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Objective To evaluate the maturity and metabolic status of heterotopic ossification(HO)by single-photon emission computed tomography(SPECT)/CT fusion bone imaging.Methods The clinical and SPECT/CT fusion bone imaging data of 57 patients with HO confirmed by pathology or follow-up were analyzed retrospectively.HO was graded by CT,and the characteristics of radioactive concentration of HO were analyzed.Results Of 57 cases,single lesion in 52 cases,and multiple lesions in 5 cases,with a total of 63 lesions,mostly located in the hip joint(55.6%,35/63)and thigh(19.0%,12/63).There were 41 lesions in the middle stage and 22 lesions in the late stage.In the visual evaluation of SPECT/CT fusion bone imaging,the middle stage lesions were mostly clumps or flakes,with moderate or high radioactive concentration(75.6%,31/41),furthermore,the concentration range was larger than or equal to the total or limited range of CT ossification(21/41,50.1%),with high concentration mainly located in the mixed areas of ossification density.The concentration of the late stage lesions was mostly non-radioactive(72.7%,16/22).Conclusion SPECT/CT fusion bone imaging can show the range,degree and maturity of HO radioactive concentration,and can accurately locate the area with osteoblastic activity,which provides scientific basis for the selection of surgical timing.
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The research and development of somatostatin analogues is a hot area in endocrinology and metabolism. The first generation octreotide, lanreotide and the second generation pareotide have been approved to be effective for the treatment of neuroendocrine tumors such as acromegaly. However, paltusotine, a somatostatin receptor ligand, is a novel non-peptide small molecule drug which can be administered orally and inhibits excessive secretion of growth hormone and insulin-like growth factor 1. This review summarizes the research progress of the pharmacokinetics, pharmacodynamics, clinical efficacy, telerability, and safety of paltusotine.
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Objective:To summarize the morphological characteristics of diffuse large B-cell lymphoma (DLBCL) cells and investigate the prognosis value of the characteristics and the number of DLBCL cells in bone marrow.Methods:Retrospective study. We collected 79 cases newly diagnosed with DLBCL in the First Affiliated Hospital of Zhengzhou University from January 2020 to August 2022. 30 cases newly diagnosed without bone marrow involvement were selected as controls, whose mean age 58 years (30-82 years). The DLBCL cells were evaluated by the bone marrow smear, biopsy and flow cytometry separetely.The detection rate of DLBCL cells in the bone marrow was compared, to analyse the relationship between the morphological characteristics of DLBCL in the smear, clinical characteristics and flow cytometry parameters, and the prognostic value of DLBCL detected in the bone marrow smear and its quantity was analyzed. Logistic regression was used to analyze the correlation between the detection of DLBCL cells in bone marrow smears and the age, clinical stage, and the number of extraderules involved organs. Multivariate Cox regression was used to analyze the influence of DLBCL cells detection and its number on the prognosis of patients.Results:(1) The positive rates of DLBCL cells in bone marrow biopsy, bone marrow smear and flow cytometry were 4.86%, 5.14% and 9.27% respectively. (2) The morphological characteristics of 79 cases in bone marrow smears were described: more than 2 times the volume of the cell body of the lymphocyte, the shape was different, round or quasi-round or irregular shape, can be seen pseudopodia or protrusion; The volume of cytoplasm was moderate, vacuoles were visible, and a few perinuclear areas were visible. The nucleus were different in shape, round or quasi-round or irregularly shaped, with a majority of them having multiple nuclei and a few of them having delicate and loose chromatin. Most nucleoli were medium or large obviously, with a majority of them having 1-2 nucleoli and a few having more than 3.Sergiosomes and hemophagocytosis were observed in some DLBCL cases, tumor cell aggregation phenomenon was observed in a few DLBCL cases, occasionally pathological mitosis.(3) DLBCL cells in bone marrow smear was positively related to the age of patients, clinical stage and the number of extranodal organs involved(regression coefficient were 2.012, 2.754, 2.028, P<0.05);The volume of DLBCL cells in bone marrow smear was positively correlated with the ratio of CD4 and CD8(regression coefficient is 2.545, P<0.05);The vacuoles in cytoplasm and the pseudopod of tumor were both negative relationship with the quantity of CD38 expressed on DLBCL cells(regression coefficient was -2.465, -3.045, P<0.05); (4) DLBCL cells in bone marrow smear was an independent risk factor for PFS and OS( RR=7.059, P<0.05); RR=5.409, P<0.05). Conclusion:The appearace of DLBCL cells in bone marrow smear with prognosis, and could be used for clinical staging.
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Objective:To investigate the correlation between the number of circulating DLBCL cell and the marrow tumor cell burden and the prognostic indicators in patients with DLBCL, and to evaluate the feasibility of circulating DLBCL cell reflecting the marrow tumor burden and disease progression. Optimization of FCM for screening circulating DLBCL cell was done to monitor MRD and recurrence.Methods:We conducted a retrospective study in 75 diagnosed DLBCL patients in the First Affiliated Hospital of Zhengzhou University from June 2020 to February 2021, including 43 males and 32 females aged 61 (37-85) years. According to the diagnosis and treatment criteria, the patients were divided into initial and recurrence group ( n = 53), partial response(PR)group ( n=14) and complete response(CR)group ( n=8). According to the positive criteria of circulating DLBCL cells, 48 cases were divided into circulating DLBCL positive group and 27 cases were negative group. 30 anemia patients with non-B-cell tumor-related diseases were selected as the control group, including 16 males and 14 females, aged 52 (30-79) years. 70 healthy subjects, including 36 males and 34 females, aged 39 (25-57), were selected for methodology optimization. FCM was used to detect the ratio of marrow and circulating DLBCL cells in each group, and analyze the connection between circulating DLBCL cells and clinical indicators. Statistical analysis was performed using t test, χ 2 test, Kruskal-Wallis H test, Spearman rank correlation, and Logistic regression. Results:(1) Bone marrow and circulating DLBCL cells were not detected in CR group and control group; The positive rate of circulating DLBCL cells in the initial/recurrent group and PR groups was 75.47% and 57.14%, respectively. The proportion of bone marrow and circulating DLBCL cells was positively correlated in the two groups ( P value was <0.001 and 0.020, respectively). (2) The proportion of bone marrow and circulating DLBCL cells in the initial and recurrent groups, PR group, CR group and control group decreased successively ( P<0.05). The proportion of DLBCL cells was 27.72% (initial and recurrent bone marrow group), 26.92% (initial and recurrent circulating group), 3.23% (bone marrow PR group) and 1.67% (circulating PR group), respectively. (3) Compared with the negative group, the circulating DLBCL cell positive group had increased LDH, β 2-MG, and CMYC expression(≥80%), with decreased LYM, HGB<100 g/L, B symptoms, PD-L1 expression, and age ≥60 years, showing higher ECOG, aaIPI/IPI scores and Ann staging ( P<0.05). Age ≥60, B symptoms, and PD-L1 expression were independent risk factors for circulating DLBCL cells ( P<0.05). Conclusions:The detectable rate of circulating DLBCL cell could be improved by optimizing the preoperative treatment conditions of FCM. Circulating DLBCL cells can reflect the tumor burden and disease progression. Detecting circulating DLBCL cells may improve patients′ compliance.
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Objective To explore the value of SPECT/CT in evaluation on long-term healing of limb fractures.Methods SPECT/CT imaging characteristics of 68 patients with limb fractures 6 months after treatment were analyzed retrospectively,and the self-healing property of fractures was evaluated.Compared with clinical follow-up results or surgical findings,the accuracy of SPECT/CT in evaluation on long-term healing of fractures was calculated.Results For all 68 patients with limb fractures,X-ray and CT were not able to determine whether the fractures would heal in the future.On SPECT/CT fusion images,radioactivity concentrations through the fracture lines and cross on both sides of fracture were found in 52 patients,which indicated that the fractures were in the process of healing and had the ability of healing in the future.Clinical follow-up confirmed that fractures then healed in 46 patients,while in 6 patients did not.Another 16 patients showed no nuclide concentrations on the fractures,indicated that the fractures were nonunion and had little ability of healing in the future,and were finally confirmed with surgery.The accuracy of SPECT/CT in evaluation on fracture healing was 91.18% (62/68).Conclusion SPECT/CT imaging can accurately evaluate the long-term healing of limb fractures,which contributes to therapeutic planning in the clinic.
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Objective To evaluate the MRI findings of synovial hemangioma.Methods Twenty-three patients with synovial hemangioma were analyzed retrospectively,and MRI characteristics were summarized.Results Of the 23 patients,there were localized type in 6 and diffuse type in 17.Localized tumors located in the articular synovial tissue and didn't invade articular capsule and peripheral tissues.T hey had envelope,well-defined margin and regular shape.5 cases showed heterogeneous signal with iso-intense or hypo-intense on T1WI,hyper-intense and internal patchy or multiple pinstripe hypo-intense on T2WI and fat-suppression sequence.Diffuse tumors distributed inside and outside the articulation,and invaded the articular capsule or peripheral tissues.17 cases were heterogeneous signal with iso-intense or hypo-intense and internal patchy or sinuous hyper-intense on T1WI,hyper-intense and internal patchy,nodular and multiple pinstripe hypo-intense on T2WI and fat-suppression sequence.Thick flow void of the vessels were showed in 6 cases and phlebolithes were showed in 3 cases.15 cases underwent contrast-enhanced scan,and the tumors showed patchy,nodular or tortuous vascular heterogeneous enhancement with internal patchy,nodular or cord-like non-enhanced areas.Conclusion Fatty-fibrous tissues and flow void of the vessels in the tumor are valuable MRI features for diagnosis of the synovial hemangioma.
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Objective To investigate the MRI characteristics of primary myxofibrosarcoma (MFS) in the extremity soft-tissues.Methods The MRI of 14 cases of MFS confirmed by operation and pathology were analyzed retrospectively.Results In the 14 cases,9 were in the thigh,3 in the lower leg,and 2 in the upper arm.The volumes of the tumors were relatively big and all located in the subcutaneous fat or superficial inter-muscular space.The tumor showed expanding growth and had well-defined boundary.On T1 WI,one case showed isosignal intensity,one showed equal signal intensity mostly,and 12 cases showed patch slightly low signal intensity;On fat suppression T2 WI and STIR,tumors showed high-low mixed signal intensity,which mainly showed high signal intensity;On MRI enhanced study,inhomogeneous enhancement was observed in most of the tumors,and "tail sign" was showed in 11 cases.Conclusion MFS is of characteristics on MRI,the position of tumor is shallow,the tumor is relatively big and has clear boundary.On T1 WI,most tumors show iso-low mixed signal intensity.On fat suppression T2WI and STIR,tumors show high-low mixed signal intensity;On enhanced MRI,inhomogeneous enhancement and "tail sign" are its characteristic signs.
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Objective To study the imaging characteristics of localized myositis ossificans for improving its diagnosis and differen-tial diagnosis ability.Methods The Clinical and radiographic data of 45 cases with localized myositis ossificans proved by pathology or clinical follow up were analyzed retrospectively,summarize its imaging features.Results Of the 45 cases,1 7 cases occurred in the elbow joint,1 5 in the hip joint,13 in the other parts of the body.X-ray showed lining or lamellar high-density ossification in soft tis-sues in 34 cases,of those 12 cases with “shell”ossification.Compared with the X-ray,CT showed more clear ossification.MRI showed the soft tissue mass with peripheral edema in 18 cases;3 cases obvious ossification,no edema around.SPECT/CT showed abnormal imaging agent concentration in soft tissue within 12 cases,of those 5 cases concentration range greater than the range of ossification,4 cases concentration range less than the range of ossification.Conclusion Localized myositis ossificans have certain im-aging characteristics.Integrated application of a variety of imaging combined with the clinical can fully display the evolution of the disease,and improve its diagnosis rate.
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Objective To explore the diagnostic value of SPECT/CT on fracture healing.Methods A total of 28 patients (13 males,15 females; average age 45.3 years) with fracture were enrolled.All underwent metal fixation.SPECT/CT scans were performed at least 6 months after the metal fixation.X-ray examination before SPECT/CT showed equivocal fracture healing.The fracture delayed union or nonunion were judged by degree of uptake as well as uptake pattern around fracture site.Final diagnosis was confirmed by surgery or follow-up X-ray film.Results Among 28 patients,15 showed delayed union (confirmed by follow-up),and 13 showed nonunion (confirmed by surgery).There were 13 screws in 6 patients showed abnormal uptake,suggesting screw loose (confirmed by surgery).Conclusions SPECT/CT imaging could be of clinical significance in assessing fracture healing.
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Objective To evaluate which b value is the best to distinguish the glioma recurrence and radiation-induced brain injury using DWI when b value were at 1 000 s/mm2、3 000 s/mm2 and 5 000 s/mm2 respectively.Methods Retrospective analysis the DWI of 21 patients who suffered from glioma recurrence and radiation-induced brain injury obtained on a 3T MRI scanner.Results (1)All recurrent glioma (100%)showed hyper-intense signal,while most radiation-induced brain injury patients (80%)showed hypo-in-tense signal when b=5 000 s/mm2 .The sensitivity and specificity were high (100% and 80% respectively)when hyper-intense sig-nal was taken as a diagnostic point of glioma recurrence and radiation-induced brain injury.(2)The receiver operating characteristic (ROC)curve analysis suggested that the minimum ADC resulted in a highest sensitivity to differentiate glioma recurrence from radi-ation-induced brain injury when b=5 000 s/mm.Conclusion High b-value is more accurate to reflect cell density,and the minimum ADC is better to differentiate the glioma recurrence and radiation-induced brain injury when b=5 000 s/mm2 on DWI.
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Objective To analyze X-ray ,CT and MRI findings of Charcot’s joint.Methods 24 cases of Charcot’s joint were collected,there were 11 males and 13 females.24 cases were examined with radiography,9 with CT ,5 with MRI,and 2 were examined with all three techniques.X-ray,CT and MRI imaging findings of Charcot’s joint were analysed.Results There were two types of Charcot’s joint,hypertrophic(12 cases) and atrophic(12 cases).X-ray and CT findings of hypertrophic type were hyperostotic osteosclerosis with osteophytes,periarticular soft tissue swelling and ossification.While the atrophic type appeared as extensive bone resorption and disappearance,periarticular debris and soft tissue swelling,articular dislocation.These imaging findings of Charcot’s joint also could be showed by MRI.The joint capsule thickened periarticular soft tissue markedly enhanced after Gd-DTPA was administrated with definite medial margin.Conclusion Charcot’s joint is of typical imaging appearances.
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Objective To explore the imaging and pathological characteristics of the telangiectatic osteosarcoma.Methods The clinical,imaging and pathological data of telangiectatic osteosareoma in 12 cases were analysed.Results The tumors often located at the diaphysialepiphysial of the os longum and most of them were occured at the lower limb,increasing of the alkaline phosphatase(AKP) was rare.X-ray and CT character istics were osteoclastic and expensive bony destruction;there were multiple small cystic formation and fluid-fluid level in the destructive region and soft masess;the cortex of the bone became thinner with multiple sieve type destruction;the periosteal reaction and radial bone spicule were often seen.Pathological characteristics were of typical tumor cell of the osteosarcoma,mutliple sinus of the blood and "color bland shape" component.Conclusion The telangiectatic osteosarcoma has certain specific clinical,imaging and histologyical characteristics.
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Objective To evaluate the imaging characteristics of the bone infarct . Methods 13 cases of the bone infarct proved by clinical manifestation and surgical pathology were collected,there were 5 males and 8 females. All patients had X-ray films, 4 were imagedwith CT scanning , 7 were imaged with MRI , and 2 underwent all three techniques . The bone infarct were classified into the early,themiddle and later stages.X-ray , CT and MRI findings of bone infarct ,were analysed characteristics . Results Partial osteoporosin and punctate calcifications could be seen on X-ray and CT , in the early and middle stages , which presented as iso-/low-signal on T_1WIand iso-/high-signal on T_2WI in the center of the bone infarct with a tortuous low-signal on T_1WI and high-signal on T_2WI zonearound.In the later stages,the bone infarct was characterize by irregular sclerosis and tortuous calcification on X-ray and CT,and by low-signal on both T_1WI and T_2WI . Conclusion MRI is the most effective way to find the bone infarct in the early stages , X-ray is helpful in diagnosing the bone infarct in the middle and later stages , CT is more sensitive than X-ray . X-ray ,CT and MRI should be combined in diagnosing the bone infarct .
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Objective To study the imaging characteristics of osteosarcoma.Methods 35 patients with osteosarcoma proved pathologically were examined by radiography,of them 25 cases were examined with CT scan or MRI,and 8 cases undergone contrast-enhanced MRI.The imaging features of osteosarcoma were analysed comparatively with that of pathology.Results The lesions localized at distal part of femur in 17 cases and proximal part of tibia in 8 cases,that were most location of this tumor.The imaging characteristics of osteosarcoma included bone destruction,neoplastic bone,periosteal reaction and soft-tissue mass,in some cases,epiphyseal plate and epiphysis were involved,even the joint face and the opposite osseous of joint(skip lesions).On enhanced MR scanning,the margin of tumor was enhanced in early and the center of tumor was delayed enhancement.CT could showed "sieve sign"and small neoplastic bone.Conclusion Osteosarcoma has certain imaging characteristics;X-ray examination is the first choice in diagnosing osteosarcoma,CT and MR could provide much more comprehensive imaging information for clinic.