Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer?

Purpose

To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC).

Materials and methods

Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard.

Results

Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p = 0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p = 0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p = 0.02).

Conclusion

Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p = 0.06) in detecting liver metastases in patients with CRC.     

Endovascular transplantation of stem cells to the injured rat CNS

Introduction

Transplantation procedures using intraparenchymal injection of stem cells result in tissue injury in addition to associated surgical risks. Intravenous injection of mesenchymal stem cells gives engraftment to lesions, but the method has low efficiency and specificity. In traumatic brain injuries (TBI), there is a transient breakdown of the blood–brain barrier and an inflammatory response, which increase migration of cells from blood to parenchyma. The aim of this investigation was to analyze the effect of intra-arterial administration on cellular engraftment.

Methods

Experimental TBI was produced in a rat model. Endovascular technique was used to administer human mesenchymal stem cells in the ipsilateral internal carotid artery. Evaluation of engraftment and side effects were performed by immunohistochemical analysis of the brain and several other organs. The results were compared to intravenous administration of stem cells.

Results

Intra-arterial transplantion of mesenchymal stem cells resulted in central nervous system (CNS) engraftment without thromboembolic ischemia. We observed a significantly higher number of transplanted cells in the injured hemisphere after intra-arterial compared to intravenous administration both 1 day (p?<?0.01) and 5 days (p?<?0.05) after the transplantation. Some cells were also detected in the spleen but not in the other organs analyzed.

Conclusion

Selective intra-arterial administration of mesenchymal stem cells to the injured CNS is a minimally invasive method for transplantation. The method is significantly more efficient than the intravenous route and causes no side effects in the current model. The technique can potentially be used for repeated transplantation to the CNS after TBI and in other diseases.     

Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?

PurposeTo study the comparative performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT or MRI (CECT/MR) in evaluating liver lesions using the LI-RADS guidelines.MethodsRetrospective analysis of radiology database from July 2010 to April 2017 revealed 228 patients who had CECT/MR and CEUS. Patients at risk of hepatocellular carcinoma (HCC), had contemporaneous CEUS and CECT/CEMR studies within 3 months and adequate follow up were included; reviewed (2 reviewers) and graded according to the 2017 CEUS and 2018 CECT/MR LI-RADS guidelines. Reference standard was multidisciplinary clinical decisions, histology or follow-up imaging.ResultsThe study cohort consisted of 45 patients with 46 lesions. HCC were significantly larger than non-malignant (mean sizes of 2.5 and 1.4 cm, respectively, p<0.001). Intraclass correlation coefficient for CEUS review (0.941) was higher than of CECT/MR review (0.643). Mean area-under-ROC curve (AUC) for CEUS (0.994) was significantly higher than of CECT/MR (0.760) for all lesions (p=0.01). For lesions scored LR-3 by CECT/MR, the AUC was significantly higher for CEUS (0.978) than CECT/MR (0.500) (p<0.001). Twenty-one (of 27) lesions, classified LR-3 or LR-4 by CECT/MR were upgraded by CEUS and 20 were found to be HCC. Six lesions that were LR-3 on both CECT/MR and CEUS were found to be non-malignant. There was good concordance for LR-5 lesions between both techniques.ConclusionCEUS is useful for reassessment of lesions with intermediate probability (LR-3) or probable for HCC (LR-4) on CECT/MR. Lesions upgraded by CEUS tend to be HCC. Lesions that remain LR-3 on CEUS tend to be non-malignant.     

Intraoperative abdominal ultrasound in oncologic imaging

Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of intraoperative sonography (IOUS) as an invaluable imaging modality in oncologic surgery of the liver, kidneys and pancreas. The ability to detect and characterize small lesions and the precise intraoperative localization of such tumors is essential for adequate surgical planning in segmental or lobar hepatic resections, metastasectomy, nephron-sparing surgery, and partial pancreatectomy. Also, diagnostic characterization of small equivocal lesions deemed indeterminate by conventional preoperative imaging such as multidetector computed tomography or magnetic resonance imaging, has become an important application of IOUS. This article will review the current applications of IOUS in the liver, kidneys and pancreas.     

Imaging findings of prostate tuberculosis by transrectal contrast-enhanced ultrasound and comparison with 2D ultrasound and pathology

Objectives:This study aimed to investigate the contrast-enhanced ultrasound (CEUS) appearances of prostate tuberculosis (PTB) and its correlation with histopathology.Methods:Clinical, transrectal ultrasonography (TRUS) and CEUS data of 12 PTB patients confirmed by pathology were retrospectively analyzed, and compared to the pathological findings to identify the pathological structures corresponding to different image enhancement areas.Results:No specific characteristics could be found for the clinical appearances. Enlarged gland, hypoechoic lesions and calcification due to PTB could be found by TRUS, which were also non-specific. CEUS showed hypo- or non-enhanced lesions with varying size, which were related to different pathological stages of PTB. The incidence rate of non-enhanced lesions was 83.3%. The detection rate of suspected lesion by CEUS was significantly higher than that by TRUS (χ² = 8.000, p = 0.005). Histopathology showed that the hypoenhanced area consisted of tuberculous granulomas, caseous necrosis and incomplete destruction of the glands, while the non-enhanced area consisted of caseous or liquified necrosis.Conclusion:CEUS could improve the detection rate of PTB lesions, and the diversity of its manifestations was related to different pathological structures. An enlarged, soft gland with non-enhanced on CEUS may provide valuable information for the diagnosis of PTB, but it is not a substitute for biopsy due to the diversity of CEUS findings.Advances in knowledge:When the lesions of prostate gland are unclear in TRUS examination, CEUS is an ideal option for the detection of lesions, which is conducive to targeted guidance of biopsy areas.     

异甘草素对创伤性脑损伤大鼠损伤灶修复作用的实验研究

目的观察异甘草素对创伤『生脑损伤大鼠病理变化和血清白介素-1α（IL-1α）、IL-1β、IL-6、IL-10和肿瘤坏死因子-α（TNF-α）的影响,探讨其在创伤性脑损伤（q33I）后促进脑损伤灶康复的作用机制。方法运用改良Feeney法建立大鼠脑损伤模型,将动物随机分为假手术组、脑损伤组、异甘草素治疗组,共治疗5d,经平衡木行走试验观察神经行为学变化后处死,采用蛋白芯片法检测血清中的细胞因子,HE染色光镜下观察损伤灶的变化。结果与脑外伤组相比异甘草素治疗组IL-1α、IL-6、IL-10的血清含量明显增高,IL-1β和TNFα的含量显著降低（P〈0．05）,损伤灶病理学变化明显改善。结论异甘草素可以促进创伤性脑损伤大鼠脑损伤灶康复,其机制可能与调节细胞因子有关。     

Decision-making based on 3D printed models in laparoscopic liver resections with intraoperative ultrasound: a prospective observational study

The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance. Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors’ relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS. Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP. 3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS. • 3D printing can help in decision-making before major and complex resections in patients with liver cancer. • In 5/19 patients, 3D printed model altered surgical plan preoperatively. • Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.     

重症颅脑损伤的急诊救治分析

目的总结重症颅脑损伤的救治经验。方法将我院自2011年2月—2012年1月救治的47例重症颅脑损伤患者按治疗方法分为观察组和对照组,其中观察组24例,对照组23例,且两组患者在性别、年龄、致伤原因以及格拉斯哥昏迷(GCS)评分等方面均无统计学差异(P>0.05)。观察组24例患者积极进行手术治疗,对照组23例患者行非手术治疗。结果观察组24例患者经过院前积极的抢救和院内及时的手术治疗,优良率为50.00%;而对照组23例患者中,优良率为21.74%。两组间优良率比较,差异有统计学意义(χ2=4.062 9,P<0.05)。结论重症颅脑损伤一般情况非常危急,在临床治疗过程中,急诊手术治疗的效果显著优于非手术治疗,因此对于重症颅脑损伤患者不但要进行积极的院外抢救,入院后要及时进行手术治疗,以提高患者的治疗效果。采用院外急救和院内手术治疗相结合的方法对挽救重症颅脑损伤患者的生命具有非常重要的意义。     

The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study

OBJECTIVE: To compare sensitivity and specificity of contrast enhanced ultrasonography (CEUS) with conventional ultrasonography (US) in detection of liver metastases in patients with colorectal adenocarcinoma (CRC) in a patient-by-patient analysis. MATERIALS AND METHODS: A prospective study of 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. In order to detect possible liver metastases all patients underwent liver US, followed by CEUS by another investigator. Multislice CT scanning (MDCT), and intraoperative ultrasonography (IOUS) were then performed. Fine-needle biopsy was performed on all suspicious lesions. Each examination was interpreted blindly and the combination of biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS: Standard of reference found liver metastases in 54 patients (14.8%). Contrast enhanced ultrasonography improved the sensitivity significantly in detection of liver metastases from 0.69 by US to 0.80 (p=0.031). In 24 patients, CEUS found a higher number of metastases than US (p<0.001). The specificity (0.98) and the positive predictive value (0.86) was the same. CONCLUSION: Contrast enhanced ultrasonography improves sensitivity in detection of liver metastases in patients with CRC and in nearly half of the cases CEUS found a higher number of metastases than US.     

Turbo-Proton Echo Planar Spectroscopic Imaging (t-PEPSI) MR technique in the detection of diffuse axonal damage in brain injury. Comparison with Gradient-Recalled Echo (GRE) sequence

PURPOSE: Diffuse axonal injury (DAI) is a common type of primary neuronal injury in patients with severe traumatic brain injury, and is frequently accompanied by tissue tear haemorrhage. The T2*-weighted gradient-recalled echo (GRE) sequences are more sensitive than T2-weighted spin-echo images for detection of haemorrhage. This study was undertaken to determine whether turbo-PEPSI, an extremely fast multi-echo-planar-imaging sequence, can be used as an alternative to the GRE sequence for detection of DAI. MATERIALS AND METHODS: Nineteen patients (mean age 24,5 year) with severe traumatic brain injury (TBI), occurred at least 3 months earlier, underwent a brain MRI study on a 1.5-Tesla scanner. A qualitative evaluation of the turbo-PEPSI sequences was performed by identifying the optimal echo time and in-plane resolution. The number and size of DAI lesions, as well as the signal intensity contrast ratio (SI CR), were computed for each set of GRE and turbo-PEPSI images, and divided according to their anatomic location into lobar and/or deep brain. RESULTS: There was no significant difference between GRE and turbo-PEPSI sequences in the total number of DAI lesions detected (283 vs 225 lesions, respectively). The GRE sequence identified a greater number of hypointense lesions in the temporal lobe compared to the t-PEPSI sequence (72 vs 35, p<0.003), while no significant differences were found for the other brain regions. The SI CR was significantly better (i.e. lower) for the turbo-PEPSI than for the GRE sequence (p<0.00001). CONCLUSIONS: Owing to its very short scan time and high sensitivity to the haemorrhage foci, the turbo-PEPSI sequence can be used as an alternative to the GRE to assess brain DAI in severe TBI patients, especially if uncooperative and medically unstable.     

Moving incision for covert breast-conserving surgery may prevent early wound complications in brachytherapy-based partial-breast irradiation

PurposeBrachytherapy-based partial-breast irradiation (PBI) is a treatment option for breast-conserving therapy. Although intraoperative catheter implantation has been introduced, early wound complications are a concern. Covert operations with a moving incision are widely performed to hide surgical scars and may reduce the incision-site radiation dose. This study aimed to compare complication rates for moving incision and conventional incision in covert breast-conserving surgery.Methods and MaterialsBetween October 2008 and December 2018, the medical records of all patients who underwent PBI using multicatheter interstitial brachytherapy after breast-conserving surgery were examined. Since July 2016, to hide the scar, we have performed a moving incision from above the tumor to an invisible site at our institution. The planning target volume included 1.0–1.5 cm of tissue surrounding the surgical cavity. High-dose-rate interstitial brachytherapy with a dose of 32 Gy in eight fractions was performed. The cumulative incidences of surgical site infections and symptomatic seromas ≤90 days were analyzed.Results: The study included 516 consecutive patients with 526 lesions. Overall, 40 (7.6%) early wound complications were observed, in which 4 (2.6%) involved 152 moving incisions and 36 (9.6%) involved 374 conventional incisions (p = 0.01). On univariate analysis, age, tumor diameter, re-excision, planning target volume, numbers of catheters and planes, and incision type were risk factors for complications. On multivariate analysis, only incision type was a risk factor. Moving incision reduced the early complication rate by 75% (p = 0.01).ConclusionMoving incision in covert breast-conserving surgery reduced the risk of early wound complications.     

Diagnostic imaging of traumatic brain injury

Traumatic brain injury (TBI)--either in isolation or within the context of multiple trauma--is a major cause of disability and death in young adults. The prognosis depends not only on the extent and localization of traumatic lesions, but also on the promptness of surgical intervention if indicated. The following article presents diagnostic imaging strategies in the acute and sub-acute phases of head injury, discussing their relevance with regard to various clinical situations. In addition to standard CT and MRI techniques, the use of other methods such as perfusion measurements, magnetic resonance spectroscopy or diffusion tensor imaging is briefly discussed. By means of these relatively new techniques it is possible to visualize not only structural changes but also gain information relating to functional and metabolic aspects of traumatic brain injury.     

术中超声检查在判断肺癌可切除性方面的研究

目的 :评估术中超声判断肺癌与肺血管关系的准确性 ,预测肺癌可切除性及术式的准确性。材料和方法 :用CT作对照 ,以手术病理结果为标准 ,采用评分的方法 ,定量描述术中超声判断肿瘤与肺血管关系的准确性 ,及其预测肺癌的可切除性和术式的准确性。结果 :术中超声判断肿瘤与肺血管关系的准确率 ( 81.0 % )要高于CT( 72 .3 % ) ,肿瘤的部位和大小对于判断的准确率有影响 ,右侧肺癌的判断准确率高于左侧 ;平均直径 3～ 5cm肺癌的准确率最高。术中超声判断中心型肺癌可切除的准确率较高 ( 86.7% ) ,预测术式的准确率仅有 63 .3 %。结论 :术中超声有助于判断中心型肺癌与肺血管的关系并预测其可切除性 ,有助于选择正确的术式 ,减少术中意外损伤。     

The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria

Objectives:To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria.Methods:A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared.Results:Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively.Conclusions:CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs.Advances in knowledge:In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.     

Bildgebende Diagnostik bei Schädel-Hirn-Trauma

Traumatic brain injury (TBI) – either in isolation or within the context of multiple trauma – is a major cause of disability and death in young adults. The prognosis depends not only on the extent and localization of traumatic lesions, but also on the promptness of surgical intervention if indicated. The following article presents diagnostic imaging strategies in the acute and sub-acute phases of head injury, discussing their relevance with regard to various clinical situations. In addition to standard CT and MRI techniques, the use of other methods such as perfusion measurements, magnetic resonance spectroscopy or diffusion tensor imaging is briefly discussed. By means of these relatively new techniques it is possible to visualize not only structural changes but also gain information relating to functional and metabolic aspects of traumatic brain injury.     

Contrast agent retention features in contrast-enhanced ultrasound: diagnostic performance for the prediction of papillary thyroid carcinoma

PurposeTo report a new feature of contrast-enhanced ultrasound (CEUS) and its diagnostic performance for the prediction of papillary thyroid carcinoma (PTC).MethodsThis retrospective study was conducted from October 2018 to March 2019, including 276 patients with 308 thyroid nodules who underwent CEUS examinations prior to surgery (90 patients, 122 nodules) or fine needle aspiration (186 patients, 186 nodules). Quantitative analysis of CEUS features was performed using time-intensity curves. After surgery, tissue sections stained with HE and an anti-CD34 primary antibody were used to characterize the cell number and microvessel density. The nodules were divided into retention and non-retention groups.ResultsThere were 168 malignant nodules and 140 benign nodules. The contrast-agent retention (CAR) feature was only observed in 52 papillary carcinomas. The CAR feature showed the sensitivity of 30.9% albeit the high specificity of 100%, for the diagnosis of thyroid cancers. The maximum slope coefficient of the washout index was significantly lower in the retention group than in the non-retention group (P < 0.001). The enhancement intensity during the late stage of enhancement index was significantly higher in the retention group than in the non-retention group (P < 0.001). The cell number and microvessel density in nodules with CAR features were higher (P < 0.001, P = 0.004).ConclusionThe combination of the retention pattern of the CEUS observed herein with other CEUS features may be a useful tool to improve the diagnostic of the PTC.     

Evaluation of hepatocellular carcinoma tumor vascularity using contrast-enhanced ultrasonography as a predictor for local recurrence following radiofrequency ablation

PurposeThe purpose of this study was to evaluate whether the hypervascularity of hepatocellular carcinomas (HCCs) on contrast-enhanced ultrasonography (CEUS) prior to radiofrequency ablation (RFA) is a significant risk factor for local recurrence after RFA.Materials and methodsInstitutional review board approval and informed consent were obtained. Overall, 208 patients (mean age, 71.7 years; range, 50–87 years; 137 men, 71 women) with 282 HCCs treated with RFA were analyzed retrospectively. The mean maximum tumor diameter was 15.7 mm. We compared the abilities of CEUS and contrast-enhanced computed tomography (CECT) to detect hypervascularity in HCCs. We then classified the HCCs into two groups according to the arterial-phase CEUS findings: a “hypervascular group” with whole or partial hypervascular areas within the lesions compared with the surrounding liver parenchyma, and a “non-hypervascular group” with isovascular or hypovascular areas within the lesions. We assessed the cumulative rate of local recurrence after RFA, and we also evaluated the risk factors for local recurrence using a univariate analysis.ResultsThe detection rate for hypervascular HCCs was significantly higher using CEUS (78%, 221/282) than that using CECT (66%, 186/282) (P < 0.001). Using the CEUS findings, the cumulative rate of local recurrence was significantly higher in the hypervascular group (41.2%, 56/221) than in the non-hypervascular group (18.4%, 6/61) (P = 0.007). A univariate analysis revealed that hypervascularity on CEUS was an independent risk factor for local recurrence (P = 0.010).ConclusionHypervascularity in HCCs as observed using CEUS is a significant risk factor for local recurrence after RFA.     

Evaluating the perfusion of occupying lesions of kidney and bladder with contrast-enhanced ultrasound

PurposeTo evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for occupying lesions of kidney and bladder.Materials and MethodsCEUS was performed for a total of 50 kidney and bladder occupying lesions in 47 cases, and CEUS manifestations of these lesions were observed and analyzed. Patterns of dynamic changes in perfusion phases of CEUS were summarized and compared with results of postoperative pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI), and follow-ups.ResultsCEUS results showed that there were 22 cases of malignant renal tumors, 11 cases of benign lesions, two cases of renal column hypertrophy, and 12 cases of malignant bladder tumors (15 lesions). Renal cell carcinoma exhibited various CEUS manifestation, with the majority showing fast filling and hyper-enhancement. CEUS manifestation of renal hamartoma was characterized by slow filling and slow outflow. Renal cystic lesions always exhibited no enhancement within the cysts. Renal column hypertrophy exhibited the same enhancement pattern as the renal cortex. CEUS manifestation of bladder carcinoma was mainly characterized by quick filling, quick outflow, and hyperenhancement.ConclusionsCEUS offers real-time observation of perfusion in occupying lesions of kidney and bladder, but the enhancement pattern of kidney occupying lesions was complex; therefore, combination of enhanced CT, MRI, and CEUS may be necessary.     

高压氧干预对大鼠创伤性脑损伤后脑组织NF-κB（p50）表达的影响

目的 观察高压氧干预（hyperbaric oxygenation treatment,HBOT）对大鼠创伤性脑损伤（traumatic brain injury,TBI）后NF-κB（p50）表达的影响,并探讨其机制。方法 将35只SD大鼠完全随机分为假手术对照组（Con组）5只、创伤组（TBI）15只、高压氧干预组（HBOT）15只。采用Allen’s改良法制造大鼠自由落体重型脑损伤模型,Con组仅切开头皮去骨窗,TBI组给予撞击损伤,HBOT组于创伤后给予高压氧治疗。利用Western-blot法分别于伤后8 h及1、3、5、8 d检测脑组织NF-κB的表达。结果 与Con组比,TBI组各时点脑组织NF-κB表达均升高（P〈0.05）,损伤后3 d达高峰（0.7267±0.0305）,5~8 d仍维持较高水平（0.5567±0.0603）。HBOT组各时点NF-κB表达水平均较TBI组下降（P〈0.05）。结论 高压氧干预可以减弱创伤后脑组织NF-κB（p50）表达,有效抑制炎性反应,为重型颅脑损伤治疗提供理论基础。     

MR-based brain and cerebrospinal fluid measurement after traumatic brain injury: correlation with neuropsychological outcome.

PURPOSETo determine the magnitude and time course of changes in the volume of brain and intracranial cerebrospinal fluid (CSF) spaces in patients who have sustained traumatic brain injury and to assess the relationship between these findings and long-term cognitive traumatic outcome.METHODSAxial intermediate and T2-weighted MR images of 123 patients with traumatic brain injury were quantified using a multispectral segmentation algorithm. Measurements were corrected for differences in age, sex, and head size using a previously reported normative database. Brain morphology was compared across groups formed on the basis of chronicity of injury. Cognitive functioning and severity of injury were statistically correlated with brain measurements.RESULTSTime-dependent expansion of CSF spaces and decreases in brain volume were observed. Increases in ventricular CSF volume, particularly in the temporal horns and third ventricle, preceded subsequent changes in total brain and subarachnoid CSF. High and moderate correlation was observed between volume measures and cognitive outcome and injury severity. Particularly strong was the relation between the volume of the left temporal horn and verbal IQ scores.CONCLUSIONPredictable time-dependent atrophic changes occurring after traumatic brain injury can be quantified using MR volumetric studies. Our results suggest significant contributions by both diffuse and focal mechanisms of injury. In the postacute period (more than 70 days after injury), MR volumetric studies may be predictive of eventual cognitive outcome.