2020 Vol. 44, No. 9
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2020, 44(9): 0-0.
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2020, 44(9): 1-4.
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2020, 44(9): 541-547.
doi: 10.3760/cma.j.cn121381-201909006-00075
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Objective To explore the value of the radiomic nomogram integrating high-resolution CT (HRCT) radiomics and traditional imaging features to predict the microvascular invasion (MVI) of lung adenocarcinoma (LAC). Methods A total of 65 patients with LAC (30 MVI-present LACs and 35 MVI-absent LACs) with pathologically confirmed MVI status in the Affiliated Hospital of Qingdao University from June 2015 to April 2019 were retrospectively enrolled, among whom 33 were males and 32 were females with age range of 34–83 (60.7±10.3) years old. After patients were numbered depending on their HRCT examination time, they were randomly divided into two groups according to the systematic sampling method (about 3∶1 ratio equidistance sampling): 46 patients constituted the training set and 19 patients constituted the validation set. The training set was used to build the model, and the validation set was used to evaluate the model effectiveness. The traditional imaging features with a significant difference between the MVI-present and MVI-absent patients were selected by two independent samples t test, χ2 test, or Fisher's exact probability method. The three-dimensional regions of interest of the tumors in the two groups were drawn, and the radiomic features were extracted. The optimal radiomic features were selected by one-way ANOVA and Lasso-Logistic regression analysis, and the radiomic scores were calculated. The combined nomogram to predict MVI of LAC, incorporating the radiomic scores and the traditional imaging features, was constructed by Logistic regression, and its effectiveness was evaluated. Results A total of 1308 radiomic features were extracted, and 6 optimal radiomic features were finally obtained. Among the traditional imaging features, only the longest diameter of the tumor was statistically different between the MVI-present and the MVI-absent patients [(28.10±11.39) mm vs. (22.32±6.26) mm; t=5.580, P=0.035]. For the traditional imaging features, the area under the curve (AUC) was 0.648 (95%CI: 0.493–0.783), the sensitivity was 38.1%, and the specificity was 88.0% in the training set; meanwhile, the AUC was 0.783 (95%CI: 0.538–0.936), the sensitivity was 88.9%, and the specificity was 70.0% in the validation set. For the combined nomogram, the AUC was 0.880 (95%CI: 0.750–0.957), the sensitivity was 90.5%, and the specificity was 72.0% in the training set; whereas the AUC was 0.811 (95%CI: 0.568–0.951), the sensitivity was 88.9%, and the specificity was 80.0% in the validation set. Conclusion The radiomic nomogram, incorporating HRCT radiomics and traditional imaging features, shows favorable predictive efficacy for MVI status in LAC, which might assist in the preoperative evaluation of patients with LAC.
2020, 44(9): 548-553.
doi: 10.3760/cma.j.cn121381-201906009-00072
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Objective To compare the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT versus enhanced CT in detecting adult patients with primary malignant tumors of the anterior mediastinum and improve the accuracy of diagnosis. Methods A total of 80 adult patients with primary tumors of the anterior mediastinum (35 malignant tumors and 45 benign tumors) confirmed by pathology from June 2016 to May 2019 in Affiliated Hospital of Hubei University of Arts and Science (Xiangyang Central Hospital) were retrospectively analyzed. The patients included 46 males and 34 females aged 20–80 years, with a median age of 45.5±10.2 years. All patients were subjected to whole-body 18F-FDG PET/CT and plain and enhanced-scan thorax CT within a 2-week interval. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT and enhanced CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were calculated and compared by χ2 test. The diagnostic efficiency of 18F-FDG PET/CT versus enhanced CT for different types of adult patients with primary malignant tumors of the anterior mediastinum was also compared by χ2 test. Results Among the 35 malignant tumors, 15 were thymic carcinomas, 10 were lymphomas, 7 were malignant germinomas, 1 was neuroendocrine carcinoma, 1 was malignant melanoma, and 1 was synovial sarcoma. The sensitivity, specificity, and accuracy [97.1%(34/35), 93.3%(42/45), 95.0%(76/80), respectively] of 18F-FDG PET/CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were significantly higher than those of enhanced CT [71.4%(25/35), 77.8%(35/45), 75.0%(60/80), respectively; χ2=8.612, 4.357, 12.471, respectively; all P<0.05]. The diagnostic accuracies of 18F-FDG PET/CT for thymic carcinoma, lymphoma, and malignant germinoma [93.3%(14/15), 100.0%(10/10), 85.7%(6/7), respectively] were significantly higher than those of enhanced CT [60.0%(9/15), 50.0%(5/10), 28.6%(2/7), respectively; χ2=4.503, 6.333, 4.333, respectively; all P<0.05]. Conclusions 18F-FDG PET/CT has significant diagnostic value for adult patients with primary malignant tumors of the anterior mediastinum. The diagnostic efficiency of this technique is better than that of enhanced CT, and it can be used as a main imaging method for the diagnosis of these types of diseases.
2020, 44(9): 554-560.
doi: 10.3760/cma.j.cn121381-202004008-00070
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Objective This study aimed to explore the characteristics of 99Tcm-methylene diphosphonate (MDP) accumulated in extraosseous soft tissue tumors in children via bone scintigraphy and determine the correlation between tracer uptake and tumor histopathology. Methods A total of 33 pediatric patients with 99Tcm-MDP uptake in extraosseous soft tissue tumors, who underwent bone scintigraphy in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Tenth People's Hospital of Tongji University from December 2008 to December 2018, were retrospectively identified. The patients included 21 male children and 12 female children, ranging in age from 3 months to 10 years. On the basis of histopathology, the extraosseous soft tissue tumors in children were categorized into blastomas, mesenchymal tumors, and germ cell tumors. The highest degree of radioactivity accumulation in focal lesions was classified as “+,” “++,” and “+++” based on the results of bone scan. The features of 99Tcm-MDP uptake in different pathological types of tumors and the correlations between 99Tcm-MDP uptake in soft tissue tumors and tumor pathology were investigated. Rank sum test was performed. Results Among 33 children, there were 26 cases of blastomas (78.8%, including 15 cases of neuroblastoma, 6 cases of Wilms' tumor, 4 cases of hepatoblastoma, and 1 case of pancreatoblastoma). Five cases were mesenchymal tumors (15.2%, including 3 cases of pulmonary metastases from osteosarcoma, 1 case of malignant extrarenal rhabdoid tumor, and 1 case of left thigh vascular tumor). Two cases were germ cell tumors (6.0%). No statistical significant difference was found in the degree of 99Tcm-MDP uptake in 33 pediatric patients with three different types of soft tissue tumors (H=1.993, P=0.369). The main imaging features of 33 cases of extraosseous tissue tumors included calcification, necrosis, and other features. Six cases of 99Tcm-MDP uptake were “+” (6/33, 18.2%), 11 cases were “++” (11/33, 33.3%), and 16 cases were “+++” (16/33, 48.5%). No significant difference in the degree of MDP uptake was found in 33 patients with different reasons causing 99Tcm-MDP accumulation (H=2.313, P=0.315). In terms of different pathological types of tumors, six cases of 99Tcm-MDP uptake were “+” (18.2%, including 5 cases of blastoma and 1 case of mesenchymal tumor). Eleven cases were “++” (33.3%, including 9 cases of blastoma and 2 cases of mesenchymal tumor). Sixteen cases were “+++” (48.5%, including 12 cases of blastoma, 2 cases of mesenchymal tumor, and 2 cases of germ cell tumor). Conclusions During the bone scan, pediatric extraosseous soft tissue tumors with 99Tcm-MDP accumulation mostly indicate malignancy, and neuroblastoma was the most common type. No significant correlation was found in the degree of neoplastic 99Tcm-MDP uptake and the histopathological types in child.
2020, 44(9): 561-568.
doi: 10.3760/cma.j.cn121381-201906004-00077
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Objective To investigate the value of serum midkine (MK) and galectine-3 (Gal-3) in the differential diagnosis of benign and malignant thyroid nodules, and to analyze the ability of serum MK and Gal-3 to evaluate metastases before the first 131I treatment in patients with differentiated thyroid cancer (DTC) after thyroidectomy. Methods ①Data on benign and malignant thyroid nodule differential diagnosis were collected from November 2016 to November 2017 in the First Hospital of Shanxi Medical University. In general surgery, 41 cases (11 males and 30 females, aged 29−73 (48.61±11.59) years) of surgical treatment of thyroid nodules in patients with preoperative blood specimens were determined. The patients were divided according to the result of pathology as follows: malignant group (23 cases) and benign group (18 cases). A total of 32 healthy subjects served as controls. One-way ANOVA was used to analyze whether preoperative serum MK and Gal-3 were different in benign and malignant thyroid nodules. Receiver operating characteristic curve was drawn to study the diagnostic value of the two in thyroid nodules. ②From November 2016 to November 2017, 51 patients (12 males and 39 females, aged 25−72 (44.41±10.21) years) with DTC before the first 131I treatment in the Nuclear Medicine Department of the First Hospital of Shanxi Medical University participated in the evaluation of postoperative metastasis. All patients underwent 131I treatment two times, and the whole body iodine scan was performed 5−7 days after each treatment. According to the results and other examination results (ultrasound, CT, PET/CT), the lymph node and/or lung metastasis was judged. Serum was collected before the first iodine treatment. The differences in MK and Gal-3 between groups were compared using two-sample t-test. Pearson test was used to analyze the correlation between serum MK and Gal-3.before the first iodine treatment. The differences in MK and Gal-3 between groups were compared using two-sample t-test. Pearson test was used to analyze the correlation between serum MK and Gal-3. Results ①Pre-surgical MK and Gal-3 levels were significantly higher in patients with malignant thyroid nodule than those in benign cases and in controls (F=48.40, 5.08, both P<0.05). The ROC curve analysis determined the optimal value of MK and Gal-3 for differential diagnosis between malignant and benign thyroid nodules. The diagnostic power of MK was the highest at 318.87 pg/mL, with an area under the ROC curve (AUC) of 0.91(95%CI: 0.81~0.99), specificity of 78.1%, and sensibility of 88.5%. The diagnostic power of Gal-3 was the highest at 1.61 ng/mL, with AUC of 0.72(95%CI: 0.57~0.86), specificity of 70.4%, and sensibility of 69.8%. ②The patients were grouped according to the presence of lymph node and bone and/or lung metastasis into metastasis positive group (8 cases) and negative group (43 cases). Thyroglobulin, MK(A), and Gal-3(A) in the positive group were significantly higher than those in the negative group (t=−4.86, −4.01, −2.89, all P<0.05). MK (r=0.67, P<0.05) and Gal-3 (r=0.84, P<0.05) were significantly correlated in pre-surgical and pre-131I-ablative. Conclusions Serum MK and Gal-3 can be used for the differential diagnosis of benign and malignant thyroid nodules and to evaluate whether metastasis is present in patients with DTC before 131I treatment.
2020, 44(9): 569-574.
doi: 10.3760/cma.j.cn121381-201912030-00078
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Objective To compare the dosimetry of three different intensity-modulated radiation therapy (IMRT) techniques in patients undergoing whole-breast radiotherapy after breast-conserving surgery for early left breast cancer. Methods Between March 2019 and August 2019, 12 female patients with early left breast cancer who underwent breast-conservative surgery in the First Affiliated Hospital of Xi'an Jiaotong University were analyzed retrospectively. The patient age was between 32 and 50 years, with an average of 42.4±6.8 years. The IMRT-based hybrid plan (3D conformal radiation therapy or 3DCRT + IMRT), the volumetric modulated arc therapy (VMAT)-based hybrid plan (3DCRT+VMAT), and the tangential VMAT plan (t-VMAT) were designed. The dosimetric parameters of the target and the organs at risk and treatment efficiency were compared among the three plans, and t-test was used for data analysis. Results Both the dose distribution in the target and dose to the organs at risk can meet the clinical requirements of the three plans. The conformal index (0.84±0.05 vs. 0.74±0.06 vs. 0.79±0.06) and uniformity index (0.10±0.03 vs. 0.14±0.03 vs. 0.13±0.03) of 3DCRT+VMAT were the best, and the difference was statistically significant compared with the two other plans (t=–9.01–6.47, all P<0.05). The protective effect of 3DCRT+IMRT was the best for V5 ((35.92±8.01)% vs. (49.33±12.05)% vs. (60.58±12.94)%), V10 ((25.50±6.91)% vs. (26.92±7.23)% vs. (41.25±10.37)%), Dmean ((10.14±2.43) Gy vs. (11.07±2.88) Gy vs. (14.52±3.32) Gy) of the ipsilateral (left) lung, V5( (0.50±1.45)% vs.(2.17±3.76)% vs. (3.00±4.94)%), and Dmean ((0.55±0.21) Gy vs. (1.79±0.58) Gy vs. (1.75±0.70) Gy) of the contralateral (right) lung and the V5 ((0.17±0.58)% vs. (1.92±4.10)% vs. (8.25±8.61)%) and Dmean ((0.86±0.38) Gy vs. (1.65±0.45) Gy vs. (2.46±0.86) Gy) of the contralateral (right) breast. 3DCRT+VMAT was significantly better than 3DCRT+IMRT and t-VAMT in V30 ((4.50±2.88)% vs. (5.00±3.25)% vs. (8.42±2.78)%) and V40 ((2.50±2.11)% vs. (3.25±2.53)% vs. (4.58±2.07)%) of the heart (t=–17.11–3.45, all P<0.05). The mean monitor unit of 3DCRT+IMRT was the lowest (280.90±52.18), but the treatment time of t-VMAT was the shortest. Conclusions The protective effect of 3DCRT+IMRT in the low-dose area (<20 Gy) for the ipsilateral lung, contralateral lung, and contralateral breast was better. 3DCRT+VMAT has obvious advantages in improving the uniformity and conformability of the target area and has better protection in the high-dose area (>20 Gy) for the contralateral lung and heart. Thus, t-VMAT shortens the treatment time and improves treatment efficiency and patient comfort.
2020, 44(9): 575-581.
doi: 10.3760/cma.j.cn121381-201905013-00067
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Renal cell carcinoma(RCC) is the commonest renal malignant tumor. Its staging and typing have important impacts on the treatment and survival of patients. Early detection and accurate localization of primary tumor and metastatic sites are critical to clinical diagnosis and treatment. This paper briefly reviews the application and development of positron radionuclides in the staging and typing of RCC, the detection of metastatic RCC and the monitoring after RCC treatment.
Renal cell carcinoma(RCC) is the commonest renal malignant tumor. Its staging and typing have important impacts on the treatment and survival of patients. Early detection and accurate localization of primary tumor and metastatic sites are critical to clinical diagnosis and treatment. This paper briefly reviews the application and development of positron radionuclides in the staging and typing of RCC, the detection of metastatic RCC and the monitoring after RCC treatment.
2020, 44(9): 582-588.
doi: 10.3760/cma.j.cn121381-201906012-00062
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Nuclear medicine imaging, as a noninvasive functional imaging method, plays a vital role in the diagnosis of neuroendocrine neoplasma. Nuclear medicine imaging relies on molecular targeted tracers. According to the published papers, nuclear medicine imaging tracers for neuroendocrine neoplasma can be divided into somatostatin receptor-targeted tracers and other types, and the former contains somatostatin receptor agonists and antagonists. In this paper, nuclear medicine imaging tracers for neuroendocrine neoplasma are reviewed.
Nuclear medicine imaging, as a noninvasive functional imaging method, plays a vital role in the diagnosis of neuroendocrine neoplasma. Nuclear medicine imaging relies on molecular targeted tracers. According to the published papers, nuclear medicine imaging tracers for neuroendocrine neoplasma can be divided into somatostatin receptor-targeted tracers and other types, and the former contains somatostatin receptor agonists and antagonists. In this paper, nuclear medicine imaging tracers for neuroendocrine neoplasma are reviewed.
2020, 44(9): 589-593.
doi: 10.3760/cma.j.cn121381-201907024-00068
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The process of tumor cells migrating from the primary lesion to distant sites to form metastatic lesions increases the mortality of patients. Radiotherapy can cause DNA damage directly through ionization or indirectly through the production of reactive oxygen species, thereby destroying tumor cells. However, recent studies have shown that radiotherapy-induced changes in tumor microenvironment can promote tumor metastasis and cause treatment failure in some cases. The relationship between tumor microenvironment changes after radiotherapy and tumor metastasis has received widespread attention, but the mechanism remains unclear. This review discusses how radiotherapy promotes tumor metastasis by inducing cytokine expression, hypoxia, increased integrin expression and changes in exosome.
The process of tumor cells migrating from the primary lesion to distant sites to form metastatic lesions increases the mortality of patients. Radiotherapy can cause DNA damage directly through ionization or indirectly through the production of reactive oxygen species, thereby destroying tumor cells. However, recent studies have shown that radiotherapy-induced changes in tumor microenvironment can promote tumor metastasis and cause treatment failure in some cases. The relationship between tumor microenvironment changes after radiotherapy and tumor metastasis has received widespread attention, but the mechanism remains unclear. This review discusses how radiotherapy promotes tumor metastasis by inducing cytokine expression, hypoxia, increased integrin expression and changes in exosome.
2020, 44(9): 594-599.
doi: 10.3760/cma.j.cn121381-201905005-00069
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Dual energy X-ray absorptiometry (DXA) is widely used in clinical and scientific research due to its advantages of low radiation dose, good reproducibility, short scanning time and easy access. DXA body composition analysis can detect various body compositions, including bone density, fat mass, lean body mass, fat-free mass, body fat rate and so on. It has been widely used in the diagnosis, treatment and risk assessment of various clinical diseases. This review is focused on the application of DXA body composition analysis and the latest research in some clinical diseases.
Dual energy X-ray absorptiometry (DXA) is widely used in clinical and scientific research due to its advantages of low radiation dose, good reproducibility, short scanning time and easy access. DXA body composition analysis can detect various body compositions, including bone density, fat mass, lean body mass, fat-free mass, body fat rate and so on. It has been widely used in the diagnosis, treatment and risk assessment of various clinical diseases. This review is focused on the application of DXA body composition analysis and the latest research in some clinical diseases.
2020, 44(9): 600-603.
doi: 10.3760/cma.j.cn121381-201905016-00073
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Ectopic pancreas often occurs in the digestive tract, and hepatic ectopic pancreas syndrome is very rare clinically. This article reports a case of hepatic ectopic pancreas detected by 18F-FDG PET/CT and confirmed by surgery and pathology. The imaging features were duodenal mass with abnormal uptake of 18F-FDG, which was considered to be an inflammatory lesion associated with hepatic ectopic pancreas. By analyzing this case and reviewing the relevant literature, the writer intends to deepens the understanding of the imaging features of hepatic ectopic pancreas through literature review.
Ectopic pancreas often occurs in the digestive tract, and hepatic ectopic pancreas syndrome is very rare clinically. This article reports a case of hepatic ectopic pancreas detected by 18F-FDG PET/CT and confirmed by surgery and pathology. The imaging features were duodenal mass with abnormal uptake of 18F-FDG, which was considered to be an inflammatory lesion associated with hepatic ectopic pancreas. By analyzing this case and reviewing the relevant literature, the writer intends to deepens the understanding of the imaging features of hepatic ectopic pancreas through literature review.
2020, 44(9): 604-607.
doi: 10.3760/cma.j.cn121381-201906015-00071
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This paper reported a case of sporadic parathyroid carcinoma with negative 99Tcm-methoxyisobutylisonitrile (MIBI) imaging. The patient with parathyroid carcinoma is characterized by severe hypercalcemia which could cause pathological changes in multiple systems and different organs. It depends on ultrasound, parathyroid nuclide scan (99Tcm-MIBI) and CT examination to localize the position of lesions for further operation treatment. Among these examinations, parathyroid 99Tcm-MIBI imaging is widely used in clinical for its easy accessibility and high sensitivity. However, there are some cases presented with negative 99Tcm-MIBI imaging and is easy to be misdiagnosed. Through the literature review, the author deeply understood the negative 99Tcm-MIBI imaging of parathyroid carcinoma. For patients suspected of parathyroid carcinoma but with negative 99Tcm-MIBI imaging, the possibility of false negative need to be considered. In this specific clinical scenario, doctors should analyze its potential causes and make a comprehensive judgment through combining with other clinical characteristics, which could reduce the rate of misdiagnosis as much as possible.
This paper reported a case of sporadic parathyroid carcinoma with negative 99Tcm-methoxyisobutylisonitrile (MIBI) imaging. The patient with parathyroid carcinoma is characterized by severe hypercalcemia which could cause pathological changes in multiple systems and different organs. It depends on ultrasound, parathyroid nuclide scan (99Tcm-MIBI) and CT examination to localize the position of lesions for further operation treatment. Among these examinations, parathyroid 99Tcm-MIBI imaging is widely used in clinical for its easy accessibility and high sensitivity. However, there are some cases presented with negative 99Tcm-MIBI imaging and is easy to be misdiagnosed. Through the literature review, the author deeply understood the negative 99Tcm-MIBI imaging of parathyroid carcinoma. For patients suspected of parathyroid carcinoma but with negative 99Tcm-MIBI imaging, the possibility of false negative need to be considered. In this specific clinical scenario, doctors should analyze its potential causes and make a comprehensive judgment through combining with other clinical characteristics, which could reduce the rate of misdiagnosis as much as possible.
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