影像组学在免疫治疗方面的应用现状

影像组学在医学图像中挖掘信息,对癌症的诊断、预后和治疗疗效预测具有极为重要的地位。当前,免疫治疗成为癌症治疗的热点,极大地推动了肿瘤学领域的发展。影像组学特征具备无创、可重复、常规获取以及量化肿瘤异质性等优点,因此可作为免疫治疗疗效的生物标志物。本文将阐述影像组学的特征提取及其数据分析,将其作为生物标志物在免疫治疗中的研究进展,包括预测治疗反应和不良事件,为影像组学在个体化治疗中的应用提供了新的见解。     

经皮肝射频治疗肝癌22例

目的:总结多弹头电极射频治疗肝癌的疗效。方法:对22例32个肝癌病灶进行射频治疗,对射频前后肿瘤血运、坏死情况和肿瘤标志物等进行观察对比。结果:25/32个病灶完全坏死,7/32个病灶部分坏死,原肿瘤标志物升高者治疗后下降,与术前相比瘤体内血供不同程度减少甚至消失。无严重并发症发生。结论:多弹头电极射频治疗肝癌近期效果确切无严重并发症,值得在临床推广。     

肝癌插管栓塞化疗后的CT与MR对照研究

目的　比较CT与MR对肝癌插管栓塞化疗疗效的评价作用。方法　回顾分析 71例共 16 2个肝癌病灶行插管栓塞化疗后同期的CT与MR表现。结果　MR提供更多肝癌治疗后的细节 ,MR上肝癌插管栓塞化疗后表现分以下 5种类型 :①肿瘤完全凝固性坏死。②肿瘤凝固性坏死合并中心液化坏死。③肿瘤不完全坏死。④肿瘤不完全坏死合并瘤栓不全坏死。⑤肿瘤坏死合并气体生成。结论　CT随访肝癌插管栓塞化疗后的疗效较简单而直观 ,而MR随访则能提供更多的细节和信息     

腹部肿瘤靶向治疗的影像学评价:现状与展望

靶向治疗是腹部肿瘤个体化精准医疗的重要组成部分,在胃肠间质瘤的疗效尤为显著,被誉为"现代抗肿瘤治疗的典范"。影像学是目前临床评价腹部肿瘤靶向治疗疗效的常用手段。由于肿瘤靶向治疗后组织学变化多样,实体肿瘤疗效评价标准(response evaluation criteria in solid tumors,RECIST)存在形态学偏倚;Choi及mChoi、SACT(size and attenuation CT)、MASS(morphology,attenuation,size and structure)等标准联合CT值指标,解决了肿瘤坏死囊变导致体积增大的问题。正电子发射断层显像(positron emission tomography,PET)、磁共振扩散加权成像(diffusion-weighted imaging,DWI)、磁共振动态增强扫描(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)及单能CT等新技术的探索应用,一系列功能影像学参数[标准摄取值(standard uptake value,SUV)、表观扩散系数(apparent diffusion coefficient,ADC)、K~(trans)、碘浓度值等]为肿瘤靶向治疗疗效的预测和治疗后早期评估提供了新的潜力指标。图像纹理分析技术则可深入挖掘影像学信息,提供丰富量化参数供临床评效参考。影像医生应通过多学科诊疗协作组(multi-disciplinary team,MDT)等模式加强与临床沟通及开展联合科研,积极探索新的参数和标准,进一步提高腹部肿瘤靶向治疗疗效预测和评价水平。     

动态增强磁共振定量分析在常见子宫肿瘤中的应用

动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量分析作为一种新的功能影像学评价手段,不但可以提供肿瘤的形态学信息,而且可以通过灌注与渗透性等参数评价肿瘤组织的微环境,间接评估肿瘤血管生成情况,有助于子宫常见肿瘤的诊断、治疗方案选择和疗效及预后的评估,在子宫肿瘤中的应用越来越受到重视。本文就动态增强MRI定量分析在子宫肿瘤的应用及进展予以综述。     

晚期肺癌免疫治疗现状及影像学疗效评价和预测

免疫治疗是近年新兴的治疗手段,为部分传统治疗疗效不佳的肿瘤患者提供新的治疗思路,已成为部分晚期肺癌患者的一线治疗方案。目前,实体瘤疗效评价标准(response evaluation criteria in solid tumors, RECIST)仍是实体瘤疗效评价的主流标准。但免疫治疗因其治疗反应的特殊性,传统RECIST评估不能及时准确评价肿瘤治疗疗效。而影像学成像已进入功能化成像新时代,可提供微观分子及代谢改变信息。人工智能与放射影像组学通过挖掘图像背后更多的数学规律,可提供更多具有诊断价值的信息,有望为肺癌免疫治疗的疗效评价与预测提供新方法和新思路。本文就晚期肺癌免疫治疗的机制、现状及评价标准作一综述,重点分析影像学疗效评价与预测,并对其作出展望。     

肝细胞肝癌患者根治性切除术后复发相关血清标志物的研究进展

肝细胞肝癌患者术后5年内复发率高, 寻找肝细胞肝癌复发转移的危险因素及预测生物标志物用于评估高复发风险人群至关重要。血清标本容易获得, 具有无创、便宜、快速检测的优势。血清标志物可以动态监测患者病情, 提示肿瘤复发状态。该文旨在总结肝细胞肝癌患者手术切除后复发相关血清标志物的预测价值, 从临床常见血清标志物和液体活检标志物角度出发, 为临床医生评估个体患者的复发转移风险提供新思路。     

肝癌栓塞化疗后的影像学评价探讨

目的分析肝癌栓塞化疗(TACE)之后的影像学特点。方法选取接受肝癌栓塞化疗治疗的肝癌肝移植术患者30例为研究组,另选肝癌肝移植术后未接受肝癌栓塞化疗及其他抗肿瘤治疗的患者30例为对照组,对比两组患者影像学特点。结果研究组栓塞化疗后肿瘤完全坏死4例、大部分坏死15例、部分坏死11例,完全坏死与大部分坏死率均明显高于对照组(P0.05)。研究组治疗后3个月肿瘤个数、大小分别为3.3±0.4个、2.7±0.9cm,肿瘤个数3个及以下12例、3~5个18例,肿瘤个数、平均大小均较治疗前少、小(P0.05);治疗后6个月肿瘤个数、大小分别为2.9±0.8个、2.1±0.4cm,肿瘤个数3个及以下15例、3~5个15例,肿瘤个数、平均大小均较治疗前及治疗后3个月少、小(P0.05)。结论肝癌栓塞化疗后CT、MRI等肿瘤影像学资料可帮助医者确切了解肿瘤坏死情况、肿瘤个数及大小。     

介入栓塞化疗联合射频消融术治疗原发性肝癌

目的探讨介入栓塞化疗联合射频消融治疗原发性肝癌的方法．疗效及前景。方法20例肝癌患者经过一次或多次介入化疗栓塞仍有肿瘤残余,且均存在无法再栓塞的情况,然后在超声引导下进行射频消融术。术后观察AFP的动态变化、影像资料、评估肿瘤坏死率、以及患者的生存情况。结果肿瘤完全坏死率达95％,肿瘤复发率10％,随访8月～1．5年,仅有2例出现了局部复发和远处转移。结论介入栓塞化疗联合射频消融术治疗原发性肝癌是安全、有效的方法,其效果明显优于单纯的介入化疗栓塞,具有广阔的应用前景,值得推广。     

结直肠癌影像组学研究进展

影像组学包含大量人眼无法识别的信息，深度挖掘影像学特征可反映人体细胞分子水平特征。影像组学具有客观性、非侵入性特征，在肿瘤诊治过程中发挥巨大优势。结直肠癌是全球第三大常见恶性肿瘤，其发病率逐渐升高，影像组学可为其术前分期、制定治疗方案、评估疗效及预后提供参考依据。本研究就影像组学在结直肠癌中的研究进展进行综述。     

光声成像在肿瘤诊断和治疗中的研究进展

癌症一直是困扰人类的一大难题，常规成像方法在肿瘤的诊断上存在一定的局限。光声成像作为目前医学影像研究的新热点，相比于常规影像方法，它可以利用内源性对比剂如黑色素和血红蛋白，实时且无创地监测与肿瘤血管生成相关物质的浓度，或者通过分子靶向性外源性造影剂与抗体或多肽结合，提供关于肿瘤结构及其分子信息，从而实现形态及功能成像。近年来，光声成像为癌症的早期诊断、肿瘤血管生成的研究、肿瘤微环境的探测，以及癌症进展和治疗反应的监测做出了有价值的贡献。根据光声成像在肿瘤成像上展示出的独特优势，本文就此种医学成像方法在癌症诊断、分期和治疗指导中的应用进展进行综述。      

尸体肝脏横断面解剖与CT增强影像对比研究对活体肝移植的术前评估

目的 用国人尸体肝脏薄层横断面结构形态学信息,为人体肝脏断层影像学的识别和活体肝移植提供解剖学依据。方法选取人体尸体肝脏连续横断面图像进行解剖形态学观察,与其相对应的CT增强图像对照研究,并完成计算机三维重建。结果在尸体肝脏连续横断面图像与其相对应的CT增强图像,清晰显示肝内管道系统主支的走行分布特点,三维重建图像能清晰显示肝内血管空间结构特征以及所支配区域的空间体积。结论通过对肝脏横断面解剖结构的探讨,CT增强图像能够完整而精确地反映出该区域复杂的解剖学结构特点,为活体肝移植的术前评估提供坚实的形态学基础。     

超声影像组学术前预测乳腺癌腋窝淋巴结转移的研究进展

乳腺癌已成为全球女性发病率最高的恶性肿瘤，是全球广泛关注的重点疾病。乳腺癌腋窝淋巴结转移的术前准确评估对于手术治疗决策至关重要，而传统的腋窝超声对少量和微转移淋巴结识别困难，无法满足精准治疗需求。近年来，随着人工智能和影像学技术的快速发展，影像组学方法可提取人眼难以识别的深层次图像信息，在医学影像领域得到了广泛应用。本文介绍超声影像组学术前预测乳腺癌淋巴结转移的研究进展，并对该领域的未来发展进行展望。     

可视化肝脏横断面解剖与MR影像对照研究

目的应用数字化可视人体肝脏薄层横断面结构形态学信息,为人体肝脏断层影像学的识别与诊断提供解剖学依据.方法选取可视化人体数据集的肝脏连续横断面图像进行解剖形态学观察,与其相对应的MR图像对照研究,并完成计算机三维重建.结果在可视化肝脏横断面与其相对应的MR图像上,清晰显示肝内管道系统主支的走行分布特点,三维重建图像能清晰显示肝内管道空间结构特征,并明确肝内管道主支在肝脏横断面的最佳显示平面.结论通过对肝脏横断面解剖结构的探讨,可视化肝脏能够完整而精确地反映出该区域复杂的解剖学结构特点,为肝脏疾病的影像定性诊断及影像辅助定位治疗提供形态学依据.     

Design of ProCAs (Protein‐Based Gd3+ MRI Contrast Agents) with High Dose Efficiency and Capability for Molecular Imaging of Cancer Biomarkers

Magnetic resonance imaging (MRI) is the leading imaging technique for disease diagnostics, providing high resolution, three‐dimensional images noninvasively. MRI contrast agents are designed to improve the contrast and sensitivity of MRI. However, current clinically used MRI contrast agents have relaxivities far below the theoretical upper limit, which largely prevent advancing molecular imaging of biomarkers with desired sensitivity and specificity. This review describes current progress in the development of a new class of protein‐based MRI contrast agents (ProCAs) with high relaxivity using protein design to optimize the parameters that govern relaxivity. Further, engineering with targeting moiety allows these contrast agents to be applicable for molecular imaging of prostate cancer biomarkers by MRI. The developed protein‐based contrast agents also exhibit additional in vitro and in vivo advantages for molecular imaging of disease biomarkers, such as high metal‐binding stability and selectivity, reduced toxicity, proper blood circulation time, and higher permeability in tumor tissue in addition to improved relaxivities.     

Clinical label-free endoscopic imaging of biochemical and metabolic autofluorescence biomarkers of benign,precancerous, and cancerous oral lesions

Early detection is critical for improving the survival rate and quality of life of oral cancer patients; unfortunately, dysplastic and early-stage cancerous oral lesions are often difficult to distinguish from oral benign lesions during standard clinical oral examination. Therefore, there is a critical need for novel clinical technologies that would enable reliable oral cancer screening. The autofluorescence properties of the oral epithelial tissue provide quantitative information about morphological, biochemical, and metabolic tissue and cellular alterations accompanying carcinogenesis. This study aimed to identify novel biochemical and metabolic autofluorescence biomarkers of oral dysplasia and cancer that could be clinically imaged using novel multispectral autofluorescence lifetime imaging (maFLIM) endoscopy technologies. In vivo maFLIM clinical endoscopic images of benign, precancerous, and cancerous lesions from 67 patients were acquired using a novel maFLIM endoscope. Widefield maFLIM feature maps were generated, and statistical analyses were applied to identify maFLIM features providing contrast between dysplastic/cancerous vs. benign oral lesions. A total of 14 spectral and time-resolved maFLIM features were found to provide contrast between dysplastic/cancerous vs. benign oral lesions, representing novel biochemical and metabolic autofluorescence biomarkers of oral epithelial dysplasia and cancer. To the best of our knowledge, this is the first demonstration of clinical widefield maFLIM endoscopic imaging of novel biochemical and metabolic autofluorescence biomarkers of oral dysplasia and cancer, supporting the potential of maFLIM endoscopy for early detection of oral cancer.     

Diffusion-weighted magnetic resonance imaging for the evaluation of musculoskeletal tumors

Conventional MR imaging provides low specificity in the differential diagnosis of musculoskeletal (MSK) tumors and is unable to offer information about the extent of tumoral necrosis and the presence of viable cells, information crucial to assess treatment response and prognosis. Therefore, diffusion-weighted imaging (DWI) is now used with conventional MR imaging to improve diagnostic accuracy and treatment evaluation. This article discusses the technical aspects of DWI, particularly the quantitative and qualitative interpretation of images in MSK tumors. The clinical application of DWI for tumor detection, characterization, differentiation of tumor tissue from others, and assessment of treatment response are emphasized.     

Percutaneous ablation of liver malignancies: imaging evaluation of treatment response.

Interventional procedures for percutaneous tumor ablation have gained an increasingly important role in the treatment of liver malignancies. After interventional therapies, diagnostic imaging has the key role to determine if the treated lesion is completely ablated or contains areas of residual viable neoplastic tissue. This is particularly important since in cases of incomplete necrosis of the lesions, treatment can be repeated, and tumor ablation can be further pursued. The evaluation of the therapeutic effect of the procedure arises different problems according to the histotype of the malignancy. In the case of hepatocellular carcinoma (HCC), detection of residual viable tumor is facilitated by the typical hypervascular pattern of this neoplasm. Contrast-enhanced US can be used to monitor tumor response, and, in cases of partial necrosis, to target the areas of residual viable tumor. With spiral CT or dynamic MR imaging, residual viable HCC is reliably depicted as it stands out in the arterial phase images against the unenhanced areas of coagulation necrosis. In the case of hypovascular metastases, a confident diagnosis of successfull ablation can be made when an area of thermal necrosis exceeding that of the original lesion is depicted. Peripheral inflammatory reaction following ablation procedures, that shows itself as an enhancing halo along the necrotic area boundary on spiral CT or dynamic MR images, should not be misinterpreted as tumor progression.