兔大腿VX2移植瘤模型磁共振扩散成像研究

采用大腿肌肉注射法建立兔VX2肿瘤模型,于造模后第7天、14天及21天进行磁共振成像(MRI)平扫、增强及扩散加权成像(DWI)检查,观察不同时期MRI表现。并于造模后第21天对照大体标本测量结果比较DWI及T2WI图像肿瘤最大径,同时比较肿瘤实体部分与髂窝内转移淋巴结的表观弥散系数(ADC)值。结果显示,造模后第7天,12只模型兔MRI常规及DWI图像均可见成瘤;第14天,2例肿瘤内出现坏死灶;第21天,12例肿瘤内均出现坏死,DWI图像可发现局部淋巴结转移灶,DWI及T2WI图像肿瘤最大径与大体标本测量结果差别无统计学意义。髂窝内转移淋巴结的ADC值与原发肿瘤实体部分ADC值间差别无统计学意义。DWI可以监测兔大腿VX2肿瘤生长,有效区分肿瘤早期坏死成分,并判断相应引流区域淋巴结的性质。     

磁共振弥散加权成像在检测短暂性脑缺血责任病灶的临床价值

目的:探讨磁共振弥散加权成像显示短暂性脑缺血责任病灶的敏感性及其临床应用价值.方法:对连续的39例资料完整的住院TIA患者进行了常规磁共振成像和弥散加权磁共振成像(diffusion-weighted MRI,DWI)检查,对比不同成像序列对短暂性脑缺血责任病灶的检出率.结果:在39例TIA患者中,快速自旋回波序列(FSET1WI和FSET2WI)检出TIA责任病灶9例(9/39);翻转恢复序列(FLAIR)检出11例(11/39);弥散加权序列检出15例(15/39).不同序列检出率比较运用单因素的方差分析显示有明显差异(P=0.001),弥散加权序列检出率最高.结论:DWI序列对TIA责任病灶的检出率明显高于常规MR,可为TIA患者的临床处理提供可靠诊断信息.     

磁共振扩散加权成像对宫颈癌诊断价值及其与临床病理特征的关系研究

目的:研究磁共振扩散加权成像(DWI)对宫颈癌的诊断价值及其与临床病理特征的关系。方法:将2016年5月至2018年5月间于本院接受诊治的90例宫颈癌患者作为研究组,其中鳞癌69例,腺癌21例。另选择同期因其他原因来本院行宫颈检查的90例非宫颈癌患者作为对照组,两组患者均接受常规磁共振成像(MRI)平扫及DWI检查。观察两组MRI影像学特征,分别比较研究组和对照组、不同病理分型以及不同临床病理特征宫颈癌患者表观弥散系数(ADC)值,采用受试者工作特征(ROC)曲线评价DWI检查对宫颈癌的诊断价值,并分析宫颈癌患者ADC值与临床病理特征的关系。结果:研究组和对照组的MRI影像学图像全部符合诊断和测量要求,无显著的伪影、变形;研究组患者的病变位在宫颈,其信号特征T1加权像(T1WI)显示为等信号,而T2加权像(T2WI)显示为稍高/高信号,经DWI检查显示为高信号肿块,且边界清晰。研究组患者DWI检查的ADC值低于对照组(P0.05);鳞癌患者DWI检查的ADC值也明显低于腺癌患者(P0.05)。ROC曲线结果显示,DWI检查鉴别诊断宫颈癌和非宫颈癌、鳞癌和腺癌的AUC分别为0.912、0.827。无淋巴结转移、临床病理分期为Ⅰ-Ⅱ期、中/高分化以及肿瘤细胞间质占比70%的宫颈癌患者ADC值分别高于有淋巴结转移、临床病理分期为Ⅲ-Ⅵ期、低分化以及肿瘤细胞间质占比≥70%的宫颈癌患者(均P0.05)。结论:DWI对宫颈癌诊断价值高,且DWI成像参数ADC值和宫颈癌的部分临床病理特征关系密切,能从一定程度上辅助医师了解宫颈癌病理分型、病理分期、分化程度及有无淋巴结转移。     

MR 弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像(DWI)鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57 例经临床或病理证实的椎体 良恶性压缩性骨折患者行矢状位T1WI、T2WI、T2WI/FS 及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR 序列 和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数(ADC)值,并进行统计学分析。结果：(1)MR 常规序列和 DWI序列(b=500s/mm2)表现：良性椎体压缩性骨折呈长T1 长或等T2 改变,T2WI/FS 呈高信号,DWI 可以呈高信号、等信号及低 信号;恶性椎体压缩性骨折呈长T1 长T2 信号,大部分病灶T2WI/FS 及DWI呈高信号,少数变现为低信号;(2)MR 常规序列和 DWI 序列(b=500s/mm2)病灶检出率的比较：T1WI、T2WI/FS 及DWI序列病灶检出率均高于T2WI 序列,其间的差别有显著性意 义(P<0.01),T1WI、T2WI/FS 及DWI序列病灶检出率之间无显著性差异(P>0.01);(3)ADC 值比较：在DWI(b=500 s/mm2)上,良性组 ADC 值为(2.03± 0.83)× 10-3mm2/s,恶性组ADC 值为(1.37 ± 0.75)× 10-3mm2/s,正常组ADC值为(0.36± 0.21)× 10-3mm2/s,成像条 件相同时,良性组高于恶性组,两组间有明显的统计学意义(P<0.05)。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化 指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

MR弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像（DWI）鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57例经临床或病理证实的椎体良恶性压缩性骨折患者行矢状位T1M、T2WI、T2WI／FS及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR序列和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数（ADC）值,并进行统计学分析。结果：（1）MR常规序列和DWI序列（b=500s／mm2）表现：良性椎体压缩性骨折呈长T1长或等T2改变,T2WI／FS呈高信号,DWI可以呈高信号、等信号及低信号;恶性椎体压缩性骨折呈长T1长T2信号,大部分病灶T2WUFS及DWI呈高信号,少数变现为低信号;（2）MR常规序列和DWI序列（b=500s／mm2）病灶检出率的比较：T1WI、T2WI／FS及DWI序列病灶检出率均高于T2WI序列,其间的差别有显著性意义（P〈0．01）,T1WI、T2WI／FS及DWI序列病灶检出率之间无显著性差异（P〉0．01）;（3）ADC值比较：在DWI（b=500s／mm2）上,良性组ADC值为（2．03±0．83）×10^3mm^2/s,恶性组ADC值为（1．37±0．75）×10^-3mm^2/s,正常组ADC值为（0．36±0．21）×10^-3mm^2／s,成像条件相同时,良性组高于恶性组,两组间有明显的统计学意义（P〈0．05）。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

阴道彩色多普勒对妇科盆腔肿瘤闭孔淋巴转移的诊断

目的:探究经阴道彩色多普勒超声对妇科盆腔肿瘤闭孔淋巴转移的诊断价值。方法:选择2013年1月至2014年12月到我院进行子宫切除联合盆腔淋巴清扫术的妇科盆腔肿瘤患者86例作为研究对象,按照手术的先后顺序将患者分为观察组和对照组,每组43例。观察组患者采用经阴道彩色多普勒超声对患者闭孔淋巴结是否转移进行检查,对照组采用B超对患者闭孔淋巴结是否转移进行检查,比较两组患者检查的准确性。结果:观察组患者检查结果中显示,转移的为14例,无转移的为29例,与病理检查结果比较无显著统计学差异(P0.05),对照组患者检查结果中显示,转移的为5例,无转移的为36例,与病理检查结果比较具有显著统计学差异(P0.05),观察组患者检查的正确率为95.3%,而对照组检查的正确率仅为81.4%,两组比较具有显著统计学差异(u=4.0737,P=0.0436),观察组患者检查后的满意率为90.7%,而对照组的满意率为79.1%,两组比较具有显著统计学差异(u=2.7051,P=0.0068)。结论:经阴道彩色多普勒超声对妇科盆腔肿瘤闭孔淋巴转移的诊断准确性高,具有较高的临床参考价值。     

18F-FDG PET/CT 在宫颈癌诊断及分期中的临床价值

目的:探讨氟代脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像/X线计算机体层成像仪(PET/CT)检查在局灶早期宫颈癌中的临床应用价值。方法:53例病理确诊为早期宫颈癌的患者行全身~(18)F-FDG PET/CT检查,并在检查结束10日内行广泛性全子宫切除术+双附件切除术+盆腔淋巴结清扫术,计算~(18)F-FDG PET/CT诊断宫颈原发部位肿瘤及盆腔淋巴结转移的敏感度,特异度与准确度。结果:~(18)F-FDG PET/CT检查诊断的宫颈原发部位肿瘤的敏感度为79.25%,特异度为86.79%,准确度为84.9%;以病人为单位诊断盆腔淋巴结转移的准确度为85.71%,特异度为97.87%;以淋巴结为单位诊断盆腔淋巴结转移的准确度为84.61%,特异度为99.00%。结论:PET/CT显像对宫颈癌诊断,分期诊断及盆腔淋巴结转移的检出具有重要临床意义。     

对比剂动力学时间分辨成像及弥散加权成像技术活体动态监测兔VX2肌肉肿瘤生物学生长与血管生成

目的:应用对比剂动力学时间分辨成像(Time Resolved Imaging of Contrast Kinetics,TRICKS)技术增强磁共振血管成像(MRangiography,MRA)及弥散加权成像(Diffusion Weighted Imaging,DWI)技术活体动态监测兔VX2肌肉肿瘤生物学生长与血管生成,探讨肿瘤血管生成与肿瘤生长的关系。方法:30只新西兰白兔,每只均在右后腿肌肉内接种VX2肿瘤细胞1×107建立肿瘤模型。分别在肿瘤接种后第4、7、10、13、16天(每个时间点6只)分别进行T1WI、T2WI、DWI、TRICKS动态增强MRA及T1WI增强延迟扫描,活体监测兔VX2肌肉肿瘤血管生成,肿瘤标本HE及CD31免疫组化染色进行验证。两位医师双盲法分别测量不同生长点肿瘤的长、短径及体积,并与大体病理标本比较;测定TRICKS增强动态MRA所能显示肿瘤血管的最小直径及形态变化;观察ADC值变化与肿瘤生长的关系。结果(:1)ADC值随着肿瘤体积的长大而逐渐增大。(2)MRI活体测定肿瘤大小与病理大体标本所测算肿瘤体积的差异无显著性。(3)TRICKS增强MRA动态显示肿瘤血管的最小...     

多参数MRI对腺性膀胱炎与膀胱癌的鉴别及膀胱癌病理分期的诊断价值分析

摘要 目的：分析多参数磁共振成像（MRI）对腺性膀胱炎与膀胱癌的鉴别及膀胱癌病理分期的诊断价值。方法：选取2019年2月～2023年2月本院收治50例腺性膀胱炎和50例膀胱癌患者进行研究，均采用MRI多参数[高分辨率T2加权图像（HR T2WI）、弥散加权成像（DWI）、动态强磁共振成像（DCE-MRI）]检查，分析腺性膀胱炎与膀胱癌的HR T2WI、DWI、DCE-MRI信号强度；以病理检查结果为诊断金标准，分析MRI参数单一诊断和联合诊断膀胱癌的正确病理分期检出率，并采用Kappa系数分析MRI多参数单一和联合诊断膀胱癌病理结果的一致性，同时计算MRI参数联合诊断在膀胱癌病理分期的诊断效能。结果：与腺性膀胱炎比较，膀胱癌HR T2WI、DWI、DCE-MRI高强度占比较高（P＜0.05）。与HR T2WI、DCE-MRI比较，T2WI+DWI+DCE-MRI正确分期诊断率较高（P＜0.05）。T2WI+DWI+DCE-MRI诊断膀胱癌分期与病理结果一致性很强，Kappa值＞0.80。HR T2WI+DWI+DCE-MRI对膀胱癌T1分期诊断的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确率分别为93.75%、94.44%、96.77%、89.47%、94.00%；T2分期分别为91.67%、94.74%、84.62%、97.30%、94.00%，T3分期分别为100.00%、93.48%、57.14%、100.00%、94.00%，T4分期分别为100.00%、93.75%、40.00%、100.00%、94.00%，≤T1 vs ≥T2分别为94.44%、93.75%、89.47%、96.77%、94.00，≤T2 vs ≥T3分别为100.00%、93.18%、66.67%、100.00%、94.00%。结论：MRI多参数信号强度可有效鉴别诊断腺性膀胱炎和膀胱癌，且多参数联合诊断可提升病理分期的诊断效能。     

系统性淋巴结清扫术对子宫内膜癌患者预后的影响及安全性分析*

目的:分析系统性淋巴结清扫术对子宫内膜癌患者预后的影响及安全性。方法:选择2010年6月~2012年6月我院收治的68例子宫内膜癌患者作为研究对象,将其随机分为研究组与对照组。对照组行两侧附件+全子宫切除+盆腔淋巴结清扫术,研究组行两侧附件+全子宫切除+系统性腹腔、盆腔主动脉旁淋巴结清扫术。观察和比较两组患者术后3年内的生存率、疾病复发转移率以及并发症的发生率。结果:研究组检出阳性淋巴结15枚,发现4例患者淋巴结转移;对照组患检出阳性淋巴结3枚,发现1例患者淋巴结转移。两组阳性淋巴结检出率及淋巴结转移发现率比较差异无统计学意义(P0.05)。研究组3年内生存率为88.24%,显著高于对照组的67.65%(P0.05);复发转移率为14.71%,显著高于对照组的35.29%(P0.05)。研究组患者术后发生不全性肠梗阻发生率为17.65%,显著高于对照组(P0.05);但两组术后下肢水肿、深静脉血栓、淋巴囊肿、输尿管尿瘘、体温转复时间5 d的发生率对比差异均无统计学意义(P0.05)。结论:系统性淋巴结清扫术可以延长子宫内膜癌患者的3年生存率,降低病灶的复发及转移率,虽然术后不全性肠梗阻的发生率有所增加,但仍在可控范围内。     

Role of Diffusion Weighted Imaging and Contrast-Enhanced MRI in the Evaluation of Intrapelvic Recurrence of Gynecological Malignant Tumor

Background and Purpose

To investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies.

Materials and Methods

Sixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis.

Results

Locally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3, 79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C.

Conclusion

MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.     

The Value of T2* in Differentiating Metastatic from Benign Axillary Lymph Nodes in Patients with Breast Cancer - A Preliminary In Vivo Study

Background

Accurate detection and determination of axillary lymph node metastasis are crucial for the clinical management of patients with breast cancer. Noninvasive imaging methods including ultrasound (US), computed tomography (CT), or conventional magnetic resonance imaging (MRI) are not yet accurate enough. The purpose of this study was to investigate the value of in vivo T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer.

Methodology/Principal Findings

In this institutional review board approved study, 35 women with breast cancer underwent multi-echo T2* weighted imaging (T2*WI) of the axillary area on a 3.0 T clinical magnetic resonance (MR) imaging system. T2* values of pathologically proven benign and metastatic axillary lymph nodes were calculated and compared. Receiver operating characteristics (ROC) analysis was conducted to evaluate the diagnostic ability. The areas under the ROC curve (AUCs) and the confidence intervals (CIs) were assessed. In total, 56 metastatic and 65 benign axillary lymph nodes were identified in this study. For metastatic lymph nodes, the average T2* value (55.96±11.87 ms) was significantly longer than that of the benign lymph nodes (26.00±5.51 ms, P<0.05). The AUC of T2* in differentiating benign from metastatic lymph nodes was 0.993. The cut-off value of 37.5 milliseconds (ms) gave a sensitivity of 94.6%, a specificity of 98.5%, a positive predictive value of 98.17 and a negative predictive value 95.54.

Conclusions

In vivo T2* can differentiate benign from metastatic axillary lymph nodes in patients with breast cancer. The high sensitivity and specificity as well as the easiness suggest its high potential for use in clinical practice.     

Efficiency of Non-Contrast-Enhanced Liver Imaging Sequences Added to Initial Rectal MRI in Rectal Cancer Patients

Purpose

The purpose of this study was to estimate the value of addition of liver imaging to initial rectal magnetic resonance imaging (MRI) for detection of liver metastasis and evaluate imaging predictors of a high risk of liver metastasis on rectal MRI.

Methods

We enrolled 144 patients who from October 2010 to May 2013 underwent rectal MRI with T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) (b values = 50, 500, and 900 s/mm²) of the liver and abdominopelvic computed tomography (APCT) for the initial staging of rectal cancer. Two reviewers scored the possibility of liver metastasis on different sets of liver images (T2WI, DWI, and combined T2WI and DWI) and APCT and reached a conclusion by consensus for different analytic results. Imaging features from rectal MRI were also analyzed. The diagnostic performances of CT and an additional liver scan to detect liver metastasis were compared. Multivariate logistic regression to determine independent predictors of liver metastasis among rectal MRI features and tumor markers was performed. This retrospective study was approved by the Institutional Review Board, and the requirement for informed consent was waived.

Results

All sets of liver images were more effective than APCT for detecting liver metastasis, and DWI was the most effective. Perivascular stranding and anal sphincter invasion were statistically significant for liver metastasis (p = 0.0077 and p = 0.0471), while extramural vascular invasion based on MRI (mrEMVI) was marginally significant (p = 0.0534).

Conclusion

The addition of non-contrast-enhanced liver imaging, particularly DWI, to initial rectal MRI in rectal cancer patients could facilitate detection of liver metastasis without APCT. Perivascular stranding, anal sphincter invasion, and mrEMVI detected on rectal MRI were important imaging predictors of liver metastasis.     

Le ganglion sentinelle dans les cancers de la cavité orale : impact clinique et apport de l’imagerie hybride

ObjectivesWe report a prospective evaluation of the sentinel lymph node identification and biopsy in oral cavity cancer in order to assess the additional value of the single photon emission computed tomography-computed tomography (SPECT-CT).Patients and methodsThirteen patients with T1 or T2 clinical N0 oral cavity cancer were prospectively included. They first underwent a lymphoscintigraphy with planar imaging. A SPECT-CT was performed secondly. Finally, excised sentinel lymph nodes were screened according to a specific histological processing.ResultsThe scintigraphic detection rate was 100%, both with planar and SPECT/CT imaging. Dynamic and early images were predictive of the lymph node drainage territory for 11 patients (85%). An impact of SPECT/CT in 83% of cases was achieved with additional quantitative information in 58% cases and qualitative information in 58% cases. A greater sensibility was also pointed out for level 1 sentinel lymph nodes, close to the injection site. Once, an occult metastasis was revealed by the histological analysis of the sentinel lymph nodes.ConclusionRadioisotopic sentinel lymph node technique for oral cavity cancers allowed determining neck node status for all patients. Ninety-two percent of them were spared from a radical neck dissection or radiotherapy. Preoperative detection of sentinel lymph node is optimised in most cases by hybrid imaging procedure. Anatomical data provided by hybrid imaging are useful for surgery.     

Prognostic Significance of Peritumoral Lymphatic Vessel Density and Vascular Endothelial Growth Factor Receptor 3 in Invasive Squamous Cell Cervical Cancer

Cervical cancer is known to metastasize primarily by the lymphatic system. Dissemination through lymphatic vessels represents an early step in regional tumor progression, and the presence of lymphatic metastasis is associated with a poor prognosis. In patients who have undergone a radical hysterectomy, lymphovascular space invasion (LVSI), assessed on hematoxylin and eosin-stained slides, is a major factor for adjuvant therapy in patients with cervical cancer. With the advent of a lymphatic endothelial cell-specific marker, such as D2-40, it is now possible to distinguish between blood and lymphatic space invasion (LSI). In this study, the utility of D2-40 was assessed for the detection of lymphatic vessel density (LVD) and identification of LSI. The expressions of vascular endothelial growth factor receptor-3 (VEGFR-3), VEGF-C, tyrosine receptor kinase-2, and angiopoietin-1 were assessed by immunohistochemical methods on 50 patients with squamous cell carcinoma of the cervix. Clinicopathologic characteristics, including pelvic lymph node metastasis, were correlated with the above histochemical findings. We found that lymphangiogenesis, measured by an increase in peritumoral LVD, was significantly associated with positive lymph node status (P < .005). VEGFR-3 expression was significantly associated with LVD (P < .05). D2-40 staining verified LSI (P = .03) and surpassed that of hematoxylin and eosin-identified LVSI (P = .54). In conclusion, lymphangiogenic markers, specifically LVD quantified by D2-40 and VEGFR-3, are independently associated with LSI and lymph node metastasis in patients with early squamous cell carcinoma of the cervix treated with radical hysterectomy and pelvic lymphadenectomy.     

幽门螺杆菌感染性胃癌组织中cyclinD1、MMP-9的表达及其临床意义

目的:探讨幽门螺杆菌(HP)感染性胃癌组织中细胞周期蛋白D1(cyclinD1)、基质金属蛋白酶-9(MMP-9)的表达及其临床意义。方法:选取2016年12月到2018年6月期间在兰州大学第一医院接受治疗的胃癌患者80例,收集其手术切除的病理组织。采用C-14呼气试验和改良Giemsa染色检测患者HP感染的情况,采用免疫组化法检测胃癌组织中cyclinD1、MMP-9表达情况。分析HP感染、cyclinD1、MMP-9表达与胃癌患者临床病理特征的关系,并分析胃癌患者HP感染与cyclinD1、MMP-9表达的相关性。结果:80例胃癌患者HP感染阳性56例(70.00%),阴性24例(30.00%)。有淋巴结转移、浸润深度为T3+T4的胃癌患者的HP感染阳性率高于无淋巴结转移、浸润深度为T1+T2的胃癌患者(P0.05)。80例胃癌患者cyclinD1阳性表达45例(56.25%),阴性表达35例(43.75%),MMP-9阳性表达65例(81.25%),阴性表达15例(18.75%),TNM临床分期为III+IV期、分化程度为低分化、有淋巴结转移、浸润深度为T3+T4的胃癌患者的cyclinD1、MMP-9阳性表达率明显高于TNM临床分期为I+II期、分化程度为中高分化、无淋巴结转移、浸润深度为T1+T2的胃癌患者(P0.05)。HP感染阳性患者的cyclinD1阳性表达率和MMP-9阳性表达率均明显高于HP感染阴性患者(P0.05)。Pearson相关分析显示,胃癌患者HP感染与cyclinD1、MMP-9表达均呈正相关(P0.05)。结论:胃癌患者的HP感染情况与淋巴结转移、浸润深度有关,cyclinD1和MMP-9的表达与TNM临床分期、分化程度、淋巴结转移、浸润深度有关,且胃癌患者HP感染与cyclinD1、MMP-9表达均呈正相关。     

Primary Tumor-Secreted Lymphangiogenic Factors Induce Pre-Metastatic Lymphvascular Niche Formation at Sentinel Lymph Nodes in Oral Squamous Cell Carcinoma

Objectives

The objectives of this study were to evaluate the formation of lymphvascular niches in lymph nodes of patients with oral squamous cell carcinoma (OSCC), and investigate the roles of lymphangiogenic and angiogenic factors, such as vascular endothelial growth factor (VEGF)-A, VEGF-C, and VEGF-D, expressed in the primary tumors.

Materials and Methods

Forty-four patients with previously untreated clinically late T2 or T3 OSCC of cN0 were evaluated for primary tumors and 166 sentinel lymph nodes (SLNs). Primary tumors were immunohistochemically analyzed for expressions of VEGFs. Densities of lymphatic vessels (LVD_podoplanin) and high endothelial venules (HEVD) in the SLNs were also calculated using antibodies for each marker, podoplanin and MECA-79, respectively.

Results

In 25 patients, all lymph nodes were metastasis-negative, whereas, in 19 patients, metastasis was positive for at least one lymph node (either at SLN, non-SLN, or nodal recurrence). From the analyses of 140 SLNs without metastasis, LVD_podoplanin in 50 SLNs of metastasis-positive cases was significantly higher than that in 90 SLNs of metastasis-negative cases (p = 0.0025). HEVD was not associated with lymph node metastasis. The patients with VEGF-A-High or VEGF-D-High tumors had significantly higher LVD_podoplanin than patients with their Low counterparts (p = 0.0233 and p = 0.0209, respectively). In cases with lymph node metastasis, the VEGF-D-expression score was significantly higher than in those without lymph node metastasis (p = 0.0006).

Conclusions

These results suggest that lymph node lymphangiogenesis occurs before metastasis in OSCC. VEGF-A and VEGF-D play critical roles in this process. VEGF-D is a potential predictive marker of positive lymph node metastasis in cN0 patients.     

磁共振扩散加权成像联合血清AFP、CA125、CEA、CA199检测在早期原发性肝癌中的诊断价值研究

摘要 目的：研究磁共振扩散加权成像（DWI）联合血清甲胎蛋白（AFP）、糖类抗原125（CA125）、癌胚抗原（CEA）、糖类抗原199（CA199）检测在早期原发性肝癌（PHC）中的诊断价值。方法：选取我院自2017年9月开始至2020年5月收治的63例早期PHC患者纳入研究,记作肝癌组,再取同期我院收治的61例良性肝病患者记作对照组。对所有受试者均实施DWI扫描,比较两组DWI图像信号强度。检测并比较两组血清AFP、CA125、CEA、CA199水平,以受试者工作特征（ROC）曲线分析上述各项血清学指标水平检测和DWI诊断早期PHC的效能。另外,比较PHC淋巴结转移患者和无淋巴结转移患者血清AFP、CA125、CEA、CA199水平。结果：肝癌组DWI信号强度为高信号人数占比高于对照组（均P<0.05）。肝癌组血清AFP、CA125、CEA、CA199水平均高于对照组（均P<0.05）。血清AFP、CA125、CEA、CA199水平联合DWI诊断早期PHC的曲线下面积、灵敏度以及特异度均高于上述各检查方式单独检测。PHC淋巴结转移患者的血清AFP、CA125、CEA、CA199水平均高于无淋巴结转移患者（均P<0.05）。结论：DWI联合血清AFP、CA125、CEA、CA199检测诊断早期PHC的价值较高,且淋巴结转移患者的血清AFP、CA125、CEA、CA199水平明显升高。