经肝动脉栓塞消融术治疗兔肝癌疗效评价中磁共振 DWI 的应用

目的探讨磁共振扩散加权成像（DWI）在兔VX．2肝癌模型经肝动脉栓塞消融术（TEA）疗效评价中的应用价值。方法取31只新西兰白兔,CT引导下经皮穿刺种植VX-2瘤株,建立VX-2肝癌模型。2周后,依次行常规磁共振（T1WI、T2WI）、DWI检查（b值取0,600s／mm2）及TEA术,TEA术后1周磁共振检查。随即处死模型兔,取肝脏组织行病理学检查。结果肝癌兔手术前后瘤区表观扩散系数（ADC）值分别为（1．56±0．08）×10-3、（2．15±0．14）×10-3mm2／s,P〈0．01。根据肝脏组织病理变化划分为肿瘤坏死区、活性肿瘤区、正常组织凝固性坏死区及正常肝组织区,其ADC值分别为（2．18±0．32）×10～、（1．50±0．30）×10-3、（1．86±0．41）×10-3、（2．28±0．35）×10-3mm2／s,肿瘤坏死区与活性肿瘤区、活性肿瘤区与正常组织凝固性坏死区及正常肝组织区、正常肝组织凝固性坏死区与正常肝组织区ADC值比较,P均〈0．05。结论磁共振DWI可初步用于肝癌TEA术后疗效评价,TEA术后瘤区ADC值升高,且肿瘤坏死区ADC值明显高于活性肿瘤区。     

表观扩散系数在肝癌动脉化疗栓塞后早期监测中的价值

目的 评价表观扩散系数(apparent diffusion coefficient,ADC)在兔VX2肝癌动脉化疗栓塞(TACE)后监测肿瘤坏死中的作用.方法 (1)选用30只成年雄性新西兰大白兔,其中6只为种兔,将VX2瘤组织碎块种植于肝包膜下,建立移植性肝癌模型.(2)2周后将接种成功的24只VX2兔行常规MRI及扩散加权成像(DWI).常规MRI用FSE序列;DWI检查用SE-EPI序列(TR/TE=3000～4000 ms/50.9～70.2 ms;层厚为3 mm;层距为0.5 mm;FOV为12 cm×12 cm;b值为600 s/mm2).(3)将24只兔平均分为A、B两组.A组动物MRI检查后用超液化碘油与阿霉素制成乳化栓塞剂行TACE治疗,B组不治疗.(4)治疗后3 d A、B两组均行MRI检查,方法同(2).在肿瘤内分散放置3个感兴趣区(ROI),分别测得3个ADC值,取平均数.(5)检查完毕后将所有动物处死取肝脏做病理,测量肿瘤坏死范围,以百分数表示.测量A、B两组的ADC值,研究其与肿瘤坏死百分数的相关性.结果 24只(100%)动物接种成功,2周后肿瘤直径约1～2 cm.治疗后A组平均ADC值为(1.92±0.19)×10-3 mm2/s,B组平均ADC值为(1.63±0.12)×10-3 mm2/s;A组肿瘤坏死率约为94%,B组为50%;A组平均坏死率为(89.1±0.4)%,B组平均坏死率为(46.6±0.5)%.A、B两组间ADC值差异有显著性(P＜0.05),与坏死率的相关系数分别为0.92和0.89.结论 ADC值与肝癌TACE治疗后的肿瘤坏死密切相关,可用于早期监测TACE的疗效.     

MR弥散加权成像在兔肝VX2肿瘤射频消融后残癌诊断中的应用价值

目的 探讨MR弥散加权成像在兔肝VX2肿瘤射频消融后残癌诊断中的应用价值.方法 制备兔肝VX2肿瘤模型,在进行射频不完全消融治疗后1、3、7、14 d行MR弥散加权成像检查,然后处死模型兔,取肝组织行病理检查.比较检查结果.结果 1周内各b值时炎症反应带、残癌ADC值相比P均＞0.05.术后第2周时b=200 s/mm2时正常肝组织、炎症反应带及残癌ADC值分别为(2.34±0.36)、(2.14 ±0.33)、(1.86±0.24) ×10-3mm2/s,b=600 s/mm2时分别为(2.09±0.21)、(1.96±0.30)、(1.55±0.10)×10-3 mm2/s,b=1 000 s/mm2时分别为(1.99±0.17)、(1.78±0.15)、(1.43±0.13)×10-3 mm2/s,各b值下不同组织ADC值比较P均＜0.05.b=200s/mm2时SNR、CNR、SIR分别为254.3±52.2、35.1±10.1、2.1±0.5,b =600 s/mm2时分别为198.0±44.0、20.2±9.2、2.7±0.8,b=1 000 s/mm2时分别为151.7±24.2、9.6±3.4、3.3±1.0.综合考虑上述数据,b=600 s/mm2为最佳扩散敏感系数.b=600 s/mm2时取残癌ADC值的95％参考值范围上限1.71×10-3mm2/s为界值鉴别残癌与炎症反应,其敏感性为57％,特异性为88％.结论 MR弥散加权成像有助于兔肝VX2肿瘤射频消融治疗后残癌的诊断.     

平阳霉素混合碘油经动脉化疗栓塞抑制兔VX2肝癌生长的实验研究

目的 评价平阳霉素混合碘油经肿瘤滋养动脉化疗栓塞对兔VX2肝癌的肿瘤组织、滋养血管及血管新生的影响.方法 将28只新西兰大白兔采用移植法建立兔VX2肝癌模型,并随机均分为单纯碘油组(A组)、平阳霉素组(B组)、平阳霉素加碘油组(C组)和等渗盐水对照组(D组).模型均于建模后第14天行CT检查并计算肿瘤体积V1,然后对各组模型作相应处理:A组经肿瘤滋养动脉注入超液态碘油,B组经肿瘤滋养动脉注入平阳霉素,C组经肿瘤滋养动脉注入平阳霉素加超液态碘油,D组经肿瘤滋养动脉注入等渗盐水.7d后再行CT检查,计算肿瘤体积V2及肿瘤的生长率.处死实验兔进行病理学检查,计算血管内皮生长因子(VEGF)阳性表达率及微血管密度(MVD).组间数据的比较用单因素方差分析,多组的两两间比较用LSD法,两组间比较用成组t检验,对方差不齐者用秩和检验;VEGF表达与MVD值比较用双变量相关分析;阳性表达率的比较用精确概率法.结果 A、B、C、D组介入治疗前的肿瘤体积分别为(389.8±167.3) mm3、(404.1±184.9) mm3、(355.1±158.3) mm3和(378.1±189.0) mm3,差异无统计学意义(F=0.257,P＞0.05);术后肿瘤体积分别为(922.6±32.9) mm3、(665.9±99.9) mm3、(349.5±177.8) mm3和(1403.5±411.2) mm3,差异有统计学意义(F=26.23,P＜0.05),且B组和C组明显小于A组和D组;VEGF阳性表达率分别为57.1％、42.9％、28.6％和100％,差异有统计学意义(F=8.407,P＜0.05).D组残余肿瘤区MVD显著升高(36.4±3.7),与A组(22.4±3.9)、B组(18.7±2.6)和C组(14.1±2.3)比较,差异有统计学意义(t值分别为6.89、10.34和13.49,P值均＜0.05),且C组明显低于其他各组(t值分别为4.89、3.53和13.49,P值均＜0.05).VEGF阳性表达率与MVD存在正相关关系(r=0.743,P＜ 0.01).结论 平阳霉素对兔VX2肝癌有较好的治疗效果,联合超液态碘油经肝动脉化疗栓塞治疗更加有效.     

磁共振扩散加权成像在前列腺癌诊断和鉴别诊断中的价值

目的 探讨磁共振扩散加权成像(DWI)和表观弥散系数(ADC)值在前列腺癌诊断与鉴别诊断中的应用价值.方法 46例经手术病理或穿刺活检证实的前列腺疾病患者行DWI检查,其中前列腺增生(BPH)21例,慢性前列腺炎9例,前列腺癌16例,扩散敏感分数值800 s/mm2.依病理结果,将前列腺外周带六分区归类为正常区、增生区,炎症区、癌区,测量每个分区的ADC值,癌与非癌组之间进行受试者操作特征曲线(ROC)分析.结果 各组ADC值分别为,BPH外周带(2.20±0.29)×10-3mm2/s,中央带(1.66±0.14)×10-3 mm2/s,炎症区(1.95±0.34)×10-3 mm2/s,癌区(1.24±0.32)×10-3 mm2/s,组间ADC值两两比较,差异均有统计学意义(均P＜0.01);ROC曲线上临界点取1.49×10-3 mm2/s,诊断的敏感性达86.8%,特异性为94.0%,ROC曲线下面积0.945±0.010.结论 前列腺DWI及ADC值可用于前列腺肿瘤的诊断和鉴别诊断,具有很高的临床应用价值.

Abstract：

Objective To explore the application of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) value in the diagnosis and differential diagnosis of prostatic cancer. Methods Diffusion-weighted echo-planar imaging (EPI) sequences were performed in 46 patients, including 21 cases of benign prostatic hyperplasia (BPH), 9 cases of chronic prostatitis and 16 cases of prostate cancer. DWI were obtained with a b-factor of 800 s/mm2. According to the pathological results obtained by ultrasound guided biopsy, the peripheral zone of prostate was divided into six parts by orientations and they were divided into noncancerous, hyperplasia, prostatitis and cancerous groups. The ADC value of each region was measured and analyzed with one-way ANOVA and ROC analysis. Results Acceptable images for ADC measurement were obtained in all cases.The mean ADC values of prostatic peripheral zone, prostatic central gland, inflammatory area and cancerous area were (2.20±0. 29)×10-3 mm2/s, (1.66±0.14)×10-3 mm2/s, (1.95±0.34)×10-3 mm2/s and ( 1.24 ± 0.32) × 10-3 mm2/s, respectively. There were statistically significant differences in ADC values between the inter-groups (P＜0. 01 ). With ROC cut point setting to 1.49 ×10-3 mm2/s, the diagnostic sensitivity and specificity for prostate cancer were 86. 8% and 94. 0%, the area under the ROC curve (AUC) was 0. 945±0. 010. Conclusions ADC value might be useful to evaluate prostate cancer. DWI has an important clinical application value in the diagnosis and differentiation of prostate cancer.     

改良兔VX2肝癌模型及其DSA影像分析

目的 通过改良接种方式探讨不同兔VX2肝癌模型植瘤方式的成功率,以及该肿瘤的DSA影像特征.方法 147只新西兰白兔分成二大组,第一组后腿荷瘤兔(供体)63只,11只注射冰冻兔VX2细胞悬液,52只注射新鲜兔VX2细胞悬液.第二组肝脏荷瘤兔(受体)84只,33只兔注射VX2肿瘤细胞悬液,51只兔肝左叶移植小瘤粒.观察:①不同组植瘤的成活率,使用χ<'2>检验或Fisher精确检验,α=0.05;②改良型VX2移植性肝癌的DSA影像特征.结果 第一组后腿荷瘤兔成瘤率分别为冰冻兔VX2细胞悬液36%,新鲜兔VX2细胞悬液86%,注射新鲜兔VX2细胞悬液成瘤率高(P=0.001 275).第二组肝脏荷瘤兔成瘤率分别为注射VX2肿瘤细胞悬液48%,肝脏移植小瘤粒82%,肝脏移植小瘤粒成瘤率高(P=0.001 04).DSA影像显示该移植性肝癌具有丰富的血供.结论 经皮注射新鲜兔VX2细胞悬液于兔后腿进行兔VX2细胞株传代和兔肝脏移植新鲜VX2肿瘤小瘤粒,能够成功的建立改良移植性兔VX2肝癌模型,为肝癌DSA治疗的基础及临床研究提供了成熟的实验动物模型.     

扩散加权成像技术在肝脏囊性病变中的应用

目的探讨MR扩散加权成像(DWI)及表观扩散系数(ADC)值在肝脏囊性病变诊断中的价值。方法对50例肝囊性病变患者行DWI检查,并测量ADC值。包括单纯性肝囊肿15例、单房囊肿型肝包虫病15例、脓腔形成期肝脓肿10例、囊性坏死性肝转移瘤10例。结果单纯性肝囊肿、单房囊肿型肝包虫病、脓腔形成期肝脓肿、囊性坏死性肝转移瘤ADC值分别为(3.85±0.23)×10-3 mm2/s、(3.52±0.53)×10-3 mm2/s、(1.069±0.1)×10-3 mm2/s、(2.159±0.14)×10-3 mm2/s,单纯性肝囊肿、单房囊肿型肝包虫病、脓腔形成期肝脓肿、囊性坏死性肝转移瘤ADC值差异有统计学意义(P<0.05)。在DWI图像上,脓腔形成期肝脓肿、囊性坏死性肝转移瘤呈高信号,而单纯性肝囊肿、单房囊肿型肝包虫病均呈低信号。结论分析DWI图像特点及ADC值在肝脏囊性病变中的鉴别诊断有重要价值。     

不同b值磁共振弥散加权成像在鉴别前列腺癌和前列腺增生中的价值

目的探讨不同b值3.0T磁共振弥散加权成像(DWI)在鉴别前列腺癌(PCa)和前列腺增生(BPH)的价值及合适的b值。方法经穿刺活检或手术病理确诊的PCa患者40例,BPH患者31例,分别接受不同b值DWI扫描获得感兴趣区的表现扩散系数(ADC)值,b值分别为300,800和1 000 s/mm~2,对比分析不同b值条件下PCa与BPH的ADC值差异,并采用受试者工作特征曲线(ROC)确定诊断PCa的灵敏度和特异度。结果不同b值条件下,PCa患者ADC值分别为(1.06±0.06)×10~(-3)mm~2/s,(0.83±0.04)×10~(-3)mm~2/s,(0.73±0.03)×10~(-3)mm~2/s,BPH患者ADC值分别为(1.38±0.06)×10~(-3)mm~2/s,(1.24±0.06)×10~(-3)mm~2/s,(1.18±0.04)×10~(-3)mm~2/s,同一b值条件下,两组结果差异有统计学意义(P<0.05)。DWI b 300,DWI b 800,DWI b 1 000诊断PCa的灵敏度和特异度分别为73.8%、76.3%,74.3%、75.0%,88.2%、84.0%。结论 ADC值对鉴别诊断PCa和BPH可提供定性和定量信息,当b=1 000 s/mm~2时,DWI对诊断PCa有较高的灵敏度和特异度。     

丹参酮Ⅱ A对小鼠肠癌皮下移植瘤血管新生的抑制作用

目的:探讨中药丹参活性成分TanⅡA对肠癌小鼠皮下移植瘤微血管生成的抑制作用.方法:通过腋下接种小鼠C26肠癌细胞,建立小鼠结肠癌移植瘤模型,随机分为:模型组、TanⅡA低[0.5 m/(kg·d)]、中[1 mg/kg·d)]、高[2 mg/(kg·d)]剂量组、5-氟脲嘧啶[1 mg/kg·d)]组,经尾静脉分别给予生理盐水、不同浓度的TanⅡA及5-氟脲嘧啶.每天1次,给药1 wk.给药7 d后摘除眼球取血,剥离瘤体,测量大小及质量.免疫组织化学法检测MVD,HE染色检测肿瘤组织坏死情况,ELISA法检测小鼠血清VEGF的表达.结果:TanⅡA低、中、高剂量的肿瘤质量抑制率分别为:45.8%、60.3%及84.5%,肿瘤体积抑制率为:50.5%、60.7%及84.2%;模型组与低剂量组肿瘤组织以轻度坏死为主,MVD值分别为:86.5±14.6与73.5±19.8,中、高剂量组则以中、重度坏死为主,MVD值分别为:48.6±15.2与19.4±6.6;模型组血清VEGF的浓度显著锅于空白组,TanⅡA低、中、高剂量组VEGF抑制率分别为:15.8%、34.2%及74.8%.结论:TanⅡA能够抑制小鼠肠癌微血管生成,并对肠癌的生长有明显抑制作用,其抗肠癌作用与抑制VEGF、MVD有关.     

磁共振扩散加权成像应用于食管癌的最佳b值选择及放疗疗效评价

目的:本研究探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)应用于食管癌的最佳b值选择.并用该b值下的DWI来评价食管癌的放疗疗效.方法:回顾性分析河北肿瘤医院行放射治疗的食管癌患者88例,于放射治疗前1 d及放射治疗结束后1 d分别行磁共振常规扫描(magnetic resonance imaging)和DWI扫描,b值选择为600、800、1000 s/mm2,比较不同b值下DWI图像的信噪比(signal to noise ratio,SNR)、放疗前后的表观扩散系数值(apparent diffusion coefficient,ADC)及病灶长度的变化.结果:放射治疗前b值为600、800和1000 s/mm2时,所测得DWI图像的SNR值分别是11.60±1.50、11.18±1.75、7.15±0.91;所测得ADC值分别为1.66×10-3±0.49×10-3、1.55×10-3±0.41×10-3、1.39×10-3±0.33×10-3 mm2/s;在b值为600、800和1000 s/mm2时,放疗后平均ADC值是2.48×10-3±0.58×10-3、2.16×10-3±0.46×10-3、1.93×10-3±0.35×10-3 mm2/s,放疗后ADC值较放疗前明显升高(P=0.001).选择b值为800 s/mm2时的图像,治疗前后肿瘤病灶长度比较有统计学意义(5.43 cm±1.25 cm vs 2.17 cm±0.95 cm,P=0.001).结论:食管癌放射治疗后ADC值较放射治疗前显著升高;食管癌放射治疗后病灶的长度较放射治疗前显著缩短;b值取800 s/mm2时所得到的DWI图像及ADC图更利于食管癌放射治疗疗效的评价.     

重组人p53腺病毒基因经介入途径治疗兔VX2肝癌的研究

目的 观察重组人p53腺病毒基因(rAd-p53)经介入途径治疗兔VX2肝癌的效果.方法 将30只新西兰大白兔采用移植法建立兔VX2肝癌模型,并随机均分为A、B、C、D、E5组,于第11天分别行磁共振成像、CT检查,计算肿瘤体积后对各组模型处理,A组:经肝动脉灌注等渗盐水0.5ml/只;B组:经肝动脉灌注超液态碘油0.5ml/只;C组:经肝动脉灌注rAd-p531×106/VP;D组:经肝动脉灌注rAd-p53 1×106/VP加超液态碘油0.5 ml/只; E组:肿瘤内直接注射rAd-p53 1×106/VP.14 d后再行磁共振成像、CT检查,计算肿瘤体积.处死实验兔,免疫组织化学方法检测肿瘤细胞凋亡、血管内皮生长因子及Ⅷ因子表达情况,对Ⅷ因子阳性血管内皮细胞进行微血管密度计数,并结合其病理学特征进行分析.多组间的比较用方差分析,多组数据两两比较用Student-Newwman-Keuls法检验,两组间比较用成组t检验,对方差不齐者用秩和检验.结果 分组处理前,A、B、C、D、E组肿瘤体积分别为(79.4±8.2)、(75.3±7.8)、(74.6±6.6)、(78.7±9.1)、(75.8±8.4)mm3,各组比较,F=12.248,P=0.0636,差异无统计学意义.处理后5组肿瘤体积分别为(564.7±96.7)、(176.5±83.2)、(239.6±42.8),(159.8±58.6)、(334.7±32.6)mm3,各组比较,F=24.537,P=0.0218,差异有统计学意义.处理前后肿瘤增长倍数分别为6.9、2.6、3.1、1.6倍和4.1倍.5组凋亡率分别为12.0%±1.1%、14.5%±2.1%、17.6%±2.3%、18.6%±2.3%和19.6%±2.5%,各组比较,F=6.23,P=0.024,差异有统计学意义.血管内皮生长因子表达阳性率分别为50.0%、83.3%、83.3%、50.0%和50.0%,各组比较,F=7.84,P=0.019,差异有统计学意义.5组吸光度值分别为81.6±16.1、85.2±24.3、75.2±23.9、71.1±21.3和72.3±25.2,各组比较,F=0.854,P=0.018,差异有统计学意义.结论 rAd-p53对兔VX2肝癌有较好的治疗效果,以与超液态碘油经肝动脉联合灌注治疗最为有效.     

31P磁共振波谱分析技术监测兔肝移植瘤及白细胞介素12基因的表达

目的 探讨31P磁共振波谱分析(31P MRS)技术监测AdCMVIL12-IRES-CKb腺病毒基因转导治疗兔VX2肝肿瘤的可行性.方法 19只新西兰大白兔,随机取1只麻醉后,取1 mlVX2瘤细胞悬液(1×107个/ml)注射于兔后腿外侧肌肉.待肿瘤长到鸡蛋大时,切开肿瘤,剪成1 mm×1 mm×1 mm大小的组织块,将组织块以开腹包埋法接种到18只大白兔肝脏中,超声监测肿瘤的生长情况,取肿瘤组织,行HE染色.18只大白兔随机分为治疗组(6只)、对照组(6只)和空白组(6只),经耳缘静脉分别注射等量的重组腺病毒AdCMVIL12-IRES-CKb颗粒(5×1012粒/kg)、AdCMV-Empty颗粒(5×1012粒/kg)和等渗盐水,注射处理后,肌酸水溶液饲养5 d行31pMRS扫描.采用免疫组织化学和酶联免疫吸附法检测各组白细胞介素12(IL-12)水平,Western blot 法检测脑型肌酸激酶(CKB)水平,超声法检测注射处理前后肿瘤的大小.采用统计软件SPSS17.0,通过t检验、单因素方差分析、LSD法作统计学处理.结果 肿瘤接种后15 d左右,直径增至1.5～1.7 cm,彩色多普勒超声检查血流成像显示肿瘤周边可见供血小动脉直通肿瘤内部.兔肝脏肿瘤模型表面可见突出的瘤体,质地偏硬,标本切面见肿瘤组织呈灰白色、鱼肉状,与周围正常肝组织分界欠清楚.HE染色显示肿瘤呈浸润性生长,可见明显异型性.治疗组、空白组和对照组注射处理前、后肿瘤直径分别为(1.63±0.04)cm和(1.62±0.03)cm、(1.59±0.05)cm和(1.84±0.11)cm、(1.60±0.02)cm和(2.07±0.12)cm,与注射处理前比较,空白组和对照组大白兔肿瘤直径增大,t值分别为-5.291、-9.475,P值均＜0.05,差异有统计学意义,治疗组注射处理前后肿瘤直径差异无统计学意义.兔肝肿瘤经AdCMVIL12-IRES-CKb腺病毒治疗后,肝组织内IL-12相关信号获得表达,但对照组、空白组未见IL-12相关信号表达;治疗组、空白组、对照组大白兔血清IL-12的浓度分别为(65.96±3.67)Pg/ml、(1.83±0.81)pg/ml、(1.60±0.76)Pg/ml,与对照组和空白组比较,治疗组IL-12浓度高,t值分别为48.893和36.548,P＜0.01,差异有统计学意义;对照组与空白组IL-12水平相比较,差异无统计学意义.治疗组肝组织CKB获得表达,但空白组和对照组未见CKB表达.与注射处理前比较,治疗组注射处理后有异常增高的典型的Pcr峰.治疗组、对照组、空白组注射处理前后的Pcr值分别为(0.23±0.14)mmol/L和(0.88±0.52)mmol/L;(0.69±0.21)mmol/L和(0.28±0.29)mmol/L;(0.19±0.19)mmol/L和(0.25±0.36)mmol/L,与处理前比较,治疗组注射处理后Pcr值增大,对照组注射处理后Pcr值减少,t值分别为-2.629、3.505,P值均＜0.05,差异有统计学意义.空白组注射处理前后Pcr值差异无统计学意义.3组大白兔注射处理前后Pcr值之差的单因素方差分析结果显示,F=6.235,P＜0.05.采用LSD法对注射处理前后3组Pcr差值进行两两比较,治疗组与对照组及空白组比较,P=0.004和0.049,差异均有统计学意义;对照组与空白组间差异无统计学意义.结论 兔肝脏肿瘤模型的建立是成功的.肝内CKB活性可预测IL-12的表达; 31P MRS技术可用于监测AdCMVIL12-IRES-CKb腺病毒基因转导治疗兔VX2肝肿瘤.     

Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits

AIM： To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT.
METHODS： Forty New Zealand rabbits were divided into 4 groups according to digital table： Immediate group （group A; transplantation of tumor immediately after the portal vein occlusion）, 3-wk group （group B; transplantation of tumor at 3 wk after the portal vein occlusion）, negative control group （group C） and positive control group （group D）, 10 rabbits in each group. Hepatic VX2 tumor was transplanted with abdominalembedding innoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion. Meanwhile, they were divided into negative control group （Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly） and positive control group （Transplanted tumor did not suffer from the portal vein occlusion）. All rabbits were scanned with multi-slice CT.
RESULTS： All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was significantly smaller than that in positive control group （2.55±0.46 vs 3.59±0.37 cm, t = 5.57, P 〈 0.001）. Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group （10% vs 400, and 90% vs 100%, respectively）. The expression intensities of the vascular endothelium growth factor （VEGF） in groups A, B, C and D were 0.10±0.06, 0.66±0.21, 0.28±0.09 and 1.48±0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C （t = 5.07; P 〈 0.001）.In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D （t = 6.38; P 〈 0.001）. Scanning with multi-slice CT showed that displaying rate of     

Tumor angiogenesis and its clinical significance in pediatric malignant liver tumor

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and microvascular density (MVD) count in pediatric malignant liver tumor and their clinical significances. METHODS: Fourteen children with malignant liver tumors including seven hepatocellular carcinomas (HCCs), five hepatoblastomas, one malignant mesenchymoma and one rhabdomyosarcoma were studied. Twelve adult HCC samples served as control group. All samples were examined with streptavidin-biotin peroxidase (SP) immunohistochemical staining for VEGF expression and MVD count. RESULTS: VEGF positive expression in all pediatric malignant liver tumors was significantly higher than that in adult HCC (0.4971±0.14 vs0.4027±0.03, P<0.05). VEGF expression in pediatric HCC group was also markedly higher than that in adult HCC group (0.5665±0.10 vs0.4027±0.03, P<0.01) and pediatric non-HCC group (0.5665±0.10 vs 0.4276±0.15, P<0.05). The mean value of MVD in pediatric malignant liver tumors was significantly higher than that in adult HCC (33.66±12.24 vs 26.52±4.38, P<0.05). Furthermore, MVD in pediatric HCC group was significantly higher compared to that in adult HCC group (36.94±9.28 vs 26.52±4.38, P<0.05), but there was no significant difference compared to the pediatric non-HCC group (36.94±9.28 vs 30.37±14.61, P>0.05). All 7 children in HCC group died within 2 years, whereas the prognosis in pediatric non-HCC group was better, in which two patients survived more than 5 years. CONCLUSION: Children with malignant liver tumors, especially with HCC, may have extensive angiogenesis that induces a rapid tumor growth and leads to a poor prognosis.     

Absence of Clinical Prognostic Value of Vascular Endothelial Growth Factor and Microvessel Density in Multiple Myeloma

Vascular endothelial growth factor (VEGF) is considered a potent stimulator of angiogenesis. In multiple myeloma (MM), it has been reported that bone marrow angiogenesis parallels tumor progression and correlates with a poor prognosis. To investigate the role of angiogenesis in MM, we investigated VEGF expression and microvessel density (MVD) in the bone marrow of 75 MM patients by immunohistochemical methods. VEGF expression was observed in 87.3% (62 of 71) of patients. MVD was 69.42 +/- 9.67 (mean +/- SE) compared with the normal control values of 26.81 +/- 2.85. MVD values were 73.98 +/- 11.27 and 36.04 +/- 6.99 in the VEGF-positive and VEGF-negative groups, respectively. The MVD of patients in the VEGF-positive group was significantly higher than in the VEGF-negative group (P = .045). However, there were no significant differences in various clinical parameters, such as age, sex, hemoglobin, platelet count, serum levels of albumin, calcium, creatinine, and beta2-microglobulin, and bone marrow plasma cell percentage, between the VEGF-positive and VEGF-negative groups. Multivariate analysis revealed that age, hemoglobin, platelet count, serum levels of albumin and creatinine, and bone marrow plasma cell percentage were correlated with overall survival, whereas VEGF expression or MVD was not. In conclusion, our results suggest that VEGF is highly expressed and that MVD is increased in MM, indicating that angiogenesis may play a role in MM. Although MVD in the bone marrow of the VEGF-positive group is significantly higher compared with the VEGF-negative group (P = .045), VEGF is not correlated with overall survival. Further studies that include other angiogenic factors are needed to determine the functional role of angiogenesis in MM.     

CT perfusion imaging can detect residual lung tumor early after radiofrequency ablation: a preliminary animal study on both tumoral and peri-tumoral region assessment

BackgroundRadiofrequency ablation (RFA) is a minimally invasive procedure to treat lung cancer. Timely evaluation on residual lung tumor after RFA is crucial to the prognosis, hence, our objective is to assess CT perfusion (CTP) on detection of residual lung tumor early after RFA.MethodsCTP imaging was performed in 24 lung VX2 tumor models 1 day before and within 1 hour after RFA. CTP maps with dual-input (n=24) and single-input [n=13, with predominant ground glass opacity (GGO) after RFA] models were generated using the maximal slope method. Regions of interest were independently placed on the maximal cross-sectional tumor before and after RFA and on GGO after RFA by two thoracic radiologists. The bronchial flow (BF), pulmonary flow (PF) and perfusion index (PI) were compared between pre-RFA and post-RFA images. The parameters (BF, PF and PI of tumor; PF of GGO) of the complete and incomplete RFA groups were compared based on nicotinamide adenine dinucleotide hydrogen (NADH) and TdT-mediated dUTP nick-end labeling (TUNEL) staining and were correlated with the microvascular density (MVD).ResultsThe BF and PF decreased after RFA (all P values <0.03). The decrease in BF and PF (ΔBF and ΔPF) in the complete RFA group was higher (P=0.01; 0.02). The areas under the curve (AUC) of ΔBF and ΔPF at 14.85 and 17.25 mL/min/100 mL in determination of tumor with complete ablation were 0.80 and 0.78, respectively. ΔBF was positively correlated with MVD (P=0.046, r=0.468). PF of GGO with incomplete RFA was higher (P=0.001). The AUC of PF ≤29.4 mL/min/100 mL in determination of tumor with complete ablation was 0.99.ConclusionsCTP could detect residual lung tumor early after RFA in a rabbit model, which might provide a clinical solution to early treatment assessment after RFA.     

GM-CSF分泌型肝癌疫苗对荷瘤鼠脾血细胞毒性T淋巴细胞杀伤活性的影响

目的观察粒细胞巨噬细胞集落刺激因子(GM-CSF)分泌型肝癌疫苗对移植性肝癌小鼠细胞毒性T淋巴细胞(CTL)杀伤活性的影响。方法取小鼠肝癌细胞株H22细胞1×106/只注入小鼠腹腔内,接种7d形成腹水瘤后再在小鼠体内传3代。取生长旺盛且无血性的腹水,在无菌条件下制成2×107/ml的细胞悬液,以2×106细胞/0.1ml/只接种于小鼠右前肢皮下。将肝癌细胞移植瘤动物分成3组。4天后,在右侧背部皮下进行免疫治疗,即制备GM-CSF分泌型H22肝癌瘤苗并免疫ICR小鼠(H22-GM-CSF组,n=5),同时设立无GM-CSF基因修饰H22肝癌瘤苗组(H22组,n=5)和PBs对照组(PBS组,n=5),测量各组小鼠肿瘤体积;采用细胞增殖计数法检测小鼠脾血CTL杀伤活性。结果随着效/靶比增加,各组CTL杀伤活性均增强。在效/靶比为50∶1时,GM-CSF-H22组CTL杀伤活性为60±6.1%,明显高于H22组(17.4±0.9%)和PBS组(12.2±0.6%,P<0.01);GM-CSF分泌型肝癌细胞瘤苗明显抑制H22荷瘤小鼠肿瘤生长。在21天时,H22-GM-CSF组、H22组和PBS组小鼠肿瘤体积分别为0.63±0.05mm3、1.47±0.75mm3和1.79±0.34mm(3P<0.01)。结论 GM-CSF分泌型肝癌细胞瘤苗可抑制肿瘤细胞生长,增强CTL杀伤活性。     

Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm

BACKGROUND & AIMS: The aim of this study was to compare the clinical outcome of percutaneous radiofrequency (RF) ablation, conventional percutaneous ethanol injection (PEI), and higher-dose PEI in treating hepatocellular carcinoma (HCC) 4 cm or less. METHODS: A total of 157 patients with 186 HCCs 4 cm or less were randomly assigned to 3 groups (52 patients in the conventional PEI group, 53 in the higher-dose PEI group, and 52 in the RF group). Clinical outcomes in terms of complete tumor necrosis, overall survival, local tumor progression, additional new tumors, and cancer-free survival were compared across 3 groups. RESULTS: The rate of complete tumor necrosis was 88% in the conventional PEI group, 92% in the higher-dose PEI group, and 96% in the RF group. Significantly fewer sessions were required to achieve complete tumor necrosis in the RF group than in the other 2 groups (P < .01). The local tumor progression rate was lowest in the RF group (vs the conventional PEI group, P = .012; vs the higher-dose PEI group, P = .037). The overall survival rate was highest in the RF group (vs the conventional PEI group, P = .014; vs the higher-dose PEI group, P = .023). The cancer-free survival rate was highest in the RF group (vs the conventional PEI group, P = .019; vs the higher-dose PEI group, P = .024). Multivariate analysis determined that tumor size, tumor differentiation, and the method of treatment (RF vs both methods of PEI) were significant factors in relation to local tumor progression, overall survival, and cancer-free survival. CONCLUSIONS: The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less.