2021 Vol. 45, No. 8
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2021, 45(8): -1--1.
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Abstract:
2021, 45(8): 479-485.
doi: 10.3760/cma.j.cn121381-202005025-00069
Abstract:
Objective To explore the clinical features and comprehensive imaging findings of phosphaturic mesenchymal tumor (PMT). Methods A total of 38 histopathologically proven patients with PMT (22 males and 16 females; age, 8–72 years; median age, 45.5 years) in the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from March 2014 to November 2018 were included in this study. The relevant clinical data and ultrasound, CT, MRI, 99Tcm-hydrazinonicotinamide-Tyr3-octreotide (99Tcm-HYNIC-TOC) SPECT/CT, 99Tcm-methylenediphosphonate (99Tcm-MDP) SPECT/CT bone scan, and 18F-fluorodeoxyglucose (FDG) PET/CT imaging findings were retrospectively analyzed, and their comprehensive imaging findings and clinical features were summarized. Results The clinical manifestations of patients with PMT were mainly progressive systemic bone pain, muscle weakness, and local discomfort at the primary site of the tumor. All patients showed hypophosphatemia before operation. Of the 38 patients included, 8, 20, 18, 12, 8, and 7 patients respectively received ultrasound, CT, MRI, 99Tcm-HYNIC-TOC SPECT/CT, 99Tcm-MDP SPECT/CT bone scan, and 18F-FDG PET/CT. The ultrasonographic characteristics were low or mixed echoes and abundant color blood flow signals. Also, 50.0% (4/8) of the osseous PMT were osteolytic on CT, 12 soft tissue lesions were abnormal density focus or soft tissue mass on CT. All lesions presented low signal intensity on T1 weighted imaging and high or low signal intensity on T2 weighted imaging in 18 patients who underwent MRI, and tumor parenchyma was obviously enhanced. Ten of the 12 (83.3%) patients were positive on 99Tcm-HYNIC-TOC SPECT/CT imaging. 99Tcm-MDP SPECT/CT bone scan showed increased radiotracer uptake over the bone lesions, and one case of soft tissue lesion showed a slight increase in radiation uptake. On 18F-FDG PET/CT, all lesions showed intense FDG uptake with a median maximum standardized uptake value of 4.0 (range, 3.1–10.7). Conclusions The clinical feature of PMT is tumor-induced osteomalacia with hypophosphatemia. However, the symptoms of the primary tumor are not prominent. No specific imaging findings of PMT were noted. However, 99Tcm-HYNIC-TOC SPECT/CT, 99Tcm-MDP SPECT/CT bone scan, and 18F-FDG PET/CT may be helpful in tumor localization and whole-body assessment.
2021, 45(8): 486-494.
doi: 10.3760/cma.j.cn121381-202010022-00089
Abstract:
Objective To explore the diagnostic efficacy of 18F-fluorodeoxyglucose(FDG) PET/CT on intramedullary relapse of acute leukemia, and screening parameters that can be used to give the diagnosis. Methods The 18F-FDG PET/CT imaging data of 81 patients (45 males and 36 females aged 3–55（25.14±15.07）years) who were clinically diagnosed with suspected intramedullary relapse of acute leukemia in Hebei Yanda Hospital from November 2016 to November 2019 were retrospectively analyzed. All the patients had received bone marrow transplantation. And the histopathological results of bone marrow biopsy were used as "golden standard" of intramedullary relapse. The patients were divided into relapse group (41 cases) and non-relapse group (40 cases). The maximum standardized uptake value (SUVmax) of all the suspected recurrent lesions and SUVmax of normal liver background (liver SUVmax) were measured and calculated. The ratio of appendicular skeleton SUVmax to that of axial skeleton and the ratio of axial skeleton SUVmax to that of normal liver background were calculated respectively. The different cut-off values and area under curve (AUC) based on receiver operating characteristic (ROC) curves were analyzed, and the diagnostic efficacy of 18F-FDG PET/CT on relapse of acute leukemia was explored preliminarily. Visual interpretation was applied as a reference criterion to explore the diagnostic efficacy of 18F-FDG PET/CT on the intramedullary relapse of acute leukemia based on different semiquantitative parameters. Differences in semiquantitative parameters between the two groups were compared by independent sample t-test for measurement data and Pearson chi-square test for qualitative data. Results Axial skeleton SUVmax of the relapse group was higher than that of the non-relapse group (3.10±1.65 vs. 1.99±1.26, t=3.367, P=0.001). Meanwhile, compared with non-relapse group, the ratio of axial skeleton SUVmax to normal liver background SUVmax (1.20±0.56 vs. 0.89±0.74), and the ratio of appendicular skeleton SUVmax to axial skeleton SUVmax (1.58±1.38 vs. 0.79±0.37) were higher than that of relapse group. Both difference has statistics significance (t=2.186, 3.477; both P<0.05). The ROC curve analysis of the semiquantitative index of SUVmax revealed that the sensitivity, specificity, and accuracy of relapse diagnosis were 70.73% (29/41), 72.50% (29/40), and 71.60% (58/81), respectively (AUC=0.770), when axial skeleton SUVmax≥2.05 was used as the criterion of intramedullary relapse. When multifocal+diffuse increased 18F-FDG uptake was used as the criterion of intramedullary relapse, visual evaluation-based results indicated sensitivity, specificity, and accuracy of 85.37% (35/41), 70.00% (28/40), and 77.78%(63/81), respectively. Conclusions Visual evaluation based on 18F-FDG PET/CT is a simple and reliable method for diagnosing acute leukemia relapse, and has high diagnostic efficacy. Based on SUVmax semi-quantitative parameter analysis is a useful supplement to visual evaluation.
2021, 45(8): 495-500.
doi: 10.3760/cma.j.cn121381-202105026-00090
Abstract:
Objective To explore the clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters in the prediction of mediastinal lymph node metastasis in patients with non-small cell lung cancer (NSCLC). Methods A total of 102 patients with NSCLC histopathologically confirmed from January 2018 to March 2021 in Fuyang People's Hospital were restrospectively analyzed in this study. The patients consisted of 59 males and 43 females aged 33–90 (66.0±11.2) years. All patients underwent 18F-FDG PET/CT imaging before operation to analyze and calculate the metabolic parameters. The coefficient of variation (CV) is the ratio of the standard deviation (SD) of the maximum standardized uptake value (SUVmax) to SUVmax of the lesion; LMV is the ratio of the SUVmax of the lymph node to the mean standardized uptake value (SUVmean) of the mediastinal blood pool; the total lesion glycolysis (TLG) is the product of metabolic tumor volume (MTV) and SUVmean. The receiver operator characteristic (ROC) curve was drawn to determine the optimal cut-off value for predicting lymph node metastasis and calculate the sensitivity and specificity. Enumeration data were evaluated using χ2 test or Fisher's exact probability method, and continuous measurement data were compared using independent-sample t test. Univariate and multivariate Logistic regression analysis were used in screening the predictors of lymph node metastasis. Results The univariate Logistic regression analysis results showed that when the long diameter of the lung primary tumor was over 30.0 mm or the short diameter of the lymph nodes was over 10.0 mm, lymph node metastasis was likely to occur (61.9% vs. 38.1%, 59.5% vs. 40.5%; χ2=9.16, 5.20; both P<0.05); the CV of the primary tumor and the SUVmax and LMV of lymph nodes of patients with lymph node metastasis were higher than those of patients without lymph node metastasis (46.7±6.1 vs. 29.4±6.0, 5.9±1.9 vs. 2.8±1.6, 2.2±0.6 vs. 1.4±0.3; t=13.81, 8.60, 3.97; all P<0.05). The multivariate Logistic regression analysis results suggested that the SUVmax of lymph nodes (OR=2.2, 95% confidence interval (CI): 1.30–3.80, P<0.05) and the CV of the primary tumor (OR=1.5, 95%CI: 1.20–1.80, P<0.01) were independent risk factors affecting the status of lymph node metastasis. The ROC curve analysis results showed that the area under the CV curve of the primary tumor was 0.97 (SD=0.02, 95%CI: 0.94–0.99, P<0.01). When CV>30.5, the sensitivity of diagnosis of lymph node metastasis was 97.5%, and the specificity was 41.7%. The area under the curve of lymph node SUVmax was 0.91 (SD=0.30, 95%CI: 0.85–0.97, P<0.01). When the lymph node SUVmax>3.1, the sensitivity and specificity of the diagnosis of lymph node metastasis were 95.2% and 23.3%, respectively. The combined diagnosis of the two risk factors resulted in an area under the curve of 0.98 (SD=0.01, 95%CI: 0.96–1.00, P<0.01). Conclusion Among the metabolic parameters of 18F-FDG PET/CT, the CV of the primary tumor and the SUVmax of lymph nodes are independent risk factors for predicting mediastinal lymph node metastasis in patients with NSCLC and can provide useful information for treatment.
2021, 45(8): 501-506.
doi: 10.3760/cma.j.cn121381-202012028-00072
Abstract:
Objective To analyze the characteristics of total glomerular filtration rate (GFR) and single GFR measured by Gate's method for radionuclide renal dynamic imaging measured by Gate's method for radionuclide renal dynamic imaging in patients with single unilateral renal cancer and to provide relevant information for clinical therapy. Methods A total of 50 patients (including 32 males and 18 females, age 43–65(54.2±9.7) years) with single unilateral renal cell cancer (renal cancer group) were collected from the Second Hospital of Tianjin Medical University from January 2018 to December 2019, and 60 healthy adults (36 males and 24 females, age 47–68(56.1±8.6) years) with high incidence age of renal cancer in China were selected as the control group to conduct a retrospective study. 99Tcm-diethylenetriaminepentaacetic acid (DTPA) renal dynamic imaging was performed in the renal cancer and control groups at the same time. The clinical data, total GFR, and split GFR of both groups were compared. Independent sample t-test was used to compare the total GFR and split GFR in both groups. To observe the incidence of asymmetric renal function and renal compensation in patients with renal cancer, the difference of total GFR calculated using the chronic kidney disease epidemiology collaboration equation and Gate's method in the renal cancer group was compared, and correlation analysis was performed using Pearson's correlation analysis. Results No significant difference was observed in gender ratio, age, smoking status, body mass index, blood pressure, blood glucose, atherosclerosis index, hemoglobin, serum creatinine, urea, and uric acid in both groups (χ2=0.185, 0.021, t=0.656–1.980, all P>0.05). No significant difference was observed in the total GFR in both groups((103.9±15.9) mL/min vs. (103.2±10.6) mL/min, t=0.116, P=0.908). Compared with the single kidney GFR of the control group ((51.2±5.9) mL/min), GFR of tumor-lateral renal ((47.4±13.0) mL/min) was significantly decreased, GFR of contra-lateral normal renal (56.1±10.9) mL/min was significantly increased, and the differences were statistically significant (t=−2.248, 2.837; both P<0.05). The absolute value of the percentage difference between GFR in split kidney and total kidney was greater than 10% in 21 of the 50 patients. In 16 patients, the GFR of contralateral normal renal was higher than the superior limit of the reference range of split kidney GFR in healthy people of the same age. The difference between the two methods (chronic kidney disease epidemiology collaboration equation and Gate's method) in the total GFR of renal cancer group was statistically significant ((120.1±26.1) mL/(min·1.73 m2) vs. (108.7±13.4) mL/(min·1.73 m2) , t=3.765, P<0.05) and they were correlated (r=0.54, P<0.05). Conclusion 99Tcm-DTPA renal dynamic imaging preoperatively can obtain accurate information about the GFR of the kidney, which has significant value for the decision-making of therapeutic regimen.
2021, 45(8): 507-514.
doi: 10.3760/cma.j.cn121381-202005013-00064
Abstract:
Objective To investigate the application value of different radiotherapy modes in patients with low burden metastatic prostate cancer (LBMP). Methods The clinical data of 91 patients diagnosed with LBMP in the 900th Hospital of the Joint Logistics Support Force of PLA from November 2009 to November 2015 were retrospectively analyzed. The average age was 53–72 (67.4±4.5) years. All patients received standard maxim androgen blockade, and 52 of them received prostate-only directed radiation therapy (PODT group), whereas 39 received prostate and metastatic radiation therapy (PMRT group). The target delineation range was prostate and bilateral seminal vesicles in the PODT group, and the total dose of the planning target volume (PTV) was 62.5 Gy (2.5 Gy per fraction, once per day, 25 fractions per 5 weeks). The target delineation range in the PMRT group was PTV combined with lymph node planning gross tumor volume (PGTVnd) and metastatic planning gross tumor volume (PGTVm). The total dose of PGTVnd was 55 Gy (2.2 Gy per fraction, once per day, 25 fractions per 5 weeks). The total dose of PGTVm was 45 Gy (1.8 Gy per fraction, once per day, 25 fractions per 5 weeks). Differences in tumor radiation volume and radiation dose to organs at risk between the groups was determined with independent sample t-test. The Expanded Prostate Cancer Index Composite and Radiation Therapy Oncology Group standards were used in evaluating the quality of life and acute radiation injury. The Mann-Whitney U rank sum test was used in comparing the two groups in terms of quality of life at various follow-up time points after radiotherapy. Acute radiation injury was compared with the chi-square test, and the Kaplan-Meier method was used for survival analysis, Log-rank χ2 test was used. Results The total radiation volume of the PODT group was (264.52±86.37) cm3, which was significantly lower than that of the PMRT group (418.47±63.64) cm3 (t=1.362, P<0.05). The radiation dose of organs at risk (rectum, bladder, left femoral head, and right femoral head) in the PODT group were significantly lower than those in the PMRT group (t=2.01–4.78, all P<0.05). The scores of urinary system function in the PODT group 1 day, 3 months, and 6 months after radiotherapy were significantly higher than those in the PMRT group (Z=4.467, 5.726, 7.984; all P<0.05). The scores of intestinal system function in the PODT group were significantly higher than those in the PMRT group (Z=3.826, 5.693, 7.874; all P<0.05). The sexual function score of the PMRT group was higher than that of the PODT group at each follow-up point 3 months after radiotherapy (Z=2.381–9.872, all P<0.05). No significant differences in five-year overall survival rate and prostate cancer specific survival rate were found between the groups (χ2=4.62, 3.07; both P>0.05). The PODT group had a lower five-year interval to biochemical failure (IBF) rate than the PMRT group (4.2% vs. 14.9%), and the difference was significant (χ2=7.68, P=0.03). The incidence rates of leukopenia, thrombocytopenia, and hemoglobin decline in the PMRT group were significantly higher than those in the PODT group (χ2=6.09, 3.12, 7.58; all P<0.05). The results were consistent with the incidence of vomiting (χ2=8.93, P<0.05). Conclusions Compared with patients who received PODT, patients who received PMRT showed increased IBF time but did not show increases in PCSS and OS time. The incidence of radiation injury increased in the PMRT group.
2021, 45(8): 515-520.
doi: 10.3760/cma.j.cn121381-202010019-00088
Abstract:
Objective To investigate the therapeutic effect of sitagliptin on hematopoietic system injury in mice after 7 Gy γ-ray irradiation. Methods Fifteen C57BL/6 mice were randomly divided into a control group, an irradiation group, and a sitagliptin+irradiation group by using a randomized block design, with five mice in each group. The mice in the irradiation and sitagliptin+irradiation groups received 7 Gy 137Cs γ-ray total body irradiation. Sitagliptin was administered to the latter via gavage 2 h after the irradiation. The dose was 10 mg/kg, and gavage infusion was continuous. Sitagliptin administration lasted for 7 days. The control and irradiation groups were given the same volume of normal saline. On the 30th day after irradiation, peripheral blood was collected for blood routine examination. After the mice were sacrificed via cervical dislocation, bone marrow cells were collected to determine the numbers of nucleated cells, hematopoietic stem cells (HSC), and hematopoietic progenitor cells (HPC), along with their reactive oxygen species (ROS) levels. The number of colony-forming units granulocyte-macrophage (CFU-GM) clones was also determined. Data between two groups were compared via independent sample t-test. Results Compared with those of the control group, the numbers of bone marrow nucleated cells, white blood cells, red blood cells, platelets, hemoglobin, and hematocrit of the irradiation group were significantly reduced (t=3.476−12.200, all P<0.05). The number and percentage of HSC and HPC were significantly reduced (t=3.174−5.287, all P<0.05). The level of ROS in HSC increased significantly (1980.6±309.3 vs. 3994.5±1119.0, t=3.904, P<0.05). The number of bone marrow cell CFU-GM clones was significantly decreased (66.2±5.3 vs. 30.8±3.9, t=13.240, P<0.05). Compared with the irradiation group, the number of bone marrow nucleated cells ((8.0±1.0)×106 vs. (11.0±0.4)×106, t=4.593, P<0.05) and white blood cells ((3.0±0.2)×109/L vs. (3.9±0.3)×109/L, t=7.020, P<0.05) increased (t=4.593, P<0.05) in the sitagliptin+irradiation group. The number of HPC (33 724.4±10 594.9 vs. 101 637.6±17 240.5, t=5.951, P<0.05) and percentage ((5.6±1.0%) vs. (11.5±3.0)%, t=4.163, P<0.05) also increased. The ROS level in HSC decreased (3994.5±1119.0 vs. 2415.7±122.9, t=2.375, P<0.05), whereas the number of the bone marrow cell CFU-GM clones increased (30.8±3.9 vs. 38.2±4.4, t=2.964, P<0.05). Conclusion Sitagliptin exerts a certain therapeutic effect on hematopoietic system injury in mice after 7 Gy γ-ray irradiation.
2021, 45(8): 521-526.
doi: 10.3760/cma.j.cn121381-202007041-00080
Abstract:
Standardized uptake value (SUV) is the most important semi-quantitative index in the clinical application of 18F-FDG PET/CT. It plays an important role in the diagnosis of various diseases, evaluation of therapeutic efficacy and prognosis in tumors. However, the accuracy of SUV measurement can be affected by many factors, such as biological and technical factors. This review summarizes the influencing factors on the accuracy of SUV measurement and their solutions in order to provide assistance for clinical setting.
Standardized uptake value (SUV) is the most important semi-quantitative index in the clinical application of 18F-FDG PET/CT. It plays an important role in the diagnosis of various diseases, evaluation of therapeutic efficacy and prognosis in tumors. However, the accuracy of SUV measurement can be affected by many factors, such as biological and technical factors. This review summarizes the influencing factors on the accuracy of SUV measurement and their solutions in order to provide assistance for clinical setting.
2021, 45(8): 527-531.
doi: 10.3760/cma.j.cn121381-202009004-00082
Abstract:
Lung cancer is a malignant tumor that seriously threatens human life and health, and its pathological type affects the treatment plan and prognosis. Although great progress has been made in the diagnosis and treatment of lung cancer, there are still a considerable number of patients whose histopathological type or subtype cannot be defined due to some special circumstances. 18F-fluorodeoxyglucose (FDG) PET/CT, as a new non-invasive imaging technique, can directly reflect the degree of tumor metabolism, and its metabolic parameters have a certain correlation with the pathological types of non-small cell lung cancer (NSCLC). Radiomics is a developing discipline, which aims to obtain automated quantitative imaging functions from medical images and be able to predict the pathological type of lung cancer non-invasively. This paper reviews the application and progress of 18F-FDG PET/CT in predicting the pathological types of NSCLC.
Lung cancer is a malignant tumor that seriously threatens human life and health, and its pathological type affects the treatment plan and prognosis. Although great progress has been made in the diagnosis and treatment of lung cancer, there are still a considerable number of patients whose histopathological type or subtype cannot be defined due to some special circumstances. 18F-fluorodeoxyglucose (FDG) PET/CT, as a new non-invasive imaging technique, can directly reflect the degree of tumor metabolism, and its metabolic parameters have a certain correlation with the pathological types of non-small cell lung cancer (NSCLC). Radiomics is a developing discipline, which aims to obtain automated quantitative imaging functions from medical images and be able to predict the pathological type of lung cancer non-invasively. This paper reviews the application and progress of 18F-FDG PET/CT in predicting the pathological types of NSCLC.
2021, 45(8): 532-538.
doi: 10.3760/cma.j.cn121381-202007039-00077
Abstract:
Tumor-associated macrophages (TAMs) are closely involved in the initiation, progression, metastasis and recurrence of tumors. According to different phenotypes and functions, TAMs can be classified as M1-like type or M2-like type, mainly related to anti-tumor immunity and tumor promotion, respectively. Radiotherapy is one of the main treatments for most solid tumors, which can directly kill tumor cells and indirectly affect tumor microenvironment (including TAMs), thus regulating macrophages to radiotherapy-resistant or radiotherapy-sensitive phenotype, which in turn affects the efficacy of radiotherapy. Targeting TAMs to inhibit the tumor-promoting effect and promoting the repolarization of TAMs to M1-like type have become promising methods of cancer therapy. The combination of targeting TAMs and radiotherapy can synergistically inhibit tumor progression, improve the therapeutic effect and reduce radiotherapy resistance. In this review, the authors discuss the current understanding of the role and interaction mechanism of TAMs in tumor radiotherapy, and the latest progression in the combination therapy of targeting TAMs and radiotherapy.
Tumor-associated macrophages (TAMs) are closely involved in the initiation, progression, metastasis and recurrence of tumors. According to different phenotypes and functions, TAMs can be classified as M1-like type or M2-like type, mainly related to anti-tumor immunity and tumor promotion, respectively. Radiotherapy is one of the main treatments for most solid tumors, which can directly kill tumor cells and indirectly affect tumor microenvironment (including TAMs), thus regulating macrophages to radiotherapy-resistant or radiotherapy-sensitive phenotype, which in turn affects the efficacy of radiotherapy. Targeting TAMs to inhibit the tumor-promoting effect and promoting the repolarization of TAMs to M1-like type have become promising methods of cancer therapy. The combination of targeting TAMs and radiotherapy can synergistically inhibit tumor progression, improve the therapeutic effect and reduce radiotherapy resistance. In this review, the authors discuss the current understanding of the role and interaction mechanism of TAMs in tumor radiotherapy, and the latest progression in the combination therapy of targeting TAMs and radiotherapy.
2021, 45(8): 539-544.
doi: 10.3760/cma.j.cn121381-202007033-00087
Abstract:
In the diagnosis and treatment of nuclear medicine, radionuclides irradiate not only the target organs in the patient, but also other normal tissues and organs. This paper introduces the development trend of human radiation dose models at home and abroad, and reviewed the internal doses of three radionuclide (18F, 99Tcm, 131I) labeled imaging agents commonly used in nuclear medicine and its influencing factors. It provides a reference for the study of radiation dose and radiation protection in nuclear medicine diagnosis and treatment.
In the diagnosis and treatment of nuclear medicine, radionuclides irradiate not only the target organs in the patient, but also other normal tissues and organs. This paper introduces the development trend of human radiation dose models at home and abroad, and reviewed the internal doses of three radionuclide (18F, 99Tcm, 131I) labeled imaging agents commonly used in nuclear medicine and its influencing factors. It provides a reference for the study of radiation dose and radiation protection in nuclear medicine diagnosis and treatment.
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