2022 Vol. 46, No. 9
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2022, 46(9): 521-529.
doi: 10.3760/cma.j.cn121381-202109015-00212
Abstract:
Objective To construct prognostic nomogram models of 18F-fluorodeoxyglucose (FDG) PET-based metabolic and clinical parameters and validate their importance to survival prediction of patients with diffuse large B-cell lymphoma (DLBCL). Methods 18F-FDG PET image and clinical characteristics of 383 patients with DLBCL who received no treatments and underwent histopathology in the Affiliated Drum Tower Hospital, Medical School of Nanjing University, and the First Affiliated Hospital of Nanjing Medical University from March 2011 to November 2019 were retrospectively analyzed. The patients included 204 males and 179 females, aged 19–93(47.3±14.9) years old. The patients were randomly allocated as the training group (n=268) and validation group (n=115) at a 7∶3 ratio. The total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) were computed. Kaplan-Meier survival analysis, univariate and multivariate Cox proportional hazard regression models were used to evaluate progression-free survival (PFS) and overall survival (OS). The models were construct, and performance was assessed and validated with regard to calibration, discrimination, and clinical usefulness by calibration curve, concordance index (C-index), and decision curve analysis (DCA). Results Univariate analysis indicated that age, lactate dehydrogenase (LDH) level, Eastern Cooperative Oncology Group performance status (ECOG PS) score, Ann Abor stage, bulky, TMTV, and TLG were factors for predicting PFS in the training group (HR=1.670–3.277, all P<0.05). Age, LDH level, B symptoms, ECOG PS score, Ann Abor stage, bulky, TMTV, and TLG were factors for predicting OS in the training group (HR=1.661–4.193, all P<0.05). Multivariate Cox regression analyses showed that age, LDH level, Ann Arbor stage, and TLG were independent predictors of PFS and OS of DLBCL patients in the training group (HR=1.589–3.367, all P<0.05). Calibration curves showed that the models had good consistency for survival. The C-index showed that the models exhibited significant prognostic superiority in training and validation group (PFS: 0.724 vs. 0.762; OS: 0.749 vs. 0.753). Clicinal DCA showed that the prediction model could bring more clinical usefulness to patients. Conclusion 18F-FDG PET metabolic (TLG) and clinical (age, LDH level, and Ann Abor stage) parameters can successfully predict patient prognosis, which may promote precision medicine.
2022, 46(9): 530-535.
doi: 10.3760/cma.j.cn121381-202201005-00213
Abstract:
Objective To evaluate the clinical diagnostic value and optimum delay time of 18F-fluorodeoxyglucose (FDG) PET/CT delayed imaging after diuresis in prostate cancer (PCa). Methods The clinical data of 235 male patients with prostate diseases who underwent 18F-FDG PET/CT whole-body imaging at the Characteristic Medical Center of the Chinese People's Armed Police Force from March 2009 to December 2018, including 77 patients with malignant prostate diseases and 158 patients with benign prostate diseases were retrospectively analyzed, aged 50–87(69.6±13.6) years old. All patients underwent delayed imaging before and after diuresis(1, 2, 3, and 4 h) to obtain the maximum standardized uptake value (SUVmax) of lesions before and after diuresis. SUVmax>2.5 after diuresis and a retention index>15% of SUVmax before and after diuresis were used as the criteria to judge as benign or malignant. Independent sample t-test was used to compare the data between the two groups in accordance with normal distribution. Results The SUVmax of patients with prostate malignant lesions delayed 1, 2, and 3 h imaging after diuresis was significantly higher than that before diuresis (5.57±1.58 vs. 4.32±1.01, 7.04±3.03 vs. 4.62±1.84, 7.28±2.90 vs. 4.73±1.8; t=3.399, 3.676, 2.660; all P<0.05). No significant difference in SUVmax existed between prediuretic and delayed 4 h imaging after diuresis (t=1.103, P=0.286). In patients with benign prostate diseases, no significant difference existed in SUVmax delayed 1, 2, 3, and 4 h imaging after diuresis compared with that before diuresis (t=0.268–0.865, all P>0.05). The SUVmax of malignant lesions delayed 1, 2, and 3 h imaging after diuresis was higher than that in benign lesions (t=2.013, 3.910, 3.554; all P<0.05). However, no significant difference in SUVmax delayed 4 h imaging existed between the two groups (t=1.379, P=0.181). The SUVmax of patients with malignant lesions delayed 2 and 3 h was higher than that for diuretic imaging delayed 1 h (t=2.220, 2.400; both P<0.05). Diagnostic efficiency of 18F-FDG PET/CT delayed imaging (1, 2, 3, and 4 h) after diuresis in Pca, the specificity (74.5%, 38/51) and accuracy (76.3%, 61/80) of 2 h delayed imaging were the highest, while the sensitivity (84.6%, 11/13) of 3 h delayed imaging was the highest. Conclusions Delayed imaging after diuresis can improve the imaging effect and clinical diagnostic efficacy of PCa patients. The diagnostic effect of delayed imaging after diuresis for 2 h was better.
2022, 46(9): 536-543.
doi: 10.3760/cma.j.cn121381-202112021-00216
Abstract:
Objective To investigate the risk factors of acute radiation-induced lung injury in patients with locally advanced non-small cell lung cancer (NSCLC) after intensity-modulated radio therapy (IMRT) and establish a nomogram model to predict the corresponding risk. Methods The clinical data of 216 patients with locally advanced NSCLC who were treated with IMRT in the Brain Hospital Affiliated to Nanjing Medical University from May 2017 to November 2019 were retrospectively analyzed, including 94 males and 122 females, with an average age of 37–83(61.5±9.6) years old. Based on the occurrence of acute radiation-induced lung injury, the selected patients with locally advanced NSCLC were divided into the acute radiation-induced lung injury group and the non-acute radiation-induced lung injury group. Herein, count data were compared using the χ2 test, LASSO analysis, and Logistic regression analysis used to screen independent risk factors of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT. In addition, the R software was used to predict the occurrence of acute radiation in patients with locally advanced NSCLC after IMRT. Risk nomogram model of lung injury, plotting calibration curve, receiver operating characteristic (ROC) curve, and decision curve. Results Among 216 patients with locally advanced NSCLC, acute radiation-induced lung injury occurred in 65 patients after IMRT, with an incidence rate of 30.09%. Logistic regression analysis showed that age, V5, V20, V30, mean lung dose, forced expiratory volume in the first second (FEV1), hypofractionated radiotherapy, and image verification are independent risk factors for acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT (OR=2.946–4.688, all P<0.05). The consistency index of the nomogram model for predicting the risk of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT was 0.819(95%CI: 0.789–0.853), the calibration curve was close to the ideal curve, and the area under the ROC curve was 0.802, the decision curve shows that when the threshold probability is between 6% and 100%, hence, there is a higher net benefit value. Conclusions The nomogram established based on age, V5, V20, V30, mean lung dose, FEV1, hypofractionated radiotherapy, and image verification has high accuracy in predicting the risk of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT.
2022, 46(9): 544-549.
doi: 10.3760/cma.j.cn121381-202205004-00217
Abstract:
Objectives To evaluate the clinical efficacy of radioactive 125I seed implantation combined with transcranial arterial chemoembolization (TACE) in the treatment of advanced liver cancer. Methods A total of 123 patients with advanced liver cancer by histopathology in the First People's Hospital of Lanzhou City, from January 2014 to December 2019 were retrospectively analyzed. The patients included 73 male patients and 50 female patients, aged 39−75(60.4±4.4) years old. Herein, patients who received radioactive 125I seed implantation combined with TACE were treated as the treatment group (69 cases), meanwhile, patients who received TACE alone were treated as the control group (54 cases). The visual analog scale (VAS) was used to evaluate the pain of all patients, and the efficacy was evaluated based on the modified Response Evaluation Criteria for Solid Tumors (mRECIST) version 1.1. χ2 test was used to compare the two groups. Results After 1 month of treatment, 94.2%(65/69) of patients in the treatment group had pain frequency of ≤2 times/d, and 5.8%(4/69) of patients with pain frequency of ≥3 times/d. Meanwhile, 70.4%(38/54) of patients in the control group had pain frequency of ≤2 times/d, and 29.6%(16/54) of patients with pain frequency of ≥3 times/d. Hence, the difference between the two groups was statistically significant (χ2=123.00, P<0.001). After 1 month of treatment, 71.0%(49/69) of patients in the treatment group had no pain or mild pain, 24.6%(17/69) had moderate pain, and 4.4%(3/69) had severe pain. Meanwhile, in the control group, 46.3%(25/54) of patients had no pain or mild pain, 40.7%(22/54) experienced moderate pain, and 13.0%(7/54) had severe pain. Thus, the difference between the two groups was statistically significant (χ2=8.480, P<0.05). After 3 months of treatment, the effective rate and disease control rate of the treatment group were 84.1%(58/69) and 92.8%(64/69), respectively, which were significantly higher than those of the control group (22.2%(12/54) and 51.9%(28/54)), and the differences were statistically significant (χ2=47.234, 36.883; P<0.001). After 6 months of treatment, the effective rate and disease control rate of the treatment group were 62.3%(43/69) and 79.7%(55/69), respectively, which were significantly higher than 16.7%(9/54) and 44.4%(24/54) of the control group, and the differences between the two groups were statistically significant (χ2=25.871, 17.999; both P<0.001). In addition, the 1- and 2-year survival rates were 75.4%(52/69) and 40.6%(28/69) in the treatment group and 33.3%(18/54) and 13.0%(7/54) in the control group, respectively, and the difference was statistically significant (χ2=21.821, 11.349; both P<0.001). Conclusion Radioactive 125I seed implantation combined with TACE treatment therapy has a good therapeutic effect on patients with advanced liver cancer.
2022, 46(9): 550-554.
doi: 10.3760/cma.j.cn121381-202205005-00215
Abstract:
In order to correctly implement the Beijing local standard DB11/T 1930—2021 Quality control specification for tests of chromosome aberration and micronucleus in radiation workers' health examinations, and better guide the cytogenetic testing for radiation workers in health examination institutions, the background, main basis and main technical content of the standard were interpreted. This standard was formulated on the basis of extensive research on domestic and foreign literature, in accordance with relevant laws and regulations, national and industry standards, and on the basis of extensive consultation with peer experts . The basic requirements, laboratory and equipment requirements, and quality control for the test process of chromosomal aberrations and micronucleus in human peripheral blood lymphocytes during the health examination of radiation workers were specified in this standard. The interpretation of the standard can be used to guide the genetic laboratory of the occupational health examination institution of radiation workers to work in a more standardized and scientific way, and better ensure the safety and health of the radiation workers.
In order to correctly implement the Beijing local standard DB11/T 1930—2021 Quality control specification for tests of chromosome aberration and micronucleus in radiation workers' health examinations, and better guide the cytogenetic testing for radiation workers in health examination institutions, the background, main basis and main technical content of the standard were interpreted. This standard was formulated on the basis of extensive research on domestic and foreign literature, in accordance with relevant laws and regulations, national and industry standards, and on the basis of extensive consultation with peer experts . The basic requirements, laboratory and equipment requirements, and quality control for the test process of chromosomal aberrations and micronucleus in human peripheral blood lymphocytes during the health examination of radiation workers were specified in this standard. The interpretation of the standard can be used to guide the genetic laboratory of the occupational health examination institution of radiation workers to work in a more standardized and scientific way, and better ensure the safety and health of the radiation workers.
2022, 46(9): 555-560.
doi: 10.3760/cma.j.cn121381-202110007-00207
Abstract:
Nanobodies have become popular targeting molecules in the field of molecular imaging due to their excellent targeting ability, superior stability, good solubility, and enhanced tissue penetration ability. A variety of nanobody-based molecular imaging probes have shown great promise for noninvasive diagnosis of human malignancies in preclinical and clinical settings. This review mainly introduces the latest research progress on nanobody-based molecular imaging probes in tumors, and further discusses the challenges and strategies for future clinical translation.
Nanobodies have become popular targeting molecules in the field of molecular imaging due to their excellent targeting ability, superior stability, good solubility, and enhanced tissue penetration ability. A variety of nanobody-based molecular imaging probes have shown great promise for noninvasive diagnosis of human malignancies in preclinical and clinical settings. This review mainly introduces the latest research progress on nanobody-based molecular imaging probes in tumors, and further discusses the challenges and strategies for future clinical translation.
2022, 46(9): 561-564.
doi: 10.3760/cma.j.cn121381-202205007-00220
Abstract:
18F-fluorodeoxyglucose (FDG) micro-PET brain imaging is an important means of basic research in brain science. In animal experiments, brain activity is affected by experimental conditions such as diet, anesthesia, administration route of imaging agents, temperature and light. As a result, there will be deviation in cerebral perfusion and metabolic imaging, which will affect the evaluation of brain cognitive function. The authors review the effects of different experimental conditions on the brain uptake of 18F-FDG in rodent imaging studies, and provide guidance for animal imaging research.
18F-fluorodeoxyglucose (FDG) micro-PET brain imaging is an important means of basic research in brain science. In animal experiments, brain activity is affected by experimental conditions such as diet, anesthesia, administration route of imaging agents, temperature and light. As a result, there will be deviation in cerebral perfusion and metabolic imaging, which will affect the evaluation of brain cognitive function. The authors review the effects of different experimental conditions on the brain uptake of 18F-FDG in rodent imaging studies, and provide guidance for animal imaging research.
2022, 46(9): 565-570.
doi: 10.3760/cma.j.cn121381-202108012-00219
Abstract:
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, which is prone to lymph node metastasis in the early stage. 131I whole body scan combining with SPECT/CT (called 131I SPECT/CT for short) can often detect residual and/or missed lymph node metastasis, which may change the postoperative staging and risk stratification of patients, affect subsequent surgical or 131I therapy options. 131I therapy is one of the effect methods for the treatment of postoperative cervical lymph node metastasis in DTC. Metastatic lymph nodes can be diagnosed by 131I SPECT/CT. This article reviews the application value of 131I SPECT/CT in the diagnosis and treatment of postoperative lymph node metastasis in patients with differentiated thyroid cancer.
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, which is prone to lymph node metastasis in the early stage. 131I whole body scan combining with SPECT/CT (called 131I SPECT/CT for short) can often detect residual and/or missed lymph node metastasis, which may change the postoperative staging and risk stratification of patients, affect subsequent surgical or 131I therapy options. 131I therapy is one of the effect methods for the treatment of postoperative cervical lymph node metastasis in DTC. Metastatic lymph nodes can be diagnosed by 131I SPECT/CT. This article reviews the application value of 131I SPECT/CT in the diagnosis and treatment of postoperative lymph node metastasis in patients with differentiated thyroid cancer.
2022, 46(9): 571-575.
doi: 10.3760/cma.j.cn121381-202110030-00218
Abstract:
Transforming growth factor beta 1 (TGF-β1) is an important fibrogenic cytokine, and its expression level can reflect the severity of pulmonary fibrosis. Radiation-induced lung injury (RILI) includes early radiation-induced pneumonia (RP) and late radiation-induced pulmonary fibrosis (RIPF). The development of RP to RIPF is accompanied by the increase of the expression level of TGF-β1. Understanding and mastering the molecular mechanism of TGF-β1 in the occurrence and development of RP and RIPF is of great significance for the prevention and treatment of RILI. This paper reviews the fibrogenic effect of TGF-β1 in the process of RILI and its mechanism.
Transforming growth factor beta 1 (TGF-β1) is an important fibrogenic cytokine, and its expression level can reflect the severity of pulmonary fibrosis. Radiation-induced lung injury (RILI) includes early radiation-induced pneumonia (RP) and late radiation-induced pulmonary fibrosis (RIPF). The development of RP to RIPF is accompanied by the increase of the expression level of TGF-β1. Understanding and mastering the molecular mechanism of TGF-β1 in the occurrence and development of RP and RIPF is of great significance for the prevention and treatment of RILI. This paper reviews the fibrogenic effect of TGF-β1 in the process of RILI and its mechanism.
2022, 46(9): 576-579.
doi: 10.3760/cma.j.cn121381-202204003-00221
Abstract:
A case of hypercalcemia caused by multiple bone metastases from Ewing sarcoma was reported. Hypercalcemia caused by malignant tumor is not uncommon, but the microcalcification of malignant bone tumor with hypercalcemia in this case is typical and rare in the whole body bone imaging. The authors discussed the limitations of whole-body bone imaging in this case, and pointed out that the sensitivity of bone imaging for multiple metastatic microcalcifications of malignant tumors is superior to that of other imaging examinations, which is also worthy of attention of nuclear medicine and clinicians.
A case of hypercalcemia caused by multiple bone metastases from Ewing sarcoma was reported. Hypercalcemia caused by malignant tumor is not uncommon, but the microcalcification of malignant bone tumor with hypercalcemia in this case is typical and rare in the whole body bone imaging. The authors discussed the limitations of whole-body bone imaging in this case, and pointed out that the sensitivity of bone imaging for multiple metastatic microcalcifications of malignant tumors is superior to that of other imaging examinations, which is also worthy of attention of nuclear medicine and clinicians.
2022, 46(9): 580-584.
doi: 10.3760/cma.j.cn121381-202109012-00214
Abstract:
As for whether ionizing radiation can induce non-Hodgkin lymphoma (NHL), the current study results have not yet reached a consensus conclusion. The authors reported a case of NHL, who was diagnosed with moderate bone marrow form of acute radiation sickness in Henan "4.26" 60Co source radiation accident and suffered from NHL 13 years after exposure. And analyzed from two aspects of epidemiological data and influence factors in combined with the patient's exposure history, characteristics of medical history, diagnosis and many international large-scale studies to provide radiation epidemiology for NHL caused by ionizing radiation.
As for whether ionizing radiation can induce non-Hodgkin lymphoma (NHL), the current study results have not yet reached a consensus conclusion. The authors reported a case of NHL, who was diagnosed with moderate bone marrow form of acute radiation sickness in Henan "4.26" 60Co source radiation accident and suffered from NHL 13 years after exposure. And analyzed from two aspects of epidemiological data and influence factors in combined with the patient's exposure history, characteristics of medical history, diagnosis and many international large-scale studies to provide radiation epidemiology for NHL caused by ionizing radiation.
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