Al18F-NOTA-Octreotide outperforms 18F-FDG in identifying rare renal metastases from pancreatic neuroendocrine tumor.

We presented a case involving a 56-year-old man who had been experiencing shoulder and back pain for over a year, with extensive bone metastases revealed by a bone scan. To identify the primary source of these issues, the patients underwent a fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan, which indicated moderate uptake in the right renal soft mass and low uptake in multiple osteolytic lesions. Pathological examination and immunohistochemical staining of the renal mass supported the diagnosis of neuroendocrine tumors. Subsequently, a novel somatostatin receptor imaging agent, Al18F-NOTA-octreotide (18F-OC), was performed to further investigate the source of metastatic lesions and to stage the tumor. The 18F-OC scan revealed a high-uptake lesion in the pancreatic head, as well as additional lymph node and bone metastases lesions. Compared to 18F-FDG, the 18F-OC demonstrated superior imaging capabilities and a significantly higher tumor-to-background ratio in neuroendocrine neoplasms, which contributed to improving the staging and treatment management.

Comparison of Al 18F-NOTA-FAPI-04 and 18F-FDG in recurrent esophageal cancer after surgery.

Recently, radionuclide labelling fibroblast activating protein inhibitors (FAPI) is regarded as the most promising imaging tracer forvarious tumours. Here we present the imaging finding of aluminium-[18F] fluoride (Al18F)-labelled 1,4,7-triazacyclononane-N,N',N"-triacetic acid (Al18F-NOTA-FAPI-04) and fluorine-18-fluorodeoxyglucose (18F-FDG) in postoperative recurrence esophageal cancer. The results presented that imaging with Al18F-NOTA-FAPI-04 showed significant improvement in detection of local recurrence and distant metastasis with higher maximum standardized uptake value (SUVmax) in the lesions compared with 18F-FDG.

Therapeutic efficacy of clomiphene citrate combined with metformin in patients with polycystic ovary syndrome.

WHAT IS KNOWN AND OBJECTIVE: Although several clinical trials have compared the clinical efficacy of clomiphene citrate (CC) combined with metformin (MET) in the treatment of women with polycystic ovary syndrome (PCOS), the results are controversial. Therefore, this study was designed to conduct a pooled analysis to evaluate the efficacy of CC combined with MET versus CC in these patients. METHODS: Computerized searches of the PubMed, Web of Science, Embase and Cochrane Library databases were conducted to identify eligible randomized controlled trials (RCTs) from the data obtained up to June 2021. The Cochrane Collaboration risk of bias tool was used to assess the risk of bias in individual RCTs, and RevMan 5.4 was used for data statistical analysis. RESULTS AND DISCUSSION: A total of 13 RCTs were included in the meta-analysis. These studies involved 1,353 patients, 707 of these were in the combination group and 646 in the monotherapy group. The results indicated a higher clinical pregnancy rate (risk ratio [RR] 1.28, 95% confidence interval [CI] 1.06-1.54, p = 0.01) in the combined group compared to the monotherapy group. However, no significant differences were observed in the ovulation rate (RR 1.13, 95% CI 0.98-1.30, p = 0.10), live birth rate (RR 1.13, 95% CI 0.89-1.42, p = 0.32), multiple pregnancy rate (RR 0.58, 95% CI 0.19-1.73, p = 0.33) and abortion rate (RR 1.26, 95% CI 0.86-1.84, p = 0.23) between the two groups. WHAT IS NEW AND CONCLUSION: CC combined with MET has an advantage in improving the clinical pregnancy rate compared to CC alone; however, there is no significant difference in the rate of ovulation. For better management of PCOS, a high-quality RCT is needed to demonstrate the safety of the combination.

Altered intrinsic brain activity in patients with hepatic encephalopathy.

Neuropsychiatric deficits are common in patients with liver cirrhosis (LC), especially in those with hepatic encephalopathy (HE). Previous studies reveal abnormalities in brain activity underlying the neuropsychiatric deficits in LC patients; however, the results are inconsistent. We conducted a meta-analysis of resting-state functional magnetic resonance imaging studies using anisotropic effect-size signed differential mapping software on LC patients to characterize the most consistent regional activity alterations, and to evaluate the potential effect of liver transplantation (LT) on brain function. Meta-regression analyses were performed to explore the relationship between brain alterations and clinical variables. Compared with healthy controls, the typical patterns of increased regional activity in the fronto-striato-cerebellar network and decreased activity in the visuo-sensorimotor network and cingulate gyrus were identified in LC patients, which remained significant in the subgroup meta-analyses of minimal HE (MHE) and overt HE (OHE) patients. Functional deficits in the default mode network (DMN) were found in OHE patients compared with MHE patients. Ammonia level positively correlated with brain activity in the right middle temporal gyrus, and the completion time of number connection test A negatively correlated with brain activity in the left anterior cingulate gyrus. In addition, patients showed increased activity in the visuo-sensorimotor network and precuneus after LT. Our study suggests that alterations in the fronto-striato-cerebellar and visuo-sensorimotor networks may be the potential pathophysiological mechanisms underlying HE, and deficits in the DMN may indicate the progression of HE. LT may improve brain function in the visuo-sensorimotor network. This study has registered in the PROSPERO (CRD42020212758).

Gray Matter Atrophy in the Cortico-Striatal-Thalamic Network and Sensorimotor Network in Relapsing-Remitting and Primary Progressive Multiple Sclerosis.

Gray matter atrophy in multiple sclerosis (MS) is thought to be associated with disability and cognitive impairment, but previous studies have sometimes had discordant results, and the atrophy patterns of relapsing-remitting multiple sclerosis (RRMS) and primary progressive multiple sclerosis (PPMS) remain to be clarified. We conducted a meta-analysis using anisotropic effect-size-based algorithms (AES-SDM) to identify consistent findings from whole-brain voxel-based morphometry (VBM) studies of gray matter volume (GMV) in 924 RRMS patients and 204 PPMS patients. This study is registered with PROSPERO (number CRD42019121319). Compared with healthy controls, RRMS and PPMS patients showed gray matter atrophy in the cortico-striatal-thalamic network, sensorimotor network, and bilateral insula. RRMS patients had a larger GMV in the left insula, cerebellum, right precentral gyrus, and bilateral putamen as well as a smaller GMV in the bilateral cingulate, caudate nucleus, right thalamus, superior temporal gyrus and left postcentral gyrus than PPMS patients. The disease duration, Expanded Disability Status Scale score, Paced Auditory Serial Addition Test z-score, and T2-weighted lesion load were associated with specific gray matter regions in RRMS or PPMS. Alterations in the cortico-striatal-thalamic networks, sensorimotor network, and insula may be involved in the common pathogenesis of RRMS and PPMS. The deficits in the cingulate gyrus and caudate nucleus are more apparent in RRMS than in PPMS. The more severe cerebellum atrophy in PPMS may be a brain feature associated with its neurological manifestations. These imaging biomarkers provide morphological evidence for the pathophysiology of MS and should be verified in future research.

Impact of 68 Gallium prostate-specific membrane antigen tracers on the management of patients with prostate cancer who experience biochemical recurrence.

OBJECTIVE: To investigate the impact of 68 Gallium prostate-specific membrane antigen (68 Ga-PSMA) tracers on the management of prostate cancer (PCa) patients with biochemical recurrence (BCR) by conducting a systematical review and meta-analysis. MATERIALS AND METHODS: We performed a literature search of the PubMed, Embase and Web of Science databases up to 29 October 2019. We included studies that reported the proportion of patients whose management changed after 68 Ga-PSMA tracers were used in patients with BCR. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate the quality of the included studies. The proportion of patients with management changes were pooled using a random-effects model. Subgroup analyses and meta-regression analyses were performed to explore the source of heterogeneity. A Sankey diagram was used to show treatment change from before to after the use of 68 Ga-PSMA tracers. RESULTS: We included 20 eligible studies (2026 patients). The pooled proportion of patients with management change was 53% (95% confidence interval [CI] 46-60) in patients with BCR and 51% (95% CI, 34-67) in patients with early BCR (prostate-specific antigen [PSA] <0.5 ng/mL). The pooled positron-emission tomography-positive rate in patients with BCR was 68% (95% CI 59-78). Fourteen studies reported management change, with most changes being intermodal in nature (42%, vs 17% intramodal change). CONCLUSIONS: The use of 68 Ga-PSMA tracers altered the management of more than half of PCa patients with BCR, including those with early BCR. 68 Ga-PSMA tracers might be used to guide individualized treatment in patients with BCR, particularly those with early BCR.

Failure of activation of striatum during the performance of executive function tasks in adult patients with bipolar disorder.

BACKGROUND: Although numerous studies have used functional neuroimaging to identify executive dysfunction in patients with bipolar disorder (BD), the findings are not consistent. The aim of this meta-analysis is to identify the most reliable functional anomalies in BD patients during performance of Executive Function (EF) tasks. METHODS: A web-based search was performed on publication databases to identify functional magnetic resonance imaging studies of BD patients performing EF tasks and a voxel-based meta-analytic method known as anisotropic Effect Size Signed Differential Mapping (ES-SDM) was used to identify brain regions which showed anomalous activity in BD patients compared with healthy controls (HC). RESULTS: Twenty datasets consisting of 463 BD patients and 484 HC were included. Compared with HC, BD patients showed significant hypo-activation or failure of activation in the left striatum (p = 0.00007), supplementary motor area (BA 6, p = 0.00037), precentral gyrus (BA 6, p = 0.0014) and cerebellum (BA 37, p = 0.0019), and hyper-activation in the left gyrus rectus (BA 11, p ≈ 0) and right middle temporal gyrus (BA 22, p = 0.00031) during performance of EF tasks. Sensitivity and subgroup analyses showed that the anomaly of left striatum is consistent across studies and present in both euthymic and BD I patients. CONCLUSIONS: Patients with BD consistently showed abnormal activation in the cortico-striatal system during performance of EF tasks compared with HC. Failure of activation of the striatum may be a reliable marker for impairment in performance of especially inhibition tasks by patients with BD.

Can fusion to S1 maintain favorable surgical outcomes following one-level pedicle subtraction osteotomy in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis?

PURPOSE: To compare the surgical outcomes between ankylosing spondylitis (AS)-related thoracolumbar kyphosis patients with the lowest instrumented vertebra (LIV) at S1 or above following one-level pedicle subtraction osteotomy (PSO). METHODS: One hundred and two AS patients undergoing one-level PSO with a minimum of 2-year follow-up were included. Twenty-two patients were in group S1 (LIV at S1), and eighty were in group non-S1 (LIV above S1). Radiographic parameters including lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA) were measured. Oswestry Disability Index (ODI) and visual analog scale (VAS) were applied for clinical assessment. RESULTS: In both S1 and non-S1 groups, the radiographic parameters and clinical outcomes were significantly improved after surgery (P < 0.05). Patients undergoing distal fusion to S1 had significantly larger preoperative PI-LL mismatch, SVA, and smaller preoperative LL and SS compared to those in group non-S1 (P < 0.05). No significant difference was found between the two groups regarding preoperative and final follow-up ODI and VAS (P > 0.05), as well as the improvement in ODI and VAS (P > 0.05). The incidence of overall complications and each type of complication including the implant failure was similar between group S1 and non-S1 (P > 0.05). CONCLUSION: Selecting S1 as the LIV without pelvic fixation following one-level PSO in thoracolumbar kyphosis caused by AS could achieve satisfactory surgical outcomes and might not increase the complications. Patients with relatively severe sagittal imbalance, loss of LL, PI-LL mismatch, and small SS might be the potential candidates for distal fusion to S1 following one-level PSO.

[Recent progress of positron radionuclide labeled small molecule inhibitors of prostate specific membrane antigen for PET/CT imaging of prostate cancer].

Prostate cancer is the most common tumor of the urinary system, and its mortality rate is second only to lung cancer. With the specific and high expression on the surface of prostate cancer cells, prostate-specific membrane antigen (PSMA) has been an ideal theranostic target of prostate cancer with great clinical significance and research value. Positron emission tomography/computed tomography (PET/CT), a new modality of molecular imaging combining functional metabolic information and anatomical structure, provides high diagnostic performance for cancer detection. This paper mainly reviewed recent progress of PSMA inhibitors labeled by positron-emitting radionuclides for early diagnosis, preoperative staging, response assessment, restaging and metastasis detection of prostate cancer.

Acute-Phase Plasma PCSK9 Levels and Recurrent Cardiovascular Events in a Chinese Acute Myocardial Infarction Cohort.

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising target for lowering plasma low-density lipoprotein cholesterol and preventing cardiovascular (CV) disease. Whether plasma PCSK9 measured during the acute phase predicts recurrent CV events in patients with acute myocardial infarction (AMI) remains unresolved. METHODS AND RESULTS: Plasma PCSK9 levels were measured in 1,646 patients with AMI from the China PEACE-Prospective AMI Study at the acute phase. Additionally, 248 patients were resampled and measured at 1 month post-AMI. Associations of acute-phase PCSK9 tertiles with clinical characteristics and recurrent CV events within 1 year were assessed. Female gender (OR 1.94, 95% CI 1.24-3.03), premature coronary heart disease (CHD; OR 2.12, 95% CI 1.37-3.26), higher high-sensitivity C-reactive protein (OR 1.67, 95% CI 1.44-1.95), and higher triglycerides (OR 1.46, 95% CI 1.03-2.09) were associated with higher baseline PCSK9. Plasma PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events in the AMI cohort (HR 0.78, 95% CI 0.52-1.16) or any subgroup. There was also no association between percentage changes in PCSK9 over the first month and 1-year recurrent events, although there was a trend of differences between patients in the upper versus lower tertiles. CONCLUSION: Plasma PCSK9 levels measured during the acute phase were associated with high-sensitivity C-reactive protein, triglycerides, premature CHD, and gender in patients with AMI but did not predict recurrent CV events within 1 year. Dynamic changes in PCSK9 suggested a trend yet no significance value in predicting recurrent CV events.

The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review.

OBJECTIVES: The aim of this meta-analysis was to evaluate the accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients. METHODS: PubMed, Embase, the Cochrane Library (Central), and the Web of Science (SCI-Expanded) were systematically searched to identify pertinent studies. The methodologic quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. The Spearman correlation coefficient was used to explore the existence of a threshold effect. Heterogeneity was assessed by the likelihood ratio I 2 index. RESULTS: The pooled values calculated with a mixed-effects model for the sensitivity, specificity and diagnostic odds ratio with 95% confidence intervals were 81.9% (76.0-86.6%), 79.3% (72.1-85.1%) and 17.35 (10.98-27.42), respectively. CONCLUSIONS: 18F-FDG PET/CT has a moderate accuracy in predicting the pathological response during the early process of NAC in breast cancer patients. To increase the role of 18F-FDG PET/CT in monitoring the therapy response, future prospective studies are needed to explore how chemotherapy regimens and different subtypes affect the levels of glucose metabolism. KEY POINTS: • This meta-analysis assesses the role of PET/CT in breast cancer during NAC. • Pathological responses were based on both primary tumour and lymph node. • 18 F-FDG PET/CT has a moderate accuracy in predicting the pathological response.

MnO2-modified persistent luminescence nanoparticles for detection and imaging of glutathione in living cells and in vivo.

Persistent luminescence nanoparticles (PLNPs) hold great promise for the detection and imaging of biomolecules. Herein, we have demonstrated a novel nanoprobe, based on the manganese dioxide (MnO2 )-modified PLNPs, that can detect and image glutathione in living cells and in vivo. The persistent luminescence of the PLNPs can be efficiently quenched by the MnO2 nanosheets. In the presence of glutathione (GSH), MnO2 was reduced to Mn(2+) and the luminescence of PLNPs can be restored. The persistent luminescence property can allow detection and imaging without external excitation and avoid the background noise originating from the in situ excitation. This strategy can offer a promising platform for detection and imaging of reactive species in living cells or in vivo.

Expression and immune characterization of a novel enzyme, protein arginine methyltransferase 1, from Schistosoma japonicum.

Protein arginine methyltransferase 1 (PRMT1) is an arginine-specific protein methyltransferase that methylates a number of proteins involved in transcription and RNA metabolism in all parasitic helminths, including the human blood fluke, Schistosoma japonicum. To characterize the role of PRMT1 in the development of S. japonicum and to investigate its influence on parasite-host interactions, we cloned and expressed the protein from an existing cDNA library. We report that the clone encoded a polypeptide comprising 360 amino acids with a predictive Mr of 42 kDa. Bioinformatic analyses predicted that there were many potential B cell epitopes and T cell epitopes associated with SjcPRMT1, suggesting it is a potential candidate molecule for vaccine development. The purified recombinant protein of S. japonicum (Chinese strain) (rSjcPRMT1) was found to be immunogenic, eliciting a high antibody titer in mice. Moreover, Western blot analysis revealed that the protein could be recognized by the sera of infected mice. Using flow cytometry, we showed that rSjcPRMT1 slightly upregulated the expression of CD40, CD80, CD86, and MHC-II molecules of mouse bone marrow-derived dendritic cell (BMDC), indicating that rSjcPRMT1 could induce mouse BMDC to mature and, therefore, activate their immune response. Overall, our findings provide evidence that rSjcPRMT1 could serve as an effective candidate molecule for the development of a vaccine against infection with S. japonicum.

[Correlation study on Chinese medical syndrome types of chronic hepatitis B patients and HLA-DR13 gene, BCP mutation, and T-lymphocyte subsets].

OBJECTIVE: To explore the correlation between the HLA-DR13, basic core promoter (BCP), changes of T lymphocyte subset and clinical Chinese medical syndromes of chronic hepatitis B (CHB). METHODS: Totally 102 CHB patients were syndrome typed as Gan depression Pi deficiency syndrome (GDPDS), Pi-Shen yang deficiency syndrome (PSYDS), Gan-gallbladder dampness heat syndrome (GGDHS), Gan-Shen yin deficiency syndrome (GSYDS), and static blood blocking collaterals syndrome (SBBCS). Besides, 30 healthy subjects were recruited as the normal control group. The blood HBV-DNA level and HLA-DR13 gene were detected with real time fluorescent PCR. The expression of CD4+ and CD8+ in T lymphocytes was detected using flow cytometry. The mutation of serum A1762T/G1764A was detected using PCR sequencing. Hepatitis Be antigen (HBeAg) was detected with ELISA, and correlation between various Chinese medical syndrome types and objective indicators were analyzed. RESULTS: There was no statistical difference in HBV-DNA quantitative results among various syndrome types (P > 0.05). HBeAg positive rate was higher in GDPDS than in other syndrome types (P < 0.05). It was sequenced as GDPDS > GSYDS > SBBCS > GGDHS > PSYDS. Compared with the normal control group, percentages of CD3+ and CD3+ CD4+ were lower in PSYDS (P < 0.05). The ratio of CD3+ CD4+/CD3+ CD8 was lower in GGDHS and PSYDS than in the normal control group (P < 0.05). There was no statistical difference in the CD3+ CD8+ percentage among various syndrome types (P > 0.05). The quantitation of HLA-DR13 gene was lower in GDPDS and GSYDS than in the normal control group (P < 0.05). The positive rate of BCP mutation was higher in GSYDS than in other syndrome types (P < 0.05). CONCLUSION: Co-detection results of HLA-DR13 and BCP could be used as reference indices of Chinese medical syndrome typing of CHB.

Prediction of cervical lymph node metastasis in differentiated thyroid cancer based on radiomics models.

OBJECTIVE: The accurate clinical diagnosis of cervical lymph node metastasis plays an important role in the treatment of differentiated thyroid cancer (DTC). This study aimed to explore and summarize a more objective approach to detect cervical malignant lymph node metastasis of DTC via radiomics models. METHODS: PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane databases were searched for all eligible studies. Articles using radiomics models based on ultrasound, computed tomography, or magnetic resonance imaging to assess cervical lymph node metastasis preoperatively were included. Characteristics and diagnostic accuracy measures were extracted. Bias and applicability judgments were evaluated by the revised QUADAS-2 tool. The estimates were pooled using a random-effects model. Additionally, the leave-one-out method was conducted to assess the heterogeneity. RESULTS: Twenty-nine radiomics studies with 6160 validation set patients were included in the qualitative analysis, and 11 studies with 3863 validation set patients were included in the meta-analysis. Four of them had an external independent validation set. The studies were heterogeneous, and a significant risk of bias was found in 29 studies. Meta-analysis showed that the pooled sensitivity and specificity for preoperative prediction of lymph node metastasis via US-based radiomics were 0.81 (95% CI, 0.73-0.86) and 0.87 (95% CI, 0.83-0.91), respectively. CONCLUSIONS: Although radiomics-based models for cervical lymphatic metastasis in DTC have been demonstrated to have moderate diagnostic capabilities, broader data, standardized radiomics features, robust feature selection, and model exploitation are still needed in the future. ADVANCES IN KNOWLEDGE: The radiomics models showed great potential in detecting malignant lymph nodes in thyroid cancer.

Effect of cognitive behavior therapy based on the health education pathway on psychology of papillary thyroid carcinoma patients: a randomized controlled trial.

OBJECTIVES: Our main aim was to explore whether cognitive behavior therapy based on the health education pathway (CBT-HEP) can effectively alleviate the distress, anxiety, and depression of papillary thyroid carcinoma (PTC) patients after 131 I treatment. In addition, we investigated the critical factors that can significantly affect the distress and quality of life in PTC patients before 131 I treatment. METHODS: In total, 496 people were screened and 357 were enrolled, followed by randomization of those with a distress thermometer (DT) ≥4. Patients in the experimental group received CBT-HEP intervention, and patients in the control group were given casual conversation. RESULTS: The scores of DT, Hamilton Anxiety Scale (HAMA) and Patient Health Questionnaire-9 (PHQ-9) in CBT-HEP group decreased gradually after intervention. In control group, DT scores decreased significantly, while HAMA and PHQ-9 scores did not change significantly. CONCLUSION: CBT-HEP is effective in relieving distress, anxiety and depression in PTC patients. In addition, female sex, lifestyle, hypothyroidism, negative emotions, related symptoms, fear of tumor recurrence and radiation safety are the critical factors affecting mental health and quality of life.

Numerical investigation on characteristics of vortex dissipation in multi-horizontal submerged jets stilling basin.

Multi-horizontal submerged jets stilling basins have been utilized in large-scale water conservancy and hydropower projects due to its stable flow pattern, high energy dissipation rate and less atomization. This study employs vorticity criterion, Q criterion, λ2 criterion and Ω criterion to investigate the characteristics of vortex formation and turbulent dissipation in multi-horizontal submerged jets stilling basins with various configurations, including crest overflowing orifice alone (COO), combination of crest overflowing orifice and mid-discharge orifice (COO-MO) and mid-discharge orifice alone (MO). The results indicate that the Q criterion and λ2 criterion are effective in identifying vortex structure within multi-horizontal submerged jets stilling basin. Specifically, the stronger intensity of vortex structure and vortex dissipation are mainly distributed in the vicinity of the vertical drop, which gradually weakens for the increasing distance to the vertical drop. Furthermore, the intensity and number of vortexes with COO-MO are the largest. This conclusion can provide guidance for energy dissipation and bottom protection of stilling pool.

Multiplexed detection and imaging of intracellular mRNAs using a four-color nanoprobe.

Simultaneous detection and imaging of multiple intracellular biomarkers hold great promise for early cancer detection. Here, we introduce a four-color nanoprobe that can simultaneously detect and image four types of mRNAs in living cells. The nanoprobe composed of gold nanoparticles functionalized with a dense shell of molecular beacons, which can identify multiple intracellular mRNA transcripts. It shows rapid response, high specificity, nuclease stability, and good biocompatibility. Intracellular experiments indicate that the nanoprobe could effectively distinguish cancer cells from their normal cells, even some mRNAs are overexpressed in normal cells. Moreover, it can identify the changes of the expression levels of mRNA in living cells. The current strategy could provide more-accurate information for early cancer detection and availably avoid false positive results.

Case Report: a rare primary gastric choriocarcinoma revealed on 18F-FDG PET/CT.

Choriocarcinoma is an exceptionally aggressive trophoblastic cell tumor that that typically originates in gonadal tissues, with rare occurrences outside the gonads, including the mediastinum, retroperitoneum, and intracranial sites. However, it rarely occurs in the stomach. Herein, we presented a case of primary gastric choriocarcinoma in a 27-year-old female patient who found multiple liver masses detected during physical examination, accompanied by remarkably elevated human chorionic gonadotropin levels. The 18F-FDG PET/CT scan suggested ring-shaped intense uptake masses located in the gastric sinus and liver, and no significance in the pelvic region. Final histopathology indicated primary choriocarcinoma of the stomach. This case illustrates that 18F-FDG PET/CT is an essential imaging technique for the clinical diagnosis and stage of primary choriocarcinoma.