肺动脉不参与肺癌供血--实验和DSA研究

目的 研究肺动脉是否参与肺癌的血供及肺动脉在肺癌中的形态学和血流状况的改变。方法 用２种颜色的硅酮灌注３３只大白鼠肺鳞癌模型的支气管动脉和肺动脉,在手术显微镜下整体和立体地观察肺癌的血供来源和肺动脉的形态改变。２８例肺癌患者同时行支气管动脉和肺动脉的数三影血管造影检查。结果 肺癌大鼠和患者所有的肺动脉在肺癌区域减少、缩小、消失,肺动脉不形成肿瘤血管。肺癌所在区域内、肺动脉血流以段和叶为单位灌注不足     

支气管动脉和肺动脉多层螺旋CT血管造影对肺癌血供的研究

目的 用支气管动脉(BA)和肺动脉(PA)多层螺旋CT血管造影(BA—MSCTA和PA—MSCTA)的方法进一步研究肺癌血供。方法 对16例原发性肺癌患者分别行支气管动脉和肺动脉数字减影血管造影(BA—DSA和PA—DSA)后，留置导管行PA—MSCTA和BA—MSCTA，判定支气管动脉和肺动脉对肺癌的血供。结果 PA—MSCTA和PA-DSA上均未见明确的肺动脉供应肿瘤，也未见肿瘤内部和边缘有肿瘤血管和肿瘤染色。BA—DSA和BA—MSCTA上均可见肿瘤内部杂乱无章的肿瘤血管影，以及对比剂进入肿块内部。PA—MSCTA清晰显示肿块内部及其与肺动脉的关系。BA—MSCTA上5例可见肿瘤内血管和对比剂部分缺损，7例可见肺门和(或)纵隔淋巴结染色，其中BA-DSA上有肺门和(或)纵隔淋巴结染色的4例中，3例染色的淋巴结个数增多。结论 MSCTA是研究肺癌血供的较好方法，该研究再次证明肺动脉不参与原发性肺癌的血供，但应注意多支体循环供血的可能。     

肺癌的肺动脉供血初步探讨

目的：对肺癌的肺动脉供血进行临床研究。材料和方法：对４３例支气管肺癌进行选择性肺动脉ＤＳＡ，并对其结果进行回顾性分析。结果：肺癌表现为血管结构异常和肿瘤染色。其肿瘤染色范围／肿瘤面积＞５０％者３１例，占７２％，肿瘤染色范围／肿瘤面积＜３０％仅４例，占９％。结论：作者认为：１肺动脉参与肺癌的供血，并且是主要供血动脉之一；２供血情况与肿瘤侵犯肺动脉程度有关；３肺动脉ＤＳＡ对肺癌诊疗很有帮助。     

晚期肝癌变异性、寄生性供血的基础研究

目的：探讨中、晚期肝癌变异、寄生性供血的产生机理。材料和方法：本研究收集TAE治疗资料完整的中、晚期肝癌340例，对其血管造影表现进行分析。结果：变异供血93例（占27．4％）；寄生供血99例（占29．1％）；变异合并寄生供血12例（占3．55）。结论：肝癌寄生性动脉供血的发生与肿瘤的大小有关（P＜0．01）。与肿瘤生长部位有关；变异供血因早期胚胎异常所致。     

肺癌血供的影像学研究进展

哺乳动物细胞的存活和生长需要氧气和营养物质,这就要求细胞的分布在血液供应的100～200μm（氧气扩散能力的高限）范围内,而肺癌的生长远超于此,因此,肺癌的生长与转移需要额外的血液供应。一方面,肺癌产生促进血管生长的细胞因子主要是血管内皮生长因子（VEGF）促进肿瘤新生血管的形成;另一方面,肺癌结节可包裹、扩张或破坏瘤内血管,也可推移或牵拉瘤周血管。     

肺部慢性炎症与原发性肺癌供血动脉CTA表现的影像比较

目的 探讨肺部慢性炎症与原发性肺癌供血动脉CT血管成像(CTA)表现差异及其鉴别诊断价值.资料与方法 搜集81例行64层螺旋CT胸部增强扫描,支气管动脉清晰显示的病例,包括原发性支气管肺癌38例,慢性炎症(含支气管扩张)21例,肺癌合并支气管扩张2例及正常对照20例,全部病例均采用容积显示(VR)、多平面重组(MPR)及最大密度投影(MIP)对支气管动脉等供血动脉行三维重组,测量支气管动脉内径并计算肺癌组与慢性炎症组肺外体循环动脉供血率,比较3组支气管动脉内径及肺癌组与慢性炎症组肺外体循环动脉供血率有无差异(2例肺癌合并支气管扩张者不纳入统计).结果 肺癌组38例中,支气管动脉内径平均值为1.87 mm,18.42%(7例)伴有肺外体循环动脉供血;慢性炎症组21例中,支气管动脉内径平均值为2.54 mm,47.62%(10例)伴有肺外体循环动脉供血;正常对照组20例中,支气管动脉内径平均值为1.49 mm,3组支气管动脉内径、肺癌组与慢性炎症组肺外体循环动脉供血率差异均有统计学意义(P<0.05).结论 肺癌与慢性炎症时支气管动脉均有扩张,慢性炎症时支气管动脉扩张较原发性肺癌更为明显,更能刺激肺外体循环动脉参与供血,两者供血动脉的CTA表现在相关鉴别诊断中有一定价值.     

前列腺供血动脉的来源及临床意义

目的观察DSA下前列腺供血动脉的来源,为动脉栓塞治疗前列腺增生提供参考。方法对72例选择性及超选择性插管成功病例,进行前列腺供血动脉造影,观察并记录前列腺供血动脉的来源、个数、优势供血动脉。结果前列腺供血动脉复杂(72例,共237支供血动脉),常有数支动脉同时参与供血,主要的起源动脉和个数为:膀胱下动脉69支、髂内动脉63支、阴部内动脉52支、直肠下动脉29支、膀胱上动脉14支。优势供血动脉63支,主要来源为:髂内动脉3支、膀胱下动脉20支、阴部内动脉6支和直肠下动脉2支。结论动脉造影检查可对前列腺供血动脉的来源和优势供血动脉作出正确判断,对指导介入栓塞治疗具有重要的临床意义。     

动脉CT血管造影对肺转移瘤的血供研究

目的　用支气管动脉 (BA)和肺动脉 (PA)CT血管造影 (BA CTA和PA CTA)的方法研究肺转移瘤血供。方法　对 1 5例肺转移瘤患者分别行BA和PA数字减影血管造影 (BA DSA和PA DSA)后 ,留置导管行多层螺旋CT的PA CTA和BA CTA ,判定BA和PA对肺转移瘤的血供。结果　 1 5例患者共 33个结节在BA DSA上 2 2个结节可见支气管动脉肿瘤染色 ,1 1个结节未见肿瘤血管或染色。PA DSA均未见肿瘤染色。PA CTA上肺动脉参与供血的 1 6个结节和未参与供血的 1 7个结节离胸壁最短距离差异有统计学意义 (t=3 32 ,P <0 0 5 ) ;而结节直径间差异无统计学意义 (t=1 1 3,P>0 0 5 )。BA CTA上支气管动脉参与供血的 2 7个结节和未参与供血的 6个结节离胸壁最短距离差异有统计学意义 (t=3 95 ,P <0 0 1 ) ;而结节直径间差异无统计学意义 (t=1 2 7,P >0 0 5 )。结论　BA仍是肺转移瘤的主要供血动脉 ,PA仅部分参与周围肺转移结节的血供。     

多排CT血管造影对肺癌支气管动脉灌注化疗的指导意义初探

目的探讨术前胸部CT血管造影对经支气管动脉治疗肺癌的指导意义。方法回顾性分析20例原发性肺癌患者,术前均行胸部16排螺旋CT血管造影(CTA),在轴位图(Ax)基础上行多平面重建(MPR)、容积再现(VR)及最大密度投影(MIP),重建供应肺癌的支气管动脉及其他体循环动脉,并以此为参照,在DSA下对患者行支气管动脉化疗灌注栓塞,术中记录寻找到的支气管动脉及非支气管动脉体循环动脉数目。结果胸部CTA共发现34支动脉参与肺癌供血,包括支气管动脉27支(其中异位于右锁骨下动脉的支气管动脉1支)、肋间动脉3支、内乳动脉和膈下动脉各2支。34支动脉均在介入治疗中顺利插管并证实为肺癌供血动脉,DSA造影还发现在CTA上未发现的患侧3支支气管动脉不参与肿瘤供血。结论多排螺旋CT血管造影可显示肺癌的供养血管(包括支气管动脉和非支气管体循环供血动脉)及其走行情况,有助于经支气管动脉介入治疗。     

多层螺旋CT灌注成像在肺癌放射治疗中的研究

目的 通过多层螺旋CT灌注成像对肺癌放疗前和放疗中血流灌注特点的研究,探讨CT灌注成像技术在肺癌放疗中的实用性。方法 对符合入组条件放疗的51例肺癌患者行CT灌注扫描,其中,22例于放疗前、放疗中,29例于放疗前进行CT灌注扫描。在静脉团注对比剂后采用电影扫描方式,快速动态扫描,选定CT平扫所示肿瘤最大层面灌注。在CT灌注原始图的相应部位画出感兴趣区,记录血容量(BV)、血流量(BF)、平均通过时间(MTT)、表面通透性(PS),并于治疗结束后2~4周复查CT,评价近期疗效。结果 51例患者放疗前平均血容量为13.6 ml/100 g, 血流量129.5 ml ·min^-1 ·100 g^-1,MTT 9.1 s, PS 10.0 ml ·min^-1 ·100 g^-1。22例患者放疗前和放疗中灌注CT的血容量分别为11.2和7.6 ml/100 g(t=1.28, P>0.05), 血流量分别为108.7和97.8 ml ·min^-1 ·100 g^-1(t=0.40, P>0.05),MTT分别为7.2和8.9 s (t=-1.15, P>0.05),PS分别为6.8和7.8 ml ·min^-1 ·100 g^-1(t=-0.57, P>0.05),肿瘤面积分别为1920.3和1189.6 mm²(t=3.98, P<0.05)。小细胞肺癌和非小细胞肺癌患者放疗前MTT分别为12.9和6.5 s(t=2.54, P<0.05)。肿瘤面积≤10 cm²与>10 cm²患者的MTT分别为11.2和5.8 s(t=2.59, P<0.05)。近期疗效缓解与未缓解患者的血容量分别为19.2和4.6 ml/100 g(t=3.62, P<0.05 )。疾病无进展生存期≤10个月与>10个月患者的灌注参数差异无统计学意义。结论 CT灌注对于肺癌的诊断及治疗具有一定的帮助,应进一步深入研究。     

病灶内支气管动脉形态在肺癌诊断中的价值

目的：利用 MSCT探讨病灶内支气管动脉形态特征在肺部疾病中的诊断的价值。方法：回顾性分析193例病灶累及肺段及以上的胸部CT增强扫描病例,其中肺癌组124例,炎性对照组69例。将原始图像行容积再现（VR）、多平面重组（MPR）和最大密度投影（MIP）后处理。由两位有5年以上工作经验的放射医师共同评价支气管动脉形态特征。用χ2检验分析支气管动脉形态特征在肺癌组与对照组中的差异。结果：193例中,109例可见病灶内BA,其中肺癌组80例,对照组29例。肺癌组BA中断19例,迂曲52例,成团22例,血管湖29例;对照组BA 中断3例,迂曲36例,成团2例,血管湖0例。肺癌组成团和血管湖征象高于对照组（P＝0．034,0．000）。结论：CTA能清楚显示肺部病灶内BA形态,血管征象对肺癌诊断与鉴别诊断有一定参考意义。     

Comparison of coronal and axial computed tomography measurements of mediastinal nodes before primary surgery for non-small cell lung cancer

Objective

To assess computed tomography (CT) evaluation of mediastinal nodes in non-small cell lung cancer to predict metastatic involvement by measurement of their axis and surface area in the coronal plane, as compared to standard short-axis measures in the axial plane.

Methods

Evaluation of mediastinal nodes was retrospectively performed on CT scans of 100 patients before thoracotomy. In all patients, mediastinal dissection was performed in the appropriate stations (n = 264) according to the side (59 right, 41 left) of the tumor. Measurements of short axis and surface area of the largest node in each dissected station were performed on axial and coronal planes.

Results

By using the standard threshold of axial short axis ≥10 mm, sensitivity and specificity were 25% and 98%, respectively. Areas under receiver operating characteristic curves were 0.828 and 0.821 for axial short axis and axial surface area data. For comparison, areas under receiver operating characteristic curves were 0.843 and 0.845 for coronal short axis and coronal surface area data, respectively. So, for a specificity of 98%, sensitivity was 29% for coronal short axis ≥11 mm and 33% for coronal surface area ≥123 mm². When using axial short axis ≥10 mm or coronal surface area ≥120 mm², sensitivity was 45%, whereas specificity remained at 96%.

Conclusion

Coronal measurements of mediastinal nodes give a slightly albeit non-significant improvement of diagnostic accuracy over axial ones. If both axial short axis and coronal surface area are taken into account, accuracy is improved.     

Radiomics and its emerging role in lung cancer research,imaging biomarkers and clinical management: State of the art

With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art.     

CT-guided cutting needle biopsy of lung lesions--an effective procedure for adequate material and specific diagnose

Objective

Computed guided percutaneous biopsy of lung lesions is widely accepted as an effective and safe procedure for specific diagnose. The purpose of this study is to present the experience of an oncology center in the use of computed tomography (CT)-guided cutting needle biopsy as an effective procedure for adequate material and specific diagnose of lung lesions.

Subjects and methods

This study reports a retrospective analysis of 94 consecutive patients admitted in an oncologic center, reference in Brazil (Hospital do Câncer—AC Camargo), between 1996 and 2004, who were submitted to 97 CT guided cutting needle biopsy of pulmonary lesions. Informations of material adequacy and specific diagnose were studied.

Results

In a total of 97 biopsies of lung lesions, 94 (96.9%) supplied adequate material for histological analyses with 71 (73.2%) as malignant lesions and 23 (23.7%) diagnosed as benign lesions and in 3 biopsies the material supplied was inadequate. The frequency of specific diagnosis was higher in both malignant and benign lesions with 63 (88.7%) cases and 20 (86.7%) cases respectively.

Conclusions

CT-guided cutting needle biopsy is an effective procedure for adequate material and specific diagnostic for malignant and benign lung lesions.     

CT引导下125I粒子联合氟尿嘧啶植入剂治疗老年肺癌的临床应用

肺癌现在已经成为世界上最常见的恶性肿瘤,老年患者中,因其临床症状不典型,发现时多已为中晚期,传统的治疗方法都有很大的局限性。CT引导下125I粒子源联合氟尿嘧啶植入剂治疗肺癌是近年来迅速发展起来的交叉学科,它能充分发挥CT的优势,在提高肿瘤控制率的同时,最大限度的减小了对机体的损伤,弥补了传统治疗方法的不足,具有广阔的临床应用前景。     

Hepatic steatosis in participants in a program of low-dose CT screening for lung cancer

ObjectiveDetermine the frequency of moderate-to-severe hepatic steatosis (HS) in asymptomatic participants in a low-dose CT (LDCT) screening program for lung cancer, to identify risk factors, and develop recommendations.MethodsBaseline LDCT scans of the chest of 170 participants in an IRB-approved study between August 2011 and April 2016 were reviewed. Demographic variables, comorbidities, and liver function tests were documented. Hepatic and splenic attenuation values hounsfield unit (HU) were measured. Regression analyses were performed.ResultsAverage liver attenuation was 57.6 HU (standard deviation (SD) 9.3) and average liver/spleen (L/S) ratio was 1.3 (SD 0.3). Liver attenuation was <40 HU for 9 (5.3%), liver/spleen (L/S) ratio <0.8 for 6 (3.5%), and either <40 HU or L/S ratio <0.8 for 9 (5.3%). Male sex (p = 0.004), diabetes (p = 0.0005), emphysema (p = 0.03), and high BMI (p = 0.0006) were significant predictors of HS. Aspartate aminotransferase (p = 0.0018) and alanine aminotransferase (p = 0.012) were negatively correlated with liver attenuation. Reduced serum levels of alpha-1-antitrypsin may be a common factor of emphysema and HS.ConclusionLDCT can detect HS in asymptomatic participants with frequencies similar to previous reports. If liver attenuation is below 40 HU and/or L/S ratio below 0.8, further evaluation of HS to the primary care physician or liver specialist is recommended.     

A single-centre experience of implementing a rapid CXR reporting and CT access pathway for suspected lung cancer: Initial outcomes

IntroductionLung cancer remains a major cause of preventable death and early diagnosis is critical to improving survival chances. The chest X-ray (CXR) remains the most common initial investigation, but clinical pathways need to support timely diagnosis through, where necessary, escalation of abnormal findings to ensure priority reporting and early CT scan.MethodsThis single-centre study included a retrospective evaluation of a rapid lung cancer CXR pathway in its first year of operation (May 2018–April 2019). The pathway was initially designed for primary care referrals but could also be used for any CXR demonstrating abnormal findings. A parallel cross-sectional survey of radiographers explored their understanding, adherence and concerns regarding their role in the pathway operation.ResultsPrimary care referrals on the rapid diagnostic pathway were low (n = 51/21,980; 0.2%), with 11 (21.6%) requiring a CT scan. A further 333 primary care CXR were escalated by the examining radiographer, with 100 (30.0%) undergoing a CT scan. Overall, 64 of the CT scans (57.7%) were abnormal or demonstrated suspicious findings warranting further investigation. There were 39 confirmed primary lung carcinomas, most with advanced disease. Survey responses showed that most radiographers were familiar with the pathway but some expressed concerns regarding their responsibilities and limited knowledge of CXR pathologies.ConclusionThis baseline evaluation of the rapid lung cancer pathway demonstrated poor referral rates from primary care and identified the need for improved engagement. Radiographer escalation of abnormal findings is an effective adjunct but underlines the need for appropriate awareness, training, and ongoing support.Implications for practiceEngagement of the multiprofessional team is critical in new pathway implementation. Rapid diagnostic pathways can enable early diagnosis and the radiographer has a key role to play in their success.     

Evaluation of the treatment response of lung cancer with positron emission tomography and l-[methyl-11C]methionine: a preliminary study

We carried out a study to evaluate treatment response and residual mass in lung cancer with positron emission tomography (PET), using l-[methyl-¹¹C]methionine (MET). MET tumour uptake and tumour volume measured by computed tomography (CT) before and within 2 weeks after radiotherapy or chemoradiotherapy were compared in 43 studies of 21 patients. Ten patients with local control (no recurrence) of tumour showed a larger decrease in MET uptake (65.2%±12.2%) than in tumour volume (50.8%±9.6%, P<0.01). Five patients with early recurrence (from 1 to 4 months) showed smaller decreases in both MET uptake (22.2%±13.5%) and tumour volume (28.6%±20.0%) than those in the no-recurrence group (P<0.01). Four patients with late recurrence (after 11 months or more) showed a similar decrease to the no-recurrence group in MET uptake (72.8%±14.8%) but little change in tumour volume (18.5%±19.0%), the latter result corresponding to that in the early-recurrence group. Using tumour volume only, the no-recurrence group was differentiated from both the early- and the late-recurrence group (P < 0.01), but the early-recurrence group was not differentiated from the late-recurrence group. Using the MET uptake data, the early-recurrence group was clearly distinguished from the late-recurrence group (P<0.01), but the late-recurrence group was indistinguishable from the no-recurrence group. CT was useful in distinguishing the no-recurrence group from the groups in which there was ultimate recurrence, whether early or late. When a residual mass is seen on CT, PET seems to be helpful in evaluating tumour viability. Correspondence to: K. Kubota     

肝癌动脉血供变异在介入治疗中的意义

目的:探讨肝癌动脉血供变异在经动脉导管化疗栓塞术中的临床意义。方法:前瞻性研究分析我院2006年全年共220例(330次)肝癌动脉血管造影及介入治疗资料。结果:220例中171例(77.7%)为典型腹腔动脉-肝总动脉供血。肝动脉解剖变异29例(13.2%,29/220),其中肝总动脉变异2例,肝右动脉变异23例,变异的肝右动脉或副肝右动脉有22例起源于肠系膜上动脉(75.9%,22/29),肝左动脉变异2例,肝左动脉和肝右动脉同时变异2例。20例(9.1%,20/220)在初次或重复介入治疗中发现存在寄生性供血动脉,其中起源于右膈下动脉10例,肠系膜上动脉、胃左动脉、网膜动脉及脾动脉各2例,左膈下动脉及右肋间动脉各1例。肝外侧支供血动脉的存在与病灶大小、位置及介入治疗次数之间显著相关。结论:认识肝癌动脉血供变异有助于提高经动脉导管栓塞成功率及介入治疗疗效。