2021 Vol. 45, No. 3
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2021, 45(3): 0-0.
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2021, 45(3): 1-4.
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2021, 45(3): 139-146.
doi: 10.3760/cma.j.cn121381-202001020-00025
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Objective To investigate the diagnostic value of 18F- fluorodeoxyglucose (FDG) PET/CT dual-phase and 18F-FDG combined with 11C-choline (CHO) PET/CT multimodal imaging in primary hepatocellular carcinoma (HCC). Methods Retrospective PET/CT analysis was conducted on 73 patients (41 males, 32 females; age range: 58–72 years) in the Affiliated Hospital of Inner Mongolia Medical University from March 2016 to December 2018. The patients had not been confirmed with primary hepatic space-occupying lesions, 47 patients underwent 18F-FDG PET/CT dual-phase imaging, and 26 patients underwent 18F-FDG combined with 11C-CHO PET/CT multimodal imaging. The maximum standardized uptake value (SUVmax) of each lesion, the liver background, and the tumor SUVmax /liver background SUVmax (T/L) value of each lesion were measured. Positive or negative lesions were adopted as state variables, and SUVmax (18F-FDG, 18F-FDG delay, and 18F-FDG dual phase) and SUVmax (18F-FDG, 11C-CHO, and 18F-FDG combined with 11C-CHO) were used as test variables. The receiver operator characteristic (ROC) curve was compared in pairs, and the histopathological examination or clinical follow-up results were used as the gold standard. The diagnostic efficacy of various imaging methods was compared and analyzed. The measurement data were compared through a paired t test, and the Z-rank test was used to compare the differences in the ROC curves of the groups. Results (1) 18F-FDG PET/CT dual-phase imaging: a total of 49 lesions were detected in 47 patients (32 of them were hypermetabolic lesions). Histopathological examination or clinical follow-ups confirmed that 9 lesions were benign and 40 were HCC (8 of them were well-differentiated and 32 were moderately-poorly differentiated). The SUVmax differences in the lesion, liver background, and T/L values of the moderately-poorly differentiated HCC were statistically significant (t=4.51, −2.53, 4.80; all P<0.05). The SUVmax differences in the lesion and T/L values of well-differentiated HCC were statistically significant (t=2.76, 2.62; both P<0.05), but no statistical difference was observed in the SUVmax value of the benign lesions (t=0.00, P>0.05). The ROC curve differences 18F-FDG SUVmax and delayed imaging, dual-phase imaging were statistically significant (Z=2.315, 2.376; both P<0.05), however, the ROC curve differences of SUVmax between delayed imaging and dual-imaging wasn't statistically significant (Z=0.252, P>0.05 ). (2) 18F-FDG combined with 11C-CHO imaging: a total of 26 lesions were detected in 26 patients (18 of them were hypermetabolic lesions). Histopathological examination or clinical follow-ups confirmed that 22 lesions were HCC (of which 9 lesions were well-differentiated and 13 lesions were moderately-poorly differentiated), and 4 lesions were benign. The SUVmax differences in the lesion and liver background values of well-differentiated HCC were statistically significant (t=9.49, 6.57; both P<0.05), but no statistically significant difference was observed in T/L value (t=2.01, P>0.05). The SUVmax difference in the lesion value of moderately-poorly differentiated HCC was not statistically significant (t=−1.68, P>0.05), but the SUVmax differences in liver background and T/L value were statistically significant (t=8.41, −5.43; both P<0.001). No statistical difference was also noted in the SUVmax of benign lesions (t=1.51, P>0.05). The difference in ROC curve between SUVmax (18F-FDG) and SUVmax (18F-FDG combined with 11C-CHO) was statistically significant (Z=2.037, P<0.05). Conclusion 18F-FDG PET/CT dual-phase imaging and 18F-FDG combined with 11C-CHO PET/CT multimodal imaging can improve the detection rate of moderately-poorly and well-differentiated primary HCC and have an important guiding value in decision-making and clinical prognosis for patients.
2021, 45(3): 147-154.
doi: 10.3760/cma.j.cn121381-202008001-00027
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Objective To evaluate the diagnostic value of 99TcmO4 − thyroid imaging and serum thyroid stimulating hormone (TSH) for differentiating benign and malignant thyroid imaging reporting and data system (TI-RADS) category-4 thyroid nodules (TNs). Methods The clinical data (thyroid ultrasonography, 99TcmO4 − thyroid scintigraphy, and TSH levels) of 201 TN patients who underwent surgery or fine-needle aspiration cytology diagnosis from October 2017 to December 2019 at the Affiliated Hospital of Guilin Medical College were analyzed retrospectively. Among these patients, 54 were males and 147 were females, aged 20–75 (49.1±13.2) years. Post-operative histopathology result was used as the gold standard to classify the patients as malignant TN and benign TN groups. The TN group was divided into three subgroups based on the maximum nodule diameter through ultrasonography: diameter ≤ 10 mm, 10 mm < diameter ≤ 20 mm, diameter > 20 mm. The basic data of the two groups were compared using two-sample t-test and independent four-cell table chi-square test, and one-way ANOVA was used for the comparison among groups. Receiver operating characteristic (ROC) curve analysis was adopted to determine the optimal cutoff value of TSH between malignant and benign TNs, and the diagnostic efficiency was calculated. Trend chi-square test was conducted to assess the relationship between TSH level and thyroid carcinoma. Results All 201 patients had a single TN, of which 62 were in malignant TN group, 139 were in benign TN group. The histopathological findings revealed that among the 201 TNs, 62 were thyroid cancer (30.8%), 33 were nodular goiter (16.4%), 81 were thyroid adenomas (40.3%), and 25 were nodular goiter with adenoma (12.4%). Ultrasonography results revealed that 81 were TI-RADS 4a nodules (40.3%), including 9 thyroid cancer (11%); 70 were TI-RADS 4b nodules (34.8%), including 20 thyroid cancer (29%); and 50 were TI-RADS 4c nodules (24.9%), including 33 thyroid cancer (66%). The findings of 99TcmO4 − thyroid scintigraphy demonstrated that 110 were cold nodules (54.7%), including 40 thyroid cancer (36.4%); 67 were cool nodules (33.3%), including 22 thyroid cancer (33%); and 24 were warm nodules (11.9%), without malignant TNs. The malignant rate of TI-RADS 4c cool or cold nodules was determined to be the highest by using the combination of 99TcmO4 − thyroid scintigraphy and ultrasonography (72%, 33/46). The preoperative serum TSH levels of the malignant TN group [(1.59±0.32) μIU/mL] were higher than those of the benign TN group [(1.29±0.45) μIU/mL], and the difference was statistically significant (t=4.752, P<0.01). Trend chi-square test showed that a higher TSH level was correlated with a higher incidence of thyroid cancer (χ2=27.513, P<0.01). However, no statistical differences in preoperative serum TSH levels were found among the three different-diameter malignant TN groups (F=0.223, P=0.800). ROC curve analysis showed the optimum cutoff value of TSH for differential diagnosis between malignant and benign TNs. The diagnostic efficiency of TSH was the highest at 1.525 μIU/mL, with an area under curve of 0.741 (95%CI: 0.666–0.816), specificity of 75.8%, and sensitivity of 70.5%. Conclusions 99TcmO4 − thyroid scintigraphy may help evaluate the 99TcmO4 − uptake functions of TNs, which clearly improved the diagnostic accuracy for TI-RADS category-4 TNs in clinical work. The role of preoperative serum TSH in the presurgical evaluation of TNs remains unclear.
2021, 45(3): 155-161.
doi: 10.3760/cma.j.cn121381-202007034-00026
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Objective To analyze the effect of preoperative short course radiotherapy and chemotherapy or conventional radiotherapy and chemotherapy on patients with stage ⅢB rectal cancer and determine the differences in the expression of Runt-related transcription factor 3 (Runx3) and cell proliferating nuclear antigen Ki-67 (short for Ki-67) in the resected tissue specimens. Methods From January 2019 to December 2019, a prospective study was conducted on 100 patients with stage ⅢB rectal cancer in the First Affiliated Hospital of Hebei North University, including 52 males and 48 females, aged 38–79(58.56±9.11) years. All patients were randomly divided into the control group and observation group, with 50 cases in each group. The control group received conventional radiotherapy + chemotherapy before operation, whereas the observation group received short-term radiotherapy + chemotherapy before operation. The operation-related conditions, postoperative pathological T staging reduction rate, pathological complete remission (pCR) rate, occurrence of adverse reactions, local recurrence rate, distant metastasis rate and survival rate were compared between the two groups. Immunohistochemical methods were used to detect the expression score of Runx3 and Ki-67 on the resected rectal cancer tissue samples. The measurement data of the two groups were compared using independent sample t test. When the number of cases was <40 or the theoretical frequency T≤1, Fisher's exact probability method was used. When the number of cases was ≥40 and when the theoretical frequency was T≥5 (uncorrection) or 1<T<5 (correction), the χ2 test was used. Results The operation time ((165.89±18.73) min), intraoperative blood loss ((215.63±56.89) mL), postoperative exhaust time ((62.28±16.47) h), hospitalization time ((13.97±7.11) d), anastomotic leakage rate (6%, 3/50), intestinal obstruction rate (4%, 2/50) and infection rate (4%, 2/50) in the observation group were compared with those in the control group (i.e., (158.14±23.57) min, (227.84±60.75) mL, (59.28±12.04) h, (15.01±5.29) d, 2% (1/50), 0 (0/50) and 8% (4/50), respectively), and the differences were not statistically significant (t=0.854–1.820, χ2=0.260, 0.177, Fisher's exact probability method, all P>0.05). There was no significant difference in the T staging rate and pCR rate between the two groups (χ2=0.160, 0.000; both P>0.05). The total incidence of radiation dermatitis in the observation group (12%, 6/50) was significantly lower than that in the control group (30% (15/50)) (χ2=4.883, P<0.05). The expression score of Runx3 in the specimens resected during operation in the observation group was 2.56±0.51, which was significantly higher than 1.87±0.72 in the control group (t=5.530, P<0.01). The expression score of Ki-67 was 2.39±1.03, which was significantly lower than 3.94±0.46 in the control group (t=9.716, P<0.01). The local recurrence rate (2%,1/50) in the observation group was significantly lower than that (17%, 8/48) in the control group (χ2=5.936, P<0.05). Conclusions Preoperative short course radiotherapy and chemotherapy for stage ⅢB rectal cancer will not increase the difficulty and risk of total mesorectal excision. It can reduce the occurrence of adverse reactions, and decrease the rate of local recurrence. A statistically significant difference was found in the expression of Runx3 and Ki-67 in surgical resection specimens obtained.
2021, 45(3): 162-169.
doi: 10.3760/cma.j.cn121381-202011020-00024
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Objective To prepare a novel antisense oligonucleotides (ASON) probe, namely, 99Tcm-HYNIC-ASON (hydrazine nicotinamide (HYNIC)), targeting long non-coding RNA (lncRNA) homeobox gene anti-sense intergenic RNA (HOTAIR); and explore its effect on the proliferation and migration of human glioma U87 cells. Methods HOTAIR ASON was designed and synthesized by chemical modification, and the bifunctional chelating agent (HYNIC) was coupled with 99Tcm. Sephadex G25 was selected for separation and purification. The labeling rate, radiochemical purity, in vitro stability, and integrity of the probe were detected by instant thin-layer chromatography and agarose gel electrophoresis. Human glioma U87 cells were cultured for experimental use. The cell uptake assay was divided into two groups: Lipo-99Tcm-HYNIC-ASON (transfection group) and 99Tcm-HYNIC-ASON (non-transfection group). The probe was transfected by liposome to determine the probe uptake rate of human glioma U87 tumor cells. The cell counting kit-8 (CCK-8) assay and cell scratch assay were divided into three groups, namely, Lipo-99Tcm-HYNIC-ASON (transfection group), 99Tcm-HYNIC-ASON (non-transfection group), and 99Tcm-Control (control group), to detect the changes of cell proliferation and migration after transfection of probe. Student t-test was used for comparison between two groups, and one-way analysis of variance was used for multi-group comparison. Results The labeling rate of 99Tcm-HYNIC-ASON was (90.0±5.6)%. Gel electrophoresis results confirmed that 99Tcm and the probe were successfully labeled without evident degradation; the probe showed good stability and radiochemical purity >80% after being incubated for 12 h. The results of cell uptake assay showed that 5 h after liposome transfection, the maximum uptake rate of probe Lipo-99Tcm-HYNIC-ASON in human glioma U87 cells was 0.70%, which was significantly higher than that in the non-transfection group (0.16%; t=17.81, P<0.01). The results of CCK-8 assay showed that the transfection probe (Lipo-99Tcm-HYNIC-ASON) could inhibit the proliferation of human glioma U87 cells, and a significant difference was observed compared with the non-transfection group at 1, 2, 3, 4, 5 d (t=2.336–30.230, all P<0.05). The results of cell scratch assay showed that the transfection probe (Lipo-99Tcm-HYNIC-ASON) could inhibit the migration of human glioma U87 cells, and a significant difference was found in the intercellular fusion rate among the three groups (F=331.8, P<0.01). Compared with the non-transfection group (60.0%), the intercellular fusion rate in the transfection group was significantly lower (23.6%), and the difference was statistically significant (t=51.54, P<0.01). Conclusions The ASON probe targeting human glioma lncRNA HOTAIR has been successfully synthesized. The probe has good stability and targeted binding ability in vitro, which can inhibit the proliferation and migration of human glioma U87 cells.
2021, 45(3): 170-175.
doi: 10.3760/cma.j.cn121381-202004020-00035
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Objective To understand the basic situation of radiation protection in the radiation diagnosis and treatment workplaces in Tianjin; to improve protection status; and to provide supporting data for regulatory authorities. Methods According to the stratified random sampling method, 105 medical institutions (19 tertiary medical institutions, 10 secondary medical institutions, 22 primary medical institutions, and 54 private medical institutions) in all administrative regions of Tianjin in 2019 were selected. A total of 434 radiological diagnosis and treatment workplaces (including 413 X-ray diagnosis workplaces (including X-ray cameras, X-ray fluoroscopy equipment, CT equipment room), 13 radiological diagnosis and treatment workplaces (including post-installation equipment and accelerators room), and 8 nuclear medicine workplaces (including PET/CT and SPECT/CT room)) were chosen to conduct a retrospective study on the analysis of radiation protection detection results. Radiation protection testing and evaluation were performed according to national and health industry standards. The comparison of the qualification rates of various radiological diagnosis and treatment workplaces was performed by R×C contingency table χ2 test. Results The overall initial pass rate of radiation protection testing in the 434 radiological diagnosis and treatment workplaces was 95.4% (414/434). In the radiological diagnosis, the radiation protection initial inspection rate of the CT computer room was the lowest at 79.6% (43/54). The CT and X-ray fluoroscopy room (95.5% (128/134)) had lower radiation protection qualification rate than the X-ray camera room (99.6% (224/225)), and the difference was statistically significant (χ2=7.146, 11.820, both P<0.05). In radiotherapy, the initial radiation protection pass rate of the accelerator room was the lowest at 81.8% (9/11). The unqualified indicator of the CT and X-ray fluoroscopy room was the door of the computer room, whereas that of the accelerator room was the wall of the computer room (secondary shielding area). The post-installation and radiation protection initial inspection pass rate of the nuclear medicine workplace reached 100% (2/2, 8/8). The digital subtraction angiography X-ray equipment and X-ray fluoroscopy machines operating in the same room near the platform had a 100% (35/35) pass rate for the air kernel energy rate in the protective area of the X-ray machine. The radiation protection testing qualification rate of secondary and tertiary medical institutions was relatively low, that is, 97.4% (38/39) and 93.3% (265/284), respectively. The radiation protection tests of primary medical institutions and private medical institutions were all qualified (100% (34/34, 77/77)). The qualification rate of the radiation protection testing in the workplace of private medical institutionswas higher than that of tertiary medical institutions, and the difference was statistically significant (χ2=5.438, P<0.05). Conclusions The radiation protection of radiation diagnosis and treatment workplaces in Tianjin in 2019 failed to meet the standard requirements. Medical institutions, especially secondary and tertiary medical institutions, should strengthen the emphasis on and improvement of radiation protection in radiation diagnosis and treatment workplaces. Supervisory departments should also strengthen the key supervision and management of workplaces with unqualified protection.
2021, 45(3): 176-181.
doi: 10.3760/cma.j.cn121381-202005003-00036
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Biological immunotherapy using checkpoint inhibitors has evolved into a promising therapy for cancer patients. Unfortunately, not all patients respond to the therapy while severe immune-related adverse effects are prevalent. Molecular imaging can detect the expression of immune checkpoint (IC) at the molecular and cellular level in tumor microenvironment. It can help in selecting patients who are suitable for immunotherapy, and also monitor the tumor response. This paper reviews the current status and latest progress of molecular imaging of IC targets.
Biological immunotherapy using checkpoint inhibitors has evolved into a promising therapy for cancer patients. Unfortunately, not all patients respond to the therapy while severe immune-related adverse effects are prevalent. Molecular imaging can detect the expression of immune checkpoint (IC) at the molecular and cellular level in tumor microenvironment. It can help in selecting patients who are suitable for immunotherapy, and also monitor the tumor response. This paper reviews the current status and latest progress of molecular imaging of IC targets.
2021, 45(3): 182-186.
doi: 10.3760/cma.j.cn121381-202003017-00038
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The survival period of patients with noncentral system is greatly prolonged after chemotherapy and other related treatments. The side effects caused by chemotherapy, that is, chemotherapy-induced cognitive impairments (CICI), have received increasing attention. The reduced learning, memory, attention, executive function, and information processing speed of cancer survivors with CICI seriously impairs the quality of life of the survivors. In recent years, many studies have reported on the neuroimaging changes in CICI. These changes include the decreases in white matter in the frontal lobe, temporal lobe, and parietal lobe shown by structural and functional MRI, and the decreases in glucose metabolism in the frontal lobe and part of limbic system revealed by 18F-fluorodeoxyglucose (FDG) PET/CT. This article reviews the progress of neuroimaging research tumor patients on CICI to explain the potential mechanism and the possible prevention and treatment measures of CICI.
The survival period of patients with noncentral system is greatly prolonged after chemotherapy and other related treatments. The side effects caused by chemotherapy, that is, chemotherapy-induced cognitive impairments (CICI), have received increasing attention. The reduced learning, memory, attention, executive function, and information processing speed of cancer survivors with CICI seriously impairs the quality of life of the survivors. In recent years, many studies have reported on the neuroimaging changes in CICI. These changes include the decreases in white matter in the frontal lobe, temporal lobe, and parietal lobe shown by structural and functional MRI, and the decreases in glucose metabolism in the frontal lobe and part of limbic system revealed by 18F-fluorodeoxyglucose (FDG) PET/CT. This article reviews the progress of neuroimaging research tumor patients on CICI to explain the potential mechanism and the possible prevention and treatment measures of CICI.
2021, 45(3): 187-191.
doi: 10.3760/cma.j.cn121381-202003031-00032
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Lymphoma is a malignant tumor of the hematological system that originates from different sites of the body and has a variety of pathological types. Maximum standardized uptake value, a traditionally used evaluation index, can reflect the maximum metabolic activity in tumor tissues, and which is the most widely studied metabolic parameter in clinical research at present. PET volume computed assisted reading (VCAR) software can measure and analyze the lymphoma lesions and automatically calculate the metabolic evaluation indexes of the lesions, including the peak SUV normalized by lean body mass, metabolic tumor volume, total lesion glycolysis, etc. There are many pathological subtypes of lymphoma, and the above metabolic evaluation parameters have different diagnosis and efficacy evaluation efficiency for different types of lymphoma. Therefore, the author intends to review recent advances in the effective prediction of the diagnostic and therapeutic effect of lymphoma based on the metabolic assessment of 18F-fluorodeoxyglucose PET VCAR software.
Lymphoma is a malignant tumor of the hematological system that originates from different sites of the body and has a variety of pathological types. Maximum standardized uptake value, a traditionally used evaluation index, can reflect the maximum metabolic activity in tumor tissues, and which is the most widely studied metabolic parameter in clinical research at present. PET volume computed assisted reading (VCAR) software can measure and analyze the lymphoma lesions and automatically calculate the metabolic evaluation indexes of the lesions, including the peak SUV normalized by lean body mass, metabolic tumor volume, total lesion glycolysis, etc. There are many pathological subtypes of lymphoma, and the above metabolic evaluation parameters have different diagnosis and efficacy evaluation efficiency for different types of lymphoma. Therefore, the author intends to review recent advances in the effective prediction of the diagnostic and therapeutic effect of lymphoma based on the metabolic assessment of 18F-fluorodeoxyglucose PET VCAR software.
2021, 45(3): 192-197.
doi: 10.3760/cma.j.cn121381-202002041-00021
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Cardiomyocytes use various substrates such as glucose, fatty acids, lactic acid, and ketone bodies to produce energy to maintain their normal systolic and diastolic function. Abnormal changes in cardiomyocytes' energy metabolism are associated with various heart diseases, such as myocardial ischemia and heart failure. As a non-invasive functional examination method, radionuclide imaging can be used to evaluate the metabolism status of cardiomyocytes. Radionuclide myocardial metabolism imaging agents are myocardial metabolism substrates. Their analogues are labeled with radionuclides, divided into oxygen metabolism imaging agents, glucose metabolism imaging agents, and fatty acid metabolism imaging agents. This paper reviews the research progress of positron radionuclide myocardial metabolism imaging agents in recent years.
Cardiomyocytes use various substrates such as glucose, fatty acids, lactic acid, and ketone bodies to produce energy to maintain their normal systolic and diastolic function. Abnormal changes in cardiomyocytes' energy metabolism are associated with various heart diseases, such as myocardial ischemia and heart failure. As a non-invasive functional examination method, radionuclide imaging can be used to evaluate the metabolism status of cardiomyocytes. Radionuclide myocardial metabolism imaging agents are myocardial metabolism substrates. Their analogues are labeled with radionuclides, divided into oxygen metabolism imaging agents, glucose metabolism imaging agents, and fatty acid metabolism imaging agents. This paper reviews the research progress of positron radionuclide myocardial metabolism imaging agents in recent years.
2021, 45(3): 198-204.
doi: 10.3760/cma.j.cn121381-202007019-00029
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Keloid is a common benign skin tumor in clinic. Accompanied by pain, itching and other symptoms, keloid could cause serious adverse effects on the physical and mental health as well as life quality of patients. At present, the clinical methods to treat keloid include surgical excision and hormone therapy. However, due to the high recurrence rate, the efficacy of monotherapy is not ideal. At present, postoperative radiotherapy is the most effective method to treat keloid, which greatly reduces the recurrence rate of the disease. This paper reviews the research progress of postoperative radiotherapy in the treatment of keloid.
Keloid is a common benign skin tumor in clinic. Accompanied by pain, itching and other symptoms, keloid could cause serious adverse effects on the physical and mental health as well as life quality of patients. At present, the clinical methods to treat keloid include surgical excision and hormone therapy. However, due to the high recurrence rate, the efficacy of monotherapy is not ideal. At present, postoperative radiotherapy is the most effective method to treat keloid, which greatly reduces the recurrence rate of the disease. This paper reviews the research progress of postoperative radiotherapy in the treatment of keloid.
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