Analysis of nodal size criterion of retropharyngeal lymph node metastasis in nasopharyngeal cancer patients / 中国医学影像技术

Objective To explore the reasonable radiologic nodal size criterion of retropharyngeal lymph node (RLN) metastasis in patients with nasopharyngeal cancer (NPC).Methods Imaging and clinical data of 817 NPC patients were analyzed retrospectively.The patients with RLN metastasis were classified into two groups according to the nodal size of 5 mm or 6 mm as standard in diagnosis.Overall survival (OS),distant metastasis-free survival (DMFS) and the local-relapse-free survival (LRFS) were assessed between the two groups taking 5 mm or 6 mm as standard in diagnosis of RLN.Results No significant difference was found for OS,DMFS,LRFS between nodal size ＜5 mm group and ≥5 mm group.Difference of OS (P＜0.001),DMFS (P=0.001) were significant statistical and difference of LRFS (P=0.380) had no significant statistical between nodal size ＜6 mm group and ≥6 mm group.OS,DMFS,LRFS were not an independent prognostic factor for NPC.Conclusion Using the minimal axial diameter of 6 mm as the nodal size criterion in diagosis of RLN metastasis in patients with NPC may be more reasonable.

[Comparison of the effectiveness of percutaneous microwave ablation versus hepatectomy for hepatocellular carcinoma].

OBJECTIVE: To compare the effectiveness of percutaneous microwave ablation ( MWA) versus hepatectomy for multifocal hepatocellular carcinoma. METHODS: From August 2002 to March 2012, one hundred and twenty-two patients with multifocal hepatocellular carcinoma (diameters 1 to 7 cm, 2 to 4 lesions) were treated by either complete MWA or radical hepatectomy, and their clinical data were collected and analyzed.The patients were divided into MWA group (n = 50) and resection group (n = 72), and the resection group was matched by MWA group based on clinical parameters. The survival and complications in the two groups were compared. RESULTS: The overall 1-, 3- and 5-year survival rates were 100.0%, 73.0% and 62.0%, respectively, in the MWA group, and 80.0%, 56.0%, and 41.0%, respectively, in the resection group (P < 0.05). The corresponding recurrence-free survival rates were 88.0%, 63.0%, and 52.0% in the MWA group, and 68.0%, 45.0%, and 36.0%, respectively, in the resection group (P< 0.05). The multivariate Cox regression analysis indicated that albumin level, performance status, treatment modality, and tumor size were independent prognostic factors. CONCLUSION: Compared with hepatectomy, percutaneous microwave ablation is a minimally invasive and reproducible procedure, and can improve the survival in patients with multifocal hepatocellular carcinoma.

125I Seed Implant Brachytherapy for Painful Bone Metastases After Failure of External Beam Radiation Therapy.

The purpose of this study was to evaluate the safety and therapeutic efficacy of computed tomography (CT)-guided I seed implant brachytherapy in patients with painful metastatic bone lesions after failure of external beam radiation therapy (EBRT).From August 2012 to July 2014, 26 patients with painful bone metastases after failure of EBRT were treated with CT-guided I seed implant brachytherapy. Patient pain and analgesic use were measured using the Brief Pain Inventory before treatment, weekly for 4 weeks, and every 4 weeks thereafter for a total of 24 weeks. Opioid analgesic medications and complications were monitored at the same follow-up intervals.Before I seed implantation, the mean score for worst pain in a 24-hour period was 7.3 out of 10. Following treatment, at weeks 1, 4, 8, 12, and 24, worst pain decreased to 5.0 (P < 0.0001), 3.0 (P < 0.0001), 2.8 (P < 0.0001), 2.6 (P < 0.0001), and 2.0 (P = 0.0001), respectively. Opioid usage significantly decreased at weeks 4, 8, and 12. Overall response rates of osseous metastases after I seed implantation at 1, 4, 8, 12, and 24 weeks were 58%, 79%, 81%, 82%, and 80%, respectively. Adverse events were seen in 4 patients, including Grade 1 myelosuppression and Grade 1 late skin toxicity.I seed brachytherapy is a safe and effective treatment for patients with painful bone metastases after failure of EBRT.

MRI signal changes in the skull base bone after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma / 中华放射学杂志

Objective To evaluate the signal changes of the skull base after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma.Methods Twenty patients with nasopharyngeal carcinoma after radiation failure underwent nasophargeryngectomy via an endoscopic transnasal approach were selected from April 2006 to December 2011,including 16 males and 4 females with 31 to 67 years old.Each patient had previously received irradiation and experienced recurrence after 8 to 83 months of completed irradiation.All patients underwent MRI no more than 2 weeks before the salvage surgery and were subjected to repeat MRI scans 2 weeks,3 months,6 months later and semi-annually thereafter,with the follow-up time of 6 to 45 months(median 18 months).A two-sided Chi-square test was used to compare the signal changes and the tendency of changes on all presurgical and postsurgical MR images.Results The MRI signal changes were detected at 92 sites of skull-base between 2 weeks and 3 months after the surgery,which was hypointense on T1 WI with moderate to marked contrast enhancement.In the follow-up period,the signal abnormalities at 36 sites of skull base had resolved or restored to the normal,and 34 sites remained stable,while in 22 sites,the MR signal changes became more obvious.The skull base bones adjacent to the region of the resection were more likely to show signal changes than nonadjacent areas (72 vs.20,x2 =33.128,P ＜0.01).The signal changes were more common on the ipsilateral skull base to the recurrent tumor in contrast to the contralateral skull base (68 vs 24,x2 =21.182,P ＜ 0.01).Conclusions The skull base signal changes after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma,and it occurs in specific location.Most of sites tend to resolve or be stable at the follow up.

CT findings of pulmonary mucosa-associated lymphoid tissue lymphoma / 中华放射学杂志

Objective To study the CT findings of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods The CT examinations of 12 patients with pathologically proven pulmonary MALT lymphoma were reviewed retrospectively. Evaluated imaging findings included number, distribution,shape, attenuation and other associated findings of each lesion were evaluated. Results Thirty-two pulmonary lesions, including consolidations, masses, nodules and lesions with ground glass attenuation,were identified in 12 patients. Multiple lesions were founded in 10 of 12 patients and solitary lesion in 2 patients. Multiple lesions found in one lung in 2 patients, and multiple lesions found in both lungs in 8 patients. Ten cases demonstrated 21 consolidation lesions with air bronchogram, and one of the ten cases demonstrated two lesions with airway dilatation. Three cases demonstrated 5 masses or nodular lesions, 3 of these 5 lesions showed air bronchogram. Two cases demonstrated 6 ground glass attenuation lesions. One case showed mediastinal and hilar lymphadenopathy. Conclusion Pulmonary MALT lymphoma usually appears as multiple bilateral consolidations, masses, nodules with air bronchogram or lesions with groundglass attenuation at CT imaging. The imaging findings described above and with an indolent clinical course may suggest the diagnosis of pulmonary MALT lymphoma.

Experimental study of radiation damage in application of 125 Iodine seed permenent implantation near rabbit ischiadic nerve / 中华放射学杂志

Objective To study the effect of 125Iodine seed on the rabbit ischiadic nerve at different time point after implantation. Methods Thirty healthy New-Zealand rabbits were randomly assigned into 3 groups( 2-week group, 2-month group and 4-month group) using envelope method. During operation, 10 radioactive 125I seeds were implanted randomly near one of the ischiadic nerve, while 10 non-radioactive seeds were implanted into the contralateral ischiadie nerve. According to treatment plan system(TPS),90% of the prescription dose (PD)was centered in the specific place, where the nerves were chosen to be studied. After 2 weeks, 2 months and 4 months respectively, nerve electro-physiolngy experiment was used to evaluate the bilateral ischiadic nerves, at the same time the morphology of the ischiadic nerve was examined by general observation, light microscope and electron microscope. The electron microscope photo with the same ×4000 amplification was divided into 100( 10 × 10) cages and non-specific changes in one cage account for 1%. The t test and sum rank test were used for statistics. Results Potential leaking point of experimental ischiadic nerves near heart in 2-week group ,2-month group and 4-month group were (0.52± 0.26), (0.60±0.19), (0.48±0.17)V, while that of the control sides were (0.59±0.19), (0.60± 0.15), (0.53±0.13 ) V, there was no statistical significance in the same group respectively (t=0.91, 0.03,0.67,P>0.05). Potential leak point of experimental ischiadic nerves far from heart in 2-week group, 2-month group and 4-month group were (0.51±0.15), (0.52 s0. 11 ), (0. 53±0.15) V,the control sides were (0.52±0.10), (0.56±0.12), (0.54±0.10)V, there was no statistical significance in the same group respectively (t= 0.25,0.74,0.17, P > 0.05 ). Action potential amplitude of experimental ischiadic nerves near heart in 2-week group,2-menth group and 4-month group were (13.18±4.09), (12.78± 4.42), (12.09±1.20) mV, while that of the control sides were (10.55± 4.21 ), ( 10.31±4.22), (12.88±3.54) mV, there was no statistical significance in the same group respectively (t=1.57,1.36, 0.50,P>0.05). Action potential amplitude of experimental ischiadic nerves far from heart in 2-week group,2-month group and 4-month group were (11.18±3.38), (11.68±3.21), ( 12.52±3.09) mV, while that of the control sides were (11.56±4.80), (10.71±3.40), (11.67±2.48) mV ,there was no statistical significance in the same group respectively(t=0.29,1.01,0.55, P>0.05 ). Nerve conduction velocity of experimental ischiadic nerves in 2-week group,2-month group and 4-month group were (40.56± 9.46), (38.79±5.78), (39.44±8.64) m/V, the control sides were (42.56±6.59), (44.64±7.53), (43.33±6.05)m/V, there was no statistical significance in the same group respectively( t = 0.57,1.94, 0.01,P>0.05). There were some changes in general observation and light microscope, in electron microscope, many non-specificity changes were observed. All of these changes included delamination, collapse, disaggregation of the myelinated nerve, mitochondria swelling and vacuolization of neurilemma cell and axon. The ratio of degenerative alterations in nerves was 60% --70% in 2-week group, 50% in 2-month group and 30% in 4-month group, and there was statistical significance among three groups (P<0.05). Conclusion 125I permanent plantation in our test dose has little effect on ischiadic nerve, all these non-specificity changes were observed in electron microscope, and it has no evident impacts on physiological functions.

CT-guided 125Ⅰ radioactive seeds implantation and chemical ablation for malignant retroperitoneal tumors / 中华放射学杂志

Objective To explore the clinical value of CT-guided 125I radioactive seeds implantation and chemical ablation for malignant retroperitoneal tumors.Methods Because of the rejection of the second surgery resection and insensitivity of chemotherapy and radiotherapy,nineteen patients with recurrent or metastasis malignant retroperitoneal tumors were treated by CT-guided125I radioactive seeds implantation according to TPS or Halarism's experienced function,and percutaneous ethanol injection was performed if the way of punctuation Was limited.The extent of pain relief was assessed one month later after therapy.All the patients received enhanced CT scan 6 months after the first treatment,and imaging evaluation wag performed according to WHO criteria.Results For the 19 patients.pain relief Was achieved more or less in all patients.Imaging evaluation revealed complete relief,partial relief,no change in 10,7,2 cases respectively.All patients are still alive now.The longest followed span is 31 months.and the shortest is 7 months,the average followed span is 13.5 months.Conclusion CT-guided 125I radioactive seeds implantation and chemical ablation ore effective for malignant retropefitoneal tumors.

Intra-arterial chrono-chemotherapy for liver metastasis arised from colorectal cancer / 介入放射学杂志

Objective To evaluate the toxic effects and efficacy of the intra-arterial chrono-chemotherapy on patients with liver metastasis arised from colorectal cancer. Methods Chemotherapy of 42 patients were randomly divided into group A (n = 20) with continuously constant arterial infusion, and group B (n = 22) with arterial chrono-modulated infusion. And the toxic effects and efficacy of two groups were compared. Results A significant difference was found in the toxic effects of digestive system between the two groups. The treatment response was similar in the two groups. Conclusions Intra-arterial chrono-chemotherapy may decrease the toxic effects and improve the life quality of these patients.

Comparison of spiral CT, plain CT with surgical-pathological findings in peritoneal metastasis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare enhanced spiral computed tomography (SCT), and plain CT with pathological findings in the diagnosis of peritoneal metastasis.</p><p><b>METHODS</b>Thirty-eight patients with peritoneal metastasis were examined by whole abdominal plain CT and enhanced SCT within one week before operation. The CT findings were compared with the pathological findings of specimens obtained during operation.</p><p><b>RESULTS</b>In the early phase of contrast SCT, various degrees of enhancement were observed in the majority of peritoneal metastases. Primary cancers and the metastatic lesions were enhanced to same degree. For lesions with rich blood supply, a 2 mm metastatic lesion was usually detected by contrast SCT. The sensitivity of plain CT and enhanced SCT for the detection of peritoneal metastasis in all involvements were 46.7% and 76.6% (chi(2) = 29.07, P < 0.005). For contrast SCT, the detection rates of peritoneal carcinomatosis were higher then 83% in the fallopian tubes, ovary, subphrenic spaces, mesentery of small intestine, transverse colon and omentum.</p><p><b>CONCLUSION</b>Enhanced spiral CT, being superior to plain CT, is effective in detecting and diagnosing peritoneal metastasis.</p>

Comparison of enhanced thin CT sections with pathologic findings in pulmonary carcinoma, inflammatory, pseudo-tumor and pulmonary tuberculoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare quantitatively the enhanced thin CT section with pathologic findings in pulmonary carcinoma, pulmonary inflammatory pseudotumor (IPT) and pulmonary tuberculoma so as to demonstrate the relation of degree of enhancement and the vascular structure within the lesion with special emphasis on pulmonary carcinoma.</p><p><b>METHODS</b>Enhanced thin CT sections were obtained in 35 cases with nodular or patchy lesions in the peripheral lung field which are difficult to differentiate clinically. There were pulmonary carcinoma 21, inflammatory pseudotumor 7 and tuberculoma 7. The number of small vessels (inner diameter 0.02 approximately 0.1 mm), relatively large vessels (inner diameter > 0.1 mm) and their vascular bed areas were analyzed by computed image analyzing system. The relation between CT average attenuation and the number of vessels or the vascular bed areas were statistically evaluated.</p><p><b>RESULTS</b>1. The differences of average attenuation in carcinoma, inflammatory pseudotumor and tuberculoma were statistically significant (P < 0.05). 2. The differences in number of small vessels, relatively large vessels and vascular bed areas among these three types of lesion were also significant (P < 0.05). 3. A positive correlation was found in the average CT affenuation of lung carcinoma and its number of small vessels and relatively large vessels and 4. A positive correlation was found between the average CT attenuation in these three lesions and the relatively large vessels, total vascular amount and vascular bed areas.</p><p><b>CONCLUSIONS</b>1. The average degree of attenuation, being divided into four degrees, is of practical value in the differentiation of lung carcinoma, inflammatory pseudotumor and tuberculoma. 2. The average CT attenuation of lung carcinoma, inflammatory pseudotumor and tuberculoma is in direct proportion to the number of vessels and vessel bed areas and 3. The characteristic CT enhancement in lung carcinoma reflexes the condition of vessels and blood supply within the tumor.</p>

Influence of MRI on the T, N staging system of nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the influence of MRI on the T, N staging system, 5(th) edition, UICC and the 92 staging system, China by comparing CT and MRI of the nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>From 1993 to Dec. 2000, fifty-six NPC patients proved by pathology underwent CT and MRI examination with Philip T5-II ultra-magnetic system (0.5T) and Elscient CT twin flash. Routine axial scans by CT and SE sequence with axial, sagittal and coronal scans by MRI from oral pharynx (lower border of second cervical vertebra) to supracellar cistern were done with enhancement (50/56).</p><p><b>RESULTS</b>The tumor beyond the nasopharyngeal cavity was accurately defined because the pharyngobasilar fascia could be seen by MRI which appeared to be more sensitive than CT in revealing the invaded soft tissues surrounding the nasopharyngeal cavity, such as longus colli (14 by CT and 26 by MRI), tensor veli palatini and levator veli palatini (17 by CT and 42 by MRI), the skull base erosion (15 by CT and 23 by MRI) and enlargement of retropharyngeal lymph nodes (13 by CT and 24 by MRI). As a result, 28.6% (16/56) of NPC staging system, UICC and 33.9% (19/56) of the 92 staging system of China should undergo changes.</p><p><b>CONCLUSION</b>MRI is able to reveal the invasion extent into the structures around the tumor mass more accurately than CT, with the pharyngobasilar fascia readily seen and the infiltration and/or destruction of the skull base more easily visualized by MRI than by CT. The impact of MRI upon the 92 staging system of China lies in the differentiation of direct infiltration by the tumor from the enlargement of the retropharyngeal lymph node and the early detection of skull base erosion. The Influence of MRI on the staging system of NPC is more pronounced than that of CT.</p>

The interventional therapy in inferior vena cava stenosis or obstruction caused by carcinoma / 中华放射学杂志

Objective To investgate the value of interventional therapy in inferior vena cava stenosis or obstruction caused by tumor and management after the operation. Methods 53 patients with IVC stenosis caused by tumor had detailed information. After the guide wire passed through the stenosised part and then undergoing balloon expansion, Gianturco Z stents or wallstents were implanted to undergo venography and measuring pressure after that. Results Technical success was attained in 50 patients, 3 cases was failure because the guide wire couldn't pass through the obstructed region.The technical success rate is 94.3%. 2 patients with IVC stenosis over 10 cm length was placed two stents. In other 48 patients,everyone was placed one stent. The pressure of IVC dropped from (28.66?4.08)cm H 2O (1 cm H 2O =0.098 kPa) before operation to (17.65?4.18)cm H 2O after operation. Through t examination, the difference of IVC pressure before and after treatment has statistic significance( t =3.261, P

Antitumor effects of recombinant vectors carrying CDglyTK suicide gene on nasopharyngeal carcinoma cell in vitro / 中国病理生理杂志

AIM: To construct the recombinant adenovirus carrying fusion suicide gene CDglyTK with the C promoter(Cp),one of the key factors in controlling Epstein-Barr virus latent gene expression,and to investigate if the Cp mediates the expression of CDglyTK in CNE1 cells and kills the cancer cells specifically.METHODS: The tk,cd,Cp sequences were amplified by PCR and subcloned into corresponding sites of pDC316 vector with directional cloning method to construct the pDC316-CP-CDglyTK.The plasmid was analyzed by DNA sequencing and enzyme digestive method.The recombinant adenovirus of Ad-Cp-CDglyTK was packaged,amplified and purified in 293 cells,and the virus titre was determined by TCID50 method.The CDglyTK gene expression in CNE1 and NP69 were examined by reverse transcription-polymerase chain reaction(RT-PCR) after in vitro transfection in CNE1 and NP69 cells.The killing effect of Ad-Cp-CDglyTK/GCV+5-FC on CNE1 cells was detected by MTT method.RESULTS: The results of restriction enzyme digestion and DNA sequencing showed that the tk,cd,and Cp gene were inserted into the pDC316 plasmid in correct orientations.The titer of the recombinant adenovirus was 5.6?1012 TCID 50/L.The Cp fragment was amplified from the total RNA of the transfected CNE1 cells by RT-PCR.The mRNA of CDglyTK gene expression was not detected in NP69 cells.The MTT results showed that after administration of GCV and 5-FC,the killing effects of fusion gene were much better than those of single gene therapy.CONCLUSION: The C promoter specifically mediates the expression of CDglyTK in CNE1 cells.The Ad-Cp-CDglyTK/GCV+5-FC has much better killing effects on CNE1 cells than single gene.