Correspondence of CT perfusion imaging to pathological manifestations in rabbit models of hyperacute cerebral infarction

BACKGROUND： Could the infarction be diagnosed quickly and accurately at the acute stage by CT perfusion imaging （CTPI） technology？ Whether the images of CTPI will correspond with the pathological changes or not？ All the questions need to be solved by experimental and clinical studies. OBJECTIVE： To reveal the rules of perfusion map changes and guide the early diagnosis of hyperacute cerebral infarction by analyzing the correlation of CTPI with pathological manifestations for hyperacute cerebral infarction. DESIGN： A randomized controlled animal experiment. SETTING： Experimental Center of Medical Radiology, Longgang Central Hospital of Shenzhen City. MATERIALS： Forty-two adult New Zealand rabbits of （2.6±0.5） kg, either male or female, were randomly divided into experimental group （n =36） and control group （n =6）. Six rabbits in the experimental group were observed after ischemia for 0.5, 1, 2, 3, 4 and 6 hours respectively, and 1 rabbit in the control group was observed at each corresponding time point. METHODS： The experiments were carried out in the Experimental Center of Medical Radiology, Longgang Central Hospital of Shenzhen City from March 2003 to July 2004. Rabbit models of cerebral infarction were established by modified O＇Brein method. （1） The rabbits in the experimental group were scanned at 0.5, 1, 2, 3, 4 and 6 hours after ischemia respectively. The dynamic CT scan slice was 13 mm from the anterior edge of the frontal cortex, and six fake color functional images were obtained, including cerebral blood flow map （CBF map）, cerebral blood volume map （CBV map）, peak to enhancement map （PE map）, flow without vessels map, time to peak map （TP map）, time to start map （TS map）. The manifestations and changes of the functional maps in different interval were observed. （2） Bilateral symmetric ranges of interest （ROI） were drawn separately on the CBF map, CBV map, TP map and TS map. The blood flow parameters of focal and contralateral cerebral tissues could be obtained to calculate relative cerebral blood flow （rCBF, rCBF=focal CBF/contralateral CBF）, relative cerebral blood volume （rCBV, rCBV= focal CBV/contralateral CBV）, a relative time to peak （rTP, rTP= focal TP - contralateral TP）, a relative time to start （rTS, rTS= focal TP - contralateral TP）. （3） The perfusion maps were input into AutoCAD software. The percents of ischemic cores and peri-ischemic areas accounting for contralateral cerebral hemisphere were calculated. （4） The animals were anesthetized and killed, then the cerebellum and low brain stem were taken out. The brain tissues were cut on coronal plane at 14 mm from the anterior edge of the frontal cortex, a 2-mm piece anterior to the incision, and a 3-mm piece posterior to the incision. The anterior piece was fixed, stained and observed. A 1-mm slice was cut from the front of the posterior piece tissues as electron microscope sample, the remnant was fixed and then taken out, and the location and size of stained ＂white＂ areas were observed as the reference for electron microscope sample. （5） The correlation between CTPI and pathological manifestations was observed. MAIN OUTCOME MEASURES： （1） Laws of time and spatial changes of ischemic areas; （2） Pathological changes of the ischemic tissues; （3） Correspondency between CTPI and pathological manifestations. RESULTS： （1） Laws of time and spatial changes of ischemic areas： Relative ischemic-core areas were consistent in each perfusion map, increased incessantly along with the ischemic times. Relative peri-ischemic areas were inconsistent in each perfusion map, on CBF map from 1 to 6 hours after ischemia, the area of ischemic core increased from （1.503±0.523）% to （7.125± 1.054）%, the ascending trend occurred. But the peri-ischemic areas showed a descending trend on CBF map, the areas decreased from （8.960±0.719）% to （5.445 ± 0.884）% from 0.5 to 6 hours; The relative areas were the largest one on TP maps, the average value was （32.796±3.029）% at 0.5 hour after ischemia happening （60.540±1.683）% at 6 hours. The trend of ischemic areas was increased. No obvious change was observed on TS maps. （2） Pathological changes of the ischemic tissues： Under light microscope, there was no obvious change at 0.5- 2 hours after ischemia, edema at 3 hours, karyopycnosis at 4 hours and eosinophilous changes at 6 hours; Under electron microscope, there was edema in ischemic cores within 4 hours after ischemia, whereas karyopycnosis or structure vanished after 4 hours; Edema was observed in peri-ischemic areas. （3） Correlation between CTPI and pathological manifestations： On CTPI maps, the ischemic core was blue on CBF and CBV maps, black on TP and TS maps. Along with the ischemic times, the rCBF and rCBV decreased, whereas the rTP and rTS prolonged. Hemodynamic parameters were not significantly different within 2 hours of ischemia and 2 hours after ischemia. The rTP and rTS became 0 after 1 and 2 hours respectively. On CTPI maps the peri-ischemic area was red on CBF and CBV maps, red and yellow on TS maps, red on TP maps. Along with the ischemic times, the rCBF decreased, and the lowest level was always at about 20%, whereas the rTP and rTS prolonged. CONCLUSION： （1） CTPI manifestations corresponded well with pathological findings, and it is a sensitive, stable and reliable technique to diagnose hyperacute cerebral infarction. （2） TP map was more sensitive than CBF map and TS map in exhibiting the peri-ischemic areas, thus TP maps could be a good choice for observing peri-ischemic areas.

巴曲酶灌注联合肝动脉化疗栓塞治疗原发性肝癌的临床初步研究(英文)

Objective:The aim of the study was to explore the therapeutic efficacy and safety of batroxobin in patients with primary hepatic carcinoma(PHC) and the advantages of transcatheter arterial perfusion of batroxobin combined with transcatheter arterial chemoembolization(TACE).Methods:Forty patients with PHC were randomized into experimental group(transcatheter arterial perfusion of batroxobin combined with TACE treatment,20 patients) and control group(TACE alone group,20 patients).The patients were followed up and the data were recorded,compared and analyzed.Results:(1) Compared with the control group,the FIB level in the experimental group was significantly decreased at the first month after treatment(P < 0.05).(2) The baseline of the tumor was shortened in both groups after the treatment.There was a significant difference between the two groups at different time intervals(P < 0.05).(3) After the treatment,there was a significant difference of progression-free survival(PFS) levels between the two groups(t =2.877,P < 0.05).(4) The incidence of metastasis were 5.0%(1/20) in both groups at 6 months after treatment,and that after one year was 10.0%(2/20) in the experimental group and 25.0%(5/20) in the control group.However,the difference was not significant(χ2 = 0.693,P > 0.05).Conclusion:Batroxobin can rapidly and effectively decrease the FIB level of the PHC cases.Therefore it may be used as an effective and safe adjuvant drug for the treatment of primary hepatic carcinomas.Transcatheter arterial perfusion of batroxobin combined with TACE therapy has advantages in comparison with TACE alone therapy.It could be taken as a new therapeutic regimen in the PHC treatment.

MR动态增强特征对乳腺癌诊断的价值(英文)

Objective:The aim of the study was to further explore the diagnostic value of breast dynamic contrast enhancement (DCE), and improve specificity of breast cancer diagnosis. Methods:The 93 patients with 105 breast masses were performed with routine magnetic resonance (MR) scan and DCE scan. Results:1. Morphological manifestations and pathologic findings:105 masses of enhance forms could be divided into six types:(1) No enhancement, 9 masses (breast cyst); (2) The heterogeneous enhancement, 31 masses (fiber adenoma, 9; breast cancer, 11; mammary gland hyperplasia, 10; leafy tumor, 1); (3) The unheterogeneous enhancement, 42 masses (fiber adenoma, 5; the hyperplasia, 3; breast cancer, 33; leafy tumor, 1); (4) Ring enhancement, 17 masses (breast cancer, 15; fiber adenoma, 1 and inflammation, 1); (5) Reticular enhancement, 2 cases (gigantic breast, 1 and inflammation, 1). (6) Duct shape enhancement, 4 (hyperplasia, 1; duct carcinoma, 3). 2. Enhancement slope and pathology results:The maximum slope in 62 malignant masses was equally 19.19 ± 8.13, maximum slopes in 43 benign masses was equally 9.46 ± 6.64, the difference had a very significance (P < 0.01). In 42 masses with II type curves, the maximum slope of 24 malignant focuses were 17.52 ± 6.39, while 18 benign focuses 8.33 ± 5.47, the difference had a very significance (P < 0.01). Use a test-receiver to work curve (ROC curve) progress analysis, with 14.85 for critical point, sensibility for 67%, specificity for 83%; with 17.10 for critical value, the specificity was 100%. 3. Curve type and pathological results:According to general type standard, type I of single-phase curve, 20 masses; type II of platform type curve, 42 and III type curve type of washout, 43. A group of six kinds of forms were as follows:(1) No increased signal strength curve, 9 (cyst); (2) The curve signal strength slowly increasing, 6 (hyperplasia 2, fiber adenoma 2, chronic inflammation 1, duct carcinoma 1); (3) The intensity of curve after rapid increase early, continued to increase slowly 5 (hyperplasia 4, inflammatory breast cancer 1); (4) Curve early signal strength increasing rapidly formed the stop after middle-late platform (platform type), 42 (hyperplasia 9, fiber adenoma 8, leafy tumor 1, and breast cancer 24); (5) Early signal strength rapid increase arrived the peak then rapid declined (outflow type), 40 (hyperplasia 1, fiber adenoma 5, leafy tumor 1, breast 33); (6) Early signal strength increase quickly reached a peak, after platform period, then rising quickly again, and all of 3 for breast cancer. Conclusion:Enhancement morphological characteristics of breast cancer such as duct or ring enhancement had diagnostic value. Maximum slope in benign or malignant lesions, particularly in the differential diagnosis of type II curve played an important role. Formation mechanism of type II curve might be that an obstacle blood backflow of blood vessels by vascular tumor emboli or tumor compression.