2015 Vol. 39, No. 6
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2015, 39(6): 437-441, 446.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.001
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Abstract:
Objective To investigate the metabolic changes in the resting brain glucose of patients with different stages of lung adenocarcinoma but without brain metastasis. Methods A total of 120 patients with primary untreated and histologically confirmed lung adenocarcinoma were divided into four groups based on TNM staging: stage I, 28 cases; stage II, 29 cases; stage III, 31 cases; and stage IV, 32 cases. The whole-body 18F-FDG PET/CT images of the patients were retrospectively analyzed. The brain PET data of the four groups were also examined individually and compared with those of the 50 healthy controls. Moreover, the metabolic changes in the brain glucose of the four groups were compared. Results The brain PET images showed relative reductions of the regional cerebral resting glucose metabolism of all the groups. In the stage I group, the reductions were mainly observed in the left superior-middle frontal, right superior-middle temporal, and left middle-inferior temporal gyrus. The total voxel value for this group was 681. The reductions in stage II group were evident in the left superior-middle frontal, right superior-middle temporal, and left middle-inferior temporal gyrus. The total voxel value for the stage II group was 1258. In the stage III group, reductions were evident in the left superior-middle frontal, right superior-middle temporal, left middle-inferior temporal gyrus, and right inferior parietal lobule. The total voxel value for the stage III group was 1810. In the stage IV group, reductions were evident in the left superior-middle frontal, right superior-middle-inferior temporal, left superior-middle-inferior temporal gyrus, right inferior parietal lobule, left anterior cingulated, and right insula gyrus. The total voxel value for the stage IV group was 2910. The four groups showed significantly different voxel values in their hypometabolic brain area(F=25.444, P=0.000 1), and the ranges expanded with tumor stage progression. Conclusion The reduced metabolic cerebral regions in lung adenocarcinoma patients involved a number of functional regions related to mood disorders. The ranges of the metabolic changes in the resting brain glucose in lung adenocarcinoma patients were closely correlated to different tumor stages.
2015, 39(6): 442-446.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.002
Abstract:
Objective To evaluate the correlation between 24 h of radioactive iodine uptake(24 h RAIU) and clinical efficacy of 131I therapy for Graves' hyperthyroidism. Methods Data of 3218 patients with Graves' hyperthyroidism from August 2009 to July 2014 were collected after a follow-up study. The follow-up times were 6 months to 60 months(mean: 28.36±14.06 months). All patients underwent radioactive 131I therapy for the first time in the first hospital of Shanxi medical university. A total of 2690 patients(83.6% of 3218 patients) were followed up. These patients comprised 855 males and 1835 females, with ages ranging from 11 years to 81 years(average: 42.81 ± 15.06 years). Patients were treated with 131I therapy doses of 74 MBq to 1850 MBq (mean dose: 402.50±279.94 MBq) and divided into three groups based on thyroid 24 h RAIU before 131I therapy as follows: group A, 405 cases(24 h RAIU < 50.0%); group B, 1764 cases(50.0%≤24 h RAIU≤80.0%); and group C, 521 cases(24 h RAIU > 80.0%). Additionally, the patients were divided into two groups based on the follow-up results of patients treated with 131I therapy. The cured group consisted of cases that were healed or had presented hypothyroidism, whereas the uncured group comprised cases with improved, invalid, and recurrent conditions. Results A total of 2690 patients with Graves' hyperthyroidism were treated with radioactive 131I, of which 2244 cases were cured(83.4%), and 446 cases were uncured(16.6%). In group A, 360 cases(88.9%) were cured, and 45 cases(11.1%) were uncured. In group B, 1534 cases(87.0%) were cured, and 230 cases(13.0%) were uncured. In group C, 350 cases(67.2%) were cured, and 171 cases(32.8%) were uncured. Statistically significant differences were found between the cured and uncured rates among the three groups(x2=21.80, P < 0.05). Multivariate linear regression results indicated that age(b=0.259), thyroid weight(b=0.340), gender(b=0.275), and use of anti-thyroid drugs(ATD) treatment(b=0.226) were all correlated with thyroid 24 h RAIU. Conclusion Thyroid 24 h RAIU was related to the clinical efficacy of 131I therapy for Graves' hyperthyroidism. Low 24 h RAIU implies high cure rate, whereas high 24 h RAIU indicates high failure rate. High 24 h RAIU was primarily caused by high thyroid weight, young age, female gender, and lack of ATD treatment. By contrast, low thyroid weight, old age, male gender, and history of ATD treatment can lead to low 24 h RAIU. Overall, this study will provide further information regarding clinical 131I treatment of Graves' hyperthyroidism.
2015, 39(6): 447-451,457.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.003
Abstract:
Objective To analyze the 18F-FDG PET/CT imaging and the clinical features of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis(SAPHO) syndrome and improved the diagnosis and awareness level about the disease. Methods This study retrospectively analyzed the PET/CT images and clinical features of five patients(including 3 females and 2 males; age range: 59-74 years old; average age: 67.2 years old) with SAPHO syndrome, as well as reviewed relevant literature. The PET/CT examinations were performed from March 2011 to August 2013. SAPHO syndrome was diagnosed through biopsy, imaging, follow-up results, and according to the Kahe Standard. Results (1) Clinic: Five patients sought treatment in the hospital for bone joint pain or skin lesions. Two of the five patients had no skin lesions, three patients exhibited elevated serum CRP and ESR levels, and one patient was positive for HLA-B27. Rheumatoid factor, extractable nuclear antigen peptide antibody spectrum and antineutrophil cytoplasmic antibodies were negative in 5 patients. The average diagnosis period was 3.78 years. (2)PET/CT imaging: Five patients showed anterior chest wall and spine involvement. Anterior chest wall involvement included 11 bone joints, such as the sternoclavicular joint, sternocostal joint, and sternal-body joint. One patient showed hypertrophy and osteomyelitis of the clavicle. Only one patient showed an involvement of a single vertebra, whereas the others showed an involvement of multiple sites of the spine, including 35 vertebra and 58 vertebral disc connections. The CT revealed the worm-eaten and hole-shaped bone destruction on the articular surface of the anterior chest wall and intervertebral disc junction. They were surrounded by relatively extensive osteosclerosis, even involving the entire vertebral body. The partially involved joints also showed joint space narrowing and even joint bone fusion. In addition, swelling, thickening, and calcification of periarticular soft tissues were observed. The PET revealed that only a part of the involved bone joints of anterior chest wall lesions(6/11) and intervertebral disc junctions(17/58) exhibited an increased 18F-FDG uptake, and the SUVmax ranged from 1.76 to 9.74. 18F-FDG uptake of the other involved bone joint lesions was similar or lower than that of the adjacent similar organization. The clavicle with hypertrophy and osteomyelitis in the patient showed an 18F-FDG uptake SUVmax of 2.68. Conclusion The anterior chest wall and spine are the common sites of involvement in SAPHO syndrome patients with or without skin lesions. 18F-FDG PET/CT scan can reveal more occult lesions and active inflammation as well as effectively exclude neoplastic lesions.
2015, 39(6): 452-457.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.004
Abstract:
Objective Cerebral glucose metabolism was measured using 18F-FDG PET/CT in healthy full-term neonates and infants exhibiting neonatal hypoxic-ischemic encephalopathy(HIE) to investigate the role of 18F-FDG PET/CT brain imaging in HIE diagnosis and in therapeutic effect evaluation in HIE. Methods Ten healthy full-term neonates and thirty-four term infants exhibiting different degrees of HIE (mild, n=16; moderate, n=11; and severe, n=7) were included in this research. The SUVmax were measured to determine the cerebral glucose metabolism in various brain anatomical regions, including bilateral sensorimotor cortex, frontal lobe, temporal lobe, occipital lobe, thalamus, basal ganglia, brain stem, and cerebellum. The cerebral glucose metabolism in healthy neonates and infants exhibiting different degrees of HIE was compared. The glucose metabolism pre- and post-treatment was also assessed using 18F-FDG PET/CT and then compared with each other. Results Results indicated that uptake in the major brain areas was significantly higher in healthy term newborns than in the neonatal HIE patients. Moreover, patients with severer HIE demonstrated lower cerebral glucose metabolism. Cerebral glucose metabolism in patients exhibiting different degrees of HIE was also significantly higher after treatment than before treatment. Conclusion 18F-FDG PET/CT brain imaging demonstrated a preferable clinical applicable value in the diagnosis and therapeutic effect evaluation of HIE patients and provides a new method for treatment of neonatal brain injury. The clinical value and neonatal radiation safety of this technique warrants further investigation.
2015, 39(6): 458-461.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.005
Abstract:
Objective To develop a method for residual organic solvent determination in 18F-fluoroacetate(18F-FAC) using capillary gas chromatography. Methods The residual organic solvents were separated on the HP-INNOWAX capillary chromatographic column using temperature programming. Nitrogen gas was used as the carrier gas, along with a flame ionization detector(FID). The FID and injector temperatures were 270℃ and 200℃, respectively, and the injection volume was 1 μl. Results Good linear relationships in the experimental concentrations(r=0.9999, 0.9973, 0.9988) were observed. The three residual organic solvents were separated completely; the average recoveries were 99.8%, 101.0%, and 97.5%, and the relative standard deviation values were 4.6%, 4.0%, and 1.5%, respectively. Conclusion The proposed method is simple, rapid, accurate, and highly sensitive, which can be used in detecting residual organic solvents in 18F-FAC.
2015, 39(6): 462-466.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.006
Abstract:
Objective To discuss the diagnostic value of multi-slice computed tomography(MSCT) as an imaging technique used for upper vein angiography. Methods A total of 56 cases were referred for upper limb vein check by MSCT from June 2010 to March 2012. The veins were scanned by using the LightSpeed 16 computed tomography(CT) scanner and reconstructed by using volume rendering, maximum intensity projection, multi-planner formation, and curve planner reformation. Three different layers were selected to measure the CT value of A, B, and C(i.e., the axial image of the cephalic and brachial veins between condyles of the humerus at 5 and 8 cm and the axial image of the subclavian vein). Statistical analysis was conducted by using SPSS 17.0, whereas one-way ANOVA F test was used to analyze the measured CT value(P < 0.05 was considered statistically significant). Results Out of 56 patients, 14 cases of right upper limb and 21 cases of left upper limb were detected to have deep vein thrombosis. That is, 62.5%(35/56) of the cases were detected by MSCT as compared with 58.9%(33/56) of the cases detected by color Doppler. The CT value of the axial image of the brachial and cephalic veins between condyles of the humerus approximately 5 and 8 cm near the heart was P>0.05, whereas that of the axial image of the subclavian vein was P>0.05(F=0.001). In different layers of vein filled with contrast medium, the CT values were uniform and the differences of the values exhibited no statistical significance between different layers. The contrast medium concentration in the distal part of the upper limb vein was higher than that near the heart, and the differences of the CT values exhibited statistical significance between different layers(F=1441.52, P < 0.05). Conclusions In conclusion, the MSCT is a superior technology for upper limb vein imaging because it is able to show the upper limb in an extensive range, display the collateral circulation clearly, identify the causes of hemadostenosis, and predict the occurrence of thrombogenesis. Simultaneously, this technology significantly reduces the dosage of iodine contrast agent, lowers the economic burden of patients, improves the rate of correct diagnosis for lesions, and provides reliable bases for selecting correct methods of treatment in clinics.
2015, 39(6): 467-469.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.007
Abstract:
Objective To investigate the clinical application value of Hilson perfusion index(PI) in patients with kidney disease. Methods The PI value and glomerular filtration rate(GFR) of 20 normal people and 80 patients with kidney disease were measured. Results The normal PI values for the left and right kidneys were 147.2±41.14 and 155.25±41.73, respectively, whereas the PI values for chronic renal failure, stenosis of renal artery, nephrotic syndrome, hydronephrosis, and renal calculus for the left and right kidneys were 459.28±68.15, 476.67±38.99; 436.14±61.88, 420.85±66.39; 379.40±111.00, 372.20±99.52; 333.75±140.94, 321.08±132.43; and 267.75±149.93, 283.37±142.63, respectively. Moreover, the PI values for mild, moderate, and severe renal impairment of the left and right kidneys were 328.62±41.21, 335.14±39.85; 412.27±53.81, 427.86±61.12; and 466.81±110.64, 471.64±112.96, respectively, which were higher than those in the normal control group. The PI results were negatively correlated with GFR, and the correlation coefficient(r) was 0.741. Conclusion Hilson perfusion index exhibited high clinical value.
2015, 39(6): 470-477.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.008
Abstract:
Apoptosis or programmed cell death is an important form of cell death. Apoptosis is involved in numerous human pathological conditions, such as neurodegenerative diseases, ischemic damage, autoimmune disorders, and many types of cancer. Visualization of apoptosis is enormously beneficial in clinical diagnosis, development of new therapies, and therapeutic evaluation. The traditional methods of apoptosis detection include optical microscopy, TdT-mediated-dUTP nick end labeling analysis, and flow cytometry. However, these invasive techniques restrict the conduct of follow-up studies. Apoptosis imaging in living subjects has contributed to nondestructive observation and in understanding the biological process of apoptosis. The developments in PET and SPECT technologies, including the synthesis of targeted radionuclide tracers, led nuclear medicine into a new era of molecular imaging. The development and application of PET and SPECT as apoptosis imaging probes rendered the non-invasive detection of apoptosis in vivo a reality. This article reviewed the recent advances in apoptosis imaging using radionuclide-labeled tracers.
Apoptosis or programmed cell death is an important form of cell death. Apoptosis is involved in numerous human pathological conditions, such as neurodegenerative diseases, ischemic damage, autoimmune disorders, and many types of cancer. Visualization of apoptosis is enormously beneficial in clinical diagnosis, development of new therapies, and therapeutic evaluation. The traditional methods of apoptosis detection include optical microscopy, TdT-mediated-dUTP nick end labeling analysis, and flow cytometry. However, these invasive techniques restrict the conduct of follow-up studies. Apoptosis imaging in living subjects has contributed to nondestructive observation and in understanding the biological process of apoptosis. The developments in PET and SPECT technologies, including the synthesis of targeted radionuclide tracers, led nuclear medicine into a new era of molecular imaging. The development and application of PET and SPECT as apoptosis imaging probes rendered the non-invasive detection of apoptosis in vivo a reality. This article reviewed the recent advances in apoptosis imaging using radionuclide-labeled tracers.
2015, 39(6): 478-482.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.009
Abstract:
Diabetes is significant public health problem. Islet transplantation has been a promising treatment for diabetes. Recently, molecular imaging methods like optical imaging, radionuclide imaging, MRI and US, could monitor islet transplantation in vivo via non-invasive way and provide high sensitive and specific monitoring methods for islet transplantation. Especially in recent years, the success of islet cell imaging with the glucagon like peptide 1 analogue, brings a new method for the monitoring of islet cell transplantation and demonstrates favorable prospect in clinical practice.
Diabetes is significant public health problem. Islet transplantation has been a promising treatment for diabetes. Recently, molecular imaging methods like optical imaging, radionuclide imaging, MRI and US, could monitor islet transplantation in vivo via non-invasive way and provide high sensitive and specific monitoring methods for islet transplantation. Especially in recent years, the success of islet cell imaging with the glucagon like peptide 1 analogue, brings a new method for the monitoring of islet cell transplantation and demonstrates favorable prospect in clinical practice.
2015, 39(6): 483-486，492.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.010
Abstract:
At present, anti-thyroid drugs, radioactive iodine(131I) and surgical therapy were considered as the three major methods for hyperthyroidism therapy. With the acceptance of the safety of 131I therapy in hyperthyroidism, more and more patients become to choose it as their therapeutic method, especially the patients with liver injury or blood cell reduction complications. This paper summaries the advantages and risks of 131I therapy in this two special hyperthyroidism patients groups according to the recent paper and clinical practice.
At present, anti-thyroid drugs, radioactive iodine(131I) and surgical therapy were considered as the three major methods for hyperthyroidism therapy. With the acceptance of the safety of 131I therapy in hyperthyroidism, more and more patients become to choose it as their therapeutic method, especially the patients with liver injury or blood cell reduction complications. This paper summaries the advantages and risks of 131I therapy in this two special hyperthyroidism patients groups according to the recent paper and clinical practice.
2015, 39(6): 487-492.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.011
Abstract:
Neoadjuvant chemotherapy(NCT) has become a standard therapeutic method for focal advanced breast carcinoma. The multidrug resistance(MDR) of tumors is one of the main causes of chemotherapy failure in breast cancer. MDR development involves the transmembrane P-glycoprotein(P-gp) encoded by the MDR gene MDR1. 99Tcm-methoxyisobutylisonitrile(MIBI) is a radiotracer for scintigraphy of tumors. MIBI is also a transport substrate for P-gp and has been used in assessing P-gp-mediated MDR in a variety of tumors. The nuclear medicine community in the USA has suggested the use of 99Tcm-MIBI scintigraphy as a noninvasive method in in vivo imaging of MDR. Studies have shown that early imaging of 99Tcm-MIBI reveals the accumulative quantity of MIBI in breast tumors, and correlated with malignant extent of tumor. Thus, early imaging through 99Tcm-MIBI can be conducted to evaluate the curative effect of NCT in breast cancer. Delayed imaging reveals the washout rates of MIBI from breast tumors, which is correlated with P-gp expression and MDR. Thus, delayed 99Tcm-MIBI may provide important information on P-gp-mediated MDR and may predict chemotherapy sensitivity.
Neoadjuvant chemotherapy(NCT) has become a standard therapeutic method for focal advanced breast carcinoma. The multidrug resistance(MDR) of tumors is one of the main causes of chemotherapy failure in breast cancer. MDR development involves the transmembrane P-glycoprotein(P-gp) encoded by the MDR gene MDR1. 99Tcm-methoxyisobutylisonitrile(MIBI) is a radiotracer for scintigraphy of tumors. MIBI is also a transport substrate for P-gp and has been used in assessing P-gp-mediated MDR in a variety of tumors. The nuclear medicine community in the USA has suggested the use of 99Tcm-MIBI scintigraphy as a noninvasive method in in vivo imaging of MDR. Studies have shown that early imaging of 99Tcm-MIBI reveals the accumulative quantity of MIBI in breast tumors, and correlated with malignant extent of tumor. Thus, early imaging through 99Tcm-MIBI can be conducted to evaluate the curative effect of NCT in breast cancer. Delayed imaging reveals the washout rates of MIBI from breast tumors, which is correlated with P-gp expression and MDR. Thus, delayed 99Tcm-MIBI may provide important information on P-gp-mediated MDR and may predict chemotherapy sensitivity.
2015, 39(6): 493-496.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.012
Abstract:
Ionizing radiation can induce atherosclerosis(AS). With increasing survival of patients after radiation therapy, the incidence of cardiovascular disease has increased significantly in the irradiated population. It is important to know the pathogenesis of ionizing radiation-induced AS. Amount of studies showed that the occurrence of AS is related to radiation-induced inflammatory, oxidative stress and genomic instability. Radiation induced bystander effect might also plays an effective role in AS induction. We hereby reviewed recent reports about radiation-induced AS and try to increase the knowledge of targeting therapy.
Ionizing radiation can induce atherosclerosis(AS). With increasing survival of patients after radiation therapy, the incidence of cardiovascular disease has increased significantly in the irradiated population. It is important to know the pathogenesis of ionizing radiation-induced AS. Amount of studies showed that the occurrence of AS is related to radiation-induced inflammatory, oxidative stress and genomic instability. Radiation induced bystander effect might also plays an effective role in AS induction. We hereby reviewed recent reports about radiation-induced AS and try to increase the knowledge of targeting therapy.
2015, 39(6): 497-500.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.013
Abstract:
Articular cartilage defects are common and caused by many reasons. However, treatments including conservative treatment, joint debridement, autologous or allogeneic bone cartilage transplantation and artificial joint replacement have obvious limitations such as incomplete repair. Mesenchymal stem cells(MSCs) transplantation therapy is considered as a new and effective therapy proposal of articular cartilage defects in future. But it is difficult to know about the role MSCs played in repairing process because of the lack of methods regarding the efficient and noninvasive technique to monitor the in vivo behavior of delivered cells in host tissue. Recently, MRI in vivo tracking of labeled cells technology provides a new train of thought. MRI molecular imaging can not only noninvasively provide anatomical information of articular cartilage, but also evaluate the fate of transplanted stem cells. The novel progress of magnetic resonance cell tracing technique in stem cells transplantation treatment of cartilage defects was reviewed, and the strengths, limitations and prospect of MR tracing technique were explored in this review.
Articular cartilage defects are common and caused by many reasons. However, treatments including conservative treatment, joint debridement, autologous or allogeneic bone cartilage transplantation and artificial joint replacement have obvious limitations such as incomplete repair. Mesenchymal stem cells(MSCs) transplantation therapy is considered as a new and effective therapy proposal of articular cartilage defects in future. But it is difficult to know about the role MSCs played in repairing process because of the lack of methods regarding the efficient and noninvasive technique to monitor the in vivo behavior of delivered cells in host tissue. Recently, MRI in vivo tracking of labeled cells technology provides a new train of thought. MRI molecular imaging can not only noninvasively provide anatomical information of articular cartilage, but also evaluate the fate of transplanted stem cells. The novel progress of magnetic resonance cell tracing technique in stem cells transplantation treatment of cartilage defects was reviewed, and the strengths, limitations and prospect of MR tracing technique were explored in this review.
2015, 39(6): 501-504.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.014
Abstract:
Computed tomography angiography(CTA)is an increasingly attractive imaging modality for assessing lower extremity arteriosclerosis obliterans. This technique has obvious advantage because it is a non-invasive and simple and convenient method than other ways. Previously, digital subtraction angiography was the only established reliable imaging technique to quantify atherosclerotic disease; however, CTA may now challenge this old " gold standard". Multidetector computed tomography enables imaging of the entire arterial tree non-invasively. Optimal technical considerations for performing Multidetector CTA are essential for accurate diagnosis of atherosclerotic diseases. The essential issue of radiation dose reduction during the processing of CTA is solved by the optimization of contrast agent and instrument parameter. CTA will certainly be a perfect technique for the diagnosis of lower extremity arteriosclerosis obliterans along with the rapid progress of Computed tomography.
Computed tomography angiography(CTA)is an increasingly attractive imaging modality for assessing lower extremity arteriosclerosis obliterans. This technique has obvious advantage because it is a non-invasive and simple and convenient method than other ways. Previously, digital subtraction angiography was the only established reliable imaging technique to quantify atherosclerotic disease; however, CTA may now challenge this old " gold standard". Multidetector computed tomography enables imaging of the entire arterial tree non-invasively. Optimal technical considerations for performing Multidetector CTA are essential for accurate diagnosis of atherosclerotic diseases. The essential issue of radiation dose reduction during the processing of CTA is solved by the optimization of contrast agent and instrument parameter. CTA will certainly be a perfect technique for the diagnosis of lower extremity arteriosclerosis obliterans along with the rapid progress of Computed tomography.
2015, 39(6): 505-508.
doi: 10.3760/cma.j.issn.1673-4114.2015.06.015
Abstract:
Described in this paper are the data structure and encoding rules of digital imaging and communication in medicine radiotherapy in tumor radiation therapy. The process and the actual distribution of the radiation data integrated. Expanded the relevant issues of data base standardization construction, focus on the logical relationship of data analysis and the details of the data construction process, combined the data processing in clinic with the method of software technology in data analysis, further explore the issues related to data integration and application in radiation therapy.
Described in this paper are the data structure and encoding rules of digital imaging and communication in medicine radiotherapy in tumor radiation therapy. The process and the actual distribution of the radiation data integrated. Expanded the relevant issues of data base standardization construction, focus on the logical relationship of data analysis and the details of the data construction process, combined the data processing in clinic with the method of software technology in data analysis, further explore the issues related to data integration and application in radiation therapy.
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