2022 Vol. 46, No. 5
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2022, 46(5): 261-269.
doi: 10.3760/cma.j.cn121381-202104017-00182
Abstract:
Objective To investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT parameters in patients with diffuse large B-cell lymphoma (DLBCL) in their middle stage of chemotherapy. Methods Clinical data and PET/CT imaging data of 112 DLBCL patients in the Fourth Hospital of Hebei Medical University from January 2011 to January 2020 after 3–4 cycles of chemotherapy were retrospectively analyzed, patients included 60 males and 52 females aged 16–79 (49.5±16.6) years. Then, 40% of the maximum standardized uptake value (SUVmax) was taken as the threshold to outline the region of interest (ROI) and subsequently obtain the SUVmax of lesion, total metabolic tumor volume (TMTV), and total of total lesion glycolysis (TTLG) of all lesions in the body. The sum of products of greatest diameter (SPD) of six target lesions were measured on a CT image. The optimal cut-off values of predicting the progress-free survival (PFS) and overall survival (OS) of the metabolic parameters and anatomical measurement parameters were calculated using the receiver operating characteristic (ROC) curve. The Log-rank test was used for univariate analysis. Kaplan-Meier method was used for the survival analysis. Cox proportional hazards regression model was used for the multivariate analysis of statistically significant prognostic factors obtained from the univariate analysis. Results Among 112 patients, 25 (22.3%) disease developed DLBCL and 14 (12.5%) died from DLBCL during the follow-up period. The optimal cut-off values of the 18F-FDG PET/CT parameters for SUVmax, TMTV, TTLG, and SPD for predicting the PFS of patients with DLBCL were 1.75, 6.40 cm3, 9.30 g, and 3.53 cm2, respectively, with corresponding area under curve (AUC) of 0.712, 0.652, 0.680 and 0.728 (95% CI: 0.596–0.829, 0.518–0.787, 0.549–0.811 and 0.619–0.837; all P<0.05). Meanwhile, the optimal cut-off values for predicting OS were 3.75, 17.80 cm3, 19.05 g, and 5.67 cm2, respectively, with corresponding AUC of 0.727, 0.686, 0.727 and 0.757 (95% CI: 0.578–0.877, 0.512–0.861, 0.559–0.896 and 0.622–0.891; all P<0.05). The results of univariate analysis indicate that age, Eastern Cooperative Oncology Group (ECOG) score, International Prognostic Index (IPI) score, National Comprehensive Cancer Network-IPI score, Deauville score, SUVmax, TMTV, TTLG, and SPD were the influencing factors of PFS (χ2=5.152–22.998, all P<0.05) and OS (χ2=4.735–19.687, all P<0.05). Meanwhile, lactate dehydrogenase (LDH) level only influences OS (χ2=4.154, P<0.05) but not PFS (χ2=2.223, P>0.05). Then, the results of multivariate analysis indicate that age, ECOG score, and TTLG were the independent risk factors affecting the PFS of patients with DLBCL (HR=0.331, 0.262, and 0.281; 95% CI: 0.145–0.753, 0.113–0.605 and 0.119–0.666; all P<0.01), whereas LDH level and SPD were the independent risk factors affecting the OS patients with DLBCL (HR=0.594, 1.922; 95% CI: 0.360–0.979 and 1.123–3.290; all P<0.05). Conclusions The 18F-FDG PET/CT parameters of SUVmax, TMTV, TTLG, and SPD have a good prognostic value for DLBCL patients in their middle stage of chemotherapy.
2022, 46(5): 270-276.
doi: 10.3760/cma.j.cn121381-202202001-00174
Abstract:
Objective To investigate the characteristics of 11C-2-carbomethoxy-3-(4-fluorophenyl) tropane (11C-CFT) brain dopamine transporter (DAT) PET/CT imaging and analyze its clinical diagnostic value in patients with Parkinson's disease (PD). Methods A retrospective analysis was performed on the clinical and images data of 41 patients with primary PD who underwent 11C-CFT PET/CT brain imaging in the Affiliated Hospital of Guizhou Medical University from August 2018 to February 2021. The patients included 21 males and 20 females aged 34–81(57.6±12.2) years. The patients were divided into early PD group (19 cases) and late PD group (22 cases) according to the Hoehn and Yahr (H-Y) grade. Moreover, eight healthy subjects matched with the PD group were included as the normal control group. The subjects including 4 males and 4 females aged 42–72 (61.0±9.8) years. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and cerebellum were obtained by delineating the regions of interest. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and new striatum; the asymmetry index and the ratio of the putamen to the caudate nucleus were calculated according to the corresponding formula. Two independent sample t-test was used to compare the measurement data. Chi square test was used to compare counting data, and Pearson correlation analysis was used to evaluate the correlation between DAT distribution in the new striatum and subareas of PD patients and clinical indicators. Results In 11C-CFT PET/CT brain imaging, the radioactivity distribution of the bilateral caudate nucleus in the PD group was slightly reduced but still uniform, and the radioactivity distribution of the bilateral putamen nucleus in the PD group was reduced or sparse. The radiation distribution of the bilateral putamen was asymmetrically reduced or defective in the early PD group and symmetrical and sparse in the late PD group. Compared with the normal control group, the 11C-CFT value of the new striatum in the PD group was significantly decreased, and the difference was statistically significant (12.29±2.75 vs.7.69±2.42, t=4.818, P<0.01). The asymmetry index increased in the PD group and was most obvious in the putamen, and the difference was statistically significant (0.06±0.08 vs. 0.14±0.09, t=2.184, P<0.05). The ratio of the 11C-CFT uptake value in the putamen to that in the caudate nucleus decreased in the PD group, and the difference was statistically significant (1.13±0.13 vs. 0.74±0.21, t=4.929, P<0.01). Compared with the early PD group, the late PD group had the most significant decrease in 11C-CFT uptake in the new striatum, and the difference was statistically significant(8.50±1.77 vs. 6.99±2.71, t=2.070, P<0.05). Significant differences were found in the asymmetry indexes between the caudate nucleus and putamen in the early PD group and the late PD group, and the differences were statistically significant (0.06±0.06 vs. 0.11±0.08, 0.18±0.10 vs. 0.11±0.07; t=2.251, 2.858; both P<0.05). In the PD patients, the 11C-CFT uptake index in the new striatum was negatively correlated with age, onset age, and H-Y grade (r=−0.444, −0.514, −0.426; all P<0.01), and positively correlated with the asymmetry index of 11C-CFT uptake in putamen (r=0.331, P<0.05). The 11C-CFT values of the caudate nucleus in the PD patients were negatively correlated with age, onset age, and H-Y grade (r=−0.537, −0.581, −0.380; all P<0.05) but positively correlated with the putamen asymmetry index (r=0.410, P<0.01). In the PD patients, the putamen 11C-CFT was negatively correlated with the onset age and H-Y grade (r=−0.353, −0.453; both P<0.05) and positively correlated with the course of disease and the ratio of the putamen to the caudate nucleus (r=0.322, 0.396; both P<0.05). Conclusions In 11C-CFT PET/CT brain DAT imaging, the patients with PD showed decreased radioactivity distribution in the bilateral caudate nucleus and putamen. 11C-CFT PET/CT brain DAT imaging is helpful for PD diagnosis and severity assessment.
Comparison of the effects of metformin and insulin on intestinal 18F-FDG uptake in diabetic patients
2022, 46(5): 277-283.
doi: 10.3760/cma.j.cn121381-202106005-00181
Abstract:
Objective To compare the effects of metformin and insulin on the intestinal uptake of 18F-fluorodeoxyglucose (18F-FDG) in patients with diabetes mellitus undergoing PET/CT. Methods The clinical and imaging data of 70 diabetic patients (41 males and 29 females, aged between 38 and 86 (62.9±12.4) years old) who underwent 18F-FDG PET/CT examination in the First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to January 2019 were retrospectively analyzed. The patients were divided into the metformin treatment group and insulin treatment group according to the hypoglycemic drugs used. Non-diabetic patients undergoing physical examination or tumor screening (38 cases, including 22 males and 16 females, aged between 16 and 82 (55.0±13.0) years old) were collected as the control group. The PET/CT images of the intestine were visually rated, and the 18F-FDG maximum standardized uptake value (SUVmax) of each segment of the intestine was measured. The Chi-square test was used to compare the gender differences of the subjects in the three groups. The nonparametric Kruskal–Wallis rank sum test was used to compare the visual rating of the extent of intestinal uptake in the three groups, and paired analysis was conducted. One-way analysis of variance was used to compare the general data and the differences in the SUVmax of each segment of the intestine and the right rectus femoris muscle among the three groups. Further comparisons were made between the groups by LSD-t test. Results Statistically significant differences were observed in the image visual score of the intestinal tract in the metformin treatment group and between the insulin treatment group and the control group (H=25.988, 21.548; both P<0.05). Compared with the control group, except for the duodenum, SUVmax of jejunum (2.23±0.51 vs. 2.60±0.57), ileum (2.19±0.66 vs. 2.95±1.66), ascending colon (2.65±1.03 vs. 4.56±3.09 ), transverse colon (2.09±0.83 vs. 3.37±2.15 ), descending colon (2.37±1.06 vs. 4.72±3.51), sigmoid colon (2.74±1.12 vs. 5.26±3.34), rectum (3.40±1.06 vs. 5.74±3.27) in metformin treatment group were significantly higher, and all differences were statistically significant (t=2.133–4.699, all P<0.05). Compared with the insulin treatment group, the SUVmax values of the jejunum (2.26±0.41 vs. 2.60±0.57), ileum (2.13±0.58 vs. 2.95±1.66), ascending colon (2.84±1.15 vs. 4.56±3.09), sigmoid colon (3.79±2.68 vs. 5.26±3.34), and rectum (3.89±2.34 vs. 5.74±3.27) in the metformin treatment group were significantly higher than those in the insulin treatment group, and all differences were statistically significant (t=2.002–2.977, all P<0.05). Conclusion Metformin can increase the intestinal uptake of 18F-FDG in diabetic patients, whereas insulin has less effect on the intestinal uptake of 18F-FDG.
2022, 46(5): 284-289.
doi: 10.3760/cma.j.cn121381-202105010-00183
Abstract:
Objective To investigate the changes in ambient dose equivalent rate and its influencing factors in patients with hyperthyroidism after 131I treatment to provide a theoretical basis for radiation protection. Methods The clinical data of 42 patients with hyperthyroidism who received 131I treatment in the First Affiliated Hospital of Chongqing Medical University from October 2018 to November 2019 were retrospectively analyzed. The patients included 12 males and 30 females aged 14–68 (38.7±11.9) years old. The ambient dose equivalent rates at 0, 0.3, 1.0, 2.0 and 4.0 m from the front of the neck of the patient were measured at 2 and 4 weeks after 131I treatment, and their trends were analyzed. The correlations among the gender, age, thyroid iodine uptake rate, effective half-life of 131I , medication dose, and ambient dose equivalent rate of the patients were also investigated. The measurement data were compared between the two groups via independent samples t test, and the correlation between the ambient dose equivalent rate and each index was analyzed through Pearson correlation analysis. Results The ambient dose equivalence rate decreased gradually with the increase in the measurement distance at 2 and 4 weeks after 131I treatment. At 2 weeks after 131I treatment and distance ≥ 2.0 m from the patients, the ambient dose equivalent rates were all <25 μSv/h. At 4 weeks after 131I treatment and distance ≥ 0.3 m from the patients, the ambient dose equivalent rates were all <25 μSv/h. There was no significant difference in the ambient dose equivalent rates at different measurement distances in patients of different genders (t=−0.467–1.766, all P>0.05). At 2 weeks after 131I treatment, the ambient dose equivalent rates measured at distances of 0, 0.3, and 4.0 m were positively correlated with the effective half-life of 131I (r=0.318–0.487, all P<0.05); the ambient dose equivalent rates measured at distances of 2.0 and 4.0 m were positively correlated with the medication dose (r=0.546, 0.491; both P<0.01); the ambient dose equivalent rates at different measurement distances had no correlation with the patients' age and thyroid iodine uptake rate (r=−1.158–0.162, all P>0.05). At 4 weeks after 131I treatment, the ambient dose equivalent rates measured at distances of 0, 0.3, 1.0 and 2.0 m were positively correlated with the effective half-life of 131I (r=0.319–0.380, all P<0.05); the ambient dose equivalent rate measured at distances of 0 m was positively correlated with the patients' age (r=0.429, P<0.01); the ambient dose equivalent rate measured at distances of 2.0 m was positively correlated with the thyroid iodine uptake rate (r=0.353, P<0.05); the ambient dose equivalent rates at different measurement distances had no correlation with the medication dose (r=0.020–0.157, all P>0.05). Conclusions Patients with hyperthyroidism should try to avoid close contact with their family members within 4 weeks after 131I treatment. Clinicians should provide guidance on radiation protection during the home isolation of patients with hyperthyroidism on the basis of the measurement results of the ambient dose equivalent rate and the effective half-life of 131I in the patients' body.
2022, 46(5): 290-297.
doi: 10.3760/cma.j.cn121381-202106007-00177
Abstract:
Objective To study the dosimetric differences between intracavitary therapy and combined intracavitary/interstitial therapy in three-dimensional brachytherapy for cervical cancer at different high-risk clinical target volumes (HR-CTV) and to explore whether HR-CTV has a threshold value. Methods The clinical data of 100 patients with advanced cervical cancer who received radical radiotherapy in the Fourth Affiliated Hospital of Guangxi Medical University from October 2019 to February 2021 were retrospectively analyzed. The age range was 35–63 years, with a median age of 51 years. According to different brachytherapy techniques, the patients were divided into two groups: intracavitary therapy group (45 cases) and intracavitary/interstitial therapy group (55 cases). According to the size of HR-CTV of each plan of a patient, the volume interval of 10 cm3 was used and divided into six volume ranges for analysis, namely, HR-CTV≤40 cm3, 40 cm3<HR-CTV≤50 cm3, 50 cm3<HR-CTV≤60 cm3, 60 cm3<HR-CTV≤70 cm3, 70 cm3<HR-CTV≤80 cm3, HR-CTV>80 cm3. Independent sample t-test was used in comparing the target dose (D90 and D100), target coverage (V100), target high dose (D50, V150, and V200), target conformity index (CI), and D2 cm3 of organ at risks (OAR) (bladder, rectum, sigmoid colon, and small intestine) of the two brachytherapy techniques in various volume ranges. Results When HR-CTV≤40 cm3, the target dose (D90 and D100), target coverage (V100), and high dose of target (D50, V150, and V200) in the intracavitary group were higher than those in the intracavitary/interstitial therapy group, and the differences were statistically significant(t=2.826–3.927, all P<0.05), but no significant difference in CI and D2 cm3 (mininum radiation dose received by the OAR volume of 2 cm3) of the bladder and rectum (t=0.186, 1.871, 0.258; all P>0.05). When 70 cm3<HR-CTV≤80 cm3 and HR-CTV>80 cm3, the target dose (D90 and D100), target coverage (V100), and CI and D2 cm3 of rectum and bladder in the intracavitary/interstitial group were significantly better, and the differences were statistically significant(t=−6.872–3.782, all P<0.05), while the high dose in target (D50, V150, and V200) of the two techniques was similar, and the differences were statistically significant (t=0.613–1.918, all P>0.05). When 40 cm3<HR-CTV≤70 cm3, no significant differences in target dose (D90, D100), target coverage (V100), and D2 cm3 of rectum were found between the two groups (t=−1.759–0.710, all P>0.05), but the CI of intracavitary/interstitial group was significantly better than that of the intracavitary group, and the differences were statistically significant (t=−2.590, −4.577, −3.144; all P<0.05). Conclusions For a small volume target (≤40 cm3), intracavitary therapy alone can better increase the dose of target and high dose volume in a target area without increasing the dose of OAR. When the target volume is large (>70 cm3), combined intracavitary/interstitial therapy can significantly improve the prescribed dose and conformity of the target while protecting the OAR.
2022, 46(5): 298-303.
doi: 10.3760/cma.j.cn121381-202201006-00176
Abstract:
With the advancement of treating methods, the survival rate and survival time of tumor patients have improved significantly, but the cancer therapeutics-related cardiac dysfunction seriously threatens the health of tumor survivors, among which the cardiotoxicity caused by anthracyclines (ANTs) is extremely common and can lead to irreversible heart damage. Early detection and timely treatment of cardiotoxicity caused by ANTs are essential for the recovery of cardiac function, so early detection of cardiotoxicity is of great clinical importance. The author focuses on new imaging methods that may help to detect the cardiotoxicity caused by ANTs early, including myocardial strain imaging by echocardiography, myocardial strain imaging and quantification imaging of myocardial tissue by cardiac magnetic resonance and PET/CT imaging, in order to provide valuable information for early clinical detection of cardiotoxicity caused by ANTs.
With the advancement of treating methods, the survival rate and survival time of tumor patients have improved significantly, but the cancer therapeutics-related cardiac dysfunction seriously threatens the health of tumor survivors, among which the cardiotoxicity caused by anthracyclines (ANTs) is extremely common and can lead to irreversible heart damage. Early detection and timely treatment of cardiotoxicity caused by ANTs are essential for the recovery of cardiac function, so early detection of cardiotoxicity is of great clinical importance. The author focuses on new imaging methods that may help to detect the cardiotoxicity caused by ANTs early, including myocardial strain imaging by echocardiography, myocardial strain imaging and quantification imaging of myocardial tissue by cardiac magnetic resonance and PET/CT imaging, in order to provide valuable information for early clinical detection of cardiotoxicity caused by ANTs.
2022, 46(5): 304-308.
doi: 10.3760/cma.j.cn121381-202106013-00166
Abstract:
Dendrimer materials emerging in recent years have become excellent materials for constructing nano-drug delivery systems due to their controllable structures and unique interactions with cell membranes and various active drug molecules, and have been widely studied in the field of tumor targeted therapy. As nanomolecules with good biocompatibility, dendrimers can be conjugated to tumor-targeting molecules to specifically deliver active drug molecules to tumor tissues, which can maximize drug targeting and reduce toxic effects on non-target tissues. In this paper, the recently research progress of nano-drug delivery systems based on dendrimer materials for tumor targeted therapy is reviewed.
Dendrimer materials emerging in recent years have become excellent materials for constructing nano-drug delivery systems due to their controllable structures and unique interactions with cell membranes and various active drug molecules, and have been widely studied in the field of tumor targeted therapy. As nanomolecules with good biocompatibility, dendrimers can be conjugated to tumor-targeting molecules to specifically deliver active drug molecules to tumor tissues, which can maximize drug targeting and reduce toxic effects on non-target tissues. In this paper, the recently research progress of nano-drug delivery systems based on dendrimer materials for tumor targeted therapy is reviewed.
2022, 46(5): 309-315.
doi: 10.3760/cma.j.cn121381-202105016-00175
Abstract:
Overexpression of somatostatin receptors (SSTR), especially SSTR2 is a common feature of neuroendocrine neoplasms (NEN) and an ideal target for NEN molecular imaging and radionuclide-targeted therapy. In the past, researchers have been working on radionuclide-labeled SSTR agonists, and have successfully used them for clinical imaging and treatment of NEN. Recent studies have shown that radionuclide-labeled SSTR antagonists have better pharmacokinetic characteristics, higher tumor uptake rates, longer retention time, and higher image contrast obtained than agonists. They are more superior in molecular imaging and radionuclide-targeted therapy of NEN. In this paper, the research progress of radionuclide-labeled SSTR antagonists in the imaging and treatment of NEN is reviewed, in order to provide reference for the clinical diagnosis and treatment of NEN.
Overexpression of somatostatin receptors (SSTR), especially SSTR2 is a common feature of neuroendocrine neoplasms (NEN) and an ideal target for NEN molecular imaging and radionuclide-targeted therapy. In the past, researchers have been working on radionuclide-labeled SSTR agonists, and have successfully used them for clinical imaging and treatment of NEN. Recent studies have shown that radionuclide-labeled SSTR antagonists have better pharmacokinetic characteristics, higher tumor uptake rates, longer retention time, and higher image contrast obtained than agonists. They are more superior in molecular imaging and radionuclide-targeted therapy of NEN. In this paper, the research progress of radionuclide-labeled SSTR antagonists in the imaging and treatment of NEN is reviewed, in order to provide reference for the clinical diagnosis and treatment of NEN.
2022, 46(5): 316-320.
doi: 10.3760/cma.j.cn121381-202105028-00180
Abstract:
Intestinal flora is an important part of human body. It has been confirmed that intestinal flora plays important roles in the occurrence and development of hypertension, diabetes, tumor and inflammatory bowel disease. Radiation enteritis (RE) is more common in patients with tumor radiation and nuclear exposure. In recent years, the relationship between intestinal flora and RE has become a research hotspot. RE was closely related with intestinal flora. The mechanism may be closely related to the infiltration of inflammatory cells and the expression of related cytokines which were caused by the imbalance of intestinal flora. Probiotics supplement therapy can partially relieve the clinical symptoms of patients with RE. Some studies are exploring the therapeutic effects of fecal bacteria transplantation and small molecule new drugs in RE. This study summarizes the recent research on the pathogenesis and clinical application of RE based on intestinal flora, hoping to provide theoretical basis for the treatment of targeted intestinal flora.
Intestinal flora is an important part of human body. It has been confirmed that intestinal flora plays important roles in the occurrence and development of hypertension, diabetes, tumor and inflammatory bowel disease. Radiation enteritis (RE) is more common in patients with tumor radiation and nuclear exposure. In recent years, the relationship between intestinal flora and RE has become a research hotspot. RE was closely related with intestinal flora. The mechanism may be closely related to the infiltration of inflammatory cells and the expression of related cytokines which were caused by the imbalance of intestinal flora. Probiotics supplement therapy can partially relieve the clinical symptoms of patients with RE. Some studies are exploring the therapeutic effects of fecal bacteria transplantation and small molecule new drugs in RE. This study summarizes the recent research on the pathogenesis and clinical application of RE based on intestinal flora, hoping to provide theoretical basis for the treatment of targeted intestinal flora.
2022, 46(5): 321-324.
doi: 10.3760/cma.j.cn121381-202105012-00187
Abstract:
Chordomas mainly occur in the axial bones, the most common in the base of the skull and the sacrococcygeal region, and are rare in other parts. The author reported a case of chordoma in the right nasal cavity and ethmoid sinus confirmed by histopathological results. The clinical symptoms, preoperative CT and MRI imaging findings, surgical findings and postoperative histopathology immunohistochemical examination results were analyzed. The characteristics of the disease and the differential diagnosis through literature review have deepened the understanding of the disease, provide valuable reference for clinical diagnosis and treatment.
Chordomas mainly occur in the axial bones, the most common in the base of the skull and the sacrococcygeal region, and are rare in other parts. The author reported a case of chordoma in the right nasal cavity and ethmoid sinus confirmed by histopathological results. The clinical symptoms, preoperative CT and MRI imaging findings, surgical findings and postoperative histopathology immunohistochemical examination results were analyzed. The characteristics of the disease and the differential diagnosis through literature review have deepened the understanding of the disease, provide valuable reference for clinical diagnosis and treatment.
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