DTI相关参数对脑胶质瘤的诊断价值及与VEGF、MMP-9、uPA表达的相关性

【摘要】目的：探讨DTI相关参数对脑胶质瘤的诊断价值及与血管内皮生长因子(VEGF)、基质金属蛋白酶-9 (MMP-9)、尿激酶型纤溶酶原激活剂(uPA)表达的相关性。方法：将55例术后病理证实为脑胶质瘤的患者分为高、低级别两组,并对DTI各参数值进行组间和组内比较。检测脑胶质瘤的MMP-9、VEGF及uPA表达情况,将三者与DTI各参数值进行相关性分析。结果：不同级别脑胶质瘤实质区与对侧正常脑实质区的ADC值、FA值差异均有统计学意义(P值均＜0.01)。高、低级别脑胶质瘤实质区的FA及相对FA（rFA）值差异均有统计学意义(P值均＜0.01),ADC值、相对ADC（rADC）值差异均无统计学意义(P值均＞0.05);高、低级别脑胶质瘤实质区的VEGF、MMP-9表达差异均有统计学意义(P值均＜0.01) ,而uPA表达差异无统计学意义(P＞0.05)。高、低级别脑胶质瘤的FA、rFA值与VEGF、MMP-9表达存在相关性(P值均＜0.01),而ADC、rADC值与VEGF、MMP-9、uPA的表达均不存在相关性(P值均＞0.05)。结论:VEGF、MMP-9在脑胶质瘤的发生发展中具有重要促进作用,FA及rFA值可为术前脑胶质瘤的分级诊断提供重要参考,间接反映VEGF、MMP-9的表达,可为临床术前方案的制定、预后评估提供影像学依据。     

Diffusion tensor imaging in the differential diagnosis of low-grade cerebral glioma,cerebral infarction and viral encephalitis

目的:探讨磁共振扩散张量成像在鉴别低级别脑胶质瘤、脑梗死和病毒性脑炎中的应用价值.方法:22例低级别脑胶质瘤、26例急性或亚急性期脑梗死和18例病毒性脑炎患者在治疗或手术前行常规MRI和DTI检查.脑低级别胶质瘤患者均经手术病理证实,病毒性脑炎和脑梗死患者均经临床治疗及随访证实.测量并计算3组病灶的表现扩散系数(ADC)值和相对表现扩散系数(rADC)值、各向异性分数(FA)值和相对各向异性分数(rFA)值,并进行统计学分析.结果:脑低级别胶质瘤组平均ADC、rADC、FA和rFA值分别为(1.55±0.08)×10-3mm2/s、1.68±0.25、0.17±0.03和0.42±0.08,脑梗死组分别为(0.54±0.12)×10-3mm2/s、0.64±0.12、0.14±0.03和0.30±0.05,病毒性脑炎组分别为(0.84±0.07)×10-3mm2/s、1.07±0.05、0.17±0.02和0.43±0.09.三组病例的平均ADC值及rADC值间的差异有高度统计学意义(P＜0.01),脑低级别胶质瘤与脑梗死的FA值和rFA值之间、病毒性脑炎与脑梗死的FA值和rFA值之间差异有高度统计学意义(P＜0.01),脑低级别胶质瘤与病毒性脑炎的FA值和rFA值之间差异无统计学意义(P＞0.05).结论:综合利用DTI的ADC值、rADC值、FA值及rFA值,对鉴别脑低级别胶质瘤、脑梗死和病毒性脑炎具有较高的指导价值.     

MR扩散张量成像在评价胶质瘤恶性程度中的作用

目的 探讨MR DTI在评价胶质瘤病理等级与毗邻纤维束状态之间相关性的价值.方法 选择24例经手术及组织病理学证实的胶质瘤患者,术前行常规MRI、DTI.在各向异性分数(FA)图上,ROI设定在瘤周纤维束FA值最低点(Faa)及对侧半球对称区域(Fac),测量出Faa及Fac值,在相同层面ADC图的相同位置,测量出ADC值最低点(ADCa)及对侧半球对标区域ADC(ADCc)值,计算出相对FA值(rFA)和相对ADC值(rADC).利用纤维束追踪技术重组出肿瘤周围纤维束三维图,根据纤维束三维图对纤维束的状态(推移、浸润或者破坏)进行评价.rFA、rADC及瘤周纤维束的状态与胶质瘤的病理级别之间的关系进行独立样本t检验及趋势X2检验.结果24例胶质瘤患者,其中低级别胶质瘤11例,高级别胶质瘤13例.低级别胶质瘤的rFA值为0.65±0.19, rADC值为1.43±0.50,重组的痛周纤维束追踪图主要呈被推移或者浸润;高级别胶质瘤的rFA值为1.51±0.39,rADC值为1.70±0.27,重组的瘤周纤维束追踪图主要旱被浸润或者被破坏.rFA值在高级、低级别胶质瘤之间差异有统计学意义(t=8.504,P=0.000),而rADC值差异无统计学意义(t=-1.435,P=0.165);纤维束的状态在高级、低级别胶质瘤之间差异亦有统计学意义(X2=5.882,P=0.015).结论胶质瘤的病理等级影响瘤周纤维束的状态,rFA可作为一个参考指标,有助于鉴别胶质瘤的恶性程度;DTI可清楚显示肿瘤与周围白质纤维的解剖位置关系,并能显示瘤周纤维不的病理状态,指导治疗方案的制定.     

DTI对鉴别脑低级别胶质瘤、脑梗死和病毒性脑炎的价值

目的:探讨磁共振扩散张量成像在鉴别低级别脑胶质瘤、脑梗死和病毒性脑炎中的应用价值。方法:22例低级别脑胶质瘤、26例急性或亚急性期脑梗死和18例病毒性脑炎患者在治疗或手术前行常规MRI和DTI检查。脑低级别胶质瘤患者均经手术病理证实,病毒性脑炎和脑梗死患者均经临床治疗及随访证实。测量并计算3组病灶的表观扩散系数(ADC)值和相对表观扩散系数(rADC)值、各向异性分数(FA)值和相对各向异性分数(rFA)值,并进行统计学分析。结果:脑低级别胶质瘤组平均ADC、rADC、FA和rFA值分别为(1.55±0.08)×10-3 mm2/s、1.68±0.25、0.17±0.03和0.42±0.08,脑梗死组分别为(0.54±0.12)×10-3 mm2/s、0.64±0.12、0.14±0.03和0.30±0.05,病毒性脑炎组分别为(0.84±0.07)×10-3 mm2/s、1.07±0.05、0.17±0.02和0.43±0.09。三组病例的平均ADC值及rADC值间的差异有高度统计学意义(P<0.01),脑低级别胶质瘤与脑梗死的FA值和rFA值之间、病毒性脑炎与脑梗死的FA值和rFA值之间差异有高度统计学意义(P<0.01),脑低级别胶质瘤与病毒性脑炎的FA值和rFA值之间差异无统计学意义(P>0.05)。结论:综合利用DTI的ADC值、rADC值、FA值及rFA值,对鉴别脑低级别胶质瘤、脑梗死和病毒性脑炎具有较高的指导价值。     

3.0T磁共振扩散张量成像对高级别脑胶质瘤和脑转移瘤的鉴别诊断价值

目的探讨3.0T磁共振扩散张量成像参数中的各向异性分数(FA)值、表观扩散系数(ADC)值对高级别脑胶质瘤和脑转移瘤的鉴别诊断价值。方法分析经手术病理或临床随访证实15例高级别脑胶质瘤和19例脑转移瘤,术前行常规MRI扫描、增强扫描、DWI及DTI扫描,选取感兴趣区(肿瘤囊变区、肿瘤实质区、肿瘤边缘区、瘤周水肿区、肿瘤周围正常脑实质区),分别测量其ADC值及FA值,比较两种肿瘤不同部位ADC值及FA值的差异,采用t检验。结果高级别脑胶质瘤与脑转移瘤的肿瘤实质区(t=4.09,P=0.001)、肿瘤边缘区(t=3.34,P=0.002)的FA值差异显著(P<0.05)。两种肿瘤周围水肿区(t=4.79,P=0.000)的ADC值差异显著(P<0.05)。结论扩散张量成像可以作为高级别脑胶质瘤和脑转移瘤的鉴别诊断方法。     

MR扩散加权成像瘤周水肿区ADC值在脑肿瘤鉴别诊断中的价值

目的探讨MR扩散加权成像(DWI)瘤周水肿区表观扩散系数(ADC)值在脑内肿瘤鉴别诊断中的价值。资料与方法82例脑肿瘤患者进行常规MRI扫描和DWI检查,对照分析病变的实质部分、周围水肿区的ADC值、相对表观扩散系数(rADC)值、指数表观扩散系数(EADC)值、相对指数表观扩散系数(rEADC)值。结果高级别胶质瘤与低级别胶质瘤、转移瘤、脑膜瘤、淋巴瘤的瘤周水肿ADC值、rADC值差异有统计学意义(P<0.05)。高级别胶质瘤与低级别胶质瘤瘤周水肿的EADC值、rEADC值差异有统计学意义。结论瘤周水肿区ADC值有助于高级别胶质瘤与其他脑内肿瘤鉴别,也可有助于胶质瘤分级。     

弥散张量成像鉴别高级别胶质瘤与单发转移瘤的价值

目的：探讨弥散张量成像鉴别脑内原发高级别胶质瘤与单发转移瘤的价值。材料和方法：测量行DTI检查的13例幕上高级别胶质瘤、8例单发转移瘤的肿瘤实质、瘤周水肿区及在大脑脚层面双侧皮质脊髓束的ADC值、FA值，并计算患侧／对侧FA相对值，行统计学分析。结果：单发转移瘤瘤周水肿区ADC值明显高于高级别胶质瘤瘤周水肿区ADC值；两者大脑脚层面患侧皮质脊髓束FA值轻度降低，ADC值无明显差异；相对FA值高级别胶质瘤较低。结论：瘤周水肿区ADC值对高级别胶质瘤与单发转移瘤的鉴别有意义；弥散张量成像提供更多瘤周受累纤维束病理改变的信息。     

磁共振扩散加权成像在幕上高级别胶质瘤及脑转移瘤瘤周水肿区的应用价值

目的 探讨DWI在幕上高级别胶质瘤与脑转移瘤鉴别诊断中的应用价值.方法 收集在治疗前行常规MRI及DWI检查的幕上脑肿瘤共45例,其中高级别胶质瘤(Ⅲ～Ⅳ级)18例,脑转移瘤27例.以瘤周1 cm为界线,将瘤周水肿区划分为近瘤区及远瘤区,分别测量高级别胶质瘤和脑转移瘤瘤周水肿区的ADC值,并计算rADC值.结果 高级别胶质瘤近瘤区rADC值明显低于脑转移瘤近瘤区rADC值,差异有统计学意义(P＜0.01),二者远瘤区rADC值间无显著性差异(P＞0.05).结论 近瘤区rADC值有助于幕上高级别胶质瘤与脑转移瘤的鉴别诊断.     

DTI 和 MRS 在 AIDS 相关脑内结核中的临床应用研究

目的：探讨扩散张量成像(DTI)和磁共振波谱成像(MRS)定量指标对获得性免疫缺陷综合征(AIDS)相关机会性感染脑内结核的诊断价值。方法收集17例 AIDS 合并颅内结核患者及16例正常志愿者,行常规 MRI、DTI 及多体素 MRS 扫描,观察病灶形态学表现,测量病例组病灶实质区、水肿区、正常区及对照组相应正常区 ADC、FA、rADC、rFA、NAA/Cho、NAA/Cr 及 Cho/Cr 定量指标,并分析其差异性。结果AIDS 相关脑内结核实质区、水肿区及正常区各指标经方差分析均有统计学意义,两两比较,除水肿区与正常区 NAA/Cr 外,其余均有统计学差异(P<0.05),实质区 ADC 值、FA 值、rADC 值、rFA 值,NAA/Cho、NAA/Cr 均低于水肿区,Cho/Cr 高于水肿区和正常区。受试者工作特征曲线(ROC)分析 rFA 值用于区分实质区及水肿区的效能最高(P <0.05)。2组间正常区比较除 Cho/Cr 外,各指标均有统计学意义(P <0.05)。结论DTI 可以反映 AIDS 脑内结核所引起的脑结构微细改变, MRS 能反映脑内结核的早期病理代谢特点。     

DTI 在基底节、放射冠区急性期脑梗死预后评估中的应用

目的：评价磁共振扩散张量成像(DTI)的表观扩散系数(ADC)和各向异性分数(FA)在急性期脑梗死预后评估中的应用价值。方法41例基底节或放射冠区急性期脑梗死病例行常规 MRI 和 DTI 检查,测量病灶区 ADC 值、FA 值和对侧镜像区 ADC值、FA 值,计算相对 ADC 值(rADC)和相对 FA 值(rFA)。首次检查后第3周行 DTI 复查并重复测量、计算上述参数。所有病例分别于入院时和发病后1年进行肌力测试。根据患侧肌力恢复情况分为3组：A 组,完全恢复(肌力恢复到5级);B 组,部分恢复(肌力有恢复但<5级);C 组,无恢复(肌力无变化或降低)。结果(1)所有病例病灶区 ADC 值、FA 值均较对侧正常脑组织 ADC 值、FA 值降低。第3周复查,所有病例 ADC 值均升高;38例 FA 值降低,3例 FA 值轻微升高。(2)rFA 值变化组间差异有统计学意义(P <0.05)。两两比较,A 组和 C 组,B 组和 C 组间 rFA 值差异有统计学意义(P <0.05)。A 组和 B 组间 rFA 值差异无统计学意义(P >0.05)。ADC 值、FA 值和 rADC 变化组间差异无统计学意义(P >0.05)。结论发生于基底节区或放射冠区的急性期脑梗死患者中,第3周 rFA 值变化幅度越小,患者肌力恢复水平越好。     

基于组织相似度图谱的MR灌注成像评价脑胶质瘤的价值探讨

目的 探讨基于组织相似度图谱(TSM)MR灌注成像(PWI)评价脑胶质瘤血流灌注情况的可行性及在胶质瘤分级中的价值.方法 搜集经手术病理证实的24例脑肿瘤(Ⅱ级9例,Ⅲ级8例,Ⅳ级7例)患者的MR常规及灌注成像资料.经TSM算法软件和MRI工作站PWI后处理软件将扫描数据进行处理,得到TSM图和脑血容量(CBV)图.分别测算肿瘤实质区和正常脑白质区(WM)的CBVPWI值或CBVTSM值,然后计算出脑胶质瘤的rCBVPWI值、rCBVTSM值,并分别对Ⅱ级、Ⅲ级、Ⅳ级胶质瘤rCBVPWI值和rCBVTSM值进行统计学分析.结果 (1)Ⅱ级、Ⅲ级和Ⅳ级胶质瘤的rCBVPWI值和rCBVTSM值之间差异均无统计学意义.(2)Ⅱ级胶质瘤的rCBVPWI值(1.83 ±0.48)显著低于Ⅲ级(5.95±2.52) (P =0.002)和Ⅳ级(6.47±2.30)(P=0.001).Ⅲ级和Ⅳ级之间差异无统计学意义(P=0.631).同样,Ⅱ级胶质瘤的CBVTSM值(2.18 ±0.38)显著低于Ⅲ级(6.06 ±2.81) (P =0.007)和Ⅳ级(6.27±2.76) (P =0.006).Ⅲ级和Ⅳ级之间差异无统计学意义(P=0.87).结论 基于TSM的MR灌注成像可用于评价脑胶质瘤的血流动力学变化,并能于术前对胶质瘤进行分级诊断.     

Relative biological effectiveness (RBE) of alpha radiation in cultured porcine aortic endothelial cells

PURPOSE: Northern peoples can receive elevated radiation doses (1- 10 mSv/y) from transfer of polonium-210 (210Po) through the lichen-caribou-human food chain. Ingested 210Po is primarily blood-borne and thus many of its short range alpha particles irradiate the endothelial cells lining the blood vessels. The relative biological effectiveness (RBE) of alpha particles vs. x-rays was examined in porcine aortic endothelial cells as a surrogate for understanding what might happen to human endothelial cells in northern populations consuming traditional foods. MATERIALS AND METHODS: Cultured porcine aortic endothelial cells were exposed to x-ray and 210Po alpha particle radiation. Alpha irradiation was applied to the cell cultures internally via the culture medium and externally, using thin-bottomed culture dishes. The results given here are based on the external irradiation method, which was found to be more reliable. Dose-response curves were compared for four lethal endpoints (cell viability, live cell fraction, release of lactate dehydrogenase [LDH] and clonogenic survival) to determine the relative biological effectiveness (RBE) of alpha radiation. RESULTS: The alpha RBE for porcine cells varied from 1.6-21, depending on the endpoint: 21.2+/-4.5 for cell viability, 12.9+/-2.7 for decrease in live cell number, 5.3+/-0.4 for LDH release to the medium but only 1.6 +/-0.1 for clonogenic survival. The low RBE of 1.6 was due to x-ray hypersensitivity of endothelial cells at low doses.     

Relative biological effectiveness (RBE) of heavy ions (O+8) for producing retinal lesions.

The relative biological effectiveness (RBE) for oxygen ions (250 MeV/nucleon) for producing an ischemic retinal lesion in the rhesus monkey has been shown to be greater than 10. The RBE concept and the use of the standard methodology is discussed with respect to other published reports.     

Relative therapeutic efficacy of (125)I- and (131)I-labeled monoclonal antibody A33 in a human colon cancer xenograft.

A33, a monoclonal antibody that targets colon carcinomas, was labeled with (125)I or (131)I and the relative therapeutic efficacy of the 2 radiolabeled species was compared in a human colon cancer xenograft system. METHODS: Nude mice bearing human SW1222 colon carcinoma xenografts were administered escalating activities of (125)I-A33 (9.25-148 MBq) or (131)I-A33 (0.925-18.5 MBq), (125)I- and (131)I-labeled control antibodies, unlabeled antibody, or no antibody. The effects of treatment were assessed using the endpoints of tumor growth delay and cure. RESULTS: Tumor growth delay increased with administered activity for all radiolabeled antibodies. Approximately 4.5 times more activity was required for (125)I-A33 to produce therapeutic effects that were equivalent to those of (131)I-A33. This ratio was approximately 7 for a nonspecific, noninternalizing isotype-matched, radiolabeled control antibody. Unlabeled A33 antibody had no effect on tumor growth. Approximately 10 times more activity of (125)I-A33 produced toxicity similar to that of (131)I-A33, and this ratio fell to approximately 6 for radiolabeled control antibody. CONCLUSION: Treatment with (125)I-A33 resulted in a relative therapeutic gain of approximately 2 compared with (131)I-A33 in this experimental system.     

Insufficient knowledge and inapproriate physiotherapy management of Relative Energy Deficiency in Sport (RED-S) in lightweight rowers

ObjectiveTo investigate the knowledge and management of Relative Energy Deficiency in Sport (RED-S), from the perspective of lightweight rowers and physiotherapists.DesignSemi-structured individual qualitative interviews.MethodsPhysiotherapists who had worked with lightweight rowers, and current and former lightweight rowers (who had experienced at least one symptom of RED-S), undertook audio-recorded semi-structured telephone interviews. An inductive thematic analysis was performed, facilitated by NVivo software.ResultsTwelve physiotherapists (n = 6 females, 1–20 years of experience managing lightweight rowers) and twelve lightweight rowers (n = 8 females, 1–8 years lightweight rowing experience, intermediate to elite/international level) were interviewed. Five key themes were identified: insufficient knowledge of RED-S, inadequate RED-S education, inappropriate management of RED-S, referral to other health professionals, prioritising performance over health. Participants provided suggestions for improving knowledge and management of RED-S in lightweight rowers, including formal physiotherapy education and training, and targeted education for athletes and coaches.ConclusionsThere was a significant lack of awareness of RED-S amongst physiotherapists and lightweight rowers. Most physiotherapists were not confident discussing or managing RED-S in athletes, and lightweight rowers were dissatisfied with the management they received. Improving RED-S education for physiotherapists and athletes may have important health implications for lightweight rowers.     

Relative biological effectiveness (RBE) of 210 Po alpha-particles versus X-rays on lethality in bovine endothelial cells

Purpose : Alpha-radiation from polonium-210 (210 Po) can elevate background radiation dose by an order of magnitude in people consuming large quantities of meat and seafood, particularly caribou and reindeer. Because up to 50% of the ingested 210 Po body burden is initially found in the blood, a primary target for the short range alpha-particles is the endothelial cells lining the blood vessels. This study examined the relative biological effectiveness (RBE) of 210 Po alpha-particles versus 250 kVp X-rays in producing injury to cultured bovine aortic endothelial cells. Materials and methods : Radiation effects on cells were measured in four different ways: the percentage viable cells by trypan blue dye exclusion, the number of live cells, the lactate dehydrogenase (LDH) release to medium and the ability to form colonies (clonogenic survival). Results : Comparison of dose-response curves yielded RBE values of 13.1 ±2.5 (SEM) for cell viability, 10.3 ±1.0 for live cell number and 11.1 ±3.0 for LDH activity. The RBE values for clonogenic survival were 14.0 ±1.0 based on the ratio of the initial slopes of the dose-response curves and 13.1, 9.9 and 7.7 for 50, 10 and 1% survival rate, respectively. At X-ray doses <0.25 Gy, a pronounced stimulatory effect on proliferation was noted. Conclusions : Exposure to 210 Po alpha-particles was seven to 14 times more effective than X-ray exposure in causing endothelial cell damage.     

Relative biological effectiveness (RBE) of 210Po alpha-particles versus X-rays on lethality in bovine endothelial cells

PURPOSE: Alpha-radiation from polonium-210 ((210)Po) can elevate background radiation dose by an order of magnitude in people consuming large quantities of meat and seafood, particularly caribou and reindeer. Because up to 50% of the ingested (210)Po body burden is initially found in the blood, a primary target for the short range alpha-particles is the endothelial cells lining the blood vessels. This study examined the relative biological effectiveness (RBE) of (210)Po alpha-particles versus 250 kVp X-rays in producing injury to cultured bovine aortic endothelial cells. MATERIALS AND METHODS: Radiation effects on cells were measured in four different ways: the percentage viable cells by trypan blue dye exclusion, the number of live cells, the lactate dehydrogenase (LDH) release to medium and the ability to form colonies (clonogenic survival). RESULTS: Comparison of dose-response curves yielded RBE values of 13.1+/-2.5 (SEM) for cell viability, 10.3+/-1.0 for live cell number and 11.1+/-3.0 for LDH activity. The RBE values for clonogenic survival were 14.0+/-1.0 based on the ratio of the initial slopes of the dose-response curves and 13.1, 9.9 and 7.7 for 50, 10 and 1% survival rate, respectively. At X-ray doses <0.25 Gy, a pronounced stimulatory effect on proliferation was noted. CONCLUSIONS: Exposure to (210)Po alpha-particles was seven to 14 times more effective than X-ray exposure in causing endothelial cell damage.     

Treatment planning for light ions: How to take into account Relative Biological Effectivness (RBE)

A new treatment planning program was developed for the heavy ion therapy facility at GSI, which is tailored to the special needs for an active beam delivery using a magnetic raster scanner. It also includes a biological model for the estimation of biological effective dose for carbon ions and realizes a fully biological treatment planning. Biological effective dose distributions and RBE maps can be displayed and assessed from the graphical user interface.