2020 Vol. 44, No. 4
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2020, 44(4): 0-0.
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2020, 44(4): 1-1.
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2020, 44(4): 205-211.
doi: 10.3760/cma.j.cn121381-201902031-00017
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Objective To analyze the changes in vertebral 99Tcm-medronate (MDP) uptake and the correlation with clinical radiotherapy parameters in chest tumor patients. Methods A retrospective study was conducted in 110 patients (including 62 males and 48 females aged 58.2 ± 11.9 years) who underwent chest tumor radiotherapy in Shandong Cancer Hospital from April 20, 2014 to October 31, 2018, and whole-body bone scan was performed before and after radiotherapy. The clinical information, tumor factors, and radiotherapy plan were analyzed using semiquantitative analysis. The results of the bone scan were divided into normal and abnormal vertebral uptake groups. In accordance with the time interval of bone imaging before and after radiotherapy, the patients were further classified into groups, namely, 60–120 (23 cases), 121–180 (30 cases), 181–240 (27 cases), and 241–365 (30 cases) days. The comparison among groups were analyzed using the χ2 test, and the statistical results were analyzed using the binary classification logistic regression. The change in the vertebral body 99Tcm-MDP uptake and the correlation with clinical radiotherapy parameters in chest tumor patients were discussed. The (T/Nbefore) − (T/Nafter)/(T/Nbefore) was calculated, and the receiver operating characteristic curve was drawn. The best diagnosis threshold of vertebral 99Tcm-MDP uptake abnormality was found. Results In 110 patients, 48 (43.6%) had local poor vertebral radioactivity uptake with minimum, maximum, and average vertebral exposure doses of 1039.5, 4488.7, and (2139.5±839.8) cGy, respectively. The shortest, longest, and median imaging interval was 61, 326, and 160 days, respectively. The remaining 62 patients (56.4%) had no obvious abnormal radioactive uptake. The degree of vertebral body uptake was correlated with the radiotherapy dose ( Conclusions Early imaging time after radiotherapy results in high detection rate of vertebral injury. The change in vertebral body 99Tcm-MDP uptake can reflect the degree of radioactive vertebral damage to some extent.
2020, 44(4): 212-216.
doi: 10.3760/cma.j.cn121381-201907038-00023
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Objective To explore the dynamic change of the ambient dose equivalent rate during diagnostic whole-bady scan with differentiated thyroid carcinoma after 131I therapy 6 months. Methods This study enrolled 85 patients aged (18 males and 67 females; 43.9±12.0 years old ) with DTC who received 131I therapy in the Department of Nuclear Medicine of The First Affiliated Hospital of Zhengzhou University from August 2018 to January 2019. Among them, 18 patients were ≥55 years old and 67 patients were <55 years old. All patients were given 148 MBq (4 mCi) of 131I on an empty stomach and received diagnostic whole-body scan 2 days later. The negative group (n=48) was defined as the excellent response. The patients in this group were administered with thyroid-stimulating hormone-stimulated thyroglobulin (<1 μg/L) in the absence of structural or functional evidence of disease (and in the absence of anti-Tg antibodies). The positive group (n=37) was defined as the biochemically incomplete response, structurally incomplete response, and indeterminate response. Ambient dose equivalent rate was determined l m away from the patients at 2, 24, and 48 h after 131I administration. One-way repeated measures ANOVA was used on the three patient groups. T test was used to compare the ambient dose equivalent rate at 1 m between different groups of gender, age, and treatment effects. Results The range of ambient dose equivalent rate at 1 m at 2, 24, and 48 h was (6.55±1.42), (1.92±0.65), and (0.58±0.22) μSv/h, respectively, indicating that ambient dose equivalent rate decreased over time. The differences were statistically significant (F=807.30, P=0.000). No statistically significant difference was found in ambient dose equivalent rate at 1 m after 131I administration at any time in groups of different genders. The ambient dose equivalent rate at 1 m at 24 h was higher in the ≥55 age group than in the <55 age group (t=2.29, P=0.02), and the other two time points were not statistically significant. No statistically significant difference was found between the negative group and the positive group at each time point. Conclusions The ambient dose equivalent rate of patients with DTC after 131I treatment who received the diagnostic dose of 131I for 48 h was less than 1.40 μSv/h (the 2017 clinical nuclear medicine patient protection requirements, WS 533-2017). Thus, no restrictions for the patients to travel should be imposed as they do not exert harmful radiation on others.
2020, 44(4): 217-224.
doi: 10.3760/cma.j.cn121381-201912034-00014
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Objective To explore the risk factors that can predict the pathological diagnosis of thyroid cancer before operation. Methods A total of 513 patients underwent surgery and received pathological diagnosis from February 2016 to February 2019 in the Jining First People′s Hospital were identified. Of these patients, 111 were males and 402 were females. Their ages ranged from 13 years old to 80 years old. The age was 49.02±12.95 years old. The patients were classified into benign and malignant groups (275 and 238 cases, respectively) according to their postoperative pathology. The biochemical parameters of thyroid stimulating hormone (TSH), thyroglobulin (Tg), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were evaluated. Thyroid ultrasound and thyroid static imaging were performed, and thyroid imaging-reporting and data system were used for grading. The basic data of the two groups were compared by using Student's t test, chi-square test, and a Mann–Whitney rank sum test. The univariate regression analysis and logistic multivariate regression analysis were conducted to examine the risk of malignant thyroid nodules. Results Differences in age (χ2=26.716, P=0.000), body mass index (t=−2.301, P=0.022), nodule function (χ2=16.882, P=0.001), nodule size (χ2=151.817, P=0.000), TSH (Z=−4.430, P=0.000), and ultrasound (χ2=225.712, P=0.000) between benign and malignant groups were observed. No significant differences were found in gender, family history of cancer, educational level, complication, weight, height, Tg, TgAb, and TPOAb. The univariate regression analysis revealed that age, weight, educational level, TSH, Tg, nodule size, and ultrasound (OR=1.004, 0.980, 0.514, 1.280, 1.002, 1.222, 0.589, all P<0.05) may be associated with malignancy. Logistic multivariate regression analysis revealed that the increase in TSH level (OR=1.198, P=0.046), young patient (OR=0.962, P=0.001) and small nodule diameter (OR=0.251, P=0.000) were independently associated with higher malignant of thyroid nodule, and ultrasound (OR=16.390, P=0.000) was significant in the prediction of pathological diagnosis. Conclusions Ultrasound plays an important role in predicting thyroid cancer. The combination of ultrasound and other factors, such as patient age, serum TSH level, and nodular diameter, can predict the pathological diagnosis accurately.
2020, 44(4): 225-230.
doi: 10.3760/cma.j.cn121381-201903008-00019
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Objective To investigate the correlation of apparent diffusion coefficient (ADC) value of MRI diffusion-weighted imaging (DWI) in breast cancer of mass-like and non-mass-like breast cancer with tumor molecular biomarkers. Methods DWI of 68 breast cancer patients admitted to Zhuhai Integrative Medicine Hospital from January 2015 to January 2019 before operation was retrospectively analyzed, all patients were female, aged 34−72 (48.5±4.7) years, 49 case mass-like and 19 case non-mass-like breast cancer patients . Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and cancer antigen were expressed by immunohistochemical assay, and the molecular subtypes were evaluated. T-test was used to compared the ADC of tumor type and non-tumor type breast cancer, different biological markers and different molecular subtypes of breast cancer. The correlation between ADC values and molecular markers and subtypes was analyzed by Spearman level correlation. Results The ADC value of mass-like breast cancer was significantly lower than that of non-mass-like breast cancer ((0.95±0.13)×103 mm2/s vs. (1.03±0.12)×103 mm2/s, t=2.193, P=0.023). The ADC values of 19 non-mass-like breast cancer patients with ER(−), PR(−) and Ki-67>14% were significantly lower than those of ER(+), PR(+) and Ki-67≤14% (t=2.742, 2.054, 2.323; all P<0.05), and patients with the HER-2 overexpression type was higher than other molecular subtypes (t=2.515, 2.336, 2.721; all P<0.05). The ADC values of 49 mass-like breast cancer patients with ER(−) and Ki-67>14% were significantly lower than those of ER(+) and Ki-67≤14% (t=3.291, 2.183; both P<0.05) and patients with the HER-2 overexpression type was higher than other molecular subtypes(t=2.493, 2.453, 2.512; all P<0.05). The ADC value of mass-like breast cancer was positively correlated with the negative expression of ER (+) and PR (+), and the expression level of Ki-67 (r=0.394, 0.360, −0.407; all P<0.05). The ADC value of mass-like breast cancer was positively correlated with ER (+) negative expression and Ki-67 expression (r=0.371, −0.397; both P<0.05). Conclusion The ADC value of non-mass-like breast cancer is higher than that of mass-like, and the ADC value has a good correlation with the expression of molecular biological characterization.
2020, 44(4): 231-235.
doi: 10.3760/cma.j.cn121381-201908031-00024
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Objective To investigate and compare the gross tumor volumes (GTVs) delineated by MRI and CT images in patients with cervical cancer who received 3D intracavitary brachytherapy. Methods A total of 12 patients, aged 50 –64 years, who were confirmed to have cervical squamous cell carcinoma or adenocarcinoma by biopsy and pathology between September 2012 and June 2016 were selected in the 900 Hospital of the Joint Logistics Team. The tumor was staged during the second and third phases. All the patients underwent pelvic MRI which was administered through external beam radiation followed by a 3D CT-based high dose rate (HDR) intracavitary brachytherapy boost. After radiotherapy CT localization, the CT and MRI images were fused. Next, in the OMP system, three experienced radiologists (radiologists 1, 2, and 3) respectively delineated the GTVs, which included the cervix uterus, corpus uteri, and primary lesion. Thirty-six target outlines were drawn based on the CT images (called GTVCT), and another 36 target outlines were drawn based on the MRI images (called GTVMRI). The ratio R of GTVMRI and GTVCT were calculated using the paired t-test to compare the difference between the two groups. Results The average target volume of GTVCT (93.8±11.8) cm3 was larger than that of GTVMRI (71.1±3.1) cm3. Some variations were observed among the definition results given by the three radiologists. The differences between the maximum volume and the minimum volume were 41.3 cm3 and 11.3 cm3 for GTVCT and GTVMRI, respectively. Compared with Radiologist 3, Radiologists 1 and 2 outlined that the volume of GTV is larger, and the difference between the ratios R is statistically significant (t =−8.644, −5.043, both P = 0.000). The difference in target volumes between the radiologists guided by MRI images was smaller than that by the radiologist guided by CT images and was more slightly affected by individual factors. Conclusions For patients with cervical cancer who are administered external beam radiation followed by 3D CT-based HDR brachytherapy boost, variations in GTVs were observed among different radiologists for individual factors. The CT/MRI-fusion technology may decrease the variation in target volume between different radiologists.
2020, 44(4): 236-242.
doi: 10.3760/cma.j.cn121381-201909007-00020
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Objective To investigate the role of asparagine-rich protein (NRP) in resistance of Arabidopsis thaliana to radiation. Methods Wild-type (WT), NRP overexpression lines (Pro35S:NRP-GFP), and NRP mutant lines (nrp) of A. thaliana seeds were used and divided into two groups: irradiation (120 Gy γ-ray irradiation) and control (no irradiation). (1) Seeds of three genotypes of A. thaliana were cultured to the third day and irradiated with 120 Gy; the root length of each group was measured after culture was continued to the seventh day. (2) The seeds of three genotypes of A. thaliana were cultured in MS medium to the seventh day, and then irradiated with 120 Gy. After irradiation, the seeds were transplanted to the substrate soil for further culture until the 30th day. The growth and morphology of each group of plants were observed. (3) WT A. thaliana seeds were cultured to the seventh day and irradiated with 120 Gy. After 24 h, the changes in the relative expression of NRP and poly-ADP-ribose polymerase 2 (PARP2) genes in WT plants before and after irradiation were analyzed by real-time quantitative PCR. (4) The seeds of Pro35S:NRP-GFP A. thaliana were cultured to the seventh day and then irradiated with 120 Gy. The seedlings were observed by fluorescence confocal microscopy at different times after irradiation. Independent sample t-test was used for comparison between groups. Results (1) After irradiation, the root lengths of WT and nrp A. thaliana were significantly shortened (t=9.212 and 6.490, both P=0.000) to (2.73±0.43) cm and (1.31±0.53) cm, respectively, whereas the root lengths of the control group were (4.56±0.41) cm and (2.89±0.60) cm. The root lengths of Pro35S:NRP-GFP with or without irradiation exhibited no significant changes ((3.01±0.34) cm vs. (2.96±0.34) cm, t=0.253, P=0.801). (2) The growth and development of WT and nrp A. thaliana were significantly reduced (t=6.361–12.250, all P=0.000), whereas that of Pro35S:NRP-GFP maintained its development after irradiation. (3) The relative expression of NRP and PARP2 of WT A. thaliana significantly increased after irradiation (t=4.447 and 7.776, P=0.002 and 0.000). (4) Pro35S:NRP-GFP seedlings exhibited NRP re-localization into the nucleus after irradiation at each time point. Conclusion NRP may play a critical role in the resistance of A. thaliana to radiation, suggesting that NRP may be an important gene in radiation-caused injury in this species.
2020, 44(4): 243-247.
doi: 10.3760/cma.j.cn121381-201902002-00015
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Diffusion kurtosis imaging (DKI) is the extension and supplement of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). DKI further reveals the Non-Gaussian diffusion model of water molecule movement in organisms. DKI is more suitable for reflecting the micro-environment of human body and provides more accurate, real, and rich organizational microstructure information compared with DWI and DTI technologies. DKI has been gradually applied to the study of diseases in various systems, particularly the nervous system. This technology has achieved remarkable results and shows good clinical value. DKI can reflect microscopic information and has great application prospects. Currently, this technology is contributing to the increase in the number of research works on the liver. This article reviews the application of DKI to the study of liver diseases.
Diffusion kurtosis imaging (DKI) is the extension and supplement of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). DKI further reveals the Non-Gaussian diffusion model of water molecule movement in organisms. DKI is more suitable for reflecting the micro-environment of human body and provides more accurate, real, and rich organizational microstructure information compared with DWI and DTI technologies. DKI has been gradually applied to the study of diseases in various systems, particularly the nervous system. This technology has achieved remarkable results and shows good clinical value. DKI can reflect microscopic information and has great application prospects. Currently, this technology is contributing to the increase in the number of research works on the liver. This article reviews the application of DKI to the study of liver diseases.
2020, 44(4): 248-252.
doi: 10.3760/cma.j.cn121381-201902025-00016
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Over the past decades, radiotherapy for intracranial germinoma has been based on craniospinal irradiation or whole ventricle radiotherapy, with either approach resulting in a high survival rate. In recent years, the research on radiotherapy has mainly focused on reducing the volume or intensity of radiation to further reduce the complications. This paper reviews the active exploration and research on the choice of radiotherapy schemes conducted by domestic and foreign scholars in order to provide some ideas and references for future clinical works.
Over the past decades, radiotherapy for intracranial germinoma has been based on craniospinal irradiation or whole ventricle radiotherapy, with either approach resulting in a high survival rate. In recent years, the research on radiotherapy has mainly focused on reducing the volume or intensity of radiation to further reduce the complications. This paper reviews the active exploration and research on the choice of radiotherapy schemes conducted by domestic and foreign scholars in order to provide some ideas and references for future clinical works.
2020, 44(4): 253-261.
doi: 10.3760/cma.j.cn121381-201901009-00012
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Tumor radiotherapy increases radiation dose in a tumor target area and improves protection for normal tissues and organs around tumors. Proton beam therapy (PBT) is the most advanced radiotherapy technology worldwide. In theory, the unique Bragg peak and superior relative biological effect of proton beam can deliver a maximum dose to tumor target areas, reduce the dose received by normal tissues and organs around tumors, achieve the "directional blasting" of a tumor target area, and improve the local treatment and control rates of tumors. This method has better features than traditional photon therapy. Currently, existing clinical studies focus on melanoma; lung, esophageal, breast, liver, and prostate cancers; childhood malignant tumor; and other diseases. However, most of these studies are retrospective clinical studies, and the cost of establishing and maintaining a proton equipment is immense. Thus, proton therapy for malignant tumors remains controversial. Future studies must address the insufficient clinical evidence of PBT, and biological effects are still under investigation. Overcoming these deficiencies is associated with the rapid development of PBT. This review discusses the physical and biological characteristics of PBT, and its application in cancer therapy.
Tumor radiotherapy increases radiation dose in a tumor target area and improves protection for normal tissues and organs around tumors. Proton beam therapy (PBT) is the most advanced radiotherapy technology worldwide. In theory, the unique Bragg peak and superior relative biological effect of proton beam can deliver a maximum dose to tumor target areas, reduce the dose received by normal tissues and organs around tumors, achieve the "directional blasting" of a tumor target area, and improve the local treatment and control rates of tumors. This method has better features than traditional photon therapy. Currently, existing clinical studies focus on melanoma; lung, esophageal, breast, liver, and prostate cancers; childhood malignant tumor; and other diseases. However, most of these studies are retrospective clinical studies, and the cost of establishing and maintaining a proton equipment is immense. Thus, proton therapy for malignant tumors remains controversial. Future studies must address the insufficient clinical evidence of PBT, and biological effects are still under investigation. Overcoming these deficiencies is associated with the rapid development of PBT. This review discusses the physical and biological characteristics of PBT, and its application in cancer therapy.
2020, 44(4): 262-266.
doi: 10.3760/cma.j.cn121381-201903060-00022
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Artifacts of myocardial perfusion imaging, greatly influence on the image quality and image discrimination, resulting in a high false-positive rate. Many techniques have been developed for correcting various artifacts, including non-X-ray attenuation correction method (such as change-position acquisition, gated acquisition and solid 153Gd line-source penetration acquisition) and CT attenuation correction method. Clarify the application scope and advantages and disadvantages of the two methods, so that the clinician can correctly analyze and judge the artifacts in the reading, thereby improving the accuracy of diagnosis.
Artifacts of myocardial perfusion imaging, greatly influence on the image quality and image discrimination, resulting in a high false-positive rate. Many techniques have been developed for correcting various artifacts, including non-X-ray attenuation correction method (such as change-position acquisition, gated acquisition and solid 153Gd line-source penetration acquisition) and CT attenuation correction method. Clarify the application scope and advantages and disadvantages of the two methods, so that the clinician can correctly analyze and judge the artifacts in the reading, thereby improving the accuracy of diagnosis.
2020, 44(4): 267-272.
doi: 10.3760/cma.j.cn121381-201812028-00011
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Sarcopenia is a syndrome characterized by extensive and progressive loss of mass and strength of skeletal muscle and may lead to disability, decline in quality of life, or even death. Dual energy X-ray absorptiometry (DXA) can simultaneously examine muscle, fat, and bone mass with the advantages of low cost, fast operation, high repeatability, and low radiation dose. This technique has become the first choice to estimate muscle mass in research and clinical practice. This review focuses on the progress of DXA application in sarcopenia.
Sarcopenia is a syndrome characterized by extensive and progressive loss of mass and strength of skeletal muscle and may lead to disability, decline in quality of life, or even death. Dual energy X-ray absorptiometry (DXA) can simultaneously examine muscle, fat, and bone mass with the advantages of low cost, fast operation, high repeatability, and low radiation dose. This technique has become the first choice to estimate muscle mass in research and clinical practice. This review focuses on the progress of DXA application in sarcopenia.
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