2022 Vol. 46, No. 6
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2022, 46(6): 387-389.
Abstract:
2022, 46(6): 325-333.
doi: 10.3760/cma.j.cn121381-202107030-00192
Abstract:
Objective To explore the differences in the imaging features, clinical manifestations, age, and laboratory examination results of patients who underwent 99Tcm-methylenediphosphonate (MDP) SPECT/CT super bone scan. Methods A total of 97 patients with super bone scan, including 54 males and 43 females, aged 25–85 (62.4±14.3) years, were recruited from 47 671 patients who underwent 99Tcm-MDP SPECT/CT imaging in the General Hospital of Ningxia Medical University from June 2012 to July 2021. The clinical manifestation, imaging, age, and laboratory examination data of the 97 patients were retrospectively analyzed. In accordance with different etiologies, the patients were divided into the bone metastases group (71 cases) and the metabolic bone disease group (26 cases, including parathyroid adenoma (9 cases), renal bone disease (6 cases), and osteoporosis (11 cases)). In accordance with the location of the primary tumor, 71 patients with bone metastases were divided into four subgroups (prostate cancer group (40 cases); breast cancer group (15 cases); lung cancer group (8 cases); malignant digestive system tumors (8 cases), including gastric cancer (4 cases), rectal cancer (2 cases), esophageal cancer (1 case) and primary liver cancer (1 case)). The differences in 99Tcm-MDP SPECT whole-body bone scan and SPECT/CT fusion imaging features, clinical manifestations, age, and laboratory examination (serum calcium, serum phosphorus, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH)) results between the bone metastasis group and the metabolic bone disease group and among the four subgroups of the bone metastasis group were statistically analyzed. Independent samples t-test, one-way ANOVA, Wilcoxon rank sum test, and Kruskal-Wallis H test were used to compare measurement data, and χ2 test was applied to compare classified variable data. Results Bone metastases (73.2%, 71/97) were the most common cause of super bone scan (among the primary tumors, prostate cancer was more common (56.3%, 40/71), followed by metabolic bone disease (26.8%, 26/97)). The bone metastasis group mainly exhibited focal scattered distribution type (type Ⅱ, 85.9%, 61/71), and the metabolic bone disease group presented mainly homogeneous and symmetrical type (type Ⅰ, 61.5%, 16/26), and the difference between the two groups was statistically significant (χ2=21.84, P<0.001). Osteogenic (74.6%, 53/71) and mixed types (19.7%, 14/71) were the main types of bone destruction in the bone metastases group, while osteolytic type (73.1%, 19/26) was the main type of bone destruction in the metabolic bone disease group, and the differences were statistically significant (χ2=39.76, 15.95; both P<0.001). In all patients, bone pain was the first symptom, and regional bone pain was the main clinical manifestation (56.7%, 55/97). Low back pain was the most common symptom in the bone metastasis group (60.0%, 24/40) and rib pain was the most common symptom in the metabolic bone disease group (40.0%, 6/15) with a significant difference between the two groups (χ2=11.11, P<0.05). Patients with bone metastasis had higher age, serum ALP and LDH levels and lower serum calcium levels than patients with metabolic osteopathy with statistically significant differences (t=4.89; Z=−2.28, −3.65; t=−5.96; all P<0.05). However, there was no significant difference in serum phosphorus levels between the two groups (t=0.01, P>0.05). No significant differences in the types of bone destruction, clinical manifestations, and local bone pain sites in SPECT whole-body bone scan and SPECT/CT fusion imaging were found among the four subgroups of the bone metastasis group (χ2=2.71–13.07; all P>0.05). Among the four subgroups of the bone metastasis group, the patients with breast cancer had the lowest age and the highest serum calcium levels, the patients with prostate cancer had the highest age, and the patients with lung cancer had the highest LDH levels, the differences were statistically significant (F=14.43, 5.13; H=13.47; all P<0.05). There were no significant differences in serum phosphorus and ALP levels (F=2.41; H=6.28; both P>0.05). Conclusions Bone metastases, followed by metabolic bone disease, are the most common causes for super bone scan. There were differences in 99Tcm-MDP SPECT whole body bone scan, focal 99Tcm-MDP SPECT/CT fusion imaging, clinical manifestation, age, and laboratory examination results in patiens with the two etiologies of super bone scan. 99Tcm-MDP SPECT/CT has a certain value in the identification of the two etiologies by super bone scan.
2022, 46(6): 334-340.
doi: 10.3760/cma.j.cn121381-202106009-00186
Abstract:
Objective To investigate the invasive signs of early lung adenocarcinoma by thin-slice CT and to provide the basis for selecting rational clinical treatment. Methods Thin-slice CT findings of 101 patients (42 males and 59 females, aged 28–75 (56.5±9.4) years) with lung adenocarcinoma confirmed by surgical histopathology examination in Huizhou Central People's Hospital from January 2015 to October 2020 were retrospectively analyzed. The imaging characteristics of nodules including internal characteristics (solid component, vascular sign, bronchial sign, and vacuole sign), marginal characteristics (smooth edges, lobulation sign, spiculated sign, and pleural indentation sign), long diameter, CT value, relative CT value, volume, and CT value/volume ratio. According to pathological subtypes, 25 patients were classified into the pre-invasion group, and 76 were classified into the invasive group. Two groups were compared, and Mann-Whitney U test and independent sample t test were used to compare the measurement data. χ2 test and Fisher's exact probability method were used for counting data comparison. Receiver operating characteristic curves were drawn and the optimal critical value and the area under the curve (AUC) were calculated. Results The pre-invasion group (25 cases) had 20 cases (80.0%) of pure ground-glass nodules and 5 cases (20.0%) of mixed ground-glass nodules. The invasion group (76 cases) had 13 cases (17.1%) of pure ground-glass nodules, 26 cases (34.2%) of mixed ground-glass nodules, and 37 cases (48.7%) of solid nodules. The probability of the internal characteristics of nodules including solid components, vascular signs, bronchial signs, and vacuole signs in the invasion group were significantly higher than that in the pre-invasion group (82.9% (63/76) vs. 20.0% (5/25), 26.3% (20/76) vs. 4.0% (1/25), 43.4% (33/76) vs. 16.0% (4/25), 32.9% (25/76) vs. 8.0% (2/25); χ2=4.14–33.82; all P<0.05). The probability of smooth edges in the pre-invasion group was significantly higher than that in the invasion group (68.0% (17/25) vs. 10.5% (8/76), χ2=33.36, P<0.001). The probability of lobulation signs, spiculated signs, and pleural indentation signs in the invasion group were significantly higher than that in the pre-invasion group (73.7% (56/76) vs. 32.0% (8/25), 71.1% (54/76) vs. 0, 47.4% (36/76) vs. 0; χ2=14.08, Fisher's exact probability method; all P<0.001). Statistically significant differences existed in long diameter (7.50 (6.50, 8.25) mm vs. 13.00 (11.00, 16.00) mm), CT value (−537.00 (−612.00, −418.00) HU vs. −61.00 (−318.25, 21.50) HU), relative CT value (−289.00 (−412.00, −210.50) HU vs. −758.50 (−839.00, −534.25) HU), volume (0.18 (0.14, 0.26) cm3 vs. 0.86 (0.44, 2.16) cm3), CT value/volume ratio (−2685.00 (−3564.00, −1972.00) vs. −48.19 (−422.14, 12.80)) between pre-invasion group and invasion group (Z=−6.51 to −5.43; all P<0.001). Optimal cutoff values existed between the pre-invasive and invasive lesions. When the long diameter of nodules was ≥8.75 mm, the sensitivity and specificity were 87.5% and 84.0%, respectively. When the nodule volume was ≥0.31 cm3, the sensitivity and specificity were 82.9% and 88.0%, respectively. When the CT value was −464 HU, the sensitivity and specificity were 89.5% and 72.0%, respectively. When the CT value/volume ratio was −1681.7, the sensitivity and specificity were 93.4% and 88.0%, respectively. The AUC of long diameter, CT value, volume, and CT value/volume ratio of nodules were 0.902 (95%CI: 0.843–0.962), 0.889 (95%CI: 0.824–0.955), 0.863 (95%CI: 0.784–0.942), and 0.936 (95%CI: 0.886–0.985), respectively. Conclusions CT findings of the invasion signs of early lung adenocarcinoma are related to the volume, length, density, internal characteristics, and marginal characteristics of the nodules. The relevant signs need to be carefully observed in multiple planes and for a comprehensive analysis. Once found that it has a tendency to infiltrate, it should be operated as soon as possible.
2022, 46(6): 341-346.
doi: 10.3760/cma.j.cn121381-202101020-00172
Abstract:
Objective To investigate the diagnostic value of X-ray digital tomosynthesis (DTS) imaging in subacromial impingement syndrome (SIS) at supraspinatus exit position. Methods A retrospective analysis was performed on patients who were admitted to Bayannur Hospital from July 2017 to January 2020. The clinical and imaging data of 93 SIS patients with shoulder joint discomfort who were diagnosed by clinical physical examination and MRI examination were included. The participants included 56 males and 37 females, aged 30−77(55.4±8.2) years. All patients underwent digital radiography (DR) and DTS imaging within 7 days after MRI examination to determine whether acromioplasty or rotator cuff reconstruction was necessary. Nonparametric rank sum test was used to compare the morphological differences of acromion measured by three imaging methods, analysis of variance was used to compare the measured acromio-humeral interval (AHI), and least significant difference (LSD)-t test was used for further pairwise comparison. The area under the curve (AUC), sensitivity and specificity of AHI measured by MRI, DTS and DR were calculated by the receiver operator characteristic (ROC) curve, and the AUCs were compared by Z test. Results MRI, DR, and DTS imaging methods had no significant difference in the results of acromion morphology examination in SIS patients (χ Conclusion Supraspinatus exit position DTS is a relatively economical and practical imaging method for diagnosis of SIS, and it can be used as a screening method for patients with shoulder discomfort.
2022, 46(6): 347-353.
doi: 10.3760/cma.j.cn121381-202202006-00189
Abstract:
Objective To compare the set-up errors of mid-thoracic esophageal cancer treated with three different radiotherapy immobilization methods and to analyze its influence on the set-up errors of the supraclavicular and infraclavicular region. Methods A total of 73 mid-thoracic esophageal cancer patients with supraclavicular lymph node metastasis treated from November 2019 to November 2021 at the Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College were retrospectively reviewed. The sample included 56 males and 17 females, with a median age of 63.6 (36.5−85.3) years. Of these, 24 patients were fixed with a thoracoabdominal flat frame, with both hands crossed on the forehead and 25 had both of their hands placed on the sides of their bodies. In addition, 24 patients were fixed with integrated cervicothoracic immobilization devices with both their hands on the sides of their bodies. Cone beam CT (CBCT) scans were performed once a day at the first five workdays and once a week in the following treatment time. Translational set-up errors in the (X direction) left and right, (Y direction) cranial and caudal, (Z direction) ventral and dorsal directions within the compared target volumes were recorded. The translational set-up error of the three modes of immobilization were compared, and the amplitudes of movement and the three-dimensional spatial displacement of the acromioclavicular joint were measured. Independent sample t-test or Wilcoxon rank sum test were employed to analyze the error values between groups. Results A total of 208, 195, and 195 CBCT scans were performed in the thoracoabdominal flat frame elevation, the thoracoabdominal flat frame side, and the integrated cervicothoracic immobilization device side groups, respectively. The translational set-up errors of the three groups were recorded for the left and right directions: (0.19±0.15), (0.16±0.15), and (0.14±0.14) cm; the cranial and caudal directions: (0.30±0.24), (0.27±0.22), and (0.21±0.20) cm; and the ventral and dorsal directions: (0.20±0.14), (0.17±0.18), and (0.16±0.17) cm, respectively. The translational set-up errors in the three directions of the integrated cervicothoracic immobilization device side group were better than those of the other two groups. Compared with the integrated cervicothoracic immobilization device side group, all the setup errors showed significant statistical differences (t=−9.85 to 5.89; all P<0.05), except for the thoracoabdominal flat frame side group in the Y direction (t=0.85, P>0.05). The three-dimensional displacement d values of the acromioclavicular joint in the three groups were (0.24±0.17), (0.28±0.16), and (0.23±0.13) cm, respectively. The difference of ΔY between thoracoabdominal flat frame elevation group and integrated cervicothoracic immobilization device side group was statistically significant ((0.11±0.11) cm vs. (0.13±0.11) cm, Z=−2.16, P<0.05). There were also significant differences in ΔZ ((0.18±0.15) cm vs. (0.12±0.10) cm, Z=−4.19, P<0.001) and the three-dimensional spatial displacement d values of the acromioclavicular joint ((0.28±0.16) cm vs. (0.23±0.13) cm, Z=−3.63, P<0.001) between the thoracoabdominal flat frame side and the integrated cervicothoracic immobilization device side groups. Conclusion For mid-thoracic esophageal cancer patients with irradiated supraclavicular and infraclavicular region, shoulder immobilization using integrated cervicothoracic immobilization devices is better in translational set-up errors and three-dimensional spatial displacement of the acromioclavicular joint than thoracoabdominal flat frame, as it can effectively improve the accuracy of a radiotherapy plan.
2022, 46(6): 354-359.
doi: 10.3760/cma.j.cn121381-202009013-00185
Abstract:
Objective To investigate the preparation method of a molecular probe 131I-ch4E5 for targeting B-cell lymphoma and its anti-tumor effect in human B-cell lymphoma-bearing nude mouse model. Methods The anti-CD80 human-mouse chimeric antibody ch4E5 was labeled with 131I through the Iodogen method, and its labeling rate and radiochemical purity were determined by radioactive thin layer chromatography scanning method. (1)In vitro experiments: 131I-ch4E5 solution was added to cytocentrifuge tubes containing 1×108, 1×109, 1×1010, 5×1010, and 1×1011 cells/L of human B-cell lymphoma cells (Raji cells) and to non-specific binding control tubes. Radioactivity counts per tube of precipitation were measured to calculate the specific binding rate of Raji cells to 131I-ch4E5. (2) In vivo experiments: 7.4 MBq of 131I-ch4E5 was injected into three tumor-bearing nude mice via the tail vein. After 72 h, the tumor-bearing nude mice were sacrificed. Fourteen organs or tissues, such as tumor and blood, were harvested and weighed, and their radioactivity was measured. The radioactivity ratio of tumor to normal tissue (T/NT) was calculated. In the treatment study, 15 tumor-bearing nude mice were divided into three groups according to the random number table method and injected with 131I-ch4E5 (131I-ch4E5 group), unlabeled ch4E5 (ch4E5 group), and normal saline (control group) through the tail vein. Tumor growth was observed in the three groups. After 15 days, the tumor inhibition rate was calculated, and then the tumor-bearing nude mice were sacrificed to harvest tumor tissues for histopathological examination by hematoxylin-eosin staining. Comparisons between the two groups were performed using two independent samples t-test. Results The labeling rate of 131I-ch4E5 was (84.2±2.4)%, and the radiochemical purity was (97.1±1.1)%. (1) In vitro experiments: the binding rate of 131I-ch4E5 to Raji cells increased with increasing cell concentration, and the maximum binding rate was (38.2±2.3)%. (2) In vivo experiments: the distribution of 131I-ch4E5 in human B-cell lymphoma-bearing nude mice was targeted, and the maximum T/NT ratio of tumor to muscle was 7.30. Compared with the ch4E5 and control groups, the 131I-ch4E5 group exhibited decreased tumor growth, and the difference was statistically significant (t=2.889, 6.516; both P<0.05). Fifteen days after the administration, the tumor inhibition rate was 71.7% in the 131I-ch4E5 group and 43.4% in the ch4E5 group. The histopathological examination results showed that tumor cell necrosis was observed in both treatment groups, and the therapeutic efficacy of the 131I-ch4E5 group was superior to that of the ch4E5 group. Conclusion The self-made molecular probe 131I-ch4E5 has high labeling rate and radiochemical purity, and has a significant inhibitory effect on the tumor growth of human B-cell lymphoma-bearing nude mice, which provides an experimental basis for further research on the application of 131I-ch4E5 in radioimmunotherapy.
2022, 46(6): 360-363.
doi: 10.3760/cma.j.cn121381-202202018-00184
Abstract:
Obesity has become an important problem that seriously endangers human health, which is closely related to cardiovascular diseases, metabolic diseases, and malignant tumors. The most commonly used indicators to assess obesity are body mass index, waist circumference, waist-to-hip ratio and so on. However, with the in-depth research on the pathogenesis of obesity, different parts and types of adipose tissue can be distinguished. There are two types of adipose tissue in the human body: white adipose tissue (WAT) and brown adipose tissue (BAT). Excessive accumulation of WAT is characteristic of obesity, while BAT is less active in obese individuals. 18F-FDG PET/CT can simultaneously acquire the volume and metabolism of different parts and types of adipose tissue. The authors review the application and progress of 18F-FDG PET/CT in obesity from the perspective of different adipose depots.
Obesity has become an important problem that seriously endangers human health, which is closely related to cardiovascular diseases, metabolic diseases, and malignant tumors. The most commonly used indicators to assess obesity are body mass index, waist circumference, waist-to-hip ratio and so on. However, with the in-depth research on the pathogenesis of obesity, different parts and types of adipose tissue can be distinguished. There are two types of adipose tissue in the human body: white adipose tissue (WAT) and brown adipose tissue (BAT). Excessive accumulation of WAT is characteristic of obesity, while BAT is less active in obese individuals. 18F-FDG PET/CT can simultaneously acquire the volume and metabolism of different parts and types of adipose tissue. The authors review the application and progress of 18F-FDG PET/CT in obesity from the perspective of different adipose depots.
2022, 46(6): 364-368.
doi: 10.3760/cma.j.cn121381-202107012-00179
Abstract:
Lung cancer is the second most common cancer in the world, among which non-small-cell lung cancer (NSCLC) is the predominant type. Epidermal growth factor receptor (EGFR) plays an important role in the development of NSCLC and has become an important target in the treatment of NSCLC. Epidermal growth factor receptor-tyrosine kinase inhibitors have been widely used in the targeted therapy of NSCLC and have been shown to effectively prolong the survival of patients with EGFR mutations, and their efficacy and prognosis are closely related to those of EGFR gene mutations. 18F-fluorodeoxyglucose (FDG) PET/CT can non-invasively evaluate NSCLC and is of great significance in predicting EGFR gene mutation status in NSCLC. The authors review the recent advances in 18F-FDG PET/CT metabolic parameters and radiomics related to EGFR gene mutation status.
Lung cancer is the second most common cancer in the world, among which non-small-cell lung cancer (NSCLC) is the predominant type. Epidermal growth factor receptor (EGFR) plays an important role in the development of NSCLC and has become an important target in the treatment of NSCLC. Epidermal growth factor receptor-tyrosine kinase inhibitors have been widely used in the targeted therapy of NSCLC and have been shown to effectively prolong the survival of patients with EGFR mutations, and their efficacy and prognosis are closely related to those of EGFR gene mutations. 18F-fluorodeoxyglucose (FDG) PET/CT can non-invasively evaluate NSCLC and is of great significance in predicting EGFR gene mutation status in NSCLC. The authors review the recent advances in 18F-FDG PET/CT metabolic parameters and radiomics related to EGFR gene mutation status.
2022, 46(6): 369-373.
doi: 10.3760/cma.j.cn121381-202107008-00178
Abstract:
PET absolute quantitative myocardial blood flow (MBF) imaging has significant clinical incremental value in the diagnosis, risk stratification, and prognosis evaluation of coronary artery disease. Still, it has not been widely used in the clinic due to the limitation of conventional positron myocardial perfusion imaging agents. The successful development of 2-tert-butylchloro-5[4-(2-fluoro-18F-ethoxymethyl) phenyl methoxy]-3(2H)-pyridazine ketone (18F-Flurpiridaz) has pioneered a new field of positron myocardial perfusion imaging agents. It has excellent absolute quantitative property in MBF and myocardial flow reserve and has obvious advantages over traditional positron myocardial perfusion imaging agents in physical properties, myocardial extraction rate, and application convenience in the clinic, also, it has entered clinical phase Ⅲ research process and has become the most promising 18F-labeled PET myocardial perfusion imaging agents. The authors review the research progress in 18F-Flurpiridaz PET absolute quantitative MBF imaging.
PET absolute quantitative myocardial blood flow (MBF) imaging has significant clinical incremental value in the diagnosis, risk stratification, and prognosis evaluation of coronary artery disease. Still, it has not been widely used in the clinic due to the limitation of conventional positron myocardial perfusion imaging agents. The successful development of 2-tert-butylchloro-5[4-(2-fluoro-18F-ethoxymethyl) phenyl methoxy]-3(2H)-pyridazine ketone (18F-Flurpiridaz) has pioneered a new field of positron myocardial perfusion imaging agents. It has excellent absolute quantitative property in MBF and myocardial flow reserve and has obvious advantages over traditional positron myocardial perfusion imaging agents in physical properties, myocardial extraction rate, and application convenience in the clinic, also, it has entered clinical phase Ⅲ research process and has become the most promising 18F-labeled PET myocardial perfusion imaging agents. The authors review the research progress in 18F-Flurpiridaz PET absolute quantitative MBF imaging.
2022, 46(6): 374-379.
doi: 10.3760/cma.j.cn121381-202107003-00188
Abstract:
Programmed cell death 1 receptor (PD-1) and its ligand (PD-L1) immunotherapy has become an important method for the treatment of a variety of malignant tumors, but only some patients have clinical benefits. One of the influencing factors is the expression level of PD-1/PD-L1 in malignant tumors. Radionuclide labeled complete monoclonal antibodies and antibody fragments are used to make targeted PD-1/PD-L1 radionuclide molecular probes for imaging, which can noninvasively, real-time, and dynamically monitor the expression of tumor PD-1/PD-L1 and quantify its expression level, so as to screen patients suitable for treatment and comprehensively evaluate the treatment efficacy and prognosis. The authors review the application of targeted PD-1/PD-L1 radionuclide molecular probes in malignant tumors.
Programmed cell death 1 receptor (PD-1) and its ligand (PD-L1) immunotherapy has become an important method for the treatment of a variety of malignant tumors, but only some patients have clinical benefits. One of the influencing factors is the expression level of PD-1/PD-L1 in malignant tumors. Radionuclide labeled complete monoclonal antibodies and antibody fragments are used to make targeted PD-1/PD-L1 radionuclide molecular probes for imaging, which can noninvasively, real-time, and dynamically monitor the expression of tumor PD-1/PD-L1 and quantify its expression level, so as to screen patients suitable for treatment and comprehensively evaluate the treatment efficacy and prognosis. The authors review the application of targeted PD-1/PD-L1 radionuclide molecular probes in malignant tumors.
2022, 46(6): 380-382.
doi: 10.3760/cma.j.cn121381-202101008-00155
Abstract:
Malignant mesenchymoma (MM) is a a kind of soft tissue sarcoma composed of two or more different types of malignant mesenchymal components with a low incidence. The authors reported a special case of MM, which occurred in lung and was found by 18F-FDG PET/CT examination. The features of MM were analyzed from clinical symptoms, laboratory examinations, imaging findings and related literature reports, in order to deepen clinicians' understanding of lung MM.
Malignant mesenchymoma (MM) is a a kind of soft tissue sarcoma composed of two or more different types of malignant mesenchymal components with a low incidence. The authors reported a special case of MM, which occurred in lung and was found by 18F-FDG PET/CT examination. The features of MM were analyzed from clinical symptoms, laboratory examinations, imaging findings and related literature reports, in order to deepen clinicians' understanding of lung MM.
2022, 46(6): 383-386.
doi: 10.3760/cma.j.cn121381-202107024-00191
Abstract:
The authors reported a case of chronic renal insufficiency with long-term peritoneal dialysis calciphylaxis and left ventricular metastatic calcification with 99Tcm-medronate (MDP) SPECT/CT imaging. The imaging results showed left ventricle metastatic calcification and lower limb calciphylaxis abnormal radioactive concentration of ertraosseous soft tissue. The authors analyzed the characteristics of the disease from the aspects of clinical symptoms, laboratory examinations and imaging findings, and deepened the understanding of the pathogenesis of calciphylaxis and metastatic calcification through literature review.
The authors reported a case of chronic renal insufficiency with long-term peritoneal dialysis calciphylaxis and left ventricular metastatic calcification with 99Tcm-medronate (MDP) SPECT/CT imaging. The imaging results showed left ventricle metastatic calcification and lower limb calciphylaxis abnormal radioactive concentration of ertraosseous soft tissue. The authors analyzed the characteristics of the disease from the aspects of clinical symptoms, laboratory examinations and imaging findings, and deepened the understanding of the pathogenesis of calciphylaxis and metastatic calcification through literature review.
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