射波刀治疗小肝癌前瞻性临床研究初步结果

目的 探讨射波刀-立体定向放疗技术治疗小肝癌的安全性和有效性。方法 前瞻性分析本院2014年6月至2016年12月应用立体定向放疗技术治疗33例小肝癌的患者资料,治疗后每3个月复查,采用修改后实体肿瘤疗效评价标准（mRECIST）进行疗效评价,采用常见不良反应事件评价标准（CTCAE）4.0分级标准评价治疗反应,采用Kaplan-Meier法计算生存率和局部控制（CR+PR+SD）率,并绘制生存曲线。结果 平均随访19.3（2.3~30.8）个月。截止随访日期,共有33个病例含33个靶点纳入研究。其中18个病灶（54.5%）完全缓解,7个病灶（21.2%）部分缓解,5个病灶（15.2%）稳定,3个（9.1%）进展。总有效（CR+PR）率为75.8%,局部控制率为90.9%。1年局部控制率为100%,2年局部控制率为83.6%,中位疾病无进展生存期（DPFS）为15.0个月。未照射肝脏体积≥ 1 000 ml、治疗前甲胎蛋白（AFP）<100 ng/ml、治疗后CTCAE分级≤ 1级均有助于延长生存期。V₅与2级及以上不良反应相关（P=0.015）。治疗后乏力、纳差、恶心、呕吐等胃肠道反应和肝损伤主要为1、2级不良反应,1例出现3级肝功能损伤在治疗半年后缓解,1例出现4级肝不良反应在治疗后1年治愈。结论 射波刀治疗小肝癌不良反应可耐受,局部控制效果好。     

双着丝粒染色体自动分析生物剂量估算研究

目的 基于遗传工作站,探讨建立双着丝粒染色体自动分析剂量-效应曲线,实现高通量自动化生物剂量估算。方法 使用⁶⁰Co放射源对3名健康志愿者外周血进行离体照射,常规培养、制片。使用遗传工作站进行染色体中期分裂相采集及双着丝粒自动分析,并人工确认,拟合双着丝粒染色体自动分析剂量-效应曲线。使用另一组不同剂量照射的离体外周血样本对拟合的双着丝粒染色体自动分析剂量-效应曲线进行准确性验证。结果 拟合的双着丝粒染色体自动分析剂量-效应曲线为Y=0.018 06D²+0.012 79D+0.000 489 1（R²=0.961）,该剂量-效应曲线可以准确地进行生物剂量估算,并且每例人工分析时间仅需数分钟。结论 成功地建立了新的双着丝粒染色体自动分析生物剂量估算方法,可以大量节省人工分析时间,对大规模核事故应急具有重要意义。     

The value of diffusion kurtosis magnetic resonance imaging for assessing treatment response of neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Objectives

To evaluate the feasibility and value of diffusion kurtosis (DK) imaging in assessing treatment response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).

Methods

Forty-one patients were included. All patients underwent pre- and post-CRT DCE-MRI on a 3.0-Tesla MRI scanner. Imaging indices (D _app , K _app and ADC values) were measured. Change value (?X) and change ratio (r?X) were calculated. Pathological tumour regression grade scores (Mandard) were the standard reference (good responders: pTRG 1-2; poor responders: pTRG 3-5). Diagnostic performance was compared using ROC analysis.

Results

For the pre-CRT measurements, pre-D _app-10th was significantly lower in the good responder group than that of the poor responder group (p?=?0.036). For assessing treatment response to neoadjuvant CRT, pre-D _app-10th resulted in AUCs of 0.753 (p?=?0.036) with a sensitivity of 66.67 % and a specificity of 77.78 %. The r?D _app had a relatively high AUC (0.859) and high sensitivity (100 %) compared with other image indices.

Conclusions

DKI is feasible for selecting good responders for neoadjuvant CRT for LARC.

Key Points

? LARC responded well after neoadjuvant chemoradiotherapy with lower pre-D _app-10th .? LARC responded well with greater increases in mean ADC and D _app .? The change ratio of D _app (r?D _app ) had a relatively better diagnostic performance.

     

高效液相色谱法分析鉴定调味品及其原料中肌苷酸钠和鸟苷酸钠

分别选用ＮＨ２柱和ＯＤＳ柱，采用两种高效液相色谱分离模式，建立了调味品及其原料中肌苷酸钠和鸟苷酸钠的定量分析和定性鉴定的方法。方法简便易行，准确可靠。     

心脏良性非粘液瘤性肿瘤的电子束CT诊断

目的：探讨电子束ＣＴ（ＥＢＣＴ）在心脏良性非粘液瘤性肿瘤诊断中的价值。方法：对１９９５－ ０７～１９９９－ ０２,经ＥＢＣＴ检查并手术、病理证实的７ 例心脏良性非粘液瘤性肿瘤的ＥＢＣＴ、超声心动图结果与手术、病理所见进行回顾性分析。７个病例,男性４例（５７．１％ ）,女性３例（４２．９％ ）,年龄从５个月至４２岁,平均２１．６岁。所有病例同时行单层增强和电影序列。结果：７例心脏非粘液性良性肿瘤,包括２例浸润性脂肪瘤,２ 例纤维瘤,１例横纹肌瘤,１例淋巴管瘤,１ 例间皮瘤,ＥＢＣＴ不但能够明确肿瘤的位置、附着、大小、范围、运动,而且以优良的密度分辨率,在６个病例显示肿瘤病理学特征,提示正确的病理学定性诊断,准确性为８５．７％ ;２ 个病例术后提示肺不张与胸腔积液。同组病例中,超声心动图无１例做出正确组织病理学定性。结论：ＥＢＣＴ具有优良的时间、空间和密度分辨率,在对超声心动图难以准确定性的良性非粘液瘤性肿瘤的诊断中具一定优势,同时可展示邻近病变情况     

脊柱孤立性浆细胞瘤的MR表现

目的：总结脊柱孤立性浆细胞瘤的ＭＲ表现,提高对该病的认识。方法：搜集了４ 例经我院病理证实的脊柱孤立性浆细胞瘤,全部病人均在我院行ＭＲ检查。结果：４例脊柱孤立性浆细胞瘤中,均只累及单个椎体,３ 例位于胸椎,１例位于颈椎。肿瘤以累及一侧椎体附件为主,１ 例肿瘤引起椎体压缩骨折。肿瘤多表现为较均匀的等或稍高Ｔ１ 信号,高Ｔ２ 信号,注药后均匀强化。肿瘤边界清楚。均可见骨质破坏,但无骨硬化及增生。在本组２例行本周蛋白检查病人,全部表现阴性。结论：浆细胞瘤的ＭＲ表现与肿瘤起源部位和浸润范围有着密切关系。ＭＲ检查很难确诊脊柱浆细胞瘤,但相应的ＭＲ表现能够提示该病及其鉴别诊断。ＭＲ能够清楚地显示肿瘤及其与周围组织的关系,是显示浆细胞瘤及其浸润范围的最佳影像学检查方法。     

Effects of ischemia on intracellular rubidium in pig and rat hearts: (87)Rb NMR imaging and spectroscopic study.

87Rb MR imaging and spectroscopy were used to study the effects of ischemia on the properties of K(+) in cardiac tissue. Isolated pig and rat hearts perfused by the Langendorff method with Krebs-Henseleit buffer were preloaded with Rb(+). Ischemia (Isc) was induced by 120-min occlusion of the left anterior descending artery in the pig hearts or by stopping perfusion for 33 min in the rat hearts. Serial (87)Rb MR images or spectra from the anterior (An) LV wall of pig hearts were acquired continuously. The intensities of the Rb images of the An and posterior (Pos) walls were similar and stable during the first 45 min of ischemia. The intensity of signal from the An wall (Isc) then gradually increased by 60 +/- 8% relative to the preischemic value (vs. 31 +/- 5% increase in Pos wall) and necrosis (19 +/- 5% of the LV wall mass) developed upon reperfusion. The Rb(+) content was lower in the ischemic (An) than in the normal (Pos) area (22.3 +/- 3 vs. 28.4 +/- 1.3 mmol/g wet wt). A similar pattern was observed in the peak heights of (87)Rb spectra from the An wall, which increased by 40 +/- 16% (vs. 21 +/- 11% in control) due to a 12% decrease in the apparent Rb linewidth (LW) and a 24 +/- 14% increase in the peak area. The Rb peak comprised narrow (297 +/- 21 Hz) and broad (1098 +/- 40 Hz, 59 +/- 3% of total area) Lorentzian components. The LW of the broad component decreased by 14%, while the narrow component did not change markedly. In the rat hearts ischemia caused a 33 +/- 4% increase in the (87)Rb peak height as a result of peak narrowing (13 +/- 1%), and an increase in peak area (17 +/- 5%). The decreases in LW and increases in Rb(+) visibility can be explained by an increase in Rb(+) mobility caused by displacement of Rb(+) from anionic binding sites by H(+) (ischemic acidosis) and changes in intracellular compartmentalization of Rb(+). Magn Reson Med 44:193-200, 2000.     

结节性硬化神经影像表现的再认识

分析结节性硬化的ＣＴ和ＭＲＩ影像表现特征。材料与方法，经临床诊断为结节性硬化患者中，２０例经ＣＴ检查，４例ＭＲＩ检查，其中２例既有ＣＴ又有ＭＲ检查。结果结节性硬化的影像表现主要征象有（１）皮层结节病灶，其表现有脑回核心样病灶，Ｈ型病灶。     

电子束CT检出冠状动脉钙化及其与心肌灌注显像的对比研究

目的比较电子束ＣＴ（ＥＢＣＴ）检查冠状动脉钙化（ＣＡＣ）及核素心肌灌注显像（ＭＰＩ）评价冠心病（ＣＨＤ）的价值。材料与方法本组５０例均为临床疑诊或确诊为ＣＨＤ患者。所有患者均行ＥＢＣＴ、ＭＰＩ及冠状动脉造影。结果４０例患者共８４支血管冠状动脉造影证实有明显的冠状动脉病变（ＣＡＤ）（狭窄＞５０％），其中１４例为单支病变，８例为双支病变，１８例为三支病变，另有１０例冠状动脉造影正常。ＥＢＣＴ预测ＣＡＤ的敏感性、特异性及准确性为８３％、８０％及８２％，ＭＰＩ预测ＣＡＤ的敏感性、特异性及准确性分别为８５％、８０％及８４％，ＥＢＣＴ与ＭＰＩ的结果间无显著性差异（Ｐ＞０．０５）。ＣＡＣ血管供血区出现心肌缺血者达６５％。结论ＣＡＣ是预测ＣＡＤ的有价值指标。在有症状的人群中ＥＢＣＴ检出ＣＡＣ预测ＣＡＤ的敏感性、特异性及准确性与ＭＰＩ相似。有症状人群中检出ＣＡＣ患者多有心肌缺血或梗死，因此为早期诊断冠心病，应对无症状人群进行筛选。     

Improved diffusion imaging through SNR‐enhancing joint reconstruction

Quantitative diffusion imaging is a powerful technique for the characterization of complex tissue microarchitecture. However, long acquisition times and limited signal‐to‐noise ratio represent significant hurdles for many in vivo applications. This article presents a new approach to reduce noise while largely maintaining resolution in diffusion weighted images, using a statistical reconstruction method that takes advantage of the high level of structural correlation observed in typical datasets. Compared to existing denoising methods, the proposed method performs reconstruction directly from the measured complex k‐space data, allowing for Gaussian noise modeling and theoretical characterizations of the resolution and signal‐to‐noise ratio of the reconstructed images. In addition, the proposed method is compatible with many different models of the diffusion signal (e.g., diffusion tensor modeling and q‐space modeling). The joint reconstruction method can provide significant improvements in signal‐to‐noise ratio relative to conventional reconstruction techniques, with a relatively minor corresponding loss in image resolution. Results are shown in the context of diffusion spectrum imaging tractography and diffusion tensor imaging, illustrating the potential of this signal‐to‐noise ratio‐enhancing joint reconstruction approach for a range of different diffusion imaging experiments. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.