钇-90微球的特性、放射栓塞的操作技术及安全防护——钇-90微球放射栓塞系列回顾(一)

钇-90(90Y)微球放射栓塞是一种局部治疗方法,它将载有发射β射线的90Y树脂或玻璃微球选择性地注射到肝动脉.90Y微球随血流被阻塞在肿瘤血管床,其发出的射线对靶肿瘤具有细胞毒性作用.该方法的安全性和有效性已经在不可切除的肝脏恶性肿瘤患者中得到证实.本文作为90Y微球放射栓塞系列综述的第一部分,将讨论90Y和90Y微球的基本特性,90Y微球放射栓塞的基本操作方法,以及放射性安全与防护.     

C臂CT在肝癌化疗性栓塞治疗中的应用价值

目的探讨C臂CT在肝癌化疗栓塞治疗中的应用。方法选择58例肝癌首次介入治疗患者(其中转移性肝癌23例,原发性肝细胞癌35例)行超选择肝动脉化疗栓塞治疗后做C臂CT检查,后利用GE公司原装AW工作站行三维重建,对栓塞效果及程度进行分析评价,同时根据与术前常规DSA造影对比,是否具有可行性。结果所有患者均能清晰显示肿瘤实质的栓塞,其中16例常规DSA病灶显示较少或不明显,栓塞术后行C臂CT检查,发现小瘤灶碘油沉积良好。结论 C臂CT技术可在肝癌介入治疗同时观察其断层影像,即时评价治疗效果,利于制订手术方案,相比与常规DSA,在提供断层影像的同时能提供直观,准确的影像信息,在肝癌的介入栓塞治疗中能起到较好的指导作用。     

C臂CT三维重建技术在三叉神经球囊压迫术中的临床应用

【摘要】 目的 评价C臂CT三维重建技术在三叉神经球囊压迫术中的临床应用意义。方法 回顾性分析利用C臂CT三维重建技术指导三叉神经球囊压迫术15例,术前及术后分别计算视觉模拟评分（VAS）,研究术后近期临床疗效、出现并发症的情况。结果 所有患者术中球囊在三维重建下均显示位于Meckel腔内,并根据Meckel腔形状在三维重建下呈现不规则的“三角锥”型,术后疼痛均有所缓解,术后1 d、1个月、3个月VAS评分明显下降,较术前有统计学意义（P＜0.05）,有效率分别为100%,93.3%,86.7%,无严重不良作用产生。结论 C臂CT能快速、安全、简便地完成卵圆孔穿刺并提供了比经典的“梨形”图像更精细的三维图像。C臂CT三维重建技术指导进行球囊压迫有穿刺准确、节省时间、疗效确切的优点,具有重要的临床应用意义。     

钇-90微球的剂量计算——钇-90微球放射栓塞系列回顾(四)北大核心CSCD

精确的钇-90(^(90)Y)微球剂量对治疗肝脏恶性肿瘤至关重要,这与临床疗效和不良反应密切相关。剂量的计算主要基于不同的^(90)Y载体:玻璃微球(TheraSpheres)或树脂微球(SIR-Spheres)。玻璃微球的剂量是以肝脏预期的辐射剂量和微球能够均匀分布于整个肝脏的假设为基础计算的,而树脂微球的剂量是以微球非均匀分布于整个肝脏的假设为基础计算的,这种非均匀分布的程度取决于正常肝脏被肿瘤组织取代的程度。许多其他因素也可能会潜在影响^(90)Y微球的治疗剂量。本综述将介绍^(90)Y微球剂量的计算方法,以及为了获得最大疗效并尽量避免不良反应发生而需要考虑的各种因素。     

亡羊补牢——论钇-90微球国产化

钇-90(90Y)微球经导管动脉放疗栓塞术(TARE)治疗不可手术切除的原发性和继发性肝癌在欧美,尤其是美国已成为主要局部治疗方法之一.大量研究证实TARE具安全性及有效性,其疗效甚至优于经导管动脉化疗栓塞术(TACE).目前中国大陆暂无临床可应用的90Y微球,但开展这项治疗已势在必行.由于90Y微球产品特殊性,单靠国外进口难以使该治疗得以推广.20世纪90年代国内曾有研制90Y微球的经验,为此应集中力量,多方合作努力,使之能够早日国产化,为广大肝恶性肿瘤患者提供新的治疗选择.     

C臂锥形束CT灌注在急性缺血性脑卒中诊治中的应用进展

【摘要】　急性缺血性脑卒中（AIS）具有高致死致残率。脑组织缺血时间越长临床预后越差,尽早恢复缺血区血流灌注,挽救缺血半暗带一直是AIS诊治重点,而启动再灌注治疗前快速识别半定量缺血半暗带是影像学筛查核心内容。基于DSA设备的新兴断层成像C臂锥形束CT（CBCT）与传统CT相比更有利于实现AIS一站式诊治,明显缩短缺血组织再灌注时间,获得良好临床预后。然而由于现有设备硬件和算法限制,该技术目前尚未广泛应用于临床。本文就CBCT灌注技术在AIS相关成像方法、原理及其在临床诊治中应用进展作一综述。     

CT多曲面重建在C臂引导经皮骶骨成形术中的应用

【摘要】 目的 探讨术前行多排螺旋CT扫描及多曲面重建(MPR）技术建立模拟穿刺路径对C臂下行经皮骶椎成形术(PSP）术中实际入路的指导价值。方法 收集2014年至2017年东南大学附属中大医院收治17例患者资料,17例患者术前均经过多排螺旋CT扫描并行MPR建立模拟穿刺入路,分别测量棘突旁开距离(AC）、椎弓根横向角(AOC）及腰骶角(AOB）,并与术中实际测量值行配对t检验。所有病例均在C臂透视引导下经椎弓根入路进行操作,术后3 d内CT复查观察骨水泥分布及有无渗漏,术后7 d内观察并发症情况。结果 17例20节次椎体成形均获成功,所有椎体术前均建立模拟穿刺路径,术前模拟AC、AOC分别为(4.3±0.4） cm、30.5°±1.9°,与术中实际测量值(4.5±0.5） cm、30.7°±1.9°,差异无统计学意义。术前腰骶角AOC为37.1°±4.1°,与术中实际测量值29.7°±3.0°,差异有统计学意义。术后CT证实椎间盘渗漏2例,骶孔渗漏1例,无穿刺路径损伤或骨水泥渗漏引起的有临床症状的并发症。 结论 多曲面重建可模拟骶1椎体经椎弓根入路穿刺路径,与实际针道具有较好的一致性,并可指导C臂透视下行骶骨成形术,提高实际穿刺的准确性和安全性。     

C臂CT在介入诊疗中的应用

C臂CT是平板探测器数字减影血管造影系统的一种新技术,在介入室同一工作床上能提供透视、摄影、DSA及容积CT成像,已在血管性及非血管介入诊疗中开始发挥其独特作用,本文介绍C臂CT在介入诊疗应用中的潜力、限度与前景.     

C臂CT在介入治疗中的临床应用

C臂CT技术的临床应用还处于初始阶段,主要用于神经系统介入治疗、肿瘤的血管内介入治疗、内支架植入术、非血管介入治疗等。它的应用大大优化了介入治疗工作流程,缩短了介入手术时间,并且有着广阔的应用前景。就C臂CT在介入治疗中的应用现状予以综述。     

可视化栓塞微球的制备及研究进展

【摘要】 介入栓塞治疗在临床医疗中发挥着越来越重要的作用,其中微球是主要的栓塞材料。目前临床上应用的栓塞微球不能在X射线、CT或MRI下显影,操作过程中需要混合对比剂达到可视化,影响了栓塞的精准性和术后的跟踪与评价。对此研发可视化微球成为当前介入治疗领域的热点之一。本文就研发可视化微球的临床意义、可视化微球的制备、生物相容性及今后展望作一综述。     

Biliary sequelae following radioembolization with Yttrium-90 microspheres

PURPOSE: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. MATERIALS AND METHODS: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. RESULTS: A total of 327 patients (HCC, n=190; liver metastases, n=137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n=26; HCC, n=7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n=17), biloma (n=3), cholecystitis (n=2), gallbladder wall enhancement (n=6), gallbladder wall rent (n=3), abscess (n=1), and stricture (n=8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). CONCLUSIONS: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.     

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

Radioembolization with yttrium-90 microspheres ((90)Y-RE), either glass- or resin-based, is increasingly applied in patients with unresectable liver malignancies. Clinical results are promising but overall response and survival are not yet known. Therefore a meta-analysis on tumor response and survival in patients who underwent (90)Y-RE was conducted. Based on an extensive literature search, six groups were formed. Determinants were cancer type, microsphere type, chemotherapy protocol used, and stage (deployment in first-line or as salvage therapy). For colorectal liver metastases (mCRC), in a salvage setting, response was 79% for (90)Y-RE combined with 5-fluorouracil/leucovorin (5-FU/LV), and 79% when combined with 5-FU/LV/oxaliplatin or 5-FU/LV/irinotecan, and in a first-line setting 91% and 91%, respectively. For hepatocellular carcinoma (HCC), response was 89% for resin microspheres and 78% for glass microspheres. No statistical method is available to assess median survival based on data presented in the literature. In mCRC, (90)Y-RE delivers high response rates, especially if used neoadjuvant to chemotherapy. In HCC, (90)Y-RE with resin microspheres is significantly more effective than (90)Y-RE with glass microspheres. The impact on survival will become known only when the results of phase III studies are published.     

Intraprocedural Yttrium-90 Positron Emission Tomography/CT for Treatment Optimization of Yttrium-90 Radioembolization

Radioembolization with yttrium-90 (⁹⁰Y) microspheres relies on delivery of appropriate treatment activity to ensure patient safety and optimize treatment efficacy. We report a case in which ⁹⁰Y positron emission tomography (PET)/computed tomography (CT) was performed to optimize treatment planning during a same-day, three-part treatment session. This treatment consisted of (i) an initial ⁹⁰Y infusion with a dosage determined using an empiric treatment planning model, (ii) quantitative ⁹⁰Y PET/CT imaging, and (iii) a secondary infusion with treatment planning based on quantitative imaging data with the goal of delivering a specific total tumor absorbed dose.     

C臂CT在肝癌介入治疗中的应用

目的 初步评价C臂CT在肝癌肝动脉介入治疗中的应用.方法 60例肝癌患者(原发性肝癌43例,转移性肝癌17例)行230例次介入治疗,其中行C臂CT扫描91例次,记录所有手术时间.依据与常规DSA造影比较,能否提供额外信息,将C臂CT对于介入手术的帮助程度分为3级∶1级,未能提供额外信息;2级,提供额外信息,但对介入治疗过程无影响;3级:提供有助于治疗的信息.使用t检验检测使用和不使用C臂CT功能的介人手术时间有无统计学意义.结果 行C臂CT扫描91例次(40%),其中40(40/91,43.9%)例次达到2级、23(25.3%)例次达到3级.使用C臂CT扫描后平均手术时间增加了18.5min(P＜0.05).结论 C臂CT优化了肝癌介入治疗工作流程,获得了清晰的软组织(CT样)断层图像,在肝癌介入治疗术前显示肿瘤实质及供血血管、术后即时监测碘油沉积方面具有较高的价值,在肝癌的介入治疗特别是肝癌化疗栓塞中能够起到较好的指导作用.该法增加了部分手术时间,但完全可以接受.     

The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors

PURPOSETo develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (⁹⁰Y) microspheres transarterial radioembolization (⁹⁰Y TARE) for primary and metastatic cancers in the liver.METHODS AND MATERIALSMembers of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for ⁹⁰Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience.RESULTSThe ABS strongly recommends the use of ⁹⁰Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of ⁹⁰Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting ⁹⁰Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with ⁹⁰Y TARE should be carefully considered.CONCLUSIONSABS consensus for implementing a safe ⁹⁰Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.