2018 Vol. 42, No. 4

Clinical Investigations
Imaging features and diagnostic value of 18F-FDG PET/CT in pulmonary lymphangitic carcinomatosis
Xiaoyan Sun, Cheng Chang, Bei Lei, Lihua Wang, Liu Liu, Maomei Ruan, Wenhui Xie
2018, 42(4): 295-300. doi: 10.3760/cma.j.issn.1673-4114.2018.04.001
ObjectiveTo explore the imaging features and diagnostic value of 18F-FDG PET/CT in pulmonary lymphangitic carcinomatosis(PLC).MethodsRetrospective analysis on 53 PLC cases was performed. The patients underwent PET/CT+ thin breath hold CT scanning. The PET images were attenuated by CT scanning data and reconstructed by TrueX+time of flight method. The mean standardized uptake value(SUVmean) of each region of interest was measured, and the standardized uptake ratios(SUR) value was calculated. The difference of the SUVmean and SUR values in different regions was compared.ResultsAmong the 53 patients with PLC, 51(96%, 51/53) displayed interlobular septal thickening of the interlobular septa with radioactive uptake, and the lung SUVmean was significantly higher than that of the normal lung field(1.46±0.92 vs. 0.58±0.18, t=19.85, P < 0.01). The interlobular septal thickening lung/mediastinal blood pool SUR was higher than that of the normal septal lung/mediastinal blood pool SUR(0.84±0.38 vs. 0.40±0.21, t=12.77, P < 0.01), and 51 cases(96%, 51/53) manifested bronchovascular bundle uptake enhancement. The SUVmean of PLC involving bronchovascular bundle was significantly higher than that of normal bronchovascular bundle(3.85±1.67 vs. 0.90±0.19, t=15.45, P < 0.01). The SUR of the thickened bronchi vascular bundle/mediastinal blood pool was higher than that of the normal bronchovascular bundle/mediastinal blood pool SUR(2.89±0.94 vs. 0.59±0.19, t=12.62, P < 0.01). In 51 cases(96%, 51/53), the swelling of the hilum and mediastinal lymph nodes was enhanced with radioactivity.ConclusionsPET/CT fusion imaging of typical patients with PLC is characterized by the thickening of bronchial vascular bundles with radioactive concentration and thickening of the interlobular septal nodules with increased uptake of radioactivity. Moreover, the hilar and mediastinal lymph nodes were enlarged or normal with abnormal concentration of radioactivity. PET/CT fusion imaging combined with local SUVmean and SUR can measurements not only enables the early and accurate diagnosis of PLC lesions.
The value of 18F-FDG PET/CT metabolic parameters in preoperative risk stratification of endometrial carcinoma
Wei Gong, Lijuan Yu, Mohan Tian, Bangyu Liang
2018, 42(4): 301-306. doi: 10.3760/cma.j.issn.1673-4114.2018.04.002
ObjectiveTo investigate the importance of maxium standardized uptake value(SUVmax), metabolizable tumor volume (MTV), and total glycolysis volume (TLG) of 18F-FDG PET/CT in predicting high-and low-risk groups of patients with endometrial cancer and their diagnostic efficacy.MethodsWe retrospectively collected the clinical pathological data of 44 patients with endometrial cancer from August 2008 to February 2017 in the PET/CT center at our hospital. The patients were divided into high-and low-risk groups based on the degree of invasion and clinicopathological features of the disease. Region of interest was automatically delineated via the percent threshold method(40% threshold of SUVmax) by using the PET VACR software of GE PET/CT AW4.6 workstation in the United States. SUVmax, MTV, and TLG were automatically generated. Mann-Whitney U test was performed to analyze the differences between SUVmax, MTV, and TLG in the high-and low-risk groups. ROC curves were obtained to determine whether SUVmax, MTV, and TLG could predict high-and low-risk groups and to reveal their predictive power.ResultsThe high-and low-risk groups yielded SUVmax of 14.54±6.54 and 13.06±8.51, respectively, and their difference was not significant(Z=-1.163, P=0.245). MTV and TLG[(MTV=17.86±19.32) mL], [TLG=(152.00±178.74) g] of the high-risk group were significantly higher than those of the low-risk group[(MTV=(7.38±5.00) mL], [TLG=(54.89±80.00) g], their difference was significant(Z=-2.808, P=0.005; Z=-3.395, P=0.001). The ROC curve analysis indicated that high-and low-risk groups could be predicted by MTV and TLG but not by SUVmax. The optimal prediction effectiveness was obtained at MTV=7.44 mL and TLV=55.52 g. The sensitivity, specificity, negative predictive value, positive predictive value, and precision rate were 76%, 61%, 72%, 68%, and 70% in MTV and 81%, 74%, 81%, 77%, and 78% in TLG, respectively.ConclusionMTV and TLG are superior to SUVmax in predicting high-and low-risk groups of endometrial cancer.
18F-FDG PET/CT diagnostic value and predictive analysis in adrenal metastasis lesions
Xiaobei Duan, Xiangmeng Chen, Binhao Huang, Weiqiang Zou, Guilin Qin, Yue'e Wu
2018, 42(4): 307-311, 327. doi: 10.3760/cma.j.issn.1673-4114.2018.04.003
ObjectiveTo discuss 18F-FDG PET/CT diagnostic value and predictive analysis in adrenal metastasis lesions.MethodsA total of 110 adrenal lesions in 95 non-symptom patients who underwent 18F-FDG PET/CT examination were retrospectively analyzed. Patients were divided into adrenal benign group(55 cases) and metastasis group(40 coses). Adrenal lesion size, CT attenuation value, SUVmax(standard uptake value maximum), and SUVmax ratio between adrenal and liver lesions(SUVmax ratio) were measured and recorded for each lesion. Univariate χ2 test, independent sample t-test, and Mann-Whitney U rank test were used for the statistical analyses. Univariate analysis and multivariate logistic analysis were used for the evaluation of predictive risk factor. The author performed ROC(receiver operating characteristic) curve analysis to determine the cut-off value in the diagnosis of adrenal metastasis lesions.ResultsA total of 110 lesions, 60 benign and 50 metastasis, were detected. The lesions diameter was 0.65 cm~5.70 cm with the average diameter (1.65±0.82) cm; the lesions CT value were -20.4~46.8 HU with the average CT value(24.2±14.9) HU; the lesions SUVmax were 1.1~31.9 with the average SUVmax 4.5±4.6; the lesions SUVmax ratio were 0.44~14.5 with the average SUVmax ratio 1.99±2.15. Differences in size, CT attenuation value, SUVmax, and SUVmax ratio between the benign and adrenal metastasis lesions were statistically significant(Z=-4.908, -6.030, -7.966, -8.252, respectively; all P < 0.001). The SUVmax ratio was the independent risk factor of adrenal metastasis. The SUVmax ratio of 1.24 was the best cutoff in the ROC analysis, yielding a sensitivity of 90.0% and specificity of 93.3%.Conclusions18F-FDG PET/CT is valuable in diagnosing adrenal metastasis lesions. The adrenal-to-liver SUVmax ratio is the independent risk factor of adrenal metastasis, and the SUVmax ratio of 1.24 was the best cutoff in the ROC analysis.
Application of 11C-acetate PET/CT imaging in the detection of recurrence and metastasis of hepatocellular carcinoma with intermediate and high differentiation
Guangyu Ma, Jiajin Liu, Baixuan Xu, Yingmao Chen, Xiaojun Zhang, Jian Liu, Jinming Zhang
2018, 42(4): 312-316. doi: 10.3760/cma.j.issn.1673-4114.2018.04.004
ObjectivesTo investigate the value of 11C-acetate PET/CT imaging in the detection of the recurrence and metastasis of hepatocellular carcinoma (HCC) with high or medium differentiation.MethodsA total of 10 patients who underwent surgical or interventional therapy, had moderately or highly differentiated HCC, underwent 11C-acetate and 18F-FDG PET/CT trunk imaging from January 2015 to December 2016 were retrospectively analyzed. Progressive increases in alpha fetoprotein were observed in the patients after the treatment. 11C-acetate and 18F-FDG PET/CT scan were performed on the patients in one week, and the diagnostic values of the two tracers were compared. In the PET images, the lesion was positive when the metabolic level of the lesion was higher than that of a normal liver tissue and negative when the metabolic level of the lesion was lower than or same as that of a normal liver tissue. The maximum standardized uptake value(SUVmax) and the ratio of target to background(T/B) were calculated by outlining the areas of interest. All patients were diagnosed with metastasis or recurrence by pathology or imaging examination.ResultsSix patients had moderately differentiated HCC and four patients had highly differentiated HCC. 11C-acetate imaging revealed 18 positive lesions, and the sensitivity was 100%(18/18). Five positive lesions were found in 18F-FDG images, and the sensitivity was 27.8%(5/18). Two tracers revealed five positive lesions (in four patients with moderately differentiated HCC). The sensitivity of 11C-acetate imaging to detect lesions was the same as that of double tracers combined imaging. The SUVmax range of 11C-acetate imaging was 1.3-14.2, and the range of T/B was 1.1-14.3. The SUVmax range of 18F-FDG imaging was 0.5-3.4, and the range of T/B was 0.6-1.1. Eight patients (13 lesions) were pathologically confirmed to have tumor recurrence or metastasis, and two patients (5 lesions) proved to be metastatic after 3 months of follow-up.Conclusions11C-acetate imaging can significantly improve the sensitivity of the diagnosis of recurrence and metastasis of moderately and highly differentiated HCC. 11C-acetate imaging is expected to replace 18F-FDG imaging in monitoring recurrence and metastasis in moderately and highly differentiated HCC.
The clinical value of different GFR methods in renal function evaluation of polycystic kidney diseases
Weiguang Chao, Jing Zhang, Guang Hu, Congge Li, Keyi Lu
2018, 42(4): 317-320. doi: 10.3760/cma.j.issn.1673-4114.2018.04.005
ObjectivesTo investigate the application value of 99Tcm-diethylene-triaminepentaacetic acid(99Tcm-DTPA) renal dynamic imaging (method A) and blood creatinine estimation method(method B) in glomerular filtration rate (GFR) detection in different stages of polycystic kidney diseases.MethodsA total of 59 polycystic kidney patients without dialysis were divided into the following groups by the gold standard method of double plasma (method C):Group A, GFR ≥ 60 mL/(min·1.73 m2) (including chronic kidney disease(CKD)1-2, 19 cases); Group B, 60 mL/(min·1.73 m2) > GFR ≥ 30 mL/(min·1.73 m2) (including CKD 3, 23 cases); Group C, GFR < 30 mL/(min·1.73 m2) (including CKD 4-5, 17 cases). The method A GFR and method B GFR were respectively matched with the method C GFR for t-test and Pearson correlation analysis.Results(1) The method B GFR in Group A, B and C were (85.43±19.77), (46.56±15.48), (20.96±11.3) mL/(min·1.73 m2). The method C GFR were (80.58±16.2), (42.66±7.63), (18.61±7.21) mL/(min·1.73 m2) respectively. There was no significant difference between method B and method C in Groups A, B and C(t=-1.462, -1.592, -1.791, all P>0.05). In each group, the method B had a good correlation with method C (r=0.69, 0.68, 0.92, all P < 0.05); (2) The method A GFR in Group A, B and C were (75.39±20.75), (42.86±18.95), (25.85±14.91) mL/(min·1.73 m2). There was no significant difference between method A and method C in Groups A and B(t=1.255, -0.061, both P>0.05); A significant correlation between method A and method C in both groups was observed (r=0.55, 0.62, both P < 0.05); In Group C, no significant difference (t=-2.132, P < 0.05) and correlation (r=0.36, P>0.05) between method A and method C.ConclusionsGate's method can evaluate renal function in the early stage of polycystic renal disease(CKD 1-3), but the late stage(CKD 4-5) is unsuitable. The blood creatinine estimation method (using the Cockcroft-Gault equation) can evaluate all stages of the renal function of the polycystic kidney disease.
Value of SPECT/CT bone imaging in the diagnosis of SAPHO syndrome
Zhijun Wang, Yingzhen Cong, Yanfei Gao, Chaowei Sun
2018, 42(4): 321-327. doi: 10.3760/cma.j.issn.1673-4114.2018.04.006
ObjectivesTo discuss the clinical value of SPECT/CT bone imaging in the diagnosis of synovitis, acne, pustulosis, hyperostosis, and osteomyelitis (SAPHO) syndrome.MethodsThe clinical data and SPECT and SPECT/CT imaging results of 11 patients with suspected SAPHO syndrome were retrospectively analyzed. All patients underwent 99Tcm-MDP full-body bone imaging, local fault imaging, and CT scanning with the same or different machines. The accuracy, sensitivity, and specificity of the diagnosis of SAPHO syndrome through SPECT and SPECT/CT imaging were analyzed and compared. Data were analyzed through χ2 test.ResultsAmong 11 patients with suspected SAPHO syndrome, 9 underwent puncture pathology or follow-up for the definite diagnosis of their conditions. Two patients were diagnosed with metastatic tumors. In 6 patients with SPECT, 41 lesions exhibited radioactive concentration. Furthermore, 44 lesions were observed in 9 patients who were diagnosed through SPECT/CT. The sensitivity, specificity, and accuracy of SPECT and SPECT/CT imaging were 66.7%(6/9) and 100%(9/9), 50.0%(1/2) and 50.0%(1/2), 63.6%(7/11) and 90.9%(10/11), respectively. The diagnostic accuracy of SPECT/CT imaging for SAPHO syndrome was higher than that for pure SPECT. Moreover, the diagnostic accuracies of the two methods were significantly different(χ2=11.82, P < 0.05).ConclusionsThe combined application of SPECT/CT may improve the accuracy of identifying the anatomical orientations of lesions and the specificity of bone imaging. This method can be used for the precise localization of lesions, the identification and diagnosis of SAPHO in its early stages, the implicit detection of lesions, and the characterization of lesion metabolic activity. Therefore, the combined application of SPECT/CT diagnosis has high clinical value in the diagnosis of SAPHO syndrome.
Comparison of ultrashort echo time-based and CT attenuation correction in the application of PET brain
Jiajin Liu, Xiao Bi, Liping Fu, Haodan Dang, DaYi Yin, Yingmao Chen, Baixuan Xu
2018, 42(4): 328-331. doi: 10.3760/cma.j.issn.1673-4114.2018.04.007
ObjectiveTo compare the accuracy of MR-ultrashort echo time(UTE) attenuation correction (AC) methods with that of CT AC methods in brain PET examination.MethodsTen patients who underwent the brain 18F-FDG examination of PET/CT and PET/MR were selected randomly. The PET data were attenuation corrected by MRI-UTE and CT methods, and PETUTE and PETCT images were obtained. With the threshold segmentation method, the UET and CT attenuation correction maps(μ Maps) were segmented, and their differences in the neurocranium, brain tissue, and air were compared using paired t test. The difference between PETUTE and PETCT was analyzed by the statistical parametric map.ResultsA significant difference was found between the UTE_μ maps and CT_μ maps in the neurocranium (t=-23.45, P < 0.05) and air(t=5.29, P < 0.05). The difference rates were -64.8%±8.7% and 74.8%±44.7%, respectively. No significant difference(-1.5%±3.9%) in the brain tissue was found between the two maps (t=-1.24, P>0.05). The closer the brain was to the skull and the air, the more metabolism was reduced.ConclusionsThe UTE sequence can accurately evaluate the μ map of brain tissue, but there was a certain underestimation of PET quantitative analysis in areas close to skull and air area.
DWI diagnosis of acute focal bacterial nephritis in children
Zhe Yan, Chunxiang Wang, Bin Zhao, Xin Li
2018, 42(4): 332-336. doi: 10.3760/cma.j.issn.1673-4114.2018.04.008
ObjectiveTo analyze the diffusion weighted imaging(DWI) manifestations of acute focal bacterial nephritis in children against the reference standard of gadolinium-enhanced T1-weighted imaging(Gd-T1WI).MethodsBetween February 2016 and December 2017, 26 cases of children (12 males, 14 females) with acute focal bacterial nephritis were examined by magnetic resonance(MR), including routine MR sequence(T1WI, T2WI), DWI, and Gd-T1WI-enhanced scan. The sensitivity and specificity of DWI in the diagnosis of acute focal bacterial nephritis were evaluated by Gd-T1WI-enhanced performance. Kappa test and McNemar test were applied for the calculation of the consistency among scanning sequences and calculation of repeatability among observers.ResultsAmong the 26 children, 24 cases showed a wedge-shaped hypoperfusion area in the enhanced Gd-T1WI images, 21 had unilateral renal involvement, and 3 had bilateral renal involvement. Twenty-six cases had positive results on DWI images, 23 had unilateral renal involvement, and 3 had bilateral renal involvement. The lesions showed high signal on DWI, and the mean apparent diffusion coefficient value is lower than that of the normal renal tissue. The sensitivity and specificity of DWI detection were 100% and 92%, respectively. DWI demonstrated excellent agreement(k=0.923) with Gd-T1WI with no significant difference(P=0.25) in detection of abnormal lesions. All the observers used DWI to detect lesions with excellent reproducibility(k=0.76).ConclusionsDWI can be used to diagnose acute focal bacterial nephritis with wedge-shaped or flaky high signal in children. The diagnostic effectiveness of DWI is basically the same as MRI enhanced scan, especially in people with renal insufficiency and inappropriate use of contrast agents.
Radiation dosage assessment of CT guided implantation of 125I seeds for medical personnel
Jidi Qian, Yu Zhang, Chunjing Yu
2018, 42(4): 337-339. doi: 10.3760/cma.j.issn.1673-4114.2018.04.009
ObjectiveThis study was conducted to assess the dosage of radiation associated with CT guided implantation of 125I seeds in medical personnel at different distances with or without radiation protection.MethodsAmbient dose equivalent was measured by gamma ray radiation detector after implantation of 125I seeds with or without protection at different distances(5 cm, 10 cm, 1 m, 2 m, and 3 m) into 50 patients. Radiation dose received by medical personnel was assessed.ResultsThe ambient dose equivalents were(1091.75±10.53), (1055.50±31.68), (123.45±20.83), (20.95±6.10), and(7.78±3.24) μSv/h in 5 cm, 10 cm, 1 m, 2 m, and 3 m. The ambient dose equivalents were(1.36±2.03), (0.97±1.48), (0.46±0.63), (0.29±0.34), and(0.14±0.12) μSv/h with 0.5 mmPb lead clothes at distances of 5 cm, 10 cm, 1 m, 2 m, and 3 m. The ambient dose equivalent was statistically significant with or without 0.5 mm Pb lead clothes (F=183.718, 71.202, 217.411, 184.169, 108.222, all P < 0.05).ConclusionsMedical personnel should take appropriate distance protection during 125I seeds implantation. Ambient dose equivalent can be significantly reduced by wearing 0.5 mmPb lead clothes.
Basic Science Investigations
Identification of genes for radiation resistance in colorectal cancer cells using bioinformatics analysis
Changchun Zhu, Guoxing Feng, Jiali Dong, Mian Jiang, Junbo He, Saijun Fan
2018, 42(4): 340-345, 351. doi: 10.3760/cma.j.issn.1673-4114.2018.04.010
ObjectiveTo preliminarily explore potential genes related to radiation resistance in colorectal cancer at the molecular level, we employed bioinformatics to screen different expression genes for radiation resistance in colorectal cancer cells.MethodsThe comparison between the gene expression levels of radiation resistance colorectal cancer cell lines and parental cell lines was downloaded from the Gene Expression Omnibus(GEO) database. The differentially expressed genes(DEGs) were screened by using the R Programming Language and were analyzed through Gene Ontology(GO) functional enrichment analysis and kyoto encyclopedia of genes and genomes(KEGG) pathway analysis and by using protein-protein interaction(PPI) networks. The hub genes were obtained on the basis of a PPI network. The mRNA relative expression level of the hub genes was verified via quantitative real-time polymerase chain reaction in HCT116 after radiation. The statistical significance of the results was analyzed via student t-test.ResultsA total of 101 DEGs were found in GSE43206, including 67 upregulated genes and 34 downregulated genes. The GO enrichment analysis suggested that these DEGs are enriched in biological processes, including cell migration and DNA replication. KEGG pathway analysis indicated that these DEGs were mainly enriched in the hypoxia inducible factor-1 signaling pathway. Six radiation resistance genes with high connectivity were identified on the basis of the PPI networks, including NDRG1, PAG1, LRP1, PIM1, LDLR, and PLAUR. Quantitative real-time polymerase chain reation verified that the expression levels of hub genes were markedly up-regulated in HCT116 after radiation, including NDRG1PAG1LRP1PIM1LDLR and PLAUR (t=49.981, P < 0.01; t=26.420, 28.698, 21.358, 23.545, all P < 0.05; t=50.601, P < 0.01).ConclusionsThe use of bioinformatics enabled effectively screening radiation resistance genes in colorectal cancer, which can be used for further researches. The molecular biology experiments confirmed the differential expression of potential genes after irradiation in colorectal cancer cell HCT116.
Difference of radiosensitivity for 137Cs γ-radiation between A549 and H460 lung cancer cell lines
Xiaohui Sun, Yangyang Kong, Qianying Lu, Chang Xu, Yan Wang, Liqing Du, Kaihua Ji, Ningning He, Qin Wang, Qiang Liu
2018, 42(4): 346-351. doi: 10.3760/cma.j.issn.1673-4114.2018.04.011
ObjectiveThis study aims to compare radiosensitivity to γ ray between A549 and H460 cells and explore the relationship between different radiosensitivities and Nrf2 expression.MethodsA549 and H460 cells were exposed to 2, 4, and 6 Gy 137Cs γ ray, and H460 cells were exposed to 1, 2, 4, and 6 Gy 137Cs γ ray. Cell proliferation was assessed by clone formation assay. DNA damage was evaluated using comet assay. Nrf2 protein level was measured by Western blot analysis.ResultsClone formation assay indicated that the clone formation rates of A549 cells were (73.78±14.69)%, (42.26±3.19)%, and (17.5±2.18)%, and those of H460 cells were (56.38±6.28)%, (23.82±8.25)%, and (4.66±0.87)% after exposure to 2, 4, and 6 Gy, respectively (t=7.99, P=0.015; t=6.75, P=0.019; t=12.03, P=0.005). Lung cancer H460 cells possessed higher olive tail moments (1.27±0.05), and tail DNA(4.51±0.19)% than A549 cells[0.68±0.04, (2.12±0.14)%] in the comet assay conducted 2 h after 4 Gy irradiation(t=8.69, 10.30, both P < 0.05). The Western blot assay indicated that the Nrf2 protein level was higher in A549 cells than in H460 cells. Radiation might induce the increase in the Nrf2 protein level in A549 and H460 cells. Moreover, the Nrf2 protein level was higher in radioresistant H460R cells than in radiosensitive H460 cells.ConclusionA549 cells are more resistant to 137Cs γ ray than H460 cells, and different radiosensitivities may be related to Nrf2 protein level.
Review Articles
Overview of PET/MR attenuation correction
Xing Chen, Jun Zhao
2018, 42(4): 352-356. doi: 10.3760/cma.j.issn.1673-4114.2018.04.012
PET/MR is the most advanced molecular imaging device nowadays. The PET image needs to be quantified by attenuation correction(AC) to obtain the real activity distribution of radioactive drugs. The principle of AC of PET/MR and four methods of AC are briefly described in this paper.This paper mainly introduces the tissue segmentation and atlas method. A more promising launch data reconstruction method is also introduced in this paper.
The value of 18F-FDG PET/CT on evaluating therapeutic effect in the treatment of lung cancer
Yanlin Tan, Chuning Dong, Yunhua Wang
2018, 42(4): 357-362. doi: 10.3760/cma.j.issn.1673-4114.2018.04.013
In recent years, the clinical application of the precise molecular targeted therapy and immunotherapy of lung cancer has been a focus of lung cancer research. 8F-FDG PET/CT is an imaging technology that merges morphology and molecular metabolism. 18F-FDG PET/CT can provide timely information about the activities of tumor cells compared with traditional imaging technologies, such as CT and MRI, and has significant value on guiding precise radio-chemotherapy and monitoring treatment efficacy in lung cancer. This article will focus on the application of 8F-FDG PET/CT in lung cancer, particularly in the delineation of targeted lesion, evaluation of treatment effect, and prognosis evaluation.
The research progress of multimodal imaging in malignant lymphoma
Jianjie Wang, Xuejuan Wang, Chaoyu Pu
2018, 42(4): 363-368. doi: 10.3760/cma.j.issn.1673-4114.2018.04.014
Medical imaging plays an important role in the clinical staging, restaging, and therapy assessment of tumors and may also serve as prognostic biomarker. Multimodal hybrid imaging technologies, such as PET/CT and recently PET/MR, have been rapidly developed in recent years. PET/CT is often recommended for the initial staging of FDG-avid lymphomas and therapy monitoring. The role of FDG PET/CT for interim therapy evaluation must be determined. Some feasibility studies indicated that using PET/MR for initial lymphoma staging is feasible. FDG PET/MR seemed to offer a comparable diagnostic performance compared with PET/CT. In this article, the research status and progress concerning multimodal hybrid imaging technologies, such as PET/CT and PET/MR, in malignant lymphoma are reviewed.
The value of Midkine as a thyroid cancer marker
Zhaowei Meng, Qiang Jia
2018, 42(4): 369-372, 376. doi: 10.3760/cma.j.issn.1673-4114.2018.04.015
Midkine (MK) has multiple biological functions, and plays an important role in the diagnosis and treatment of tumor. Midkine is generally overexpressed in diverse malignant tumors, and enhances proliferation, migration and angiogenic activity of tumor cells. Recent studies have found that MK is closely related with thyroid cancer. Immunohistochemical studies showed that MK expression in thyroid cancer cells and tissues was significantly higher than that of normal thyroid. MK level of the needle aspiration eluant had a good diagnostic value for the differentiationbetween benign and malignant thyroid nodules. MK is cytokinesecreted in the blood; it could be used as a serological marker for the differentiation between benign and malignant thyroid nodules. MK could also beapplied for the prognosis of differentiated thyroid carcinoma treated by 131I (whether with or without metastases). In addition, in the case of thyroglobulin antibody positivity, MK could be surrogated as a viable serological marker for predicting thyroid cancer metastasis. The major limitation of MK is lowoncological specificity. In many cases, it is necessary to measure MK with other specific tumor markers. Future researches should focus on the mechanism of MK in the occurrence, development and therapeutic resistance of thyroid cancer. This review discusses the value of MK as a thyroid cancer marker.
Case Reports
Small cell neuroendocrine carcinoma of the cervix with multiple metastases:18F-FDG PET/CT findings
Chongjiao Li, Yueli Tian, Meijuan Shen, Diankui Xing, Bing Wen, Yong He
2018, 42(4): 373-376. doi: 10.3760/cma.j.issn.1673-4114.2018.04.016
The author reports a case of small cell carcinoma of the cervix. The patient had a 7-day history of headache and a hard mass in the parietal region of the cranium on the right side as the first manifestation. Cranial CT scan showed a high-density nodule on the right parietal lobe, with a surrounding low-density edema and adjacent skull bone destruction; thus, intracranial tumor was considered. MRI brain scan showed a slightly longer T1 and T2 signal nodule, with edema in the right parietal lobe. The lesion was significantly enhanced after the application of contrast. The 18F-FDG PET/CT whole-body imaging showed a solid mass of cervix and slightly large bilateral pelvic lymph nodes and presented multiple bone destruction with high FDG uptake. The histopathological examination revealed small cell carcinoma of the cervix. Small cell carcinoma of the cervix has extremely low incidence, its clinical manifestation lacks specificity, and it is not easily detected at its early stage. Small cell carcinoma of the cervix is an aggressive tumor and commonly have early metastasis through lymph node and blood circulation, with a poor prognosis. The sensitivity of 18F-FDG PET/CT in detecting primary lesions and metastases, including lymph node, bone, and other occult lesions, is high. Thus, this method is valuable in the clinical management of the small cell carcinoma of the cervix.
A case of bilateral extrarenal pelvis accompanied with severe hydronephrosis of left pelvis of 99Tcm-DTPA renal dynamic imaging
Wanting Li, Haiyan Liu, Jing Niu, Yali Cui, Zhifang Wu, Jianzhong Liu
2018, 42(4): 377-379. doi: 10.3760/cma.j.issn.1673-4114.2018.04.017
The present case describes the 99Tcm-DTPA renal dynamic imaging of bilateral extrarenal pelvis accompanied by severe hydronephrosis of the left pelvis. The extrarenal pelvis is usually asymptomatic and is often found through abdominal examination via abdominal ultrasonography or CT scan. Hydronephrosis generally does not compress the renal cortex because the renal pelvis is located outside the kidney; thus, the patient's early serum urea and creatinine levels are normal or slightly increased. 99Tcm-DTPA renal dynamic imaging is the clinicians' first choice for evaluating left or right renal functions. Bilateral extrarenal pelvis, accompanied by severe hydronephrosis of pelvis, presents an abnormal concentration of 99Tcm-DTPA outside the renal area. This abnormality needs to be identified as urinary leakage or renal dysplasia. Therefore, we explored the characteristics of 99Tcm-DTPA renal dynamic imaging and the differential diagnosis of extrarenal pelvis with severe hydronephrosis in this study. Understanding this anatomical variation and providing information about renal functions can help clinicians make appropriate clinical decisions and reduce the risk of damage in the renal pelvis during surgery.
Difficult and Complicated Cases Analysis
Differential diagnosis of large mediastinal mass in children with 18F-FDG PET/CT
Xiaoyuan Liu, Lei Zhu, Zhao Yang, Jianjing Liu, Wengui Xu
2018, 42(4): 380-384. doi: 10.3760/cma.j.issn.1673-4114.2018.04.018
Among mediastinal tumors, thymoma, neurogenic tumors, lymphomas and germ cell tumors are more common. The clinical manifestations of mediastinal tumor vary according to tumor size, site and benign and malignant. Mediastinal tumor in children is common in clinical, with no typical early symptoms, lack of specificity, and generally increases with tumors appeared some symptoms such as chest pain, dyspnea, cough, so early diagnosis is difficult. Two cases of mediastinal mass in children without specific clinical symptoms were selected, through its 18F-FDG PET/CT imaging features and clinical data for the differential diagnosis, summarize the diagnosis idea, in order to improve the imaging diagnostic accuracy.