Relationship between the SUV max of primary lesion on 18F-FAPI-42 PET/CT imaging and the clinicopathological characteristics of patients with gastric cancer / 中华核医学与分子影像杂志

Objective:To explore the relationship between 18F-fibroblast activation protein inhibitor (FAPI)-42 SUV max of primary gastric cancer and clinicopathological factors of patients. Methods:Fifty-one patients (31males, 20 females, age: 51(47, 65) years) with gastric cancer who underwent 18F-FAPI-42 PET/CT before surgical resection in Nanfang Hospital, Southern Medical University from February 2022 to January 2023 were analyzed retrospectively. The clinicopathological factors that might affect tumor SUV max (including gender, age, tumor location, pathological type, histological grade, Lauren classification, vascular and(or) neural invasion, programmed cell death-ligand 1 (PD-L1) expression, pathologic(p)T stage, pN stage and pTNM stage) were evaluated by the univariate analysis (Mann-Whitney U test or Kruskal-Wallis rank sum test) and multivariate analysis (multiple linear regression analysis). Results:The sensitivity of 18F-FAPI-42 PET/CT in the diagnosis of patients with primary gastric cancer was 82.35% (42/51). The diagnostic sensitivities for early gastric cancer (T1) and locally advanced gastric cancer (T2-T4) were 59.09%(13/22) and 100%(29/29), respectively. The SUV max of primary lesion was 4.90(1.71, 12.51). The univariate analysis showed that SUV max of primary gastric cancer was related to tumor location ( z=-2.00, P=0.046), pT stage ( H=36.94, P<0.001), pN stage ( z=-3.89, P<0.001), pTNM stage ( H=31.49, P<0.001) and vascular and(or) nerve invasion ( z=-5.22, P<0.001), but not related to pathological type, histological grade, Lauren typing, and PD-L1 expression ( z values: from -1.78 to -0.09, all P>0.05). pT stage was found to be a significant independent factor for SUV max in primary gastric lesion by multivariate analysis ( t=2.52, P=0.015). Conclusions:The 18F-FAPI-42 SUV max of primary tumor was related to tumor location, pT stage, pN stage, pTNM stage, and vascular and(or) nerve invasion; pT stage is an independent factor affecting tumor SUV max. The ability of 18F-FAPI-42 PET/CT to detect gastric cancer is mainly affected by pT stage.

Preclinical evaluation and pilot clinical study of 18FAlF-labeled FAPI-tracer for PET imaging of cancer associated fibroblasts

In recent years, fibroblast activation protein (FAP) has emerged as an attractive target for the diagnosis and radiotherapy of cancers using FAP-specific radioligands. Herein, we aimed to design a novel 18F-labeled FAP tracer ([18F]AlF-P-FAPI) for FAP imaging and evaluated its potential for clinical application. The [18F]AlF-P-FAPI novel tracer was prepared in an automated manner within 42 min with a non-decay corrected radiochemical yield of 32 ± 6% (n = 8). Among A549-FAP cells, [18F]AlF-P-FAPI demonstrated specific uptake, rapid internalization, and low cellular efflux. Compared to the patent tracer [18F]FAPI-42, [18F]AlF-P-FAPI exhibited lower levels of cellular efflux in the A549-FAP cells and higher stability in vivo. Micro-PET imaging in the A549-FAP tumor model indicated higher specific tumor uptake of [18F]AlF-P-FAPI (7.0 ± 1.0% ID/g) compared to patent tracers [18F]FAPI-42 (3.2 ± 0.6% ID/g) and [68Ga]Ga-FAPI-04 (2.7 ± 0.5% ID/g). Furthermore, in an initial diagnostic application in a patient with nasopharyngeal cancer, [18F]AlF-P-FAPI and [18F]FDG PET/CT showed comparable results for both primary tumors and lymph node metastases. These results suggest that [18F]AlF-P-FAPI can be conveniently prepared, with promising characteristics in the preclinical evaluation. The feasibility of FAP imaging was demonstrated using PET studies.

Ability of 18F-FDG PET/CT radiomic features to differentiate EGFR mutation status in patients with lung adenocarcinoma / 中华核医学与分子影像杂志

Objective:To explore and compare the value of radiomic features based on 18F-fluorodeoxyglucose (FDG) PET and CT in distinguishing epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. Methods:Pretreatment 18F-FDG PET/CT images and EGFR gene status of 114 patients (64 males and 50 females, aged range: 35-84 (average age: 61) years) with primary lung adenocarcinoma between January 2017 and December 2017 were retrospectively collected. The volume of interest was drawn manually slice by slice, then the features were extracted by the LIFEx software. The parameters were screened by least absolute shrinkage and selection operator (LASSO) method for 200 times, and ten-fold cross-validation was used to select the best tuning parameter λ. Three models, namely M PET, M CT, M PET+ CT, were constructed by binary logistic stepwise regression. The receiver operating characteristic (ROC) curve was generated and the corresponding area under the curve (AUC), sensitivity, specificity and accuracy were calculated. The AUCs of three models were compared by Delong test. Results:Totally, 53.51%(61/114) patients were with wild type EGFR and 46.49%(53/114) patients had EGFR mutation. There were 3, 3, 7 parameters selected to form M PET, M CT, M PET+ CT, respectively. The AUCs for M PET, M CT, M PET+ CT were 0.730, 0.752 and 0.866 respectively. When the cut-off values were 0.427, 0.522, 0.378 for M PET, M CT and M PET+ CT, the Youden index were up to the maximum as 0.420, 0.405, 0.630, with sensitivities of 83.0%(44/53), 58.5%(31/53), 92.5%(49/53), specificities of 59.0%(36/61), 82.0%(50/61), 70.5%(43/61) and accuracies of 70.2%(80/114), 71.1%(81/114), 80.7%(92/114), respectively. There was no significant difference between AUC of M PET and M CT ( z=-0.320, P>0.05). The differences of AUCs between M PET+ CT and M PET, M PET+ CT and M CT were statistically significant ( z values: 2.963, 2.523, both P<0.05). Conclusions:PET, CT and PET+ CT radiomic features are all associated with EGFR gene expression in lung adenocarcinoma. M PET+ CT has the highest predictive efficiency.

Predicative value of radiomics nomogram based on 18F-FDG PET/CT for the prognosis of patients with postoperative gastric carcinoma / 中华核医学与分子影像杂志

Objective To investigate the clinical value of radiomics nomogram,which is established by 18F-fluorodeoxyglucose (FDG) PET/CT radiomics signature combined with clinical-pathologic risk factors,in predicting the prognosis of patients with postoperative gastric carcinoma.Methods 18F-FDG PET/CT data of 207 patients (143 males,64 females,age range:20-85 years) with postoperative gastric carcinoma from January 2008 to August 2015 was reviewed retrospectively.Patients were divided into training group (n=104) and validation group (n =103),and the clinicopathologic information and disease-free survival (DFS) data were acquired.Significant textural features were selected from PET/CT images,and radiomics score (RS) for individual patient was calculated based on the radiomics signatures.The relationship between RS and DFS was analyzed.Cox regression analysis was performed to determine the risk factors ofDFS.The radiomics nomo-gram,obtained from combination of RS with clinicopathologic risk factors,was established and further evaluated in predictive value for recurrence or metastasis of postoperative gastric carcinoma,and the concordance index (C-index) was calculated.Results Cox regression analysis demonstrated that RS,tumor location,depth of invasion,lymph node metastasis,and distant metastasis were the significant risk factors for DFS (hazard ratios:2.148-2.828,all P＜0.05).The radiomics nomogram combined with RS and 4 clinicopathologic risk factors had a better prediction for the estimated DFS,comparing to RS alone.C-index of radiomics nomogram and RS were 0.830 and 0.700 in training group,and 0.776 and 0.681 in validation group,respectively.Conclusion Radiomics nomogram which is established by radiomics signatures and clinicopathologic risk factors may be better for predicting DFS of patients with postoperative gastric carcinoma.

Correlation between the immunophenotypes, treatment strategies and prognosis of gastrointestinal diffuse large B-cell lymphoma / 中华消化杂志

Objective To explore the differences in the prognosis of patients with different immunophenotypes gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) who received different treatment strategies.Methods From March 2006 to January 2016,at Nanfang Hospital,Southern Medical University in Guangzhou,the clinical data of 99 patients with pathologically confirmed GI-DLBCL were retrospectively analyzed.According to treatment strategies,patients were divided into chemotherapy alone group and combination of surgery and chemotherapy group.According to immunophenotypes,patients were divided into germinal center B-cell-like (GCB) type and non-GCB type.The two-year progression-free survival (PFS) rate and overall survival (OS) rate were evaluated.Kaplan-Meier analysis,log-rank test and Cox regression were performed for statistical analysis.Results Among the 99 patients with GI-DLBCL,51 patients were treated with chemotherapy alone,and 48 patients were treated with combination of surgery and chemotherapy.Forty-one cases were GCB phenotype and 40 cases were non-GCB phenotype.The median follow-up time was 25 months.The two-year PFS and OS rates were 70.9％ and 89.5％,respectively.The two-year PFS and OS rates of chemotherapy alone group were 63.6％ and 85.0％,respectively;both were lower than those of combination of surgery and chemotherapy group (79.4％ and 94.7％),and the differences were statistically significant (x2 =4.232,P =0.040 and x2 =4.260,P =0.039).The two-year PFS and OS rates of GCB group were 68.8％ and 93.9％,respectively.And the two-year PFS and OS rates of non-GCB group were 73.2％ and 85.6％,respectively.There were no statistically significant differences between these two groups (both P ＞ 0.05).Among 41 patients with GCB type,25 were treated with combination of surgery and chemotherapy and 16 were treated with chemotherapy alone.The two-year PFS rate of patients treated with combination of surgery and chemotherapy (83.1％) was higher than that of patients treated with chemotherapy alone (49.2％),and the difference was statistically significant (x2 =5.627,P =0.018).The results of multivariate analysis indicated that treatment strategy was not an independent prognostic factor for all the enrolled patients and in patients with GCB type (all P ＞ 0.05).Conclusions Immunophenotypes may lack evaluation value of prognosis in patients with GI-DLBCL.Although among all the enrolled patients and patients with GCB type,the prognosis of patients treated with combination of surgery and chemotherapy is better than that of patients treated with chemotherapy alone,treatment strategy is not an independent prognostic factor.Multi-factors should be evaluated before selection of treatment strategy.

Crohn's disease misdiagnosed as intestinal malignancy by 18F-FDG PET/CT in six patients / 中华核医学与分子影像杂志

Objective To analyze the causes of Crohn's disease (CD) misdiagnosed as intestinal malignancy by 18F-fluorodeoxyglucose (FDG) PET/CT.Methods The clinical and 18F-FDG PET/CT data of 70 CD patients (48 males,22 females;average age:(32.1± 16.7) years) confirmed pathologically from June 2010 to June 2016 in PET Center of Nanfang Hospital were retrospectively reviewed.Patients misdiagnosed as malignancy were selected.The locations,morphologic and metabolic features were retrospectively analyzed.Results Six of seventy CD cases were misdiagnosed as intestinal malignancy (maximum standardized uptake value (SUVmax):7.8-29.8).Among them,4 patients were misdiagnosed as colonic carcinoma and 2 patients were misdiagnosed as intestinal lymphoma.All the intestinal lesions in 6 patients were FDG-avid,4 patients that were misdiagnosed as colonic carcinoma presented as localized irregular mass with extra luminal wall air bubble sign on CT.Two cases that were misdiagnosed as intestinal lymphoma presented as segmental diffusive intestinal wall thickening companied with bowel stiffness,intestinal loops enlargement and finger-pressing pattern along the surface of the intestinal mucosa on CT.Conclusions FDG-avid CD presenting as single localized irregular mass or segmental diffusive intestinal thickening can mimic intestinal malignancy.CT features are useful for differential diagnosis and reducing diagnostic errors.

Prognostic efficiency of interim 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma / 中华核医学与分子影像杂志

Objective To explore whether the prognostic efficiency of international prognostic index (IPI) can be further improved by interim 18F-fluorodeoxyglucose (FDG) PET/CT.Methods A total of 185 patients (116 males,69 females;average age 49 years) with pathologically confirmed diffuse large Bcell lymphoma (DLBCL) from January 2004 to January 2014 were enrolled in this retrospective study.The risk was classified by IPI (0-2 was considered as low risk,3-5 was considered as high risk) and all patients underwent 18F-FDG PET/CT scan before and after 4 cycles of immunochemotherapy.Based on interim 18 F-FDG PET/CT imaging,5-point Deauville score was used to reclassify DLBCL patient into negative group and positive group,and the interpretations were evaluated for 2-year progression-free survival (PFS) and overall survival (OS) rates.Kaplan-Meier analysis,log-rank test and Cox regression were used for data analysis.Results With a median follow-up of 27 (2-146) months,the 2-year PFS and OS rates were 60％(111/185) and 81％(150/185),respectively.A total of 114 patients were included in the low-risk group and 71 patients were in the high-risk group.Both 2-year PFS rates and OS rates between the 2 groups were statistically different:72％(82/114) vs 37％(26/71),x2=20.86,P＜0.01;90％(103/114) vs 63％(45/71),x2=13.39,P＜0.01.The interim PET/CT showed 113 patients with negative results and 72 patients with positive results,whose 2-year PFS rates and OS rates were also statistically different:82％ (93/113) vs 24％(17/72),x2 =66.66,P＜0.01;90％(102/113) vs 51％(37/72),x2 =33.11,P＜0.01.In the low-risk group,85 patients were PET-negative and 29 patients were PET-positive.The 2-year PFS rates were 88％ (75/85) and 31％(9/29),respectively (x2 =35.52,P＜0.01).The 2-year OS rates were 96％ (82/85) and 66％(19/29),respectively (x2 =11.88,P＜0.01).In the high-risk group,28 patients were PET-negative and 43 patients were PET-positive.The 2-year PFS and OS rates were 64％(18/28) vs 19％(8/43;x2 =17.33,P＜0.01) and 86％(24/28) vs 49％(21/43;x2=9.95,P＜0.01),respectively.Conclusions Both IPI and interim 18F-FDG PET/CT have the prognostic value for patients with DLBCL.Interim 18F-FDG PET/CT can improve the prognostic efficiency of IPI.

Comparison of PET conventional parameters and texture parameters in prediction of KRAS gene mutation in colorectal cancer / 中华核医学与分子影像杂志

Objective To evaluated the value of PET conventional parameters and texture parameters in prediction of the Kirsten rat sarcoma viral oncogene (KRAS) gene expression status in colorectal cancer (CRC) by analyzing the relationship between those parameters and KRAS gene status. Methods From December 2012 to January 2017, 18 F-fluorodeoxyglucose (FDG) PET/ CT data and KRAS gene status of 58 CRC patients (40 males, 18 females, average age 56.31 years) before anti-tumor therapies were collected. The relation-ship between PET parameters and KRAS gene expression was analyzed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the values of PET conventional parameters and texture parame-ters for predicting the KRAS gene status. Spearman rank correlation and Mann-Whitney u test were used to analyze the data. Results Of 58 CRC patients, 19(32.8％) had KRAS mutation, while 39(67.2％) were with wild type KRAS. Among the 46 PET image parameters extracted by Chang-Gung image texture analysis (CGITA), 14 PET image parameters were selected by Spearman rank correlation (all ︳rs︳>0.8), inclu-ding 12 texture parameters and 2 conventional parameters (maximum standardized uptake value (SUVmax ) and total lesion glycolysis (TLG)). Six PET image parameters (4 texture parameters and 2 conventional pa-rameters) were found to be different between KRAS gene mutant group and wild group (u values: from -4.481 to -2.046, all P < 0. 05). Among the 4 texture parameters, standardized uptake value ( SUV) kurtosis (SUVkur ) had the best prediction value, while SUVmax was the better one for prediction in the 2 conventional parameters. When 4.27 was selected as the cut-off value for SUVkur , the Youden index was up to the maxi-mum as 0. 35 and it yielded 0.667 on the area under curve (AUC) (95％ CI: 0.517-0.816, P = 0.041) with the sensitivity of 15/ 19 and specificity of 56.4％(22/ 39), respectively. When 16.6 was selected as the cut-off value of for SUVmax , the Youden index was up to the maximum as 0.64 and the AUC on predicting the KRAS mutant was 0.865 (95％ CI: 0.770-0.960, P<0.001) with the sensitivity of 17/ 19 and specifici-ty of 74.4％(29/ 39), respectively. The efficacy of SUVmax for predicting KRAS mutation was significantly better than that of SUVkur(z= 3.258, P= 0.001). Conclusion PET texture parameters and conventional pa-rameters can be used to predict the KRAS gene status in CRC patients, and SUVmax may be the best parameter.

Characteristics of T-and NK/T-cell lymphomas with different pathological subtypes on 18F-FDG PET/CT / 中华核医学与分子影像杂志

Objective To investigate the imaging presentation of T-and NK/T-cell lymphomas with different pathology subtypes on 18F-FDG PET/CT.Methods A total of 95 patients (66 males, 29 females, average age 38.42 years) with T-and NK/T-cell lymphoma proved by pathology from June 2006 to February 2016 were retrospectively analyzed.18F-FDG uptake (SUVmax), nodal invasion, nodal distribution, extra-nodal involvement and staging were compared among 7 pathological subtypes of T-and NK/T-cell lymphomas.One-way analysis of variance, Fisher exact test and Kruskal-Wallis H test were used for data analysis.Results There were significant differences in terms of 18F-FDG uptake, nodal invasion, nodal distribution, extra-nodal involvement and staging among different pathological subtypes of T-and NK/T-cell lymphomas (F=2.937, P<0.05;Fisher exact test,all P<0.01;H=19.883, P<0.01).NK/T-cell lymphoma was found to be prone to invade the nasal cavity and nasopharynx, enteropathic type T-cell lymphoma was specific to the intestine, and subcutaneous panniculitis-like T-cell lymphoma presented with subcutaneous infiltration.All those 3 subtypes were quite specific in their extra-nodal involvement.Most patients with angioimmunoblastic T-cell lymphoma (ATCL), peripheral unspecified T-cell lymphoma (PUTCL) and T immunoblastic lymphoma (TIBL) presented as stage Ⅳ disease.Widespread lymph node disease associated with splenic, parotid and serous membrane involvement were often seen in ATCL patients (most commonly to involve the parotid glands and serous membrane among the 7 subtypes).Nodal involvement was found in PUTCL patients, but extranodal involvement was rather non-specific.TIBL had a non-specific pattern of nodal involvement with low 18F-FDG uptake, lower than ATCL and the other 5 subtypes.Anaplastic large cell lymphoma subtypes had the highest 18F-FDG uptake when compared with the other 6 subtypes, but were less often to manifest as stage Ⅳ disease despite their preponderance for marrow and nodal infiltration.Conclusion Different pathological subtypes of T-and NK/T-cell lymphoma manifest different imaging presentations on 18F-FDG PET/CT, which are useful for understanding their biological characteristics.

Characteristics of 99Tcm-MIBI hepatobiliary scintigraphy in biliary atresia model and its association with the expression of P-glycoprotein in intestinal tissues / 中华核医学与分子影像杂志

Objective To establish rat models of extrahepatic biliary atresia,and to observe the characteristics of 99Tcm-MIBI hepatobiliary scintigraphy and evaluate its association with the expression Pglycoprotein (P-gp) in intestinal tissues.Methods A total of 12 SD rats were randomly divided into the normal control group (3 rats) and the group of common bile duct ligation (CBDL;9 rats).CBDL was used to establish the rat model of extrahepatic biliary atresia.99Tcm-MIBI hepatobiliary scintigraphy was performed at 2,3 and 4 weeks after ligation in the CBDL group and normal control group with continuous dynamic acquisition (3 min/frame) for 30 min and then delaying imaging at 30 min,1,2 and 3 h.After that,all rats were sacrificed,and the blood samples were taken out for the determination of serum ALT,AST,TBIL,DBIL,IBIL,ALP,γ-GT and TBA,and the tissues of duodenum,jejunum,ileum,colon and cecum were taken out for analyzing the expression level of P-gp by immunohistochemistry.Two-sample t test and one-way analysis of variance were used.Results Compared with the normal control group,the serum levels of ALT,AST,TBIL,DBIL,IBIL,ALP,γ-GT and TBA were significantly increasing at 2,3,4 weeks after ligation in CBDL group (t:-3.04 to-44.54,all P＜0.05).99Tcm-MIBI hepatobiliary imaging showed that there was radioactive accumulation in colon or cecum area,excluding the duodenum,jejunum and ileum area,at 3 h after intravenous injection of 99Tcm-MIBI in CBDL group.The results of immunohistochemistry showed that with the obstruction time prolonged,the expression levels of P-gp in duodenum,jejunum and ileum segments were gradually decreased (F=5.17,9.07,23.52;all P＜0.05),while the expression levels in the colon and cecum segments were not changed obviously (F=2.00,3.17;both P＞0.05).Conclusion 99Tcm-MIBI can be excreted through intestinal mucosa,and this process may be associated with P-gp expression.

Value of 18F-FDG PET/CT in the diagnosis of inflammatory bowel diseases / 中华核医学与分子影像杂志

Objective To explore the diagnostic value of 18F-FDG PET/CT in the inflammatory bowel diseases (IBD).Methods The clinicopathological data of 75 patients(46 males,29 females;average age 38 years) with IBD confirmed by colonoscopy from March 2010 to March 2014 were reviewed retrospectively.Among the 75 patients,30 were with ulcerative colitis(UC) and 45 were with Crohn's disease (CD).All underwent whole-body 18F-FDG PET/CT imaging.Enteroscope and CRP examination were performed within 1 week before or after PET/CT imaging.The results of 18F-FDG PET/CT were compared with those of located CT and enteroscope (x2,t tests).Linear correlation analysis was used to analyze the relationship between CRP and the SUVmax of lesions presented in IBD.Results (1) 18 F-FDG PET/CT accurately detected 65 patients with IBD,while located CT diagnosed 55 patients with IBD.The diagnostic sensitivities were significantly different:86.7％ (65/75) vs 73.3％ (55/75),x2 =4.167,P＜0.05.(2) Among 65 patients with positive results in 18F-FDG PET/CT,lesions were consistent with those detected by endoscopy in 33 (33/75,44.0％)patients.Results of the 2 methods in 24 patients (24/75,32.0％)were not completely same,those in 8 patients (8/75,10.7％)were totally different.18F-FDG PET/CT detected 145 lesions,while enteroscope only detected 119 lesions.Diffuse high FDG uptake was shown in intestinal wall in 40 of 65 patients,and mild mucosa injury was showed by enteroscope in 18 patients (45.0％,18/40).(3)Fortyeight of 65 patients detected by PET/CT were proven clinically to be in active stage,and the rest were in stable stage.The SUVmax of active stage group (8.31±4.21) was significantly higher than that of the chronic stage group (6.36±3.15;t =2.033,P＜0.05).There was a linear correlation between CRP and SUVmax of patients in active stage(r=0.453,P＜0.01).Conclusions 18F-FDG PET/CT is helpful to assess the activity of IBD and may serve as a supplementary diagnosing tool to detect the lesions under the epithelium of bowel,which are often false-negative by enteroscope.

Establishment of a diagnostic model for charactering solitary pulmonary nodule based on 18F-FDGPET/CT and clinical data / 中华核医学与分子影像杂志

Objective To establish a diagnostic model based on 18F-FDG PET/CT and clinical data and assess its diagnostic potency for characterizing SPN.Methods From November 2004 to May 2014,164 patients with SPN who underwent 18F-FDG PET/CT scan were retrospectively analyzed.The patients'clinical factors (age,gender,history of smoking and history of malignancy),information on CT (diameter,location and spiculated edge of the lesion) and metabolic information on PET imaging were collected to establish a diagnostic model by using the binary logistic regression.Then,the optimal operating point (OOP)of the established model was set.The diagnostic potencies of the established model and PET were assessed by ROC curve.Results Malignancy was diagnosed in 104 of 164 SPN patients.The rest 60 patients had benign diseases.The factors of age,spiculation(0:no spiculation,1:obvious spiculation) and metabolic information(0:≤ mediastinal blood pool,1:＞mediastinal blood pool) were demonstrated to be useful for the establishment of the model (x2 =5.486,16.240,33.855,all P＜0.05).However,the factors of gender,history of smoking,the diameter and location of lesions showed no influence for the model (x2 =2.452,0.453,0.127,0.390,all P＞0.05) and rejected from the model established.The history of malignancy was excluded from statistical analysis because there were only 2 patients with history of malignancy.The established model was as follows:P=1/(1+e-Z),z=-5.512+0.061xage+2.208xspiculation+3.767×metabolic increase.The ROC AUC of the established model and PET using two-point scoring scale (TPSS) for charactering SPN were 0.92(95％ CI:0.87-0.96)and 0.80(95％ CI:0.73-0.86).The model had higher diagnostic efficacy compared with TPSS (z=4.369,P＜0.05).When P=0.796 7 was set as an OOP,the diagnostic sensitivities of the model and PET for charactering SPN were 91.3％ (95/104) and 94.2％ (98/104) respectively,and no significant difference was found between them (x2 =0.800,P＞0.05).However,significant difference was found between the diagnostic specificities of them (80.0％ (48/60) vs 65.0％ (39/60);x2 =7.111,P＜0.05).Conclusions A new diagnostic model for characterizing SPN based on the information from 18FFDG PET,thin-section CT and clinical data is successfully established.Its sensitivity for diagnosis of lung cancer is high,and its specificity is superior to PET using with TPSS.This model has a potential value for clinical application.

Performance of 18 F-FDG PET/CT in the diagnosis of recurrent and metastatic endometrial cancer / 中华核医学与分子影像杂志

Objective To evaluate the clinical value of 18 F?FDG PET/CT in the diagnosis of recur?rent and metastatic endometrial cancer. Methods A total of 62 patients with endometrial cancer from October 2004 to February 2014 were retrospectively analyzed. The diagnostic efficiency of 18 F?FDG PET/CT for the de?tection of recurrent and metastatic endometrial cancer was evaluated based on the results of pathological biopsy or clinical follow?up. Results There were 28 endometrial cancer cases with recurrence and metastasis, 9 ca?ses with a second primary cancer and without recurrence and metastasis of endometrial carcinoma. PET/CT imaging had false positive findings in 3 cases, false negative findings in 2 cases. The overall sensitivity, speci?ficity and accuracy of PET/CT for detection of recurrence and metastatic endometrial carcinoma were 93.3%(28/30), 90.6%(29/32), 91.9%(57/62), respectively. The sensitivity and specificity of PET/CT for the diagnosis of vaginal stump recurrence, lymph node metastasis and distant metastasis were 9/10 and 98. 1%(51/52), 95.7%(22/23) and 92.3%(36/39), 15/18 and 95.5%(42/44), respectively. Conclusion 18F?FDG PET/CT is a useful diagnostic tool for the detection of recurrent and metastatic endometrial cancer and a second primary cancer.

18F-FDG PET/CT in Synchronous Multiple Primary Esophageal Carcinomas / 中国医学影像学杂志

Purpose Synchronous multiple primary esophageal carcinomas may be undetected by gastroscopy. This study aims to assess the role of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting synchronous multiple primary esophageal carcinomas. Materials and Methods Thirteen patients with synchronous multiple primary esophageal carcinoma who underwent gastroscopy and 18F-FDG PET/CT within two weeks before treatment were retrospectively analyzed. Results Gastroscopy and 18F-FDG PET/CT detected 22 and 29 esophageal carcinomatous foci respectively, and the difference was statistically significant (Z=-2.333, P<0.05). All the 29 esophageal carcinomatous foci showed high 18F-FDG uptake with a SUVmax ranging from 3.1 to 20.1 (mean, 10.7±5.7). 18F-FDG PET/CT also detected surrounding organ invasion in 3 patients, lymphatic metastasis in 10 patients and distant metastasis in 3 patients. Conclusion 18F-FDG PET/CT detects more esophageal carcinomatous foci compared with gastroscopy in patients with synchronous multiple primary esophageal carcinomas and also performs the staging diagnosis, which may help in improving clinical management and prognosis.

¹⁸F-FDG PET/CT for predicting outcomes of diffuse large B-cell lymphoma: shall it be performed in the interim versus later phase of chemotherapy? / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the value of ¹⁸F-FDG PET/CT performed in the interim and later phase of chemotherapy in predicting the prognosis of diffuse large B-cell lymphoma (DLBCL).</p><p><b>METHODS</b>¹⁸F-FDG PET/CT was performed in 71 patients with DLBCL in the interim phase of chemotherapy (3-4 cycles) and in another 71 patients in the later phase of chemotherapy (5-8 cycles). The patients were followed up for an average of 28.73 months (18-114 months) to compare the progression-free survival (PFS) and the PFS rate.</p><p><b>RESULTS</b>The positive finding rate was similar between ¹⁸F-FDG PET/CT performed in the interim and the later phase (36.6% vs 33.8%, X²=12.423, P>0.05). The PFS was much longer in patients with negative findings than in those with positive findings in both the interim (63.56 vs 19.23 months, P=0.000) and later phase groups (65.78 vs 24.32 months, P=0.000), but showed no significant difference between the negative patients (P>0.05) or between the positive patients (P>0.05) in the two groups. The PFS rate was significantly greater in patients with negative than those with positive findings in the interim group (73.3% vs 15.4%, P=0.000) and in the later phase group (74.5% vs 16.7%, P=0.000), but comparable between the negative (P>0.05) and between the positive patients (P>0.05) in the two groups.</p><p><b>CONCLUSIONS</b>¹⁸F-FDG PET/CT in the interim and later phase of chemotherapy has similar value for predicting the prognosis of DLBCL, and we therefore recommend that ¹⁸F-FDG PET/CT be performed in the interim but not in the later phase.</p>

Study on the effect of the haze episodes on the visits to pediatrics outpatient departments and emergency departments in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>The aim of this study was to investigate the impact of air pollution on the number of pediatric outpatient and emergency room visits in January 2013.</p><p><b>METHODS</b>Health-related data was from a major hospital in Haidian,Beijing while related data on air pollution was from the Chinese Research Academy of Environmental Sciences. Data on weather was from the China Weather Website. Number of hospital outpatient visits per day during the haze period was compared to those from the previous year to get the increase of percentage. Concentration-response functions were estimated using generalized additive modeling with natural log link function, while multiple structural change test was used to determine the changing point in CRFs. Constrained piecewise linear function was used to estimate the risks for different segments of CRFs.</p><p><b>RESULTS</b>The peak of NO(X), SO₂, PM(2.5) and PM(10) reached 672.63 µ g/m³, 146.20 µ g/m³, 312.19 µ g/m³ and 995.00 µ g/m³, around 28 December 2012 and 10 January 2013. The peaks of visits to the pediatric department were observed at the some days, showing 47.75% and 34.14% of increase in the visits to the pediatric department. In the low or intermediate ranges of concentration, all the four air pollutants were significantly associated with pediatric outpatient visits, in the form of C- and S- shape of concentration-response function. However, in the range of high concentration, only PM(10) and SO₂were significantly associated with the number of visits to the pediatric emergency room, appeared as the J-shape form. Discernable thresholds were found in S- and J- shapes which were located at 200 µg/m³, 20 µg/m³, 40 µg/m³ and 100 µ g/m³ for NO(X), SO₂, PM(2.5) and PM(10), respectively.</p><p><b>CONCLUSION</b>Air pollution during the haze period was associated with the increase of pediatric outpatient and emergency room visits. There were different sensitive groups within the pediatric cases. Their susceptibility showed a decreasing trend from C-, S-, to J- shape related group.</p>

Value of 18F-FDG PET/CT in the evaluation of treatment response and prognosis for patients with recurrent uterine cervical cancer / 中华核医学与分子影像杂志

Objective To investigate the value of 18F-FDG PET/CT in the evaluation of treatment response and prognosis for patients.with recurrent uterine cervical cancer.Methods Forty-five patients with recurrent uterine cervical cancer underwent 18F-FDG PET/CT before and after treatment from October 2004 to December 2014,and their PET/CT results were retrospectively analyzed.Treatment response was categorized as complete metabolic response (CMR),partial metabolic response (PMR),stable metabolic disease (SMD) and progressive metabolic disease (PMD) according to PET response criteria in solid tumors (PERCIST).Kaplan-Meier survival analysis was used.The difference of progression-free survival (PFS) between patients with and without PMD was compared by x2 test.The PFS difference among patients with different SUVmax on pretreatment PET/CT was also compared byx2 test.Results After treatment,22.2％ (10/45) of patients were categorized as CMR,22.2％(10/45) as PMR,4.4％(2/45) as SMD and 51.1％ (23/45) as PMD by post-treatment 18F-FDG PET/CT.Thirty-two patients had long-term (6-64 months) clinical follow-up.The PFS was 1-64 months and the median PFS was 5 months.The patients without PMD had a significantly better PFS than those with PMD(12.2 vs 4.2 months,x2 =7.223,P＜0.01).Patients with lesion SUVmax＜7.5 on pretreatment PET/CT had a better PFS than those with SUVmax ≥7.5 (16.3 vs 5.9 months,x2 =5.415,P＜0.05).Conclusion 18F-FDG PET/CT is useful forthe evaluation of treatment response and prognosis in patients with recurrent cancer of the uterine cervix.

Preliminary study on the evaluation of Langerhans cell histiocytosis using F-18-fluoro-deoxy-glucose PET/CT / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Limited number of studies have been reported regarding the utilization of F-18-fluoro-deoxy-glucose (F-18-FDG) positron emission tomography/computed tomography (F-18-FDG PET/CT) in Langerhans cell histiocytosis (LCH). The aim of this study was to assess the role of F-18-FDG PET/CT in the diagnosis and treatment of LCH.</p><p><b>METHODS</b>Eight newly diagnosed and seven recurrent patients with LCH received F-18-FDG PET/CT scans. The diagnosis of LCH was established by pathology, multi-modality imaging, and clinical follow-up.</p><p><b>RESULTS</b>F-18-FDG PET/CT was positive in 14 patients with 13 true positives and one false positive. All 45 LCH lesions were F-18-FDG avid including six small bone lesions <1.0 cm in diameter. The mean maximal standardized uptake value (SUVmax) was 7.13 ± 4.91. F-18-FDG uptake showed no significant difference between newly diagnosed lesions vs recurrent lesions (SUVmax: 6.50 ± 2.97 vs. 7.93 ± 6.60, t = -0.901, P = 0.376). Among 45 LCH lesions, 68.9% (31/45) were found in bones and 31.1% (14/45) in soft tissue. The most commonly involved bones were the pelvis and vertebrae. There was no significant difference in F-18-FDG uptake between bone lesions vs. non-bone lesions (SUVmax: 6.30 ± 2.87 vs. 8.97 ± 7.58, t = 1.277, P = 0.221). In two patients, changes in F-18-FDG uptake on serial PET/CT scans reflected response of lesions to treatment.</p><p><b>CONCLUSIONS</b>The present study suggests that F-18-FDG PET/CT may be useful for diagnosis and assessing the treatment response of LCH. Because of the small sample size, further research is warranted to confirm our findings.</p>

Value of dual-phase (18)F-FDG PET/CT in preoperative staging of bladder cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical value of dual-phase (18)F-FDG PET/CT with oral diuretics in preoperative staging of bladder cancer.</p><p><b>METHODS</b>The imaging data were analyzed of 73 patients with bladder cancer undergoing preoperative dual-phase (18)F-FDG PET/CT with oral diuretic between May, 2003 and May, 2012. All the patients underwent whole-body PET/CT scan 60 min after intravenous injection of 270-350 MBq of (18)F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis using oral furosemide (40 mg). All the patients underwent subsequent radical cystectomy, and (18)F-FDG PET/CT findings were compared with the histopathologic results to evaluate the value of dual-phase (18)F-FDG PET/CT in preoperative staging.</p><p><b>RESULTS</b>The concordance rate of dual-phase FDG PET/CT-based bladder cancer staging with the histopathologic results was 63.0% in the 73 patients, and was 100% (7/7) for pT4 bladder cancers. With dual-phase FDG PET/CT, the detection rate was 75.0% (6/8) for lymph node metastases, 100% (4/4) for distant metastases, and 100% (4/4) for other concurrent primary malignancies.</p><p><b>CONCLUSION</b>Though with limited accuracy in T-staging of pTa, pT1, pT2, and pT3 bladder cancer, dual-phase FDG PET/CT has important clinical value in staging of pT4 bladder cancer and in N-staging, M-staging and detection of other concurrent primary malignancies.</p>

Tumor targeting efficacy of a novel PET radiotracer (1)8F-AlF-NOTA-PRGD2 in mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the tumor targeting efficacy of (18)F-AlF-NOTA-PRGD2, a novel radiotracer of Arginine-glycine-aspartic acid (RGD) peptides.</p><p><b>METHODS</b>(18)F-AlF-NOTA-PRGD2 was synthesized in one-step by conjugating NOTA-PRGD2 with (18)F-AlF at 100 degrees celsius;. The tumor targeting efficacy and in vivo biodistribution profile of (18)F-AlF-NOTA-PRGD2, following intravenous injection via the tail vein, were evaluated in a nude mouse model bearing subcutaneous U87MG glioblastoma xenograft by radioactivity biodistribution assessment, PET/CT and microPET/CT.</p><p><b>RESULTS</b>NOTA-PRGD2 was (18)F-fluorinated successfully in one-step with a yield of 17%-25% within 15-20 min. Radioactivity biodistribution study confirmed the tumor-targeting ability of (18)F-AlF-NOTA-PRGD2 in the tumor-bearing mice. At 1 and 2 h following injection, (18)F-AlF-NOTA-PRGD2 uptake in the tumor reached 4.14∓1.44 and 2.80∓1.18 % ID/g (t=1.910, P=0.070) with tumor/brain ratios of 2.95∓0.61 and 5.21∓2.62, respectively (t=-1.686, P=0.167). Both PET/CT and microPET/CT were capable of showing the radioactivity biodistribution of (18)F-AlF-NOTA-PRGD2 in the mouse model and clearly displayed the tumor, but microPET/CT showed a much better image quality.</p><p><b>CONCLUSION</b>(18)F-AlF-NOTA-PRGD2 prepared by one-step radiosynthesis can selectively target to the tumor, demonstrating its potential as a good radiotracer for tumor imaging.</p>