MR间质淋巴造影显示乳腺癌前哨淋巴结初步研究

目的 探讨MR间质淋巴造影显示乳腺癌前哨淋巴结(SLN)的价值.方法 收集58例浸润性乳腺癌患者,用15 mL Gd-DTPA对比剂与2 mL 2%利多卡因配制对比剂混合液,按0.5 mL/人的剂量行乳晕外侧皮下注射,然后采用西门子3.0T Magnetom Trio MRI扫描仪体积插值屏气检查序列动态扫描,在最大密度投影(MIP)图像上追踪引流淋巴管并确定SLN,用胶囊标记的方法进行体表定位,将此标记的淋巴结定义为M-SLN.术中采用美兰示踪的方法,进行前哨淋巴结活检(SLNB)及切除,将美兰染色的淋巴结定义为D-SLN.对MR间质淋巴造影与美兰显示SLN的数目行配对样本比较的秩和检验,并采用Spearman等级相关分析两者的相关性.评估MR间质淋巴造影诊断M-SLN的敏感度,特异度,准确率.结果 MR间质淋巴造影共显示75枚M-SLN,平均(1.60±0.52)枚,在体表胶囊的标记下均在手术中成功获得.术中美兰为示踪剂显示91枚D-SLN,平均(1.94±0.63)枚,显著多于MR间质淋巴造影,但两者存在强相关性(Spearman等级相关系数0.69,P<0.001).MR间质淋巴造影诊断D-SLN转移的敏感度95.8%,特异度88.9%,准确率93.3%.结论 MR间质淋巴造影可以准确寻找诊断乳腺癌SLN并引导活检,具有较好的临床运用价值.     

间质磁共振淋巴管造影在检测乳腺癌患者前哨淋巴结转移情况中的应用价值

目的探讨间质磁共振(MR)淋巴管造影与弥散加权成像(DWI)序列相结合检测乳腺癌患者前哨淋巴结转移情况的应用价值。方法选取河南大学第一附属医院2018年6月至2019年6月30例前哨淋巴结阳性乳腺癌患者,并招募30名健康志愿者作为阴性组,给予MR间质淋巴造影检查,观察乳腺癌患者淋巴管及前哨淋巴结情况,对比分析2组淋巴管走行、管径情况和前哨淋巴结数目、大小、边缘、形态及弥散系数(ADC)值的指标。结果阳性组淋巴管走行、管径与阴性组对比差异有统计学意义(P<0.05);阳性组及阴性组前哨淋巴结平均数目差异无统计学意义(P>0.05);阳性组前哨淋巴结大小、边缘、形态及ADC值的指标均有明显差异(P<0.05)。结论 MR间质淋巴管造影与DWI序列相结合可以高分辨率的显示淋巴管和淋巴结的形态和功能,提高了乳腺癌患者前哨淋巴结转移的检出率。     

乳腺癌前哨淋巴结MRI研究进展

无创性方法准确评估乳腺癌前哨淋巴结状态对于避免不必要的外科手术及选择最佳治疗方案具有重要意义。扩散加权成像（DWI）和动态增强MRI(DCE-MRI)等多种MRI技术可为术前评估乳腺癌前哨淋巴结状态提供有价值的信息。就MRI评估乳腺癌前哨淋巴结状态的研究进展进行综述。     

兔VX2瘤磁共振成像技术的探讨

目的:探讨临床型磁共振成像仪用于动物实验成像扫描参数的优化。材料和方法:利用1.5T磁共振成像仪对不同部位接种的52只兔VX2肿瘤模型进行常规自旋回波(T1WI,T2WI)及梯度回波扫描,并进行Gd-DTPA和铁剂增强扫描,比较各种序列图像质量并比较不同部位肿瘤/组织对比信噪比。结果:T2WI和增强扫描可以提供较好的肿瘤病灶的组织对比显示。结论:选择适当的成像参数可以在临床型磁共振成像仪上获得较好的动物图像。     

3D重建及CPR技术在乳腺癌腋窝前哨淋巴结CT淋巴管造影检查中的实验研究

目的 探讨多层螺旋CT 3D重建及曲面重建(CPR)技术在乳腺癌腋窝前哨淋巴结(SLN)CT淋巴管造影(CT-LG)检查中的应用价值.方法 采用VX2肿瘤组织块悬液皮下注射法制作VX2乳腺癌大白兔动物模型,对其行CT-LG检查.所有原始数据传至后处理工作站,运用3D重建及CPR技术显示显影的淋巴管及淋巴结,CT-LG图像上SLN定义为自对比剂注射部位至腋窝方向最先引流的淋巴结,并与SLN活检结果对照.结果 (1)20只荷瘤兔行CT-LG检查后,3D重建及CPR可显示SLN及其引流淋巴管;且70%(14/20)的实验兔成像效果良好,CT-LG共显示22条引流淋巴管,16枚SLN,7枚非SLN.(2)3D图像显示连续且对比剂充填均匀的8条淋巴管在CPR图像上均显示为均匀、连续的线管状高密度影;3D图像大部分显示对比剂充盈良好,局部中断或模糊的14条淋巴管,在CPR图像上均见自对比剂注射部位至腋窝SLN方向的连续的密度不均的线管状高密度影.余6只实验兔CT-LG检查显像效果较差,其中3只SLN显影淋巴管未显影,其CPR图像见自对比剂注射部位至SLN方向显影浅淡的线管状略高密度影,密度不均匀;而2只仅淋巴管起始段显影及1只SLN和淋巴管均未显影的实验兔,CPR图像与3D图像显像效果类似.(3)前哨淋巴结活检(SLNB)共摘取SLN 24枚,病理为转移性18枚,阴性6枚.淋巴结长径及CT-LG显像SLN出现充盈缺损在转移性和阴性SLN中有统计学差异(P=0.041和P=0.001);淋巴结短径、形状及边缘清晰与否在二者间无统计学意义(均P>0.05).结论 CT-LG检查中3D重建及CPR技术均可有效显示腋窝SLN及淋巴管的形态,且CPR技术显示更清楚、细致;淋巴结长径及CT-LG显像SLN的充盈缺损有助于鉴别转移性和阴性SLN.     

兔VX2移植性肝癌血管造影

目的研究兔VX2肝癌血管造影表现.方法34只新西兰大白兔开腹直视下肝左中叶瘤组织块接种VX2肿瘤,接种后第3周直视下穿刺右侧股动脉进路行腹腔动脉-肝动脉造影.结果6只兔数字电影方式(DC)腹腔动脉造影不能清晰显示肿瘤血管与肿瘤染色征象;28只兔数字减影方式(DSA)腹腔动脉造影,都能清晰显示肿瘤血管与肿瘤染色征象.兔肝VX2肿瘤典型血管造影征象表现为肿瘤呈膨胀性生长,供血动脉环绕肿瘤呈握拳状、抱球状、环圈状,从环绕的肿瘤主干血管上发出或长或短的细小芽状、根状、丝状的增生血管从周边向中心推进,显影的周边血管密度明显大于肿瘤中心,形成薄壁、厚壁、玉佩状等形状的圆形或椭圆形周边深染中心相对淡染的肿瘤染色结节;≥1cm的肿瘤结节染色完整、边缘清晰,当肿瘤较小时结节呈团片状染色,边缘欠清晰.结论兔肝VX2肿瘤为富血供性肿瘤,肿瘤周边部血供比中心部丰富,腹腔动脉造影足以显示清晰典型征象.     

乳腺癌的前哨淋巴结定位

了解患者的腋窝淋巴结情况对判断早期乳腺癌的预后非常重要，它也对制定术后的治疗计划有所帮助。我们通过对前哨淋巴结的精确定位和病灶组织学评价准确地预测其它腋窝淋巴结的转移情况，从而避免了对阴性淋巴结病人进行腋窝根治手术。放射性示踪技术在前哨淋巴结的术前和术中定位中起着很重要的作用。理想的前哨淋巴结定位是在术前和术中进行放射性淋巴闪烁显像，同时淋巴闪烁显像也可以检查出病人腋公外的淋巴引流，从而可进行更适合的治疗。常规的前哨淋巴结定位，需要了解放射性药物或其他示踪剂的动力学及所使用的探测仪器。应用前哨淋巴结技术，外科医师、核医学医师和病理科医师之间需要紧密合作。     

乳腺癌的前哨淋巴结定位

了解患者的腋窝淋巴结情况对判断早期乳腺癌的预后非常重要，它也对制定术后的治疗计划有所帮助。我们通过对前哨淋巴结的精确定位和病灶组织学评价准确地预测其它腋窝淋巴结的转移情况，从而避免了对阴性淋巴结病人进行腋窝根治手术。放射性示踪技术在前哨淋巴结的术前和术中定位中起着很重要的作用。理想的前哨淋巴结定位是在术前和术中进行放射性淋巴闪烁显像，同时淋巴闪烁显像也可以检查出病人腋公外的淋巴引流，从而可进行更适合的治疗。常规的前哨淋巴结定位，需要了解放射性药物或其他示踪剂的动力学及所使用的探测仪器。应用前哨淋巴结技术，外科医师、核医学医师和病理科医师之间需要紧密合作。     

探测乳腺癌前哨淋巴结的初步应用

目的 评价核素淋巴显像和γ探针定位确定乳腺癌前哨淋巴结（SLN）的价值。方法 28例妇性乳腺癌患者,体检腋窝未扪及肿块。^99Tc^m－右旋糖酐（Dx）37MBq皮下注射,行淋巴显像后用γ探针皮肤定位,并与手术、病理检查结果对照。结果 28例患者中活检的SLN26例,灵敏度为85.7%(6/7例）,特异性100％（19／19例）。结论 核素淋巴显像和γ探针定位是一种简便、安全、易被患者接受的检测SLN的方法,对预测腋窝淋巴结转移有很大帮助。     

乳腺癌前哨淋巴结显像研究

目的　探讨乳腺癌前哨淋巴结 (SLN)显像的方法及其临床意义。方法　对 117例早期乳腺肿瘤患者进行乳腺SLN显像 ,6例进行双侧比较和SPECT CT图像融合。其中 13例在瘤体表面皮下注射99Tcm DTPA 人血清白蛋白 [HSA ,5 5 5MBq(0 5ml) ];5 0例在瘤周乳腺组织内注射未过滤99Tcm 硫胶体 [SC ,92 5MBq(4ml) ,分 4点 ];5 4例在瘤体上部乳腺组织内一点注射相同体积SC。结果　 3种方法均能快速显示SLN ,但最佳显示时间和淋巴结显示量因人而异 ,与注射深度和体积有关 ,第 3种方法能显示较多的锁骨区和内乳淋巴结。HSA、SC显像成功率分别为 6 9 2 % (30min时 )和 >84 % (2h内 )。断层图像融合有助于识别SLN和引流变异。结论　乳腺SLN显像对于正确定位SLN、识别淋巴引流变异和制定辅助治疗方案是必需的。     

Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

Objective

To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.

Materials and Methods

This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed.

Results

All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention.

Conclusion

Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.     

早期乳腺癌前哨淋巴结活检替代腋窝清扫的临床应用

目的：探讨腋窝前哨淋巴结活检术在早期乳腺癌中替代腋窝淋巴清扫术的意义。方法：选择15例早期（T1-2N0M0）乳腺癌患者,用1%亚甲蓝溶液行腋窝前哨淋巴结活检,淋巴结阴性,不行腋窝清扫。结果：15例患者随访1～3年,术后无一例出现患侧上肢肿胀、患侧上肢感觉麻木、运动障碍等并发症。所有患者未发现有局部复发及腋窝肿大淋巴结。结论：对于早期乳腺癌患者,腋窝前哨淋巴结活检阴性可替代腋窝清扫术。     

兔VX2肝移植瘤磁共振背景信号抑制弥散加权成像的实验研究

目的 探讨磁共振背景信号抑制弥散加权体部成像在经肝动脉化疗栓塞术联合静脉注射血管生成抑制剂内皮抑素治疗VX2肝移植瘤疗效评价中的作用.方法 荷瘤兔随机分为2组,每组8只.对照组经耳缘静脉注射生理盐水10 ml/d,连续应用12 d;介入治疗(TACE+ES)组经肝动脉给予超液化碘油0.2 ml/kg和阿霉素2 mg/kg,并经耳缘静脉注射内皮抑素0.7 mg/kg·d,连续应用12 d.2组均于治疗前后行MR DWIBS检查,分别测量各组肿瘤组织在不同时间点的表观弥散系数,并评价DWIBS及DWIBS原始图经3D MIP重建及黑白翻转获得类PET图像的图像特征.结果 ADC值从治疗后第3天起即有变化,TACE+ES组ADC值在治疗后第3、7、13天均高于对照组并有统计学意义(P<0.05).结论 DWIBS结合ADC值的定量测量可为VX2肝肿瘤的诊断、分期、疗效评价提供有价值的信息.     

Photo-Guided Sentinel Node Mapping in Breast Cancer Using Marker-Free Photo-Gamma Fusion Lymphoscintigraphy

Purpose

Photo-gamma fusion lymphoscintigraphy (PGFLS) was developed by overlying a conventional planar gamma image on a photograph for the guidance of sentinel node biopsy. The feasibility and accuracy of PGFLS was assessed in breast cancer patients.

Methods

A digital camera and a gamma camera were coordinated to obtain photograph and gamma images from the same angle. Using the distance to the object and calibration acquisition with a flat phantom and radioactive markers, PGFLS was performed both in phantom and in patients without fiducial markers. Marker-free PGFLS was verified using flat phantom, anthropomorphic phantom with markers simulating sentinel nodes and breast cancer patients. In addition, the depth of the radioactive marker or sentinel node was calculated using two gamma images taken at right angles. The feasibility and accuracy of PGFLS were assessed in terms of mismatch errors of co-registration and depth with reference to the data from SPECT/CT.

Results

The mismatch error was less than 6 mm in the flat phantom image at a distance from 50 to 62 cm without misalignment. In the anthropomorphic phantom study, co-registration error was 0.42 ± 0.29 cm; depth error was 0.51 ± 0.37 cm, which was well correlated with the reference value on SPECT/CT (x scale: R² = 0.99, p < 0.01; y scale: R² = 0.99, p < 0.01; depth: R² = 0.99, p < 0.01). In ten patients with breast cancer referred for lympho-SPECT/CT, PGFSL enabled photo-guided sentinel lymph node mapping with acceptable accuracy (co-registration error, 0.47 ± 0.24 cm; depth error, 1.20 ±0.41 cm). The results from PGFSL showed close correlation with those from SPECT/CT (x scale: R² = 0.99, p < 0.01; y scale: R² = 0.98, p < 0.01; depth: R² = 0.77, p < 0.01).

Conclusions

The novel and convenient PGFLS technique is clinically feasible, showing acceptable accuracy and providing additional visual and quantitative information for sentinel lymph node mapping. This approach will facilitate photo-guided sentinel lymph node dissection in breast cancer.     

乳腺癌前哨淋巴结转移与VEGF、分子分型的关系

目的 探讨乳腺癌前哨淋巴结转移(SLNM)与血管内皮细胞生长因子(VEGF)、分子分型的关系.方法 搜集手术病理证实的乳腺癌42例,其中SLNM 22例为研究组,无淋巴结转移20例为对照组,术前行1.5 T Aurora乳腺专用磁共振动态增强扫描,术后标本进行VEGF-c及ER,PR,Her-2免疫组织化学染色,比较两组VEGF-c评分及分子分型的差异.结果 研究组VEGF-c评分≥2分比例高于对照组(P=0.005),Her-2阳性型+三阴型的比例高于对照组(P =0.043).结论 乳腺癌SLNM与VEGF-c、分子分型关系较为密切,VEGF-c高表达、Her-2阳性型+三阴型更容易发生前哨淋巴结转移.     

兔肝VX2瘤活体二维多体素 1H-MRS成像STEAM和PRESS序列的比较

目的 探讨不同的定位序列对兔肝VX2瘤活体二维多体素1H-MRS(2D 1H-MRS)成像的影响. 材料与方法 兔肝VX2瘤荷瘤兔14只,于第一期(种植后第2～3周)和第二期(种植后第4周)利用1.5T磁共振扫描仪行常规MRI,并在其他参数不变的条件下分别采用激励回波采样(STEAM)和点解析波谱(PRESS)序列行活体2D 1H-MRS检查,观察不同序列波谱图的基线情况,测量主要代谢物波峰的信噪比、中心位置、半高宽和峰下积分面积比值,并进行统计学分析. 结果 (1)STEAM和PRESS序列各行25瘤次2D 1H-MRS采集,其中第一期成功率为78.6%,第二期成功率为100%,总体技术成功率为88.0%.(2)在相同时期、相同部位,不同序列所得波谱图在基线情况、代谢物波峰的信噪比、中心位置、半高宽及各个代谢物峰下积分面积的比值(包括谷氨酸胺和谷氨酸复合物(Glx)/脂质(Lip)、胆碱化合物(Cho)/Lip和糖原和葡萄糖复合物(Glyu)/Lip)差异无统计学意义(P>0.05). 结论 利用1.5T磁共振扫描仪行兔肝VX2瘤活体2D 1H-MRS检查可成功获得可析性波谱,技术成功率为88.0%.其他扫描条件和参数相同时,采用短TE(30 ms),STEAM和PRESS序列在波谱质量和检测肝内主要代谢物的敏感性方面无明显差异.     

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

Purpose

Hybrid imaging techniques can provide functional and anatomical information about sentinel lymph nodes in breast cancer. Our aim in this study was to evaluate which imaging parameters on hybrid sentinel lymphoscintigraphy predicted metastatic involvement of sentinel lymph nodes (SLNs) in patients with breast cancer.

Methods

Among 56 patients who underwent conventional sentinel lymphoscintigraphy, 45 patients (age, 53.1 ± 9.5 years) underwent hybrid sentinel lymphoscintigraphy using a single-photon emission computed tomography (SPECT)/computed tomography (CT) gamma camera. On hybrid SPECT/CT images, we compared the shape and size (long-to-short axis [L/S] ratio) of the SLN, and SLN/periareolar injection site (S/P) count ratio between metastatic and non-metastatic SLNs. Metastatic involvement of sentinel lymph nodes was confirmed by pathological biopsy.

Results

Pathological biopsy revealed that 21 patients (46.7 %) had metastatic SLNs, while 24 (53.3 %) had non-metastatic SLNs. In the 21 patients with metastatic SLNs, the SLN was mostly round (57.1 %) or had an eccentric cortical rim (38.1 %). Of 24 patients with non-metastatic SLNs, 13 patients (54.1 %) had an SLN with a C-shape rim or eccentric cortex. L/S ratio was 2.04 for metastatic SLNs and 2.38 for non-metastatic SLNs. Seven (33 %) patients had T1 primary tumors and 14 (66 %) had T2 primary tumors in the metastatic SLN group. In contrast, 18 (75 %) patients had T1 primary tumors and six (25 %) had T2 tumors in the non-metastatic SLN group. S/P count ratio was significantly lower in the metastatic SLN group than the non-metastatic SLN group for those patients with a T1 primary tumor (p = 0.007).

Conclusions

Hybrid SPECT/CT offers the physiologic data of SPECT together with the anatomic data of CT in a single image. This hybrid imaging improved the anatomic localization of SLNs in breast cancer patients and predicted the metastatic involvement of SLNs in the subgroup of breast cancer patients with T1 primary tumors.     

超声造影在兔肝VX2肿瘤模型演变评估中的应用

目的:探讨超声造影在兔肝VX2肿瘤模型演变评估中的价值.方法:建立30只新西兰兔肝VX2肿瘤模型,随机分为3组,术后16天、28天、42天各对一组荷瘤兔行超声造影检查.超声造影后立即处死荷瘤兔,切除肿瘤组织行病理学检查.结果:超声造影动脉相与病理测量肿瘤最大直径差异无统计学意义(P>0.10),其中第3组大于第2组,第2组大于第1组(P<0.05).三组肿瘤超声造影均呈"快进快出"恶性肿瘤造影声像表现,但动脉相增强模式不同,即在第1组主要呈整体增强(6/10),第2组主要呈不均匀性增强(6/10),第3组主要呈周边环状增强(9/10),三组比较差异有统计学意义(P<0.05).结论:超声造影可准确测量出兔肝VX2肿瘤直径及变化趋势,可根据肿瘤在动脉相的增强模式来判断肿瘤的血供状态及坏死范围,能较好地评估兔肝VX2肿瘤的演变过程.