2016 Vol. 40, No. 6
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2016, 40(6): 403-407.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.001
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Abstract:
Objective To investigate the 18F-FDG PET/CT imaging characteristics in secondary bone lymphoma. Methods A total of 46 patients with 18F-FDG PET/CT imaging of secondary bone lymphoma from April 2012 to June 2015 were selected; the PET/CT imaging characteristics were retrospectively analyzed. The patients were divided according to the results of their bone marrow biopsies:negative and positive groups. The SUV of the biopsy sites in 18F-FDG PET/CT imaging between the two groups were compared by independent sample t test, and the receiver operating characteristic curve(ROC) of the SUV in the puncture sites in the diagnosis of secondary bone lymphoma was drawn. Results The 46 cases of secondary bone lymphoma included 6 cases of Hodgkin's lymphoma and 40 cases of non-Hodgkin's lymphoma. The cases comprised 10 cases of single bone lesion, 18 cases of multiple bone lesions, and 18 cases of diffuse bone lesions in the whole body. The bone densities of the 46 cases were abnormal with the following conditions:31 cases of bone marrow infiltration type(67.40%), 10 cases of mixed type(21.74%), 3 cases of sclerosis type(6.52%), and 2 cases of osteolysis type(4.34%); 32 cases of humeral or femoral involvement(69.57%) with the bone marrow infiltration type was included. The independent sample t-test in the negative and positive groups showed a t value of 4.036, P < 0.001, revealing that the difference was statistically significant. The ROC curve of the SUV in the puncture sites in the diagnosis of secondary bone lymphoma showed a cut-off value of 2.35; the specificity and sensitivity of the diagnosis of secondary bone lymphoma were 83.3% and 80.0%, respectively. Conclusions The PET/CT imaging features of secondary bone lymphoma showed certain characteristics that are important and of clinical value to the diagnosis and differential diagnosis of secondary bone lymphoma, thus revealing that it has instructional significance for choosing biopsy sites.
2016, 40(6): 408-413.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.002
Abstract:
Objective To analyze the diagnostic value of 18F-FDG PET/CT and enhanced CT in detecting metastatic lymph nodes of thoracic esophageal squamous cell carcinoma. Methods Fifty-four patients with thoracic esophageal squamous cell carcinoma underwent both 18F-FDG PET/CT and enhanced CT before surgery within a week. All lesions were confirmed histopathologically as the golden standard. The sensitivity, specificity, and accuracy of the two imaging modalities were compared. In addition, the diagnostic accuracy of the two methods in detecting metastatic lymph nodes having different diameters in patients with thoracic esophageal squamous cell carcinoma was evaluated. Theχ2-test was used with SPSS 13.0. Results A total of 186 lymph node specimens, including 77 specimens of metastases, were extracted and confirmed by pathology. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT were 77.9%(60/77), 95.4%(104/109), 88.2%(164/186), respectively, whereas those of enhanced CT were 40.3%(31/77), 75.2%(82/109), and 60.8%(113/186), respectively. All values were statistically significant(χ2=24.04, 15.77, and 36.77, all P < 0.01). The diagnostic accuracy of 18F-FDG PET/CT is significantly better than that of enhanced CT in the group of R>5 mm (χ2=26.03 and 26.47, both P < 0.01) without the group of R≤5 mm(χ2=0.24, P>0.05). Conclusion 18F-FDG PET/CT has a great value in detecting metastatic lymph nodes of thoracic esophageal squamous cell carcinoma, especially lymph nodes that are R>5 mm.
2016, 40(6): 414-418.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.003
Abstract:
Objective To compare and analyze the PET signals at regions with abnormal and normal pulmonary parenchyma on high resolution CT(HRCT) in idiopathic pulmonary fibrosis(IPF) patients to explore the diagnostic value of PET/CT. Methods According to the standards for the clinical diagnosis of IPF, a total of 27 IPF patients(21 men and 6 women) and 27 control populations(19 men and 8 women) were randomly selected and recruited for PET/CT. The abnormal regions were described to show ground-glass appearance, reticulation, honeycombing, and so on. Normal regions corresponding to areas of minimal observed density were noted as distinct from the abnormal regions. The maximal standard uptake value(SUVmax) of the abnormal regions was measured. The ROI in HRCT images of the control population was placed in areas of each lung that were considered morphologically normal to measure the CT densities. The ROI was selected in PET/CT images at corresponding locations; the SUVmax and mean standard uptake value(SUVmean) were measured and used to calculate the aortic blood pool of mediastinal large blood vessels. The LT/MBmax, LT/MBmean, and CT densities of each ROI were analyzed by the independent sample t-test. Results Increased pulmonary 18F-FDG uptake was observed in 27 of 27 patients. The parenchymal patterns on HRCT at the site of high metabolism were ground-glass appearance(14/27), reticulation(27/27), and honeycombing(13/27). The LT/MBmax in the normal lung parenchyma of IPF patients was higher than in the control population[(0.44±0.55 vs. 0.32±0.05); t=5.87, P < 0.05]. The LT/MBmean in normal lung parenchyma of IPF was higher than in the controls[(0.55±0.38 vs. 0.33±0.05); t=2.89, P < 0.05]. The CT densities in normal lung parenchyma of IPF and control population were not significantly different[(-836.59±32.33 vs.-837.99±29.90); t=-0.15, P>0.05]. Conclusions IPF patients showed increased pulmonary uptake of 18F-FDG on PET in lung regions with abnormal and normal morphological appearances on HRCT. Therefore, PET/CT gives superior diagnosis and therapeutic monitoring.
2016, 40(6): 419-423.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.004
Abstract:
Objective To investigate the efficacy of low-dose(1.11 GBq) and high-dose(3.70 GBq) radioactive 131I on residual thyroid tissues in patients after a non-high-risk differentiated thyroid carcinoma(DTC) resection. Methods Clinical data of a total of 63 patients with non-high-risk DTC who had experienced 131I therapy were analyzed retrospectively. Binary logistic regression was employed to analyze the effects of age, interval from initial resection to initial 131I ablation, rate of thyroid iodine uptake for 24 h, serum TSH level, and 131I dose on efficacy of thyroid remnant ablation. Out of 63 patients, 27 were given low doses while 36 patients were given high doses of 131I therapy. Pearson's chi-square test was used to differentiate the efficacy of low-dose and high-dose 131I on residual thyroid tissues. P < 0.05 was considered statistically significant. Results Among the 63 non-high-risk DTC patients, 46 patients achieved successful thyroid remnant ablation(73.02%, 46/63) but 17 failed(26.98%, 17/63). Binary logistic regression analysis indicated that the ablation dose of 131I was the main factor for the efficacy of ablation(Wald=6.42, P=0.011). Among the 27 patients who had low doses of 131I therapy, 15 achieved effective thyroid remnant ablation. However, 31 patients achieved effective thyroid remnant ablation after high doses of 131I therapy among 36 patients. Pearson's chi-square test revealed that the ablation efficacy in patients with high-dose 131I(86.11%, 31/36) was higher than those with low-dose 131I(55.56%, 15/27)(χ2=7.311, P=0.007). Conclusion In clinical practice, high-dose 131I on residual thyroid tissues should be considered for patients after non-high-risk DTC resection to improve the efficacy of 131I ablation at first dose when the volume of thyroid remnant tissues is low.
2016, 40(6): 424-428.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.005
Abstract:
Objective To investigate the clinical value of 125I radioactive seed interstitial implantation in the treatment of advanced pancreatic cancer. Methods The pain classification, solid tumor response evaluation criteria, and tumor markers(carbohydrate antigen CA242 and CA19-9) were examined in 97 patients with advanced pancreatic cancer by using ultrasound-guided 125I particle implantation surgery to evaluate the complications and adverse reactions of the tool. Results Comparison among preoperative state, 1 week, 2 weeks, 1 month and 3 months post-surgery revealed significant differences in pain scores(χ2=0.018, 0.022, 0.034, 0.045, all P < 0.05); 8 cases had complete remission, 46 cases had partial remission, 34 cases were stable, and 9 cases progressed. The total effectiveness rate was 55.67%(54/97); moreover, comparison among the preoperative state, 1 month, and 3 months post-surgery indicated significant differences in the serum levels of CA19-9 and CA242(χ2=0.027, 0.029, 0.017, 0.022, all P < 0.05). After treatment, the median survival time was(8.0±4.5) months. No serious complications and adverse reactions were observed. Conclusion 125I radioactive particle implantation for the treatment of advanced pancreatic cancer using ultrasound-guided surgery had curative effects, high safety, and significant pain relief.
2016, 40(6): 429-434.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.006
Abstract:
Objective To explore the toxicity, long-term overall survival(OS), and prognostic factors in advanced cervical cancer treated with IMRT and simultaneous integrated boost-intensity modulated radiation therapy(SIB-IMRT). Methods A retrospective analysis was performed on 277 patients with advanced cervical cancer. These patients were admitted from January 2009 to June 2015. Among the 277 patients, 70 patients received IMRT, and 207 patients received SIB-IMRT. Toxicities, survival rates, and prognostic factors were compared between the two groups. The Kaplan-Meier method was used to calculate the survival rates, and the Cox model was used for multivariate prognostic analysis. Results The follow-up rate was 100% in both the IMRT and SIB-IMRT groups. Compared with IMRT, SIB-IMRT showed no significant differences in acute proctitis and cystitis toxicities(χ2=0.306, 0.971, both P>0.05), as well as in long-term toxicity(χ2=0.014, 0.381, both P>0.05). The 1-year OS rates for the IMRT and SIB-IMRT groups were 100% and 99.5%, respectively, and the 3-year OS rates were 75.0% and 84.7%, correspondingly(χ2=0.339, 0.674, both P>0.05). The age and status of the pretreatment lymph nodes were the prognostic factors for all patients(χ2=7.971, 15.938, both P < 0.05), including the SIB-IMRT group(χ2=7.503, 10.048, both P < 0.05) in terms of OS. Conclusion Results indicated that SIB-IMRT can feasibly treat advanced cervical cancer. SIB-IMRT is a promising alternative treatment for patients who are not fit for brachytherapy treatment; this method also helps to reduce treatment fractions. Hence, SIB-IMRT is a recommended external beam technology for cervical cancer treatment.
2016, 40(6): 435-441.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.007
Abstract:
Objective To explore the detective values of various MRI sequences in breast polyacrylamide hydrogel(PAHG) injection for augmentation patients. Methods A total of 80 patients who have been injected for augmentation and who have suspected breast lesions were subjected to MRI scanning. The MRI scan sequence included T1 weighted imaging(T1WI), T2 weighted imaging(T2WI), short time inversion recovery(STIR), diffusion weighted imaging(DWI) and MR hydrography(MRH), as well as liver acquisition with valume acceleration(LAVA) dynamic contrast-enhanced sequence. The main sequence analysis indicators included the detection rate of breast disease and breast cancer, and to analyze statistically. Results A total of 86 lesions were observed in 160 breasts. The breast-lesion detection rates of the T1WI, T2WI, STIR, DWI and MRH, as well as LAVA dynamic contrast-enhanced sequence were 32.56%(28/86), 61.11%(53/86), 63.88%(55/86), 41.66%(36/86), 89.53%(77/86), and 100%(86/86), respectively; the breast-cancer detection rates of these sequences were 33.33%(10/30), 66.67%(20/30), 66.67%(20/30), 46.67%(14/30), 100%(30/30), and 100%(30/30), respectively. Each MRI scanning sequence of breast-lesion detection rate of R×C cross-table analysis, χ2=129.428, P < 0.05; the difference was statistically significant. Each MRI scanning sequence of breast-cancer detection rate of R×C cross-table analysis, χ2=51.843, P < 0.05; the difference was statistically significant. Each MRI scanning sequence detection rate of breast disease and breast cancer in the group were compared pairwise. The detection rates of breast lesions were not statistically significant in T1WI and MRH, T2WI and STIR(χ2=1.593, 0.100, both P>0.05), whereas those in the other scanning sequences were statistically significant(χ2=6.729~87.509, all P < 0.05). The differences in breast-cancer detection rates in MRH and T1WI, MRH and T2WI, MRH and STIR, T2WI and STIR, and DWI and LAVA were not statistically significant(χ2=1.111, 2.443, 2.443, 0.000, 0.000, all P>0.05), whereas those of the other sequences were statistically significant(χ2=12.000~30.000, all P < 0.05). Conclusions The total detection rate of breast lesions with PAHG injection for augmentation mammoplasty by DWI and LAVA-enhanced sequence wasthe highest. Rational use of MRI sequence will help improve the lesion detection rate of patients' breast augmentation PAHG injection and has important clinical value.
2016, 40(6): 442-446.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.008
Abstract:
Objective To evaluate the morphological characteristics of myocardial bridge and mural coronary artery(MB-MCA) and to discuss the correlation between atherosclerosis and MB-MCA. Methods The coronary artery imaging data of 186 with suspected coronary heart disease patients undergoing 640-slice computed tomography angiograms(CTA) were included. After the MB-MCA diagnosis was confirmed, the location and distribution of MB-MCA were recorded. The diameter and thickness of MB in the middle segment of LAD(LAD2) during the diastole and systole phases were also recorded, and changes in the MB-MCAs were calculated. In addition, the correlation between atherosclerosis and MB-MCA was discussed. Results Among the 186 patients, 70 MB-MCAs were found in 56 patients(30.1%), whereas 48 MB-MCAs(68.6%) were located in LAD2. According to the MB thickness, 70 patients had MB-MCAs. Among which, 44 patients(62.9%) have the superficial type of MB-MCA, whereas 26(37.1%) have the deep type. The change in the average diameter of MCA in LAD2 from the systole phase to the diastole phase was obvious and statistically significant differences(t=2.84, 3.38, both P < 0.05) were observed. Notably, 28(65.1%) of the patients have MCA diameters indicative of Grade Ⅱ stenosis. Among the 70 diagnosed MB-MCA, 48 segments have atherosclerosis. Atherosclerosis occurred in approximately 42(87.5%) of the MB-MCA patients, which was higher than the occurrence of distal segments in 6 MB-MCA patients(t=3.12, P < 0.05). Conclusion A 640-slice coronary CTA directly displays MB-MCA and can be used for the quantitative analysis of morphological characteristics and changes in the cardiac cycle of MB-MCA patients to provide reliable imaging data for clinical settings.
2016, 40(6): 447-451.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.009
Abstract:
The correct N staging of non-small cell lung cancer(NSCLC) is very important for the option of treatment. 18F-FDG PET/CT as a new imaging method which combines the advantages of functional and anatomic images has become more and more accurate in the N staging of NSCLC. Numerous researches have proved some risk factors that influenced the mediastinal lymph node metastasis. This review focus on the new parameters and new technologies which improve the accuracy of the N staging of NSCLC recently.
The correct N staging of non-small cell lung cancer(NSCLC) is very important for the option of treatment. 18F-FDG PET/CT as a new imaging method which combines the advantages of functional and anatomic images has become more and more accurate in the N staging of NSCLC. Numerous researches have proved some risk factors that influenced the mediastinal lymph node metastasis. This review focus on the new parameters and new technologies which improve the accuracy of the N staging of NSCLC recently.
2016, 40(6): 452-458.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.010
Abstract:
There are various radionuclide imaging modalities for the diagnosis and evaluation of curative effect about differentiated thyroid cancer with bone metastases. Radionuclide imaging is widely used in many kinds of malignant tumors with bone metastases. Recently, SPECT and PET are main included in the radionuclide imaging.The former main contains 131I、99Tcm-MDP imaging and the later one main contains 124I、18F-FDG as wall as 18F-NaF imaging. This review concentrates on the commonly used radionuclide imaging methods in patients with DTC of bone metastases.
There are various radionuclide imaging modalities for the diagnosis and evaluation of curative effect about differentiated thyroid cancer with bone metastases. Radionuclide imaging is widely used in many kinds of malignant tumors with bone metastases. Recently, SPECT and PET are main included in the radionuclide imaging.The former main contains 131I、99Tcm-MDP imaging and the later one main contains 124I、18F-FDG as wall as 18F-NaF imaging. This review concentrates on the commonly used radionuclide imaging methods in patients with DTC of bone metastases.
2016, 40(6): 459-463.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.011
Abstract:
When it comes to 99Tcm-MDP bone scintigraphy, normal and abnormal bone tissue can uptake skeletal imaging agent, so does the extraosseous tissue, especially the thorax soft tissue. The understanding of the possible explanations for the abnormal 99Tcm-MDP uptake in the thoracic tissue on bone scintigraphy is of great importance to clinical diagnosis. The relevant reports about this field in recent years are reviewed.
When it comes to 99Tcm-MDP bone scintigraphy, normal and abnormal bone tissue can uptake skeletal imaging agent, so does the extraosseous tissue, especially the thorax soft tissue. The understanding of the possible explanations for the abnormal 99Tcm-MDP uptake in the thoracic tissue on bone scintigraphy is of great importance to clinical diagnosis. The relevant reports about this field in recent years are reviewed.
2016, 40(6): 464-468.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.012
Abstract:
Prostate cancer has a high bone metastasis tendency. At the time of initial diagnosis, there is a high rate of bone metastasis. Early detection of bone metastases in patients with prostate cancer has important significance for staging, treatment and prognosis of prostate cancer. Radionuclide bone imaging(SPECT) is a commonly used imaging examination method of bone metastases, which had a higher detection rate in early bone metastases. Combined with X-ray, CT, MRI and other ways can improve the accuracy of bone metastases. This review summarizes the research status of the imaging examination of bone metastasis of prostate cancer, which provides the imaging evidence for early diagnosis of bone metastases.
Prostate cancer has a high bone metastasis tendency. At the time of initial diagnosis, there is a high rate of bone metastasis. Early detection of bone metastases in patients with prostate cancer has important significance for staging, treatment and prognosis of prostate cancer. Radionuclide bone imaging(SPECT) is a commonly used imaging examination method of bone metastases, which had a higher detection rate in early bone metastases. Combined with X-ray, CT, MRI and other ways can improve the accuracy of bone metastases. This review summarizes the research status of the imaging examination of bone metastasis of prostate cancer, which provides the imaging evidence for early diagnosis of bone metastases.
2016, 40(6): 469-473.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.013
Abstract:
Intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI) not only determines various parameters(D value, D* value, and f value) but also provides diffusion and perfusion information without the contrast agents. IVIM-DWI can show the complexity of the tissue microstructure in a manner more sophisticated than normal and can reflect with high sensitivity the pathological changes of organization. It can confirm the authenticity of the disease. It has become the focus of research in MRI technology in the recent years. Considering data obtained from a large number of local and international studies, we described comprehensively and briefly the basic principle, status, and progress in clinical applications of IVIM-DWI.
Intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI) not only determines various parameters(D value, D* value, and f value) but also provides diffusion and perfusion information without the contrast agents. IVIM-DWI can show the complexity of the tissue microstructure in a manner more sophisticated than normal and can reflect with high sensitivity the pathological changes of organization. It can confirm the authenticity of the disease. It has become the focus of research in MRI technology in the recent years. Considering data obtained from a large number of local and international studies, we described comprehensively and briefly the basic principle, status, and progress in clinical applications of IVIM-DWI.
2016, 40(6): 474-477.
doi: 10.3760/cma.j.issn.1673-4114.2016.06.014
Abstract:
Since the application of computed tomography virtual colonography(CTVC) in clinic, it shows an increasing superiority in the diagnosis of colorectal cancer(CRC). Its high image quality, low radiation dose and high scanning speed make it possible to become a suitable method for the early diagnosis of CRC. This article makes a brief review about the progress of CTVC in the diagnosis of CRC and its clinical value.
Since the application of computed tomography virtual colonography(CTVC) in clinic, it shows an increasing superiority in the diagnosis of colorectal cancer(CRC). Its high image quality, low radiation dose and high scanning speed make it possible to become a suitable method for the early diagnosis of CRC. This article makes a brief review about the progress of CTVC in the diagnosis of CRC and its clinical value.
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