Complex use of radiation diagnostic techniques in tumors of the pancreatoduodenal area

In the work are summarized the results of the examination of the 500 patients with tumors of pancreas (141), tumors of biliary ducts (9), tumor of duodenum (1), chronic pancreatitis (315), choledocholithiasis (12) and non-specific biliary dilatation (13). The are show the possibilities different methods of radiation diagnosis (ultrasonography, CT, MRI, MR cholangiopancreatography) in the differential diagnosis tumors of pancreatico-duodenal region, estimation of the localization, specification, degree of invasion into the neoplasms gathering round the cells. The paper presents algorithm, used in the Regional hospital of Chelyabinsk.     

The computed tomographic semiotics of inflammatory diseases of the adnexa uteri

The authors sum up the results of CT and clinical investigation of 46 women with inflammatory diseases of the uterine appendages: salpingo-oophoritis, pyosalpinx, pyoovarium, and 2 types of tuboovarian abscesses. They have shown CT potentialities in differential diagnosis of inflammations of the uterine appendages with cysts and true ovarian tumors on the basis of routine investigation and an iv contrast study of intensified images. Retrospective analysis of the most typical diagnostic errors is given.     

Computed tomography in the diagnosis of malignant renal neoplasms and their dissemination]

CT, performed in 66 patients with suspected renal tumors, showed renal cell carcinoma in 36. Tumor spreading was correctly established in 80.6%. Accurate diagnosis was made in 64 of 66 cases. The authors regard CT as an effective method for the recognition of sizable processes and differential diagnosis of solid tumors. Among the visual methods of investigation, used to define a tumor stage, CT turned out to be the most effective one.     

超声造影与增强CT鉴别诊断肾实质性恶性肿瘤的临床价值比较

摘要目的：比较超声造影（CEUS）和增强CT（CECT）鉴别诊断肾实质性恶性肿瘤的临床价值。方法：将93例肾脏肿瘤患者分别给予CEUS与CECT检查,将诊断结果与病理检查结果作对照,比较两种诊断方法的敏感度、特异度和准确率。结果：两种诊断方法的特异度无显著差异,P〉0．05;而CEUS对肾脏恶性肿瘤诊断的敏感度及准确率均显著优于CECT,P〈0．05。结论：CEUS在鉴别诊断肾实质性肿瘤方面较CECT在敏感度和准确率上具有一定的优势,临床上二者联合应用可优势互补,提高肾脏肿瘤的鉴别诊断价值。     

肺部炎性假瘤的CT影像学表现及其鉴别诊断价值

目的:分析肺部炎性假瘤的高分辨率CT影像学表现极其鉴别诊断的价值。方法:收集2012年4月-2015年4月我院收治的59例经手术病理检查证实为肺部炎性假瘤的患者为病例组,并于同一时期随机选取80例周围型肺癌患者为对照组。比较两组患者的高分辨率CT影像学特征,并分析各种影像学特征与肺部炎性假瘤的关系。结果:病例组刀切征、桃尖征及延迟期持续强化的发生率高于对照组,分叶征的发生率低于对照组(均P0.05)。多因素Spearman的秩相关分析发现,刀切征、桃尖征及延迟期持续强化与肺部炎性假瘤诊断呈正相关关系(r=0.738,0.829,0.763,均P0.05),分叶征与肺部炎性假瘤的诊断呈负相关关系(r=-0.791,P0.05)。结论:CT影像学表现中的刀切征、分叶征、桃尖征及延迟期持续强化对肺部炎性假瘤具有较高的鉴别诊断价值,可作为临床辅助诊断肺部炎性假瘤的重要影像学资料。     

Imaging of pediatric brain tumors using somatostatin analogue 111Ih-DTPA-D-Phe1-octreotide

Malignant solid tumors and leukemias are the second most common causes of death in childhood. The most frequent pediatric solid tumors are brain tumors. Brain tumors, especially medulloblastoma should be treated by surgery, irradiation and chemotherapy. However, chemotherapy has only moderate effect. Pediatric brain tumors, especially medulloblastomas, express somatostatin receptors. The aim of this study was the investigation of the expression of somatostatin receptors in pediatric brain tumors for diagnostic and therapeutic purpose. Fifty-six scintigraphic imagings (111In-DTPA-D-Phe1-octreotide) made in 45 children treated with brain tumor at the Unit of Oncology of the 2nd Department of Pediatrics, Semmelweis University. The diagnosis was medulloblastoma in 21 cases (46.7%). MRI scans have been performed parallel with the Octreoscan images. Octreoscan images were positive in 27 of 56 (48.2%) cases. The 27 positive Octreoscan images consisted of 16 medulloblastomas, 4 ependymomas, 4 astrocytomas and 3 glioblastomas. In 37 (66.1%) cases the results of Octreoscans were the same as those of the MRI scans. However, in 19 scans (33.9%) the outcome was different. Octreoscan imaging is not suitable for differential diagnosis in pediatric brain tumors, including medulloblastomas. Isotopes specifically binding to the somatostatin receptors (111In-DTPA-D-Phe1-octreotide) can be applied in medulloblastomas for diagnosis and follow-up treatment. In Octreoscan-positive tumors the Octreoscan images establish the opportunity to somatostatin analogue and/or specifically targeted radiation therapies.     

成人不典型肺结核的CT 表现及鉴别诊断分析( 附30 例报告)

目的：回顾性分析成人不典型肺结核的CT表现,探讨与其他同影性疾病的鉴别方法,做到早诊断早治疗,减低病人的治疗成本和思想负担。方法：选择性收集病变不典型。CT影像检壹曾误诊或诊断困难的病例30例做回顾性分析。所有病例均有最后治疗结果或术后病理结果证实。结果：节段性阴影12例,局灶性斑片及斑点状影8例,散在少数小结节样影4例,多发结节并空洞影3例,肺内弥漫分布的粟粒结节影3例,肺内阴影伴有肺门淋巴结及纵隔淋巴结肿大者9例以青壮年病人吸收较快,病程较短,以粟粒影和大片影表现者吸收最快。讨论：对于不典型的成人肺结核,不能片面的强调或突出某一方面征象,年龄因素、临床症状、实验室检查如结核茵素试验（PPD）、痰结核茵培养、抗结核抗体阳性在鉴别诊断中有着重要意义。进一步正确认识及探究病变的影像特点,对于正确的诊断提供了强有力的理论根据。     

A Novel Peptide for Simultaneously Enhanced Treatment of Head and Neck Cancer and Mitigation of Oral Mucositis

We have characterized a novel 21 amino acid-peptide derived from Antrum Mucosal Protein (AMP)-18 that mediates growth promotion of cultured normal epithelial cells and mitigates radiation-induced oral mucositis in animal models, while suppressing in vitro function of cancer cells. The objective of this study was to evaluate these dual potential therapeutic effects of AMP peptide in a clinically relevant animal model of head and neck cancer (HNC) by simultaneously assessing its effect on tumor growth and radiation-induced oral mucositis in an orthotopic model of HNC. Bioluminescent SCC-25 HNC cells were injected into the anterior tongue and tumors that formed were then subjected to focal radiation treatment. Tumor size was assessed using an in vivo imaging system, and the extent of oral mucositis was compared between animals treated with AMP peptide or vehicle (controls). Synergism between AMP peptide and radiation therapy was suggested by the finding that tumors in the AMP peptide/radiation therapy cohort demonstrated inhibited growth vs. radiation therapy-only treated tumors, while AMP peptide-treatment delayed the onset and reduced the severity of radiation therapy-induced oral mucositis. A differential effect on apoptosis appears to be one mechanism by which AMP-18 can stimulate growth and repair of injured mucosal epithelial cells while inhibiting proliferation of HNC cells. RNA microarray analysis identified pathways that are differentially targeted by AMP-18 in HNC vs. nontransformed cells. These observations confirm the notion that normal cells and tumor cells may respond differently to common biological stimuli, and that leveraging this finding in the case of AMP-18 may provide a clinically relevant opportunity.     

The evaluation of contrast-enhancing brain lesions: pitfalls in current practice

The definitive diagnosis of space-occupying brain lesions can be established more readily since the advent of computerized tomographic (CT) scanning. Some brain lesions are more clearly defined when contrast-enhancing agents are utilized; however, so-called ring-enhancing lesions are not pathognomonic for specific neurological entities. Review of the literature suggests that at least four disorders must be considered in the differential diagnosis of contrast-enhancing lesions. These include mature brain abscesses of any etiology, cerebrovascular accidents, and primary or metastatic brain tumors. Since the medical and surgical management of these conditions is quite different, it is critical to establish a diagnosis before therapy is instituted. In many instances the combination of history, physical examination, laboratory, and radiologic examination will enable physicians to correctly diagnose the etiology of such brain lesions. However, we present two cases for which the above clinical and non-invasive parameters led to incorrect working diagnoses. Brain biopsy was required before appropriate management was eventually instituted. Potentially, such delays in diagnosis and institution of therapy can result in unnecessary morbidity and mortality. Each case illustrates the need to substantiate a presumptive diagnosis based on these clinical and radiographic criteria, regardless of how "typical" lesions may appear on CT scans.     

功能与分子影像在头颈部肿瘤放射治疗计划和疗效评价中的应用

目前临床普遍采用功能与分子影像检测手段能来评价头颈部肿瘤的放射治疗计划和疗效,可指导个体化治疗从而提高疗效。文章概述了功能与分子影像技术CT,MRI,PET-CT,超声检测技术在头颈部肿瘤放射治疗计划制定和疗效评价中的应用进展。结果显示,不同分子影像检测方法如在检查时机的选择、诊断和鉴别诊断的价值、观察放射治疗后肿瘤的残存和复发、预测放射治疗效果、指导后续治疗等方面均可起到重要作用。采用图像融合技术进行联合应用,如PET-CT和MRI-CT等,可提高检测的准确率。临床医生需在常规影像学手段的基础上,根据头颈部肿瘤患者病情和治疗方法的不同选用正确的功能和分子影像检测手段,更好地指导制定放射治疗计划及综合评价放射治疗后的疗效。     

Radiation diagnosis of interstitial lung diseases

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.     

Immunohistochemistry in detection of paraneoplastic secretion of calcium regulating hormones

29 non-endocrine tumors with clinical suspicion of paraneoplastic hypercalcemia were examined using immunohistochemistry specific for PTH and CT. In 19 of these cases intracellular immunoprecipitates have been demonstrable thus showing the paraneoplastic production of peptide hormones (18 PTH, 1 CT). Four of these tumors have been tested in tissue culture for in vitro production of endocrine active substances. In all cases the incubation medium yielded a positive reaction for PTH. The use of immunocytochemistry in the differential diagnosis of hypercalcemia in tumor patients is discussed.     

直径小于1 cm孤立性肺结节的18F-FDG PET/CT诊断研究进展

孤立性肺结节的鉴别诊断一直是胸部影像学的研究热点。早期且准确地鉴别肺内小结节的良恶性,对于患者治疗方案的确定以及随访情况的评估均具有重要的临床意义。~(18)F-FDG PET/CT在鉴别诊断恶性肿瘤方面具有明显优于其他传统检查的高特异性和高敏感性,其公认的恶性肿瘤的诊断阈值是最大化标准摄取值(maximum standard uptake value, SUVmax)为2.5,然而部分临床数据显示一些直径小于1 cm的恶性肺结节的SUVmax数值小于2.5。因此在早期研究中,~(18)F-FDG PET/CT在诊断直径较小的肺结节的其临床价值仍存在争议。为了尽量降低SUVmax的测量误差,提高~(18)F-FDG PET/CT诊断的准确率,衍生出了许多SUVmax辅助诊断方法以及优化的重建算法、放射性显像剂的联合应用等手段。本文将对~(18)F-FDG PET/CT鉴别诊断直径小于1 cm孤立性肺结节的研究进展进行综述。     

Use of current radiation techniques in the diagnosis and treatment of juvenile angiofibromas of the nasopharynx

In 1992-2001 seventeen patients with juvenile nasopharyngeal angiofibromas (JNAs) were treated at Krasnoyarsk Territorial Clinical Hospital. The patients underwent a comprehensive diagnosis involving computed tomography (CT), magnetic resonance imaging (MRI), and angiography, followed by tumor vascular embolization. Later on JNAs were surgically removed in 14 patients, a course of radiation therapy was performed. In suspected JNA, the authors consider it necessary to concomitantly use CT, MRI, and angiography, which provides the most complete diagnostic picture of a pathological focus. X-ray endovascular occlusion considerably lowers blood loss, facilitates a complete angiofibroma removal, and affects the tolerability of radiation therapy in inoperable cases.     

Expression of human apolipoprotein(a) kringles in colon cancer cells suppresses angiogenesis-dependent tumor growth and peritoneal dissemination

BACKGROUND: Anti-angiogenesis therapy has been regarded as a promising treatment of cancer based on the fact that most tumors and their metastasis are angiogenesis-dependent. Gene therapy can potentially expand the horizons of tumor angiogenesis therapy by virtue of its ability to produce high concentrations of therapeutic agents in a local area for a sustained period. The present study was performed to evaluate the therapeutic potential of gene therapy for the treatment of cancer and metastasis. METHODS: The murine colon carcinoma cell line CT26 was manipulated ex vivo to express an anti-angiogenic molecule, LK68, consisting of human apolipoprotein(a) kringle domains, KIV(9)-KIV(10)-KV, using retrovirus-mediated gene transfer. Its effects on colon tumor growth and metastasis were evaluated in experimental animal models established by injecting LK68-expressing and control CT26 cells subcutaneously or into the peritoneal cavity of BALB/c mice, respectively. RESULTS: Expression of LK68 significantly suppressed colon tumor growth in mice, but did not influence the growth of tumor cells in vitro. Immunohistochemical analysis of tumor tissues revealed a significant reduction in microvessel density in LK68-expressing tumors. Thus, the suppression of tumor growth appears to result mainly from inhibition of tumor angiogenesis. This decrease in vessel density is correlated with a notable increase in tumor cell apoptosis in vivo, but has no influence on proliferation. Moreover, expression of LK68 prevents peritoneal dissemination, and consequently improves overall host survival. CONCLUSIONS: These results collectively indicate that a gene therapy strategy using LK68 cDNA is useful for the treatment for both colon tumor growth and peritoneal dissemination.     

磁感应热疗联合放疗治疗颈部淋巴结复发的临床观察

目的：探索磁感应热疗技术联合放疗治疗不宜手术的颈部淋巴结复发的疗效和安全性。方法：2012年2月至2012年7月选取27例不宜手术的颈部淋巴结复发病例,给予2次磁热籽植入和4—8次不等的加热治疗,计划治疗目标温度为48—50℃、维持30min,磁感应治疗后一周内行放射治疗,治疗结束后1—3个月时复查CT,治疗后6月内不予化疗。结果：治疗结束后3个月时,27例患者中CR55．6％,PR37％,NC3．7％,PD3．7％,治疗总有效率为92．6％;25例疼痛缓解,疼痛缓解有效率92．6％。治疗结束后6个月未发现远处转移病例,未发生大出血、放射性食管炎、放射性骨坏死、骨髓抑制、粒子移位脱落等并发症。结论：磁感应热疗联合放疗治疗不宜手术的复发颈部淋巴结安全、有效。     

TEP/TDM au FDG et bilan initial des lymphomes : du diagnostic au pronostic

Lymphoma represents a very heterogeneous pathologic disease group and its initial assessment, treatment strategy and prognosis is closely related within each histological subtype. The diagnosis of lymphoma disease is often due to the development of a tumour mass at a lymph node area, or within an organ with or without systemic symptoms. However, all these signs remain non specific. Biopsy is the only reliable diagnostic tool, which can be carried out surgically or guided by the morphological and functional imaging. Once the histological diagnosis is determined by the WHO classification, the staging procedure aim is to provide the prognosis to assist the therapeutic decision. Morphologic imaging primarily based on CT remains the reference in exploring most cases. But in the last decade, the introduction of functional imaging using FDG-PET/CT has dramatically changed the therapeutic management of lymphoma. The additional clinical value provided by initial FDG-PET/CT could lead to an alteration of the therapeutic strategy, as well as to the optimization of radiation therapy or to the establishment of prognostic score and lead to improved lymphoma patient survival in the future.     

CT仿真结肠镜与腹部增强CT 在炎症性肠病诊断中的对比分析

目的:对比CT仿真结肠镜(CTC)与腹部增强CT在炎症性肠病诊断中的价值,为临床诊疗提供依据。方法:选取2015年1月到2016年1月我院收治的炎症性肠病患者60例为研究组,另选取非炎症性肠病患者60例为对照组,两组均30例患者接受CTC检查,30例患者接受腹部增强CT检查,对影像图片进行盲法阅读,将炎症性肠病的可信度分为5个等级进行评价,对6项影像学特征进行Logistic回归分析。结果:腹部增强CT对炎症性肠病诊断的准确率、敏感性、特异性分别为68.33%,59.09%,71.39%显著低于CTC的93.33%,95.01%、89.63%,比较差异具有统计学意义(P0.05);Logistic回归分析显示:结肠粘膜呈颗粒状、不光滑;肠壁强化并增厚;结肠袋消失对炎症性肠病具有预测作用;肠壁强化及增厚对炎症性肠病诊断敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病的特异性较高。结论:CTC对炎症性肠病具有较高的检出率,肠壁强化及增厚对炎症性肠病诊断的敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病特异性较高。     

CT增强结合多b值DWI对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断研究

摘要 目的：探讨计算机断层扫描（CT）增强结合多b值弥散加权成像（DWI）对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断价值。方法：回顾性分析2017年4月-2021年10月于我院经手术病理或逆行胰胆管造影（ERCP）证实为胆总管炎性或肿瘤性狭窄的106例患者的临床资料,术前均行CT增强、多b值（200、400、600、800、1000 s/mm²）DWI的磁共振成像（MRI）检查并测量其多b值DWI下的ADC值,分析胆总管炎性狭窄与肿瘤性狭窄的影像表现,比较CT增强、多b值DWI单独及结合对胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断效能。结果：106例患者中胆总管炎性狭窄共43例,肿瘤性狭窄患者共63例。当b值分别为200、400、600、800、1000 s/mm²时,胆总管肿瘤性病变ADC值均显著低于胆总管炎性狭窄,差异均具统计学意义（P＜0.05）,随着b值增加,其ADC值均减小。当b值分别取200、400、600、800、1000 s/mm²时,对应曲线下面积（AUC）分别为0.574、0.705、0.715、0.781、0.726,b值为800 s/mm²时诊断胆总管炎性狭窄与肿瘤性狭窄的效能最佳。CT增强结合多b值DWI对比CT增强或多b值DWI对胆总管炎性狭窄与肿瘤性狭窄的诊断效能最佳。结论：当多b值DWI取800 s/mm²时,CT增强结合多b值DWI可以显著提高胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断价值,具有一定的临床应用价值。