^99mTc-MDP和SPECT／CT在诊断牙龈癌侵犯下颌骨的应用

目的：探讨^99mTc-MDP和SPECT／CT同机融合图像在牙龈癌浸润下颌骨中的诊断价值。方法：对18例牙龈癌住院患者行术前^99mTc-MDP SPECT／CT同机融合图像、曲面断层片检查，确定牙龈癌浸润下颌骨的程度，术后病理检查结果与之对照。结果：13例高分化鳞癌中11例肿瘤部位下颌骨显示常放射性浓聚灶．经SPECT／CT同机融合和曲面断层片发现1例为假阳结果；3例中分化鳞癌和2例低分化鳞癌病变部位下颌骨见异常浓聚灶，病理显示肿瘤浸润到骨髓腔。结论：^99mTc-MDP、SPECT／CT图像同机融合对牙龈癌浸润下颌骨程度诊断具有重要价值。     

SPECT／CT同机融合在恶性肿瘤侵犯下颌骨中的诊断价值

目的:研究SPECT/CT同机融合骨扫描在恶性肿瘤侵犯下颌骨中的诊断价值.方法:选择43 例口腔恶性肿瘤侵犯下颌骨而行下颌骨节段性或半侧下颌骨切除的患者,分为A(外周侵犯型)、B(中心侵犯型)2 组,对比研究SPECT/CT骨扫描和组织病理学检查的下颌骨病变范围.结果:A组:SPECT/CT显示的下颌骨受侵犯的范围较病理检查高估(1.02±0.20) cm,二者的差异有高度统计学意义(P<0.01).B组:SPECT/CT比病理检查高估(1.3±0.39) cm,二者的差异亦有高度统计学意义(P<0.01).A、B组相比较, SPECT/CT和病理检查之间的差异并无统计学意义(t=1.656,0.446,P>0.05).结论:SPECT/CT显示的病变范围符合手术需要切除的合理范围,对下颌骨病变的定位及定量等方面具有明显的优势,是临床检查的理想工具.     

CT在口腔恶性肿瘤侵犯下颌骨中的定量诊断价值

目的研究CT在下颌骨癌侵犯中的诊断价值。方法选择43例口腔癌侵犯下颌骨而行下颌骨节段性切除的病人,分为A（外周侵犯型）、B（中心侵犯型）两组,对比研究CT与手术标本组织病理学检查的切缘范围。结果A组：CT骨侵犯范围较病理检查低估1.42±0.35cm,二者的差异有高度统计学意义。B组：CT比病理检查低估2.55±1.44cm,二者的差异有统计学意义。结论CT检查可以估测下颌骨癌侵犯下颌骨的范围从而避免术中过多的切除下颌骨,对术后下颌骨的重建及下颌骨功能的保存具有重要的意义。     

磁共振成像对口腔癌下颌骨骨侵犯诊断价值的系统评价

目的 通过系统评价的方法,探讨磁共振（MR）在口腔癌下颌骨骨侵犯诊断中的价值。方法 通过对Medline Medline、荷兰医学文摘（EMBASE）、欧洲灰色文献数据库（SIGLE）、中国生物医学文献数据库等进行相关文献的电子检索。同时手工检索19种中文口腔医学期刊。两位研究者分别独立完成文献纳入排除并提取数据,运用Meta-Disc 1.4对MR在口腔癌下颌骨骨侵犯诊断的敏感度（SEN）和特异度（SPE）及95%可信区间（95%CI）等进行分析。结果 共纳入相关文献研究12篇,其中前瞻性研究5篇,回顾性研究7篇,共涉及患者476名,所有文献偏倚风险均为中度。Meta分析结果显示MR诊断口腔癌下颌骨骨侵犯的SEN为0.779（95%CI：0.719~0.831）,SPE为0.823（95%CI：0.767~0.870）,合并阳性似然比（+LR）为3.442（95%CI：2.181~5.431）,合并阴性似然比（-LR）为0.286（95%CI：0.181~0.451）,合并诊断比值比（DOR）为25.702（95%CI：13.406~49.273）,曲线下面积（AUC）为0.903 9,Q*值为0.835 4。因仅有2篇研究报告了MR在口腔癌下颌骨骨髓侵犯中的诊断效能,报告文献较少,故未行相关Meta分析,2篇研究包含55例患者,其SEN为0.838,SPE为0.722。结论 MR诊断口腔癌的下颌骨骨侵犯有较高的诊断效能,对口腔癌的下颌骨骨侵犯的术前评估有一定临床价值。     

原发性下颌骨鳞状细胞癌1例报告及文献复习

原发性下颌骨鳞状细胞癌由于早期缺少特征性的临床表现,诊断较为困难。本文报告1例原发性下颌骨鳞状细胞癌,并复习相关文献,就其组织来源、临床表现、诊断、治疗及预后进行讨论。     

下颌骨中央性鳞状细胞癌（附14例报告）

我院１９８０－１９９０年治疗下颌骨中央性鳞状细胞癌１４例。其中男性１２例,女性２例,年龄在３３－７０岁之间,平均５２岁,病程平均为９月左右。该肿瘤大多数发生于下颌角区,病员多以牙痛或下唇麻木为临床特征,Ｘ线主要表现为骨松质的溶解、吸收、破坏及牙槽骨破坏。临床上应根据临床特征、Ｘ线及组织学征象,对该病作出早期诊断,以便指导临床治疗,提高该病患者的生存率。     

牙龈卟啉单胞菌促进口腔鳞状细胞癌发生机制研究进展

口腔鳞状细胞癌是颌面部最常见的恶性肿瘤,具有发病率高、存活率低、预后不良的特点。近年来在针对口腔鳞状细胞癌的流行病学研究中,其与牙龈卟啉单胞菌的联系引起了越来越多的关注。随着对牙龈卟啉单胞菌致癌机制研究的不断深入,作为牙周炎主要致病菌的牙龈卟啉单胞菌在诸多方面显示出了较强的致癌潜力。文章就牙龈卟啉单胞菌促进口腔鳞状细胞癌发生机制的研究进展做一综述。     

牙龈卟啉单胞菌与口腔鳞状细胞癌关系的研究进展

目前已有大量证据支持慢性感染性炎症与癌症的形成有关,慢性牙周炎可能促进了头颈部鳞状细胞癌的发生发展。口腔鳞状细胞癌是口腔颌面部最常见的恶性肿瘤,而牙龈卟啉单胞菌是口腔中引发慢性感染性炎症反应最重要的牙周致病菌;随着分子生物学技术的发展,牙龈卟啉单胞菌与口腔鳞状细胞癌之间的关系也越来越受到重视。本文就牙周病与口腔颌面部肿瘤,牙龈卟啉单胞菌与口腔鳞状细胞癌的相关性及可能致病机制在口腔医学领域的研究进展作一综述,以期为临床提供帮助。     

Patterns of mandibular invasion by gingival squamous cell carcinoma.

PURPOSE: This study examined patterns of invasion of lower gingiva cancer into the mandible. Our goal was to clarify the most common routes for gingival squamous cell carcinoma to enter and spread within the mandible. PATIENTS AND METHODS: The subjects were 176 patients with lower gingival squamous cell carcinoma who underwent mandibulectomy; all tumors were examined histopathologically. The method of mandibulectomy was decided on the basis of conventional plain radiographic and computed tomographic findings. RESULTS: The tumor extended to the periosteum in 33%, to the cortical bone in 23%, and to the bone marrow in 9% of the patients who underwent mandibular resection. The remaining 35% of our patients had no evidence of mandibular invasion. CONCLUSION: The area of bone resorption on preoperative clinical and radiographic examinations often disagreed with the extent of mandibular invasion on histopathologic examination.     

A study of osteoclast-related cytokines in mandibular invasion by squamous cell carcinoma

The purpose of this study was to analyze the mechanism of bone invasion in carcinoma of the mandibular gingiva. We investigated 38 specimens of lower gingival carcinoma and histopathologically classified them into an invasion group (23 cases) and a non-invasion group (15 cases) on the basis of light microscopy evidence. These specimens were examined using immunohistochemical techniques involving antibodies of parathyroid hormone-related protein (PTHrP), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1alpha, -1beta, -6, -11, -18 and transforming growth factor (TGF)-beta. The invasion group showed a high level of expression of PTHrP, TNF-alpha, IL-6 and IL-11 positive cells (P<0.01 versus non-invasion group). The difference in the levels of expression of IL-1alpha, -1beta, -18 and TGF-beta positive cells was not significant between these two groups. Our results suggest that various cancer-derived cytokines, such as PTHrP, TNF-alpha, IL-6 and IL-11, play an important role in the mechanism of bone invasion associated with lower gingival squamous cell carcinoma.     

68例下颌牙龈鳞癌预后影响因素分析

目的 通过对68例下颌牙龈鳞癌患者的回顾性研究,分析影响下颌牙龈鳞癌预后的因素。方法 对江苏省口腔医院口腔颌面外科2003—2012年收治的68例下颌牙龈鳞癌患者进行回顾分析,利用SPSS 20.0软件包进行Kaplan-Meier生存分析,计算术后3年、5年的生存率（overall survival rate, OSR）;采用单因素Log-rank及多因素Cox回归进行生存分析。结果 68例患者的3年、5年OSR分别为77.2%、72.3%。单因素Log-rank分析结果表明,肿瘤颊、舌侧位置,颈淋巴结转移及术后复发与患者预后显著相关（P<0.05）。多因素Cox回归分析显示,肿瘤颊、舌侧部位,颈淋巴结转移与局部复发是5年生存率的独立预后因素（P<0.05）。结论 在下颌牙龈鳞癌中,肿瘤颊、舌侧位置,局部复发,颈淋巴结阳性与患者预后相关,是影响生存率的重要因素。     

成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节单光子发射型CT/CT同机融合骨显像的比较研究

目的 采用单光子发射型(single-photo Emission CT,SPECT)CT/CT同机融合骨显像技术对成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节的生长差异进行比较研究.方法 选取成人骨性下颌偏斜患者20例和正常成人志愿者15例,进行SPECT/CT同机融合骨扫描检查,以分析比较下颌偏斜患者与正常人两侧下颌骨及颞下颌关节骨血流和骨代谢的差异性.结果 成人骨性下颌偏斜患者下颌骨不同部位的骨血流和骨代谢存在特定性差异,正常人下颌骨不同部位的骨血流和骨代谢存在特定性差异;正常人下颌骨不同部位左右两侧放射性计数值比值均接近于1,对称性较好;与正常对照组相比,骨性下颌偏斜患者放射性强度均为对侧高于偏斜侧;髁状突差异最大(P＜0.01),其次为下颌角(P＜0.01),下颌升支中份差异最小(P＜0.05);不同部位两侧差异均有统计学意义.结论 SPECT/CT同机融合骨显像在精确解剖定位的基础上,能更加准确显示颞下颌关节的功能变化.

Abstract：

Objective To investigate mandible and temporomandibular joint (TMJ) in adults with and without mandible deviation using SPECT/CT fusion imaging. Methods SPECT/CT fusion imaging over bilateral mandible and TMJ was performed in 20 adult patients with mandibular deviation and 15 adult volunteers without mandibular deviation. Results Compared with the control group, the radioactive intensity of contralateral side was higher than that of the deviated side in patients with mandibular deviation. The biggest difference was found in the condyle process (P＜0. 01) and the mandibular angle (P＜0. 01). Conclusions Based on accurate anatomical localization, SPECT/CT fusion imaging was very sensitive in detecting functional alteration in TMJ.     

Clinical value of 3D SPECT/CT imaging for assessing jaw bone invasion in oral cancer patients

PurposeThis study compared the diagnostic accuracy of jaw bone invasion (JBI) of oral cancer observed with three-dimensional (3D) SPECT/CT, CT, and MRI, and evaluated the clinical advantages of 3D SPECT/CT compared to conventional two-dimensional (2D) SPECT/CT.Materials and methodsFrom April 2014 to January 2018, consecutive 16 oral cancer patients with suspected JBI, who had preoperatively undergone the imaging tests, were retrospectively enrolled. The likelihood of JBI was independently scored by a radiologist and oral surgeon. Using 2D or 3D SPECT/CT images, 20 oral surgeons delineated virtual surgical areas on 3D-printed jaws for 3 cases in which the extent of JBI was fully pathologically confirmed. The surgeons completed questionnaires regarding surgical planning and explanations for patients using Likert scales.ResultsJBI was found in 9 patients including 5 (56%) with initial bone invasion. 3D SPECT/CT showed very high negative predictive value (100%) and inter-observer agreement (kappa = 0.917). 3D SPECT/CT was more sensitive than CT and MRI when inconclusive findings for JBI were considered negative. Compared to 2D SPECT/CT, 3D SPECT/CT had greater clinical advantages such as surgical planning and explanation to patients (p < 0.005).Conclusion3D SPECT/CT is useful not only for detecting JBI but also for surgical planning.     

Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study

This preliminary retrospective study evaluates the diagnostic value of cone-beam computed tomography (CBCT), as a potential standard preoperative procedure, in assessing mandibular invasion by oral squamous cell carcinoma (OSCC) compared with conventional preoperative panoramic radiography (PR), magnetic resonance imaging (MRI) and histological examination of the resection specimen (the golden standard). Between September 2006 and September 2009, 23 patients with histology proven primary OSCC, adjacent to or fixed to the mandible were included. The tumours were classified into four groups, ranging from no bone invasion to evident bone invasion. Sensitivity and specificity for PR were 55% (95% CI [0.350;0.619]) and 92% (95% CI 0.737;0.984]), respectively, both were significantly lower than the 91% (95% CI [0.740;0.909]) and 100% (95% CI [0.845;1]), respectively, for CBCT. MRI showed 82% sensitivity (95% CI [0.608;0.941]) and 67% specificity (95% CI [0.474;0.779]). CBCT has the potential to become a new diagnostic tool in the OSCC screening procedure to predict mandibular invasion or erosion, but its value may be limited by its relatively low sensitivity. A prospective study will start on 64 patients (α = 0.05; power 0.8; effect size 0.5) to improve these results statistically.     

荷瘤裸鼠口腔鳞状细胞癌乏氧状况的初步研究

目的检测荷口腔鳞状细胞癌裸鼠肿瘤组织乏氧区域分布,明确厌氧菌能否在肿瘤乏氧区内生长,为认识和开发利用肿瘤乏氧区域提供依据。方法荷瘤裸鼠尾静脉注射^99mTc-HL91,应用SPECT检测鳞癌组织及正常组织乏氧区域分布。荷瘤裸鼠尾静脉注射青春双歧杆菌菌悬液,切取鳞癌组织及其它正常组织,匀浆后厌氧培养。结果^99mTc-HL91在肿瘤组织内高浓度聚集,与肿瘤体积呈线性相关;肿瘤区域、肿瘤对侧部位及头胸部位平均像素^99mTc-HL91吸收值有显著性差异。肿瘤组织内可见青春双歧杆菌生长,其它正常组织内未见青春双歧杆菌生长。结论口腔鳞癌组织中乏氧区域分布广泛,且与肿瘤体积密切相关。口腔鳞癌组织乏氧微环境适合严格厌氧菌-青春双歧杆菌的生长。