2018 Vol. 42, No. 1
Display Method:
2018, 42(1): 1-8.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.001
[PDF 1197KB]
Abstract:
ObjectiveTo evaluate the influence of thoracic radiation therapy (TRT) on the survival of patients with extensive-stage small cell lung cancer (ES-SCLC) after chemotherapy. MethodsA retrospective review was conducted on patients with ES-SCLC who received chemotherapy±TRT from January 2007 to December 2012. Most patients received initial chemotherapy with carboplatin plus etoposide or chemotherapy with cisplatin plus etoposide. A total of 130 cases of patients (39.8%) underwent TRT. TRT was performed through intensive modified radiotherapy. The median thoracic radiation dose was 56 Gy(32-67 Gy), with 1.8-2.3 Gy per fractions. The Kaplan-Meier, Log Rank test, and Cox regression were used for survival analysis and identification of prognostic factors. Statistically significant difference was set at P < 0.05. ResultsOverall, 327 consecutive patients were enrolled. The follow-up rate was 95.1%. Patients reaching complete response(CR), partial response(PR), and stable disease(SD) after chemotherapy accounted for 2.4%, 76.1%, and 21.4%, respectively. The median follow-up time for survival patients was 69 months. The median overall survival (OS) of the whole group was 13.7 months, and the median progression-free survival(PFS) was 9.3 months. These results showed that TRT significantly improved the OS and PFS of patients. The median OS was 20.0 and 11.4 months in the TRT and non-TRT groups, respectively. Correspondingly, their median PFS was 10.8 and 7.7 months, respectively. The two-, three-, and five-year OS were 42.5%, 27.8%, and 18.8% in the TRT group and 11.6%, 6.6%, and 3.5% in the non-TRT group, respectively(χ2=50.730, P < 0.001). Stratified analysis indicated that TRT can increase the OS in all the subgroups when the participants were divided according to different brain metastasis statuses and responses after chemotherapy(CR+PR, SD). However, TRT cannot improve the PFS of patients with brain metastasis. TRT can significantly decrease the locoregional recurrence rate to 19.2% and that of the non-TRT group was approximately 75.6%(χ2=100.080, P < 0.001). ConclusionTRT can significantly improve the OS and PFS and decrease the locoregional recurrence rate in all patients with ES-SCLC with different brain metastasis statuses and responses after chemotherapy.
2018, 42(1): 9-14.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.002
Abstract:
ObjectiveTo investigate the correlation between the maximum standardized uptake value(SUVmax) of colorectal cancer primary lesions and clinical pathological features, such as TNM staging and clinical staging. MethodsEighty-three patients diagnosed with colorectal cancer and without any previous treatment were retrospectively analyzed and underwent 18F-fluorodeoxyglucose PET/CT examinations within one week, in which the SUVmax of the primary lesions was measured. Data were compared using one-way ANOVA and two-sample t test. Spearman correlation analysis was used to evaluate the correlation of the SUVmax of colorectal cancer primary lesions with TNM staging and clinical staging. ResultsThe SUVmax of colorectal cancer primary lesions correlated with the tumor diameter(t=2.497, P < 0.05), pathological type and differentiation degree(F=3.727, P < 0.05). Statistically significant differences were found in the SUVmax of different N stages, M stages, and clinical stages(t=2.081, t=2.168, F=2.839, all P < 0.05) but not in the SUVmax of different T stages. The SUVmax of colorectal cancer primary lesions positively correlated with N, M, and clinical stages(r=0.248, 0.273, 0.324, all P < 0.05) but not with T stages (r=0.004, P>0.05). ConclusionsThe SUVmax of colorectal cancer primary lesions correlated with the tumor diameter, pathological type, differentiation degree, N stages, M stages, and clinical stages. Hence, SUVmax can reflect the invasion and proliferation abilities of colorectal cancer.
2018, 42(1): 15-20.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.003
Abstract:
ObjectiveTo explore the value of the 18F-FDG PET/CT imaging on the staging of gastric carcinoma and its influence on therapeutic schedule formulation. MethodsA retrospective analysis on the 18F-FDG PET/CT images of 46 patients with suspected clinical diagnosis of gastric cancer was performed through visual and semiquantitative evaluation by detecting the SUVmax and the maximum gastric wall thickness (Tmax). Subsequently, the diagnostic efficiency of the 18F-FDG PET/CT imaging for lesions was assessed by comparing with the pathology obtained from gastroscopy or postoperative pathology. Pearson correlation analysis was used to analyze the correlation between SUVmax and Tmax. ResultsThe sensitivity, specificity, and accuracy of 18F-FDG PET/CT imaging in detecting primary lesions were 94.4%, 40.0%, and 82.6%, respectively. The SUVmax of the primary lesions was positively correlated with the Tmax (r=0.922, P=0.001). The sensitivity, specificity, and accuracy of 18F-FDG PET/CT imaging were 76.9%, 90.0%, and 82.6% in detecting lymph node metastasis and 92.9%, 96.9%, and 95.7%, respectively, in recognizing distant metastasis. Conclusions18F-FDG PET/CT imaging showed high specificity and sensitivity in detecting primary foci, lymph node metastasis, and distant metastasis of gastric cancer. This technique is also remarkably important in accurate assessment of the clinical stage and therapeutic schedule formulation.
2018, 42(1): 25-29.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.005
Abstract:
ObjectiveTo invetigate the metabolic changes in the resting brain glucose of patients with type 2 diabetes but without brain metastasis. MethodsA total of 96 patients with type 2 diabetes were confirmed by 18F-FDG PET/CT examination. The whole-body 18F-FDG PET/CT images of the patients were retrospectively analyzed. Ninety-six healthy subjects were included as controls for comparison. The metabolic changes in resting brain glucose of the 96 patients with type 2 diabetes were analyzed using a statistical parametric mapping software. Data were processed with two independent sample t test of voxel to voxel in the images. ResultsCompared with the control group, the hypometabolic brain areas in patients with type 2 diabetes were in the bilateral middle-inferior frontal, bilateral superior-heschl gyrus, bilateral superior-middle-lingual gyrus, calcarine cortex, bilateral inferior parietal gyrus, and bilateral wedge anterior lobe(t=5.51-6.42, all P < 0.001). Hypermetabolic areas were not observed in patients. ConclusionsThe reduced metabolic cerebral regions in the patients with type 2 diabetes involved a number of functional regions related to visual cortex and mood disorders.
2018, 42(1): 30-35.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.006
Abstract:
ObjectiveTo study the effect of first time 131I clearance therapy on chronic salivary gland function in patients with differentiated thyroid cancer(DTC) after comprehensive intervention. MethodsFifty-two cases of DTC patients who were treated with 131I[(4200.24±604.21) MBq] clearance for the first time in the Department of Nuclear Medicine in Panzhihua Central Hospital were selected from August 2016 to September 2017. All patients were treated with 131I clearance immediately after the comprehensive intervention (diet nursing, psychological nursing, physical nursing, oral health care, health education, and drug therapy) and before and 6 months after treatment. Moreover, patients underwent 99TcmO4- salivary gland scintigraphy, and the peak uptake and excretion fraction(%) were calculated. The obtained data were analyzed by self-compared t test. The dry mouth scores of salivary gland function damage were also evaluated. Results(1) The peak uptake of the left parotid gland before 131I clearance and after 6 months of treatment was 45.157±19.421 and 52.600±21.716, respectively. The difference was statistically significant (t=2.470, P=0.018). (2) No significant difference was observed in the peak values between the right parotid and bilateral submandibular gland and between the bilateral parotid and bilateral submandibular glands(t=0.784, 0.524, 0.514, 0.362, 0.731, 0.596, 0.507, all P>0.05). (3) Fifty-two patients were analyzed by using questionnaires and dry mouth scores. Result showed that 50 cases(96.2%) indicated no xerostomia, and only two cases (3.8%) presented mild xerostomia. Conclusions(1) The first 131I treatment can cause salivary gland dysfunction in patients with DTC. This damage is mainly unilateral parotid gland uptake, which is an asymmetrical injury. Additionally, the uptake and excretory function of bilateral submandibular glands are not significantly affected. (2) Approximately 96.2% patients showed no significant dry mouth after receiving 131I clearance treatment for 6 months. Therefore, the intervention exerted significant effects on the quality of life of patients.
2018, 42(1): 36-40.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.007
Abstract:
ObjectiveTo study the sensitivity of vertebral fracture evaluation(VFA) combined with the use of lateral lumbar spine bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) in the diagnosis of senile osteoporosis. MethodsA total of 86 cases were collected using DXA to detect hip, lumbar spine, lateral lumbar spine BMD, and VFA simultaneously. Osteoporosis diagnosis was based on low-density DXA or VFA on fragile fracture. The osteoporosis detection rates between lateral lumbar spine BMD combined with VFA and conventional detection of DXA toward hip and lumbar BMD detection were compared by using chi-square test. ResultsAmong the subjects, 58 (76.3%) and 76 (100%) osteoporosis cases were detected by conventional DXA detection of hip and lumbar spine and lateral bone density combined with VFA. The osteoporosis detection rates of two groups were statistically significant (χ2=10.617, P < 0.001). The osteoporosis detection rate of femoral neck bone density(55.3%) was more than that of the whole hip (34.2%), and the difference was statistically significant (χ2=6.812, P < 0.05). The osteoporosis detection rates of hip BMD, lumbar orthotopic BMD, lateral lumbar spine BMD, and VFA were 60.5%, 47.4%, 84.2%, and 78.9%, respectively. The difference in the osteoporosis detection rates between lateral bone density and VFA was not statistically significant (χ2=0.700, P>0.05), but both rates were more than that of hip BMD (χ2=10.66, 6.110, both were P < 0.05). ConclusionThe detection of DXA toward lumbar lateral spine BMD combined with VFA is considerably significant in the diagnosis of senile osteoporosis. Therefore, the missed diagnosis of osteoporosis can be possibly avoided.
2018, 42(1): 41-46.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.008
Abstract:
ObjectiveTo determine the dosimetric differences between volumetric modulated arc radiotherapy(VMAT) an five fields intensity-modulated radiation therapy(5F-IMRT) for postoperative cervical cancer. MethodsTen patients with postoperative cervical carcinoma were enrolled in this study. Single arc VMAT, double arc VMAT, and 5F-IMRT plans were generated for these patients. Dose of target, conformal index (CI), homogeneity index (HI), organs at risk and monitor units (MU) were analyzed. The measurement data were analyzed by single factor analysis of variance, and an LSD test was performed in both two groups. ResultsSingle arc and double arc VMAT plans both satisfied the clinical dosimetriy requirements. No significant difference was observed between the VMAT and 5F-IMRT plans with respect to the maximum dose(Dmax) of the target, mean dose(Dmean), CI, and HI. Compared with these plans, the single arc VMAT was weaker and significantly different with respect to the above-mentioned variables (F=24.102, 13.710, 5.919, 11.045, all P < 0.05). There is no significant difference between the 3 plans of the minimum dose of the target (F=3.323, P>0.05). The MU values o f the single arc and double arc VMAT plans were significantly lower than that of 5F-IMRT(F=295.138, P>0.05). Meanwhile, significant difference was observed between the Dmax values of the small intestine, rectum, and bladder for double arc VMAT plan, single arc VMAT plan and those of the 5F-IMRT plan(F=16.069, 7.521, 13.966, all P < 0.05). The bladder V20, V30 and V40 for 5F-IMRT were better than those of the single arc and double arc VMAT, and the differences were significant(F=5.142, 20.095, 7.387, all P < 0.05). The left femoral head V20 and V30 for single arc and double arc VMAT plan was superior to that of 5F-IMRT, and the differences were statistically significant (F=3.717, 16.040, both P < 0.05). The right femoral head V30 and V40 for single arc and double arc VMAT plan was superior to that of 5F-IMRT, and the differences were statistically significant (F=10.873, 7.791, both P < 0.05). ConclusionsCompared with 5F-IMRT, the double arc VMAT achieved equal dosimetric parameters with fewer MU. In terms of organ at risk protection, the three plans have their own advantages, but the MU of the VMAT plan is significantly reduced, which can improve the treatment efficiency and worth further study.
2018, 42(1): 21-24, 29.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.004
Abstract:
ObjectiveTo explore the diagnostic value of SPECT localization and CT-guided percutaneous lung biopsy and tumor markers in peripheral lung cancer. MethodsA total of 275 patients with peripheral lung neoplasms were retrospectively analyzed. Pathological diagnosis was performed by SPECT with localizable CT-guided lung biopsy. The value of this imaging modality in combination with tumor markers in diagnosing lung cancer was evaluated. T-test or approximate t-test were used for data analysis using SPSS13.0 software. ResultsAll of the lung biopsies were successful. The sensitivity, specificity, and accuracy for lung cancer diagnosis were 97.01%, 100%, and 97.82%, respectively. No significant difference in carcino-embryonic antigen and CYFRA21-1 values was detected between non-small-cell lung cancer and small-cell lung cancer(t=1.081, 0.666, both P>0.05). However, the neuron-specific enolase(NSE) value of small-cell lung cancer(SCLC) was significantly higher than that of non-small-cell lung cancer(NSCLC), and the difference was statistically significant(t=3.671, P < 0.05). The area under the receiver operating curve of NSE was 0.935. The cut-off value of the diagnostic critical of NSE was 26.86 ng/mL, with a sensitivity of 91.34% and specificity of 84.92%. ConclusionsSPECT with localizable CT-guided percutaneous lung biopsy is feasible and highly accurate for diagnosis of peripheral lung cancer. In addition, NSE is useful in the identification of SCLC and NSCLC.
2018, 42(1): 47-52.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.009
Abstract:
ObjectiveTo develope a novel radiolabeled translocator protein(TSPO) ligand CB86 targeting agent 99Tcm-diethylene-triaminepentaacetic acid (DTPA)-CB86 and evaluate its biological properties. MethodsDPTA-CB86 was prepared by coupling with a bifunctional chelating agent, and then labeled with 99Tcm to obtain 99Tcm-DTPA-CB86. The labeling efficiency, radiochemical purity, and stability were determined in vitro. In vitro cellular uptake and efflux were performed using RAW264.7 macrophage cells. Biodistribution and micro-SPECT/CT images were investigated on Freund's adjuvant-induced left arthritis in mice. SPSS 18.0 analysis software(t-test) was used to fit the normal distribution and homogeneity of variance. ResultsThe labeling yields and radiochemical purity of 99Tcm-DTPA-CB86 were (95.86±2.45)% and (97.45±0.69)%, respectively. 99Tcm-DTPA-CB86 displayed good stability, with a radiochemical purity of more than 90%, in phosphate-buffered solution(PBS) at 4 h. It also exhibited high specific TSPO binging in RAW264.7 macrophage cells in vitro. The highest uptake ratio was (36.45±2.18)% at 3 h after incubation, which then decreased significantly[(10.43 ±2.01)%; t=6.217, P < 0.05)] after adding excessive unlabeled DTPA-CB86. The difference was significant. Cell efflux analysis showed that 99Tcm-DTPA-CB86 had good cell retention by RAW264.7 cells, with only about 13.99%[decreased from (33.31±2.34)% to (19.32±2.01)% of total input radioactivity] of 99Tcm-DTPA-CB86 efflux observed during 4.5 h to 8 h of incubation. Biodistribution and SPECT/CT imaging demonstrated that the uptake of 99Tcm-DTPA-CB86 in the left arthritic ankles was significantly increased compared with that in contralateral normal ankles. Uptake in the arthritic ankles could be largely blocked by an excess of DTPA-CB86. Conclusion99Tcm-DTPA-CB86 can be readily synthesized and clearly visualize arthritis with low background, thus demonstrating its potential as a promising molecular probe targeting TSPO for arthritic SPECT imaging.
2018, 42(1): 53-57.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.010
Abstract:
ObjectiveTo assess the diagnostic value of 18F-FDG PET/CT on mediastinal lymph node(MLN) metastasis in non-small cell lung cancer(NSCLC) by Meta analysis. MethodsPublications on MLN staging of NSCLC by PET/CT published from 1990 to 2016 were filtered and assessed according to the criteria from Wanfang, China National Knowledge Infrastructure, Vip database, PubMed, Embase, Cochrane Library database. Receiver operating characteristic curve analysis was applied and senstivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio(DOR) were calculated. The threshold effect analysis uses the area under the calculated curve. Subgroup analysis adopted t test. ResultsTwenty-two relevant literatures were enrolled (including 2543 patients). Meta analysis showed that the pooled senstivity, specificity, PLR, NLR and DOR were 0.66(0.62-0.69), 0.82(0.80-0.84), 3.60(2.82-4.58), 0.45(0.37-0.54), 9.12(6.15-13.52), respectively. Area under curve was 0.826. The results of subgroup analysis suggested that there was a statistically significant difference between the history of tuberculosis and no history of tuberculosis, and pulmonary tuberculosis was one important factor which influenced the PET/CT diagnosis of MLN metastasis in NSCLC patients. ConclusionPET/CT has a high accuracy for the MLN staging in NSCLC patients.
2018, 42(1): 58-61, 79.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.011
Abstract:
Compared with conventional radiation beams, heavy ion beam excels in its physical properties and biological characteristics. Limited energy release is absorbed by normal tissue before reaching the tumor while the energy bursts at the target region. This review presents the physical properties and biological characteristics of carbon ion beam and emphasizes recent progresses on apoptosis.
Compared with conventional radiation beams, heavy ion beam excels in its physical properties and biological characteristics. Limited energy release is absorbed by normal tissue before reaching the tumor while the energy bursts at the target region. This review presents the physical properties and biological characteristics of carbon ion beam and emphasizes recent progresses on apoptosis.
2018, 42(1): 62-68.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.012
Abstract:
131I whole-body scan and SPECT imaging in patients with differentiated thyroid cancer can provide information regarding metastasis and prognosis, and assist in treatment planning. However, false positive uptake, which is not residual thyroid tissue or metastases, is sometimes encountered. Unless recognized as a false positive, 131I uptake may result in diagnostic error and lead to administration of an unnecessary therapeutic dose. This review discussed various possibilities of false positive uptake on 131I whole-body scan, as well as the underlying causes and mechanisms.
131I whole-body scan and SPECT imaging in patients with differentiated thyroid cancer can provide information regarding metastasis and prognosis, and assist in treatment planning. However, false positive uptake, which is not residual thyroid tissue or metastases, is sometimes encountered. Unless recognized as a false positive, 131I uptake may result in diagnostic error and lead to administration of an unnecessary therapeutic dose. This review discussed various possibilities of false positive uptake on 131I whole-body scan, as well as the underlying causes and mechanisms.
2018, 42(1): 69-73.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.013
Abstract:
Sentinel lymph node biopsy is widely used in melanoma, breast cancer, and other malignancies. Main tracers used are radiotracers, vital blue dyes, and near-infrared fluorescent dyes; however, all have a problem with nonspecific uptake in secondary lymph nodes. The new specific-targeted sentinel node agents, which target points such as CD20 (presenting on the membrane of B lymphocytes) and CD206 (expressing on macrophages and dendritic cells), can be labeled with nuclide, fluorescence, or both. Compared with commonly used agents, these new tracers exhibit rapid clearance from the injection site, rapid uptake, high retention within the sentinel node, and low uptake by distal lymph nodes, thus satisfying the properties of an ideal lymph node imaging agent. A specific-targeted fluorescent radiopharmaceutical approach aims to apply pre-surgical nuclear imaging and intra-operative fluorescence imaging for the sentinel node localization of cancers, such as prostate and colon cancer. This article reviews and summarizes the research progress on these new specific-targeted agents.
Sentinel lymph node biopsy is widely used in melanoma, breast cancer, and other malignancies. Main tracers used are radiotracers, vital blue dyes, and near-infrared fluorescent dyes; however, all have a problem with nonspecific uptake in secondary lymph nodes. The new specific-targeted sentinel node agents, which target points such as CD20 (presenting on the membrane of B lymphocytes) and CD206 (expressing on macrophages and dendritic cells), can be labeled with nuclide, fluorescence, or both. Compared with commonly used agents, these new tracers exhibit rapid clearance from the injection site, rapid uptake, high retention within the sentinel node, and low uptake by distal lymph nodes, thus satisfying the properties of an ideal lymph node imaging agent. A specific-targeted fluorescent radiopharmaceutical approach aims to apply pre-surgical nuclear imaging and intra-operative fluorescence imaging for the sentinel node localization of cancers, such as prostate and colon cancer. This article reviews and summarizes the research progress on these new specific-targeted agents.
2018, 42(1): 74-79.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.014
Abstract:
In patients with Parkinson's disease(PD), a chronic progressive neurological degeneration order, the degeneration and loss of dopaminergic neurons in the substantia nigra is generally associated with the significant decrease in the number and disrupted function of dopamine transporters(DATs) in the presynaptic membrane. 11C-Altropane, a DAT-imaging agent, can specifically binds with DAT and directly reflects the changes in presynaptic dopaminergic neuron. In this paper, the synthesis of 11C-Altropane and its application as a PET imaging agent in clinical research were reviewed.
In patients with Parkinson's disease(PD), a chronic progressive neurological degeneration order, the degeneration and loss of dopaminergic neurons in the substantia nigra is generally associated with the significant decrease in the number and disrupted function of dopamine transporters(DATs) in the presynaptic membrane. 11C-Altropane, a DAT-imaging agent, can specifically binds with DAT and directly reflects the changes in presynaptic dopaminergic neuron. In this paper, the synthesis of 11C-Altropane and its application as a PET imaging agent in clinical research were reviewed.
2018, 42(1): 80-83.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.015
Abstract:
In 131I whole-body scan (WBS), imaging of normal thyroid tissues and differentiated thyroid cancer (DTC) can often uptake 131I and non-thyroid tissues to some extent. The author analyzes the reason and mechanism of false-positive uptake in the thorax cavity to provide essential help for the clinical diagnosis and treatment of patients with DTC.
In 131I whole-body scan (WBS), imaging of normal thyroid tissues and differentiated thyroid cancer (DTC) can often uptake 131I and non-thyroid tissues to some extent. The author analyzes the reason and mechanism of false-positive uptake in the thorax cavity to provide essential help for the clinical diagnosis and treatment of patients with DTC.
2018, 42(1): 84-86.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.016
Abstract:
We report a 69-year-old female with nearly 4 months of bilateral lower limb weakness and about 1 week of limited activity and pain. MRI of the thoracolumbar spine revealed that the lesion was mainly on the vertebral body and the corresponding intraspinal, epidural, and paravertebral soft tissues. In the Gd-enhanced images, the lesion was highly apparent and was diagnosed as a malignant tumor. However, the punctate bone density was increased upon PET/CT and 18F-FDG uptake was low. Furthermore, PET/CT imaging showed a cavernous hemangioma, and this was confirmed by histological examination of the tumor. The understanding of the cavernous hemangioma was deepened by literature review. A cavernous hemangioma can involve the vertebral body and vertebral appendages, and can even extend into the spinal canal and surrounding tissues. Cavernous hemangioma is a benign vascular malformation. The Gd-enhanced imaging is a valuable enhancement tool. Moreover, PET showed low 18F-FDG uptake. When the MRI lesions are widespread and obvious, malignancy should not be ruled out. Furthermore, PET/CT should be used for the differential diagnosis of benign lesions, such as cavernous hemangioma.
We report a 69-year-old female with nearly 4 months of bilateral lower limb weakness and about 1 week of limited activity and pain. MRI of the thoracolumbar spine revealed that the lesion was mainly on the vertebral body and the corresponding intraspinal, epidural, and paravertebral soft tissues. In the Gd-enhanced images, the lesion was highly apparent and was diagnosed as a malignant tumor. However, the punctate bone density was increased upon PET/CT and 18F-FDG uptake was low. Furthermore, PET/CT imaging showed a cavernous hemangioma, and this was confirmed by histological examination of the tumor. The understanding of the cavernous hemangioma was deepened by literature review. A cavernous hemangioma can involve the vertebral body and vertebral appendages, and can even extend into the spinal canal and surrounding tissues. Cavernous hemangioma is a benign vascular malformation. The Gd-enhanced imaging is a valuable enhancement tool. Moreover, PET showed low 18F-FDG uptake. When the MRI lesions are widespread and obvious, malignancy should not be ruled out. Furthermore, PET/CT should be used for the differential diagnosis of benign lesions, such as cavernous hemangioma.
2018, 42(1): 87-89, 94.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.017
Abstract:
The author reports a patient who was admitted due to 'pain in the lumbosacral region and bilateral lower limbs with limited activity for 1 year'. Based on clinical symptoms, laboratory tests, imaging examinations, bone marrow cell morphological examinations, and postoperative pathology, the patient was diagnosed with multiple myeloma, acute renal failure, hypercalcemia, hematopoietic dysfunction of bone marrow, and pulmonary infection. Moreover, SPECT revealed diffuse uptake of 99Tcm-MDP in bilateral pulmonary. Relevant literature suggests that multiple myeloma may cause renal insufficiency and induce secondary hyperparathyroidism, thereby leading to hypercalcemia. In the resulting hypercalcemia, Ca2+ is passively transported along the concentration gradient to the pulmonary alveoli and bronchial epithelial cells, where Ca2+ binds to the mitochondria and forms metastatic microcalcifications that take up 99Tcm-MDP and are opacified in SPECT. Combining medical history, examination results, and relevant literature, we suspected that extensive metastatic microcalcium deposition in the bilateral pulmonary mainly causes the diffuse development of 99Tcm-MDP. The metastatic calcification in bilateral pulmonary is low; therefore, it is difficult to detect using common imaging methods. Moreover, these patients always have severe ventilatory disorders, which have extremely poor prognosis. Therefore, 99Tcm-MDP imaging may be used to evaluate the diagnosis and efficacy, thus suggesting that clinicians should perform active symptomatic treatment as early as possible to improve prognosis and reduce mortality.
The author reports a patient who was admitted due to 'pain in the lumbosacral region and bilateral lower limbs with limited activity for 1 year'. Based on clinical symptoms, laboratory tests, imaging examinations, bone marrow cell morphological examinations, and postoperative pathology, the patient was diagnosed with multiple myeloma, acute renal failure, hypercalcemia, hematopoietic dysfunction of bone marrow, and pulmonary infection. Moreover, SPECT revealed diffuse uptake of 99Tcm-MDP in bilateral pulmonary. Relevant literature suggests that multiple myeloma may cause renal insufficiency and induce secondary hyperparathyroidism, thereby leading to hypercalcemia. In the resulting hypercalcemia, Ca2+ is passively transported along the concentration gradient to the pulmonary alveoli and bronchial epithelial cells, where Ca2+ binds to the mitochondria and forms metastatic microcalcifications that take up 99Tcm-MDP and are opacified in SPECT. Combining medical history, examination results, and relevant literature, we suspected that extensive metastatic microcalcium deposition in the bilateral pulmonary mainly causes the diffuse development of 99Tcm-MDP. The metastatic calcification in bilateral pulmonary is low; therefore, it is difficult to detect using common imaging methods. Moreover, these patients always have severe ventilatory disorders, which have extremely poor prognosis. Therefore, 99Tcm-MDP imaging may be used to evaluate the diagnosis and efficacy, thus suggesting that clinicians should perform active symptomatic treatment as early as possible to improve prognosis and reduce mortality.
2018, 42(1): 90-94.
doi: 10.3760/cma.j.issn.1673-4114.2018.01.018
Abstract:
Sacoidosis is a systematic disease that can involve multiple organs including lymph nodes, lungs, liver, spleen, heart and kidneys, etc. Lymph nodes and lungs are the most common involved places and lymphadenopathy in the mediastinum and bilateral hilum with or without lung invasion is the typical manifestation. It is difficult to differentiate the atypical sarcoidosis and other multiple systems involved disease, such as lymphoma, tuberculosis and lung cancer with metastasis. Two cases and their PET/CT imaging were presented here to discuss and help with differentiation and diagnosis of sarcoidosis in clinical practice.
Sacoidosis is a systematic disease that can involve multiple organs including lymph nodes, lungs, liver, spleen, heart and kidneys, etc. Lymph nodes and lungs are the most common involved places and lymphadenopathy in the mediastinum and bilateral hilum with or without lung invasion is the typical manifestation. It is difficult to differentiate the atypical sarcoidosis and other multiple systems involved disease, such as lymphoma, tuberculosis and lung cancer with metastasis. Two cases and their PET/CT imaging were presented here to discuss and help with differentiation and diagnosis of sarcoidosis in clinical practice.
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