2021 Vol. 45, No. 12
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2021, 45(12): 1-4.
Abstract:
2021, 45(12): 741-749.
doi: 10.3760/cma.j.cn121381-202009005-00113
Abstract:
Objective To explore significant differences in the metabolic volume parameters of prostate specific membrane antigen labeled with 68Gallium (68Ga-PSMA-11) PET/CT among different risk stratification subgroups in patients with newly diagnosed prostate carcinoma (PCa). Methods The images and clinical data of 85 untreated patients with PCa (aged 49–88 (69.1±7.7) years) newly diagnosed by prostate biopsy and examined by 68Ga-PSMA-11 PET/CT in the First Affiliated Hospital of Naval Military Medical University from January 2019 to December 2019 were analyzed retrospectively. In accordance with the occurrence of tumor metastasis and the risk stratification recommended by the guidelines of National Comprehensive Cancer Network, patients were divided into binary subgroups: non-metastasis and metastasis subgroups as well as low-medium- and high-risk subgroups. Taking the Gleason score (GS)=8 as the critical value, patients were divided into GS<8 and GS≥8 subgroups. Taking serum prostate specific antigen (PSA)=20 ng/mL as the critical value, patients were divided into PSA≤20 ng/mL and PSA>20 ng/mL subgroups. In accordance with clinical stage, patients were divided into clinical T1–T2 and T3–T4 subgroups. Three dimensional sketching method was used to automatically measure and sketch the region of interest of tumor lesions on 68Ga-PSMA-11 PET/CT images, and calculate the maximum standardized uptake value (SUVmax), primary PSMA tumor volume (PSMA-TVprimary), whole-body PSMA tumor volume (PSMA-TVwhole body), total number of primary PSMA tumors (TL-PSMAprimary), and total number of whole-body PSMA tumors (TL-PSMAwhole body) separately. The metabolic volume parameters between subgroups were compared by the nonparametric Mann-Whitney U rank sum test of two independent samples. Results The results of 68Ga-PSMA-11 PET/CT were positive in all 85 patients, including 46 cases (54.1%) in the non-metastasis subgroup and 39 cases (45.9%) in the metastasis subgroup as well as 15 cases (17.6%) in the low-medium-risk subgroup and 70 cases (82.4%) in the high-risk subgroup. The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the metastasis subgroup were significantly higher than those in the non-metastasis subgroup (16.2 vs. 9.8, 39.5 cm3 vs. 10.8 cm3, 58.8 cm3 vs. 10.8 cm3, 318.4 cm3 vs. 37.2 cm3, 628.0 cm3 vs. 37.2 cm3; Z=−6.301 to −2.580, all P<0.05). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the high-risk subgroup were significantly higher than those in the low-medium-risk subgroup (13.8 vs. 4.2, 16.5 cm3 vs. 8.4 cm3, 21.9 cm3 vs. 11.4 cm3, 146.1 cm3 vs. 27.4 cm3, 229.6 cm3 vs. 28.6 cm3; Z=−4.242 to −2.438, all P<0.05). The SUVmax, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the GS≥8 subgroup were significantly higher than those in the GS<8 subgroup (14.8 vs. 9.9, 23.9 cm3 vs. 14.3 cm3, 146.1 cm3 vs. 36.3 cm3, 229.6 cm3 vs. 36.3 cm3; Z=−2.850 to −2.074, all P<0.05), whereas the PSMA-TVprimary was not significantly different between the two subgroups (16.5 cm3 vs. 12.5 cm3, Z=−1.231, P=0.218). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the PSA>20 ng/mL subgroup were significantly higher than those in the PSA≤20 ng/mL subgroup (16.2 vs. 6.4, 24.7 cm3 vs. 8.2 cm3, 41.4 cm3 vs. 10.2 cm3, 253.9 cm3 vs. 28.0 cm3, 361.5 cm3 vs. 29.7 cm3; Z=−6.279 to −3.948, all P<0.001). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the clinical T3–T4 subgroup were significantly higher than those in the clinical T1–T2 subgroup (16.6 vs. 9.3, 34.9 cm3 vs. 10.7 cm3, 62.3 cm3 vs. 14.3 cm3, 303.5 cm3 vs. 32.6 cm3, 482.1 cm3 vs. 45.9 cm3; Z=−4.889 to −3.629, all P<0.001). Conclusion The metabolic volume parameters based on 68Ga-PSMA-11 PET/CT in metastatic and high-risk patients with newly diagnosed PCa were significantly higher than those in non-metastatic and low-medium-risk patients.
2021, 45(12): 750-758.
doi: 10.3760/cma.j.cn121381-202010010-00124
Abstract:
Objective To comparatively analyze the 18F-fluorodeoxyglucose (FDG) PET metabolic characteristics and multislice spiral CT imaging features of pulmonary invasive adenocarcinoma appearing as ground-glass nodules (GGN) with different risk levels and to evaluate the value of 18F-FDG PET/CT in the diagnosis of risk levels of GGN. Methods Retrospective analysis was performed on 143 patients (54 males, 89 females, 30−79(60.2±8.9) years old) with pulmonary invasive adenocarcinoma confirmed by histopathological examination or follow-up. All patients underwent 18F-FDG PET/CT whole body imaging (including 50 cases of 18F-FDG PET/CT dual-phase imaging) and surgical resection of solitary GGN of the lung. In accordance with the adenocarcinoma growth pattern, the patients were further divided into two groups. Patients with lesions with lepidic predominant adenocarcinoma and/or acinar predominant adenocarcinoma and/or papillary predominant adenocarcinoma were assigned to the low-risk group, and those with lesions with solid predominant adenocarcinoma and/or micropapillary predominant adenocarcinoma were classified into the high-risk group. The recorded data included gender, age, lesion location, size, density, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), retention index (RI) in dual phase imaging, the SUVmax ratio of tumor to contralateral normal lung background (T/N), the rate of change in the ratio of tumor to contralateral normal lung background based on the SUVmax (ΔT/Nmax), lobulation sign, spiculation sign, vocule sign, air bronchgram, pleural indentation, and vascular convergence sign. Qualitative factors were analyzed by using independent-sample t test, whereas quantitative variables were analyzed by using χ2 test. Multivariate unconditional Logistic regression analysis was utilized to test the correlation factors with statistical differences before treatment. Receiver operating characteristic (ROC) curve analysis was performed in accordance with the Logistic regression analysis results. Results In 143 patients, lesion size ((14.33±4.18) mm vs. (17.61±4.48) mm), SUVmax (1.32±1.07 vs. 2.00±1.25), SUVmean (1.07±0.85 vs. 1.66±1.11), RI (0.01±0.36 vs. 0.20±0.07), lobulation (76.1%(89/117) vs. 92.3%(24/27)), and pleural indentation (39.3%(46/117) vs. 69.2%(18/26)) showed statistically significant differences between low-risk group (117 cases) and high-risk group (26 cases) (t=−3.242 to −2.392; χ2=4.773, 6.766; all P<0.05). In 50 patients underwent 18F-FDG PET/CT dual-phase imaging, delayed imaging SUVmax (1.18±0.63 vs. 2.85±1.82), delayed imaging SUVmean (0.92±0.43 vs. 2.72±1.69), delayed imaging T/N (2.55±1.33 vs. 5.84±3.83) showed statistically significant differences between low-risk group (40 cases) and high-risk group (10 cases) (t=−2.867, −3.359, −2.678; all P<0.05). Among these factors, SUVmean, lesion size, and pleural indentation were the independent influencing factors for differentiating the two groups. When the value of SUVmax was 1.625, the area under the ROC curve was 0.699. The sensitivity, specificity, and accuracy of differentiating the two groups were 57.7%(15/26), 78.6%(92/117), and 74.8%(107/143), respectively. When the value of SUVmean was 0.845, the area under the ROC curve was 0.698. The sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 43.6%(51/117), and 50.3%(72/143), respectively. When the lesion size was 13.765 mm, the area under the ROC curve was 0.716, and the sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 54.7%(64/117), and 59.4%(85/143), respectively. The combined diagnosis with SUVmax+SUVmean+lesion size+pleural indentation+lobulation sign has the highest efficiency in differentiating the two groups compared with single diagnosis. Conclusion In the diagnosis of pulmonary invasive adenocarcinoma appearing as GGN, 18F-FDG PET/CT contributes to risk levels.
2021, 45(12): 759-766.
doi: 10.3760/cma.j.cn121381-202011036-00122
Abstract:
Objective To explore the feasibility of diagnosing diabetic foot (DF) based on radiomic features of magnetic resonance imaging (MRI) . Methods The clinical data of 127 patients with foot diseases who underwent foot MRI examination in Shanghai University of TCM, Shanghai TCM-integrated Hospital from August 2018 to August 2020 were analyzed retrospectively, including 83 males and 44 females, aged 16–88 (59.3±14.8) years. The patients were divided into the DF group (85 cases) and non-DF group (42 cases) according to the clinical diagnosis of the patient. Based on the features of radiomics, using simple random sampling method, the patients were divided into the training group (76 cases) and test group (51 cases) at the ratio of 3∶2. First, the cuboid was sketched on sagittal images of the T1-weighted imaging (T1WI) and proton density weighted imaging (PDWI) fat suppression sequence of MRI, and the radiomic features were extracted. Then, the T1WI sequence, PDWI fat suppression sequence, and combined models were constructed; the combined model included gender, age, bone marrow signals, and radiomic features. Based on the pretreatment of normalization of the maximum absolute value of three groups of model parameters, the optimal feature dimensions were selected using optimal feature and model selection. The age between the two groups was compared using the independent-sample t test, and the gender and abnormal bone marrow signal of midfoot between the two groups were compared using the chi-square test. Results Significant differences in age, gender ratio, and abnormal bone marrow signal of midfoot were observed between the DF group and non-DF group (t=29.2; χ2=17.15, 6.53; all P<0.05). The T1WI sequence model, PDWI fat suppression sequence model, and combined model finally screened 9, 7, and 10 optimal feature dimensions, respectively. The support vector machine model was used to distinguish DF and non-DF patients. On the T1WI sequence model, the area under the curve (AUC) of the training and test groups were 0.86 and 0.84, respectively, and the accuracy rates were 78% and 69%, respectively. On the PDWI fat suppression sequence model, the AUC of the training and test groups were 0.85 and 0.83, respectively, and the accuracy rates were 82% and 78%, respectively. On the combined model, the AUC of the training and test groups were 0.93 and 0.85, respectively, and the accuracy rates were 84% and 76%, respectively. The diagnostic efficacy of the T1WI sequence model was equivalent to that of the PDWI fat suppression sequence model, whereas the combined model showed better diagnostic efficacy than the two aforementioned models. Conclusion MRI radiomics can effectively distinguish DF from non-DF, which can provide a new, efficient, and noninvasive method for DF imaging diagnosis.
2021, 45(12): 767-772.
doi: 10.3760/cma.j.cn121381-202102024-00123
Abstract:
Objective To quantify the detectability of implanted markers in volume-modulated arc therapy for prostate cancer and to identify the best implant location. Methods (1) Markers were implanted with different fixed coordinate combinations in pelvic prostheses in proper order under four modes. (2) Twenty-five past volume-modulated arc therapy plans for prostate cancer were selected. In accordance with the experimental design, the pelvic prostheses implanted with the markers were irradiated for 25 times with single dose of about 60 Gy, and MV-level electronic portal image device images were obtained at each control point. (3) The mean value of detectability score (\begin{document}${ \overline{D}}$\end{document} ![]()
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Results Group-level results: Among all group-level coordinate combinations, the \begin{document}$ \overline{D}$\end{document} ![]()
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Conclusion This study successfully quantified the detectability of implanted markers, and the best implant location from the group level to the model level and then to the system level was obtained.
2021, 45(12): 773-782.
doi: 10.3760/cma.j.cn121381-202009033-00125
Abstract:
Objective To investigate the effect of the antibody neutralization of astacin-like metalloendopeptidase (ASTL) on the radiosensitivity of human cervical carcinoma ME-180 cells. Methods ME-180 cells and HeLa cells were grouped as follows in accordance with different experimental treatments: (1) ME-180 cells were divided into the control group, irradiation (4 Gy) group, ASTL antibody group, and ASTL antibody + irradiation (4 Gy) group. The number and proliferative capacity of viable cells were detected via 5-ethynyl-2'deoxyuridine nucleoside (EdU) staining and 3-(4,5-dimethylthiazol-2)-2,5-diphenyltetrazolium bromide (MTT) assay. Immunofluorescence and Western blot analyses were used to detect the localization of ASTL in the cells at 0, 24, 48, and 72 h after irradiation. (2) ME-180 cells were divided into two groups: the irradiation group and the ASTL antibody + irradiation group irradiated with 0, 2, 4, and 8 Gy γ-rays. The proliferative capacity of the cells was detected through the clone formation assay. (3) HeLa cells were divided into two groups: the irradiation group and the ASTL antibody + irradiation group irradiated with 0, 2, 4, and 8 Gy γ-rays. MTT assay was used to detect the proliferative capacity of the cells. (4) ME-180 cells were divided into two groups: the sh-control group and the sh-ASTL transfection group. Protein kinase B expression levels were analyzed through quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analyses; at the same time, ME-180 cells were treated with 0, 5, 10 nmoL/L antibodies respectively, and the effect of antibody neutralization on target gene expression was detected by western blot test. (5) ME-180 cells were divided into two groups: the control group and the irradiation (4 Gy) group. Western blot analysis was used to detect ASTL and AKT expression.For the relative experiments, the cells were treated with 137Cs γ-ray irradiation at the dose rate of 1 Gy/min. Independent samples t-test was used for comparison between two groups. Results (1) The results of the EdU staining experiments showed that neutralizing ASTL significantly inhibited the proliferation of ME-180 cells after irradiation (t=9.25, P<0.05). The results of the MTT assay validated that the proliferative capacity of the ASTL antibody + irradiation group (4 Gy) was significantly (t=5.17, 10.32, 14.27; all P<0.05) reduced compared with that of the irradiation group after 24, 48, and 72 h of irradiation. The results of immunofluorescence and Western blot analyses revealed that the cytoplasmic localization of ASTL in ME-180 cells was significantly enhanced after 24 h of 4 Gy irradiation, and ASTL was relocalized on the cell membrane after 48–72 h of irradiation. (2) The results of the clone formation assay demonstrated that ASTL antibodies could significantly reduce the survival rate of ME-180 cells after 8 Gy irradiation (t=7.63, P<0.05). (3) The results of the MTT assay showed that ASTL antibodies could significantly reduce the survival rates of HeLa cells after 2, 4, and 8 Gy irradiation (t=4.27, 9.66, 15.71; all P<0.05). (4) qRT-PCR analysis revealed that the expression level of AKT was significantly (t=13.94, P<0.05) down-regulated after ASTL interference, whereas the results of Western blot analysis showed that ASTL interference or ASTL antibody addition could reduce the protein expression levels of AKT and its target genes. (5) The results of Western blot analysis demonstrated that in ME-180 cells, the levels of the ASTL protein and AKT and its target genes significantly increased after 4 Gy irradiation. Conclusion The radiosensitivity of human cervical cancer ME-180 cells was correlated with the level of ASTL, and ASTL antibody or sh-ASTL could enhance the radiosensitivity of ME-180 cells after irradiation.
2021, 45(12): 783-788.
doi: 10.3760/cma.j.cn121381-202011026-00106
Abstract:
The potential risk of radiation exposure is increasing because of the widespread use of nuclear technologies in the fields of medicine, science, technology, and military and various industries. Moreover, safe and effective radioprotective agents are lacking. Polypeptides play a vital regulatory role in various living processes. Polypeptide drugs are highly selective, efficacious, and safe, and modifications are easy to incorporate for the optimization of peptide functionality. Hence, many studies on radioprotective polypeptides have been conducted. Here, we provide an overview of peptides as radioprotective agents, particularly their molecular characteristics, design ideas, and the specific therapeutic effects of potential radioprotective peptides, aiming to lay the groundwork for the research of radioprotective polypeptides.
The potential risk of radiation exposure is increasing because of the widespread use of nuclear technologies in the fields of medicine, science, technology, and military and various industries. Moreover, safe and effective radioprotective agents are lacking. Polypeptides play a vital regulatory role in various living processes. Polypeptide drugs are highly selective, efficacious, and safe, and modifications are easy to incorporate for the optimization of peptide functionality. Hence, many studies on radioprotective polypeptides have been conducted. Here, we provide an overview of peptides as radioprotective agents, particularly their molecular characteristics, design ideas, and the specific therapeutic effects of potential radioprotective peptides, aiming to lay the groundwork for the research of radioprotective polypeptides.
2021, 45(12): 789-794.
doi: 10.3760/cma.j.cn121381-202012013-00111
Abstract:
Extranodal natural killer/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma associated with Epstein-Barr virus infection with high aggressiveness and poor prognosis. Accurate diagnosis and staging, timely curative effect and prognostic evaluation are crucial to the formulation of patient treatment strategies. With the wide application of 18F-FDG PET/CT in lymphoma, its value in ENKTL has also received more and more attention. This article reviews the application progress of PET/CT in the diagnosis and treatment of ENKTL.
Extranodal natural killer/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma associated with Epstein-Barr virus infection with high aggressiveness and poor prognosis. Accurate diagnosis and staging, timely curative effect and prognostic evaluation are crucial to the formulation of patient treatment strategies. With the wide application of 18F-FDG PET/CT in lymphoma, its value in ENKTL has also received more and more attention. This article reviews the application progress of PET/CT in the diagnosis and treatment of ENKTL.
2021, 45(12): 795-799.
doi: 10.3760/cma.j.cn121381-202012010-00117
Abstract:
Depression is often associated with executive dysfunction, a cognitive impairment that can have an effect on quality of daily life and prognosis. Executive function requires the synergy among the frontal cortex, limbic system, temporal parietal lobe, thalamus, cerebellum, insular lobe, and brainstem reticular system. The damage of the corresponding neural circuit (mainly including the default mode network, executive control network, salience network, and limbic system) and the inter-regional connections of the important network components of these neural circuits leads to the destruction of executive function. MRI can noninvasively reveal structural and functional changes in the brain and its neural networks and can be used as a biomarker to identify depression-related executive dysfunction and its response to treatment to assess the related neural mechanisms underlying its function. In this work, the authors review the current research progress of structural (diffusion tensor imaging and morphological structural imaging) and functional MRI for depression-related executive dysfunction.
Depression is often associated with executive dysfunction, a cognitive impairment that can have an effect on quality of daily life and prognosis. Executive function requires the synergy among the frontal cortex, limbic system, temporal parietal lobe, thalamus, cerebellum, insular lobe, and brainstem reticular system. The damage of the corresponding neural circuit (mainly including the default mode network, executive control network, salience network, and limbic system) and the inter-regional connections of the important network components of these neural circuits leads to the destruction of executive function. MRI can noninvasively reveal structural and functional changes in the brain and its neural networks and can be used as a biomarker to identify depression-related executive dysfunction and its response to treatment to assess the related neural mechanisms underlying its function. In this work, the authors review the current research progress of structural (diffusion tensor imaging and morphological structural imaging) and functional MRI for depression-related executive dysfunction.
2021, 45(12): 800-802.
doi: 10.3760/cma.j.cn121381-202012009-00102
Abstract:
A case of multiple intraosseous hemangioma (IH) with 18F-fluorodeoxyglucose (FDG) PET/CT imaging was reported, which was differentiated from the aspects of clinical symptoms, laboratory examinations and imaging findings. IH in different location have different imaging findings, and 18F-FDG PET/CT can provide a reference for clinical differentiation of benign and malignant tumors. As it was rare to find IH in flat bones, whose imaging findings were lack of specificity, the authors analyzed the 18F-FDG PET/CT imaging characteristics in order to improve the understanding of imaging physicians about the disease.
A case of multiple intraosseous hemangioma (IH) with 18F-fluorodeoxyglucose (FDG) PET/CT imaging was reported, which was differentiated from the aspects of clinical symptoms, laboratory examinations and imaging findings. IH in different location have different imaging findings, and 18F-FDG PET/CT can provide a reference for clinical differentiation of benign and malignant tumors. As it was rare to find IH in flat bones, whose imaging findings were lack of specificity, the authors analyzed the 18F-FDG PET/CT imaging characteristics in order to improve the understanding of imaging physicians about the disease.
2021, 45(12): 803-805.
doi: 10.3760/cma.j.cn121381-202102011-00112
Abstract:
The author reported a case of multiple brown bone tumors secondary to parathyroid adenoma by 18F-fluorodeoxyglucose (FDG) PET/CT. Although the disease was not rare, the 18F-FDG metabolic characteristics of this case are different from those of other reported cases, so it was misdiagnosed as multiple myeloma. The author mainly analyzed the characteristics of 18F-FDG PET/CT of brown bone tumor, and carried out literature review, pathological analysis and differential diagnosis, in order to provide more reference for 18F-FDG PET/CT in the diagnosis of brown bone tumor.
The author reported a case of multiple brown bone tumors secondary to parathyroid adenoma by 18F-fluorodeoxyglucose (FDG) PET/CT. Although the disease was not rare, the 18F-FDG metabolic characteristics of this case are different from those of other reported cases, so it was misdiagnosed as multiple myeloma. The author mainly analyzed the characteristics of 18F-FDG PET/CT of brown bone tumor, and carried out literature review, pathological analysis and differential diagnosis, in order to provide more reference for 18F-FDG PET/CT in the diagnosis of brown bone tumor.
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