CT增强扫描对脑星形细胞瘤的诊断价值

目的 总结分析脑星形细胞瘤的增强CT表现,以提高对该病的诊断与鉴别诊断能力.方法 分析47例经手术病理证实的各级星形细胞瘤的CT平扫、增强表现及水肿特点并与病理进行对照.结果 47例中,幕上43例,幕下4例,其中,Ⅰ级8例,Ⅱ级18例,Ⅲ级11例,Ⅳ级10例.平扫呈低密度或等低混杂密度,增强后Ⅰ级星形细胞瘤多无强化,水肿轻或无;Ⅱ级呈断续或连续环结节形强化或片团状强化居多,水肿程度不一;Ⅲ级～Ⅳ级多呈环结节型片团状伴囊变或厚壁花环状强化,且实体部分强化程度较Ⅰ级～Ⅱ级明显,水肿较重.结论 增强扫描对脑星形胶质细胞瘤良恶性鉴别分级有重要参考意义.     

脑胶质瘤伽玛刀术后MR影像学分析(附106例分析)

目的　评价脑胶质瘤伽玛刀疗效及放射反应特点。方法　分类型分阶段对 10 6例脑胶质瘤患者伽玛刀术后复查的 189份MR资料进行归纳分析。结果　室管膜瘤及少枝胶质疗效最好 ,其次为星形细胞瘤Ⅰ～Ⅱ级 ,星形细瘤Ⅲ～Ⅳ级疗效欠佳。星形细胞瘤Ⅰ～Ⅱ级术后 1年内有效率高于术后 2～ 3年。术后第 2年是灶周水肿及特征性的放射性强化发生的高峰期。结论　伽玛刀是治疗胶质瘤的一种有效方法 ,尤其是室管膜瘤、少枝胶质瘤及星形细胞瘤Ⅰ～Ⅱ级。其放射反应性的灶周水肿及病灶强化具有可逆性。     

不同级别星形细胞瘤MRI表现与病理的相关性

目的 探讨不同级别星形细胞瘤MRI征象与病理分型的关系.方法 回顾性分析经病理证实的42例星形细胞瘤MRI表现.结果 42例星形细胞瘤中,WHO Ⅰ级者5例(11.9%),其中毛细胞型星形细胞瘤4例,室管膜下巨细胞星形细胞瘤1例,肿瘤边界清楚,信号均匀,瘤周水肿0级,有明显囊变坏死,无出血,增强后无明显强化;WHO Ⅱ级者13例(31.0%),其中弥漫性星形细胞瘤11例,多形性黄色星形细胞瘤2例,肿瘤边界欠清,信号不均,瘤周水肿Ⅱ级,有囊变坏死,仅有1例有出血,增强后强化程度不等;WHO Ⅲ级者6例(14.3%),肿瘤边界不清,信号不均,瘤周水肿Ⅱ级,有囊变出血,坏死少见,增强呈不均匀强化;WHO Ⅳ级者18例(40.5%),肿瘤边界不清,信号杂乱,瘤周水肿Ⅲ级,有明显囊变坏死及出血,其典型表现是环形强化伴中央区坏死.结论 不同级别星形细胞瘤的MRI表现与病理分型具有相关性,结合MRI表现可以提示病理分型,提高MRI对星形细胞瘤的定性定级水平,从而有助于临床医生选择确定手术方案,最终达到提高患者术后生存质量的目的.     

星形胶质瘤MRI的表现与病理分级的相关性

目的：探讨星形胶质瘤的病理分级与MRI表现的相关性。方法：对90例经CT、MRI检查并经病理证实的胶质瘤(其中Ⅰ级40例、Ⅱ级19例、Ⅲ一Ⅳ级31例)进行回顾性对比分析，观察肿瘤的MRI表现及其病理分级关系。结果：肿瘤的MRI表现及其病理分级具有相关性。结论：评价胶质瘤的CT、MRI的某些特征表现对胶质瘤的术前分级和制定治疗方案具有重要意义。     

CT脑灌注成像各参数在脑星形细胞瘤分级中诊断价值的差异

目的:使用脑血流CT灌注图像各参数评价脑星形细胞瘤的血流动力学特点,探讨与肿瘤分级的相关性。方法:回顾性分析27例病理证实为脑星形细胞瘤患者的CT灌注图像。按照WHO神经上皮肿瘤分级标准(2007年),将所有患者分为低级别组(WHOⅠ级或Ⅱ级)与高级别组(WHOⅢ级或Ⅳ级)。在PCT图上测量肿瘤的表面渗透性(PS)、血容量(CBV)、血流量(CBF)和平均通过时间(MTT)各参数数值。使用Wilcoxon检验分析对低级别组与高级别组、Ⅲ级组与Ⅳ级组的各参数值进行组间比较。使用受试者操作特征(ROC)曲线评价各参数对鉴别低级别与高级别脑星形细胞瘤、Ⅲ级与Ⅳ级脑星形细胞瘤的诊断价值。结果:低级别组的PS、CBV、CBF较高级别组低,其差异具有统计学意义。WHOⅢ级组的PS值较WHOⅣ级组低,差异具有统计学意义。各组间MTT差异均无统计学意义。在区别高级别与低级别脑星形细胞瘤时,PS、CBV、CBF、MTT的ROC曲线下面积分别为0.954、0.895、0.855、0.441。区别Ⅲ级和Ⅳ级脑星形细胞瘤时,PS、CBV、CBF、MTT的ROC曲线下面积分别为0.943、0.682、0.642、0.551。结论:PS、CBV、CBF有助于脑星形细胞瘤的分级判定,PS对区别Ⅲ、Ⅳ级脑星形细胞瘤具有一定价值。     

脑多发胶质瘤影像特点与病理结果的对比分析

目的:探讨脑多发性胶质瘤的影像学特点与病理结果关系,并对其结果进行对比分析,提高对本病的认识和临床诊断.方法:选取我院经手术病理证实的脑多发性胶质瘤患者14例,所有患者均行头部CT和MRI平扫及增强扫描,所有病灶均行手术取材,进行组织病理学切片检查,比较患者影像学特征和病理结果.结果:影像表现为脑内各叶多发肿块样病灶,病变主要在额叶、颞叶呈弥漫性生长,病灶间相互独立.影像MRI增强扫描共显示30个病灶,呈中度至明显强化的病灶13个,都以不均匀强化方式为主,其中有12个经病理证实为星形胶质瘤WHOⅢ-Ⅳ级;17个病灶无明显或轻度强化,其中13个经病理证实为星形胶质瘤WHOⅡ级,3例为少突胶质细胞瘤Ⅱ级.结论:脑多发胶质瘤影像表现特征与其病理学类型及分级相关,可初步诊断该疾病并判断其恶性程度,对临床治疗提供帮助,值得进一步推广应用.     

小儿脑胶质瘤CT表现与PCNA表达相关性研究

目的:探讨小儿脑胶质瘤CT表现与增殖细胞核抗原(PCNA)表达的相关性。方法:搜集经术前CT诊断及手术后病理证实的脑胶质瘤46例,分析CT表现,并进行PCNA免疫组织化学染色,测定PCNA标记指数。结果:低级别胶质瘤(Ⅰ~Ⅱ级)的PCNALI明显低于高级别胶质瘤(Ⅲ~Ⅳ级)(P<0.05),胶质瘤的密度均匀度、瘤周水肿程度及强化程度与PCNA表达水平差异有统计学意义,胶质瘤的部位与PCNA表达水平差异无统计学意义。结论:小儿脑胶质瘤CT表现与PCNA的表达水平密切相关,CT表现能够间接反映小儿脑胶质瘤的生物学行为。     

星形细胞瘤rCBF图与rCBV图的表现差异及其意义

目的 比较星形细胞瘤局部脑血流量(rCBF)图与局部脑血容量(rCBV)图的表现差异并探讨其意义.资料与方法 对29例星形细胞瘤患者(Ⅰ～Ⅱ级15例,Ⅲ～Ⅳ级14例),行CT平扫及灌注检查,得到时间-密度曲线(TDC),生成脑血流量(CBF)图、脑血容量(CBV)图,比较感兴趣区的rCBF和rCBV.结果 24例星形细胞瘤rCBF图与rCBV图表现一致;5例局部区域的rCBF图与rCBV图表现不一致,呈现低rCBF、中等或高rCBV.结论 星形细胞瘤rCBF、rCBV图表现可不一致,在术前分级和判定疗效时应予重视.     

立体定向星形细胞瘤活检的病理与CT影像学关系之探讨

对25例星形细胞瘤患者在CT导向下行立体定向活检术的病理结果与CT影像学关系进行探讨.发现星形细胞瘤的组织分级与CT影像间有密切的关系.4例CT表现低密度无增强型,病理证实为星形细胞瘤Ⅰ级.2例CT表现低密度造影后有增强,病理证实为星形细胞瘤Ⅱ级.19例CT为混杂密度,造影后有结节或不规则增强,病理证实为星形细胞瘤Ⅲ～Ⅳ级.CT影像确实可为星形细胞瘤的组织分级提供诊断依据.采用多靶点取材的方法发现肿瘤阳性诊断率不同,于肿瘤中心部取材阳性诊断率为40%;于肿瘤周边部取材阳性诊断率为30%;于肿瘤高密度区取材阳性诊断率为86%.立体定向多靶点连续取材是提高肿瘤活检阳性率的理想方法.对于星形细胞瘤的治疗具有实际的指导意义.     

磁敏感加权成像与动态磁敏感加权对比增强MR灌注加权成像联合应用在脑星形细胞瘤分级中的价值

目的 探讨磁敏感加权成像(SWI)与动态磁敏感加权对比增强(DSC) MR灌注加权成像联合应用在脑星形细胞瘤分级诊断中的价值.方法 82例经手术病理证实的脑星形细胞瘤患者行SWI与DSC MR灌注加权成像扫描,低级别星形细胞瘤15例(WHOⅡ级),间变性星形细胞瘤10例(WHOⅢ级),胶质母细胞瘤57例(WHOⅣ级).评价肿瘤内磁敏感信号(ITSS)与相对脑血容量(rCBV)最大值,应用Kruskal Wallis检验、Welch检验、Spearman相关系数、Pearson相关性分析和受试者工作特征曲线分析ITSS和rCBV单独使用和两者联合应用对星形细胞瘤分级的效能.结果 低级别星形细胞瘤14例未见到ITSS,间变性星形细胞瘤ITSS分级为1～3级,胶质母细胞瘤ITSS分级均为3级,3组间差异有统计学意义(H=71.96,P＜0.01).Ⅱ、Ⅲ和Ⅳ级星形细胞肿瘤内rCBV最大值分别是1.26 ±0.42、3.59 ±2.09和8.34±1.16,3组间差异有统计学意义(F'=681.72,P＜0.01).肿瘤内ITSS与rCBV最大值和病理分级呈正相关(r值分别为0.72、0.89,P值均＜0.01),rCBV与病理分级呈正相关(r=0.78,P＜0.01).SWI、DSC及SWI与DSC联合应用鉴别Ⅱ和Ⅲ级星形细胞瘤ROC曲线下面积分别是0.99、0.93、1.00,鉴别Ⅲ和Ⅳ级星形细胞瘤ROC曲线下面积分别是0.70、0.94、0.94,鉴别高低级别星形细胞瘤ROC曲线下面积分别是1.00、0.99、1.00.结论 脑星形细胞瘤ITSS可以对脑星形细胞瘤进行分级,SWI与DSC联合应用可以提高脑星形细胞瘤分级的准确性.     

A dosimetric and centeredness comparison of the conventional and novel endobronchial applicators: A preliminary study

PurposeThis study compared the applicator position relative to the tracheal wall and dosimetric parameters between conventional and novel applicators among patients receiving endobronchial brachytherapy (EBBT) for intratracheal tumors.Methods and MaterialsData from 7 patients who received EBBT for intratracheal tumors were retrospectively analyzed; 4 and 3 patients were treated with conventional (2-wing) or novel (5-wing) applicators, respectively. Applicator centrality was evaluated using the distance between the center of the trachea and main bronchus (TMB) lumen and path of source (L). Dosimetric parameters, including plans normalized to D_2cc of the TMB = 45 Gy (normalized plan), were compared between the applicators.ResultsThe mean and maximum values of L in cases of the 2-wing applicator group were approximately 5.0 mm and 10.0 mm, respectively. In the novel applicator group, the corresponding values were approximately 3.0 and 6.0 mm, respectively. In the normalized plan of the 2-wing applicator group, the ranges of median V_90% of clinical target volume (CTV) and D_0.1cc of the TMB in all cases were 23.0–91.9% and 66.3–153.1 Gy, respectively. In the 5-wing applicator group, the corresponding values were 69.2–83.8% and 60.4–84.5 Gy, respectively.ConclusionsIn the 5-wing applicator group, the range was narrow in all dose–volume parameters except for D_2cc of the TMB. Compared to the conventional applicator, the 5-wing applicator can give a stable dose to the CTV and can reduce the maximum dose of the TMB. This suggests that stable EBBT can be given to any patient using the 5-wing applicator.     

MEBO、SD-Ag治疗耳廓烧伤的疗效分析

目的比较MEBO和SD-Ag对耳廓烧伤的疗效。方法将1998年2月-2000年1月采用MEBO治疗的（称MEBO组）52例（70耳）治疗效果,同1996年1月-1998年1月应用SD-Ag治疗的（称SD-Ag组）48例（64耳）疗效进行对比分析。结果与SD-Ag组比较MEBO组治疗耳廓烧伤在促进愈合,减轻疼痛和感染,瘢痕增生不明显等方面有明显优势。结论在治疗耳廓烧伤时MEBO优于SD-Ag。     

A comprehensive strategy for the evaluation and triage of the chest pain patient: A cost comparison study

BACKGROUND: Our objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied. METHODS AND RESULTS: We compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay. CONCLUSIONS: Implementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost.     

原发性骨血管肉瘤(附3例报告并文献复习)

血管肉瘤 (ａｎｇｉｏｓａｒｃｏｍａ ,简称ＡＳ)是血管内皮细胞发生的高度恶性肿瘤 ,多见于皮肤软组织[1] 及内脏器官 ,如肝[2 ] 、脾[3 ]等 ;而上皮样血管肉瘤 (ｅｐｉｔｈｅｌｉｏｉｄａｎｇｉｏｓａｒｃｏｍａ ,简称ＥＡＳ)是ＡＳ的一个特殊类型。原发于骨的ＡＳ及ＥＡＳ极少见 ,现将我院经手术病理证实的 2例ＡＳ及 1例ＥＡＳ报告如下。1　病例报告例 1　男 ,38岁。全身持续刺痛 1年余 ,并中等度发热 ,反复鼻衄 1月 ,左耳失听 4ｄ。查体 :恶病质 ,骨盆、胸腰段脊柱、左侧颅顶压痛 ,相应部位软组织肿胀 ,并可扪及包块。实验室检查 :血红…     

乳腺包虫囊肿的钼靶X线诊断(附7例报告及文献复习)

目的　提高对乳腺包虫囊肿的X线征象认识。方法　对 7例经手术病理证实的乳腺包虫囊肿的钼靶X线表现进行回顾性分析并复习文献。结果　 7例乳腺包虫囊肿 ,1例多发 ,6例单发 ,其中 1例因外伤而破裂。X线片表现为圆形或椭圆形密度均匀的高密度影 ,其边缘光整 ,3例有典型的“蛋壳”样钙化影。结论　结合临床及流行病学资料 ,钼靶X线摄影可作出乳腺包虫囊肿的正确诊断。     

A mastocytoma of the liver--computed tomographic follow-up and biopsy

CT findings of a mastocytoma of the liver are reported. Follow-up studies over 1 year showed density changes in both the pre- and postcontrast scan. Diagnosis was established by percutaneous CT-guided biopsy, which was complicated by a simultaneous anaphylactoid reaction, probably due to direct histamine liberation.     

A morphometric analysis of the infant calvarium and dura

Literature addressing the anatomic development of the dura and calvarium during childhood is limited. Nevertheless, histological features of a subdural neomembrane (NM), including its thickness and vascularity, developing in response to an acute subdural hematoma (SDH) have been compared to the dura of adults to estimate when an injury occurred. Therefore, we measured the morphometric growth of the calvarium and dura and the vascular density within the dura during infancy. The mean thicknesses of the calvarium and dura as a function of occipitofrontal circumference (OFC), as well as the mean number of vessels per 25× field, were determined from the right parasagittal midparietal bone lateral to the sagittal suture of 128 infants without a history of head trauma. Our results showed that as OFC increased, the mean thicknesses of the calvarium and dura increased while the vascular density within the dura decreased. Our morphometric data may assist in the interpretation of subdural NM occurring during infancy. We recommend future investigations to confirm and extend our present data, especially by evaluating cases during later infancy and beyond as well as by sampling other anatomic sites from the calvarium. We also recommend morphometric evaluation of subdural NM associated with SDH in infancy and childhood.     

A calcified carcinoma of the lung and intracerebral metastasis

A case of a calcified carcinoma of the lung which later developed a large diffusely calcified brain metastasis is reported. Considerations which caused us to suspect a malignant lesion at presentation, although diffusely calcified, are discussed.