2023 Vol. 47, No. 12
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2023, 47(12): 1-4.
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2023, 47(12): 727-732.
doi: 10.3760/cma.j.cn121381-202212005-00368
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Objective To assess the influence of coronary vessel dominance on myocardial perfusion imaging (MPI) by SPECT. Methods A total of 97 patients who performed exercise stress/rest SPECT MPI in Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences from August 2019 to June 2022 were retrospectively analyzed. The patients included 52 males and 45 females, aged (55.9±11.5) years. Coronary dominance was determined by coronary angiography or coronary artery contrast CT. They were divided into two groups according to the coronary vessel dominance: a dominant right coronary artery group (DRCA, n=87) and a non-dominant right coronary artery group (NDRCA, n=19), including a left-dominant coronary artery and a balanced coronary artery. The American Heart Association 17-segment model was used to analyze the MPI images of the two groups of patients, and the differences in stress/resting perfusion scores of each myocardial segment were calculated. The Wilcoxon rank-sum test was used to compare the differences in perfusion scores between the two groups. Results Among the total of 97 patients, 63 (64.9%) showed radioactive uptake defects on the MPI images. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) in the NDRCA group were significantly higher than those in the DRCA group: SSS (2 (1, 4) vs. 1 (0, 2) score), SRS (1 (1, 2) vs. 0 (0, 1) score), and SDS (0 (0, 2) vs. 0 (0, 0) score). The differences were statistically significant (Z=−2.969, −2.945, and −2.109, respectively; all P<0.05). There were no significant differences in the scores of the apical, anterior, lateral, and septal walls between the two groups (Z=−1.108 to 0.000, all P>0.05). The perfusion scores and ischemia rate in the inferior wall were significantly higher in the NDRCA group. Among them, the SSS, SRS, and SDS of the inferior wall of the NDRCA group were 1(0, 3)、0(0, 2) and、0(0, 1) score, respectively, which were significantly higher than those of the DRCA group at 0 (0, 0)、0(0, 0) and 0(0, 0) score, the differences were statistically significant (Z=−3.093, −2.938, and −2.813, respectively; all P<0.05). The positive rate of inferior wall myocardial ischemia in the NDRCA group (4/19, 21.1%) was higher than that in the DRCA group (5/78, 6.4%), and the differences were statistically significant (χ=3.892, P=0.049). Conclusions A significant difference in myocardial perfusion was found between patients with varied coronary vessel dominance. Patients with NDRCA had higher perfusion scores in the inferior wall on SPECT MPI. This result indicates that when the inferior wall presents a mild radioactive uptake defect, information about coronary vessel dominance may need to be considered to reduce the potential for false-positive diagnoses.
2023, 47(12): 733-737.
doi: 10.3760/cma.j.cn121381-202303007-00373
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Objective To explore the radiation dose and its variation patterns of diagnostic 131I SPECT/CT whole-body imaging in patients with differentiated thyroid cancer after iodine remnant ablation to provide a basis for radiation safety evaluation and occupational protection research. Methods Using convenience sampling, retrospective analysis was conducted on 20 patients (including 5 males and 15 females, aged (45.7±11.7) years, ranging from 24.0 to 65.0 years old) who underwent diagnostic 131I SPECT/CT whole-body imaging at the 980th Hospital of the Joint Logistics Support Force of PLA from June to December 2021. An X-γ dose rate meter was used to measure the radiation dose rate on the chest surface of patients at different time periods (2, 24, 48, 72, and 96 h) and at different distances (1.0, 2.0, and 3.0 m) after taking 131I. The effective dose equivalent of patients was measured on the first to fourth day by using a thermoluminescent dosimeter after taking 131I. Results After 2 h of taking 131I, the highest radiation dose rate was observed on the chest surface of patients (186.12 (135.52–201.01) μSv/h), and the radiation dose rate significantly decreases with the prolongation of time after taking 131I and with the increase of distance from the chest surface. The radiation dose rate on the chest surface above 96 h after taking 131I, as well as the radiation dose rate at any time 3.0 m away from the body surface, can reach the background radiation level. After taking 131I, the radiation equivalent dose on the chest surface of patients was (1.19±0.28) mSv (ranging from 0.90 to 1.66 mSv) on the first day, and no significant increase was found from the second day onwards compared with the previous day. Conclusions The radiation dose rate of patients with differentiated thyroid cancer who underwent diagnostic 131I SPECT/CT whole-body imaging after iodine remnant ablation was low, and it decreased rapidly. Therefore, quarantine is not required for patients, but the radiation dose on the body surface is relatively high in the early stages of taking 131I, so abstaining the patients from contacting others is necessary.
2023, 47(12): 738-745.
doi: 10.3760/cma.j.cn121381-202303028-00370
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Objective To evaluate the radiation dosimetry, pharmacokinetics, and safety of 177Lu-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-D-Phe1-Tyr3-Thr8-octreotate (177Lu-DOTA-TATE) in the treatment of advanced metastatic neuroendocrine tumors (NETs). Methods A prospective analysis was performed for 6 patients with advanced metastatic NETs diagnosed by histopathological examination in the First Medical Center of PLA General Hospital from July 2021 to March 2022, including 4 males and 2 females, aged (50.2±9.6) years old. Patients were given intravenous injection of 177Lu-DOTA-TATE at a single dose of (7 400±740) MBq for up to 4 cycles, with each cycle interval of (8±1) weeks. Considering the difficulties in the supply of 177LuCl3 raw materials owing to pandemic, only 3 patients received a full 4 cycles of treatment, 1 patient received 3 cycles treatment and 2 patients received 1 cycles treatment and then withdrew from the study. The distribution and metabolism of 177Lu-DOTA-TATE in patients were analyzed, and the related parameters such as radiation dosimetry and pharmacokinetics were calculated, safety follow-up was also carried out. Patients undergoing radiation dosimetry and pharmacokinetic studies were subjected to SPECT images, blood samples, and urine samples at different time points after the first dose. Paired-sample t-test was used to compare the measured data with normal distribution and homogeneity of variance. Results The dosimetry study of 177Lu-DOTA-TATE was completed in 3 patients with NETs. The absorbed dose of 177Lu-DOTA-TATE decreased in the following order: focus > kidney > spleen > liver. Three patients completed the pharmacokinetics study at the same time; the average calculated peak concentration (Cmax) was 16.61 μg/L, and the average concentration time AUC (AUC0-t) from zero to the last quantifiable concentration was 57.11 μg/(L·h). The average value of AUC (AUC0-∞) extrapolated from zero to infinity was 76.25 μg/(L·h), the average apparent volume of distribution (Vz) was 222.55 L, the average clearance rate (CL) was 3.44 L/h, and the average half-life (T1/2α) of the distributed phase was 0.89 h. The mean half-life (T1/2β) of the elimination phase was 48.94 h. 177Lu-DOTA-TATE was metabolized primarily by the kidney. The cumulative excretion rate of 177Lu-DOTA-TATE was 61.05% within 48 h after administration. No serious adverse events occurred during the safety follow-up period after 177Lu-DOTA-TATE therapy in 6 patients. No significant difference in blood routine, blood biochemistry, coagulation function and urine routine was found before and after treatment (t=−1.437 to 1.378, all P>0.05). Conclusions 177Lu-DOTA-TATE is excreted mostly in the urinary system, with rapid clearance in vivo and high tumor uptake. It has good safety and tolerance in patients with advanced metastatic neuroendocrine tumors.
2023, 47(12): 746-751.
doi: 10.3760/cma.j.cn121381-202209019-00376
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Objective To evaluate the characteristics of changes in thyroglobulin antibody (TgAb), thyroid stimulating hormone receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb) and thyroid stimulating antibody (TSAb) and the value of the combined semi-quantitative score in assessing the effectiveness of 131I treatment for Graves' hyperthyroidism (GH). Methods Retrospective analysis of clinical data of 512 patients with GH who underwent 131I treatment at Shanghai Ruijin Hospital, School of Medicine, Shanghai JiaoTong University from January 2000 to August 2021. The patients comprised 101 males and 411 females, aged (38±12) years. According to the efficacy evaluation, patients treated with 131I were divided into four groups: hypothyroidism group, complete remission group, partial remission group, and ineffective group. The first three groups were the effective group (Group A) with a total of 431 cases, and the ineffective group (Group B) had 81 cases. According to the time after 131I treatment, Group A was further divided into 4 groups: Group A1 (within 1 year after 131I treatment; 80 cases); Group A2 (1−4 years after 131I treatment; 193 cases), Group A3 (5−9 years after 131I treatment; 90 cases); Group A4 (more than 10 years after 131I treatment; 68 cases). The GH patients enrolled in the study underwent continuous and combined measurements of free triiodothyronine, free thyroxine, thyroid stimulating hormone, TgAb, TRAb, TPOAb, and TSAb levels were performed at 4 weeks, 7 weeks, 3 months, 6 months, 12 months, or annually after 131I treatment. The semi-quantitative score ranges for single and four combined thyroid antibodies (TgAb, TRAb, TPOAb and TSAb) were 0–3 and 0–12 points, respectively. The intergroup differences were compared using paired t-test. Results TgAb, TRAb, TPOAb, and TSAb increased to varying degrees after 131I treatment, and the abnormal increase period could last for 29, 21, 26, and 26 months, respectively. Thereafter, they exhibited different degrees of decline (until it could be negative). In group B, A1, A2, A3 and A4, the combined semi-quantitative scores of four thyroid antibodies were 7.43±2.31, 5.41±2.23, 4.43±2.40, 2.15±1.99 and (1.52±1.50) score respectively. The differences between groups A1 and A2, A2 and A3, A3 and A4, A1 and B, were statistically significant (t=3.237, 8.358, 2.252, −5.639, all P<0.05). After 131I treatment for 5 and more than 10 years, the positive rates were 64.56% (102/158) and 55.88% (38/68) for TPOAb, 34.81% (55/158) and 33.82% (23/68) for TgAb, 18.35% (29/158) and 11.76% (8/68) for TRAb, 24.68% (39/158) and 17.65% (12/68) for TSAb, respectively. Conclusions The semi-quantitative score of the combination of the four thyroid antibodies could be used to assess the severity of thyroid autoimmune status and its evolution. The initial onset of GH is characterized by a significant increase of TRAb, and the antibody index is relatively stable after 5 years of 131I treatment, and TPOAb positive rate of more than 50% suggests the presence of hypothyroidism resulting from Hashimoto's thyroiditis.
2023, 47(12): 752-757.
doi: 10.3760/cma.j.cn121381-202307007-00375
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Objective To explore the role of digital apical film combined with cone beam computed tomography (CBCT) in the evaluation of curative effect and prognosis of root canal therapy (RCT). Methods The clinical data of 84 patients who underwent RCT, including 45 males and 39 females, aged (42.7±10.4) years, in Cangzhou People's Hospital from January 2021 to December 2021 were analyzed retrospectively. The patients were divided into observation (n=42) and control (n=42) groups using the random number table method. Apical film was used to assist in the RCT of the control group, and apical film combined with CBCT scanning was used during the RCT of the observation group. A total of 54 teeth, including 11 maxillary first molars, and 12 maxillary second molars, 13 mandibular first molars, and 18 mandibular second molars were observed in the control group. A total of 56 teeth were detected in the observation group, exactly 13 maxillary first molars and 10 maxillary second molars were recorded, respectively, meanwhile, 14 and 19 mandibular first and second molars were identified, respectively. Proper filling rates and qualified rates of dense root canal filling of the maxillary first and second molars and mandibular first and second molars in two groups were compared by χ2 test. Results The control group showed lower proper filling rates of the maxillary first molars and mandibular second molars compared with the observation group (65.71%(23/35) vs. 88.10%(37/42), 68.29%(28/41) vs. 87.50%(42/48)), and the differences were statistically significant (χ2=5.560, 4.858; both P<0.05). The control group also presented lower proper filling rates of maxillary second molars and mandibular first molars than the observation group (71.43% (25/35) vs. 85.71% (24/28), 74.00% (37/50) vs. 86.27% (44/51)), but the differences showed no statistical significance (χ2=1.837, 2.395; both P>0.05). A lower qualified rate of dense root canal filling was observed in the control group than that in the observation group (68.52% (37/54) vs. 85.71% (48/56)), and the difference was statistically significant (χ2=4.630, P<0.05). The control group exhibited a lower cure rate after three revisits compared with the observation group (76.19% (32/42) vs. 92.86% (39/42)), and the difference was statistically significant (χ2=4.459, P<0.05). Conclusions CBCT combined with digital apical film as evaluation methods for the curative effect of RCT, the evaluation of the length and severity of root canal filling of RCT becomes more accurate and can effectively improve the prognosis of patients.
2023, 47(12): 758-767.
doi: 10.3760/cma.j.cn121381-202303033-00371
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Objective To evaluate the short-term efficacy and long-term prognosis of patients with low- and intermediate-risk differentiated thyroid cancer (DTC) treated with different 131I doses. Methods Studies on the short-term efficacy and long-term prognosis evaluation of patients with DTC after 131I treatment were searched from databases such as PubMed, EMBASE, Cochrane Library, CNKI, and Wanfang from inception to September 2022. Screening of literature was based on specific inclusion and exclusion criteria. Meta-analysis was performed with RevMan 5.4 software. Dichotomous data were compared using relative risk (RR), and 95% confidence intervals (95%CI) were calculated for each estimate. Heterogeneity was evaluated by χ2 test and I2 value. Results Seven studies with 2754 patients were included. The low-dose group (1.1–2.2 GBq) comprised 1452 cases, and the high-dose group (3.7 GBq) consisted of 1302 cases. (1) No significant difference in short-term efficacy (RR=0.93, 95%CI: 0.86–1.01, P=0.07) was found between the low- and high-dose groups. Further analysis showed no statistically significant difference between the subgroups of regions (Europe (RR=0.95, 95%CI: 0.90–1.01, P=0.08) and Asia (RR=0.86, 95%CI: 0.68–1.08, P=0.20)); operation modes(total thyroidectomy (RR=0.78, 95%CI: 0.49–1.23, P=0.28); and near total thyroidectomy (RR=0.97, 95%CI: 0.93–1.01, P=0.15)); risk stratification (low and intermediate risk (RR=0.92, 95%CI: 0.83–1.01, P=0.08); and low risk (RR=0.98, 95%CI: 0.83–1.14, P=0.76)); thyroid-stimulating hormone (TSH) stimulation modes (thyroid hormone withdrawal (RR=0.90, 95%CI: 0.79–1.02, P=0.11); and thyroid hormone withdrawal/recombinant human TSH (RR=0.96, 95%CI: 0.90–1.03, P=0.23)); and criteria for successful ablation (Tg<10 ng/ml (RR=0.94, 95%CI: 0.86–1.03, P=0.20), Tg<2 ng/ml (RR=0.85, 95%CI: 0.68–1.05, P=0.13), and Tg<1 ng/ml (RR=0.96, 95%CI: 0.84–1.11, P=0.61)). (2)No significant difference in long-term prognosis was observed between the low- and high-dose groups (RR=0.93, 95%CI: 0.58–1.49, P=0.77). Further analysis showed no statistically significant difference between the subgroups of operation modes (total thyroidectomy (RR=1.09, 95%CI: 0.28–4.21, P=0.80); and near total thyroidectomy (RR=0.88, 95%CI: 0.52–1.50, P=0.63)); risk stratification (low and intermediate risk (RR=2.00, 95%CI: 0.50–7.94, P=0.32); and low risk (RR=0.83, 95%CI: 0.50–1.37, P=0.46)); and follow-up time (<5 years (RR=0.45, 95%CI: 0.10–2.02, P=0.30), ≥5 years (RR=1.03, 95%CI: 0.60–1.75, P=0.93), <10 years (RR=1.00, 95%CI: 0.56–1.76, P=0.99), and ≥10 years (RR=0.80, 95%CI: 0.35–1.82, P=0.54)). (3) Significant difference in subsequent 131I treatment was found between the low- and high-dose groups (RR=1.61, 95%CI: 1.33–1.95, P<0.001). Conclusions No statistically significant difference in short-term efficacy and long-term prognosis was observed between low- and high-dose 131I treatments for low- and intermediate-risk DTC. Patients treated with low-dose 131I are likely to undergo ≥ 2 times of 131I treatment due to residual thyroid or persistent/recurrent diseases.
2023, 47(12): 768-773.
doi: 10.3760/cma.j.cn121381-202301003-00374
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Fibroblast-activated protein (FAP) is overexpressed in the tumor stroma. In recent years, 68Ga-labelled FAP inhibitors (FAPI) have been widely used in clinical research, it has certain advantages in the diagnosis of digestive system malignant tumors, the evaluation of distant metastasis, and the assistance of delineate target volume. In this paper reviews the research progress of 68Ga-FAPI PET/CT in common digestive system malignant tumours, in order to provide a reference for clinicians in the diagnosis and treatment of digestive system malignant tumors.
Fibroblast-activated protein (FAP) is overexpressed in the tumor stroma. In recent years, 68Ga-labelled FAP inhibitors (FAPI) have been widely used in clinical research, it has certain advantages in the diagnosis of digestive system malignant tumors, the evaluation of distant metastasis, and the assistance of delineate target volume. In this paper reviews the research progress of 68Ga-FAPI PET/CT in common digestive system malignant tumours, in order to provide a reference for clinicians in the diagnosis and treatment of digestive system malignant tumors.
2023, 47(12): 774-780.
doi: 10.3760/cma.j.cn121381-202302004-00364
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Ovarian cancer is one of the common malignant tumors of female reproductive system. It is difficult to diagnose early, prone to relapse after initial treatment, and has a poor prognosis, so diagnosis and treatment still face great challenges. Imaging examination is an indispensable part in the diagnosis and treatment of ovarian cancer. Among them, nuclear medicine molecular imaging technology has become a highly potential non-invasive imaging method in the diagnosis and treatment of ovarian cancer. PET/CT has been widely used in the diagnosis, staging, treatment efficacy, prognosis, and recurrence evaluation of ovarian cancer. PET/MRI has shown significant advantages in the diagnosis and treatment of ovarian cancer due to its high soft tissue resolution and low radiation dose. SPECT/CT also plays an important role in the diagnosis and treatment of ovarian cancer due to the development of various new radioactive tracers. The authors review the application and research progress of PET/CT, PET/MRI and SPECT/CT about ovarian cancer, in order to further improve the value of molecular imaging technology in the diagnosis and treatment of ovarian cancer.
Ovarian cancer is one of the common malignant tumors of female reproductive system. It is difficult to diagnose early, prone to relapse after initial treatment, and has a poor prognosis, so diagnosis and treatment still face great challenges. Imaging examination is an indispensable part in the diagnosis and treatment of ovarian cancer. Among them, nuclear medicine molecular imaging technology has become a highly potential non-invasive imaging method in the diagnosis and treatment of ovarian cancer. PET/CT has been widely used in the diagnosis, staging, treatment efficacy, prognosis, and recurrence evaluation of ovarian cancer. PET/MRI has shown significant advantages in the diagnosis and treatment of ovarian cancer due to its high soft tissue resolution and low radiation dose. SPECT/CT also plays an important role in the diagnosis and treatment of ovarian cancer due to the development of various new radioactive tracers. The authors review the application and research progress of PET/CT, PET/MRI and SPECT/CT about ovarian cancer, in order to further improve the value of molecular imaging technology in the diagnosis and treatment of ovarian cancer.
2023, 47(12): 781-785.
doi: 10.3760/cma.j.cn121381-202302012-00369
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This paper reports the imaging and clinical features of a patient with an atypical parathyroid adenoma characterized by recurrent fractures, high parathyroid hormone level, negative 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT imaging at initial diagnosis and positive 99Tcm-MIBI SPECT/CT tracking imaging at follow-up. By reviewing and analyzing relevant literature, this paper aims to explore the diagnostic approach when both CT and ultrasound localization diagnostic results are negative, and even when the 99Tcm-MIBI SPECT/CT imaging are still negative, in order to improve the understanding and early diagnosis of atypical parathyroid adenoma and avoid clinical missed diagnosis.
This paper reports the imaging and clinical features of a patient with an atypical parathyroid adenoma characterized by recurrent fractures, high parathyroid hormone level, negative 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT imaging at initial diagnosis and positive 99Tcm-MIBI SPECT/CT tracking imaging at follow-up. By reviewing and analyzing relevant literature, this paper aims to explore the diagnostic approach when both CT and ultrasound localization diagnostic results are negative, and even when the 99Tcm-MIBI SPECT/CT imaging are still negative, in order to improve the understanding and early diagnosis of atypical parathyroid adenoma and avoid clinical missed diagnosis.
2023, 47(12): 786-788.
doi: 10.3760/cma.j.cn121381-202302021-00372
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The authors reported a case of 99Tcm-methylenediphosphonate(MDP) whole-body bone imaging in a child with McCune-Albright syndrome (MAS). The imaging showed multiple abnormal hyperactive and elevated bone metabolism, and were comprehensively evaluated by X-ray, CT and MRI imaging. Pathological examination confirmed the diagnosis of multiple fibrous dysplasia of bone (FDB). MAS is rare in clinical, the authors analyzed the characteristics of MAS from the clinical characteristics and imaging manifestations respectively, and combined with the literature review of 99Tcm-MDP whole body bone imaging features of FDB in different parts, which to provide more references for its diagnosis.
The authors reported a case of 99Tcm-methylenediphosphonate(MDP) whole-body bone imaging in a child with McCune-Albright syndrome (MAS). The imaging showed multiple abnormal hyperactive and elevated bone metabolism, and were comprehensively evaluated by X-ray, CT and MRI imaging. Pathological examination confirmed the diagnosis of multiple fibrous dysplasia of bone (FDB). MAS is rare in clinical, the authors analyzed the characteristics of MAS from the clinical characteristics and imaging manifestations respectively, and combined with the literature review of 99Tcm-MDP whole body bone imaging features of FDB in different parts, which to provide more references for its diagnosis.
2023, 47(12): 789-792.
Abstract:
2023, 47(12): 793-794.
Abstract:
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