脑胶质瘤磁共振灌注成像与病理对照研究

目的　评价磁共振灌注成像在术前评估脑胶质瘤组织病理学分级中的价值。方法　经手术及病理证实的胶质瘤共 2 6例。行常规MR及MR灌注成像检查。构建脑血流容积 (CBV)图和脑血流量 (CBF)图 ,计算最大相对CBV(rCBV)和最大相对CBF(rCBF) ,并与组织病理学分级对照。结果　低级组 (Ⅰ～Ⅱ级 )胶质瘤rCBV、rCBF范围分别为 0 .72～ 4.2 6和 0 .82～ 2 .89,均值分别为 2 .10± 1.18和 1.5 2± 0 .65。高级组 (Ⅲ～Ⅳ级 )胶质瘤rCBV、rCBF范围分别为 0 .89～ 10 .0 2和 1.5 0～ 6.40 ,均值分别为 5 .2 3± 1.86和 4.81± 2 .60。 2组rCBV和rCBF差别有显著性 (t检验 ,Ρ <0 .0 1)。非参数相关性分析表明rCBV与rCBF间有显著的正相关性 (r =0 .712 ,Ρ <0 .0 1)。结论　脑磁共振灌注成像对胶质瘤的术前分级有重要临床意义。     

多层螺旋CT灌注成像在胶质瘤术后随访中的应用价值初探

目的探讨多层螺旋CT灌注成像在胶质瘤术后随访中的应用价值。方法对23例胶质瘤术后患者进行CT灌注成像,测量术后复发残余病灶、术后未复发病变区、残腔病灶及脑组织正常区域的CT灌注参数值[包括脑血流量(CBF)、脑血容量(CBV)、脑血管表面通透性(PS),以及其各相对参数值(rCBF、rCBV、rPS)],应用SPSS11.0统计软件包,独立样本t检验进行显著性分析。结果复发残余组10例,CBF值、CBV值及PS值均升高,rCBF值为1.99±0.72,rCBV值为2.57±0.79,rPS值为10.79±5.85。未复发组11例,CBF值及CBV值均降低,rCBF为0.36±0.99,rCBV为0.76±0.41。8例PS值接近正常值,3例术后早期CT灌注检查PS值较明显升高,8～10个月再次复查PS值接近正常。术后残腔2例,CBF值略降低,CBV值略升高,PS值较明显升高。胶质瘤术后复发残余组与术后未复发组比较,二者的CT灌注参数值差异均有统计学意义(P<0.01);与正常脑组织区域比较,二者的CT灌注参数值差异有统计学意义(P<0.01);与术后残腔组比较,CBF值差异有统计学意义(P<0.05),CBV值及PS值差异无统计学意义(P>0.05)。未复发组与脑组织正常区域比较,CBF值差异有统计学意义(P<0.001),CBV值差异有统计学意义(P<0.05),PS值差异无统计学意义(P>0.05)。未复发病例组与术后残腔组比较,CBF值差异无统计学意义(P>0.05),CBV值及PS值差异均有统计学意义(P<0.01)。结论CT灌注成像能准确地反映脑肿瘤术后的血流动力学改变,在确定肿瘤术后是复发残余还是未复发上有重要价值;PS值大小能较准确反映血脑屏障的破坏程度,但在鉴别肿瘤术后为复发残余还是残腔上无特异性。     

MR灌注成像在鉴别胶质瘤复发与放射性脑损伤中的价值

目的 分析MR灌注成像在鉴别胶质瘤复发与放射性脑损伤中的作用.方法 选取15例脑胶质瘤术后、放疗后并出现新强化灶的患者.所有患者均经二次手术病理或随访(随访时间＞6个月)证实为胶质瘤复发或放射性脑损伤.15例患者均行常规MR平扫、增强扫描和MR脑灌注成像.灌注成像采用梯度回波-回波平面成像(GRE-EPI)序列,ROI放置在横断面T1WI异常强化区域和对侧相对正常的脑白质内,大小为20～40 mm2,每个病灶测量10～15次,取平均值,计算异常强化区与对侧正常区的参数比值,包括相对脑血容量(rCBV)、相对脑血流量(rCBF)及相对平均通过时间(rMTT),采用秩和检验比较胶质瘤复发和放射性脑损伤各灌注参数.并采用ROC曲线评价rCBV、rCBF及MTT鉴别诊断两者的灵敏度及特异度.结果 15例患者最终经手术和随访证实有9例胶质瘤复发,6例放射性脑损伤.胶质瘤复发rCBV、rCBF比值的M分别为2.87(范围0.70～4.91)、1.89(范围0.64～3.96),明显高于放射性脑损伤比值[rCBV 0.70(范围0.12～1.62)、rCBF 0.56(范围0.12～2.08)],差异有统计学意义(Z值分别为-2.55、-2.08,P值均＜0.05).rCBV和rCBF比值鉴别诊断为胶质瘤复发或放射性脑损伤的ROC曲线下面积为0.893和0.821.rCBV比值≤0.77时诊断放射性脑损伤灵敏度为100.0%,rCBV比值≥2.44时诊断胶质瘤复发特异度为100.0%.结论 MR灌注成像是鉴别胶质瘤复发和放射性脑损伤的有效方法,rCBV比值和rCBF比值在鉴别诊断中具有重要价值.

Abstract：

Objective To evaluate the feasibility of perfusion weighted imaging (PWI) in the differentiation of recurrent glioma and radiation-induced brain injuries. Methods Fifteen patients with previously resected and irradiated glioma, presenting newly developed abnormal enhancement, were included in the study. The final diagnosis was determined either histologically or clinicoradiologically. PWI was obtained with a gradient echo echo-planar-imaging (GRE-EPI) sequence. The normalized rCBV ratio[CBV(abnormal enhancement)/CBV(contralateral tissue)], rCBF ratio[CBF(abnormal enhancement)/CBF(contralateral tissue)]and rMTT ratio[(MTT abnormal enhancement)/MTT(contralateral tissue)]were calculated, respectively. The regions of interest (ROIs) consisting of 20-40 mm2 were placed in the abnormal enhanced areas on postcontrast T1-weighted images. Ten to fifteen ROIs measurements were performed in each lesion and the mean value was obtained. Mann-Whitney test was used to determine whether there was a difference in the rCBV/rCBF/MTT ratios between glioma recurrence and radiated injuries. Results Nine of the 15 patients were proved recurrent glioma,6 were proved radiation-induced brain injuries. The mean rCBV ratio[2.87(0.70-4.91)]in glioma recurrence was markedly higher than that[0.70(0.12-1.62)]in radiation injuries (Z=-2.55,P＜0.05). The mean rCBF ratio[1.89(0.64-3.96)]in glioma recurrence was markedly higher than that[0.56(0.12-2.08)]in radiation injuries (Z=-2.08,P＜0.05). The areas under rCBV and rCBF ROC curve were 0.893 and 0.821. If the rCBV ratio ≤0.77, the diagnosis sensitivity of radiation-induced brain injuries was 100.0%;If ≥2.44, the diagnosis specificity of recurrent glioma was 100.0%. Conclusion PWI was an effective technique in distinguishing glioma recurrence from radiation injuries and rCBV and rCBF ratios were of great value in the differentiation.     

PWI鉴别诊断单发脑转移瘤和高级别胶质瘤的价值分析

目的探讨磁共振灌注加权成像(PWI)在单发脑转移瘤和高级别胶质瘤鉴别诊断中的价值。方法选择在本院治疗的255例单发脑转移瘤和104例高级别胶质瘤为研究对象(共359例,经病理组织活检确诊),术前均常规进行核磁共振扫描以及PWI检查,详细测量肿瘤区、瘤旁区、肿瘤周围水肿区(瘤周区)以及健侧无肿瘤的正常脑组织CBV(脑血容量)值,得出肿瘤区、瘤旁区、瘤周区相对无肿瘤的正常脑组织的rCBV(相对脑血容量)值,记录患者PWI特征。结果 255例单发脑转移瘤,104例高级别胶质瘤PWI显示:1)在肿瘤区,单发脑转移瘤的rCBV值(4. 85±2. 17),比高级别胶质瘤rCBV值(6. 32±2. 59)低,两者比较无统计学意义(P 0. 05),但均高于健侧正常脑组织的rCBV(2. 15±0. 42),差异具有统计学意义(P 0. 05); 2)转移瘤瘤旁区的rCBV值(1. 31±0. 25)低于高级别胶质瘤瘤旁区rCBV值是(3. 01±0. 56),差异具有统计学意义(P 0. 05); 3)在肿瘤周围水肿区内,单发脑转移瘤的rCBV值(1. 11±0. 31),比高级别胶质瘤的rCBV值低(1. 58±0. 29);差异均有统计学意义(P 0. 05); 4)单发转移瘤的PWI在对比剂首过后,信号恢复较高级别胶质瘤明显慢。结论对单发脑转移瘤与高级别胶质瘤采用PWI的检查手段,计算瘤周区的rCBV值,显示其血流灌注特性,有助于两者的鉴别诊断。     

CT灌注成像对脑缺血半暗带的评估研究

目的探讨CT灌注成像在脑缺血半暗带评估中的应用价值。方法共43例伴有急性脑血管意外症状和体征的患者,男27例,女16例,年龄50~71岁(平均58.5岁),起病至就诊时间约为2.5~13.5 h。行头部常规CT检查后,立即做CT灌注成像检查,使用CT Perfusion软件分别计算出CBF、CBV、MTT及镜像区CBF、CBV的比值rCBF、rCBV(患侧/健侧),最后应用统计学软件对数据进行分析。结果所有患者在CT灌注参数图像能够明确显示出病灶区,表现为病灶区MTT延长和CBF的下降。患侧半球缺血中心区的CBF、CBV、MTT分别为(24.8±9.6)m l/100 g/m in,(3.3±0.86)m l/100 g,(7.1±2.2)s;缺血边缘区的CBF、CBV、MTT分别为(38.6±10.3)m l/100 g/m in,(3.4±0.91)m l/100 g,(6.4±1.3)s;正常区的CBF、CBV、MTT分别为(48.8±11.2)m l/100 g/m in,(3.7±1.1)m l/100 g,(3.5±1.9)s。缺血坏死区和半暗带区的rCBF分别为0.35±0.16,0.53±0.13,P<0.05。rCBV分别为0.61±0.18,0.81±0.15,Ρ>0.05。结论脑CT灌注成像能很好地评价脑血流动力学改变,准确显示缺血脑组织的部位和范围,计算出多种参数图像及缺血半暗带阈值,为指导临床溶栓治疗提供依据。     

高CO2分压下大鼠神经胶质瘤肿瘤血管的MR灌注成像特点

目的 了解MR灌注成像显示肿瘤血管成熟度和变异度的可行性.方法 20只雄性SD大鼠,采用数字表法随机平分为肿瘤组和正常对照组.肿瘤组大鼠于右侧尾状核区种植C6胶质瘤细胞,复制大鼠脑胶质瘤模型.种植肿瘤细胞后4周,两组大鼠吸入高浓度CO2混合气体,吸入气体前后,分别行全脑灌注成像扫描,检测局部相对脑血容量(rCBV)、局部相对脑血流量(rCBF).扫描前测定大鼠血CO2分压、pH值等血气指标.检查后处死肿瘤组大鼠并取脑固定,全脑切片,分别行苏木精-伊红及鼠特异性平滑肌抗体反应素(SMA)抗体免疫组织化学染色.光学显微镜下观察肿瘤组织特征并进行SMA阳性血管计数.采用配对t检验比较两组大鼠脑组织MR灌注值、肿瘤组织微血管计数及血气指标的差异,并将免疫组织化学检查结果与MR检查结果进行Pearson相关性分析.结果胶质瘤的rCBV和rCBF呈明显的高灌注.所有大鼠在吸入含高浓度CO2的混合气体15 min后,血液CO2分压肿瘤组从(4.69±0.62)kPa升高至(7.62±0.81)kPa,对照组从(4.67±0.51)kPa升高至(7.63±0.78)kPa,差异具有统计学意义(t值分别为6.09,7.012,P值均＜0.05);pH值肿瘤组从(7.42±0.03)降至(7.10±0.05),对照组从(7.40±0.04)降至(7.08±0.02),差异具有统计学意义(t值分别为2.745,2.693,P值均＜0.05).肿瘤实质部分的rCBV和rCBF的增加率分别为(26±17)%和(26±18)%,低于肿瘤组健侧正常脑组织[分别为(90±32)%和(45±14)%],二者差异具有统计学意义(t值分别为5.05,2.355,P值均＜0.05).SMA染色部位在血管的平滑肌细胞,形态规则,肿瘤内SMA阳性血管较正常脑组织的阳性血管管壁薄,管腔直径宽;肿瘤内SMA阳性血管[(6.7±2.8)个/高倍视野]明显少于肿瘤组健侧脑组织[(12.7±2.8)个/高倍视野](t=1.86,P＜0.05).吸入高浓度CO2混合气体后,肿瘤实质区的rCBV和rCBF的变化率与免疫组织化学的SMA阳性血管计数之间均无显著的相关性(r值分别为0.504和0.607,P值均＞0.05).但正常脑组织的rCBV和rCBF变化率与其SMA阳性血管计数之间呈正相关(r值分别为0.721和0.525,P值均＜0.05).结论 MR灌注技术在改变血液CO2分压的条件下可以反映正常脑组织和肿瘤组织血流变化,进而间接判断肿瘤血管的成熟度.     

脑膜瘤瘤周水肿的64层螺旋CT灌注成像定量研究

目的:应用64层螺旋CT灌注成像定量估计脑膜瘤瘤周水肿的灌注状况.方法:对15例脑肿膜瘤伴瘤周水肿患者进行MSCT灌注成像,经灌注软件处理分别计算近瘤周水肿区及远瘤周水肿区局部脑血流量(rCBF)、局部脑血容量(rCBV)、表面通透性(PS),并与对侧脑白质灌注参数进行比较;测量并计算水肿指数EI[(V水肿+V肿瘤)/V肿瘤],并与rrCBV(rCBV水肿平均/rCBV对侧脑白质)的进行相关性分析.结果:脑膜瘤近瘤周水肿区、远瘤周水肿区的rCBF和rCBV明显低于对侧脑白质(rCBF:t=5.78和4.34,P=0.001,0.005; rCBV:t=6.46和8.46,P=0.001,0.003),近瘤周水肿区的rCBF和rCBV低于远瘤周水肿区(rCBF:t=3.49,P=0.013;rCBV:t=4.10,P=0.006),三组间PS值的差异均没有统计学意义(P值均＞0.05);水肿指数跟瘤周水肿区的rrCBV值呈负相关(r=-0.72,P＜0.01);2例恶性脑膜瘤近瘤周水肿区的rCBV、rCBF、PS值的均数明显高于良性脑膜瘤近瘤周水肿区.结论:脑膜瘤瘤周水肿区的灌注具有一定特征,有助于鉴别肿瘤良恶性,优化手术方案及相关辅助治疗、评价手术疗效、鉴别肿瘤复发和坏死.     

胶质瘤MR灌注成像与分子病理学的对照研究

目的探讨胶质瘤最大相对脑血容量(rCBV)与肿瘤微血管密度(MVD)以及血管内皮生长因子(VEGF)表达水平之间的相关性。资料与方法对30例脑胶质瘤(低级别8例,高级别22例)术前行MR常规及灌注成像检查。MR灌注指标rCBV值由肿瘤及对侧正常脑白质的CBV相比后得出。对肿瘤病理片进行SP法免疫组织化学染色,并检测MVD及VEGF表达水平,然后分别对低级别、Ⅲ级和Ⅳ级胶质瘤的rCBV值和MVD及VEGF表达水平进行分析。结果经Spearman相关分析,rCBV值与MVD之间呈显著正相关(r=0·447,P<0.05)。按VEGF低表达和高表达分为两组,两组的rCBV值分别为4.39±3.41(1.20~13.35)、8.24±3.23(3.25~14.26),MVD分别为70.11±32.37(34.5~140.0)、167.15±100.66(38.2~360.0)。两组间的rCBV值或MVD均有显著性差异(P<0·01)。结论rCBV值与MVD及VEGF表达水平之间存在良好的相关性,可用于术前评价肿瘤的血管新生。随着该技术的不断提高,MR灌注成像对于评价胶质瘤的术前病理分级以及指导肿瘤的基因治疗和估计预后具有较好的应用前景。     

CT灌注成像在急性自发性高血压性脑出血中的应用

目的 应用CT灌注成像(CT perfusion,CTP)对急性自发性高血压出血性脑卒中(acute spontaneously hypertensive intracerebral hemorrhage,shICH)血肿周围脑血液动力学变化进行定量研究,验证血肿周围是否存在缺血半暗带.方法 对26例(男22例,女4例,年龄33～74岁,平均55.08岁)临床及CT确诊为幕上shICH患者行CTP检查,自发病到灌注扫描的时间为8～19h,平均14.88h.以血肿最大层面为参照,测量血肿内部、血肿周围、远隔区及对侧镜像区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT),并计算相对灌注参数值rCBF、rCBV、rMTT(患侧/健侧).结果 shICH血肿灌注参数伪彩图从血肿中心到外周色差呈阶梯样分布.血肿周围组CBV值为(1.61±1.53)ml·100g-1、CBF值为(16.48±17.38)ml·100g-1·min-1),低于对侧镜像区(ZCBV=-2.603、ZCBF=-4.178,P＜0.05);MTT值为(9.12±2.57)s,较对侧镜像区延长(t=4.747,P＜0.05).方差分析显示血肿内部、血肿周围组及远隔区组灌注参数MTT及相对值rCBF、rCBV、rMTT均数间差异有统计学意义(FMTT=9.043、FrCBV=38.031、FrCBF=25.023、FrMTT=12.486,P＜0.05),进一步LSD分析,血肿周围组与远隔区组MTT、rMTT、rCBF差异有统计学意义(P＜0.05),但两组间rCBV值无统计学差异(P＞0.05).且秩和检验显示血肿周围组CBF明显低于远隔区组(Z=2.288,P＜0.05),但两组间CBV均值差异无显著性(Z=-0.357,P＞0.05).结论 CTP可反应shICH血肿周围低灌注状态,但没有证据显示存在缺血半暗带.     

常规MRI联合三维动脉自旋标记技术在胶质瘤复发诊断中的应用

目的探讨常规磁共振成像(MRI)联合三维动脉自旋标记(3D-ASL)技术在提高胶质瘤复发诊断正确率中的应用。方法本组选取80例高级别脑胶质瘤术后放疗后经MRI提示术区存在异常强化病灶的患者,其中33例确诊为放射性脑损伤(RBI组),47例经二次手术、随访确诊肿瘤复发(复发组)。两组患者均行常规MRI平扫、增强和3D-ASL检查,比较两组病变区最大相对脑血流量(rCBF)比值,并比较不同诊断方法与确诊结果的符合率。结果两组均行3D-ASL检查后,复发组病灶实性部分最大脑血流量(rCBF)与对侧灰质、对侧白质、对侧镜像区比值较RBI组均明显升高(P0.01)。相比常规MRI平扫+增强,常规MRI平扫+MRI增强+3D-ASL诊断RBI和术后肿瘤复发的符合率明显升高(P0.01)。结论 3D-ASL检查具有无需注入对比剂、无创、安全等优势,可用于鉴别和诊断脑胶质瘤术后复发和RBI,且常规MRI联合3D-ASL检查对脑胶质瘤术后复发的诊断准确性显著升高。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.