X线片和多层螺旋CT诊断及鉴别周围型肺癌的对比研究

目的:对比X线平片和多层螺旋CT诊断及鉴别周围型肺癌的效果。方法:选取了100例周围型肺癌患者,所有患者入院后先行X线片检查,后进行多层螺旋CT检查。通过观察并记录X线片与多层螺旋CT对周围型肺癌的影像学特征、临床TNM分期的诊断效果,评价X线平片和多层螺旋CT对周围型肺癌的诊断效果。结果:多层螺旋CT对周围型肺癌的肿块、分叶征、支气管气象征、空洞、胸膜凹陷、血管集束征,胸腔积液的检出率均高于X线片(P0.05)。根据外科病理TNM分期结果,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率为92.0%,X线对周围型肺癌的临床TNM分期诊断符合率为61.0%,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率明显高于X线(P0.05)。结论:多层螺旋CT对于周围型肺癌各类型影像学征象具有较好的检出率,对周围型肺癌临床TNM分期诊断准确性接近病理诊断结果。     

Computed tomography in the evaluation of tumor regression after neoadjuvant therapy: X-ray surgery and X-ray morphological comparisons

An analysis was made of chest computed tomograms of 38 small-cell lung cancer patients subjected to radical surgical treatment after neoadjuvant therapy. CT data were compared with the findings of macro- and microscopic examination of surgical specimens. In 24 (63.2%) patients, computed tomograms made before surgery showed complete tumor response confirmed by gross examination in 22 (96.1%) of them. However, microscopic examination found cancer cells in 8 (33.3%) patients. In 2 (8.3%) patients, small residual tumors could be detected by sight, which was confirmed by pathological examination. In 14 (36.8%) patients with partial response, radiological and gross examination findings fully coincided. Nevertheless, in 2 (14.3%) cases the "residual tumor" appeared to be a segment of fibrocicatrical tissue under pathological examination. On the basis of the CT findings the values of diagnostic sensitivity, accuracy and specificity in tumor response evaluation were calculated which made up 87.5%, 68.4% and 54.5% respectively. With sufficiently high sensitivity, CT specificity is low. CT makes it possible to objectively define the response of small-cell lung cancer to neoadjuvant therapy. However, the conclusion about complete response to the treatment can be made only on the basis of a comprehensive evaluation of the results of all available investigation methods and pathological examination.     

DNA hypomethylation-mediated activation of Cancer/Testis Antigen 45 (CT45) genes is associated with disease progression and reduced survival in epithelial ovarian cancer

Epithelial ovarian cancer (EOC) is a highly lethal malignancy due to a lack of early detection approaches coupled with poor outcomes for patients with clinically advanced disease. Cancer-testis (CT) or cancer-germline genes encode antigens known to generate spontaneous anti-tumor immunity in cancer patients. CT45 genes are a recently discovered 6-member family of X-linked CT genes with oncogenic function. Here, we determined CT45 expression in EOC and fully defined its epigenetic regulation by DNA methylation. CT45 was silent and hypermethylated in normal control tissues, but a large subset of EOC samples showed increased CT45 expression in conjunction with promoter DNA hypomethylation. In contrast, copy number status did not correlate with CT45 expression in the TCGA database for EOC. CT45 promoter methylation inversely correlated with both CT45 mRNA and protein expression, the latter determined using IHC staining of an EOC TMA. CT45 expression was increased and CT45 promoter methylation was decreased in late-stage and high-grade EOC, and both measures were associated with poor survival. CT45 hypomethylation was directly associated with LINE-1 hypomethylation, and CT45 was frequently co-expressed with other CT antigen genes in EOC. Decitabine treatment induced CT45 mRNA and protein expression in EOC cells, and promoter transgene analyses indicated that DNA methylation directly represses CT45 promoter activity. These data verify CT45 expression and promoter hypomethylation as possible prognostic biomarkers, and suggest CT45 as an immunological or therapeutic target in EOC. Treatment with decitabine or other epigenetic modulators could provide a means for more effective immunological targeting of CT45.     

MAGE-C2/CT10 protein expression is an independent predictor of recurrence in prostate cancer

The cancer-testis (CT) family of antigens is expressed in a variety of malignant neoplasms. In most cases, no CT antigen is found in normal tissues, except in testis, making them ideal targets for cancer immunotherapy. A comprehensive analysis of CT antigen expression has not yet been reported in prostate cancer. MAGE-C2/CT-10 is a novel CT antigen. The objective of this study was to analyze extent and prognostic significance of MAGE-C2/CT10 protein expression in prostate cancer. 348 prostate carcinomas from consecutive radical prostatectomies, 29 castration-refractory prostate cancer, 46 metastases, and 45 benign hyperplasias were immunohistochemically analyzed for MAGE-C2/CT10 expression using tissue microarrays. Nuclear MAGE-C2/CT10 expression was identified in only 3.3% primary prostate carcinomas. MAGE-C2/CT10 protein expression was significantly more frequent in metastatic (16.3% positivity) and castration-resistant prostate cancer (17% positivity; p<0.001). Nuclear MAGE-C2/CT10 expression was identified as predictor of biochemical recurrence after radical prostatectomy (p = 0.015), which was independent of preoperative PSA, Gleason score, tumor stage, and surgical margin status in multivariate analysis (p<0.05). MAGE-C2/CT10 expression in prostate cancer correlates with the degree of malignancy and indicates a higher risk for biochemical recurrence after radical prostatectomy. Further, the results suggest MAGE-C2/CT10 as a potential target for adjuvant and palliative immunotherapy in patients with prostate cancer.     

Tumor-derived TGF-beta reduces the efficacy of dendritic cell/tumor fusion vaccine

Dendritic cell (DC)-based antitumor vaccine is a novel cancer immunotherapy that is promising for reducing cancer-related mortality. However, results from early clinical trials were suboptimal. A possible explanation is that many tumors secrete immunosuppressive factors such as TGF-beta, which may hamper host immune response to DC vaccine. In this study, we demonstrated that TGF-beta produced by tumors significantly reduced the potency of DC/tumor fusion vaccines. TGF-beta-secreting (CT26-TGF-beta) stable mouse colon cancer cell lines were generated using a retroviral vector expressing TGF-beta. A non-TGF-beta-secreting (CT26-neo) cell line was generated using an empty retroviral vector. The efficacies of DC/tumor fusion vaccines were assessed in vitro and in vivo. DC/CT26-TGF-beta fusion cells failed to induce a strong T cell proliferative response in vitro, mainly due to the effect of TGF-beta on T cell responsiveness rather than DC stimulatory capability. Animals vaccinated with DC/CT26-TGF-beta fusion vaccine had lower tumor-specific CTL activity and had significantly lower survival after tumor challenge as compared with animals immunized with DC/CT26-neo hybrids (45 vs 77%, p < 0.05). Ex vivo exposure of DCs to TGF-beta did not appear to lessen the efficacy of DC vaccine. These data suggest that tumor-derived TGF-beta reduces the efficacy of DC/tumor fusion vaccine via an in vivo mechanism. Neutralization of TGF-beta produced by the fusion cells may enhance the effectiveness of DC-based immunotherapy.     

Computed tomography in the diagnosis of endophytic cancer of the stomach

The authors discuss the potentialities of CT in the diagnosis of endophytic stomach cancer. They proposed a method for CT of the stomach based on a pneumatic study of its lumen via a nasogastric probe with graded inflation and repeated CT imaging. The major CT-semiotics of endophytic stomach cancer were obtained. This method should be employed in combination with the existing routine methods of stomach cancer diagnosis, and its efficacy is in direct relation to the quality of preliminary routine x-ray and endoscopic investigations.     

Virtual bronchoscopy and 3D spiral CT reconstructions in the management of patient with bronchial cancer--our experience with Syngo 3D postprocessing software

Multislice helical CT generated virtual bronchoscopy (VB) represents one of the most recent developments in three-dimensional computer aided visualisation techniques. VB allows non-invasive and relatively accurate 3D evaluation of tracheobronchal tree. We performed virtual bronchoscopy and in-space 3D volume analysis on CT-data set acquired from sixty-four-year old male with bronchial cancer in order to demonstrate advantages and disadvantages of these methods in diagnostics and preoperative management of metastatic bronchial cancer. Siemens Somatom Emotion 16 helical CT scanner was used for data acquisition. Data post-processing was done with 3D Syngo 2006G software package from Siemens medical systems. CT scanning of the thorax was performed in heavy smoker with an expansive T4N1M1 malignant process in a superior lobe of the right lung accompanied with large metastatic lesion attached on the right lateral chest wall. Metastatic lesions were also found in vertebral column. In-space 3D analysis followed with virtual bronchoscopy had revealed obstruction of apical branch of superior lobe segmental bronchus. External compression done by tumor to the superior segmental and right main bronchus was found. We concluded that multi-slice CT in connection with VB became a possible non-invasive alternative to bronchoscopy, if tissue samples are not required.     

CT45A1 promotes the metastasis of osteosarcoma cells in vitro and in vivo through β-catenin

Increased expression of cancer/testis antigens (CTAs) is reported in various tumors. However, the unique role of CTAs in tumor genesis has not yet been verified. Here, we first report the functional role of CT45A1 in the carcinogenesis of osteosarcoma. RNA sequencing and immunohistochemistry confirmed that elevated expression of CT45A1 was detected in osteosarcoma, especially in metastatic tissues of osteosarcoma. Furthermore, osteosarcoma patients with poorer prognosis showed high expression of CT45A1. In cell tests, CT45A1 overexpression was shown to strengthen the proliferation, migration, and invasion abilities of osteosarcoma cells, while silencing CT45A1 markedly elicited the opposite effects in these tests by disrupting the activation of β-catenin. In summary, we identify a novel role of CT45A1 in osteosarcoma. Furthermore, our results suggested that CT45A1 may contribute to the development of osteosarcoma and could be a possible therapeutic target for osteosarcoma patients.Subject terms: Epithelial-mesenchymal transition, Sarcoma     

PET/CT和超声弹性成像在乳腺癌诊断中的价值对比分析

目的:探讨PET/CT和超声弹性成像(UE)在乳腺癌诊断中的价值。方法:回顾性分析2011年1月至2012年5月在我院确诊的173例乳腺患者的临床资料,所有患者均行PET/CT和UE检查。依据病理组织活检和临床随访分别评价PET/CT和UE对乳腺癌诊断的灵敏性、特异性、准确性,并比较两者的结果。结果:PET/CT和UE诊断乳腺癌的灵敏性分别为98.8%和81.3%;特异性分别为84.3%和97.2%;准确性分别为90.7%和90.2%;两种方法联合检测诊断乳腺癌的灵敏性、特异性、准确性分别为98.8%、98.1%、98.4%,UE检测乳腺癌的敏感性明显低于PET/CT及PET/CT+UE,PET/CT检测乳腺癌的特异性明显低于UE及PET/CT+UE,PET/CT+UE诊断乳腺癌的准确性显著提高(P0.05)。结论:PET/CT和超声弹性成像在乳腺癌诊断中均有较高的应用价值,各有优缺点,二者联合检测可提高乳腺癌诊断的准确率。     

CT与MRI对肝硬化背景下小肝癌检出率的比较

目的:分析比较CT与MR对肝硬化背景下小肝癌检出情况,探究CT与MR在肝硬化背景下小肝癌的诊断价值。方法:选择2010年6月~2015年6月期间,我院收治确诊为肝硬化背景下小肝癌患者91例为研究对象,病理及临床相关方法确诊102个病灶,其中小肝癌69个和微小肝癌33个,患者均在不同时期或序列下行多排螺旋CT与MRI检查,分析比较两者对小肝癌和微小肝癌的检出率。结果:多排螺旋CT检查发现肝癌小病灶91个,其中66个小肝癌,25个微小肝癌;MRI检查发现95个病灶,小肝癌67个,微小肝癌28个;69个小肝癌病灶,检出率最高的为CT动脉期(92.75%)与LAVA动脉期(92.75%),检出率最低的为CT平扫(76.81%);33个微小肝癌病灶,检出率最高为LAVA动脉期(75.76%),检出率最低的为LAVA平衡期(36.36%);CT平扫、门静脉期、动脉期、平衡期、MRI-IN-PHASE、LAVA平衡期、LAVA平扫对小肝癌的检出率显著高于对微小肝癌的检出率(P0.05);CT对小肝癌的检出率显著高于微小肝癌的检出率(P0.05),MRI对小肝癌与微小肝癌的检出率无显著差异(P0.05);MRI与CT对小肝癌的检出率不存在差异(P0.05),但MRI对微小肝癌的检出率显著高于CT(P0.05)。结论:MRI-LAVA的动脉期序列对小肝癌病灶与微小肝癌病灶的检出率最高;CT与MRI在对小肝癌的检出率不存在差异,但MRI对微小肝癌的检出具有更明显的优势。     

Unusual spread of the follicular thyroid carcinoma,metastases to liver and pancreas

We report a multimetastatic follicular thyroid carcinoma(FTC) with match lesions between ¹⁸F-FDG PET/CT and post-treatment ¹³¹I imaging. The patient had a history of thoracic vertebra corpectomy surgery and liver tru-cut biopsy; both resulted in metastases of FTC. After total thyroidectomy surgery, the patient was referred to the ¹⁸F-FDG PET/CT to investigate other possible metastatic foci. ¹⁸F-FDG PET/CT showed increased FDG uptakes on a cervical lymph node, bones, lung, liver, and pancreas. After treatment of ¹³¹I, post-treatment iodine scintigraphy demonstrated iodine uptakes in the same areas as the ¹⁸F-FDG PET/CT scan and at the thyroid bed. All the matched lesions were concluded as a spread of the FTC. Here we describe an infrequent differentiated thyroid carcinoma case with metastases to the liver and pancreas. This case report also highlights the importance of ¹⁸F-FDG PET/CT in determining the extent of thyroid cancer.     

增强CT和18F-FDG PET/CT在胃癌术前分期评估中的临床价值比较

目的:对比评估增强计算机断层扫描(contrast enhancement computed tomography,CECT)和~(18)F-FDG正电子发射计算机断层扫描(positron emission tomography/computed tomography,PET/CT)在胃癌术前分期中的临床应用价值。方法:回顾性分析经病理证实的胃癌患者的术前CECT(27例)及~(18)F-FDG PET/CT(39例)图像,于两种影像学手段下,双盲法判定每位患者胃癌的TNM分期,然后分别计算每种影像学方法在胃癌术前分期中的敏感性、特异性、阳性预测值、阴性预测值和准确性。两种影像学方法的差异比较采用Pearson卡方检验。结果:CECT和~(18)F-FDG PET/CT诊断胃癌T分期的敏感性、阳性预测值和准确性分别是100.00%、72.73%、59.26%和100.00%、90.91%、76.92%;CECT和~(18)F-FDG PET/CT诊断胃癌N分期的敏感性、特异性、阳性预测值、阴性预测值和准确性分别是75.00%、71.43%、88.24%、50.00%、74.07%和42.86%、92.00%、75.00%、74.19%、35.90%。结论:CECT和~(18)F-FDG PET/CT均可用于胃癌术前分期的预估,尤其在N分期方面,CECT的敏感性和准确性高于~(18)F-FDG PET/CT。     

CT及MRI在直肠癌诊断和分期的应用价值研究

目的:探究在直肠癌的诊断以及分期方面,CT与MRI技术的应用价值。方法:选取我院近年来经过病理检测,确诊为直肠癌的患者160例,随机分为两个实验组,其中一组采取CT成像方法,另一组患者采取MRI成像。并记录在不同的分期中CT及MRI的应用价值。CT诊断包含了常规CT平扫以及CT增强扫描,MRI诊断包括轴位DWI、T2W1冠状位以及矢状位、轴位T1WI、轴位T2WI的图像。结果:在直肠癌的诊断中,CT诊断的T分期与病理性T分期差异不大,其准确率为70.0%。MRI诊断的T分期和病理性T分期差异极小,其准确率为85.0%。CT诊断的N分期与病理性N分期差异不大,准确率为72.5%;MRI诊断的N分期与病理性N分期差异较小,其准确率为87.5%。CT诊断的T分期以及N分期的准确率与MRI诊断的T分期以及N分期的准确率之间差异均存在统计学意义(P0.05)。结论:在直肠癌的术前诊断以及局部分期中,MRI诊断与CT诊断相比,有更高的诊断价值。     

Diagnosis of chronic obstructive pulmonary disease in lung cancer screening Computed Tomography scans: independent contribution of emphysema,air trapping and bronchial wall thickening

Background

Beyond lung cancer, screening CT contains additional information on other smoking related diseases (e.g. chronic obstructive pulmonary disease, COPD). Since pulmonary function testing is not regularly incorporated in lung cancer screening, imaging biomarkers for COPD are likely to provide important surrogate measures for disease evaluation. Therefore, this study aims to determine the independent diagnostic value of CT emphysema, CT air trapping and CT bronchial wall thickness for COPD in low-dose screening CT scans.

Methods

Prebronchodilator spirometry and volumetric inspiratory and expiratory chest CT were obtained on the same day in 1140 male lung cancer screening participants. Emphysema, air trapping and bronchial wall thickness were automatically quantified in the CT scans. Logistic regression analysis was performed to derivate a model to diagnose COPD. The model was internally validated using bootstrapping techniques.

Results

Each of the three CT biomarkers independently contributed diagnostic value for COPD, additional to age, body mass index, smoking history and smoking status. The diagnostic model that included all three CT biomarkers had a sensitivity and specificity of 73.2% and 88.%, respectively. The positive and negative predictive value were 80.2% and 84.2%, respectively. Of all participants, 82.8% was assigned the correct status. The C-statistic was 0.87, and the Net Reclassification Index compared to a model without any CT biomarkers was 44.4%. However, the added value of the expiratory CT data was limited, with an increase in Net Reclassification Index of 4.5% compared to a model with only inspiratory CT data.

Conclusion

Quantitatively assessed CT emphysema, air trapping and bronchial wall thickness each contain independent diagnostic information for COPD, and these imaging biomarkers might prove useful in the absence of lung function testing and may influence lung cancer screening strategy. Inspiratory CT biomarkers alone may be sufficient to identify patients with COPD in lung cancer screening setting.     

Cholera toxin-induced alteration of the phenotype and behaviour of an ovarian carcinoma cell line, SR8.

Cholera toxin (CT) has been reported to cause a variety of effects on several different cell types. Recently, CT has been shown to increase the susceptibility of ovarian carcinoma cells to cytotoxicity mediated by a variety of effector cells (natural killer, lymphokine-activated killer cells and tumour-associated lymphocytes derived from ascites of ovarian cancer patients) of both autologous and allogenic background. In the present study, CT demonstrated several effects on a newly established ovarian carcinoma line (SR8)1 when added to the culture medium at a concentration of 12.5 ng/mL for 2 days. Cholera toxin altered SR8 morphology to a uniform polygonal cellular shape, with less cell dispersion than the non-CT treated cells. Cholera toxin prolonged the population doubling time by approximately 10 h. The CT-treated SR8 cells exhibited reduced epidermal growth factor receptor expression (39 versus 50%), and increased carbohydrate antigen 125 expression (45 versus 2%) in both immunocytochemical and quantitative flow cytometric analyses. These changes in morphology and tumour marker expression were reversible when CT was removed from the culture. The CT-treated SR8 cells showed reduced capacity to generate tumours in female nude mice in comparison with non-CT treated cells, which produce both subcutaneous and intraperitoneal xenografts with local invasion in an animal model. Cytogenetic analysis of the cell line SR8 before and during treatment with CT showed no new clonal rearrangements. The possible mechanisms involved and the influence of CT on the biological behaviour of ovarian tumour cells are discussed.     

上消化道造影和CT扫描诊断胃部肿瘤的应用价值比较

目的:比较上消化道造影和CT扫描诊断胃部肿瘤的临床应用价值。方法:选取我院胃外科收治的胃部肿瘤82例,随机分为两组,其中对照组41例,采用上消化道造影技术诊断;实验组41例,采用螺旋CT扫描,进行胃部肿瘤诊断。对比两组检查方式的诊断结果与病理诊断的符合率。结果:1进行螺旋CT扫描诊断与病理诊断符合率(95.12%,39/41)明显高于上消化道造影技术诊断符合率(80.49%,33/41),差异有统计学意义(P0.05);2淋巴结转移的敏感性和特异性比较中,螺旋CT明显高于上消化道造影技术,差异有统计学意义(P0.05)。结论:上消化道造影和CT扫描在诊断胃部肿瘤的临床应用中,上消化道造影技术是早期胃部肿瘤的首选检查方法,但是螺旋CT对胃部肿瘤正确诊断率要高,螺旋CT对淋巴结转移的敏感性和特异性较高,能够给确定胃部肿瘤分期提供依据,值得临床推广。     

Medical diagnostic radiation exposures and risk of gliomas

High-dose ionizing radiation is an established risk factor for glioma, but it remains unknown whether moderate- and low-dose radiation increase glioma risk. In this analysis, we assessed the evidence that self-reported exposures to diagnostic ionizing radiation, including computerized tomography (CT) scans, is associated with increased risk of adult glioma. While no independent association was observed for CT scans alone (3+ scans compared to none P = 0.08 and 1-2 scans compared to none P = 0.68), our findings suggest an increased risk of adult gliomas with cumulative exposure to three or more CT scans to the head and neck region (OR = 1.97, 95% CI: 0.92-4.23) limited to those who reported a family history of cancer: the P value for the interaction between having three or more CT scans and family history of cancer was 0.08. The stratum-specific adjusted OR for those with family history of cancer was more than three times that for the sub-group without family history of cancer. While there is some potential for symptom-related bias, one might expect this to be present for all diagnostic procedures rather than specific to one procedure. The interaction between CT scans and glioma with family history of cancer supports the biological plausibility of our findings, because similar results have been found for breast cancer and radiation. This observational data will increase awareness about potential risks associated with CT scans and the need to minimize the use of unnecessary examinations.     

CT联合DR对早期周围型肺癌的诊断价值

目的:分析数字X线摄片(DR)、CT及其联合应用对周围型肺癌的诊断价值。方法:选择该院2012年2月~2016年3月收治早期周围型肺癌患者90例为研究对象,分别进行数字化X线摄影和CT检查,以手术切除或病理结果为最终诊断的金标准,计算两种检查方法及其联合对早期诊断周围型肺癌的敏感度、特异度和准确率阳性预测值以及阴性预测值。结果:胸部DR检出空泡征者7例(7.8%),分叶征47例(52.2%),边缘有细小毛刺征36例(40%),胸膜凹陷征9例(10%);CT见病变边缘分叶征71例(78.8%),长短毛刺征57例(63.3%),空洞征27例(30%),胸膜凹陷征32例(35.6%)。DR诊断周围型肺癌的敏感性、特异性及准确性分别为85%、81%、85.6%,而CT则为90%,87.6%,90.5%,均高于DR。DR与CT两者联合诊断周围型肺癌的敏感性为98.4%,显著高于DR(85%)和CT(90%)。结论:在早期周围型肺癌的影像学诊断中,CT的临床价值显著优于DR,而两者联合诊断的临床价值明显优于单独检测。     

能谱CT鉴别肺癌成骨性转移瘤与骨岛

目的:探讨能谱CT成像在鉴别诊断肺癌成骨性转移瘤(Osteoblastic metastases,OBMs)与骨岛(Bone island,BIs)的临床应用价值。方法:回顾性分析经病理证实的16例肺癌患者诊断为成骨性转移瘤36个病灶及临床诊断21例骨岛患者21个病灶,所有患者均行能谱CT扫描,测量各病灶40-140 ke V区间单能量水平CT值及钙(水)基物质浓度,最后计算出能谱曲线斜率k。采用独立样本t检验对两组各参数进行差异性比较分析。结果:OBMs的各水平单能量CT值、k值、钙(水)浓度均低于BIs,两组差异均有统计学意义(P0.05)。结论:能谱CT有助于鉴别诊断肺癌成骨性转移瘤与骨岛。