2023 Vol. 47, No. 9
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2023, 47(9): 588-589.
Abstract:
2023, 47(9): 525-530.
doi: 10.3760/cma.j.cn121381-202210024-00340
Abstract:
Objective To investigate the effect of different kidney depth estimation formulas modified using SPECT/CT renal dynamic imaging on the calculation of the glomerular filtration rate (GFR) in living kidney transplant donors. Methods The clinical data of 127 healthy kidney transplant donors who underwent preoperative 99Tcm-diethylene triamine pentoacetic acid (DTPA) renal dynamic imaging in the First Affiliated Hospital of Xi'an Jiaotong University from October 2011 to December 2017 were retrospectively analyzed. Included 36 males and 91 females, aged (49.2±7.3) years. The computed GFR of kidney depth measured via CT was adopted as the standard reference standard. The Tønnesen and Itoh formulas were used to calculate kidney depth and the corresponding GFR and then compare them with the CT results. The measurement data that did not conform to the normal distribution were expressed as M (Q1, Q2), and the Wilcoxon rank sum test was used to compare between the renal depth calculated by each formula. Spearman correlation analysis and linear regression analysis were used to analyze the correlation between renal depth and the corresponding GFR of lelf and right kidney by each formula. Results The depth of the left and right kidneys from 127 healthy kidney transplant donors measured via CT [7.03(6.34, 7.67) cm, 7.21(6.51, 8.13) cm] was significantly higher than those obtained using the Tønnesen formula [5.66(5.30, 6.06) cm, 5.70(5.33, 6.10) cm] and the Itoh formula [6.70(6.33, 7.10) cm, 6.88(6.52, 7.26) cm], and the differences were statistically significant (left kidney: Z=−9.53, −3.77, both P<0.001; right kidney: Z=−9.73, −4.64, both P<0.001). The renal depth measured via CT was positively correlated with the renal depth calculated using the Tønnesen and Itoh formulas (left kidney: r=0.330, 0.331, both P<0.001; right kidney: r=0.359, 0.358, both P<0.001). The GFR of left and right kidneys that corresponded to the renal depth measured via CT [46.4(39.9, 52.0) ml/min, 46.0(40.5, 54.9) ml/min] was higher than those obtained using the Tønnesen formula [36.6(33.0, 41.9) ml/min, 36.2(32.1, 40.1) ml/min] and the Itoh formula [43.2 (39.4, 49.8) ml/min, 43.8 (39.4, 48.7) ml/min], and the differences were statistically significant (left kidney: Z=−9.52, −3.76, both P<0.001; right kidney: Z=−9.73, −4.75, both P<0.001). The CT measurement was positively correlated with the GFR values that corresponded to kidney depth estimates obtained using the Tønnesen and Itoh formulas (left kidney: r=0.476, 0.476, both P<0.001; right kidney: r=0.386, 0.539, both P<0.001). Conclusions The GFR calculated using the Tønnesen and Itoh formulas are suitable for the routine screening and evaluation of kidney diseases. For kidney transplant donors with more stringent requirements for renal GFR, kidney depth measured via CT should be used to correct the GFR calculated using SPECT/CT.
2023, 47(9): 531-537.
doi: 10.3760/cma.j.cn121381-202210002-00341
Abstract:
Objective To explore the imaging characteristics and clinical value of CT angiography (CTA) of the aorta in children with Takayasu arteritis (TA). Method We conducted a retrospective analysis of clinical data, imaging data, and laboratory examination results of 11 children with TA admitted to People’s Hospital of Xinjiang Uygur Autonomous Region from January 2016 to September 2022. The patients comprised 1 male and 10 females (8 adolescent girls). The age was (14.3±3.7) years. The course of the disease was (24.3±37.9) months. All children underwent chest and abdominal CT plain scan, aortic CTA, and post-processing examination, including multi-plane reconstruction, maximum density projection, volume reconstruction, and surface reconstruction. The imaging features of pediatric TA were analyzed, and the Numano classification was determined. Moreover, we observed the extent and degree of involvement of the aorta, branches, and pulmonary arteries, as well as the wall (thickening, calcification, high-density ring sign, low-density ring sign, and uneven enhancement), lumen (stenosis, dilation, and positive remodeling), and perivascular adipose tissue. Result Among the 11 children with TA, 9 were in the active phase (81.8%, 9/11), 10 were complicated with hypertension (90.9%, 10/11), 5 were accompanied with systemic symptoms (45.5%, 5/11), 4 were accompanied with cardiac symptoms (36.4%, 4/11), and 3 were accompanied with central nervous system symptoms (27.3%, 3/11), of which 1 case was complicated with hypertensive encephalopathy (9.1%, 1/11). There were 5 cases of elevated C-reactive protein and 5 cases of decreased hemoglobin (45.5%, 5/11), and there were 4 cases of elevated red blood cell sedimentation rate, white blood cell count, and platelet count (36.4%, 4/11). The most common types of Numano classification were IV and V, with a total of 10 cases (90.9%, 10/11); 11 cases (100%, 11/11) involved the descending aorta, 10 cases (90.9%, 10/11) involved the renal artery, 5 cases (45.5%, 5/11) involved the aortic arch and its branches, and 2 cases (18.2%, 2/11) involved the pulmonary artery. All 11 cases (100%, 11/11) of TA children showed increased wall density on CT plain scan, presenting as a high-density ring sign, and 3 cases (27.3%, 3/11) had wall calcification. Nine cases (81.8%, 9/11) of active children had perivascular adipose tissue opacity. In all 11 cases of CTA, the aorta and its branches were diffusely and multi-segmentally involved, with thickening of the wall (3.1±0.9) mm and uneven enhancement. Eight cases (72.7%, 8/11) showed a low-density ring sign in the inner wall. Renal artery stenosis in the aortic branches had the highest incidence (90.9%, 10/11), with 2 cases (18.3%, 2/11) of pulmonary artery involvement with stenosis and/or occlusion of the lumen and 4 cases of aortic dilation (36.4%, 4/11). Conclusions Aortic CTA can clearly display the aorta and its branches and pulmonary arteries. It can also comprehensively display the situation of affected blood vessels. Analyzing the CTA imaging features of children with TA is of great significance for the screening, diagnosis, and evaluation of the disease.
2023, 47(9): 538-544.
doi: 10.3760/cma.j.cn121381-202209009-00334
Abstract:
Objective To investigate the prophylactic effect of silicone on radiodermatitis during the treatment of keloid by using 90Sr-90Y applicator. Methods The clinical data of 175 patients who received 90Sr-90Y applicator for keloids at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to June 2021 were retrospectively analyzed. The patients included 81 males and 94 females, with ages of (27.2±3.7) years. The patients were divided into the control group (57 cases), the 1 mm-thick silicone protection group (55 cases), and the 2 mm-thick silicone protection group (63 cases) by using the envelope random grouping method. All the patients were treated with multiple small-dose radiation therapy by using a 90Sr-90Y applicator. The skin around the lesion was respectively protected with 1 mm- and 2 mm-thick silicone in the 1 mm-thick and 2 mm-thick silicone protection groups. Radidermatitis for the three groups of patients was graded using the radidermatitis grading criteria of the Radiation Therapy Oncology Group. The incidence and severity of radiodermatitis were compared among the groups. The effects of the treatment course and silicone protection on the occurrence of severe radidermatitis were analyzed. Independent sample t-test (equal variances assumed) was used to compare the two groups for the measurement data in accordance with normal distribution. One-way ANOVA was adopted to compare the three groups. The chi-squared test was conducted to compare the count data in the three groups. Lastly, the factors that affected the efficacy of the treatment were analyzed via univariate Logistic regression analysis. Results No statistically significant difference was found in the incidence of radiodermatitis between the 1 mm-thick silicone protection group and the control group (83.6% vs. 89.5%, χ2=0.815, P=0.367). The incidence of radiodermatitis was significantly lower in the 2 mm-thick silicone protection group than in the control group and the 1 mm-thick silicone protection group (89.5% vs. 83.6% vs. 54.0%), and the differences were statistically significant (χ2=18.108, 11.738; both P<0.05). The severity of overall radiodermatitis was lower in the 1-mm thick silicone protection group than in the control group (1.05±0.65 vs. 1.37±0.75), and the difference was statistically significant (t=−2.409, P<0.05). The severity of radiodermatitis in the 2 mm-thick silicone protection group (0.63±0.66) was lower than that in the control group and the 1 mm-thick silicone protection group, and the differences were statistically significant (t=−5.749, −3.473; both P<0.05). The increase in the number of treatment courses augmented the risk of radiodermatitis (OR=2.348, 95%CI: 1.524–3.618, P<0.001). Meanwhile, the use of silicone with different thicknesses can reduce the risk of radiodermatitis (1 mm-thickness silicone: OR=0.273, 95%CI: 0.109–0.685, P<0.01; 2 mm-thickness silicone: OR=0.099, 95%CI: 0.034–0.293, P<0.001). Conclusion During the treatment of keloid with 90Sr-90Y applicator, the use of 2 mm-thick silicone to protect the surrounding normal skin tissue can significantly reduce the incidence and severity of radiodermatitis.
2023, 47(9): 545-554.
doi: 10.3760/cma.j.cn121381-202211010-00345
Abstract:
Objective To investigate the clinical value of a combined model of enhanced CT-based entropy features and traditional imaging features for the differential diagnosis of risk status in patients with thymic epithelial tumor (TET). Methods A retrospective analysis was conducted on the clinical data of 178 TET patients (83 males and 95 females; aged (52.7±12.4) years, ranged from 26 years to 83 years) confirmed by surgical and histopathological results at Jiangmen Central Hospital and the Fifth Affiliated Hospital of Sun Yat-sen University from October 2008 to May 2021 were retrospectively analyzed. They were divided into low-risk (A, AB, and B1 types) and high-risk (B2 and B3 types) groups according to histopathology subtypes. All patients were further divided into a training set (n=86), an internal validation set (n=51), and an external validation set (n=41). The internal and external validation sets were called the total validation set (n=92). The training and validation sets were used for the process construction and performance evaluation of the predictive model, respectively. The clinical characteristics of TET patients were recorded, and the traditional CT features of lesions were analyzed. Entropy features were extracted and selected from enhanced CT venous phase images by using software developed based on MATLAB R2016 platform. Mann-Whitney U test was used to select valuable entropy features. Extreme learning machine classification algorithm was adopted to calculate the different weights of entropy features and entropy signature value. Clinical model, entropy model, and combined model were constructed through Logistic analysis, and receiver operating characteristic curve was used to compare the diagnostic efficacy of the three predictive models. Results A total of 83 cases were included in the low-risk group (38 males and 45 females; aged (52.8±12.4) years, ranged from 26 years to 83 years), whereas 95 cases were in the high-risk group (45 males and 50 females; aged (52.0±12.0) years, ranged from 27 years to 80 years). Univariate analysis showed that the difference in peripheral invasion between the two groups in the training set was statistically significant (χ2=5.108, P=0.024). A total of 1 680 initial entropy features were extracted, and 21 core entropy features were ultimately selected. The entropy signature value of the low-risk group in the training set was 0.519±0.21, which was significantly lower than that of the high-risk group (0.997±0.23). The difference between the two groups was statistically significant (t=−9.747, P<0.001). The area under curve (AUC) of the entropy model in the training set, internal validation set, external validation set, and total validation set were 0.929(95%CI: 0.876–0.983), 0.832(95%CI: 0.723–0.941), 0.802(95%CI: 0.666–0.939), and 0.803(95%CI: 0.715–0.890), respectively. Results of multivariate Logistic regression analysis showed that peripheral invasion (OR=6.343; 95%CI: 1.009−36.604; P=0.039) and entropy signature value (OR=20.145; 95%CI: 5.887−68.936; P<0.001) were independent risk factors for predicting TET risk status. The combined model constructed by the two together had AUCs of 0.941(95%CI: 0.894–0.987), 0.871(95%CI: 0.775–0.968), 0.819(95%CI: 0.689–0.949), and 0.840(95%CI: 0.761–0.919) in the training set, internal validation set, external validation set, and total validation set, respectively. Conclusions The entropy feature based on enhanced chest-CT images can be used to assess the risk status of TET quantitatively. The combined model constructed by peripheral invasion and entropy signature value showed the highest diagnostic efficacy, which can accurately guide the preoperative treatment strategy of TET patients.
2023, 47(9): 555-561.
doi: 10.3760/cma.j.cn121381-202211019-00344
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Objective To investigate the value of MRI DWI-based radiomics models for evaluating the treatment response in osteosarcoma after neoadjuvant chemoherapy. Methods A retrospective analysis was conducted on the medical records and imaging data of 41 patients with osteosarcoma (26 males and 15 females; aged (22.0±11.0) years, range of 11–49 years) who underwent MRI examinations before and after receiving neoadjuvant chemotherapy, and confirmed by postoperative histopathological examinations at the Third Hospital of Hebei Medical University from June 2015 to November 2017. In accordance with the postoperative histopathological examination results, patients with a tumor tissue necrosis rate of ≥90% were included in the good-efficacy group, and those with a necrosis rate of <90% were included in the poor-efficacy group. The apparent diffusion coefficient (ADC, denoted as ADC0, ADC1, and ADC2) were measured in all patients before neoadjuvant chemotherapy, within 5 days after the end of the first stage of chemotherapy, and after the completion of the entire chemotherapy. The differences in ADC were compared between the two groups. The region of interest of the lesion was manually delineated on DWI (b=1 000 s/mm2) and ADC images after the end of the first stage of chemotherapy, and the radiomics features were extracted. Data were divided into training set and validation set by using random grouping at 6∶4. The SMOTE algorithm was used to expand the data on the training set. The variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) algorithm were used to screen the radiomics features. A radiomics model was constructed using a logistic regression classifier. Independent sample t-test or Wilcoxon rank sum test was used to compare the two groups. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of traditional imaging (ADC) and radiomics models on the efficacy of neoadjuvant chemotherapy for osteosarcoma. Results A total of 10 and 31 cases were included in the good-efficacy and poor-efficacy groups, respectively. No statistically significant difference was found in the ADC0 value between the two groups ((0.95±0.05)×10−3 mm2/s vs. (1.05±0.05)×10−3 mm2/s, t=1.14, P>0.05)). The values of ADC1 and ADC2 in the good-efficacy group were higher than those in the poor-efficacy group, with statistical significance ((1.44±0.10)×10−3 mm2/s vs. (1.10±0.06)×10−3 mm2/s, t=−2.92, P<0.05; 1.68 (1.55, 1.85)×10−3 mm2/s vs. (1.33±0.06)×10−3 mm2/s, Z=−2.61, P<0.01). ROC curve analysis showed that when ADC1 ≥1.34×10−3 mm2/s, the sensitivity for evaluating the efficacy of neoadjuvant chemotherapy in osteosarcoma was 80%, the specificity was 81%, and the area under the curve (AUC) was 0.797 (95%CI: 0.629–0.965). When ADC2 ≥1.51×10−3 mm2/s, the sensitivity for evaluating the efficacy of neoadjuvant chemotherapy in osteosarcoma was 90%, the specificity was 71%, and the AUC was 0.777 (95%CI: 0.588–0.967). A total of 1 409 radiomics features were extracted from the DWI and ADC images after the end of the first stage of chemotherapy. They were randomly divided into training set and validation set at a ratio of 6∶4 (24 (good efficacy: 6, poor efficacy: 18)∶17 (good efficacy: 4, poor efficacy: 13)). The training set data were expanded to 70 (good efficacy: 20, poor efficacy: 50). After the radiomics features were screened, five optimal radiomics features were ultimately obtained, including InterquartileRange, Skewness, Uniformity, Median, and Maximum. Logistic regression classifier was used to construct a radiomics model. The ROC curves showed that in the training set, the AUC of the model for predicting the efficacy of neoadjuvant chemotherapy in osteosarcoma was 0.881 (95%CI: 0.811–0.942), with sensitivity of 90% and specificity of 74%. Meanwhile, in the validation set, the AUC was 0.769 (95%CI: 0.515–0.933), with sensitivity of 75% and specificity of 69%. Conclusion The radiomics model based on MRI DWI outperforms the traditional imaging (ADC) in evaluating the efficacy of neoadjuvant chemotherapy for osteosarcoma, showing great potential in clinical applications.
2023, 47(9): 562-567.
doi: 10.3760/cma.j.cn121381-202304024-00331
Abstract:
Objective To prepare human vascular endothelial growth factor (hVEGF) radioimmunoassay (RIA) and chemiluminescence immunoassay (CLIA) kits and evaluate their clinical value in diagnosis of early lung cancer and colorectal cancer. Methods A detection method was established according to the technical indices of the kits. The techniques for coating magnetic particles and 125iodine and acridine ester labeling with antibody were evaluated. Sensitivity, precision, and recovery of the kits were determined. The sensitivity and specificity of the kits in the diagnosis of early cancers (lung and colorectal cancers) were evaluated by testing cancer and normal serum samples. Independent sample t-test was used for inter-group comparison. Results The optimal ratios were as follows: 1 mL of magnetic particles to 1 mg of the antibody, 55.5 MBq 125iodine to 0.1 mg of the antibody, and 25 μg acridine ester to 0.2 mg of the antibody. The detection sensitivities of RIA and CLIA kits were 17.6 and 9.2 pg/mL respectively. For precision, the CLIA kit had slightly higher intra-batch variability and lower inter-batch variability than the RIA kit. The mean recovery levels of the RIA and CLIA kits were 103.28% and 101.85% respectively, and the latter had higher detection accuracy. The clinical sensitivity and specificity in the diagnosis of lung cancer and colorectal cancer were all above 90%. RIA kit and CLIA kit showed that the specificity of hVEGF in normal serum samples was 98.11% (104/106) and 99.06% (105/106), respectively.. There were significant differences in hVEGF between cancer patients and normal subjects (t=−16.695–−14.920, all P<0.01). Conclusions The technical indices of the hVEGF RIA and CLIA kits were good. The CLIA kit had higher sensitivity and specificity than the RIA kit and has clinical value in screening and auxiliary diagnosis of early lung and colorectal cancers.
2023, 47(9): 568-572.
doi: 10.3760/cma.j.cn121381-202302015-00342
Abstract:
18F-fluorodeoxyglucose (FDG) PET/MRI imaging of viable myocardium has always been concerned by clinicians, especially cardiologists. Both PET and MRI can play a unique value in the diagnosis and prognosis of ischemic cardiomyopathy. Integrated PET/MRI equipment provides a new platform for exploring its integrated value. By reviewing the pathophysiology of ischemic cardiomyopathy, the characteristics of PET myocardial imaging and the clinical application of MRI, and combing the research progress in related fields in the past ten years, the author reviews the characteristics and clinical value of PET/MRI viable myocardial imaging, so as to provide reference for the clinical scientific research of PET/MRI viable myocardial imaging.
18F-fluorodeoxyglucose (FDG) PET/MRI imaging of viable myocardium has always been concerned by clinicians, especially cardiologists. Both PET and MRI can play a unique value in the diagnosis and prognosis of ischemic cardiomyopathy. Integrated PET/MRI equipment provides a new platform for exploring its integrated value. By reviewing the pathophysiology of ischemic cardiomyopathy, the characteristics of PET myocardial imaging and the clinical application of MRI, and combing the research progress in related fields in the past ten years, the author reviews the characteristics and clinical value of PET/MRI viable myocardial imaging, so as to provide reference for the clinical scientific research of PET/MRI viable myocardial imaging.
2023, 47(9): 573-578.
doi: 10.3760/cma.j.cn121381-202301008-00335
Abstract:
Thyroid-associated ophthalmopathy (TAO) leads a significant negative impact on patients' quality of life, mental health and community economy. Treatment in the early active stage of the disease will achieve better efficacy. At present clinical activity score (CAS) is the mainly method of judging disease activity, but it has many shortcomings. Recent studies have suggested that 99Tcm-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT shows important value in the early diagnosis, treatment and follow-up of TAO. It can complement with CAS and has a broad application prospect. The authors summarize the current research progress in this field and highlight the need for more research to establish a standardized consensus on collection method and result analysis. Investigating a new tool to judge disease activity which can combine 99Tcm-DTPA orbital SPECT/CT with the artificial intelligence will more accurately and conveniently guide the clinical practice.
Thyroid-associated ophthalmopathy (TAO) leads a significant negative impact on patients' quality of life, mental health and community economy. Treatment in the early active stage of the disease will achieve better efficacy. At present clinical activity score (CAS) is the mainly method of judging disease activity, but it has many shortcomings. Recent studies have suggested that 99Tcm-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT shows important value in the early diagnosis, treatment and follow-up of TAO. It can complement with CAS and has a broad application prospect. The authors summarize the current research progress in this field and highlight the need for more research to establish a standardized consensus on collection method and result analysis. Investigating a new tool to judge disease activity which can combine 99Tcm-DTPA orbital SPECT/CT with the artificial intelligence will more accurately and conveniently guide the clinical practice.
2023, 47(9): 579-583.
doi: 10.3760/cma.j.cn121381-202206011-00337
Abstract:
Keloid is a fibroproliferative disease, usually caused by abnormal wound healing, and it is easy to recur after surgical resection. In recent years, the application of radioactive adjuvant therapy has greatly reduced the recurrence rate of keloids after resection. This article reviews several brachytherapy methods commonly used in clinical practice, and provides references for clinicians and researchers in related fields in the treatment of keloids.
Keloid is a fibroproliferative disease, usually caused by abnormal wound healing, and it is easy to recur after surgical resection. In recent years, the application of radioactive adjuvant therapy has greatly reduced the recurrence rate of keloids after resection. This article reviews several brachytherapy methods commonly used in clinical practice, and provides references for clinicians and researchers in related fields in the treatment of keloids.
2023, 47(9): 584-587.
doi: 10.3760/cma.j.cn121381-202209006-00339
Abstract:
The authors reported a case of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes (POEMS) syndrome located in the right iliac bone by 18F-fluorodeoxyglucose (FDG) PET/CT. The authors summarized the diagnostic criteria and 18F-FDG PET/CT imaging manifestations of POEMS syndrome through literature review. Although 18F-FDG PET/CT in POEMS syndrome has been well reported, imaging manifestations involving only the right iliac bone are rare. Understanding the diagnostic criteria, clinical manifestations and laboratory findings of POEMS syndrome can help to obtain more information and make an accurate diagnosis.
The authors reported a case of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes (POEMS) syndrome located in the right iliac bone by 18F-fluorodeoxyglucose (FDG) PET/CT. The authors summarized the diagnostic criteria and 18F-FDG PET/CT imaging manifestations of POEMS syndrome through literature review. Although 18F-FDG PET/CT in POEMS syndrome has been well reported, imaging manifestations involving only the right iliac bone are rare. Understanding the diagnostic criteria, clinical manifestations and laboratory findings of POEMS syndrome can help to obtain more information and make an accurate diagnosis.
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