotid artery. In 4 patients with a partial response, the residual tumors were seen in the territory of the perfusion defect or in the perfusion territory of the internal carotid artery. CONCLUSION: Superselective IA-CTA is a useful technique to correctly identify the intratumoral perfusion and to predict tumor response to the intra-arterial chemotherapy of advanced maxillary sinus cancer.     

Simultaneous quantitative cerebral perfusion and Gd-DTPA extravasation measurement with dual-echo dynamic susceptibility contrast MRI.

Quantification of cerebral perfusion using dynamic susceptibility contrast MRI generally relies on the assumption of an intact blood-brain barrier. The present study proposes a method to correct the tissue response function that does not require this assumption, thus, allowing perfusion studies in, for example, high-grade brain tumors. The correction for contrast extravasation in the tissue during the bolus passage is based on a two-compartment kinetic model. The method separates the intravascular hemodynamic response and the extravascular component and returns the corrected tissue response function for perfusion quantification as well as the extravasation rate constant of the vasculature. Results of simulation experiments with different degrees of contrast extravasation are presented. The clinical potential is illustrated by determination of the perfusion and extravasation of a glioblastoma multiforme. The correction scheme proves to be fast and reliable even in cases of low signal-to-noise ratio. It is applicable whether extravasation occurs or not. When extravasation is present, application of the proposed method is mandatory for accurate cerebral blood volume measurements. Magn Reson Med 43:820-827, 2000.     

低剂量对比剂双能量肺灌注成像评估肺动脉内血栓与灌注缺损间的关系

目的:应用双源CT低剂量对比剂双能量肺灌注成像评估急性肺动脉栓塞患者血管内血栓与肺灌注缺损间的关系,以提高对肺动脉栓塞诊断的准确性。方法:随机选择无肺动脉栓塞患者的低剂量与常规剂量双能量肺灌注成像各15例,对比分析其图像质量;收集20例疑肺动脉栓塞患者行低剂量双能量肺灌注成像;同时获得肺动脉CTA及肺灌注图像。分析肺动脉内有无血栓,以及血栓的部位、数量及形态特征。用双能量肺灌注分析软件判断有无灌注缺损及缺损的部位、形态及范围。对比分析并统计肺动脉内血栓与肺灌注缺损间的关系。结果:肺动脉栓塞患者的低剂量与常规剂量双能量肺灌注成像质量无明显差异(P>0.05)。20例疑似病例中,15例诊断为肺动脉栓塞,其中13例患者肺灌注图像中出现102个肺叶、肺段、或亚段灌注缺损,4例共6个灌注缺损CTA无明确血栓;11例肺动脉CTA显示43个血栓,其中9例血栓与灌注缺损同时存在,2例CTA共5个血栓肺内无灌注缺损。75个灌注缺损与栓塞肺动脉供血范围一致,21个灌注缺损(8段、13亚段)与肺动脉供血范围无关。结论:综合分析双源CT低剂量双能量肺灌注图与CTPA,可以提高肺动脉栓塞诊断的准确性。     

Comprehensive assessment of lung CT attenuation alteration at perfusion defects of acute pulmonary thromboembolism with breath-hold SPECT-CT fusion images

Regional computed tomography attenuation (CTA) alteration at perfusion defects in acute pulmonary thromboembolism (PTE) was comprehensively assessed using deep-inspiratory breath-hold SPECT-CT fusion images. Subjects were 14 acute and 9 chronic PTE patients and 13 control subjects. Regional perfusion, CTA, and intravascular clots were correlated on deep-inspiratory breath-hold SPECT-unenhanced/angiographic CT fusion images. Fusion images visualized hypo-CTA in 57% of the acute PTE patients, which preferentially occurred at extensively and severely decreased perfusion areas caused by central clots. CTA at 35 defects of acute PTE was significantly decreased compared with that of normal lungs (P<0.001), but the degree was less compared with chronic PTE (P<0.0001). Fusion images also revealed variable relationships of clots and regional perfusion/CTA in the distal lungs of each central clot. Fusion images provide important information about the actual effects of intravascular clots on peripheral perfusion/CTA and indicate that lung CTA can be decreased at perfusion defects in acute PTE.     

Discrepancy between the dynamic computed tomography and T2 magnetic resonance perfusion imaging in brain tumors: a report of 2 cases

In this report, we separately performed dynamic computed tomographic perfusion and dynamic susceptibility contrast-T2 magnetic resonance perfusion imaging on 2 cases of brain tumors (one was a glioblastoma, and the other was a central neurocytoma). Between the 2 methods, we saw the discrepancy in values of cerebral blood volume and cerebral blood flow, differences in location of the maximal cerebral blood volume, and regions with abnormal increased cerebral blood flow besides the solid part of the tumors. Both differences and similarities of the 2 techniques with their advantages and pitfalls were analyzed in detail. The developing trends in the near future were also discussed.     

Relation between lung perfusion defects and intravascular clots in acute pulmonary thromboembolism: assessment with breath-hold SPECT-CT pulmonary angiography fusion images

PURPOSE: The relation between lung perfusion defects and intravascular clots in acute pulmonary thromboembolism (PTE) was comprehensively assessed on deep-inspiratory breath-hold (DIBrH) perfusion SPECT-computed tomographic pulmonary angiography (CTPA) fusion images. MATERIALS AND METHODS: Subjects were 34 acute PTE patients, who had successfully performed DIBrH perfusion SPECT using a dual-headed SPECT and a respiratory tracking system. Automated DIBrH SPECT-CTPA fusion images were used to assess the relation between lung perfusion defects and intravascular clots detected by CTPA. RESULTS: DIBrH SPECT visualized 175 lobar/segmental or subsegmental defects in 34 patients, and CTPA visualized 61 intravascular clots at variable locations in 30 (88%) patients, but no clots in four (12%) patients. In 30 patients with clots, the fusion images confirmed that 69 (41%) perfusion defects (20 segmental, 45 subsegmental and 4 lobar defects) of total 166 defects were located in lung territories without clots, although the remaining 97 (58%) defects were located in lung territories with clots. Perfusion defect was absent in lung territories with clots (one lobar branch and three segmental branches) in four (12%) of these patients. In four patients without clots, nine perfusion defects including four segmental ones were present. CONCLUSION: Because of unexpected dissociation between intravascular clots and lung perfusion defects, the present fusion images will be a useful adjunct to CTPA in the diagnosis of acute PTE.     

Autoperfused balloon catheter for intravascular MR imaging

An intravascular magnetic resonance (MR) imaging catheter for high-resolution imaging of vessel walls was developed. The catheter design is based on an autoperfusion balloon catheter that allows passive perfusion of blood during balloon inflation. The blood enters a central lumen through multiple sideholes of the catheter shaft proximal to the balloon. A remotely tuned, matched, and actively decoupled, expandable single-loop radiofrequency coil was mounted onto the balloon to receive intravascular MR signals. The autoperfusion rate through the catheter was determined experimentally relative to perfusion pressure. The catheter concept was evaluated in vitro on human femoral artery specimens and in vivo in the internal carotid artery of two pigs. The proposed catheter design allowed for maintained blood perfusion during the acquisition of high-resolution intravascular images. During perfusion, image quality remained unaffected by flow, motion, and pulsatility artifacts. The availability of an autoperfused intravascular catheter design can be considered an important step toward high-resolution atherosclerotic plaque imaging in critical vessels such as the carotid and coronary arteries.     

Pulmonary function–morphologic relationships assessed by SPECT–CT fusion images

Pulmonary single photon emission computed tomography-computed tomography (SPECT-CT) fusion images provide objective and comprehensive assessment of pulmonary function and morphology relationships at cross-sectional lungs. This article reviewed the noteworthy findings of lung pathophysiology in wide-spectral lung disorders, which have been revealed on SPECT-CT fusion images in 8?years of experience. The fusion images confirmed the fundamental pathophysiologic appearance of lung low CT attenuation caused by airway obstruction-induced hypoxic vasoconstriction and that caused by direct pulmonary arterial obstruction as in acute pulmonary thromboembolism (PTE). The fusion images showed better correlation of lung perfusion distribution with lung CT attenuation changes at lung mosaic CT attenuation (MCA) compared with regional ventilation in the wide-spectral lung disorders, indicating that lung heterogeneous perfusion distribution may be a dominant mechanism of MCA on CT. SPECT-CT angiography fusion images revealed occasional dissociation between lung perfusion defects and intravascular clots in acute PTE, indicating the importance of assessment of actual effect of intravascular colts on peripheral lung perfusion. Perfusion SPECT-CT fusion images revealed the characteristic and preferential location of pulmonary infarction in acute PTE. The fusion images showed occasional unexpected perfusion defects in normal lung areas on CT in chronic obstructive pulmonary diseases and interstitial lung diseases, indicating the ability of perfusion SPECT superior to CT for detection of mild lesions in these disorders. The fusion images showed frequent "steal phenomenon"-induced perfusion defects extending to the surrounding normal lung of arteriovenous fistulas and those at normal lungs on CT in hepatopulmonary syndrome. Comprehensive assessment of lung function-CT morphology on fusion images will lead to more profound understanding of lung pathophysiology in wide-spectral lung disorders.     

原发性脑淋巴瘤与高级别脑胶质瘤的MR灌注成像对照研究

目的 评价MR灌注成像鉴别诊断原发性脑淋巴瘤和高级别脑胶质瘤的价值.资料与方法 对经手术病理或定向穿刺活检证实的11例原发性脑淋巴瘤行MRI常规平扫、MR灌注成像和增强扫描.另随机搜集经手术病理证实的25例胶质母细胞瘤患者资料,用于MR灌注成像对比研究.MR灌注成像采用动态磁敏感性对比增强技术,计算每例肿瘤最大相对脑血容量(rCBV)比值和相对平均通过时间(rMTT)比值,用两样本t检验,比较分析原发性脑淋巴瘤和胶质母细胞瘤的平均最大rCBV比值和平均rMTT比值.结果 增强后11例脑淋巴瘤均有强化,其中7例重度强化、3例中重度强化、1例中度强化;25例脑胶质母细胞瘤的实质部分多呈不均匀性中重度强化,肿瘤内有不同程度的坏死和囊变.11例原发性脑淋巴瘤的平均最大rCBV比值为2.05、平均rMTT比值为1.07;25例胶质母细胞瘤的平均最大rCBV比值为6.78、平均rMTT比值为1.04.两者之间平均最大rCBV比值差异有统计学意义(t=8.15,P＜0.01)、平均rMTT比值差异无统计学意义(t=0.96,P＞0.05).结论 原发性脑淋巴瘤具有低rCBV比值的趋势,结合其常规MRI表现,MR灌注成像可作为鉴别原发性脑淋巴瘤与高级别脑胶质瘤的一种有效的方法 .     

Gadolinium-enhanced echo-planar T2-weighted MRI of tumors in the extracranial head and neck: feasibility study and preliminary results using a distributed-parameter tracer kinetic analysis

PURPOSE: To examine the feasibility of first-pass dynamic contrast-enhanced (DCE) T2-weighted MRI of tumors in the extracranial head and neck by applying a distributed-parameter (DP) tracer kinetic model to quantify the perfusion parameters. MATERIALS AND METHODS: A total of 16 patients with primary malignant and benign tumors in the head and neck underwent DCE-MR studies. A spin-echo (SE) echo-planar-imaging (EPI) MR-sequence was applied for first-pass DCE-T2-weighted imaging. The data were postprocessed applying a DP tracer kinetic model that accounts for capillary-tissue exchange. Region-of-interest (ROI) analysis was performed in the tumor sites and the adjacent normal tissue. Blood flow (F), intravascular blood volume (v(1)), extravascular extracellular volume (v(2)), difference in bolus arrival time between arterial input and tissue (t(0)), intravascular mean transit time (t(1)), permeability (PS), and extraction ratio (E) maps were generated for each patient. RESULTS: All perfusion values in the tumor sites were significantly different (0.000 < or = P < or = 0.01) than those in the normal muscle tissue. The median perfusion values in the tumor tissue were: F = 150.5 mL/minute/100 g, v(1) = 11.0 mL/100 g, v(2) = 31.5 mL/100 g, t(0) = 4.5 seconds, t(1) = 8.0 seconds, PS = 96.0 mL/minute/100 g, and E = 32.5. CONCLUSION: EPI-T2-weighted DCE-MR in head and neck tumors as well as quantification of the perfusion values using DP model physiologic imaging was feasible and the promising initial results have encourages further validation studies in the future.