肝细胞癌相关动静脉瘘的多排螺旋CT表现

背景与目的：临床上相当一部分患者不可能常规作经导管肝动脉造影检查,这往往导致肝细胞癌(hepatocellular carcinoma,HCC)相关的动静脉瘘(arteriovenous fistula,AVF)漏诊,丧失栓塞治疗的机会。本研究旨在探讨HCC相关AVF的多排螺旋CT(muhidetector spiral CT,MDSCT)表现,以提高其诊断与鉴别诊断水平。方法：分析经数字减影血管造影(DSA)检查证实的56例HCC相关AVF的MDSCT薄层动态增强表现。结果：MDSCT显示31例门静脉主干和／或1级分支增强早于肠系膜上静脉或脾静脉,其中1例有左肝静脉提早增强浓密显影并左肝静脉和下腔静脉上端癌栓形成,1例肝动脉晚期HCC病灶周围短暂片状强化、门静脉期变为等密度;18例门静脉主干和／或1级分支显影浓密于肠系膜上静脉或脾静脉;4例门静脉2级及以下分支增强早于门静脉主干,3例门静脉2级及以下分支显影浓密于门静脉主干,伴有肝动脉晚期HCC病灶周围短暂的片状(3例)或楔形(4例)强化,门静脉期变为等密度。49例重中度分流中央型病例,病灶和脾脏强化程度均降低,非癌变肝实质强化程度增加且密度不均。结论：HCC相关AVF具有复杂的MDSCT表现,门静脉和／或肝静脉提早增强、浓密显影是其主要改变。     

CT对预测肝硬化患者肝性脑病发生风险的价值

目的:探讨螺旋CT门静脉造影对肝硬化病变程度的评估价值及其与肝性脑病发生风险的相关性.方法:对82例经临床、实验室及多种影像学方法确诊的肝硬化病例,其中Child I级38例,Child Ⅱ级32例,Child Ⅲ级12例,行螺旋CT门静脉造影,观察肝门水平门静脉主干直径等指标分析门静脉系统病变程度与肝硬化Child分级之间的关系,确定螺旋CT门静脉造影对肝硬化分级,探讨其与Child分级的相关性.结果:82例中,全部病例均见门静脉增粗,但与肝硬化病变程度没有统计学意义(P>0.05).螺旋CT门静脉造影对上述病例分级为一级34例,二级36例,三级12例,与Child分级结果一致(P>0.05).一级无肝性脑病,二级有肝性脑病12例,三级有肝性脑病8例,肝性脑病发生的风险与螺旋CT门静脉造影对肝硬化分级存在一定相关性. 讨论:门静脉系统病变与肝硬化病变程度间有比较明确的正相关性,随着肝硬化程度的加重,门静脉系统改变趋于显著;肝性脑病的发生率与门静脉系统病变程度有一定相关性.结论:螺旋CT门静脉造影对肝硬化病变程度的评估价值较高,并能较为准确提示肝性脑病的发生,可以辅助临床选择治疗方案及评估预后.     

多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用

目的探讨多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用价值。方法选择拟诊为肝癌患者81例作为研究对象,所有患者给予多层螺旋CT血管造影三维重建,记录造影参数,判断诊断价值。结果在81例患者中,病理诊断为肝癌67例,肝硬化14例,肝癌患者的BF值显著高于肝硬化患者,BV、TTS与TTP值显著低于肝硬化(P<0.05)。CT三维重建图像均可清晰所有患者的肝动脉,MIP、DSA、MPR/CPR重建方法显示肝血管有高度一致性,重建评分对比差异无统计学意义(P>0.05)。多层螺旋CT血管造影三维重建诊断肝癌的敏感性、特异性与准确性分别为95.5%、81.3%和95.1%。结论多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用具有很高的诊断敏感性、特异性与准确性,可反映肝脏血流的灌注状况,可清晰肝脏血管结构。     

多层螺旋CT门静脉成像对原发性肝癌的诊断价值

目的 探讨多层螺旋CT门静脉成像对原发性肝癌的诊断价值.方法 80例原发性肝癌患者都进行多层螺旋CT门静脉成像分析.结果 CT平扫发现病灶90个(图像评分都为5分),门静脉增强扫描发现病灶85个(图像评分都为5分),CT平扫与门静脉扫描发现的病灶情况对比差异无统计学意义(P＞0.05).与癌灶边缘相比,原发性肝癌组病灶中心的BF值明显较高(P＜0.05),而BV、TTS与TrP值明显较低(P＜0.05).80例患者中,78例为甲胎蛋白阳性,2例为甲胎蛋白阴性;BV、BF与AFP呈现明显正相关性(P＜0.05).结论 使用多层螺旋CT门静脉成像,可以有效发现原发性肝癌的病灶情况,反映肿瘤内部及边缘的血流动力学变化,与肿瘤标记物阳性表达有一定相关性,值得推广应用.     

原发性肝癌的CT 血供分型与VEGF相关性

 目的 检测肝细胞癌（Hepatocellular carcinoma,HCC）患者血清血管内皮细胞生长因子（vascu-lar endothelial growth factor,VEGF）水平与HCC血供分型的关系。方法 根据多层螺旋CT（multislice helical computed tomography,MSCT）增强扫描时病灶的强化特点分为肝动脉、肝动脉加门静脉、少血供等不同血供类型HCC患者60例;采用酶联免疫吸附（ELISA）法检测20例健康人和60例HCC患者血清中的VEGF水平,并将HCC血供类型与血管内皮细胞生长因子（VEGF）水平的相关性作统计学分析。结果 20例肝动脉血供HCC患者血清中VEGF含量及20例门静脉与肝动脉双重血供HCC患者VEGF水平明显高于少血供和健康人群（P〈0.01）;20例少血供HCC患者VEGF水平与健康人群无明显差异（P〉0.05）。结论 HCC患者的CT不同血供类型与血清VEGF水平有关,可为HCC介入治疗方案的制定提供帮助。     

16层螺旋CT增强检查及血管成像技术对肝细胞癌的诊断价值

目的探讨16层螺旋CT增强检查及血管成像技术对肝细胞癌的诊断价值。方法回顾性分析2011年5月至2013年5月间收治的100例经手术、病理或临床证实为肝细胞癌患者的相关资料。所有患者均采用GE LightSpeed 16层螺旋CT机进行增强检查。结果 100例患者病灶均清晰显示,发现病灶共计115个。共有18例患者出现肝动脉解剖变异,变异总发生率为18.0%。误诊6例,误诊率6.0%,诊断符合率为94.0%。结论 16层螺旋CT增强检查及血管成像技术对肝细胞癌诊断具有较高的临床应用价值。     

术前CT血管造影不同后处理方法对肝门部胆管细胞癌血管侵犯的诊断价值

目的:探讨术前256层螺旋CT血管造影（256-slice spiral CT angiography,256-SCTA）常用后处理方法在肝门部胆管细胞癌肝动脉、门静脉侵犯评估中的诊断价值。方法:回顾性纳入2015年3月至2017年8月西安交通大学第一附属医院35例经病理证实的肝门部胆管细胞癌患者,所有患者术前均行256层螺旋CT血管造影检查,并采用动态容积扫描及Philip EBW后处理工作站对肝动脉及门静脉行容积再现（volume rendering,VR）、最大密度投影（maximum intensity projection,MIP）及多平面重组（multi-planar-reformatting,MPR）重建,在相应后处理图像中评估肿瘤周围血管有无受侵,以术中探查结果作为金标准,分别计算三种后处理方法的灵敏度、特异度、准确率并行Kappa检验以比较三种后处理方法的诊断效能。结果:判断肝动脉有无受侵时,诊断效能以MPR最佳,其诊断灵敏度、特异度、准确性分别为92.3%、86.4%、88.6%,阳性预测值80.0%,阴性预测值95.0%,Kappa值0.763（P＜0.001）,ROC曲线下面积0.893（P＜0.01）。判断门静脉有无受侵时,诊断效能同样以MPR最佳,其诊断灵敏度、特异度、准确性分别为94.4%、100.0%、97.1%,阳性预测值100%,阴性预测值94.4%,Kappa值0.943（P＜0.001）,ROC曲线下面积0.972（P＜0.01）。结论:256-SCTA三种常用后处理方法在判断肝门部胆管细胞癌血管有无受侵时以MPR诊断效能最高,VR及MIP次之。因此,在日常影像后处理工作中应合理应用这些后处理方法以便为临床术前血管评估提供更准确的信息。     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的:探讨超声造影在评价微波凝固治疗肝细胞癌(HCC)的应用价值.方法:经静脉注射造影剂 SonoVue 后,对 30例(男20例、女10例)HCC患者(共 33 个病灶)在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至 2 周采用超声造影检查评价疗效,并与同期增强 CT 检查结果进行比较,12 个病灶治疗区取病理标本送检,21 个病灶治疗区接受随访观察.结果:微波治疗后超声造影显示 22 个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11 个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及 6 个月以上的随访,证实微波治疗联合肝动脉栓塞化疗(TACE),的 2 个 HCC 病灶,增强 CT 判断失误,增强 CT 诊断肿瘤灭活准确率为 94%(31/33);超声造影诊断肿瘤灭活准确率为 97%(32/33).统计结果显示,两者诊断肿瘤灭活差异无统计学意义(P>0.05).结论:超声造影不仅能评价 HCC 微波治疗的疗效,且能有效地评价 TAE 和微波凝固联合治疗 HCC 的疗效,因不受碘油干扰可优于增强 CT.     

螺旋CT对肝脏炎性假瘤与原发性肝癌的诊断价值

目的 探讨螺旋CT多期扫描对肝脏炎性假瘤(IPL)与原发性肝癌(HCC)的诊断价值.方法 选择54例经手术及病理检查证实的肝肿瘤病例,其中IPL 21例,HCC 33例.对所有患者进行CT平扫和螺旋CT多期增强扫描.结果 CT多期扫描对19例IPL患者诊断正确,检出率为90.48％(19/21);对32例HCC患者诊断正确,检出率为96.97％(32/33).CT平扫对IPL检出率为90.48％(19/21),对HCC检出率为87.88％ (29/33),差异无统计学意义(x2=0.27,P=0.87).CT多期增强扫描对HCC的总检出率(96.97％)高于对IPL的总检出率(90.48％),但差异无统计学意义(x2=1.03,P=0.31).结论 螺旋CT多期扫描可充分反映IPL与HCC病灶的血供特征,对明确两者的诊断具有重要价值.     

多层螺旋CT血管成像在肝癌化疗栓塞中的临床指导作用

背景与目的：多层螺旋CT血管成像具有扫描速度快、覆盖范围大、肝脏血管图像清晰．多角度三维显示等特点,对肝脏病变的诊断和治疗已显示出重要价值。目前对于多层螺旋CT肝脏血管三维成像的研究主要集中在肝脏肿瘤、肝移植术前评价及肝脏血管系统解剖,对于指导肝癌动脉化疗栓塞的研究仍然有限。本研究通过对比分析肝癌患者肝脏多层螺旋CT血管成像（muhislice CT angiography,MSCTA）与数字减影血管造影（digital subtraction angiography,DSA）图像．探讨MSCTA在肝癌肝动脉化疗栓塞治疗中的临床指导作用。方法：本组50例肝癌患者行多层螺旋CT肝脏双期增强扫描。采用最大密度投影（maximal intensitypmjection,MIP）和容积再现（volume rendering technique,VRT）重建技术行肝动脉、门静脉血管成像,再经股动脉插管分别行腹腔动脉、肠系膜上动脉、肾动脉、膈动脉DSA造影及TACE治疗,对比分析肝癌MSCTA与DSA图像。结果：肝动脉解剖分型和肿瘤供血动脉来源的DSA与MSCT的MIP、VRT血管成像显示符合率达到100％,χ^2检验,两者间差异无统计学意义（P=1．00）,而对肝动门脉瘘及门脉癌栓的显示MSCTA比DSA更有优势。结论：MSCTA检查无创、简单易行,其图像的三维重建立体感强,可准确提供肝动脉、门静脉及肿瘤供血来源等信息,对指导肝癌经肝动脉化疗栓塞有很好的临床指导作用。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers

Alcoholic beverages are causally related to cancer of the oral cavity, pharynx, larynx and esophagus. Ethanol is oxidized to acetaldehyde and then to acetate by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), both of which have genetic polymorphisms. A review of case-control studies of the effects of ALDH2, ADH2 and ADH3 genotypes shows consistently positive associations between inactive heterozygous ALDH2 and the less-active ADH2 genotypes and the risk for esophageal cancer in East Asian heavy drinkers and this enzyme-related vulnerability may extend to light-to-moderate drinkers. Some studies suggest similar associations with the risk for head and neck cancer in moderate-to-heavy-drinking Japanese. An established carcinogen in experimental animals, acetaldehyde can interact with human DNA. ALDH2-associated cancer susceptibility fits into a scenario in which acetaldehyde plays a critical role in the development of human cancer. Alcohol flushing and drinking behavior may partly explain this carcinogenic effect in carriers of less-active ADH2 genotypes. Whether the ADH3 genotype influences head and neck cancer risk in Western nations is controversial. Professional and public education about risky conditions connected to the ALDH2 and ADH2 genotypes and environmental factors is important in a new strategic approach to the prevention of alcohol-related cancers in East Asians. The use of simple tests to identify inactive ALDH2 on the basis of alcohol flushing responses could benefit many people, by helping them to identify their own cancer risks. Such testing could also help clinicians diagnose esophageal cancer earlier, through the use of endoscopic screening in the high-risk population.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.