2023 Vol. 47, No. 5
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2023, 47(5): 1-4.
Abstract:
2023, 47(5): 265-273.
doi: 10.3760/cma.j.cn121381-202212002-00302
Abstract:
Objective To investigate the predictive accuracies of four indicators based on the interim 18F-fluorodeoxyglucose (FDG) PET/CT in terms of their efficacy and prognoses in patients with extranodal diffuse large B-cell lymphoma (EN-DLBCL). Methods Data of a total of seventy-seven newly diagnosed patients (35 males, 42 females; aged (62.7±16.2) years) with EN-DLBCL confirmed by histopathological examination or follow-up results were retrospectively analyzed from May 2011 to April 2020, including baseline PET/CT before treatment, interim PET/CT during initial chemotherapy for 3 to 4 cycles, and clinical data. Follow-up was performed through the hospital's electronic medical record system or phone call. Using the receiver operating characteristic (ROC) curve to select the optimal cutoff value for interim SUVmax, patients were divided into SUVmax < the cutoff value group and ≥ the cutoff group. Following the clinical practice guideline of 18F-FDG PET/CT and PET/MR in lymphoma (2021 edition), ΔSUVmax=70% was chosen as the cutoff value, patients were divided into ΔSUVmax%<70% group and ≥70% group. Based on the Deauville five-point scale, patients were divided into 1–3 group and 4–5 group. According to the Lugano classification criteria, patients were divided into the disease remission group and unrelieved group based on the interim response evaluation. The χ2 test, Kaplan-Meier, and Cox regression analysis were performed to analyze SUVmax, Deauville five-point scale, and the Lugano classification criteria based on interim PET/CT and ΔSUVmax% between baseline PET and interim PET in order to predict the efficacy of primary chemotherapy and prognosis of EN-DLBCL. Results (1) At the end of primary chemotherapy, 51 patients (66.2%) achieved complete remission (CR). The rates of CR in SUVmax<4.9 group and Deauville scores 1–3 group were 82.6% (38/46) and 85.0% (34/40), respectively, which were significantly higher than those of the other corresponding groups (χ2=13.699, 13.108, both P<0.001). No significant difference was found between the rates of CR of patients grouped by ΔSUVmax70% or the interim response evaluation based on the Lugano classification criteria (χ2=0.018, 0.368, both P>0.05). (2) The median follow-up time was 24 (4–105) months. In addition, 19 patients (24.7%) progressed, relapsed, or died at the end of follow-up. Patients in the SUVmax<4.9 group, Deauville scores 1–3 group, or remission group assessed by the Lugano classification criteria had significantly higher 2-year progression-free survival (PFS) than those in the other corresponding groups (χ2=6.148, 4.586, and 4.765, all P<0.05). The 2-year overall survival (OS) of the remission group was significantly higher than that of the nonremission group (χ2=7.248, P=0.007). No significant difference was found in the PFS or OS between patients grouped by ΔSUVmax70% (χ2=0.051, 3.331, both P>0.05). Furthermore, multivariate COX analysis confirmed that Lugano classification criteria and International Prognosis Index were independent predictors of PFS (HR=12.179, 14.330, P=0.015, 0.005) and OS (HR=8.645, 8.903, P=0.008, 0.041) in EN-DLBCL patients. Conclusion Among the four assessment indicators of interim PET/CT in patients with EN-DLBCL, the interim SUVmax<4.9 and the Deauville scores 1–3 were the better indicators for predicting CR at the end of primary chemotherapy, whereas the interim Lugano classification criteria can be considered an independent predictive factor of PFS and OS.
2023, 47(5): 274-280.
doi: 10.3760/cma.j.cn121381-202211008-00305
Abstract:
Objective To investigate the predictive values of 18F-fluorodeoxyglucose (FDG) PET/CT in patients with incidental focal colorectal FDG uptake in diagnosing early colorectal adenocarcinoma and advanced adenomas by comparing such values with colonoscopic and histopathologic findings. Methods Fifty-six patients (31 males and 25 females, aged (66±11) years, range 38–84 years) were retrospectively enrolled for the study. These patients underwent 18F-FDG PET/CT for noncolorectal lesions with incidental focal colorectal FDG uptake in Beijing Hospital between January 2016 and June 2020. Taking the results of colonoscopy and histopathology within 3 months after 18F-FDG PET/CT examination as the final diagnostic criteria, the predictive values of 18F-FDG PET/CT for early colorectal adenocarcinoma and advanced adenoma were analyzed. The normally distributed measurement data were compared between two groups using independent sample t-test (with equal variance) and among multiple groups using analysis of variance. Skewed distribution measurement data were compared between these two groups using Mann-Whitney test, whereas those for multiple groups were compared using the Kruskal-Wallis test. Rate enumeration data were also compared using the Chi-square test. Furthermore, the receiver operating characteristic (ROC) curve was delineated to analyze the diagnostic efficacy and optimal diagnostic threshold of maximum standardized uptake value (SUVmax) for diagnosing early colorectal adenocarcinoma and advanced adenomas. Results Fifty-six patients were enrolled in this study. A total of 74 incidental colorectal 18F-FDG uptake foci were found, while colonoscopy revealed 140 lesions. Among 74 incidental colorectal 18F-FDG uptake foci, 59 and 15 foci were found to be positive and negative, respectively, during colonoscopy. Among 59 positive colonoscopic findings, 69.5%(41/59) were early colorectal adenocarcinoma (n=7) and advanced adenomas (n=34). Among 81 lesions that were considered missed diagnoses via 18F-FDG PET/CT, 55.6% were nonadvanced adenomas (n=45) and 27.2% were nonadenomatous polyps (n=22). The sensitivities of 18F-FDG PET/CT in nonadenomatous polyps, nonadvanced adenomas, advanced adenomas, and early colorectal adenocarcinoma were 26.7% (8/30), 10.0% (5/50), 72.3% (34/47), and 100% (7/7), respectively (χ2=35.09, P<0.001). The positive predictive value of 18F-FDG PET/CT in early colorectal adenocarcinoma and advanced adenomas was 55.4% (41/74). In terms of the ROC analysis, the optimal cut-off value of SUVmax for diagnosing early colorectal adenocarcinoma and advanced adenomas was 11.6. Conclusions In this study, 18F-FDG PET/CT showed high positive predictive value and sensitivity in diagnosing early colorectal adenocarcinoma and advanced adenomas. According to the findings, follow-up colonoscopy is needed, especially in incidental focal colorectal 18F-FDG uptake lesions with high SUVmax.
2023, 47(5): 281-288.
doi: 10.3760/cma.j.cn121381-202301001-00304
Abstract:
Objective To evaluate the diagnostic efficiency of 99Tcm-sodium toluene sulfonate nicotinamide hydrazone PEGylated bicyclic arginine-glycine-aspatic acid peptide (abbreviation 99Tcm-3PRGD2) SPECT/CT imaging to progressive radioiodine refractory differentiated thyroid cancer (RAIR-DTC) without iodine uptake. Methods A total of 59 patients with RAIR-DTC who underwent 99Tcm-3PRGD2 SPECT/CT examination in Fujian Provincial Hospital from October 2019 to May 2022 were prospectively selected, including 17 males and 42 females, with a median age of 51 (28, 80) years. All patients underwent 99Tcm-3PRGD2 SPECT/CT, among them, 22 patients were treated with a tyrosine kinase inhibitor (TKI), and 37 patients had thyroid-stimulating hormone (TSH) inhibition [13 patients underwent 18F-fluorodeoxyglucose (FDG) PET/CT within two weeks]. Maximum standardized uptake value (SUVmax) of the lesion with the largest-length diameter in each patient was analyzed. The diagnostic efficiency of 99Tcm-3PRGD2 SPECT/CT imaging was evaluated by receiver operating characteristic (ROC) curves analysis and was also used to calculate the SUVmax cut-off value of 99Tcm-3PRGD2 SPECT/CT to assist in the detection of RAIR-DTC lesions. Using Pearson correlation analysis method to analyze the correlations between the target lesion (TL), stimulated thyroglobulin (sTg) levels and SUVmax. The relationships between the sTg levels, SUVmax and TL in RAIR-DTC patients before and after TKI treatment were analyzed by paired t test. Results A total of 276 lesions from 59 RAIR-DTC patients were included in the analysis. These 59 lesions were compared before and after TKI treatment. The sensitivity and specificity of 99Tcm-3PRGD2 SPECT/CT imaging for the diagnosis of RAIR-DTC lesions were 94.9% (95%CI: 90.7%–97.3%) and 88.7% (95%CI: 77.5%–95.0%), respectively. The ROC curves results showed that the cut-off value of SUVmax for RAIR-DTC lesions detected by 99Tcm-3PRGD2 SPECT/CT imaging was 2.70. The results of the Pearson correlation analysis showed that the SUVmax of the target lesions was positively correlated with the sTg levels and TL (r=0.811, 0.635, both P=0.001). The paired t test results showed that SUVmax in RAIR-DTC lesions was significantly decreased before and after TKI treatment (t=11.027, P=0.001). Spearman correlation analysis showed that there was a positive correlation between 99Tcm-3PRGD2 SPECT/CT imaging and 18F-FDG PET/CT imaging in detecting SUVmax of positive lesions (r=0.560, P=0.001). However, the results of ROC curves analysis did not show statistical significance in the diagnostic efficiency of 99Tcm-3PRGD2 SPECT/CT imaging for RAIR-DTC lesions versus 18F-FDG PET/CT imaging (Z=0.312, P=0.753). Conclusion 99Tcm-3PRGD2 SPECT/CT imaging had high sensitivity and specificity in the diagnosis of progressive RAIR-DTC without iodine uptake, similar to 18F-FDG PET/CT.
2023, 47(5): 289-294.
doi: 10.3760/cma.j.cn121381-202208003-00300
Abstract:
Objective To investigate the inhibitory effect of 90Y-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-Tyr (3)-octreotide (DOTATOC) on the human pancreatic neuroendocrine tumor cell line BON-1. Methods (1) DOTATOC was labeled with 90Y, and then purified it. (2) The stability of 90Y-DOTATOC was investigated in vitro. (3) The thiazole blue method was used to examine the inhibitory effects of 90Y, DOTATOC, and 90Y-DOTATOC on human pancreatic neuroendocrine tumor cell BON-1 and human pancreatic cholangioma cell PANC-1, and then the cell proliferation inhibition rate was calculated. Negative control group, positive control group (Vincristine, 50 μmol/L), DOTATOC group (25 μmol/L), 90Y group (1.8 MBq/ml), 90Y-DOTATOC high-dose group (90Y dose was 1.8 MBq/ml, DOTATOC concentration was 25 μmol/L), 90Y-DOTATOC medium dose group (90Y dose was 0.37 MBq/ml, DOTATOC concentration was 25 μmol/L), 90Y-DOTATOC low-dose group (90Y dose was 0.074 MBq/ml, DOTATOC concentration was 25 μmol/L) were set up. Independent sample t-test was used for inter group comparison. Result (1) The labeling rate of the DOTATOC labeled with 90Y was (61.93±3.53)%. Its radiochemical purity was (98.88±0.38)%, its radioactive concentration was 4.6 MBq/ml, and its specific activity was 1.6 GBq/μmol. (2) The radiochemical purity of 90Y-DOTATOC after being placed in physiological saline and 10% bovine serum for 7 days was 97.73% and 97.02%, respectively. (3) After 24 h and 48 h of drug addition, the inhibitory effect of the DOTATOC group on BON-1 cells was significantly increased compared with that of the negative group, and the difference was statistically significant (t=2.654, 3.981, all P<0.05). After 24 h and 48 h of drug addition, the inhibitory effects of the high and medium 90Y-DOTATOC dose groups on BON-1 and PANC-1 cells were superior to that of the DOTATOC group, and the difference was statistically significant (t=2.267–3.852, all P<0.05). After 24 h and 48 h of drug addition, the inhibitory effects of the pure 90Y group on PANC-1 and BON-1 cells were significantly lower than that of the high-dose 90Y-DOTATOC group, and the difference was statistically significant (t=2.698–3.180, all P<0.05). Conclusion 90Y-DOTATOC exerts a strong inhibitory effect on BON-1 tumor cells and is dose-dependent on 90Y dosage. Compared with using DOTATOC or 90Y alone, 90Y-DOTATOC exhibits better inhibitory effect on BON-1 tumor cells.
2023, 47(5): 295-301.
doi: 10.3760/cma.j.cn121381-202302029-00307
Abstract:
Stomach neoplasm is one of the most common malignant tumor of the digestive system, with a poor prognosis. Accurate qualitative diagnosis and staging are of great value for the formulation of treatment plans for gastric cancer. Radionuclide imaging such as PET/CT or PET/MR can perform in vivo imaging of tumors at the molecular or cellular level, thereby providing important information in the diagnosis, staging, restaging and therapeutic efficacy evaluation of gastric cancer. As some limitations of the conventional positron tracer 18F-FDG in gastric cancer applications still exist, a variety of novel molecular probes have been developed for gastric cancer diagnosis. In this paper, the current clinical application and research progress of PET/CT molecular imaging probes in the diagnosis of gastric cancer are reviewed.
Stomach neoplasm is one of the most common malignant tumor of the digestive system, with a poor prognosis. Accurate qualitative diagnosis and staging are of great value for the formulation of treatment plans for gastric cancer. Radionuclide imaging such as PET/CT or PET/MR can perform in vivo imaging of tumors at the molecular or cellular level, thereby providing important information in the diagnosis, staging, restaging and therapeutic efficacy evaluation of gastric cancer. As some limitations of the conventional positron tracer 18F-FDG in gastric cancer applications still exist, a variety of novel molecular probes have been developed for gastric cancer diagnosis. In this paper, the current clinical application and research progress of PET/CT molecular imaging probes in the diagnosis of gastric cancer are reviewed.
2023, 47(5): 302-307.
doi: 10.3760/cma.j.cn121381-202206010-00290
Abstract:
Chimeric antigen receptor T cell (CAR-T) therapy is a novel adoptive cell therapy, and has received extensive attention in the field of tumor therapy in recent years, especially in the treatment of hematological tumors, such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma. However, its application in solid tumors is limited because of the complex tumor microenvironment and target specificity. Molecular imaging based on radionuclides can better realize the visualization and therapeutic monitoring of CAR-T cells, and reflect the functional information and immune status of CAR-T cells, which has important guiding significance for the prediction and safety evaluation of CAR-T cells. This review will systematically introduce the latest advances in the application of radionuclide based molecular imaging strategies in CAR-T therapy.
Chimeric antigen receptor T cell (CAR-T) therapy is a novel adoptive cell therapy, and has received extensive attention in the field of tumor therapy in recent years, especially in the treatment of hematological tumors, such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma. However, its application in solid tumors is limited because of the complex tumor microenvironment and target specificity. Molecular imaging based on radionuclides can better realize the visualization and therapeutic monitoring of CAR-T cells, and reflect the functional information and immune status of CAR-T cells, which has important guiding significance for the prediction and safety evaluation of CAR-T cells. This review will systematically introduce the latest advances in the application of radionuclide based molecular imaging strategies in CAR-T therapy.
2023, 47(5): 308-313.
doi: 10.3760/cma.j.cn121381-202210009-00301
Abstract:
Emphysema is one of the frequent co-morbidities in many lung diseases, and the occurrence, progression, prognosis, and individual therapy of pulmonary diseases all greatly depend on the objective quantitative evaluation of its distribution type and severity by imaging examination. The authors review the existing imaging evaluation methods, the application of machine learning and artificial intelligence, low-dose CT evaluation, and the application progress of new technologies in order to provide a basis for the quantitative evaluation of emphysema.
Emphysema is one of the frequent co-morbidities in many lung diseases, and the occurrence, progression, prognosis, and individual therapy of pulmonary diseases all greatly depend on the objective quantitative evaluation of its distribution type and severity by imaging examination. The authors review the existing imaging evaluation methods, the application of machine learning and artificial intelligence, low-dose CT evaluation, and the application progress of new technologies in order to provide a basis for the quantitative evaluation of emphysema.
2023, 47(5): 314-320.
doi: 10.3760/cma.j.cn121381-202207021-00292
Abstract:
Plutonium emits α particles, which is one of the main occupational hazard factors for workers in nuclear fuel reprocessing. When evaluating the detriment of internal exposure caused by plutonium entering the body and the effect of decorporation, it is necessary to estimate the internal irradiation dose. The identification of the transfer and metabolism of plutonium in vivo is the basis for the estimation of internal exposure dose. In this paper, the current models related to plutonium transfer metabolism and their studies are reviewed, in order to provide reference for biokinetic research on plutonium.
Plutonium emits α particles, which is one of the main occupational hazard factors for workers in nuclear fuel reprocessing. When evaluating the detriment of internal exposure caused by plutonium entering the body and the effect of decorporation, it is necessary to estimate the internal irradiation dose. The identification of the transfer and metabolism of plutonium in vivo is the basis for the estimation of internal exposure dose. In this paper, the current models related to plutonium transfer metabolism and their studies are reviewed, in order to provide reference for biokinetic research on plutonium.
2023, 47(5): 321-323.
doi: 10.3760/cma.j.cn121381-202206016-00306
Abstract:
The authors reported a case of nodular fasciitis (NF) misdiagnosed as recurrence of Hodgkin's lymphoma (HL). The patient developed HL more than 2 years ago. This time the disease presents as a painful mass on the left shoulder, MRI and PET/CT examinations indicated the possibility of HL recurrence, and the pathological result of puncture confirmed NF. The authors analyzed the imaging and pathological features of NF and reviewed the relevant literature in order to share the experience in 18F-FDG PET/CT diagnosis of this type of cases.
The authors reported a case of nodular fasciitis (NF) misdiagnosed as recurrence of Hodgkin's lymphoma (HL). The patient developed HL more than 2 years ago. This time the disease presents as a painful mass on the left shoulder, MRI and PET/CT examinations indicated the possibility of HL recurrence, and the pathological result of puncture confirmed NF. The authors analyzed the imaging and pathological features of NF and reviewed the relevant literature in order to share the experience in 18F-FDG PET/CT diagnosis of this type of cases.
2023, 47(5): 324-326.
doi: 10.3760/cma.j.cn121381-202211002-00303
Abstract:
The authors reported a rare case of radiation bronchitis after radiotherapy of left lung squamous cell carcinoma. The case was confirmed by electronic Bronchoscopy and treated by interventional bronchoscopy. The authors analyzed the influencing factors of radiation bronchitis, endoscopic diagnosis and treatment, and reviewed the literature. Through the treatment of this case, the authors hoped to share experience in endoscopic diagnosis and treatment of this type of case.
The authors reported a rare case of radiation bronchitis after radiotherapy of left lung squamous cell carcinoma. The case was confirmed by electronic Bronchoscopy and treated by interventional bronchoscopy. The authors analyzed the influencing factors of radiation bronchitis, endoscopic diagnosis and treatment, and reviewed the literature. Through the treatment of this case, the authors hoped to share experience in endoscopic diagnosis and treatment of this type of case.
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