2021 Vol. 45, No. 11
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2021, 45(11): 675-681.
doi: 10.3760/cma.j.cn121381-202010024-00110
Abstract:
Objective To investigate the value of 99Tcm-methylenediphosphonate (MDP) whole-body bone scan in screening fresh osteoporotic vertebral compression fractures (OVCF) in geriatric patients with osteoporosis (OP) and acute or chronic low back pain. Methods The clinical data and other imaging data of 104 geriatric patients with OP who underwent 99Tcm-MDP whole-body bone scan for acute or chronic low back pain in Zhongshan Hospital Xiamen University from January 2017 to December 2019 were analyzed retrospectively. The patients included 33 males and 71 females aged 62–88 (78.8±7.7) years old. The patients were divided into 60–69 years old group (n=42), 70–79 years old group (n=43), and ≥80 years old group (n=19) according to their age and were divided into acute pain group (n=78) and chronic pain group (n=26) according to the pain onset time. With reference to X-ray examination results, the 99Tcm-MDP whole-body bone scan images of all patients were analyzed, and the detection rates of fresh OVCF were calculated. χ2 test was used for comparison among groups. Results The detection rate of fresh OVCF in 104 geriatric patients with OP by 99Tcm-MDP whole-body bone scan was 72.1% (75/104), and the detection rate of fresh OVCF in the acute pain group was higher than that in the chronic pain group (87.2% (68/78) vs. 26.9% (7/26), χ2=35.209, P<0.001). The detection rates of fresh OVCF in the three age groups were 66.7% (28/42), 76.7% (33/43), and 73.7% (14/19), respectively, and the difference was not statistically significant (χ2=1.101, P>0.05). Among the three age groups, the detection rates of fresh OVCF in patients with acute pain was higher than that in patients with chronic pain (83.9% (26/31) vs. 18.2% (2/11), 88.6% (31/35) vs. 25.0% (2/8), 91.7% (11/12) vs. 42.9% (3/7); χ2=12.948, 11.398, 5.456; all P<0.05). Among the fresh OVCF detected, 80.0% (60/75) involved a single vertebral body, and 20.0% (15/75) involved two or more vertebral bodies. Conclusion 99Tcm-MDP whole-body bone scan has clinical screening value for fresh OVCF when low back pain (especially acute low back pain) occurs in geriatric patients with OP.
2021, 45(11): 682-688.
doi: 10.3760/cma.j.cn121381-202010012-00118
Abstract:
Objective To investigate the effects of titanium clip implantation under endoscope on target delineation and dosimetric parameters in patients with locally advanced esophageal cancer treated with preoperative radiotherapy. Methods The clinical data of 36 patients with locally advanced esophageal squamous cell carcinoma confirmed by ultrasound gastroscopy and histopathology in the Joint Logistics Support Force Hospital 900 from January 2018 to December 2019 were retrospectively analyzed, including 23 males and 13 females, aged 18−65(43.7±6.9) years. All patients were treated with titanium clip implantation at the upper and lower boundaries of esophageal lesions under endoscopy before and after radiotherapy. CT scan localization and target delineation were performed before and after titanium clip implantation. Gross tumor volume (GTV) length, GTV, clinical target volume (CTV), and normal organ irradiation dose were compared before and after titanium clip implantation. The patients were divided into accurate group (error < 1 cm) and error group (error≥1 cm) according to the error value, and the influencing factors of esophageal target delineation were analyzed. Paired sample t-test and independent sample t-test were used to compare the error values of tumor length, diameter, upper bound and lower bound before and after titanium clip implantation, spinal cord, and heart as well as the difference of the average irradiation dose of double lung V10 and V20. χ2 test was used to analyze the clinical case characteristics of the accurate group and the error group by univariate logistic regression. Cox multivariate regression risk factor analysis was used to analyze the risk factors affecting the accurate delineation of the target area. Results Titanium clips were successfully placed under endoscope in all patients, but 4 cases (11.1%) had the upper boundary titanium clips falling off. The postoperative pathological complete response rate was 52.8% (19/36). The length of GTV before titanium clip implantation was (4.74±1.02) cm, which was higher than that after implantation (3.98±0.79) cm, and the difference was statistically significant (t=9.472, P<0.05). The GTV and CTV of the tumor before implantation were (28.87±3.21) cm3 and (72.46±6.37) cm3, respectively, which were higher than (24.59±2.67) cm3 and (56.37±4.52) cm3 after implantation. The differences were statistically significant (t=6.726, 7.696; both P<0.05). The irradiation doses of V10, V20 (the percentage of lung volume in total lung volume that received more than 10 Gy and 20 Gy irradiation dose, respectively), and spinal cord in both lungs before titanium clip implantation were higher than those after implantation ((21.64±1.57)% vs. (17.32±0.96)%, (14.87±2.32)% vs. (11.69±1.84)%, (28.87±3.21) Gy vs. (24.59±2.67) Gy), and the differences were statistically significant (t=8.05, 7.64, −2.43; all P<0.01). Univariate Logistic regression analysis showed that age, tumor location, drinking history, and GTV length were correlated with the accurate delineation of GTV (χ2=5.64, 11.57, 13.33, 8.23; all P<0.01). Cox multivariate regression analysis showed that tumor location and GTV length were independent risk factors affecting the accurate delineation of GTV (RR=0.296, 95%CI: 0.137~0.586; 2.313, 95%CI: 1.280~4.875; both P<0.01). Conclusions Endoscopic titanium clip implantation is of great value in preoperative radiotherapy for locally advanced esophageal cancer. It can accurately guide the delineation of the target area under CT localization and reduce the irradiation dose of normal organs.
2021, 45(11): 689-694.
doi: 10.3760/cma.j.cn121381-202009030-00119
Abstract:
Objective To evaluate the value of variable flip angle three dimensional sampling perfertion with application optimized contrasts using deifferent flip angle evolutions (3D-SPACE) combined with three dimensional turbo spin echo retore (3D-TSERT) sequence scanning technology in the diagnosis of calculi using magnetic resonance cholangiopancreatography (MRCP). Methods A retrospective study was conducted on the clinical data of 168 patients diagnosed with pancreatic and biliary calculi in the Central Hospital of Xuzhou from January to September 2019. The patients comprised 93 males and 75 females, aged 24–70(42.91±3.20) years, who underwent pancreatic and biliary tract 3D-SPACE-sequence and 3D-TSERT-sequence MRCP. The surgical result was used as the diagnostic standard. 3D-SPACE-sequence, 3D-TSERT-sequence, and their combination were used to determine and analyze different sizes of calculi in the pancreas and biliary tract. The three methods were compared in terms of their detection rates of pancreatic and biliary tract calculi. Receiver operating characteristic curve was used to analyze the sensitivity, specificity, and accuracy of 3D-SPACE, 3D-TSERT sequence, and their combination in the diagnosis of pancreatic and biliary tract calculi in MRCP. χ2 test was used to compare the detection rates between the two groups. Result The detection rate of 3D-SPACE combined with 3D-TSERT sequence for pancreatic and biliary calculi (98.45%, 191/194) was higher than those of 3D-SPACE-sequence (81.44%, 158/194) and 3D-TSERT-sequence (78.87%, 153/194), and the difference was statistically significant (χ2=12.738, 13.461; both P<0.01). The detection rate of 3D-SPACE combined with 3D-TSERT sequence for pancreas and biliary tract calculi with maximum diameter ≤0.8 cm (97.14%, 102/105) was higher than those of 3D-SPACE-sequence (69.52%, 73/105) and 3D-TSERT-sequence (66.67%, 70/105), and the difference was statistically significant (χ2=10.684, 11.374; both P<0.01). The detection rates of 3D-SPACE combined with 3D-TSERT sequence for gallbladder calculi, intrahepatic bile duct calculi, common bile duct calculi, lower common bile duct ampullary calculi, and pancreatic duct calculi were higher than those of 3D-SPACE-sequence and 3D-TSERT-sequence, and the differences were statistically significant (χ2=9.105–15.715, all P<0.01). The sensitivity, specificity, and accuracy of 3D-SPACE combined with 3D-TSERT sequence for the diagnosis of pancreatic and biliary calculi were 89.73%, 90.64%, and 88.26%, respectively, which were higher than those of 3D-SPACE-sequence (78.46%, 79.68%, and 79.38%) and 3D-TSERT-sequence (77.53%, 78.62%, and 76.19%). Conclusion 3D-SPACE combined with 3D-TSERT sequence scanning technology has high clinical application value in the diagnosis of calculi (especially small calculi) through the MRCP of different parts of the pancreas and biliary tract.
2021, 45(11): 695-700.
doi: 10.3760/cma.j.cn121381-202009042-00114
Abstract:
Objective To design and synthesize a new type of 18F-labeled short-chain fatty acid imaging agent, namely 2-18F-fluorobutyric acid (2-18F-FBA) and to evaluate its use as a tumor PET/CT imaging agent. Methods Methyl 2-bromobutyrate as a precursor was radiolabeled via 18F− nucleophilic substitution reaction. 2-18F-Methyl fluorobutyrate formed as an intermediate was separated through high performance liquid chromatography. Components with a retention time of 16–18 min were collected. After being diluted with 20 mL of water, the components were passed through a C18 column, rinsed with 10 mL of water, and blow-dried. The intermediate was adsorbed and hydrolyzed with 1 mL of NaOH solution to obtain 2-18F-FBA. The clarity of the product was visually inspected, and its pH value was determined with pH paper. Its radiochemical purity and stability were also measured. Institute of cancer research healthy mice were injected with 2-18F-FBA (0.2 mL, 7 MBq) through the tail vein to examine the biological distribution of 2-18F-FBA. S180 sarcoma tumor-bearing mice were subjected to micro-PET/CT imaging and performed image analysis, Calculated SUVmax. Biological distribution in various tissues and organs at different time points was compared via Student's t test. Results The whole preparation time of 2-18F-FBA was 40 min, the radiochemical yield was (40±5)% (corrected by time), and radiochemical purity was >98%. The product solution was clear and did not contain particles. Its pH value was 7.2, and its stability was good in vivo and in vitro. Biological distribution in vivo showed that the liver, heart and lungs had significant radioactive uptake after injected of 2-18F-FBA 5 min. Brain tissue had low uptake at all time points. Radioactive uptake gradually decreased with time and stabilized after 60 min. The bone uptake rate did not change significantly with time, and the radioactive uptake rate 5 min after the injection of the imaging agent did not significantly differ from the rates at 30 min and 90 min (t=1.532, 1.104; both P>0.05). The micro-PET/CT image of S180 sarcoma tumor-bearing mice revealed that the radioactive uptake in the tumor was significant 30 min after 2-18F-FBA was injected. Conversely, the uptake of the surrounding tissues was low at this time point, and the tumor uptake reached the maximum after 60 min, SUVmax=1.90±0.03. The liver, intestines, and other abdominal organs also had radioactivity uptake. Conclusions 2-18F-FBA has a short synthesis time and a high radiochemical yield. It is a new fatty acid metabolite that can be used as an imaging agent with potential for application in tumor detection.
2021, 45(11): 701-709.
doi: 10.3760/cma.j.cn121381-202101027-00116
Abstract:
Radiotherapy is one of the main modalities of cancer treatment, but the benefits from radiotherapy varies among different types of tumors and individuals. One of the important means to solve this problem is to improve the radiosensitivity of tumor tissues. Recent studies have shown that long non-coding RNA (lncRNA) influences the radiosensitivity of tumor cells through multiple mechanisms, and is expected to be an adjuvant therapeutic target for radiotherapy in the near future. In this paper, the authors review the action of lncRNA involved in the process of tumor radiotherapy resistance and its related molecular mechanisms.
Radiotherapy is one of the main modalities of cancer treatment, but the benefits from radiotherapy varies among different types of tumors and individuals. One of the important means to solve this problem is to improve the radiosensitivity of tumor tissues. Recent studies have shown that long non-coding RNA (lncRNA) influences the radiosensitivity of tumor cells through multiple mechanisms, and is expected to be an adjuvant therapeutic target for radiotherapy in the near future. In this paper, the authors review the action of lncRNA involved in the process of tumor radiotherapy resistance and its related molecular mechanisms.
2021, 45(11): 710-714.
doi: 10.3760/cma.j.cn121381-202109009-00115
Abstract:
Radiotherapy, as a method for tumor treatment, refers to the utilization of ionizing radiation to cause direct or indirect damage to tumor cells. However, the effect of radiotherapy is limited because of the normal tissue damage and tumor radiation resistance of tumor cells. Tumor radiosensitization is a research hotspot in recent years, which aims to increase the sensitivity of tumors to radiotherapy, overcome the defects of radiotherapy and improve the efficacy of radiotherapy. Inorganic nanomaterial-mediated tumor radiosensitization can improve radiotherapy efficacy mainly by increasing intracellular radiation energy deposition, catalyzing the generation of reactive oxygen species and regulating the tumor microenvironment. This article reviews the research progress on inorganic nanomaterial-mediated tumor radiosensitization.
Radiotherapy, as a method for tumor treatment, refers to the utilization of ionizing radiation to cause direct or indirect damage to tumor cells. However, the effect of radiotherapy is limited because of the normal tissue damage and tumor radiation resistance of tumor cells. Tumor radiosensitization is a research hotspot in recent years, which aims to increase the sensitivity of tumors to radiotherapy, overcome the defects of radiotherapy and improve the efficacy of radiotherapy. Inorganic nanomaterial-mediated tumor radiosensitization can improve radiotherapy efficacy mainly by increasing intracellular radiation energy deposition, catalyzing the generation of reactive oxygen species and regulating the tumor microenvironment. This article reviews the research progress on inorganic nanomaterial-mediated tumor radiosensitization.
2021, 45(11): 715-720.
doi: 10.3760/cma.j.cn121381-202011016-00109
Abstract:
In China, the incidence and mortality of prostate cancer (PCa) are increasing gradually, and the early diagnosis and accurate staging of PCa patients is still a major problem. Therefore, most patients have been diagnosed with advanced stage, leading to poor survival prognosis. MRI, CT, PET/CT and other imaging examinations are currently the main means for the diagnosis and staging of PCa, but these methods have also been found to have certain limitations, so they are constantly being explored and optimized. In particular, the application of various imaging agents in PET/CT has greatly improved the diagnostic sensitivity and specificity of PCa and shows a good prospect in the early diagnosis, timely treatment, clinical staging and prognosis evaluation of PCa. In this paper, these common imaging methods and PET/CT imaging agents are discussed; their advantages, disadvantages and new application progress are summarized, hoping to provide references to clinicians.
In China, the incidence and mortality of prostate cancer (PCa) are increasing gradually, and the early diagnosis and accurate staging of PCa patients is still a major problem. Therefore, most patients have been diagnosed with advanced stage, leading to poor survival prognosis. MRI, CT, PET/CT and other imaging examinations are currently the main means for the diagnosis and staging of PCa, but these methods have also been found to have certain limitations, so they are constantly being explored and optimized. In particular, the application of various imaging agents in PET/CT has greatly improved the diagnostic sensitivity and specificity of PCa and shows a good prospect in the early diagnosis, timely treatment, clinical staging and prognosis evaluation of PCa. In this paper, these common imaging methods and PET/CT imaging agents are discussed; their advantages, disadvantages and new application progress are summarized, hoping to provide references to clinicians.
2021, 45(11): 721-727.
doi: 10.3760/cma.j.cn121381-202011023-00121
Abstract:
The curative efficacy and safety of the 131I therapy of Graves' disease have been recognized by most domestic and international scholars, but the choice of the specific therapeutic dose is still controversial. According to different therapeutic targets, the choice of the dose-determination scheme is also different. Domestic scholars mostly choose the combination of calculated dose method individualized scheme, while foreign scholars mostly choose the fixed dose scheme. This article reviews the dose-determination schemes of 131I therapy for Graves' disease.
The curative efficacy and safety of the 131I therapy of Graves' disease have been recognized by most domestic and international scholars, but the choice of the specific therapeutic dose is still controversial. According to different therapeutic targets, the choice of the dose-determination scheme is also different. Domestic scholars mostly choose the combination of calculated dose method individualized scheme, while foreign scholars mostly choose the fixed dose scheme. This article reviews the dose-determination schemes of 131I therapy for Graves' disease.
2021, 45(11): 728-732.
doi: 10.3760/cma.j.cn121381-202106001-00096
Abstract:
More and more studies have shown that children with congenital heart disease (CHD) will suffer from brain developmental deficiency. Recently, how to predict the brain development of children with CHD based on imaging data in the early stage has become a hot issue. Ultrasound and MRI have been proven to predict the brain development of children with CHD, and play an important role in the early assessment and intervention. In this paper, the current research status and progress of imaging-based prediction models in the brain development of children with CHD are reviewed, aiming to provide references for clinical treatment and follow-up.
More and more studies have shown that children with congenital heart disease (CHD) will suffer from brain developmental deficiency. Recently, how to predict the brain development of children with CHD based on imaging data in the early stage has become a hot issue. Ultrasound and MRI have been proven to predict the brain development of children with CHD, and play an important role in the early assessment and intervention. In this paper, the current research status and progress of imaging-based prediction models in the brain development of children with CHD are reviewed, aiming to provide references for clinical treatment and follow-up.
2021, 45(11): 733-735.
doi: 10.3760/cma.j.cn121381-202101021-00107
Abstract:
Heterotopic gray matter (HGM) is a rare congenital developmental abnormality caused by the accumulation of neurons in abnormal parts due to the blockage of neuronal migration in the embryonic stage. The authors analyzed the imaging characteristics of a patient with HGM by18F-fluorodeoxyglucose (FDG) PET/CT-MRI three-mode imaging, in order to improve the understandingof the imaging manifestations of the disease, so as to facilitate accurate diagnosis and timely treatment.
Heterotopic gray matter (HGM) is a rare congenital developmental abnormality caused by the accumulation of neurons in abnormal parts due to the blockage of neuronal migration in the embryonic stage. The authors analyzed the imaging characteristics of a patient with HGM by18F-fluorodeoxyglucose (FDG) PET/CT-MRI three-mode imaging, in order to improve the understandingof the imaging manifestations of the disease, so as to facilitate accurate diagnosis and timely treatment.
2021, 45(11): 736-739.
doi: 10.3760/cma.j.cn121381-202101010-00100
Abstract:
The authors reported a case of cardiac epithelioid angiosarcoma (EA) with extensive metastasis on 18F-fluorodeoxyglucose (FDG) PET/CT imaging. The characteristics of EA were analyzed from clinical symptoms, laboratory examinations, ultrasound, CT, MRI and 18F-FDG PET/CT whole-body imaging, and the imaging features of cardiac epithelioid angiosarcoma were summarized through literature review. Cardiac EA is rarely seen in clinic, and 18F-FDG PET/CT imaging has certain clinical significance in the diagnosis and clinical staging of EA.
The authors reported a case of cardiac epithelioid angiosarcoma (EA) with extensive metastasis on 18F-fluorodeoxyglucose (FDG) PET/CT imaging. The characteristics of EA were analyzed from clinical symptoms, laboratory examinations, ultrasound, CT, MRI and 18F-FDG PET/CT whole-body imaging, and the imaging features of cardiac epithelioid angiosarcoma were summarized through literature review. Cardiac EA is rarely seen in clinic, and 18F-FDG PET/CT imaging has certain clinical significance in the diagnosis and clinical staging of EA.
2021, 45(11): 740-741.
Abstract:
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