2021 Vol. 45, No. 2
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2021, 45(2): 0-0.
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2021, 45(2): 1-4.
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2021, 45(2): 69-74.
doi: 10.3760/cma.j.cn121381-201910026-00010
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Objective To analyze the glucose metabolism of right ventricle between patients with idiopathic pulmonary arterial hypertension (IPAH) and patients with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Methods From November 2016 to December 2018, 26 patients with IPAH (the IPAH group) (17 females, 9 males, 28.23±8.92 years old) and 16 patients with PAH-CHD (the PAH-CHD group) (10 females, 6 males, 29.19±10.62 years old) diagnosed in Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College were enrolled and underwent dynamic 18F-FDG PET myocardial metabolic imaging. The rate of myocardium glucose utilization (rMGU) of both the right and left ventricles was quantified via Patlak analysis. Within 1 week, right heart catheterization was performed in all subjects to evaluate pulmonary hemodynamic parameters. rMGU and other parameters were compared via independent sample t test. The relationship between rMGU and pulmonary vascular resistance and mean pulmonary artery pressure (mPAP) in the two groups of patients was analyzed via Pearson correlation analysis. Results No significant difference in mPAP was observed between patients in IPAH group and PAH-CHD group ((59.85±16.46) mm Hg) vs. (69.75±18.93) mm Hg, t=1.79, P=0.81) (1 mm Hg=0.133 kPa). The right ventricular rMGU of patients in PAH-CHD group was not significantly different from that of patients in IPAH group ((0.135±0.165) μmol·g−1·min−1 vs. (0.095±0.074) μmol·g−1·min−1, t=1.07, P=0.29). Similarly, the left ventricular rMGU between the former ((0.070±0.047) μmol·g−1·min−1) and the latter ((0.057±0.065) μmol·g−1·min−1) was not significantly different (t=0.77, P=0.49). The right ventricular rMGU was significantly correlated with mPAP in patients with IPAH (r=0.420, P=0.033), but not in patients with PAH-CHD (r=0.016, P=0.953). Conclusion In patients with PAH-CHD and IPAH with no difference in mPAP, no significant difference in rMGU was found in both the right ventricles.
2021, 45(2): 75-82.
doi: 10.3760/cma.j.cn121381-202003009-00013
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Objective To compare the diagnostic values of 18F-fluorodeoxyglucose (FDG) PET/CT and PET/MRI in colorectal cancer liver metastases. Methods A retrospective analysis was performed on data collected from 27 patients with suspected colorectal cancer liver metastases, including 19 males and 8 females aged 28–78 (60.6±12.2) years old who underwent whole-body 18F-FDG PET/CT and upper abdomen 18F-FDG PET/MRI examination in Ningbo Mingzhou Hospital from September 2018 to September 2019. The result of histopathological examination and imaging follow-up served as the reference standards. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of both methods in the diagnosis of liver metastases were calculated. Liver metastases lesions were divided into three groups according to size: lesion length≤1 cm, 1 cm< lesion length≤2 cm, and lesion length>2 cm. The sensitivity of 18F-FDG PET/CT and PET/MRI in each group were calculated. McNemar test was used to compare the sensitivity, specificity, and accuracy of the two methods in the diagnosis of liver metastases. χ2 test was used to compare the PPV and NPV of the two methods in the diagnosis of liver metastases. Results Based on 27 patients with colorectal cancer analysis, the sensitivity and accuracy of 18F-FDG PET/MRI in the diagnosis of liver metastases (94% (15/16) and 96% (26/27)) were higher than those of PET/CT (81% (13/16) and 89% (24/27)), but the difference was not statistically significant (McNemar test, both P>0.05). Based on lesion analysis, mong the 118 liver lesions found in the 27 patients, 72 lesions were liver metastases and 46 lesions were benign liver lesions. The sensitivity, accuracy, and NPV of 18F-FDG PET/MRI in the diagnosis of liver metastases (85% (61/72), 91% (107/118) and 81% (46/57)) were significantly higher than those of PET/CT (63% (45/72), 76% (90/118) and 63% (45/72); McNemar test, χ2=5.072, all P<0.05). The sensitivity of 18F-FDG PET/MRI (63% (17/27)) for lesions with length≤1 cm was significantly higher than that of PET/CT (7% (2/27); McNemar test, P<0.05). Conclusion Compared with 18F-FDG PET/CT, 18F-FDG PET/MRI has higher diagnostic value in colorectal cancer liver metastases, especially for lesion with length≤1 cm.
2021, 45(2): 83-87.
doi: 10.3760/cma.j.cn121381-202005035-00012
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Objective To explore the effects of strengthening protein on mucosal injury and nutritional status in patients with head and neck cancer undergoing radiotherapy. Methods A total of 72 patients with head and neck cancer admitted to Nanjing Drum Tower Hospital Cancer Center from July 2018 to December 2019 were involved in this prospective study. All patients were randomly divided into two groups according to the random number table. Eventually, 32 cases (5 females, 27 males, 51.67±12.92 years old ) were included in the intervention group, which accepted additional protein intake based on a conventional diet (50 g/d supplementary whey protein powder to reach the total protein of 1.5–2.0 g/(kg·d)), and 29 cases were included in the control group (6 females, 23 males, 56.03±8.26 years old), which treated with a conventional diet (the total protein of 1.0–1.2 g/(kg·d)) according to the elimination criteria. All the patients were treated with radical concurrent chemoradiotherapy. The degree of mucosal damage, the change of nutritional indexes, therapeutic effect and related complications between the two groups were compared before and after treatment. The fourfold table χ2 test was used in the comparison of enumeration data and group t test was used to compare the means of two samples. Results There were no statistically significant differences in age, height, blood pressure, heart rate (t=−1.59–1.26, all P>0.05), sex, education background and disease types (nasopharyngeal carcinoma and other diseases) (χ2=0.01–0.45, all P>0.05) between the two groups. In terms of oral mucosal injury, the degree of injury in the intervention group was lower than that in the control group (16%(5/32) vs. 38%(11/29), χ2=3.913, P=0.04). In nutritional indicators, intervention group was better than the control group in maintaining weight [(−2.80±2.66) kg vs. (−4.85±2.35) kg, t=3.18, P<0.01], body mass index [(−1.00±0.95) kg/m2 vs. (−1.81±0.89) kg/m2, t=3.38, P<0.01], grip strength [(5.59±4.20) kg vs. (2.59±5.32) kg, t=2.46, P=0.02], serum albumin [(−1.40±3.37) g/L vs. (−3.07±2.92) g/L, t=2.06, P=0.04] except the skeletal muscle, body fat, hemoglobin. There was no significant difference between the two groups in efficacy evaluation, diarrhea, constipation, and fever (χ2=0.24−1.30, all P>0.05). Conclusion Strengthening protein supplement can help effectively reduce the degree of mucosal injury and have advantages in maintaining the indexes of the nutritional status of head and neck cancer patients.
2021, 45(2): 88-93.
doi: 10.3760/cma.j.cn121381-201909036-00005
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Objective To prepare 125I-CD90 monoclonal antibody (mAb) and evaluate its potential as a molecular imaging agent to trace mesenchymal stem cells (MSCs). Methods 125I-CD90 mAb was prepared by chloramine T method, and labeling rate was tested. (1) In in vitro experiment, the radioactive count of the supernatant and precipitate was measured after incubating 125I-CD90 mAb with MSCs. Binding fraction was calculated at six time points. (2) In in vivo experiment, tumor-bearing BALB/c mice were constructed and divided into four groups (a, b, c and d) by completely random design. MSCs and normal saline were administered by intraperitoneal injection in groups a and b, respectively. MSCs and normal saline were given by intratumoral injection in groups c and d, respectively. 125I-CD90 mAb (3.7 MBq/0.2 mL) was injected via caudal vein in each mouse, and Micro-SPECT/CT analysis was performed. The radioactive uptake values (percentage activity of injection dose per gram of tissue (%ID/g)) in tumor and main organs was calculated at four different time points. The difference between two groups was analyzed by two independent sample t test. Results The labeling rate and radiochemical purity of 125I-CD90 mAb were 54.4% and 98.79%, respectively. (1) After incubation for 10 min, 30 min, 1 h, 2 h, 6 h and 8 h, the binding ratios of 125I-CD90 mAb in MSCs were 0.86%, 1.73%, 1.88%, 5.67%, 12.20% and 10.69%, respectively. The highest binding ratio was detected at 6 h of incubation. (2) Tumors of tumor-bearing mice (150−200 mm3) were used. Micro-SPECT/CT images showed varying degrees of 125I-CD90 mAb distribution in the tumor and main organs of MSCs tumor-bearing mice after 6 h, 1 d, 2 d and 3 d of incubation. The radioactive uptake values in the tumor were (3.66±1.69), (2.35±1.30), (1.36±0.95) and (1.33±0.84)%ID/g in group a, which were higher than those ((2.93±1.74), (1.92±1.15), (1.12±0.78) and (1.03±0.72)%ID/g) in group b, at 6 h, 1 d, 2 d and 3 d, respectively, but the differences were not statistically significant (t=0.35−0.52, all P>0.05). The radioactive uptake values in the tumor were (5.75±1.30), (3.75±0.77), (2.70±0.44) and (1.88±0.48)%ID/g in group c, which were higher than those ((3.17±0.75), (2.03±0.54), (1.44±0.39) and (1.38±0.27)%ID/g) in group d, at 6 h, 1 d, 2 d and 3 d, respectively, and all the differences were statistically significant (t=1.59−3.70, all P<0.05). Conclusion The prepared 125I-CD90 mAb exhibits good binding ability to MSCs and has the potential as a nuclide probe to trace MSCs.
2021, 45(2): 94-98.
doi: 10.3760/cma.j.cn121381-201912024-00016
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Programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) signaling pathway aids the evasion of tumor immune by producing negative control signals, leading to immune tolerance and promoting progress of tumors. PD-1/PD-L1 targeted immumotherapy, the new therapeutic method of malignant tumors, can restore the immune responses of microenviroment in tumors and mediate proliferation of T lymphocytes that could kill tuomr cells. However, there are differences of immune responses in different patients. To date, there have not been valid clinicopathological biomarkers to identify responders or non-responders. 18F-FDG PET/CT is a useful, real-time and noninvasive modality for the assessment of tumor glucose metabolism. Positive expression of PD-L1 also has been shown to influent glucose metabolism in microenviroment of tumors. Thus, it is promising that 18F-FDG PET/CT could be useful to the PD-1/PD-L1 immumotherapy. This review focuses on advances of 18F-FDG PET/CT in PD-1/PD-L1 targeted immumotherapy of tumors.
Programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) signaling pathway aids the evasion of tumor immune by producing negative control signals, leading to immune tolerance and promoting progress of tumors. PD-1/PD-L1 targeted immumotherapy, the new therapeutic method of malignant tumors, can restore the immune responses of microenviroment in tumors and mediate proliferation of T lymphocytes that could kill tuomr cells. However, there are differences of immune responses in different patients. To date, there have not been valid clinicopathological biomarkers to identify responders or non-responders. 18F-FDG PET/CT is a useful, real-time and noninvasive modality for the assessment of tumor glucose metabolism. Positive expression of PD-L1 also has been shown to influent glucose metabolism in microenviroment of tumors. Thus, it is promising that 18F-FDG PET/CT could be useful to the PD-1/PD-L1 immumotherapy. This review focuses on advances of 18F-FDG PET/CT in PD-1/PD-L1 targeted immumotherapy of tumors.
2021, 45(2): 99-104.
doi: 10.3760/cma.j.cn121381-201912031-00017
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Multiple myeloma (MM) is a malignant disease of clonal plasma cell hyperplasia, which occurs mostly in the elderly. The incidence of MM ranks second in hematological malignancies and is currently on the rise in China year by year. 18F-fluorodeoxyglucose (FDG) PET/CT imaging can provide information on the proliferation and metabolism of malignant tumors at the molecular level. Existing studies have proved that 18F-FDG PET/CT is of great significance in the diagnosis, staging, monitoring of efficacy and prognostic evaluation of MM. This paper reviews the research progress of 18F-FDG PET/CT imaging in the diagnosis and treatment of MM.
Multiple myeloma (MM) is a malignant disease of clonal plasma cell hyperplasia, which occurs mostly in the elderly. The incidence of MM ranks second in hematological malignancies and is currently on the rise in China year by year. 18F-fluorodeoxyglucose (FDG) PET/CT imaging can provide information on the proliferation and metabolism of malignant tumors at the molecular level. Existing studies have proved that 18F-FDG PET/CT is of great significance in the diagnosis, staging, monitoring of efficacy and prognostic evaluation of MM. This paper reviews the research progress of 18F-FDG PET/CT imaging in the diagnosis and treatment of MM.
2021, 45(2): 105-110.
doi: 10.3760/cma.j.cn121381-20200238-00020
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Duplex kidney is a common congenital urinary system disease, and its diagnosis mainly relies on conventional imaging methods such as intravenous pyelography, ultrasound, CT, MRI, etc. These methods have their own advantages and disadvantages. Renal radionuclide imaging, with lower radiation dose, is convenient, repeatable, safe and reliable, and it can evaluate the morphological structure and function of kidneys simultaneously, which has great advantages in the diagnosis, clinical decision making, efficacy evaluation and prognostic analysis of duplex kidney. With the rapidly widespread use of SPECT/CT, renal nuclide imaging could complement advantages with other imaging methods and become an important method for the diagnosis and treatment evaluation of duplex kidney. This paper reviews the application of renal radionuclide imaging in the diagnosis and treatment of duplex kidney.
Duplex kidney is a common congenital urinary system disease, and its diagnosis mainly relies on conventional imaging methods such as intravenous pyelography, ultrasound, CT, MRI, etc. These methods have their own advantages and disadvantages. Renal radionuclide imaging, with lower radiation dose, is convenient, repeatable, safe and reliable, and it can evaluate the morphological structure and function of kidneys simultaneously, which has great advantages in the diagnosis, clinical decision making, efficacy evaluation and prognostic analysis of duplex kidney. With the rapidly widespread use of SPECT/CT, renal nuclide imaging could complement advantages with other imaging methods and become an important method for the diagnosis and treatment evaluation of duplex kidney. This paper reviews the application of renal radionuclide imaging in the diagnosis and treatment of duplex kidney.
2021, 45(2): 111-117.
doi: 10.3760/cma.j.cn121381-201912002-00014
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As a new type of therapeutic drug, immune checkpoint inhibitors (ICIs) has greatly enriched the cancer therapies. However, the subsequent emergence of immune-related response patterns, such as pseudoprogression, delayed response and hyperprogression have challenged the current response evaluation criteria in malignant tumors. Therefore, researchers have constantly revised the relevant evaluation criteria to enable them to assess the therapeutic effects more objectively and guide the formulation of clinical therapy more scientifically. This paper reviews the immunotherapy-related response evaluation criteria in malignant tumors proposed in recent years.
As a new type of therapeutic drug, immune checkpoint inhibitors (ICIs) has greatly enriched the cancer therapies. However, the subsequent emergence of immune-related response patterns, such as pseudoprogression, delayed response and hyperprogression have challenged the current response evaluation criteria in malignant tumors. Therefore, researchers have constantly revised the relevant evaluation criteria to enable them to assess the therapeutic effects more objectively and guide the formulation of clinical therapy more scientifically. This paper reviews the immunotherapy-related response evaluation criteria in malignant tumors proposed in recent years.
2021, 45(2): 118-123.
doi: 10.3760/cma.j.cn121381-202009038-00019
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The rapid assessment of the radiation dose absorbed by the human body during nuclear and radiation accidents is extremely important for the classification and treatment of the wounded. In order to formulate effective radiation injury treatment strategies and develop new anti-radiation drugs, the research on biomarkers related to radiation injury has aroused strong interest of researchers. Evaluating the radiation absorbed dose or the effectiveness of anti-radiation drugs through changes in radiation damage-related biomarkers has become a research hotspot. Therefore, this paper reviews the biomarkers used in recent years to evaluate the radiation absorbed dose and the effectiveness of anti-radiation drugs.
The rapid assessment of the radiation dose absorbed by the human body during nuclear and radiation accidents is extremely important for the classification and treatment of the wounded. In order to formulate effective radiation injury treatment strategies and develop new anti-radiation drugs, the research on biomarkers related to radiation injury has aroused strong interest of researchers. Evaluating the radiation absorbed dose or the effectiveness of anti-radiation drugs through changes in radiation damage-related biomarkers has become a research hotspot. Therefore, this paper reviews the biomarkers used in recent years to evaluate the radiation absorbed dose and the effectiveness of anti-radiation drugs.
2021, 45(2): 124-131.
doi: 10.3760/cma.j.cn121381-202005040-00018
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Radiation-induced brain injury (RBI) is a serious complication of patients with primary and secondary tumors in the head, neck and brain after receiving radiotherapy. Regarding the mechanism of RBI, there are several hypotheses such as vascular injury, inflammatory immune response and demyelination. Among them, inflammatory response is considered to play an important role in the pathogenesis of RBI. Microglia (MG) is the innate immune cell in the brain, which plays an important role in the pathophysiology of neuroinflammation induced by various central nervous system diseases. The author summarizes the research progress of the role of MG in RBI and its mechanism in recent years.
Radiation-induced brain injury (RBI) is a serious complication of patients with primary and secondary tumors in the head, neck and brain after receiving radiotherapy. Regarding the mechanism of RBI, there are several hypotheses such as vascular injury, inflammatory immune response and demyelination. Among them, inflammatory response is considered to play an important role in the pathogenesis of RBI. Microglia (MG) is the innate immune cell in the brain, which plays an important role in the pathophysiology of neuroinflammation induced by various central nervous system diseases. The author summarizes the research progress of the role of MG in RBI and its mechanism in recent years.
2021, 45(2): 132-135.
doi: 10.3760/cma.j.cn121381-202008017-00023
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This paper reports a case of subacute liver failure caused by sorafenib treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC), and comprehensively analyzes the characteristics of the disease from clinical symptoms, laboratory examinations, imaging examinations, histopathological examination results as well as the patient's clinical treatment and outcome. Through literature review, the authors deepen the understanding of the characteristics of the disease, the efficacy and adverse reactions of sorafenib in the treatment of advanced thyroid cancer. This paper aims to remind clinicians that when encountering similar cases, they should not only pay attention to the efficacy of sorafenib treatment, but also improve the clinical awareness and management of adverse reactions related to the application of targeted drug therapy in RAIR-DTC, and ultimately improve the efficacy and safety of targeted therapy.
This paper reports a case of subacute liver failure caused by sorafenib treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC), and comprehensively analyzes the characteristics of the disease from clinical symptoms, laboratory examinations, imaging examinations, histopathological examination results as well as the patient's clinical treatment and outcome. Through literature review, the authors deepen the understanding of the characteristics of the disease, the efficacy and adverse reactions of sorafenib in the treatment of advanced thyroid cancer. This paper aims to remind clinicians that when encountering similar cases, they should not only pay attention to the efficacy of sorafenib treatment, but also improve the clinical awareness and management of adverse reactions related to the application of targeted drug therapy in RAIR-DTC, and ultimately improve the efficacy and safety of targeted therapy.
2021, 45(2): 136-138.
doi: 10.3760/cma.j.cn121381-202003041-00022
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A case of rib hemangioma was reported. The characteristics of the disease were analyzed including the clinical symptoms, imaging manifestations, clinical diagnosis, pathological diagnosis and histopathological, and were deepened the understanding through literature review. The case was confirmed as rib hemangioma by the pathology. The disease progresses relatively slowly and had low specificity in the imaging. It was not only diagnosed by histopathological, but the imaging findings still have some value in this disease. The imaging manifestations of the disease are varied, which are easy to be confused with malignant bone tumors and bone tumor-like lesions. Once myofibroblastoma occurs, it is easy to misdiagnose. Thus, a combination of clinical symptoms, imaging manifestations, postoperative histopathological and therapeutic considerations is needed.
A case of rib hemangioma was reported. The characteristics of the disease were analyzed including the clinical symptoms, imaging manifestations, clinical diagnosis, pathological diagnosis and histopathological, and were deepened the understanding through literature review. The case was confirmed as rib hemangioma by the pathology. The disease progresses relatively slowly and had low specificity in the imaging. It was not only diagnosed by histopathological, but the imaging findings still have some value in this disease. The imaging manifestations of the disease are varied, which are easy to be confused with malignant bone tumors and bone tumor-like lesions. Once myofibroblastoma occurs, it is easy to misdiagnose. Thus, a combination of clinical symptoms, imaging manifestations, postoperative histopathological and therapeutic considerations is needed.
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