3-D CT成像技术在小儿腹膜后神经母细胞瘤治疗中的应用

目的:探讨CT三维成像(3-D CT)在小儿腹膜后神经母细胞瘤手术中的应用.方法: 对12例小儿神经母细胞瘤应用CT机工作软件对图像进行多平面重建、容积再现及透明重建,根据情况制订手术方案.结果: 完整切除术5例;大部切除术3例;部分切除2例;明确诊断, 放弃手术治疗2例.1例发生并发症是由于术中肿瘤包绕腔静脉,术前腔静脉腹段显示不清.所有病例经3-D CT成像后,显著提高了对肿瘤与周围脏器的解剖关系的了解,血供及供应血管等信息可清晰显示.结论: CT三维成像可以立体直观地显示小儿神经母细胞瘤的形态轮廓及与邻近结构的关系, 帮助医生了解病理解剖、体积测定、制订手术计划、最大限度地降低术中损伤.     

CT 在小儿神经母细胞瘤诊断和随访中的应用

目的：评价 CT 检查在小儿神经母细胞瘤的诊断及治疗后随访中的临床应用价值。方法：回顾性分析23例经病理证实为神经母细胞瘤患儿的临床资料及 CT 表现特征。结果：23例神经母细胞瘤中来源于肾上腺13例,腹膜后7例,纵隔3例;15例肿瘤形态不规整,5例肿瘤呈椭圆形或类圆形,3例呈分叶状;肿瘤内部多呈混杂密度,20例瘤体内伴多发钙化灶,15例内伴囊性坏死低密度区,增强扫描后,17例瘤体呈明显强化,4例呈轻中度强化,2例未见明显强化;11例瘤体包绕大血管;CT 正确诊断20例,诊断准确率为87.0%。结论：CT 检查是诊断小儿神经母细胞瘤及治疗后随访观察的重要检查方法。     

小儿腹膜后神经母细胞瘤20例分析

神经母细胞瘤(NB)约占儿童时期恶性肿瘤的7%～14%,其中腹膜后NB占绝大多数,其原发灶小,隐匿于腹膜后,易早期转移,表现复杂,初诊病例易误诊漏诊.本院自1990年以来共收治小儿腹膜后NB20例,现总结分析如下.     

小儿腹膜后神经母细胞瘤20例分析

神经母细胞瘤（ＮＢ）约占儿童时期恶性肿瘤的７ %～１４ % ,其中腹膜后ＮＢ占绝大多数 ,其原发灶小 ,隐匿于腹膜后 ,易早期转移 ,表现复杂 ,初诊病例易误诊漏诊。本院自１９９０年以来共收治小儿腹膜后ＮＢ２０例 ,现总结分析如下。１临床资料１．１一般资料男１３例 ,女７例。年龄４月～７岁 ,其中＜１岁１例 ,１岁～５岁１５例 ,５岁～７岁４例。病程＜１月４例 ,１月～５月１４例 ,＞５月者２例。１．２临床表现发热１７例 ,面色苍白１３例 ,肝脾肿大１２例 ,骨痛１０例 ,腹痛腹胀５例 ,皮下出血１例。体检触及腹部包块１４例 ,淋巴结肿…     

增强CT在小儿神经母细胞瘤化疗监测方面的价值

目的:评价CT增强检查在小儿神经母细胞瘤化疗监测中的作用。方法:搜集经病理证实、临床影像资料完整的小儿神经母细胞瘤患者44例,男26例,女18例,年龄2个月到7岁,平均3.15岁。分为术前组(10例)和术后组(34例)。所有患者化疗前后均行增强CT检查,对比分析化疗前后的CT图像。结果:CT增强检查可以清晰显示原发肿瘤的体积及肿块内钙化的变化,了解肿瘤推挤临近器官或包绕大血管的情况;帮助判断原发肿瘤部位有无复发、残留;明确有无远处转移及其变化。结论:无论是手术前还是手术后化疗,CT增强扫描均是帮助评价小儿神经母细胞瘤化疗疗效的重要手段。     

超声和CT在儿童神经母细胞瘤诊断、临床分期和治疗方案制定中的价值分析

目的:对比分析超声和CT对儿童神经母细胞瘤的诊断价值以及二者在该病临床分期和治疗方案制定中的价值。方法:筛选经病理证实的儿童神经母细胞瘤34例（其中术后证实瘤内钙化者26例）,分析其临床及影像资料。结果:本研究的34例患者中,有29例超声显示为大小不等、回声不均匀的实性肿块,其中20例肿块表现为跨中线生长,18例包绕腹部大血管,18例后腹膜淋巴结肿大,且有9例、8例和2例分别为肾脏、肝脏、脾脏受累患者。本研究中有28例患者在术前通过超声进行了确诊,其符合率高达82.4%,特征性瘤内钙化的检出率达88.5%（23/26）;CT示大小不等、密度不均匀的肿块34例,增强可见明显强化,包绕大血管者18例,跨中线生长者20例,侵犯椎管腔者8例,后腹膜淋巴结肿大者15例,肾脏、肝脏、脾脏受累者分别为9例、6例、1例,头颅转移者7例,30例术前做出正确诊断,术前CT诊断符合率为88.2%,瘤内钙化的检出率高达96.2%（25/26）。结论:儿童神经母细胞瘤有其典型的影像学表现,超声和CT对该病的诊断符合率都很高,且各具优势,二者联合应用对儿童神经母细胞瘤的诊断、临床分期和指导治疗有重要价值。     

护理干预联合中医治疗小儿神经母细胞瘤化疗后疲乏的疗效

目的探讨护理干预联合中医治疗小儿神经母细胞瘤(NB)化疗后疲乏的临床疗效。方法选取2015年1月至2016年1月间德州市陵城区人民医院收治的68例NB患者,采用随机数表法分为观察组和对照组,每组34例。两组患者均服用来复汤中药治疗,观察组患者给予循证护理干预,对照组患者给予常规护理。分别于治疗前后采用Piper疲乏量表和生活质量评分量表评价治疗效果。结果两组患者治疗后疲乏程度均较治疗前有所缓解,差异均有统计学意义(均P<0.05),治疗后观察组患者疲乏程度低于对照组患者,差异有统计学意义(P<0.05)。治疗后两组患者躯体功能、角色功能、认知功能、情感功能、社会功能和总体健康评分均显著提高,差异均有统计学意义(均P<0.05),观察组患者功能量表各项评分和总体健康评分显著高于对照组患者,差异均有统计学意义(均P<0.05)。治疗后两组患者生活质量症状量表各项评分均显著降低,差异均有统计学意义(均P<0.05),观察组患者生活质量症状量表各项评分显著低于对照组患者,差异均有统计学意义(均P<0.05)。结论护理干预联合中医治疗可以有效的缓解小儿NB化疗后的疲乏,提高生活质量,有较好的疗效。     

CT灌注成像在食管癌中的应用

目的:总结国内外CT灌注技术及其在食管癌中的应用进展。方法:应用Medline和CNKI期刊全文数据库系统,以"食管癌、计算机体层成像、灌注"为关键词,检索1991-01—2010-01的相关文献,共检索到英文文献61篇和中文文献11篇。纳入标准:1)CT灌注技术的理论基础;2)食管癌灌注参数的意义;3)CT灌注在食管癌诊断、治疗中的价值。根据纳入标准分析24篇文献。结果:1)食管癌CT灌注参数血容量(BV)和峰值到达时间(TTP)与食管癌微循环情况有良好相关性;2)放疗前后的食管癌CT灌注参数毛细血管通透性(PS)、强化峰值(PEI)有显著差异;3)食管癌患者对放化疗的敏感性及治疗效果与CT灌注参数显著相关,对放化疗敏感的患者其灌注参数BV、血流量(BF)高于不敏感者,而MTT短于不敏感者;4)CT灌注可以对局部和远处转移的食管癌进行检测和分期。结论:CT灌注技术可以评价血管生成情况,对食管癌具有诊断价值;也可以评价和预测放化疗疗效,辅助食管癌治疗;同时,CT灌注还是食管癌分期的一种新方法。     

腹膜后神经母细胞瘤术后复发一例

患儿男,7岁。以间断性左腿疼1年,加重4个月入院。患儿1年前无诱因出现腿疼、腹痛并伴有盗汗,无发热、咳嗽,当地医院给与对症治疗后,稍有好转。4个月前感冒后开始腿疼,且较前剧烈,行走时尤为明显,对症治疗效果不佳。骨穿显示为继发性贫血。CT检查示:胰尾后方可见不规则混杂密度肿块,与周围边界尚清晰,实性部分大小约39.4mm×46.3mm。其增强前后的CT值分别为30Hu和57Hu,其内不规则小斑点状高密度影CT值为132Hu。CT考虑为腹膜后占位,神经母细胞瘤可能性大。手术所见:腹膜后有一约10.0cm×7.0cm大小的包块,质软,与周围边界清楚,移动度尚可…     

小儿腹部节细胞神经瘤的诊断和治疗

目的提高小儿腹腔节细胞神经瘤的诊治水平。方法回顾分析3例腹腔节细胞神经瘤的临床资料，结合文献对其发病情况、生物学特性、临床、病理诊断及手术原则进行讨论。结果术前经B超、CT检查，2例分别诊断神经母细胞瘤和腹膜后肿瘤；1例考虑节细胞神经瘤。3例均手术切除肿瘤，2例为腹膜后节细胞神经瘤，1例为肾上腺节细胞神经瘤。术后恢复顺利。随访6个月～8年，患儿健康，无肿瘤复发。结论小儿腹部节细胞神经瘤临床少见，平均发病年龄6岁左右，除腹部包块外，一般情况良好。B超、CT可了解肿瘤的部位及其与周围组织、脏器的关系，对于诊断和指导手术有帮助。确诊有赖病理。完全切除肿瘤，预后良好。     

Dosimetric improvements following 3D planning of tangential breast irradiation

Purpose: To evaluate the dosimetric difference between a simple radiation therapy plan utilizing a single contour and a more complex three-dimensional (3D) plan utilizing multiple contours, lung inhomogeneity correction, and dose-based compensators.

Methods and Materials: This is a study of the radiation therapy (RT) plans of 85 patients with early breast cancer. All patients were considered for breast-conserving management and treated by conventional tangential fields technique. Two plans were generated for each patient. The first RT plan was based on a single contour taken at the central axis and utilized two wedges. The second RT plan was generated by using the 3D planning system to design dose-based compensators after lung inhomogeneity correction had been made. The endpoints of the study were the comparison between the volumes receiving greater than 105% and greater than 110% of the reference dose, as well as the magnitude of the treated volume maximum dose. Dosimetric improvement was defined to be of significant value if the volume receiving > 105% of one plan was reduced by at least 50% with the absolute difference between the volumes being 5% or greater. The dosimetric improvements in 49 3D plans (58%) were considered of significant value. Patients’ field separation and breast size did not predict the magnitude of improvement in dosimetry.

Conclusion: Dose-based compensator plans significantly reduced the volumes receiving > 105%, >110%, and volume maximum dose.     

Stanford 3D hyperthermia treatment planning system. Technical review and clinical summary

In the field of deep regional hyperthermia cancer therapy the Sigma 60 applicator of the BSD-2000 Hyperthermia System is one of the most widely used devices. This device employs four independent sources of radiofrequency electromagnetic energy to heat tumour sites deep within the body. The difficulty in determining the input parameters for the four sources has motivated the development of a computer-based three-dimensional (3D) treatment planning system. The Stanford 3D Hyperthermia Treatment Planning System has been in clinical use at Stanford Medical Center for the past 2 years. It utilizes a patient-specific, three-dimensional computer simulation to determine safe and effective power deposition plans. An optimization programme for the selection of the amplitudes, phases and frequency for the sources has been developed and used in the clinic. Examples of the application of the treatment planning for hyperthermia treatment of pulmonary, pelvic, and mediastinal tumours are presented. Methods for quantifying the relative effectiveness of various treatment plans are reviewed.     

4D Proton treatment planning strategy for mobile lung tumors

PURPOSE: To investigate strategies for designing compensator-based 3D proton treatment plans for mobile lung tumors using four-dimensional computed tomography (4DCT) images. METHODS AND MATERIALS: Four-dimensional CT sets for 10 lung cancer patients were used in this study. The internal gross tumor volume (IGTV) was obtained by combining the tumor volumes at different phases of the respiratory cycle. For each patient, we evaluated four planning strategies based on the following dose calculations: (1) the average (AVE) CT; (2) the free-breathing (FB) CT; (3) the maximum intensity projection (MIP) CT; and (4) the AVE CT in which the CT voxel values inside the IGTV were replaced by a constant density (AVE_RIGTV). For each strategy, the resulting cumulative dose distribution in a respiratory cycle was determined using a deformable image registration method. RESULTS: There were dosimetric differences between the apparent dose distribution, calculated on a single CT dataset, and the motion-corrected 4D dose distribution, calculated by combining dose distributions delivered to each phase of the 4DCT. The AVE_RIGTV plan using a 1-cm smearing parameter had the best overall target coverage and critical structure sparing. The MIP plan approach resulted in an unnecessarily large treatment volume. The AVE and FB plans using 1-cm smearing did not provide adequate 4D target coverage in all patients. By using a larger smearing value, adequate 4D target coverage could be achieved; however, critical organ doses were increased. CONCLUSION: The AVE_RIGTV approach is an effective strategy for designing proton treatment plans for mobile lung tumors.     

Immunocytochemical detection of 14-3-3 in primary nervous system tumors

Summary 14-3-3 proteins have attracted much recent interest in the etiopathogenesis of human cancers owing to their involvement in the prevention of apoptosis. However, the expression of 14-3-3 in primary nervous system tumors has not been previously characterized. In this paper, Immunohistochemistry using a specific anti-14-3-3 antibody was performed on formalin-fixed, paraffin embedded archival tissue from 124 primary human nervous system tumors and 10 normal brain tissues. In the normal control brains, 14-3-3 immunoreactivity was localized mainly in the neuronal somata and processes, and some glial cells showed only weak immunoreactivity. However, 14-3-3 immunoreactivity was seen in the majority of astrocytomas [grade I (9/11), II (16/21), III (13/17), IV (17/21)]. There was no difference between the positive expression rates of 14-3-3 in different grades of astrocytomas (P = 0.968). But the intensity and degree of 14-3-3 immunoreactivity in diffuse astrocytomas, anaplastic astrocytoma, and glioblastoma multiformes showed trends with tumor grade, with glioblastomas having the highest positivity (P = 0.048). The 14-3-3 immunoreactivity was also seen in the majority of other gliomas [oligodendroglioma (2/3), anaplastic oligodendroglioma (4/4), ependymoma (1/2), anaplastic ependymoma (2/2), choroid plexus papilloma (3/3), pineocytoma (2/2), medulloblastoma (5/8)]. All meningiomas [syncytical (3), fibrous/fibroblastic (4), angiomatous (4), transitional/mixed (3)] were intensely and diffusely positive. All schwannomas (4), neurofibromas (2), pituitary adenomas (6) and craniopharyngiomas(4) also showed intense positive staining. These results showed that 14-3-3 is expressed in the majority of the primary human nervous system tumors. The up-regulated expression of 14-3-3 may be a common mechanism for evading apoptosis in most primary human nervous system tumors, and targeting 14-3-3 may be a novel promising strategy for the treatment of these tumors, especially for malignant tumors.