磁共振功能成像技术在脑胶质瘤诊治中的应用

磁共振脑功能成像技术(f MRI)的着眼点在于利用某些特定的原子或化合物在磁场中的不同表现而对病变进行分析,从不同角度反映正常脑组织和肿瘤组织的功能和代谢变化,在研究和诊断中的作用正日益突出。在脑功能区或附近、深部脑胶质瘤手术致残率高、预后差。在常规MRI反映脑胶质瘤的解剖特征的基础上,f MRI提供有关肿瘤代谢、生化、脑白质纤维束的走行、脑功能区定位等信息,降低脑胶质瘤术后并发症等方面具有重要的应用价值。本文就目前几种常见的f MRI成像技术在胶质瘤诊治中的应用进行总结。     

磁共振功能性成像用于胶质瘤术前术中的研究进展

脑胶质瘤是最常见原发脑内肿瘤,起源于神经胶质细胞,以局部侵袭性生长为特征。MRI是诊断脑胶质瘤的主要影像手段。随着MR波谱成像(MR spectroscopy,MRS)、扩散张量成像(diffusion tensor imaging,DTI)和血氧水平依赖性功能磁共振成像(blood oxygen level-dependent functional magnetic resonance imaging,BOLD-f MRI)等功能MRI的发展,对于以手术为主的胶质瘤,能进行个性化的术前规划和术中监测,从而降低术后损伤,改善预后。作者就MRI及MRS、DTI、BOLD-f MRI这三种功能成像对胶质瘤术前规划和术中监测及存在的问题进行综述。     

磁共振成像联合正电子发射断层显像在脑胶质瘤术前诊断中的价值分析

目的:对于脑胶质瘤患者,分析磁共振成像(MRI)联合正电子发射断层显像(PET-CT)在其术前诊断中的临床价值.方法:选取2018年6月-2020年6月我科收治的40例疑似单发脑胶质瘤患者作为研究对象,于术前分别完善MRI、PET-CT检查,并以手术病理为金标准.比较MRI以及联合PET-CT在术前诊断脑胶质瘤的临床效...     

DWI、DTI联合常规MRI可提高高级别脑胶质瘤的诊断准确度

目的探讨扩散加权成像（DWI）、扩散张量成像（DTI）及常规MRI对高级别脑胶质瘤的诊断价值。方法选取2018年10月~2020年7月医院收治的65例脑胶质瘤患者作为研究对象。手术取病理组织标本,根据病理结果分为高级别脑胶质瘤组和低级别脑胶质瘤组。术前行MRI检查,扫描序列为T1WI、T2WI、DWI、DTI。分析不同级别脑胶质瘤MRI图像,比较不同级别脑胶质瘤的表观弥散系数（ADC）和各向异性分数（FA）值。分析瘤体ADC_DWI、ADC_DTI、FA诊断高级别脑胶质瘤阈值、敏感度及特异性。结果65例患者经术后病理检查均确诊为脑胶质瘤,其中低级别脑胶质瘤29例,高级别脑胶质瘤36例;不同级别脑胶质瘤瘤周ADC_DWI、ADC_DTI和FA值差异无统计学意义（P > 0.05）;不同级别脑胶质瘤瘤体FA值差异无统计学意义（P > 0.05）。高级别脑胶质瘤瘤体ADC_DWI和ADC_DTI值低于低级别脑胶质瘤（P < 0.05）。ADC_DWI、ADC_DTI、FA诊断高级别脑胶质瘤的AUC分别为0.775、0.817、0.716。DWI和DTI联合检测诊断高级别脑胶质瘤敏感度和特异度较高,AUC为0.903（P < 0.05）。结论常规MRI联合DWI、DTI有助于提高脑胶质瘤诊断和病理分级准确度。     

磁共振功能成像在高级别胶质瘤疗效监测的研究进展

高级别胶质瘤的治疗是复杂多变的。目前高级别胶质瘤的标准治疗方案是手术+放疗+口服化疗。持续的后期脑磁共振成像(magnetic resonance imaging,MRI)检查区分治疗反应与治疗效果可能具有困难,影响临床决策。各种先进的MRI技术(例如扩散加权成像、灌注加权成像、波谱分析、多参数成像)现在可以结合新的生理和生化参数,提供新的方法来帮助区分肿瘤进展,即假性进展和假性反应。本文总结了MR功能成像在监测高级别胶质瘤疗效方面的最新进展和挑战。     

MRI在高级别脑胶质瘤放射治疗中的临床疗效分析

目的:分析在高级别脑胶质瘤放射治疗中MRI的作用.方法:回顾性分析2012年2月到2020年7月我院收治的高级别脑胶质瘤患者,共90例,对其予以MRI检测,观察脑胶质瘤的类型、特征及高级别脑胶质瘤MRI影像特征、治疗后MRI的检测情况情况.结果:经MRI检测后发现,星形细胞瘤类型、少突胶质瘤类型、室管膜肿瘤的患者、脉络...     

脑胶质瘤MRI影像基因组学研究进展

脑胶质瘤是一种发病率高、复发率高、预后差的中枢神经系统恶性肿瘤。伴随着近年来肿瘤分子学和基因学的研究,脑胶质瘤的诊断正向分子遗传学水平发展,分子遗传学改变整合进肿瘤诊断标准已获得广泛认同。磁共振成像能够反映肿瘤的组织病理、细胞代谢和分子遗传学改变,在肿瘤疾病中的应用前景广阔。笔者就磁共振成像技术在评估脑胶质瘤影像基因组学方面的应用进展予以综述。     

3.0MRI弥散加权成像对脑胶质瘤分级的诊断价值及准确性分析

目的:研究脑胶质瘤患者,在开展检查的过程中应用3.0MRI弥散加权成像对于分级的有效价值以及准确性。方法:选取248例脑胶质瘤患者,均为我院2021年1月到2022年1月时间段内收治,均进行3.0MRI弥散加权成像,分析弥散系数值对于不同级别(低级/高级)脑胶质瘤的诊断价值;正常脑组织以及脑脊液的弥散系数以及弥散系数值。结果:弥散系数值1.11×10^-3mm²/s属于最佳的临界点,当检测值大于最佳临界点时候,计为低级别的脑胶质瘤,3.0MRI弥散加权成像时可知,灵敏度93.33%,特异度93.75%,准确率93.55%,阳性的预测值为93.33%,阴性预测值为93.75%;弥散系数值0.93×10^-3mm²/s属于最佳的临界点,当数值小于最佳临界点以上,则计为高级别的脑胶质瘤,进行检测可知,灵敏度、特异度、准确性、阳性的预测值、阴性预测值分别：81.25%、93.33%、87.10%、95.86%、82.35%,通过弥散系数值分析判定脑胶质瘤可知(P<0.05);正常白质的DWI信号低于正常灰...     

对比剂首过MR灌注成像在脑胶质瘤中的应用价值

对比剂首过MR灌注成像是近年来发展较快的技术,其在脑卒中的价值已经确立.血管生成是恶性肿瘤的生长与转移的病理学基础,且与肿瘤的分级有密切关系,MR灌注成像能无创性检测瘤内的血流动力学改变,可以反映血管生成的情况,因此在脑胶质肿瘤中的应用也得到关注,其在胶质瘤分级、指导立体定向活检、检测治疗效果及鉴别诊断中有常规MRI无法取代的优势.本文从其在胶质瘤中的理论研究背景、技术及其临床应用角度分析其研究现状.     

脑胶质瘤VEGF表达与动态增强MRI灌注成像的相关性研究

目的:探讨脑胶质瘤血管内皮生长因子(VEGF)表达与动态增强MRI灌注成像之间的相关性。材料与方法:对37例证实为脑胶质瘤的患者术前行动态增强MRI灌注成像,获得反映局部血流灌注的3个参数,rrCBV、rrCBF、TTP*,对术后的病理切片采用免疫组化法测定组织内VEGF的表达。分析VEGF与胶质瘤组织学级别的关系,并对血流动力学参数与VEGF表达间进行相关性检验。结果:VEGF在不同级别胶质瘤组中的表达具有显著性差异,VEGF与rrCBV、rrCBF具有明显的正相关,r分别为0.699和0.558。结论:VEGF作为促进胶质瘤血管生成最重要的调节因子,其表达程度的高低与分级密切相关,动态增强MRI灌注成像可以作为预测VEGF表达的一种新方法,从而为抗血管治疗提供依据。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.