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, Available online , doi: 10.3760/cma.j.cn121381-202212013-00349
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Abstract:
Objective To explore the diagnostic value of ultrasound, MRI, and mammography in different molecular subtypes of breast cancer. Methods A cohort of 212 female patients, aged (47.6±9.3) years old and with confirmed breast cancer, from Huizhou Municipal Central Hospital from January 2018, to April 2022, was retrospectively analyzed. In accordance with the results of pathology and immunohistochemistry, the patients were grouped into four groups: 31 cases of Luminal A, aged (49.2±10.8) years; 104 cases of Luminal B, aged (46.1±8.9) years; 45 cases of human epidermal growth factor receptor-2 (HER-2) overexpression, aged (49.6±10.1) years; and 32 cases of triple-negative breast cancer (TNBC), aged (48.5±8.5) years. The clinical characteristics of the patients and the imaging features of ultrasound, MRI, and mammography were analyzed. Intergroup comparisons of metric data conforming to normal distribution were performed using independent sample t-test (equal variance). Intergroup comparisons of count data were performed using chi-square test or Fisher’s exact probability method. Statistically significant features were evaluated for accuracy of the diagnostic efficacy by using ordered logistic regression analysis and area under the curve (AUC). Results Among the clinical features, the differences in menopausal status and lymph node metastasis among patients with breast cancer of different molecular subtypes were statistically significant (χ2=10.345, 10.026; P=0.016, 0.018). The results of ultrasonography showed that the margins of Luminal A breast cancer tumor were mostly blurred, the margins of Luminal B and HER-2 overexpression breast cancer tumors were mostly angular or hairy, and the margins of TNBC tumor were mostly lobulated. Moreover, the internal echoes in the tumors of the four subtypes were mostly heterogeneous echogenicity, which was more commonly seen in Luminal B. The blood flow Alder grade was mostly grade 0 or Ⅰ within Luminal A and TNBC, whereas the blood flow Alder grade within Luminal B and HER-2 overexpression breast cancer was mostly grade Ⅱ or Ⅲ. The differences were statistically significant (χ2=33.542, 12.283, 10.699; all P<0.05). The results of MRI showed that the tumor enhancement characteristics of Luminal A, Luminal B, and HER-2 overexpression breast cancer were mainly inhomogeneous enhancement, and the proportion of ring enhancement in TNBC tumors was higher than those in the other three, with a statistically significant difference (χ2=30.142, P<0.001). The results of mammography showed that calcification was mostly present in Luminal B and HER-2 overexpression breast cancer tumors, whereas no calcification was found in Luminal A and TNBC tumors. The calcification pattern in Luminal A and Luminal B breast cancer tumors was mainly punctate calcification, whereas that in HER-2 overexpression and TNBC tumors was mainly polypoidal or linear. The differences were all statistically significant (χ2=9.627, 11.792; both P<0.05). The tumor margins of breast cancer and the patients' menopausal status could be used as independent predictors of the molecular subtypes of breast cancer (OR=23.696, 7.053; both P<0.05), with an AUC of 0.635. Conclusion Differences were observed in the characteristics of ultrasound, MRI, and mammography in different molecular subtypes of breast cancer, indicating their certain diagnostic value.
, Available online , doi: 10.3760/cma.j.cn121381-202306022-00391
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Objective Analyze the radioactive level of drinking water around the uranium mine and in the control area (Chabuchar County and Ürümqi City) and conduct health risk assessment. Methods Collect 176 drinking water samples from the vicinity of a uranium mine and the control area (Chabuchar County and Urumqi City) from 2020 to 2022, and determine their total content α And the total β Radioactivity levels and concentrations of radioactive nuclides 238U, 232Th, 226Ra, and 40K were compared in different regions, water sources, and distances from uranium mines. The total radioactive levels of drinking water were estimated using methods recommended by the United States Environmental Protection Agency US EPA, International Commission On Radiological Protection ICRP, and WHO. The annual effective dose of drinking water in adults was estimated using the carcinogenic risk factors proposed by the United States Environmental Protection Agency US EPA. The lifelong health risk of residents was evaluated using the carcinogenic risk factors proposed by the US EPA. Results 176 servings of drinking water, total ɑThe average radioactivity is 0.11 Bq/L, and 0.5% of drinking water exceeds the national standard limit (0.5 Bq/L); Its total β The average radioactivity is 0.14 Bq/L, which does not exceed the national standard limit (1 Bq/L). The total amount of drinking water in the same region ɑ The difference in radioactive levels is statistically significant (F=9.854), Ρ< 0.01), around the uranium mine (mean 0.13 Bq/L)>Chabuchar County (0.12 Bq/L)>Urumqi City (0.08 Bq/L); Total drinking water in different regions β The difference in radioactive levels is statistically significant (F=10.522, Ρ< 0.01), around uranium mines (0.17 Bq/L)>Chabuchar County (0.13 Bq/L)>Urumqi City (0.10 Bq/L). Total drinking water from different water sources ɑ Or total β There was no statistically significant difference in the comparison of radioactive levels (F=2.849, 1.352, all) Ρ> 0.05). Total drinking water at different distances from uranium mines ɑ The difference in radioactive levels is statistically significant (F=21.720, Ρ< 0.01), tota lɑ The order of radioactive levels from high to low is: 5 km (0.16 Bq/L)>20 km (0.15 Bq/L)>25 km (0.14 Bq/L)>15 km (0.11 Bq/L)>10 km (0.07 Bq/L); Total drinking water at different distances from uranium mines β The difference in radioactive levels is statistically significant (F=46.364), Ρ< 0.01), total β The order of radioactive activity from high to low is: 5 km (0.24 Bq/L)>15 km (0.19 Bq/L)>20 km (0.17 Bq/L)>25 km (0.13 Bq/L)>10 km (0.09 Bq/L). Total through drinking water ɑ The average annual effective dose caused by drinking this drinking water is estimated to be 0.040 mSv/a. Based on the concentration of various radioactive nuclides in the drinking water, the average annual effective dose caused by drinking this drinking water is estimated to be 0.005~0.084 mSv/a. The lifelong risk of cancer among residents caused by drinking this drinking water is 1.75×10−13−4.35×10−11. Conclusion The radioactive levels of drinking water around a certain uranium mine and the control area (Chabuchar County and Urumqi City) are relatively low. Drinking this drinking water results in a low annual effective dose and lifelong cancer risk, and will not cause observable adverse health effects. It poses a low health risk to the surrounding residents.
, Available online , doi: 10.3760/cma.j.cn121381-202310003-00398
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Objective To explore the expression patterns of small nucleolar RNA (snoRNA) SNORA72 gene in various cancers, particularly in colorectal cancer (CRC), and its effect on the growth and radiosensitivity of CRC cells. Methods The expression of SNORA72 in different cancer and CRC tissues was analyzed using open cancer databases. The CRC cell line HT29, overexpressing or knocking down SNORA72, was constructed, dividing HT29 cells into the overexpressing SNORA72 group (LV-SNORA72) and its negative control group (LV-NC), as well as the SNORA72 knockdown group (ASO-SNORA72) and its negative control group (ASO-NC). The expression of SNORA72 in HT29 cells was detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). The effects of SNORA72 overexpression or knockdown on cell proliferation, colony formation, apoptosis, and cell cycle were evaluated. The HT29 cells from the LV-SNORA72 and LV-NC groups were irradiated with different doses of 60Co γ-rays, and the survival fraction (SF) and apoptosis rate of cells in each group were assessed. Transcriptomic analysis was employed to explore the potential mechanisms by which SNORA72 affects HT29 cell growth. An independent sample t-test was used for comparisons between two groups. Results Analysis of cancer databases revealed that SNORA72 is overexpressed in various cancer tissues, including CRC, the difference was statistically significant (all P<0.05). qRT-PCR results indicated that the relative expression of SNORA72 in the LV-SNORA72 group was significantly higher than that in the LV-NC group ((2.68±0.06) vs. (1.00±0.17)), and the difference was statistically significant (t=16.570, P<0.001). Conversely, the relative expression of SNORA72 in the ASO-SNORA72 group was significantly lower than that in the ASO-NC group ((0.61±0.08) vs. (1.00±0.13)), and the difference was statistically significant (t=4.355, P<0.05). Cell proliferation assay results showed that the absorbance values of the LV-SNORA72 group were significantly higher than those of the LV-NC group ((0.79±0.05) vs. (0.51±0.09), (1.78±0.04) vs. (1.22±0.05), and (3.30±0.05) vs. (2.19±0.06)) on the 3rd, 4th, and 5th day of the experiment, and the difference was statistically significant (t=8.582, 16.400, 31.200; all P<0.001). Conversely, the absorbance values of the ASO-SNORA72 group were significantly lower than those of the ASO-NC group ((0.42±0.07) vs. (0.55±0.05), (1.04±0.08) vs. (1.25±0.05), and (1.46±0.09) vs. (1.74±0.08)), and the difference was statistically significant (t=3.957, 6.147, 8.471; all P<0.01). Colony-formation assay results indicated that the colony formation rate of the LV-SNORA72 group was significantly higher than that of the LV-NC group((40.87±1.70)% vs. (26.60±0.40)%), and the difference was statistically significant (t=14.140, P<0.001). Conversely, the colony formation rate of the ASO-SNORA72 group was significantly lower than that of the ASO-NC group ((9.60±0.40)% vs. (12.43±0.38)%), and the difference was statistically significant (t=8.910, P<0.001). Apoptosis assay results showed that the apoptosis rate of the LV-SNORA72 group was significantly lower than that of the LV-NC group ((1.89±0.1)% vs. (2.64±0.15)%), and the difference was statistically significant (t=6.115, P<0.01). Conversely, the apoptosis rate of the ASO-SNORA72 group was significantly higher than that of the ASO-NC group((6.44±0.54)% vs. (3.92±0.37)%), and the difference was statistically significant (t=6.644, P<0.01). Western blot results demonstrated that compared with the ASO-NC group, the ASO-SNORA72 group promoted the cleavage activation of apoptosis proteins PARP and Caspase3, increased the expression of Bax protein, and inhibited the expression levels of anti-apoptotic proteins Survivin and Bcl-2. The results of radiosensitivity analysis through colony formation assay post-radiation showed that after exposure to 1, 2, 4, and 6 Gy of γ-rays, the SF of the LV-SNORA72 group increased compared with that of the LV-NC group ((0.89±0.05) vs. (0.81±0.03), (0.64±0.10) vs. (0.47±0.01), (0.16±0.04) vs. (0.09±0.01), and (0.04±0.01) vs. (0.02±0.01)), the difference was statistically significant (t=4.063, 8.802, 4.045, 2.937; all P<0.05). Radiation-induced apoptosis results showed that 48 h and 72 h after 4 Gy irradiation, the apoptosis rate in the LV-SNORA72 group was significantly lower than that in the LV-NC group ((8.14±0.12)% vs. (9.86±0.22)% and (11.26±0.52)% vs. (15.83±1.54%)), and the difference was statistically significant (t=3.470, 9.208; both P<0.05). After 8 Gy irradiation at 48 h and 72 h, the apoptosis rate in the LV-SNORA72 group was significantly lower than that in the LV-NC group ((13.29±0.17)% vs. (14.88±0.58)% and (19.82±0.56)% vs. (23.7±0.6)%), and the difference was statistically significant (t=3.201, 7.819, both P<0.05). After 12 Gy irradiation at 48 h and 72 h, the apoptosis rate in the LV-SNORA72 group was significantly lower than that in the LV-NC group ((14.06±0.32)% vs. (18.56±1.08)%) and (22.19±0.02)% vs. (26.84±0.66)%), the difference was statistically significant (t=9.054, 9.369; both P<0.001). Transcriptomic analysis results showed that overexpression of SNORA72 affects biological processes, such as cell activation, cell adhesion, and immune and inflammatory responses, cell migration, and cell proliferation. Conclusion SNORA72 is specifically overexpressed in CRC tissues and associated with poor prognosis in patients. It promotes CRC cell growth and proliferation and increases cellular radio-resistance.
, Available online , doi: 10.3760/cma.j.cn121381-202212011-00348
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Objective To explore the consistency and influencing factors between diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) in diagnosing acute cerebral infarct (ACI). Methods Ninety-eight suspected ACI patients who received treatment at Lai'an Jianing Hospital from January 2020 to February 2022 were selected as the study subjects and included in the training set. Among them, 58 were males and 40 were females, aged 45–80 (60.5±3.3) years old. Suspected ACI patients (33 cases) diagnosed and treated at Lai'an Jianing Hospital from March to October 2022 were selected for retrospective analysis according to the same criteria and included in the validation set. Among them were 18 males and 15 females, aged 42–79 (61.1±3.6) years old. Using clinical comprehensive diagnosis as the "gold standard", we analyzed the diagnostic efficacy, imaging manifestations, and consistency of examination results of DWI and MRA. Two independent sample t-tests were used for intergroup comparison of econometric data. The intergroup comparison of counting data was conducted using a χ2 test. Kappa test with multiple classification data was performed to analyze the consistency between DWI and MRA in diagnosing ACI. Multiple Logistic regression analysis was conducted to screen for independent risk factors with inconsistent results between DWI and MRA examinations. Empower Stats and statistical software package "R" were used to draw a forest map, construct a risk column-chart prediction model, and evaluate the model. The discriminability and calibration of the risk-prediction model were determined using the receiver operating characteristic (ROC) curve and the Hosmer–Lemeshow goodness-of-fit test. Model accuracy was evaluated using decision curve analysis (DCA). Results Among the 74 patients diagnosed with ACI clinically, 73 (98.65%) were positive for DWI and 71 (95.95%) were positive for MRA. The difference in ADC values between the healthy [≤6 h, (1.06±0.24)×10–4 cm2/s; 6–24 h, (1.13±0.26)×10–4 cm2/s; 24–72 h, (1.05±0.17)×10–4 cm2/s] and affected [≤6 h, (0.59±0.11)×10–4 cm2/s; 6–24 h, (0.44±0.10)×10–4 cm2/s; 24–72 h, (0.53±0.09)×10–4 cm2/s] brain tissues of patients was statistically significant (t=10.227, 12.630, 7.646; all P<0.05). Within 24 h after the onset of the disease, the ADC value and rADC [≤6 h, (0.53±0.08); 6–24 h, (0.43±0.05)] in the affected side of the brain initially decreased significantly (t=5.410, 5.569; all P<0.05) and then increased significantly [24–72 h, ADC: (0.53±0.09)×10–4 cm2/s, 24–72 h, rADC: (0.49±0.06)] (t=2.274, 2.835; all P<0.05). A total of 68 patients had consistent results between DWI and MRA (Group A), whereas 30 had inconsistent ones (Group B). The consistency between DWI and MRA was good (Kappa=0.654, P<0.05). Results of multivariate Logistic regression analysis showed that onset time ≤24 h, posterior circulation, length of infarct lesion <2 cm were independent risk factors for inconsistent results between the DWI and MRA diagnosis of ACI patients (OR=1.119, 1.169, 1.567; all P<0.05). Evaluation results of the risk column-chart prediction model showed that its discrimination [AUC of the training and validation sets were 0.930 (95%CI: 0.899–0.961, P<0.01) and 0.855 (95% CI: 0.812–0.898, P<0.01), accuracy, and effectiveness were all high. Conclusion DWI can clearly display the location and degree of ischemia of the lesion, whereas MRA can accurately locate the infarcted blood vessels and their stenosis. The consistency between the two examinations is good, and both can help diagnose and evaluate ACI. The onset time, posterior circulation, and length of infarct lesion are risk factors that affect the consistency of diagnosis between the two.
, Available online , doi: 10.3760/cma.j.cn121381-202212010-00377
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Objective To explore the consistency and influencing factors of American college of radiology thyroid imaging reporting and data system (ACR-TIRADS) and European thyroid imaging reporting and data system (EU-TIRADS) in the diagnosis of thyroid nodules (TN). Methods TN patients (282 cases) admitted to Lai'an Jianing Hospital and Nanjing Hospital Affiliated to Nanjing Medical University from June 2019 to January 2022 were selected as the study subjects. With FNAC or surgical pathology as the gold standard, the diagnostic efficacy and the consistency of the results of the two systems were analyzed. Multi-factor Logistic regression analysis was used to analyze the risk factors that affected the inconsistency between the two inspection results, and the forest map was drawn and evaluated. Results The malignant risk of TN increases with the increase of system progression. Compared with the two, EU-TIRADS had higher sensitivity (91.54 vs 79.31%) (P<0.001), and ACR-TIRADS had higher specificity (75.67% vs 62.38%) (P<0.001). Both benign and malignant nodules in ACR-TIRADS system 2~4 were consistent with EU-TIRADS system 2~4. Logistic regression analysis showed that nodule<20 mm, spongiform nodule, low/middle/low echo, round, blurred edge and margin of differential lobe were all independent risk factors for inconsistency between the two examination results (P<0.05). The evaluation results of the Logistic regression prediction model showed high accuracy. Conclusion For TN, EU-TIRADS has high sensitivity and low specificity. The consistency between ACR-TIRADS and EU-TIRADS systems is good. The length, structure, echo, shape, and edge of TN are all risk factors that affect the consistency of their diagnostic results.
, Available online , doi: 10.3760/cma.j.cn121381-202308031-00389
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Ubiquitin and small ubiquitin-like modifier (SUMO) can be covalently attached to specific protein substrates, undergo ubiquitination modification and SUMOylation modification, and affecting their stability, activity, localization or interaction, thus regulating various cell activities, including DNA damage repair, cell cycle, apoptosis and immune responses. When cells experience DNA damage, ubiquitination modification and SUMOylation modification regulate the function and interaction of relevant proteins, thereby participating in the process of DNA damage repair and signal transduction. These modifications are indispensable for maintaining genome integrity. Recent studies have revealed that ubiquitination modification and SUMOylation modification in these repairs. The author reviews these roles, so as to provide a reference for in-depth understanding of the ionizing radiation-induced DNA damage repair mechanism.
Ubiquitin and small ubiquitin-like modifier (SUMO) can be covalently attached to specific protein substrates, undergo ubiquitination modification and SUMOylation modification, and affecting their stability, activity, localization or interaction, thus regulating various cell activities, including DNA damage repair, cell cycle, apoptosis and immune responses. When cells experience DNA damage, ubiquitination modification and SUMOylation modification regulate the function and interaction of relevant proteins, thereby participating in the process of DNA damage repair and signal transduction. These modifications are indispensable for maintaining genome integrity. Recent studies have revealed that ubiquitination modification and SUMOylation modification in these repairs. The author reviews these roles, so as to provide a reference for in-depth understanding of the ionizing radiation-induced DNA damage repair mechanism.
, Available online , doi: 10.3760/cma.j.cn121381-202304014-00392
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Nasopharyngeal carcinoma is a malignant tumor prevalent in China and Southeast Asian countries, characterized by a high recurrence and metastasis rate. Clinically, 18F-fluorodeoxyglucose (FDG) PET/CT imaging and monitoring of biochemical indicators have become indispensable components of the management of patients with nasopharyngeal carcinoma. The combined use of 18F-FDG PET/CT and inflammatory markers may have significant potential in improving the accuracy of nasopharyngeal carcinoma diagnosis and personalized treatment. This combination also plays a crucial role in enhancing the clinical prognosis of nasopharyngeal carcinoma patients. The authors systematically reviewed the application progress of 18F-FDG PET/CT parameters and inflammatory markers in predicting the prognosis of nasopharyngeal carcinoma patients.
Nasopharyngeal carcinoma is a malignant tumor prevalent in China and Southeast Asian countries, characterized by a high recurrence and metastasis rate. Clinically, 18F-fluorodeoxyglucose (FDG) PET/CT imaging and monitoring of biochemical indicators have become indispensable components of the management of patients with nasopharyngeal carcinoma. The combined use of 18F-FDG PET/CT and inflammatory markers may have significant potential in improving the accuracy of nasopharyngeal carcinoma diagnosis and personalized treatment. This combination also plays a crucial role in enhancing the clinical prognosis of nasopharyngeal carcinoma patients. The authors systematically reviewed the application progress of 18F-FDG PET/CT parameters and inflammatory markers in predicting the prognosis of nasopharyngeal carcinoma patients.
, Available online , doi: 10.3760/cma.j.cn121381-202308018-00388
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Following the official release of the Medium and Long-term Development Plan for Medical Isotopes (2021—2035) and motivated by national policies, hospitals at all levels are actively advancing the construction of nuclear medicine departments. However, achieving the goal of comprehensive coverage of nuclear medicine departments in tertiary hospitals by 2025 still presents numerous challenges. The authors focused on the layout and configuration of SPECT rooms and the disposal of radioactive waste, analyzing both domestic and international radiation protection policies and experiences. The aim was to draw on advanced international technologies and management models to promote the sustainable development of nuclear medicine in China.
Following the official release of the Medium and Long-term Development Plan for Medical Isotopes (2021—2035) and motivated by national policies, hospitals at all levels are actively advancing the construction of nuclear medicine departments. However, achieving the goal of comprehensive coverage of nuclear medicine departments in tertiary hospitals by 2025 still presents numerous challenges. The authors focused on the layout and configuration of SPECT rooms and the disposal of radioactive waste, analyzing both domestic and international radiation protection policies and experiences. The aim was to draw on advanced international technologies and management models to promote the sustainable development of nuclear medicine in China.
, Available online , doi: 10.3760/cma.j.cn121381-202304023-00397
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Objective To explore the value of low-dose digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in screening early breast cancer. Methods 246 female patients (age (47.3±6.2) years old, ranging from 28 to 65 years old) with breast lumps and breast swelling pain treated in the Second People's Hospital of Liaocheng from January 2020 to April 2022 were prospectively selected. All patients underwent routine FFDM and low-dose DBT examinations, and underwent ultrasound-guided puncture biopsy. The pathological examination results of biopsy tissue was taken as the "gold standard", and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FFDM, low-dose DBT and combination of the two in screening early breast cancer were compared and analyzed, and the consistency (Kappa value) between FFDM, low-dose DBT, alone and combination examination of the two and histopathological examination results were analyzed and compared. The average glandular dose and examination time of different examination methods were compared. The intergroup comparison of quantitative data adopted t test or one-way analysis of variance, while the intergroup comparison of counting data adopted χ2 test, and analysis of consistency between different examination methods and histopathological examination results adoptedKappa test. Results Of the 246 patients included in the study, 192 cases were diagnosed as early breast cancer and 54 cases were diagnosed as benign breast lesions by histopathological examination. 154 cases of early breast cancer and 92 cases of benign breast lesions were diagnosed by FFDM. 169 cases of early breast cancer and 77 cases of benign breast lesions were diagnosed by low-dose DBT. 177 cases of early breast cancer and 69 cases of benign breast lesions were diagnosed by FFDM combined with low-dose DBT. The sensitivity (86.98%), specificity (96.30%), accuracy (89.02%), positive predictive value (98.82%) and negative predictive value (67.53%) of low-dose DBT in the diagnosis of early breast cancer were higher than those of FFDM (75.00%, 81.48%, 76.42%, 93.51% and 47.83%), and the differences were statistically significant (χ2=6.000~13.677, all P<0.05). The sensitivity (90.63%), specificity (94.44%), accuracy (91.46%), positive predictive value (98.31%) and negative predictive value (73.91%) of FFDM combined with low-dose DBT in the diagnosis of early breast cancer were higher than those of FFDM, and the differences were statistically significant (χ2 =4.285~20.644, all P<0.05). There was no significant difference in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value between low-dose DBT alone and FFDM combined with low-dose DBT in diagnosing early breast cancer (χ2=0.159~1.283, all P>0.05). The results of FFDM in the diagnosis of early breast cancer has good consistency with the histopathological examination results (Kappa value=0.655), and the results of low-dose DBT in the diagnosis of early breast cancer has good consistency with the histopathological examination results (Kappa value=0.722), and the combination diagnostic results of the two has good consistency with the histopathological examination results (Kappa value=0.792).. There was no statistically significant difference in the average glandular dose among FFDM [(1.03±0.18)mGy], low-dose DBT [(1.04±0.19) mGy]and combined examination of the two [(1.06±0.21) mGy] (F=1.529, P>0.05), and there was no statistically significant difference between FFDM examination time [(6.25±0.52) min] and low-dose DBT examination time [(6.33±0.57) min] (t=1.626, P>0.05). Conclusions Compared with FFDM, low-dose DBT has higher application value in screening early breast cancer, and it has good consistency with histopathological examination results, which can be used as an important examination method for clinical screening of early breast cancer.
, Available online , doi: 10.3760/cma.j.cn121381-202309017-00393
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Langerhans cell histiocytosis (LCH) is a rare neoplastic disease with abnormal proliferation of immature dendritic cells, and histopathological examination is the "gold standard" for its diagnosis. The author reports a case of multisystem LCH in an adolescent with CT, MRI, and 18F-fluorodeoxyglucose(FDG) PET/CT imaging, and analyzes the characteristics of the disease from the clinical, histopathological, imaging, and therapeutic perspectives, and deepens the understanding of the disease by reviewing the literature to provide more references for the diagnosis of the disease.
Langerhans cell histiocytosis (LCH) is a rare neoplastic disease with abnormal proliferation of immature dendritic cells, and histopathological examination is the "gold standard" for its diagnosis. The author reports a case of multisystem LCH in an adolescent with CT, MRI, and 18F-fluorodeoxyglucose(FDG) PET/CT imaging, and analyzes the characteristics of the disease from the clinical, histopathological, imaging, and therapeutic perspectives, and deepens the understanding of the disease by reviewing the literature to provide more references for the diagnosis of the disease.
, Available online , doi: 10.3760/cma.j.cn121381-202303006-00378
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Objective To investigate the predictive value of 18F-fluorodeoxyglucose(FDG) PET/CT primary lesions metabolic heterogeneity index for occult lymph node metastasis(OLM) in gastric cancer. Methods A retrospective analysis was performed on 79 patients [62 males, 17 females, age (63.8±9.0) years] with gastric cancer who underwent 18F-FDG PET/CT imaging and were diagnosed as clinical (c)N0 stage before surgery from January 2016 to December 2022 in the First Affiliated Hospital of Zhengzhou University. All patients underwent radical gastrectomy in our hospital within 1 month after imaging, and were divided into OLM-positive group and OLM-negative group according to postoperative pathology to determine whether there was lymph node metastasis. The following PET/CT parameters were measured: The maximum, mean and peak normalized uptake values (SUVmax, SUVmean, SUVpeak) , tumor metabolic volume (MTV) and total focal glycolysis (TLG)of the primary lesions.And TLR (tumor - liver ratio), heterogeneity index -1 (HI-1) and heterogeneity index -2 (HI-2) were calculated. The t test and Mann-Whitney U test of two independent samples were used to compare the parameters between groups. The independent risk factors of OLM were analyzed by logistic regression. The diagnostic efficacy of heterogeneity index on OLM was analyzed by receiver operating characteristic (ROC) curve. Results A total of 39 (49.4%, 39/79) of the 79 patients were pathologically confirmed to have OLM. HI-2 in OLM positive group was higher than that in OLM negative group [4.98 (2.68, 8.44) vs 2.61 (1.84, 4.23), z=−3.178, P < 0.05], while SUVmax in OLM negative group was higher than that in OLM negative group [5.59 (4.46, 7.51) vs 6.91 (5.11, 10.64). z=−2.000, P < 0.05], SUVmean[3.33 (3.06, 3.85) vs 3.65 (3.25, 4.64), z=−2.001, P < 0.05], HI-1[0.23±0.12 vs 0.29±0.14, t=2.096, P < 0.05] were significantly higher than those in OLM positive group. Multivariate logistic regression analysis showed that HI-2 was an independent risk factor for OLM [odds ratio (OR) =6.893, 95%CI: 1.922-24.718, P < 0.05]. The area under ROC curve (AUC) of HI-2 for OLM prediction was 0.708 (95%CI: 0.237-0.483, P=0.001), and the sensitivity and specificity for OLM diagnosis were 51.3% (20/39) and 87.5% (35/40), respectively, when the threshold was 4.962. Conclusion 18F-FDG PET/CT tumor metabolic heterogeneity index has predictive value for OLM in gastric cancer, and heterogeneity index -2 is an independent risk factor for OLM.
, Available online , doi: 10.3760/cma.j.cn121381-202211020-00395
Abstract:
Objective To explore the application of enhanced CT combined with 18F-FDG PET/CT in the diagnosis of pulmonary sequestration (PS) and analyze the image characteristics. Methods The clinical data of 6 patients with PS, including 2 males and 4 females, aged (49.8±17.5) years, who were surgically confirmed to be accompanied by elevated levels of tumor markers at the Affiliated Qingdao Central Hospital of Qingdao University from October 2007 to December 2020 were retrospectively analyzed.18F-FDG PET/CT imaging and enhanced CT scanning were performed in the 6 patients, and the location of the lesions, morphology, density, CT enhancement characteristics and 18F-FDG metabolism were observed. Results The lesions in the six patients were all located in the posterior basal segment of the lower lobe of the lung, including four cases in the right lung and two cases in the left lung. The maximum diameter of the lesion was (4.3±2.0) cm, and the CT value on plain scan was (27.2±13.9) HU. 2 patients had oval, rounded, or triangular-shaped lesions, and 1 patient had calcified foci within the lesion; 1 patient had marked enhancement on the CT image, 4 had moderate enhancement, and 1 had no marked enhancement. 6 patients were found to have an abnormal arterial blood supply originating from the thoracic aorta. Two patients had cystic masses, three patients had solid masses, and one patient had a cystic-solid mass. There were 3 patients with localized vascularization, coarsening, and disorganization in the lobes of the lungs, 2 patients with moderately increased 18F-FDG metabolism, 3 patients with mildly increased metabolism, and 1 patient with no metabolism increased metabolism. Conclusion The possibility of PS should be considered when patients have different degrees of elevated levels of tumour markers, round-like, oval-like, triangular-like nodules or masses found adjacent to the spine in the lower lobes of both lungs, increased 18F-FDG metabolism and abnormal blood-supplying arteries detected on CT-enhanced scans with mild-to-moderate enhancement, or when the lesion has no increased 18F-FDG metabolism and there is no significant enhancement on CT-enhanced scans, but abnormal blood-supplying arteries were detected. CT enhancement combined with 18F-FDG PET/CT imaging improves the accuracy of PS diagnosis.
, Available online , doi: 10.3760/cma.j.cn121381-202307002-00396
Abstract:
Objective To explore the value of derived parameters based on DCE-MRI in the evaluation of epilepsy recurrence caused by cerebral cysticercosis (CC). Methods 40 patients with acute epilepsy caused by CC treated in the second people's Hospital of Baoshan City, Yunnan Province from January to December 2020 were analyzed retrospectively, including 22 males and 18 females, aged (35.6 ±11.0) years. According to the recurrence of epilepsy within half a year, all patients were divided into recurrent group and non-recurrent group. The dynamic contrast enhanced MRI (DCE-MRI) derivative parameters, such as rate constant (Kep), volume transfer constant (Ktrans) and extracellular space volume fraction (Ve), were observed and recorded in all patients at first admission and half a year after follow-up, respectively. The permeability of blood-brain barrier (BBB) was evaluated in two groups. Independent sample t-test or χ2 test was used for inter-group comparison. Results There was no significant difference in general data such as gender, age, first onset time, and epilepsy types between the two groups(χ2=0.020, t=0.692, t=0.902, χ2=0.030, all P >0.05). At the first admission, the levels of Kep, Ve and K trans in the non-recurrent group were (30.17±5.32)×10−2/min, (102.32±6.58)×10−2 and (19.98±2.64) × 10−2/min, respectively, which were significantly lower than those in the recurrent group [(36.32±4.36)×10−2/min, (110.35±7.12)×10−2, (23.21±3.21)×10−2/min] (t=3.839、3.660、3.477, all P<0.001). After half a year of follow-up, the levels of Kep, Ve and Ktrans in the non-recurrent group were (12.57±3.29)×10−2/min, (78.02±4.36)×10−2 and (17.96±3.01)×10−2/min, respectively, which were also significantly lower than those in the recurrent group (24.25±3.58)×10−2/min, (90.37±8.27)×10−2, (23.32±3.98)×10−2/min, and the differences were statistically significant (t=10.620、10.161、4.848, all P<0.001). Conclusion Using DCE-MRI derived parameters can analyze the BBB permeability to distinguish the recurrence of epilepsy caused by CC.
, Available online , doi: 10.3760/cma.j.cn121381-202305022-00394
Abstract:
Objective To evaluate the efficacy and safety of TP regimen (paclitaxel and cisplatin combined chemotherapy) combined with concurrent radiotherapy in the treatment of advanced cervical cancer. Methods A prospective study was conducted on 60 female patients with advanced cervical cancer, aged (52.2±3.2) years, who were treated in Heping Hospital Affiliated to Changzhi Medical College from August 2020 to August 2021. Patients were divided into control group 30 cases (cisplatin chemotherapy and radiotherapy) and observation group 30 cases (paclitaxel+cisplatin chemotherapy and radiotherapy) by random number table method. The clinical efficacy, serum tumor marker levels, incidence of adverse reactions, apoptosis and extracellular matrix degradation of patients in the two groups were compared. The t test (homogeneity of variance) was used to compare the measurement data conforming to the normal distribution, and the χ2 test was used to compare the counting data. Results The objective remission rate of the observation group was higher than that of the control group (86.67% (26/30) vs. 63.33% (19/30)), and the difference was statistically significant (χ2=4.355, P<0.05). The levels of squamous cell carcinoma antigen and carbohydrate antigen (CA) 125 in the observation group were lower than those in the control group after treatment [(2.18±0.68) μg/L versus (4.06±1.12) μg/L, (22.24±5.93) U/ml versus (26.28±6.71) U/ml]. Fatigue (3.33%(1/30) vs. 6.67%(2/30)), myelosuppression (6.67%(2/30) vs. 3.33%(1/30)), gastrointestinal reaction (6.67% (2/30) vs. 10.00%(3/30)), radiation enteritis (6.67%(2/30) vs. 3.33%(1/30)) and urinary reaction (3.33% (1/30) vs. 6.67%(2/30)) and the incidence of liver and kidney function injury (3.33%(1/30) vs. 10.00%(3/30)) were not statistically significant (χ2=0.218-1.071, all P>0.05). Compared with the control group after treatment, the levels of matrix metalloproteinase(MMP)-2 ((522.47±45.93) ng/L vs. (325.41±32.54) ng/L) and MMP-9 ((378.18±33.59) ng/L vs. (516.28±45.84) ng/L) in the observation group were decreased. The level of cysteine proteinase-8 (Caspase-8) ((219.49±33.88) ng/L vs. (96.48±9.33) ng/L) was increased, and the differences were statistically significant (t=19.175, 13.310, 19.172; all P<0.05). Conclusions TP regimen combined with synchronous radiotherapy can improve the objective remission rate of patients with advanced cervical cancer. After treatment, the levels of squamous cell carcinoma antigen and CA125, MMP-2, MMP-9 and Caspase-8 were decreased. TP regimen combined with synchronous radiotherapy has good safety.
, Available online , doi: 10.3760/cma.j.cn121381-202303013-00390
Abstract:
Immunoglobulin G4-related disease (IgG4-RD) is a type of systemic inflammatory diseases that often affect multiple organs. IgG4-related cardiovascular disease (IgG4-RCVD) includes IgG4-related aortic disease, IgG4-related coronary artery disease, IgG4-related pulmonary artery disease, and IgG4-related pericarditis. IgG4-positive plasma cells accumulate and exhibit high expression of glucose transport proteins at the site of IgG4-RCVD involvement. 18F-fluorodeoxyglucose (FDG) PET/CT can assess the extent and degree of vascular inflammation on a systemic scale by evaluating the metabolic activity of lesions in IgG4-RCVD patients. It plays a pivotal role in diagnosing and quantitatively assessing IgG4-RCVD vascular inflammation, aiding in the selection of biopsy sites, and monitoring treatment efficacy. The authors conducted a comprehensive review of the advancements in the utilization of 18F-FDG PET/CT for IgG4-RCVD, aiming to furnish clinicians with a valuable reference for diagnosing IgG4-RCVD through the application of 18F-FDG PET/CT.
Immunoglobulin G4-related disease (IgG4-RD) is a type of systemic inflammatory diseases that often affect multiple organs. IgG4-related cardiovascular disease (IgG4-RCVD) includes IgG4-related aortic disease, IgG4-related coronary artery disease, IgG4-related pulmonary artery disease, and IgG4-related pericarditis. IgG4-positive plasma cells accumulate and exhibit high expression of glucose transport proteins at the site of IgG4-RCVD involvement. 18F-fluorodeoxyglucose (FDG) PET/CT can assess the extent and degree of vascular inflammation on a systemic scale by evaluating the metabolic activity of lesions in IgG4-RCVD patients. It plays a pivotal role in diagnosing and quantitatively assessing IgG4-RCVD vascular inflammation, aiding in the selection of biopsy sites, and monitoring treatment efficacy. The authors conducted a comprehensive review of the advancements in the utilization of 18F-FDG PET/CT for IgG4-RCVD, aiming to furnish clinicians with a valuable reference for diagnosing IgG4-RCVD through the application of 18F-FDG PET/CT.
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