The relationship between fluid intelligence and sustained inattentional blindness in 7-to-14-year-old children.

Previous researches have shown that people with higher fluid intelligence are more likely to detect the unexpected stimuli. The current study systematically explored the relationship between fluid intelligence and sustained inattentional blindness in children. In Experiment 1, we measured one hundred and seventy-nine 7-to-14-year-old children's fluid intelligence and sustained inattentional blindness. The results showed that fluid intelligence was negatively related to sustained inattentional blindness only in 7-to-8-year-old children. In Experiment 2, we explored sustained inattentional blindness in sixty children with high Raven's scores. We found that compared with children who have average Raven's scores aged 11-to-12 years old, children with high Raven's scores were unable to better avoid sustained inattentional blindness. In general, this research implies that the relation between fluid intelligence and sustained inattentional blindness is weak. Fluid intelligence could predict sustained inattentional blindness only when children do not have enough perceptual capacities to complete the primary task.

Biomarker alterations with metronomic use of low-dose zoledronic acid for breast cancer patients with bone metastases and potential clinical significance.

Zoledronic acid has direct and indirect antitumor effects. However, the optimal regimen for breast cancer patients remains to be determined. This study aimed to compare biomarker changes between a weekly low dose (metronomic arm) and a conventional dosage of zoledronic acid (conventional arm), and to explore correlations between biomarkers and progression-free survival (PFS). Sixty breast cancer patients with bone metastases were randomized to receive either zoledronic acid 1 mg IV weekly for 4 doses or a single dose of zoledronic acid 4 mg IV. Administration of other treatments was delayed for 1 month. Serial blood samples were collected on days 1, 15, 29, and at 3 months. Serum VEGF alteration was the primary endpoint. Compared to the conventional arm, the metronomic arm resulted in a significantly greater reduction in serum levels of VEGF and N-telopeptide of type I collagen (NTx) over time during the first month of treatment. Serum CA 15-3 level stabilized over time in the metronomic arm, but increased in the conventional arm. Independent prognostic factors for PFS included chemotherapy received (HR, 8.042; P = 0.000), estrogen receptor status (HR, 2.837; P = 0.020), VEGF levels at 3 months after intervention (HR, 2.026; P = 0.045), and baseline NTx (HR, 1.051; P = 0.001). Metronomic low-dose zoledronic acid is more effective than the conventional regimen and generates sustained reductions in circulating VEGF and NTx levels, as well as stabilization of serum CA 15-3 levels (ClinicalTrials.gov number, NCT00524849).

The Assessment of Estrogen Receptor Status and Its Intratumoral Heterogeneity in Patients With Breast Cancer by Using 18F-Fluoroestradiol PET/CT.

AIM: The aim of this study was to investigate the clinical value of F-fluoroestradiol (F-FES) PET/CT in the assessment of the estrogen receptor (ER) and its intratumoral heterogeneity in breast cancer patients. METHODS: Forty-six female patients (50 lesions) with histologically confirmed invasive breast cancer who underwent both F-FES and F-FDG PET/CT in our center were retrospectively included. All the patients enrolled were scheduled to undergo biopsy. The F-FES and FDG uptakes were compared with pathological features (tumor size, ER, progesterone receptor, human epidermal growth factor receptor 2, and Ki67%). The optimal threshold to discriminate ER-positive and ER-negative lesions was determined by receiver operating characteristic curve analysis. Furthermore, we observed the intratumoral heterogeneity by a heterogeneity index (SUVmax/SUVmean) and compared the results with the Chang-Gung Image Texture Analysis. RESULTS: There was good agreement between F-FES uptake and ER, progesterone receptor, and human epidermal growth factor receptor 2 expression (P < 0.001), and the use of SUVmean instead of SUVmax can provide a slightly better correlation. The optimal threshold for F-FES PET/CT to discriminate between ER-positive and ER-negative lesions, as determined by receiver operating characteristic curve analysis, was an SUVmax of 1.82 (sensitivity = 88.2% and specificity = 87.5%) and SUVmean of 1.21 (sensitivity = 85.3% and specificity = 93.7). Our simplified heterogeneity index-FES can easily observe ER heterogeneity. In addition, our results suggested that recurrent/metastatic patients and lesions located other than breast might have greater heterogeneity. CONCLUSIONS: F-FES PET/CT is a feasible, noninvasive method for assessing ER expression in breast cancer patients. Because intratumoral heterogeneity exists, F-FES PET/CT might better reflect the ER expression, especially in metastatic patients after treatment, thus assisting in making individualized treatment decisions.

Pretreatment (18)F-FDG uptake heterogeneity can predict survival in patients with locally advanced nasopharyngeal carcinoma--a retrospective study.

BACKGROUND: Intratumoural heterogeneity has been demonstrated to be a strong indicator of malignant transformation. Our study was to investigate pretreatment (18)F-FDG parameters, including (18)F-FDG based heterogeneity for predicting survival in patients with locally advanced nasopharyngeal carcinoma (NPC). METHODS: Forty newly diagnosed, biopsy-proven locally advanced NPC patients who underwent (18)F-FDG PET/CT were retrospectively included. The following PET parameters were assessed: maximum and mean standardised uptake value (SUVmax and SUVmean), metabolic tumour volume (MTV), total lesion glycolysis (TLG) and intratumoral heterogeneity index (HI). The previous parameters were recorded both for the primary tumor (-T) and neck lymph nodes (-N). The following endpoints were evaluated: local control (LC), progression-free survival (PFS) and overall survival (OS). The survival analyses were performed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test. RESULTS: Patients with a lower HI-T, SUVmax-T, SUVmean-T and TLG-T had significantly better 2-year LC. In predicting PFS, we found that both lower HI-T and HI-N had significantly better prognosis. However, the OS was only statistically associated with HI-T. CONCLUSION: (18)F-FDG based heterogeneity appears to be an potential predicator of patient survival after treatment.

The preliminary study of 16α-[18F]fluoroestradiol PET/CT in assisting the individualized treatment decisions of breast cancer patients.

OBJECTIVE: To evaluate the clinical value of 16α-[18F]fluoroestradiol (18F-FES) PET/CT in assisting the individualized treatment decisions of breast cancer patients. METHODS: Thirty-three breast cancer patients, who underwent both 18F-FES and 18F-FDG PET/CT from July 2010 to March 2013 in our center, were enrolled in this preliminary study. All the patients used 18F-FES PET/CT as a diagnostic tool with a clinical dilemma. We used the maximum Standardized Uptake Value (SUVmax) to quantify ER expression and a cutoff value of 1.5 to dichotomize results into ER positive and negative lesions. All patients were clinically followed up at least 6 months. RESULTS: In evaluating equivocal lesions on conventional work-up group (n = 4), three lung lesions and another iliac lesion were enrolled. As for three lung lesions, 18F-FES PET/CT showed one lesion with high uptake, which suggested it was an ER positive metastasis. The other two lesions were 18F-FES negative, which meant an ER negative metastasis or secondary primary tumor. Additionally, one iliac lesion was detected by MRI. 18F-FDG uptake was high at the suspected lesion, whereas 18F-FES uptake was absent; In predicting origin of metastasis group (n = 2), two breast cancer patients had secondary primary tumors were collected. They were 18F-FES negative, which showed low possibility of metastasis from breast cancer and they were all confirmed by biopsy. In detecting ER status in metastasis group (n = 27), 18F-FES PET/CT showed increased 18F-FES uptake in all metastatic lesions in 11 patients; absent in all lesions in 13 patients; and the remaining 3 patients had both 18F-FES positive and negative lesions. Totally, on the basis of the 18F-FES PET/CT results, we found changes in the treatment plans in 16 patients (48.5%, 16/33). CONCLUSIONS: 18F-FES PET/CT could assess the entire tumor volume receptor status; therefore, it may be used to assist the individualized treatment decisions of breast cancer patients.

Is 18F-FDG PET/CT more reliable than 99mTc-MDP planar bone scintigraphy in detecting bone metastasis in nasopharyngeal carcinoma?

OBJECTIVE: Bone metastasis occurs frequently in nasopharyngeal carcinoma (NPC) patients. The aim of this study was to compare the clinical value of 18F-FDG PET/CT with that of 99mTc-MDP planar bone scintigraphy (PBS) for detecting bone metastasis in NPC patients. METHODS: Thirty-five histologically proven NPC patients were enrolled in this retrospective study. They underwent both 18F-FDG PET/CT and PBS within 7 days in our department. In a lesion-based analysis, the skeletal system, excluding the head, was divided into four regions: the spine, the pelvis, the thorax, and the appendix. Bone metastasis was considered to be present by either biopsy or clinical follow-up for at least 6 months. PET/CT and PBS were compared by McNemar's paired-sample test. RESULTS: A total of 50 lesions were confirmed to be malignant (spine 27, thorax 11, pelvis 8 and appendix 4). Although PET/CT was found to be more sensitive on lesion level than PBS (sensitivity 70.0 versus 42.0%; P=0.044), there were still 14 metastatic (28.0%) lesions that could be detected by PBS while negative in PET/CT imaging. In a patient-based analysis, fifteen (42.9%) of 35 eligible patients were found to have bone metastasis. The sensitivity, specificity and accuracy of PET/CT was 60.0% (9/15), 100% (20/20) and 82.9% (29/35); as for PBS, it was 66.7% (10/15), 85.0% (17/20) and 77.1% (27/35), respectively. There was no statistical difference between PET/CT and PBS (P>0.05). CONCLUSIONS: PBS, as a conventional imaging, should be used as an important complement for detecting bone metastasis in NPC patients.

Prevalence and risk of cancer of incidental uptake in prostate identified by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography.

OBJECTIVE: The objective was to investigate the prevalence of incidental fluorine-18 fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography. METHODS: A total of 11,239 male nonprostate disease patients were included retrospectively. RESULTS: The prevalence of incidental prostate FDG uptake was approximately 1.8%. Among 198 incidental lesions, 100 patients had further examinations; 20 lesions were confirmed to be malignant, while 80 lesions were benign. After logistic regression analysis, age, site, and the maximum standard uptake value were the potent predictors for differentiation of malignant prostate lesions. CONCLUSION: When focal FDG uptake in the peripheral zone of prostate is detected, especially in elderly men, further clinical evaluation is recommended.

Can fluorine-18 fluoroestradiol positron emission tomography-computed tomography demonstrate the heterogeneity of breast cancer in vivo?

AIM: Our study was to investigate the heterogeneity of estrogen receptor (ER) expression among tumor sites by using fluorine-18 ((18)F) fluoroestradiol (FES) positron-emission tomography-computed tomography (PET-CT) imaging. METHODS: Thirty-two breast cancer patients underwent both (18)F-FES and (18)F fluorodeoxyglucose (FDG) PET-CTs from June 2010 to December 2011 in our center (mean age, 53 years; range, 27-77 years). We used the maximum standardized uptake value to quantify ER expression and a cutoff value of 1.5 to dichotomize results into ER(+) and ER(-). The difference of heterogeneity between the initial patients and patients with recurrent or metastatic disease after treatments was assessed by using the χ(2) test. Also, the (18)F-FES uptake was compared with the (18)F-FDG uptake by use of Spearman correlation coefficients. RESULTS: A total number of 237 lesions in 32 patients were detected. Among them, most lesions (64.1% [152/237]) were bone metastasis. A striking 33.4-fold difference in (18)F-FES uptake was observed among different patients (maximum standardized uptake value range, 0.5 to approximately 16.7), and a 8.2-fold difference was observed among lesions within the same individual (1.0 to approximately 8.2). As for (18)F-FDG uptake, the difference was 11.6-fold (1.3 to approximately 15.1) and 9.9-fold (1.4 to approximately 13.8), respectively. In 28.1% (9/32) of the patients, both (18)F-FES(+) and (18)F-FES(-) metastases were present, which suggests partial discordant ER expression. After treatments, 37.5% (9/24) patients with recurrent or metastatic breast cancer showed heterogeneity, whereas no untreated patient was detected to exist discordant ER expression (χ(2), 4.174; P < .05). In addition, the (18)F-FES uptake showed a weak correlation with the (18)F-FDG uptake (ρ = 0.248; P < .05). CONCLUSION: (18)F-FES and (18)F-FDG uptake varied greatly both within and among patients. (18)F-FES PET-CT demonstrated a conspicuous number of patients with the heterogeneity of ER expression.

Can positron emission tomography/computed tomography with the dual tracers fluorine-18 fluoroestradiol and fluorodeoxyglucose predict neoadjuvant chemotherapy response of breast cancer?--A pilot study.

OBJECTIVE: To assess the clinical value of dual tracers Positron emission tomography/computed tomography (PET/CT) (18)F-fluoroestradiol ((18)F-FES) and (18)F-fluorodeoxyglucose ((18)F-FDG) in predicting neoadjuvant chemotherapy response (NAC) of breast cancer. METHODS: Eighteen consecutive patients with newly diagnosed, non-inflammatory, stage II and III breast cancer undergoing NAC were included. Before chemotherapy, they underwent both (18)F-FES and (18)F-FDG PET/CT scans. Surgery was performed after three to six cycles of chemotherapy. Tumor response was graded and divided into two groups: the responders and non-responders. We used the maximum standardized uptake value (SUVmax) to qualify each primary lesion. RESULTS: Pathologic analysis revealed 10 patients were responders while the other 8 patients were non-responders. There was no statistical difference of SUVmax-FDG and tumor size between these two groups (P>0.05). On the contrary, SUVmax-FES was lower in responders (1.75±0.66 versus 4.42±1.14; U=5, P=0.002); and SUVmax-FES/FDG also showed great value in predicting outcome (0.16±0.06 versus 0.54±0.22; U=5, P=0.002). CONCLUSIONS: Our study showed (18)F-FES PET/CT might be feasible to predict response of NAC. However, whether the use of dual tracers (18)F-FES and (18)F-FDG has complementary value should be further studied.

Prevalence and risk of cancer of thyroid incidentaloma identified by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography.

OBJECTIVE: To investigate the prevalence and risk of thyroid incidentaloma identified by positron emission tomography/computed tomography (PET/CT). STUDY DESIGN: Historical cohort study. SETTING: Fudan University Shanghai Cancer Center. METHODS: A total of 15 948 non-thyroid disease patients who underwent fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT from November 2006 to September 2010 were included. They were divided into two groups: 12 080 patients for metastatic evaluation and 3868 patients for cancer screening. When thyroid incidentaloma was found, further diagnostic examination was conducted. MAIN OUTCOME MEASURES: Prevalence and risk of thyroid incidentaloma. RESULTS: The prevalence of incidental thyroid 18F-FDG uptake was approximately 2.5% (395 of 15 948). The prevalence of incidentaloma in healthy subjects (118 of 3868; 3.1%) was statistically higher than that in patients with suspected or known cancer (277 of 12 080; 2.3%) (p < .05). Among 395 incidentalomas, 146 patients had further examinations (53 patients with histologic confirmations, 93 patients with clinical monitoring). Finally, 43 lesions were confirmed to be malignancies. Therefore, the cancer risk was 29.5% (43 of 146), and it was higher in cancer screening patients (24 of 59; 40.7%) than in alleged cancer patients (19 of 87; 21.8%) (p < .05). As for FDG uptake pattern, the prevalence of thyroid cancer was 11.6% (5 of 43) and 36.9% (38 of 103) in the group of patients with diffuse and focal uptake, respectively (p < .05). After logistic regression analysis, age, sex, maximal standardized uptake value, and calcification were the potent predictors of differentiation. CONCLUSION: The presence of focal uptake with high SUVmax and calcification detected on CT images correlates with a high likelihood of thyroid malignancy. When a focal thyroid incidentaloma is detected, further examination should be performed.

The clinical value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in postoperative patients with gastrointestinal mucinous adenocarcinoma.

OBJECTIVE: To evaluate the clinical value of F-fluorodeoxyglucose positron emission tomography and computed tomography (¹8F-FDG PET/CT) in postoperative patients with gastrointestinal mucinous adenocarcinoma. METHODS: From July 2007 to March 2009, 30 patients who had previous surgical resection of histopathologically diagnosed gastrointestinal mucinous adenocarcinoma underwent ¹8F-FDG PET/CT scans in our center. The standard of reference for tumor recurrence, regional lymph node (LN) metastasis, peritoneal and distant metastasis consisted of histopathologic confirmation or clinical follow-up information for at least 6 months after PET/CT examinations. RESULTS: With final diagnosis, tumor recurrences were confirmed in eight of the 30 patients (26.7%). If a maximum standardized uptake value (SUVmax) of 2.5 or more was used as a cut-off point, the sensitivity, specificity, and accuracy of PET/CT were 87.5, 77.3, and 80.0%, respectively. However, if an SUVmax of 4.0 or more was the criterion, the sensitivity, specificity, and accuracy were 25.0, 86.4, and 70.0%, respectively. A cut-off point of 2.5 showed a higher sensitivity (P=0.041), and there was no statistical difference in the specificity and the accuracy of these two criteria. For the diagnosis of metastasis in regional LNs and peritoneum, the detection rate was 95.2 and 86.4%, respectively. In addition, we followed up 20 patients with 26 suspicious distant lesions. The sensitivity, specificity, and accuracy were 58.3, 92.9, and 76.9%, respectively. CONCLUSION: ¹8F-FDG PET/CT may be effective to discriminate tumor recurrence, and to detect regional LNs, peritoneal and distant metastasis in postoperative patients with gastrointestinal mucinous adenocarcinoma.