1.5TMRI评估肺动脉高压患者右心功能及肺动脉血液动力学

背景与目的肺动脉高压(pulmonary hypertension,PH)患者肺动脉压力增高,右心功能逐渐下降,最终导致右心衰竭而死亡,因而准确、无创地监测PH患者右心功能及肺动脉血液动力学改变尤为重要。本研究旨在评价心脏MRI(cardiac magnetic resonance imaging,CMRI)在评估PH患者右心功能及肺动脉血液动力学中的价值。方法对25例PH患者及30例健康志愿者进行心脏电影MRI(cine-MRI)及相位对比法MRI(PC-MRI)扫描。对cine-MRI扫描图像进行后处理,计算获得右心室舒张末期容积(end-diastolicvolume,EDV)、收缩末期容积(end-systolic volume,ESV)、搏出量(stroke volume,SV)、射血分数(ejection fraction,EF)及心肌质量(myocardial mass,MM),以上数据除EF外均经体表面积(body surfacearea,BSA)校正。对PC-MRI扫描图像进行处理并计算获得主肺动脉(main pulmonary artery,MPA)峰值流速及其顺应性。采用两独立样本t检验分析两组参数有无差异,明显性标准为P<0.05。结果与对照组相比,PH组右心室EDV、ESV及MM指数均明显高于后者(P<0.01),EF明显低于后者(P<0.01),SV指数与对照组无明显差异(P>0.05),MPA峰值流速及顺应性均明显低于对照组(P<0.01)。结论 CMRI在PH患者右心功能及MPA血液动力学参数评估中具有重要意义。     

CMR评估肺高血压：肺高血压患者与健康志愿者对照研究

背景与目的肺高血压（pulmonary hypertension, PH）临床病程表现为进行性恶化和间断急性失代偿发作,死亡可突然或缓慢发生,而临床医生往往对病情的进展评估不足。本研究旨在应用心脏核磁共振（cardiac magnetic resonance, CMR）评估PH患者右心室（right ventricle, RV）形态、功能及主肺动脉（main pulmonary artery, MPA）血液动力学,并与健康人对照,探讨CMR在检出PH中的临床应用价值。方法对56例PH患者及22例健康志愿者进行CMR扫描并获得RV舒张末期容积（end-diastolic volume, EDV）、收缩末期容积（end-systolic volume, ESV）、射血分数（ejection fraction, EF）、心肌质量（myocardial mass, MM）、RV面积变化分数（RV fractional area change, RVFAC）、室间隔与左室游离壁曲率比,MPA正向峰值流速、最大截面积、最小截面积及顺应性。PH组与对照组测量结果采用两独立样本t检验进行比较。受试者工作特征曲线（re-ceiver operating characteristic curve,ROC曲线）用于比较MPA正向峰值流速、顺应性、曲率比、RVFAC单项指标及综合评估检出PH的效能。P<0.05为差异有统计学意义。结果与对照组相比,PH组RV形态改变、功能明显下降,血液动力学指标恶化。顺应性对检出PH的效能较高（AUC为0.950）;综合应用正向峰值流速、顺应性、曲率比和RVFAC时,检出PH的效能最高（AUC为0.988）。结论 CMR综合评估指标有利于准确反映PH患者RV-肺循环整体状态。     

乳腺癌患者术后心电图QT间期及P波电轴等指标的变化研究

目的探讨乳腺癌患者手术前后心电图QT间期及P波电轴等指标的差异性。方法选取接受治疗的乳腺癌患者200例,比较术前术后患者心电图各项指标的变化。结果将200例患者在手术前和手术后的心电图检测指标进行自身对比,心电轴钟向转位变化、RV5+SV1的电压(P=0.201)、SV1的电压(P=0.921)、RV5的电压(P=0.031)、P电轴(P=0.031)、T电轴(P=0.901)、QT间期(P=0.040)、PR间期(P=0.902)、QRS时限(P=0.79)和QRS电轴(P=0.81)。经统计分析患者在手术前后有统计学意义的指标是:V5导联的R波电压、QT间期和P波电轴,其他指标未见明显差异。结论乳腺癌患者在手术后心电图QT的间期、P波电轴和V5导联的R波较手术前有明显差异。     

实时三维超声心动图联合速度向量成像技术评价乳腺癌蒽环类药物化疗后患者的左心房功能

目的:采用实时三维超声心动图(real-time three-dimensional echocardiography, RT-3DE)及速度向量成像技术(velocity vector imaging, VVI)评价蒽环类药物(anthracycline, ATC)化疗后乳腺癌患者的左心房功能。方法:纳入我院行ATC化疗的女性乳腺癌术后患者72例,分别采集化疗前、化疗3个周期(化疗中)、化疗6个周期(化疗后)三个阶段的超声心动图参数。获取RT-3DE图像,得到左心房舒张末容积(left atrial end-diastolic volume, LAV_max)、左心房收缩前容积(left atrial pre-systolic volume, LAV_prep)、左心房收缩末容积(left atrial end-systolic volume, LAV_min),计算左心房主动射血分数(left atrial active ejection fraction, LAAEF)、左心房总射血分数(left atrial tota...     

二维斑点追踪成像技术结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响#br#

背景与目的：应用二维斑点追踪成像（two-dimensional speckle tracking imaging,2D-STI）结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响。方法：前瞻性选择2019年9月—2020年3月在复旦大学附属肿瘤医院行蒽环类药物治疗的35例乳腺癌患者,分别于化疗前、化疗2个周期后、4个周期后行常规超声心动图检查并获取动态二维图像,同时使用肱动脉袖带血压计测量患者收缩期及舒张期血压值,测量左房内径（left atrial diameter,LAD）、左心室舒张末期内径（left ventricular end-diastolic diameter,LVEDD）、左心室收缩末期内径（left ventricular end-systolic diameter,LVESD）、舒张末期室间隔厚度（diastolic interventricular septal depth,IVSD）、左心室舒张末期容积（left ventricular end-diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、左心室射血分数（left ventricular ejection fraction,LVEF）、二尖瓣口舒张早期峰值流速（early diastolic peak velocity,E峰）、舒张晚期峰值流速（late diastolic tissue velocity,A峰）、二尖瓣环间隔处舒张早期峰值速度（early diastolic tissue velocity,e’）,并计算E/A、E/e’;应用EchoPac软件脱机分析,获取左心室整体纵向应变（global longitudinal strain,GLS）、左心室分层纵向应变（GLSendo、GLSmid、GLSepi）,以及左心室心肌整体做功指数（global myocardial work index,GWI）、整体有用功（global constructive work,GCW）、整体无用功（global wasted work,GWW）、整体做功效率（global myocardial work efficiency,GWE）;并行统计学分析。结果：与化疗前比较,化疗2个周期乳腺癌患者GLSeondo、GLS有所减低,但差异无统计学意义（P＞0.05）;GWW增加,GWE降低（P＜0.05）;化疗4个周期后GLS、GLSendo、GWI、GCW、GWE均降低,GWW增加。与化疗2个周期后比较,化疗4个周期后乳腺癌患者GLS、GLSendo、GWI、GCW、GWE降低,GWW增加（P＜0.05）。与化疗前比较,化疗4个周期后乳腺癌患者E/e’升高（P＜0.05）。各周期结束后的其余各项超声心动图参数与化疗前比较差异均无统计学意义（P＞0.05）。结论：2D-STI能早期检测乳腺癌患者在蒽环类药物化疗中左心室功能的早期改变, GWW及GWE较其他参数更敏感。     

接受蒽环类药物化疗的早期乳腺癌患者体质量指数变化对左心功能的影响

目的探讨接受蒽环类药物化疗的早期乳腺癌患者体质量指数(BMI)的变化(ΔBMI)对左心功能的影响。方法回顾性分析2018年1月至2021年10月在连云港市东方医院就诊的170例乳腺癌患者的临床资料, 收集患者的临床病理资料及心脏彩色超声检查结果。采用单因素和多因素方法分析患者化疗后发生心脏毒性的危险因素。计算ΔBMI, 绘制受试者工作特征(ROC)曲线, 测量ΔBMI的截断值并得出诊断精度。结果与化疗前比较, 化疗后的BMI、左室舒张末期容量(EDV)、左室收缩末期容量(ESV)、左室舒张末期内径(LVD)、左室收缩末期内径(LVS)的均值均升高, 左室射血分数(LVEF)值降低, 其中BMI化疗前后[(22.30±1.88)kg/m2比(23.59±2.32)kg/m2]及LVEF化疗前后[(63.69±4.69)%比(59.08±4.28)%]比较差异均有统计学意义(t值分别为3.40、4.98, 均P<0.05)。ΔBMI范围为0～41.3%, LVEF的变化(ΔLVEF)范围为0～15.9%。ΔLVEF与ΔBMI存在显著相关性(r=0.709, P<0.001)。心...     

脑胶质瘤治疗中自由基清除剂的价值

目的:探讨自由基清除剂依达拉奉(EDA)对肿瘤大小的影响及在肿瘤治疗中的价值。方法:MTT比色法测定EDA对胶质瘤细胞的影响。采用立体定向技术将C6脑胶质瘤细胞接种于大鼠右侧尾状核,建立脑胶质瘤模型,将荷瘤大鼠随机分为EDA高和低剂量组、对照组及空白组4组。空白组用来测定肿瘤组织与正常脑组织中超氧化物歧化酶(SOD)活力和丙二醛(MDA)含量,其他组用EDA或生理盐水干预,观察对肿瘤大小的影响。结果:浓度为1×10-3、1×10-4、1×10-5和1×10-6mol/L的EDA作用48 h后,细胞的增殖率分别为8.3%、13.2%、21.9%和30.6%,呈浓度依赖性。与正常脑组织相比,胶质瘤组织中SOD活性较低,而MDA含量较高,差异均有统计学意义,P=0.000。EDA高剂量组平均肿瘤体积最大,其次为EDA低剂量组,对照组最小。3组荷瘤大鼠肿瘤平均体积差异有统计学意义(F=5.863,P=0.008),EDA高剂量组与其他2组比较差异均有统计学意义,但EDA低剂量组与对照组间差异无统计学意义。结论:自由基清除剂EDA能够促进肿瘤的生长,自由基在肿瘤的综合治疗中有潜在的价值。     

VX2兔脑瘤模型三维放疗解剖学靶区灌注CT与增强CT对照研究

Objective To compare the accuracy of blood volume perfusion imaging (perfusion CT)with contrast enhanced 64-slice spiral computed tomography (CECT) in the evaluation of gross tumor volume (GTV) and clinical target volume (CTV) using rabbits with VX2 brain tumor. Methods Perfusion CT and CECT were performed in 20 rabbits with VX2 brain tumor. The GTV and CTV calculated with the maximal and minimal diameter of each tumor in the blood volume (BV) maps and CECT were measured and compared to those in pathological specimens. Results The mean value of the maximal and minimal diameter of GTV was (8.19 ± 2. 29) mm and (4.83 ± 1.31) mm in pathological specimens, (11.98 ±3.29) mmand (7.03±1.82) mm in BV maps, while (6.36±3.85) mm and (3.17±1.93) mm in CECT images, which were significantly different (pathological specimen vs. BV map, t = 7. 17,P =0. 000;pathological specimen vs. CECT, t = 8.37, P = 0. 000, respectively). The mean value of the maximal and minimal diameter of CTV in pathologic specimens was (12.87 ± 3.74) mm and (7.71 ± 2. 15) mm, which was significantly different from that of GTV and CTV in CECT (t = - 3. 18, P = 0. 005 and t = - 4. 24, P =0. 000;t= -11.59,P=0.000 and t= -9.39,P=0.000), while similar with that of GTV in BV maps (t = - 1.95,P = 0. 067; t = - 2. 06, P = 0. 054). For CECT, the margin from GTV to CTV was 81.83% ±40.33% for the maximal diameter and 276.73% ± 131.46% for the minimal. While for BV maps, the margin was 7.93% ± 17. 84% and 12.52% ± 27. 83%, which was significant different from that for CECT images (t=7.36,P=0. 000 and t= -8.78,P=0.000). Conclusions Compared with CECT, the BV map from 64-slice spiral CT peffusion imaging might have higher accuracy in target volume delineation for brain tumor.     

VX2兔脑瘤模型三维放疗解剖学靶区灌注CT与增强CT对照研究

Objective To compare the accuracy of blood volume perfusion imaging (perfusion CT)with contrast enhanced 64-slice spiral computed tomography (CECT) in the evaluation of gross tumor volume (GTV) and clinical target volume (CTV) using rabbits with VX2 brain tumor. Methods Perfusion CT and CECT were performed in 20 rabbits with VX2 brain tumor. The GTV and CTV calculated with the maximal and minimal diameter of each tumor in the blood volume (BV) maps and CECT were measured and compared to those in pathological specimens. Results The mean value of the maximal and minimal diameter of GTV was (8.19 ± 2. 29) mm and (4.83 ± 1.31) mm in pathological specimens, (11.98 ±3.29) mmand (7.03±1.82) mm in BV maps, while (6.36±3.85) mm and (3.17±1.93) mm in CECT images, which were significantly different (pathological specimen vs. BV map, t = 7. 17,P =0. 000;pathological specimen vs. CECT, t = 8.37, P = 0. 000, respectively). The mean value of the maximal and minimal diameter of CTV in pathologic specimens was (12.87 ± 3.74) mm and (7.71 ± 2. 15) mm, which was significantly different from that of GTV and CTV in CECT (t = - 3. 18, P = 0. 005 and t = - 4. 24, P =0. 000;t= -11.59,P=0.000 and t= -9.39,P=0.000), while similar with that of GTV in BV maps (t = - 1.95,P = 0. 067; t = - 2. 06, P = 0. 054). For CECT, the margin from GTV to CTV was 81.83% ±40.33% for the maximal diameter and 276.73% ± 131.46% for the minimal. While for BV maps, the margin was 7.93% ± 17. 84% and 12.52% ± 27. 83%, which was significant different from that for CECT images (t=7.36,P=0. 000 and t= -8.78,P=0.000). Conclusions Compared with CECT, the BV map from 64-slice spiral CT peffusion imaging might have higher accuracy in target volume delineation for brain tumor.     

晚期肺癌患者肺功能指标与患者生存期的相关性研究

背景与目的晚期肺癌患者的治疗以提高疗效和改善生活质量为最终目的,肺功能指标是较好的评价指标。本研究探讨晚期肺癌患者肺功能改变及肺功能指标与患者生存期的相关性。方法通过对59例晚期肺癌患者的肺功能进行检测,且与患者生存期进行相关性分析,并与63例健康人进行对照。结果晚期肺癌患者的肺通气及弥散功能指标明显低于正常,与对照相比有统计学差异。肺功能指标中肺活量(vital capacity,VC)、第1秒用力呼出量(forced expiratory volume in one second,FEV1)、用力肺活量(gorced vital capacity,FVC)、最大呼气流速(peak expiratory flow,PEF)、最大呼气流速%(peak expiratory flow%,PEF%)、最大通气量(maximal ventilatory volume,MVV)与患者生存期呈正相关(r分别为0.29、0.28、0.28、0.27、0.26、0.28,P<0.05),残气量/肺总量(residualvolume/total lung,RV/TLC)值与患者生存期呈负相关(r=-0.31,P<0.05)。结论肺癌患者存在肺功能的减退,肺癌患者肺功能指标中VC、FEV1、FVC、PEF、PEF%、MVV、RV/TCL值与患者生存期具有相关性,肺功能的部分指标可作为肺癌患者预后评估的重要因素之一。     

Pinnacle与Eclipse计划系统对感兴趣区体积计算的比较

目的 分析Pinnacle与Eclipse计划系统在计算靶区与正常器官感兴趣区(ROI)体积上的差异,为临床应用提供参考.方法 在Pinnacle计划系统上、在层厚分别为1、3、5mm的CT上分别勾画1、2、5个层面的正方形和圆形ROI.同时选取头、胸、腹部肿瘤病例各5例.在患者CT上勾画常见的正常器官ROI.将图像和ROI通过DICOM协议传输至Pinnacle和Eclipse计划系统,分析两种计划系统计算的ROI体积.结果 小体积的ROI两种计划系统计算结果有明显的差异,ROI体积越小体积差异越大(小体积相差12倍,大体积基本相同);体积计算的差异受许多因素的影响,感兴趣区的层数和几何体的大小与体积计算的差异显著线性相关(R2=1.000,P=0.000),CT层厚(R2=0.200,P=0.972)和几何体形状(R2=0.200,P=0.089)的对体积计算的差异的影响不显著.几何中心不一致对Pinnacle的ROI体积计算无影响,Eclipse的ROI体积计算有3%左右的增加.CT层厚与R0I体积呈正比(Pinnacle的R2=0.548,P=0.011;Eclipse的R2=0.502,P=0.027).对视交叉、视神经和晶体的体积差异均＞35%.结论 两种计划系统间传输ROI,特别是小体积ROI,需要注意两种计划系统在计算ROI体积时的差异.

Abstract：

Objective To compare the difference region of interest volume (ROI) calculation method between Pinnacle and Eclipse treatment planning system. Methods To acquire CT image with 3 of slice thickness (1 mm, 3 mm, and 5 mm). Delineate 1, 2 and 5 slices square and circle contours in Pinnacle treatment planning system. Meanwhile 15 cases that include 5 cases with head neck tumor, 5 with thorax tumor and 5 with abdomen tumor were selected. Those image and ROI were transfer to Eclipse treatment plan system by DICOM RT protocol . The ROI volume was compared between two TPS . Results For ROI with small volume, the volume difference between TPS was obvious (for small volume ROI have 12 times difference, for big volume ROI almost same). The volume difference between TPS was influenced by many factors. The number of ROI slice and the magnitude of ROI was related with the difference between TPS (R2 = 1. 000, P = 0. 000). The CT thickness (R2 = 0. 200, P = 0. 972 ) and the shape of ROI ( R2 =0. 200, P = 0. 089) were not significant factors. The center of ROI on different axis was not affect the volume calculation in Pinnacle, which cause 3% different in Eclipse. The CT thickness was proportional to the ROI volume ( Pinnacle R2 = 0. 548, P = 0. 011; Eclipse R2 = 0. 502, P = 0. 027 ). In clinical case, optic chiasm and Len averagely have more than 35% volume difference between those two TPS. Conclusions We should pay more attention about the difference volume calculation algorithm between Pinnacle and Eclipse,especially when transfer small volume ROI to another TPS, which may have significant difference.     

雾化吸入岩舒注射液对肺癌咯血的疗效

目的:观察岩舒注射液雾化吸入治疗肺癌咯血的疗效.方法:设立常规止血组、岩舒注射液静脉滴注组、岩舒注射液雾化吸入组,比较三组的止血有效率、止血平均时间及副作用.结果:岩舒注射液雾化吸入组的止血有效率为71.2%,显著高于常规止血组(P=0.01)、岩舒注射液静脉组(P=0.03);岩舒注射液雾化吸入组的止血平均时间为4.65±1.25d,显著短于常规止血组(P=0.005)、岩舒注射液静脉组(P=0.01).结论:雾化吸入岩舒注射液治疗肺癌咯血有较好的疗效.     

Treatment of Non-Small Cell Lung Cancer （NSCLC） Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung can-cer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, i.e. the dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeu- tic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks. RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET exami- nation (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547). CONCLUSION The recurrence rate in the lymph nodes beyond the tar-get area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.     

重组人血管内皮抑制素联合化疗治疗晚期小细胞肺癌的疗效及安全性Meta分析

[目的]评价重组人血管内皮抑制素联合化疗治疗晚期小细胞肺癌的有效性和安全性。[方法]检索Cochrane图书馆、PubMed、EMbase、中国知网、万方数据库、中国生物医学文献数据库,收集重组人血管内皮抑制素联合化疗对比单纯化疗治疗晚期小细胞肺癌的随机对照试验,采用RevMan 5.3软件进行Meta分析。[结果]共纳入9篇文献,合计661例病例。Meta分析结果显示,重组人血管内皮抑制素联合化疗与单纯化疗相比,联合治疗在客观缓解率(RR=1.37,95%CI:1.21~1.55,P<0.001)、疾病控制率(RR=1.14,95%CI:1.06~1.22,P=0.0007)方面均显示出优势。提高了半年的PFS(RR=1.83,95%CI:1.12~3.01,P=0.02)和1年PFS(RR=3.67,95%CI:1.72~7.86,P=0.0008)。延长了2年OS(RR=3.53,95%CI:1.74~7.14,P=0.0005),但1年OS无统计学差异(RR=1.26,95%CI:0.86~1.83,P=0.24)。不良反应方面,联合化疗组和单纯化疗组在白细胞减少、血小板减少、血红蛋白减少、肝肾功能损害和胃肠道反应方面差异均无统计学意义。[结论]重组人血管内皮抑制素联合化疗治疗晚期小细胞肺癌安全有效。     

SV40 BKV及JCV在人脑肿瘤中的表达

目的:探讨多瘤病毒SV40、BKV、JCV与人脑肿瘤发生之间的关系.方法:采用聚合酶链式反应(PCR)技术,对脑星形细胞瘤23例,少突胶质细胞瘤19例,室管膜瘤18例,脉络丛乳头状瘤12例,脑膜瘤11例及正常脑组织12例进行了三种病毒的检测.结果:SV40、BKV和JCV在脑肿瘤组织的阳性率分别为56.6%(47例)、53.0%(44例)和14.5%(12例);在正常脑组织中阳性率分别为8.3%(1例)、8.3%(1例)和16.7%(2例).SV40在脑肿瘤组织中阳性率显著高于正常脑组织(P＜0.01),所检测的五种脑肿瘤与正常组织相比具有显著性差异(P＜0.05);BKV在脑肿瘤组织中阳性率显著高于正常脑组织(P＜0.01),所检测的五种脑肿瘤与正常组织相比具有显著性差异(P＜0.05);SV40与BKV在脑肿瘤中的阳性率具有相关性(关联系数=0.56).JCV在肿瘤组织与正常组织间无显著性差异.结论:SV40及BKV参与脑肿瘤的发生.     

结直肠癌患者血清可溶性E-选择素和细胞内黏附分子-1浓度的临床意义

目的:探讨结直肠癌患者可溶性E选择素(sEselectin)和细胞内黏附分子1(ICAM1)的血清浓度与结直肠癌转移的关系。方法:采用酶联免疫吸附实验方法(ELISA法)测定了64例结直肠癌患者可溶性E选择素和细胞内黏附分子1的血清浓度。同时测定癌胚抗原(CEA)的血清浓度。结果:可溶性E选择素的浓度和可溶性sICAM1的血清浓度显著增高,P=0001和P=0032,伴有远处转移者增高显著,P=0004和P=0015。可溶性E选择素的浓度和可溶性sICAM1的血清浓度与血清癌胚抗原的水平有相关性,P=0025和P=0038。结论:可溶性E选择素的浓度和sICAM1的血清浓度的升高可能与结直肠癌的发展和广泛转移有关。     

经阴道彩色多普勒超声定量参数对宫颈癌患者的诊断和临床价值分析

目的:探讨经阴道彩色多普勒超声定量参数对宫颈癌患者的诊断和临床价值。方法:2013年6月至2018年6月期间，回顾性收集我院收治的宫颈癌患者32例作为观察组，同期随机抽取至我院健康体检的成年女性32例作为对照组。观察两组经阴道彩色多普勒超声定量参数差异，同时分析超声定量参数与TNM分期、肿瘤体积的相关性。结果:与对照组比较，观察组收缩峰值流速降低(0.51±0.14 vs 0.72±0.12,P=0.000)；舒张末期流速增加(12.73±3.87 vs 8.67±4.01,P=0.000)；阻力指数增加(6.34±2.62 vs 3.02±1.04,P=0.000)；血管形成指数增加(4.12±1.82 vs 1.03±0.34,P=0.000)；血流指数增加(41.37±4.82 vs 37.92±5.12,P=0.007)；血管形成-血流指数增加(2.35±1.04 vs 0.82±0.36,P=0.000)。宫颈癌患者肿瘤体积与收缩峰值流速显著负相关，与舒张末期流速、阻力指数、血管形成指数、血流指数、血管形成-血流指数显著正相关(P＜0.05)。与Ⅰ期或Ⅱ期的患者相比，Ⅲ期或Ⅳ期的患者收缩峰值流速降低(0.43±0.12 vs 0.56±0.15,P=0.016)；舒张末期流速增加(13.92±2.94 vs 12.02±2.23,P=0.047)；阻力指数增加(7.52±2.42 vs 5.63±2.07,P=0.026)；血管形成指数增加(5.51±1.67 vs 3.29±1.92,P=0.002)；血流指数增加(49.82±5.58 vs 36.30±6.62,P=0.000)；血管形成-血流指数增加(3.01±1.27 vs 1.95±1.48,P=0.048)。结论:经阴道彩色多普勒超声定量参数可以较好反应宫颈癌患者局部血流情况，对早期诊断宫颈癌具有一定价值，且与宫颈癌患者临床分期有关。     

应用四维CT评价肺癌大体肿瘤体积随呼吸运动的位移及影响因素

目的 应用四维CT(4DCT)测量肺癌大体肿瘤体积(GTV)在三维方向上随呼吸运动的位移并分析其影响因素.方法 选择21例肺癌患者共22个肺部病灶行4DCT扫描,勾画10个呼吸时相中的GTV0%～GTV90%.测量GTV变化及GTV质心、边界在三维方向上随呼吸运动的位移,计算出三维空间位移向量→(II)v并分析其影响因素.结果 GTV变化的平均值为+14.3%或-8.4%,GTV 中心点和GTV各边界在左右、前后、头脚方向上随呼吸运动的位移分别为(0.20±0.16)、(0.18±0.12)、(0.53±0.59)cm和(0.42±0.23)、(0.41±0.22)、(0.57±0.70)cm,其中GTV中心点在头脚方向上的位移大于左右(Z=-2.12,P=0.034)、前后方向(Z=-2.10,P=0.035),GTV各边界在头脚方向上的位移与左右、前后方向差异无统计学意义(Z=-0.81,P=0.417;Z=-0.86,P=0.391).GTV中心点随呼吸的位移大小只与所在肺叶有关,GTV位于下叶者在头脚方向的位移大于位于上叶者[(0.87±O.64)和(0.35±0.49)em,(t=-2.12,P=0.047)],在前后、左右方向上的位移无差异[(0.23±0.10)和(0.19±0.18)cm(t=-0.49,P=0.629)、(0.21±0.13)和(0.17±0.11)cm(t=-0.76,P=0.460)].GTV体积大小与GTV中心点在头脚、前后、左右方向位移以及三维空间位移向量→(II)v间无明显相关性(r=0.306、-0.062、-0.279、-0.300,P=0.189、0.796、0.234、0.199).结论 肺癌患者GTV随呼吸运动的位移个体化差异明显,头脚方向位移尤为显著,应用4DCT可进行较好评价;下叶病灶位移大,GTV大小与位移间无明显相关性.

Abstract：

Objective This study was to assess the three-dimensional gross tumor volume(GTV)motion of lung cancer caused by respiration using four-dimensional computed tomography(4DCT),and to analyze the influenee factors.Methotis Four-DCT scans of 22 lung focuses in 21 patients with lung cancer were analyzed.The gross tumor volume was contoured in all 10 respiration phases of 4DCT scans.The changes in volume of GTV,the 3D motion of the centroid,boundary of GTV and the 3D spatial motion vectors were calculated and the irdluenee factors were analyzed.Results The average change in volume of GTV was+14.3%(0.2%.42.5%)/-8.4%(0.4%-38.6%),the average movement amplitude of GTV centroid and GTV boundary were(0.18±0.12)cm,(0.20±0.16)cm,(0.53±0.59)cm and(0.42±0.23)cm,(0.41±0.22)cm,(0.57±0.70)cm in medio-lateral,vertro-dorsal,cranio-caudal(CC) direction,respectively.The CC movement was larger than other directions(Z=-2.12,P=0.034;Z:-2.10,P=0.035),and no significant difference was observed in 3D motion of GTV boundary(Z=-0.81.P=0.417;Z=-0.86,0.391).The CC motion of GTV eentroid in lower lobe was larger than that in upper lobe[(0.87±0.64)and(0.35±0.49)cm,(t=-2.12,P=0.047)],and no significant difference was found in other directions[(0.23±0.10)and(0.19±0.18)em(t=-0.49,P=0.629),(0.21±0.13)and(0.17±0.11)cm(t=0.76,P=0.460)].There was no correlation of the 3D movement and 3D spatial motion vector of GTV to the volume of GTV(r=-0.306,-0.062,-0.279,-0.300;P=0.189,0.796.0.234,0.199).Conclusions GTV motion of patients with lung cancer is individual,the CC movement is the moat obvious,using 4DCT to assess is comparatively accurate.The motion amplitude of lower lobe focuses is larger.No significant correlation of the GTV motion to the volume was observed.Larger sample study is needed to analyze the influence of adjacency to the GTV motion.