Prognostic significance of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with primary T cell lymphomas.

OBJECTIVE: T cell lymphomas are associated with an aggressive worse prognosis. This study is designed to assess T cell lymphomas using 18F-FDG PET/CT. METHODS: Sixty-four patients with newly diagnosed T cell lymphomas underwent PET/computed tomography (PET/CT) scans, 47 cases who were fully followed up were retrospectively reviewed and analyzed. Overall survival (OS) and progression-free survival (PFS) were recorded for prognosis. We measured the maximum standardized uptake value (SUVmax) in all cases, analyzed the correlation between SUVmax and survival and other clinicopathologic parameters. Kaplan-Meier log-rank tests were then used to compare the survival of high and low PET/CT parameter groups, and multivariate Cox proportional hazards regression analysis was carried out to identify predictors of OS and PFS. RESULTS: With a median follow-up of 26.5 (range 0.7-117.5) months, the 1-, 2- and 3-year OS were 75.6, 61.7 and 49.2%, and PFS were 49.3, 39.9 and 29.9%, respectively in 47 patients. Among them, 33 cases progressed with a median time of 9.5 (0.7-115.0) months, and 26 patients died with a median survival time of 26.5 (0.7-117.5) months. Multivariate analysis showed the following independent prognostic factors for OS: age >60 years (P = 0.002), SUVmax >9.7 (P = 0.009) and extranodal involvement of more than one site (P = 0.018). In addition, lactate dehydrogenase level (P = 0.003) and B symptoms (P = 0.018) were independent risk factors for PFS. CONCLUSION: Pretherapy SUVmax may serve as an independent predictor of outcome in patients with newly diagnosed T cell lymphomas.

[Efficiency evaluation of diuretic renography in the operative or conservative treatments of unilateral ureteropelvic junction obstruction patients].

OBJECTIVE: To analyze the efficiency of diuretic renography in the management of unilateral ureteropelvic junction obstruction (UPJO) patients, by observing the affected kidney relative renal function (RRF) and drainage in the period of follow-up. METHODS: In the study, 76 patients diagnosed as unilateral UPJO were retrospectively collected. Diuretic renography was performed on all the patients initially, and during the period of follow-up. No morphological or functional abnormalities were detected on the contralateral kidney. Changes of affected renal RRF and drainage were observed during the follow-up period. The correlations of initial RRF (RRFinitial) and drainage type with RRF improvement were analyzed. RESULTS: In the operative group (57 cases), the RRFinitial of affected kidney was 40.81%±12.96%, and the RRF in the last follow-up (RRFrecent) was 44.63%±13.21% (P<0.05). Drainage improvements was found in 54.00% of the obstructive patients (27/50), and unchanged in 71.43% of the non-obstructive patients (5/7). In the conservative group (19 cases), the RRFinitial was 46.47%±12.84%, and the RRFrecent was 46.95%±11.86% (P>0.05). One obstructive patient (1/10) was found with improved drainage, and the other 9 obstructive patients (9/10) and all of the non-obstructive patients (9/9) were observed with unchanged drainage. Four patients with deteriorated RRF in the conservative group received surgery. There were no significant differences in the changes of affected renal RRF in different RRFinitial and drainage types in both operative and conservative groups. CONCLUSION: Diuretic renography could be effectively applied in the follow-up of unilateral UPJO patients. Operation could improve affected kidney's RRF, and better some patients' drainage conditions. However, for those patients with no or minor clinical symptoms, conservative management could be accepted if RRF remains stable during the period of follow up.

[Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in fever of unknown origin].

OBJECTIVE: To evaluate the diagnostic value of fluorine-18 fluorodeoxyglucose (¹8F-FDG) positron emission tomography/computed tomography (PET/CT) in fever of unknown origin (FUO) in a Chinese hospital. METHODS: The records of 51 patients with FUO (32 men and 19 women; mean age 54 years with a range between 3 and 81 years) were analyzed retrospectively. All the patients were examined by ¹8F-FDG PET/CT scan and the results were compared with the final diagnosis which was established by additional procedures including pathology, laboratory examination, and clinical follow-up for more than 3 months. The t test was used for statistical analysis. RESULTS: A final diagnosis was established for 48 patients, including 32 patients with infectious diseases, 9 with malignancies, and 7 with non-infectious inflammatory diseases. By FDG PET scan alone, the rates of true positive, false positive, false negative, and true negative were 52.9%, 27.5%, 17.6%, and 2.0%, respectively. By FDG PET/CT scan, the rates of true positive, false positive, false negative, and true negative were 70.6%, 27.5%, 2.0%, and 0, respectively. ¹8F-PET/CT had a sensitivity of 97.3% (36/37), specificity of 0 (0/14), and accuracy of 70.6% (36/51) in FUO, especially a high sensitivity and accuracy of 100% (9/9) in the diagnosis of malignant tumor. Moreover, the maximum standardized uptake value (SUVmax) in tumor was significant higher than that in infection (3.7 ± 2.7 vs. 7.7 ± 3.5, P=0.001, t=3.6), which implied that SUVmax might be useful in differential diagnosis in FUO. CONCLUSION: FDG PET/CT is a valuable imaging tool for the identification and location of the potential lesion in FUO and is helpful for the etiological diagnosis, especially in the diagnosis of malignant lesions.

Synthesis and evaluation of novel organogermanium sesquioxides as antitumor agents.

Five new organogermanium sesquioxides have been synthesized and characterized by elemental analysis and IR spectra. All the compounds were tested for antitumor activities against KB, HCT, and Bel cells in vitro. Compound 5 (gamma-thiocarbamido propyl germanium sesquioxide) showed excellent antitumor activity, and its inhibition yield to KB, HCT, and Bel cells was 92.9%, 84.9%, and 70.9%, respectively. A rapid method was described for the labeling compound 5 with (99m)Tc, and the optimum labeling conditions were investigated. The labeling yield is above 90% in pH 7.0, 20 degrees C, reaction time greater than 10 minutes, 1 mg of compound 5, and 0.075 approximately 0.1 mg of SnCl(2). The biodistribution of (99m)Tc labeled compound 5 in nude mice bearing human colonic xenografts was studied. The result showed that the tumor uptakes were 0.73, 0.97, 0.87, and 0.62 ID%/g at 1-hour, 3-hour, 6-hour, and 20-hour postinjection, respectively. T/NT (the uptake ratio for per gram of tumor over normal tissues) was 18.3 for tumor versus brain and 5.81 for tumor versus muscle at 20-hour postinjection. The tumor clearance was slow. The results showed that compound 5 may be developed to be a suitable cancer therapeutic agent.

Development of formulae for accurate measurement of the glomerular filtration rate by renal dynamic imaging.

AIM: Currently, the widely adopted renal dynamic imaging in clinical practice uses Gates' method to calculate the glomerular filtration rate (GFR), but many researchers have proven that Gates' method may result in bias. Thus, this article explores alternative improved formulae to calculate GFR by renal dynamic imaging. METHODS: Three hundred and sixty-seven patients were selected and their GFR values were measured using renal dynamic imaging and the two-plasma method with 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) as the imaging agent. With the two-plasma GFR as reference value, two equations were obtained from linear and non-linear regression analyses between the renal uptake percentage and two-plasma GFR. The 367 patients were divided into two random groups, with the first group used to derive the regression formulae and the second to verify the formulae. Finally, all patients were studied to derive the formulae to calculate GFR. The comparison of our formulae with the commonly used Gates' formula was conducted by the Bland-Altman method. RESULTS: The linear and non-linear GFR formulae were as follows: GFR (ml/min/1.73 m2)=(631.633 x renal uptake percentage - 2.040) x 1.73/BSA (BSA, body surface area) and GFR (ml/min/1.73 m2)=(-1996.585 x renal uptake percentage2 + 1013.526 x renal uptake percentage - 12.739) x 1.73/BSA, respectively. The biases of the GFR values calculated using the linear and non-linear formulae and Gates' formula relative to the two-plasma GFR were -2.5 +/- 19.1 ml/min/1.73 m2, -2.0 +/- 19.3 ml/min/1.73 m2 and 3.4 +/- 19.4 ml/min/1.73 m2, respectively. CONCLUSIONS: The GFR values calculated using our new formulae correlate better with the reference GFR value than does GFR calculated by Gates' formula, and the GFR values measured using the non-linear formula are more accurate than those obtained using the linear formula.

[Study of clinical value of dual-phase imaging using single photon emission computed tomography with coincidence detection for differentiating benign from malignant lesions].

OBJECTIVE: To investigate the clinical value of dual-phase imaging of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) using single photon emission computed tomography with coincidence detection (SPECT with coincidence) for differentiating benign and malignant lesions. METHODS: Thirty patients with unknown lesions from June 2003 to March 2004 in our hospital were enrolled in this study. All patients underwent dual-phase imaging of 18F-FDG SPECT with coincidence. The early images were obtained 60 min post injection. And the patients were divided into 2 groups, one receiving delayed scans at 210 min after 18F-FDG injection and the other at 270 min. Lesion status was determined by pathologic findings or by clinical follow-up. RESULTS: Forty-eight lesions (30 malignant and 18 benign lesions verified by pathologic findings or clinical follow-up) of 30 patients were detected by dual-phase imaging, in which there were 29 true positive results, 15 true negative, 3 false positive and 1 false negative. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of dual-phase imaging were 96.7%, 83.3%, 91.6%, 90.6%, and 93.8%, respectively. Those of early imaging and CT were 93.3%, 72.2%, 85.4%, 84.8%, 86.7% and 76.9%, 57.1%, 70.0%, 76.9%, 57.1%, respectively. The T/NT of all malignant lesions (except 1 false negative case) in delayed imaging were significantly increased (t=-3.071, P<0.01). However, there were no statistical differences in the T/NT of benign lesions (t=0.398, P=0.695) between early and delayed imagings. CONCLUSION: Dual-phase imaging of FDG SPECT with coincidence provides benefit for differentiating benign and malignant lesions.

[Influence of lipopolysaccharide pretreatment on acute lung injury induced by lipopolysaccharide in rats].

OBJECTIVE: To evaluate the effect of lipopolysaccharide pretreatment on blocking the development of lipopolysaccharide (E.Coli O(55):B(5)) induced acute lung injury. The activity of nuclear factor-kappaB (NF-kappaB) in alveolar macrophages was assessed to elucidate its mechanism. METHODS: Thirty-six Wistar rats were divided into three groups: normal saline (A), lipopolysaccharide (B), lipopolysaccharide preconditioning (C). Rat model of acute lung injury was reproduced by administering intraperitoneally lipopolysaccharide in a dose of 6 mg/kg. Group A and B served as control. In the test group (group C) lipopolysaccharide was given intraperitoneally 0.5 mg/kg, 0.5 mg/kg and 1.0 mg/kg consecutively for 3 days before lipopolysaccharide challenge. Four hours after lipopolysaccharide/normal saline administration, the animals were killed. Blood gas was measured. And total protein of bronchoalveolar lavage fluid (BALF) was calculated by measuring the radioactivity of (99)Tc labeled serum albumin. Wet/dry ratios of the lungs of each group were determined. The nuclear protein of the alveolar macrophages was extracted from BALF, and the activity of NF-kappaB was assayed with electrophoretic mobility shift assay (EMSA). Microscopic examination of the lung was done. RESULTS: In group C, partial pressure of oxygen in artery (PaO(2)) was significantly higher than that in group B, and total protein content of BALF was significantly lower in group A and C than that in group B. Activity of NF-kappaB in group C was higher than group A and B. CONCLUSION: Lipopolysaccharide pretreatment can reduce the severity of acute lung injury induced by lipopolysaccharide challenge. This phenomenon may be related with change in the activity of NF-kappaB of the alveolar macrophages.

[The clinical application of 18F-fluorodeoxyglucose coincidence imaging in lymphoma].

OBJECTIVE: To investigate clinical value of (18)F-fluorodeoxyglucose ((18)F-FDG) coincidence imaging (SPECT/PET) in diagnosis and treatment of lymphoma. METHODS: (18)F-FDG metabolic imaging was performed in eighteen patients NHL before and after treatment using a Vertex(Plus) EPIC MCD/AC from ADAC Company. The findings of (18)F-FDG metabolic images were analyzed in qualitative and semi-quantitative ways. (18)F-FDG images were compared with synchronous routine images such as ultrasonography and CT. RESULTS: Thirty studies were performed in 18 patients with NHL in this study. There were 21 true positives, 6 true negatives, 2 false positives and 1 false negative. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 90.0%, 95.5%, 75.0%, 91.3%, and 85.7%, respectively. (18)F-FDG imaging led to a change of 16.7% in clinical staging, and 46.7% in management. The PPV and NPV of recurrence detected by (18)F-FDG SPECT/PET were 100% and 80.0%, while these of CT were 50.0% and 25.0% after therapy. Four of five patients with negative entered clinical complete remission (CR), whereas all the 11 patients with abnormal (18)F-FDG uptake relapsed or reprogressed. Progression-free survival (PFS) with negative (18)F-FDG was 16 - 47 months (median: 28.7 months) and PFS with positive was 3 - 46 months (median: 8.3 months). CONCLUSION: SPECT/PET (18)F-FDG metabolic imaging plays an important role in clinical diagnosis and treatment of NHL.