弥漫性胸膜间皮瘤的CT诊断

目的总结弥漫性胸膜间皮瘤的CT表现及诊断方法,提高对此病的认识及诊断的正确率。方法回顾性分析我院自1997-2008年收治的13例经组织学证实的弥漫性胸膜间皮瘤的临床及CT影像资料。结果右侧胸腔7例,左侧胸腔6例。所有的病例CT均表现为不同程度的弥漫性胸膜增厚（〉1 cm）：呈广泛性、结节样、瘤样、不规则状、盔甲样增厚、大量胸水等征象。结论CT在弥漫性胸膜间皮瘤的诊断中具有重要地位。能发现和显示病变、确定病变的范围,为选择治疗方法及判断预后提供重要参考。     

恶性胸膜间皮瘤22例CT表现分析

目的：探讨恶性胸膜间皮瘤的CT表现特点。方法：对22例经病理证实的恶性胸膜间皮瘤进行回顾性分析。结果：22例恶性胸膜间皮瘤中,9例为局限型,13例为弥漫型。CT胸部检查诊断为恶性胸膜间皮瘤16例,诊断符合率为72．73％。结论：CT诊断恶性胸膜间皮瘤与病理符合率较高,能为临床诊断提供有价值的依据,但最后确诊有赖于病理证实。     

胸膜间皮瘤的影像学分析

目的探讨胸膜间皮瘤的影像学表现。方法 15例患者均行X线平片、CT及胸部穿刺活检。结果胸膜间皮瘤弥漫增厚型(6例),结节型(5例),肿块型(4例)。结论胸部普通X线检查是最基础的检查方法,CT检查对胸膜间皮瘤的定性、病变良恶性以及病变的范围有重要的诊断价值。     

青石棉污染区恶性胸膜间皮瘤的CT表现及分析

目的分析青石棉污染区恶性胸膜间皮瘤的CT表现特点,以提高诊断符合率。方法搜集大姚县医院2010年7月～2012年3月21例经临床及病理证实的恶性胸膜间皮瘤患者CT表现,行回顾性分析。结果 21例患者中,20例胸膜增厚,其中弥漫性增厚16例,结节状增厚4例;单纯胸腔积液1例,后经胸膜穿刺后胸膜弥漫性增厚。大量胸腔积液7例,中等1例,少量7例,无胸腔积液6例。其中,单侧胸腔积液13例,双侧胸腔积液2例。CT表现为胸膜增厚≥1.1cm,大部分〉2.0cm,最大厚度为6.8cm,呈结节状、条片状或巨块状软组织肿块,经增强扫描有明显强化。结论石棉污染区恶性胸膜间皮瘤典型CT表现为胸膜增厚、肿块、胸腔积液,并伴有胸膜斑、冰冻纵隔、胸壁侵犯。     

恶性胸膜间皮瘤X线细胞学病理组织学诊断分析（附5例报告）

本院从１９９８年～２００１年间经Ｘ线检查及细胞学病理组织学证实为胸膜间皮瘤共５例 ,为提高临床、Ｘ线及病理诊断 ,现结合本组病例分析如下。１病例介绍１ １例１ :患者男性 ,６１岁 ,左侧胸痛 ,咳嗽１月余 ,经当地医院对症治疗无效来我院以左侧渗出性胸膜炎收住院 ,入院后胸水增长迅速 ,每隔４～５天抽胸水１次 ,每次量约８００～１２００ｍｌ,为血性。Ｘ线检查 :胸透视左侧胸腔积液 ,液平位于第一肋间 ,在抽出胸水同时注入４００ｍｌ气体 ,人工气胸后摄胸部正侧位和透视下转动病人身体切线位点片 ,所见胸片肺组织压缩１／３左右 ,胸壁…     

28例恶性胸膜间皮瘤的病理诊断

<正>弥漫性胸膜间皮瘤来源于胸膜的间皮细胞及胸膜下间皮组织,是一种较少见的胸部恶性肿瘤。该病常常被误诊为肺癌,发病率有逐年增加的趋势。现将笔者对28例恶性胸膜间皮瘤临床病理诊断和鉴别诊断分析报告如下。     

骨原发性恶性纤维组织细胞瘤的影像学诊断

目的 探讨骨恶性纤维组织细胞病的影像学表现及诊断。方法 28例经病理检查证实的骨原发性恶性纤维组织细胞瘤影像学表现进行回顾性分析。结果 19例位于长骨干骺端,其中股骨10例,胫骨6例;15例X线表现偏心性溶骨性改变;23例CT表现为边界清楚的结节状略低密度软组织密度肿块;25例病灶强化不明显;28例MRI表现边界清楚软组织密度肿块,23例T_1加权像呈不均匀中等信号,T_2加权像呈高信号;24例病灶强化不明显。讨论 CT、MRI强化不明显对骨原发性恶性纤维组织细胞瘤的诊断具有相对特异性。     

原发性骨恶性纤维组织细胞瘤的影像学诊断

目的探讨原发性骨恶性纤维组织细胞瘤(PBMFH)的影像学表现及其诊断价值。方法回顾性分析经手术病理证实的7例原发性BMFH的X线片、CT、MRI表现,总结不同影像学检查方法的诊断价值。结果 7例BMFH中,位于长骨4例,扁骨及不规则骨3例,X线、CT表现为溶骨性骨破坏,其中5例呈地图样、虫蚀样,2例呈无结构的溶骨性破坏,5例骨皮质中断,4例骨髓内软组织肿块,纵径大于横径,密度与周围肌肉相仿,髓外软组织肿块,范围大于溶骨病变,软组织块内均未见钙化,2例骨鞘完整,5例不完整。MRI表现以长T1长T2信号为主的骨质破坏区,其软组织肿块T1呈稍低信号,T2呈不均匀高信号影,压脂序列呈高信号影,周围大片状软组织水肿。结论骨恶性纤维组织细胞瘤的X线、CT和MRI具有一定的特征性表现,若中年人出现单发长骨骨内不规则骨质破坏且软组织肿块大于骨质破坏区,骨膜反应不明显但大范围水肿时应考虑骨恶性纤维组织细胞瘤可能。     

胸膜结核的CT诊断

目的 探讨胸膜结核的CT表现.方法 回顾分析23例已确诊的胸膜结核病例的CT资料.结果 渗出性胸膜病变14例,其中单侧性胸腔积液11例,双侧胸腔积液3例,合并活动性肺内结核2例.局限性胸膜病变6例,其中包裹性胸腔积液3例,胸膜结节样增厚2例,胸膜局部钙化1例.慢性胸膜改变3例,其中胸膜弥漫增厚伴弧线状钙化1例.结论 CT可以检出少量胸水和被胸水掩盖的肺内结核灶;能敏感地发现钙化灶,准确鉴别胸膜病变与肺实质病变;有助于判断结核性胸膜病变的活动性.     

Anti-angiogenic therapies for malignant pleural mesothelioma

Introduction: Malignant pleural mesothelioma (MPM) is a disease with a dismal prognosis. Currently available treatments have modest results. Therefore, new agents and new treatment strategies are eagerly awaited by patients and clinicians. Preclinical and clinical studies have shown that angiogenesis plays a very important role in MPM. Therefore, a great hope has been placed in the use of anti-angiogenic agents in this disease.

Areas covered: Studies regarding anti-angiogenic treatments in MPM with bevacizumab, tyrosine-kinase inhibitors (TKIs) and other agents were critically analyzed, with an overview of ongoing trials and future perspectives, including research on biomarkers.

Expert opinion: The clinical use of angiogenesis inhibitors in MPM patients has resulted more challenging than anticipated. The intrinsic complexity of neo-angiogenesis, and its redundant regulatory mechanisms, suggests that multiple and different biomarkers are needed to predict efficacy of anti-angiogenic agents and to monitor their biological and therapeutic effects. The growing understanding of the molecular alterations and key pathways that underlie the resistance to VEGF inhibitors will allow to design studies of the combination of agents targeting these pathways with anti-VEGF therapies. Only a tight integration of preclinical and clinical studies will allow to achieve a real progress in MPM patients with this therapeutic strategy.     

血管生成抑制剂治疗恶性胸膜间皮瘤的有效性及安全性的Meta分析

目的 系统评价血管生成抑制剂治疗恶性胸膜间皮瘤(MPM)的有效性及安全性.方法 计算机检索中英文4种数据库,包括PubMed、The Cochrane Library、Embase、中国知网(CNKI),收集血管生成抑制剂治疗MPM的临床随机对照试验(RCT).经过对研究数据的提炼以及对纳入RCT的质量评估后,采用Re...     

胸膜间皮瘤致多年胸腔积液1例并文献复习

目的研究生存期长的恶性胸膜间皮瘤(MPM)患者的特点。方法报告2010年1月大连市中心医院呼吸科收治的1例病程达10年之久并发胸腔积液的MPM病例并相关文献复习。结果患者男,77岁,反复活动后呼吸困难10年,加重2月,每年行2～4胸膜腔穿刺术检查,缓解症状,否认石棉接触史,肺CT:右胸腔积液伴包裹,余未见异常。胸腔镜检查镜下见脏层胸膜、壁层胸膜广泛半透明小结节样凸起,病理明确为上皮细胞型MPM。结合此例患者和文献复习,病理类型为高分化上皮细胞型和无石棉接触史的MPM患者生存期长。结论病理类型为上皮细胞型和无石棉接触史的MPM患者生存期长,研究生存期长的MPM患者的特点对识别影响肿瘤侵袭和生存期相关的独特的因素是有价值的。     

The role of in vivo molecular imaging with PET and SPECT in the elucidation of psychiatric drug action and new drug development

This paper reviews the contribution of human PET and SPECT neuroreceptor occupancy studies to the understanding of drug action in psychiatric illness, and how they can aid the development of new drugs. All effective antipsychotics show significant D₂ receptor occupancy. However, at least for atypical antipsychotics, there is no clear relationship between occupancy and clinical response. The mechanisms underlying antipsychotic efficacy, and the minimal effective D₂ occupancy, remain to be elucidated, particularly for drugs with modest or transient occupancy. The low liability of some atypical antipsychotics for extrapyramidal side effects does not appear to be explained by their 5-HT_2A antagonism, and the muscarinic receptor occupancy of some drugs may be partly explanatory. Previous reports of apparent ‘limbic selectivity’ of atypical antipsychotics may be in error, and may be due to technical differences in radiotracers. For SSRIs, high occupancies at the serotonin transporter (SERT) are achieved at therapeutic doses, although the minimum SERT occupancy required for therapeutic response remains undefined. Previous attempts to augment the antidepressant effect of SSRIs by pindolol have generally used daily doses which result in inadequate 5-HT_1A receptor occupancy. For benzodiazepines, clinical doses would appear to leave a wide margin of unoccupied receptors. For methylphenidate and cocaine, typical doses occupy more than 50% of dopamine transporters, and their profiles are extremely similar. In therapeutic drug development, these techniques may be used to assess receptor occupancy profiles, likely drug dosages and dosing intervals which cannot be reliably assessed in humans by other methods.     

青少年单纯性椎小关节紊乱的影像学诊断

目的 探讨青少年脊椎椎小关节紊乱的发病机制,分析其临床表现及影像学表现,以明确诊断.方法 回顾性分析250例10～30岁年龄组椎小关节紊乱引起颈、胸、腰背部酸痛患者的脊椎X线平片或CT平扫片或MRI片资料.结果 青少年椎小关节紊乱有典型椎小关节不对称、关节面笔样增生硬化及周围软组织非特异炎性改变等影像学表现.结论 青少年单纯性椎小关节紊乱在影像学上可以明确诊断及鉴别诊断,X线检查仍是诊断椎小关节紊乱的重要手段,CT及MRI可以更清楚显示椎小关节及其周围软组织的改变,还可以鉴别椎间盘突出性改变或其他原因引起的病患.     

磁共振成像在恶性胆道梗阻临床诊断中的应用

目的探讨磁共振成像在恶性胆道梗阻中的应用价值。方法对63例经手术病理或临床治疗证实的恶性胆道梗阻性患者,回顾性分析其影像学表现及与临床病理的关系。所有患者均做MR检查,采用单次激发放射状自旋回波序列技术。其中胆囊癌2例,肝门转移癌7例,胆管癌43例,胰头癌11例。结果本组63例MR检查均一次成功,肝内外胆管显示率100%。MRI定位诊断准确率为92.1%,定性诊断准确率为87.3%。结论MR是一种无创性的有效检查手段,能清晰显示正常或异常的胰胆管结构,定位和定性诊断准确率高,能为临床提供十分有意义的诊断资料。     

Chemotherapy of malignant pleural mesothelioma

Background: Owing to worldwide use of asbestos during the past century, the global incidence of mesothelioma is still increasing. Although the outcome for patients remains poor, there has been definite progress in the systemic treatment of this disease within the past 5 years. Objective: By examining the clinical trials performed and the role of novel emerging agents, this review aims to provide an ‘expert opinion’ on evidences that validate chemotherapy as current ‘standard of care’ for inoperable mesothelioma. Methods: Relevant literature about clinical trials was reviewed using a PubMed search and other relevant data about novel therapeutic approaches both established and in development. Conclusion: The response rates achieved using chemotherapeutic treatments are higher than previous ones, and in the future may be improved by the use of combined and personalized therapies.     

^18F-脱氧葡萄糖正电子发射断层显像-X线计算机断层显像误诊分析

目的探讨^18F-脱氧葡萄糖正电子发射断层显像-X线计算机断层显像（FDGPET／CT）肿瘤显像与误诊原因。方法分析3例^18F-FDGPET／CT误诊为恶性肿瘤的临床资料并复习相关文献。结果全身^18F-FDGPET／CT显像在恶性肿瘤诊断、分期、疗效评价和预后判断等方面有明确的临床价值,但炎症、结核是最常见的非肿瘤性浓聚原因,常导致临床误诊。结论^18F-FDGPET／CT对恶性肿瘤的诊断有一定的价值,但易出现假阳性,特别是炎症、结核较为常见。因此,临床工作中,对恶性肿瘤的诊断应谨慎结论。     

Advances in treatment of mesothelioma

Introduction: Malignant pleural mesothelioma (MPM) is an uncommon, aggressive cancer, derived from pleural mesothelial cells, that has a close relationship to asbestos exposure. To date, MPM prognosis is poor and very few treatment options are available for both localized and advanced MPM. Areas covered: The standard of care is still chemotherapy with platinum derivates and antifolate agents. In the last few years, several new agents have been studied on the basis of mesothelioma carcinogenesis and invasiveness mechanisms; however, the recent results are poor and few drugs have been tested in phase III trials because of toxicity or because they did not improve patient outcomes. The aim of this review is to focus on the current available treatment for MPM through the analysis of the results comes from the phase III trials and to discuss the future perspectives in the pathogenesis, diagnosis and treatment. Expert Opinion: Many compounds are currently under investigation in different subsets of patients. Interesting data have come from preliminary studies on immunotherapy, but randomized studies are needed to confirm the preliminary positive results of this new strategy. A better comprehension of MPM pathogenesis should be obtained to improve and develop new diagnostic tools and target therapies.