氢质子磁共振波谱在颅内肿瘤放疗效果评价中的应用研究

目的探讨颅内肿瘤放疗后采用氢质子磁共振波谱(~1HMRS)评价其疗效的临床应用价值。方法选择需行放疗的颅内肿瘤患者40例,在放疗前后分别观察和测量肿瘤和对侧正常组织的N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酐(Cr)。计算肿瘤组织放疗前后的NAA/Cr、Cho/Cr、Cho/ NAA的比值,并以Cho、Cbo/NAA为观察指标,随访1年。结果颅内肿瘤放疗后,~1HMRS表现为Cho明显降低,NAA、Cr下降,Cho/Cr下降最明显,部分患者出现放射性坏死波。随访中有8例患者局部复发,~1HMRS表现为Cho、Cho/NAA再升高,未复发的患者~1HMRS未见明显异常。结论~1HMRS可评估颅内肿瘤放疔后的代谢变化,是一种判断其疗效的有价值的检查方法。     

氢质子磁共振波谱联合磁共振成像对脑胶质瘤的诊断价值

目的探讨氢质子磁共振波谱(1H-MRS)联合磁共振成像(MRI)对脑胶质瘤的诊断价值。方法选取2015年10月至2016年10月间哈尔滨医科大学附属第二医院收治的48例脑胶质瘤患者,其中低级别脑胶质瘤30例,高级别脑胶质瘤18例。均在行MRI基础上行1H-MRS检查,检测N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和胆碱(Cho),分析患者肿瘤实质区与瘤周水肿区的低级别脑胶质瘤和高级别脑胶质瘤Cho/Cr和Cho/NAA的差异。结果 MRI扫描显示低级别脑胶质瘤和高级别脑胶质瘤的瘤周水肿区的水肿和肿瘤实质区的强化程度对比,差异均无统计学意义(均P>0.05)。1H-MRS扫描显示高级别脑胶质瘤的肿瘤实质区的Cho/Cr和Cho/NAA值与瘤周围水肿区的Cho/Cr值均高于低级别脑胶质瘤,差异均有统计学意义(均P<0.05)。而高级别脑胶质瘤和低级别脑胶质瘤瘤周水肿区的Cho/NAA值比较,差异无统计学意义(P>0.05)。结论在传统MRI扫描的基础上联合使用1H-MRS,可以提供定量的检测结果来评价肿瘤的恶性度,为脑胶质瘤做出准确的分级诊断。     

氢质子磁共振波谱成像在脑肿瘤中的应用价值

磁共振波谱（meganetic resonance spectroscop，MRS）能无创性地检测活体器官组织代谢及定量分析化合物的浓度，文章主要综述了1H—MRS在不同脑肿瘤中代谢物的变化及其对脑肿瘤诊断与鉴别诊断、肿瘤分级、放疗等方面的应用。     

氢质子磁共振波谱对脑膜瘤的诊断价值

目的 探讨脑膜瘤氢质子磁共振波谱的表现特点。方法 对20例脑膜瘤行常规磁共振检查、肿瘤部位及健侧相应部位二维相位编码氢质子磁共振波谱成像（2D 1HMRS）检查。分析脑膜瘤的常规磁共振表现,对照分析肿瘤和健侧的磁共振波谱特点。检查包括SE序列, 平扫横断T1WI、T2WI, 所有病例均作了Gd DTPA T1WI横、冠、矢状位增强扫描。结果 20例脑膜瘤中,16例在T1WI表现为等低信号影,3例为混杂信号影;14例在T2WI呈等高信号, 6例为混合信号影,Gd DTPA增强扫描肿瘤实性部分均有不同程度的明显强化, 9例可见“脑膜尾征”。波谱分析见脑膜瘤较健侧Cho峰升高(P＜0.05),Cr峰降低(P＜0.05),Cho/Cr值升高(P＜0.01),未见NAA峰。其中2例出现Lac峰。9例可见Ala峰。结论 脑膜瘤的1HMRS表现有一定的特征性,1HMRS可成为脑膜瘤诊断的重要补充手段。     

新型1.5T MR对大鼠诱发肝癌进行1 H-MRS扫描可行性的初步分析

目的：探讨应用新型1．5T磁共振扫描仪对二乙基亚硝胺(DEN)诱发大鼠肝癌实施氢质子磁共振波谱(^1H-MRS)检查的可行性，并对该模型不同阶段的波谱曲线变化特征作初步了解。方法：建立诱发Wistar大鼠肝癌模型，分阶段随机抽取动物进行^1H—MRS检查，而后处死动物，对其肝脏进行组织学观察。结果：3只大鼠意外死亡，其余27只(90％)大鼠均按照计划进行了扫描及病理处置。T1WI图像显示解剖结构较好，但在病变细节方面不如T1WI序列。经过逐步改良扫描方法，本组单体素和多体素扫描的成功率分别达到64％及50％.结论：DEN诱导大鼠肝癌模型适合用于影像研究，新型1．5T磁共振扫描机对大鼠肝脏的^1H-MRS检查是可行的。     

脑胶质瘤氢质子磁共振波谱代谢物与Ki-67抗原的相关性及其应用价值

摘 要：［目的］ 探讨胶质瘤氢质子磁共振波谱（1-H magnetic resonance spectroscopy,1H-MRS）所示代谢物值与Ki-67抗原的相关性及其应用价值。［方法］ 回顾性分析83例术前行1H-MRS检查、术后病理学结果为脑胶质瘤的患者资料,对比分析胶质瘤实质部位主要代谢物N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）及其比值（Cho/Cr、Cho/NAA、NAA/Cr）与Ki-67表达的相关性。［结果］ Cho/Cr、Cho/NAA比值与Ki-67表达呈正相关(r=0.257,P=0.019;r=0.329,P=0.002),NAA/Cr比值与Ki-67表达呈负相关(r=-0.206,P=0.049);Lip出现率与Ki-67表达呈正相关（r=0.304,P=0.005）。［结论］ 1H-MRS检查的各代谢物值与Ki-67表达关系密切,可有效反应脑胶质瘤的增殖活性,其中Cho/NAA比值的诊断价值最高。     

氢质子磁共振波谱(~1H-MRS)分析对放射性脑坏死与脑肿瘤复发的鉴别作用

目的:探讨氢质子磁共振波谱分析(1H-MRS)对放射性脑坏死和脑肿瘤复发的鉴别作用。方法:选择35例经放射治疗后,在常规MRI图像上发现原肿瘤部位或周边有新的异常强化灶的脑恶性胶质瘤、脑转移瘤患者,其中3-4级胶质瘤18例,脑转移瘤17例。多体素1H-MRS采用PRESS序列。研究指标包括N-乙酰门冬氨酸(NAA)、胆碱(Cho)及肌酐(Cr)。结果:NAA、Cho及Cr下降或消失,NAA/Cr比值与Cho/Cr比值均下降;脑肿瘤复发Cho上升,NAA明显下降。脑肿瘤复发和放射性脑坏死之间,Cho/Cr、Cho/NAA有统计学差异(P<0.05),NAA/Cr无统计学差异(P>0.05)。结论:1H-MRS对脑肿瘤放射治疗后的脑坏死及脑肿瘤复发的评估和鉴别诊断有重要临床应用价值。     

氢质子磁共振波谱（^1H-MRS）分析对放射性脑坏死与脑肿瘤复发的鉴别作用

目的：探讨氢质子磁共振波谱分析（^1H-MRS）对放射性脑坏死和脑肿瘤复发的鉴别作用。方法：选择35例经放射治疗后,在常规MRI图像上发现原肿瘤部位或周边有新的异常强化灶的脑恶性胶质瘤、脑转移瘤患者,其中3—4级胶质瘤18例,脑转移瘤17例。多体素^1H-MRS采用PRESS序列。研究指标包括N-乙酰门冬氨酸（NAA）、胆碱（Cho）及肌酐（Cr）。结果：NAA、Cho及Cr下降或消失,NAAVCr比值与Cho／Cr比值均下降;脑肿瘤复发Cho上升,NAA明显下降。脑肿瘤复发和放射性脑坏死之间,Cho／Cr、Cho／NAA有统计学差异（P〈0．05）,NAAVCr无统计学差异（P〉0．05）。结论：^1H-MRS对脑肿瘤放射治疗后的脑坏死及脑肿瘤复发的评估和鉴别诊断有重要临床应用价值。     

磁共振质子波谱在颅内肿瘤放疗效果评价中的应用研究

Objective： To evaluate the clinical application of proton magnetic resonance spectroscopy （1HMRS） in patients with radiotherapy treated intracranial tumors. Methods： Forty patients with intracranial tumors underwent multivoxel 1HMRS examination before and after radiotherapy. The concentrations of N-acetyl aspartate （NAA）, choline （Cho） and creatine （Cr） were obtained both in the tumors and the contralateral normal brain regions, The ratios of NANCr, Cho/Cr and Cho/NAA were calculated at the same time and follow-up one year. Results： （1） After radiotherapy, tumors inhibited by radiation had decreased Cho, NAA and Cr on proton MRS. Some cases showed necrotic wave. （2） During the one year follow-up, local tumor recurred in 8 cases and their Cho and Cho/NAA increased high again. Other cases without recurrence, HMRS showed no change. Conclusion： Multivoxel proton MR spectroscopy is available for study of tumor metabolites after radiotherapy and it is a valuable method in the evaluation of radiotherapy treated tumors,     

42例脑胶质瘤及转移瘤放疗前后磁共振质子波谱变化

[目的]探讨脑胶质瘤及转移瘤放疗后磁共振质子波谱（^1 HMRS）的变化。[方法]脑胶质瘤及转移瘤患者42例分别在放疗前后测量肿瘤和对侧脑组织的N2乙酰天冬氨酸（NAA）、胆碱（Cho）、肌酐（Cr）、乳酸（Lac）、脂质（Lip）峰值。[结果]42例脑胶质瘤及转移瘤放射治疗后，^1 HMRS均表现为NAA、Cho、Cr降低，Cho及Cho／Cr降低最明显，放射性坏死灶可表现出乳酸——脂质峰（Lac-Lip峰）。[结论]^1 HMRS可评估肿瘤放疗后的代谢变化，是一种判断近期疗效较有价值的检查方法。     

Proton beam therapy for hepatocellular carcinoma

BACKGROUND:

The authors have published a series of studies evaluating the safety and efficacy of proton beam therapy for the treatment of hepatocellular carcinoma in a variety of clinical settings. In the current study, they retrospectively reviewed their entire experience treating hepatocellular carcinoma patients with proton beam therapy at their hospital‐based facility at the University of Tsukuba.

METHODS:

From November 2001 to December 2007, 333 patients with hepatocellular carcinoma were treated with proton beam therapy at the University of Tsukuba. A total of 318 patients were included in this study. Total dose delivered and fractionation scheme were determined by protocols that varied based on location of tumor. Survival rates and prognostic factors were assessed.

RESULTS:

Overall actuarial survival rates at 1‐year, 3‐years, and 5‐years were 89.5% (95% confidence interval [95% CI], 85.7‐93.1%), 64.7% (95% CI, 56.6‐72.9%), and 44.6% (95% CI, 29.7‐59.5%), respectively. Child‐Pugh liver function (hazards ratio [HR], 2.84; P < .01), T stage (HR, 1.94; P < .05), performance status (HR, 2.12; P < .01), and planning target volume (HR, 2.12; P < .05) significantly impacted survival. The 3‐year and 5‐year survival rates were 69.1% (95% CI, 59.9‐78.3%) and 55.9% (95% CI, 41.5‐70.3%), respectively, for patients with Child‐Pugh A disease and 51.9% (95% CI, 32.3‐71.5%) and 44.5% (95% CI, 23.1‐65.8%), respectively, for patients with Child‐Pugh B disease. The actuarial survival rates of patients with Child‐Pugh class A were statistically different between groups of planned target volume ≤125 mL and >125 mL (P < .05).

CONCLUSIONS:

The authors have shown proton beam therapy to be both safe and effective for the treatment of patients with hepatocellular carcinoma. They strongly recommend the consideration of proton beam therapy in patients for whom other treatment options are risky or contraindicated. Cancer 2009. © 2009 American Cancer Society.     

Proton beam therapy for hepatocellular carcinoma

Introduction: Radiation therapy is an effective treatment option for hepatocellular carcinoma (HCC) patients. However, radiotherapy for HCC still has limited recognition as a standard treatment option in international consensus guidelines due to a paucity of randomized controlled trials and the risk of hepatotoxicity, which is primarily mediated by baseline liver function and dose delivered to non-tumor liver cells. Proton beam therapy (PBT) may offer advantages over photon-based radiation treatments through its dosimetric characteristic of sparing more liver volume at low to moderate doses. PBT has the potential to reduce radiation-related hepatotoxicity and allow for tumor dose escalation.

Areas covered: This article reviews the clinical rationale for using PBT for HCC patients and clinical outcome and toxicity data from retrospective and prospective studies. PBT-specific technical challenges for these tumors and appropriate selection of patients to be treated with PBT are discussed.

Expert commentary: Local control, overall survival, and toxicity results are promising for liver PBT. Future studies, including ongoing randomized cooperative group trials, will aim to determine the incremental benefit of PBT over photons and which patients are most suitable for PBT.     

CT及MR多期动态增强扫描对肝细胞肝癌介入治疗后随诊的对比分析

目的比较多排螺旋CT与MR多期动态增强扫描对肝细胞肝癌（HCC）经肝动脉化疗栓塞（TACE）后肿瘤局灶复发或残存的诊断价值。方法18例结节型HCC患者共38个病灶,TACE介入后22天-11个月分别行多排螺旋CT增强扫描及MRLAVA多期增强扫描,检查平均间隔9天（1～21天）。2位影像诊断医师分别读片,评价肿瘤复发或残存。所有病灶经血管造影、碘油CT、随诊等方法证实。通过计算2种诊断方法的ROC曲线下面积（Az）,比较两者诊断的准确性,并评价CT及MR诊断的敏感性差异。结果38个病灶中24个有肿瘤复发或存活,Az值分别为0．948±0．035和0．762±0．074（P〈0．05）,MRLAVA诊断的准确性显著高于CT扫描。根据诊断复发的评分标准,MRLAVA诊断存活肿瘤组织的敏感性为87．5％（21／24）,CT的敏感性为45．8％（11／24）,MRLAVA多期增强扫描的敏感性显著高于CT增强扫描（P〈0．05）。结论在评估肝细胞肝癌TACE治疗后肿瘤残存或复发方面,MR多期增强扫描优于CT增强扫描。     

Proton MR spectroscopy of the breast

Magnetic resonance imaging (MRI) of the breast has emerged as a highly sensitive modality. In addition to morphologic and kinetic analysis obtained from contrast-enhanced breast MRI, functional information has been needed for diagnosis of breast disease. In vivo proton (hydrogen 1 [¹H]) MR spectroscopy of the breast has demonstrated that choline (Cho) can be detected in breast cancers, whereas Cho is generally undetectable in normal breast tissue. Thus, breast MR spectroscopy has shown great promise as a way to differentiate between benign and malignant lesions and to gauge the effect of chemotherapeutic agents in patients with locally advanced breast cancer. Prior studies performed on 1.5-T MR imagers have reported sensitivities of 70–100% (average 89%; 149/168) and specificity of 67–100% (average 87%; 97/112) for breast MR spectroscopy. Moreover, the presence of a Cho peak in breast cancer may reflect the increased cell proliferation, with a decrease in this peak after treatment reflecting decreased viability of the tumor. With further development and the assessment of Cho quantity in the tumor, breast MR spectroscopy may be helpful in the elucidation of the biology of breast cancer.     

Microwave ablation with chemoembolization for large hepatocellular carcinoma in patients with cirrhosis

Objective: To evaluate the safety and long-term outcomes of microwave ablation (MWA) combined with transarterial chemoembolization (TACE) in a single stage for the treatment of hepatocellular carcinoma (HCC) with a maximum diameter of 5.0–10.0?cm.

Methods: From January 2013 to December 2016, 84 consecutive HCC patients with cirrhosis from two medical centers who underwent MWA-TACE as a first-line treatment for up to three HCCs with maximum diameters of 5.0–10.0?cm were included. Feasibility, safety and effectiveness were evaluated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan–Meier method. Cox regression models were used to identify the prognostic factors.

Results: The technique was successfully performed in all the patients. Grade 3 complications consisted of two cases of hemoperitoneum requiring blood transfusions and embolization. The cumulative incidence of local tumor progression was 25.8% at 3?years, with tumor size found to be the only significant predictive factor (p?=?.007). The cumulative incidence of OS was 81%, 68% and 49% at 1, 2 and 3?years, respectively. According to the Cox proportional hazards model analysis, serum AFP level, Child-Pugh class and tumor number were significant prognostic factors for OS.

Conclusion: MWA-TACE is a safe, feasible and effective therapy for the treatment of 5.0- to 10.0-cm HCC lesions in patients with cirrhosis.     

磁共振弥散加权成像评价肝癌冷冻术后近期疗效

目的:探讨采用磁共振弥散加权成像(MRI-DWI)对鉴别肝细胞性肝癌(HCC)冷冻术后肿瘤坏死、残留的应用价值.方法:对接受冷冻治疗的27例肝癌患者共30个病灶行T1 WI、T2WI常规MRI平扫、DWI序列及动态增强扫描.观察肿瘤冷冻前、后MRI信号改变.对HCC一般特征与ADC值的相关性进行分析.比较冷冻前后正常肝脏、肿瘤组织及术后坏死、残留组织的ADC值.结果:冷冻坏死的肝肿瘤组织在T1WI图中呈稍低或稍高信号,T2WI呈低或等信号,DWI呈低信号,动态增强无强化.活性残留肿瘤14个(其中12个肿瘤直径＞5.0 cm),残留率为46.7％.b值=800 s/mm2时,ADC值由低到高依次为:术后残留肿瘤组织(0.98±0.17)×10-3 mm2/s、术前肝肿瘤组织(1.03±0.20)×10-3 mm2/s、正常肝组织(1.14 ±0.07)×10-3mm2/s、术后坏死肿瘤组织(2.07±0.23)×10-3 mm2/s.肝肿瘤组织与对照组正常肝组织ADC值相比,差异有统计学意义(P=0.016).肝肿瘤组织ADC值与肿瘤大小不相关(r=-0.10,P=0.614),与直径范围,肿瘤分期、是否远端转移无关(P＞0.05)、与分化程度有关(P＜0.05).肿瘤坏死区ADC值与术前肿瘤组织相比,差异均有显著统计学意义(P＜0.01).残留组织ADC值与坏死组织及正常肝组织相比,差异均有统计学差异(P＜0.01,P=0.03),与肿瘤组织相比无统计学差异(P=0.192).结论:MRI-DWI能有效鉴别肝癌冷冻术后的病灶坏死及残留,为进一步的临床诊治提供影像学依据.     

肝细胞癌经导管动脉化疗栓塞前后磁共振波谱研究

背景与目的:肝脏活体氢质子磁共振波谱(1H proton magnetic resonance spectroscopy,1HMRS)尚处于实验阶段,用1HMRS观察肝癌经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)疗效报道少。本研究旨在用1HMRS评价肝细胞癌TACE术前后代谢物的改变。方法:对25例肝细胞癌患者,应用GESignaHorizonLX、1.5T磁共振扫描仪,分别在TACE术前后进行MRS检查,所得的数据经机器自带的分析软件FuncTool2.5.36处理,得出术前术后Cho/Lip比值、Glu/Lip比值、Glx/Lip比值,并进行统计学分析。结果:成功实施MRS有21例,Cho/Lip比值TACE术前为0.21±0.08,术后为0.10±0.08;Glu/Lip比值TACE术前为0.11±0.05,术后为0.07±0.07;Glx/Lip比值术前为0.28±0.10,术后为0.18±0.12。术前术后比较,均P<0.05。结论:MRS可观查到肝癌TACE术前后的代谢物改变。