磁共振波谱和~(11)C-蛋氨酸正电子发射显像联合检查在早期诊断幕上非强化胶质瘤中的应用

目的探讨磁共振波谱(MRS)和~(11)C-蛋氨酸正电子发射显像(~(11)C-MET PET)联合检查在幕上非强化胶质瘤早期诊断中的价值。方法 65例手术后经病理证实的幕上非强化胶质瘤(T2 FLAIR高信号,T1增强无强化)的患者为研究对象。患者术前同时接受MRS和~(11)C-MET PET两项检查,当其中一项达到阳性阈值(MRS中胆碱与乙酰天冬氨酸的比值最大值CNImax为2.0;或者~(11)C-MET PET中肿瘤摄取值和正常脑组织摄取值的T/N值为1.3)时即拟诊为胶质瘤,与手术标本病理诊断进行对照。结果单用MRS阳性检出率为60.0%,单用~(11)C-MET PET阳性检出率为78.5%,两种方法联合检查的阳性检出率达89.2%。两种方法联合检查的阳性检出率与单用一项检查方法比较,差异有统计学意义(P0.05)。结论 MRS和~(11)C-MET PET联合检查可显著提高幕上非强化胶质瘤的早期诊断阳性检出率,具有较高的临床应用价值。     

11C-Met PET与MRI影像融合技术在胶质瘤术前评价和术中导航中的应用价值

研究背景随着多模态影像融合技术在临床的应用,11C-Met PET与MRI融合技术也应用于临床,本研究通过比较胶质瘤在11C-Met PET与MRI中不同影像显示结果,探讨11C-Met PET与MRI影像融合技术在脑胶质瘤外科手术前评价、术中导航和手术切除过程中的应用价值。方法手术前于神经导航工作站对25例胶质瘤患者进行11C-Met PET与MRI影像融合,勾画肿瘤边界、计算肿瘤体积并进行分类。结果据影像学分类,25例胶质瘤患者中1例Ⅱ级、6例Ⅲ级和8例Ⅳ级MRI所显示的肿瘤灶轮廓大部分位于PET内(Ⅰ类);2例Ⅲ级PET所显示的肿瘤灶轮廓大部分位于MRI内(Ⅱ类);6例Ⅱ级和2例Ⅲ级MRI与PET显示的病灶轮廓无从属关系(Ⅲ类)。结论 PET在揭示胶质瘤增殖活性和描述肿瘤界限方面具有特殊优势,通过MRI与PET所显示的肿瘤轮廓关系,可用于术前初步预测肿瘤病理分级,有助于制定详细的手术计划。     

^11C—MetPET与MRI影像融合技术在胶质瘤术前评价和术中导航中的应用价值

研究背景随着多模态影像融合技术在临床的应用,^11C—MetPET与MRI融合技术也应用于临床,本研究通过比较胶质瘤在^11C-MetPET与MRI中不同影像显示结果,探讨^11C—MetPET与MRI影像融合技术在脑胶质瘤外科手术前评价、术中导航和手术切除过程中的应用价值。方法手术前于神经导航工作站对25例胶质瘤患者进行^11C—MetPET与MRI影像融合,勾画肿瘤边界、计算肿瘤体积并进行分类。结果据影像学分类,25例胶质瘤患者中1例Ⅱ级、6例Ⅲ级和8例Ⅳ级MRI所显示的肿瘤灶轮廓大部分位于PET内（I类）;2例Ⅲ级PET所显示的肿瘤灶轮廓大部分位于MRI内（Ⅱ类）;6例Ⅱ级和2例Ⅲ级MRI与PET显示的病灶轮廓无从属关系（Ⅲ类）。结论PET在揭示胶质瘤增殖活性和描述肿瘤界限方面具有特殊优势,通过MRI与PET所显示的肿瘤轮廓关系,可用于术前初步预测肿瘤病理分级,有助于制定详细的手术计划。     

脑干胶质瘤治疗现状

<正>脑干肿瘤由于生长在生命中枢,致残率和致死率高,严重威胁着人类的生命健康。脑干胶质瘤占原发脑干肿瘤的75%,治疗方法及效果多年来一直是人们所关注的热点[1]。近年来,随着科学技术的进     

小儿脑干胶质瘤的显微手术治疗

目的探讨显微手术在小儿脑干胶质瘤治疗中的作用以及手术的适应证。方法对18例显微手术治疗的脑干胶质瘤患儿的临床资料,术中影像资料和术后随访检查结果进行分析总结。结果肿瘤全切除12例,次全切除4例,部分切除2例,其中9例术后进行放疗。平均随访2.8年,总体效果良好。结论适应证明确的脑干胶质瘤患儿应积极显微手术治疗。在选择手术患儿时,除肿瘤系外生型、内生局限型或颈延髓型外,MRI上有局限性强化灶和神经功能缺失不明显也是重要的手术指征。     

PET显像在阿尔茨海默病的应用进展

阿尔茨海默病是老年期痴呆之临床常见类型,随着发病率的逐年升高,受到社会各界更多的关注。PET功能显像可通过各种显像剂敏感、特异性地反映阿尔茨海默病的病理生理学改变,笔者将重点介绍18F-FDG显像剂、淀粉样蛋白和神经原纤维缠结tau蛋白显像剂在阿尔茨海默病中的应用,详细阐述PET显像在阿尔茨海默病病因学研究、早期诊断、鉴别诊断、疾病转归和药物治疗中的作用。     

CHO PET功能显像:脑胶质瘤诊断和优化放化疗方案

目的 11碳-胆碱正电子发射断层扫描(11C-Choline PET/CT,CHO-PET)功能显像在脑胶质瘤诊断和优化放化疗治疗方案中的作用.方法 分析2008年1月至2009年6月经术后病理确诊的23例(其中WHO Ⅱ级9例、Ⅲ级9例、Ⅳ级5例)脑胶质瘤患者的CHO-PET功能显像结果,与同期MRI结构影像结果相比较,依据CHO-PET显像肿瘤生物靶区(BTV)优化放化疗治疗方案.结果 ①CHO-PET功能显像的病变靶区与正常脑组织对比度良好,肿瘤边界更清晰;②CHO-PET功能显像改变了10例(43.5%)患者的诊断及靶区范围,包换术后放疗前患者5例(31.3%);放疗后患者5例(71.4%).其中1例(Ⅲ级)肿瘤靶区(GTV)范围增大而扩大GTV放疗;1例(Ⅱ级)肿瘤复发,改定期复查为化疗;4例(Ⅱ级)术后肿瘤残留,改临床肿瘤靶区(CTV)放疗为CTV+GTV放疗;4例(1例Ⅲ级;3例Ⅱ级)未见肿瘤复发,改化疗为定期复查;③ CHO-PET对WHO Ⅱ、Ⅲ、Ⅳ级患者治疗方案的改变率分别为88.9%(8/9)、22.2%(2/9)、0(0/5);④ MRI对高级别胶质瘤患者(WHO III、Ⅳ级)的诊断符合率为85.7%(12/14).结论 CHO-PET功能显像对脑胶质瘤病变显示清楚,肿瘤边界清晰;有利于WHO II、III级患者的诊断;有利于优化治疗方案;有利于疗效的判断以及肿瘤复发与坏死的鉴别诊断.     

脑干神经节胶质瘤的诊断及治疗

目的总结脑干神经节胶质瘤的诊治经验。方法回顾性分析10例脑干神经节胶质瘤的临床资料。肿瘤均位于延髓,其中单纯位于延髓3例,累及上颈髓3例,累及脑桥3例,累及小脑1例。均经枕下后正中入路,行显微手术治疗。结果肿瘤近全切除6例,大部分切除2例,部分切除2例。术后辅助放疗2例。病理诊断为神经节胶质瘤。随访3个月～12年,失访2例;存活7例,未见肿瘤复发;术后4个月因急性呼吸道梗阻死亡1例。结论显微神经外科手术是脑干神经节胶质瘤的首选治疗方法,手术主要切除突出到脑干外及脑干内相对表浅的肿瘤。脑干神经节胶质瘤预后较好,后组脑神经麻痹是其主要术后并发症。     

脑肿瘤干细胞与胶质瘤生物治疗研究进展

脑肿瘤是中枢神经系统常见疾病之一,对人类健康乃至生命的危害极大。脑肿瘤发病率约占全身肿瘤的5％,占儿童肿瘤的70％,且近年来仍呈上升趋势。其中以胶质细胞瘤发病率最高,约占脑肿瘤总数的40.49％,综合发病年龄高峰位于30～40岁,或10～20岁。     

Human brain glioma stem cells are more invasive than their differentiated progeny cells in vitro

Glioma, the most commonly occurring primary intracranial tumor, remains associated with a dismal outcome, despite the availability of multimodal therapies. Recently, however, the identification of brain glioma stem cells (BGSC) has opened up new avenues for research. BGSC are now accepted as the progenitor cells of gliomas and are thought to determine the biological features of the resulting tumors. Thus, the diffuse invasiveness of gliomas should also be theoretically driven by BGSC. However, little research effort has been directed at understanding the invasiveness of BGSC. In the present study, BGSC from eight surgical glioma specimens were cultured and identified. Using Matrigel invasion assays, the invasiveness of these cells was measured and compared with that of their respective differentiated progeny cells in vitro. For all eight clinical specimens, the BGSC were significantly more invasive than their differentiated progeny cells. These findings indicate a key role for BGSC in glioma infiltration and invasion. We also found that BGSC tended to aggregate and reform into new spheres after travelling into the Matrigel, preserving some of the morphological characteristics of the suspended cells. The invasiveness of the BGSC did not correlate with the pathological grade of glioma in the present study, so further investigations using larger sample sizes are needed to better understand the mechanisms underlying the invasiveness of BGSC.     

成人脑干胶质瘤手术治疗的预后分析

目的 分析影响成人脑干胶质瘤术后生存的多种相关因素,并对这些因素进行探讨.方法 生命表法计算患者1、3、5年生存率,采用SPSS13.0统计软件,对预期变量进行单因素卡方检验,分析该变量是否存在统计学意义,卡方检验不可靠者,再次进行秩和检验.结果 到随访截止时,尚有8例患者存活,存活时间超过5年、3年和1年的分别有6例、9例和15例,1年、3年和5年生存率分别为58%、35%和23%.患者1年生存率与入院日常生活质量评分(KPS,P<0.001)、肿瘤边界是否清楚(P=0.024<0.05)有关.患者3年生存率与性别(P<0.001)、肿瘤边界是否清楚(P=0.009<0.05)、侵犯脑神经的数目(P=0.032<0.05)有关.患者5年生存率与肿瘤边界是否清楚(P=0.047<0.05)、肿瘤大小(P=0.029<0.05)、年龄(P=0.029<0.05)、是否接受正规放疗(P=0.005)有关.结论 患者入院时KPS评分、肿瘤边界是否清楚、侵犯脑神经数目、肿瘤大小、性别、年龄以及是否接受正规放疔是影响脑干胶质瘤患者术后生存的重要因素;影响1年生存率、3年生存率及5年生存率的冈素各不相同.     

The pathological characteristics of glioma stem cell niches

Brain tumor stem cells (BTSC) are predicted to be critical drivers of tumor progression due to their self-renewal capacity and limitless proliferative potential. Recent studies suggest that stem cells are controlled by a particular microenvironment known as a “niche”. We therefore analysed human glioma tissues and found that the CD133⁺ and nestin⁺ niches are perivascularly localized in all glioma tissues. Furthermore, there is a positive correlation between the CD133⁺ niches and CD133⁺ blood vessels, which is similar to the correlation between the nestin⁺ niches and nestin⁺ blood vessels. We demonstrate that both CD133⁺ blood vessels and nestin⁺ blood vessels have an important role in maintaining the structure of the glioma stem cell niche. Moreover, the abundance of CD133⁺ niches and nestin⁺ niches increases significantly as tumor grade increases. These findings provide a new insight into the biology of BTSC and open a new perspective for targeted therapy against the brain tumors.     

肿瘤干细胞与脑胶质瘤干细胞的研究现状

以往认为，肿瘤是由体细胞突变而成，每个肿瘤细胞都可以无限制地生长。但这无法解释肿瘤细胞似乎具有无限的生命力以及并非所有肿瘤细胞都能无限制生长的现象。肿瘤细胞生长、转移和复发的特点与干细胞的基本特性十分相似，因此，有学者提出肿瘤干细胞的理论，这一理论为我们重新认识肿瘤的起源和本质，以及临床肿瘤治疗提供了新的方向和视觉角度。其中的脑胶质瘤起源于脑胶质瘤干细胞（brain gliomastem cells．BGSCs）的学说对正确认识和理解脑胶质瘤的发生、发展及其生物学行为如侵袭性、转移、肿瘤的耐药性等均具有十分重要的理论意义和潜在的应用价值。[第一段]     

Basal ganglia germinoma: diagnostic value of MR spectroscopy and (11)C-methionine positron emission tomography

We herein report a 12-year-old girl with a basal ganglia germinoma who presented with right-sided hemiparesis after a minor head trauma. Magnetic resonance (MR) imaging revealed a minimally enhanced lesion involving the left putamen, thalamus, and corona radiata. The lesion showed low-signal intensity on T1-, and high intensity on T2- and diffusion-weighted imaging. The MR signal in the adjacent globus pallidum was also low on T2-weighted imaging. MR spectroscopy on the lesion showed a large lactate/lipid/macromolecule peak with a decreased NAA/Cr ratio, but no increase in the Cho/Cr ratio. However, posttraumatic infarction at the territory of lateral lenticulostriate artery was ruled out 1 month later. This was based on progression of the hemiparesis and neuroimaging results, including an increased Cho/Cr ratio and weak uptake on (11)C-methionine positron emission tomography of the basal ganglia lesion. Stereotaxic brain biopsy confirmed the diagnosis of germinoma.     

肿瘤干细胞致敏的树突状细胞对脑胶质瘤细胞免疫的影响

目的 研究肿瘤干细胞(BTSCs)致敏的树突状细胞(DCs)疫苗对颅内荷瘤小鼠的治疗作用.方法 无血清培养基中加入表皮生长因子和碱性成纤维细胞生长因子,将C6胶质瘤细胞诱导成胶质瘤干细胞,以此致敏大鼠骨髓来源的树突状细胞制备疫苗;立体定向建立大鼠颅内C6胶质瘤模型,分为A、B、C、D四组.每组分别经尾静脉注射1×107BTSCs致敏的DCs(DCs-BTSCs)、1×107 C6胶质瘤细胞致敏的DCs(DCs-C6)、1×107DCs及PBS,Kaplan-Meier法对大鼠生存情况进行分析,大鼠脑组织标本行HE染色及免疫组化分析.结果 胶质瘤干细胞CD133+及nestin染色阳性;DCs具有典型的树突状结构,特异性标志OX62+表达阳性;生存时间A组较其他组明显延长,Log-rank检验差异有统计学意义(P＜0.05);A组HE染色炎性细胞浸润最多,免疫组化可见较多的CD8+T淋巴细胞.结论 肿瘤干细胞致敏的树突状细胞疫苗能明显提高机体对胶质瘤的免疫力,其作用优于胶质瘤细胞致敏的树突状细胞疫苗,为树突状细胞疫苗的临床应用提供了新的依据.

Abstract：

Objective To investigate the effect of dendritic cells pulsed with brain tumor stem cells which are used to treat on intracranial glioma.MethodWe obtained murine brain tumor stem cells by growing C6 cells in epidermal growth factor/basic fibroblast growth factor without serum.Dendritic cells isolated from rat bone marrow were pulsed with BTSCs.Rat brain glioma models were established by stereotactic technique.107 DCs pulsed with BTSCs and C6 were injected through tail vein in group A and group B respectively.The same number of DCs and the same volume PBS were applied to group C and group D.The survival time of rats was analyzed by Log- rank survival analysis.Tumor samples were examinedwithHE staining and immunohistochemistry.Methods BTSCs expressedCD133 + and nestin.DCs appeared typical long dentrite in morphology and expressed OX62+ markers.The survival analysis showed group A was statistically significant in constrast to the other goups (P<0.05).The tumors in group A have the most inflammation and CD8 + T lymphocytes.Concluion DCs loading with BTSCs lysates can provide a higher level of immunity protect against gliomas than those loading with C6 cells,which provide a new method in the immuntherapy of brain glioma.     

CT中脑背侧脑池出血对原发性脑干损伤的早期诊断价值

目的 分析颅脑外伤急诊CT中脑背侧脑池出血的表现,探讨其对临床原发性脑干损伤的早期诊断价值.方法 回顾性分析52例颅脑外伤患者临床表现及影像学资料,并依据GCS评分分为轻、中、重及特重型.所有患者均在伤后48 h内接受CT检查,CT采用常规程序扫描.MRI检查则根据病情变化在伤后1周内完成,采用自旋回波T1WI、T2WI序列.结果 所有病例的CT表现均与MRI的T1WI、T2WI序列行比较研究,其中39例颅脑损伤患者的急诊CT有中脑背侧环池或四叠体池出血表现,合并弥漫性脑肿胀19例,脑实质出血灶单发或多发点状出血灶11例,直径小于2 cm;37例MRI检查存在不同程度的脑干组织损伤表现.结论 重型和特重型颅脑外伤(GCS<9分)伤后早期CT的中脑背侧脑池出血表现高度提示原发性脑干损伤可能,对提高原发性脑干损伤早期诊断水平具有重要的参考价值.