Reproducibility of perfusion CT derived CBV and rCBV measurements with different slice thickness in patients with brain neoplasms

Objective:To assess inter-and intraobserver reproducibility for measuring perfusion CT derived cerebral blood volume (CBV) and relative cerebral blood volume (rCBV) with different slice thickness in patients with brain neoplasms. Meth- ods: Three independent observers who were blinded to the histopathologic diagnosis performed perfusion derived CBV and rCBV measurements with 5 mm and 10 mm slice thickness in 52 patients with various cerebral neoplasms. The results of the measurements with different slice thickness were compared. Calculation of coefficient of variation (CV), and relative paired difference of the measurements were used to determine the levels of inter- and intraobserver reproducibility. Results: The differences of CBV and rCBV measurements between different slice thickness groups were statistically significant (P < 0.05) respectively in observer 2, and were not significant in the other two observers (P > 0.05). For the same slice thickness, both the difference of CBV and rCBV measurements among the three observers were not statistically significant. Interobserver CV and relative paired difference of the measurements with 10 mm slice thickness group were slightly lower than those of 5 mm slice thickness group. Interobserver CV and relative paired difference of CBV group were slightly lower than those of rCBV group. The intraobserver differences of CBV and rCBV in 10 mm slice thickness group were statistically significant for observer 2 respectively. No other intraobserver differences of measurements were statistically significant. CV and relative paired difference of intraobserver CBV and rCBV measurements for observer 2 were significantly higher than for the other two observers. Conclusion: High reproducibility of CBV and rCBV measurements was acquired with the two different slice thickness. Suitable training may be helpful to maintain a high level of consistency for measurements.

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy:Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P<0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P<0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P<0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS <70 (P<0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.

胃癌组织中Survivin、TrkB和BDNF的表达及意义

目的观察生存素基因蛋白（Survivin）、酪氨酸激酶受体B（TrkB）及其配体脑源性神经营养因子（BDNF）在胃癌组织和癌旁黏膜中的表达情况，探讨和分析Survivin、TrkB和BDNF与胃癌临床病理学参数的关系。方法采用免疫组化sP法检测64例原发性胃癌组织、癌旁黏膜组织和34例淋巴结癌转移组中对应的阳性淋巴结Survivin、TrkB和BDNF蛋白的表达，分析其与临床病理学特征的关系。结果胃癌组织中Survivin、TrkB和BDNF蛋白的阳性表达率分别为71．87％（46／64）、60．93％（39／64）和59．37％（38／64），而癌旁黏膜组织无一例表达。Survivin、TrkB和BDNF蛋白表达与患者性别、年龄、肿瘤分化程度等无关（P〉0．05），而与浸润深度、淋巴结转移和TNM分期有关。浸润至胃壁全层组、有淋巴结转移组和TNM分期Ⅲ～Ⅳ组的Survivin、TrkB和BDNF阳性表达率明显高于未浸润至胃壁全层组、无淋巴结转移组和TNM分期Ⅰ～Ⅱ组（分别P〈0．01）。研究还显示，Survivin与TrkB和BDNF的阳性表达率随着肿瘤不同浸润深度、有无淋巴结转移呈现相同的变化趋势，相关分析表明，Survivin阳性表达与TrkB和BDNF呈正相关（P〈0．05）。胃癌转移组Survivin、TrkB和BDNF蛋白在淋巴结转移癌中的阳性表达率（82．35％，28／34；76．47％，26／34；70．58％，24／34）均较原发癌（88．23％，30／34；85．29％，29／34；82．35％，28／34）低，但两者差异无显著性（分别P〉0．05）。结论Survivin、TrkB和BDNF表达与胃癌发生发展密切相关，联合检测Survivin、TrkB和BDNF可有助于判断胃癌局部侵袭和远处转移的能力。

人脑星形细胞肿瘤组织中Survivin基因表达的研究

目的:探讨Survivin mRNA的表达与星形细胞肿瘤发生、发展的关系。方法:应用RT-PCR技术检测各级别星形细胞肿瘤组织及非肿瘤(脑)组织中Survivin mRNA的表达水平。结果:Survivin mRNA在肿瘤组织和非肿瘤(脑)组织中的表达阳性率分别为68.6%和8.3%;Survivin mRNA的相对含量在肿瘤组织和非肿瘤(脑)组织中分别为119.67±46.56和13.19±9.26;Survivin在肿瘤组织中的表达显著高于其在非肿瘤(脑)组织中的表达,P=0.000。结论:Survivin mRNA表达与星形细胞肿瘤的发生、发展呈显著正相关,是评估星形细胞肿瘤恶性生物学行为的可靠指标;Survivin作为凋亡抑制基因为星形细胞肿瘤的治疗提供了一个新靶点。

survivin、caspase-3在脑胶质瘤的表达及suvivin ASODN对U251细胞的影响

目的：观察脑胶质瘤患者脑组织survivin、caspase-3的表达情况及survivin ASODN对脑胶质瘤U251细胞survivin和caspase-3表达的影响,探讨两者与脑胶质瘤发病及预后的相关性。方法：免疫组化法检测脑胶质瘤患者survivin和caspase-3蛋白表达,RT-PCR检测脑胶质瘤组织survivin mRNA表达,以脑胶质瘤U251细胞为研究对象,转染不同剂量survivin ASODN（100nmol/L、300nmol/L、500nmol/L）,并于培养不同时间（24h、48h、72h）后,RT-PCR检测U251细胞survivin和caspase-3的表达。结果：脑胶质瘤患者脑组织survivin蛋白高表达（阳性率69.6%）,而caspase-3低表达（阳性率50.7%）,且两者表达的阳性率与肿瘤的恶性程度有关。U251细胞在不同浓度survivin ASODN转染不同时间后,以500nmol/L survivin ASODN转染72h对U251 survivin mRNA的抑制率达62.06%,与对照组及不同浓度组间比较差异均有统计学意义（P〈0.05-P〈0.01）。免疫组化结果显示转染后survivin表达下调,而caspase-3表达上调。结论：脑胶质瘤患者脑组织高表达survivin蛋白,而低表达caspase-3蛋白,survivin ASODN可诱导U251细胞株survivin mRNA及蛋白表达下调,而caspase-3蛋白表达水平上调。

Relationship between HER-2 overexpression and brain metastasis in esophageal cancer patients

AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy.METHODS:We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and 2010.Data analyzed consisted of demographic and clinical variables.The brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test.RESULTS:One hundred and forty two patients were reviewed.Median age was 64 years(36-86 years).Eighty eight patients(62%) received neoadjuvant chemoradiotherapy.Pathological complete and partial responses were achieved in 17(19%) and 71(81%) patients.Cancer relapsed in 43/142(30%) patients.The brain was the first site of relapse in 9/43 patients(21%,95% CI:10%-36%).HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9(56%) cases overexpressed HER-2(3+ staining).CONCLUSION:HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following esophagectomy.Further studies will be required to validate this observation.

RDW、PDW与su-PAR对重度创伤性颅脑损伤患者预后的评估价值

目的 研究红细胞体积分布宽度(RDW)、血小板体积分布宽度(PDW)、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)对重度创伤性颅脑损伤(TBI)患者预后的评估价值。方法 120例TBI患者根据格拉斯哥昏迷评分(GCS)分为重度组64例、轻中度组56例,另选50例健康者为对照组。比较各组血清RDW、PDW及su-PAR水平,ROC曲线分析其在预测重度TBI患者预后中的价值。结果 重度组相较于轻中度组和对照组,RDW和PDW水平均升高,三组su-PAR依次下降(P<0.05)。随访3个月,重度组预后不良33例,预后不良组RDW、PDW及su-PAR均高于预后良好组(P<0.05)。重度组RDW、PDW、su-PAR与入院时GCS评分呈负相关(P<0.05),su-PAR与RDW和PDW呈正相关(P<0.05)。ROC曲线分析发现,三指标联合预测重度TBI患者预后不良的价值最高。结论 重度TBI患者RDW、PDW及su-PAR均异常升高,可作为评估TBI病情及预后的潜在指标。

人脑星形细胞瘤组织Survivin与VEGF表达及意义

目的探讨凋亡抑制基因Survivin与血管内皮生长因子(VEGF)在人脑星形细胞瘤中的表达及意义。方法采用免疫组织化学SP法检测60例人脑星形细胞瘤组织和12例正常脑组织中Survivin、VEGF基因的表达,并分析其与临床病理特征的关系以及两者间的相互关系。结果正常脑组织中仅2例VEGF呈弱阳性表达,阳性率为16.7%;Survivin均未见阳性表达。人脑星形细胞瘤组织中Survivin、VEGF表达的阳性率分别为63.3%(38/60)、70.0%(42/60),其表达强度均显著强于正常脑组织(Uc=3.668、3.403,P<0.01)。高级别星形细胞瘤Survivin、VEGF的表达阳性率及阳性强度均高于低级别组(χ2=4.341、6.609,Uc=2.318、3.141;P<0.05、0.01)。Survivin、VEGF在脑星形细胞瘤组织中的表达呈显著正相关(rs=0.71,P<0.001)。结论Survivin、VEGF的表达与人脑星形细胞瘤的发生发展有关,且二者具有正相关性;二者的检测可能成为评价脑星形细胞瘤恶性程度与预后的有价值指标。

Brain metastasis of hepatocellular carcinoma:A case report and review of the literature

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in the world. It is more common in far eastern countries and relatively rare in the United States and western European countries where at autopsy it accounts for only 1-2% of malignant rumors, The disease is usually manifested in the the 6^th and 7^th decade of life. HCC is one of the highly malignant neoplasms, Extrahepatic metastases are seen in 64% of patients with HCC. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of HCC metastasis^[1-3], But, metastasis to brain and skull is extremely rare. Table I shows some of the reported cases of HCC with brain metastasis. These case reports reaffirms the complex and multidisciplinary care of these patients^[4-5].

A Phase Ⅰ trial of dose escalation of topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer

Objective The aim of this study was to define the maximum-tolerated dose (MTD) and observe the toxicity of escalating topotecan combined whole brain radiotherapy for brain metastasis in lung cancer.

Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

Colonic lymphangioma is an unusual benign malformation.We herein describe two cases.A 36-year-old woman was admitted with one year of intermittent abdominal pain;colonoscopy,abdominopelvic computed tomography and endoscopic ultrasonography(EUS)revealed enlarged cystic masses at the ascending colon.In another 40-year-old man,colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon.Both patients underwent laparoscopic segmental colectomy.Both masses were histologically confirmed as cystic lymphangiomas,and the patients were discharged without complications.The management of colonic lymphangioma depends on the individual situation;close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter.Surgical intervention can be considered for larger lesions or in patients who develop complication risks.Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive,minimally invasive intervention with a fast postoperative recovery.

脑胶质瘤扩散张量成像定量参数与肿瘤细胞Ki-67及Survivin表达的相关性

目的研究脑胶质瘤的扩散张量成像(DTI)参数与肿瘤细胞Ki-67抗原表达指数(EI)及Survivin蛋白免疫反应评分(IRS)的相关性。资料与方法纳入50例胶质瘤患者,分为低级别组22例和高级别组28例;比较高、低级别胶质瘤间表观扩散系数(ADC)、相对表观扩散系数(rADC)、部分各向异性分数(FA)、相对部分各向异性分数(rFA)、EI值及IRS值的差异,分析DTI各参数与EI及IRS的相关性。结果与低级别胶质瘤组比较,高级别胶质瘤组ADC值、rADC值较低,EI值及IRS值较高(P均<0.01),两组FA及rFA值差异无统计学意义(P>0.05)。ADC值、rADC值与EI呈负相关(r=-0.64、-0.58,P<0.01),与IRS呈负相关(r=-0.58、-0.54,P<0.01);FA值、rFA值与EI(r=-0.18、-0.15,P>0.05)、IRS(r=-0.22、-0.15,P>0.05)均无相关性。结论ADC值、rADC值与Ki-67、Survivin表达呈负相关,DTI可在一定程度上反映胶质瘤的生物学行为。

Diffusion tensor imaging and proton magnetic resonance spectroscopy in brain tumor Correlation between structure and metabolism

Proton magnetic resonance spectroscopy and diffusion tensor imaging are non-invasive techniques used to detect metabolites and water diffusion in vivo. Previous studies have confirmed a positive correlation of individual fractional anisotropy values with N-acetylaspartate/creatine and N-acetylaspartate/choline ratios in tumors, edema, and normal white matter. This study divided the brain parenchyma into tumor, pedtumoral edema, and normal-appearing white matter according to MRI data, and analyzed the correlation of metabolites with water molecular diffusion. Results demonstrated that in normal-appearing white matter, N-acetylaspartate/creatine ratios were positively correlated with fractional anisotropy values, negatively correlated with radial diffusivities, and positively correlated with maximum eigenvalues. Maximum eigenvalues and radial diffusivities in peritumoral edema showed a negative correlation with choline, N-acetylaspartate, and creatine. Radial diffusivities in tumor demonstrated a negative correlation with choline. These data suggest that the relationship between metabolism and structure is markedly changed from normal white matter to peritumoral edema and tumor. Neural metabolism in the peritumoral edema area decreased with expanding extracellular space. The normal relationship of neural function and microstructure disappeared in the tumor region.

Parent’s Perceived Provision of Information Regarding Diagnosis to Children with Brain Tumors

Background: The aim of this study was to clarify the degree of information provision to children with brain tumors, factors influencing this provision, and the relationship between this provision and psychosocial consequences. Methods: A total of 157 parents completed a questionnaire on the degree of information provision to their children and sociodemographic and medical characteristics. Parents and their children completed subscales of the Pediatric Quality of Life Inventory (PedsQL) Cancer Module. Relevant factors were investigated using ordinal logistic regression analysis and compared with PedsQL scores by degree of information provision with adjustment for age. Results: The majority of children aged 2 - 4 years received a low level of information only in regard to medical procedure and preparation. The majority of children aged 5 - 11 years were provided information regarding disease symptoms and treatment, but not actual diagnosis. Approximately half of children aged 12 - 18 years were provided detailed information including their actual diagnosis. Older children generally received more information regarding their disease (odds ratio [OR] = 1.3 per 1 year old, P < 0.001), while children with intellectual disability received less (OR = 0.2, P = 0.006). The provision of information did not worsen scores for Procedural Anxiety, Treatment Anxiety, Worry, or Communication. Conclusions: To our knowledge, this is the first report on the degree of information provision to children with brain tumors. Parents of children with brain tumors in Japan provide information dependent on age and intellectual level. The disclosure of information to children regarding their disease might affect their trust of medical and health care professionals.

Experimental study on angiogenesis in rabbit VX_2 brain tumor using perfusion CT

Objective： To study the perfusion CT features of rabbit VX2 brain tumor with correlation to MVD and VEGF, and to validate perfusion CT for reflection of tumor angiogenesis. Methods： Rabbit VX2 brain tumor model was established by injection of 100 μL viable tumor cells （10qmL） through a 2 mm-hole 5 mm to the right of the sagittal suture and 5 mm posterior to the coronal suture bored by dental drill. MRI was performed every 2 days after seven days of implantation to evaluate the growth of the tumor. Twenty New Zealand White rabbits with tumor size over 3 mm in diameter were randomly divided into 2 groups according to the tumor growth time with those less than 3 weeks as group 1 and those more than 3 weeks as group 2, and perfusion CT were performed accordingly. CT measurements of BV, BF and PS from tumor, peritumor and contralateral normal tissue regions were obtained. After that the animals were sacrificed and 2% Evans blue （2 mL/kg） was given intravenously in 16 of these animals 1 h prior to sacrifice to detect breakdown of the blood brain barrier. VEGF and MVD were evaluated in immunohistochemical examination of the specimens. Results： Tumor had significantly higher BV, BF and PS （P=0.000） than peritumor and normal tissue region. Tumor BV, BF and MVD in group 2 were significantly higher than that in group 1 （P〈0.01）. Significant linear correlation was found between MVD and BV （t=-0.915, P=-0.000）, MVD and BF （t=0.901, P=-0.000）, and MVD and PS （t=-0.459, P=0.042）. We also found a rank correlation between PS and blue stain of tumor （rs=0.861, P=0.000）. Conclusion： Perfusion CT can distinguish tumor from peritumor and normal tissue clearly, reflect tumor angiogenesis accurately, and provide useful information for the evaluation of brain tumor.

A Report of Two Cases of Tuberous Sclerosis Combined with Subependymal Giant-Cell Astrocytoma

Case 1, was a 23 year old female. The chief complaints were headache, vomiting for over 20 days, which was aggravated upon exercising, and confusion for 5 days. The patient was retarded and had a history of epilepsy for 20 years. Her family said her intelligence was that of a 3 year-old child. Many red papules were dispersed on her cheeks. A highly thick 2.2 cm by 2.3 cm by 2.4 cm round-like neoplasm was found by CT scanning in the body of the left ventricle near the interventricle foramen, and there was a spot-like calcification in the tumor. There was also a spot-like calcification （Fig.1） in a shuttle-like slightly high thickness node at the same place on the opposite side. The above-mentioned neoplasms enhanced evenly （Fig.2）. CT diagnosis： tuberous sclerosis combined with subependymal giant-cell astrocytoma. A 2.0 cm by 2.0 cm by 3.0 cm tumor was seen near the interventricle foramen in the body of the left ventricle and frontal horn upon operation. The tumor had a wine-red color, with a fairly clear border, a tough nature an ample blood supply and calcification. Pathologic diagnosis： subependymal giant-cell astrocytoma.

Langerhans cell histiocytosis presenting as an isolated brain tumour:A case report

Langerhans cell histiocytosis(LCH)is a rare proliferative histiocyte disorder.It can affect any organ or system,especially the bone,skin,lung,and central nervous system(CNS).In the CNS,the hypothalamic-pituitary is predominantly affected,whereas the brain parenchyma is rarely affected.LCH occurring in the brain parenchyma can be easily confused with glioblastoma or brain metastases.Thus,multimodal imaging is useful for the differential diagnosis of these intracerebral lesions and detection of lesions in the other organs.CASE SUMMARY A 47-year-old man presented with a headache for one week and sudden syncope.Brain computed tomography(CT)and magnetic resonance imaging showed an irregularly shaped nodule with heterogeneous enhancement.On^(18)F-fluorodeoxyglucose(^(18)F-FDG)positron emission tomography/CT,a nodule with^(18)F-FDG uptake and multiple cysts in the upper lobes of both lungs were noted,which was also confirmed by high-resolution CT.Thus,the patient underwent surgical resection of the brain lesion for further examination.Postoperative pathology confirmed LCH.The patient received chemotherapy after surgery.No recurrence was observed in the brain at the 12-mo follow-up.CONCLUSION Multimodal imaging is useful for evaluating the systemic condition of LCH,developing treatment plans,and designing post-treatment strategies.

^(131)I treatment for brain metastases from differentiated thyroid carcinoma

To assess the clinical value of treatment with 131I for brain metastases from differentiated thyroid cancer (DTC), we have observed 8 cases of brain metastases from DTC who received follow-up after 131I therapy (2male, 6 female, aged 12～65 years). The results of 131I therapy were evaluated with clinical presentation, imaging scan and survival analysis. The main results are as follows. (1) All cases had been survival for 2～35 years in follow-up. (2)A space-occupying lesion in right cerebellum was reduced after taking 20.65 GBq and disappeared after 23.61 GBq,demonstrated by computed tomography. (3) The sequences and doses of 131I therapy were clearly decreased for the cases with total thyroidectomy in comparison with those with semithyroidectomy (p＜0.01). (4) The brain metastases with lung and/or bone metastasis from DTC were 75% (6/8) and it was difficult to cure these metastases at the same time. It is concluded that the postoperative treatment of 131I for brain metastases from DTC after undergoing thyroidectomy may improve clinical symptoms and life quality, reduce lesions, and prolong survival.

基于脑MRI的机器学习预测非小细胞肺癌T790M突变

目的:本研究基于脑部T_(1)C和T_(2)W MRI建立人工智能模型,预测肺癌脑转移患者在靶向治疗中的耐药性T790M突变。方法:本研究收集80例肺癌脑转移患者(2017年6月—2019年12月)的T_(1)C和T_(2)W MRI影像和临床数据进行回顾性分析(患者按照2∶1的比例分成训练集和测试集)。采用无监督k-means算法将肿瘤区域划分为高亮度区域和低亮度区域,提取不同区域的影像组学图像特征构建模型,评估每个模型的诊断效果。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(Area under curve,AUC)、特异性和敏感性作为模型评价指标,分析模型的潜在临床应用价值。结果:对T_(1)C和T_(2)W MRI和临床特征融合的统计计算表明,本研究建立的模型对T790M突变具有良好的预测能力,在训练集和测试集上的AUC分别为0.899和0.818。结论:本研究建立的计算机模型可以有效预测肺癌脑转移患者T790M突变,具有潜在的临床辅助诊断价值。