星形细胞肿瘤CT灌注成像参数与MVD的相关性

目的评价星形细胞肿瘤CTP参数与MVD之间的相关性。方法选择我院神经外科53例脑肿瘤患者,经手术和病理学证实为星形细胞肿瘤者纳入研究对象。CTP采用GE LightSpeed 64层螺旋CT机进行灌注扫描,在AW4.2P后处理工作站对原始数据进行后处理,测定肿瘤最大灌注区和对侧正常脑组织的CBF、CBV、MTT及PS值。手术获取脑肿瘤标本,进行组织病理学分级和MVD测定。结果高、低级别星形细胞肿瘤的CBF、CBV、PS和MVD值均显著高于相对应正常侧脑组织(P<0.01),而MTT值的差异无统计学意义(P>0.05)。AA-GBM组的CBF、CBV、PS及MVD值均显著高于LGA组(P<0.01),而MTT值差异无统计学意义(P>0.05)。星形细胞肿瘤CTP参数CBF、CBV、PS与MVD均有显著线性正相关(r＝0.819,0.862,0.776,P<0.01),以CBV值最强,而MTT与MVD无相关性(r＝-0.320, P>0.05)。结论CTP参数CBF、CBV及PS值对星形细胞肿瘤血管生成的评价具有很高的准确性。     

CT灌注参数变化在肺癌放疗中的应用

目的:观察肺癌患者放疗前后 CT 灌注参数的变化,监测治疗疗效,评价预后.方法:对诊断肺癌的24例患者放疗前行CT灌注扫描.非离子型对比剂50ml,注射速率4.0ml/s,延迟10s,扫描时间50s.放疗后再次进行CT灌注扫描.比较治疗前后灌注参数的变化及其与无进展生存时间和总生存时间的关系.结果:24例患者中,早期疗效评价为缓解者14例,未缓解者10例.表面通透性(PS)值升高者13例,治疗前为(13.7±6.2)ml·min-1·100g-1,治疗后为(20.1±7.5)ml·min-1·100g-1,差异有统计学意义(P=0.013);PS值降低者11例,治疗前为(15.3±5.1)ml·min-1·100g-1,治疗后为(8.2±5.5)ml·min-1·100g-1,差异有统计学意义(P=0.000).升高组和降低组的中位无进展生存时间分别为4.2个月和19.0个月(P=0.000),中位总生存时间分别为7.9个月和19.3个月,差异有统计学意义(P=0.002).结论:肺癌患者放疗前后,CT灌注值的变化对预后评估有一定作用,升高者预后不良.     

肺癌MSCT灌注成像与病理分型的相关性研究

目的：对肺癌MSCT灌注成像及相关灌注参数进行分析,研究肺癌MSCT灌注成像与病理类型之间的关系,探讨其临床应用价值.方法：对32例肺癌患者,先行常规CT扫描,确定肿瘤的中心层面,然后采用电影技术对肿瘤中心层面进行连续扫描,以获得该层面内组织的时间-密度曲线,计算出血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面渗透性（PS）,以此评价肿瘤灌注情况,并与病理分型进行对比分析.结果：中心型肺癌与周围性肺癌各灌注参数均无明显差异（P＞0.05）.对各型肺癌的灌注参数进行分析得出：各型肺癌BF、PS值大小关系为鳞癌＜腺癌（P＜0.05）,鳞癌＜小细胞癌（P＜0.05）,腺癌BF、PS值小于小细胞癌但两者之间的差异无统计学意义（P＞0.05）;各型肺癌BV值大小顺序为鳞癌＜腺癌＜小细胞癌（P＜0.05）;各型肺癌MTT值之间无明显差异.结论：肺癌MSCT灌注成像反映各型肺癌血流特点及肿瘤内部微血管密度变化,有利于肺癌病理分型诊断.     

胶质瘤的CT灌注成像与微血管密度的相关性

目的 探讨胶质瘤CT灌注成像参数相对脑血容量（rCBV）与肿瘤微血管密度（MVD）的相关性,以及对胶质瘤分级的价值。方法 30例胶质瘤患者,低级别组11例,高级别组19例。常规CT扫描的基础上行CT灌注成像检查。测量肿瘤实质部分CBV的绝对值和相对值,并对两组进行比较。术后病理切片行SP 法免疫组织化学染色,检测MVD水平,并分析rCBV与MVD的相关性。结果 经Spearman相关分析,rCBV与MVD间呈显著正相关（r=0.562,P<0.05）。低级别与高级别胶质瘤rCBV的均值分别为（2.31±0.28）、（4.69±1.65）,两组间比较差异有统计学意义。结论 rCBV与MVD间存在良好的相关性,对胶质瘤术前分级具有临床实用价值。     

ＣＴ灌注成像在肿瘤血管生成中的应用

血管生成是恶性肿瘤的重要特点,对其生长、侵袭及转移起到关键性作用。早期已有研究证实抑制血管生成可以增强治疗肿瘤的疗效。但传统分析肿瘤血管生成的标准方法为组织病理学上微血管密度（ＭＶＤ）计数,有创且间接评估肿瘤血管,不能提供体内肿瘤血管生成方面的信息。ＣＴ灌注成像（ＣＴＰＩ）作为一种无创、定量的方法,可以用来评估活体内肿瘤的血流动力学,以及监测抗血管生成疗效,本文就ＣＴＰＩ在肿瘤血管生成研究中的研究进展作一综述。     

乳腺癌新辅助化疗MR灌注成像与微血管密度的相关性研究

目的:探讨乳腺癌新辅助化疗前后MR灌注成像与肿瘤微血管密度之间的相关性。方法:对20例乳腺癌患者在新辅助化疗前及化疗4个周期后手术前行磁共振灌注成像,并对化疗前穿刺及术后标本行免疫组织化学检测肿瘤的微血管密度,分析MR灌注成像最大信号丢失率与微血管密度在化疗前后的变化情况及其相关性。结果:按照实体肿瘤治疗反应评估标准(RECIST)指南,20例患者中,化疗有反应组16例(80%),无反应组4例(20%)。化疗后肿瘤灌注最大信号丢失率明显低于化疗前(P<0.05),有反应组最大信号丢失率明显下降(P<0.05),而无反应组最大信号丢失率未发生显著变化,P>0.05。化疗后肿瘤微血管密度明显降低(P<0.05),有反应组的CD34表达明显下降(P<0.05),而无反应组CD34表达的变化无统计学意义,P>0.05。化疗前后Ratio值变化率与CD34变化率之间存在正相关关系,r=0.703,P<0.05。结论:乳腺癌新辅助化疗前后磁共振灌注成像与微血管密度存在一定的相关性,可在一定程度上反映肿瘤的血管生成情况。     

一站式CT能谱联合灌注成像技术在肺癌病理类型鉴别中的应用研究

目的:研究一站式CT能谱联合灌注成像技术在肺癌诊断中的应用价值.方法:收集在本院就诊患肺癌的患者,所有患者均采用Aquilion ONE 640层CT扫描仪进行能谱联合灌注扫描,最后经病理证实病灶分别为鳞状细胞癌24例,腺癌29例,小细胞肺癌8例.采集图像后应用Dual Energy能谱处理程序处理每一组能谱数据,通过...     

Syntenin在非小细胞肺癌中的表达及其与患者总生存期的关系

目的：检测Syntenin在非小细胞肺癌（NSCLC）组织中的蛋白表达水平并探讨其临床意义。方法：采用组织芯片和免疫组织化学染色法,检测Syntenin在147例NSCLC及相应癌旁组织中的表达水平,并分析Syntenin的表达与NSCLC患者临床病理指标及预后的关系。结果：Syntenin在NSCLC组织中的阳性表达率（49.7%）显著高于癌旁组织（4.1%）（P < 0.01）。Syntenin的表达与NSCLC的淋巴结转移、临床分期和病理类型显著相关（P值分别为0.039、0.038、0.024）,与患者的性别和年龄无显著相关（P > 0.05）。Kaplan-Meier分析表明,Syntenin的表达与NSCLC患者的总生存期显著相关（P=0.028）。结论：Syntenin在NSCLC组织中高表达,并且其高表达预示了患者的不良预后。     

多层螺旋CT灌注成像诊断周围型肺癌及其微血管密度对照研究

Objective： To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT （MSCT） perfusion imaging and the relationship with microvessel density （MVD）. Methods： 38 patients with pulmonary masses proved by pathology including 25 cases of peripheral lung cancer and 13 cases of benign masses were studied prospectively with GE Lightspeed Qx/I plus 16-slice helical CT perfusion imaging, and 25 patients with lung cancer were comparative studied with its MVD calculated using LSAB. With the CT perfusion 2-body tumor software, the parameters of CT perfusion including blood value （BV）, blood flow （BF）, mean transit time （MTT） and permeability surface （PS） were analyzed. Results： The four parameter values in lung cancer were all higher than that in pulmonary benign masses, and there were significant differences among BV, MTT and PS （P〈0.05）, especially in BV （P〈0.01）. The MVD value of lung cancer was higher than that of pulmonary benign masses （P〈0.05）, and the MVD of adenocarcinoma was higher than that of squamous cell carcinoma （P〈0.05）. In 25 cases with lung cancer, there was positive correlation only between BV and MVD value （r=0.852, P〈0.01）. Conclusion： It is helpful to diagnose the peripheral lung cancer with MSCT perfusion imaging and to differentiate from pulmonary benign masses, its bases are MVD pathologically.     

肺灌注显像检查预测肺癌放射性肺损伤的价值

目的探讨肺癌患者肺灌注显像的特点及其放射治疗过程中的变化,观察其与放射性肺损伤发生的关系。方法31例接受根治性放疗的肺癌患者接受了肺灌注显像检查,其中8例仅在放疗前接受了此项检查。以照射前后计算区域的肺灌注平均计数值占相应全肺平均计数值的百分比,比较照射前后肺灌注的变化。放射性肺损伤的评价按美国肿瘤放射治疗组（RTOG）急性放射性肺炎标准评定。结果31例患者中,中央型22例,周围型9例。病理类型：鳞癌12例,腺癌1例,小细胞肺癌15例,未分型3例。Ⅰ、Ⅱ期8例,Ⅲa期9例,Ⅲb期14例。行适形放疗26例,常规放疗5例;照射剂量32—72Gy,中位剂量58Gy。6例发生2级或3级放射性肺炎,无放射性肺炎死亡病例。全部患者治疗前均有不同程度的灌注受损,中央型肺癌患者灌注受损范围≥2级者占68．2％（15／99）,而周围型仅占22．2％（2／9,P=0．04）。受损范围为1级和2级以上者,分别有40．0％（6／15）和37．5％（6／16）的患者发生2级以上放射性肺损伤。在两次行肺灌注检查的23例中,肺灌注受损有所改善者占70．0％（16／23）,其中2级以上放射性肺炎发生率为31．3％（5／16）;在肺灌注受损加重者中,2级以上放射性肺炎发生率为42．9％（3／7）。结论灌注受损是肺癌患者的常见表现,中央型肺癌灌注受损较重,放射治疗后多数病例肺灌注受损有所改善;放疗前和放疗中,肺灌注受损范围的变化和放射性肺损伤的发生无明显相关性。     

The Development of a Correlation between Lung Cancer Antigen Expression and CT Imanging

Over the past few years, with the development of molecular biology and immunology, research concerning carcinoma antigens has advanced rapidly. At the same time, the application of spiral CT for imaging diagnosis also has achieved excellent success. Many scholars have conducted studies on the correlation between the expression of tumor antigens and CT imaging. This report is a summary of these studies.     

SPECT肺灌注显像优化肺癌放疗计划对肺功能保护价值的研究

目的 探讨SPECT肺灌注显像在Ⅲ期不可切除非小细胞肺癌放疗中指导放疗路径、优化放疗计划及保护肺功能方面的应用价值。方法 本研究纳入 84例Ⅲ期不可切除非小细胞肺癌患者,随机分为对照组(44例)及观察组(40例)。对照组依据常规CT图像制定放疗计划,观察组依据常规CT及SPECT肺灌注显像提示的肺功能信息制定P1、P2计划,但最终均按P2计划进行治疗。比较两组患者放射性肺炎发生率、放疗前后肺功能变化,并对比观察组P1、P2计划的剂量体积参数情况。结果 计划优化后观察组放射性肺炎发生率降低,肺功能下降情况得以改善(均 P≤0.001);P2计划在功能剂量参数上有明显改善(P<0.05),且危及器官受量变化不大(P>0.05)。结论 SPECT肺灌注显像优化调强放疗计划能够在不增加其他危及器官受量条件下,降低功能肺受量,提高肿瘤放疗剂量,对患者的肺功能有保护作用。     

生存素蛋白在非小细胞肺癌中的表达及与MVD的关系

Objective:To investigate microvessel density (MVD) and expression of Survivin in non-small cell lung cancer (NSCLC),and to explore their correlations to clinicopathologic features of NSCLC.Methods:66 specimens of tumor adjacent tissues,and 20 specimens of benign lesions were detected by SP immunohistochemistry;their interrelations and correlations to clinicopathologic features of NSCLC were analyzed.Results:Positive rate of Survivin in NSCLC was significantly higher than that in adjacent tissues and benign lesions (54.5% vs.30%,P＜0.05),its positive rate was 63.6% in lung adenocercinoma tissues,and its positive rate was 54.5% in lung SCC,there was no significant difference between them.Its expressions were respectively 41.2%,87.5% in well-differentiated and poorly differentiated lung SCC;its expressions were respectively 47.1%,81.2% in well-differentiated and poorly differentiated lung adenocarcinoma;the discrepancy had statistical significance.Its expression was 74.1% in lymphatic metastasis group,which was obviously higher than that in no lymphatic metastasis group,which was 48.7%.The rate of MVD in Survivin positive group was obviously higher than that of Survivin negative group.Conclusion:The expression of Survivin is connected with the degree of differentiation on lung cancer and lymphatic metastasis,which indicates Survivin can be as an index for the judgment of condition and the evaluation of prognosis,the expression of Survivin is direct correlation with that of MVD.It is evident that Survivin functions the promotion of tumor angiogenesis.     

热化疗治疗晚期肺癌

目的　探讨手术加胸腔内温热灌注 (IPHC)联合化疗治疗 15例伴胸膜转移及胸腔积液的晚期肺癌病人的临床效果。方法　 15例温热灌注联合化疗治疗的晚期肺癌 ,首先采取手术切除原发肿瘤及术侧淋巴结和部分胸膜 ,再用顺铂 2 0 0mg/m2 和 43℃温盐水 ,进行连续灌注 1小时。结果　两组分期、性别和年龄有可比性。术后随访IPHC组病人 ,6个月生存率 13/ 15 ,1年生存率 10 / 15 ,2年生存率 8/15。对照组 6个月生存率 11/ 15 ,1年生存率 7/ 15 ,2年生存率 5 / 15。结果有明显差异 (P <0 0 5 )。结论　热化疗治疗晚期肺部恶性肿瘤在临床上是一种有效、安全的方法。     

Evaluation of megavoltage CT imaging protocols in patients with lung cancer

Currently, megavoltage CT studies in most centres with tomotherapy units are performed prior to every treatment for patient set-up verification and position correction. However, daily imaging adds to the total treatment time, which may cause patient discomfort as well as results in increased imaging dose. In this study, four alternative megavoltage CT imaging protocols (images obtained: during the first five fractions, once per week, alternating fractions and daily on alternative weeks) were evaluated retrospectively using the daily position correction data for 42 patients with lung cancer. The additional uncertainty introduced by using a specific protocol with respect to the daily imaging, or residual uncertainty, was analysed on a patient and population bases. The impact of less frequent imaging schedules on treatment margin calculation was also analysed. Systematic deviations were reduced with increased imaging frequency, while random deviations were largely unaffected. Mean population systematic errors were small for all protocols evaluated. In the protocol showing the greatest error, the treatment margins necessary to accommodate residual errors were 1.2, 1.3 and 1.7 mm larger in the left–right, superior–inferior and anterior–posterior directions, respectively, compared with the margins calculated using the daily imaging data. The increased uncertainty because of the use of less frequent imaging protocols may be acceptable when compared with other sources of uncertainty in lung cancer cases, such as target volume delineation and motion because of respiration. Further work needs to be carried out to establish the impact of increased residual errors on dose distribution.     

Preserving functional lung using perfusion imaging and intensity-modulated radiation therapy for advanced-stage non-small cell lung cancer

PURPOSE: To assess quantitatively the impact of incorporating functional lung imaging into intensity-modulated radiation therapy planning for locally advanced non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: Sixteen patients with advanced-stage NSCLC who underwent radiotherapy were included in this study. Before radiotherapy, each patient underwent lung perfusion imaging with single-photon-emission computed tomography and X-ray computed tomography (SPECT-CT). The SPECT-CT was registered with simulation CT and was used to segment the 50- and 90-percentile hyperperfusion lung (F50 lung and F90 lung). Two IMRT plans were designed and compared in each patient: an anatomic plan using simulation CT alone and a functional plan using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the two types of plans were compared in terms of tumor coverage and avoidance of normal tissues. RESULTS: In incorporating perfusion information in IMRT planning, the median reductions in the mean doses to the F50 and F90 lung in the functional plan were 2.2 and 4.2 Gy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with >5 Gy, >10 Gy, and >20 Gy in the functional plans were 7.1%, 6.0%, and 5.1%, respectively, for F50 lung, and 11.7%, 12.0%, and 6.8%, respectively, for F90 lung. A greater degree of sparing of the functional lung was achieved for patients with large perfusion defects compared with those with relatively uniform perfusion distribution. CONCLUSION: Function-guided IMRT planning appears to be effective in preserving functional lung in locally advanced-stage NSCLC patients.