脑型血吸虫病的影像学与免疫组织化学研究
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摘要
目的
探讨脑型血吸虫病的MRI表现特征和诊断价值。
材料与方法
66例经手术病理或临床证实的脑型血吸虫病患者,常规行MRI平扫及增强扫描。在MRI表现分型的基础上,对病变的部位、数目、信号改变、灶周水肿、邻近脑膜和脑沟内血管强化情况等几个方面进行回顾性分析。
结果
1.单发结节型9例,8例位于大脑半球,7例位于皮层及皮层下白质区等浅表部位。T1WI呈等信号4例,稍低信号5例,T2WI呈等信号2例,呈稍高信号7例。7例为中度灶周水肿。增强扫描8例可见多个明显强化的小结节融合为大结节。3例出现邻近脑膜强化和脑沟内血管强化较对侧增多、增强表现。
2.多发结节型45例,42例位于大脑半球,累及脑皮层及皮层下区44例,均可见结节聚集、融合征象。多处病灶者16例,均可见“主体病灶”。T1WI呈等信号16例,稍低信号29例。T2WI呈等信号11例,稍高信号29例。34例为中度灶周水肿。增强扫描均呈多发大小不等均匀结节状强化。35例出现邻近脑膜线样强化,34例出现邻近脑沟内血管强化较对侧增多、增强表现。
3.环状强化型2例,均位于大脑半球,呈中度灶周水肿,增强扫描呈多发小环状强化,可见结节聚集、融合征象。
4.脑炎型8例,6例位于大脑半球,5例为轻度灶周水肿,3例为中度灶周水肿。增强扫描呈淡薄小片状、条状及边缘模糊的小点状强化。5例有邻近脑膜线状强化和脑沟内血管强化较对侧增多、增强表现。
5.脑梗塞型2例,均位于小脑半球。增强扫描呈不规则片状、脑回样强化。1例出现邻近脑膜线状强化。
结论
1.脑型血吸虫病依据其MRI表现可分为单发结节型、多发结节型、环状强化结节型、脑炎型和脑梗塞型,以多发结节型最多见。
2.单发和多发结节型MRI表现具有一定特征性,有利于临床鉴别诊断。
3.脑炎型和脑梗塞型表现无特征性,应结合临床表现及相关实验室检查进行综合分析。
目的
运用多层螺旋CT灌注成像(CT perfusion imaging, CTPI)的方法对脑型血吸虫病进行研究,探讨脑血吸虫病灶及灶周水肿的灌注参数特性及诊断价值。
材料与方法
10例经临床或手术病理证实的脑型血吸虫病患者,常规CT扫描的基础上行CT灌注成像检查。分析灌注图像,分别测量脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑组织的脑血流量(CBV)、脑血容量(CBF)、平均通过时间(MTT)和表面通透性(PS)值；并以对侧正常脑白质为标准,分别计算相对CBF(rCBF), rCBV, rMTT和rPS值。各部位的CT灌注参数值间的比较采用单因素方差分析。
结果
1.10例脑型血吸虫病中,脑炎型1例,单发结节型2例,多发结节型7例。
2.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的CBF均值分别为(44.6±13.94)、(7.82±1.79)、(7.85±2.23)和(11.85±2.05)(ml／100g／min)。脑血吸虫病灶的CBF值较近、远侧灶周水肿和对侧正常脑白质的CBF值均明显增高。近、远侧灶周水肿间CBF值无明显差异,但均较对侧正常脑白质的CBF减低。脑血吸虫病灶的rCBF值较近、远侧灶周水肿的明显增高,而近、远侧灶周水肿间rCBF值无明显差异。
3.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的CBV均值分别为(1.99±0.59)、(0.47±0.089)、(0.45±0.11)和(0.64±0.13)(ml／100g)。脑血吸虫病灶CBV值较近、远侧灶周水肿及对侧正常脑组织的CBV值均明显增高。近、远侧灶周水肿间CBV值间无明显差异,但均较对侧正常脑白质的明显减低。脑血吸虫病灶的rCBV值较近、远侧灶周水肿的明显增高,近、远侧灶周水肿间rCBV值无明显差异
4.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的MTT均值分别为(3.17±0.74)、(5.89±1.47)、(5.81±2.02)和(4.42±1.02)(s)。脑血吸虫病灶的MTT值较近、远侧灶周水肿及对侧正常脑白质的MTT值均明显减低。近、远侧灶周水肿间MTT值无明显差异,但均较对侧正常脑白质的明显增高。脑血吸虫病灶的rMTT值较近、远侧灶周水肿的明显减低,而近、远侧灶周水肿间rMTT值无明显差异。
5.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的PS均值分别为(4.86±2.36)、(0.82±0.33)、(0.61±0.26)、(0.72±0.38)(ml／100g／min)。脑血吸虫病灶的PS值较后三者明显增高。近、远侧灶周水肿及对侧正常脑白质的PS间均无显著性差异。脑血吸虫病灶的rPS值较近、远侧灶周水肿的明显增高,近、远侧灶周水肿间rPS值无明显差异。
结论
脑血吸虫病灶是一种高血流灌注、高表面通透性、短平均通过时间的病灶。其灶周水肿呈低血流灌注、长平均通过时间特性。CTPI能对脑型血吸虫病微循环水平进行量化评价,其灌注参数值对诊断与鉴别诊断具有一定的临床应用价值。
目的
对脑型血吸虫病、高级别胶质瘤和脑转移瘤行磁共振弥散加权成像(diffusion-weighted imaging, DWI)检查,探讨DWI、表观弥散系数(apparent diffusion coeffcient, ADC)值及指数表观弥散系数(exponential ADC, eADC)值对脑型血吸虫病的诊断与鉴别价值,提高对脑型血吸虫病的认识。
材料与方法
16例脑型血吸虫病、18例高级别胶质瘤和16例脑转移瘤患者行常规MRI平扫、增强扫描及DWI检查。所有病例均经手术病理或临床证实。分析DWI图像,测量脑血吸虫、胶质瘤和转移瘤病灶,近、远侧灶周水肿,及对侧正常脑组织的ADC和eADC值,并进行组内比较。以对侧正常脑组织为参照,计算三种病灶及相应水肿的rADC和reADC值,并进行组间比较。所有数据均经SPSS 14.0进行统计分析处理,组内及组间差异均采用单因素方差分析。
结果
脑型血吸虫病16例中,脑炎型3例,单发结节型3例,多发结节型10例。DWI图上,血吸虫病灶呈低信号1例,等信号10例,稍高信号5例；灶周水肿呈等信号11例,稍低信号2例,稍高信号4例。脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿和对侧正常脑白质的ADC值分别为(12.81±1.28)、(16.74±2.03)、(16.97±1.37)、(8.89±0.61)(×10-4 mm2／s),eADC值分别为0.28±0.034、0.19±0.040、0.19±0.022、0.41±0.031。脑血吸虫病灶的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低,而eADC值较对侧正常脑组织的明显减低,较近、远侧灶周水肿的明显增高。近、远侧灶周水肿的ADC值和eADC值间均不存在显著性差异,但其ADC值均较与对侧正常脑组织明显增高,eADC值均明显减低。
高级别胶质瘤18例。DWI图上,肿瘤实质呈稍高信号8例,不均匀高信号10例；水肿呈等信号9例,稍低信号3例,稍高信号6例。胶质瘤实质的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低；而eADC值较对侧正常脑组织明显减低,较近、远侧灶周水肿的明显增高。近侧灶周水肿的ADC值较远侧灶周水肿的明显减低,eADC值明显增高。与对侧正常脑组织相比,近、远侧灶周水肿的ADC值均明显增高,eADC值均明显减低。
转移瘤16例。DWI图上,肿瘤实质呈高或稍高信号12例,等信号4例；水肿呈等信号11例,稍低信号3例,稍高信号2例。转移瘤实质的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低,而eADC值较对侧正常脑组织的明显减低,较近、远侧灶周水肿的明显增高。转移瘤近、远侧灶周水肿的ADC值和eADC值间均不存在显著性差异,但ADC值均较对侧正常脑组织明显增高,eADC值均明显减低。
脑血吸虫病灶rADC值较转移瘤的明显减低,reADC值明显增高。高级别胶质瘤的rADC值和reADC值与脑血吸虫病灶和转移瘤间均无明显差异。高级别胶质瘤近侧灶周水肿的rADC较脑血吸虫病灶和转移瘤的减低,reADC值增高。脑血吸虫病和转移瘤的近侧灶周水肿rADC值和reADC值间均无明显差异。三种病变远侧灶周水肿的rADC值和reADC值间无显著差别。
结论
脑血吸虫病灶的ADC和eADC值与正常脑组织和灶周水肿间均有显著性差异,有助于病变成份的区分。与高级别胶质瘤和脑转移瘤相比,血吸虫病灶具有相对较低的rADC值和相对较高的reADC,特别是与脑转移瘤间具有明显差异,有助于脑型血吸虫病的诊断与鉴别诊断。脑血吸虫病灶近侧灶周水肿的rADC和reADC值与高级别胶质瘤间有显著差异,有助于二者的鉴别,但与脑转移瘤间无差别。远侧灶周水肿的rADC和reADC值在三者间均没有差异,对鉴别诊断没有价值。脑型血吸虫病DWI检查及ADC值和eADC值测量可为其诊断与鉴别诊断提供更多的信息,具有一定的临床实用价值。
目的
检测CD34和Ki-67在脑型血吸虫病和低、高级别胶质瘤中的表达,分析三种病变之间微血管密度(miarovessel density, MVD)和Ki-67阳性表达率的差异,提高对脑型血吸虫病的分子病理学认识。
材料与方法
应用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法(streptavidin-perosidase, SP)检测12例脑血吸虫病灶、12例低级胶质瘤和12例高级别胶质瘤手术标本的CD34和Ki-67的阳性表达情况。Ki-67的表达水平根据阳性细胞表达率分为四个等级,计算三组Ki-67的阳性表达率,并采用秩和检验进行比较。MVD表达采用CD34抗体标记测定,数据以均数±标准差(x±S)表示,三组间MVD的比较采用单因素方差分析。
结果
Ki-67在脑型血吸虫病组、低级别胶质瘤组和高级别胶质瘤组的阳性表达率分别为66.67%、41.7%和100%。脑血吸虫病灶Ki-67的表达水平与低级别胶质瘤间没有差异,但比高级别胶质瘤明显减低。脑血吸虫病灶、低级别胶质瘤和高级别胶质瘤MVD值分别为(16.6±7.75)、(54.34±15.37)和(97.69±27.78)个／视野,三组的MVD值相互之间均存在显著性差异,脑型血吸虫病组最低,高级别胶质瘤组最高。
结论
脑血吸虫病灶内具有Ki-67的表达,表明病灶内具有较强的细胞增殖活性；其阳性表达率为66.67%,表达水平比高级别胶质瘤低,对二者的鉴别诊断具有一定价值；但与低级别胶质瘤间没有差异,不能用以二者的鉴别诊断。脑血吸虫病灶的MVD值比低、高级别胶质瘤均明显减低,对脑型血吸虫病的诊断和鉴别诊断具有重要临床价值。
Objective
To evaluate characteristics and diagnostic value of MRI of cerebral schistosomiasis.
Materials and Methods
Routine plain and enhanced MRI scans were performed on 66 patients with cerebral schistosomiasis which were confirmed by surgical pathology or clinic. On the base of classification of MRI performance, several aspects including the locations, numbers, signal changes of the lesion, and also the perifocal edema, enhancement of adjacent meninges and brain blood vessels in sulcus were analyzed retrospectively.
Results
1. In 9 cases of single nodular type, the lesions were located in cerebral hemisphere in 8 cases, in the cortex and subcortical white matter and other superficial parts in 7 cases. The lesions appeared isointensity in 4 cases, and slightly lower signal in 5 cases on T1WI; and they showed isointensity in 2 cases and slightly higher signal in 7 cases on T2WI. There were moderate perifocal edema in 7 cases, and significantly enhanced multiple small nodules consisting of large nodules in 8 cases, as well as adjacent leptomeningeal enhancement and enhanced cerebral blood vessels much more than the opposite side.
2. There was multiple nodular pattern appeared in 45 cases, in which the lesion was located in the cerebral hemisphere in 42 cases, and the cerebral cortex and subcortical areas were involved in 44 cases. Nodules showed gathering and fusion signs in all of them.16 patients had multiple lesions, in which "the main lesion" were seen. T1WI showed isointensity in 16 cases, slightly lower signal in 29 cases. T2WI showed isointensity in 11 cases, slightly higher signal in 29 cases. The moderate perifocal edema appeared in 34 patients. Multiple enhancing punctate nodules were documented in all cases.35 cases showed linear enhancement of adjacent meningeal. In 34 cases enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.
3.2 cases appeared ring-like enhancement nodular type, located in cerebral hemisphere, which showed moderate perifocal edema. Enhanced scan showed multiple small ring-like enhancement. Nodules were gathering and fusing.
4.8 cases appeared encephalitic type, in which 6 cases in the cerebral hemisphere,5 cases with mild perifocal edema and 3 cases with moderate edema. Enhanced scan showed weak small pieces, sticks and small point-like with fuzzy edges enhanced. In 5 cases showed linear enhancement of adjacent meningeal and enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.
5.2 cases appeared cerebral infarction type, located in the cerebellum. Enhanced scan showed irregular flakes, gyrus-like enhancement.1 case showed linear enhancement of adjacent meningeal.
Conclusion
1. MRI patterns of cerebral schistosomiasis can be divided into single nodular type, multiple nodular type, ring enhanced nodular type, encephalitic type and cerebral infarction type.
2. The MRI pattern of single and multiple nodular type is of certain characteristic and can help differentiate from other diseases.
3. The MRI patterns of encephalitic type and cerebral infarction type are of no characteristic. Comprehensive analysis should be associated with clinical manifestations and laboratory examination.
Objective
To explore the characteristics and diagnostic value of perfusion parameters of cerebral schistosomiasis foci and perifocal edema using multiple slices CT perfusion imaging.
Materials and Methods
10 patients with cerebral schistosomiasis clinically or pathologically confirmed underwent conventional CT and CT perfusion imaging. The perfusion images were analysed with the cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), surface permeability (PS) of schistosomiasis foci, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue measured respectively. To set up the contralateral normal brain as standard to calculate the relative CBF (rCBF), rCBV, rMTT and rPS value. CT perfusion parameters in different parts were compared by single factor variance analysis.
Results
1. In the 10 cases of cerebral schistosomiasis, there were 1 case of encephalitic type,2 cases of single nodular type and 7 cases of multiple nodular type. The mean CBF value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (44.6±13.94), (7.82±1.79), (7.85±2.23), (11.85±2.05) (ml/100g/min) respectively. The CBF value of schistosomiasis foci was significantly higher than that of proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBF values between proximal and distal perifocal edema, which was lower than that of contralateral normal white matter. The rCBF value of schistosomiasis foci was significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.
2. The CBV values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (1.99±0.59), (0.47±0.089), (0.45±0.11), (0.64±0.13) (ml/100g) respectively. The CBV values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBV values between proximal perifocal edema and distal perifocal edema, which was lower than contralateral normal white matter. The rCBV value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.
3. The MTT values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (3.17±0.74), (5.89±1.47), (5.81±2.02), (4.42±1.02) (s) respectively. The MTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema and distal perifocal edema, which was higher than contralateral normal white matter. The rMTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.
4. The PS values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (4.86±2.36), (0.82±0.33), (0.61±0.26), (0.72±0.38) (ml/100g/min) respectively. The PS values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema, distal perifocal edema and contralateral normal white matter. The rPS value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.
Conclusion
Schistosomiasis is a lesion with highly cerebral blood flow, high surface permeability, short mean transit time, while the perifocal edema was of low blood flow, long mean transit time. The microcirculation level of cerebral schistosomiasis can be quantitativly assessed by CTPI, its perfusion parameters has some clinical application value in diagnosis and differential diagnosis.
Objective
To investigate the diagnostic and differential value of DWI, apparent diffusion . coefficient (ADC) value and exponential apparent diffusion coefficient (eADC) value by completing DWI examination in patients with cerebral schistosomiasis, high-grade gliomas and metastatic tumors, thus increase awareness of cerebral schistosomiasis.
Materials and Methods
16 cases with cerebral schistosomiasis,18 patients with high grade gliomas and 16 patients with brain metastases underwent conventional MRI scan, enhanced MRI scan and DWI examination. All cases were confirmed clinically or pathologically. DWI images were analysed and the ADC, eADC value of cerebral schistosomiasis, glioma, metastatic tumor lesions, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue were measured respectively which were compared with each other in groups. Set contralateral normal brain tissue as a reference to calculate the rADC and reADC value of three types lesions and the corresponding edema which were compared among all groups. All data were statistically analyzed by SPSS 14.0. Differences in and between groups were analysed by single factor variance analysis.
Results
1. In the 16 cases of cerebral schistosomiasis, there was 3 case of encephalitic type,3 cases of single nodular type and 10 cases of multiple nodular type. In DWI map, schistosomiasis lesions in 1 case showed low signal,5 cases showed slightly higher signal and 10 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,4 cases showed slightly lower signal and 2 case showed higher signal. The ADC value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (12.81±1.28), (16.74±2.03), (16.97±1.37), (8.89±0.61) (×10-4 mm2/s) respectively, and eADC value were 0.28±0.034,0.19±0.040, 0.19±0.022,0.41±0.031 respectively. The ADC value of lesions were significantly higher than contralateral normal brain tissue, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
2. In the DWI map of 18 cases with high grade gliomas, the tumor parenchyma in 8 case showed slightly higher signal,10 cases showed uneven high signal. Edema in 9 cases showed equivalent signals,3 cases showed slightly lower signal and 6 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema.while the eADC value were contrary with ADC value. The ADC value of proximal perifocal edema were significantly lower than distal perifocal edema, and the eADC value was significantly higher. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
3. In the DWI map of 16 cases with brain metastases, the tumor parenchyma in 12 case showed slightly higher or high signal,4 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,3 cases showed slightly lower signal and 2 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
4. The rADC value of cerebral schistosomiasis foci was significantly lower than the metastatic tumors, while the reADC value was significantly higher. There were no significant differences in rADC and reADC value between high-grade gliomas and brain metastases or schistosomiasis. The rADC value of proximal perifocal edema in high-grade gliomas foci was lower than the metastatic tumors and cerebral schistosomiasis, while the reADC value was higher. There were no significant differences in rADC and reADC value of proximal perifocal edema between brain metastases and schistosomiasis. There were no significant differences in rADC and reADC value of distal perifocal edema among high-grade gliomas, brain metastases and schistosomiasis.
Conclusion
Cerebral schistosomiasis mostly showed equivalent signal in DWI maps.There was significant difference in ADC and eADC value between cerebral schistosomiasis foci and perifocal edema or contralateral normal brain tissue, which may contribute to the distinction between disease components. Compared with high-grade gliomas and brain metastases, cerebral schistosomiasis foci had lower rADC value and higher reADC value, especially with brain metastases, which may contribute to diagnosis and differential diagnosis of schistosomiasis. There was significant difference in ADC and eADC value of proximal perifocal edema between cerebral schistosomiasis foci and high grade gliomas which contribute to the differential diagnosis between them, but there was no difference with brain metastases. There was no difference in ADC and eADC value of distal perifocal edema among the three. The DWI examination and measurement of ADC, eADC value can provide more information in the diagnosis and differential diagnosis for cerebral schistosomiasis.
Objective
To promote the understanding of molecular pathology of cerebral schistosomiasis by detecting the expression of CD34 and Ki-67 in cerebral schistosomiasis and gliomas, and analyzing the differences of miarovessel density (MVD) and Ki-67 expression among the three types of lesions.
Materials and Methods
The positive expressions of CD34 and Ki-67 in surgical specimens of 12 cases of cerebral schistosomiasis lesions,12 cases of low-level gliomas and 12 cases of high-grade glioma were detected by immunohistochemical SP method. The expression level of Ki-67 was divided into four grades according to the expression rate of positive cells. Ki-67 positive expression rates of the three groups were calculated and compared by rank sum test. Microvessel density (MVD) expression was measured by CD34 antibody labeling, and data were presented as mean±standard deviation (x±s). ANOVA was used to compare MVD among the three groups.
Results
Positive expression rate of Ki-67 were 66.67%,41.7% and 100% in cerebral schistosomiasis group, low-grade glioma and high grade gliomas group separately. Expression levels of Ki-67 of cerebral schistosomiasis had no significant difference with low-grade gliomas, but significantly lower than that of the high-grade gliomas. The average MVD of the three groups were (16.6±7.75), (54.34±15.37) and (97.69±27.78)/field separately. MVDs of these three groups were significant differences, among which cerebral schistosomiasis group was the lowest and high-grade glioma group was the highest.
Conclusion
Ki-67 expressing, with the positive expression rate 66.67%, in lesions of cerebral schistosomiasis indicates that the lesions has a strong cell proliferation. The lower expression level than the high grade gliomas helps to distinguish these two, but can no be used to distinguish cerebral schistosomiasis and low-grade gliomas for there are no difference between the two. MVD value of cerebral schistosomiasis foci is significant lower than low and high grade gliomas, which has important clinical value for diagnosis and differential diagnosis of cerebral schistosomiasis.
探讨脑型血吸虫病的MRI表现特征和诊断价值。
材料与方法
66例经手术病理或临床证实的脑型血吸虫病患者,常规行MRI平扫及增强扫描。在MRI表现分型的基础上,对病变的部位、数目、信号改变、灶周水肿、邻近脑膜和脑沟内血管强化情况等几个方面进行回顾性分析。
结果
1.单发结节型9例,8例位于大脑半球,7例位于皮层及皮层下白质区等浅表部位。T1WI呈等信号4例,稍低信号5例,T2WI呈等信号2例,呈稍高信号7例。7例为中度灶周水肿。增强扫描8例可见多个明显强化的小结节融合为大结节。3例出现邻近脑膜强化和脑沟内血管强化较对侧增多、增强表现。
2.多发结节型45例,42例位于大脑半球,累及脑皮层及皮层下区44例,均可见结节聚集、融合征象。多处病灶者16例,均可见“主体病灶”。T1WI呈等信号16例,稍低信号29例。T2WI呈等信号11例,稍高信号29例。34例为中度灶周水肿。增强扫描均呈多发大小不等均匀结节状强化。35例出现邻近脑膜线样强化,34例出现邻近脑沟内血管强化较对侧增多、增强表现。
3.环状强化型2例,均位于大脑半球,呈中度灶周水肿,增强扫描呈多发小环状强化,可见结节聚集、融合征象。
4.脑炎型8例,6例位于大脑半球,5例为轻度灶周水肿,3例为中度灶周水肿。增强扫描呈淡薄小片状、条状及边缘模糊的小点状强化。5例有邻近脑膜线状强化和脑沟内血管强化较对侧增多、增强表现。
5.脑梗塞型2例,均位于小脑半球。增强扫描呈不规则片状、脑回样强化。1例出现邻近脑膜线状强化。
结论
1.脑型血吸虫病依据其MRI表现可分为单发结节型、多发结节型、环状强化结节型、脑炎型和脑梗塞型,以多发结节型最多见。
2.单发和多发结节型MRI表现具有一定特征性,有利于临床鉴别诊断。
3.脑炎型和脑梗塞型表现无特征性,应结合临床表现及相关实验室检查进行综合分析。
目的
运用多层螺旋CT灌注成像(CT perfusion imaging, CTPI)的方法对脑型血吸虫病进行研究,探讨脑血吸虫病灶及灶周水肿的灌注参数特性及诊断价值。
材料与方法
10例经临床或手术病理证实的脑型血吸虫病患者,常规CT扫描的基础上行CT灌注成像检查。分析灌注图像,分别测量脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑组织的脑血流量(CBV)、脑血容量(CBF)、平均通过时间(MTT)和表面通透性(PS)值；并以对侧正常脑白质为标准,分别计算相对CBF(rCBF), rCBV, rMTT和rPS值。各部位的CT灌注参数值间的比较采用单因素方差分析。
结果
1.10例脑型血吸虫病中,脑炎型1例,单发结节型2例,多发结节型7例。
2.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的CBF均值分别为(44.6±13.94)、(7.82±1.79)、(7.85±2.23)和(11.85±2.05)(ml／100g／min)。脑血吸虫病灶的CBF值较近、远侧灶周水肿和对侧正常脑白质的CBF值均明显增高。近、远侧灶周水肿间CBF值无明显差异,但均较对侧正常脑白质的CBF减低。脑血吸虫病灶的rCBF值较近、远侧灶周水肿的明显增高,而近、远侧灶周水肿间rCBF值无明显差异。
3.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的CBV均值分别为(1.99±0.59)、(0.47±0.089)、(0.45±0.11)和(0.64±0.13)(ml／100g)。脑血吸虫病灶CBV值较近、远侧灶周水肿及对侧正常脑组织的CBV值均明显增高。近、远侧灶周水肿间CBV值间无明显差异,但均较对侧正常脑白质的明显减低。脑血吸虫病灶的rCBV值较近、远侧灶周水肿的明显增高,近、远侧灶周水肿间rCBV值无明显差异
4.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的MTT均值分别为(3.17±0.74)、(5.89±1.47)、(5.81±2.02)和(4.42±1.02)(s)。脑血吸虫病灶的MTT值较近、远侧灶周水肿及对侧正常脑白质的MTT值均明显减低。近、远侧灶周水肿间MTT值无明显差异,但均较对侧正常脑白质的明显增高。脑血吸虫病灶的rMTT值较近、远侧灶周水肿的明显减低,而近、远侧灶周水肿间rMTT值无明显差异。
5.脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿及对侧正常脑白质的PS均值分别为(4.86±2.36)、(0.82±0.33)、(0.61±0.26)、(0.72±0.38)(ml／100g／min)。脑血吸虫病灶的PS值较后三者明显增高。近、远侧灶周水肿及对侧正常脑白质的PS间均无显著性差异。脑血吸虫病灶的rPS值较近、远侧灶周水肿的明显增高,近、远侧灶周水肿间rPS值无明显差异。
结论
脑血吸虫病灶是一种高血流灌注、高表面通透性、短平均通过时间的病灶。其灶周水肿呈低血流灌注、长平均通过时间特性。CTPI能对脑型血吸虫病微循环水平进行量化评价,其灌注参数值对诊断与鉴别诊断具有一定的临床应用价值。
目的
对脑型血吸虫病、高级别胶质瘤和脑转移瘤行磁共振弥散加权成像(diffusion-weighted imaging, DWI)检查,探讨DWI、表观弥散系数(apparent diffusion coeffcient, ADC)值及指数表观弥散系数(exponential ADC, eADC)值对脑型血吸虫病的诊断与鉴别价值,提高对脑型血吸虫病的认识。
材料与方法
16例脑型血吸虫病、18例高级别胶质瘤和16例脑转移瘤患者行常规MRI平扫、增强扫描及DWI检查。所有病例均经手术病理或临床证实。分析DWI图像,测量脑血吸虫、胶质瘤和转移瘤病灶,近、远侧灶周水肿,及对侧正常脑组织的ADC和eADC值,并进行组内比较。以对侧正常脑组织为参照,计算三种病灶及相应水肿的rADC和reADC值,并进行组间比较。所有数据均经SPSS 14.0进行统计分析处理,组内及组间差异均采用单因素方差分析。
结果
脑型血吸虫病16例中,脑炎型3例,单发结节型3例,多发结节型10例。DWI图上,血吸虫病灶呈低信号1例,等信号10例,稍高信号5例；灶周水肿呈等信号11例,稍低信号2例,稍高信号4例。脑血吸虫病灶、近侧灶周水肿、远侧灶周水肿和对侧正常脑白质的ADC值分别为(12.81±1.28)、(16.74±2.03)、(16.97±1.37)、(8.89±0.61)(×10-4 mm2／s),eADC值分别为0.28±0.034、0.19±0.040、0.19±0.022、0.41±0.031。脑血吸虫病灶的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低,而eADC值较对侧正常脑组织的明显减低,较近、远侧灶周水肿的明显增高。近、远侧灶周水肿的ADC值和eADC值间均不存在显著性差异,但其ADC值均较与对侧正常脑组织明显增高,eADC值均明显减低。
高级别胶质瘤18例。DWI图上,肿瘤实质呈稍高信号8例,不均匀高信号10例；水肿呈等信号9例,稍低信号3例,稍高信号6例。胶质瘤实质的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低；而eADC值较对侧正常脑组织明显减低,较近、远侧灶周水肿的明显增高。近侧灶周水肿的ADC值较远侧灶周水肿的明显减低,eADC值明显增高。与对侧正常脑组织相比,近、远侧灶周水肿的ADC值均明显增高,eADC值均明显减低。
转移瘤16例。DWI图上,肿瘤实质呈高或稍高信号12例,等信号4例；水肿呈等信号11例,稍低信号3例,稍高信号2例。转移瘤实质的ADC值较对侧正常脑组织的明显增高,较近、远侧灶周水肿的明显减低,而eADC值较对侧正常脑组织的明显减低,较近、远侧灶周水肿的明显增高。转移瘤近、远侧灶周水肿的ADC值和eADC值间均不存在显著性差异,但ADC值均较对侧正常脑组织明显增高,eADC值均明显减低。
脑血吸虫病灶rADC值较转移瘤的明显减低,reADC值明显增高。高级别胶质瘤的rADC值和reADC值与脑血吸虫病灶和转移瘤间均无明显差异。高级别胶质瘤近侧灶周水肿的rADC较脑血吸虫病灶和转移瘤的减低,reADC值增高。脑血吸虫病和转移瘤的近侧灶周水肿rADC值和reADC值间均无明显差异。三种病变远侧灶周水肿的rADC值和reADC值间无显著差别。
结论
脑血吸虫病灶的ADC和eADC值与正常脑组织和灶周水肿间均有显著性差异,有助于病变成份的区分。与高级别胶质瘤和脑转移瘤相比,血吸虫病灶具有相对较低的rADC值和相对较高的reADC,特别是与脑转移瘤间具有明显差异,有助于脑型血吸虫病的诊断与鉴别诊断。脑血吸虫病灶近侧灶周水肿的rADC和reADC值与高级别胶质瘤间有显著差异,有助于二者的鉴别,但与脑转移瘤间无差别。远侧灶周水肿的rADC和reADC值在三者间均没有差异,对鉴别诊断没有价值。脑型血吸虫病DWI检查及ADC值和eADC值测量可为其诊断与鉴别诊断提供更多的信息,具有一定的临床实用价值。
目的
检测CD34和Ki-67在脑型血吸虫病和低、高级别胶质瘤中的表达,分析三种病变之间微血管密度(miarovessel density, MVD)和Ki-67阳性表达率的差异,提高对脑型血吸虫病的分子病理学认识。
材料与方法
应用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法(streptavidin-perosidase, SP)检测12例脑血吸虫病灶、12例低级胶质瘤和12例高级别胶质瘤手术标本的CD34和Ki-67的阳性表达情况。Ki-67的表达水平根据阳性细胞表达率分为四个等级,计算三组Ki-67的阳性表达率,并采用秩和检验进行比较。MVD表达采用CD34抗体标记测定,数据以均数±标准差(x±S)表示,三组间MVD的比较采用单因素方差分析。
结果
Ki-67在脑型血吸虫病组、低级别胶质瘤组和高级别胶质瘤组的阳性表达率分别为66.67%、41.7%和100%。脑血吸虫病灶Ki-67的表达水平与低级别胶质瘤间没有差异,但比高级别胶质瘤明显减低。脑血吸虫病灶、低级别胶质瘤和高级别胶质瘤MVD值分别为(16.6±7.75)、(54.34±15.37)和(97.69±27.78)个／视野,三组的MVD值相互之间均存在显著性差异,脑型血吸虫病组最低,高级别胶质瘤组最高。
结论
脑血吸虫病灶内具有Ki-67的表达,表明病灶内具有较强的细胞增殖活性；其阳性表达率为66.67%,表达水平比高级别胶质瘤低,对二者的鉴别诊断具有一定价值；但与低级别胶质瘤间没有差异,不能用以二者的鉴别诊断。脑血吸虫病灶的MVD值比低、高级别胶质瘤均明显减低,对脑型血吸虫病的诊断和鉴别诊断具有重要临床价值。
Objective
To evaluate characteristics and diagnostic value of MRI of cerebral schistosomiasis.
Materials and Methods
Routine plain and enhanced MRI scans were performed on 66 patients with cerebral schistosomiasis which were confirmed by surgical pathology or clinic. On the base of classification of MRI performance, several aspects including the locations, numbers, signal changes of the lesion, and also the perifocal edema, enhancement of adjacent meninges and brain blood vessels in sulcus were analyzed retrospectively.
Results
1. In 9 cases of single nodular type, the lesions were located in cerebral hemisphere in 8 cases, in the cortex and subcortical white matter and other superficial parts in 7 cases. The lesions appeared isointensity in 4 cases, and slightly lower signal in 5 cases on T1WI; and they showed isointensity in 2 cases and slightly higher signal in 7 cases on T2WI. There were moderate perifocal edema in 7 cases, and significantly enhanced multiple small nodules consisting of large nodules in 8 cases, as well as adjacent leptomeningeal enhancement and enhanced cerebral blood vessels much more than the opposite side.
2. There was multiple nodular pattern appeared in 45 cases, in which the lesion was located in the cerebral hemisphere in 42 cases, and the cerebral cortex and subcortical areas were involved in 44 cases. Nodules showed gathering and fusion signs in all of them.16 patients had multiple lesions, in which "the main lesion" were seen. T1WI showed isointensity in 16 cases, slightly lower signal in 29 cases. T2WI showed isointensity in 11 cases, slightly higher signal in 29 cases. The moderate perifocal edema appeared in 34 patients. Multiple enhancing punctate nodules were documented in all cases.35 cases showed linear enhancement of adjacent meningeal. In 34 cases enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.
3.2 cases appeared ring-like enhancement nodular type, located in cerebral hemisphere, which showed moderate perifocal edema. Enhanced scan showed multiple small ring-like enhancement. Nodules were gathering and fusing.
4.8 cases appeared encephalitic type, in which 6 cases in the cerebral hemisphere,5 cases with mild perifocal edema and 3 cases with moderate edema. Enhanced scan showed weak small pieces, sticks and small point-like with fuzzy edges enhanced. In 5 cases showed linear enhancement of adjacent meningeal and enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.
5.2 cases appeared cerebral infarction type, located in the cerebellum. Enhanced scan showed irregular flakes, gyrus-like enhancement.1 case showed linear enhancement of adjacent meningeal.
Conclusion
1. MRI patterns of cerebral schistosomiasis can be divided into single nodular type, multiple nodular type, ring enhanced nodular type, encephalitic type and cerebral infarction type.
2. The MRI pattern of single and multiple nodular type is of certain characteristic and can help differentiate from other diseases.
3. The MRI patterns of encephalitic type and cerebral infarction type are of no characteristic. Comprehensive analysis should be associated with clinical manifestations and laboratory examination.
Objective
To explore the characteristics and diagnostic value of perfusion parameters of cerebral schistosomiasis foci and perifocal edema using multiple slices CT perfusion imaging.
Materials and Methods
10 patients with cerebral schistosomiasis clinically or pathologically confirmed underwent conventional CT and CT perfusion imaging. The perfusion images were analysed with the cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), surface permeability (PS) of schistosomiasis foci, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue measured respectively. To set up the contralateral normal brain as standard to calculate the relative CBF (rCBF), rCBV, rMTT and rPS value. CT perfusion parameters in different parts were compared by single factor variance analysis.
Results
1. In the 10 cases of cerebral schistosomiasis, there were 1 case of encephalitic type,2 cases of single nodular type and 7 cases of multiple nodular type. The mean CBF value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (44.6±13.94), (7.82±1.79), (7.85±2.23), (11.85±2.05) (ml/100g/min) respectively. The CBF value of schistosomiasis foci was significantly higher than that of proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBF values between proximal and distal perifocal edema, which was lower than that of contralateral normal white matter. The rCBF value of schistosomiasis foci was significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.
2. The CBV values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (1.99±0.59), (0.47±0.089), (0.45±0.11), (0.64±0.13) (ml/100g) respectively. The CBV values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBV values between proximal perifocal edema and distal perifocal edema, which was lower than contralateral normal white matter. The rCBV value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.
3. The MTT values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (3.17±0.74), (5.89±1.47), (5.81±2.02), (4.42±1.02) (s) respectively. The MTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema and distal perifocal edema, which was higher than contralateral normal white matter. The rMTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.
4. The PS values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (4.86±2.36), (0.82±0.33), (0.61±0.26), (0.72±0.38) (ml/100g/min) respectively. The PS values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema, distal perifocal edema and contralateral normal white matter. The rPS value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.
Conclusion
Schistosomiasis is a lesion with highly cerebral blood flow, high surface permeability, short mean transit time, while the perifocal edema was of low blood flow, long mean transit time. The microcirculation level of cerebral schistosomiasis can be quantitativly assessed by CTPI, its perfusion parameters has some clinical application value in diagnosis and differential diagnosis.
Objective
To investigate the diagnostic and differential value of DWI, apparent diffusion . coefficient (ADC) value and exponential apparent diffusion coefficient (eADC) value by completing DWI examination in patients with cerebral schistosomiasis, high-grade gliomas and metastatic tumors, thus increase awareness of cerebral schistosomiasis.
Materials and Methods
16 cases with cerebral schistosomiasis,18 patients with high grade gliomas and 16 patients with brain metastases underwent conventional MRI scan, enhanced MRI scan and DWI examination. All cases were confirmed clinically or pathologically. DWI images were analysed and the ADC, eADC value of cerebral schistosomiasis, glioma, metastatic tumor lesions, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue were measured respectively which were compared with each other in groups. Set contralateral normal brain tissue as a reference to calculate the rADC and reADC value of three types lesions and the corresponding edema which were compared among all groups. All data were statistically analyzed by SPSS 14.0. Differences in and between groups were analysed by single factor variance analysis.
Results
1. In the 16 cases of cerebral schistosomiasis, there was 3 case of encephalitic type,3 cases of single nodular type and 10 cases of multiple nodular type. In DWI map, schistosomiasis lesions in 1 case showed low signal,5 cases showed slightly higher signal and 10 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,4 cases showed slightly lower signal and 2 case showed higher signal. The ADC value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (12.81±1.28), (16.74±2.03), (16.97±1.37), (8.89±0.61) (×10-4 mm2/s) respectively, and eADC value were 0.28±0.034,0.19±0.040, 0.19±0.022,0.41±0.031 respectively. The ADC value of lesions were significantly higher than contralateral normal brain tissue, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
2. In the DWI map of 18 cases with high grade gliomas, the tumor parenchyma in 8 case showed slightly higher signal,10 cases showed uneven high signal. Edema in 9 cases showed equivalent signals,3 cases showed slightly lower signal and 6 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema.while the eADC value were contrary with ADC value. The ADC value of proximal perifocal edema were significantly lower than distal perifocal edema, and the eADC value was significantly higher. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
3. In the DWI map of 16 cases with brain metastases, the tumor parenchyma in 12 case showed slightly higher or high signal,4 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,3 cases showed slightly lower signal and 2 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.
4. The rADC value of cerebral schistosomiasis foci was significantly lower than the metastatic tumors, while the reADC value was significantly higher. There were no significant differences in rADC and reADC value between high-grade gliomas and brain metastases or schistosomiasis. The rADC value of proximal perifocal edema in high-grade gliomas foci was lower than the metastatic tumors and cerebral schistosomiasis, while the reADC value was higher. There were no significant differences in rADC and reADC value of proximal perifocal edema between brain metastases and schistosomiasis. There were no significant differences in rADC and reADC value of distal perifocal edema among high-grade gliomas, brain metastases and schistosomiasis.
Conclusion
Cerebral schistosomiasis mostly showed equivalent signal in DWI maps.There was significant difference in ADC and eADC value between cerebral schistosomiasis foci and perifocal edema or contralateral normal brain tissue, which may contribute to the distinction between disease components. Compared with high-grade gliomas and brain metastases, cerebral schistosomiasis foci had lower rADC value and higher reADC value, especially with brain metastases, which may contribute to diagnosis and differential diagnosis of schistosomiasis. There was significant difference in ADC and eADC value of proximal perifocal edema between cerebral schistosomiasis foci and high grade gliomas which contribute to the differential diagnosis between them, but there was no difference with brain metastases. There was no difference in ADC and eADC value of distal perifocal edema among the three. The DWI examination and measurement of ADC, eADC value can provide more information in the diagnosis and differential diagnosis for cerebral schistosomiasis.
Objective
To promote the understanding of molecular pathology of cerebral schistosomiasis by detecting the expression of CD34 and Ki-67 in cerebral schistosomiasis and gliomas, and analyzing the differences of miarovessel density (MVD) and Ki-67 expression among the three types of lesions.
Materials and Methods
The positive expressions of CD34 and Ki-67 in surgical specimens of 12 cases of cerebral schistosomiasis lesions,12 cases of low-level gliomas and 12 cases of high-grade glioma were detected by immunohistochemical SP method. The expression level of Ki-67 was divided into four grades according to the expression rate of positive cells. Ki-67 positive expression rates of the three groups were calculated and compared by rank sum test. Microvessel density (MVD) expression was measured by CD34 antibody labeling, and data were presented as mean±standard deviation (x±s). ANOVA was used to compare MVD among the three groups.
Results
Positive expression rate of Ki-67 were 66.67%,41.7% and 100% in cerebral schistosomiasis group, low-grade glioma and high grade gliomas group separately. Expression levels of Ki-67 of cerebral schistosomiasis had no significant difference with low-grade gliomas, but significantly lower than that of the high-grade gliomas. The average MVD of the three groups were (16.6±7.75), (54.34±15.37) and (97.69±27.78)/field separately. MVDs of these three groups were significant differences, among which cerebral schistosomiasis group was the lowest and high-grade glioma group was the highest.
Conclusion
Ki-67 expressing, with the positive expression rate 66.67%, in lesions of cerebral schistosomiasis indicates that the lesions has a strong cell proliferation. The lower expression level than the high grade gliomas helps to distinguish these two, but can no be used to distinguish cerebral schistosomiasis and low-grade gliomas for there are no difference between the two. MVD value of cerebral schistosomiasis foci is significant lower than low and high grade gliomas, which has important clinical value for diagnosis and differential diagnosis of cerebral schistosomiasis.
引文
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