18F-FDG与18F-FLT PET/CT在肺结核瘤与恶性肿瘤鉴别诊断中的应用

目的：探讨18F-FDG与18F-FLT显像在诊断与鉴别肺结节尤其是肺结核与恶性肿瘤中的效能。方法：肺结节患者163例,年龄17~92岁,其中结核瘤组29例,其它良性结节组46例,恶性结节组88例,以盲法集中读片、前瞻性多中心临床研究标准方案进行18F-FDG与18F-FLT显像和读片,获得病灶最大值SUVFDG和SUVFLT并对病灶进行定量分析。结果：肺结节的最大SUVFDG及最大SUVFLT中位值均以恶性结节、肺结核、其他良性结节之序依次减低;SUVFDG、SUVFLT恶性结节组与结核组对照有显著性差异（P<0.001）;据ROC曲线分析,FDG、FLT显像SUVmax分别以5.9、2.4为界值可鉴别结核瘤与恶性结节,FLT显像诊断的灵敏度为80.68%,特异性为75.86%,准确性为79.49%,诊断效能高于FDG（P<0.001）。SUVFLT/SUVFDG比值的诊断效能高于单独FDG、FLT显像SUV值。结论：在鉴别诊断肺结核瘤与恶性结节中,FLT显像的诊断效能高于FDG显像,双示踪剂显像明显提高鉴别诊断的准确性。SUVFLT/SUVFDG比值在肺结节鉴别诊断中有重要价值。     

生物材料补片在胸外科手术中的临床应用研究

【目的】探讨新型生物材料补片在胸外科手术中应用的安全性和有效性。【方法】27例胸外科手术患者分为实验组（n=17）和对照组（n=10）,两组分别应用生物材料补片和自体组织补片进行食管胃吻合口覆盖、包埋及加固,气管、支气管残端加固、包埋,膈肌缺损、破裂修补等。观察两组围术期及术后1、6个月的重建效果、急慢性排斥反应及并发症。【结果】两组在围术期及术后1、6个月均未出现吻合口及支气管胸膜瘘、急慢性排斥反应及与植入物相关的并发症;相关临床指标比较差异无统计学意义（P〉0．05）。【结论】生物材料补片在胸外科手术中的应用具有良好的生物相容性和应用安全性。     

PET/CT在评价及观察大鼠肺癌放疗效果中的应用

Objective The aim of this study was to understand the role of PET/CT in monitoring the therapeutic effect of radiotherapy (RT) on lung cancer with Wistar rats. Methods Thirty Wistar in-bred strain rats (6-8 weeks, weighed 180-280 g, female, ordinary) were made into Lewis pulmonary tumor model rats. 18F-fluorodeoxyglucose (FDG) PET/CT was performed when tumor reached 1.5-2.0 cm in greatest diameter (4-6 weeks) as a baseline. In order to get the optimal time point of PET/CT for moni-toring RT effect in rat cancer model, PET/CT was performed at the 3rd day, 1st, 2nd, 3rd, and 4th week after giving single dose of 5 Gy to each rat. Standardized uptake values (SUV) from FDG PET were measured and rats were sacrificed at different time point for validation. Besides, the expressions of glucose transport1 (Glut1) in tumor tissue were studied using immunohistochemistry. The level of tumor cell apoptosis, degra-dation, and necrosis were observed. SPSS 11.0 software was used for data analyses. Results A negative correlation of SUV uptake and time after RT and negative correlation of Glut1 expression and time after RT were observed in rat tumors, respectively. Positive correlation of SUV uptake and Glut1 expression in rat tumors was observed (Spearman rank correlation test, rs = 0.97, P < 0.01). Before RT, the SUV in rat tumor was 1.28 ± 0.31 and was decrease to 1. 00 ± 0.23 at the 3rd day and 0.18 ± 0. 10 at the 4th week after RT (F=15. 126, P<0.05). Before RT, the Glut1 in rat tumor was 0.2558 ±0.03 and was decrease to 0. 2320 ± 0. 01 at the 3rd day and 0. 1320±0.04 at the 4th week after RT. The amounts of tumor cell apopto-sis, degradation, and necrosis increased with time after RT. Conclusion Though FDG PET could monitor the therapeutic effect at the 3rd day after giving single dose of RT to rat lung tumor model, the optimal time was the the 4th week after treatment.     

PET／CT在评价及观察大鼠肺癌放疗效果中的应用

目的观察Wistar大鼠肺癌放疗后不同时期的PET／CT表现,观察和评价大鼠肺癌放疗疗效的时间点。方法将30只近交系Wistar大鼠（鼠龄6～8周,体质量180～280g,均为雌性普通级）制作成Lewis肺癌的模型鼠,肿瘤模型建立4—6周后当肿瘤长到最大径1．5～2．0cm时,对大鼠进行^18F-脱氧葡萄糖（FDG）PET／CT显像;显像后对大鼠进行肿瘤局部单次放疗,放疗剂量为5Gy。放疗后第3天和第1、第2、第3、第4周末再对大鼠进行PET／CT显像,观察放疗的疗效,从而评价疗效观察的时间点。而后取一部分肿瘤组织制成免疫组织化学切片,观察葡萄糖转运蛋白1（Glut1）的表达。一部分肿瘤组织被制成病理切片,经HE染色,观察光学显微镜下肿瘤细胞的坏死及萎缩情况。统计学处理采用SPSS11．0软件。多组样本均数之间比较采用单因素方差分析,标准摄取值（SUV）与Glut1表达行等级相关分析。结果随着放疗后时间的延长,^18F-FDG的摄取逐渐减少,代谢活性逐渐减低,SUV放疗前为1．28±0．31,放疗后第3天为1．00±0．23,放疗后第4周下降到0．18±0．10。放疗后各不同时间点肿瘤的平均SUV与放疗前的差异具有统计学意义（F=15．126,P〈0．05）。免疫组织化学结果：Glut1表达阳性的染色主要位于胞膜和胞质,随着放疗后观察时间的延长,肿瘤组织的Glut1表达逐渐减低,Glut1表达的平均吸光度（A）值放疗前为0．2558±0．03,放疗后第3天为0．2320±0．01,放疗后第4周为0．1320±0．04。肿瘤平均SUV与Glut1表达呈正相关（等级相关系数L=0．97,P〈0．01）。病理检查结果：随着放疗后观察时间的延长,肿瘤细胞萎缩、碎裂及坏死逐渐增多。结论PET／CT能于Wistar大鼠肺癌放疗后早期（第3天）观察到治疗效果,到第4周疗效显示最佳。     

手术加球囊置入32P内放疗治疗脑胶质瘤

探讨手术全切或大部切除肿瘤后 ,球囊置入3 2 P内放疗治疗脑胶质瘤的疗效及临床价值。对 2 18例脑胶质瘤患者行手术切除或大部切除后 ,瘤腔内置硅胶球囊外接注药泵埋入皮下。手术后即将3 2 P9mci注入硅胶球囊 ,以后每 2个月更换一次 (通过穿刺注药泵更换 )。随访观察存活 1年以上者 166例 ,占 76 1% ( 166/2 18) ,2年以上者 10 9例 ,占 5 0 0 % ( 10 9/2 18) ,3年以上者 89例 ,占 40 8% ( 89/2 18) ;5年以上者 61例 ,占 2 7 9% ( 61/2 18)。其中生存 5年以上者 ,有 3 4例取硅胶球时 ,球囊周围多点取病理 ,未见肿瘤细胞。手术加球囊置入3 2 P内放疗生存时间长 ,并发症少 ,是治疗脑胶质瘤的理想方法 ,值得临床推广     

DNA去甲基化药物作用机制的研究进展

癌症被认为是一种表观遗传疾病。表观遗传异常改变导致参与细胞正常生长的关键基因失活,促进癌症发生和发展,这使得对癌症治疗上可采取一些主动性表观遗传调节。DNA去甲基化药物通过化学逆转重新激活高甲基化的肿瘤抑制基因,已成为一个令人兴奋的癌症治疗方法。其作用机制主要有:抑制DNA甲基转移酶,干扰甲基转移反应途径和影响三羧酸循环途径。介绍了近年来DNA去甲基化药物作用机制的研究进展。     

PET特异性分子探针在肝纤维化早期诊断中的应用

肝纤维化是许多慢性肝病的标志性过程,临床上以肝穿刺活组织检查作为肝纤维化的诊断金标准,目前缺乏无创诊断早期肝纤维化的有效手段。肝纤维化进程伴随着复杂的分子水平的物质变化,各种物质变化与肝纤维化进展程度有一定相关性。PET作为能够提供组织功能与代谢等分子水平信息的影像学检查,有能力监测这些定量化信息。简单介绍了应用于早期肝纤维化诊断的PET特异性分子探针的原理,总结了目前PET特异性分子探针对早期肝纤维化诊断、分期的应用价值,以及寻找更多、更合适的PET特异性分子探针应用于早期肝纤维化。     

同侧肾癌并肾蒂节细胞神经瘤手术中误认为淋巴结转移1例报告

同侧肾癌并肾蒂节细胞神经瘤手术中误认为淋巴结转移１例报告辛军，王晓雄（北京解放军总医院泌尿外科１００８５３）１临床资料患者，男性，６７岁。固体检Ｂ超发现左肾肿物１个月，于１９９２年３月入院。患者一般状态好。ＩＶＰ示左肾轮廓较对侧长，左肾盂、肾盏显影较...     

PET/CT在评价及观察大鼠肺癌放疗效果中的应用

Objective The aim of this study was to understand the role of PET/CT in monitoring the therapeutic effect of radiotherapy (RT) on lung cancer with Wistar rats. Methods Thirty Wistar in-bred strain rats (6-8 weeks, weighed 180-280 g, female, ordinary) were made into Lewis pulmonary tumor model rats. 18F-fluorodeoxyglucose (FDG) PET/CT was performed when tumor reached 1.5-2.0 cm in greatest diameter (4-6 weeks) as a baseline. In order to get the optimal time point of PET/CT for moni-toring RT effect in rat cancer model, PET/CT was performed at the 3rd day, 1st, 2nd, 3rd, and 4th week after giving single dose of 5 Gy to each rat. Standardized uptake values (SUV) from FDG PET were measured and rats were sacrificed at different time point for validation. Besides, the expressions of glucose transport1 (Glut1) in tumor tissue were studied using immunohistochemistry. The level of tumor cell apoptosis, degra-dation, and necrosis were observed. SPSS 11.0 software was used for data analyses. Results A negative correlation of SUV uptake and time after RT and negative correlation of Glut1 expression and time after RT were observed in rat tumors, respectively. Positive correlation of SUV uptake and Glut1 expression in rat tumors was observed (Spearman rank correlation test, rs = 0.97, P < 0.01). Before RT, the SUV in rat tumor was 1.28 ± 0.31 and was decrease to 1. 00 ± 0.23 at the 3rd day and 0.18 ± 0. 10 at the 4th week after RT (F=15. 126, P<0.05). Before RT, the Glut1 in rat tumor was 0.2558 ±0.03 and was decrease to 0. 2320 ± 0. 01 at the 3rd day and 0. 1320±0.04 at the 4th week after RT. The amounts of tumor cell apopto-sis, degradation, and necrosis increased with time after RT. Conclusion Though FDG PET could monitor the therapeutic effect at the 3rd day after giving single dose of RT to rat lung tumor model, the optimal time was the the 4th week after treatment.