2012 Vol. 36, No. 6
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2012, 36(6): 323-328.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.002
Abstract:
Objective To explore the diagnostic value of PET-CT and PET-CT combined with lung volume computed assisted reading(Lung VCAR)software in hilar area lymph nodes. Methods Preoperative whole body PET-CT imaging was performed in 49 patients who were highly suspicious of non-small cell lung cancer. PET-CT images of the hilar area lymph nodes and the PET-CT images of the hilar area lymph nodes from Lung VCAR software were evaluated by two experienced doctors, and then compared with the pathological diagnosis. Results There was no significant difference between the CT values of benign and malignant lymph nodes (t=-1.40, P > 0.05). But a significant difference was existed between the benign and malignant hilar lymph nodes with the density visual analysis, the lymph short diameter and the maximum of standardized uptake value(SUVmax)(χ2=30.37, 27.40, 20.06, all P < 0.05). The sensibility, specificity and accuracy of PET-CT in diagnosis of the hilar area lymph nodes were 76.5%、90.7%、88.3% respectively, and the accuracy of the diagnosis was significantly higher than that of CT and PET alone(χ2=15.27, P < 0.05) using the lymph short diameter≥1 cm of CT, the density of lymph node is equal to (slightly lower than) the same layer vascular density and the lymph node SUVmax≥2.5 of PET as the diagnostic criteria. One hundred and three hilar area lymph nodes were diagnosed by PET-CT and four nodes were not hilar lymph nodes proved by the Lung VCAR software (3 hilar vascular uptake, 1 bronchial cartilage). Conclusion The methods of PET-CT lymph visual density analysis plus lymph node diameter and SUVmax had a high diagnostic accuracy of non-small cell lung hilar lymph. For the PET-CT, the pulmonary vascular uptake was the main cause affecting the discrimination of hilar lymph nodes, while Lung VCAR software was helpful to diagnosis.
2012, 36(6): 329-333.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.003
Abstract:
Objective To evaluate the clinical value of 18F-FDG PET-CT in diagnosis of the pleural or peritoneal carcinomatosis. Methods A total of 37 patients with pleural effusion or ascites of unknown origin were analyzed retrospectively. All patients underwent whole body 18F-FDG PET-CT. The 18F-FDG distributional pattern and the maximum standardized uptake value(SUVmax) of lesions were analyzed. The final diagnosis of all cases were established based on the results of catamnestic analysis, tumor markers assay, histopathology or clinical follow-up. Results Of all the 37 cases, 29 had positive findings on 18F-FDG PET-CT, of which 26 were pleural or peritoneal carcinomatosis and 3 were pleural or peritoneal tuberculosis; 8 patients had negative findings on 18F-FDG PET-CT, of which 6 were pleural or peritoneal benign lesions and 2 were peritoneal carcinomatosis. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of 18F-FDG PET-CT in diagnosis of peritoneal carcinomatosis were 92.9%, 66.7%, 86.5%, 89.7% and 75.0% respectively. The SUVmax between the ring-form and strip-type lesions were significantly different(5.97±3.39 vs. 2.89±0.92, t=2.93, P < 0.05). Conclusions 18F-FDG PET-CT is simple, noninvasive and high sensitive in detecting pleural or peritoneal carcinomatosis, and may be an ideal technique of highly clinical usefulness in the diagnosis of the pleural or peritoneal carcinomatosis.
2012, 36(6): 334-338.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.004
Abstract:
Most anticancer drugs are effective only in subgroups of patients, which makes the individualization of tumor response monitoring quite in need. Since the current anatomic imaging has certain limitations for this utility, and the clinical evidence of 18F-FDG PET from meta-analysis is increasing, this study gives a comprehensive review of the performance of PET in monitoring response of a variety of tumors. Given the early metabolic characterization of tumors by PET, this technology exhibited special advantages to traditional imaging modalities and generally yielded high accuracies in tumor response assessment in many meta-analyses. In certain type of tumors as malignant lymphoma, PET has recently been placed to a central role in defining tumor response in international criteria. In other tumors as non-small cell lung cancer, breast cancer, esophageal cancer, adenocarcinomas of the esophagogastric junction, rectal cancer and gastrointestinal stromal tumor, questions remain due to lack of standard regimen of PET and heterogeneity between individual study results. Besides, certain numbers of false positive and false negative results of PET still call for caution in clinical scenarios. More prospective and large sampled random trials are warranted to fully validate and position PET in tumor management.
Most anticancer drugs are effective only in subgroups of patients, which makes the individualization of tumor response monitoring quite in need. Since the current anatomic imaging has certain limitations for this utility, and the clinical evidence of 18F-FDG PET from meta-analysis is increasing, this study gives a comprehensive review of the performance of PET in monitoring response of a variety of tumors. Given the early metabolic characterization of tumors by PET, this technology exhibited special advantages to traditional imaging modalities and generally yielded high accuracies in tumor response assessment in many meta-analyses. In certain type of tumors as malignant lymphoma, PET has recently been placed to a central role in defining tumor response in international criteria. In other tumors as non-small cell lung cancer, breast cancer, esophageal cancer, adenocarcinomas of the esophagogastric junction, rectal cancer and gastrointestinal stromal tumor, questions remain due to lack of standard regimen of PET and heterogeneity between individual study results. Besides, certain numbers of false positive and false negative results of PET still call for caution in clinical scenarios. More prospective and large sampled random trials are warranted to fully validate and position PET in tumor management.
2012, 36(6): 339-343.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.005
Abstract:
For the evaluation of the early effect of different therapies for the treatment of malignant tumors, reduction in tumor volume is the most commonly used criterion for efficacy. However, the time until tumor shrinkage can be long and it requires repeated tumor volume measurements several times weekly to show effect. Non-invasive method such as PET allows for biological processes to be visualized and quantified non-invasively over time, and it has a high specificity for the early diagnosis, staging and evaluate the response of tumors. 18F-FDG is the most widely used radiotracer for imaging in oncology and is very useful for detecting and characterizing cancers currently. But it is not a tumor specific agent for the intrinsic property. 3′-deoxy-3′-18F- fluorothymidine(18F-FLT) is used as a PET tracer for visualization of cell proliferation and it has become more widely used in clinic. Both of them have their own features in the diagnosis, staging and early detect response of tumors. This article reviewed the application of 18F-FDG and 18F-FLT to evaluate the early response of malignant tumors after different therapies. Besides, at the same time, 18F-FDG and 18F-FLT which is more specific or superiority to measure early response of tumors after definite treatment was discussed.
For the evaluation of the early effect of different therapies for the treatment of malignant tumors, reduction in tumor volume is the most commonly used criterion for efficacy. However, the time until tumor shrinkage can be long and it requires repeated tumor volume measurements several times weekly to show effect. Non-invasive method such as PET allows for biological processes to be visualized and quantified non-invasively over time, and it has a high specificity for the early diagnosis, staging and evaluate the response of tumors. 18F-FDG is the most widely used radiotracer for imaging in oncology and is very useful for detecting and characterizing cancers currently. But it is not a tumor specific agent for the intrinsic property. 3′-deoxy-3′-18F- fluorothymidine(18F-FLT) is used as a PET tracer for visualization of cell proliferation and it has become more widely used in clinic. Both of them have their own features in the diagnosis, staging and early detect response of tumors. This article reviewed the application of 18F-FDG and 18F-FLT to evaluate the early response of malignant tumors after different therapies. Besides, at the same time, 18F-FDG and 18F-FLT which is more specific or superiority to measure early response of tumors after definite treatment was discussed.
2012, 36(6): 344-347.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.006
Abstract:
It is very difficult to differentiate correctly between the benign and malignant solitary pulmonary nodules(SPNs). About 30% of the resected indefinite SPNs are benign. Conventional imaging techniques can identify most patients with SPN, but cannot afford a few patients with SPN which have equivocate manifestations, and each has some limitations. PET-CT is a new imaging technique that can offer metabolic and anatomical information of SPN, which results in higher diagnostic sensitivity and accuracy of SPN. Recently various new imaging method is further improved the diagnostic accuracy.
It is very difficult to differentiate correctly between the benign and malignant solitary pulmonary nodules(SPNs). About 30% of the resected indefinite SPNs are benign. Conventional imaging techniques can identify most patients with SPN, but cannot afford a few patients with SPN which have equivocate manifestations, and each has some limitations. PET-CT is a new imaging technique that can offer metabolic and anatomical information of SPN, which results in higher diagnostic sensitivity and accuracy of SPN. Recently various new imaging method is further improved the diagnostic accuracy.
2012, 36(6): 348-351.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.007
Abstract:
Objective To investigate the value of 18F-FDG PET-CT in the detection and diagnosis of recurrent and metastasis ovarian cancer. Methods Retrospective analysis of whole body PET-CT imaging data of 65 patients after operation for ovarian cancer. All the case were followed-up for 3-57 months. The diagnosis was confirmed by surgical pathological examination, imaging studies and clinical follow-up. Results Of the 65 patients, 55 cases developed tumor recurrence and metastasis, and 10 patients didn't show tumor recurrence and transfer. Of the 180 positive lesions displayed on 18F-FDG PET-CT images, 165 lesions were finally diagnosed as recurrence and metastasis, the remaining 15 lesions were identified as lymph node reactive hyperplasia. With 18F-FDG PET-CT, the accurate diagnosis were given in 60 patients(positive in 51 cases and negative in 9 cases), 1 given false positive diagnosis, and 4 cases of false negative diagnosis. As a result, the sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value for detecting the ovarian lesions by 18F-FDG PET-CT were 92.7%(51/55), 90.0%(9/10), 93.8%(61/65), 98.1%(51/52), 69.2%(9/13)respectively. Carbohydrate antigen 125(CA125)levels had a positive relationships with the results of 18F-FDG PET-CT. The level of CA125 was increased in 47 cases, and positive images were found in 45 cases, the positive rate was 95.7%. Conclusion 18F-FDG PET-CT has a high sensitivity and accuracy in the detection of recurrent and metastasis ovarian cancer. It is recommend to perform 18F-FDG PET-CT, in particular when elevated CA125 is detected.
2012, 36(6): 352-357.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.008
Abstract:
Objective To explore the clinical value of 18F-FDG PET-CT in the evaluation of efficacy of Hodgkin lymphoma(HL). Methods Thirty-one cases of post-treatment patients with HL were studied retrospectively. 18F-FDG PET-CT images after chemotherapy were compared with CT post-therapy results. The final diagnosis was based on pathology or clinical follow-ups. Results ① A total of 94 malignant lesions and 51 benign lesions were found in 31 patients in the study. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET-CT in the evaluation of efficacy of HL were 97.87%, 94.12%, 96.84%, 96.00% and 96.55% respectively, which were significantly superior to CT examination alone(χ2=9.83, 13.49, 11.50, 11.69, 22.58, all P < 0.05). ②According to the results of PET-CT, therapeutic schedules of 16 cases(51.61%)had been changed. Conclusion 18F-FDG PET-CT is an effective method in the evaluation of efficacy of HL.
2012, 36(6): 358-361.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.009
Abstract:
Malignancy has been one of the most dangerous threats to human health. Early diagnosis and treatment are key factors for improving prognosis. Cancer screening is an important way to detect early-stage cancer and precancerous lesion. PET has been used increasingly in cancer screening in accordance with the requirement of the public. Though a great number of data show that PET can find some subclinical malignancy, yet as a cancer screening modality, PET is still controversial in contemporary medical practice. The aim of this article is to review the application status and existing problem of PET in cancer screening, and to offer some recognition and view about cancer srceening.
Malignancy has been one of the most dangerous threats to human health. Early diagnosis and treatment are key factors for improving prognosis. Cancer screening is an important way to detect early-stage cancer and precancerous lesion. PET has been used increasingly in cancer screening in accordance with the requirement of the public. Though a great number of data show that PET can find some subclinical malignancy, yet as a cancer screening modality, PET is still controversial in contemporary medical practice. The aim of this article is to review the application status and existing problem of PET in cancer screening, and to offer some recognition and view about cancer srceening.
2012, 36(6): 362-365.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.010
Abstract:
Objective To investigate the mechanism of Graves disease by observing the changes of CD4+CD25+CD127- regulatory T cells (Treg) population in the patients. Methods Flow cytometry was used to detect the proportion of CD4+CD25+CD127- Treg of CD4+ T cells in 90 Graves disease patients (Graves disease group) and 50 healthy adults(control group). Thyroid function and autoantibody levels were determined simultaneously. The t test was adopted for comparison between groups. The relationship between CD4+CD25+CD127- Treg and thyroid function was analyzed by linear correlation analysis. Results The percentages of CD4+CD25+CD127-Treg in Graves disease group and control group were 1.39%±1.09% and 4.59%±1.14% separately. There was significant difference between the two groups(t=16.4, P < 0.01). There were negative correlation between CD4+CD25+CD127- Treg percentages and total triiodothyronine, total thyroxine, free triiodothyronine, free thyroxine and thyrotropin receptor antibody, thyroglobulin antibody, thyroid microsomal antibody(r=-0.62, -0.65, -0.56, -0.71, -0.50, -0.15, all P < 0.01). Conclusions The reduction of CD4+CD25+CD127-Treg percentages in Graves disease group and close relations of CD4+CD25+CD127-Treg with thyroid function and thyroid autoantibody levels suggest that CD4+CD25+CD127-Treg decrease in the number may be associated with the onset of Graves disease. CD4+CD25+CD127- may be the specific marker of Treg.
2012, 36(6): 366-370.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.011
Abstract:
Solid tumors cause regional hypoxia when they outgrow the blood supply. The presence of hypoxia cells within the tumor is the primary factor influencing the effect of therapy. Hypoxia imaging agents selectively accumulate in the oxygen deficient organizations or cells that can be detected by the non-invasive methods such as PET and SPECT. It has great practical value in guiding treatment, evaluating efficacy and accessing prognosis. This review briefly introduces the research progress of tumor hypoxia imaging agents.
Solid tumors cause regional hypoxia when they outgrow the blood supply. The presence of hypoxia cells within the tumor is the primary factor influencing the effect of therapy. Hypoxia imaging agents selectively accumulate in the oxygen deficient organizations or cells that can be detected by the non-invasive methods such as PET and SPECT. It has great practical value in guiding treatment, evaluating efficacy and accessing prognosis. This review briefly introduces the research progress of tumor hypoxia imaging agents.
2012, 36(6): 371-375.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.012
Abstract:
Objective To investigate the application value of urine brain natriuretic peptide(BNP)level in 131I treatment of hyperthyroid heart disease. Methods One hundred and eleven hyperthyroidism patients who received 131I therapy were divided into two groups, hyperthyroidism group(51 cases) and hyperthyroid heart disease group(60 cases), and 30 healthy subjects as control. Sixty patients in the hyperthyroid heart disease group all received ultrasonic cardiogram. The hyperthyroid heart disease group was divided into two subgroups according to New York Heart Association(NYHA) functional classification(hyperthyroid heart disease A subgroup and hyperthyroid heart disease B subgroup). The urine and serum BNP level and serum free triiodothyronine(FT3), free thyroxine(FT4) level were measured through chemiluminescence before and after therapy. Results The urine and serum BNP level before 131I therapy of the hyperthyroid heart disease group were significantly higher than those of hyperthyroidism group(serum:t=8.98 and 9.52, both P < 0.01; urine:t=10.83 and 12.73, both P < 0.01)and the control group(serum:t=8.97 and 9.52, both P < 0.01; urine:t=9.21 and 5.64, both P < 0.01). The urine and serum BNP level before and 6, 12 months after 131I therapy of the hyperthyroid heart disease A subgroup were significantly higher than those of hyperthyroid heart disease B subgroup(serum:t=5.98, 5.87 and 6.35, all P < 0.01; serum:t=4.33, 4.09 and 5.02, all P < 0.01). The urine level of BNP was gradually increased with the severity of cardiac insufficiency and it was positively correlated with the serum level of BNP(r=0.829, P < 0.01), the NYHA functional classification(r=0.751, P < 0.01)and the serum level of FT3 and FT4(FT3:r=0.635, P < 0.01; FT4:r=0.672, P < 0.01). Conclusions The urine BNP level of hyperthyroid heart disease patient increased with the severity of cardiac insufficiency. The urine BNP level could accurately reflect cardiac function of hyperthyroid heart disease patient, and could be used as objective indicator for clinical diagnosis, effective evaluation and prognosis evaluation. The urine BNP level has the same value as the serum BNP level.
2012, 36(6): 376-379.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.013
Abstract:
As one of the essential trace elements, selenium takes part in the synthesis, activation and metabolism of thyroid hormones so as influencing thyroid function. In autoimmune thyroid disease, the level of selenium is lower than normal. The low serum selenium level may have impact on the multiple selenoproteinase on the surface of follicular epithelial cell or on the immune system of the body resulting in the occurrence and progression of thyroid disease. Selenium supplementation should be one of the potential and new measures for the prevention and therapy of autoimmune thyroid disease.
As one of the essential trace elements, selenium takes part in the synthesis, activation and metabolism of thyroid hormones so as influencing thyroid function. In autoimmune thyroid disease, the level of selenium is lower than normal. The low serum selenium level may have impact on the multiple selenoproteinase on the surface of follicular epithelial cell or on the immune system of the body resulting in the occurrence and progression of thyroid disease. Selenium supplementation should be one of the potential and new measures for the prevention and therapy of autoimmune thyroid disease.
2012, 36(6): 380-384.
doi: 10.3760/cma.j.issn.1673-4114.2012.06.014
Abstract:
p53 is a hot spot in the studies of tumor etiology and radiobiology, but the function of p53-reguated energy metabolism in radiation biological effects still remains many uncertainties. The in-depth study of p53-regulated energy metabolism is of great significance to investigate the tumor radiotherapy efficacy, radiation damage, carcinogenesis and even molecular epidemiology. The current research progress at this point was stated in this article.
p53 is a hot spot in the studies of tumor etiology and radiobiology, but the function of p53-reguated energy metabolism in radiation biological effects still remains many uncertainties. The in-depth study of p53-regulated energy metabolism is of great significance to investigate the tumor radiotherapy efficacy, radiation damage, carcinogenesis and even molecular epidemiology. The current research progress at this point was stated in this article.
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