超声弹性成像技术在涎腺疾病诊断中的应用

近年来组织弹性成像技术的出现,实现了超声技术对组织定性、半定量及定量的评价价值.利用弹性成像估测组织弹性模量分布并且转化为可视的声像图,操作简单方便、结果直观,因此该方法一经提出便很快成为医学超声界的关注热点,成为医学超声成像中一项迅速发展的技术.文章就超声弹性成像技术在鉴别涎腺肿瘤良恶性、区别涎腺良性肿瘤以及评价头颈部肿瘤放疗后涎腺损伤等方面的临床应用进行综述.     

彩色多普勒超声在涎腺疾病诊断中的应用

近年来，超声显像在涎腺疾病诊断中的作用越来越引起临床的关注。现就彩色多普勒超声在这方面的应用综述如下：     

p53在涎腺良恶性肿瘤中的表达及意义

目的　探讨p5 3基因在涎腺良、恶性肿瘤的表达及其肿瘤生物学特性的关系。 方法　采用免疫组化SP法检测了 2 0例多形怀腺瘤 (pleomorphicadenoma ,PA)、12例腺淋巴瘤 (adenolyphoma ,AL)、19例恶性多形性腺瘤 (malignantpleomorphicadenoma ,MPA)和 2 5例腺样囊性癌 (adenoidcarcinoma ,ACC)中突变p5 3基因的表达产物p5 3蛋白。 结果　p5 3蛋白在两种恶性涎腺肿瘤中的检出率 (5 0 .0 % )显著高于在两种良性涎腺肿瘤中的检出率 (6 .3% ) (P <0 .0 5 ) ;在MPA中的检出率 (5 2 .6 % )显著高于在PA中的检出率 (10 .0 % ) (P <0 .0 5 ) ;晚期恶性涎腺肿瘤 (TNM分型为Ⅲ -Ⅳ期 )的p5 3检出率 (78.9% )显著高于早期恶性涎腺肿瘤 (TNM分期为 :Ⅰ -Ⅱ期 )的检出率 (2 8.0 % ) (P <0 .0 5 )。 结论　p5 3基因在PA恶变过程中起着一定作用 ;p5 3蛋白检测可作为判断涎腺恶性肿瘤临床分期和估计预后的参考指标。     

涎腺结石1例

患者，女，18岁，1年前自感进食时尤其是吃酸性食物时颌下腺处出现阻塞症状，右时突然发生胀痛，有少量诞腺流出．近日疼痛加剧，局部出现红肿．查体：颌下腺处触造有注状硬性物，边缘光滑，化验：白细胞2022，血钙15．2mg，X线咬台片检查，可见有柱状物约1．5cm×4cm大小密度增高影，边缘较清晰．讨论细砂粒状诞腺结石在临床上比较常见，多发生在40岁左右男性，然而成柱状发生在青年不多见．涎腺结石好发于颌下腺，病因是由于颌下晚导管长而粗，导管口位于口底，额下膝主要分泌腺液，放异物易进入导管而排出困难逐渐形成涎石，涎腺结石堵…     

C-MET在涎腺腺样囊性癌中的表达和意义

目的:通过检测C-MET在涎腺腺样囊性癌组织中的表达,探讨C-MET与腺样囊性癌的关系及相关性,为临床的转移趋势、预后判断和术后的随诊监测提供一定的理论依据.方法:应用SP免疫组织化学法检测36例涎腺腺样囊性癌和10例正常涎腺组织中C-MET的表达.结果:C-MET主要表达于细胞浆,在36例涎腺腺样囊性癌中的C-MET阳性表达率为66.7％ (23/31),明显高于正常涎腺组织(0.00％),组间比较差异具有统计学意义(P＜0.05).C-MET蛋白与性别、年龄肿瘤大小无关(P＞0.05),与组织学分型,转移、侵润和复发有关(P＜0.05).结论:C-MET在腺样囊性癌组织中的表达明显高于正常涎腺组织,与涎腺腺样囊性癌的发生、发展及转移密切相关.     

彩色多普勒影像在涎腺肿瘤中的诊断价值

目的:研究涎腺肿瘤的彩色多普勒影像表现,探讨彩色多普勒影像对涎腺肿瘤的评估价值.方法:选取125例经病理证实的涎腺肿瘤患者的术前超声检查图像及病理组织,并运用免疫组织化学技术S-P法对活检切除的标本进行检测.分析涎腺肿瘤的某些彩色多普勒特征性图像.结果:依靠二维超声的特征性表现判断涎腺肿瘤的良恶性有一定的特异性,涎腺肿瘤中良恶性肿瘤的超声特征性表现具有统计学意义(P＜0.05);涎腺良恶性肿瘤内部彩色多普勒血供之间差异具有统计学意义(P＜0.05),但对于无血流信号的小肿瘤也排除不了恶性的可能性,如果能同时结合肿瘤内多普勒血流参数就可以大大提高肿瘤良恶性的诊断准确性.结论:涎腺瘤良恶性与彩色多普勒超声特征性表现有一定的相关性呈正相关.     

MR磁敏感加权成像在脑部疾病中的应用

目的 评价磁共振磁敏感加权成像(susceptibility weighted imaging,SWI)在脑部疾病中的临床应用价值.方法 收集脑部疾病82例,其中脑外伤25例,脑梗死20例,海绵状血管瘤8例,脑出血10例,小血管畸形3例,脑肿瘤5例,多发性硬化5例,脑部大片状钙化2例,血管性痴呆和淀粉样血管病3例,基底节矿物质、铁沉积1例,行常规T1WI、T2WI、DWI、FLAIR、SWI序列及增强T1WI、MRA.评价SWI序列较其他序列对显示小的出血灶、小的静脉、含铁血黄素、矿物质等顺磁性物质的优越性.结果 在脑外伤,SWI可以发现常规序列难以发现的更多的小出血灶.在早期脑梗塞,能提示与受累血管分布有关的区域可能处于危险之中及部分小出血灶,海绵状血管瘤能鉴别出血与血窦及发现更多的小出血灶.在脑出血,能提供出血受压周边脑组织的微量出血范围.在小血管畸形,能发现平扫不能发现的小静脉畸形及显示更多的细小的静脉向大静脉引流.脑肿瘤,SWI显示小的引流静脉及病灶内的出血灶.多发性硬化,能提示与之相连静脉血管.脑部大片状钙化,能和出血明确区分.血管性痴呆和淀粉样血管病,可以发现弥漫分布的小出血灶.结论 SWI是显示低流量血管畸形、小的静脉结构、多发细小出血以及铁钙沉积十分敏感,可以作为MRI的重要补充.     

磁共振胰胆管造影的临床应用

目的：探讨磁共振胰胆管造影（ＭＲＣＰ）的临床应用价值,方法：应用半傅立叶转换自旋回波序列（ＦＡＳＥ）,重Ｔ２加权,对４１例胰胆管疾病患者行ＭＲＣＰ检查。结果：４１例中２４例经手术和病理证实（５８．５％）其中胆管癌９例,壶腹痛６例,胆总管结石４例,胰头癌４例,慢性胰腺炎１例,余１７例未手术,属临床诊断（４１．５％）其中硬化性胆管炎单凭ＭＲＣＰ难以诊断,结论：ＭＲＣＰ可清楚显示胰胆管的形态,对梗阻部位     

磁共振胰胆管造影与内镜逆行胰胆管造影在胆道梗阻病变中的对比研究

目的 评价磁共振胰胆管造影(MRCP)与内镜逆行胰胆管造影(ERCP)在胆系梗阻性病变中的应用价值.方法 收集经手术病理证实的胆系梗阻性病变36例,以其手术病理结果为标准,回顾性阅读MRCP及ERCP的影像资料,对照其诊断结果的差异,分析MRCP及ERCP在胆系梗阻性病变诊治中的作用.结果 36例胆系梗阻性病例中,胆系肿瘤16例,胆系结石15例,其他胆系病变5例.MRCP与ERCP对胆系梗阻病因诊断的准确性分别为86.1%及91.7%,两者之间差异无统计学意义(P>0.05);ERCP检查显示不佳的病例,MRCP检查获得了较为满意的诊断信息.结论 MRCP对胆系梗阻性病变能进行准确的定位和相对准确的定性诊断,可作为胆系梗阻性病变病因诊断的首选检查方法.     

PLAG1在涎腺正常组织和病变组织中的表达

目的检测多形性腺瘤基因1即PLAG1(pleomorphic adenoma gene 1,PLAG1)在涎腺正常组织及病变组织的基因表达是否异同。方法随机选取2010年9月至2011年11月间贵阳医学院附属医院口腔颌面外科经手术切除病理证实的涎腺病变组织标本15例。其中恶性肿瘤3例,良性肿瘤8例,涎腺炎症4例,手术中切取的病变涎腺组织10 mm以外的腺体组织8例,采用免疫组织化学SABC法检测8例涎腺正常组织、8例涎腺病变组织中的PLAG1的表达的强弱。结果 PLAG1在涎腺正常组织及涎腺的病变组织中均有表达,且在病变组织中的阳性表达高于正常组织(P<0.05),差异具统计学意义。结论 PLAG1在涎腺正常组织中的阳性表达低于在病变组织中表达,提示PLAG1可能为正常涎腺组织中的生理蛋白,只是处于失活状态,一旦通过特定的通路被激活后便导致涎腺病变发生。     

Effects of selective D1 and D2 dopamine agonists on cockroach salivary gland acinar cells in vitro.

1. The ability of the selective dopamine receptor agonists, fenoldopam and SKF38393 (D1) and quinpirole and LY163502 (D2), to mimic the effect of dopamine on cockroach salivary gland acinar cells has been investigated. 2. Intracellular recordings of the membrane potential established that all the agonists mimicked dopamine (i.e. they induced a hyperpolarization which was occasionally followed by a depolarization), whether applied by addition to the superfusate or locally by pressure ejection. 3. The rank order of potency of the agonists to induce a hyperpolarization was (equipotent molar ratio relative to dopamine in parentheses): dopamine (1) much much greater than fenoldopam (1000) greater than SKF38393 (3500) greater than LY163502 (13750) greater than quinpirole (35000). 4. The agonists also elicited secretion from the salivary gland when superfused onto the preparation. SKF38393 and quinpirole did not induce the same maximum rate of secretion as dopamine. The rank order of potency of the agonists was (minimum effective concentration in parentheses): dopamine (0.03 microM) much much greater than fenoldopam (4.8 microM) greater than SKF38393 (40.8 microM) greater than quinpirole (132 microM). 5. Both the hyperpolarizing and secretory responses to all the agonists were antagonized by the selective D1 antagonist, (+)-SCH23390, but not the selective D2 antagonist, (+/-)-sulpiride. 6. These results support the idea that the same receptors mediate both the hyperpolarizing and secretory responses, and that they are similar to the mammalian D1 receptor.     

Short-term surgical denervation increases 3H-clonidine binding in rat salivary gland

The effect of several sympathomimetic agents on the efflux of noradrenaline and its metabolites has been evaluated using the ventral artery of the rat tail as the experimental model. This vessel is richly endowed with sympathetic nerves and is therefore well suited to examine the efflux patterns of that transmitter. Etilefrine, tyramine, ephedrine and REN-293 were all found to increase the efflux of ³H-noradrenaline and/or ³H-DOPEG to different degrees from the artery. Possible reasons for this variation in metabolite efflux are discussed.     

COX－2在涎腺恶性肿瘤中的表达及其意义

目的：研究环氧化酶－2（cyclooxygenase－2,COX－2）在涎腺恶性肿瘤腺样囊性癌中的表达及其与肿瘤发生发展的关系。方法：采用免疫组织化学SP法检测15例涎腺腺样囊性癌及10例正常涎腺组织中COX--2的表达情况。结果：涎腺腺样囊性癌中COX--2表达阳性率为80％,并且随临床分期的增高而增加（P〈0．05）。结论：COX--2与涎腺腺样囊性癌的发生及恶变关系密切。     

三维对比增强磁共振血管成像在脑血管疾病诊断中的应用研究

目的 探讨三维对比增强磁共振血管成像(3D CE-MRA)对常见脑血管病的诊断价值及其影响因素.方法 收集行颅脑3D CE-MRA检查患者450例,其中135例在1周内行数字减影血管造影(DSA)检查.常规MRI包括T1、T2WI轴位扫描和冠状面T1WI扫描及T2WI FLAIR轴位扫描;3D CE-MRA采用三维快速场回波序列,Gd-DTPA剂量30ml,注射速率2.5 mL/s,行增强前、增强后动脉期及静脉期4次扫描,图像减影后至工作站上三维重建.结果 ①3D CE-MRA疑脑动脉狭窄或闭塞者75例,其中65例行DSA进行对照,3D CE-MRA与DSA在轻度、中度、重度狭窄和闭塞的一致率分别为75.6%(31/41)、83.3%(30/36)、88.9%(16/18).3D CE-MRA比DSA更易把正常血管评估为轻度狭窄.②3D CE-MRA疑脑动脉瘤者71例,其中55例行DSA进行对照,3D CE-MRA与DSA在小型、中型、大型和巨大型动脉瘤的一致率分别为78.9%(30/38)、86.5%(32/37)、90.0%(18/20)、100%(4/4).3D CE-MRA比DSA更易把正常血管评估为小型动脉瘤.③3D CE-MRA疑是脑动静脉畸形23例,其中15例行DSA进行对照,3D CE-MRA对供血动脉、引流静脉的显示率分别为90.7%(39/43)、91.4%(32/35),3D CE-MRA联合MRI对异常血管团的定位优于DSA,但在细节显示上不如DSA.④3D CE-MRA质量的影响因素有采集时间、延迟时间、扫描参数、K空间填充技术、造影剂团注参数等.结论 3D CE-MRA能无创、快速、有效诊断常见脑血管病,可作为脑血 管病患者的首选诊断方法.

Abstract：

Objective To explore the diagnosis value and influence factors of three dimensional contrast enhanced MR angiography(3D CE-MRA)in common cerebrovascular diseases.Methods Totally 450 patients underwent cerebral CE-MRA,among then,150 patients were received DSA in a week.Conventional MRI includes transverse T2WI and T1WI,transverse T2WI FLAIR,and coronal T1WI.3D fast field sequence(FFE)was used for CEMRA with Gd-DTPA(30 ml,2.5 ml/s).includes front-line,enhanced arterial phase and venous phase scan.The sion was detected by MRA,in which,65 patients were received DSA,the consistency of MRA and DSA in mild,moderate,severe stenosis and occlusion was 75.6%,83.3%,88.9%,100%,respectively.MRA is easy to assess tients were received DSA,the consistency of MRA and DSA in small.medium.large and giant aneurysms was Twenty-three patients with cerebral arteriovenous malformations was detected by MRA,in which,15 patients were underwent DSA.The sensitivity of MRA in depicting feeding arteries,draining veins was 90.7%,91.4%,respectors of MRA have acquisition time,delay time,scan parameters,K space-filled technique,contrast agent parameters.Conclusions CE-MRA is a fast,noninvasive and effective technique of diagnosing common cerebrovascular diseases.It can be the first diagnosis metllod of detecting cerebrovascular diseases.     

Cardiovascular magnetic resonance T2-weighted imaging of myocardial edema in acute myocardial infarction

Technical advances in cardiovascular magnetic resonance (CMR) T2-weighted imaging have allowed in-vivo visualization and accurate quantification of myocardial edema, a substantial feature of myocardial ischemic/reperfusion injury. In acute myocardial infarction, myocardial edema imaging can be used to differentiate acute from chronic irreversible injury. This can also be of particular importance in the sub-acute phase in which laboratory markers are equivocal or in the setting of missed infarction. Furthermore, CMR-T2-weighted edema imaging identifies the area at risk and thus can be used to quantify the area of salvaged myocardium after coronary reperfusion by comparing the area of irreversible injury to that of the myocardium at risk. Another exciting area of research employs edema imaging to monitor the effect of interventions that target reduction of myocardial edema. The premise is that myocardial edema results in vascular compression, and may thus contribute to failure of myocardial tissue reperfusion even after reestablishing the patency of the infarct related coronary artery. This can be used to monitor the efficiency of novel therapeutic strategies targeting post-infarction myocardial edema. This mini review will address the pathophysiological, clinical and some technical issues related to edema imaging in acute myocardial infarction. Some recent patents on myocardial edema, Magnetic resonance imaging and myocardial infarction are also addressed.     

On the disposition of [3H]metaraminol in the rat salivary gland

The left salivary glands of rats were sympathetically denervated or decentralized. In some experiments the excretory ducts of the left submaxillary and sublingual glands were ligated to produce atrophy of the acinar cells. The rats received [³H]metaraminol (³H-MA) intravenously and were killed at various time intervals thereafter. The amount of ³H-MA in the salivary glands was determined. ³H-MA was taken up and retained in the intact gland, but disappeared rapidly from the denervated one, indicating that ³H-MA is taken up and stored in the adrenergic neuron. Decentralization resulted in a decreased turnover of the amine, especially during the first 18 hr, which supports the view that metaraminol is released by nerve activity. The ability of the salivary gland to take up ³H-MA was diminished by glandular atrophy, and the disappearance of the ³H-MA so taken up was delayed.     

T2-weighted image hyperintensities in major depression: focus on the basal ganglia

A major focus of attention in structural brain-imaging research in major depression is the increased prevalence of T2-weighted image 'hyperintensities' (T2-WIH). Our aims in this study were to characterize the distribution and magnetic resonance imaging (MRI) presentation of brain hyperintensities in major depression patients compared to healthy control subjects and to explore the association between the presence of T2-WIH and measures of clinical and cognitive state. Thirty-seven patients suffering from major depression and 27 age- and sex-matched healthy controls underwent brain MRI and were evaluated by the Hamilton Rating Scale for Depression, the Mini Mental State Examination and the Haschinsky Ischaemia Index. T2-WIH (at least one) were found in 26 out of 37 major depression patients and 7 out of 27 controls (p=0.0001). The number of brain T2-WIH was significantly and positively correlated with age in depressed (p=0.001) but not in healthy subjects. Mean volume of T2-WIH was significantly greater (p=0.004) in depressed subjects. In the control group T2-WIH were exclusively located in the supratentorial hemispheral white matter while in the depressed group T2-WIH were also found in basal ganglia, temporal lobe, cerebellum and brainstem. More (52 vs. 20%; p=0.018) T2-WIH were demonstrable on T1 in depressed subjects. Depressed patients with T2-WIH in basal ganglia were clearly the most severely depressed and cognitively impaired subjects, and may constitute a clinically distinct subgroup within major depression.     

Modulation of uptake2 of3H-(±)-isoprenaline by isoprenaline-induced depolarization of rat salivary gland cells

Previous observations by Almgren and Jonason (1974) showed that propranolol is able to increase the extraneuronal accumulation of 3H-isoprenaline in rat salivary gland slices. The present experiments were carried out in order to test the hypothesis that 3H-isoprenaline, by acting on beta-adrenoceptors, might depolarize the gland cells and thereby hinder its own uptake2 and that this hindrance might be prevented by propranolol. After inhibition of catechol-O-methyltransferase the extraneuronal accumulation of the 3H-catecholamine in slices of rat salivary glands was determined subsequent to 20 min of exposure of the tissue to 0.5 to 5,000 nmol/l 3H-(+/-)-isoprenaline. Expressed as a tissue/medium ratio, accumulation decreased with increasing amine concentration, although all amine concentrations were well below those saturating uptake2. The 3H-isoprenaline-induced decrease of the tissue/medium ratio was antagonized by (-)-propranolol, and increasing concentrations of the antagonist were needed to antagonize the effect of increasing concentrations of 3H-isoprenaline. In parallel experiments K+-induced (60 mmol/l) depolarization reduced the tissue/medium ratio observed for 0.5 nmol/l 3H-(+/-)-isoprenaline. Gland slices were preloaded with 3H-(+/-)-isoprenaline and then washed out for 60 min with solution not containing labelled amine. When 500 nmol/l (+/-)-isoprenaline were present in the wash-out solution, the addition of 10 mumol/l (-)-propranolol impeded the efflux of 3H-isoprenaline. In parallel experiments, K+-induced (60 mmol/l) depolarization facilitated the efflux of 3H-isoprenaline [in the presence of 10 mumol/l (-)-propranolol]. The results support the working hypothesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic implications of NUMB immunoreactivity in salivary gland carcinomas

The gene numb encodes for a protein (Numb) involved in cell fate decisions in Drosophila, with proposed endocytic and developmental functions in mammalians. The distribution pattern of Numb in human tissues however, has not been fully characterized. We set out to explore the immunohistochemical expression of Numb in normal and neoplastic (28 adenoid cystic and 34 mucoepidermoid carcinomas) salivary glands, and correlated the results with the clinico-pathologic features of the neoplasms. Intense Numb immunoreactivity was detected in normal ductal cells and in a subset of acinar cells. In salivary carcinomas, we detected diffuse and intense Numb immunostaining in 5 adenoid cystic and 8 mucoepidermoid carcinomas. By contrast, the majority of adenoid cystic and mucoepidermoid cancers showed only moderate (14 and 5 cases) or focal staining (9 and 21 cases), respectively. The corresponding expression of Numb mRNA was documented in normal parotid gland and adenoid cystic carcinoma. Numb immunoreactivity was inversely correlated with the histological grade and Ki-67 immunoreactivity of both adenoid cystic and mucoepidermoid carcinomas. In addition, while tumor grade, stage, Ki-67 and Numb immunoreactivity were associated with disease-free survival in univariate analysis, only Numb and Ki-67 immunoreactivities retained independent prognostic significance in multivariate analysis. These data suggest that loss of Numb is implicated in aberrant differentiation programs of salivary gland carcinomas and may serve as a prognostic indicator in patients treated for these neoplasms.     

活性维生素D在肾脏病领域的应用进展

活性维生素D3自临床应用以来,在治疗慢性肾衰竭继发性甲状旁腺功能亢进取得了显著的效果。本文对继发性甲状旁腺功能亢进的发病机制、活性维生素D3的作用机制、疗效、副作用、治疗指南作一综述,同时介绍了活性维生素D3的临床新用途和新型活性维生素D3类似物。