2022 Vol. 46, No. 10
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2022, 46(10): 585-591.
doi: 10.3760/cma.j.cn121381-202202009-00228
Abstract:
Objective To investigate the imaging features of 18F-fluorodeoxyglucose (FDG) PET/CT in pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and differential diagnosis value in inflammatory-type non-small cell lung cancer (NSCLC). Methods Retrospectively analyzed the clinical data of 21 patients with pulmonary MALT lymphoma (13 males and 8 females, aged 56~74(66.2±5.8) and 33 patients with inflammatory-type NSCLC (20 males and 13 females, aged 48~84(64.6±9.6)), respectively, who underwent 18F-FDG PET/CT from January 2015 to December 2020 at Fujian Medical University Union Hospital. In addition, the included patients were those whose lungs showed inflammation-like changes and were confirmed by histopathological examination. The CT and PET regions of interest were manually outlined. Then, the long and short diameters of the largest cross-sections of the lesions, CT values, maximum standardized uptake values (SUVmax), and peak standardized uptake values (SUVpeak) were measured. Moreover, the imaging signs (lesion morphology, bronchial signs, location of lesion onset, lymph node and spleen metabolism) were analyzed. The differences between the two groups were subsequently compared using the χ2 test, independent samples t-test, and corrected t-test. Results There were fewer masses than solids in 21 patients with pulmonary MALT lymphoma (28.6% vs.71.4%) and more masses than solids in 33 patients with inflammatory-type NSCLC (57.6% vs. 42.4%), with a statistically significant difference between the two groups (χ2=4.342, P=0.037); the proportion of bronchial signs was higher in patients with pulmonary MALT lymphoma than that in patients with inflammatory-type NSCLC (90.5% vs. 75.8%), and the proportion of combined hypermetabolic lymph nodes was significantly lower than that in inflammatory-type NSCLC (14.3% vs. 48.5%), with no statistically significant difference between the two group (χ2=0.996, 3.288; both P>0.05); there were fewer unilateral than bilateral morbidities in patients with pulmonary MALT lymphoma (23.8% vs. 85.7%) and more unilateral than bilateral in patients with inflammatory-type NSCLC (84.8% vs.15.2%), with a statistically significant difference between the two groups (χ2=26.133, P<0.001); 11 cases of splenic hypermetabolism in patients with pulmonary MALT lymphoma (52.4%) and none in inflammatory-type NSCLC, with a statistically significant difference between the two groups (χ2=21.708, P<0.001). The mean long and short diameters of patients with pulmonary MALT lymphoma were shorter than those of patients with inflammatory-type NSCLC [(5.89±2.14) cm vs. (6.26±2.75) cm, (3.88±1.98) cm vs. (4.21±1.56) cm], with no statistically significant difference between the two groups (t=−1.46, −1.87; both P>0.05). CT values were higher in patients with pulmonary MALT lymphoma than that in patients with inflammatory-type NSCLC [(45.4±10.5) HU vs.(21.6±50.1) HU], and the difference between them was statistically significant (t=30.89, P<0.001); SUVmax and SUVpeak were lower in patients with pulmonary MALT lymphoma than those in patients with inflammatory-type NSCLC [(5.71±2.10) vs. (9.89±4.53), (4.48±2.31) vs. (7.46±4.44)], and the differences between them were statistically significant (t=−4.58, −3.23; both P<0.01). Conclusions 18F-FDG PET/CT is of great value for the differential diagnosis of pulmonary MALT lymphoma and inflammatory-type NSCLC, in which SUVmax, SUVpeak, spleen metabolism, lesion morphology, lesion onset, and CT value in CT images can be used as reference indicators.
2022, 46(10): 592-598.
doi: 10.3760/cma.j.cn121381-202110002-00223
Abstract:
Objective To investigate the diagnostic gain value and its effect on clinical diagnosis and treatment of post-therapeutic 131I SPECT/CT imagings in patients with differentiated thyroid carcinoma (DTC). Methods This retrospective study enrolled 404 DTC patients composed of 89 males and 315 females and aged 21 to 69 (46.3±5.9) years old. The patients took their first 131I therapy at the West China Hospital of Sichuan University between January 2017 and May 2020. All patients were evaluated using SPECT/CT imagings and whole-body anteroposterior position 131I planar scans five days after receiving a dose of 1.11–9.25 GBq. The 131I planar scans and the SPECT/CT imagings were evaluated independently for iodine uptake foci, which were categorized as residual thyroid, lymph node, distant metastasis and the equivocal foci. According to the anatomical location information of CT, the correction ratio of SPECT/CT imagings to the original diagnosis of iodine uptake foci shown by 131I planar scans was calculated. Then, the influence of SPECT/CT imagings on the clinical diagnosis and management of DTC patients was further assessed. McNemar test and McNemar–Bowker test were both used to assess the distribution differences between 131I planar scans and SPECT/CT imagings. Results A total of 927 iodine uptake foci were detected in the 131I planar scans of 404 DTC patients. According to the images of 131I planar scans, SPECT/CT imagings led to a revision of the original diagnosis in 179 of 927 iodine uptake foci, and 118 iodine uptake foci considered to be indeterminate based solely on the planar images were accurately classified. SPECT/CT imagings has diagnostic gain value for 11.9% (48/404) of DTC patients, and 1.7% (7/404) patients' diagnosis and treatment decisions have changed. The difference between 131I planar scans and SPECT/CT imagings in the qualitative diagnosis of iodine uptake foci was statistically significant (χ2=101.69, P<0.001). Regarding the detection of metastatic cervical lymph nodes, the characterization of the 131I uptake by SPECT/CT was significantly better than that by planar scans (McNemar test, P<0.05). Conclusion Post-therapeutic 131I SPECT/CT imagings is of positive significance in the diagnostic gain value and diagnosis and treatment of patients with DTC.
2022, 46(10): 599-605.
doi: 10.3760/cma.j.cn121381-202109001-00222
Abstract:
Objective To explore the value of the quantitative parameters of dual-energy CT iodine map combined with morphological signs in predicting cervical central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC). Methods Clinical and imaging data of 165 patients with PTMC diagnosed by postoperative histopathology and who underwent central lymph node dissection in Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University from January 2020 to December 2020 were retrospectively analyzed. The cohort included 51 males and 114 females, aged 22–69 (47.8±13.9) years old. The patients were divided into the CLNM and non-CLNM groups according to the histopathological results. Morphological signs of the lesions, including multiple lesions, long diameter, irregular shape, microcalcification, thyroid edge contact, and blurred boundary after enhanced scanning, were evaluated. The iodine concentration (IC) and CT value of the PTMC lesions in the arteriovenous phase were measured by dual-energy CT scanning before the operation. The normalized IC (NIC) and normalized CT (NCT) value of the lesions in the arteriovenous phase were calculated. Independent sample t-test was used to compare the IC, NIC, CT, and NCT values of the arteriovenous lesions between the two groups. χ2 test was used to compare the morphological signs of lesions between the two groups. A receiver operator characteristic curve (ROC) was drawn for the morphological signs and quantitative parameters of the dual-energy CT iodine map with statistically significant differences in univariate analysis, and the area under curve (AUC) was calculated. Binary stepwise logistic regression was used to obtain the joint prediction coefficient of the quantitative parameters and the morphological signs. Results Significant differences were found in the multiple lesions, lesion diameter, irregular shape, and thyroid edge contact between the two groups (χ2=7.298–12.422, all P<0.01), and thyroid edge contact had the highest diagnostic efficiency for cervical CLNM(AUC=0.695). The NIC and NCT values of the CLNM group were higher than those of the non-CLNM group in the arteriovenous phase, and the differences were statistically significant (0.36±0.02 vs. 0.32±0.03, 0.70±0.11 vs. 0.59±0.10, 0.43±0.06 vs. 0.37±0.07, 0.81±0.08 vs. 0.75±0.12; t=4.248–8.301, all P<0.01). The NIC in the arterial phase had the highest diagnostic efficiency for cervical CLNM(AUC=0.822), and the optimal cut-off value was 0.36. The quantitative parameters of the dual-energy CT iodine map combined with the morphological signs had the highest diagnostic efficiency for cervical CLNM, with AUC of 0.908, sensitivity of 86.70%, and specificity of 75.10%. Thyroid edge contact was an independent risk factor for cervical CLNM. Conclusion The quantitative parameters of dual-energy CT iodine map combined with the morphological signs exhibited important clinical value in predicting cervical CLNM of patients with PTMC before an operation.
2022, 46(10): 606-612.
doi: 10.3760/cma.j.cn121381-202111019-00225
Abstract:
Objective To compare the dosimetry difference between flattening filter free (FFF) mode and flattening filter (FF) mode in deep inspiration breath-hold(DIBH) treatments of left-sided breast cancer after modified radical mastectomy with volumetric modulated arc therapy (VMAT). Methods Retrospectively analyzed the clinical data of 16 female patients with left breast cancer after modified radical mastectomy with DIBH radiotherapy in the First Affiliated Hospital of Xi'an Jiaotong University from December 2020 to May 2021, aged 37 to 61 (43.5±5.7) years old. VMAT plans of FFF and FF modes were designed for the same patient, and the same prescription dose of 50 Gy/25 times was set in the planning target volume (PTV). Under the same dose normalization, the dosimetric parameters of the target and the organs at risk(OAR) and treatment efficiency were compared between the two plans. Paired t-test was used to compare the data between groups. Results No significant differences in D2%, D50%, D98%, CI , HI and GI were found in the target area between the two modes (t=−1.519-1.644; all P>0.05). FFF mode was superior to FF mode in protection of OAR, such as V5 Gy, V30 Gy (Vx Gy: ≥x Gy volume as a percentage of total volume) and mean dose (Dmean) of heart; V5 Gy, V10 Gy and Dmean of ipsilateral lung; V5 Gy, V10 Gy, V20 Gy and Dmean of whole lung; and V5 Gy of patient dose, and the differences between the two modes were statistically significant (t=−4.741 to−2.156; all P<0.05). The total monitor units of FFF mode was 1.32 times of that in FF mode ((1073.41±143.79) MU vs.(815.70±87.69) MU), but the total delivery time was reduced to 88.9% of that in FF mode((128.00±11.64) s vs.(144.75±11.45) s), and the differences between the two modes were statistically significant (t=8.665, −4.373; both P<0.05). Conclusion The target dose between the two modes were similar. The FFF mode can remarkably reduce the radiation dose of OAR and normal tissues, and can significantly shorten the time of DIBH therapy.
2022, 46(10): 613-618.
doi: 10.3760/cma.j.cn121381-202201010-00240
Abstract:
In recent years, cardio-oncology has become a new field to identify, prevent and treat the cardiovascular complications caused by tumor itself or tumor treatment. With the increase in the number of patients, it has gradually attracted people's attention. Nuclear medical imaging plays an important role in the research of cardio-oncology, which can help to early and accurately diagnose and monitor the cardiotoxicity caused by tumor treatment, and effectively improve the prognosis of tumor patients. Based on this, the author reviewed the research progress of nuclear medicine imaging in cardio-oncology.
In recent years, cardio-oncology has become a new field to identify, prevent and treat the cardiovascular complications caused by tumor itself or tumor treatment. With the increase in the number of patients, it has gradually attracted people's attention. Nuclear medical imaging plays an important role in the research of cardio-oncology, which can help to early and accurately diagnose and monitor the cardiotoxicity caused by tumor treatment, and effectively improve the prognosis of tumor patients. Based on this, the author reviewed the research progress of nuclear medicine imaging in cardio-oncology.
2022, 46(10): 619-623.
doi: 10.3760/cma.j.cn121381-202201016-00232
Abstract:
Lung cancer is one of the most common cancers in the world. With the popularization of low-dose CT lung cancer screening, the detection rate of stage ⅠA non-small cell lung cancer (NSCLC) is increasing. 18F-fluorodeoxyglucose (FDG) PET/CT as an imaging method to reflect the metabolic state of tumor cells at the molecular level, has become an important tool for the diagnosis, staging and prognosis of NSCLC. The clinical application of PET/CT in stage ⅠA NSCLC is increasing year by year. This paper reviews the research related to the application of 18F-FDG PET/CT in stage ⅠA NSCLC patients in recent years, and the value of these researches in clinical decision-making and prognosis.
Lung cancer is one of the most common cancers in the world. With the popularization of low-dose CT lung cancer screening, the detection rate of stage ⅠA non-small cell lung cancer (NSCLC) is increasing. 18F-fluorodeoxyglucose (FDG) PET/CT as an imaging method to reflect the metabolic state of tumor cells at the molecular level, has become an important tool for the diagnosis, staging and prognosis of NSCLC. The clinical application of PET/CT in stage ⅠA NSCLC is increasing year by year. This paper reviews the research related to the application of 18F-FDG PET/CT in stage ⅠA NSCLC patients in recent years, and the value of these researches in clinical decision-making and prognosis.
2022, 46(10): 624-628.
doi: 10.3760/cma.j.cn121381-202112011-00227
Abstract:
Diffuse large B-cell lymphoma (DLBCL) is one of the most common hematologic malignancies, and the conventional application of Rituximab in combination with cyclophosphamide + adriamycin + vincristine + prednisone treatment regimen has increased the cure rate of DLBCL, but the prognosis varies widely among patients. The current methods for predicting prognosis have some limitations. 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used in the diagnosis and treatment of DLBCL, and its metabolic parameter metabolic tumor volume (MTV) is a strong predictor. However, there are still some controversies on how to better apply MTV in clinical practice. This paper reviews the research progress of MTV in predicting the prognosis of DLBCL.
Diffuse large B-cell lymphoma (DLBCL) is one of the most common hematologic malignancies, and the conventional application of Rituximab in combination with cyclophosphamide + adriamycin + vincristine + prednisone treatment regimen has increased the cure rate of DLBCL, but the prognosis varies widely among patients. The current methods for predicting prognosis have some limitations. 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used in the diagnosis and treatment of DLBCL, and its metabolic parameter metabolic tumor volume (MTV) is a strong predictor. However, there are still some controversies on how to better apply MTV in clinical practice. This paper reviews the research progress of MTV in predicting the prognosis of DLBCL.
2022, 46(10): 629-634.
doi: 10.3760/cma.j.cn121381-202112017-00226
Abstract:
Cancer-associated fibroblasts (CAFs) are the essential components in the tumor microenvironment. Fibroblast activation protein (FAP) is a promising theranostic target because it is highly expressed in the CAFs of tumor stroma but lowly expressed in most of the normal tissue. Recently, a burst of studies reported the research progress of radiolabeled FAP-targeted molecular probe for tumor diagnosis as well as radionuclide therapy. For comprehensively understanding the clinical value of FAPI probe in tumoral nuclear medicine, this review summarizes the state-of-the-art of FAP inhibitors-based molecular imaging probe (FAPI) for cancer diagnosis, clinical therapeutic regimen improvement, and targeted radionuclide therapy.
Cancer-associated fibroblasts (CAFs) are the essential components in the tumor microenvironment. Fibroblast activation protein (FAP) is a promising theranostic target because it is highly expressed in the CAFs of tumor stroma but lowly expressed in most of the normal tissue. Recently, a burst of studies reported the research progress of radiolabeled FAP-targeted molecular probe for tumor diagnosis as well as radionuclide therapy. For comprehensively understanding the clinical value of FAPI probe in tumoral nuclear medicine, this review summarizes the state-of-the-art of FAP inhibitors-based molecular imaging probe (FAPI) for cancer diagnosis, clinical therapeutic regimen improvement, and targeted radionuclide therapy.
2022, 46(10): 635-639.
doi: 10.3760/cma.j.cn121381-202112019-00230
Abstract:
Intraplaque hemorrhage is one of the main factors involved in atherosclerotic plaque instability. The diagnosis of intraplaque hemorrhage is very important for the correct staging, treatment and prevention of ischemic stroke in patients with carotid plaque. Histopathological examination is the "gold standard" to evaluate intraplaque haemorrhage, but it required carotid endarterectomy surgery to collect the tissue sample. Therefore, imaging examination can be used as a non-invasive method to detect intraplaque haemorrhage. This paper reviews the main characteristics and development prospects of intraplaque vascularization and intraplaque haemorrhage in ultrasound, computed tomography, magnetic resonance and nuclear medicine.
Intraplaque hemorrhage is one of the main factors involved in atherosclerotic plaque instability. The diagnosis of intraplaque hemorrhage is very important for the correct staging, treatment and prevention of ischemic stroke in patients with carotid plaque. Histopathological examination is the "gold standard" to evaluate intraplaque haemorrhage, but it required carotid endarterectomy surgery to collect the tissue sample. Therefore, imaging examination can be used as a non-invasive method to detect intraplaque haemorrhage. This paper reviews the main characteristics and development prospects of intraplaque vascularization and intraplaque haemorrhage in ultrasound, computed tomography, magnetic resonance and nuclear medicine.
2022, 46(10): 640-644.
doi: 10.3760/cma.j.cn121381-202203038-00238
Abstract:
The authors reported a case of hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) of 18F-fluorodeoxyglucose (FDG) PET/CT imaging. HVLPD is rare in clinic. At present, there are few cases reported in the literature about HVLPD 18F-FDG PET/CT imaging and efficacy evaluation. The characteristics of HVLPD were analysed according to clinical symptoms, laboratory examinations and 18F-FDG PET/CT imaging. The therapeutic effect of patients was evaluated in order to deepen clinicians' understanding of HVLPD.
The authors reported a case of hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) of 18F-fluorodeoxyglucose (FDG) PET/CT imaging. HVLPD is rare in clinic. At present, there are few cases reported in the literature about HVLPD 18F-FDG PET/CT imaging and efficacy evaluation. The characteristics of HVLPD were analysed according to clinical symptoms, laboratory examinations and 18F-FDG PET/CT imaging. The therapeutic effect of patients was evaluated in order to deepen clinicians' understanding of HVLPD.
2022, 46(10): 645-648.
doi: 10.3760/cma.j.cn121381-202203004-00224
Abstract:
Bone islands are completely benign bone lesions, most of the bone islands are small. In clinical, bone imaging shows that bone island with increased metabolism is rare. The author reported a case of bone island with 99Tcm-methylenediphosphonate(MDP) SPECT/CT showing increased metabolism. The characteristics of the disease were analyzed including the clinical symptoms, imaging manifestations, pathological diagnosis and histopathology, and were deepened the understanding through literature review. The aim of this study is to improve the awareness of the disease and to avoid misdiagnosis for imaging physicians.
Bone islands are completely benign bone lesions, most of the bone islands are small. In clinical, bone imaging shows that bone island with increased metabolism is rare. The author reported a case of bone island with 99Tcm-methylenediphosphonate(MDP) SPECT/CT showing increased metabolism. The characteristics of the disease were analyzed including the clinical symptoms, imaging manifestations, pathological diagnosis and histopathology, and were deepened the understanding through literature review. The aim of this study is to improve the awareness of the disease and to avoid misdiagnosis for imaging physicians.
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