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Objective To evaluate the curative effect between conventional fraction radiotherapy (CFRT) and intensity modulated radiation therapy (IMRT) combined with concurrent chemotherapy for unresectable esophageal carcinoma.Methods 144 patients were enrolled into this study.They were divided into CFRT group and IMRT group.CFRT group (60 cases):irradiation field encompassed primary lesion and mediastinal lymph drainage regin.Neck and thoracic upper segment cases were made front thorax T field irradiation first,DT 36 Gy/18 f,followed by two front oblique field made Iso-central irradiation,field width was 4.5-5.0 cm,gantry angle 50°-60°,wedge filter 30°,DT added to 66 Gy.For thorax middle or lower segment patients,field width was 6.0-6.5 cm,field length was that the tumor upper and lower each extended 3.0-5.0 cm,vertically irradiated in thoracic front and at the back,after DT 36 Gy/18 f,changed to two back ablique field,made Iso-central irradiation,DT added to 66 Gy.IMRT group (84 cases):GTV was esophageal primary lesion and metastasis lymph node (GTVnd);CTV included GTV,GTVnd and mediastinal lymph drainage region,at GTV around all was widened 0.8-1.0 cm,its upper and lower each extended 3.0-5.0 cm;PTV were in the basis of CTV,all were widened 0.5 cm again.With ≥95 ％ isodose curve covering the PTV and the target dose was prescribed to PTV 60-64 Gy/30-32 f.Organ at risk (OAR):both lungs V20≤30 ％,spinal cord ≤45 Gy/6 weeks,heart V30≤40 ％.Chemotherapy of two groups was same,DDP 25-30 mg/m2 × 3-5 days,5-Fu 450-500 mg/m2 × 5 days civ,28 days were one period,total 2 period,after 1-3 months,strengthen chemotherapy 3-4 period.Results Leucopenia and radiation-induced esophagitis as shown by the WHO staging system were the most common acute toxicities,but were mainly grade 1 or 2.The incidence rate of leucopenia and radiation-induced esophagitis in CFRT group were 78.3 ％ (47/60) and 83.3 ％ (50/60),IMRT group were 82.1％ (69/84) and 79.8 ％ (67/84).After symptomatic treatment,all patients completed the planner treatment.During radiotherapy and after treatment,the patients showed grade 1-2 radiation-induced pneumonitis,CFRT group were 36.7 ％ (22/60),but IMRT group were only 9.5 ％ (8/84) (x2 =9.99,P ＜ 0.01).In CFRT group and IMRT group,the 1-,3-,5-year survival rates were 75.0 ％ (45/60),36.7 ％ (22/60),20.0 ％ (17/84) and 79.8 ％ (67/84),35.7 ％ (30/84),21.4 ％ (18/84),respectively.Conclusion The overall response and 5-year survival rates of CFRT and IMRT combined with concurrent chemotherapy are similar,however,the incidence of grade 1-2 radiation-induced pneumonitis of IMRT is low,which indicates that IMRT can reduce the lungs irradiational volume and dose.
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Objective To seek the curative effect of stereotactic radiation therapy (SRT) combined with gemcitabine for unresectable advanced pancreatic carcinoma.Methods 24 patients were treated by SRT of 6MV X-ray.Patients were fixed with the rack of stereotactic localization and heated plastics mould.The CT scanning results were put into the treatment planning system.According to the target area of tumor,sensitive organs and moving error drew GTV,CTV and PTV.The best plan was selected by the dose-volume histogram (DVH).5 to 7 beams of non-coplanar radiation ray were chosen.PTV was surrounded by ≥95 ％ isodose curves.Conventional fraction,5 fractions per week,1.8-2 Gy per fraction was used.All patients received a total dose of 50-60 Gy.Gemcitabine was performed 1000 mg/m2,once a week,iv gtt,in the 1st,2nd and 4th,5 th weeks.Results In chemo-radiotherapy,50.0 ％ (12/24) patients showed light nausea,41.7 ％ (10/24) patients showed leucopenia or thrombocytopenia of grade 1 or 2,after symptomatic treatment,all patients completed the planned treatment.In a period of one month to three months,after SRT combined with chemotherapy,appetite improvement was 83.3 ％ (20/24),jaundice disappeared in 6 of 6 patients (100.0 ％),abdominal pain was relieved in 21 of 24 patients (87.5 ％),3 patients were relieved completely among them.The complete remission (CR) rate was 16.7 ％ (4/24) and partial remission (PR) rate was 66.7 ％ (16/24),with CR+PR rate of 83.4 ％ (20/24).One-year survival rate was 70.8 ％ (17/24).As a consequence of cachexia,intestinal obstruction or bleeding,7 patients died within one year.Nobody survived more than 2 years.Conclusions SRT combined with gemcitabine for advanced pancreatic carcinoma may relieve symptoms.It is an effective approach to improve life quality and prolong survival time for advanced pancreatic carcinoma,especially lod and weak patients are more suitable to select SRT combined with gemcitabine.
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Objective To evaluate the effect and patient 's tolerance on late-course high-dose radiotherapy (LCHDRT) combined with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC).Methods 73 NSCLC patients were entered into this study from May 2000 to May 2006.The treatment regime consisted of conventional radiotherapy first (40 Gy,20 f,4 w),followed by LCHDRT (24-30 Gy,6 f,2 w,tumor α/β =10 Gy,BED =81.6-93 Gy) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,hilum of lung and mediastinal lymph drainage region.LCHDRT focused on the primary lesion only,with ≥95 ％ isodose curve covering the planning target volume (PTV) and the target dose was prescribed to PTV.Supraclavicular metastases lymph node was treated by 6 MV X-ray and electron beam to a total dose of 65-70 Gy.Chemotherapy regime consisted of vinorelbine (25 mg/m2,d1,8 iv) and cisplatin (30 mg/d,d1-3,iv gtt) in the lst and 5th weeks.Results Leukopenia and radiation-induced pneumonitis,as shown by the WHO staging system were the most common acute toxicities.In V20≤25 ％,17.2 ％ (5/29) patients happened radiation-induced pneumonitis only.But in V20 ＞ 25 ％ and ≤ 30 ％,65.9 ％ (29/44) happened radiation-induced pneumonitis (x2 =16.63,P ＜ 0.01).It showed that patients accompany increment of V20,the happening rate of radiation-induced pneumonits probability was increased.The other acute toxicities such as nausea,fever,radiation-induced esophagitis,hemoglobin decrease and thrombocytopenia were mainly grade 1 or 2.After symptomatic treatment,all patients completed the planned treatment without interruption except 4 patients above 70 old years of grade 3 radiation-induced pneumonitis.Late lung radio-fibrosis was 34.3 ％ (25/73).Before the end of the second month after treatment,the complete response (CR) and partial response (PR) rates were 17.8 ％ (13/73) and 69.9 ％ (51/73),respectively,with CR+PR rate of 87.7 ％.The 1-,3-,5-year local control and overall survival rates as monitored by the x2 test method were 82.2 ％,60.3 ％,50.7 ％ and 57.5 ％,23.3 ％,13.7 ％,respectively.Conclusion LCHDRT combined with concurrent chemotherapy shows a promising results,but the rational time-dose-fraction model still need further observation.
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@#Objective To observe the course of motor related activation cortex after unilateral subcortical ischemic stroke. Methods6 healthy volunteers and 3 patients with solitary lacunar infarction in subcortical region underwent blood-oxygen level dependent functional MRI （BOLD-fMRI） as a block design of sequential finger tapping task. The data were analyzed with Statistical Parametric Mapping (SPM2). The activated voxels and the laterality index (LI) were calculated. The patients were assessed with the Fugl-Meyer Assessment of upper limb after scanning, and were scanned again 8 months after stroke. ResultsThe activated cortices in patients were more extensive than that of volunteers. In the early stage of stroke, the activation cortex involved the bilateral sensory motor cortex (SMC) in all the patients, but various in other regions. In the late stage, the ipsilateral activations decreased while the contralateral activation increased in SMC. The LI of hemisphere, SMC, and M1 is higher than the early stage. ConclusionThe motor related activation gradually localized to the contralateral SMC with motor function recovery.
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Objective To compare the clinical and MRI characteristics of pituitary macroadenoma between male and female patients. Methods Two hundred and thirty patients with pathologically diagnosed pituitary macroadenomas (104 mlaes and 126 females) were divided into two groups according to different gender. Patient age, the ratio of intratumoral hemorrhage and cavernous sinus invasion, and tumor volume were calculated in each group and compared between the two groups. The constitution of different pathological types was also compared. Results The age, ratio of intratumoral hemorrhage and cavernous sinus invasion, and tumor volume was (44.8±13.2) years old, 21.15% (22/104), 50.00% (52/104), and 6100.48 (mm3, median) in the male group and (44.8±11.9) years old, 28.57% (36/126), 48.41% (61/126) and 5037.05 (mm3, median) in the female group, respectiveluy. There was no statistical difference between the two groups regarding to patient age, the ratio of intratumoral hemorrhage and cavernous sinus invasion, tumor volume, and constitution of pathological types (P=0.972, P=0.197, P=0.811, P=0.189, P=0.093, respectively). Conclusion Pituitary macroadenomas show no gender preference in clinical and MRI characteristics.
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AIM:Xilei Powder,a traditional Chinese prescription,has been used to treat wounds for hundreds of years,but the mechanism has not been fully understood.METHODS:The effects of Xilei Powder on fibroblast proliferation,collagen accumulation,matrix metalloproteinases-2,9 ( MMP-2,9 ) activities and tissue inhibitor of metalloproteinase 1 (TIMP-1) production were investigated by MTT,chloramine T method,gelatin zymography and enzyme-linked immunosorbent assays ( ELISA),respectively.RESULTS: The aqueous extract of Xilei Powder significantly promoted fibroblasts proliferation in a time and concentration manner,the population doubling time (125 μg/mL) was 33.8 h,it also significantly (P ＜0.05 ) promoted collagen production.Both of the aqueous and alcoholic extracts could significantly ( P ＜ 0.05 ) increase MMPo2 activity,and also very significantly ( P ＜ 0.01 )promote TIMP-1 production.CONCLUSION: Xilei Powder could promote fibroblasts proliferation,collagen and TIMP-1 production,this might be parts of mechanism to promote wound healing.
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To explore the influence of calculus bovis on the function of primary cultured mice oral fibroblasts, we determined the effects of calculus bovis on the fibroblast proliferation, collagen production, matrix metalloproteinases-2, -9 activities and tissue inhibitor of metalloproteinase-1 production by MTT assay, chloramine T method, gelatin zymography and enzyme-linked immunosorbent assays respectively. The results showed that calculus bovis could significantly inhibit the proliferation of fibroblasts and collagen synthesis in a concentration dependent manner, could significantly (P<0.05) suppress matrix metalloproteinases-2 activity and very significantly (P<0.01) inhibit the production of tissue inhibitor of metalloproteinase-1. In conclusion, the major function of calculus bovis in the process of ulcer healing is not to promote tissue regeneration, the mechanism that calculus bovis inhibits collagen synthesis may be partly due to its ability to very significantly (P<0.01) suppress the production of tissue inhibitor of metalloproteinase-1.
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Animals , Cattle , Mice , Cell Proliferation , Cells, Cultured , Cholelithiasis , Chemistry , Collagen , Metabolism , Fibroblasts , Cell Biology , Physiology , Materia Medica , Pharmacology , Mice, Inbred BALB C , Mouth Mucosa , Cell Biology , Tissue Inhibitor of Metalloproteinase-1 , MetabolismABSTRACT
Objective To establish a new automatic lung segmentation method in order to deal with the omission of pleural nodules and pulmonary vessels. Methods Lung parenchyma were extracted from chest CT images with the inversed operation of 2D region growing and connected area classification, then the contours and locating the contour points were traced with scan line searching. Finally, the parameters of lung contour points were analyzed to locate the contours distorted by nodules, and curve spline was used to correct distorted contours. Results The experimental results of many sets of CT images verified that the technique proposed was effective. The comparison with other contour correction algorithm verified that line searching contour correction was superior. Conclusion The proposed algorithm includes tumors in the segment results, and confirms the integrality, veracity, real-time quality of this auto-segmentation method.
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Objective To assess the value of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) value at 3.0T diffusion tensor imaging (DTI) in glioma grading before operation. Methods DTI was performed on 104 patients with histologically proved glioma. ADC, FA and DWI maps were produced, and ADC, FA value of solid tumors were measured and compared with the WHO classification of gliomas. Results Fifty-eight gliomas were WHO Ⅱ, 25 were WHO Ⅲ and 21 were WHO Ⅳ. The ADC value of WHO Ⅳ (0.81±0.20)×10~(-3)mm~2/s was lower than that of WHO Ⅲ [(1.05±0.30)×10~(-3)mm~2/s] and WHO Ⅱ[(1.26±0.32)×10~(-3)mm~2/s (P=0.008, P＜0.001)]. The ADC value of WHO Ⅲ was lower than that of WHO Ⅱ (P=0.003). The FA value of WHO Ⅳ (0.18±0.06) was higher than that of WHO Ⅱ (0.15±0.06) (P=0.046). No significance of FA was found between WHO Ⅲ (0.15±0.10) and Ⅱ, nor WHO Ⅳ and Ⅲ. Conclusion ADC and FA value can distinguish different grade gliomas. It is useful in deciding the surgical strategy and predicting the patient's prognosis.
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An insight of the building and operation of the medical rescue and assurance system for Beijing Olympic Games will help identify effective practices for design and implementation of medical rescue plans in large-scale activities held in cities. Practice-proven: large-scale activities call for systems designed in view of characteristics of medical assurance tasks of such events, and such systems must be improved all the way. Keys to operations of Olympic venues in the run-up period are setup of medical services, development of general medical procedures, management of medical teams in venues, and design of medical rescue flows. Focuses of venue operations during the games are reporting of medical information from the venues, seamless interconnection between venues and medical organizations in the city, and crisis management for medical operations on the venues.
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Building of medical teams was a basic preparation for Beijing 2008 Olympic Games and Paralympic Games as well. In this consideration, the Beijing Organizing Committee for the Olympic Games (BOCOG) and Beijing Health Bureau developed a complete set of mechanism to integrate human resources, coveting standards development, selection, training and testing for members of medical teams. This ensures the success of medical services delivery and provides medical services delivery of subsequent Large-scale activities with valuable experiences as well
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Objective To study the recovery mechanism of dysphagic patients after stroke using functional magnetic resonanee imaging(fMRI). Methods Thirteen patients with dysphagia caused by unilateral cortical or subcortical lesions were recruited into a dysphagia group,and eight age-matched healthy volunteers were recruited as controls.Both grouDs performed experimental volitional swallowing tasks during fMRI studies.All patients of the dys-phagia group received rehabilitation treatment targeting dysphagia.Of the 13 dysphagia patients,7 reached almost complete recovery and were identified as recovered in follow-up fMRI studies.A 3.0 T MR scanner and echo planar imaging(EPI)T_2 WI sequence were employed to obtain the fMRI data.SPM2 software was used for post-processing of the fMRI data and displaying activated brain maps.Lateral index(LI)was calculated as LI:(C-1)/(C+I).Paired t tests were used to compare activated brain volume before and after complete recovery. Results Consistent activation of the bilateral primary sensorimotor cortex,anterior cingulated gyrus and the bilateral insular cortex were observed in the control group. Activation of the pons,medulla,left cerebellum,left prefrontal area,right occipital area and the left insular cortex were observed in the dysphagia group.Activation was observed in the bilateral primary sensorimotor cortex.bilateral prefrontal area,bilateral superior temporal gyrus,left insular cortex,bilateral frontal o-pereulum and anterior cingulated gyrus in the recovered patients.The total activated volume before recovery in the ip-silesional hemisDhere was significantly less compared with the contralesional hemisphere in the dysphagia group.In the recovered patients,both the activated brain volume of the ipsilesional hemisphere and value of LI were significant-ly larger than those at the initial examination.Conclusions Decreased activation in the sensorimotor cortex,the in-sular lobe and the cingulate gyms might be causes.of dysphagia.Compensation by the contralesional hemisphere in the early stages and then the restoration of the ipsilesional hemisphere after recovery may be mechanisms of dysphagia recovery in stroke patients.
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Objective To explore the curative effect and patient's tolerance combined transcatheter arterial chemoembolization(TACE) and three dimensional conformal radiotherapy(3DCRT) for primary hepatocellular carcinoma.Methods 38 patients were treated by combined TACE and 3DCRT.The treatment regimen consisted of TACE first,it took TACE of Doxombicin 50 mg/m2,Fluorouracil 600 mg/m2,Cisplatin 60 mg and iodine Oil 10～15 ml.repeated every four weeks.thlee times totally.After resting one or two months,followed by 3DCRT(44～56 Gy/7～11f/3～4w),the planning target volume(PTV)was covered by the 80%～90% isodose curve and the target dose was prescribed to PTV.Resuits All patients completed the planned treatment without interruption.Hematological and radiation-induced toxicities as shown by the WHO staging system were 52.6% of grade 1～2 acute gastrointestinal tract reaction and 47.4% of grade 1～2 bone marrow inhibition but they were tolerable.The complete response(CR)and partial response(PR)rates were 23.7% and 63.2%.respectively,with a CR+PR rate of 86.8%.The median survival was 18.5 months.The 1-,2-and 3-year survival rates were 73.7%,57.9% and 34.2% respectively. Conclusion Combined TACE and 3DCRT iS better to short-term curative effect,it has lesser toxicities and it is a satisfactory therapy for unreseetable primary hepatocellular carcinoma.Long-tem survival and late toxicities need further observation.
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Objective To evaluate the use of diffusion-weighted imaging(DWI)for early detection of tumor response to Angiostatin-Endostatin(Statin-AE)fusion gene therapy in a rat C6 glioma model.Methods Fifty male wistar rats with C6 tumor cells implanted into the striatum were examined by a 3.0T MR scanner,then the rats beating tmors were divided into two groups,treatment group and control group.Rats in the treatment group received 107 plaque forming unit(pfu)recombinant herps simplex viral (R-HSV)mediated Statin-AE fusion gene therapy on day 7,and then the tumors were conformed on MRI.Conventional MR and DWI examination were acquired on 1,2,3 weeks after implantation with a 5-inch surface coil.Two(1 w),eight(2 w)and all the residual rats(3 w)of each group were sacrificed to perform the histopathological examination after each MBI examination.Pretreatment and post treatment tumor volulnes and apparent diffusion coefficient(ADC)values were calculated.Rank sum test and t test were employed for statistical analysis.Results On MRI,43 rats demonstrated tumors on day 7 with a successful rate of 86%,On week 2,the tumor volumes of the controh and treatment group were 90.6 and 91.64 mm3,with no significant difference(Z=-0.14,P＞0.05).On week 3,the tumor volumes of the controls and treatment group were 156.64 and 29.64 mm3,and a significant difference was observed(Z=-3.45,P＜0.01).On week 2.the ADC values of the tumor centers of the treatment group and the control group were (1.20±0.25)×10-3 and(0.99±0.08)×10-3 mm2/s,and the values of the tumor peripheral parts of the two groups were(1.00±0.25)×10-3 and(0.83±0.12)×10-3mm2/s,the ADC values of both tumor centers and peripheral parts of the treatment group were significantly higher than those of the control group (t=-0.82 and-0.46,P＜0.05).On week 3,the ADC values of the tumor centers of the treatment group and the control group were(0.92±0.21)× 10-3 and(0.99±0.09)×10-3mm2/s,and the values of the tumor peripheral parts of the two groups were(0.81±0.19)×10-3 and(0.78±0.11)×10-3 mm2/a,there were no statisfical difference between the two groups(t=0.82,and-0.46,P＜0.05).HE stained slices showed more prominent tumor interstifial edenla.swelling and death of tumor cells in the treated rats than the controls.Conclusions Combination of conventional MRI and DWI can be powerful to monitor tumor progression and therapy effecL Conventional MRI showed that the therapy slow the tumor progression in size while DWI demonstrated the tumor response even earlier than size change.DWI has potential use forthe detection of early response to antiangiogenic gene therapy.
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BACKGROUND:Diffusion tensor imaging aad fiber tractography(DT-FT)is the only method to identify cerebral white matter fiber organization in vivo.OBJECTIVE:To observe the changes in brain areas with language function and the fiber stucture in patients with Broca aphasia.DESIGN,TIME AND SETTING:Comparative observation was performed at First Hospital of Kunming Medical College and Tiantan Hospital of Capital Medical University between November 2003 and February 2005.PARTICIPANTS:Thirty patients(9 females,21 males,aged 17-63 years)with Broca aphasia of different degree were selected.They were diagnosed by a set of Chinese aphasia examinations of Research Laboratory of Neuropsychology,First Hospital of Beijing Medical University,following by further classification according to the subitems.METHODS:3T super-high field magnetic resonance scanner was used for the data collection and processing of the entire brain.Brodmann areas 45,44,areas 22 and 39(Wernicke area),and the corresponding brain areas in the right hemisphere are selected as areas with language function.The primary commissure,commissural fibers(arcuate fasciculus,internal capsule,external capsule)that are closely correlated with language function were regarded as region of interest of fiber tracking.The neural fiber tracking was conducted.MAIN OUTCOME MEASUIURES:The tracking and distribution of neural fiber tracts,and its correlation with other brain areas,and changes under pathological conditions.All data were compared with normal brain.RESULTS:Thirty patients with Broca aphasia were included in final analysis.The mean fractional anisotropy of fiber tracts in left Brodmann areas 45 and 44 was significantly lower than that in normal Brodmann areas(t=-2.683 65,-5.300 55,P＜0.05).The inferior fiber tracts in Broca area showed interruption or displacement,loosely connected even separate from the frontal arcuate fasciculus.The fibers of precentral gyrus and medial frontal lobe were decreased.The separation of arcuate fasciculus from Broca area caused by the integrity disruption and displacement of fiber tracts of arcuate fasciculus was the main alteration of arcuate fasciculus in Broca aphasia.The number of fiber tracts of left arcuate fasciculus and the mean fractional anisotropy in Broca aphasia were significantly less than normal people(P＜0.05).CONCLUSION:The lesions of cerebral cortex and its fiber pathway in Broca area can result in Broca aphasia.
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@#ObjectiveTo identify the finding of functional MRI(fMRI) during active and passive fingers moving in hemipegic patients after stroke.Methods23 stroke patients with hemipegia were asked to actively moving their fingers and then passively moving with others' help.MSEPI technique was performed with planar parallel AC-PC.During each scan series,they were asked to perform repetitive finger-thumb opposition movement in the same period of active and rest.All the scanning data was transferred to a workstation and dealt with statistical method.Some patients examined fMRI again after rehabilitation.ResultsfMRI showed normal in the healthy side,with the decrease or displacement in the affected side of motor cortex area.Motor cortex area in the affected side would be recovered after rehabilitation.ConclusionfMRI can be used to evaluate the difference between active and passive moving motor cortex,and help to judge the prognosis of the patients with motor functional disorder.
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@#目的改善了脑梗死患者及家属的遵医行为和自护能力,预防再发脑梗死。方法运用整体护理对576例脑梗死患者及家属进行健康教育。结果提高了脑梗死患者的生存质量和健康水平。结论使患者及家属掌握了脑梗死的相关知识,增进了护患沟通,能积极配合医护人员进行治疗和护理;也提高了护理人员的理论知识水平。
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Objective To evaluate the effect and tolerance of late-course three dimensional conformal radiotherapy(LC3DCRT) combined with concurrent chemotherapy for stage Ⅲ non-small cell lung cancer(NSCLC).Methods From May 2000 to May 2003,48 such patients were entered into this study.The patient's characteristics were: 38 male and 10 female,with median age of 62 years(range 40 to 74);Karnovsky performance score ≥70;stage ⅢA 16 and ⅢB 32,squamous cell carcinoma 38 and adenocarcinoma 10.The treatment regimen consisted of conventional radiotherapy first(40Gy/20f/4W),followed by 3DCRT(24-30Gy/4-5f/2W) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,ipsilateral hilum and mediastinal lymph drainage region.LC3DCRT focused on the primary lesion only,with the 80%-90% isodose curve covering the planning target volume(PTV) and the target dose was prescribed to PTV.Supraclavicular metastatic lymph node was treated by mixed 6MV X-ray and electron beam to a total dose of 65-70Gy.Chemotherapy treatment regimen consisted of isophosfomide(25mg/m~2,d1、8,iv) and cisplatin(30mg/d,d1-3,iv) in the 1st and 5th week.Results Before the end of the second month after treatment,the complete response(CR)and partial response(PR) rate was 16.7% and 75.0%,respectively,with a CR+PR rate of 91.7%.The 1-,2-and 3-year local control and overall survival rates as monitored by the Kaplan-Meier method was 87.5%,50.0%,35.7% and 87.5%,46.7%,28.6%,respectively.All patients completed the planned treatment without interruption.Hematological toxicity and radiation-induced pneumonitis as shown by the WHO staging system were the most common acute toxicities but they were tolerable,with 8.3% of grade 3 leukopenia and 4.2% of grade 3 radiation-induced pneumonitis.The severity of the other acute toxicities such as nausea,fever,hemoglobin decrease,and radiation-induced esophagitis were mainly grade 1 or grade 2.Conclusions Late course three dimensional radiotherapy combined with concurrent chemotherapy shows a promising results with tolerable acute toxicities.Long-term survival and late toxicities need further observation.
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<p><b>OBJECTIVE</b>To evaluate the value of the clinical use of CT perfusion imaging (CTPI) and CT subtraction angiography (CTSA) for diagnosing acute ischemic cerebrovascular disease (AICVD).</p><p><b>METHODS</b>Twenty-four patients with AICVD onset within 24 hours were examined with regular CT, CTPI, and CTSA. Some cases received CTPI, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or single photon emission computer tomography (SPECT) during follow-up examinations.</p><p><b>RESULTS</b>Of the 24 cases, 11 had negative results from regular CT scans 3 - 6 hours after onset of stroke in 6 cases, 6 - 12 hours in 3 cases, and 12 - 24 hours in 2 cases. Ten of these cases were then confirmed by CTPI as having ischemic lesions, 2 with middle cerebral artery occlusion (MCAO), and 1 case with transient ischemic attack (TIA) with CTPI negative. Of the 24 cases, 13 had positive results from regular CT, 9 were diagnosed with ischemic lesions larger by using CTPI than regular CT, 1 case had MCAO and 1 had internal carotid artery occlusion (ICAO). There were 4 cases with ischemic lesions observed with regular CT having nearly the same range as that of lacunar infarctions using CTPI. Another 4 cases had more than 2 lesion areas. The peak time (PT), mean transit time (MTT) and relative flow (RF) of 24 cases were markedly different. The sides of ischemic lesions compared to each other and the core of the lesion compared to peripheral zones were also altered significantly (P < 0.01).</p><p><b>CONCLUSIONS</b>Combined CTPI with CTSA can detect acute ischemic lesions at early and hyper-early stages and could distinguish between TIA, lacunar infarction and a larger area of infarction. Using semiquantitative blood perfusion analysis status, CTPI with CTSA could define position, area and range of the ischemic lesion and penumbra. These scans can also analyze the brain blood perfusion status. It is important to early diagnose the occlusion of the entire division of the internal carotid artery or middle cerebral artery and it is meaningful to assess prognosis and assignment of therapy.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Angiography, Digital Subtraction , Brain Ischemia , Diagnostic Imaging , Cerebral Angiography , Cerebrovascular Circulation , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To evaluate the value of perfusion MR imaging and angiographic evidence of collateral circulation in symptomatic patients with ischemic cerebrovascular diseases (ICVD).</p><p><b>METHODS</b>Cerebral angiography and perfusion MR were performed in 16 patients with symptoms of ICVD. Qualitative perfusion maps were calculated for regional cerebral blood volume (rCBV) and mean transit time (MTT).</p><p><b>RESULTS</b>A total of 27 lesions were seen on the perfusion MR maps (6 infarcts and 21 ischemic lesions) and most of them (26/27) showed a prolonged MTT. MTT is sensitive to the presence of ischemic lesions, but not sufficient in distinguishing infarct from ischemia. All of the infarcts showed a decreased rCBV, while most of the ischemic lesions showed a normal or increased rCBV. When collateral circulation was identified on angiography, most ischemic lesions were not infarcts and had a normal or increased rCBV. The absence of angiographically identifiable cerebral collaterals may not always result in an infarct; 50% had decreased rCBV. Despite the absence of angiographic collaterals, the other half had normal or increased rCBV.</p><p><b>CONCLUSION</b>Cerebral angiographic evidence of collateral circulation is important in identifying a favorable outcome in patients with ICVD. However, a lesion with a normal or increased rCBV suggests a sufficient collateral circulation even without angiographic collaterals. Perfusion images may be a potentially useful adjunctive tool in the prediction of the outcome of ICVD, particularly where no apparent collateral macrocirculation is seen on CA.</p>