2023 Vol. 47, No. 7
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2023, 47(7): 391-398.
doi: 10.3760/cma.j.cn121381-202301013-00322
Abstract:
Objective To analyze the correlation and difference of biventricular function from planar gated equilibrium radionuclide angiography with conventional sodium iodide SPECT (NaI-SPECT planar imaging) and tomographic gated equilibrium radionuclide angiography with cadmium zinc telluride SPECT (CZT-SPECT tomographic imaging), and reconstructed-planar imaging from CZT-SPECT tomographic imaging (CZT-SPECT re-planar imaging) to investigate the methodology and advantages of CZT-SPECT tomographic imaging. Methods A retrospective analysis was performed on 58 patients (38 males and 20 females aged (60.6±12.3) years), who underwent gated equilibrium radionuclide angiography in TEDA International Cardiovascular Hospital from August 2021 to November 2022. All patients were subjected to NaI-SPECT planar imaging and CZT-SPECT tomographic imaging on the same day. CZT-SPECT tomographic imaging data were reprocessed in re-planar form and at different acquisition times. The left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) of NaI-SPECT planar imaging (P), CZT-SPECT tomographic imaging (T), and CZT-SPECT re-planar imaging (re) were compared and analyzed, and the CZT-SPECT tomographic imaging acquisition data at 3, 4, and 5 min were reconstructed. The LVEF (3 min), LVEF (4 min), LVEF (5 min), and RVEF (3 min), RVEF (4 min), RVEF (5 min) were compared with the original acquisition data LVEF (10 min) and RVEF (10 min), respectively. Divide LVEF (10 min) and RVEF (10 min) into subgroups of ≥20%, ≥30%, ≥40%, and ≥50%, and analyze them separately with the reconstructed data mentioned above. Paired t-test (or Wilcoxon signed rank test) and Pearson (or Spearman) were used in analyzing differences and correlations among the data. Results The differences among LVEF (re) (30.50% (20.00%, 38.50%)), LVEF (P) (31.00% (22.00%, 41.00%)), and LVEF (T) (27.00% (19.75%, 38.50%)) were statistically significant (Z=−2.645, −3.065; both P<0.05), whereas the differences between LVEF (re) and LVEF (P) were not statistically significant (Z=−1.057; P>0.05). No significant difference was found among RVEF (P) (39.78%±12.16%), RVEF (T) (41.57%±15.18%) and RVEF (re) (40.88%±13.19%; t=−1.949, −1.721, 0.883; all P>0.05). The LVEF and RVEF correlations obtained by the three imaging methods were excellent (r=0.892–0.946; all P<0.001). The differences between LVEF (3 min), LVEF (4 min), LVEF (5 min), and LVEF (10 min), and between RVEF (3 min), RVEF (4 min), RVEF (5 min), and RVEF (10 min) were statistically significant (Z=−2.798, −3.288, and −3.995; t=−2.187, −3.976, and −5.154; all P<0.05), and the correlations were excellent (r=0.903–0.970; all P<0.001). Subgroup analysis showed no significant difference between LVEF (5 min) and LVEF (10 min) and between RVEF (5 min) and RVEF (10 min) in all subgroups, except the LVEF≥20% subgroup (Z=−1.853 to −1.158; t=−1.804, −0.132; all P>0.05). Conclusions CZT-SPECT tomographic imaging can obtain planar datasets through reconstruction. Owing to its acquisition performance, CZT-SPECT tomographic imaging can further reduce the radiation dose or time for examination while obtaining reliable data for postprocessing and accurate measurement results.
2023, 47(7): 399-405.
doi: 10.3760/cma.j.cn121381-202206002-00323
Abstract:
Objective To explore 18F-flurodexyglucose (FDG) PET/CT dual-phase imaging characteristics of reactive lymphoid hyperplasia (RLH) of the liver. Methods The clinical and imaging data of 7 patients with liver RLH diagnosed by 18F-FDG PET/CT dual-phase imaging in Zhongshan Hospital Affiliated with Fudan University from September 2016 to July 2021 were analyzed retrospectively. The patients comprised 2 males and 5 females, aged (60.4±3.7) years. The 18F-FDG PET/CT imaging findings of the lesions were observed. The length and diameter of the lesions, CT values of the lesions and the adjacent liver, maximum standardized uptake value (SUVmax), liver background SUVmax, and retention index (RI) were measured and calculated. The measurement data in accordance with normal distribution were compared by two independent sample t-test. Results Among the 7 patients with liver RLH, 71.4% (5/7) patients had a single lesion, whereas 28.6% (2/7) patients had multiple lesions, amounting to 11 lesions in total, all of which were located under the liver capsule. The shape of the lesions was quasi-round or oval, the boundary was blurred, and the length diameter of lesions was 5.5–19.2 (14.9±1.2) mm. The results of the CT plain scan showed that the density of 11 lesions was homogeneous, of which 2 lesions showed isodensity and 9 lesions were hypodense. The CT value of 11 lesions was lower than that of adjacent hepatic parenchyma (42.1±3.1) HU, which was lower than that of adjacent hepatic parenchyma (55.9±1.5) HU, and the difference between them was statistically significant (t=−7.36, P<0.001). The results of 18F-FDG PET/CT imaging showed that the 18F-FDG uptake of 63.6% (7/11) lesions was higher than that of liver parenchyma, of which SUVmax of 85.7% (6/7) lesions increased, and SUVmax of 14.3% (1/7) lesions decreased. The SUVmax values of early imaging and delayed imaging lesions were 6.2±0.4 and 6.8±0.7, respectively. RI was 12.2% (8.9%, 15.5%). The 18F-FDG uptake of 36.4% lesions was lower than or adjacent to the liver parenchyma, and SUVmax of delayed imaging had no significant change. SUVmax of early imaging and delayed imaging were 2.2±0.4 and 2.1±0.4, respectively. Conclusions Most of the liver RLH lesions were located under the liver capsule, showing homogeneous and slightly low-density lesions, and the boundary was blurred. 18F-FDG PET/CT imaging showed high 18F-FDG uptake in most lesions, equal or low uptake in a few lesions, increased SUVmax in delayed imaging, and similar or different patterns of 18F-FDG uptake in multiple lesions.
2023, 47(7): 406-412.
doi: 10.3760/cma.j.cn121381-202210008-00324
Abstract:
Objective To investigate the risk factors of salivary gland injury in patients with differentiated thyroid cancer (DTC) after 131I treatment. Methods The clinical data of 107 patients with DTC who received 131I treatment in the First Hospital of Shanxi Medical University from January 2019 to July 2022 were retrospectively analyzed. The patients included 35 males and 72 females, aged (42.8±1.0) years. The age, body mass index, systolic blood pressure, diastolic blood pressure, histopathological classification and stage of the primary tumor, lymph node metastasis, diabetes, thyroid stimulating hormone (TSH) level before 131I treatment, levothyroxine sodium discontinuation (L-T4) time, 131I treatment dose, 131I whole-body imaging, and other clinical data were compared between patients with salivary gland injury and those with normal salivary gland. Univariate analysis of variance was used to compare the measurement data conforming to normal distribution, and χ2 test was used to compare count data. Fisher's exact probability method was used when the expected frequency is less than 5. Univariate regression analyses and multivariate Logistic regression analyses were conducted to identify factors related to salivary gland injury. Results Among 107 DTC patients, 37 cases had salivary gland injury with an incidence of 34.6%. Univariate regression analysis showed that age and systolic blood pressure of patients with salivary gland injury were higher than those of patients with normal salivary gland ((45.84±2.10) years vs. (41.11±0.97) years, (127.59±3.10) mm Hg vs. (119.86±1.84) mm Hg); the TSH level before 131I treatment of patients with salivary gland injury was lower than that of patients with normal salivary gland ((99.82±8.46) mIU/L vs. (122.59±4.03) mIU/L), and the differences were statistically significant (F=5.457, 5.210, 6.288; all P<0.05). Multivariate Logistic regression analysis showed that age, TSH level before 131I treatment, and systolic blood pressure were independent risk factors for salivary gland injury (OR=1.017, 0.989, 1.023; all P>0.05). Conclusion Old age, low TSH level before 131I treatment, and high systolic blood pressure are related factors to salivary gland injury in patients with DTC after 131I treatment.
2023, 47(7): 413-418.
doi: 10.3760/cma.j.cn121381-202209007-00316
Abstract:
Objective To investigate the advantages of shaping pad combined with thermoplastic membrane in postural fixation for radiotherapy patients of head and neck neoplasms. Methods The clinical data of 50 patients with head and neck neoplasms treated by radiotherapy the First Hospital of Shanxi Medical University from February 2021 to December 2021 were collected, including 40 males and 10 females, aged (58.0±8.2) years. The selected patients were divided into the control group (20 cases) and the observation group (30 cases). The observation group was immobilized using individualized shaping pad with thermoplastic membrane, and the control group was fixed with standard plastics pillow with the thermoplastic membrane. The MV electronic portal imaging device (EPID) was carried out for postioning verification once a week, and the setup errors were compared in a vertical (abdominal and dorsal), longitudinal (head and foot), and lateral (left and right) direction. The setup errors were analyzed by independent sample t-test. Results A total of 50 patients completed 258 EPID validations, including 101 validations in the observation group and 157 validations in the control group. With the target area as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((0.057±1.805) mm vs. (0.599±2.531) mm, (0.569±1.611) mm vs. (0.637±2.239) mm; (0.020±2.946) mm vs. (0.780±1.957) mm, respectively), and the differences were statistically significant in a vertical and lateral direction (t=−2.435, P=0.016; t=2.289, P=0.023). With the head center as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((−0.327±1.898) mm vs. (0.975±1.950) mm, (0.594±2.089) mm vs. (0.917±2.245) mm, (0.891±1.944) mm vs. (1.070±1.912) mm, respectively), and the difference was statistically significant in a vertical direction (t=5.320, P<0.001). With the neck center as ROI, the setup errors in a vertical, longitudinal, and lateral direction of the observation group were lower than those of the control group ((0.010±2.278) mm vs. (1.217±2.663) mm, (0.554±2.095) mm vs. (0.637±2.397) mm, (−0.574±2.321) vs. (−0.764±2.600) mm, respectively). Furthermore, and the differences were statistically significant in a vertical and lateral direction (t=−3.947, P<0.001; t=3.431, P=0.001). Conclusions The application of shaping pad and thermoplastic membrane in postural fixation of head and neck neoplasms during radiotherapy can improve positioning accuracy and patients' comfort, indicating their clinical promotion value.
2023, 47(7): 419-424.
doi: 10.3760/cma.j.cn121381-202205008-00315
Abstract:
Objective To compare the radiotherapy positioning error and radiation skin response of post-breast conserving radiotherapy patients with breast cancer using breast bracket positioning and thermoplastic membrane double labeling combined with fenestration technology. The feasibility of the positioning method based on thermoplastic-membrane double labeling combined with fenestration technology was also explored. Methods The clinical data of 83 female patients post-breast conserving radiotherapy for breast cancer after breast-conserving surgery at the Fifth Affiliated Hospital of Zhengzhou University from January 2019 to December 2020 were retrospectively analyzed. The patients were aged (47.5±10.1) years. According to the positioning method, they were divided into breast-bracket group (41 cases) and body-membrane group (42 cases). Two groups of patients underwent positioning verification using a linear accelerator under airborne cone-beam CT before radiotherapy. Evaluated the acute and late radiation skin reactions in enrolled patients according to the standards established by the Radiation Therapy Oncology Group of United States. Intergroup comparison of the positioning error was conducted using the t-test, and intergroup comparison of the counting data was conducted using the chi-square test. Results Positioning errors in the left and right (X-axis) [(2.14±0.19) mm vs. (2.96±0.20) mm], head and foot (Y-axis) [(2.49±0.15) mm vs. (3.05±0.16) mm], and abdominal back (Z-axis)[(2.41±0.22) mm vs. (3.14±0.19) mm] directions of the body-membrane group were significantly lower than those of the breast-bracket group (t=2.98, 2.63, and 2.49, respectively; all P<0.05). When the positioning error was ≤3 mm, the distribution proportion of the body-membrane group in the Y-axis direction was higher than that of the breast-bracket group (72.20% vs. 48.78%; χ2=7.23, P=0.01), when the positioning error was >5 mm, the distribution proportion of body membrane in the X-axis(3.81% vs. 8.78%), Y-axis (8.78% vs. 33.17%), and Z-axis (10.95% vs. 24.88%) groups was lower than that of the breast-bracket group (χ2=4.37, 12.40, and 13.73, respectively; all P<0.05). The incidence of acute radiation skin reaction was significantly different between the two groups (30.95% vs. 53.66%; χ2=4.39, P=0.04). Conclusions The thermoplastic membrane double labeling combined with fenestration technology reduces the positioning error and alleviates acute radioactive skin reaction. It also has better stability and repeatability, is safer and more reliable, and is easy to operate.
2023, 47(7): 425-429.
doi: 10.3760/cma.j.cn121381-202211024-00317
Abstract:
Thyroid cancer is one of the most common endocrine cancer. 131I treatment is one of the important treatment methods in differentiated thyroid cancer(DTC) postoperative, which plays a key role in reducing the recurrence rate of patients and improving the quality of life. 131I treatment is classified as ionizing radiation. The reproductive system is highly radiosensitivity, and its exposed to 131I from the blood, bladder urine, and intestines may cause transient damage to the ovaries or testes, which is manifested mainly by increased serum follicle-stimulating hormone levels, premature ovarian failure, decreased sperm count and viability. and decreased levels of anti-müllerian hormone. Existing clinical studies are still controversial about whether 131I trerapy of DTC increases the risk of secondary tumors in the reproductive system remains controversial. Therefore, the radiation effect of 131I therapy of DTC on reproductive system radiation has attracted wide attention.
Thyroid cancer is one of the most common endocrine cancer. 131I treatment is one of the important treatment methods in differentiated thyroid cancer(DTC) postoperative, which plays a key role in reducing the recurrence rate of patients and improving the quality of life. 131I treatment is classified as ionizing radiation. The reproductive system is highly radiosensitivity, and its exposed to 131I from the blood, bladder urine, and intestines may cause transient damage to the ovaries or testes, which is manifested mainly by increased serum follicle-stimulating hormone levels, premature ovarian failure, decreased sperm count and viability. and decreased levels of anti-müllerian hormone. Existing clinical studies are still controversial about whether 131I trerapy of DTC increases the risk of secondary tumors in the reproductive system remains controversial. Therefore, the radiation effect of 131I therapy of DTC on reproductive system radiation has attracted wide attention.
2023, 47(7): 430-434.
doi: 10.3760/cma.j.cn121381-202210006-00319
Abstract:
131I is commonly used in the treatment of thyroid diseases, but there is no unified conclusion whether radiation will cause changes in the function of adjacent parathyroid gland. Some studies have shown that 131I therapy will increase the risk of parathyroid adenoma and cause changes in parathyroid gland function, but other studies have shown that 131I therapy will not affect parathyroid gland function. This article reviews the previous studies on the correlation between 131I therapy and parathyroid diseases, and analyzes the shortcomings of the relevant literatures to provide a basis for further research.
131I is commonly used in the treatment of thyroid diseases, but there is no unified conclusion whether radiation will cause changes in the function of adjacent parathyroid gland. Some studies have shown that 131I therapy will increase the risk of parathyroid adenoma and cause changes in parathyroid gland function, but other studies have shown that 131I therapy will not affect parathyroid gland function. This article reviews the previous studies on the correlation between 131I therapy and parathyroid diseases, and analyzes the shortcomings of the relevant literatures to provide a basis for further research.
2023, 47(7): 435-438.
doi: 10.3760/cma.j.cn121381-202209022-00321
Abstract:
Liver cancer can be divided into two categories: primary liver cancer and secondary liver cancer. Hepatocellular cancinoma (HCC) is the most common type of primary liver cancer, which has the characteristics of high incidence and high mortality. 90Y microsphere selective internal radiotherapy (SIRT) can be used in many stages of liver cancer, which can reduce the tumor, increase the volume of the remaining liver, treat portal vein tumor thrombus and improve the quality of life for patients. The clinical application value and research progress of 90Y microspheres SIRT in the treatment of HCC was introduced.
Liver cancer can be divided into two categories: primary liver cancer and secondary liver cancer. Hepatocellular cancinoma (HCC) is the most common type of primary liver cancer, which has the characteristics of high incidence and high mortality. 90Y microsphere selective internal radiotherapy (SIRT) can be used in many stages of liver cancer, which can reduce the tumor, increase the volume of the remaining liver, treat portal vein tumor thrombus and improve the quality of life for patients. The clinical application value and research progress of 90Y microspheres SIRT in the treatment of HCC was introduced.
2023, 47(7): 439-444.
doi: 10.3760/cma.j.cn121381-202209008-00314
Abstract:
Dysphagia is one of the common adverse reactions after radiotherapy for head and neck cancers (HNC). As time goes on, the disease will worsen, leading to malnutrition, aspiration pneumonia and even death. Although swallowing function training has certain therapeutic effects on HNC patients, the training methods have not yet been unified. The author reviews the mechanism, influencing factors and evaluation methods of dysphagia in HNC patients after radiotherapy, in order to provide ideas for the prevention and treatment of dysphagia in HNC patients after radiotherapy.
Dysphagia is one of the common adverse reactions after radiotherapy for head and neck cancers (HNC). As time goes on, the disease will worsen, leading to malnutrition, aspiration pneumonia and even death. Although swallowing function training has certain therapeutic effects on HNC patients, the training methods have not yet been unified. The author reviews the mechanism, influencing factors and evaluation methods of dysphagia in HNC patients after radiotherapy, in order to provide ideas for the prevention and treatment of dysphagia in HNC patients after radiotherapy.
2023, 47(7): 445-449.
doi: 10.3760/cma.j.cn121381-202209004-00318
Abstract:
The authors reported a case of idiopathic eosinophilia hepatic infiltration by 18F-fluorodeoxyglucose (FDG) PET/CT. 18F-FDG PET/CT imaging can not only detect hepatic lesions earlier and provide information on glucose metabolism, but also evaluate the distribution of multiple organ involved in the whole body. The authors intend to analyze the case and review the relevant literature in order to deepen the understanding of the imaging characteristics of hepatic infiltration in idiopathic eosinophilia.
The authors reported a case of idiopathic eosinophilia hepatic infiltration by 18F-fluorodeoxyglucose (FDG) PET/CT. 18F-FDG PET/CT imaging can not only detect hepatic lesions earlier and provide information on glucose metabolism, but also evaluate the distribution of multiple organ involved in the whole body. The authors intend to analyze the case and review the relevant literature in order to deepen the understanding of the imaging characteristics of hepatic infiltration in idiopathic eosinophilia.
2023, 47(7): 450-453.
doi: 10.3760/cma.j.cn121381-202206007-00312
Abstract:
Paraneoplastic pemphigus (PNP) is a tumor-related autoimmune disease affecting the skin and mucosa, while the occurrence of mediastinal giant thymoma with PNP is infrequent in clinical practice. In this study, the authors presents a case of PNP and conducts a comprehensive analysis of its clinical, histopathological, therapeutic, and 18F-fluorodeoxyglucose (FDG) PET/CT imaging characteristics, thereby deepening the understanding of this disease through literature review. The possibility of PNP should be considered in patients with polymorphic skin lesions, the diagnosis of which is based on clinical presentation, histopathologic examination, and immunofluorescence. The autors found occult malignant tumors by PET/CT imaging, which assisted clinicians to understand the intrinsic connection between thymoma and PNP, improved the diagnostic accuracy of preoperative diagnosis, and provided an important basis for the choice of treatment plan.
Paraneoplastic pemphigus (PNP) is a tumor-related autoimmune disease affecting the skin and mucosa, while the occurrence of mediastinal giant thymoma with PNP is infrequent in clinical practice. In this study, the authors presents a case of PNP and conducts a comprehensive analysis of its clinical, histopathological, therapeutic, and 18F-fluorodeoxyglucose (FDG) PET/CT imaging characteristics, thereby deepening the understanding of this disease through literature review. The possibility of PNP should be considered in patients with polymorphic skin lesions, the diagnosis of which is based on clinical presentation, histopathologic examination, and immunofluorescence. The autors found occult malignant tumors by PET/CT imaging, which assisted clinicians to understand the intrinsic connection between thymoma and PNP, improved the diagnostic accuracy of preoperative diagnosis, and provided an important basis for the choice of treatment plan.
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