肺鳞癌、腺癌脑转移瘤CT影像对比分析

肺鳞癌、腺癌脑转移瘤CT影像对比 ComparativeStudyofCTImagesofCerebralMetastasisfrom PulmonarySquamousCellCarcinomaandAdenocarcinoma GAODepei,DINGYingying,andTANJing DepartmentofRadiology,YunnanTumorHospital,Kunming650118,China Received29September2003 Abstract0bjective:ToexplorethedifferenceofCTimagesofmetastatictumorstothebrainoflung squamouscellcancerandlungglandularcancer.Methods:Forty-fivecasesoflungsquamouscellcancer and59casesoflungglandularcancerhavegonethroughpathologicalconfirmationandallthe104caseshave beenPutunderenhancedscanningonthebasisoffiatscanning.Theshapeanddensityofthemetastatic tumors,encephaledemaaroundthetumors,andthereinforcementchangeaftertheenhancementwere analyzed.ReslLIt8:TheCTscanningimagesofallthecasesshowedthat,underfiatscanning,thedensity ofthemetastatictumorstothebrainoflungsquamouscellcancerwasovertheslightly-highleveland bynomeanseven.Again,underflatscanning,some10casesofmetastatictumorstothebrainoflung glandularcancershowedaslightly-highdensityandsome49othercasesalowdensityandsack-likelow density.Forty.fivecasesofmetastatictumorstothebrainoflungsqualnouscellcancerwerewithhydroncus whilesome30casesofthatoflungglandularcancerwereinthesamecondition.Mostofthetwo typesof metastatictumors,amountingto97cases,tookplaceinsupratentorialmanner,andonly7casestookplace insubtentorialmanner.Conclusion:TheCTimagesofmetastatictumorstothebrainoflungsquamous cellcancerandlungglandularcancerareobviouslydifierentfromeachother.Asforthelungsquamous cellcancer,theflatscanningdensityofthetumorisovertheslightly.highlevelwithunevenness.Thereis relativelyobviousreinforcementandobvioushydroncus.Asforthelungglandularcancer,themetastatic tumortothebrainshowsalowdensityandsack-likelowdensityunderflatscanning.Thereisnoobvious reinforcementandrelativelyslighthydroncus. Keywords:tumor,lung;metastatictumor,brain;tomography,X—raycomputer Themetastatictumortothebrainisacommontu_ motamongintracranialbraintumors[川.Itsprimarytumor comesfromlungcancer,mostlyfr , omlungsquamouscell cancerandlungglandularcancer[2J.Thesetwotypesof tumorsaredifierentintheircytobiologicalbehaviorsand growthmodesandtheyleadtodifierentlungCTimages. Asthemetastatictumorisofbiologicalcharacteristics oftheprimarytumor,theCTimagesofthemetastatic tumorstothebrainofthesetwotypesoftumorsshow differencefromeachother. Thispapercovers104casesofmetastatictumorsto thebrainthathadgonethroughpathologicalconfirma- tioninourhospita1from1994to2002.including45cases fromthelungsquamouscellcancerand59casesfromthe lungglandularcancer.Itmakesretrospectiveanalysisof theirCTappearanceandcarriesoutstatisticalandcom— parativeanalysisofCTimagesofthetwotypesoftumors. ThispaperaimstofindoutthedifierenceofCTimages ofthetwotypesofmetastatictumorstothebrain. Correspondenceto:GAODepei Materialsandmethods Allthe45casesoflungsquamouscellcancerand59 casesoflungglandularcancerhavegonethroughpatho- logicalconfirmation.Thepatientswerebetween25and 75yearsold(averagely52),including68malesand36 females. ?performedtransversescanningwithSiemensSO— MATOMARWhole-lengthScanningMachineofGermany inaccordancewithskul1scanningbaseline.Thescanning termswereasfollows:130kV,70mA,3ms,10mmof layerthickness,and10mmoflayerdistance.Wlemade5 mmthinlayerscanningwhenitwasnecessary.Allthe104 caseshavebeenputunderenhancedscanningonthebasis offlatscanningbyvenousmassrodof50mlofionicor nonioniccontrastmedium. Thefollowinginformationwascollected:shapesofmet— astatictumors(ring-likeshape,tubercleshape,andmul- tiformshape),density(including1owdensity,isodensity, andslightly-highdensity;judgingcriteria:lowdensityrefe- rstothatlowerthan15HU,thenormalCTvalueofalba; isodensityreferstothatsimilartothenormalCTvalue ofalba;slightly-highdensityreferstothathigherthan15 GAODepeieta1.:ComparativeStudyofCTImagesofCerebralMetastasisfromPulmonary Squamous35 HU.thenormalCTvalueofalba),encephaledemaaround thetumor,tumor'sreinforcementaftertheenhancement fwithobviousreinforcement,theCTvalueincreasesover 30HUandwithmediumreinforcement,theCTvaluein- creases10HUto30HU).Wlealsocarriedout)(examina- tionoverthedensityvalueanditschangeafterenhance- mentofthetwotypesofmetastatictumors. Results TheCTscanningimagesof45casesoflungsquamous cellcancerand59casesoflungglandularcancerrevealed thatthefiatscanningdensityofthemetastatictumor tothebrainofthelungsquamouscel1cancerwasover theslightly-highlevel(meaningthedensityvalueofthe metastatictumorwashigherthan15HU,thenormalden- sityvaluealba1anddisplayedunevenness.Underflatscan- ning,some10casesofmetastatictumortothebrainof lungglandularcancerwereofslightly-highdensityandthe leftcases(49of59,accountingfor83%1wereoflowden- sityandsack—likelowdensity.Thecomparativeanalysisof CTfiatscanningdensityofthetwotypesofmetastatictu- morstothebrain,theshapestatisticsofthetwotypesof metastatictumors,andthereinforcementchangesofthe tumorsaftertheenhancementwereshowninTable1-3. Forty-fivecasesofmetastatictumortothebrainoflung squanmuscellcancerwerewithhydroncuswhilesome30 casesofthatoflungglandularcancerwereinthesame condition.Thetwotypesofmetastatictumorstookplace mainlyinsupratentorialmanner,amountingto97cases andtheramaining7casestookplaceinsubtentorialman— ner Discussion Themetastatictumortothebrainisacommonmalig— nanttum ,. oramongintracranialbraintumorsandaccounts for15%【lJofallthebraintumors.About76.1%ofthe metastatictumorstothebraincomefromlungcancers[2]. Thecommonlyseenlungcancersincludelungsquamous cellcancer,smallcelllungcancer.andlungglandularcan- cerandtheyaccountfor50%.40%,and15%ofallthe Table1Comparativeanalysisofdensityofmetastatic tumorstothebrainof45casesoflungsquamouscellcancer and59casesoflungglandularcancer Note:(1)Theslightly-highdensityreferstothedensityvalue ofthemetastatictumorwhichishigherthan15HU,the normaldensityvalueofalba.(2)Thelowdensityreferstothe densityvaluewhichislowerthanthenormaldensityvalueof alba.(3)Accordingtoexamination,Pisequaltoorlower than0.05 Table2Imagechangeof 45casesoflungsquamous glandularcancer metastatictumorstothebrainof cellcancerand59casesoflung lungcancers.respectivelyDJfAsthesmallcelllungcancer makesuponlyasmallproportionamongallcancercases inourhospita1.itwasexcludedfromourstatisticalanal— ysis1.Thelungsquamouscellcancerandlungglandular canceraremalignanttumorsoriginatingrespective!yfrom bronchialmucousepitheliumandbronchialglandDJ.With thedifferentorigins,thetwocancershavedifferentbiolog— icalcharacteristicsandtheirlungCTimagesaredifferent fromeachother.Acertainmetastatictumorisofbiolog— icalcharacteristicssimilartothatofitsprimarytumor. Becauseofthis,theimagesofthesetwotypesofmalig- nanttumorsaftertheirmetastasestothebraintissuesare different.ThisconclusiondoesnottallywithPottsand Weisberg's【4,5Jideathatwecannotdeducetheprimary tumor'spathologicalnaturefrommetastatictumor'sCT image.Thewritersofthispaperbelievethatwecangen- erallyjudgetheprimarytumorandpathologicaltypeofa metastatictumorbymakingadetailedanalysisoftheCT imageofthemetastatictumortothebrain.Infact.the writersdidfindtheCTimagedifferenceofthemetastatic tumorstothebrainoftheaforesaidtwotypesoflung cancersthroughstatisticalanalysis. TheCTimageofthemetastatictumortothebrain oflungsquamouscellcancershowsmainlyfrequently- occurringring.shapedtubercle—shapedandmultiformfo- CUSCSwithslightly—highdensityinbraintissues.Thereis notasinglecasewithlowdensityorsack—likelowdensity. Thefocusesareindifierentsizesandareofunevenden— sities,especiallythering—shapedandmultiformfocuses, whichareofobviouslyunevendensitiesrFig.1-31.There isobviousbraintissuehydroncusaroundthefocusesand themetastaticfoCUSCSshowreinforcementatovermedium levelaftertheenhancement,butmostofthereinforcement showsunevenness.Thereisalsolittlesymptomofrein- forcement(Fig.4),whichdemonstratesnecrosisofthetu- morduringitsgrowth.Suchphenomenonisobviouswith ring-shapedandmultiformfoCUSCS.Thering-shapedfoCUS iSusuallyoftheirregularwal1.whichisthecasesimilarto thereportmadebyLiandhiscolleaguesIsJ.Themetastatic tumorstothebrainoflungsquamouscellcanceroccur mainlyinsupratentorialmanner,whichconformstothe relevantdocumentaryreportsonmetastatictumorstothe brain[7—91. TheCTimageofthemetastatictumortothebrainof lungglandularcancershowsmainlyfrequently-occurring multiformlowdensityorsack—likelowdensityfocusesin braintissues.Ofthe59casesinthisgroup,49casesshow lowdensity(Fig.5)andsacllikelowdensityfocusesand CHINESEABSTRACTSOFORIGINALENGHSHPAPERS 空洞型肺转移瘤的CT表现及与原发灶病理类型的关系 ca,ritaP—ul"mona.ryMetastases:CTFeaturesandTheirCorrelationwiththePathology ofthePrimaryMalignancy 于小平王平梁赵玉 湖南省肿瘤医院放射诊断科410006 目的探讨空洞型肺转移瘤的CT表现及其与原发灶病理类型的关系. 方法报告空洞型肺转移瘤40例131枚,分析其cT表现并与原发灶病理类型进行 对比. 结果全部空洞瘤灶均与肺多发实性结节共存.共有泡样空洞41枚,不规则空洞33 枚,囊样空洞26枚,小环形空洞31枚.壁厚 度均匀者61枚,不均匀者70枚.瘤灶直径<15mm者44枚,15—25mm者66 枚,25,40mm者1枚,>40mm者4枚.洞壁厚度 <4mm者69枚,4,15mm者44枚,>15mm者18枚.空洞型瘤灶多见于腺癌(22例)与鳞癌(13例),二者在cT表现上各有一 定特征.空洞型瘤灶的发生与其在肺内的部位无关. 结论空洞型肺转移瘤的cT表现具有一定特点,并与原发灶病理类型有关. 关键词肺;肿瘤,转移性;体层摄影术,x线计算机;病理 Chinese—GermanJClinOncol,2004,3(1):29—33 肺鳞癌,腺癌脑转移瘤CT影像对比分析 ComparativeStudyofCTImagesofCerebralMetastasisfromPulmonarySqunmous CellCarcinomaandAdenocarcinoma 高德培丁莹莹谭静 云南省肿瘤医院放射科650118 目的探讨肺鳞癌,肺腺癌脑转移瘤CT影像的差异性. 方法45例肺鳞癌和59例肺腺癌均经病理证实,104例病例均在平均的基础上行增强扫描;从转移瘤的形态,密度,瘤周脑水肿, 增强后的强化变化几个方面进行分析. 结果全部病例的CT扫描影像结果显示肺鳞癌的脑转移瘤在平扫时密度均在稍高密度以上,密度表现为不均匀;肺腺癌的脑转移 瘤平扫有10例表现为稍高密度,49例表现为低密度及囊状低密度.肺鳞癌脑转移瘤瘤周水肿有45例,肺腺癌脑转移瘤瘤周水肿 有30例.两类转移瘤主要发生在幕上,共有97例,其余7例发生在幕下. 结论肺鳞癌,肺腺癌的脑转移瘤在CT影像上有明显的差别性,主要是肺鳞癌表现为平扫密度均在稍高密度以上,密度表现为不 均匀,强化相对明显,脑水肿明显;肺腺癌的脑转移瘤平扫表现为低密度及囊状低密度,强化不明显,水肿相对较轻. 关键词肿瘤,肺;转移瘤,脑;体层摄影术,x线计算机 Chinese.GermanJClinOncol,2004.3(1):34_36 p21wAn/C删基因DNA序列分析及其与骨肉瘤表型的关系 p21wAFcH'GeneDNASequenceChangeandTheirRelationshipwiththephenotype ofHumanOsteosarcoma 张春林廖威明李佛保曾炳芳曾益新 上海交通大学附属第六人民医院骨科200233 目的通过检测骨肉瘤组织中021基因的DNA序列变化,探讨021基因的序列,基因突变与骨肉瘤表型的关系. 方法采用PCR方法扩增骨肉瘤p21W^基因外显子.采用SSCP方法检测骨肉瘤p21W^基因DNA缺失,重排和突变.采 用双脱氧核苷酸末端终止法进行DNA的直接测序. 结果DNA序列分析结果显示:骨肉瘤中p21W^删基因第三外显子(exon3)的cDNA全长序列的609位碱基处发生c—T改变,发 生率为44.4%(16/36);健康无骨肉瘤家族史者外周血中同样发现021W^基因第三外显子的cDNA全长序列的6O9位碱基处由 c—T改变,发生率为80%(8/10). 结论p21WA基因的突变在人类骨肉瘤中是十分少见的.本实验第一次对黄种人骨肉瘤中的p21TM基因的DNA多态性位 点进行了定位,这个位点可能会对今后对该基因的研究提供有意义的参考. 关键词p21W^基因;骨肉瘤;PCR—SSCP;DNA测序 Chinese—GermanJClinOncol,2004,3(1):37-41