2021 Vol. 45, No. 10
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2021, 45(10): 611-620.
doi: 10.3760/cma.j.cn121381-202008048-00079
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Abstract:
Objective To explore the application value of 18F-fluorodeoxyglucose (FDG) PET/CT combined with carbohydrate antigen 125 (CA125) and human epididymal protein 4 (HE4) levels in the diagnosis of recurrent ovarian cancer and prognostic evaluation of peritoneal metastasis. Methods The imaging data of 89 postoperative ovarian cancer patients who underwent 18F-FDG PET/CT in the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed. Pathological examinations diagnosed 59 patients with recurrent ovarian cancer (recurrence group, median age: 51(26–82) years), whereas 30 patients with ovarian cancer were diagnosed with benign peritoneal thickening by histopathological examination after surgery (non-recurrence group, median age: 55(34–79) years). All patients were followed up for at least 1 year. The efficacy of 18F-FDG PET/CT and contrast-enhanced CT in the diagnosis of recurrent ovarian cancer and postoperative stump recurrence, peritoneal metastasis, lymph node metastasis, and other metastases outside the abdominal cavity was calculated. The receiver operator characteristic curve of 18F-FDG PET/CT, CA125, HE4 alone, and combined detection of recurrent ovarian cancer was obtained, and the efficacy of independent or combined detection of recurrent ovarian cancer was analyzed. Comparison of diagnostic efficency used χ2 text. The Cox model was used for multivariate prognostic analysis to evaluate the influence of multiple factors on the prognosis of patients with recurrent ovarian cancer and calculate the 95% confidence interval (CI). Kaplan–Meier survival curve was used to analyze the influence of a single prognostic factor on the overall survival of patients with recurrent ovarian cancer. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT in diagnosing recurrent ovarian cancer were 93.22%(55/59), 93.33%(28/30), 93.26%(83/89), 96.49%(55/57) and 87.50%(28/32), respectively, which were higher than those of contrast-enhanced CT (79.66%(47/59), 73.33%(22/30), 77.52%(69/89), 85.46%(47/55), and 64.71%(22/34)). The differences among all items were statistically significant (χ2=4.193–8.828, all P<0.05). In addition, the diagnostic efficacy of 18F-FDG PET/CT for postoperative stump recurrence, peritoneal metastasis, and lymph node metastasis (except the positive predictive values of peritoneal metastasis, sensitivity, and lymph node metastasis) were all higher than those of the contrast-enhanced CT (χ2=2.885–8.868, all P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT combined with CA125 and HE4 in the diagnosis of recurrent ovarian cancer were 98.31%(58/59), 96.67%(29/30), 97.75%(87/89), 98.31%(58/59), and 96.67%(29/30), respectively, which were higher than the three methods were applied alone or two combined applications, except for the application of 18F-FDG PET/CT alone, the differences between the other items were statistically significant (χ2=5.192–27.101, all P<0.05). The diagnostic cut-off values of standardized uptake, serum CA125, and HE4 were 5.60, 91.80 U/mL, and 196.89 pmol/L, respectively. Peritoneal metastasis is an important independent prognostic factor for recurrent ovarian cancer (95%CI: 3.784–819.477, P=0.003). The overall survival of patients with negative peritoneal metastasis was significantly higher than that of patients with positive peritoneal metastasis (χ2=30.320, P<0.001). Peritoneal metastasis lesions were mostly distributed in the susceptible area of peritoneal implantation and metastasis. Conclusions 18F-FDG PET/CT performs better than contrast-enhanced CT in recurrence diagnosis and metastasis assessment of recurrent ovarian cancer. 18F-FDG PET/CT metabolic parameters, serum tumor markers, and the combined use of drugs can improve the diagnostic efficiency for recurrent ovarian cancer.
2021, 45(10): 621-630.
doi: 10.3760/cma.j.cn121381-202008049-00108
Abstract:
Objective To analyze the maximum standardized uptake value (SUVmax) threshold to distinguish benign and malignant solitary pulmonary cavity (SPV) and the efficacy of the comprehensive imaging analysis of SPV. Methods The clinical data of 56 patients with SPV who underwent 18F-FDG PET/CT, thin slice spiral CT, and enhanced CT in Xiamen University Zhongshan Hospital from October 2015 to October 2019 were analyzed retrospectively. The patients included 43 males and 13 females aged 41–82 (54.7±13.4) years old. By constructing and analyzing the receiver operating characteristic (ROC) curve, the optimal SUVmax threshold was calculated, and its diagnostic efficiency was evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy rate of 18F-FDG PET/CT, thin slice spiral CT, enhanced CT, and the comprehensive imaging analysis (comprehensive evaluation of the diagnostic results of the three imaging methods) of benign and malignant SPV were calculated based on the results of the histopathological examination and follow-up along with clinical data. Independent sample t-test was used to compare measurement data, and chi-square test was used to compare counting data. Results Among the 56 patients with SPV, 39 cases had malignant lesions (69.6%), SUVmax=7.04±2.3, and 17 cases had benign lesions (30.4%), SUVmax=5.91±2.17. No significant difference was found in SUVmax between benign and malignant lesions (t=1.714, P=0.092). ROC curve analysis shows that the optimal critical value of SUVmax was 7.05, the area under the ROC curve was 0.652, and the 95% confidence interval was in the range 0.494–0.809. When SUVmax=7.05, the sensitivity, specificity, PPV, NPV, and the accuracy rate were 46.2% (18/39), 82.4% (14/17), 85.7% (18/21), 40.0% (14/35), and 57.1% (32/56), respectively. The sensitivity rates of comprehensive imaging analysis, PET/CT, thin slice spiral CT, and enhanced CT in the diagnosis of SPV were 94.9% (37/39), 76.9% (30/39), 82.1% (32/39), and 71.8% (28/39); the specificity rates were 76.5% (13/17), 64.7% (11 /17), 35.3% (6/17), and 76.5% (13/17); the PPVs were 90.2% (37/41), 83.3% (30/36), 74.4% (32/43), and 87.5% (28/32); the NPVs were 86.7% (13/15), 55.0% (11/20), 46.2% (6/13), and 54.2% (13/ 24); and the diagnostic accuracy rates were 89.3% (50/56), 73.2% (41/56), 67.9% (38/56), and 73.2% (41/56), respectively. Conclusions SUVmax has a limited value in differentiating benign and malignant SPV. Comprehensive imaging analysis helps improve the diagnostic accuracy of SPV.
2021, 45(10): 631-635.
doi: 10.3760/cma.j.cn121381-202104016-00110
Abstract:
Objective To analyze the differences of intensity-modulated radiotherapy (IMRT) plan verification results obtained from various verification methods with PTW 729 ionization chamber matrix for postoperative cervical cancer patients. Methods The radiotherapy data of 10 postoperative cervical cancer patients, aged 44–69 years old, with a median age of 59 years old were analyzed retrospectively. The patients were underwent IMRT in the Second Affiliated Hospital of Nantong University from August 2020 to December 2020. The IMRT plan was designed with seven fields. Using the treatment planning system, four verification plans, namely, V1–V4, with different phantoms were designed. Three 2D isocenter plane verification plans (V1−V3) and one 3D stereoscopic verification plan (V4) were designed. In V1, all field angles were converted to 0°, and PTW 729 RW3 solid water was used which composed of 4.2 cm-thick solid water + ionization chamber matrix + 5.0 cm-thick solid water. In V2, all field angles were converted to 0°, and the PTW Octavius 4D phantom was used. The actual angle and the Octavius 4D phantom were used to obtain one-plane verification (V3) and stereoscopic verification (V4). Then, all of the above mentioned four verification plans were actually measured in an accelerator, and the differences of the measurement results between the verification plans in which different verification phantoms were used (V1 vs. V2), between two 2D plans in which all field angles were converted to 0° or actual angle were used (V2 vs. V3), and between 2D and 3D plans(V1, V2, V3 vs. V4), were analyzed with paired t test respectively. Results (1) The plan validation pass rate of V1 was significantly higher than that of V2 ((99.72±0.44)% vs. (94.95±6.13)%, t=2.621, P<0.05). The evaluation point of V1 were lower than that of V2 (311±50 vs. 392±61, t=−6.992, P<0.05). (2) The single-field validation pass rates of 180° and 232° fields in V2 were higher than that in V3 ((96.86±3.79)% vs. (95.72±3.56)%, (98.50±2.28)% vs. (92.98±5.04)%; t=2.294, 4.052; both P<0.05). (3) The plan validation pass rates of V1, V2, and V3 plans were significantly higher than that of V4 ((99.72±0.44)%, (94.95±6.13)%, (94.72±6.43)% vs. (86.91±2.63)%; t=17.912, 6.645, 5.962; all P<0.05). The evaluation points of V1, V2, and V3 were significantly lower than that of V4 (311±50, 392±61, 391±60 vs. 726 034±61 656; t=−37.244, −37.253, −37.252; all P<0.05). Conclusions Differences were found in the verification results of the IMRT plan obtained from different verification methods with PTW 729 ionization chamber matrix, especially the single field verification results for 180° and 232°. Therefore, to judge whether the IMRT plan for postoperative cervical cancer passed the verification, the verification methods and the location of the evaluation point with significant dose difference must be considered.
2021, 45(10): 636-641.
doi: 10.3760/cma.j.cn121381-202006015-00084
Abstract:
Objective To observe the long-term effects on the immune systems of three patients with moderate or severe bone marrow form of acute radiation sickness in the "4.26" 60Co radiation accident in Henan province and summarize the characteristics of long-term changes in the immune system after acute radiation injury. Methods Two patients ("Tian" and "Wang"; aged 37 and 8 years, respectively; both were males) with moderate bone marrow form of acute radiation sickness and one patient ("Mei"; female; 38 years old) with severe bone marrow form of acute radiation sickness in the "4.26" 60Co radiation accident in 1999 were followed up. The levels of serum immunoglobulin (Ig) A, IgG, IgM, and complement C3 in the patients' peripheral blood were detected through immune turbidimetry and used in evaluating humoral immunity. T lymphocyte subsets (including the percentages of CD3+, CD3+CD4+, and CD3+CD8+ T-cells and the ratio of CD3+CD4+ T-cells to CD3+CD8+ T-cells) were analyzed through flow cytometry for the evaluation of cellular immunity. Results The follow-up time was up to September 4, 2019, with a total of 11 times. Humoral immunity results showed that the complement C3 level of "Mei" decreased in half a year and in the second year, and her IgG level increased in the 5th, 11th, 13th, and 20th years. The IgM and IgG levels of "Tian" decreased in the third year and increased in the fifth year, respectively. As for "Wang", the complement C3 level increased in the first and fifth years after irradiation. The abnormal frequency and duration of Ig showed as "Mei">"Tian"="Wang". Cellular immunity results showed that the percentage of CD3+ and CD3+CD4+ T-cells and the ratio of CD3+CD4+ T-cells to CD3+CD8+ T-cells of "Mei" decreased significantly half a year after irradiation, and the percentages of her CD3+, CD3+CD4+, and CD3+CD8+ T-cells decreased in the seventh and 11th years, and the percentages of her CD3+ and CD3+CD4+ T-cells decreased in the 15th year. The percentages of CD3+CD4+ T-cells of "Tian" increased 5 and 11 years after irradiation, and the percentages of his CD3+ and CD3+CD8+ T-cells decreased in the seventh year. The percentages of CD3+, CD3+CD4+, and CD3+CD8+ T-cells of "Wang" decreased 7 years after irradiation. The abnormal frequency and duration of T lymphocyte subsets showed as "Mei">"Tian">"Wang". Conclusions The acute radiation-induced damage to the immune system is long term, dose-dependent, and reversible. For individuals, the damage to immune system is positively correlated with radiation dose, and age and gender are the possible influencing factors.
2021, 45(10): 642-647.
doi: 10.3760/cma.j.cn121381-202009013-00105
Abstract:
Objective To measure the EBT3 film dose of brachytherapy with 90Sr-90Y applicator to provide a rapid dose verification method for clinical application. Methods EBT3 films with good energy response were selected and compared with a solid water phantom. The gray scale dose curve of 0–500 cGy film was established using a linear accelerator, and its tissue equivalence was detected. Twenty 6 cm × 6 cm EBT3 films (0.28 mm thickness) were overlapped, and a 90Sr-90Y applicator was placed on the top and irradiated for 4 min. The absorbed dose near the central axis of each film was calculated using the gray scale dose curve. The radiation dose and isodose distributions at different distances from the applicator were calculated according to film thickness. Non-parametric independent sample U-test was used to compare the differences in absorbed doses measured before and after exposure to electron rays with different energies. Results The measurement results of film replacement with equal thickness solid water molds were slightly higher than those of pure solid water molds, but the difference was not statistically significant (Z=−0.31, P=0.84). The absorbed dose in the central region corresponding to different film depths decreased rapidly with decreasing gray values, and the dose at a depth of 0.5 cm was only 7.0 cGy. After irradiation for 4 min, the absorbed dose at different depths from the applicator met the fitting curve, y=739.07e−0.56x−44.8, and the range of isodose line initially increased and then decreased with the increasing depth. Conclusion EBT3 film verification can well meet the dose verification of 90Sr-90Y applicator, which is simple, easy, and accurate and is suitable of primary medical institutions.
2021, 45(10): 648-653.
doi: 10.3760/cma.j.cn121381-202010025-00108
Abstract:
In recent years, with the rapid development of nuclear medicine in China, radionuclides have been widely used in the diagnosis and treatment of tumors, heart diseases, and neurodegenerative diseases. Positron radiopharmaceutical nuclide packing is a necessary step before diagnosis and treatment can be performed in nuclear medicine clinics. Given that the process of manual packing would expose nuclear medicine workers to nuclear radiation, the development of an automatic nuclide packing instrument is of great clinical value. The development process of the automatic nuclide packaging instruments was reviewed; the functions of existing products, including nuclide packing, stock solution dilution, and bubble detection, were demonstrated; and problems in existing products, including maintaining difficulties, expensive costs, and insufficient functions, were identified. Finally, this paper discussed the prospects for the future development directions of nuclide packing, such as combining nuclide injection, nuclide quantity calculation, functional modularization, and others.
In recent years, with the rapid development of nuclear medicine in China, radionuclides have been widely used in the diagnosis and treatment of tumors, heart diseases, and neurodegenerative diseases. Positron radiopharmaceutical nuclide packing is a necessary step before diagnosis and treatment can be performed in nuclear medicine clinics. Given that the process of manual packing would expose nuclear medicine workers to nuclear radiation, the development of an automatic nuclide packing instrument is of great clinical value. The development process of the automatic nuclide packaging instruments was reviewed; the functions of existing products, including nuclide packing, stock solution dilution, and bubble detection, were demonstrated; and problems in existing products, including maintaining difficulties, expensive costs, and insufficient functions, were identified. Finally, this paper discussed the prospects for the future development directions of nuclide packing, such as combining nuclide injection, nuclide quantity calculation, functional modularization, and others.
2021, 45(10): 654-658.
doi: 10.3760/cma.j.cn121381-202011011-00104
Abstract:
Pericarditis is usually part of multiple systemic diseases and the first manifestation of some systemic diseases. Therefore, to find and remove the cause of systemic diseases and early intervention to delay the disease progression are helpful to prevent long-term complications and improve patient prognosis. Because it is relatively difficult to obtain pericardial effusion or pericardial tissue by pericardial biopsy, and the positive rate of biopsy is low, the identification of the cause of pericarditis is always being a difficult point. 18F-FDG PET/CT can integrate systemic physiological, metabolic, and anatomical information at one time, and has important value in determining the etiology of pericarditis. In addition, it has great advantages on determining the staging and grading of the disease, evaluating the therapeutic effect, and prognosticating, especially in the early identification of tumor recurrence, tumor restaging of the tumor, searching for the primary tumor, and positioning of the biological target area of radiotherapy. The author reviews the application value of 18F-FDG PET/CT in the diagnosis of pericarditis.
Pericarditis is usually part of multiple systemic diseases and the first manifestation of some systemic diseases. Therefore, to find and remove the cause of systemic diseases and early intervention to delay the disease progression are helpful to prevent long-term complications and improve patient prognosis. Because it is relatively difficult to obtain pericardial effusion or pericardial tissue by pericardial biopsy, and the positive rate of biopsy is low, the identification of the cause of pericarditis is always being a difficult point. 18F-FDG PET/CT can integrate systemic physiological, metabolic, and anatomical information at one time, and has important value in determining the etiology of pericarditis. In addition, it has great advantages on determining the staging and grading of the disease, evaluating the therapeutic effect, and prognosticating, especially in the early identification of tumor recurrence, tumor restaging of the tumor, searching for the primary tumor, and positioning of the biological target area of radiotherapy. The author reviews the application value of 18F-FDG PET/CT in the diagnosis of pericarditis.
2021, 45(10): 659-662.
doi: 10.3760/cma.j.cn121381-202012008-00101
Abstract:
Spinal infection (SI) is a disease caused by pathogenic bacteria spreading along the axial skeleton. Although MRI is the first imaging examination method for SI diagnosis, it has some disadvantages in diagnosis and differential diagnosis of SI. And 18F-FDG PET/CT, as one-stop general check-up method, is superior to MRI in identifying specific primary lesion and postoperative infection, and evaluating treatment response. The review mainly includes the clinical application of 18F-FDG PET/CT in early diagnosis, differential diagnosis and therapeutic efficacy evaluation of SI and compares it with MRI.
Spinal infection (SI) is a disease caused by pathogenic bacteria spreading along the axial skeleton. Although MRI is the first imaging examination method for SI diagnosis, it has some disadvantages in diagnosis and differential diagnosis of SI. And 18F-FDG PET/CT, as one-stop general check-up method, is superior to MRI in identifying specific primary lesion and postoperative infection, and evaluating treatment response. The review mainly includes the clinical application of 18F-FDG PET/CT in early diagnosis, differential diagnosis and therapeutic efficacy evaluation of SI and compares it with MRI.
2021, 45(10): 663-668.
doi: 10.3760/cma.j.cn121381-202104027-00109
Abstract:
The incidence of differentiated thyroid carcer (DTC) is increasing year by year. When distant metastasis occurs, the patients' life quality and survival rate were significantly reduced. Lung is the most common site, accounting for 55%-85% of distant metastasis with DTC, and is the main factor of death threat of thyroid cancer. Therefore, early diagnosis, evaluation and treatment decisions for these patients are particularly important, and it is also the key to shorten the gap between the diagnosis and treatment of thyroid cancer in China and developed countries and improve the quality of life of patients. This paper reviews the research progress in the epidemiological and clinic pathologic features, diagnosis, evaluation and treatment of pulmonary metastasis with DTC.
The incidence of differentiated thyroid carcer (DTC) is increasing year by year. When distant metastasis occurs, the patients' life quality and survival rate were significantly reduced. Lung is the most common site, accounting for 55%-85% of distant metastasis with DTC, and is the main factor of death threat of thyroid cancer. Therefore, early diagnosis, evaluation and treatment decisions for these patients are particularly important, and it is also the key to shorten the gap between the diagnosis and treatment of thyroid cancer in China and developed countries and improve the quality of life of patients. This paper reviews the research progress in the epidemiological and clinic pathologic features, diagnosis, evaluation and treatment of pulmonary metastasis with DTC.
2021, 45(10): 669-672.
doi: 10.3760/cma.j.cn121381-202009041-00099
Abstract:
The authors reported a case of differentiated thyroid cancer (DTC) with multiple bone metastases after resection, whose 99Tcm-methylenediphosphonate whole-body bone scan was negative while 131I post-treatment whole body scan (Rx-WBS) was positive. This article clarified the characteristics of the disease from laboratory examinations, histopathological examinations and imaging examinations results. This case illustrated that 131I Rx-WBS was conducive to the discovery of DTC bone metastases, and 131I therapy has a significant effect.
The authors reported a case of differentiated thyroid cancer (DTC) with multiple bone metastases after resection, whose 99Tcm-methylenediphosphonate whole-body bone scan was negative while 131I post-treatment whole body scan (Rx-WBS) was positive. This article clarified the characteristics of the disease from laboratory examinations, histopathological examinations and imaging examinations results. This case illustrated that 131I Rx-WBS was conducive to the discovery of DTC bone metastases, and 131I therapy has a significant effect.
2021, 45(10): 673-675.
doi: 10.3760/cma.j.cn121381-202011002-00098
Abstract:
The authors reported a case of inflammatory myofibroblastic tumor (IMT) of the right parietal bone. The characteristics of the disease were analyzed on the basis of clinical symptoms, imaging findings, laboratory examinations and pathological diagnosis results. IMT is rare to occur in the parietal bone, both the clinical manifestations and imaging findings are non-specific. The imaging features and differential diagnosis methods of the disease were summarized combined with literature review, aiming to improve the understanding and diagnostic ability of the disease.
The authors reported a case of inflammatory myofibroblastic tumor (IMT) of the right parietal bone. The characteristics of the disease were analyzed on the basis of clinical symptoms, imaging findings, laboratory examinations and pathological diagnosis results. IMT is rare to occur in the parietal bone, both the clinical manifestations and imaging findings are non-specific. The imaging features and differential diagnosis methods of the disease were summarized combined with literature review, aiming to improve the understanding and diagnostic ability of the disease.
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