经阴道子宫输卵管四维超声造影评价输卵管通畅性的研究

目的探讨经阴道子宫输卵管四维超声造影(4D-HyCoSy)在输卵管通畅性评价中的临床应用价值。方法对160例不孕不育妇女进行4D-HyCoSy检查,分析所获得图像,评估其输卵管通畅性;其中49例随后进行子宫输卵管碘油造影(HSG),72例进行腹腔镜检查。结果 160例患者316条输卵管(其中1例为单角子宫,3例曾行单侧输卵管切除术)4DHyCoSy显示输卵管通畅209条,输卵管通而不畅43条,输卵管不通64条。其中49例同时进行HSG检查,总体符合率约97.9%(96/98),72例同时进行腹腔镜检查,总体符合率约91.4%(128/140)。结论 4D-HyCoSy能动态立体显示输卵管形态,准确评价输卵管通畅性,可作为不孕不育患者输卵管检查的首选检查方法。     

Evaluation of dosimetric variance in whole breast forward-planned intensity-modulated radiotherapy based on 4DCT and 3DCT

This study was performed to explore and compare the dosimetric variance caused by respiratory movement in the breast during forward-planned IMRT after breast-conserving surgery. A total of 17 enrolled patients underwent the 3DCT simulation scans followed by 4DCT simulation scans during free breathing. The treatment planning constructed using the 3DCT images was copied and applied to the end expiration (EE) and end inspiration (EI) scans and the dose distributions were calculated separately. CTV volume variance amplitude was very small (11.93 ± 28.64 cm³), and the percentage change of CTV volumes receiving 50 Gy and 55 Gy between different scans were all less than 0.8%. There was no statistically significant difference between EI and EE scans (Z =–0.26, P = 0.795). However, significant differences were found when comparing the D_mean at 3DCT planning with the EI and EE planning (P = 0.010 and 0.019, respectively). The homogeneity index at EI, EE and 3D plannings were 0.139, 0.141 and 0.127, respectively, and significant differences existed between 3D and EI, and between 3D and EE (P = 0.001 and 0.006, respectively). The conformal index (CI) increased significantly in 3D treatment planning (0.74 ± 0.07) compared with the EI and EE phase plannings (P = 0.005 and 0.005, respectively). The V₃₀, V₄₀, V₅₀ and D_mean of the ipsilateral lung for EE phase planning were significantly lower than for EI (P = 0.001–0.042). There were no significant differences in all the DVH parameters for the heart among these plannings (P = 0.128–0.866). The breast deformation during respiration can be disregarded in whole breast IMRT. 3D treatment planning is sufficient for whole breast forward-planned IMRT on the basis of our DVH analysis, but 4D treatment planning, breath-hold, or respiratory gate may ensure precise delivery of radiation dose.     

基于4D-CT扫描放疗中食管癌靶区空间位置及重合度的变化

目的 基于四维CT（4D-CT）模拟定位扫描,探讨放疗疗程中不同时段胸段食管癌原发肿瘤内靶区及计划靶区空间位置及重合度的变化。方法 33例胸段食管癌患者,分别于放疗前及放疗10次、20次时行4D-CT模拟定位扫描,分别在每次扫描各时相图像上勾画食管癌大体肿瘤体积（GTV）,并构建内靶区（ITV）及计划靶区（PTV）。结果 放疗疗程中ITV及PTV体积均呈递减趋势,两靶区中心点位置变化均不明显。初始各靶区对疗程中各靶区包含度ITV分别为0.85、0.77（Z=-3.10,P<0.05）,PTV为0.86、0.82（Z=-2.49,P<0.05）。疗程中不同时段各靶区匹配指数ITV分别为0.77、0.70（Z=-3.16,P<0.05）,PTV为0.82、0.76（Z=-2.49, P<0.05）。疗程中ITV及PTV各自体积比值变化与其初始靶区对疗程中靶区包含度变化均呈正相关（r_ITV=0.71、r_PTV=0.77,P<0.05）,疗程中ITV及PTV各自体积比值变化与各自匹配指数变化呈正相关（r_ITV=0.47、r_PTV=0.59,P<0.05）。ITV及PTV三维运动矢量与各自匹配指数呈负相关（r_ITV=-0.52、r_PTV=-0.36,P<0.05）。放疗疗程中若以初始PTV制定放疗计划,则放疗10次、20次时分别有8.80%和6.37%的靶区漏照（Z=-0.55,P>0.05）,11.45%和18.49%的正常组织受照射（Z=-2.49,P<0.05）。结论 胸段食管癌原发肿瘤常规剂量分割放疗时,内靶区及计划靶区空间位置变化均<0.6 cm;放疗疗程中靶区退缩致使靶区包含度及匹配指数不同程度下降,导致不同程度脱靶及正常组织受照射。     

Normal standards of fetal behavior assessed by four-dimensional sonography

Objective.?In this prospective randomized study, fetal behavior was investigated in order to determine the standard parameters of fetal movements and facial expressions in all three trimesters of normal pregnancy.

Methods.?Sixty-three pregnant women with singleton pregnancies in all trimesters were included in the investigation. Four-dimensional (4D) ultrasound was performed for each patient over a 30-minute period. Variables of maternal and fetal characteristics including gestational age, eight fetal movement patterns in the first trimester, and sixteen parameters of fetal movement and fetal facial expression patterns in the second and third trimesters were recorded for the construction of fetal neurological charts.

Results.?In the first trimester, a tendency towards an increased frequency of fetal movement patterns with increasing gestational age was noticed. Only the startle movement pattern seemed to occur stagnantly during the first trimester (p > 0.05). At the beginning of the second trimester, the frequency of fetal movement patterns tended to increase. During the second and third trimester, multiple regression and polynomial regression revealed statistically significant changes in tongue expulsion (p < 0.05), smiling (p < 0.05), grimacing (p < 0.05), swallowing (p < 0.05), eye blinking (p < 0.01), head movements, and all hand to body contact movements (p < 0.01), except for head anteflexion (p > 0.05). There were no statistically significant changes during the second and third trimesters in mouthing, yawning, and sucking (p > 0.05). At the middle of the third trimester, the fetuses displayed decreasing or stagnant incidence of fetal facial expressions except for eye blinking, which showed increased frequency with increasing gestational age. A statistically significant correlation was found between all head movements and hand to body contact patterns during the second and third trimesters except for head anteflexion (r = ?0.231; p > 0.05).

Conclusions.?The full range of quantitative fetal facial expressions and fetal movement patterns can be assessed successfully by 4D sonography. It is important to be able to assess normal fetal behavior throughout gestation to identify abnormal behavior before birth.     

3DCT、4DCT和PET-CT定义的胸段食管癌PTV比较研究

目的 探讨基于PET-CT图像SUV≥2.5、20%或25%SUV_max与基于3DCT、4DCT构建的胸段食管癌PTV位置及体闫积差异性。方法 18例胸段食管癌患者序贯完成3DCT、4DCT、FDG PET-CT 胸部定位扫描。3DCT图像常规外扩获得PTV_3D;PTV_4D通过10个时相靶区融合获得;基于SUV≥2.5、20%或25%SUV_max分别得到IGTV_PET2.5、IGTV_PET20%、IGTV_PET25%,分别将这3个靶区上下方向外扩3.5 cm,左右前后方向外扩1 cm得到PTV_PET2.5、PTV_PET20%、PTV_PET25%。结果 PTV_3D体积显著大于PTV_4D和PTV_PET(P=0.000~0.044),而PTV_PET和PTV_4D相近(P=0.216~0.633)。PTV_3D、PTV_4D相互间DI分别为0.70、0.95,同三维运动矢量呈负相关(P=0.039)。PTV_PET2.5、PTV_PET20%、PTV_PET25%相互间DI分别为0.74、0.72、0.78、0.73、0.77、0.70,同三维运动矢量无相关性(P=0.150~0.822)。PTV_3D、PTV_PET间相互DI分别为0.86、0.84、0.88、0.63、0.67、0.59。结论 由于各自所包含的靶区信息差异等原因,基于3DCT、4DCT及PET-CT构建的胸段食管癌PTV在空间上很难达到完全重合。利用自由呼吸状态下PET扫描图像来构建胸段食管癌PTV尚需慎重。     

采用4DCT评价胃癌术后放疗中吻合口分次内和分次间动度的前瞻性研究

目的 采用4DCT技术研究胃癌术后辅助放疗中吻合口的分次内和分次间动度。方法 前瞻性纳入8例经毕Ⅰ式吻合胃癌根治术后行辅助放疗的局部晚期胃癌患者。在平静呼吸状态和控制残胃充盈条件下,进行疗前、疗中共4次4DCT扫描。以术后置入吻合钉为观察对象,评价吻合口在左右、前后、上下方向上分次内和分次间动度,并分析残胃体积变化与分次间动度的关系。组内差异行配对t检验,组间差异行单因素方差分析。结果 吻合口分次内动度在左右、前后、上下方向上分别为(2.4±2.3)、(2.1±2.0)、(5.6±4.0) mm,上下方向上的显著大于左右、前后方向(P=0.000、0.000)。分次间动度在左右、前后、上下方向上分别为(6.1±6.6)、(3.3±3.0)、(4.8±4.3) mm,分次间动度各方向间相近(左右:前后,P=0.064;左右:上下,P=0.156;前后:上下,P=0.161)。在左右方向上分次间动度显著大于分次内动度(P=0.018)。左右、前后、上下方向内边界分别为24.2、10.3、18.3 mm。结论 经毕Ⅰ式胃癌根治术后辅助放疗时应考虑到分次内和分次间动度,吻合口合理内边界在左右、前后和上下方向上可分别外放24.2、10.3、18.3 mm。     

A new time-resolved 3D angiographic technique (4D DSA): Description,and assessment of its reliability in Spetzler–Martin grading of cerebral arteriovenous malformations

Background and purpose

The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional DSA: 2D DSA) in AVM grading using the SM classification.

Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face

Ultrasonographic examination of the fetal face can provide information that may lead to the diagnosis of anomalies in other organs or systems. Thus, the fetal face represents a "diagnostic window" for fetal diseases and syndromes. Three-dimensional ultrasonography (3DUS) improves the evaluation of anatomic fetal facial anomalies over what is possible by 2-dimensional ultrasonography (2DUS). Four-dimensional ultrasonography (4DUS), by adding the temporal component to the examination, allows visualization of facial expressions that might be useful in the study of fetal behavior and maternal-fetal bonding. In this article, we evaluate the potential of 3D/4DUS for the study of structural and functional development of the fetal face.     

Computation of color and brightness differences by neurons in the lateral geniculate nucleus of the rabbit

The responses of 51 neurons in the lateral geniculate nucleus of the rabbit to substitution of colored stimuli different brightness and stimuli differing only in intensity were studied. Neurons in the geniculate nucleus, like neurons in the visual cortex, were found to respond with initial phasic discharges at 50–90 msec after stimulus substitution, the magnitudes of these responses correlating with the interstimulus differences; neurons also showed prolonged tonic responses in which the spike frequency depended on the intensity of the stimulus presented. Analysis of phasic responses allowed two groups of neurons to be identified: some were specialized to discriminate stimulus intensity only, while others were specialized to discriminate both the intensity and the color tone of the stimulus. Use of the magnitude of the early phasic discharge as a measure of the difference between stimuli yielded a sensory space for lateral geniculate nucleus neurons. The responses of neurons in the first group (44 cells, 86%) produced a two-dimensional achromatic space with two axes-brightness and darkness; this structure appeared independently of whether stimuli were of the same or different color tones. The phasic responses of neurons in the second group (seven of 51, 14%) generated a four-dimensional space with two color and two achromatic axes. The color and achromatic spaces of lateral geniculate nucleus neurons were analogous to the spaces previously identified for neurons in the rabbit visual cortex using the same stimulation conditions. The sensory spaces reconstructed on the basis of neuron phasic discharges essentially coincided with the spaces obtained from analysis of the N85 component of visual evoked potentials in rabbits, which provides support for the vector information coding principle in the visual analyzer. The tonic discharges of most lateral geniculate nucleus neurons correlated linearly with changes in stimulus intensity and can be regarded as reflecting a pre-detector function for the visual cortex detector neurons. __________ Translated from Zhurnal Vysshei Nervnoi Deyatel’nosti imeni I. P. Pavlova, Vol. 56, No. 1, pp. 75–85, January–February, 2006.