OBJECTIVE:To observe clinical efficacy and safety of recombinant human endostatin(rh-endostatin)com-bined with CT-guided percutaneous microwave ablation in the treatment of non-small cell lung cancer(NSCLC)complicat-ed with chronic obstructive pulmonary disease (COPD). METHODS:A total of 80 cases of NSCLC complicated with COPD were selected from our hospital during Feb. 2014-Feb. 2016,and then divided into control group and observation group according to random number table,with 40 cases in each group. Control group was treated by CT-guided percutane-ous microwave ablation. Observation group was additionally given rh-endostatin injection 7.5 mg/m2,once a day,d1-14, added into 500 mL 0.9％ sodium chloride injection,ivgtt lasting for 4 h,for consecutive 14 d,on the basis of control group;7 d later,next course was performed. A treatment course lasted for 21 d,and they received 4 courses of treat-ment. Survival time,clinical efficacy as well as KPS score and lung function indexes before and after treatment,the oc-currence of ADR were compared between 2 groups. RESULTS:Median survival time of observation group(19.8 months) was significantly longer than that of control group(15.2 months),and total response rate of observation group(72.5％) was significantly higher than that of control group (55.0％),with statistical significance (P<0.05). Before treatment, there was no statistical significance in KPS score,FEV1,FEV1/FVC or DLCO between 2 groups(P>0.05). After treat-ment,KPS score and above lung function indexes levels of 2 groups were increased significantly,and those of observa-tion group were significantly higher than those of control group,with statistical significance (P<0.05). No grade Ⅳwas found in 2 groups. There was no statistical significance in the cases of ADR at different levels between 2 groups (P>0.05). CONCLUSIONS:rh-endostatin combined with CT-guided percutaneous microwave ablation in the treatment of NSCLC complicated with COPD show good clinical efficacy with less ADR,and can significantly improve lung function and quality of life.

Objective To analyze the clinical features of melioidosis spleen abscess.Methods A retrospective analysis of 26 cases with melioidosis spleen abscess at Hainan People′s Hospital between October 2002 and March 2015 was performed.Data with general conditions, clinical characteristics, imaging features, treatment and outcome were all extracted and analyzed.Results High fever (100.0%) and splenomegaly (73.1%) were the main clinical symptoms and signs.Laboratory examinations showed that white blood cell and neutrophil percentage increased, with a mean value of 12.6×10.9/L and 0.86, respectively.88.5% cases had diabetes mellitus which was the main underlying disease.Apart from spleen abscess, pulmonary infection (73.1%) and liver abscess (38.5%) were the majority.Imaging showed multiple small abscess (92.3%).All patients had at least one positive blood culture of Burkholderia pseudomalleiand were treated with imipenem, ceftazidime and sulfamethoxazole alone or in combination.Hospitalization days ranged between 8 to 65 days with the mean of 29.5 days.Twenty-three cases (88.5%) were cured, the remaining 3 cases (11.5%) abandoned treatment and were all lost for follow-up.Conclusions Melioidosis should be suspected in patients from epidemic areas, who have diabetes and imaging shows spleen abscess and other organ infections including pulmonary infection and liver abscess.Microbiological culture is needed immediately.

Objective To investigate the imaging features of alar ligament and its extent, and provide the basis forclinical treatment.Methods 3.0 T superconducting MRI was used to scan the alar ligament with high resolution PDWI sequence (Proton density weighted imaging, PDWI)in 109 patients of emergency admissions due to head and neck trauma. Based on imaging features, ligamentous injury was classified into three degrees(Ⅰ to Ⅲ degrees).Patients with Ⅰ degree ligamentous injury were treated conservatively, andⅡtoⅢdegree injury patients were treated with surgery, then follow-up was performed with MRI for the recovery of ligaments and clinical evaluation for symptoms (6 months follow-up period). Results High-resolution PDWI showed 78 patients with no ligament injury.On follow-up, patients recovered well (atlantoaxial joint motor function and clinical symptoms). Thirty one patients had alar ligament injury in varying degrees, of which 18 patients had grade Ⅰ injury, nine patients had degree Ⅱinjury, and four patients had degreeⅢinjury .All gradeⅠinjury patients received conservative treatment. Follow-up of patients showed good recovery, MR revealed the lesions shrank in varying degrees or disappear.
Six gradeⅡinjury patients had surgical treatment, and three received conservative treatment. On follow-up, seven patients had a good recovery, two patients underwent surgical treatment within 3 months after injury and recovered well.Three gradeⅢpatients treated by surgery, and all with good recovery postoperative, and a patient died of respiratory failure. Conclusions High resolution PDWI is an effective tool to evaluate the extent of the alar ligament injury. Grade Ⅰ ligamentous injury patients treated conservatively can achieve good results, GradeⅡandⅢligamentous injury patients should receive surgical treatment early.

Objective To study the preoperative application value of the three-dimensional angiography in surgical strategy for the elderly patients with meningioma. Methods Forty-two elderly patients aged 60 years and over with meningioma were examined preoperatively with multi-slice spiral CT angiography(MSCTA) and (or) 3 dimensional contrast-enhancement MR angiography(3D CE-MRA)as simulation group.In three-dimensional post-processing workstation,the oppression and invasion degree of the intracranial important blood vessels,nervous running zone and sinus,as well as surgical risks were evaluated. 28 elderly patients without the above examination were as control group. The operation time, blood transfusions and postoperative complications were compared between the two groups. Results All 42 cases of simulation group completed reasonable surgical plan and approach.The incidence of postoperative complications were lower in simulation group than in control group (35.7％ vs.50.0％,P＞0.05),intra-operative blood transfusion were significantly decreased in simulation group as compared with control group [(5301.0± 150.6) ml vs.( 621.4±226.7)ml,t=2.01,P=0.049],operation time after three-dimensional simulation were reduced as compared with control group [(257.1 ±72.6) min vs.(307.5±88.2)min,t=2.61,P=0.011].Conclusions Application of three-dimensional angiography in elderly patients with meningioma to evaluate the operative risk may help make reasonable surgical strategy,thus reducing the surgical trauma and complications.

Objective To assess the value of CT perfusion imaging in differentiation of mild from moderate liver fibrosis .Methods 18 patients with mild liver fibrosis (F1 phase) and 21 ones with moderate fibrosis (F2 and F3 phase) confirmed by liver biopsy were analyzed ,and all patients underwent the liver 256‐slice CT perfusion imaging .The differences in the CT parameters including hepatic arterial perfusion (HAP) ,portal venous perfusion (PVP) ,total liver perfusion (TLP) and time to peak (TTP) between dif‐ferent fibrosis were analyzed .ROC curve was used to evaluate the ability of perfusion indexes to distinguish mild from moderate liver fibrosis ,then the maximum Youden index was selected as a cutoff point to calculate the sensitivity and specificity .Results Compared with the mild fibrosis ,the TTP [(43 .86 ± 13 .41)s vs (37 .84 ± 9 .97)s ,P=0 .034)] in liver with moderate fibrosis was significantly increased .However ,no differences in the HAP ,PVP and TLP were found .The ROC curve analysis showed that a TTP threshold of 41 .7 s allowed discrimination of mild from moderate fibrosis with a sensitivity of 72 .7% and a specificity of 75% .Conclusion 256‐slice CT perfusion imaging can reflect the hemodynamic changes of liver fibrosis ,and the TTP may help to discriminate mild from moderate fibrosis .

Objective To probe the value of multi-slice spiral CT angiography (MSCTA) in decreasing surgical trauma of the cranial base meningioma. Methods Thirty-two patients with cranial base meningioma were examined preoperatively with MSCTA to observe the shape and the relationship with the adjacent vessels and the skull base. Three-dimensional images were reconstructed to imitate the approach of operation and compared with surgical findings. Meanwhile, 22 patients withnot MSCTA were selected randomly as control group. The amount of blood transfusion and the occurrence rate of complications were compared between the two groups. Results MSCTA depiceted clear three dimensional images of the meningioma and the relationship with the adjacent vessels and the skull base, corresponded very well to the surgery. By imitating the operation, all patients were designed the incision size of bone appropriately, the vessels of peritumoral were kept off effectively and the risk of the embedded vascular were assessed accurately. The conventional surgical approach and method were changed in 9 patients, 4 formulated the planning of the sub-total resection and radiotherapy preoperatively. Compared with control group, the amount of blood transfusion reduced significantly (P<0.05) and postoperative complications decreased. Conclusion MSCTA can imitate the surgical operations in multi-angle and supply the vital information for choosing the proper surgical approach, thereby reducing surgical trauma and postoperative complications.

OBJECTIVE: To determine the value of high-resolution three dimensional contrast enhanced magnetic resonance venography (3D CE-MRV) in evaluating sinus meningiomas in the region of interest (ROI). METHODS: Twenty patients with sinus meningiomas underwent 3D CE-MRV with ROI preoperatively (including 9 patients postoperatively). We observed the changes of venous sinus adjacent the tumor. RESULTS: All patients received high-resolution image, the single acquisition time was about 11.4 s, and the voxel value was about 1.3 mm3. The images of 20 patients showed the change of the sinus clearly, 6 of which with integral sinus, 14 with sinus invaded at various degrees, including 5 with sinus occlusion and 9 with stenosis. CE-MRV also showed 4 patients with clear sinuses, 1 with narrow sinus, partial interruption, and 4 with sinus removed after the surgery. CONCLUSION Application of high-resolution 3D CE-MRV in ROI in sinus meningiomas may help obtain a series of high-resolution images in a short time, show the relationship between the tumor and venous sinus, display the degree of invasion of venous sinus clearly, provide information for the surgical treatment, and evaluate the change of sinus after the surgery.
Adult ; Aged ; Aged, 80 and over ; Cranial Sinuses ; pathology ; Female ; Humans ; Image Enhancement ; methods ; Imaging, Three-Dimensional ; Magnetic Resonance Angiography ; methods ; Male ; Meningeal Neoplasms ; diagnosis ; Meningioma ; diagnosis ; Middle Aged ; Phlebography ; methods

OBJECTIVE: To observe the imaging features for chronic whiplash alar ligament injury in elderly patients and to provide an effective diagnostic method for long-term neck pain and headaches due to alar ligament injury in elderly patients. METHODS: A total of 134 elderly patients, who engaged in the work or activities related to whiplash motion and suffered from chronic neck pain, were enrolled for the study. All patients were performed comprehensive health examination (CT, MR, ultrasound and laboratory examination) and high resolution PDWI. The patients were divided into 2 groups according to the results of comprehensive health examination: a clear etiology group(CE group, n=96) and an unknown etiology group(UE group, n=38). Th e characteristics of PDWI signal in the ligament were analyzed between the 2 groups. RESULTS: Th e anatomy and signal characteristics of the alar ligament were clearly displayed by high resolution PDWI. Th e alar ligaments were effectively displayed by oblique coronal image. In the CE group, 7 patients (7/96) showed the positive sign of ligament injured, while 21 (21/38) patients showed positive sign of ligament injured in the UE group (P<0.01). Chronic whiplash ligament injury was proved to be the reason for long-term neck pain and headaches in 15.7% patients. CONCLUSION Th e whiplash injury of alar ligament is an important reason for chronic neck pain in elderly patients. High resolution PDWI is an effective method to evaluate the image features of alar ligament and can provide an accurate diagnosis for chronic neck pain and headaches caused by the alar ligament whiplash injury.
Aged ; Cervical Vertebrae ; Chronic Pain ; Fascia ; Humans ; Ligaments ; pathology ; Magnetic Resonance Imaging ; Whiplash Injuries ; diagnosis

Objective To investigate the value of DWI high b value and ADC value in the diagnosis of hyperacute cerebral is-chemia.Methods Adult SD rats were selected and divided into the control and ischemic group by adopting the random number table method,the ischemic group was re-divided into 0.25,0.50,2.00,4.00、6.00 h groups according to the ischemic time,6 cases in each group with a total of 42 cases.The ischemic group conducted the right middle cerebral artery occlusion(MCAO)for performing the head T2WI and DWI scanning(b values were 0,400,800,2 000,3 000 s/mm2),the CNR and SNR values were recorded,rs-T2WI, rs-DWI and relative apparent diffusion coefficient(rADC)were measured.Then the imaging change of ischemic area was observed. The sensitivity and specificity were detected.Results In b=2 000 s/mm2and 3 000 s/mm2,the diagnostic rates of DWI for hyper-acute cerebral ischemia were obviously higher than those in b=400 s/mm2and 800 s/mm2,and when the b values were 400,800, 2 000,3 000 s/mm2,the sensitivities were 16.7%,50.0%,100.0% and 100.0% respectively and the specificities were 16.7%, 50.0%,100.0% and 100.0% respectively.The difference of ADC values under different b values had statistical significance(P<0.05).Conclusion High b value DWI in the diagnosis of hyperacute ischemia is significantly better than that of low b value,espe-cially in the aspect of displaying the lesion at 0.25,0.50 h cerebral ischemia.

Objective To explore the application value of fractional anisotropy(FA)values of magnetic resonance diffusion tensor imaging(DTI)parameters in rat rat glioma grading.Methods Sixty-seven female Wistar rats were divided into the experi-mental group(n=57)and control group(n=10)according to the random number table method.All the surviving rats were exam-ined by 3.0T DTI at 1-2 weeks(22 cases)and 3-4 weeks(35 cases)after inoculation,and the FA values of the tumor were ob-tained and compared with the pathological results.Results Among 57 tumor-loading rats,there were 18 low-grade gliomas and 39 high-grade gliomas.DTI showed that the FA value of high-grade gliomas was higher than that of the low-grade glioma,the differ-ence was statistically significant[(0.167 ± 0.035)vs.(0.147 ± 0.015),t=2.34,P<0.05].Conclusion The FA value of DTI pa-rameters can provide accurate,reliable and noninvasive imaging information for preoperative glioma grading.