About Journal
The International Journal of Radiation Medicine and Nuclear Medicine is one of the national medical journals which is administered by National Health Commission of the People’s Republic of China and published by Chinese Medical Association and Institute of Radiation Medicine.
Founded in 1977, the journal was formerly known as Foreign Medicine: Radiation Medicine and Nuclear Medicine. In 2006, it was renamed The International Journal of Radiation Medicine and Nuclear Medicine.
The journal takes the scientific research personnel and clinicians engaging in radiation medicine and nuclear medicine or the related areas as the target readers, the original article, review and reports in the international academic conference as the main forms. It particularly reports the new trends, recent developments, up-to-date technologies, and the newly-acquired experience in overseas and mainland in the fields of radiation medicine and nuclear medicine with the domestic situation, emphasizes article’s scientificalness and timeliness. This print specialized in experimental nuclear medicine, clinical nuclear medicine, radiobiology, clinical radiation medicine, radiation does, damage and radiation protection, radioactive labeling of drugs, molecular biology technology, radiation and security and related standards and regulations.
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Superintended by: National Health Commission of the People's Republic of China
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Institute of Radiation Medicine, Chinese Academy of Medical Sciences
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, Available online ,
doi: 10.3760/cma.j.cn121381-202212013-00349
[PDF 2599KB]
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.
Accepted Manuscript
, Available online ,
doi: 10.3760/cma.j.cn121381-202306022-00391
Abstract:
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
Abstract:
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
Abstract:
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
Abstract:
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
Abstract:
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
Abstract:
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
Abstract:
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.
Accepted Manuscript
, Available online ,
doi: 10.3760/cma.j.cn121381-202304023-00397
Abstract:
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
Abstract:
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.
Accepted Manuscript
, Available online ,
doi: 10.3760/cma.j.cn121381-202303006-00378
Abstract:
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.
Accepted Manuscript
, 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.
Accepted Manuscript
, 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.
Accepted Manuscript
, 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.
Accepted Manuscript
, 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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2024, 48(1): 1-4.
doi: 10.3760/cma.j.cn121381-202308011-00380
Abstract:
Cardiovascular radionuclide imaging is an irreplaceable technique for the diagnosis and management of cardiovascular diseases. With the increasing clinical needs, radionuclide imaging technique is facing higher requirements for precision diagnostics. To play a more important role, further updated technology and more reasonable clinical usage are needed for the commonly used radionuclide myocardial perfusion imaging and myocardial metabolic imaging. Meanwhile, more and more novel radionuclide imaging techniques are translating from clinical trials to daily practice to fulfill the needs of precision diagnostics and promote the development of nuclear cardiology.
Cardiovascular radionuclide imaging is an irreplaceable technique for the diagnosis and management of cardiovascular diseases. With the increasing clinical needs, radionuclide imaging technique is facing higher requirements for precision diagnostics. To play a more important role, further updated technology and more reasonable clinical usage are needed for the commonly used radionuclide myocardial perfusion imaging and myocardial metabolic imaging. Meanwhile, more and more novel radionuclide imaging techniques are translating from clinical trials to daily practice to fulfill the needs of precision diagnostics and promote the development of nuclear cardiology.
2024, 48(1): 5-14.
doi: 10.3760/cma.j.cn121381-202307008-00383
Abstract:
Objective To investigate the diagnostic value of cadmium zinc telluride (CZT) cardiac SPECT dynamic myocardial perfusion imaging (D-MPI) quantitative parameters in prognostic assessment of patients with ischaemia and non-obstructive coronary arteries (INOCA) and obstructive coronary artery disease (OCAD). These parameters were compared with myocardial perfusion imaging (MPI) semi-quantitative parameters. Methods Retrospective analysis was performed on patients who received CZT cardiac SPECT D-MPI in TEDA International Cardiovascular Hospital from March 2020 to July 2021, had coronary angiography data before and after D-MPI, and completed follow-up. A total of 100 patients with INOCA (37 males and 63 females, aged 62.0(55.3, 66.0) years) and 203 patients with OCAD (122 males and 81 females, aged 63.0(57.0, 69.0) years) were followed for major adverse cardiovascular events (MACE). According to MACE results, patients with INOCA were divided into the MACE and non-MACE groups, similar to patients with OCAD. The D-MPI quantitative parameters (including myocardial flow reserve (MFR), rest myocardial blood flow (r-MBF), and stress myocardial blood flow (s-MBF)) and MPI semi-quantitative parameters (including summed stress score (SSS), summed rest score (SRS), summed different score (SDS), stress total perfusion defect (s-TPD) and rest total perfusion defect (r-TPD)) were compared between the MACE group and the non-MACE group. Two independent sample t-test or the Mann-Whitney U test were used to compare measurement data between groups, and the Pearson′s chi-square test was used to compare counting data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of quantitative parameters of D-MPI and semi-quantitative parameters of MPI in predicting MACE in patients with INOCA and OCAD. The Delong test and net reclassification index (NRI) were used to verify the differences in diagnostic efficacy between D-MPI quantitative parameters and MPI semi-quantitative parameters. Results Among the 100 patients with INOCA, s-MBF and MFR in the MACE group were significantly lower than those in the non-MACE group (1.27(1.03, 1.88) ml/(min·g) vs. 2.25(1.59, 3.13) ml/(min·g); 1.65(1.35, 2.04) vs. 2.52(1.75, 3.39)), and the differences were statistically significant (Z=−2.986 and −2.859, both P<0.05). ROC curve analysis showed that s-MBF and MFR had high diagnostic efficiency in predicting MACE in patients with INOCA (area under curve (AUC)=0.777 and 0.765, both P<0.001). When the cut-off value of s-MBF was 1.57 mL/(min·g), the sensitivity and specificity of predicting MACE in patients with INOCA were 72.7% and 75.3%, respectively. When the cut-off value of MFR was 2.04, the sensitivity and specificity of predicting MACE in patients with INOCA were 81.8% and 66.3%, respectively. According to NRI results, the proportion of correct classification in prognosis of INOCA patients with s-MBF≤1.57 ml/(min·g) and MFR≤2.04 was 44.4% and 44.5% higher than that of abnormal MPI semi-quantitative parameters (SSS≥4 and SDS≥2). Among 203 patients with OCAD, s-MBF and MFR in the MACE group were significantly lower than those in the non-MACE group (1.21 (0.61, 1.51) ml/(min·g) vs. 1.76 (1.14, 2.56) ml/(min·g); 1.51 (0.81, 1.91) vs. 2.02(1.50, 2.86)), and the differences were statistically significant (Z=−2.891 and −2.984, both P<0.05). ROC curve analysis showed that MFR and s-MBF had high diagnostic efficacy in predicting MACE in patients with OCAD (AUC=0.725 and 0.718, both P<0.001). When the cut-off value of MFR was 1.71, the sensitivity and specificity of predicting MACE in patients with OCAD were 75.0% and 63.6%, respectively. When the cut-off value of s-MBF was 1.49 ml/(min·g), the sensitivity and specificity of predicting MACE in patients with OCAD were 81.3% and 61.5%, respectively. According to NRI results, the proportion of correct classification in prognosis of OCAD patients with s-MBF≤1.49 ml/(min·g) and MFR≤1.71 was 32.9% and 28.7% higher than that of abnormal MPI semi-quantitative parameters (SSS≥4 and SDS≥2). Conclusions MFR and s-MBF obtained by CZT cardiac SPECT D-MPI can be used to indicate the occurence of MACE in patients with INOCA and OCAD and have good predictive diagnostic efficacy. Compared with MPI semi-quantitative parameters, MFR and s-MBF provide more accurate prognostic evaluation for clinical practice.
2024, 48(1): 15-21.
doi: 10.3760/cma.j.cn121381-202309001-00382
Abstract:
Objective To explore the diagnostic value of Al18F-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-fibroblast activation protein inhibitor (FAPI) PET/CT imaging in light chain cardiac amyloidosis (AL-CA). Methods The clinical data of 8 patients (7 males and 1 female, aged (62.9±5.6) years) diagnosed with AL-CA in Beijing Chao-Yang Hospital, Capital Medical University from September to December 2021 were prospectively studied. Five healthy volunteers and 5 patients with multiple myeloma (MM), who matched the gender and age with AL-CA patients, were recruited as controls. All subjects were divided into 4 groups: 5 cases in the AL-CA+MM group (AL-CA with MM), 3 cases in the AL-only group (AL-CA without MM), 5 cases in the MM control group (MM without AL-CA), and 5 cases in the healthy control group. All subjects underwent Al18F-NOTA-FAPI PET/CT imaging. Laboratory index type B natriuretic peptide (BNP) level, echocardiography data, and Al18F-NOTA-FAPI PET/CT imaging results were analyzed. Measurement data were compared among the 4 groups by using LSD or Kruskal-Wallis test and between 2 groups by independent samples t-test (homogeneity of variance). Enumeration data were compared by χ2 test. Results BNP level in the AL-only group was higher than that in the MM control group, and the difference was statistically significant ((259.0±40.0) pg/ml vs. (19.2±15.7) pg/ml, t=9.928, P<0.05). The left ventricular interventricular septum thickness and the left ventricular posterior wall thickness increased in the AL-CA+MM group, and the differences were statistically significant ((13.9±1.1) mm vs. (10.8±0.3) mm, t=6.197, P<0.05; (13.7±0.9) mm vs. (10.3±0.6) mm, t=6.774, P<0.05). Al18F-NOTA-FAPI PET/CT imaging results showed that the Al18F-NOTA-FAPI uptake of the left ventricular myocardium was positive in 3 cases (3/5, 60.0%) of the AL-CA+MM group and 3 cases (3/3, 100.0%) of the AL-only group. The left ventricular myocardium Al18F-NOTA-FAPI uptake was negative in 4 patients (4/5, 80.0%) of the MM control group and 5 subjects (5/5, 100.0%) of the healthy control group. The left ventricular myocardium maximum standardized uptake value (SUVmax) and target to background ratio (T/B) in the AL-only group were higher than those in the healthy control group (SUVmax: (4.1±1.1) vs. (2.1±0.2), t=3.234, P=0.081; T/B: (4.7±0.6) vs. (2.2±0.4), t=6.748, P=0.001). The SUVmax and T/B of the left ventricular myocardium in the AL-CA+MM group were higher than those in the MM control group (SUVmax: (4.2±1.8) vs. (2.5±1.4), t=1.699, P=0.128; T/B: (4.2±2.1) vs. (3.0±1.2), t=1.120, P=0.295). The SUVmax and T/B of left ventricular myocardium in the AL-CA+MM group were higher than those in the healthy control group (SUVmax: (4.2±1.8) vs. (2.1±0.2), t=2.642, P=0.056; T/B: (4.2±2.1) vs. (2.2±0.4), t=2.047, P=0.104). Conclusion Al18F-NOTA-FAPI PET/CT imaging can detect cardiac fibroblast activation non-invasively and effectively and has a certain diagnostic value in patients with AL-CA.
2024, 48(1): 22-29.
doi: 10.3760/cma.j.cn121381-202308025-00387
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Objective To explore the clinical application value of 99Tcm-pyrophosphate (PYP) dual-phase planar imaging and tomographic imaging in the diagnosis of transthyretin-related cardiac amyloidosis (ATTR-CA). Methods This retrospective study was conducted on 157 patients with suspected cardiac amyloidosis (CA) at Fuwai Hospital, Chinese Academy of Medical Sciences, from March 2020 to January 2023, including 108 males and 49 females, aged (58.9±14.8) years, ranging from 10 to 88 years old. The patients were intravenously injected with 740 MBq 99Tcm-PYP, and planar imaging and tomographic imaging were performed at 1 h (hereinafter referred to as early imaging) and 3 h (hereinafter referred to as delayed imaging) after injection. The Perugini method and semi-quantitative analysis method were used for the positive diagnosis of ATTR-CA in planar imaging, while the semi-quantitative scoring method was used for the positive diagnosis of ATTR-CA in tomographic imaging. Using clinical classification as the grouping criteria, all patients were divided into light chain cardiac amyloidosis (AL-CA) group, ATTR-CA group, and non-CA group. Diagnostic results of the Perugini method in planar imaging (positive for ≥2 points), semi-quantitative analysis method in planar imaging (positive for the uptake ratio of heart to contralateral lung ≥1.5), and semi-quantitative scoring method in tomographic imaging (positive for 2 points) were compared among the groups, and the 99Tcm-PYP imaging characteristics and diagnostic efficacy of different acquisition phases and different acquisition methods were analyzed. One-way analysis of variance and Bonferroni test were used to analyze the intergroup differences in measurement data. The χ2 test or Fisher′s exact probability method was used to analyze intergroup differences in counting data. In addition, the Kappa test was used to analyze the intergroup consistency of counting data, and the paired χ2 test (McNemar test) was used to compare the differences in diagnostic efficiencies among various diagnostic methods. Results According to clinical diagnosis, of the 157 suspected patients with CA, 83 were confirmed to have CA (including 23 cases of ATTR-CA and 60 cases of AL-CA), and 74 cases were identified as non-CA. The sensitivity, specificity, and accuracy of the semi-quantitative scoring method for delayed tomographic imaging in the diagnosis of ATTR-CA were 91.3%, 98.5%, and 97.5%, respectively, compared with other diagnostic methods with different acquisition phases and different acquisition methods, and the accuracy was the highest. On the contrary, the sensitivity, specificity, and accuracy of the Perugini method for early planar imaging were 100%, 40.3%, and 49.0%, respectively, compared with various diagnostic methods, and the accuracy was the lowest. After pairwise comparison of the diagnostic results for various different acquisition phases and methods, early tomographic imaging and delayed tomographic imaging showed good consistency in the semi-quantitative scoring method for the diagnosis of ATTR-CA (Kappa=0.835), but the difference in diagnostic efficacy was not statistically significant (χ2=110.883, P=0.219). The Perugini method of delayed planar imaging and the semi-quantitative scoring method of delayed tomographic imaging also had good consistency in the diagnosis of ATTR-CA (Kappa=0.784), and the difference in diagnostic efficacy was statistically significant (χ2=101.258, P=0.004), with the latter having a higher diagnostic accuracy. Moreover, the diagnostic consistency among other diagnostic methods with different acquisition phases and methods was average or poor (Kappa is 0.135–0.679). Conclusions Misdiagnosis was found in the diagnosis of ATTR-CA using early planar imaging. Early tomographic imaging and delayed tomographic imaging, as well as delayed planar imaging, had high diagnostic accuracy for ATTR-CA.
2024, 48(1): 30-37.
doi: 10.3760/cma.j.cn121381-202309002-00385
Abstract:
Objective To explore the feasibility of quantitative analysis in 99Tcm-methoxyisobutylisonitrile (MIBI)/123I-metaiodobenzylguanidine (MIBG) dual-isotope and dual-dynamic cardiac imaging using cadmium zinc telluride (CZT) SPECT. Methods Twenty-four patients (14 males and 10 females) aged (49.2±16.8) years with cardiac dysfunction were prospectively enrolled from October 2021 to June 2023 at Fuwai Hospital, Chinese Academy of Medical Sciences. All the patients underwent 99Tcm-MIBI single-isotope dynamic cardiac imaging (referred to as single-isotope imaging) on the first day and 99Tcm-MIBI/123I-MIBG dual-isotope dual-dynamic cardiac imaging (referred to as dual-isotope imaging) on the second day. And complete physical correction and incomplete-physical correction were performed. Myocardial blood flow (MBF) for left ventricle (LV), left anterior descending branch (LAD), left circumflex branch (LCX), and right coronary artery (RCA) dominant area was quantified. Differences, correlation, and agreement of these parameters from two imaging methods were analyzed using Wilcoxon rank sum test, Pearson correlation test, and Bland-Altman analysis. Results The MBF of LV and LAD, LCX, RCA dominant area of single-isotope imaging and dual-isotope imaging with complete physical correction were 0.74 (0.64, 0.79) ml·min−1·g−1 vs. 0.74 (0.64, 0.80) ml·min−1·g−1, 0.72 (0.68, 0.82) ml·min−1·g−1 vs. 0.74 (0.64, 0.84) ml·min−1·g−1, 0.73 (0.66, 0.80) ml·min−1·g−1 vs. 0.74 (0.61, 0.79) ml·min−1·g−1, and 0.77 (0.64, 0.82) ml·min−1·g−1 vs. 0.77 (0.66, 0.82) ml·min−1·g−1, respectively. The differences were not statistically significant (Z=−1.349, −0.396, −0.350, −1.126; all P>0.05). The MBF of LV and LAD, LCX, RCA dominant area between single-isotope imaging and dual-isotope imaging with complete physical correction showed good correlations (r=0.857, 0.832, 0.708, 0.815; all P<0.001). The MBF mean differences of LV and LAD, LCX, RCA dominant area between single-isotope imaging and dual-isotope imaging with complete physical correction were 0.023, 0.016, 0.008, 0.040 ml·min−1·g−1, and the 95% confidence intervals were −0.125 to 0.170, −0.196 to 0.228, −0.181 to 0.196, and −0.193 to 0.271, respectively. The agreement between the two acquisition methods was good. Conclusions CZT-SPECT can be used to obtain comparable MBF between single-isotope imaging and dual-isotope cardiac imaging on the basis of complete physical correction. It is feasible to conduct a quantitative analysis of MBF and cardiac sympathetic nervous system through a single examination.
2024, 48(1): 38-45.
doi: 10.3760/cma.j.cn121381-202308010-00386
Abstract:
Objective To compare the capability of radionuclide myocardial perfusion/metabolic imaging (hereinafter referred to as 18F-FDG PET) and cardiac magnetic resonance (CMR) in the assessment of myocardial viability among patients with ischemic heart failure. Methods A total of 285 consecutive patients with ischemic heart failure combined with cardiac dysfunction who underwent 18F-FDG PET and CMR imaging simultaneously (within a month) at Fuwai Hospital, Chinese Academy of Medical Sciences from March 2016 to December 2019 were included in the retrospective analysis. The patients comprised 260 males and 25 females, aged (57.8±10.0) years. The 17-segment method was used to compare the agreement and differences of 18F-FDG PET and CMR in the identification of viable myocardium and infarcted myocardium in each myocardial segment. Spearman correlation coefficient and Kendall′s tau-b correlation coefficient were used to analyze the correlation between the two methods in the identification of different myocardial viabilities. The Bland-Altman method was used to evaluate the diagnostic agreement between the two methods in assessing infarcted myocardium. Results Of the 285 patients with a total of 4845 myocardial segments, 3376 (69.7%) myocardial segments with wall motion abnormality on 18F-FDG PET were included in the analysis. The total content of infarcted myocardium measured through 18F-FDG PET and CMR was 17.6%±13.0% and 19.2%±13.4%, respectively, and a significant correlation existed between them (r=0.67, P<0.001). By contrast, 18F-FDG PET may underestimate the content of infarcted myocardium compared with CMR (The 95%CI of the total difference in infarcted myocardium content was −12.7%–27.8%, and the mean difference was 7.5%). Among the 697 segments with motion abnormality detected through CMR as transmural infarctions, most (90.4%, 630/697) showed transmural or non-transmural infarctions detected through 18F-FDG PET, showing a high agreement between the two methods. Among the 1371 segments detected as non-transmural infarctions through CMR, as many as 686 (50.0%) did not show infarct changes on 18F-FDG PET. At the individual level, no significant correlation (r=−0.09, P=0.12) exists between the total infarcted myocardium content detected through CMR and the total hibernating myocardium content detected through 18F-FDG PET in each patient. Among the 1371 segments detected as non-transmural infarctions through CMR, 838 (61.1%) had hibernating myocardium detected through 18F-FDG PET. Moreover, among the 697 segments detected as transmural infarctions through CMR, 286 (41.0%) had hibernating myocardium detected through 18F-FDG PET. Segments with non-transmural infarctions detected through CMR contained more hibernating myocardium than those with transmural infarctions (61.1% vs. 41.0%, χ2=66.207, P<0.001). Conclusions 18F-FDG PET and CMR have their strengths in assessing myocardial viability in patients with ischemic heart failure. CMR is superior to 18F-FDG PET in terms of identifying infarcted myocardium, whereas 18F-FDG PET is more sensitive in detecting viable myocardium with the ability to distinguish hibernating myocardium. Combining 18F-FDG PET and CMR will provide more comprehensive information on myocardial viability.
2024, 48(1): 46-51.
doi: 10.3760/cma.j.cn121381-202307038-00381
Abstract:
Objective To evaluate the value of cold press test (CPT) myocardial perfusion imaging (MPI) in the diagnosis of vasospastic angina pectoris in patients with ischaemia and non-obstructive coronary arteries (INOCA). Methods A retrospective analysis was conducted on 676 suspected INOCA patients with angina pectoris or chest tightness, wheezing, and other equivalent symptoms of angina pectoris in Xuzhou Central Hospital from January 2019 to June 2023. The sample included 439 males and 237 females, aged (49.3±20.4) years. All patients underwent CPT and resting MPI. In accordance with 2019 expert consensus for key points of technique and image process during SPECT myocardial perfusion imaging, the degree of myocardial ischemia in the patients was assessed. Semiquantitative parameters, such as summed stress score (SSS), summed resting score, and total perfusion defect (TPD), were calculated. One-way ANOVA was used to compare the measurement data with a normal distribution, and the χ2 test was employed to compare the counting data. Results The number of patients with negative CPT MPI results (CPT (−) group) and positive results (CPT (+) group) was 202 and 474, respectively. A significant difference in the proportion of patients with anxiety symptoms was observed between the two groups (14.9% vs. 89.9%; χ2=4.667, P<0.05). No significant differences in the other general data was found between the two groups (t=1.009, χ2=0.136–3.042; all P>0.05). According to the SSS results, 299 (44.2%) patients had mild myocardial ischemia, 156 (23.1%) patients had moderate myocardial ischemia, and 19 (2.8%) patients had severe myocardial ischemia. The TPD results revealed that 318 (47.0%) patients had mild myocardial ischemia, 136 (20.1%) patients had moderate myocardial ischemia, and 20 (3.0%) patients had severe myocardial ischemia. On the basis of the location of ischemia, 331 (49.0%), 349 (51.6%), and 277 (41.0%) patients were determined to have transmural myocardial ischemia, apical myocardial ischemia, and subendocardial myocardial ischemia, respectively. Conclusion CPT MPI can diagnostically evaluate myocardial ischemia caused by vasospastic angina pectoris in patients with INOCA and provide an important reference for noninvasive imaging diagnosis of this kind of patients.
2024, 48(1): 52-59.
doi: 10.3760/cma.j.cn121381-202307028-00384
Abstract:
Ultra-high dose rate (FLASH) radiotherapy is an innovation radiotherapy technique that has emerged as one of the revolutionary technologies in the field of radiotherapy over the past six years. It demonstrates excellent normal tissue protective effects without compromising the therapeutic efficacy on tumors. Moreover, the extremely short delivery time of FLASH radiotherapy helps eliminate the impact of organ or tumor motion on treatment accuracy, thereby enhancing treatment precision and patient comfort. This technology holds the potential to fundamentally transform the landscape of malignant tumor treatment. Currently, the underlying mechanism of the protective effects of FLASH radiotherapy on normal tissues are not fully understood. The authors present provide a comprehensive overview of the research progress in FLASH radiotherapy, encompassing both normal tissue protection and tumor treatment effects. Additionally, this paper provides insights into the potential biological mechanisms underlying the protection effects of FLASH radiotherapy. Consequently this paper serves as a valuable reference for further research in the field of FLASH radiotherapy.
Ultra-high dose rate (FLASH) radiotherapy is an innovation radiotherapy technique that has emerged as one of the revolutionary technologies in the field of radiotherapy over the past six years. It demonstrates excellent normal tissue protective effects without compromising the therapeutic efficacy on tumors. Moreover, the extremely short delivery time of FLASH radiotherapy helps eliminate the impact of organ or tumor motion on treatment accuracy, thereby enhancing treatment precision and patient comfort. This technology holds the potential to fundamentally transform the landscape of malignant tumor treatment. Currently, the underlying mechanism of the protective effects of FLASH radiotherapy on normal tissues are not fully understood. The authors present provide a comprehensive overview of the research progress in FLASH radiotherapy, encompassing both normal tissue protection and tumor treatment effects. Additionally, this paper provides insights into the potential biological mechanisms underlying the protection effects of FLASH radiotherapy. Consequently this paper serves as a valuable reference for further research in the field of FLASH radiotherapy.
2024, 48(1): 60-63.
doi: 10.3760/cma.j.cn121381-202306026-00379
Abstract:
The authors reported a case of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). The characteristics of RAIR-DTC were analyzed from the aspects of clinical history and 18F-prostate specific membrane antigen (PSMA) PET/CT imaging. RAIR-DTC has a poor prognosis, and the diagnostic and therapeutic methods are limited. At present, there are few studies on 18F-PSMA PET/CT imaging in the diagnosis of RAIR-DTC patients. The authors performed 18F-PSMA PET/CT imaging on a patient with RAIR-DTC, in order to provide new diagnostic and therapeutic methods for patients with RAIR-DTC.
The authors reported a case of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). The characteristics of RAIR-DTC were analyzed from the aspects of clinical history and 18F-prostate specific membrane antigen (PSMA) PET/CT imaging. RAIR-DTC has a poor prognosis, and the diagnostic and therapeutic methods are limited. At present, there are few studies on 18F-PSMA PET/CT imaging in the diagnosis of RAIR-DTC patients. The authors performed 18F-PSMA PET/CT imaging on a patient with RAIR-DTC, in order to provide new diagnostic and therapeutic methods for patients with RAIR-DTC.
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