186 铼-碘化油治疗原发性肝癌的临床研究

目的：了解^186铼－碘化油（^186Re-Lipiodol,RL）进入人体后是否能在肝癌组织中浓聚，对靶组织有无杀伤作用，对周围组织及全身脏器毒性如何。方法：通过理化方法将核素^186铼包在碘化油中，制成RL。选原发性肝癌（primary liver cancer,PLC）患者14例，经Seldinger‘s法插管到肝动脉，根据肿块大小分别注入RL10－20ml（含^186铼1110－2220MBq），通过ECT了解RL的体内分布，根据甲胎蛋白（AFP）含量的消长及肿块缩小情况，判官其疗效。结果：RL进入人体后，几乎全部浓聚于肝癌组织中，靶／非靶（N／NT）值达（10－14）：1；对机体的毒性反应极轻；所有患者的AFP进行性降低，其中1例转阴；肿瘤均不同程度缩小，其中PR占78％。结论：RL中的核素^186铼随碘化油的微小油滴“选择性”地分布在肝癌组织中，起到了核素内照射的作用。     

The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid

This investigation was undertaken to assess the risk to the embryo/fetus associated with sentinel lymph node biopsy and lymphoscintigraphy of the breast performed in pregnant patients. Approximately 92.5 MBq (2.5 mCi) of filtered Tc-99m sulfur colloid was injected peritumorally the day before surgery in two nonpregnant women with breast cancer. The whole-body distribution of the radiopharmaceutical was evaluated using a gamma camera 1 hour after injection. We then calculated the absorbed dose to the embryo/fetus for three theoretical extreme scenarios of biodistribution and pharmacokinetics: 1) all of the injected radiopharmaceutical remains in the breast and is eliminated only by physical decay; 2) all of the injected radiopharmaceutical is instantaneously transported to the urinary bladder, where it remains and is eliminated only by physical decay; and 3) the injected radiopharmaceutical behaves as though it were administered intravenously, that is, it has the biodistribution and pharmacokinetics of Tc-99m sulfur colloid injected for a liver/spleen or bone marrow scan. The fetal radiation absorbed dose was then estimated for two Tc-99m dosages: 18.5 MBq (0.5 mCi) and 92.5 MBq (2.5 mCi). The Medical Internal Radiation Dosimetry (MIRD) program was used to estimate the absorbed doses to the embryo/fetus for the first two scenarios. Published data were used to calculate the doses for the third scenario. A single breast is not among the source organs in the MIRD program, so the heart was used as a surrogate in the first scenario. In the two breast cancer patients, whole-body gamma-camera images obtained 1 hour after radiopharmaceutical injection revealed no radioactivity except in the vicinity of the injection site. In the theoretical scenarios, with 92.5 MBq, the highest absorbed doses to the embryo/fetus were as follows: scenario 1, 7.74 x 10(-2) mGy at 9 months of pregnancy; scenario 2, 4.26 mGy during early pregnancy; and scenario 3, 0.342 mGy at 9 months of pregnancy. The maximum absorbed dose to the fetus of 4.3 mGy calculated for the worst-case scenario is well below the 50 mGy that is believed to be the threshold absorbed dose for adverse effects. Thus breast lymphoscintigraphy during pregnancy appears to present a very low risk to the embryo/fetus.     

Immunoscintigraphy of xenotransplanted hepatoblastoma with iodine 131-labeled anti-alpha-fetoprotein monoclonal antibody.

BACKGROUND/PURPOSE: Hepatoblastoma (HB) is the most common primary malignant liver tumor affecting infants and young children. The alpha-fetoprotein level is elevated in 95% of all children with hepatoblastoma. Therefore, it is of interest to assess targeting of the HB marker alpha-fetoprotein by antibody imaging. In this pilot study, the authors investigated the radioimmunoscintigraphy of xenotransplanted HB in nude mice utilizing an anti-alpha-fetoprotein antibody. METHODS: HB cell suspensions from tumors of 3 children were transplanted subcutaneously into nude mice NMRI (nu/nu). A total of 200 microg of intact anti-alpha-fetoprotein antibody was injected intravenously into 8 animals from each HB. Before injection, the monoclonal antibody was labeled with iodine (I) 131 (specific activity of 75 MBq/mg, labeling yield of 95%) using the conventional iodogen method. Planar scintigraphic images of anesthetized mice in posterior views were acquired with a gamma camera immediately after injection, and after 1, 2, 3, 7, and 14 days. The biodistribution data were obtained by killing and dissecting animals, and the activity in the tissues was measured in a gamma counter. The alpha-fetoprotein levels in the animals' sera were recorded 15 days after imaging and were compared with the control group. RESULTS: A total of 66% of the hepatoblastomas could be detected by scintigraphy. Within 24 hours, the mean specific tumor uptake in nude mice hepatoblastomas with a volume of over 1,000 mm3, was 14% per injected dose (+/-3.9%). The biological half-life of the labeled antibody complex in the tumor was 3.86 (+/-0.84) days. Thyroid uptake of free I-131 was 2.85% per injected dose (+/-1.5%) reflecting the deiodination of the labeled antibody complex. CONCLUSIONS: The results show the possibility of imaging xenotransplanted hepatoblastoma with 131I-labeled anti-alpha-fetoprotein and may, in the future, determine tumor recurrence and extension, and thereby improve the prognosis of advanced HBs.     

Imaging of murine liver tumor using microCT with a hepatocyte-selective contrast agent: accuracy is dependent on adequate contrast enhancement

INTRODUCTION: A major limitation in using both spontaneous and implanted murine liver tumor models in cancer research is the inability to accurately detect and monitor tumor volume. Because microCT without contrast enhancement cannot accurately distinguish tumor from normal liver, we sought to determine the accuracy of contrast enhanced microCT for monitoring liver tumors in mice, performed with intravenous (i.v.) injection of ITG, a hepatocyte-selective contrast agent. METHODS: Twelve female BALB/c mice were injected with 5 x 10(5) CT26 tumor cells in two sites in the liver on day 0, resulting in 24 liver tumors. On days 3, 5, 7, and 10, three mice per day were injected with ITG (0.1 mL ITG/10 g body weight) by tail vein, followed 4 hours later by imaging with microCT (ImTek, Inc.). ITG is transported selectively to hepatocytes by an apoE receptor-mediated process that results in opacification of normal liver parenchyma after i.v. injection. Contrast enhancement on CT scans was graded as good, fair, or poor. After imaging, mice were euthanized to perform gross and histopathologic correlation of liver tumors with CT images. RESULTS: The mean tumor size on microCT and at histopathologic evaluation was 2.2 and 2.3 mm, respectively (P > 0.05). Regression analysis showed no difference between the CT-measured tumor and the actual tumor size (P > 0.05). The overall accuracy for detection of tumor on microCT was 88%, with one false-positive and two false-negative readings. All three erroneous readings on CT scan occurred in mice in which the contrast enhancement of the liver was poor due to inadequate i.v. injection. Although the overall sensitivity and specificity was 90% and 75%, respectively, this was highly dependent on the degree of contrast enhancement. CONCLUSIONS: MicroCT with ITG contrast is an excellent means to monitor tumor diameter in murine hepatic tumor models. However, adequate contrast enhancement is critical for accurate imaging.     

肝脏局灶性结节增生的诊断和治疗(附21例报告)

目的：探讨肝脏局灶性结节增生(focal nodular hyperplasia，FNH)的诊断和治疗经验。方法：回顾性分析两所医院1996年4月至2001年4月5年间收治并经病理证实的21例FNH的临床、影像学和病理学资料。结果：FNH术前正确诊断率较低(19．0％)，该病多见于中、青年(50岁以下占81．O％)，多无症状(57．1％)，多无乙型肝炎病毒感染(95．2％)，肝功能和AFP检查均正常(100％)；彩色多普勒检查发现80．0％(12／15)的病灶有血管通过，66．7％(10／15)的病灶血流丰富；CT动态扫描增强后60．0％(9／15)早期显著强化，60．0％(9／15)强化均匀；MRI检查强化后64．3％(9／14)早期明显强化，57．1％(8／14)信号均匀，35．7％(5／14)的病灶出现中央疤痕。本组行手术切除20例，1例未经任何治疗。结论：FNH在临床和影像学上均有一定特征，综合分析临床与多种影像学资料可提高正确诊断率。诊断FNH明确者不需外科治疗。     

肝癌手术中肝段门静脉染色并化疗栓塞的临床研究

目的探讨肝段染色指导下肝段切除术和术中灌注化疗栓塞治疗肝癌的临床效果。方法42例肝癌手术治疗者,其中20例肝癌患者术中应用B超引导肝段门静脉阻断灌注化疗栓塞并肝段染色后肝切除术(观察组),22例应用常规肝切除术(对照组)。两组均术后定期复查肝功能、AFP,CT及MRI的变化,并随访。结果观察组术中出血量为(295±105)mL,输血量(280±85)mL,术后1周肝功能指标超出正常范围者占15%(3/20),术后并发症发生率40.0%(8/20),术后3年生存率60.0%,术后3年局部复发率35.0%;对照组术中出血量(490±140)mL,输血量(370±105)mL,术后1周肝功能指标超出正常范围病例占40.9%(9/22),术后并发症发生率45.5%(10/22),术后3年生存率40.91%,术后3年局部复发率68.2%。观察组术中出血量、输血量、术后1周肝功能指标超出正常范围者比率、术后3年局部复发率均显著低于对照组(P0.05),观察组术后3年生存率显著高于对照组(P0.05),两组术后并发症发生率比较差异无统计学意义(P0.05)。结论肝段门静脉阻断灌注化疗栓塞并肝段染色后肝切除术可减少术后并发症,降低术后复发率,提高患者的生存率。     

原发性肝癌切肝量的前瞻性研究

目的探讨合并肝硬化或肝炎的肝癌患者安全手术能耐受的切缘大小。方法前瞻性研究连续76例肝癌标本的肿瘤体积及无瘤肝体积;根据CT测算前40例患者的无瘤肝体积。分析切肝量、无瘤肝切除率(HPRR)与术后肝功能、并发症和切缘的关系。结果76例患者切缘为(5±7)mm;标本肿瘤体积和无瘤肝体积分别为(107±203)cm3和(153±120)cm3。前40例患者CT测得的无瘤肝体积为(1079±179)cm3,HPRR为(14.0±9.3)%。HPRR≤20%、20%~30%的患者术后并发症发生率、并发症积分和术后1周内总胆红素最大值低于>30%的患者(P<0.05)。术后并发症积分为0分的HPRR低于3~6分者(P<0.05)。术前肝功能、HPRR、手术大小、肝门阻断时间和标本肝体积均是影响术后肝功能和并发症的重要因素(P<0.05)。结论对无肉眼癌栓或子灶的肝癌患者,如肿瘤直径小于10 cm,10 mm切缘能保证足够的剩余肝功能和完全清除癌周肝内的微转移,如肿瘤直径大于10 cm,6 mm切缘能基本保证足够的剩余肝功能和清除99%的癌周肝内的微转移;而对有肉眼癌栓或子灶的肝癌患者,如肿瘤直径小于6 cm,20 mm切缘能基本保证足够的剩余肝功能和清除99%的癌周肝内的微转移。     

Visualization of prostate cancer with 11C-choline positron emission tomography

BACKGROUND AND OBJECTIVE: Visualization of prostate cancer with positron emission tomography (PET) using 2-[18F]-2-deoxy-D-glucose (FDG) as radiopharmaceutical is limited by the low uptake of FDG in the tumor and by radioactivity excreted into the bladder. More specific PET radiopharmaceuticals would be welcome. Carbon-11 labeled choline (CHOL) is a new radiopharmaceutical potentially useful for tumor imaging as it is incorporated in the cell membranes as phosphatidylcholine. We prospectively studied the visualization of prostate cancer using CHOL PET. METHODS: A total of 25 consecutive patients with histologically proven prostate cancer and five patients with a benign prostate were included. PET images were performed with an ECAT HR(+) using 400MBq CHOL. Data acquisition was started at 5 minutes post-injection. Attenuation-corrected images were evaluated visually. Standardized uptake values (SUV) were calculated of the normal prostate gland and of the prostate tumor tissue. RESULTS: The normal prostate was visualized with a mean SUV of 2.3 (range 1.3-3.2). The primary tumor could be visualized with a mean SUV of 5.0 (range 2.4-9.5). Lymph node metastases >5mm could be identified. Non-specific uptake of CHOL was noticed in the intestines. Little to no radioactivity in the bladder was observed. CONCLUSION: Carbon-11-choline is avidly taken up in prostate cancer, both primary tumor and lymph node metastases, in the virtual absence of urinary radioactivity. These results confirm the early results obtained by others and permit further clinical research on the value of CHOL PET as a metabolic imaging technique in areas where conventional imaging have a limited sensitivity.     

B超引导下射频热凝固治疗肝癌

目的：探讨B超引导下射频热凝固（RFA）治疗肝癌的及疗效。方法：B超引导下将多极射频针穿刺入瘤体,采用分区定点使凝固区在三维空间上完全覆盖并超出肿瘤边缘1cm。术后检测AFP,B超或CT或肝穿细胞学检查或肝动脉造影。结果：1月内复醒：AFP20例升高18例降至正常,B超或CT检查9例瘤体增大,8例无变化,其余缩小,6例肝穿1例瘤体边缘有活瘤细胞;8例肝动脉造影1例肝边缘和瘤内不同区域有散在血供3月复查：25例瘤体明显缩小。结论：RFA治疗只有方法得当,能有效灭活肿瘤。     

原发性肝癌切除术前应用立体定向适形放疗的价值

目的　探讨立体定向适形放疗对原发性肝癌的治疗效果及其术前应用的价值。方法　 1 998年 5月至 2 0 0 1年 1 0月 ,2 5例肝癌行术前短程大剂量立体定向适形放疗 2周后手术切除 ,与同期单纯手术切除的病例对照 ,进行病理、肝功能、血常规、AFP、术中出血量、术后复发率及生存率的分析研究。结果　立体定向适形放疗能有效杀灭肿瘤细胞 ,导致癌周小血管、淋巴管闭塞及纤维机化带形成 ,显著缩小肿瘤体积 (P<0 .0 1 ) ,减少术中出血量 (P<0 .0 5 ) ,提高术后近期 AFP转阴率 (P<0 .0 1 ) ,降低术后 1年复发率 (P<0 .0 1 ) ,提高术后 2年生存率 (P<0 .0 1 )。同时 ,没有严重副作用。　结论　立体定向适形放疗是治疗肝癌的有效手段 ,术前短程大剂量冲击放疗可以提高手术切除率 ,改善预后 ,增加二期切除的机会     

Radioimmunotherapy of prostate cancer in human xenografts using monoclonal antibodies specific to prostate specific membrane antigen (PSMA): studies in nude mice

BACKGROUND: Prostate specific membrane antigen (PSMA), expressed by virtually all prostate cancers is an ideal target for targeted therapy of prostate cancer. Radiolabeled J591 monoclonal antibody (MAb) binds with high affinity to an extracellular epitope of PSMA and localizes specifically in PSMA positive LNCaP tumors in vivo. METHODS: Pre-clinical radioimmunotherapy (RIT) studies using (131)I-huJ591 and (90)Y-1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (DOTA)-huJ591 MAbs were studied in nude mice bearing LNCaP xenografts. RESULTS: A 15-90% reduction in mean tumor volume was observed after a single dose of (131)I-huJ591 (3.7-11.1 MBq) or (90)Y-DOTA-huJ591 (3.7-7.4 MBq). The median survival time increased 2-3 times relative to untreated controls. Multiple administrations of fractionated doses of (90)Y-DOTA-huJ591 were even more effective with minimal toxicity. Radiation dose to blood and tumor was higher with (90)Y than with (131)I. The maximum tolerated dose (MTD) is 5.55 MBq for (90)Y-DOTA-huJ591 and more than 11.1 MBq for (131)I-huJ591. For (90)Y-DOTA-huJ591 at MTD, dose to the tumor was 2,753 cGy. CONCLUSIONS: In nude mice bearing PSMA positive tumors, radiation dose to the tumor with (90)Y-DOTA-J591 is greater for large tumors than with (131)I-J591. The theoretical and practical considerations strongly suggest that (90)Y-DOTA-huJ591 may be a suitable radiopharmaceutical for the treatment of prostate cancer.     

pcDNA3/AFP/TK/Angio融合基因靶向性治疗人原发性肝癌的实验研究

目的研究pcDNA3/AFP/TK/Angio融合基因对人肝癌细胞系SMMC-7721裸鼠移植瘤模型的靶向性治疗作用。方法建立人原发性肝癌裸鼠皮下移植瘤模型,将荷瘤裸鼠随机分成肿瘤对照组、空质粒组、丙氧鸟苷（GCV）组、pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组5组。于瘤体内分别直接注射不同的质粒,同时于裸鼠腹腔内注射GCV,观察不同时段皮下肿瘤的生长情况并做病理学检查,免疫组化法检测肿瘤微血管密度（MVD）以及血管内皮细胞生长因子（VEGF）的表达量,原位末端标记（TUNEL）法检测细胞原位凋亡。放免法检测裸鼠血清甲胎蛋白（AFP）的变化,透射电镜观察肿瘤细胞超微结构的变化。结果裸鼠皮下成瘤率100%;pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组的肿瘤体积、血清AFP含量、肿瘤MVD和VEGF表达强度均明显低于对照组、空质粒组和GCV组（P〈0.05）,细胞凋亡指数都明显高于后3组（P〈0.05）,可见较多的凋亡细胞。而pcDNA3/AFP/TK/Angio组的肿瘤体积、AFP、MVD及VEGF表达强度又明显低于pcDNA3/TK/An-gio组（P〈0.05）,凋亡指数高于后者（P〈0.05）。结论pcDNA3/AFP/TK/Angio融合基因系统可显著抑制肿瘤的生长,有望成为治疗原发性肝癌的新型生物制剂之一。     

Image-Guided Liver Mapping Using Fluorescence Navigation System with Indocyanine Green for Anatomical Hepatic Resection

BACKGROUND: In malignant hepatic neoplasm, anatomic resection could improve survival and limit complications from hepatectomy. Our purpose was to develop an intraoperative method for identifying segment and subsegment of the liver with high-sensitivity near-infrared fluorescence imaging. METHODS: The subjects were 35 patients with hepatic malignant liver disease who received hepatectomy in 2006. The segments of liver method of identification that used infrared observation camera system termed Photo Dynamic Eye-2 (PDE-2) with indocianine green (ICG) for the patient with malignant liver tumor (hepatocellular carcinoma: 13 cases; metastatic liver cancer: 18 cases; intrahepatic cholangio carcinoma: 4 cases) were performed before liver resection. RESULTS: Although greenish stain of the liver surface after the injection of ICG via portal vein is not visible clearly without infrared observation camera system PDE-2, 1 minute after injection of ICG with fluorescent using infrared observation camera system PDE-2, demarcation of liver segment and subsegment was clearly detected. Ten minutes after injection of ICG with fluorescent using infrared observation camera system PDE-2, fluorescence of liver subsegment remained. Stained subsegment and segment of liver were identifiable in 33 (94.3%) of the 35 patients. There were no complications or side-effects related to the injection of patent blue dye. CONCLUSION: We demonstrated here that near-infrared fluorescence imaging system is a novel and reliable intraoperative technique to identify hepatic segment and subsegment for anatomical hepatic resection.     

门静脉和肝动脉结扎序贯二步法肝切除术治疗巨大肝癌

巨大肝癌切除术后剩余肝脏体积不足是发生肝衰竭的主要原因.通过阻断一侧的门静脉和肝动脉,使肿瘤降低分期,增加对侧术后剩余肝脏体积,成为目前切除巨大肝癌的方法之一.2013年3-4月厦门大学附属第一医院收治的1例原发性右半肝巨大肝癌患者,因肝脏剩余体积不足,术者一期行选择性门静脉及肝动脉结扎术后,序贯二期行肝切除术.患者2次手术均顺利完成,一期行门静脉右支及肝右动脉结扎术,术后肝肿瘤体积缩小,剩余左半肝代偿性增生良好,肝脏体积由术前488 mL增加到术后1个月689 mL.一期手术后33 d顺利实施二期巨大肝癌肝切除术,2次术后均无严重并发症发生.术后随访2个月,患者剩余肝脏未见肿瘤复发,AFP由术前425 mg/L降至26×10^-3mg/L.因此,选择性门静脉及肝动脉结扎后序贯二步法肝切除术可能是传统手术无法切除的巨大肝癌患者有效的治疗方法.     

Utilizing alpha-fetoprotein expression to enhance oncolytic viral therapy in hepatocellular carcinoma

OBJECTIVE: To determine whether alpha-fetoprotein (AFP)-regulated ribonucleotide reductase (RR) production would promote more vigorous and specific viral killing in AFP-expressing hepatocellular carcinoma (HCC). BACKGROUND: AFP is expressed in over 70% of primary HCC but not in normal adult liver. AFP production by HCC can be exploited to target viral killing of tumor cells. G207 is an oncolytic herpes virus lacking UL39, the gene encoding RR. RR is an enzyme required for viral DNA synthesis and cytotoxicity. METHODS: Enzyme-linked immunosorbent assay (ELISA) was performed for AFP levels on Hep3B and PLC5 human HCC cells. An AFP-albumin enhancer-promoter complex (AFP-alb) was constructed in a luciferase vector to assess function. AFP-alb was cloned upstream of UL39 (AFP-alb/UL39) and transfected into HCC cells for G207 cytotoxicity assays. Viral plaque forming assays evaluated G207 replication. Hep3B flank tumors, with and without AFP-alb/UL39 transfection, were established in athymic mice (n = 28) and treated with G207. RESULTS: Hep3B had 5-fold higher AFP levels than PLC5 (P < 0.00001). AFP-alb increased luciferase expression 72-fold in Hep3B (P < 0.001) and 3-fold in PLC5 (P < 0.001). AFP-alb/UL39 transfection increased G207 cytotoxicity 93% in Hep3B (P < 0.0005), with no significant increase in PLC5. Peak viral titers were 46-fold higher in Hep3B transfected with AFP-alb/UL39 versus mock-transfected cells (P < 0.01), with no significant change in PLC5. Flanks tumors transfected with AFP-alb/UL39 and treated with G207 demonstrated a 76% volume reduction versus mock-transfected tumors infected with G207 (P < 0.0001). CONCLUSIONS: AFP-driven RR production by hepatoma cells significantly enhances herpes viral cytotoxicity and specificity in vitro and reduces tumor burden in vivo.     

Sentinel Node Biopsy and Concomitant Probe-Guided Tumor Excision of Nonpalpable Breast Cancer

Background Preliminary data have shown encouraging results of a single intratumoral radiopharmaceutical injection that enables both sentinel node biopsy and probe-guided excision of the primary tumor in patients with nonpalpable breast cancer. The aim of the study was to evaluate this approach in a large group of patients. Methods Lymphoscintigraphy was performed in 368 patients with nonpalpable breast cancer after intratumoral injection of ^99mTc-nanocolloid (.2 mL, 123 MBq, 3.3 mCi) guided by ultrasound or stereotaxis. The sentinel node was pursued with the aid of vital blue dye (1.0 mL, intratumoral) and a gamma ray detection probe. In case of breast-conserving surgery, the probe was used to guide the excision. Results At least one sentinel node could be identified intraoperatively in 357 patients (97%), of whom 69 had involved nodes (19%). Age over 60 years was associated with less frequent nonaxillary lymphatic drainage and absence of internal mammary chain dissemination. Tumor-free margins were obtained in 262 (89%) of the 293 patients who underwent segmental excision. Re-excision of the primary tumor bed was performed in six patients (2%). During a median follow-up of 22 months, one breast recurrence and one axillary recurrence were observed. Conclusions Lymphatic mapping and probe-guided tumor excision of nonpalpable breast cancer by intralesional administration of a single dose of ^99mTc-nanocolloid and blue dye resulted in 97% identification of the sentinel node and in tumor-free margins in 89% of the patients who underwent breast-conserving surgery. Longer follow-up is needed to substantiate the accuracy and safety of this technique.     

Serum alpha-fetoprotein subfractions in hepatic malignancies identified by different reactivities with concanavalin A, lentil lectin or phytohemagglutinin-E

Using a modified method of concanavalin A (Con A), lentil lectin (LCH) or phytohemagglutinin-E (PHA-E) affinity crossed-line immunoelectrophoresis (ACIE), we studied alpha-fetoprotein (AFP) subfractions in 69 sera, including 58 from patients with primary liver cancer and 11 from patients with hepatic metastasis of gastric cancer. We found that Con A non-reactive subfraction (type b) or LCH weakly-reactive subfraction (type B) was more frequently detected in metastatic liver cancer, as compared with liver cancer hepatoma. The amount of Con A non-reactive subfraction (type b) or of PHA-E reactive subfraction (type X) was significantly higher in case of metastatic liver cancer than in primary liver cancer. Since different affinities between AFP and lectins are due to the microheterogeneity in AFP sugar chain, our findings suggest that AFP in primary liver cancer and metastatic liver cancer is glycosylated in a different manner. It is also indicated that different patterns of AFP subfractions identified by the combination of Con A, LCH or PHA-E ACIE facilitate a differential diagnosis of these hepatic malignancies.     

AFP-IgM复合物在肝癌中的表达与临床关系

目的 分析甲胎蛋白-IgM免疫复合物(AFP-IgM)在肝细胞癌(HCC)中的含量,探讨AFP-IgM对诊断肝癌的临床意义.方法 采用酶联免疫吸附法与电化学发光法,对103名正常人、74例肝癌、43例肝硬化和58例脂肪肝病人血清AFP-IgM与甲胎蛋白(AFP)含量检测,并分析其与临床病理特点之间的关系.结果 应用ROC曲线确定AFP-IgM和AFP的最佳切割值分别为300 Au/ml和10μg/L作为诊断学意义的临界值.在此切割值下,肝癌组AFP-IgM和AFP血清水平均高于脂肪肝组和健康体检组(P<0.05).对早期(Ⅰ与Ⅱ期)肝癌诊断时,AFP-IgM的ROC曲线下面积大于AFP(0.91 vs 0.82);当肿瘤直径≤3 cm时,AFP-IgM为(1090.4±571.8)Au/ml,而当直径>3 cm时,AFP-IgM为(604.9±749.9)Au/ml,两者比较P<0.05.且AFP-IgM在诊断小肝癌时ROC曲线下面积大于AFP(0.92 vs 0.78);AFP-IgM对性别、年龄、乙型肝炎表面抗原、肿瘤数量、包膜的相关性无统计学意义(P>0.05),而与肿块大小和分期密切相关.结论 AFP-IgM对早期(Ⅰ与Ⅱ期)肝癌和小肝癌(≤3 cm)诊断具有重要作用,且对判断肝癌的肿瘤大小与分期等具有一定的临床意义.     

CT灌注成像在肝细胞癌诊断中的应用

目的 探讨CT灌注成像在肝细胞癌(HCC)诊断中的价值.方法 对21例肝占位患者共26个病灶行CT灌注扫描,获得以下灌注参数:肝血流量(HBF)、肝血容量(HBv)、平均通过时间(MTT)、血管表面通透性(PS)以及肝动脉分数(HAF)等,并对比病灶和非病灶区灌注参数.HCC 患者同时测定血清甲胎蛋白(AFP)值,并与相应病灶的灌注参数作直线相关分析.结果 灌注失败3例,共3个病灶;成功18例,共23个病灶,其中HCC 18个,肝血管瘤4个,肝局灶性结节增生1个.HCC组病灶灌注参数与非病灶相比较,HAF增大,MTT及PS减小,差异有统计学意义,其中以HAF的差异最为显著,前者是后者的4.11倍.HBF和HBV无统计学差异.血清AFP与HCC病灶的灌注参数无相关性.肝血管瘤组病灶和非病灶各灌注参数的改变与HCC类似,但血管瘤病灶区的HBF较HCC大.肝局灶性结节增生和非结节的灌注参数无明显差异.结论 CT灌注成像在AFP阴性和(或)增强CT表现不典型的HCC诊断及鉴别诊断中具有重要的参考价值.

Abstract：

Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT.     

Imaging of renal cancer using positron emission tomography with 2-deoxy-2-(18F)-fluoro-D-glucose: pilot animal and human studies

The feasibility of imaging renal cancers with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) and whole-body positron emission tomographic scanning was assessed in nude mice with human renal adenocarcinoma xenografts and then in 5 patients with primary renal cancer (4 adenocarcinomas and 1 transitional cell carcinoma). In nude mouse biodistribution studies tumor FDG uptake was maximal at 0.33 to 2 hours but tumor-to-blood ratios increased continuously to 7.8/l. by 4 hours after intravenous FDG injection. In all 5 patients primary and metastatic tumors were imaged within 1 hour by FDG positron emission tomography following intravenous injection of the FDG. By contrast, an hepatic hemangioma did not accumulate FDG. In summary, FDG metabolic and anatomical imaging of primary and metastatic renal cancer is feasible and in these pilot studies appears to be a promising imaging methodology that may be further enhanced by delayed imaging times. Additional study in a larger number of patients is essential to define better the accuracy and potential clinical use of this method.