中国汉族正常成人海马体积的高分辨率MRI测量

目的 测量中国汉族成人海马体积的正常值范围,为各种导致海马结构改变疾病的临床诊断和科学研究提供基础性数据.方法 采用全国多中心临床研究形式,选取18～70岁健康志愿者1000名,按照年龄18～30、31～40、41～50、51～60、61～70岁进行分组,每组男、女各100名.所有受试者均行3D磁化强度预备梯度回波序列T1WI,应用3D体积分析软件手工勾绘ROI,测量健康中国成年人海马的体积.采用多元线性回归方法探讨海马体积与性别、年龄、体重和身高的关系.不同性别、侧别间海马体积的差别采用两独立样本t检验.不同性别和年龄分组间采用方差分析.结果 左、右侧海马体积分别为(4752±659)、(5032±660)mm3,与性别和年龄相关(左、右侧r值分别为0.283和0.311,F值分别为30.127和37.050,P值均<0.01),而与身高和体重不相关(P<0.05).男性左、右侧海马体积分别为(4897±670)、(5192±667)mm3,女性左、右侧海马体积分别为(4647±624)、(4904±630)mm3,右侧海马体积均大于左侧(t值分别为7.030、6.696,P值均<0.05),男性左、右海马体积均大于女性(t值分别为6.586、7.326,P值均<0.05).男性5组左侧海马体积分别为(4981±684)、(5003±609)、(4976±657)、(4841±631)、(4631±681)mm3,右侧海马体积分别为(5340±647)、(5276±582)、(5264±620)、(5133±661)、(4894±699)mm3,5组间差异均有统计学意义(左、右侧F值分别为5.737和7.607,P值均<0.01),其中男性两侧海马结构在18～30、31～40、41～50岁组分别与61～70岁组比较,差异均有统计学意义(P值均<0.05),其余各组间差异无统计学意义(P>0.05).女性不同组别的海马体积差异无统计学意义(P>0.05).结论 采用高分辨率MRI获得中国汉族正常人不同年龄段的海马体积数据,为进一步研究海马相关疾病提供了基础性数据.     

中国汉族成人额叶体积的高分辨率MRI测量

目的 测量中国汉族正常成人大脑额叶体积,为建立中国成人数字标准脑提供基础数据.方法 采用全国多中心临床研究形式,选取18～70岁健康志愿者200名,按照年龄18～30、31～40、41～50、51～60、61～70岁进行分组,每组男、女各20名.所有受试者均行3D磁化强度预备梯度回波序列T1WI采集额叶体积,通过人工勾画ROI法分别测量志愿者左、右侧额叶体积,并对测量数据进行统计学分析.男、女性别间比较采用独立样本t检验;左、右侧别间比较采用配对样本t检验;年龄与额叶体积进行相关与回归分析.结果 200名志愿者大脑额叶总体积为(563±73)cm3.100名男性左、右侧额叶体积值分别为(288±42)、(292±41)cm3;100名女性左、右侧额叶体积值分别为(273±30)、(274±30)cm3.大脑额叶总体积男、女性别间差异有统计学意义(t=3.334,P<0.05).男性左、右侧额叶体积差异有统计学意义(t=-3.09,P<0.05),女性左、右侧额叶体积差异无统计学意义(t=-1.304,P>0.05).男性及女性大脑额叶总体积均与年龄呈负相关(r值分别为-0.586、-0.498,P值均<0.01).结论 健康国人男性额叶总体积大于女性.男性右侧额叶体积大于左侧,而女性双侧额叶体积差异无统计学意义.随着年龄的增长,男性及女性的额叶总体积均呈现逐渐缩小的趋势,男性额叶缩小的趋势比女性明显.     

中国汉族正常成人扣带回的高分辨率MRI测量

目的 建立中国汉族正常成人扣带回体积的正常值范围,探讨扣带回体积与年龄的相关关系,为中国成人数字标准脑提供基础性数据.方法 采用全国多中心临床研究形式,选取1000名中国健康成年志愿者,按年龄18～30、31～40、41～50、51～60、61～70岁分为A、B、C、D、E组,每组男、女各100名,行大脑3D磁化强度预备梯度回波序列T1WI,应用3D体积分析软件测量扣带回的体积.不同年龄组扣带回体积的比较采用方差分析,不同性别、侧别扣带回体积的比较采用配对样本t检验,扣带回体积与年龄进行相关与回归分析.结果 男、女扣带回总体积分别为(20 347±2504)、(19 432±2184)mm3,差异有统计学意义(方差不齐,采用两组独立样本t'检验,t'=6.156,P<0.05),男性扣带回总体积大于女性.男性左、右侧扣带回体积分别为(9630±1498)、(10 717±1629)mm3,女性分别为(9368±1441)、(10064±1407)mm3,男、女不同侧别扣带回体积比较差异均有统计学意义(t值分别为-12.960、-8.511,P值均<0.05),右侧扣带回体积均大于左侧.男性A、B、C、D、E组扣带回体积:左侧分别为(10 132±1291)、(10 113±1638)、(9599±1576)、(9594 ±1288)、(8710 ±1212)mm3,右侧分别为(11 212±1442)、(11 096±1602)、(11 040 ±1403)、(10 633±1638)、(9604 ±1522)mm3,不同年龄组间差异有统计学意义(F值分别为16.738、18.707,P值均<0.01).女性A、B、C、D、E组扣带回体积:左侧分别为(9689 ±1426)、(9652±1676)、(9347±1500)、(9098±1225)、(9053±1233)mm3,右侧分别为(10 558 ±1325)、(10 266 ±1463)、(10 100±1497)、(9779±1304)、(9617±1254)mm3,不同年龄组间差异有统计学意义(F值分别为16.859、7.528,P值均<0.01).男、女双侧扣带回体积与年龄均存在负相关(r值分别为-0.330、-0.324、-0.169、-0.243,P值均<0.05),但相关性不强.结论 基于高分辨率MR图像和3D体积分析软件可以准确测量扣带回的体积,为中国成人数字标准脑提供基础性数据,为可能引起扣带回体积改变的相关疾病诊断提供正常对照标准.     

中国汉族正常成人视束的高分辨率MRI测量

目的 研究中国汉族正常成人视束MRI形态特征,为建立中国标准脑提供视束形态学测量数据.方法 采用全国多中心临床研究形式,选取18～70岁健康中国成年志愿者共1000名,按照年龄18～30、31～40、41～50、51～60、61～70岁分为A、B、C、D、E组,每组男、女各100例.所有受试者均行3D磁化强度预备梯度回波序列T1WI采集容积数据,再采用多基线技术最佳化显示视束结构及形态,测量视束各径线:视束脑池段横径(TD1)、视束大脑脚周段横径(TD2)、视束起点池段到大脑脚周段长度(L)、视束夹角(AOT),以及视束从前到后5个断面上下径(H):视束起始点层面上下径(H1)、视束池-前联合层面上下径(H2)、视束乳头体层面上下径(H3)、视束室间孔层面上下径(H4)、视束近外侧膝状体节段上下径(H5).不同性别及年龄分组的视束测量值比较采用协方差分析,左、右视束侧别的比较采用配对样本t检验分析.结果 (1)男、女性别间视束径线比较:男性左、右侧L分别为(11.69±1.45)、(11.56±1.44)mm,女性左、右侧L分别为(10.58±1.29)、(10.40±1.34)mm,男性左、右侧H1分别为(2.56±0.28)、(2.60±0.29)mm,女性左、右侧H1分别为(2.57±0.31)、(2.63±0.32)mm,以上测量指标在性别间差异有统计学意义(F值分别为22.236、29.703、11.130、7.805,P值分别为0.000、0.000、0.000、0.005),男性L大于女性,男性H1小于女性;余测量径线性别差异无统计学意义(P值均>0.05);(2)年龄分组比较:左、右侧TD1、右侧TD2在5个年龄分组的值分别为:左TD1为(4.64±0.51)、(4.64±0.57)、(4.55±0.58)、(4.39±0.53)、(4.36±0.58)mm;右TD1为(4.84±0.53)、(4.80±0.60)、(4.77±0.65)、(4.60±0.59)、(4.57±0.59)mm;右TD2为(3.33±0.45)、(3.34±0.41)、(3.33±0.36)、(3.23±0.38)、(3.23±0.39)mm,在年龄分组间差异有统计学意义(F值分别为3.458、2.735、4.711,P值分别为0.008、0.028、0.001),且两两比较结果为50岁前后差异有统计学意义(P值均<0.05);左、右侧L在5个年龄分组的值分别为:左L为(11.09±1.37)、(10.99±1.58)、(10.96±1.43)、(11.15±1.53)、(11.50±1.40)mm;右L为(10.88±1.35)、(10.79±1.62)、(10.83±1.45)、(11.04±1.52)、(11.34±1.51)mm,在年龄分组间差异有统计学意义(F值分别为14.510、14.532,P值均为0.000),两两比较结果为60岁前后差异有统计学意义(P值均<0.05);左TD2及双侧H1～H5年龄分组差异无统计学意义(P值均>0.05);(3)视束测量径线的左、右侧别比较:左、右侧TD1分别为(4.52±0.57)、(4.72±0.60)mm,左、右侧H1分别为(2.56±0.30)、(2.61±0.30)mm,左、右侧H2分别为(2.66±0.30)、(2.70±0.30)mm,左、右侧L分别为(11.14±1.47)、(10.98±1.50)mm,以上测量指标侧别差异均有统计学意义(t值分别为12.460、-6.013、5.595、4.784,P值均为0.000),双侧TD2、H3、H4及H5侧别差异无统计学意义(P值均>0.05).结论 高分辨率MRI 3D数据重组能清晰显示视束形态,能准确测量视束各段径线.     

中国汉族正常成人海马体积的高分辨率MRI测量

Objective To measure the volume of hippoeampal formation(HPF) in healthy Chinese Han adults and provide database for researching on a variety of diseases associated with alteration of hippocampal structure. Methods This is a clinical multi-center study. One thousand Chinese healthy volunteers (age range = 18 to 70) recruited from 15 hospitals were divided into 5 groups, i. e. , Group A (age range = 18 to 30), B (age range =31 to40), C (age range =41 to 50), D (age range=51 to 60),and E (age range =61 to 70). Each group contained 100 males and 100 females. All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence. The margin of HPF were outlined manually for each side. Using multiple linear regression,relationships between hippocampal volume and sex, age, weight and height were analyzed respectively.Independent two sample t test was used to study the differences between male and female and between lcft and right. The differences of hippoeampal volume among age groups were analyzed by ANOVA. Results Hippocampal volume for left and right side were (4752 ± 659) and (5032 ± 660) mm3 respectively. The volume of HPF is significant correlated with gender and age, but without relevance to height and weight ( left and right r = 0. 283,0. 311, F = 30. 127,37. 050 ,P < 0. 01 ). The volumes of left and right hippocampus were (4897 ± 670), (5192 ± 667)mm3 respectively for men, and (4647 ± 624) and (4904 ± 630) mm3 for women. The right hippocampal volume was larger than the left ( t = 7. 030,6. 696, P < 0. 05 ). On both sides, men have larger hippocampus than that of women ( t = 6. 586,7. 326, P < 0. 01 ). The volumes of the left hippocampus among the five age groups in the male were (4981 ± 684), ( 5003 ± 609 ), (4976 ± 657 ),(4841 ± 631 ), (4631 ± 681 ) mm3 respectively, while the volumes of the right hippoeampus were (5340 ±647) ,(5276 ±582), (5264 ±620), (5133 ±661 ), (4894 ±699) mm3 respectively. Among age groups,the differences were statistically significant ( left and right F = 5. 737,7. 607, P < 0. 01 ). For male, there was significant difference of bilateral hippoeampus between the 18-30, 31-40, 41-50 years group and 61-70 years group ( P < 0. 05 ) and there was no significant difference among the other groups ( P > 0. 05 ).There was no significant difference of hippocampal among different groups in women (P > 0. 05 ).Conclusions With high-resolution MRI, the volume of the HPF was accurately measured, so as to provide the basic data for research of the hippocampus-related disease.     

中国汉族正常成人垂体的高分辨率MRI研究

Objective To study the morphological characteristics of pituitary glands in healthy adult of the Han nationality on the High-resolution MRI and provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.Nine hundred and seventy eight Chinese healthy volunteers (age range = 18 to 70) recruited from 16 hospitals were divided into 5 groups, i.e., Group A ( age range = 18 to 30), B ( age range = 31 to 40), C ( age range = 41 to 50), D ( age range = 51 to 60 ), and E ( age range = 61 to 70).All of the volunteers were scanned by MR using T, weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.By Multiplan reconstruction with 3D software, the pituitary gland's volume, size, and inclination of pituitary stalk were measured and the differences between sexualities and among age groups were compared by analysis of variance using SPSS13.0; those among five age groups were compared pair-wised by Tukey analysis; and the differences between male and female were analyzed by independent t test, and the differences of measurements of typing of pituitary glands were analyzed by Chi-square analysis.Results( 1 ) Volume of pituitary glands: the mean volume of male and female among 5 age groups were ( 1142±290), (996±223), (979 ±178), (971 ±174), (930 ±189) and (1247 ±210), (1199 ±216),( 1108 ± 196), ( 1059 ± 212 ), (984 ± 177 ) mm3 respectively.There were significant differences among the age groups(F = 13.811,27.091 ,P <0.01), the volume tended to decrease after 30 years old in male and 40 years old in female.Female has bigger volume than man in the same age group (P < 0.05).There were statistically correlation between sexes, age, typing, heights in middle sagittal width in coronal MR and anteroposterior diameter in middle sagittal MR.(2) The size of pituitary giands:the mean heights on middle sagittal MR images of male and female among 5 age groups were(6.6±1.5), (6.0±1.4), (5.6±1.1 ),(5.0±1.2), (4.9±1.4)and (7.9±1.6), (6.4±2.0), (5.6±1.7), (5.1±1.7), (4.4±1.4)mm respectively.There were significant difference among the age groups ( F = 24.582,62.978, P < 0.01 ).Females demonstrated larger pituitary glands than men in the age from 18 to 30 year old groups ( P < 0.01 ).The pituitary height tended to decline after 30 years old, minimum after 50 years old group in male and 40 years old in female.The heights were statistically correlated with sexes and age.The mean width in coronal MR images of male and female among 5 age groups were( 14.8± 1.8), ( 14.7 ± 1.4), ( 14.2±1.9), (14.3 ±2.1), (13.8 ±2.4) and (14.9±1.8), (15.8±1.7), (15.5±2.1), (15.6±2.2),( 14.9±2.1 ) mm respectively.There were significant difference among the age groups( F = 4.566,4.233,P<0.05),The width of pituitary before 30 years old and after 60 years old were smaller than the other groups (P <0.05 ), but man did not show this relationship.The widths were statistically correlation with sexes, age and weight.The mean anteroposterior diameter in middle sagittal images of male and female among 5 age groups were (11.2±1.2), (11.8±1.3), (11.8±1.5), (12.3±1.8), (12.2±2.0) and (11.9±1.3), (12.5±1.5), (12.4±1.5), (12.9±1.6), (12.7±1.6)mm respectively.There were significant difference among the age groups ( F = 7.270, 5.903, P < 0.01 ).Before 60 year old, the anteroposterior diameter was smaller in male than all female groups (P < 0.05 ), and there was a tendency to grow downwards with age.The anteroposterior diameter was statistically correlated with sexes and age.(3)The angle of inclination of pituitary stalks: on reconstructed coronal MRI imaging, the angle of inclination of pituitary stalk were in the middle, no significant differences in the angle measurements were found between male and female among 5 age groups ( P > 0.05).(4) The typing of pituitary glands in middle sagittal MR images : there were significant differences between each typing ( χ2 = 44.212, 107.518, P < 0.01 ), there was a tendency of pituitary upper border to depressed when age increased.Conclusions With highresolution MRI and 3D volumetric analytic software, volume and size of pituitary glands and the angle of inclination of pituitary stalks were accurately measured, and that provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.     

中国汉族正常成人岛叶体积的高分辨率MRI测量

Objective To explore the normal range of the insula volume of Chinese adults of the Han nationality and its relationship with age, which provide morphological data for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.One thousand Chinese healthy volunteers (age range = 18 to 70) recruited from 16 hospitals were divided into 5 groups, i.e.,Group A ( age range = 18 to 30), B ( age range = 31 to 40 ), C ( age range = 41 to 50 ), D ( age range =51 to 60), and E (age range =61 to 70).Each group contained 100 males and 100 females.All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.After three dimension data reconstruction, the volumes of bilateral insula were manually measured.The volume of bilateral insula were compared by paired sample t test.The insula volumes were compared between male and female by independent sample t test, and the differences among 5 age groups were compared by one-way ANNOVA.The relationship between the volumes of insula and age,sex or cerebral volume were analyzed using bivariate correlation, respectively.Results The left snd right side volume of insula before standarized were (7764±1165) and (7387±1128) mm3 respectively, after standarized were (8413±1201 ) and (7871±1140) mm3 respectively.The left insula volume were significant larger than that of right(t = - 10.565, - 16.014,P <0.01 ).The left and fight volume of insula were (8146±1181 ) and (7735±1113) mm3 for male, and (7393±1022) mm3 and (7050±1038) mm3for female.The left and right insula volumes for male were larger than the female's(t = 10.934,9.945 ,P <0.01 ).The left and right insula volume of male after standarized were (8779±1230 ) and (8224±1081 )mm3, female were (8043±1054) and (7515±1091 ) mm3 ,the left and right insula volume of male were larger than the female's ( t = 4.858,4.632, P < 0.01 ).The left insula volumes among Group A, B, C, D,E before standarized were ( 8268±1221 ), ( 8067±1107 ), ( 7869±1109), ( 7603±1111 ), ( 6997±934 )mm3 respectively,the right were (8028±1156), (7636±1075), (7294±986), (7249±1068), (6717±916) mm3 respectively, there were significant differences among 5 groups between left and right insula volume(F= -0.361,-0.337,P <0.01 ).The left insula volume of A,B,C,D,E after standarized were ( 9093±1105 ), ( 8679±965 ), ( 8810±1136), ( 8202±980), ( 7273±940 )mm3, the right were ( 8694±1005), (8136±1100), (8034±910), (7496±990), (6989±932) mm3, there were significant differences among 5 groups between left and right insula volume(F = -0.490, -0.512,P < 0.01 ).There was significant negative correlation between the volume and age ( before standarizded:r = -0.361, -0.337, after standardized r = -0.490, -0.512, P<0.05).Before and after standardized, there was significant correlation between the volume of right and left insula and cerebral volume ( r = 0.470,0.459, P < 0.05 ).Before and after standardized, there was significant correlation between the volume of right and left insula and weight( r = 0.141, 0.092, P < 0.05 ).Conclusions 1.5 T MR scanner has high resolution, for distinguishing the white matter from the gray matter, and provide morphological data of insula for the construction of database for Chinese Standard Brain.     

Norplant皮下埋植避孕150例临床研究

目的:探讨Norplant皮下埋植避孕的效果。方法:选择Norplant皮下埋植避孕妇女150例作为治疗组,以宫内节育环避孕妇女150例作为对照组,比较两组使用情况、避孕效果和月经紊乱情况。结果:5年后随访,治疗组因不适取出32例,取出率为21.33%,其余118例全部达到避孕效果,有效率100.00%;期间出现月经紊乱58例,发生率为49.15%;对照组因不适取出或自行脱出10例,取出率为6.67%,其余140例中达到避孕效果115例,有效率82.14%,出现月经紊乱33例,发生率为23.57%。两组避孕效果、月经紊乱和不适失败率比较均具有统计学差异(P<0.01)。结论:对生育期要求避孕妇女行皮下Norplant埋植避孕手术可达到有效的避孕效果,但月经紊乱发生率相对较高,宫内节育环避孕有效率较皮下Norplant埋植避孕手术低,但月经紊乱发生率亦较治疗组低。使用Norplant埋植避孕如何减少月经紊乱,仍是今后值得探讨的一个问题。     

促纤维增生性恶性黑色素瘤临床病理分析

[目的]总结促纤维增生性恶性黑色素瘤的临床病理学特征。[方法]对5例促纤维增生性恶性黑色素瘤术后标本行HE、免疫组织化学(En Vision法)染色、电镜观察及随访。[结果]光镜下见肿瘤性梭形黑色素细胞位于成熟的胶原束内或之间,梭形肿瘤细胞排列混乱,肿瘤细胞胞质内几乎未见黑色素。免疫组化示肿瘤细胞S-100、NSE及SMA阳性。电镜示成纤维细胞样的肿瘤细胞。[结论]促纤维增生性恶性黑色素瘤是一种罕见疾病,临床易与其它梭形细胞肿瘤混淆,特征性的病理组织学及免疫组织化学特征有助于诊断及鉴别诊断。     

蛋白芯片技术检测肿瘤标志物对乳腺癌的诊断价值

目的探讨应用蛋白芯片技术检测肿瘤标志物对乳腺癌的诊断价值。方法采用多肿瘤标志物蛋白芯片诊断系统,检测90例乳腺癌患者、60例乳腺良性病变者和100名健康体检者12种血清肿瘤标志物,采用SPSS13．0统计软件进行数据分析。结果乳腺癌组CEA、CA125、FER、CA153水平,均显著高于良性病变组和对照组（P〈0．01）：良性捐变组CEA、CA125、FER、CA153水平与对照组比较,差异无显著性意义（P〉0．05）;而CA199、NSE、CA242、HCG、AFP、f-PSA、PSA、HGH在三三组间比较均未见统计学意义（P〉0．05）;乳腺癌组与对照组的logistic回归方程P=1／1＋e^-（-1.29＋2.25×cea＋3.12×CA125＋10.59×CA153）;ROC曲线中,CA125、CA153、CEA、FER联合检测的AUC大于各项肿瘤标志物单项检测的AUC（P=0．000）。结论蛋白芯片技术检测肿瘤标志物对乳腺癌的有较高的临床诊断价值;血清CA125、CA153、CEA、FER是乳腺癌辅助诊断的理想指标,其联合检测有利于提高乳腺癌的诊断率;CA199,NSE,CA242,HCG,AFP,f-PSA,PSA,HGH这些指标对乳腺癌诊断价值较低;作为1种统计手段,logistic回归可改善诊断的灵敏度和特异性。