2020 Vol. 44, No. 2
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2020, 44(2)
Abstract:
2020, 44(2): 73-80.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.001
Abstract:
Objective To explore the related factors affecting the reduction of radiation dose rate and to estimate the hospitalization days in papillary thyroid cancer (PTC) patients with postoperative after first 131I therapy. Methods A total of 167 patients with PTC were hospitalized and treated with iodine-131 from May 2015 to November 2018 at Zhujiang Hospital, Southern Medical University. The patients were divided into the high-dose group (63 cases) and the low dose-group (104 cases). The radiation dose rates of the two groups of patients at different time points were measured at a distance of 1 m, the required hospitalization isolation time was analyzed, and the factors related to the reduction in radiation dose rate were analyzed by using multiple linear regression method. Two independent samples nonparametric test and t-test were used to compare the differences between groups. Results After iodine-131 treatment for the first time, the radiation dose rate of the patients with PTC decreased exponentially with time, and the radiation dose rates of the high-dose group[(70.62± 34.45), 15.64 μSv/h] at 24 h and 48 h after iodine-131 treatment were significantly higher than those of the low-dose group [(11.27±5.13), 2.03 μSv/h] (t=−13.581, −7.952, both P < 0.01). Approximately 81.0% (51/63) and 90.5% (57/63) of the high-dose group were discharged after iodine-131 treatment for 48 h and 72 h, respectively. By contrast, 99% (103/104) of the low-dose group was discharged after iodine-131 treatment for 24 h. According to multiple linear regression analysis, the effects of iodine-131 dose, iodine uptake rate at 2 h on radiation dose rate at 24 h in the high dose group were statistically significant (F = 9.23, complex correlation coefficient R2 = 0.212, P < 0.01), and both iodine-131 dose and iodine uptake rate at 2 h had positive correlation with 24 h radiation dose rate. The effects of gender, iodine uptake rate at 24 h and residual thyroid volume (method 3) on radiation dose rate at 48 h in the high-dose group were statistically significant (F=34.45, complex correlation coefficient R2 = 0.622, P < 0.01), moreover the radiation dose rate at 48 h was positively correlated with iodine uptake rate at 24 h and residual thyroid volume, and negatively correlated with gender. The effects of iodine-131 dose and drinking water amount at 24 h on the radiation dose rate at 24 h in the low-dose group were statistically significant (F=12.76, complex correlation coefficient R2=0.186, P < 0.01), furthermore the radiation dose rate at 24 h in the low-dose group was positively correlated with iodine-131 dose, and negatively correlated with drinking water amount at 24 h. Conclusions After the first iodine-131 treatment for 24 h, the main factors influencing the reduction in the radiation dose rate of patients with PTC were the dose of iodine-131. The main factors influencing the reduction in radiation dose rate after 48 h were the iodine uptake rate of the thyroid at 24 h, the volume of the residual thyroid gland, and the gender of the patient. The mean hospitalization time in low dose group and high dose group was about 1 day and 2 days respectively.
2020, 44(2): 81-86.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.002
Abstract:
Objective To investigate the clinical value of third-generation dual-source dual-energy CT virtual decalcification bone marrow imaging in evaluating vertebral osteogenic bone metastases. Methods A retrospective analysis was conducted on 48 patients with malignant tumor [27 males and 21 females, aged (62.4±10.5) years] hospitalized in the First Hospital of Shanxi Medical University from November 2017 to September 2018. All patients underwent dual-source dual-energy CT imaging and 99Tcm-methylenediphosphonate (MDP) whole-body bone imaging simultaneously. On the basis of clinical follow-up or pathological diagnosis, the diagnostic value of three methods of whole-body bone imaging, conventional CT, and bone marrow imaging in vertebral osteogenic bone metastases were compared and studied. Bone marrow density (CT value) was measured through bone marrow imaging. First, the sensitivity, specificity, positive and negative predictive values, and accuracy of the three methods for diagnosis of vertebral osteogenic bone metastases were compared through χ2 test. Second, the bone marrow CT value of vertebral metastases was compared with that of the normal vertebral body through t-test. Third, the subjective score and bone marrow CT value were analyzed through receiver operating characteristic curve analysis. Results A total of 48 patients with 598 vertebral bodies were examined in this study, where in 135 vertebral bodies were diagnosed with osteogenic bone metastases. 99Tcm-MDP whole-body bone imaging was diagnosed in 127 cases, conventional CT was diagnosed in 119 cases, and bone marrow imaging was diagnosed in 129 cases. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of bone marrow imaging diagnosis were 95.56%, 94.82%, 84.31%, 98.65%, and 94.98%, respectively. The negative predictive values (98.17%, 96.60%, and 98.65%) and accuracy (92.81%, 95.82%, and 94.98%) of the three methods had no statistical significance (χ2=4.891, 5.591; P=0.087, 0.061). Sensitivity (94.07% vs. 95.56%), specificity (92.44% vs. 94.81%), and positive predictive value (78.40% vs. 84.31%) of whole-body bone and bone marrow imaging were not statistically different (χ2= 0.301, 2.190, 1.811; P =0.583, 0.139, 0.178). The bone marrow density of the metastatic focus of the diseased vertebral body was lower than that of the normal vertebral body (−588.96±332.37) HU vs. (−55.03±75.62) HU (t=31.906, P=0.000). The AUC of bone marrow density was 0.99 with a cut-off value of −119.6 HU (sensitivity and specificity were 97.80% and 96.50%, respectively). Conclusion The third-generation dual-source dual-energy CT virtual decalcified bone marrow imaging can be used for detecting osteogenic bone metastases of vertebral bodies.
2020, 44(2): 87-91.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.003
Abstract:
Objective To study the equivalence of the Novel Medical NET632 SPECT and the SIEMENS Symbia T16 SPECT/CT in whole-body bone scintigraphy. Methods A total of 32 cases (21 males and 11 females; aged 60.87±12.25 years) in the Department of Nuclear Medicine of the Affiliated Hospital of Inner Mongolia Medical University from March 2018 to September 2018 were found positive with bone lesions in the whole-body bone scintigraphy using the SIEMENS Symbia T16 SPECT/CT and the Novel Medical NET632 SPECT. Then, the image quality was compared using the same image scoring criteria. The positive lesion involvement area and the number of areas in each patient were determined using the two devices. Results The image qualities were scored 5, 4, and 3 (including < 3) for 18, 14, and 0 in the Symbia T16 SPECT/CT, and the image qualities were scored 5, 4, and 3（including < 3）for 16, 16, and 0. A total of 84 positive lesion sites were found in the chest, spine, pelvis, limbs, and skull by using the Symbia T16 SPECT/CT, and the numbers in each location were 19, 24, 20, 16, and 5, respectively. The same number of positive lesions was observed in the same locations for the NET 632 SPECT. Conclusion The Novel Medical NET632 SPECT and the SIEMENS Symbia T16 SPECT/CT detect the lesions in whole-body bone scintigraphy equivalently.
2020, 44(2): 92-98.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.004
Abstract:
Objective To analyze the current situation and development trend of nuclear medicine in China and to provide references for the scientific and effective utilization of nuclear medicine resources and the formulation of development policies by relevant competent authorities. Methods The current situation and development trend of nuclear medicine in China were analyzed using five censuses conducted by the Chinese Society of Nuclear Medicine that contain basic information on the discipline, drug preparation, equipment, personnel, teaching and training, and development restrictions for the department. Results The number of nuclear medicine-related departments has increased remarkable and reached 927 in 2018, which is 5.94% higher than that in 2010. The highest increase of 27.29% was observed from 601 in 2010 to 765 in 2018. The number of self-made positron radiopharmaceuticals also increased from 46 in 2012 to 107 in 2018, and those of positron and single-photon imaging equipment increased by 122.46% and 41.65%, respectively, from 138 and 605 in 2012 to 307 and 857 in 2018, respectively. The number of personnel in nuclear medicine departments was 6838 in 2010 and increased to 9090 in 2018. In addition, 112 and 223 teaching institutions (from 52 and 98 in 2014 and 2010, respectively) have become available to train doctoral and master students, respectively, in 2018. The factors restricting the advancement of departments include administrative and economic constraints, insufficient publicity, and lack of talents, equipment, knowledge, and scientific research. Conclusions At present, the current status of nuclear medicine in the country has a good development trend, and it is becoming more and more perfect in the training of nuclear medicine talents and discipline construction. The hospital has formed a good training ladder and a talent team with a reasonable structure. However, there are still many factors restricting the development of nuclear medicine. In order to better promote the development of nuclear medicine in China, relevant authorities should issue corresponding policies to provide guidance and support.
2020, 44(2): 99-104.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.005
Abstract:
Diffuse large B-cell lymphoma is a hematopoietic system disease with high incidence rate, rapid progression, and high mortality rate. Accurate prognosis evaluation through existing examination techniques is a major problem faced by scholars. At present, PET/CT has been widely used in the treatment monitoring and prognosis evaluation of lymphomas because of its unique advantage of simultaneously providing anatomical and functional images. However, a major controversy persists about which evaluation system provides accurate image assessment. This paper mainly introduces the application value of qualitative, semi-quantitative, and other new evaluation systems in the prognosis evaluation of diffuse large-B cell lymphoma.
Diffuse large B-cell lymphoma is a hematopoietic system disease with high incidence rate, rapid progression, and high mortality rate. Accurate prognosis evaluation through existing examination techniques is a major problem faced by scholars. At present, PET/CT has been widely used in the treatment monitoring and prognosis evaluation of lymphomas because of its unique advantage of simultaneously providing anatomical and functional images. However, a major controversy persists about which evaluation system provides accurate image assessment. This paper mainly introduces the application value of qualitative, semi-quantitative, and other new evaluation systems in the prognosis evaluation of diffuse large-B cell lymphoma.
2020, 44(2): 105-108.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.006
Abstract:
Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease, and its ischemic symptoms, such as cerebral infarction and hemorrhage due to the angiorrhexis of the abnormal venous blood network of the skull base. The former may occur during childhood, whereas the latter may occur in adulthood. The continuous development of nuclear medical imaging technology has provided new methods and abundant information for determining the affected area, scope, and degree of the disease and for studying the cerebral blood flow reserves of patients. Thus, the technology is essential to the clinical treatment of MMD and evaluation of the efficacy of MMD treatment. The current paper reviews the progress in MMD research by nuclear medical imaging technology.
Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease, and its ischemic symptoms, such as cerebral infarction and hemorrhage due to the angiorrhexis of the abnormal venous blood network of the skull base. The former may occur during childhood, whereas the latter may occur in adulthood. The continuous development of nuclear medical imaging technology has provided new methods and abundant information for determining the affected area, scope, and degree of the disease and for studying the cerebral blood flow reserves of patients. Thus, the technology is essential to the clinical treatment of MMD and evaluation of the efficacy of MMD treatment. The current paper reviews the progress in MMD research by nuclear medical imaging technology.
2020, 44(2): 109-113.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.007
Abstract:
Radiation therapy is one of the primary treatments for chest malignant tumors. The heart is exposed inevitably under radiation, therefore, caused early or late structural or functional heart damage and even reduced severely the survival benefit of the radiotherapy patients. With the application of radiotherapy in chest malignant tumors, the morbidity of heart injury caused by radiotherapy increases accordingly. Therefore, the research on the method of diagnosis (hematology, imaging, etc.) of radioactive heart damage, and the early detection and guidance of early intervention are the major problems faced by modern clinicians.
Radiation therapy is one of the primary treatments for chest malignant tumors. The heart is exposed inevitably under radiation, therefore, caused early or late structural or functional heart damage and even reduced severely the survival benefit of the radiotherapy patients. With the application of radiotherapy in chest malignant tumors, the morbidity of heart injury caused by radiotherapy increases accordingly. Therefore, the research on the method of diagnosis (hematology, imaging, etc.) of radioactive heart damage, and the early detection and guidance of early intervention are the major problems faced by modern clinicians.
2020, 44(2): 114-118.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.008
Abstract:
The 18F-FDG PET/CT myocardial metabolism imaging is currently recognized as the "gold standard" for monitoring patient myocardial survival and plays a guiding role in the treatment of coronary heart disease and the prognosis evaluation of vascular recanalization. Ensuring qualified image quality is the key in achieving this role. However, the myocardial metabolism imaging quality of 18F-FDG PET/CT is affected by many factors, such as diet before examination, fasting time, long-term drug use, daily blood glucose level examination, blood glucose regulation methods and the timing of tracer injection. To this end, the author intends to review the research status and the latest progress of the factors affecting the quality of myocardial metabolism imaging with the 18F-FDG PET/CT.
The 18F-FDG PET/CT myocardial metabolism imaging is currently recognized as the "gold standard" for monitoring patient myocardial survival and plays a guiding role in the treatment of coronary heart disease and the prognosis evaluation of vascular recanalization. Ensuring qualified image quality is the key in achieving this role. However, the myocardial metabolism imaging quality of 18F-FDG PET/CT is affected by many factors, such as diet before examination, fasting time, long-term drug use, daily blood glucose level examination, blood glucose regulation methods and the timing of tracer injection. To this end, the author intends to review the research status and the latest progress of the factors affecting the quality of myocardial metabolism imaging with the 18F-FDG PET/CT.
2020, 44(2): 119-124.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.009
Abstract:
Bisphosphonate is one of the important antibone absorbents in the treatment of bone metabolic diseases. It is mainly used in Paget's disease, osteoporosis and bone disease associated with tumor. Bisphosphonates are not only used to treat bone-related diseases, but bisphosphonate functionalized imaging agents are widely used in the diagnosis of bone-related diseases in nuclear medical bone imaging. The radioactive tracer can be coupled with bisphosphonates by chelation, and the coupled probe can be used as a bone targeting tracer for bone imaging. The molecular structure of bisphosphonates contains P-C-P bonds, so they are resistant to enzymatic hydrolysis and are not easily hydrolyzed by enzymes in human body. Because of its high affinity with inorganic hydroxyapatite crystals in bone tissue, it has high selectivity in bone tissue. This paper is based on the general characteristics and mechanism of bisphosphonates and summarized the preclinical study on the treatment of osteoporosis with bisphosphonates and the application of bisphosphonates in the treatment of bone metastasis.
Bisphosphonate is one of the important antibone absorbents in the treatment of bone metabolic diseases. It is mainly used in Paget's disease, osteoporosis and bone disease associated with tumor. Bisphosphonates are not only used to treat bone-related diseases, but bisphosphonate functionalized imaging agents are widely used in the diagnosis of bone-related diseases in nuclear medical bone imaging. The radioactive tracer can be coupled with bisphosphonates by chelation, and the coupled probe can be used as a bone targeting tracer for bone imaging. The molecular structure of bisphosphonates contains P-C-P bonds, so they are resistant to enzymatic hydrolysis and are not easily hydrolyzed by enzymes in human body. Because of its high affinity with inorganic hydroxyapatite crystals in bone tissue, it has high selectivity in bone tissue. This paper is based on the general characteristics and mechanism of bisphosphonates and summarized the preclinical study on the treatment of osteoporosis with bisphosphonates and the application of bisphosphonates in the treatment of bone metastasis.
2020, 44(2): 125-128.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.010
Abstract:
Limb weakness was presented as the first symptom. This work analyzes the characteristics of the patient based on clinical symptoms, related laboratory tests, CT, and 18F-FDG and 68Ga-1, 4, 7, 10-tetraazacyclododecane-N, N, N, N-tetraacetic acid-D-Phe1-Tyr3-Thr8-octreotide (68Ga-DOTATATE) PET/CT and reviewed the imaging diagnosis methods of primary pulmonary NK/T cell lymphoma. Considering the low incidence of the disease, this study suggests that imaging physicians should understand the whole situation when encountering similar cases and avoid preconceived thinking to improve the diagnostic level.
Limb weakness was presented as the first symptom. This work analyzes the characteristics of the patient based on clinical symptoms, related laboratory tests, CT, and 18F-FDG and 68Ga-1, 4, 7, 10-tetraazacyclododecane-N, N, N, N-tetraacetic acid-D-Phe1-Tyr3-Thr8-octreotide (68Ga-DOTATATE) PET/CT and reviewed the imaging diagnosis methods of primary pulmonary NK/T cell lymphoma. Considering the low incidence of the disease, this study suggests that imaging physicians should understand the whole situation when encountering similar cases and avoid preconceived thinking to improve the diagnostic level.
2020, 44(2): 129-132.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.011
Abstract:
The author reported a case of crossed fused renal ectopia of 99Tcm-DTPA renography, which is rare and lacks specific symptoms. This article clarifies the characteristics from the clinical features, laboratory test, pathology and imaging examination, and evaluates the renal function by 99Tcm-DTPA renal dynamic imaging, aiming to provide a powerful reference for the detection, diagnosis and treatment of the disease in clinical work.
The author reported a case of crossed fused renal ectopia of 99Tcm-DTPA renography, which is rare and lacks specific symptoms. This article clarifies the characteristics from the clinical features, laboratory test, pathology and imaging examination, and evaluates the renal function by 99Tcm-DTPA renal dynamic imaging, aiming to provide a powerful reference for the detection, diagnosis and treatment of the disease in clinical work.
2020, 44(2): 133-136.
doi: 10.3760/cma.j.issn.1673-4114.2020.02.012
Abstract:
Langerhans cell histiocytosis (LCH), formerly known as histiocytosis X, is a group of monoclone derived dendritic cell proliferative diseases. This histiocyte exhibits the characteristics of Langerhans cells, which primarily include bone destruction, benign focal histiocytosis, and eosinophil infiltration. The cause of the disease remains unknown at present. LCH can occur at any age, but more than 50% of the cases were reported in children aged 1−15 years old and can involve multiple systems and organs. The onset of the disease varies. Severe cases can involve extensive organ infiltration with fever and body weight reduction. LCH with simple bone destruction is easily misdiagnosed, and thus, the author selected two LCH cases through their 18F-FDG PET/CT imaging features and clinical data for differential diagnosis and then summarized the diagnosis idea to improve imaging diagnostic accuracy.
Langerhans cell histiocytosis (LCH), formerly known as histiocytosis X, is a group of monoclone derived dendritic cell proliferative diseases. This histiocyte exhibits the characteristics of Langerhans cells, which primarily include bone destruction, benign focal histiocytosis, and eosinophil infiltration. The cause of the disease remains unknown at present. LCH can occur at any age, but more than 50% of the cases were reported in children aged 1−15 years old and can involve multiple systems and organs. The onset of the disease varies. Severe cases can involve extensive organ infiltration with fever and body weight reduction. LCH with simple bone destruction is easily misdiagnosed, and thus, the author selected two LCH cases through their 18F-FDG PET/CT imaging features and clinical data for differential diagnosis and then summarized the diagnosis idea to improve imaging diagnostic accuracy.
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