2020 Vol. 44, No. 11
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2020, 44(11): 0-0.
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2020, 44(11): 1-4.
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2020, 44(11): 671-678.
doi: 10.3760/cma.j.cn121381-201909020-00100
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Objective To demonstrate whether 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters could predict the prognosis of patients with extranodal natural killer/T-cell lymphoma (ENKTL). Methods Thirty-seven patients, which comprise 27 males and 10 females, with a median age of 46 (21–76) years and newly diagnosed with ENKTL in Nanjing Drum Tower Hospital, were retrospectively analysed. The patients were divided into progression-free group and progression group according to their disease progression status and into survival group and death group according to their survival status. The maximum standardized uptake value (SUVmax) of each group was measured. Whole-body metabolic tumor volume (MTV) and whole-body total lesion glycolysis (TLG) were measured automatically using the threshold of 40% SUVmax. Mann-Whitney U test was used to evaluate the difference in PET parameters between groups. The optimal critical value of systemic MTV and systemic TLG was obtained by using the receiver operating characteristic curve analysis. The patients were divided into high or low groups according to the optimal critical value of PET parameters. The differences in the overall survival (OS) and progression-free survival (PFS) between groups divided by PET parameters were predicted by Kaplan-Meier method and Log-rank test. Univariate analysis was used to evaluat. Results The M (P25, P75) of SUVmax, whole-body MTV and whole-body TLG were 10.8 (6.9, 14.4), 13.1 (7.0, 16.7) cm3 and 53.81 (34.1, 97.4) in the progression-free group and 11.7 (9.5, 17.8), 29.4 (17.3, 69.2) cm3 and 183.5 (125.1, 725.3) in the progression group, respectively. The SUVmax, whole-body MTV and whole-body TLG of the progression group were higher than those of the progression-free group, and the difference was statistically significant (Z=−2.60, −3.28, −3.25; all P<0.01). The M (P25, P75) of SUVmax, whole-body MTV and whole-body TLG were 9.9 (6.7, 12.7), 10.2 (6.7, 17.1) cm3 and 52.4 (33.4, 90.4) in the survival group and 12.3 (9.9, 18.7), 25.5 (13.4, 113.6) cm3 and 187.8 (110.0, 1006.9) in the death group. The SUVmax, whole-body MTV and whole-body TLG of the dead group were higher than those of the survival group, and the differences were statistically significant (Z=−3.37, −3.11, −3.76; all P<0.01). The differences in the OS between the high and low SUVmax, whole-body MTV and whole-body TLG groups were statistically significant (χ2=5.12, 13.07, 15.51; all P<0.05). The differences in the PFS between the high and low whole-body MTV and whole-body TLG groups were statistically significant (χ2=17.55, 16.21; both P<0.05). The cut-off values for SUVmax, whole-body MTV and whole-body TLG were 9.03, 19.17 cm3 and 99.95, respectively, according to the receiver operating characteristic curve analysis. Univariate analysis showed that Ann Arbor stageⅢ/Ⅳ, Korean prognostic index score>2, SUVmax>9.03, whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were associated with OS, and Ann Arbor stageⅢ/Ⅳ stage, whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were associated with PFS. Multivariate analysis showed that whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were independent prognostic factors of both OS and PFS.whole-body TLG>99.95 were associated with PFS. Multivariate analysis showed that whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were independent prognostic factors of both OS and PFS. Conclusion The 18F-FDG PET/CT metabolic parameters whole-body MTV and whole-body MTV have remarkable prognostic value in patients with ENKTCL, whereas SUVmax has little value in prognosis prediction.
2020, 44(11): 679-684.
doi: 10.3760/cma.j.cn121381-201908003-00102
Abstract:
Objective To evaluate the association between BRAFV600E mutation and the lymph node metastasis (LNM) of papillary thyroid cancer (PTC). The effect of BRAFV600E mutation on stimulated thyroglobulin (s-Tg) after radioactive iodine (RAI) remnant ablation treatment was also evaluated. Methods The clinicopathological data of 2647 PTC patients (599 males; 2048 females; age range: 8–84 (45.00±11.70) years) who underwent near total or total thyroidectomy at Henan CancerHospital Affiliated to Zhengzhou University, from January 2013 to December 2018 were retrospectivelycollected and analyzed. The BRAFV600E status of the primary tumor was then identified. The patients were subsequently divided into the BRAFV600E mutation group (2230 cases) and the BRAFV600E wild group (417 cases), and differences in age, gender, tumor size, and lymph node metastasis between these two groups were analyzed. A total of 86 PTC patients (males 28; females 58; age range: 13–77 (42.72±15.69) years) who had received two RAI treatments were filtered from the groups and evaluated further in terms of differences in s-Tg level. The basic data of the two groups were compared via the chi-squared, two independent samples Student's t, and Mann-Whitney U rank-sum tests. Paired t test was used to evaluate the relationship between s-Tg and BRAFV600E mutation. Results The overall prevalence of BRAFV600E mutation in this study was 84.2% (2230/2647). The mean age and proportion of LNM were significantly higher in the mutation group than in the non-mutation group [(45.29±11.51) years vs. (43.43±12.53) years, t=5.28, P=0.022; 48.39% vs. 41.97%, χ2=5.81, P=0.016]. Among the 86 PTC patients who received RAI two RAI treatments, s-Tg levels were slightly higher in the mutation group [(61.16±90.95) ng/mL vs. (18.56±37.77) ng/mL, Z=−2.41, P=0.003], while significantly sharp decreased of s-Tg in wild group [(−1.61±37.18) ng/mL vs. (−24.00±30.00) ng/mL, t=−2.81, P=0.006] undergoing the first RAI remnant ablation. High s-Tg levels were present in the mutation group after the initial treatment. Conclusion PTC patients with the BRAFV600E mutation are at higher risk of developing LNM in PTC and show poor improvement in biochemical indicators after initial treatment.
2020, 44(11): 685-690.
doi: 10.3760/cma.j.cn121381-201912019-00095
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Objective To analyze the radiation-exposure dose of non-nuclear medical staff from patients who had undergone 99Tcm-MDP administration for whole-body bone scan. Methods From August 2018 to January 2019, 51 subjects who had undergone whole-body bone scan in our department were selected. The subjects were injected with 925 MBq 99Tcm-MDP and had drunk 1000 mL of water. They were divided into two groups, namely, micturition and non-micturition groups within 0.5 h. The equivalent dose rates of external radiation 0.5, 1, 2, 4, and 6 m away from the head or abdomen of the subject were measured at 0.5, 1, 2, 3, 4, and 6 h after 99Tcm-MDP injection and water drinking by using an χ, γ dosimeter. The Mann-Whitney U test of two independent samples was used to compare two groups. Repeated-measurement ANOVA was used to compare different times and distances of multiple measurements. The nonparametric Wilcoxon Z test was used for paired samples. Results The radiation equivalent dose rates of 0.5, 1, 2, 4, and 6 m in the urination group were significantly lower than those in the non-urination group [(40.29±4.67) μSv/h vs. (77.29±10.71) μSv/h, (15.22±1.64) μSv/h vs. (29.48±4.56) μSv/h, (4.15±0.47) μSv/h vs. (7.45±1.07) μSv/h, (1.32±0.10) μSv/h vs. (2.63±0.31) μSv/h, (0.45±0.05) μSv/h vs. (0.78±0.15) μSv/h], and the differences were statistically significant (Z=5.197, 5.148, 5.251, 5.199, and 5.202, respectively; all P<0.001). The radiation equivalent dose rates of the abdominal or head level in the urination group decreased rapidly with prolonged time (F=5397.675 and 4834.512, respectively; both P<0.001) and with increased distance (F=3459.712 and 3105.426, respectively; both P<0.001), and the differences were statistically significant. Meanwhile, the cumulative equivalent dose increased with prolonged time and decreased distance. Compared with the 6 h cumulative dose equivalent (148.51±13.83) μSV at 0.5 m of abdominal horizontal distance in urination group, the 6 h cumulative dose equivalent (55.85±5.22) μSV at 1 m of abdominal horizontal distance in urination group decreased significantly (Z=5.610, P<0.001). Compared with the 6 h cumulative dose equivalent (132.74±12.95) μSV at 0.5 m of head horizontal distance in urination group, the 6 h cumulative dose equivalent (49.88±4.72) μSV at 1 m of head horizontal distance in urination group decreased significantly (Z=5.438, P<0.001). The cumulative dose equivalent in urination group increased with the extension of irradiation time and decreased with the increase of distance. Conclusion The external exposure dose of 99Tcm-MDP from patients awaiting whole-body bone scan was far less than the limitation (≤1 mSv/year per individual) set by domestic and international legal rules for non-nuclear medical staff. Most of the exposure risks of non-nuclear medicine staff to 99Tcm-MDP from patients could be avoided by staying more than 1 m from the patient 3 h after injection.
2020, 44(11): 691-696.
doi: 10.3760/cma.j.cn121381-201909024-00094
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Objective To investigate the application of 99Tcm-diethylene-triaminepentaaccetic acid (99Tcm-DTPA) dynamic renal imaging in evaluating the compensatory function of healthy kidneys in patients with unilateral hydronephrosis. Methods A total of 257 cases of unilateral hydronephrosis admitted to the Second Hospital of Tianjin Medical University from January 2016 to July 2019 were retrospectively analyzed. They included 149 males and 108 females, aged 12~87 (52.84±14.23) years. All patients underwent 99Tcm-DTPA renal dynamic imaging, and their glomerular filtration rate (GFR) was counted using the Gates method. They were also grouped in accordance with the degree of hydronephrosis, the degree of renal impairment, gender, age, and etiology. The GFR compensation rate (%) of the uninfected kidney in different groups was calculated. The GFR of both kidneys was compared using independent sample t-test. The influencing factors of the compensatory ability were analyzed using the Mann-Whitney U and Kruskal-Wallis tests. Results The GFR of the affected kidney was (28.60±15.13) mL/min, while that of the contralateral kidney was (63.17±15.74) mL/min, and the total GFR was (92.94±24.46) mL/min. The GFR of the affected kidney was significantly lower than that of the contralateral kidney (t=25.39, P<0.001). Varying degrees of compensatory increase were observed in the GFR of the uninfected kidney, the GFR compensation rate was 9.54% (−5.94%, 26.45%). Statistically significant differences were also found in the GFR compensation rate of the contralateral kidney among patients of different ages and degrees of hydronephrosis (χ2=47.32, 12.71, both P<0.01). No statistically significant difference was found in the GFR compensation rate of the contralateral kidney among patients with different degrees of renal damage on the affected side, the location of hydronephrosis, the location of the stones, and gender (χ2=4.34, Z=−0.51, −1.62, −1.41, all P>0.05). Conclusion Using renal dynamic imaging to study the factors affecting the compensatory ability of the contralateral kidney in patients with unilateral hydronephrosis could further provide a basis for the diagnosis, treatment, and prognostic evaluation of these patients.
2020, 44(11): 697-703.
doi: 10.3760/cma.j.cn121381-201909015-00096
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Objective To explore differences in the morphology of atherosclerotic plaques among active smokers, passive smokers, and nonsmokers using CT angiography (CTA). Methods A retrospective analysis was performed on 284 patients (133 males and 151 females aged 42−79 (60.3±12.5) years old) with suspected cerebrovascular disease, including 95 active smokers and 87 passive smokers, and 102 nonsmokers who underwent 64-slice extracranial CTA in Chiping People's Hospital in Liaocheng City of Shandong Province from January 2017 to July 2019. Numbers of plaque involved segments, plaque type, area, burden, and remodeling index were compared among the three groups. Correlations between smoking index and numbers of plaque involved segments in the smoking and passive smoking groups were also calculated. Rates and the χ2 test were used to analyze qualitative data, while t test and one-way ANOVA were used to assess quantitative data. Spearman’s rank correlation test was used to analyze the relationship between smoking index and numbers of plaque involved segments. Results No difference in age, body mass index, incidence rates of diabetes, hypertension, hyperlipidemia was observed between groups (F=0.30, 0.43; χ2=1.58, 0.19, 0.56, all P>0.05). More males belonged to the active smoking group (83.2%, 79/95) than to the passive smoking (31.0%, 27/87) and nonsmoking (26.5%, 27/102) groups (χ2=10.03, 9.77, both P<0.05). A total of 2840 segments from 284 patients were studied, and 2058 (72.5%) segments revealed plaques. Total plaques (80.5% (765/950), 74.7% (650/870)), noncalcified plaques (46.8% (445/950), 40.0% (348/870)), and mixed plaques (45.6% (433/950), 41.4% (360/870)) involved segments percentages were more higher in the smoking and passive smoking groups than in the nonsmoking group (total plaques, 63.0% (643/1020); noncalcified plaques, 20.9% (213/1020); mixed plaques, 30.8% (314/1020)) (χ2=7.43−21.33, all P<0.05). Total plaques, noncalcified plaques involved segments percentages in the smoking group were more higher than in the passive smoking groups(χ2=7.40, 9.77, both P<0.05). Smokers and passive smokers had a higher plaque area, plaque burden, and remodeling index than nonsmokers in three types of plaques(t=6.54−20.11, all P<0.05), while smokers had a higher plaque area, plaque burden, and remodeling index than passive smokers in noncalcified and mixed plaques (t=9.05−15.64, all P<0.05). A positive correlation between smoking index and total plaques, noncalcified plaques, mixed plaques involved segments numbers in the smoking and passive smoking groups (smoking: r=0.52, 0.57, 0.48, all P<0.05; passive smoking: r=0.40, 0.42, 0.43, all P<0.05) were observed. Conclusions Active and passive exposure to smoke can lead to more atherosclerotic plaques and higher quantitative index. The greater the amount of smoking and the longer the age, the more segments involved in carotid artery plaque will be found.
2020, 44(11): 704-708.
doi: 10.3760/cma.j.cn121381-201908030-00090
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Lung cancer is one of the commonest cancers in the world. Among all malignant tumors, lung cancer has the highest fatality rate, while non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancer. As a functional imaging method that reflects the metabolic status of tumor cells at the molecular level, 18F-fluorodeoxyglucose (FDG) PET/CT has become an important tool for diagnosis, staging and efficacy evaluation of NSCLC. 18F-FDG PET/CT plays an increasingly important role in the prognosis of the patients with surgically resected NSCLC, because it can detect lesions left out by conventional CT. This paper reviews the application progress of 18F-FDG PET/CT related metabolic parameters in predicting the prognosis of resectable NSCLC.
Lung cancer is one of the commonest cancers in the world. Among all malignant tumors, lung cancer has the highest fatality rate, while non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancer. As a functional imaging method that reflects the metabolic status of tumor cells at the molecular level, 18F-fluorodeoxyglucose (FDG) PET/CT has become an important tool for diagnosis, staging and efficacy evaluation of NSCLC. 18F-FDG PET/CT plays an increasingly important role in the prognosis of the patients with surgically resected NSCLC, because it can detect lesions left out by conventional CT. This paper reviews the application progress of 18F-FDG PET/CT related metabolic parameters in predicting the prognosis of resectable NSCLC.
2020, 44(11): 709-716.
doi: 10.3760/cma.j.cn121381-201908025-00091
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Prostate-specific membrane antigen (PSMA), highly expressed in prostate cancer, provides a new strategy for the clinical diagnosis and treatment of prostate cancer as a specific biological target. At present, the research on the labeling of PSMA small molecule inhibitors is mostly focused on positron nuclide labels, such as 68Ga and 18F or beta radionuclide labels, such as 177Lu to realize diagnosis and targeted therapy of prostate cancer. In recent years, the application of single photon nuclide-labeled PSMA small molecule inhibitors has also made progress. This review summarizes the clinical application of single photon nuclide-labeled PSMA small molecule inhibitors in prostate cancer.
Prostate-specific membrane antigen (PSMA), highly expressed in prostate cancer, provides a new strategy for the clinical diagnosis and treatment of prostate cancer as a specific biological target. At present, the research on the labeling of PSMA small molecule inhibitors is mostly focused on positron nuclide labels, such as 68Ga and 18F or beta radionuclide labels, such as 177Lu to realize diagnosis and targeted therapy of prostate cancer. In recent years, the application of single photon nuclide-labeled PSMA small molecule inhibitors has also made progress. This review summarizes the clinical application of single photon nuclide-labeled PSMA small molecule inhibitors in prostate cancer.
2020, 44(11): 717-721.
doi: 10.3760/cma.j.cn121381-201907043-00093
Abstract:
The incidence of Hashimoto thyroiditis (HT) combined with papillary thyroid cancer (PTC) is increasing year by year, but the relationship between them remains controversial. This paper reviews the research progress in the epidemiology and pathogenesis, marker antibody, molecular characteristics, clinical pathological features, imaging diagnosis and treatment of HT combined with PTC.
The incidence of Hashimoto thyroiditis (HT) combined with papillary thyroid cancer (PTC) is increasing year by year, but the relationship between them remains controversial. This paper reviews the research progress in the epidemiology and pathogenesis, marker antibody, molecular characteristics, clinical pathological features, imaging diagnosis and treatment of HT combined with PTC.
Relationship between BRAFV600E mutation and pathological features and clinical poor prognosis of PTC
2020, 44(11): 722-727.
doi: 10.3760/cma.j.cn121381-201909031-00098
Abstract:
Thyroid cancer is the most common malignant tumor in the endocrine system, which can be divided into follicular thyroid cancer, papillary thyroid cancer (PTC), medullary thyroid carcinoma and anaplastic thyroid carcinoma. Among them, PTC is the most common pathological subtype. At present, surgical resection, 131I therapy and thyroid hormone replacement inhibition therapy are considered as the best treatments for PTC, but a small part of patients will undergo tumor recurrence or metastasis and their 10 years survival rate will be significantly reduced by 40% ~ 85%. Different clinical pathological features, such as lymph node metastasis, extrathyroid invasion, TNM stage will cause different prognosises (recurrence, metastasis, death, etc.). Therefore, the clinicopathological features above are also used to predict the prognosis of patients with PTC, and identifying such risk factors as soon as possible will buy more time for appropriate intervention and treatment to improve the prognosis. This paper reviews the relationship between BRAFV600E mutation and the clinicopathological features above and clinical poor prognosis of patients with PTC.
Thyroid cancer is the most common malignant tumor in the endocrine system, which can be divided into follicular thyroid cancer, papillary thyroid cancer (PTC), medullary thyroid carcinoma and anaplastic thyroid carcinoma. Among them, PTC is the most common pathological subtype. At present, surgical resection, 131I therapy and thyroid hormone replacement inhibition therapy are considered as the best treatments for PTC, but a small part of patients will undergo tumor recurrence or metastasis and their 10 years survival rate will be significantly reduced by 40% ~ 85%. Different clinical pathological features, such as lymph node metastasis, extrathyroid invasion, TNM stage will cause different prognosises (recurrence, metastasis, death, etc.). Therefore, the clinicopathological features above are also used to predict the prognosis of patients with PTC, and identifying such risk factors as soon as possible will buy more time for appropriate intervention and treatment to improve the prognosis. This paper reviews the relationship between BRAFV600E mutation and the clinicopathological features above and clinical poor prognosis of patients with PTC.
2020, 44(11): 728-736.
doi: 10.3760/cma.j.cn121381-201909026-00081
Abstract:
Great progress has been achieved in breast cancer molecular imaging thanks to the rapid development of nuclear medicine equipment and novel imaging agents. The exploration of specific molecular targets is not only helpful in the diagnostic evaluation of breast cancer, but also promotes the blossom of radionuclide targeted therapy. Along with the continuous emergence of molecular targeted probes and improvement of molecular targeted technologies, radionuclide targeted imaging and therapy may eventually become promising approaches in the personalized therapy of breast cancer. This review summarizes the research progress of radionuclide targeted therapy of breast cancer mediated by receptor, antibody and gene, and briefly introduces the improvement strategies and development prospects in the theranostics of breast cancer.
Great progress has been achieved in breast cancer molecular imaging thanks to the rapid development of nuclear medicine equipment and novel imaging agents. The exploration of specific molecular targets is not only helpful in the diagnostic evaluation of breast cancer, but also promotes the blossom of radionuclide targeted therapy. Along with the continuous emergence of molecular targeted probes and improvement of molecular targeted technologies, radionuclide targeted imaging and therapy may eventually become promising approaches in the personalized therapy of breast cancer. This review summarizes the research progress of radionuclide targeted therapy of breast cancer mediated by receptor, antibody and gene, and briefly introduces the improvement strategies and development prospects in the theranostics of breast cancer.
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