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PURPOSE: The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast. MATERIALS AND METHODS: A small particle radiotracer ((99m)Tc-Dextran 40) was prepared and tested. (99m)Tc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging. RESULTS: The radiochemical purity of (99m)Tc-Dextran 40 was > 95%. (99m)Tc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After (99m)Tc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then (99m)Tc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area. CONCLUSION: The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.
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Experimentação Animal , Neoplasias da Mama , Mama , Drenagem , Linfonodos , Vasos Linfáticos , Biópsia de Linfonodo Sentinela , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
<p><b>OBJECTIVE</b>To explore the effects of different injection techniques of radiotracer on the visualization rate of internal mammary sentinel lymph nodes (IMSLN) in breast cancer patients.</p><p><b>METHODS</b>A series of 137 consecutive breast cancer patients was included in this prospective study. Fifty-eight patients (group A) received the radiotracer (99)Tc(m)-sulphur colloid injected only into 1-2 points in the breast parenchyma in one quadrant, and seventy-nine patients (group B) received the radiotracer injection into the breast parenchyma in two quadrants of the breast. The differences of IMSLN visualization rates of the two groups were compared and the relevant affecting factors were analyzed.</p><p><b>RESULTS</b>The IMSLN visualization rate of the group B (70.9%, 56/79) was significantly higher than that of the group A (13.8%, 8/58) (P < 0.001). Both techniques seemed to be reliable to identify sentinel lymph node in the axilla (98.7% vs. 98.3%, P = 0.825). In addition, the visualization rate of internal mammary hotspots (82.2%) was more commonly seen in patients receiving injection of a larger volume of radiotracer ( ≥ 0.5 ml/point) than those receiving a smaller volume of radiotracer (<0.5 ml/point, 55.9%, P = 0.011).</p><p><b>CONCLUSIONS</b>The modified injection technique (two quadrants, large volume radiotraver, and ultrasound guidance) can significantly improve the visualization rate of IMSLN. Our findings should make the biopsy of IMSLN widely implemented and provide an effective and minimally invasive technique to evaluate the internal mammary lymph node status.</p>
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Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Axila , Diagnóstico por Imagem , Patologia , Neoplasias da Mama , Diagnóstico por Imagem , Patologia , Cirurgia Geral , Injeções , Linfonodos , Diagnóstico por Imagem , Patologia , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela , Métodos , Coloide de Enxofre Marcado com Tecnécio Tc 99mRESUMO
ObjectiveTo evaluate the prognostic value of MTV on 18F-FDG PET/CT in patients with esophageal cancer.MethodsForty-nine patients with esophageal cancer underwent 18 F-FDG PET/CT scan before surgery.The median follow-up time for the patients was 29 months (range,8- 57 months).The prognostic significance of MTV,age,sex,histologic grade,SUVmax of the primary tumor,tumor size measured on PET/CT,T stage,N stage,M stage,American Joint Committee on Cancer (AJCC) stage,number and location of lymph nodes metastases were assessed by Kaplan-Meier analysis and multivariate Cox model.ResultsIn the univariate analysis,AJCC stage (x2 =16.206,hazard ratio (HR) =1.177,P <0.001),N stage (x2 =9.536,HR =10.833,P =0.002),T stage (x2 =5.810,HR=2.397,P=0.016),number of lymph nodes metastases (x2 =11.423,HR =1.567,P =0.001 ),and MTV (x2 =3.872,HR =2.433,P =0.049 ) were significant predictors of survival.Multivariate analysis showed that MTV and AJCC stage were independent predictors of survival (x2 =4.525,HR1.170,P =0.033 ;X2=4.875,HR =3.071,P =0.027).Kaplan-Meier survival curves revealed longer survival time of low-MTV group as compared to high-MTV group ( Log-rank,x2 =4.186,P =0.041 ).ConclusionMTV on 18 F-FDG PET/CT may be an independent prognostic factor in patients with esophageal cancer.
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<p><b>OBJECTIVE</b>To assess the feasibility of [(18)F]fluoroerythronitroimidazole ((18)F-FETNIM) with integrated positron emission tomography and computed tomography (PET-CT) imaging in detection of hypoxia in non-small-cell lung cancer (NSCLC) patients.</p><p><b>METHODS</b>Forty-two patients with newly diagnosed NSCLC underwent (18)F-FETNIM PET-CT before treatment. Nineteen patients rested for approximately 120 minutes before undergoing PET-CT, 23 patients underwent 2 sequential PET-CT scans at 60 minutes and 120 minutes after intravenous injection (18)F-FETNIM. (18)F-FETNIM uptake was quantified by calculating the maximum standardized uptake value in the tumor (SUVmax-T) and contralateral normal lung tissue (SUVmax-N). Regions of interest (ROIs) were drawn in the tumor and contralateral position and the radioactivity ratio of tumor to normal (T/N) was calculated.</p><p><b>RESULTS</b>SUVmax-T (2.43 +/- 1.34) was significantly higher than SUVmax-N (0.87 +/- 0.46, P < 0.001) at 120 min. SUVmax-T (2.80 +/- 1.09) and SUVmax-N (1.16 +/- 0.56) at 60 min were significantly higher than SUVmax-T (2.61 +/- 1.10) and SUVmax-N (P < 0.01) at 120 min. T/N (2.56 +/- 0.71) at 60 min was higher than that at 120 min (2.48 +/- 0.60), but the difference between them was not significant (P = 0.324).</p><p><b>CONCLUSION</b>Our results indicate that (18)F-FETNIM PET-CT may be a useful tool for evaluating hypoxia and may be a means to target specifically tumor cells resistant to conventional treatment before and during ongoing therapy in NSCLC.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico por Imagem , Patologia , Hipóxia Celular , Neoplasias Pulmonares , Diagnóstico por Imagem , Patologia , Nitroimidazóis , Tomografia por Emissão de Pósitrons , Métodos , Tomografia Computadorizada por Raios XRESUMO
<p><b>OBJECTIVE</b>(99)Tc(m)-HL91 ((99)Tc(m) labeled 4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime) is a potential noninvasive marker of tumor hypoxia. It has been reported that (99)Tc(m)-HL91 has validity for hypoxia imaging in non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the (99)Tc(m)-HL91 SPECT hypoxia imaging of NSCLC, the expression of inducible hypoxia factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF), and to analyze their correlations with clinicopathological characteristics.</p><p><b>METHODS</b>Twenty NSCLC patients who underwent radical resection were enrolled into this study prospectively. (99)Tc(m)-HL91 SPECT scanning was performed in all patients at one or two days before surgery. After intravenous injection of approximately 740 MBq (99)Tc(m)-HL91, anterior, posterior and lateral planar images were collected at 2, 4 and 6 hours, respectively. Regions of interest (ROIs) were drawn in the tumor and the contralateral normal lung tissue, and the radioactivity ratio of tumor to normal tissue (T/N) was calculated. Immunohistochemistry was used to detect the expression of HIF-1alpha and VEGF in sequential histological sections of specimens.</p><p><b>RESULTS</b>Among the 20 NSCLC patients, 13 showed positive expression of HIF-1alpha and 15 had positive expression of VEGF, with a positive rate of 65.0% and 75.0%, respectively. The uptake of (99)Tc(m)-HL91 was strongly correlated with the expression status of HIF-1alpha. No correlation between HIF-1alpha and VEGF expression levels was observed. The HIF-1alpha expression level was not correlated with histological subtype, but with lymph node involvement. The expression levels of HIF-1alpha and VEGF were positively correlated with tumor stage.</p><p><b>CONCLUSION</b>The result of (99)Tc(m)-HL91 SPECT hypoxia imaging is found to be positively correlated with expression of HIF-1alpha in the non-small cell lung cancer. HIF-1alpha expression is positively correlated with VEGF expression. Furthermore, both HIF-1alpha and VEGF expressions are increasing with the increase of tumor stage.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico por Imagem , Metabolismo , Patologia , Subunidade alfa do Fator 1 Induzível por Hipóxia , Metabolismo , Neoplasias Pulmonares , Diagnóstico por Imagem , Metabolismo , Patologia , Metástase Linfática , Estadiamento de Neoplasias , Compostos de Organotecnécio , Oximas , Estudos Prospectivos , Radiografia , Tomografia Computadorizada de Emissão de Fóton Único , Métodos , Fator A de Crescimento do Endotélio Vascular , MetabolismoRESUMO
<p><b>OBJECTIVE</b>To investigate the correlation between 18F-fluorodeoxyglucose (18FDG) uptake of primary lesions during PET-CT (positron emission tomography and computed tomography) examination and clinicopathological parameters such as the tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status in the patients with esophageal carcinoma.</p><p><b>METHODS</b>From June 2004 to November 2006, 68 operable esophageal carcinoma patients were enrolled into this study, and all had a whole body 18FDG PET-CT scan before operation. The maximum standardized uptake value (SUVmax) of the primary lesions was measured. The tumor length, depth of invasion, differentiation of the primary lesions and lymph node metastasis status were determined by postoperative pathological examination. The correlation between the standardized uptake value (SUV) of primary lesions and the above mentioned clinicopathological parameters was analyzed.</p><p><b>RESULTS</b>The overall length of primary lesion was positively correlated with SUVmax (r=0.512, P=0.01). Depth of invasion was also positively correlated with SUVmax (r=0.860, P=0.000). There was a statistically significant difference in SUVmax between poorly differentiated group and moderately or well differentiated group (r=0.781, P=0.000), and also between the groups with or without lymph node metastasis (r=0.852, P=0.000).</p><p><b>CONCLUSION</b>The tumor length, depth of invasion and differentiation of the primary lesions of the esophageal carcinoma are all positively correlated with maximum standardized uptake value of 18FDG. The more poorly differentiated lesions show a higher 18FDG maximum standardized uptake value. The lesions with lymph node metastasis have also a significantly higher 18FDG maximum standardized uptake value than those without lymph node metastases.</p>
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas , Diagnóstico por Imagem , Metabolismo , Patologia , Neoplasias Esofágicas , Diagnóstico por Imagem , Metabolismo , Patologia , Fluordesoxiglucose F18 , Metabolismo , Metástase Linfática , Invasividade Neoplásica , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Métodos , Compostos Radiofarmacêuticos , Metabolismo , Tomografia Computadorizada por Raios X , Carga TumoralRESUMO
<p><b>OBJECTIVE</b>To evaluate the value of (18)F-FDG PET-CT in detecting the primary tumor in patients with metastatic cancers of unknown primary origin.</p><p><b>METHODS</b>Sixty-seven patients with metastatic cancers of unknown primary origin after extensive conventional diagnostic work-up were enrolled into this study. (18)F-FDG PET-CT scans were performed at approximately 60 minutes after the intravenous injection of 7.4 MBq (18)F-FDG/kg, then delayed imaging scans was done at approximately 180 minutes for detecting the primary focus. The standardized uptake value (SUV) >or= 2.5 on standard PET/CT imaging was considered as positive. Ten percent increase of retention index (RI) was also regarded as positive. The correlation between (18)F-FDG PET-CT results and histopathological and clinical findings were analyzed, and the SUV of detected primary focus and that of metastatic cancers were compared.</p><p><b>RESULTS</b>Of the 67 patients, the primary tumors were identified in 39 (53.7%) by (18)F-FDG PET-CT, and 36 of them were confirmed by pathology or follow-up. Thirteen distant metastases and seventeen lymphatic metastases were newly discovered by whole body (18)F-FDG PET-CT imaging. The SUV of metastatic tumors was significantly lower than that of primary tumors (t = 3.470,P = 0.001) and closely correlated with that of the primary tumors (r = 0.738, P = 0.000).</p><p><b>CONCLUSION</b>(18)F-FDG PET-CT is not only valuable in identifying the unknown primary tumor in patients with metastatic carcinoma, but can also be used to reveal the biological characteristics of the tumors by functional imaging.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Diagnóstico por Imagem , Carcinoma de Células Escamosas , Diagnóstico por Imagem , Fluordesoxiglucose F18 , Seguimentos , Neoplasias Pulmonares , Diagnóstico por Imagem , Patologia , Neoplasias Primárias Desconhecidas , Diagnóstico por Imagem , Neoplasias Ovarianas , Diagnóstico por Imagem , Patologia , Tomografia por Emissão de Pósitrons , Métodos , Tomografia Computadorizada por Raios XRESUMO
<p><b>OBJECTIVE</b>To explore the diagnostic value of dual-time-point 18F-FDG PET-CT imaging in detecting hilar and mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>Forty-six patients with NSCLC underwent standard whole body single-time 18F-FDG PET-CT scans and a delayed imaging for the thorax alone before surgery, meanwhile, the standard uptake value (SUV) and retention index (RI) were calculated.</p><p><b>RESULTS</b>A total number of 584 lymph nodes were excised in the 46 patients. Of these, 134 metastatic lymph nodes were pathologically confirmed in 31 patients. There were 189 lymph nodes detected and suspected to be metastatic by standard single-time 18 F-FDG PET-CT imaging, and 161 by dual-time-point imaging. Therefore, the sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value in the detection of hilar and mediastinal lymph node metastasis were 87.3%, 84.0%, 84.8%, 61.9% and 95.7% by standard single-time 18F-FDG PET-CT imaging, versus 94.8%, 92.2%, 92.8%, 78.9% and 98.1%, respectively, by dual-time-point imaging. There was a statistically significant difference in the detection of lymph node metastasis between the standard single-time imaging and dual-time-point 18F-FDG PET-CT imaging.</p><p><b>CONCLUSION</b>Dual-time-point 18F-FDG PET-CT imaging is more sensitive, specific and accurate than standard single-time 18F-FDG PET-CT imaging in the detection of hilar and mediastinal lymph node metastasis, and may provide more information for diagnosis, staging and treatment of non-small cell lung cancer.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico por Imagem , Patologia , Reações Falso-Negativas , Reações Falso-Positivas , Fluordesoxiglucose F18 , Neoplasias Pulmonares , Diagnóstico por Imagem , Patologia , Linfonodos , Diagnóstico por Imagem , Patologia , Metástase Linfática , Diagnóstico por Imagem , Mediastino , Patologia , Tomografia por Emissão de Pósitrons , Métodos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
<p><b>OBJECTIVE</b>To investigate the value of 11C-PD153035 as an EGFR imaging agent in C6 tumor-bearing rat.</p><p><b>METHODS</b>The tumor-bearing rats were generated by subcutaneous injection of glioma C6 cells. Positron emission tomography/computer tomography (PET/CT) scans started as soon as intravenous injection of 11C-PD153035 (15-20 MBq/0.3 ml) was completed, images were collected continuously. The region of interest (ROI) was used to study the percentage of radioactivity in major organs and implanted tumors in the rats. The accumulation and blocking study in vitro was completed.</p><p><b>RESULTS</b>There were significant differences in 11C-PD153035 uptake among major organs. The maximum uptake in the organs ranked in the following order: liver > gastrointestinal tract > kidney > lung > brain > muscle. Radioactivity could be also observed in the tumors. The radioactivity ratio (T/NT, target/non-target) peaked (4.15) at 40 - 50 min post injection. The in vitro blocking study showed that 11C-PD153035 uptaken by C6 cells could be blocked by PD153035.</p><p><b>CONCLUSION</b>The results of this study show that 11C-PD153035 can be uptaken by EGFR-expressing tumors. 11C-PD153035 has a potential as a bioprobe to yield useful information for both diagnosis and therapy of tumors. However, the high concentration of 11C-PD153035 in the gastrointestinal tract is unfavorably affecting the tumor detection in these organs.</p>
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Animais , Masculino , Ratos , Neoplasias Encefálicas , Diagnóstico por Imagem , Metabolismo , Patologia , Radioisótopos de Carbono , Linhagem Celular Tumoral , Trato Gastrointestinal , Metabolismo , Glioma , Diagnóstico por Imagem , Metabolismo , Patologia , Fígado , Metabolismo , Transplante de Neoplasias , Tomografia por Emissão de Pósitrons , Quinazolinas , Farmacocinética , Ratos Wistar , Receptores ErbB , Metabolismo , Distribuição Tecidual , Tomografia Computadorizada por Raios XRESUMO
Objective The aim of this study was to investigate the radiation dose caused by 18 F-fluorodeoxyglucose (FDG) in PET/CT examination and to optimize the concerned radiation protection. Methods Thirty patients from our conventional PET/CT examination were simple randomly selected, and they all underwent whole body PET/CT imaging. The radioactive dose of injected 18F-FDG was recorded. The internal radiation dose was calculated and the external radiation dose from patients was measured with the 451P-DE-SI ion chamber survey meter. The staff's dose was recorded with thermoluminescent detector (TLD). All dosimetry data were processed and analyzed statistically with Excel 2003. Results The injected radioactive dose of 18F-FDG was (432.9±51.8) MBq, and effective dose equivalent received per patient was (8.23±0.99) roSy. The correlation coefficient (r) of the dose equivalent rate and distance was-0.994 by power function curve fitting, and that of dose equivalent rate and time was - 0.988 by exponential curve fitting. The staff's dose was lower than the annual dose limit. Conclusions The patient's internal radiation dose caused by 18F-FDG in PET/CT examination is low, nonetheless, the clinician should always consider optimizing and minimizing the necessary radiation received by the patients. The patients having been injected with 18F-FDG should stay in one place to decrease their radiation to the public. From the medical point of view in optimizing radiation exposure, there may still be a potential to lower the injected 18F-FDG activity.
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<p><b>OBJECTIVE</b>To investigate the value of 18F-FDG PET-CT in detecting metastatic lymph node and radiation planning for patient with non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>The data of 58 NSCLC patients were retrospectively analyzed. Preoperatively, Both 18F-FDG PET-CT and CT scan were performed for all patients. Blinded interpretation of these images was then carried out. The gross tumor volume defined by radiation oncologist based on imaging results of either PET-CT or CT alone was compared with pathological results eventually.</p><p><b>RESULTS</b>The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of detecting metastatic lymph node in the mediastinum was 56.0%, 54.2%, 54.8%, 38.9%, 70.3% by CT alone, and 88.0%, 85.4%, 86.3%, 75.9%, 93.2% by PET-CT, respectively. There was a statisticalty significant difference between two methods(P < 0.05). However, statisticalty no significant difference in detecting hilar lymph nodes was observed. The radiation target volume defined by CT was identical to that by PET-CT in 31(53.5%) cases, but changed in the other 27 (46.5%) cases when 18F-FDG PET data was added. The accuracy was 75.9% in detecting metastatic lymph nodes in the radiation target volume defined by PET-CT, while it was much lower by CT alone (48.3%) with a statistically significant difference between two methods (P < 0.05).</p><p><b>CONCLUSION</b>18F-FDG PET-CT is more accurate than CT alone in assessment of mediastinal lymph nodes for NSCLC patients. It may be recommended as a method in defining the radiation target volume.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico por Imagem , Patologia , Radioterapia , Fluordesoxiglucose F18 , Neoplasias Pulmonares , Diagnóstico por Imagem , Patologia , Radioterapia , Linfonodos , Diagnóstico por Imagem , Patologia , Efeitos da Radiação , Metástase Linfática , Mediastino , Diagnóstico por Imagem , Efeitos da Radiação , Tomografia por Emissão de Pósitrons , Métodos , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
<p><b>BACKGROUND</b>(11)C-4-N-(3-bromoanilino)-6,7-dimethoxyquinazoline ((11)C-PD153035) has been reported as a tracer for imaging human tumors that overexpress epidermal growth factor receptor (EGFR). However it is still unclear whether (11)C-PD153035 uptake correlates with EGFR expression levels. The objective of this study was to investigate the relationship between (11)C-PD153035 accumulation and EGFR expression levels.</p><p><b>METHODS</b>Synthesis of (11)C-PD153035 was performed in the Tracerlab FXc system. Accumulation of (11)C-PD153035 by MDA-MB-468, A549 and MDA-MB-231 cells was measured in vitro. There were six tumor-bearing mice in each group. (11)C-PD153035 uptake in tumors was determined by positron emission tomography/computed tomography (PET/CT). Tumor/normal muscle tissue (T/NT) analysis in PET images was applied to quantify the PET data. Sixty minutes after PET/CT scanning, the nude mice were sacrificed and the tumors were excised. The (11)C-PD153035 accumulation in different tumors was determined by a gamma counter.</p><p><b>RESULTS</b>Close correlation existed between the uptake and the level of EGFR expression both in vitro and ex vivo (r(2) = 0.72, P < 0.001; r(2) = 0.63, P = 0.003). When the static T/NT analysis method was applied to analyze the PET data, the observed correlation was again excellent (r(2) = 0.70, P = 0.001).</p><p><b>CONCLUSIONS</b>The uptake of PET tracer (11)C-PD153035 closely correlates with the EGFR expression levels in tumor cells. (11)C-PD153035 has the potential to yield useful information for both cancer diagnosis and therapy.</p>
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Animais , Feminino , Humanos , Camundongos , Radioisótopos de Carbono , Linhagem Celular Tumoral , Ligantes , Camundongos Endogâmicos BALB C , Camundongos Nus , Tomografia por Emissão de Pósitrons , Quinazolinas , Metabolismo , Receptores ErbB , MetabolismoRESUMO
<p><b>OBJECTIVE</b>To compare the combined FDG PET/CT with PET alone in the detection of lymph node metastasis (LNM) for esophageal carcinoma patient.</p><p><b>METHODS</b>From November 2003 to August 2005, 35 patients with esophageal carcinoma underwent FDG PET/CT before esophagectomy and lymph node (LN) dissection. The patients who had history of previous anticancer treatment or diabetes mellitus and inflammatory lung diseases as well as being inoperable for medical reasons were excluded. The results of LNM detection by PET/CT and PET alone were compared with pathological results.</p><p><b>RESULTS</b>Twenty-nine men and 6 women were eligible for this study, with a mean age of 57 years (range: 40 to 72 years). Of these 35 patients, 3 had lesion at the upper third thoracic esophagus, 22 at the middle third and 10 at the lower third. All patients underwent surgical resection successfully. Twenty-five patients and 65 out of 313 excised nodal groups were found to have metastases by pathological examination. The true positive and true negative LNM interpretation reached 61 and 229 LN groups on PET/CT versus 53 and 217 LN groups on PET alone. False negative LNM interpretation was found in 12 LN groups on PET alone, and 8 of them were corrected by PET/CT including one cervical LN, 4 paraesophageal LNs, one left gastric arterial LN, one left gastric cardia LN, one lesser gastric curve LN. False positive interpretations on PET alone were found in 31 LN groups, 12 of them were corrected by PET/CT which included 9 false-positive interpretations due to physical tracer uptake (2 in the cervical region and 7 in gastrointestinal tract ) and 3 lesions with heterogeneous tracer uptake in the primary tumor. The sensitivity, specificity and accuracy of LNM detection by PET alone was 81.54% (53/65), 87.50% (217/248), and 86.26% (270/313), whereas by PET/CT, which was 93.85% (61/65), 91.24% (229/248) and 92.65% (290/313), respectively. There were statistically significant differences in sensitivity and accuracy of LNM detection between PET/CT and PET alone (0.033 and 0.009).</p><p><b>CONCLUSION</b>Compared with FDG PET alone, FDG PET combined with CT can improve the sensitivity and accuracy in detection of lymph node metastasis in esophageal carcinoma.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Diagnóstico , Patologia , Cirurgia Geral , Carcinoma de Células Escamosas , Diagnóstico , Patologia , Cirurgia Geral , Neoplasias Esofágicas , Diagnóstico , Patologia , Cirurgia Geral , Esofagectomia , Fluordesoxiglucose F18 , Linfonodos , Diagnóstico por Imagem , Cirurgia Geral , Metástase Linfática , Diagnóstico , Esvaziamento Cervical , Tomografia por Emissão de Pósitrons , Métodos , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , MétodosRESUMO
<p><b>OBJECTIVE</b>Tumor hypoxia can influence response to radiotherapy and other treatment modalities. Oxygenation status is proved to be an independent prognostic factor. 99mTc-HL91 (99mTc labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime) is a potential noninvasive marker of tumor hypoxia. It has been reported that 99mTc-HL91 has certain validity for hypoxia imaging. But its clinical study had not been reported widely. This study was carried out to evaluate the relationship between the T/N ratio of HL91 SPECT hypoxia imaging and the radiotherapeutic outcome.</p><p><b>METHODS</b>32 patients with pathologically proven non-small cell lung cancer received three-dimensional conformal radiotherapy were enrolled into the study. 99mTc-HL91 SPECT scanning was performed in all patients at one or two days before radiotherapy. It was also performed in 18 patients at one or two days after the onset of radiotherapy, when they received a dose of 30 - 40 Gy already. Anterior, posterior and lateral planar images were collected at 2, 4 and 6 hours, respectively, after intravenous injection of approximately 740 MBq 99mTc-HL91. Regions of interest (ROIs) were drawn in the tumor and the contralateral normal lung tissue, and the radioactivity ratio of tumor to normal tissue (T/N) was calculated. To assess whether the tumor uptake of 99mTc-HL91 is predictive of treatment response, the SPECT results were correlated with the results of clinical follow-up.</p><p><b>RESULTS</b>The relationship between T/N ratios at 4 h images after injection was shown to be the best of three acquired images before radiotherapy. The response and overall survival to radiotherapy were analyzed for all 32 patients. The results of 9mTc-HL91 correlated well with radiotherapy response (P = 0. 002) and also patients' survival (P = 0.043). The average T/N values of 18 patients who received serial scanning were 1.57 +/- 0.18, 1.44 +/- 0.19 and 1.30 +/- 0.14, respectively. There was a significant difference between those three groups (P = 0. 000). The T/N changes during radiotherapy were not associated with the treatment outcome.</p><p><b>CONCLUSION</b>HL91 SPECT imaging can identify the hypoxia status and changes during radiotherapy in lung cancer. Hypoxia SPECT imaging with HL91 before treatment may predict radiotherapy response and patients' survival. Longer follow up in more patients is planned to confirm this result.</p>
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico por Imagem , Patologia , Radioterapia , Hipóxia Celular , Seguimentos , Estimativa de Kaplan-Meier , Pulmão , Diagnóstico por Imagem , Patologia , Efeitos da Radiação , Neoplasias Pulmonares , Diagnóstico por Imagem , Patologia , Radioterapia , Estadiamento de Neoplasias , Compostos de Organotecnécio , Oximas , Aceleradores de Partículas , Prognóstico , Radioterapia Conformacional , Métodos , Indução de Remissão , Tomografia Computadorizada de Emissão de Fóton Único , MétodosRESUMO
<p><b>AIM</b>To prepare a new oral colon-specific delivery formulation and to investigate the release profile in vitro and the colon-specific delivery property in vivo in dogs.</p><p><b>METHODS</b>Sodium 4-aminosalicylic acid was selected as the model drug. The combination of Eudragit RL30D and RS30D were used as sustained-release film, and Eudragit FS30D used as enteric film, which was expected to release drug depending on pH and time. The release profile of tablets was studied in three phosphate buffers with the pH 6.5, 7.0 or 7.4 for 12 h after a simulated gastric presoak for 2 h in 0.1 mol x L(-1) HCl. The tablets were radiolabelled with 99mTc to make their release times and positions in the gastrointestinal tract be followed using a gamma camera.</p><p><b>RESULTS</b>For the in vitro study, there was no drug released in 0.1 mol x L(-1) HCl for 2 h, and release occurred slowly when pH was above 6.5. Drug was released faster while pH was higher. For the in vivo study, the coated tablets remained intact in the upper gastrointestinal tract, and drug release began after the colonic arrival. The uncoated tablets, however, disintegrated in the stomach of the dogs rapidly.</p><p><b>CONCLUSION</b>The coating could protect the drug until the tablets reached the ascending colon, where drug was released slowly for over 10 h.</p>
Assuntos
Animais , Cães , Masculino , Resinas Acrílicas , Química , Administração Oral , Ácido Aminossalicílico , Química , Farmacocinética , Antituberculosos , Química , Farmacocinética , Colo , Metabolismo , Preparações de Ação Retardada , Sistemas de Liberação de Medicamentos , Concentração de Íons de Hidrogênio , Comprimidos com Revestimento EntéricoRESUMO
Objective To assess the value of 18-fluoro-deoxy-glucose positron emission-CT(FDG PET-CT) in defining the length of primary esophageal cancer.Methods Thirty-two patients had underg- one esophagoscopy,esophagography and FDG PET-CT scans one week before esophagectomy.There was one tumor located in the upper thoracic esophagus,22 in the middle thoracic esophagus,and 9 in the lower tho- racic esophagus.The location and length of primary lesion of the tumor was determined by esophagoscopy, esophagography,and FDG PET-CT.The length of the abnormality seen on the CT portion of the PET-CT scan was determined separately and independently by two radiologists.All results were compared with the resected specimen.Results According to esophagography,CT and PET-CT,all lesion lengths were compared with that of the resected specimen.It was found that the tumor location determined by esophagoscopy was not in accordance with the resected specimen in 2 patients.The mean length of the primary tumor,being from short to long,were (3.8?1.4),(4.1?1.5),(4.4?1.6),(5.3?1.9) and (4.7?1.7) cm,as determined by esophagoscopy,esophagography,CT,actral length of the resected specimen and PET-CT.Compared with the resected specimen,there was obvious difference (P=0.000,0.007,0.025,0.001).Considering that there might be some kind of shrinkage in the resected specimen (about 83.59%,as reported by Ma et al), we rectified the length of resected specimen and compared with other findings again.It was found that insig- nificant difference existed between PET-CT and rectified length value of the resected specimen (P=0.082). Conclusions FDG PET-CT is effective in the length determination of primary esophageal cancer.It may he used to determine the length of esophagus to be resected for patients indicated for esophagectomy.It may also be used to ac- curately delineate the gross tumor volume for patients eligible for radiotherapy.
RESUMO
Objective Under different standard uptake value(SUV),to assess gross tumor volume (GTV) definition for non-small cell lung cancer(NSCLC) with 18-fluoro-deoxy-glucose positron emission tomography (~(18)FDG PET) both under definite threshold (42 percent threshold) and various relative threshold (threshold SUV/maximum SUV) derived from the linear regressive function,threshold SUV=0.307?(mean target SUV)+0.588,with computer tomography (CT).Methods Of 20 patients with non-small cell lung cancer,the CT GTV (GTV_(?)).PET GTV with 42 percents threshold (GTV_(42%)) and PET GTV with relative threshold (GTV_(?)) were obtained and compared.Results The mean GTV_(42%),,mean GTV_(?) and mean GTV_(CT) was (13 812.5?13 841.4),(24 325.3?22 454.7) and (28 350.9?26 079.8)mm~3,respectively,with the difference in mean GTV among these three methods significant (F =10,P<0.01).The GTV_(42%) was smaller than the GTV_(?) and the GTV_(CT)(P<0.01),with i(?)significant difference between GTV_(?) and GTV_(CT)(P=0.125).Conclusion The relative threshold is more suitable to define the gross tumor volume than the definite threshold.