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Objective To explore the clinical significance of 3.0T dynamic?contrast enhanced MRI scan in the grading of intracranial glioma. Methods The magnetic resonance examination were performed in 40 cases of patients of brain tumors confirmed by surgery pathology(29 pa?tients with glioma),including conventional MRI and dynamic contrast?enhanced MRI. Using Kinetic Modeling?version 3.0 software on the GE 3.0T magnetic resonance workstation calculation of intracranial tumor parenchyma area corresponding quantitative parameters Ktrans and Ve values. The quantitative parameters between any two classification were compared ,and the difference was statistically analyzed. The characteristics of the different level of intracranial glioma's dynamic enhanced scan parameters were preliminary analyzed. The receiver?operating characteristic curve (ROC)analysis of Ktrans value and Ve value was performed,and the diagnosed threshold,sensitivity and specificity were acquired. Results While applying dynamic?contrast enhanced MRI scan acquired Ktrans and Ve values ,both values of high grade gliomas include gradeⅢandⅣwere significantly higher than that of low grade gliomas include gradeⅠandⅡ(P0.05). To identify low grade gliomas with high grade glioma ,Ktrans and Ve diagnosis threshold was 0.204/min and 0.099 respectively. To distinguish between gradeⅡandⅢglioma,Ktrans and Ve diagnosis threshold was 0.247/min and 0.176 respectively. Conclusion Combining quantitative parameters Ktrans and Ve value that come from 3.0T dynamic con?trast enhanced MRI scan with regular enhancement MRI can distinguish low grade gliomas with high grade gliomas glioma ,as well as distinguish gradeⅡwithⅢglioma;However,it is still difficult to identify low grade gliomaⅠwithⅡ,as well as high grade gliomaⅢwithⅣ. The Ktrans and Ve value plays an important role in discriminate different grade intracranial tumors in a preoperative noninvasive way.
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INTRODUÇÃO: A referência padrão para determinação do grau tumoral é a avaliação histopatológica. Entretanto, algumas limitações estão associadas com a correta graduação histopatológica dos gliomas: (a) erro inerente da amostra associada a biópsia estereotáxica, sendo que a porção mais maligna do tumor pode não estar incluída na amostra obtida; (b) dificuldade em obter uma gama suficiente de amostras se o tumor for inacessível ao cirurgião;(c) dinâmica própria dos tumores do sistema nervoso central, com diferenciação freqüente em graus de maior malignidade; (d) variabilidade entre patologistas; (e) inabilidade para avaliação de tecido tumoral residual após cirurgia redutora. Embora a ressonância magnética (RM) convencional seja a técnica de maior utilidade no diagnóstico e avaliação de tumores cerebrais, de forma isolada não possui acurácia em predizer o grau tumoral. Técnicas avançadas de RM, tais como caracterização de alterações metabólicas na espectroscopia de prótons (ERM), valores de volume sanguíneo cerebral relativo (VSCr) obtido com a perfusão por RM e imagem de difusão com o cálculo do coeficiente de difusão aparente (CDA), têm sido avaliadas como ferramentas diagnósticas na graduação prospectiva dos gliomas cerebrais. OBJETIVOS: Determinar quais são os parâmetros derivados da perfusão, difusão e espectroscopia que auxiliam a graduação tumoral. Determinar a sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) de cada método. Determinar se há alguma correlação entre os parâmetros utilizados na determinação do grau de malignidade tumoral. Determinar se a combinação destas técnicas aumenta a efetividade diagnóstica para graduação tumoral. MÉTODOS: 56 pacientes com tumores de origem glial, sendo 37 glioblastomas multiforme, 2 astrocitoma anaplásico, 1 oligoastrocitoma anaplásico, 3 oligoastrocitomas grau II, 9 astrocitomas grau II e 4 astrocitomas pilocíticos, foram submetidos a RM convencional, difusão...
INTRODUCTION: The current reference standard for determining glioma grade is histopathologic assessment. However some limitations are associated with correct histopathologic grading of gliomas: (a) inherent sampling error associated with stereotactic biopsy and the risk of missing the most malignant portion of the tumor in the sampling; (b) difficulty in obtaining a representative range of samples if the tumor is inaccessible to the surgeon; (c) the dynamic nature of central nervous system tumors, with frequent dedifferentiation into more malignant grades; (d) interpathogist variability and (e) inability to evaluate residual tumor tissue after reductive surgery. Although MR imaging is the most useful radiologic technique in the diagnosis and evaluation of common brain tumors, it is not accurate enough in predicting tumor grade. Advanced MR imaging techniques such as characterization of metabolic changes in MR spectroscopy (MRS), relative cerebral blood volume (rCBV) measurements derived from perfusion MR imaging, and diffusion-weighted MR imaging with calculation of apparent diffusion coefficient (ADC), have been evaluated as diagnostic tool in prospective grading of cerebral gliomas. OBJECTIVES: To determine the usefulness of perfusion, diffusion, and spectroscopy values for glioma grading. To determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), of each method. To determine if there is any correlation between parameters used in glioma grading. To determine whether the combination of these techniques can improve the diagnostic effectiveness of glioma grading. METHODS: 56 patients with glial tumors: 37 glioblastoma multiforme, 2 anaplastic astrocytoma, 1 anaplastic oligoastrocytoma, 3 oligoastrocytomas grade II, 9 astrocytomas grade II and 4 pylocitic astrocytomas. Patients underwent conventional MR, diffusion, perfusion and MRS, performed with a 1.5-T unit (GE-Horizon LX9.1)...
Sujet(s)
Humains , Tumeurs du système nerveux central , Diffusion , Spectroscopie par résonance magnétique , Tumeurs/classification , PerfusionRÉSUMÉ
Objective To investigate the changes in the tight junctions of the blood-brain barrier (BBB) in a rat model bearing C6 glioma. Methods Rat models bearing C6 glioma were established in 30 male Wistar rats by stereotactic injection of C6 glioma cells into the caudate nuclei, with another 30 rats as the normal control group. Twenty-one days after the injection, magnetic resonance imaging (MRI) was performed, and the normal brain tissue, tumor core, tumor margin and the ipsilateral hemisphere tissues 2 mm from the tumor margin were sampled for ultrastructural observation of the BBB using electron microscopy, Immunohistochcmistry and RT-PCR were used to analyze the expression of claudin-5 protein and mRNA in these tissues, respectively. Results MRI revealed tumor formation in the brain 21 days after C6 cell injection. In normal control brain tissues, the paracellular cleft between the adjacent endothelial cells was sealed by continuous tight junction strands, which were found in only 22.23% of the microvesscls in the core of the brain gliomas, and obvious paracellular clefs were found between the adjacent endothelial cells in other microvessels. In the tissues on the tumor margin, intercellular tight junctions were found in 57.15% of the microvessels with the rest microvesseis having obvious paracellular clefts. Immunohistochemistry showed strong claudin-5 positivity in the control brain tissue but yielded negative results in the core of the gliomas. Compared with the core of the gliomas, the tissues on the tumor margin, those 2 mm from the tumor margin and the control brain tissues showed significantly increased claudin-5 expression (P<0.05,respectively). Conclusion In C6 glioma-bearing rats, the continuity of the tight junctions in the BBB is interrupted due to decreased expression of claudin-5 in the brain gliomas.
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Objective To investigate the clinical value of ～ 99m Tc-HL91 hypoxia imaging in diagnosed and predicted the degree of malignancy in brain gliomas.Methods ～ 99m Tc-HL91 hypoxia imaging were performed on 32 patients with brain gliomams(9 low potential malignancy patients and 23 high potential malignancy patients)and 20 normal persons.Performed the qualitative analysis and half quantitative analysis to the early(15min)and delayed(4h)images.And compared the results of half quantitative analysis with low potential malignancy group and high potential malignancy group.Results The sensitivity,specificity and accuracy of ～ 99m Tc-HL91 hypoxia imaging was 81.3%(26/32),100%(20/20)and 88.5%(46/52)respectively.The positive rate of high potential malignancy group was 100%(23/23),and low potential malignancy group was 33.3%(3/9).Compared the results of half quantitative analysis to the early and delayed images,the uptake of high potential malignancy group was obviously higher than low potential malignancy group.Conclusions Using ～ 99m Tc-HL91 hypoxia imaging had high clinical value in diagnosed and predicted the degree of malignancy in brain gliomas.
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Objective To investigate cancer suppressor Genes p16, p15 in the brain gliomas expression and its relations with the gliomas pathology graduation and the malignant degree.Methods P16 and P15 protein expression level in human brain gliomas from 63 surgery specimens were assayed by immunobistochemical S-P method.Results P16, the P15 protein expression rate the brain gliomas pathology graduation assumes the inverse correlation with, also compared with the high malignant group the low malignant group (Ⅰ~Ⅱ level) (Ⅲ~Ⅳ level) has the remarkable difference (P
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Objective The effects of photodynamic therapy(PDT)were observed in different malignant tumors.Methods Photosan(2mg/kg)was intravenously given in 45 cases of 20 central lung cancer,8 recurrent brain gliomas,6 esophagus cancer,2 stomach cancer,2 colum cancer,5 the others.After 48 and 72 hours later,PDT(He-Ne Gas Laser,630nm)was performed respectively with 800~1000mW,energy density 200~300J/cm(or 300J/cm2).More than 1 cm of normal tissue around the tumor was treated by laser in 10~20 minutes.Results Tumor necrosis could be found in next day of PDT,which showed that heavy white blanket covered the tumor accompanied by severe edema around the tumor.The volume of lumen cancer should be enlarged after 1 week of PDT.Necrosis and cavities could be discovered under light microscopy.The efficiency was 100% in all patients after 1 month of PDT.Conclusions PDT is a minimal,targeted and perspective therapy to tumors.
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Human gliomas are one of the most aggressive tumors in brain.Radiotherapy plays an important role for patients with gliomas,as well as surgery.The efficacy of radiotherapy is associated with radiosensitivity of human gliomas.Radiosensitive genes of gliomas and apoptosis、cell cycle transformation、DNA damage induced by irradiation and DNA repair promoted by them are suggested to be associated with glioma radiosensitivity.The rediosensitive genes associated with apoptosis and DNA repairment are becoming hot spots of study.The other radiosensitivity genes are paid attention too.This paper makes a summary of current situation and progress for radiosensitive genes of human brain glomas.
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It is difficult to resect completely for brain glioma with surgery because of the characteristic of strong invasion and no obvious verge with the brain tissue, and result in easily recurrentshort life time and high mortality. Radiotherapy is important for patients after surgery. The factor of prognosis include ageKarnofsky score, pathology and degree of invasion. Recently, the improvement of new equipment and technology provide the more approach for brain glioma. The paper make a summary of current situation and progress for radiotherapy of brain glioma.
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0^05). Conclusion MMP\|2 and MMP\|9 may serve as indicators of invasion and malignant phenotype.Neither of them can represent the phenotype of metastasis,but both can represent that of matrix degradation.Moreover,MMP\|9 may play more important role in glioma invasion than does MMP\|2.