成人胶质母细胞瘤的测量:容积测量与线性测量方法的比较

目的用线性测量方法还是容积测量方法评价治疗前后肿瘤大小的变化尚无定论。本研究对比分析两种方法在评价脑胶质母细胞瘤（GBM）治疗反应方面的价值。方法分别用线性和容积测量方法测量30例成人GBM的112次增强后T1WI上肿瘤大小,比较两种方法所得肿瘤大小之间的关系,并根据肿瘤变化情况将其配成56对,分别用两种测量方式对肿瘤缓解进行评价。结果线性和容积测量方法所测得的肿瘤大小间有明显相关性（P〈0.001）。当比较56对肿瘤大小百分比变化时,相关性稍为降低（P〈0.001）。根据肿瘤变化的百分比,按传统的肿瘤缓解标准而分为完全缓解、部分缓解、疾病稳定、疾病进展等四类,两种方法所得的肿瘤缓解在56对中45对一致,无显著性差异。当进一步对两种方法评价不一致的11对进行分析时,结果提示8例容积方法较为准确,3例线性方法较为准确。结论容积测量在评价一些特殊表现的肿瘤灶时更为准确。     

乳头状胶质神经元肿瘤1例

运用无创性手段对心源性猝死（SCD）高危人群进行早期识别,从而规避危险因子、及早实施有效干预,进而减低猝死发生率,具有十分重要的意义。放射性核素显像可通过SPECT或PET技术进行心肌血流灌注、心肌糖代谢或脂肪酸代谢、心脏交感神经活性分布显像,为预测包括心脏猝死在内的心脏事件发生、识别高危人群、筛选植入式心脏复律除颤器适应证提供了无创性影像学诊断和评价方法,其中以¹²³I-MIBG心脏交感神经活性分布单光子显像的研究和应用最为深入广泛,本研究对此进行综述。     

常规MRI与弥散加权成像测量的肿瘤容积对直肠癌TN分期的诊断价值

目的探讨常规MRI与弥散加权成像(DWI)测量的肿瘤容积对直肠癌TN分期的诊断价值。材料与方法对经肠镜确诊的74例直肠癌患者行盆腔3.0 T MRI检査。分析MRI对直肠癌术前TN分期的准确性,用检验评价MRI术前TN分期与病理分期的一致性。用单因素方差分析评价DWI(b=10000 s/mm~2)测量的肿瘤容积与病理TN分期的相关性。结果MRI诊断直肠癌T、N分期的准确率分别为87.8%(66/74)、66.2%(49/74);病理学和MRI对T分期诊断有较好的一致性(Kappa=0.78,P=0.000)、对N分期诊断一致性较差(Kappa=0.33,F=0.000)。在DWI上测量肿瘤容积≤T2期、T3期、T4期分别为(4145.13±718,00)mm~3、(14939.73±3591.38)mm~3、(22714.76±4251.71)mm~3;N0期、N1期、N2期分别为(14367.15±6425.83)mm~3,(17967.69±5259.88)mm~3、(19464.00±3588.77)DWI测肿瘤容积越大直肠癌T分期越高,差异有统计学意义(F=75.189,P=0.000);肿瘤容积与直肠癌不同N分期间差异有统计学意义(F=3.545,P=0.034)。结论MRI评价直肠癌T分期准确率较高,对N分期也有一定诊断价值。MR肿瘤容积测量对直肠癌TN分期有重要参考价值。     

基于T1增强最大层面直方图分析在胶质肉瘤与胶质母细胞瘤之间的鉴别价值

目的:研究增强MRI直方分析在胶质肉瘤、胶质母细胞瘤这两种肿瘤最大层面之间的鉴别诊断价值。方法:回顾性研究了35例胶质母细胞瘤与30例胶质肉瘤患者,分别在各组MR增强轴位图像上每一层肿瘤层面用Mazda软件勾画感兴趣区并进行灰度直方图分析,分别对获得的两组直方图参数特征进行统计学分析,比较各参数之间的统计学意义。结果:通过灰度全域直方图分析得到的9个参数中,其中偏度和峰度在两组间的差异有统计学意义(P均<0.05),其余7个参数均值、变异度、第1百分位数、第10百分位数、第50百分位数、第90百分位数及第99百分位数这7个参数没有有统计学意义(P均>0.05)。结论:最大层面DCE-MRI直方分析对胶质母细胞瘤和胶质肉瘤具有鉴别价值。     

MRI在胶质母细胞瘤患者预后的应用进展

胶质母细胞瘤是最常见的颅内原发恶性肿瘤,主要是由星形胶质细胞分化的恶性程度最高的肿瘤。胶质母细胞瘤患者的治疗复杂、致残率高、生存率低、平均生存期短等都是临床工作中遇到的困难,而患者的预后及生存率与诸多因素相关。MRI对于临床制定GBM治疗方案提供了客观依据,对于术前最初形态的分析测量,以及肿瘤对治疗敏感度的监测和分析得到了各界学者的肯定。MRI在预测胶质母细胞瘤患者预后方面,可利用不同的MRI序列通过肿瘤患者的肿瘤范围、水肿坏死程度等指标评估患者肿瘤因素并结合临床综合对患者的生存期做出预测,并对患者治疗后的情况做出预测。     

合成磁共振成像在肿瘤诊断中的应用价值

合成磁共振成像(SyMRI)是一种全新的定量磁共振技术,一次扫描即可得到多种对比度加权图像,同时可量化组织的弛豫时间和质子密度。近年来,不断有关于SyMRI在前列腺、乳腺、直肠等肿瘤诊断中的应用报道。该文简要介绍SyMRI的基本原理及优缺点,综述其在肿瘤诊断、鉴别诊断及预后评估中的应用价值,并展望SyMRI在肿瘤诊断中的进一步广泛应用。     

磁共振功能成像在肿瘤非手术治疗早期疗效评价中的应用

随着非手术抗肿瘤治疗技术的发展，传统的评定治疗效果的方法显出很大不足。MRI的发展提供了明显超前于形态学变化的监测手段。本文介绍磁共振功能成像在肿瘤非手术治疗早期疗效监测中的应用及进展。     

T2WI直方图鉴别诊断脑胶质母细胞瘤与单发转移瘤的价值

目的 探讨T2WI直方图鉴别诊断胶质母细胞瘤（GBM）与单发转移瘤瘤体中的价值。方法 回顾性分析经手术病理确诊的GBM和单发转移瘤患者103例,其中GBM组57例,单发转移瘤组46例。所有患者术前均接受MR检查（T1WI、T2WI、T2-FLAIR和增强后T1WI）。采用Image J软件于肿瘤最大层面手动勾画瘤体边界,计算直方图相关参数,包括均数、标准差、中位数、峰度值和偏度值。采用独立样本t检验比较GBM与脑单发转移瘤的直方图各参数,评价差异有统计学意义参数的诊断效能。结果 GBM组的均数、标准差及中位数均高于单发转移瘤组,差异有统计学意义（P均< 0.05）。均数、标准差及中位数的ROC曲线下面积分别为0.772[95% CI （0.681,0.862）,P<0.001]、0.719[95% CI （0.616,0.822）,P<0.001]和0.767[95% CI （0.674,0.860）,P<0.001]。以均数临界值为509.575,鉴别两种病变的敏感度为0.719,特异度为0.783;以标准差临界值为58.844,鉴别两种病变的敏感度为0.702,特异度为0.652;以中位数临界值为550.500,鉴别两种病变的敏感度为0.719,特异度为0.826。结论 肿瘤瘤体T2WI直方图均数、标准差和中位数均可用于GBM和脑单发转移瘤的鉴别,其中以均数的鉴别诊断效能最佳。     

MR纹理分析鉴别诊断脑胶质母细胞瘤和单发转移瘤的价值

目的 探讨MR纹理分析鉴别脑胶质母细胞瘤和单发转移瘤的价值。方法 收集我院病理或临床证实为脑胶质母细胞瘤患者35例、脑单发转移瘤患者40例。所有患者均接受常规MR平扫及增强检查,包括T1 FLAIR、T2WI、T2 FLAIR、DWI及增强T1WI。采用MaZda软件于DWI及增强T1WI序列最大层面上手动勾画肿瘤ROI,提取病变的纹理特征。结果 脑胶质母细胞瘤和单发转移瘤的直方图纹理参数中增强T1WI的偏度,灰度共生矩阵参数中增强T1WI自相关、均值,DWI自关性差异有统计学意义。基于这些纹理参数构建多变量Logistic回归分析显示该模型的ROC曲线下面积为0.834。结论 纹理分析为鉴别脑胶质母细胞瘤和单发转移瘤,提供可靠、可以量化的客观依据。     

表观扩散系数在诊断小脑原发肿瘤的应用价值

目的：表观扩散系数（Apparent diffusion coemcient，ADC）能反映肿瘤细胞的微观状态，本文探讨其对小脑原发肿瘤的诊断价值。方法：对44例经手术病理证实的小脑原发肿瘤的MRI资料进行回顾性分析，包括11例血管母细胞瘤，12例毛细胞型星形细胞瘤，11例髓母细胞瘤，6例室管膜瘤，2例淋巴瘤，2例脉络丛乳头状瘤。全部病例均行MRI常规扫描，弥散加权成像（Diffusion-weighted imaging，DWI）及ADC值测量，对前4种肿瘤的绝对ADC值、相对ADC值在Stata9．0上进行单因素方差分析及Bonferronitt检验。结果：不同肿瘤间的绝对ADC值及相对ADC值均有差异（P〈0．001），血管母细胞瘤的ADC值【（1．97±0．214）×10^-3mm^2/s）】要明显高于毛细胞型星形细胞瘤【（1．643±0．223）×10^-3mm^2／s]（P=0．001），髓母细胞瘤的ADC值【（0．698±0．124）×10^-3mm^2/s】明显低于室管膜瘤【（1．062±0．148）×10^-3mm2／s】（P=0．003），毛细胞型星形细胞瘤则明显高于室管膜瘤（P〈0．001）；脉络丛乳头状瘤亦有较高的ADC值，而淋巴瘤有较低的ADC值。在髓母细胞瘤、室管膜瘤、毛细胞型星形细胞瘤及血管母细胞瘤这4种肿瘤中，取〈0．8×10^-3mm^2/s、（0．9-1．2）×10^-3mm^2／s、（1.3-1．7）×10^-3mm^2/s、〉2．1×10^-3mm^2／s分别作为上述肿瘤的ADC值的界值时，可获得100％的特异性。结论：ADC值是诊断小脑肿瘤的简便而实用的工具。     

Volumetric intravascular ultrasound measurements in coronary arteries

Editorial Commentary

Volumetric intravascular ultrasound measurements in coronary artries     

Perfusion CT measurements predict tumor response in rectal carcinoma

Abdominal Radiology - To evaluate the capacity of perfusion CT imaging to distinguish between complete and incomplete responders after neoadjuvant chemoradiation therapy for rectal carcinoma, with...     

Volumetric measurements of peripheral oedema in clinical conditions

Water‐displacement volumetry can be used for quantifying the volume of the leg. However, not much is known about its application in patients with peripheral oedema of cardiopulmonary origin. We measured the reproducibility of a water‐displacement apparatus with a solid object and in ten non‐oedematous clinical patients (group A). The day‐to‐day variability of the leg volume was assessed in the same group. The diurnal variability was assessed in ten patients with persisting peripheral oedema (group B). The effect of treatment on the severity of peripheral oedema was evaluated in another nine patients with peripheral oedema, who were in need of diuretic treatment (group C). Volumetric results were compared to the ankle circumference method and the body weight method. The coefficient of variation was 0·16% in the fixed object and 0·47% in group A. The day‐to‐day variability was 1·52% after 1 day and 1·76% after a mean interval of 4·8 days. In group B, leg volume and circumference increased during the day (5·9%, P<0·001, and 2·4%, P<0·01, respectively), while body weight remained unchanged. In group C, leg volume, circumference and body weight decreased significantly after treatment (13·1%, P<0·01, 7·1%, P<0·05, and 5·9%, P<0·05). The correlation between the changes in volume and body weight was poor (r=0·37, P=0·33). In conclusion, (1) water‐displacement volumetry is highly reproducible, (2) a diurnal variability of peripheral oedema was found, and (3) volumetry is a suitable tool for monitoring peripheral oedema, while the body weight method appears to be less accurate.     

Volumetric tumor delineation and assessment of its early response to radiotherapy with optical coherence tomography

Texture analyses of optical coherence tomography (OCT) images have shown initial promise for differentiation of normal and tumor tissues. This work develops a fully automatic volumetric tumor delineation technique employing quantitative OCT image speckle analysis based on Gamma distribution fits. We test its performance in-vivo using immunodeficient mice with dorsal skin window chambers and subcutaneously grown tumor models. Tumor boundaries detection is confirmed using epi-fluorescence microscopy, combined photoacoustic-ultrasound imaging, and histology. Pilot animal study of tumor response to radiotherapy demonstrates high accuracy, objective nature, novelty of the proposed method in the volumetric separation of tumor and normal tissues, and the sensitivity of the fitting parameters to radiation-induced tissue changes. Overall, the developed methodology enables hitherto impossible longitudinal studies for detecting subtle tissue alterations stemming from therapeutic insult.     

Volumetric interstitial hyperthermia: nursing implications for brain tumor treatment

Malignant glioma is a devastating disease which presents a clinical challenge to physicians and neuroscience nurses. It carries a dismal prognosis, with a median survival of only nine months following application of conventional therapies of surgical resection, radiotherapy and chemotherapy. Hyperthermia is the application of sufficient heat to raise the temperature in a volume of tumor to cytocidal levels. Patient tolerance and response to volumetric interstitial hyperthermia treatment in this clinical study of over 40 patients has been extremely encouraging. Hyperthermia, as part of multi-modality treatment of brain tumors, presents a change in the nursing management of this patient population. The neuroscience nurse plays a crucial role in linking clinical observations to decisions of patient management and treatment planning. Because hyperthermia is a new treatment modality, nurses, patients and families require additional education and extended support during therapy.     

Interferences in current methods for measurements of creatinine

We measured the interference of carbonyl compounds, drugs, and other substances in human serum on the determination of creatinine by the two-point, fixed-time kinetic modification of the Jaffé reaction as well as by four enzymatic methods. We added known concentrations of the interfering substances to a solution of creatinine in water. For bilirubin, we used both pooled normal sera with added bilirubin and icteric patient sera. The magnitude of interferences varies widely from method to method. Carbonyl compounds, dopamine, cephalosporines, and bilirubin interfere with the Jaffé reaction. Bilirubin, creatine, dopamine, ascorbic acid, and sarcosine interfere with the enzymatic methods. We conclude that the elimination of interferences in the determination of creatinine has still not been achieved.     

应用交感皮肤反应评价膀胱感觉功能

目的:探讨膀胱充盈诱发交感皮肤反作为膀胱感觉功能客观指标的可行性。方法:所有对象入选时间为2004-04/12。10例自愿受检的健康成年人作为膀胱感觉功能正常组;10例急性下尿路感染患者作为感觉增高组;10例慢性尿潴留患者作为膀胱感觉降低组。受试者口服20mg速尿和1L水,要求受试者在无尿意感时自主排尿1次,然后在膀胱充盈过程中主观感受初始充盈感觉、初始尿意感和强烈尿意感,在强烈尿意感觉出现后排尿。采用Keypoint诱发电位肌电图仪,用表面电极持续记录手掌和脚底的交感皮肤反应。结果:按意向处理分析,所有受检者在首次尿意感出现的同时能记录到交感皮肤反应,此后随着尿意感的频繁出现,交感皮肤反应也能同步出现;强烈尿意出现时,记录到的交感皮肤反应的波幅和频率明显增加,并与受检者的主观感觉有很好的一致性;在强烈尿意感觉出现后让受检者排尿,先前所见到的交感皮肤反应几乎完全消失,而此时主观的尿意感也是消失的。在无尿意感觉时的自主排尿,除了3例尿路感染患者诱发出交感皮肤反应,其余所有受检者均不能诱发出交感皮肤反应。结论:膀胱充盈在唤起主观尿意感觉的同时能诱发出交感皮肤反应,且交感皮肤反应与主观尿意感觉的出现和消失有着较好的一致性。并且随着尿意感觉的增强,交感皮肤反应的波幅和频     

Comparison of methods for evaluating bacterial contamination of ultrasound probes

Purpose  

To determine suitable methods for evaluating bacterial contamination of ultrasound probes.