2017 Vol. 41, No. 3
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2017, 41(3): 159-165.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.001
Abstract:
Objective To evaluate the clinical value of 18F-FDG PET/CT imaging in detecting the recurrence and metastasis, therapeutic strategy, and prognosis of postoperative breast cancer patients. Methods From July 2007 to September 2016, 59 patients with postoperative breast cancer were retrospectively studied. The influence of PET/CT imaging results on the choice of therapeutic strategy was analyzed. Kaplan-Meier survival analysis was conducted based on the true-positive and true-negative groups of patients. Comparison of SUVmax according to the age, estrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor-2(HER2), and subtypes of the patients in the PET/CT imaging true-positive group was performed using t-test. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT were 100%, 87.5%, 94.9%, 92.1%, and 100%, respectively. No statistically significant difference in the SUVmax for breast cancer recurrence and metastasis was observed between the two groups of patients according to age, ER, PR, HER2, and subtypes of breast cancer(t=0.808, 0.225, 0.355, -0.426 and -1.076, all P>0.05). The true-positive and true-negative groups were followed for a median period of 58.33±37.69 and 47.40±25.99 months, and their median survival times were 3.58 and 4.16 years, respectively. The two groups significantly differed in the overall survival and progression-free survival times (Kaplan-Meier survival analysis, χ2=10.274, P < 0.01; χ2=17.187, P < 0.01). Clinical restaging was raised in 25 true-positive patients after PET/CT imaging, and the therapeutic strategy was changed in 30 true-positive patients. Conclusions PET/CT imaging is highly sensitive and accurate in diagnosing the recurrence and metastasis of postoperative breast cancer and allows clinical restaging in a timely manner. It helps in choosing the appropriate clinical therapeutic strategy, thereby improving the prognosis of patients. Compared with the true-positive patients, the true-negative patients who underwent PET/CT imaging had a better prognosis. Therefore, PET/CT imaging has a high clinical value in the follow-up of postoperative breast cancer patients.
2017, 41(3): 166-172.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.002
Abstract:
ObjectiveTo explore the value of 18F-FDG PET/CT examination in the differential diagnosis of primary nasopharyngeal lymphoma (PNL) and nasopharyngeal carcinoma (NPC). MethodsPET/CT data of 33 patients with PNL and 71 patients with NPC who were confirmed histopathologically and had not undergone oncotherapy before examination were retrospectively analyzed. The form, range, invasion, volume, SUVmax of nasopharyngeal lesion, and lymphadenopathy involvement were analyzed comparatively. The SUVmax and volume of lesions that confirmed diffuse large B cell lymphoma(DLBCL) were compared with NPC. t-text and χ2-text with SPSS 13.0. ResultsDiffuse infiltration of all nasopharyngeal walls was detected in 20 of 33 patients with PNL(bilateral symmetry in 14 patients and asymmetry in 6) and 10 of 71 patients with NPC(bilateral symmetry in 4 patients and asymmetry in 6). Partial infiltration of nasopharyngeal walls was observed in 13 of 33 patients with PNL(unilateral invasion in 7 patients and bilateral invasion in 6) and 61 of 71 patients with NPC(unilateral invasion in 39 patients and bilateral invasion in 22). Statistical significances were found between diffuse and partial infiltration, unilateral and bilateral invasion, and symmetry and asymmetry of nasopharyngeal walls of PNL and NPC(χ2=23.75, 10.38, and 16.74, respectively; all P < 0.001). Tumor limited to the nasopharyngeal wall was found in 26 patients with PNL and 17 patients with NPC. Meanwhile, deep-structure invasion was detected in 7 patients with PNL and 54 patients with NPC. Significant difference was found in tumor invasion between PNL and NPC(χ2=27.94; P < 0.001). Tumor volumes of PNL, DLBCL, and NPC were 3.70±5.53×104, 5.05±6.89×104, and 2.06±2.31×104 mm3, respectively. No significant difference was found between tumor volume of PNL and DLBCL compared with NPC(t=1.63 and 1.85 respectively; both P>0.05). The SUVmax's of PNL and NPC were 12.00±6.34, 14.26±6.42, and 10.09±4.41, respectively. No significant difference was found between the SUVmax's of PNL and NPC(t=1.55; P>0.05). Significant difference was found between DLBCL and NPC(t=2.67; P < 0.05). Lesions in 21 patients with PNL and 24 patients with NPC protruded into posterior nasal apertures, and significant difference was found between the two groups(χ2=8.17; P < 0.05). A total of 26 patients with PNL had retropharyngeal or cervical lymphatic involvement. A total of 51 patients with NPC had retropharyngeal or cervical lymphatic metastasis. SUVmax, major diameter, minor diameter, and average diameter did not significantly differ from largest lymphatic involvement or metastasis in PNL and NPC(t=0.79, 1.37, 2.03, and 1.71, respectively; all P>0.05). Through CT imaging, lymphatic necrosis was detected in 3 of 26 patients with lymphatic involvement of PNL and 31 of 51 patients with lymphatic metastasis of NPC. Significant difference was found between the two groups(χ2=16.94; P < 0.001). Lymphatic blend was detected in 5 patients with PNL and in 6 patients with NPC. No significant difference was found between the two groups(χ2=0.78; P>0.05). ConclusionsPET/CT examination has a definite diagnosis value in patients with PNL and NPC. The differential diagnosis between PNL and NPC was mainly according to form, range, and invasion of nasopharyngeal lesion. The metabolic level of different pathological subtypes may be higher or lower than that of NPC. The metabolic activity of DLBCL was higher than that of NPC. The volume of nasopharyngeal lesion cannot be considered as a main basis to distinguish between PNL and NPC.
2017, 41(3): 173-177.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.003
Abstract:
ObjectiveTo assess incremental values of 99Tcm-MDP SPECT/CT bone scan imaging by semi-quantitative analysis indexes for osteoporotic thoracolumbar vertebral fractures in postmenopausal women. MethodsThis retrospective study enrolled 81 postmenopausal women patients diagnosed and treated for back pain from November 2012 to October 2016. All patients were diagnosed with osteoporotic thoracolumbar vertebral compression fractures. All patients underwent 99Tcm-MDP SPECT/CT bone imaging, and techniques for ROI were repeatedly applied to draw sagittal imaging sites of regional uptake in ROI, to record the number of radioactive counting of lesions (T) and adjacent normal vertebral sagittal imaging (NT), and to calculate T/NT ratio. Patients were divided into two groups. One group was treated by vertebroplasty or kyphoplasty after 99Tcm-MDP SPECT/CT bone imaging, and the other was treated with conservative treatment. T/NT ratios of the two groups were statistically analyzed. ResultsA total of 110 vertebral fractures were treated by vertebroplasty or kyphoplasty after 99Tcm-MDP SPECT/CT bone imaging, and 70 vertebral fractures were treated with conservative treatment. T/NT ratio of fractures reached 2.44±0.84 and 1.04±0.14, respectively (t=13.654, P < 0.05), after treatment with vertebroplasty or kyphoplasty; and conservative treatment. Some concurrent lesions which were absent in X-ray or MRI were detected by SPECT/CT, for example, 29 rib fractures and 2 sacrum fractures. Conclusion99Tcm-MDP SPECT/CT bone imaging by semi-quantitative analysis can effectively guide treatment of vertebral compression fractures.
2017, 41(3): 178-183.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.004
Abstract:
ObjectiveGastric emptying scintigraphy was performed with radionuclide-labeled liquid test meal to determine the best position and evaluation index for the clinical examination of gastric emptying. Subsequently, the incidence of gastroparesis in diabetic patients was evaluated, and the basis for its diagnosis and severity index was obtained. MethodsA total of 155 participants were divided into the control (n=55) and experimental groups (n=100). The volunteers were made to drink 99Tcm-DTPA radioactive nuclide liquid test meal and to lie down on an exam table. SPECT was utilized to dynamically and instantaneously image anterior and posterior gastric emptying in the lying position. After image acquisition, the stomach area was highlighted as the ROI. Through computer processing, the time-radioactive change curve was obtained, and then lying anterior and posterior gastric-half emptying time (GET1/2) and gastric emptying rate in 30 minutes (GER30min) were calculated. Three days later, the patients received the same amount of radionuclides in liquid test meal for the dynamic imaging of posterior gastric emptying in the sitting position. Data acquisition and processing were conducted using the previously described protocol for gastric emptying in the lying position. Imaging data from the normal control and experimental groups were compared by using t-test. ResultsIn the control group, the lying anterior GET1/2 was(12.76±2.22) min with an upper limit of 95% confidence interval of 17.1 min. This parameter could be used as a criterion for the evaluation of gastric emptying function. The GET1/2 and GER30min of the lying anterior and posterior of the normal control group were significantly different (t=5.35, 11.20, -6.37, -9.77, all P < 0.05). The lying anterior GER30min of experimental groups 1 (without digestive system symptom diabetes) and 2 (with digestive system symptom diabetes) were significantly different (t=6.22, 3.01, both P < 0.05). The lying anterior GER30min of the experimental group was lower than that of the control group, and was lower in experimental group 2 than in experimental group 1. Based on the GET1/2 of the experimental group, 41% of the patients exhibited dysfunctional gastric emptying, whereas 9% of the patients suffered from severely impaired gastric emptying. ConclusionRadionuclide-labeled liquid test meal gastric emptying imaging is a simple, accurate and reliable detection method. GET1/2 and GER30min can be used as gastric emptying function impairment degree index, and the lying anterior position was selected as a better method of radionuclide-labeled liquid test meal gastric emptying imaging which can be used in clinical extension.
2017, 41(3): 184-187.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.005
Abstract:
ObjectiveTo investigate the difference between electrochemiluminescent immunoassay (ECLIA) and radioimmunoassay (RIA) in the detection of serum cortisol. MethodsA total of 188 patients were selected from healthy outpatients and inpatients. The serum cortisol of the patients and quality control serum cortisol were detected by ECLIA and RIA. The detection accuracy of the methods in the two batches and the coefficient of variation (CV) of within-batch and between-batch were calculated. To evaluate the precision of the test, quality control serum was added to low, medium, and high concentrations of serum cortisol for the evaluation of recovery rate and detection accuracy. The correlation between results was analyzed by regression. ResultsThe sensitivity and specificity of the ECLIA method was higher than those of the RIA method. The CV of the ECLIA method was also lower than that of the RIA method, and the recovery rate of the ECLIA method was higher than that of the RIA method. The two methods showed good correlation and highly correlated results (r=0.991, P < 0.01). ConclusionsThe two methods have their own advantages in the detection of serum cortisol. The degree of automation of ECLIA is high, whereas the RIA method is mature and inexpensive. Although ECLIA is the current and future development trend, RIA retains a certain advantage in terms of sensitivity and specificity. The two methods provide different reference intervals. RIA remains an indispensable method for clinical cortisol testing.
2017, 41(3): 188-192.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.006
Abstract:
ObjectiveTo evaluate the effect of arterial input and ROI selection on the perfusion CT parameters of parotid tumors. MethodsA deconvolution-based software(Philips ADW4.5) was used to perform perfusion calculations on 12 parotid tumor patients. Blood flow(BF), blood volume(BV), and peak enhancement index(PEI) of different arterial inputs and ROI selection were recorded. These values were compared using one-way ANOVA. Independent sample t-test was performed to compare the values of adenolymphoma and non-adenolymphoma. ResultsNo significant difference was observed among BF, BV, and PEI obtained when external carotid artery(ECA), internal carotid artery(ICA), and common carotid artery(CCA) were used as input arteries(F=0.012, 0.007 and 0.233, all P>0.05). Similarly, no significant difference was observed among the perfusion parameters of different ROIs of lesions(F=0.220, 0.033, and 0.283, all P>0.05). When ECA was selected as arterial input, the area of ROI was approximately S80%, and PEI had the best diagnostic effect for adenolymphoma differential diagnosis. ConclusionsArterial input selection and area of ROI had no significant effect on perfusion CT calculation of parotid tumor. However, ECA and S80% of ROI selected for perfusion post-processing might facilitate parotid adenolymphoma diagnosis.
2017, 41(3): 193-198.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.007
Abstract:
ObjectiveTo explore the effects of B7-H3 down-regulation on cell cycle and apoptosis in lung cancer A549 cells. Method Human lung cancer cell line A549 were cultured. siB7-H3 RNA which can specifically silence the expression of B7-H3 protein was transfected into A549 cells. 137Cs γ-ray irradiation was used with a single dose of 4 Gy. Experiments included control group, siB7-H3 transfected group, irradiation group, and irradiation+siB7-H3 transfected group. After transfected with siB7-H3, Western blotting and quantitative real-time PCR assays were used to detect the expression of B7-H3 protein and mRNA in A549 cells. The cell cycle and apoptosis of A549 cells following 4 Gy irradiation were detected by flow cytometry. ResultsThe protein and mRNA expression of B7-H3 were significantly decreased in A549 cells transfected with siB7-H3 compared with the control group, and the differences between the two groups were statistically significant(t=-4.222, P=0.013). siB7-H3 transfection induced significant effect on cell cycle with increase of G0/G1 phase arrest and reduction of S and G2/M phase population. A mild enhanced G0/G1 phase arrest and an obvious enhanced G2/M phase arrest of irradiation group were detected compared with the control group. An enhanced G0/G1 and G2/M phase arrest of irradiation+siB7-H3 transfected group were detected compared with the control group. Compared with the control group, the necrosis and apoptosis induction of the irradiated group significantly increased at 48 h after irradiation. However, No significant alterations of necrosis and apoptosis induction were observed between irradiation group and irradiation+ siB7-H3 transfected group. ConclusionsDown-regulation of B7-H3 can significantly elevated the G0/G1 arrest in A549 cells following radiation. This conclusion indicated that the alteration of B7-H3 expression could play a key role in the regulation of the radiosensitivity of lung cancer via mediating the G0/G1 check point.
2017, 41(3): 199-204.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.008
Abstract:
With the improvement of economic level, the requirement to achieve quality of life is increased. An increasing number of individuals are undergoing joint replacement surgery due to femoral neck fracture, traumatic arthritis, and femoral head necrosis. Prosthesis loosening and complications, such as infection, causes post-operative discomfort among patients. Traditional imaging for evaluating the existence of complications has advantages and disadvantages. Thus, single-photon emission computed tomography (SPECT) is combined with spiral CT scanning. Fusing functional imaging and anatomical imaging significantly improves diagnostic accuracy. SPECT imaging has shown its advantage in terms of implant surrounding bone metabolic activity. This technique retains high image quality regardless of the presence of metal prosthesis. Moreover, spiral CT improves anatomical detail display in SPECT imaging. This review explores 3D CT imaging data on hip measurement accuracy, advantages, and methods, as well as SPECT and CT imaging features on the common complications after total hip arthroplasty. These complications include infection around the implant, aseptic loosening tissue reaction, prosthesis peripheral fracture, polyethylene liner wear, heterotopic ossification, and prosthesis pseudotumor formation.
With the improvement of economic level, the requirement to achieve quality of life is increased. An increasing number of individuals are undergoing joint replacement surgery due to femoral neck fracture, traumatic arthritis, and femoral head necrosis. Prosthesis loosening and complications, such as infection, causes post-operative discomfort among patients. Traditional imaging for evaluating the existence of complications has advantages and disadvantages. Thus, single-photon emission computed tomography (SPECT) is combined with spiral CT scanning. Fusing functional imaging and anatomical imaging significantly improves diagnostic accuracy. SPECT imaging has shown its advantage in terms of implant surrounding bone metabolic activity. This technique retains high image quality regardless of the presence of metal prosthesis. Moreover, spiral CT improves anatomical detail display in SPECT imaging. This review explores 3D CT imaging data on hip measurement accuracy, advantages, and methods, as well as SPECT and CT imaging features on the common complications after total hip arthroplasty. These complications include infection around the implant, aseptic loosening tissue reaction, prosthesis peripheral fracture, polyethylene liner wear, heterotopic ossification, and prosthesis pseudotumor formation.
2017, 41(3): 205-208, 219.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.009
Abstract:
Radiation therapy is an important treatment for malignant tumors as more than 50% of patients receive radiation therapy for their illnesses. Patients receiving radiation doses have been significantly reduced because of the advancement in image-guided radiation. However, serious side effects occur owing to the off-target radiation damage to normal tissues. To decrease the level of injury, researchers have explored new radiation protection methods. Currently, agents available for protecting normal tissues against radiation damage mainly include synthesized small molecules and plant extracts with poor results. Researchers have explored new efficient approaches to radiation protection. Several advantages in gene therapy, such as targeting, low toxity, and minimal side effects, render it as an ideal strategy for radiation protection and significantly enhance the biological properties of cells and tissues. Radiation protection gene therapy and its development as a radiation protection strategy are reviewed in this paper.
Radiation therapy is an important treatment for malignant tumors as more than 50% of patients receive radiation therapy for their illnesses. Patients receiving radiation doses have been significantly reduced because of the advancement in image-guided radiation. However, serious side effects occur owing to the off-target radiation damage to normal tissues. To decrease the level of injury, researchers have explored new radiation protection methods. Currently, agents available for protecting normal tissues against radiation damage mainly include synthesized small molecules and plant extracts with poor results. Researchers have explored new efficient approaches to radiation protection. Several advantages in gene therapy, such as targeting, low toxity, and minimal side effects, render it as an ideal strategy for radiation protection and significantly enhance the biological properties of cells and tissues. Radiation protection gene therapy and its development as a radiation protection strategy are reviewed in this paper.
2017, 41(3): 209-213.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.010
Abstract:
Extensive research on the mechanism of tumor radiotherapy shows that the bystander effect induced by radiation therapy in vivo plays an important role in tumor therapy and prognosis. The induction of the bystander effect is mainly related to the transmission of oxidative stress signals, DNA damage, and activation of the immune system caused by radiotherapy in vivo. Therefore, the intervention of the bystander effect could reduce injury on normal tissue and improve radiotherapy efficiency. This paper summarizes the research progress on the bystander effect of radiotherapy and its molecular mechanism in recent years in vivo.
Extensive research on the mechanism of tumor radiotherapy shows that the bystander effect induced by radiation therapy in vivo plays an important role in tumor therapy and prognosis. The induction of the bystander effect is mainly related to the transmission of oxidative stress signals, DNA damage, and activation of the immune system caused by radiotherapy in vivo. Therefore, the intervention of the bystander effect could reduce injury on normal tissue and improve radiotherapy efficiency. This paper summarizes the research progress on the bystander effect of radiotherapy and its molecular mechanism in recent years in vivo.
2017, 41(3): 214-219.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.011
Abstract:
The effect of radiotherapy can be enhanced by radiosensitizers because these compounds can improve the killing rate of radiation on tumor cells, especially on hypoxic cells. Moreover, radiosensitizers show little damage to the aerobic normal tissue and are easy to use. For these reasons, radiosensitizers are expected to become the important treatment in radiotherapy. RRx-001, a novel dinitroazetidine radiosensitizer, is an aerospace industry-derived anti-cancer agent. As an NO-donating compound, RRx-001 can pass through erythrocyte membrane, selectively bind to hemoglobin at the beta-cysteine 93 residue, and release large amounts of NO under hypoxic conditions, so as to improve radiosensitivity of hypoxic cells. RRx-001 shows good safety and tolerability in clinical studies and now is undergoing phase Ⅱ clinical trials in cholangiocarcinoma, colorectal neoplasms, ect.
The effect of radiotherapy can be enhanced by radiosensitizers because these compounds can improve the killing rate of radiation on tumor cells, especially on hypoxic cells. Moreover, radiosensitizers show little damage to the aerobic normal tissue and are easy to use. For these reasons, radiosensitizers are expected to become the important treatment in radiotherapy. RRx-001, a novel dinitroazetidine radiosensitizer, is an aerospace industry-derived anti-cancer agent. As an NO-donating compound, RRx-001 can pass through erythrocyte membrane, selectively bind to hemoglobin at the beta-cysteine 93 residue, and release large amounts of NO under hypoxic conditions, so as to improve radiosensitivity of hypoxic cells. RRx-001 shows good safety and tolerability in clinical studies and now is undergoing phase Ⅱ clinical trials in cholangiocarcinoma, colorectal neoplasms, ect.
2017, 41(3): 220-226.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.012
Abstract:
A characteristic of cancer is resistance to programmed cell death, which sustains cell survival through oncogenic transformation and therapeutic resistance. Recent studies have shown that programmed cell death is not limited to caspase-dependent apoptosis. Necroptosis, a caspase-independent form of cell death, is regulated by receptor interacting protein 1, receptor interacting protein 3, and mixed lineage kinase domain-like proteins. This review summarized current research studies on necroptosis to provide perspectives for the development of novel tumor radiotherapy and chemotherapy strategies that target this process.
A characteristic of cancer is resistance to programmed cell death, which sustains cell survival through oncogenic transformation and therapeutic resistance. Recent studies have shown that programmed cell death is not limited to caspase-dependent apoptosis. Necroptosis, a caspase-independent form of cell death, is regulated by receptor interacting protein 1, receptor interacting protein 3, and mixed lineage kinase domain-like proteins. This review summarized current research studies on necroptosis to provide perspectives for the development of novel tumor radiotherapy and chemotherapy strategies that target this process.
2017, 41(3): 227-231.
doi: 10.3760/cma.j.issn.1673-4114.2017.03.013
Abstract:
Prostate cancer is the most common malignant tumor in the male urinary system. miRNA is a newly discovered small non-coding RNA of 19-23bp nucleotides, which was involved in regulating many important biological functions, even play a key role in tumor development. The blood research has indicated miRNA in blood could be a biomarker for diagnosis of prostate cancer but did not find specific extracellular miRNA as a prostate cancer biomarkers. Investigate the expression and the action mechanism of miRNA of prostate cancer have a great meaning to further discuss the pathogenesis of prostate cancer, search for new diagnostic and therapeutic method. This review focuses on the different abundance of miRNA among healthy population, patients with prostate cancer, patients with metastatic prostate cancer and moderating effect of miRNA of prostate cancer on tumor radiosensitivity, try to explore the clues of miRNA as biological markers for prostate cancer.
Prostate cancer is the most common malignant tumor in the male urinary system. miRNA is a newly discovered small non-coding RNA of 19-23bp nucleotides, which was involved in regulating many important biological functions, even play a key role in tumor development. The blood research has indicated miRNA in blood could be a biomarker for diagnosis of prostate cancer but did not find specific extracellular miRNA as a prostate cancer biomarkers. Investigate the expression and the action mechanism of miRNA of prostate cancer have a great meaning to further discuss the pathogenesis of prostate cancer, search for new diagnostic and therapeutic method. This review focuses on the different abundance of miRNA among healthy population, patients with prostate cancer, patients with metastatic prostate cancer and moderating effect of miRNA of prostate cancer on tumor radiosensitivity, try to explore the clues of miRNA as biological markers for prostate cancer.
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