Value of 18F-FDG PET/CT Combined with Lung HRCT in Diagnosis of Solitary Pulmonary Intravascular Metastasis.

Background: Solitary pulmonary intravascular metastasis is a rare complication of malignant tumors, and accurate diagnosis can improve clinical decision-making, but diagnosing it effectively using conventional techniques is difficult. Purpose: To explore the value of 18F-FDG PET/CT combined with lung high-resolution computed tomography (HRCT) in the diagnosis of solitary pulmonary intravascular metastasis. Methods: 18F-FDG PET/CT, lung HRCT, and follow-up data of 18,143 cancer patients were retrospectively analyzed to select patients with pulmonary vessel involvement besides the primary tumor only. The histopathological or imaging follow-up results were used as the diagnostic criteria for pulmonary intravascular metastasis. Results: A total of 13 patients with 17 pulmonary intravascular metastases were found, of which 9 patients had a single lesion and 4 had double. The SUVmax was 1.1-5.4 (average, 2.4 ± 1.4), and the length of hypermetabolic metastasis was 5.1-24.1 mm (average, 10.7 ± 6.5 mm). All the intravascular metastases were located in the terminal pulmonary vessels. Strip or branched pulmonary vessels enlargement with increased metabolism was the main imaging manifestation (15/17, 88.2%), while the other 2 cases only showed strip metabolic enhancement without abnormalities in pulmonary vessels (2/17, 11.8%). Four pulmonary intravascular metastases were confirmed by pathology, and the other 13 cases were diagnosed by imaging follow-up. Conclusion: 18F-FDG PET/CT combined with lung HRCT is an effective technique for the diagnosis of solitary pulmonary intravascular metastasis. High-strip or branched FDG uptake in the distal pulmonary vessel accompanied by corresponding morphological changes in patients with malignant tumors can be used as a specific diagnostic indicator.

Ultrasound Findings to Predict Risk of Recurrence in Pediatric Intussusception After Air Enema Reduction.

OBJECTIVES: Intussusception is one of the most common abdominal emergencies in early children. Intussusception recurs in 8-20% of children after successful nonoperative reduction. The aim of this study was to explore the ultrasound findings to predict risk of recurrence in pediatric intussusception after air enema reduction. METHODS: A total of 336 intussusception children were followed up for 1 year after received successful air enema reduction. They were divided into the recurrent group and the non-recurrent group. The differences of clinical characteristics, ultrasonic features, and laboratory tests were analyzed by univariate analyses and the Cox proportional hazard model. RESULTS: Sixty-five children with recurrent intussusception were identified. There were statistically significances in the diameter of the mass, in the presence or absence of enlarged lymph nodes out of the sleeve, and in the sleeve between recurrent and non-recurrent groups (P < .05). Other ultrasonic features, clinical characteristics, and blood parameters had no differences (P > .05). Multivariate Cox proportional hazard model showed that the diameter of the mass and abdominal lymph nodes may be the risk factors of intussusception recurrence (HR = 1.395, 95% CI: 1.045~1.863 and HR = 2.078, 95% CI: 1.118~3.865, P < .05). The cut-off value of mass diameter was 2.55 cm, above which recurrence is more likely. CONCLUSIONS: Intussusception recurrence was prone with greater mass diameter (>2.55 cm) and enlarged abdominal lymph nodes. Although these ultrasound findings for recurrence do not necessarily reduce the rate of recurrence, it can predict the recurrent possibility, and help the emergency physicians to be more vigilant in these children and better counsel parents upon discharge.

Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma.

BACKGROUND: Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC. METHODS: Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade. RESULTS: The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor - HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781. CONCLUSION: Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.

Association of Hepatitis B Virus DNA Level and Follow-up Interval With Hepatocellular Carcinoma Recurrence.

Importance: Antiviral treatment is important in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) comprehensive therapy. A high HBV DNA level is an independent risk factor for HBV-related HCC, but no quantifiable clinical index is available to date. Objective: To evaluate the feasibility and availability of the novel HBV DNA quantitation-time index (HDQTI), which includes HBV DNA quantitation and follow-up, to predict HBV-related HCC prognosis. Design, Setting, and Participants: This retrospective prognostic study of patients with HCC from multiple centers in China was performed from January 1, 2002, to December 31, 2016. The median follow-up time was 18 months, and the longest follow-up time was 147 months. Data analysis was performed from January 1, 2017, to December 31, 2018. Main Outcomes and Measures: Clinical characteristics, antitumor management, antiviral treatment, HDQTI scores, follow-up information, and overall survival were recorded and analyzed. A receiver operating characteristic curve and accompanying area under the curve were calculated for HDQTI. Results: A total of 842 patients (mean [SD] age, 61.80 [9.85] years; 513 [60.9%] male) were included in the study. Of all included patients, 734 received no antiviral therapy before diagnosis (no previous diagnosis of HBV infection), 43 underwent nonstandard antiviral therapy, and 65 received regular antiviral therapy. Compared with the group without antiviral treatment, the Barcelona Clinic Liver Cancer (BCLC) stage was earlier (A:B:C, 73.8%:26.2%:0% to 5.7%:65.5%:28.8%, P < .001), the mean (SD) tumor size was smaller (2.89 [1.26] to 7.56 [3.28] cm, P < .001), the ratio of baseline HBV DNA level of more than 105 copies/mL was lower (10.8% to 40.6%, P < .001), and the ratio of the α1-fetoprotein level more than 400 ng/mL was less (21.5% to 78.2%, P < .001) in the standard antiviral treatment group, whereas the nonstandard treatment group was between the 2 groups. Recurrence occurred in 39 of 109 BCLC stage A cases. Patients with HDQTI scores higher than 34 had high risk of recurrence; at this cutoff level, the sensitivity of the HDQTI was 76.9% and the specificity was 92.9%, with an area under curve of 0.928. Patients in various BCLC stages had similar trends in overall survival and HDQTI scores (BCLC stage A: HDQTI score <34, not applicable; HDQTI score ≥34, 44.0 months; 95% CI, 38.3-49.7 months; BCLC stage B: HDQTI score <34, 35.0 months; 95% CI, 33.3-36.7 months; HDQTI score ≥34, 17.0 months; 95% CI, 14.5-19.5 months; P = .002; BCLC stage C: HDQTI score <34, 18.0 months; 95% CI, 16.5-19.6 months; HDQTI scores ≥34, 10.0 months; 95% CI, 8.5-11.5 months; P = .005). Conclusions and Relevance: The findings suggest that the HDQTI can be used as an independent prognostic indicator of recurrence in HBV-related HCC. Shorter follow-up intervals and accurate imaging evaluation are recommended in patients with HDQTI scores of 34 or higher.

A dose-response meta-analysis of coffee consumption and thyroid cancer occurrence.

The relationship between coffee consumption and thyroid cancer (TC) occurrence has been evaluated in several observational studies with controversial results. The study aims to examine the associations between coffee consumption and TC occurrence. Systematic searches up to February 2019 were conducted. We estimated summary adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs). The dose-response analysis was conducted by using generalised least square trend estimation. A total of ten studies involving 379,825 participants and 1,254 TC cases were included. The total summary RR showed that high coffee consumption was a protection factor of TC (RR = 0.75; 95% CI, 0.62-0.91). With the linear cubic spline model, the occurrence of TC was reduced by 5% with each one cup/day increment of coffee consumption (RR = 0.95; 95% CI, 0.91-0.99).This meta-analysis provides quantitative evidence that coffee consumption was inversely associated with the TC occurrence in a linear dose-response manner.