钆塞酸二钠增强磁共振成像联合磁共振扩散加权成像对肝细胞癌微血管侵犯和预后的预测价值

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)征象和扩散加权成像(DWI)对肝细胞癌(HCC)患者病理学微血管侵犯(pMVI)的联合预测价值及其预测结果与患者预后的关系。方法收集2012年1月至2018年6月中国医学科学院肿瘤医院收治的181例初诊HCC患者,评估病灶的影像学特征并测量表观扩散系数(ADC)。分析影像学特征和ADC值在不同pMVI组中的差异,应用多因素logistic回归和受试者工作特征(ROC)曲线分析有意义的参数对pMVI预测的价值。分析MRI预测的结果(mrMVI)与患者无复发生存时间(RFS)的关系。结果 pMVI阳性组51例,pMVI阴性组130例。pMVI阳性组的ADC值为(1.10±0.17)×10^-3 mm²/s,明显低于pMVI阴性组[(1.27±0.22)×10^-3 mm²/s,P<0.001]。不完整的增强假包膜、肿瘤边缘不光滑、动脉期瘤周强化、马赛克征和肝胆期瘤周低信号的发生率在pMVI阳性组明显高于pMVI阴性组(均P<0.05)。多因素logistic回归分析显示,肿瘤边缘、动脉期瘤周强化、肝胆期瘤周低信号和ADC值与pMVI独立相关(均P<0.05)。ROC分析显示,联合上述参数预测pMVI的曲线下面积、敏感度和特异度分别为0.830、76.5%和81.5%。mrMVI阳性组患者的中位RFS为23.6个月,明显低于mrMVI阴性组(38.2个月,P=0.004)。结论肿瘤边缘、动脉期瘤周强化、肝胆期瘤周低信号和ADC值是HCC发生pMVI的独立预测因素,且mrMVI与患者的RFS有关。     

钆塞酸二钠增强磁共振成像联合磁共振扩散加权成像对肝细胞癌微血管侵犯和预后的预测价值

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)征象和扩散加权成像(DWI)对肝细胞癌(HCC)患者病理学微血管侵犯(pMVI)的联合预测价值及其预测结果与患者预后的关系。方法收集2012年1月至2018年6月中国医学科学院肿瘤医院收治的181例初诊HCC患者, 评估病灶的影像学特征并测量表观扩散系数(ADC)。分析影像学特征和ADC值在不同pMVI组中的差异, 应用多因素logistic回归和受试者工作特征(ROC)曲线分析有意义的参数对pMVI预测的价值。分析MRI预测的结果(mrMVI)与患者无复发生存时间(RFS)的关系。结果 pMVI阳性组51例, pMVI阴性组130例。pMVI阳性组的ADC值为(1.10±0.17)×10-3 mm2/s, 明显低于pMVI阴性组[(1.27±0.22)×10-3 mm2/s, P<0.001]。不完整的增强假包膜、肿瘤边缘不光滑、动脉期瘤周强化、马赛克征和肝胆期瘤周低信号的发生率在pMVI阳性组明显高于pMVI阴性组(均P<0.05)。多因素logistic回归分析显示, 肿瘤边缘、动脉期瘤周强化、肝胆期...     

钆喷酸二葡甲胺的致突性研究

本文应用鼠伤寒沙门菌／徽粒体试验，小鼠骨髓细胞微核试验和体外哺乳动物细胞（ＣＨＬ）染色体畸变试验对钆喷酸二葡甲胺进行了致突性研究．结果表明：钆喷酸二葡甲胺各剂量ＴＡ９７，ＴＡ９８，ＴＡ１００，ＴＡ１０２在加和不加Ｓ９条件下均无致突性。在徽核试验中，各剂量诱发小鼠骨髓多染红细胞的微核率与阴性对照相比，无显著差异（Ｐ＞０．０５）染色体畸变试验也未观察到钆喷酸二葡甲胺对体外培养细胞的损伤作用．研究表明，钆喷酸二葡甲胺对原核生物和哺乳动物细胞无致突变作用．     

帕米膦酸二钠与氯甲膦酸二钠治疗晚期肿瘤骨转移的随机对照临床研究

为了评价帕米膦酸二钠对骨转移所致高血钙和骨痛的治疗作用。方法；本临床研究为随机化对照研究，共收治有溶骨性骨转移病二的闰人５８例。病人随机分为两组，治疗组３０例，采用帕米膦酸二钠３０ｍｇ／天，共用１天；对照组２８例，采用骨磷３００ｍｇ／天，共用５天。帕米膦酸二钠和骨膦均加入５％的葡萄糖溶液５００ｍｌ中静脉滴注４个小地。血钙下降率和骨痛的缓解率作为评价指标。     

帕米膦酸二钠与氯甲磷酸二钠治疗晚期肿瘤骨转移的疗效观察

目的 为了比较帕米膦酸二钠与氯甲膦酸二钠对骨转移所致高血钙和骨痛的治疗作用。方法将收治的有溶骨性骨转移病灶的７８例随机分为两组,治疗组４０例,采用帕米膦酸二钠０ｍｇ／天,共用１天;对照组３８例,采用氯甲膦酸二钠３００ｍｇ／天,共用５天。两均加入５％葡萄糖溶液５００ｍｌ中静脉滴注５个小时,血钙下降率和骨痛缓解率作为评价指标。结果 治疗组血钙血高者１３例,治疗后第７天１１例血钙降至正常,下降率８４．     

帕米膦酸二钠与氯甲磷酸二钠治疗晚期肿瘤骨转移的疗效观察

目的　为了比较帕米膦酸二钠与氯甲膦酸二钠对骨转移所致高血钙和骨痛的治疗作用。方法将收治的有溶骨性骨转移病灶的７８ 例随机分为两组,治疗组４０ 例,采用帕米膦酸二钠３０ ｍｇ／ 天,共用１ 天;对照组３８ 例,采用氯甲膦酸二钠３００ ｍｇ／ 天,共用５ 天。两者均加入５ ％ 葡萄糖溶液５００ ｍｌ 中静脉滴注４ 个小时,血钙下降率和骨痛缓解率作为评价指标。结果　治疗组血钙升高者１３ 例,治疗后第７ 天１１ 例血钙降至正常,下降率８４．６ ％ 。对照组血钙升高者５ 例,治疗后３ 例降至正常,下降率６０ ％ 。疼痛缓解方面,治疗组与对照组治疗前均有骨痛,治疗后分别有２５ 例和１５ 例缓解,疼痛缓解率分别为６２．５ ％ 和３９．６％ 。治疗组血钙下降率和疼痛缓解率均高于对照组,但两者之间差异无显著性（ Ｐ＞ ０．０５） 。两组病人在用药过程中均未见严重不良反应。结论　帕米膦酸二钠与氯甲膦酸二钠均为治疗晚期肿瘤骨转移所致高血钙和骨痛的有效药物,临床使用方便,病人耐受性好。     

钆贝酸葡甲胺与钆喷替酸葡甲胺在肝脏MRI增强扫描中的应用与评价

目的对钆贝酸葡甲胺（Gd—BOPTA）与钆喷替酸葡甲胺（Gd—DTPA）在肝脏MRI增强扫描中的安全性、耐受性及诊断性疗效进行临床研究与评价。方法经超声或CT检查怀疑为肝脏原发肿瘤或转移瘤而要求行MR检查的患者共42例。先进行MR平扫,然后随机经静脉注射Gd—BOPTA或Gd—DTPA中任1种试验药物,剂量0．1mmol／kg。在开始注射对比剂后15～45s、1～2min、2～3min、4～5min和8min时,进行早期动态增强T1FFE扫描;给药后40～120min,进行T1FFE和T1SE延迟扫描。将每一病例的全部影像资料分为3组：给药前与给药后早期成像组、给药前与给药后延迟成像组、给药前与给药后早期＋延迟成像组;并对每组资料从4个方面进行配对判读：（1）肝脏病变信号的增强程度;（2）检出或排除肝脏病变的准确性;（3）对病变内部形态的评估;（4）显示病变特点的可信度。将判读结果分别进行组内及组间比较,最后进行放射学应用价值评估。结果在Gd—DTPA组内,给药后早期成像组的增强效果明显优于给药前与给药后延迟成像组,差异有统计学意义（P〈0．01）。给药前与给药后延迟成像组内,Gd-BOPTA组优于Gd．DTPA组,两组间差异有统计学意义（P〈0．05）。Gd—BOPTA组与Gd—DTPA组分别有72．7％和70．0％的病例在用药后图像质量得到显著改善,两组间差异无统计学意义。结论Gd-DTPA给药后早期的增强效果明显优于延迟期;Gd—BOPTA给药后早期的增强效果与Gd—DTPA相仿,而延迟期明显优于Gd-DTPA。     

帕米膦酸二钠治疗骨转移癌疼痛

恶性肿瘤晚期骨转移发生率高达20％～70％,骨转移发生后,常出现顽固性疼痛、病理性骨折等,影响生存质量。自2000年3月至2003年3月,我们应用国产帕米膦酸二钠治疗实体瘤骨转移患58例,疗效满意。现报告如下：     

帕米膦酸二钠治疗骨转移引起疼痛的临床研究

背景与目的:临床研究表明,帕米膦酸二钠治疗骨转移引起的疼痛有肯定的疗效,提高使用剂量能否提高疗效尚未明确.本研究的目的是观察两组不同剂量的帕米膦酸二钠治疗骨转移引起疼痛的效果和毒副作用.方法:将90例实体瘤骨转移患者随机分为治疗组和对照组.治疗组45例,采用帕米膦酸二钠120 mg分3天静滴(即60 mg,d1;30 mg,d2～3);对照组采用帕米膦酸二钠90 mg分3天静滴(即30 mg,d1～3).二组均4周为一周期.结果:治疗组45例,显效20例,有效23例,无效2例,总有效率95.6%(43/45);用药一疗程取得疗效40例(88.9%),一周内取得疗效36例(80%);不良反应3例(6.7)%.对照组45例,显效16例,有效20例,无效9例,总有效率80.0%;用药一疗程取得疗效26例(57.8%),一周内取得疗效26例(57.8%);不良反应3例(6.7%).经统计学分析,总有效率及一周内有效率两组比较有显著性差异(P＜0.05),用药一疗程有效率两组间有非常显著性差异(P＜0.01).结论:帕米膦酸二钠对骨转移引起的疼痛有良好的止痛效果,一疗程采用120 mg优于90 mg,患者可以耐受.     

钆喷酸葡胺多期增强MRI预测原发性肝癌腹膜后淋巴结转移的临床研究

目的 探究钆喷酸葡胺多期增强磁共振成像(magnetic resonance imaging, MRI)预测原发性肝癌(primary liver cancer, PLC)腹膜后淋巴结转移的临床效果。方法 选取70例PLC患者，常规MRI检查后开启多期增强MRI检查，患者接受钆喷酸葡胺多期增强MRI扫描，2 ml/kg,经外周肘静脉团注，速率是2.0～2.5 ml/s,注射后使用20 ml生理盐水冲洗导管。以病理学检查结果为标准，比较两种成像模式下PLC、PLC腹膜后淋巴结转移诊断准确率，以及两种成像模式诊断PLC腹膜后淋巴结转移的灵敏度和特异度。结果 常规MRI扫描诊断PLC、PLC腹膜后淋巴结转移的准确率为82.86%,经钆喷酸葡胺多期增强MRI扫描准确率为95.71%,钆喷酸葡胺多期增强MRI扫描的诊断准确率高于常规MRI扫描(P<0.05);使用钆喷酸葡胺多期增强MRI诊断PLC腹膜后淋巴结转移的灵敏度和特异度高于常规MRI(P<0.05)。结论 钆喷酸葡胺多期增强MRI可提升诊断原发性肝癌腹膜后淋巴结转移准确率，建议临床使用。     

MRI assessment of ventricular function

Cine-MRI is a robust non invasive technique able to assess regional and global systolic function of both ventricles. Conventinal cine-MRI was used for LV global function parameters both on horizontal long axis and vertical long axis, applying area-length methods, as in echocardiography. Recent developments of segmented k-space techniques allowed breath-held cine-MRI, making possible a rapid acquisition of the entire ventricles, both left and right. Using the Simpson's rule volumes are estimated with high accuracy, without any geometrical assumption; this method is considered gold standard for global function assessment. Regional function is studied by cine-MRI both qualitatively and quantitatively, as it represents the best technique in defining endo- and epi-cardial borders. The ability of quantify wall thickness and wall thickening makes cine-MRI highly suitable for stress-imaging, both in ischemia detection and viability assessment. Tagging is a novel technique, able to assess the complex mechanism of myocardial contraction and to quantify myocardial strain. Finally MRI is also able to assess diastolic function with phase velocity mapping.     

The breast dynamic contrast enhanced MRI: preliminary results of a quantitative analysis

The objective of our study was to apply a quantitative analysis to the dynamic contrast enhanced MR imaging of the breast. Automated criteria increase the objectivity and reproducibility of the diagnostic interpretation of the imaging for differentiating benign and malignant lesions. The validation of this applied method was evaluated by analysing the time- signal intensity curves and the performance of the extracted enhancement parameters. The performance of some extracted parameters was evaluated by ROC (Receiver Operating Characteristic) analysis. These parameters were found to be particularly accurate in differentiating lesions.     

Prognostic radiology: quantitative assessment of tumor oxygen dynamics by MRI

It is generally recognized that tumor hypoxia has a strong influence over therapeutic outcome in the clinic. The authors have developed an oximetry approach using 19F echo planar magnetic resonance imaging-FREDOM (Fluorocarbon Relaxometry using Echoplanar imaging for Dynamic Oxygen Mapping), which reveals dynamic changes based on sequential maps of regional tumor PO2. Preclinical investigations focused on diverse sublines of the Dunning prostate R3327 tumor. As expected, intratumoral heterogeneity was considerable. However, large tumors (>3.5 cm3) were significantly less well oxygenated than smaller tumors (<2 cm3). Faster growing, less differentiated tumors were less well oxygenated than size-matched tumors of slower growing sublines. The greatest potential of this technique is the ability to follow the fate of individual tumor regions with respect to interventions. For each subline, there was a significant response to respiratory challenge with oxygen for initially well-oxygenated regions (baseline PO2 > 10 mm Hg). More interestingly, subline dependent behavior was found for initially hypoxic regions that correlated with rate of growth. The authors believe the FREDOM approach is essentially ripe for translation to the clinic. This approach could help to identify patients with hypoxic tumors and indicate the feasibility of manipulating tumor characteristics through adjuvant interventions to improve therapeutic response.     

Treatment of liver cancer: current status and future prospectives

The most common liver cancers are hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), and metastatic colorectal cancer. In HCC patients, the extent of the surgical resection is limited due to the functional status of the underlying cirrhotic liver. Limited resection, transarterial catheter embolization, ethanol injection, and microwave coagulation have been applied to treat the patients with liver hypofunction; however, the intrahepatic recurrence rate was relatively high in those patients. Therefore, liver transplantation is the only radical treatment to remove HCC and cirrhotic livers with viral infections. Recent advances in anti-viral agents promise to improve the outcome after liver transplantation in patients with HCC. On the other hand, CCC is outside the indications for liver transplantation because of the broad extension of lymph node and nerve plexus. In liver metastasis from colorectal cancer, overall survival is not greatly improved, although arterial chemotherapy reduces mortality related to liver metastasis. Surgical resection including repeated hepatectomy indicates better survival in patients with liver metastases. In the future, both CCC and metastatic liver cancer could be candidates for gene therapy. For the 21 century, a new therapeutic strategy incorporating clinical evidence, molecular biology, and organ replacement needs to be established for the treatment of liver cancer.     

The current status of cochlear implants

In the University of Sydney cochlear implant programmes, 109 adults and teenagers have received a 22 electrode cochlear implant (Cochlear? implant) since 1984; and 127 children have received a Cochlear? implant since 1987. The results were analysed when all patients were still using the MSP speech processors rather than the newer SPEAK processors. Seventy five percent of adults and teenagers deafened after learning speech for a period of less than 15 years were able to recognise some words by audition alone. Only 30 percent of adults and teenagers deafened for over 15 years regaining hearing were able to recognise any words by audition alone but most found the device very helpful in aiding lipreading. None of adults and teenagers who were born deaf who received a cochlear implant found they could recognise any sounds and half of them abandoned using the device. Children who were deafened after learning speech usually did extremely well with a cochlear implant and could remain in their regular school situation. Children who had done well with hearing aids were also very likely to succeed with a cochlear implant. Children who had learnt to communicate by gestures or signs who had reached an age of over 6 years did poorly with the cochlear implant with 73 percent unable to recognise speech by listening alone and unable to improve their speech production to an intelligible level. Children born deaf who received the implant early in life and were taught primarily through audition could be very successful with 52% recognising words by audition alone and gaining intelligible speech. Preliminary studies suggested that the younger the child received the cochlear implant the greater the possibility of success. Neural plasticity or the ability to the brain to learn or relearn tasks appear to be the most important factor affecting the selection of candidates for a cochlear implant. It appeared that after the age of 6 years, if a child had not utilised the auditory and motor areas of spech production within the brain, the neural plasticity remaining was insufficient to allow effective use of a cochlear implant. The cochlear implant is a device which can restore when a person is too deaf to be able to use a conventional hearing aid. The cochlear implant does not provide normal hearing but may provide sufficient information for the recipient to distinguish several words without the need for lipreading. Evidence will be presented which shows that the device can enable children suffering from congenital deafness to gain excellent speech and listening providing it is fitted at an early age and there is an appropriate training programme to teach the child.     

腹腔镜在胃癌中的应用现状

随着微创外科的理念被引入胃癌外科领域,腹腔镜技术在胃癌诊断及治疗中得到广泛应用。腹腔镜下早期胃癌手术的治疗疗效优于传统开腹手术,并已成为标准手术方式之一,腹腔镜下进展期胃癌手术的近期疗效虽优于传统手术方式,但远期疗效仍缺乏多中心、大样本、前瞻性随机对照研究来验证。