2023 Vol. 47, No. 3
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2023, 47(3): 1-4.
Abstract:
2023, 47(3): 133-140.
doi: 10.3760/cma.j.cn121381-202208004-00280
Abstract:
Objective To investigate the prognostic value of primary and metastatic metabolic parameters of 18F-fluorodeoxyglucose(FDG) PET/CT imaging before chemoradiotherapy in patients with esophageal squamous cell carcinoma (ESCC). Methods A retrospective analysis was performed on 106 patients [98 males, 8 females, aged (63.9±8.8) years] with metastatic ESCC who received radiochemotherapy and underwent 18F-FDG PET/CT from November 2013 to April 2021 in the Affiliated Hospital of Qingdao University. Clinical factors included age, sex, primary location, clinical stage, degree of differentiation, and treatment. Using 40% maximum standardized uptake value (SUVmax) as the threshold, delineate the region of interest (ROI) of the primary and metastatic lesions of esophageal cancer before treatment. Metabolic parameters included SUVmax of primary lesion, metabolic tumor volume (MTV) of primary lesion (MTVp), total lesion glycolysis (TLG) of primary lesion (TLGp), MTV of whole body (MTVwb), TLG of whole body (TLGwb), and SUVmax, MTV, TLG ratio of metastatic lesion to primary lesion (R-SUVmax, R-MTV, R-TLG). Kaplan-Meier method and Log-Rank test were used for univariate analysis and multivariate analysis was conducted by Cox proportional hazards model to predict the prognostic factors affecting progression-free survival (PFS) and overall survival (OS) of patients. Results Univariate analysis showed that T stage, MTVp, TLGp, MTVwb, TLGwb and R-TLG were prognostic factors for PFS and OS in ESCC patients receiving chemoradiotherapy (χ2=4.105−27.992, all P<0.05). Multivariate analysis showed that T stage and R-TLG were independent prognostic factors for PFS (HR=2.210, 95%CI: 1.307−3.737, P=0.003; HR=3.118, 95%CI: 1.414−6.875, P=0.005) and OS (HR=1.885, 95%CI: 1.072−3.317, P=0.028; HR=2.584, 95%CI: 1.186−5.629, P=0.017) in ESCC patients. Combined with T stage and R-TLG, the patients were divided into low-risk, medium-risk and high-risk groups. The results showed that there were statistically significant differences in PFS and OS among the groups (χ2=38.392, 19.857; both P<0.001). Conclusion T stage and 18F-FDG PET/CT metabolic parameter R-TLG were independent prognostic factors for PFS and OS in ESCC patients before chemoradiotherapy.
2023, 47(3): 141-147.
doi: 10.3760/cma.j.cn121381-202209011-00282
Abstract:
Objective To investigate the relationship between programmed death-ligand 1 (PD-L1) protein expression in non-small cell lung cancer (NSCLC) tissues and 18F-fluorodeoxyglucose (FDG) PET/CT metabolic markers and to provide theoretical basis for NSCLC immunotherapy on PET/CT metabolic level. Methods The clinical data of 55 patients with NSCLC who underwent 18F-FDG PET/CT from January 2020 to July 2021 in Third Clinical Medical College of Qingdao University (Qingdao Municipal Hospital) and confirmed by histopathological examination (biopsy or surgery) were retrospectively collected and analyzed, including 34 males and 21 females, aged (66.5±9.3) years. 18F-FDG PET/CT examination was performed before treatment. The metabolic parameters of primary lung cancer lesions were measured using the PET volume computed assisted reading (VCAR) image processing system, including maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV). Taking the tumor proportion score (TPS) of tumor cells with a positive PD-L1 protein expression=1% as the threshold, patients were divided into positive PD-L1 protein expression group (TPS≥1%) and negative group (TPS<1%). With the threshold of TPS=50% for PD-L1 protein expression, patients in the positive group were divided into high PD-L1 protein expression group (TPS≥50%) and low expression group (1%≤TPS<50%). Two independent sample t-test was performed for the intergroup comparison of measurement data in accordance with normal distribution. Chi-square test was conducted for the intergroup comparison of counting data. Pearson correlation analysis was performed on the relationship between SUVmax and PD-L1 protein expression in lesions. Spearman rank correlation analysis was conducted on the relationship among TLG, MTV, and PD-L1 protein expression in lesions. The receiver operating characteristic (ROC) curve was drawn. Enrolled patients were divided into high and low SUVmax groups on the basis of the optimal critical value of SUVmax. PD-L1 protein expression was observed in both groups. Results A positive correlation was found between SUVmax and TPS of tumor cells with a positive PD-L1 protein expression in NSCLC lesions (r=0.604, P<0.001); no correlation was observed between MTV, TLG, and TPS (r=0.083, 0.102, both P>0.05). Among 55 patients, 34 were in the positive PD-L1 protein expression group and 21 in the negative group. The SUVmax in the positive group was higher than that in the negative group (12.58±6.35 vs. 5.60±4.83, t=2.576, P<0.05). The ROC curve results revealed that with SUVmax=5.15 as the optimal critical value, 36 cases were found in the high SUVmax group and 19 cases in the low SUVmax group. The positive expression rates of PD-L1 protein in the two groups were 80.56% (29/36) and 28.16% (5/19). The TPS of tumor cells with a positive PD-L1 protein expression were 12.50%±3.21% and 1.28%±0.46%, respectively. Patients in the high SUVmax group had a higher positive expression rates of PD-L1 protein and TPS, and the differences were statistically significant (χ2=15.500, t=2.671, both P<0.05). Conclusion A positive correlation is found between SUVmax in 18F-FDG PET/CT and TPS of tumor cells with a positive PD-L1 protein expression in patients with NSCLC, which can provide evidence for NSCLC immunotherapy.
2023, 47(3): 148-154.
doi: 10.3760/cma.j.cn121381-202208007-00283
Abstract:
Objective Aimed to compare similarities and differences of the quantitative measurements of liver proton density fat fraction (PDFF) and iron content (R2*) between 3.0 T and 1.5 T MRI with iterative decomposition of water and fat with asymmetry and least squares estimation quantitative fat imaging (IDEAL-IQ) sequences. Methods Twenty healthy volunteers [13 males and 7 females, aged (23.7±2.5) years] and plastic test tube models with different fat contents were scanned with IDEAL-IQ sequence for prospective research on two MRI equipment of 3.0 T (group A) and 1.5 T (group B) in December 2019 in First People's Hospital of Foshan. The FatFrac images and R2* images automatically generated were used to draw the region of interests (ROIs) automatically. The PDFF and R2* values of the models and the liver and subcutaneous fat of the healthy volunteers were measured and compared between groups A and B. Measurement data that conformed to normal distribution were compared using paired sample t test (equal variances assumed) and Mann-Whitney U test (equal variances not assumed). Results The measured mean PDFF values of the model of groups A1 and B1 were (20.59±14.39)% and (21.89±14.95)%, respectively, with no significant difference (Z=−1.550, P=0.121). The measured mean R2* values of the model of groups A1 and B1 were (84.86±116.43) Hz and (43.61±54.59) Hz, respectively, with a statistically significant difference (Z=−3.448, P=0.001). No significant difference was found in the mean PDFF values of liver and subcutaneous fat of healthy volunteers [(3.33±2.95)% vs. (4.39±2.80)%, (81.78±6.33) Hz vs. (81.54±5.53) Hz)(Z=−1.867, t=−0.301; both P>0.05] with 3.0 T and 1.5 T MRI, respectively. The average R2* measured values of group A of the liver and subcutaneous fat of the healthy volunteers were higher than those of group B, with statistical significantly differences [(52.42±12.22) Hz vs. (32.73±5.62) Hz, (50.88±10.32) Hz vs. (39.41±9.11) Hz)(Z=−3.920, t=4.372; both P<0.001]. Conclusions Results showed no significant differences in the PDFF values of models and the liver and subcutaneous fat of the volunteers measured between 3.0 T MR and 1.5 T MR based on IDEAL-IQ sequences, but the PDFF values of 3.0 T MRI may be closer to the clinical actual situation than that of 1.5 T MRI. The R2* values obtained based on 3.0 T MRI field strength were significantly different from that of 1.5 T MRI, and its influencing factors need to be further studied.
2023, 47(3): 155-162.
doi: 10.3760/cma.j.cn121381-202208019-00285
Abstract:
Objective To investigate the effects of different doses of radiation exposure on acute lung injury and mortality from decompression sickness (DCS) induced by rapid floating escape in rats. Methods A total of 53 Sprague-Dawley rats were stratified in accordance with body weight and divided into 5 groups by using a random number table method. The groups were as follows: blank control group (10 rats), simple decompression group (10 rats), 4 Gy irradiation with decompression group (11 rats), 6 Gy irradiation with decompression group (11 rats), and 8 Gy irradiation with decompression group (11 rats). The animals in the irradiation groups were given different doses of 60Co γ whole-body radiation and then exposed to decompression treatment (i.e., after staying at a depth of 57 m for 45 min, the rats were made to ascend quickly to atmospheric pressure within 37 s) 1 h after irradiation. The mortality rate, lung wet-dry weight ratio, degree of lung tissue pathological damage, and changes in levels of inflammatory factors and oxidative stress-related molecules in the alveolar lavage fluid were observed in each group of rats. Mortality rates among groups were compared using Chi-square test, while the remaining variables were analyzed using one-way ANOVA. Further comparison between two groups using LSD t-test. Results Compared with that in the blank control group, the number of animal deaths and the lung wet-dry weight ratio increased in each experimental group, with the lung wet-dry weight ratio increasing significantly in the 6 Gy and 8 Gy irradiation with decompression groups (F=3.096, LSD-t=2.758, 2.959; all P<0.05). The pathological damage of lung tissues in each experimental group was evident, and those in the 6 Gy and 8 Gy irradiation with decompression groups were more significant among the irradiation groups. The interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and malondialdehyde (MDA) in the bronchoalveolar lavage fluid of each experimental group were significantly increased (F=45.680–78.270, all P<0.01), whereas superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were significantly decreased (F=35.720, 51.370; both P<0.01). Compared with that in the simple decompression group, the number of animal deaths in the 4 Gy and 8 Gy irradiation with decompression groups increased, but no statistical difference was noted in the mortality rate (χ2=7.925, P>0.05). Although the lung wet-dry weight ratio of the rats in each irradiation group exhibited an upward trend, no statistically significant difference was found (LSD-t=0.901, 1.818, 2.020; all P>0.05). The pathological damage of lung tissues was aggravated to different degrees, and the damage degree of the 8 Gy irradiation with decompression group was the most serious. Inflammatory factors (IL-1β, IL-6, and TNF-α) and oxidative stress-related molecules (SOD, GSH-Px, and MDA) in bronchoalveolar lavage fluid changed significantly (LSD-t=3.081–8.265, all P<0.01). Among which, the 6 Gy irradiation with decompression group exhibited the most significant change. Conclusions Nuclear radiation can worsen lung tissue inflammation and oxidative stress damage caused by rapid floating escape. Such effect is manifested as aggravated lung tissue pathological damage and increased mortality, increasing the risk of DCS caused by rapid floating escape.
2023, 47(3): 163-168.
doi: 10.3760/cma.j.cn121381-202206008-00277
Abstract:
The incidence of differentiated thyroid cancer (DTC) is increasing annually, and most patients have excellent prognoses. However, the survival rate decreases significantly in patients with recurrences and metastases. Therefore, the detection, evaluation, and treatment for the recurrences and metastases of DTC are particularly crucial. With the continuous progress of PET/CT research in oncology, its application value has received increasing attention in such patients; it also provides important information for accurate diagnoses and treatment methods. In this study, the authors review the application progress of PET/CT in the diagnosis of recurrences and metastases of DTC.
The incidence of differentiated thyroid cancer (DTC) is increasing annually, and most patients have excellent prognoses. However, the survival rate decreases significantly in patients with recurrences and metastases. Therefore, the detection, evaluation, and treatment for the recurrences and metastases of DTC are particularly crucial. With the continuous progress of PET/CT research in oncology, its application value has received increasing attention in such patients; it also provides important information for accurate diagnoses and treatment methods. In this study, the authors review the application progress of PET/CT in the diagnosis of recurrences and metastases of DTC.
2023, 47(3): 169-174.
doi: 10.3760/cma.j.cn121381-202210013-00284
Abstract:
Improving the delivery efficiency of radioactive nuclides, increasing the sensitivity of obtaining lesion information, and enhancing the efficacy of tumor treatment based on nanomedicine strategies have become a hot research topic today. Different types of nanocarriers have been used as radioactive tracer, but radioactive labeling is still a key step. To ensure the labeling rate and stability of radionuclide-labeled nanocarriers, the most appropriate radiolabeling strategies are selected on the basis of the type of materials, radionuclides, and reaction conditions. The authors mainly reviewed the two kinds of radionuclide labeling strategies, chelator-based and chelator-free radiolabeling, as well as their advantages and disadvantages, in order to provide assistance for the labeling of different nanocarriers with radioactive nuclides for nuclide diagnosis and treatment.
Improving the delivery efficiency of radioactive nuclides, increasing the sensitivity of obtaining lesion information, and enhancing the efficacy of tumor treatment based on nanomedicine strategies have become a hot research topic today. Different types of nanocarriers have been used as radioactive tracer, but radioactive labeling is still a key step. To ensure the labeling rate and stability of radionuclide-labeled nanocarriers, the most appropriate radiolabeling strategies are selected on the basis of the type of materials, radionuclides, and reaction conditions. The authors mainly reviewed the two kinds of radionuclide labeling strategies, chelator-based and chelator-free radiolabeling, as well as their advantages and disadvantages, in order to provide assistance for the labeling of different nanocarriers with radioactive nuclides for nuclide diagnosis and treatment.
2023, 47(3): 175-181.
doi: 10.3760/cma.j.cn121381-202204034-00266
Abstract:
Glutamine has the highest concentration of amino acid in plasma, and the growth and proliferation of tumor cells depend on glutamine and its intermediate metabolites, such as glutamate, lactate, proline, and ammonia. The growth rate of tumor cells is closely related to the intracellular concentrations of glutamine and glutamate, which play an important role in tumor metabolism. The mechanism of glutamate and glutamine analog PET imaging agents uptaked by tumor cells primarily involves amino acid transport and protein synthesis. Glutamate and glutamine analog PET imaging agents have advantages in the differential diagnosis of hepatocellular carcinoma, brain tumors, glioma, and many other tumors, which can compensate for some deficiencies of 18F-fluorodeoxyglucose PET imaging. This paper primarily reviews the research progress of glutamate and glutamine analog PET imaging agents.
Glutamine has the highest concentration of amino acid in plasma, and the growth and proliferation of tumor cells depend on glutamine and its intermediate metabolites, such as glutamate, lactate, proline, and ammonia. The growth rate of tumor cells is closely related to the intracellular concentrations of glutamine and glutamate, which play an important role in tumor metabolism. The mechanism of glutamate and glutamine analog PET imaging agents uptaked by tumor cells primarily involves amino acid transport and protein synthesis. Glutamate and glutamine analog PET imaging agents have advantages in the differential diagnosis of hepatocellular carcinoma, brain tumors, glioma, and many other tumors, which can compensate for some deficiencies of 18F-fluorodeoxyglucose PET imaging. This paper primarily reviews the research progress of glutamate and glutamine analog PET imaging agents.
2023, 47(3): 182-189.
doi: 10.3760/cma.j.cn121381-202204022-00281
Abstract:
Programmed cell death protein 1(PD-1)/programmed cell death ligand 1(PD-L1) is a pair of important immune checkpoint in tumor immunotherapy. PD-L1 expressed mainly in tumor cells and tumor-associated myeloid cells. The radionuclide-labeled molecular probe targeting PD-L1 can be detected by PET/CT and visualize PD-L1 expression at the molecular level, which is an important method to guide immunotherapy. PET probes targeting PD-L1 include antibodies, peptides, small molecules, and other probes, and some of them are currently used in clinical applications. This article reviews molecular probes targeting PD-L1 and their clinical applications.
Programmed cell death protein 1(PD-1)/programmed cell death ligand 1(PD-L1) is a pair of important immune checkpoint in tumor immunotherapy. PD-L1 expressed mainly in tumor cells and tumor-associated myeloid cells. The radionuclide-labeled molecular probe targeting PD-L1 can be detected by PET/CT and visualize PD-L1 expression at the molecular level, which is an important method to guide immunotherapy. PET probes targeting PD-L1 include antibodies, peptides, small molecules, and other probes, and some of them are currently used in clinical applications. This article reviews molecular probes targeting PD-L1 and their clinical applications.
2023, 47(3): 190-195.
doi: 10.3760/cma.j.cn121381-202209012-00279
Abstract:
Alzheimer disease (AD) is one of the most common neurodegenerative diseases in the elderly. The symptoms of AD begin with mild memory difficulties and gradually evolve into cognitive dysfunction, complex daily activity disorders and so on. At present, the early and differential diagnosis of AD are still challenging, and biomarkers such as beta amyloid protein (Aβ) and Tau protein play a more and more important role in the diagnosis of AD. This paper reviews the positron imaging agents related to the diagnosis of AD, in order to let more medical workers understand the new nuclear medical imaging technology, so as to make early diagnosis and treatment of AD and delay the deterioration of the disease.
Alzheimer disease (AD) is one of the most common neurodegenerative diseases in the elderly. The symptoms of AD begin with mild memory difficulties and gradually evolve into cognitive dysfunction, complex daily activity disorders and so on. At present, the early and differential diagnosis of AD are still challenging, and biomarkers such as beta amyloid protein (Aβ) and Tau protein play a more and more important role in the diagnosis of AD. This paper reviews the positron imaging agents related to the diagnosis of AD, in order to let more medical workers understand the new nuclear medical imaging technology, so as to make early diagnosis and treatment of AD and delay the deterioration of the disease.
2023, 47(3): 196-198.
doi: 10.3760/cma.j.cn121381-202208017-00276
Abstract:
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignant tumor originating from the skin. The author reported a patient with advanced MCC whose local lesions were treated with 125I seed implantation, evaluated the therapeutic efficacy by comparing 18F-FDG PET/CT images before and after treatment. The features of MCC were analyzed from clinical symptoms, imaging findings, treatment process and relevant literature reports, in order to deepen clinicians' understanding of MCC and provide a basis for the local use of 125I seed implantation in patients with advanced MCC.
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignant tumor originating from the skin. The author reported a patient with advanced MCC whose local lesions were treated with 125I seed implantation, evaluated the therapeutic efficacy by comparing 18F-FDG PET/CT images before and after treatment. The features of MCC were analyzed from clinical symptoms, imaging findings, treatment process and relevant literature reports, in order to deepen clinicians' understanding of MCC and provide a basis for the local use of 125I seed implantation in patients with advanced MCC.
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