2020 Vol. 44, No. 10
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2020, 44(10): 0-0.
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2020, 44(10): 1-4.
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2020, 44(10): 607-609.
doi: 10.3760/cma.j.cn121381-202009032-00086
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Novel coronavirus pneumonia is a new infectious disease which is highly contagious and serious harm to human health. It spreads mainly through droplet and contact with patients. In the process of the diagnosis and treatment in department of nuclear medicine, effective prevention and control measures should be taken accordance with the relevant national guidelines and standards according to different epidemic periods, so as to avoid cross infection and ensure the life, health and medical safety of nuclear medicine staff, patients and caregivers.
Novel coronavirus pneumonia is a new infectious disease which is highly contagious and serious harm to human health. It spreads mainly through droplet and contact with patients. In the process of the diagnosis and treatment in department of nuclear medicine, effective prevention and control measures should be taken accordance with the relevant national guidelines and standards according to different epidemic periods, so as to avoid cross infection and ensure the life, health and medical safety of nuclear medicine staff, patients and caregivers.
2020, 44(10): 610-615.
doi: 10.3760/cma.j.cn121381-202007038-00087
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Objective To evaluate and compare the diagnostic values of CT findings and nucleic acid testing in the corona virus disease 2019 (COVID-19) and investigate their features in the disease course. Methods The retrospective analysis was performed on the data of patients who received chest CT and nucleic acid testing from January 20, 2020 to March 5, 2020 in the First Affiliated Hospital of Zhengzhou University. This study involved 164 patients, including 76 confirmed (40 males and 36 females, aged 25−83 years old) and 88 suspected (47 males and 41 females, aged 21−75 years old) cases. The patients were divided into <60 years old group (122 cases) and ≥60 years old group (42 cases). The performance of CT in diagnosing COVID-19 was assessed using nucleic acid testing results as the gold standard. For confirmed patients with multiple CT images and nucleic acid tests, the CT findings and nucleic acid testing results were analyzed comparatively from the beginning of the disease to the progress and turnover of the disease. Results Of 164 patients, 46.3% (76/164) had positive nucleic acid testing results, and 87.2% (143/164) had positive CT findings. Considering the nucleic acid testing results as standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosing COVID-19 were 96.1% (73/76), 20.5% (18/88), 51.0% (73/143), 85.7% (18/21), and 55.5% (91/164), respectively. There was no significant difference in CT diagnostic efficiency between <60 years old group and ≥60 years old group (χ2=0.051−0.414, all P>0.05). In patients with negative nucleic acid testing results, 79.5% (70/88) had positive CT findings. In patients with positive nucleic acid testing results, 10.5% (8/76) had no symptom, 9.2% (7/76) had negative CT findings, and 14.5% (11/76) had negative nucleic acid testing results when first examined. Among the 11 patients with initially negative nucleic acid testing results, 81.8% (9/11) had positive CT findings, and the nucleic acid testing results changed from negative to positive during the follow-up period. In the course of disease development, the CT could present progress and improvement. The nucleic acid testing results of 50.0% (14/28) of cases with CT finding improvement changed from positive to negative in the follow-up at 4 to 8 days, and the nucleic acid testing results of 67.4% (31/46) cases changed from positive to negative in the follow-up at 9 to 12 days. Conclusion CT had higher sensitivity for the diagnosis of COVID-19 compared with the initial nucleic acid testing and could show condition improvement earlier than the nucleic acid testing results, it is an important supporting means in clinical practice .
2020, 44(10): 616-621.
doi: 10.3760/cma.j.cn121381-202006039-00083
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COVID-19 has been rapidly spreading since its discovery. Early diagnosis benefits the patients and helps control the spread of COVID-19. At present, the diagnosis of COVID-19 is based on epidemiology, clinical characteristics, imaging features, and reverse transcription-polymerase chain reaction (RT-PCR) test. The diagnosis of COVID-19 is confirmed by RT-PCR test, which detects a positive severe acute respiratory syndrome coronavirus 2 nucleic acid. Imaging features, especially lung high-resolution CT features, are essential for the clinical diagnosis of COVID-19. 18F-FDG PET/CT is a widely used imaging modality, but its value for COVID-19 diagnosis is still unknown. This review summarizes the potential value of 18F-FDG PET/CT for the diagnosis, differential diagnosis, and assessment of mediastinal lymph node involvement. The possible imaging features of extrapulmonary involvement in patients with COVID-19 are also discussed.
COVID-19 has been rapidly spreading since its discovery. Early diagnosis benefits the patients and helps control the spread of COVID-19. At present, the diagnosis of COVID-19 is based on epidemiology, clinical characteristics, imaging features, and reverse transcription-polymerase chain reaction (RT-PCR) test. The diagnosis of COVID-19 is confirmed by RT-PCR test, which detects a positive severe acute respiratory syndrome coronavirus 2 nucleic acid. Imaging features, especially lung high-resolution CT features, are essential for the clinical diagnosis of COVID-19. 18F-FDG PET/CT is a widely used imaging modality, but its value for COVID-19 diagnosis is still unknown. This review summarizes the potential value of 18F-FDG PET/CT for the diagnosis, differential diagnosis, and assessment of mediastinal lymph node involvement. The possible imaging features of extrapulmonary involvement in patients with COVID-19 are also discussed.
2020, 44(10): 622-626.
doi: 10.3760/cma.j.cn121381-202002014-00079
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Corona virus disease 2019 (COVID-19) has been discovered and spread quickly since December 2019. It is extremely important to protect the staff and patients in nuclear medicine department during the epidemic period. Nuclear medicine diagnosis and treatment work, such as outpatient service, imaging tests, clinical examinations and radionuclide ward treatments, involves many workplaces and relatively complex procedures. Therefore, the requirements for the protection and management of staff and patients in all aspects of the process and the environmental disinfection of workplaces should be more stringent. Based on relevant national guidelines and the actual situation, this paper puts forward protection and management proposals on nuclear medicine diagnosis and treatment work during the COVID-19 epidemic period to ensure the safety of staff and patients.
Corona virus disease 2019 (COVID-19) has been discovered and spread quickly since December 2019. It is extremely important to protect the staff and patients in nuclear medicine department during the epidemic period. Nuclear medicine diagnosis and treatment work, such as outpatient service, imaging tests, clinical examinations and radionuclide ward treatments, involves many workplaces and relatively complex procedures. Therefore, the requirements for the protection and management of staff and patients in all aspects of the process and the environmental disinfection of workplaces should be more stringent. Based on relevant national guidelines and the actual situation, this paper puts forward protection and management proposals on nuclear medicine diagnosis and treatment work during the COVID-19 epidemic period to ensure the safety of staff and patients.
2020, 44(10): 627-630.
doi: 10.3760/cma.j.cn121381-202002018-00084
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At the end of 2019, corona virus disease 2019 (COVID-19) was discovered and spread quickly. It has brought great challenges to the routine work of medical workers. The nuclear medicine department, different from the general imaging department, is mainly responsible for three parts of work including radioactive nuclide diagnosis, nuclide therapy and in vitro analysis. Numerous staff, scattered locations, complex process and inspection items make the management of patients more complicated. Protection work during this period includes not only radioprotection but also strict protection and defense against COVID-19, which called “Dual Defense”. This paper summarizes the special workflow of nuclear medicine department during the outbreak period of COVID-19 based on a series of diagnosis and treatment schemes, protective measures, and guidelines issued by the National Health Commission of the People's Republic of China, as well as actual work experience. The main purpose is to effectively protect people against nuclide radiation and blockade the spread of COVID-19 to the maximum extent simultaneously, reduce the risk of infection for medical staff and improve the medical safety and quality.
At the end of 2019, corona virus disease 2019 (COVID-19) was discovered and spread quickly. It has brought great challenges to the routine work of medical workers. The nuclear medicine department, different from the general imaging department, is mainly responsible for three parts of work including radioactive nuclide diagnosis, nuclide therapy and in vitro analysis. Numerous staff, scattered locations, complex process and inspection items make the management of patients more complicated. Protection work during this period includes not only radioprotection but also strict protection and defense against COVID-19, which called “Dual Defense”. This paper summarizes the special workflow of nuclear medicine department during the outbreak period of COVID-19 based on a series of diagnosis and treatment schemes, protective measures, and guidelines issued by the National Health Commission of the People's Republic of China, as well as actual work experience. The main purpose is to effectively protect people against nuclide radiation and blockade the spread of COVID-19 to the maximum extent simultaneously, reduce the risk of infection for medical staff and improve the medical safety and quality.
2020, 44(10): 631-633.
doi: 10.3760/cma.j.cn121381-202002031-00082
Abstract:
The study reported a COVID-19 case performed with asthenia, fever as the first symptom, unclear history of epidemiology, laboratory examination implied bacterial infection. Chest CT imaging examination on the 8th day after onset indicated suspected case and finally confirmed by nucleic acid detection. The disease is a respiratory infectious disease caused by a novel corona virus. It is highly communicable. Some patients had multiple visceral involvement, and the disease progressed rapidly. This case is the first case of regional aggregation. The authors are trying to imply that patients with high-risk occupation but without a clear history of epidemiology should pay enough attention to the clinical work of COVID-19 and control. Early chest CT imaging examination and repeated nucleic acid tests for suspected cases are helpful to reduce ignored diagnosis.
The study reported a COVID-19 case performed with asthenia, fever as the first symptom, unclear history of epidemiology, laboratory examination implied bacterial infection. Chest CT imaging examination on the 8th day after onset indicated suspected case and finally confirmed by nucleic acid detection. The disease is a respiratory infectious disease caused by a novel corona virus. It is highly communicable. Some patients had multiple visceral involvement, and the disease progressed rapidly. This case is the first case of regional aggregation. The authors are trying to imply that patients with high-risk occupation but without a clear history of epidemiology should pay enough attention to the clinical work of COVID-19 and control. Early chest CT imaging examination and repeated nucleic acid tests for suspected cases are helpful to reduce ignored diagnosis.
2020, 44(10): 634-640.
doi: 10.3760/cma.j.cn121381-202003048-00088
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Objective To investigate the efficacy and safety of regadenoson injection as cardiac stress medicine. It was compared with adenosine injection by using radionuclide myocardial perfusion imaging (MPI) to diagnose coronary disease. Coronary angiography (CAG) was the standard used for this study. Methods Forty-two subjects with suspected coronary heart disease who were admitted in the First Hospital of Shanxi Medical University from September 2017 to October 2018 were retrospectively analyzed. All subjects were randomly divided into two groups, namely, regadenoson group (8 males; 9 females; age: 59.83±7.88 years old) and adenosine group (12 males; 13 females; age: 56.32±7.34 years old). All subjects underwent rest MPI and stress MPI. Regadenoson and adenosine were injected as medicines. All subjects underwent CAG within 2 weeks. The diagnostic efficacy of regadenoson and adenosine were compared with the results of CAG, which was defined as the gold standard. Adverse reactions were also observed for the two drugs. Two sample t-test, paired t-test or analysis of variance, and Wilcoxon Z rank sum test were used to compare measurement data. Two sample McNemar test or Fisher's exact test were used to measure data. Kappa test was used to test the consistency of the two groups. Results There were no statistically significant difference between the two groups of general data, the positive rate and the degree of stenosis (t=−1.503−1.201, Z=−1.346−−0.228, Fisher's exact test, all P>0.05). With the results of CAG as the gold standard, the diagnosis sensitivity of regadenoson MPI was 70.00% (7/10), specificity was 87.80% (36/41), positive predictive value was 58.33% (7/12), negative predictive value was 92.31% (36/39), and accuracy was 84.31% (41/51). The sensitivity of adenosine MPI was 71.43% (10/14), specificity was 86.89% (53/61), positive predictive value was 55.56% (10/18), negative predictive value was 92.98% (53/57), and accuracy was 84.00% (63/75). No obvious statistically significant difference for each value was found between the two drugs (Fisher's exact test, all P=1.00). The consistency was moderate between the two groups of drugs and CAG (κ=0.537, 0.525, respectively, both P<0.001). The side effects were mild and transient. No obvious statistically significant difference (Fisher's exact test, all P>0.05) was found between the two groups in terms of adverse reactions, such as blushing, chest pain, chest tightness, dyspnea, dizziness, headache, nausea, and palpitation. Statistically significant difference was only found for abdominal discomfort (Fisher's exact test, P=0.044). Conclusion Regadenoson injection is similar in terms of efficacy and safety when compared with the injection drug load of adenosine according to the results of myocardial perfusion imaging.
2020, 44(10): 641-648.
doi: 10.3760/cma.j.cn121381-201909027-00089
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Objective To investigate the clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in preoperative tumor, node, metastasis (TNM) staging of rectal cancer and the correlation between the maximum standardized uptake value (SUVmax) of primary lesions and clinicopathological features. Methods To evaluate the accuracy of 18F-FDG PET/CT in assessing invasion depth, lymph node metastasis, metastasis, and clinical staging before operation, a retrospective analysis was performed on data collected from 117 rectal cancer patients, including 66 males and 51 females (aged 29–83 years old, median age 57 years), who underwent 18F-FDG PET/CT examination before operation in Fujian Cancer Hospital from January 2013 to December 2018. Kappa test was used for consistency test. The patients were grouped according to gender, age, length of primary lesion, pathological type, differentiated degree, lymphovascular invasion (LVI), perineural invasion (PNI), TNM staging, and clinical staging. Independent sample t-test and one-way ANOVA were used to analyze the difference in SUVmax between groups. Pearson or Spearman correlation was used to analyze the relationship between the SUVmax of primary lesions and clinicopathological features. Results The diagnostic accuracies of 18F-FDG PET/CT on rectal cancer invasion depth, lymph node metastasis, metastasis, and clinical staging were 76.1%, 81.2%, 95.7%, and 76.9%. The consistency with pathological results was as follows (κ=0.601, 0.535, 0.867, 0.667, all P<0.01). Statistically significant differences were observed in the SUVmax of different groups of length of primary lesion (t=4.982, P<0.01), LVI (t=−2.581, P=0.011), PNI (t=−2.873, P=0.005), N staging (t=2.792, P=0.006), and clinical staging (F=3.072, P=0.031), but no statistically significant differences were observed in the SUVmax of different groups of gender (t=0.688, P=0.493), age (t=1.523, P=0.130), pathological type (t=0.886, P=0.377), differentiated degree (t=0.045, P=0.964), T staging (F=2.323, P=0.103), and M staging (t=−1.502, P=0.136). The SUVmax of the primary lesion was positively correlated with the length of the primary lesion, LVI, PNI, N staging, and clinical staging (r=0.230–0.308, all P<0.05). Conclusions 18F-FDG PET/CT has high accuracy in diagnosing rectal cancer primary lesions, lymph nodes, and metastasis and is an effective method for staging rectal cancer. The SUVmax of primary lesions can partially reflect the invasion and proliferation ability of rectal cancer.
2020, 44(10): 649-654.
doi: 10.3760/cma.j.cn121381-201906022-00080
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As the common side effect of radiotherapy for abdominal and pelvic tumors, radiation-induced intestinal injury (RIII) has seriously affected the subsequent therapy for cancer patients and the life quality of survivors. The number of patients with RIII are far exceeded those with inflammatory bowel disease, and there is an urgent need for effective treatment. Evidence supporting a pivotal role of the gut microbiota in the development of RIII has been growing. Fecal microbiota transplantation (FMT) has been confirmed to restore the abundance and diversity of patients' microbiota, and has become a potential method in the treatment of RIII. In this review, we put foward our current understanding of the role and mechanism of intestinal microbes in RIII and the application of FMT in the treatment of RIII.
As the common side effect of radiotherapy for abdominal and pelvic tumors, radiation-induced intestinal injury (RIII) has seriously affected the subsequent therapy for cancer patients and the life quality of survivors. The number of patients with RIII are far exceeded those with inflammatory bowel disease, and there is an urgent need for effective treatment. Evidence supporting a pivotal role of the gut microbiota in the development of RIII has been growing. Fecal microbiota transplantation (FMT) has been confirmed to restore the abundance and diversity of patients' microbiota, and has become a potential method in the treatment of RIII. In this review, we put foward our current understanding of the role and mechanism of intestinal microbes in RIII and the application of FMT in the treatment of RIII.
2020, 44(10): 655-660.
doi: 10.3760/cma.j.cn121381-201906019-00076
Abstract:
Hepatic uptake is often used as the reference standard for the evaluation of image quality, therapeutic efficiency and diagnosis of diseases in 18F-fluorodeoxyglucose (FDG) PET/CT imaging. However, the liver shows diffuse, homogeneous or heterogeneous high 18F-FDG uptake sometimes, called "hepatic superscan". Except for biologic and technical factors, many diffuse hepatic parenchymal diseases and malignancies may increased the uptake of 18F-FDG by the liver. This paper reviews this in order to widen the view in clinical differential diagnosis.
Hepatic uptake is often used as the reference standard for the evaluation of image quality, therapeutic efficiency and diagnosis of diseases in 18F-fluorodeoxyglucose (FDG) PET/CT imaging. However, the liver shows diffuse, homogeneous or heterogeneous high 18F-FDG uptake sometimes, called "hepatic superscan". Except for biologic and technical factors, many diffuse hepatic parenchymal diseases and malignancies may increased the uptake of 18F-FDG by the liver. This paper reviews this in order to widen the view in clinical differential diagnosis.
2020, 44(10): 661-666.
doi: 10.3760/cma.j.cn121381-201909035-00074
Abstract:
The rupture of vulnerable plaques often leads to acute coronary syndrome, causing severe cardiovascular events. Therefore, early detection of vulnerable plaques is of great significance. Molecular imaging technology, such as nuclear medicine molecular imaging, ultrasound molecular imaging, MRI and optical imaging, are used to monitor vulnerable plaques. In recent years, multimodal molecular imaging technology, providing more anatomical and biological metabolism information, has higher application value in monitoring vulnerable plaques. The preparation and construction of multimodal molecular probes are crucial for molecular imaging diagnosis of diseases. Seeking suitable targets and enhancing the targeting of molecular probes are beneficial to improve the detection rate of diseases and vulnerable plaques. Nanomaterials with special properties and advantages have been widely used in multimodal molecular probes. However, these nanoprobes are still in the preclinical research stage and are mainly used in animal models. This review focuses on the various biomarkers that appear in the histological, cellular and molecular biological changes of vulnerable plaques, and summarizes the research progress in targeted molecular imaging of multimodal nanomolecular probes in vulnerable plaques in animal models.
The rupture of vulnerable plaques often leads to acute coronary syndrome, causing severe cardiovascular events. Therefore, early detection of vulnerable plaques is of great significance. Molecular imaging technology, such as nuclear medicine molecular imaging, ultrasound molecular imaging, MRI and optical imaging, are used to monitor vulnerable plaques. In recent years, multimodal molecular imaging technology, providing more anatomical and biological metabolism information, has higher application value in monitoring vulnerable plaques. The preparation and construction of multimodal molecular probes are crucial for molecular imaging diagnosis of diseases. Seeking suitable targets and enhancing the targeting of molecular probes are beneficial to improve the detection rate of diseases and vulnerable plaques. Nanomaterials with special properties and advantages have been widely used in multimodal molecular probes. However, these nanoprobes are still in the preclinical research stage and are mainly used in animal models. This review focuses on the various biomarkers that appear in the histological, cellular and molecular biological changes of vulnerable plaques, and summarizes the research progress in targeted molecular imaging of multimodal nanomolecular probes in vulnerable plaques in animal models.
2020, 44(10): 667-671.
doi: 10.3760/cma.j.cn121381-202004018-00085
Abstract:
In renal dynamic imaging, shot injection is needed, because the quality of shot injection directly affects the imaging result, therefore, the injection requirements are higher. This article reviews the application of direct injection, three-way injection, indwelling needle injection, intravenous injection and other methods in radionuclide renal dynamic imaging, and analyzes the advantages and disadvantages of various injection methods, to provide reference for improving the success rate of nuclide kidney dynamic pellet injection.
In renal dynamic imaging, shot injection is needed, because the quality of shot injection directly affects the imaging result, therefore, the injection requirements are higher. This article reviews the application of direct injection, three-way injection, indwelling needle injection, intravenous injection and other methods in radionuclide renal dynamic imaging, and analyzes the advantages and disadvantages of various injection methods, to provide reference for improving the success rate of nuclide kidney dynamic pellet injection.
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