放射性核素骨显像在前列腺癌骨转移中的研究价值

目的:探讨放射性核素骨显像与血清前列腺特异性抗原(PSA)联合检测在前列腺癌骨转移诊断中的临床意义。方法:对130例前列腺癌患者的PSA检测结果及SPECT骨显像进行回顾性分析。结果:130例前列腺癌患者,骨显像诊断骨转移86例,阳性率为66.2%。在86例骨转移的患者中,发生脊椎转移77例,占77.9%,骨盆转移65例,占75.6%,肋骨转移42例,占48.8%,肩胛骨转移11例,占12.8%,胸骨转移7例,占8.1%,颅骨转移6例,占7%。脊椎和骨盆是前列腺癌骨转移主要涉及的部位。骨显像阳性组和骨显像阴性组PSA均值差异有显著性(P<0.01),PSA<20μg/L的前列腺癌患者发生骨转移的可能性小,PSA≥20μg/L的患者发生骨转移的可能性大。结论:PSA≥20μg/L的前列腺患者应行放射性核素骨显像检查。放射性核素全身骨显像与血清PSA浓度联合检测对于前列腺癌骨转移的临床诊断具有重要的指导意义。     

小儿成神经细胞瘤骨转移影像学特征及诊断价值

目的:分析小儿成神经细胞瘤骨转移的影像学特征,并探讨X线平片、CT和MRI的诊断价值.方法:收集小儿成神经细胞瘤骨转移患者47例,分析骨转移在X线平片、CT和MRI上的特征,并比较其诊断价值.结果:成神经细胞瘤骨转移89.2%位于长管状骨、骨盆、头颅和脊柱.形态上包括溶骨型(71.4%)、混合型(28.6%)和单纯成骨型.X线和CT表现为虫蚀样、不规则、极小透光区,部分伴有硬化边缘或骨膜反应.CT在头颅、骨盆、椎体等部位显示更细微、更广泛的病变.MRI骨髓侵犯表现为T1WI低信号,T2WI高信号,MRI发现髓内转移的时间早于CT和X线,显示病变范围更大.结论:X线平片是诊断成神经细胞瘤骨转移的基本影像学方法,为观察长骨转移最佳方法;CT利于显示骨结构重叠较多部位的病变和细节;MRI早期发现髓内、椎管内转移.     

前列腺癌骨转移的特点及其相关危险因素分析

目的 探讨前列腺癌骨转移的临床特点及其危险因素.方法 回顾性分析2006年6月-2016年6月南昌大学第一附属医院收治的、经穿刺活检或术后病理检查确诊为前列腺癌患者的临床资料,记录首次入院时的一般资料、化验检查结果 及病理切片Gleason评分,分析各临床因素与骨转移发生的关系,明确骨转移发生的相关危险因素.结果 共纳入585例前列腺癌患者,其中发生骨转移228例,无骨转移357例.在骨转移患者中,骨盆转移发生率最高,占81.58%,其次是脊柱转移(63.16%)和肋骨转移(58.33%),锁骨转移最少(14.47%).Logistic回归分析显示年龄<71.5岁、碱性磷酸酶(ALP)>85.5U/L、前列腺特异性抗原(PSA)>79.88μg/L和Gleason评分>7.5分是前列腺癌骨转移的危险因素.ROC曲线分析显示,上述各因素诊断骨转移的灵敏度分别为56.1%、66.7%、68.4%、56.1%,特异度分别为56.6%、81.8%、70.0%、65.3%.结论 前列腺癌骨转移以骨盆转移最为多见,年龄、ALP、PSA及Gleason评分是前列腺癌发生骨转移的危险因素.     

MRI与骨扫描诊断前列腺癌骨转移的比较

目的 通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断,以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法 回顾性分析2011年1月-2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁,平均年龄（73±7.98）岁,分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（ＮＰＶ）。结果 54例病人诊断为骨转移（成骨性骨转移48例,混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA）>50 ng/mL,而92%（182/19８）的前列腺癌无骨转移病人的PSA<50 ng/mL。MRI诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为85.1%、100%、96.8%、100%、96.1%;全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高,骨扫描的敏感度较高。MRI与骨扫描可以实现优势互补,利于前列腺癌的准确临床分期。     

前列腺癌骨转移影像诊断方法研究进展

前列腺癌具有很高的骨转移倾向,在初次诊断时即有较高的骨转移率,所以前列腺癌患者早期筛查骨转移对前列腺癌的分期、治疗及预后判断具有重要意义。放射性核素骨显像是临床常用的骨转移影像学检查方法,对骨转移瘤早期即有较高的检出率,辅以X线平片、CT、MRI等手段,有助于进一步提高诊断的准确性。笔者就前列腺癌骨转移的影像学检查的研究现状做一综述,为临床早期诊断骨转移瘤提供影像学依据。     

89Sr治疗乳腺癌和前列腺癌多发性骨转移的临床观察

目的 探讨放射性核素89Sr治疗乳腺癌和前列腺癌多发性骨转移患者的临床效果.方法 回顾性分析30例乳腺癌和40例前列腺癌多发性骨转移患者接受89Sr治疗的病例资料,采用Karnofsky评分量表和骨显像方法进行疗效评估.结果 乳腺癌组的止痛总有效率为79%,前列腺癌组的止痛总有效率为85%,两组患者之间差异无统计学意义(x2=0.78,P＞0.05).两组患者的生存质量均有明显改善,治疗前后两组患者的Karnofsky评分均有明显提高(t=2.46,P＜0.05;t=2.68,P＜0.05).治疗后两组患者均未见明显骨髓抑制与肝肾功能损伤.结论 89Sr治疗乳腺癌和前列腺癌多发性骨转移止痛效果良好,患者生存质量有明显提高.     

骨盆原发性恶性肿瘤的影像学临床分析

目的:探讨骨盆原发性恶性肿瘤的病种分布及其影像学表现。方法:回顾本院11年间经活检和/或手术病理证实的骨盆原发性恶性肿瘤56例,分析其发病情况及影像学主要表现。结果:骨盆原发性恶性肿瘤共56例,按其发生比例依次为骨髓瘤(包括单发及多发性骨髓瘤)34例(占60.7%),软骨肉瘤、尤文氏肉瘤及原发性骨淋巴瘤各6例(分别占10.7%),骨肉瘤2例(占3.6%),恶性骨母细胞瘤及恶性纤维组织细胞瘤各1例(占1.8%)。主要影像表现为溶骨性骨质破坏(48例)或混合性骨质破坏(6例),软组织肿块或肿胀(22例),病灶边界清楚(35例),边界模糊(21例);出现瘤骨或钙、骨化(9例),少数可出现骨膜反应(4例)。结论:骨盆原发性恶性肿瘤种类较多,影像学表现缺乏特异性,综合影像检查可提高对各类病变的诊断及鉴别诊断准确率。     

前列腺癌骨转移的临床诊断:MRI与同位素骨扫描的比较

目的比较盆腔MRI和全身骨扫描对前列腺癌骨转移的临床诊断效能。方法收集183例前列腺疾病患者的资料,包括盆腔MRI和全身骨扫描检查结果。根据临床综合诊断结果,将所有患者分为骨转移组和非骨转移组。对获得的资料进行统计学分析。结果①183例患者中,37例确诊临床骨转移,146例无临床骨转移。37例骨转移患者的转移灶位置,5例位于盆腔内,3例位于盆腔外,29例位于盆腔内外。②盆腔MRI检查诊断24例骨转移,均经临床综合评价确诊为骨转移(100%,24/24)。全身骨扫描诊断27例骨转移,96.4%(27/28)经临床综合评价确诊为骨转移。其它骨转移的确诊均经临床综合诊断。③将盆腔MRI和同位素骨扫描的结果进行比较,盆腔MRI检查未见明确骨转移灶的患者共159例,其中仅有4例患者(4/159,2.52%)全身骨扫描可明确诊断骨转移。④评价2种影像检查方法对全身骨转移的预测和诊断效果,盆腔MRI对全身骨转移预测的敏感性、特异性和准确性分别为78.38%、87.0%和85.25%;全身骨扫描对骨转移的诊断敏感性、特异性和准确性分别为94.59%、62.33%和68.85%。MRI的特异性和准确性高于同位素骨扫描(χ2=23.458,P=0.000;χ2=13.906,P=0.000),同位素骨扫描的敏感性高于MRI(χ2=4.163,P=0.041)。结论盆腔MRI也可用作前列腺癌全身骨转移的诊断。当盆腔MRI检查未见骨转移灶时,发生全身骨转移的机会较低。     

SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。     

全身骨显像诊断前列腺癌骨转移与PSA水平及病理分级的相关性研究

目的 探讨核素全身骨显像诊断前列腺癌骨转移与血清前列腺特异性抗原(PSA)水平及前列腺癌病理分级的关系,并研究前列腺癌发生骨转移的规律和特点.方法　对107例前列腺癌患者术前用放免法测定其血清PSA水平,并进行 99Tcm-亚甲基二瞵酸盐全身骨显像,术后对其进行病理分级,分析前列腺癌骨转移与3种方法检查结果的相关性.结...     

Bronchogenic carcinoma in breast carcinoma patients

Forty-eight female patients who developed bronchogenic carcinoma synchronously with or after the occurrence of breast carcinoma are reported. The object of the study was to review the radiographic findings for possible clues to the diagnosis of bronchogenic carcinoma and to ascertain the histologic diagnoses observed. In 40 patients on whom films were available, the original radiographs before surgery for bronchogenic carcinoma were examined. The clinical records of the 48 patients were also reviewed. Histologic diagnosis of primary bronchogenic carcinoma was required. A solitary pulmonary lesion in a patient with breast carcinoma, a cavitated lesion, or a lesion that failed to respond to appropriate therapy for metastatic breast carcinoma suggested the diagnosis of bronchogenic carcinoma. An increase in the frequency of small cell carcinoma and a decrease in the frequency of adenocarcinoma was seen in bronchogenic carcinomas developing 5 years or more after radiation therapy for breast carcinoma. It was concluded that the benefits of radiation therapy in selected patients far outweighed the risk of bronchogenic carcinoma.     

Pancreatic carcinoma masquerading as renal cell carcinoma

Three cases of pancreatic carcinoma that arose in the tail and extended into the adjacent left kidney are presented. Because of misleading symptoms and radiographic features, the tumors were misdiagnosed as primary renal tumor. In most cases, computed tomography (CT) provides the correct diagnosis and prevents unnecessary surgery.     

Perfusion CT of breast carcinoma: arterial perfusion of nonscirrhous carcinoma was higher than that of scirrhous carcinoma

RATIONALE AND OBJECTIVES: Our goals were to apply perfusion CT technique to breast tumor and to evaluate the correlation between arterial perfusion value and other tumor characteristics. MATERIALS AND METHODS: Thirty-one female patients with primary breast tumors were included in this study. A single-slice dynamic CT was performed after an intravenous bolus injection of contrast material (40 ml; 370 mg I/ml) at 8 ml/sec. The parameters were calculated on a pixel-by-pixel basis by using maximum slope method, and quantitative maps of arterial perfusion were created. Statistical correlation between tumor size, patient age, and perfusion were assessed. Differences in perfusion between scirrhous and nonscirrhous carcinoma were also assessed. RESULTS: Perfusion CT images were successfully created for 24 patients (mean age, 55.9 years old; range, 36-85 years). In five patients, dynamic CT was not performed due to lack of visualization of the breast tumor on unenhanced CT. In two patients, reliable perfusion CT image could not be created because of motion artifact. The mean perfusion for 24 tumors was 33.1 +/- 16.9 ml/min/100 ml (mean +/- SD; range, 14-78), and the tumor perfusion did not correlate with patient's age or tumor size (21.0 +/- 10.2 mm; range, 10-45 mm). The mean perfusion of nonscirrhous carcinoma (45.8 ml/min/100 ml; n = 11) was higher than that of scirrhous carcinoma (22.7 ml/min/100 ml; n = 11; P < .001). CONCLUSION: Determination of the perfusion of breast carcinoma is feasible by dynamic CT and can be performed during a routine CT study without much supplementary burden on the patient. There are differences in blood flow between scirrhous and nonscirrhous breast carcinoma, and further research is needed to determine the impact of this finding.     

原发性肝、胆、胰及胃癌的周围脏器及淋巴结转移的CT诊断

目的:分析本组原发性肝、胆、胰及胃癌的上腹部淋巴结转移的CT表现,提高CT对本组原发性肝、胆、胰及胃癌的上腹部淋巴结转移诊断重要性的认识。方法:回顾性分析67例经手术、病理证实的有上腹部转移的原发性肝、胆、胰及胃癌的CT表现。结果:原发性肝、胆、胰及胃癌的上腹部淋巴结转移及周围结构侵犯的CT征象,主要有上腹部淋巴结转移,邻近脏器的侵犯,血管、腹膜、种植转移及血道转移。结论:原发性肝、胆、胰及胃癌的上腹部淋巴结转移虽有相同的CT征象,但亦有各自的特点。     

Urachal carcinoma

Urachal carcinoma is a rare tumor that often does not manifest clinically until late in its course. Several radiographic features are helpful in suggesting the diagnosis preoperatively. We present a case of urachal carcinoma in which preoperative evaluation included magnetic resonance imaging. This technique was helpful not only in suggesting the diagnosis preoperatively, but also, and more importantly, in the preoperative staging of the neoplasm.     

Urachal carcinoma

Urachal carcinoma is a rare tumor that often does not manifest clinically until late in its course. Several radiographic features are helpful in suggesting the diagnosis preoperatively. We present a case of urachal carcinoma in which preoperative evaluation included magnetic resonance imaging. This technique was helpful not only in suggesting the diagnosis preoperatively, but also, and more importantly, in the preoperative staging of the neoplasm.     

Thymic carcinoma

This is a case of thymic carcinoma-a rare and highly aggressive type of tumor found in the anterior mediastinum. During a routine chest X-ray, a 66-yr-old male pilot was found to have a mediastinal mass. After diagnosis, he underwent chemotherapy, surgery, and radiation therapy and 1 yr after completion of these therapies he was re-issued a third-class medical certificate to fly.