Combined early dynamic 18F-FDG PET/CT and conventional whole-body 18F-FDG PET/CT in hepatocellular carcinoma.

OBJECTIVE: To investigate the diagnostic value of early dynamic 18F-FDG PET/CT(ED 18F-FDG PET/CT) combined with conventional whole-body 18F-FDG PET/CT(WB 18F-FDG PET/CT) in hepatocellular carcinoma (HCC), as well as the difference of early dynamic blood flow parameters and maximum standardized uptake value (SUVmax) in HCC patients with/without liver cirrhosis or microvascular invasion (MVI). METHODS: Twenty-two consecutive patients (mean age 57.8 years) with 28 established HCC lesions (mean size 4.5 cm) underwent a blood flow study with an 18F-FDG dynamic scan divided into 24 sequences of 5 s each and a standard PET/CT scan. On the ED PET/CT study, an experienced PET/CT physician obtained volumes of interest (VOIs) where three blood flow estimates (time to peak [TTP], blood flow [BF], and hepatic perfusion index [HPI]) were calculated. On the WB PET/CT study, a VOI was placed on the fused scan for each HCC and maximum standardized uptake value (SUVmax) was obtained. Comparison of blood flow estimates, SUVmax, and tumor/background ratio (TNR) was performed among HCCs with and without angioinvasion, as well as HCCs in cirrhotic and non-cirrhotic liver. RESULTS: Compared with WB 18F-FDG PET/CT alone, ED combined with WB 18F-FDG PET/CT can significantly increase the detection rate of moderately differentiated and poorly differentiated HCCs (both P < 0.05). HPI was higher in HCCs in patients with liver cirrhosis than those without liver cirrhosis (P = 0.044). There was no significant difference in TTP, BF, SUVmax, or TNR between HCCs in patients with liver cirrhosis and those without liver cirrhosis. There was no significant difference in blood flow estimates or SUVmax in background liver parenchyma between patients with and those without cirrhosis. TTP was shorter in HCCs with MVI than without MVI (P = 0.046). There was no significant difference in BF, HPI, SUVmax, or TNR between HCCs with MVI and without MVI. There was no significant difference in blood flow estimates or SUVmax in background liver parenchyma between patients with and those without MVI. CONCLUSION: ED combined with WB 18F-FDG PET/CT can significantly increase the detection rate of moderately differentiated and poorly differentiated HCCs. HPI was significantly higher in HCCs in patients with liver cirrhosis than those without liver cirrhosis. TTP was significantly shorter in HCCs with MVI than without MVI.

Correlation among maximum standardized 18F-FDG uptake and pathological differentiation, tumor size, and Ki67 in patients with moderately and poorly differentiated intrahepatic cholangiocarcinoma.

OBJECTIVE: To investigate the correlation among the maximum standardized uptake value (SUVmax) on fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and tumor differentiation, size, and Ki67 in patients with moderately and poorly differentiate dintrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS: The 18F-FDG PET/CT imaging data of 116 patients with single ICC lesions confirmed by pathology were retrospectively evaluated. Pathological characteristics of the tumor such as the largest tumor diameter, differentiation, Ki67 expression, SUVmax of the primary tumor, and the tumor to normal background ratio (TNR) were recorded. RESULTS: Among the 116 lesions, 45, 51, and 20 lesions were classified into the moderately differentiated, moderately-poorly, and poorly differentiated groups, respectively. There were significant differences in the SUVmax (P=0.033) and TNR (P=0.044) among the three groups. Maximum SUV was significantly correlated with differentiation (r=0.244, P=0.008). When the cases were categorized according to the tumor size (group 1, ≤3cm, n=14; group 2, >3 and ≤5 cm, n=37; group 3, >5 and ≤10 cm, n=52; group 4, >10 cm, n=13), there were significant differences in the SUVmax (P<0.001) and TNR (P<0.001) among the four groups. Maximum SUV was significantly correlated with tumor size (r=0.481, P<0.001). Among the 116 lesions, 38 lesions and 78 lesions were classified into the low Ki67 and high Ki67 expression groups, respectively. There were significant differences in the SUVmax (P=0.028) and TNR (P=0.007) between the two groups. Maximum SUV was significantly correlated with Ki67 expression (r=0.242, P=0.009). CONCLUSION: In moderately and poorly differentiated ICC, the SUVmax and TNR are significantly associated with tumor differentiation, size, and Ki67 expression.

FDG-avid antrum-pylorus ulcer, adjacent lymph node, and abdominal wall nodule mimicking gastric cancer with metastases.

Gastric cancer presents with similar clinical symptoms as gastric ulcer, and the morphologic features of gastroscopy overlap considerably. We report a 58-year-old man with the clinical presentation of recurrent gastric discomfort and black stools. A suspected malignant tumor of the gastric antrum-pylorus was observed on gastroscopy. Contrast-enhanced CT showed enhancement of the lesion. PET/CT revealed an FDG-avid lesion at the gastric antrum-pylorus, an intense FDG-uptake perigastric lymph node, and an enlarged nodule with high FDG uptake in the right abdominal wall. Subsequent surgical pathology revealed an inflammatory ulcer of the gastric antrum-pylorus with reactive hyperplastic lymph node, while the lesion in the right abdominal wall was a scar nodule. This case suggests that when multiple FDG-avid lesions accompany an atypical gastric ulcer, it can easily lead to misdiagnosis, and therefore more emphasis should be placed on histopathological analysis.

Exploration of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture as day surgery: a retrospective study.

BACKGROUND: The purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients underwent PVP for OVCF as day surgery with the outcomes of patients managed as traditional inpatients. METHODS: According to the selection criteria, patients who underwent PVP for single-segment thoracolumbar OVCF were included retrospectively in the day surgery procedure (DSP) group and the traditional inpatient procedure (TIP) group between April 2018 and September 2019. The visual analog scale score (VAS) and Oswestry Disability Index (ODI) score were recorded preoperatively and 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Duration of hospital stay, preoperative waiting time, hospital cost, and postoperative complications were recorded and analyzed. RESULTS: A total of 335 patients (53 in DSP group; 282 in TIP group) were enrolled and completed 12-month follow-up. The mean duration of hospital stay, the mean preoperative waiting time, and the mean hospital costs were significant lower in the DSP group. The postoperative VAS and ODI scores in both groups were significantly improved after surgery. Moreover, both VAS and ODI scores at each follow-up stage were also significantly lower than the previous follow-up stage. However, the ODI score in the DSP group was significantly lower at 1-day, 1-week, 1-month, and 3-month follow-up, respectively. For cement leakage and secondary vertebral compression fractures, there was no statistical difference between the two groups. CONCLUSIONS: We suggest that PVP for OVCFs in day surgery procedure is worthy of wide application.

Mendelian randomization analysis of the association between human blood cell traits and uterine polyps.

Human blood cells (HBCs) play essential roles in multiple biological processes but their roles in development of uterine polyps are unknown. Here we implemented a Mendelian randomization (MR) analysis to investigate the effects of 36 HBC traits on endometrial polyps (EPs) and cervical polyps (CPs). The random-effect inverse-variance weighted method was adopted as standard MR analysis and three additional MR methods (MR-Egger, weighted median, and MR-PRESSO) were used for sensitivity analyses. Genetic instruments of HBC traits was extracted from a large genome-wide association study of 173,480 individuals, while data for EPs and CPs were obtained from the UK Biobank. All samples were Europeans. Using genetic variants as instrumental variables, our study found that both eosinophil count (OR 0.85, 95% CI 0.79-0.93, P = 1.06 × 10-4) and eosinophil percentage of white cells (OR 0.84, 95% CI 0.77-0.91, P = 2.43 × 10-5) were associated with decreased risk of EPs. The results were robust in sensitivity analyses and no evidences of horizontal pleiotropy were observed. While we found no significant associations between HBC traits and CPs. Our findings suggested eosinophils might play important roles in the pathogenesis of EPs. Besides, out study provided novel insight into detecting uterine polyps biomarkers using genetic epidemiology approaches.

The value of skeletal standardized uptake values obtained by quantitative single-photon emission computed tomography-computed tomography in differential diagnosis of bone metastases.

PURPOSE: The aim of this study was to explore the value of skeletal standardized uptake value (SUV) obtained by quantitative single-photon emission computed tomography-computed tomography (SPECT/CT) in differential diagnosis of bone metastases from benign lesions. MATERIALS AND METHODS: Retrospective analysis has been conducted to 51 patients with extraskeletal malignant tumors who underwent whole-body bone scan with quantitative SPECT/CT imaging, and there are no more than three hotspots that were visually detected in the SPECT/CT imaging range. Fifty-one patients were enrolled, including 28 men and 23 women with an average age of 58.8 ± 9.5 (37-77) years. A total of 88 hotspots, including 40 benign lesions and 48 metastatic lesions, and corresponding normal sites were obtained. The region of interest (ROI) of the hotspots was sketched. The ROI of the normal bone of the spinal vertebral body adjacent to the lesions or normal bone of the symmetric side of the lesions of other locations was delineated to obtain the maximum SUV (SUVmax) and the average SUV (SUVave). RESULTS: The SUVmax value of all lesions was 20.73 ± 14.01 (3.90-92.61), and the SUVmax value of the corresponding normal parts was 5.88 ± 2.36 (2.08-12.52). The difference between the two groups was statistically significant (t = 10.343, P < 0.01). The SUVave of all lesions was 8.42 ± 4.81 (37-77), and the SUVave of the corresponding normal sites was 3.10 ± 1.51 (0.65-7.54). The difference between the two groups was statistically significant (t = 11.342, P < 0.01). The SUVmax of metastases was 24.77 ± 16.32 (3.90-92.61), and the SUVmax of benign lesions was 15.89 ± 8.51 (4.68-42.32). The difference between the two groups was statistically significant (t = 3.273, P = 0.002). The SUVave of metastases was 9.09 ± 5.59 (0.81-29.08), and the SUVave of benign lesions was 7.61 ± 3.57 (1.66-17.48). There was no significant difference between the two groups (t = 1.44, P = 0.154). The area under the curve (AUC) values of the SUVmax curves was greater than that of the SUVave curve. AUCs of the SUVmax and SUVave were 0.687 (P = 0.03) and 0.576 (P = 0.223), respectively. SUVmax had greater accuracy for discriminating bone metastasis from benign lesions. Hotspots of the patients with malignant neoplasms in bone SPECT/CT may be discriminated using SUVmax with certain accuracy, and the optimal cutoff value was 17.705. CONCLUSION: The SUVmax of bone metastases was significantly larger than that of benign lesions, and there was no significant difference in SUVave between the two groups. Therefore, the SUVmax has a certain value for the differential diagnosis of metastases from benign lesions.

Diagnostic performance of whole-body bone scintigraphy in combination with SPECT/CT for detection of bone metastases.

OBJECTIVE: This retrospective study investigated the performance of whole-body bone scintigraphy combined with SPECT/CT and established a grading diagnostic criterion for bone metastases. METHODS: We summarized signs of whole-body bone imaging combined with SPECT in nuclear medicine and CT signs of corresponding parts. Then we established a diagnostic criterion for bone metastases by using whole-body bone scintigraphy combined with local SPECT/CT. The criterion is classified into five grades. 120 patients with a total of 141 lesions underwent whole-body bone scintigraphy and SPECT/CT. Two reviewers read the images according to the diagnostic criterion. With pathological diagnosis as the "gold standard", the diagnostic efficacy for bone metastases and the diagnostic agreement between the two reviewers were analyzed to validate the feasibility of the criterion. Diagnostic effectiveness was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: The diagnostic accuracy of the two reviewers was 90.1% and 92.9% respectively, sensitivity was both 100%, specificity was 41.7% and 58.3%, positive predictive value was 89.3% and 92.1%, and negative predictive value was both 100%. The kappa value of the diagnostic tests performed by the two reviewers on whole-body bone scintigraphy combined with SPECT/CT was 0.919 (P < 0.001). CONCLUSION: The grading diagnostic criterion for bone metastases by whole-body bone scintigraphy combined with SPECT/CT has high diagnostic accuracy and good consistency between reviewers, but the specificity was still low even with SPECT/CT.

Preliminary application of micro-SPECT/CT imaging by 99m Tc-tricine-EDDA-HYNIC-c-Met for non-small-cell lung cancer.

OBJECTIVE: A novel 99m Tc-tricine-EDDA-Hynic-c-Met molecular probe was synthetized, and nude mice models of human non-small-cell lung cancer (NSCLC) were established in order to preliminarily investigate that whether the molecular probe can be used to screen c-Met inhibitor for targeted drug therapy in NSCLC. METHODS: With Hynic as the chelating agent, 99m TcO4 -labeled c-Met receptor was used to synthetize 99m Tc-tricine-EDDA-HYNIC-c-Met. Two nude mice successfully transplanted with H1993 tumor and two nude mice transplanted with H292 tumor were injected with 99m Tc-tricine-EDDA-HYNIC-c-Met through the tail vein. After 2 and 4 hr, micro-SPECT/CT imaging was performed. RESULTS: micro-SPECT/CT imaging of nude mice transplanted with H1993 and H292 tumors using 99m Tc-tricine-EDDA-HYNIC-c-Met showed that uptake of 99m Tc-tricine-EDDA-HYNIC-c-Met was high in H1993 tumor, while it was mild in H292 tumor both at 2 and 4 hr postinjection. Semiquantitative analysis of the ratio of radioactivity intensity at tumor site to radioactivity intensity of adjacent muscles (T/N value) showed that the average T/N value of H1993 and H292 tumors at 2 hr was 3.90 and 2.85, while it was 4.88 and 2.36 at 4 hr. CONCLUSION: micro-SPECT/CT imaging through 99m Tc-tricine-EDDA-HYNIC-c-Met can be used to screen c-Met indicators of NSCLC in H1993 nude mice models for targeted drug therapy.

Hepatic Epithelioid Angiomyolipoma and 18F-FDG PET/CT.

Hepatic epithelioid angiomyolipoma (AML) is rare. Although generally epithelioid AML shows benign biological behavior, it can occasionally have malignant potential. In this study, we report a case of 2 hepatic epithelioid AMLs with different F-FDG uptake; one is intensely FDG avid, and the other is non-FDG avid.

Added value of SPECT/spiral CT versus SPECT or CT alone in diagnosing solitary skeletal lesions.

AIM: The aim of this study was to investigate the added value of SPECT/spiral CT versus SPECT or CT alone in the differential diagnosis of solitary skeletal lesions. METHODS: This was a retrospective study on a total of 69 patients who had a solitary skeletal "hot spot" that could not be definitively diagnosed using planar scintigraphy. Thus, SPECT/spiral CT was performed on the indeterminate lesions. SPECT, CT and SPECT/spiral CT images were independently interpreted by two experienced doctors who have both identification of CT and nuclear medicine. Each lesion was graded on a 4-point diagnostic scale (1: benign, 2: likely benign, 3: likely malignant, 4: malignant). The final diagnosis of each lesion was based on pathological confirmation after surgery within 3 weeks of the bone scan. RESULTS: Final diagnoses based on the pathological results revealed that 43 of the 69 patients were diagnosed with malignancy, and the remaining 26 patients were diagnosed as having benign lesions. For SPECT and CT scans, both of the reviewers rated 55.1 % (38/69) and 37.7 % (26/69) of lesions as equivocal, with the help of SPECT/CT, 33.3 % (23/69) of lesions were rated as equivocal. The diagnostic accuracies of SPECT, CT alone and SPECT/CT were 66.7 % (46/69) ,82.6 % (57/69) and 85.5 %(59/69), respectively. The kappa scores for the degree of agreement between SPECT, CT alone or SPECT/CT with pathological results were 0.185 (p = 0.054) , 0.612 (p < 0.001) and 0.671 (p < 0.001), respectively. CONCLUSION: Compared with SPECT or imaging alone, SPECT/spiral CT imaging was more accurate and valuable in the differential diagnosis of solitary skeletal lesions and resulted in significantly fewer equivocal findings.

An imaging target TGF-ß1 for hepatocellular carcinoma in mice.

It has been reported that the positive detection rate of Fluorine-18-fluorodeoxyglucose (18F-FDG) metabolism in positron emission tomography (PET) imaging, for the diagnosis of hepatocellular carcinoma (HCC) is only about 50%. In particular, 18F-FDG PET imaging is prone to false negative findings in HCC. Transforming growth factor-beta1 (TGF-ß1) shows over expression rates in early HCC liver tissue growth and promotes tumor invasion and metastases. Our aim was to use In this study, we used the feasibility of iodine-125 (125I)-labeled TGF-ß1 antibody as a nuclear medicine imaging target in HCC. MATERIALS AND METHODS: The TGF-ß1 antibody was obtained from Bioss Inc. The Huh-7 cell line (Liver Cancer Institute, Zhongshan Hospital, Fudan University) is a HCC cell line with high metastatic potential. Each mouse was subcutaneously injected with 5×106/0.1mL Huh-7 cells in the right upper flank region for the establishment of a subcutaneous xenograft model. The Iodogen method was used to label TGF-ß1 antibody with 125I. In this experiment, 100µL of 125I- TGF-ß1 antibody solution, which contained approximately 18,5MBq of 125I-liraglutide, was injected into the tail veins of each of three nude mice with Huh-7 HCC. Micro SPET/CT imaging was performed for each mouse using a nano SPET/CT. RESULTS: The average percentage of injected dose per gram of tissue (ID%) was 1,3% and 2,4%. The tumor was strongly positive for TGF-ß1. CONCLUSION: This pilot study provides an experimental basis for further exploration of the feasibility of TGF-ß1 receptor as a target in HCC imaging and in other cancers.

Nineteen cases with synchronous multiple primary cancers studied by 18F-FDG PET/CT.

OBJECTIVE: To evaluate the value of fluorine -18-fuoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in evaluating synchronous multiple primary cancers (SMPC). METHODS: Nineteen patients with pathologically-confirmed SMPC were collected. Clinical and 18F-FDG PET/CT characteristics of these patients were reviewed and analyzed. Maximum standardized uptake value, (SUVmax) of all lesions was measured and difference (Δ)SUVmax between the SUV of two primary tumors in each patient was calculated as: [(the larger SUVmax - the smaller SUVmax)/ the larger SUVmax]×100%. RESULTS: A total of 38 lesions were identified, which were most frequently located in gastrointestinal tract (n=16), followed by lung (n=10), breast (n=4), kidney (n=4), liver (n=2), pancreas (n=1) and thyroid (n=1). Pathologies of these 38 lesions were 18 adenocarcinomas, 8 squamous cell carcinomas, 4 breast invasive ductal carcinomas, 4 renal cell carcinomas, 2 hepatocellular carcinomas, 1 pancreatic ductal adenocarcinoma and 1 papillary thyroid carcinoma. The mean SUVmax of all lesions was 8.5±6.9, most of them being more than 2.5 (n=30). The mean ΔSUVmax was 57.3%±24.6%, indicating different metabolism of the primary cancers in each patient. CONCLUSION: In our center, SMPC most commonly involved the gastrointestinal tract and adenocarcinomas were the most common pathology type. 18F-FDG PET/CT was useful in the diagnosis of SMPC and the ΔSUVmax indicates different pathological origins of the synchronous cancers.

Neovascularization of hepatocellular carcinoma in a nude mouse orthotopic liver cancer model: a morphological study using X-ray in-line phase-contrast imaging.

BACKGROUND: This study aimed to determine whether synchrotron radiation (SR)-based X-ray in-line phase-contrast imaging (IL-PCI) can be used to investigate the morphological characteristics of tumor neovascularization in a liver xenograft animal model. METHODS: A human hepatocellular carcinoma HCCLM3 xenograft model was established in nude mice. Xenografts were sampled each week for 4 weeks and fixed to analyze tissue characteristics and neovascularization using SR-based X-ray in-line phase contrast computed tomography (IL-XPCT) without any contrast agent. RESULTS: The effect of the energy level and object-to-detector distance on phase-contrast difference was in good agreement with the theory of IL-PCI. Boundaries between the tumor and adjacent normal tissues at week 1 were clearly observed in two-dimensional phase contrast projection imaging. A quantitative contrast difference was observed from weeks 1 to 4. Moreover, 3D image reconstruction of hepatocellular carcinoma (HCC) samples showed blood vessels inside the tumor were abnormal. The smallest blood vessels measured approximately 20 µm in diameter. The tumor vascular density initially increased and then decreased gradually over time. The maximum tumor vascular density was 4.29% at week 2. CONCLUSION: IL-XPCT successfully acquired images of neovascularization in HCC xenografts in nude mice.

Primary Liver Carcinosarcoma and 18F-FDG PET/CT.

Primary liver carcinosarcoma is a very rare, malignant neoplasm that is concomitantly composed of a mixture of sarcomatous and carcinomatous elements. In the present study, an initial staging FDG PET/CT showed intense FDG uptake in a patient with liver carcinosarcoma composed of hepatocellular carcinoma and rhabdomyosarcoma. Two months after surgical resection, a restaging PET/CT showed rapid progression of the disease with abdominal and lung metastases, indicating aggressive feature of the disease. The case shows the importance to repeat a restaging PET/CT at early time after surgery for a patient with liver carcinosarcoma to monitor disease progression.

Vertebral Hemangiolymphangioma Mimics Bone Metastases on 99mTc-MDP SPECT/CT.

Hemangiolymphangioma is a very rare, congenital malformation of both lymphatic and blood vessels. In the present study, we report a case of vertebral hemangiolymphangioma that was misdiagnosed as bone metastasis on 99mTc-MDP SPECT/CT.

Sarcomatoid carcinoma of the lung mimics aspergilloma on ¹8F-FDG PET/CT.

Primary PSC in the lung is a rare malignant cancer that represents a particularly aggressive subtype of non-small cell lung carcinomas (NSCLC) containing sarcoma or sarcoma-like components with spindle or giant cell features. The medical literature referring to imaging characteristics by fluorine-18-fluorodeoxyglucose (¹8F-FDG) positron emission tomography/computed tomography (PET/CT) of these tumors is very limited. We present a case of PSC with air crescent and halo signs that resemble aspergilloma on the ¹8F-FDG PET/CT, scan.

Imaging by ¹8F-FDG PET/CT of diffuse large B-cell lymphoma with cellulitis.

Non-Hodgkin's lymphomas (NHL) quite often present in the neck but are seldom accompanied with cellulitis at the first diagnosis of the disease. We report a 56 year old woman with gradually neck swelling, which was initially treated as cellulitis. After examined by ultrasonography, computed tomography and after pathologically assessments, the diagnosis of large B-cell lymphoma was made. This case highlights the usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography (¹8F-FDG PET/CT) in staging and assessing treatment response in NHL.

Gastric Carcinosarcoma and 18F-FDG PET/CT.

Gastric carcinosarcoma is a rare, malignant neoplasm that simultaneously comprises mixed epithelial and mesenchymal elements. In the present study, we report a case of gastric carcinosarcoma composed of rhabdomyosarcoma and adenocarcinoma on F-FDG PET/CT.