Diagnosis, treatment and prognosis of FH-deficient renal cell carcinoma with tumor thrombus / 中华泌尿外科杂志

Objective:To Explore the diagnosis, treatment and prognosis of FH-deficient renal cell carcinoma (FH-deficient RCC) with tumor thrombus, and share surgical experience.Methods:From August 2019 to October 2022, 6 cases of FH-deficient RCC with tumor thrombus were diagnosed and treated in our center, including 4 males and 2 females. The patients were aged 22 to 57 years, with 2 cases younger than 40 years, icluding 5 cases on the left and 1 case on the right. The median maximum diameter of the tumor is 8 (4.8, 14.0) cm. Operations were performed after complete examination (enhanced CT and other related examinations). One case underwent open surgery and palliative resection of the left kidney was performed because of severe adhesion of the inferior vena cava. Among the remaining 5 cases, 1 case underwent retroperitoneal laparoscopic right radical nephrectomy with inferior vena cava thrombectomy, 1 case underwent transabdominal laparoscopic left radical nephrectomy with inferior vena cava thrombectomy, and 3 cases underwent robot assisted laparoscopic left radical nephrectomy with inferior vena cava thrombectomy.Results:The median surgical time was 293 (185, 366) min, with blockage of the vena cava for 13 min and 28 min in 2 of 6 cases, respectively. The pathological report of renal tumor and tumor thrombus was FH-deficient renal carcinoma. The pathological features were as follows: the gross section of the specimen was gray yellow solid, often accompanied by necrosis, and the cystic cavity could be seen locally. Microscopically, the tumor extensively involved the renal parenchyma, with papillary, cribriform and tubular cystic structures. Immunohistochemistry showed FH (-), 2SC (+ ). The median postoperative hospital stay was 8 (4, 15) days. The median follow-up time was 13 (4, 27) months. One patient undergoing palliative resection of the left kidney underwent targeted therapy and radiotherapy after surgery (died 15 months after surgery due to gastrointestinal perforation). During the follow-up process, 4 cases experienced metastasis and received systematic treatment, with 1 death 27 months after surgery. Uterine leiomyomas were found in the remaining 1 case during follow-up.Conclusions:FH-deficient RCC with tumor thrombus is very rare. This disease is highly invasive, difficult to be diagnosed preoperatively and poor clinically prognostic. Operation combined with systemic therapy is an effective way to treat FH-deficient RCC with tumor thrombus.

Practice and thinking of introducing nuclear medicine systematic courses into standardized residency training in imaging specialty / 中华医学教育探索杂志

Objective:To review the practice of introducing nuclear medicine systematic courses into the standardized residency training in imaging specialty in recent years, and to explore the effect of nuclear medicine systematic courses on the training quality.Methods:A total of 105 residents participated in the training of nuclear medicine from 2015 to 2017 were enrolled in this study. During the training period, those who took the complete nuclear medicine systematic courses were assigned to the teaching group, and the other 52 residents who participated in the standardized residency training from 2012 to 2014 but not received the systematic courses were enrolled in the non-teaching group. The results of the completion examination, including the theoretical written test and the film reading skill test, were analyzed as the evaluation index to compare the differences between the results of two groups by the Mann-Whitney U test using SPSS 22.0.Results:The median scores of the theoretical test and the reading skill test in the teaching group were 93.52 (72.00-100.00) and 92.00 (70.00-98.00), respectively; while, the corresponding scores in the non-teaching group were 88.00 (64.00-96.00) and 90.00 (60.00-96.00), respectively. The scores of theoretical test and skill test in the teaching group were both significantly higher than those in the non-teaching group ( P=0.005, P=0.001). Conclusion:It is necessary and feasible to carry out comprehensive nuclear medicine systematic courses in the standardized residency training in imaging specialty, which can improve the theoretical basis and clinical skills of students and help to improve the overall training quality.

18F-FDG PET/CT manifestations of elastofibroma dorsi / 中国医学影像技术

Objective: To observe 18F-FDG PET/CT manifestations of elastofibroma dorsal (EFD). Methods 18F-FDG PET/CT findings of 26 patients with EFD were retrospectively analyzed. The differences of maximum standard uptake (SUVmax) of lesions and the ratio of SUVmax to mean standardized uptake of liver (SUR-BP) were compared between males and females, patients aged 0.05). Conclusion: 18F-FDG PET/CT manifestations of EFD demonstrate some characteristics, and might be helpful to diagnosis of this disease.

Diagnostic value of 99Tcm-MAA dynamic-whole body-local lung perfusion imaging in unexplained dyspnea / 中国医学影像技术

Objective: To investigate the differential diagnostic value of 99Tcm-MAA dynamic-whole body-local lung perfusion imaging in unexplained dyspnea. Methods: Nineteen patients with unexplained dyspnea underwent 99Tcm-MAA dynamic-whole body-local lung perfusion imaging. The imaging results were analyzed based on the discharged diagnosis. Results: A total of 13 patients were diagnosed as intrapulmonary shunt, 9 of them were diagnosed as hepatopulmonary syndrome, the other 4 patients included 1 case of hereditary telangiectasia and 3 cases of intrapulmonary shunt were with unknown causes. All patients were excluded from pulmonary embolism. Conclusion: 99Tcm-MAA dynamic-whole body-local lung perfusion imaging can simultaneously diagnose or exclude pulmonary shunt and pulmonary embolism, and can be widely used in clinical practice.

From solitary bone plasmacytoma to multiple myeloma: Early predicting with 18F-FDG PET/CT / 中国医学影像技术

Objective: To investigate the predictive value of 18F-FDG-PET/CT imaging and other clinicopathological factors for prognosis of solitary bone plasmacytoma (SBP) to multiple myeloma (MM). Methods: Twenty patients underwent 18F-FDG PET/CT. All patients were pathologically confirmed as SBP and followed-up. Taken progression to MM as a clinical outcome, the patients were divided into progressive group and non-progressive group. Immunoglobulin fixed electrophoresis, M protein, positive rate of free light chain in blood, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in PET/CT images were analyzed between the two groups. Results: Eight patients developed into MM (progressive group), whereas the other 12 patients did not (non-progressive group). MTV in progressive group was higher than that in non-progressive group (Z=-2.807, P=0.031). There was no significant difference of serum immunoglobulin electrophoresis, M protein, free light chain level, Ki67 positive rate of tumor cells, SUVmax nor TLG between the two groups (all P>0.05). Conclusion: High MTV level is a poor prognostic factor for the progression of SBP to MM. Patients with high MTV level may need more clinical attention and active intervention to delay progression of SBP to multiple myeloma as far as possible.

Differentiation between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic 99Tcm-MDP bone scintigraphy / 中华核医学与分子影像杂志

Objective To differentiate between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic bone scintigraphy.Methods Twenty-eight patients (9 males,19 females; mean age 67.5 years,range 49-80 years) with recurrent joint pain after arthroplasty were retrospectively assessed.All patients underwent triphasic bone scintigraphy.ROI of each joint was drawn and the ratios of affected to unaffected side were calculated.The ratios of blood flow phase,blood pool phase,static phase,Creactive protein (CRP) and erythrocyte sedimentation (ESR) were quantitatively analyzed by ROC curve.The final diagnosis was based on microbiological and histological examinations.The optimal cut-off value was chosen based on the ideal sensitivity and specificity.Results Nine patients were diagnosed as septic loosening,17 patients aseptic loosening,1 patient bursitis of hip joint and 1 patient suture reaction.Taking the positive results of blood flow phase or blood pool phase as standard for diagnosing septic loosening,the sensitivity,specificity and accuracy of bone scintigraphy were 7/9,78.9％ (15/19) and 78.6％ (22/28),respectively.The AUC of blood pool phase was 0.942,and the sensitivity and specificity were 8/9 and 78.9％(15/19),respectively,with the optimal cut-off value of 1.40.The AUCs of blood flow ratio and CRP were 0.816 and 0.795,with cut-off values of 1.53 and 1.20,respectively.The AUCs of static phase ratio and ESR were 0.474 and 0.722,respectively,both P＞0.05.Conclusions For the diagnosis of septic loosening,quantitative analysis of triphasic 99Tcm-MDP bone scintigraphy,particularly with the ratio of blood pool phase,is more accurate than qualitative analysis.