胃肠道间质瘤的螺旋CT诊断与临床病理分析

20世纪80年代以前认为消化道间叶性肿瘤大多数是平滑肌源性肿瘤,近年来,随着病理学的发展,尤其是免疫组织化学及超微结构研究的进展,国内外许多学者提出了胃肠道间质瘤（gastrointestlnal stromal tumors,GIST）这一概念。GIST实为一组独立的起源于胃肠道壁的问叶性肿瘤,临床症状和体征缺乏特异性,早期诊断颇为困难。     

直肠间质瘤的临床分析

目的探讨直肠间质瘤的诊断及治疗。方法对1998年1月至2010年12月间收治的15例直肠间质瘤患者的临床资料进行回顾性分析。结果 15例患者中经肛门肿物切除术4例,经腹会阴联合切除术（Miles术）5例,经腹直肠前切除术（Dixon术）6例,所有患者最后均经病理和免疫组化证实。CD117、CD34的阳性率分别为93.3%、73.3%。15例患者获6～72个月的随访,其中2例患者分别术后12、26个月局部复发再次行手术切除,术后口服伊马替尼400mg.d^-1辅助治疗;5例经腹前切除或经肛局部切除患者出现腹腔复发并肝多发转移,其中3例死亡;2例服用伊马替尼治疗后肿瘤缩小,带瘤生存;其余6例患者无复发、转移。结论直肠间质瘤的治疗以手术为主、分子靶向治疗为辅的综合治疗。伊马替尼对中高危患者的复发、转移的治疗有效。     

胃肠道外间质瘤的治疗与预后

目的探讨胃肠道外间质瘤(EGIST)的临床表现、外科治疗及预后。方法回顾性分析2004年1月-2010年6月收治的35例EGIST患者的临床资料。男26例,女9例;年龄33～78岁,平均56岁。病程5 d～8个月,平均2个月。临床表现主要有腹部不适、腹痛及腹部包块等。均在术前行CT或腹部增强CT等检查发现病灶,其中位于系膜16例,网膜15例,腹膜后4例。35例均行手术治疗。结果术后均由病理学检查及免疫组织化学检测确诊,肿瘤标本镜下均以梭形细胞为主;极低危险、低危险、中危险、高危险患者分别为0、3、0、32例。免疫组织化学检测示酪氨酸激酶受体(CD117)、DOG-1、骨髓干细胞抗原(CD34)、酸性钙结合蛋白、平滑肌肌动蛋白、结蛋白阳性率分别为91.4%(32/35)、100%(3/3)、71.4%(25/35)、8.6%(3/35)、22.9%(8/35)、0%(0/35)。15例患者均获随访,时间19～96个月,平均46个月。8例出现进展,7例病情稳定。结论 EGIST发现时往往体积较大,预后较差,手术切除是首选治疗手段,甲磺酸伊马替尼对其具有较好的治疗效果。     

胃肠道间质瘤彩色多普勒超声诊断及临床分析

目的探讨胃肠道间质瘤（GIST）彩色多普勒超声表现及其在诊断中的应用价值。方法回顾性分析2008年1月-2010年7月75例经病理证实的GIST的彩色多普勒超声声像图表现,将其与手术病理结果进行对比分析。结果 GIST患者中男性高危险度肿瘤的比例较女性高（χ^2=7.210,P〈0.01）。肿瘤的大小、内部回声与其病理危险度高低有关：危险度低者、肿瘤最大径〈5cm,内部回声较均匀;危险度高者,肿瘤最大径≥5cm,内部回声不均匀。肿瘤的彩色血流分布与其危险度高低无明显相关。常规的超声检查对肿瘤检出率较高,在胃及直肠的GIST诊断准确率高于其他部位的GIST。结论彩色多普勒超声检查有助于GIST的定位及分化程度的判断,可作为首选检查方法。     

胃肠道间质瘤21例临床分析

目的:探讨胃肠道间质瘤(GIST)的诊断和治疗方法。方法:收集21例GIST临床资料,进行回顾性分析。结果:21例平均年龄56.2岁,主要临床表现为腹部胀痛、腹部包块、黑便及贫血,2例无任何不适于查体时发现。9例经超声内镜检查确诊。21例均行根治性手术,肿瘤位于胃14例,小肠5例,肠系膜2例。21例均经术后病理检查及免疫组化确诊GIST,免疫组化表型以CD117、CD34阳性率较高。根据Miettinen等原则分类,良性5例,低度恶性10例,中等度恶性3例,高度恶性3例。结论:GIST的术前诊断有赖于纤维内镜、超声内镜、B超、CT等检查的综合应用,病理检查及免疫组化表型分析是确诊金标准,手术切除是最有效的治疗手段。     

胃肠道间质瘤27例临床病理及肿瘤标记物分析

[目的]探讨胃肠道问质瘤(GIST)的临床表现及病理特征,分析多肿瘤标记物蛋白芯片(C12)在其诊断中的价值.[方法]27例GIST行常规病理检查和免疫组化染色,观察其临床病理形态及免疫组化特征.用C12检测系统测定分析病例组的12种常见肿瘤标志物的含量.[结果]GIST患者的Vimentin、CD117、CD34阳性表达率高,肿瘤恶性及潜在恶性占了绝大部分(88.9%),C12各项指标的阳性率均很低.[结论]GIST的恶性程度较高,但缺乏特异的临床表现,没有能早期诊断的特异性肿瘤标志物蛋白.CD117、CD34的阳性表达对GIST的诊断有重要意义.     

胃肠道间质瘤的CT应用价值

目的：分析胃肠道间质瘤（gastrointestinal stromal tumors,GIST）的CT表现,探讨CT的应用价值。材料与方法：回顾性分析经手术病理或活检确诊为问质瘤的17例患者的CT资料。结果：17例间质瘤患者中,9例发生在胃,5例发生在小肠,2例发生在结肠,1例发生在腹膜后。良性病灶8例,潜在恶性6例,恶性3例,远处转移2例。多数肿块形态规则,肿块较小时密度均匀,强化明显,部分病灶内可见异常强化的肿瘤血管。结论：CT在明确肿瘤的位置、形态和大小,有无转移或周围浸润,鉴别肿瘤的良恶性等方面,具有重要的临床应用价值。     

口服甘露醇螺旋CT胃肠造影对胃肠间质瘤的诊断价值

[目的]评价口服大剂量5%等渗甘露醇螺旋CT胃肠造影在胃肠肿瘤诊断中的价值.[方法]回顾分析了46例经手术病理证实胃肠道间质瘤的CT检查资料,检查方法:包括传统法口服阳性对比剂CT扫描(20例)及口服甘露醇胃肠造影后CT检查(26例).[结果]26例口服甘露醇组病人中有25例清晰显示病变,20例传统组仅13例显示病变.口服甘露醇组与临床诊断的符合率为90%,传统口服阳性对比剂组为61.76%;GIST的CT特征:恶性胃肠间质瘤CT特征为:肿块相对较大,密度不均,肿瘤中央坏死及囊变多见;肿瘤边缘多不光整,可呈分叶状.增强扫描肿瘤呈不均匀强化;良性GIST体积较小,密度均匀,肿瘤坏死及囊变少见,病灶边缘光整,增强扫描多呈均匀强化.[结论]口服甘露醇螺旋CT胃肠造影是诊断胃肠间质瘤最有价值的影像检查手段,能明显提高肿瘤的检出率.     

胃肠道间质瘤临床病理研究进展

传统上 ,胃肠道原发性间叶源性梭形细胞肿瘤几乎都归为平滑肌肿瘤 ,包括平滑肌瘤与平滑肌肉瘤及它们的各种亚型。但新近研究表明 ,大多数胃肠道间叶源性肿瘤既不同于典型的平滑肌瘤 (电镜下无肌丝 ) ,也不同于雪旺瘤 (不表达Ｓ - 10 0蛋白 ) ,而是一组具有不同特征的 (向平滑肌或神经不完全分化或完全未分化的 )肿瘤 ,称为胃肠道间质瘤 (ｇａｓ ｔｒｏｉｎｔｅｓｔｉｎａｌｓｔｒｏｍａｌｔｕｍｏｒｓ,ＧＩＳＴｓ)。ＧＩＳＴ涵盖了绝大部分胃肠道原发性间叶源性肿瘤 ,而真正的胃肠道平滑肌瘤及雪旺瘤很少见。本文综述ＧＩＳＴ的特征 ,并介绍…     

小肠间质瘤并发消化道大出血1例

1病例资料 患者,女性,54岁,因"黑便2d"于2012年3月14日来我院就诊.患者2d前开始出现柏油样便,每日1～2次,每次量50～100 mL.患者既往体健.入院后体检:血压110/70 mmHg,神志清,无明显贫血貌,皮肤巩膜无黄染,未见肝掌.双肺呼吸音清,心率86次/min,律齐.腹软,腹壁未见曲张静脉,肝脾肋下未触及,无压痛,肠鸣音亢进.血红蛋白111 g/L,血细胞压积36.3％,血小板计数257×109/L,粪便隐血(++++),凝血功能、肝肾功能正常,腹部B超未见明显异常,拟诊为"上消化道出血",给予抑酸、止血、补液等对症支持治疗,但仍反复解黑稀便并呕鲜血.3月16日体检:重度贫血貌,血压95/64 mmHg,心率110次/min,腹软,无压痛,肠鸣音亢进(约9次/min),血红蛋白37 g/L,血细胞压积12.4％,人血纤维蛋白原＜40 ng/mL.     

Pharmacodynamic Evaluation of Irinotecan Therapy by FDG and FLT PET/CT Imaging in a Colorectal Cancer Xenograft Model

Purpose

Longitudinal changes of 3??-[¹⁸?F]fluoro-3??-deoxythymidine (FLT) and 2-deoxy-2-[¹⁸?F]fluoro-d-glucose (FDG) in response to irinotecan therapy in an animal model of colorectal cancer were compared.

Procedures

SCID/CB-17 mice with HCT116 tumors were treated with 50?mg/kg irinotecan by intraperitoneal injection weekly for 3?weeks. FLT and FDG-positron emission tomography (PET) were performed at baseline, the day after each treatment, and 5?days after the first treatment. Proliferation and apoptosis were evaluated by immunohistochemistry (IHC) after day 15 of imaging.

Results

Irinotecan treatment resulted in a suppression of tumor growth. Tumor FLT uptake was decreased the day after each treatment but to a lesser extent 5?days after the first treatment. FDG uptake increased the day after each treatment with a continuous increase throughout the experiment. IHC analysis of phospho-H3 and Ki67 confirmed FLT-PET results, indicating a decrease in proliferation the day after the final irinotecan treatment. Increased apoptosis monitored by caspase-3 was observed after day 15 with irinotecan treatment.

Conclusions

FLT-PET may be a better method than FDG-PET for assessing treatment response to irinotecan. Changes in imaging occur before changes in tumor volume.     

Tumor Dosimetry Using [124I]m-iodobenzylguanidine MicroPET/CT for [131I]m-iodobenzylguanidine Treatment of Neuroblastoma in a Murine Xenograft Model

Purpose

[¹²⁴I]m-iodobenzylguanidine (¹²⁴I-mIBG) provides a quantitative tool for pretherapy tumor imaging and dosimetry when performed before [¹³¹I]m-iodobenzylguanidine (¹³¹I-mIBG) targeted radionuclide therapy of neuroblastoma. ¹²⁴I (T _1/2?=?4.2?days) has a comparable half-life to that of ¹³¹I (T _1/2?=?8.02?days) and can be imaged by positron emission tomography (PET) for accurate quantification of the radiotracer distribution. We estimated expected radiation dose in tumors from ¹³¹I-mIBG therapy using ¹²⁴I-mIBG microPET/CT imaging data in a murine xenograft model of neuroblastoma transduced to express high levels of the human norepinephrine transporter (hNET).

Procedures

In order to enhance mIBG uptake for in vivo imaging and therapy, NB 1691-luciferase (NB1691) human neuroblastoma cells were engineered to express high levels of hNET protein by lentiviral transduction (NB1691-hNET). Both NB1691 and NB1691-hNET cells were implanted subcutaneously and into renal capsules in athymic mice. ¹²⁴I-mIBG (4.2?C6.5?MBq) was administered intravenously for microPET/CT imaging at 5 time points over 95?h (0.5, 3?C5, 24, 48, and 93?C95?h median time points). In vivo biodistribution data in normal organs, tumors, and whole-body were collected from reconstructed PET images corrected for photon attenuation using the CT-based attenuation map. Organ and tumor dosimetry were determined for ¹²⁴I-mIBG. Dose estimates for ¹³¹I-mIBG were made, assuming the same in vivo biodistribution as ¹²⁴I-mIBG.

Results

All NB1691-hNET tumors had significant uptake and retention of ¹²⁴I-mIBG, whereas unmodified NB1691 tumors did not demonstrate quantifiable mIBG uptake in vivo, despite in vitro uptake. ¹²⁴I-mIBG with microPET/CT provided an accurate three-dimensional tool for estimating the radiation dose that would be delivered with ¹³¹I-mIBG therapy. For example, in our model system, we estimated that the administration of ¹³¹I-mIBG in the range of 52.8?C206?MBq would deliver 20?Gy to tumors.

Conclusions

The overexpression of hNET was found to be critical for ¹²⁴I-mIBG uptake and retention in vivo. The quantitative ¹²⁴I-mIBG PET/CT is a promising new tool to predict tumor radiation doses with ¹³¹I-mIBG therapy of neuroblastoma. This methodology may be applied to tumor dosimetry of ¹³¹I-mIBG therapy in human subjects using ¹²⁴I-mIBG pretherapy PET/CT data.     

PET/CT在非小细胞肺癌临床分期中的应用

目的：探讨18F-FDG代谢PET/CT检查在非小细胞肺癌（N SCLC）的临床分期中的应用。方法：对120例病理已明确证实为非小细胞肺癌的患者进行PET/CT检查,利用18F-FDG在肿瘤病灶及转移灶中的高代谢原理,分析全身各系统病灶放射性摄取的最大标准摄取值（SUVm ax）。依据美国联合癌症分类委员会（A JCC）和国际抗癌联盟（U ICC）2002年制订的TNM分期标准,从而对肺癌患者进行准确的临床分期。结果：以PET/CT检查结果为依据对N SCLC患者进行临床分期,准确率较其他检查设备高。结论：^18F-FDG代谢PET/CT检查对N SCLC患者的临床分期,疗效和预后判断具有一定的指导意义。     

Preclinical Evaluation of a Novel c-Met Inhibitor in a Gastric Cancer Xenograft Model Using Small Animal PET

Purpose

Here, we describe the efficacy of the novel small molecule c-Met inhibitor BAY 853474 in reducing tumor growth in the Hs746T gastric cancer xenograft model and tested the suitability of 2-deoxy-2-[¹⁸F]fluoro-d-glucose ([¹⁸F]FDG) versus 3′-deoxy-3′-18F-fluorothymidine ([¹⁸F]FLT) for response monitoring in a gastric cancer xenograft mouse model using small animal PET.

Procedures

The c-Met inhibitor or vehicle control was administered orally at various doses in tumor-bearing mice. Glucose uptake and proliferation was measured using PET before, 48 and 96 h after the first treatment. The PET data were compared to data from tumor growth curves, autoradiography, Glut-1 and Ki-67 staining of tumor sections, and biochemical analysis of tissue probes, i.e., c-Met and ERK phosphorylation and cyclin D1 levels.

Results

BAY 853474 significantly reduces tumor growth. [¹⁸F]FDG uptake in Hs746T tumors was significantly reduced in the groups receiving the drug, compared with the control group. The [¹⁸F]FLT uptake in the tumor tissue was completely absent 96 h after treatment. Autoradiographic, immunohistochemical, and biochemical analyses confirmed the PET findings. Treatment with the c-Met inhibitor did not affect body weight or glucose levels, and no adverse effects were observed in the animals.

Conclusion

These preclinical findings suggest that clinical PET imaging is a useful tool for early response monitoring in clinical studies.     

PET/CT在乳腺病变诊断中的应用价值

PET/CT是集功能、形态学检查于一体的影像学检查手段,在肿瘤良恶性鉴别、分期、转移监视等方面优于传统影像学检查,尤其在乳腺病变中显示出了独特的优势。PET/CT在乳腺癌诊断、淋巴结评估及术后复发与转移等方面起非常重要的作用,在预测乳腺癌新辅助化疗疗效方面也取得了很大进步。本文简要介绍该技术在乳腺病变诊断中的研究进展及应用。     

PET/CT在食管癌分期诊断中的价值

目的评价18F-FDG PET/CT在食管癌分期诊断中的价值。方法对86例病理已明确证实为食管癌的患者进行PET/CT检查,利用18F-FDG在肿瘤病灶及转移灶中的高代谢原理,分析全身各系统病灶放射性摄取的最大标准摄取值（SUVmax）,对患者进行准确的诊断分析。结果 PET/CT的分期准确率（88.4%）以及区域淋巴结转移检查的敏感性（63.3%）、特异性（83.8%）均较单纯CT高。结论 18F-FDG PET/CT检查对食道癌患者的临床分期和治疗选择具有重要的指导意义。     

肝癌经动脉栓塞化疗后FDG PET显像的临床价值 ——附10例FDG PET和CT结果对照

目的：探讨核医学影像诊断技术－FDG PET在中晚期肝癌栓塞化疗后随诊中的临床价值,并着重比较FDG PET与CT在判断介入治疗后局部肿瘤坏死及残留状况方面的互补作用。方法：10例临床确诊的肝癌患者,术前CT或MRI示肿瘤短轴均大于4cm,经栓塞化疗后6－10个月同期行FDG PET和CT检查,并采用双盲法将FDG PET与CT结果进行比较。结果：10例CT扫描结果显示,4例肿瘤内碘油分布密集,3例肿瘤内碘油分布稀疏,3例肿瘤内碘油短期内排空;PET显示其中6例肿瘤内碘油分布稀疏或碘油短期内排空者局部肿瘤内及周边区域均有FDG明显浓聚的病变,4例肿瘤内碘油分布密集者,FDG PET均显示肿瘤边缘部位可见到不规则的放射性分布浓聚现象。结论：中晚期肝癌栓塞化疗后病灶边缘部分多有肿瘤存活或残留,但CT检查不能准确判断这一现象,而FDG PET在准确定位肿瘤残留病灶方面正好弥补了CT扫描的不足。     

腹腔间质瘤33例临床治疗体会

【目的】探讨腹腔间质瘤的临床、病理特点及诊断、治疗和预后。【方法】回顾性分析2006年4月至2008年8月收治的33例腹腔间质瘤患者的临床和病理资料。【结果】手术切除率93．9％（31／33）,17例行淋巴结清扫,1例见淋巴结转移。瘤体直径为1．5～25．0cm,良性11例,交界性4例,恶性18例。CD117（＋）93．8％,CD34（＋）76．4％,Vimentin（＋）65．3％,SMA（＋）45．8％,S-100（＋）19．7％,Nestin（＋）11．2％,CD117和CD34共同阳性率为56．2％。极低度危险性7例,低度危险性6例,中度危险性14例,高度危险性5例。术后随访率90．9％（30／33）,随访6～28个月,12例良性或交界性间质瘤患者无复发和转移,13例恶性患者未进一步行任何治疗,5例高度危险性间质瘤均定期复查：1例坚持服用格列卫,未见复发或转移;1例发生肝转移行射频损毁术;3例发生不同程度的肿瘤局部复发伴腹腔转移,经再次手术治疗或（和）口服格列卫等治疗,均存活至今。【结论】腹腔间质瘤无特殊临床表现,术前内镜、B超和cT是主要的辅助检查及鉴别方法;手术切除是间质瘤首选的治疗手段,其预后与恶性潜能分级有关。具有分子靶向治疗的格列卫表现出良好的_疗效,可用于间质瘤的辅助治疗。     

18F-FDG PET/CT显像对胃癌术前分期的临床价值

目的：探讨18F-脱氧葡萄糖（18F-FDG）PET/CT显像对胃癌TNM分期的临床价值。方法：对33例胃癌初诊患者于手术前2周内行18F-FDG PET/CT检查,将33例手术治疗患者的PET/CT结果与病理学检查、其他影像结果及临床随访结果相比较。结果：将PET/CT显像TNM分期与手术病理学检查TNM分期进行对比分析,结果证明对胃癌原发灶的检出,18F-FDG PET灵敏度为84.8％,PET/CT为100％。18F-FDG PET/CT显像与手术病理学检查比较,对T分期、N分期、M分期的一致性分别为81.8％、75.8％、93.9％,对TNM分期的一致性为90.9％（Kappa值分别为0.514、0.557、0.767、0.759,P<0.01)。结论：18F-FDG PET/CT显像对胃癌的TNM分期具有重要价值,且PET/CT检查结果与手术病理学检查结果有较好的一致性,但应注意印戒细胞癌等细胞类型易出现的假阴性。