2017 Vol. 41, No. 6
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2017, 41(6): 379-384.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.001
Abstract:
ObjectiveTo investigate the value of improved radionuclide imaging in the evaluation of fallopian patency by hysterosalpingography (HSG) and laparoscopy. MethodsA total of 166 cases showed at least one side of tubal patency in HSG were considered in this study. Of these cases, 19 were unilaterally obstructed fallopian tubes, 222 were obstructed fallopian tubes, and 91 were unobstructed fallopian tubes. Radionuclide imaging was conducted, and the results were compared with laparoscopy results. ResultsRadionuclide imaging showed a damage rate of 78.3% in patients with unobstructed tubes in HSG. In the unobstructed fallopian tube group, radionuclide imaging and laparoscopic examination differed significantly(χ2=27.56, P < 0.005). When the laparoscopic examination showed tubal patency, radionuclide oviduct imaging showed normal or mildly impaired fallopian tubes. When the laparoscopic examination showed poor tubal patency, radionuclide oviduct imaging showed moderately damaged, severely damaged, or nonfunctional tubes. ConclusionsRadionuclide imaging of the fallopian tubes with different degrees of damage has great clinical value in evaluating the patency and extent of damage of fallopian tubes and is an efficient guide to the choice of laparoscopy, especially in patients with tubal patency in HSG.
2017, 41(6): 385-388.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.002
Abstract:
ObjectiveTo explore the advantages of heterogeneous fusion in diagnosing gastric cancer by comparing the images obtained from 18F-FDG SPECT/CT and 64-multislice spiral CT heterogeneous fusion. MethodsClinical and radiological image data were collected from 35 patients examined by both 18F-FDG SPECT/CT and 64-multislice spiral CT. All the 35 patients suffered from gastric cancer. These patients showed a total of 56 masses, which were grouped into three types, namely, gastric tumor, metastatic lymph node, and distant metastasis. The images processed by homogeneous and heterogeneous technologies were compared in terms of size, mass boundary, and image artifacts. Chi-square test was used to compare the enumeration data between the two groups. ResultsThe gastric cancer group comprised a total of 28 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 8, 14, and 6 and that after heterogeneous fusion technology was 25, 3, and 0, respectively. The metastatic lymph node group comprised a total of 19 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 7, 5, and 7, and that after heterogeneous fusion technology was 17, 2, and 0, respectively. The distant metastasis group comprised a total of 9 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 0, 3, and 6 and that after heterogeneous fusion technology was 8, 1, and 0, respectively. Significant differences were noted between the images obtained from homogenous and heterogeneous fusion technologies, and the images obtained from the latter were better than those of the former (χ2=21.875, 12.452, and 15.000, all P < 0.05). ConclusionThe heterogeneous fusion technology of 18F-FDG SPECT/CT and the 64-slice spiral CT can compensate for the deficiencies of the homogeneous fusion technology of 18F-FDG SPECT/CT in terms of display, evaluation, and metastatic detection of gastric cancer.
2017, 41(6): 389-395, 429.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.003
Abstract:
ObjectiveTo compare radioiodine therapy with antithyroid drugs in terms of clinical outcomes using meta-analysis, including development or worsening of ophthalmopathy, hyperthyroid cure rate, hypothyroidism, relapse rate, and adverse events. MethodsRandomized controlled trials(RCTs) published in PubMed, Embase, Web of Science, SinoMed, and National Knowledge Infrastructure, China were analyzed. These studies were published between 1990 and 2016. The selected key search terms were as follows:Graves' disease, radioiodine, and antithyroid drugs. Therapy was systematically reviewed to compare the effects of radioiodine therapy with antithyroid drugs among patients with Graves' disease. STATA software v.12.0 was used for data analysis. Results were expressed as risk ratio with 95% confidence intervals(CIs). Pooled estimates were determined using fixed-effect model or random-effect model, depending on the heterogeneity among studies. ResultsA total of 17 RCTs involving 4024 patients satisfied the inclusion criteria; these studies were published between1992 and 2015. Comprehensive analysis and results indicated that the rate of new ophthalmopathy developed in radioiodine therapy group and antithyroid drug group was 23.3% and 16.1%, respectively. Correspondingly, the hyperthyroid cure rate was 77.8% and 45.6%, the hypothyroidism rate was 19.7% and 9.3%, and the hyperthyroid relapse rate was 6.3% and 35.0%, respectively. Results also showed that radioiodine treatment increased the risk of new ophthalmopathy(RR=1.3, 95% CI:[1.04, 1.77]; P=0.024), development or worsening of ophthalmopathy(RR=1.76, 95% CI:[1.30, 2.38]; P < 0.001), and hypothyroidism(RR=1.76, 95% CI:[1.30, 2.38]; P < 0.001). Furthermore, radioiodine treatment presented a higher hyperthyroid cure rate(RR=1.66, 95% CI:[1.49, 1.86]; P < 0.001), lower recurrence rate(RR=0.16, 95% CI:[0.08, 0.33]; P < 0.001), and lower incidence of adverse events(RR=0.22, 95% CI:[0.10, 0.49]; P < 0.001) than those of antithyroid drugs. ConclusionsRadioiodine therapy is associated with a higher hyperthyroid cure rate and lower relapse rate than those of antithyroid drugs. However, this treatment also increases the risk of ophthalmopathy and hypothyroidism. Considering that antithyroid drug treatment can be associated with unsatisfactory control of hyperthyroidism, we recommend radioiodine therapy as treatment option for patients with Graves' disease.
2017, 41(6): 396-400.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.004
Abstract:
ObjectiveTo analyze the digital radiography(DR), CT, and MRI manifestations and clinical and pathologic features of skeleton Rosai-Dorfman disease(RDD) to improve the understanding of the disease. MethodsTwo cases of skeleton RDD were analyzed retrospectively with a review of the literature on skeletal RDD. ResultsTwo patients were examined before operation. One case had multiple lesions of long and flat bones on DR film, characterized by intramedullary and lytic lesion without periosteal reaction and cortical destruction or soft tissue involvement. Several lesions showed heterogeneous density. The other case had a singly lytic lesion of the cranial bone on CT image, characterized by a clear boundary and homogeneous density. T1WI and T2WI showed moderate signals, with a high signal on diffusion-weighted imaging and significantly enhanced on Gd-DTPA T1WI. The adjacent scalp and the meninges were also affected. ConclusionsRadiologically, most lesions are lytic and centrally located in the medullary cavity, infrequent with sclerotic borders or periosteal reaction. Cortical disruption or soft-tissue proliferation is rarely observed in the long bone, with a slight predilection in the cranial bone. The radiological features of skeletal RDD are not pathognomonic, so it must be differentiated with other diseases.
2017, 41(6): 401-406.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.005
Abstract:
ObjectiveTo analyze large data on CT radiation dose through the Radimetrics system by evaluating the CT scan program to meet radiation protection requirements. MethodsThe radiation dose report of target tissue and sensitive tissue of 3980 patients was generated by immediately transferring the data from Toshiba Aquilion 64 rows CT and Siemens Emotion 16 rows CT to the Radimetrics workstation. The radiation dose distribution of CT in the head, chest, abdomen, and pelvis were analyzed, and then t-test was used for data analysis using SPSS17.0 software. Results(1) The radiation doses of head, chest, abdominal, and pelvic CT were 2.31, 4.82, 3.65, and 4.48 mSv, respectively, and their enhanced CT scan results were 4.58, 9.58, 10.51, and 8.71 mSv, respectively; (2) The majority of patients received the radiation doses in the range of ICRP103, and only 80 patients received beyond the range of ICRP103; (3) As the highly sensitive tissue approached the scanning area, the radiation dose increased; (4) The radiation doses of the arterial and venous phases were lower than that of plain scan; (5) The radiation dose of 64 rows CT was lower than that of 16 rows CT. ConclusionThe Radimetrics system can effectively evaluate the radiation protection rationality of the CT scan program through analyzing CT radiation dose.
2017, 41(6): 407-412.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.006
Abstract:
ObjectiveTo investigate the anti-radiation mechanism and its mechanism of dark tea extract. MethodsThe mechanism of radiation protection of dark tea extract groups (50 mg/kg, 100 mg/kg, 200 mg/kg) were investigated by 30 days survival rate experiment of 137Cs γ-rays irradiated mice, protection of oxidative damage in liver, lung and serum, and TLR5 receptor activation test of HEK-BlueTM hTLR5 cell after deal with dark tea extract (1 ng/mL, 100 ng/mL). ResultsIn 30 d survival rate test, average survival time of dark tea extract groups (50 mg/kg, 100 mg/kg, 200 mg/kg) increased from 18.73 d to 23.40 d, 24.07 d and 27.73 d compared with the irradiation-only group, especially in the high dose group (t=3.126, P < 0.05). The survival rate of the high dose group was 53.4% lifted. The results of oxidative damage protection test showed that dark tea extract could increase the activity of superoxide dismutase(t=2.993, P < 0.05; t=4.049, P < 0.01), catalase(t=4.883, P < 0.01) and glutathione peroxidase (t=2.702, 2.959, both P < 0.05) in serum and tissues of mice, and reduce the content of lipid peroxides malondialdehyde(MDA). The dark tea extract polysaccharide could activate the TLR5 receptor when compared with the control group, the difference was sign that dark tea extract can effectively prolong the survival time of mice from 18.73 days to 27.7 days after irradiated with 7.0 Gy γ-rays, the survival rate of mice treated with dark tea siginificant(t=9.222, P < 0.05). ConclusionThe data suggested that the radiation protection mechanism of dark tea extract may be related to the activation of TLR5 receptor by dark tea polysaccharide.
2017, 41(6): 413-422.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.007
Abstract:
ObjectiveAmifostine is clinically used as a chemical radioprotector. Nevertheless, its efficacy as a radioprotector remains controversial. MethodsPubMed, Cochrane Central Register of Controlled Trials, EMBASE, China National Knowledge Infrastructure, and the references of the published results of trials on the efficacy of amifostine in patients with lung cancer and who received radiotherapy or concomitant chemoradiotherapy were searched. The pooled radiation protection efficacy, treatment response, and side effects of amifostine were calculated using RevMan software. ResultsTwelve randomized controlled trials involving 1000 patients with lung cancer were ultimately analyzed. Results of meta-analysis revealed that the use of amifostine reduced the risk of acute esophageal toxicity(RR, 0.56; 95% CI, 0.39-0.81; P=0.002) and pulmonary toxicity(RR, 0.42; 95% CI, 0.25-0.70; P=0.001). Subgroup analysis also demonstrated that the risk of acute esophageal toxicity and pulmonary toxicity significantly reduced in patients who received chemoradiation concurrent with amifostine or radiation only. Pooled data showed that the use of amifostine did not significantly decrease the risk of late pulmonary toxicity(RR, 0.74; 95% CI, 0.45-1.19; P=0.210). Moreover, subgroup analysis demonstrated that the risk oflate pulmonary toxicity did not significantly decrease in patients who received chemoradiotherapy concomitant with amifostine(RR, 0.84; 95% CI, 0.48-1.46; P=0.540). Amifostine did not exert tumor-protective effects in partial response(RR, 0.98; 95% CI, 0.83-1.15; P=0.800) but improved complete response(RR, 1.50; 95% CI, 1.03-2.18; P=0.030), although publication bias was observed through Egger's test(P=0.000). Moreover, amifostine had no effect on one-year overall survival (RR, 0.94; 95% CI, 0.81-1.09; P=0.400) and two-year overall survival(RR, 1.06; 95% CI, 0.81-1.39; P=0.680) rates. The incidence of neutropenia, a hematologic side effect of amifostine, was not significantly different(RR, 1.02; 95% CI, 0.61-1.71; P=0.940) between the amifostine and control group. The use of amifostine, however, significantly decreased the incidence of thrombocytopenia(RR, 0.45; 95% CI, 0.21-0.94; P=0.030). The most common amifostine-related side effects were nausea, vomiting, and hypotension with average incidence rates of 11%, 14%, and 24%, respectively. ConclusionsThis systematic review showed that the concurrent administration of amifostine with radiotherapy to patients with lung cancer significantly reduced the risks of acute esophageal toxicity and acute pulmonary toxicity and decreased the incidence of thrombocytopenia without tumor-protecting effects. In addition, the toxicities of amifostine were generally controllable through clinical treatment or resting.
2017, 41(6): 423-429.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.008
Abstract:
With the improvement of positron emission computed tomography (PET/CT) devices and the availability of cardiac positron tracers, the clinical interest in myocardial perfusion PET(PET-MPI) has increased over the years. PET-MPI enables noninvasive and accurate quantification of myocardial blood flow(MBF) and myocardial flow reserve(MFR), making it possible to enhance detection of early stages of vascular dysfunction, improve risk stratification of coronary heart disease, guide clinical management, evaluate efficacy and prognosis. The aim of this narrative review was to summarize the progress of cardiac PET for myocardial perfusion and its quantitative analysis.
With the improvement of positron emission computed tomography (PET/CT) devices and the availability of cardiac positron tracers, the clinical interest in myocardial perfusion PET(PET-MPI) has increased over the years. PET-MPI enables noninvasive and accurate quantification of myocardial blood flow(MBF) and myocardial flow reserve(MFR), making it possible to enhance detection of early stages of vascular dysfunction, improve risk stratification of coronary heart disease, guide clinical management, evaluate efficacy and prognosis. The aim of this narrative review was to summarize the progress of cardiac PET for myocardial perfusion and its quantitative analysis.
2017, 41(6): 430-436.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.009
Abstract:
18F-FDG PET plays an increasingly important role in clinical assessment. However, some false-positive and false-negative results for certain tumors have been achieved with 18F-FDG. Furthermore, fatty acid metabolic imaging is valuable in lipid-metabolism PET imaging. This technique compensates for the deficiency of 18F-FDG PET examination and improves the diagnostic sensitivity and accuracy of tumor detection. This review provides an overview of recent developments in the use of short-chain fatty acid radioactive probes in PET imaging.
18F-FDG PET plays an increasingly important role in clinical assessment. However, some false-positive and false-negative results for certain tumors have been achieved with 18F-FDG. Furthermore, fatty acid metabolic imaging is valuable in lipid-metabolism PET imaging. This technique compensates for the deficiency of 18F-FDG PET examination and improves the diagnostic sensitivity and accuracy of tumor detection. This review provides an overview of recent developments in the use of short-chain fatty acid radioactive probes in PET imaging.
2017, 41(6): 437-442.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.010
Abstract:
Diffuse large B-cell lymphoma(DLBCL) is a common aggressive non-Hodgkin lymphoma(NHL). When rituximab combined with cyclophosphamide, doxorubicin, vincristine, and methylprednisolone chemotherapy regimen is applied, the cure rate of DLBCL patients can reach 60%-80%. However, DLBCL possesses prominent heterogeneity of molecular pathology, and different patients have different efficacies and prognoses. Therefore, the correct evaluation of efficacy and prognosis is the focus of the current study. 18F-FDG PET/CT is an imaging tool commonly used for DLBCL patients during therapeutic and prognostic evaluation. The international prognostic index(IPI) and the national comprehensive cancer network-international prognostic index (NCCN-IPI) are widely used clinical prognostic scoring systems for malignant lymphoma. Recently, the prognostic value of a number of new clinical and molecular pathological factors has been explored. This study reviews the application, research progress, and development trend of PET/CT, clinical prognostic score system, different clinical and molecular pathologic prognostic factors during treatment evaluation, and prognosis of DLBCL patients.
Diffuse large B-cell lymphoma(DLBCL) is a common aggressive non-Hodgkin lymphoma(NHL). When rituximab combined with cyclophosphamide, doxorubicin, vincristine, and methylprednisolone chemotherapy regimen is applied, the cure rate of DLBCL patients can reach 60%-80%. However, DLBCL possesses prominent heterogeneity of molecular pathology, and different patients have different efficacies and prognoses. Therefore, the correct evaluation of efficacy and prognosis is the focus of the current study. 18F-FDG PET/CT is an imaging tool commonly used for DLBCL patients during therapeutic and prognostic evaluation. The international prognostic index(IPI) and the national comprehensive cancer network-international prognostic index (NCCN-IPI) are widely used clinical prognostic scoring systems for malignant lymphoma. Recently, the prognostic value of a number of new clinical and molecular pathological factors has been explored. This study reviews the application, research progress, and development trend of PET/CT, clinical prognostic score system, different clinical and molecular pathologic prognostic factors during treatment evaluation, and prognosis of DLBCL patients.
2017, 41(6): 443-447.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.011
Abstract:
Hashimoto's thyroiditis is a common autoimmune thyroid disease, and thyroid carcinoma is the most common endocrine malignancy. Moreover, papillary thyroid carcinoma is the most prevalent manifestation in patients with thyroid carcinoma. Recently, the prevalence of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma has increased, and the related pathogenesis and prognosis have become the focus of research and debate. This review focused on the research progress into epidemiological characteristics, histopathology features, pathogenesis, and prognosis-related factors of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.
Hashimoto's thyroiditis is a common autoimmune thyroid disease, and thyroid carcinoma is the most common endocrine malignancy. Moreover, papillary thyroid carcinoma is the most prevalent manifestation in patients with thyroid carcinoma. Recently, the prevalence of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma has increased, and the related pathogenesis and prognosis have become the focus of research and debate. This review focused on the research progress into epidemiological characteristics, histopathology features, pathogenesis, and prognosis-related factors of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.
2017, 41(6): 448-451.
doi: 10.3760/cma.j.issn.1673-4114.2017.06.012
Abstract:
Coronary heart disease, which commonly threatens human health, refers to coronary atherosclerosis caused by vascular stenosis, obstruction-induced myocardial ischemia, and hypoxic necrosis of heart disease. Various diagnostic methods are available for detecting coronary atherosclerotic plaque formation. However, these strategies exhibit evident limitations. With the development of CT technology, coronary CT angiography has become an important diagnostic and troubleshooting means for easy identification of plaque loss in the prevention and treatment of acute coronary events. This technology offers a positive clinical value.
Coronary heart disease, which commonly threatens human health, refers to coronary atherosclerosis caused by vascular stenosis, obstruction-induced myocardial ischemia, and hypoxic necrosis of heart disease. Various diagnostic methods are available for detecting coronary atherosclerotic plaque formation. However, these strategies exhibit evident limitations. With the development of CT technology, coronary CT angiography has become an important diagnostic and troubleshooting means for easy identification of plaque loss in the prevention and treatment of acute coronary events. This technology offers a positive clinical value.
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