2023 Vol. 47, No. 6
Display Method:
[PDF 11459KB]
2023, 47(6): 327-337.
doi: 10.3760/cma.j.cn121381-202301011-00310
Abstract:
Objective To investigate the value of 18F-fluorodeoxyglucose (FDG) PET/CT in the histopathological classification and prognosis of common primary gastric lymphoma (PGL) (diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma). Methods The clinical and imaging data of 83 patients with PGL who underwent 18F-FDG PET/CT at the Second Xiangya Hospital of Central South University from March 2015 to March 2022 were retrospectively analyzed. The patients included 39 males and 44 females aged 13–78 years old with a median age of 56 (48, 66) years. DLBCL (46 cases) and MALT lymphoma (37 cases) were classified in accordance with histopathological type to compare the clinical characteristics (sex, age, Lugano stage, B symptoms, lactate dehydrogenase level, international prognostic index (IPI), and cell proliferating nuclear antigen Ki-67 (Ki-67) level), imaging features (gastric wall thickness, gastric wall thickening type, lesion site, gastric wall morphology, and extragastric infiltration), and metabolic parameters (maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG)) and metabolic tumor volume (MTV)) of the two types of patients with PGL. Counting data were expressed as frequency and percentage, and comparison between groups was performed by using chi-square test or Fisher's exact probability method. Measurement data conforming to normal distribution were expressed as \begin{document}$\bar x\pm s $\end{document} ![]()
![]()
Results Patients with DLBCL were more likely to have perigastric invasion, luminal mass, antral involvement, multisite involvement, and the diffuse thickening of the gastric wall than those with MALT lymphoma (58.7% vs. 21.6%, 21.7% vs. 2.7%, 71.7% vs. 35.1%, 54.3% vs. 32.4%, 43.5% vs. 27.0%, χ2=3.99–11.56, all P<0.05). The gastric wall thickness, TLG, and SUVmax of patients with DLBCL were significantly higher than those of patients with MALT lymphoma, and their differences were statistically significant (20.5 (13.0, 32.3) vs. 12.0 (10.0, 16.5) mm, 603.2 (138.8, 1 971.0) g vs. 69.9 (22.3, 208.3) g, (23.4±11.5) vs. (6.6±3.9), Z=−3.72, −4.24, t=−9.30, all P<0.05). ROC curve analysis showed that SUVmax, TLG, and gastric wall thickness had significant differences in their diagnostic power for differentiating MALT lymphoma from DLBCL (AUC=0.915, 0.772, 0.738; all P<0.05). When the critical value was SUVmax=11.95, the sensitivity was 80.4% and the specificity was 91.9%. Kaplan-Meier survival analysis revealed that gastric wall thickness, SUVmax, TLG, and MTV were significantly correlated with PFS rate (χ2=6.98–12.71, all P<0.01). Age, Lugano stage, IPI, Ki-67, and diffuse thickening of the gastric wall were significantly correlated with PFS rate (χ2=4.31–15.11, all P<0.05). Univariate Cox regression analysis demonstrated that gastric wall thickness, SUVmax, TLG, and MTV were the risk factors of PFS time in patients with DLBCL, and the differences of these factors were statistically significant (HR=5.749–8.768, all P<0.05). The type of gastric wall thickening was a risk factor of PFS time in patients with MALT lymphoma, and its difference was statistically significant (HR=8.683, P=0.022). Multivariate Cox regression analysis revealed that SUVmax was an independent risk factor of PFS time in patients with DLBCL, and its difference was statistically significant (HR=9.317, P=0.047). Conclusions The 18F-FDG PET/CT imaging of DLBCL and MALT lymphoma has certain characteristics. 18F-FDG PET/CT metabolic parameters can not only distinguish DLBCL from MALT lymphoma, it can also predict the prognosis of patients with DLBCL.
2023, 47(6): 338-344.
doi: 10.3760/cma.j.cn121381-202210005-00313
Abstract:
Objective To analyze the value of SPECT/CT and iodine uptake rate in predicting response to the first 131I treatment of patients with differentiated thyroid carcinoma (DTC). Methods From January 2021 to January 2022, 138 postoperative patients with DTC who received 131I treatment for the first time in Suizhou Hospital, Hubei University of Medicine were retrospectively analyzed, including 36 males and 102 females aged (47.8±9.8) years. All patients underwent 131I whole-body scan and SPECT/CT imaging, determine the iodine uptake rate. After 131I treatment, the patients were followed up for at least 6 months to evaluate efficacy and response. The patients were divided into the excellent response (ER) group and non-ER group. Comparison of clinical data between the two groups select independent sample t-test, Mann Whitney U test, χ2 conduct analysis, and Logistic regression analysis were used to identify the predictors of the unsatisfactory response to the first 131I therapy in patients with DTC. In addition, the receiver operating characteristic (ROC) curve was used to obtain the best critical value, and the area under curve (AUC) was used to determine the predictive value of predictive factors on treatment response. Results The proportion of extraglandular invasion (63.89% vs. 36.27%); the proportion of tumor, node, metastasis (TNM) stages Ⅲ–Ⅳ (69.44% vs. 44.12%); the proportion of recurrence risk stratification medium/high risk (91.67% vs. 68.63%); preablation stimulated thyroglobulin (psTg) level before treatment (1.65 (0.90, 1.87) μg/L vs. 1.32 (0.65, 1.66) μg/L); and lymph node short diameter in the non-ER group ((6.33±2.01) mm vs. (4.52±1.43) mm) were higher than those in the ER group, and the thyroid-stimulating hormone (TSH) level (59.10 (35.32, 118.33) mU/L vs. 65.33 (42.41, 120.33) mU/L), and iodine uptake rate before treatment ((5.63±1.50)% vs. (8.65±2.33)%) were lower than those in the ER group, with statistically significant differences (t=5.314, 5.837; χ2=6.829–8.257; Z=4.683, 6.861; all P<0.05). Multivariate Logistic regression analysis showed the following predictive factors of the unsatisfactory response to the first 131I treatment after DTC operation: the level of TSH before treatment, the proportion of extraglandular invasion, the proportion of TNM stages Ⅲ–Ⅳ, the proportion of middle/high risk of recurrence risk stratification, the level of psTg, the short diameter of lymph nodes, and the iodine uptake rate (OR=1.941–4.545, all P<0.01). The ROC curve analysis results showed that the critical value of the maximum Yodon index of the short diameter of lymph nodes displayed by SPECT/CT was 5.52 mm, and the AUC that predicted the unsatisfactory response to the first 131I treatment of DTC was 0.766 (95%CI: 0.687–0.834). The critical value corresponding to the maximum Yodon index of the iodine uptake rate was 7.47%, with an AUC of 0.749 (95%CI: 0.669–0.819), and the AUC of the combination of the two is 0.911 (95%CI: 0.850–0.953). The AUC predicted by the two methods for the first 131I treatment response of DTC was higher than that predicted by the two methods alone, and the difference was statistically significant (P<0.001). Conclusion The short diameter of lymph nodes of SPECT/CT imaging and the iodine uptake rate are considered as predictors of dissatisfaction with the first 131I treatment effect to DTC, and such predictors are of great importance in predicting the response of 131I treatment. Furthermore, the combination of the two methods has a better predictive value.
2023, 47(6): 345-353.
doi: 10.3760/cma.j.cn121381-202204014-00275
Abstract:
Objective To investigate the potential application of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion-weighted imaging (DWI) in evaluating response to concurrent chemoradiotherapy (CCRT) in locally advanced esophageal carcinoma (EC). Methods The clinical data of 48 patients with locally advanced EC who were treated with CCRT at Jiangsu Cancer Hospital from February 2018 to June 2021 were retrospectively analyzed, including 24 males and 24 females, with an average age of (67.1±7.7) years. DCE-MRI and DWI-MRI were performed before and during CCRT (2–3 weeks). Patients were categorized into two groups, namely, the response group and non-response group, after 3 months of treatment in accordance with the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The quantitative parameters of DCE-MRI (Ktrans, Kep, and Ve) and the changes in parameters (ΔKtrans, ΔKep, and ΔVe), as well as the quantitative parameter of DWI-MRI (apparent diffusion coefficient (ADC)) and the changes in ADC (ΔADC), were calculated and compared by using the paired sample t-test and Wilcoxon rank sum test before and during CCRT of the two groups, respectively. The independent sample t-test and Mann-Whitney U test were used to evaluate the differences between the response group and non-response group. Moreover, univariate and multivariate Logistic regression analysis were used to analyze the potential prognostic factors. Receiver operating characteristic curve was used to evaluate the efficiency of the prediction model. Results A total of 48 patients were divided into two groups: 32 in the response group and 16 in the non-response group. Ktrans before the start of CCRT in the response group was significantly higher than that in the non-response group (0.42(0.33, 0.55) min−1 vs. 0.29(0.25, 0.42) min−1, Z=−2.909, P=0.007), whereas ADC before the start of CCRT ((1.42±0.38)×10−3 mm2/s vs. (1.14±0.21)×10−3 mm2/s), ADC during CCRT ((2.30±0.43)×10−3 mm2/s vs. (1.63±0.44)×10−3 mm2/s), and ΔADC ((0.86±0.39)×10−3 mm2/s vs. (0.45±0.49)×10−3 mm2/s) also showed a remarkable difference between the two groups (t=−3.244, −5.013, −3.068; all P<0.05). Univariate Logistic regression analysis showed that Ktrans before the start of CCRT (OR=1.093, 95%CI: 1.021–1.171), ΔKtrans (OR=0.968, 95%CI: 0.939–0.997), ADC before the start of CCRT (OR=18.304, 95%CI: 1.606–208.659), ADC during CCRT (OR=22.678, 95%CI: 3.920–131.211), and ΔADC (OR=9.996, 95%CI: 1.802–55.440) were the potential prognostic factors for effective early treatment. Multivariable Logistic regression analysis showed that ADC during CCRT could be the best parameter to evaluate treatment performance (95%CI: 1.331–81.220, AUC=0.892, P=0.026). Conclusion The combination of DCE-MRI and DWI-MRI can be used in predicting response to CCRT in locally advanced EC.
2023, 47(6): 354-361.
doi: 10.3760/cma.j.cn121381-202207013-00309
Abstract:
Objective Aims to investigate the protective effects of Vitex trifolia L. extracts on hematopoietic radiation injury in mice. Methods (1) For in vitro analysis, bone marrow cells were flushed and divided into control group, Vitex trifolia L. group, radiation group, and Vitex trifolia L.+radiation group. The concentrations of Vitex trifolia L. were 0.01 and 0.001 mg/mL in the V. trifolia L. group and 0.001 mg/mL in the Vitex trifolia L.+radiation group. Cells in the radiation group and Vitex trifolia L.+radiation group were irradiated with 1 Gy. Cell viability was detected by microplate reader, reactive oxygen species (ROS) level was detected by fluorescein isothiocyanate (FITC) channel, and apoptosis level was detected by FITC and phycoerythrin (PE) channels. (2) For in vivo analysis, 15 male C57BL/6 mice were divided by simple random sampling into the following groups: control group (n=5), radiation group (n=5), and Vitex trifolia L.+radiation group (ig, 400 mg/kg/day, 7 times, n=5). Mice in the control group were sham irradiated (0 Gy). Mice in the radiation group and the Vitex trifolia L.+radiation group were total body irradiated with a single dose of 2 Gy. The extract of Vitex trifolia L. was prepared with dimethyl sulfoxide to make a solution of 500 mg/mL and diluted with normal saline before gavage. Mice in the Vitex trifolia L.+radiation group were given 0.2 mL of Vitex trifolia L. extract (400 mg/kg) for 7 days before irradiation. Mice were sacrificed 10 days after irradiation. Peripheral blood and bone marrow nucleated cells (BMNC) were counted by automatic hematology analyzer. The number and percentage of hematopoietic stem progenitor cells and the levels of ROS, human phosphorylated histone H2A variants (γH2AX), and phosphorylated p38 (pp38) expression in bone marrow hematopoietic cells were analyzed by flow cytometry. Independent sample t test (homogeneity of variance) was used to compare measured data with normal distribution between two groups. Results The viability of bone marrow cells in the Vitex trifolia L. (0.001 mg/mL)+radiation group increased (585 485.00±37 335.80), the ROS level decreased (12 260.67±232.34), and the percentage of apoptosis significantly decreased ((28.97±0.32)%) compared with those in the radiation group ((460 384.55±53 786.37, 17 969.67±467.24, and (35.33±0.35)%, respectively)). The differences were all statistically significant (t=4.245, 18.950, 23.161, respectively; all P<0.01). The following parameters increased in comparison with the radiation group: bone marrow nucleated cells count ((23.34±3.01)×106/mouse vs. (16.73±2.57) ×106/mouse), white blood cell count ((2.80±0.35)×109/L vs. (2.21±0.24)×109/L), red blood cell count ((10.54±0.51)×1012/L vs. (9.68±0.26)×1012/L), platelet count ((339.80±49.42)×109/L vs. (289.40±54.08)×109/L), and hemoglobin content ((139.20±3.66) g/L vs. (129.20±3.87) g/L) (t=2.582, 2.824, 2.999, 1.376, 9.739, respectively; all P<0.01). The number and percentage of hematopoietic progenitor cells ((34916.03±697.36)/mouse vs. (26388.04±241.78)/mouse; (29.83±4.32)% vs. (22.76±2.20)%) and the number of hematopoietic stem cells ((2 074.00±23.12)/mouse vs.(929.40±166.52)/mouse) increased in the Vitex trifolia L.+radiation group compared with those in the radiation group, and the differences were statistically significant (t=5.423, 9.171, 3.175, respectively; all P<0.01). The levles of ROS in the hematopoietic stem cells decreased ((7 750.20±589.05) vs. (8 515.20±1 036.46), (9 360.20±831.97) vs. (10 291.40±767.57)) in the Vitex trifolia L.+radiation group compared with those in the radiation group, and the differences was not statistically significant (t=1.435, 1.839; P=0.189, 0.103). The expression of γH2AX in hematopoietic stem cells significantly decreased ((693.20±4.82) vs. (751.60±32.72), t=3.064, P<0.05). The expression of pp38 in the hematopoietic stem progenitor cells of Vitex trifolia L.+radiation group decreased compared with that in the radiation group (1181.20±11.28 vs. 1183.60±49.70, 1411.20±50.25 vs. 1424.40±80.95), but the difference was not statistically significant (t=0.105, 0.765; P=0.014, 0.310). Conclusion Vitex trifolia L. extracts can reduce oxidative stress and inhibit DNA damage in hematopoietic stem cells to achieve radiation protection.
2023, 47(6): 362-366.
doi: 10.3760/cma.j.cn121381-202207012-00299
Abstract:
Cell adhesion factor integrin αvβ3 is highly expressed in the surface of neovascularization endothelial cells and cells of many kinds of tumors, including gliomas, while it is low or not expressed in the surface of normal cells. Arginine-glycine-aspartic acid (RGD) peptides can specifically bind to integrin αvβ3. Radionuclide-labeled RGD peptide has become the research focus of targeted imaging of glioma. RGD PET imaging has certain value in the diagnosis and curative effect monitoring of glioma. Based on this, this article reviews the application of RGD PET imaging in the diagnosis and treatment of glioma.
Cell adhesion factor integrin αvβ3 is highly expressed in the surface of neovascularization endothelial cells and cells of many kinds of tumors, including gliomas, while it is low or not expressed in the surface of normal cells. Arginine-glycine-aspartic acid (RGD) peptides can specifically bind to integrin αvβ3. Radionuclide-labeled RGD peptide has become the research focus of targeted imaging of glioma. RGD PET imaging has certain value in the diagnosis and curative effect monitoring of glioma. Based on this, this article reviews the application of RGD PET imaging in the diagnosis and treatment of glioma.
2023, 47(6): 367-371.
doi: 10.3760/cma.j.cn121381-202207020-00289
Abstract:
The purpose of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is to save dying myocardium as much as possible. The amount of myocardial salvage (MS) is closely related to whether the patients benefit from the PCI. MS is of great value for PCI efficacy evaluation and prognosis. To assess MS, the initial myocardial area at risk (AAR) before PCI and the final infarction size (FIS) after PCI should be determined, and the difference between the two is called MS. AAR and FIS can be quantified by double 99Tcm-methoxy-isobutyl-isonitrile gated SPECT myocardial perfusion imaging (GSMPI) on emergency admission and after PCI, respectively. The results are objective and accurate, and its clinical value has been confirmed in early large sample studies. However, emergency GSMPI has many limitations that make AAR difficult to obtain. In recent years, some scholars proposed that the only one GSMPI method early after PCI could replace double imaging method for MS evaluation, which significantly improved the feasibility and expanded the application extent of GSMPI in the diagnosis and treatment of AMI, and provided supplementary information for risk stratification in patients with AMI. The principle, application value, advantages and development prospect of the new method for evaluating MS in AMI patients are reviewed by authors.
The purpose of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is to save dying myocardium as much as possible. The amount of myocardial salvage (MS) is closely related to whether the patients benefit from the PCI. MS is of great value for PCI efficacy evaluation and prognosis. To assess MS, the initial myocardial area at risk (AAR) before PCI and the final infarction size (FIS) after PCI should be determined, and the difference between the two is called MS. AAR and FIS can be quantified by double 99Tcm-methoxy-isobutyl-isonitrile gated SPECT myocardial perfusion imaging (GSMPI) on emergency admission and after PCI, respectively. The results are objective and accurate, and its clinical value has been confirmed in early large sample studies. However, emergency GSMPI has many limitations that make AAR difficult to obtain. In recent years, some scholars proposed that the only one GSMPI method early after PCI could replace double imaging method for MS evaluation, which significantly improved the feasibility and expanded the application extent of GSMPI in the diagnosis and treatment of AMI, and provided supplementary information for risk stratification in patients with AMI. The principle, application value, advantages and development prospect of the new method for evaluating MS in AMI patients are reviewed by authors.
2023, 47(6): 372-377.
doi: 10.3760/cma.j.cn121381-202208014-00308
Abstract:
Amyloidosis is the accumulation of amyloid in the cells of various organs in the body caused by various reasons, resulting in the gradual failure of the affected organs. When amyloid affects the heart, known as cardiac amyloidosis (CA), the prognosis is the worst. In CA, transthyretin amyloidosis and immunoglobulin light chain amyloidosis are the most common, and there are huge differences in the median survival time and treatment methods of the two. Therefore, early diagnosis and accurate classification are crucial for the treatment of such patients. Nuclear medicine imaging can non-invasively diagnose and accurately classify CA, and has been widely used in clinical practice. This article reviews the recent progress of nuclear medicine imaging in CA to improve clinicians' understanding of CA and facilitate early diagnosis of CA.
Amyloidosis is the accumulation of amyloid in the cells of various organs in the body caused by various reasons, resulting in the gradual failure of the affected organs. When amyloid affects the heart, known as cardiac amyloidosis (CA), the prognosis is the worst. In CA, transthyretin amyloidosis and immunoglobulin light chain amyloidosis are the most common, and there are huge differences in the median survival time and treatment methods of the two. Therefore, early diagnosis and accurate classification are crucial for the treatment of such patients. Nuclear medicine imaging can non-invasively diagnose and accurately classify CA, and has been widely used in clinical practice. This article reviews the recent progress of nuclear medicine imaging in CA to improve clinicians' understanding of CA and facilitate early diagnosis of CA.
2023, 47(6): 378-383.
doi: 10.3760/cma.j.cn121381-202204036-00287
Abstract:
Oncolytic virus can recruit and activate immune cells against tumor cells without damaging normal cells, thus to infect and destroy the target cells and the tumor vascular system. The transformed oncolytic virus can selectively replicate and express reporter genes in tumor cells, which has attracted more and more attention in oncology field. Currently, many studies are committed to optimizing the traceability of oncolytic virus replication, via noninvasive and continuous identification of virus targeting tumor and measuring the level of virus infection, to provide safe and effective information by molecular imaging. This real-time tracking will provide useful virus dose and administration schedule information for optimizing treatment and avoid repeated biopsies. In addition, molecular imaging of oncolytic virus therapy can provide a more sensitive and specific diagnostic technique to detect the origin and metastasis of tumor. Imaging methods for tracking virus replication mainly include optical imaging and deep tissue imaging. Authors summarize the progress of oncolytic virus imaging methods in recent years, ploting the advantage and deficiency of each imaging method.
Oncolytic virus can recruit and activate immune cells against tumor cells without damaging normal cells, thus to infect and destroy the target cells and the tumor vascular system. The transformed oncolytic virus can selectively replicate and express reporter genes in tumor cells, which has attracted more and more attention in oncology field. Currently, many studies are committed to optimizing the traceability of oncolytic virus replication, via noninvasive and continuous identification of virus targeting tumor and measuring the level of virus infection, to provide safe and effective information by molecular imaging. This real-time tracking will provide useful virus dose and administration schedule information for optimizing treatment and avoid repeated biopsies. In addition, molecular imaging of oncolytic virus therapy can provide a more sensitive and specific diagnostic technique to detect the origin and metastasis of tumor. Imaging methods for tracking virus replication mainly include optical imaging and deep tissue imaging. Authors summarize the progress of oncolytic virus imaging methods in recent years, ploting the advantage and deficiency of each imaging method.
2023, 47(6): 384-390.
doi: 10.3760/cma.j.cn121381-202207011-00311
Abstract:
The removal of skin contamination from radioactive nuclides is a key measure to prevent further harm to the human body. Based on the strategies for removing skin contamination from radioactive nuclides at home and abroad, the authors summarize the currently available and under research decontaminating agent of radionuclides from skin, including several aspects such as chitosan derivatives, organic phosphates, polymer, organic skeleton materials, which have the potential to become candidate formulations for the removal of skin contamination from radioactive nuclides. The aim is to provide reference for future research on new formulations for the removal of skin contamination from radioactive nuclides.
The removal of skin contamination from radioactive nuclides is a key measure to prevent further harm to the human body. Based on the strategies for removing skin contamination from radioactive nuclides at home and abroad, the authors summarize the currently available and under research decontaminating agent of radionuclides from skin, including several aspects such as chitosan derivatives, organic phosphates, polymer, organic skeleton materials, which have the potential to become candidate formulations for the removal of skin contamination from radioactive nuclides. The aim is to provide reference for future research on new formulations for the removal of skin contamination from radioactive nuclides.
Submit
Author Login
Referees
Editor-in-Chief
Editor Center
Email alert
RSS
