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Objective:To investigate whether the image quality of total-body PET/CT (TB PET/CT) with 1 min acquisition can meet the clinical diagnostic requirements.Methods:From May 2019 to September 2021, a total of 90 malignant tumor patients (60 males, 30 females, age 31-86 years) with primary lesions confirmed by pathological diagnosis in Zhongshan Hospital, Fudan University were respectively analyzed. All patients underwent conventional PET/CT (C PET/CT) scan with conventional clinical acquisition and TB PET/CT scan with 1 min acquisition after injecting 18F-FDG in random order. Paired t test or Wilcoxon signed rank test was used to analyze the image quality of these two scans. Results:SUV max of primary lesions in TB PET/CT group was significantly higher than that in C PET/CT group (15.9(7.9, 24.6) vs 12.5(5.8, 16.6); z=8.14, P<0.001), so were signal-to-noise ratio (SNR) of the blood pool, liver, muscles (9.3±3.0, 11.4(9.5, 14.2), 8.3(7.3, 10.1) vs 6.2±1.7, 9.4(7.7, 11.8), 6.0(4.9, 7.1)), tumor-to-blood pool ratio (TBR) (9.3(4.3, 14.8) vs 8.5(4.3, 11.1)), tumor-to-liver ratio (TLR) (6.7(3.0, 10.4) vs 6.1(2.9, 7.7)), tumor-to-muscle ratio (TMR) (23.2(11.5, 38.0) vs 18.3(9.6, 26.6); t=9.36, z values: 4.44-7.40, all P<0.001). Conclusion:The image quality of TB PET/CT scan with 1 min acquisition can meet the diagnostic requirements, and is better than the C PET/CT image quality with conventional clinical acquisition.
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Multiple sclerosis (MS) is regarded as a chronic inflammatory disease that leads to demyelination and eventually to neurodegeneration. Activation of innate immune cells and other inflammatory cells in the brain and spinal cord of people with MS has been well described. However, with the innovation of technology in glial cell research, we have a deep understanding of the mechanisms of glial cells connecting inflammation and neurodegeneration in MS. In this review, we focus on the role of glial cells, including microglia, astrocytes, and oligodendrocytes, in the pathogenesis of MS. We mainly focus on the connection between glial cells and immune cells in the process of axonal damage and demyelinating neuron loss.
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Humans , Multiple Sclerosis , Neuroglia , Inflammation/pathology , Brain/pathology , Spinal Cord/pathologyABSTRACT
Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune-mediated inflammatory demyelinating diseases of the central nervous system, characterized by optic nerve and spinal cord lesions, with high chance of recurrence and disability. Disease-modifying therapy, including immunosuppressants, monoclonal antibodies, stem cell transplantation etc., is the key to prevent recurrence. This article made a systematic review about the sequential treatment or prognosis of NMOSD by searching for the related articles published on PubMed from 2017 to 2022 to provide recommendations and references for disease-modifying therapy of NMOSD.
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Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently-established autoimmune central nervous system demyelinating disease, characterized by the detection of serum anti-myelin-oligodendrocyte glycoprotein antibody of IgG1 type. Sharing similar clinical manifestations with multiple sclerosis and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder, it has yet demonstrated a unique disease course, pathological and radiological features. Therefore, MOGAD should be regarded as a disease entity to carry out further investigation. This review intends to summarize its pathogenesis, diagnosis and treatment progresses, so as to provide guidance for clinical practice.
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Objective:To explore the imaging features of 18F-fluorodeoxyglucose (FDG) PET/CT (high-resolution CT, HRCT) imaging in focal organizing pneumonia (FOP). Methods:Patients with solid nodular FOP ( n=45; 33 males, 12 females, age (58±9) years) and early peripheral non-mucinous solid lung adenocarcinoma ( n=47; 21 males, 26 females, age (63±10) years) confirmed by postsurgical pathology between May 2012 and December 2018 in Zhongshan Hospital, Fudan University were retrospectively analyzed. All patients underwent 18F-FDG PET/CT (HRCT) imaging followed by surgery within 3 weeks. The imaging findings and characteristics of the lesions were recorded. Differences of the maximum standardized uptake value (SUV max) and maximum diameter between FOP and adenocarcinoma were analyzed by Mann-Whitney U test or t′ test. Spearman correlation or Pearson correlation analysis was performed to analyze the relation between SUV max and maximum diameter. Binary logistic regression analysis was performed to identify the predictive factors for FOP. Finally, the receiver operating characteristic (ROC) curve analysis was used for evaluation of diagnostic efficiency. Results:The SUV max of FOP was lower than that of lung adenocarcinoma (3.1(1.7, 4.9) vs 6.5(3.8, 9.3); z=-4.598, P<0.01), and the maximum diameter of FOP was smaller than that of lung adenocarcinoma ((18.0±6.3) mm vs (21.8±4.3) mm; t′=-3.424, P<0.01). The SUV max was positively correlated with the maximum diameter in FOP group ( r s=0.509, P<0.01), while the SUV max of lung adenocarcinoma was not correlated with the lesion size ( r=0.076, P>0.05). HRCT of the PET/CT system showed the fusiform shape were more common in FOP ( χ2=9.549, P<0.05). Multivariate regression analysis identified that SUV max≤7.1, diameter≤18.3 mm, and fusiform shape were independent factors to predict FOP, with odds ratio ( OR) of 10.585, 4.674, 9.073, respectively (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of SUV max≤7.1 combined with diameter≤18.3 mm and fusiform nodule was 0.860, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 97.8%(44/45), 70.2%(33/47), 75.9%(44/58), 97.1%(33/34), and 83.7%(77/92), respectively. Conclusion:SUV max≤ 7.1 combined with maximum diameter≤ 18.3 mm and fusiform shape may predict solid nodular FOP.
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Objective@#To investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD).@*Methods@#Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis.@*Results@#Of 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR.@*Conclusion@#As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
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Objective To investigate the incremental value of coronary flow reserve ( CFR) as-sessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD). Methods Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+CFR in the di-agnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analy-sis. Results Of 132 patients, 61 (46.2％) were CAD with stenosis of at least 75％ in one vessel (47.5％, 29/ 61), two vessels (34.4％, 21/ 61), or three vessels (18.0％, 11/ 61). A total of 104 (26.3％) vessels with stenosis of at least 75％, 25 (6.3％) vessels with stenosis of 65％-74％, and 30 (7.6％) vessels with stenosis of 50％-64％ were found in 396 vessels. For detecting coronary stenosis of at least 75％, the sensi-tivity and accuracy of MPI on per-patient analysis were 86.89％(53/ 61) and 68.94％(91/ 132), which in-creased to 96.72％(59/ 61; χ2 = 3.921, P<0.05) and 87.88％(116/ 132; χ2 = 13.984, P<0.01) by MPI+CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12％ (75/ 104) and 77. 53％(307/ 396) and increased to 96.15％(100/ 104; χ2 = 22. 511, P<0.01) and 85.10％(337/ 396; χ2 = 7.479, P<0.05) by MPI+CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72. 41％(21/ 29), 42.86％ (9/ 21), and 5/ 11 and were improved to 93.10％ (27/ 29; χ2 = 4.350, P =0. 037), 90.48％(19/ 21; χ2 = 10.714, P = 0.001), and 11/ 11 (P = 0.012) by MPI+CFR. For coronary with stenosis of 65％-74％, the sensitivity of MPI was 24. 00％(6/ 25) and was improved to 64.00％(16/25; χ2 = 8.117, P= 0.004) by MPI+CFR. For coronary with stenosis of 50％-64％, the sensitivity of MPI was 40.00％(12/ 30) and was improved to 76.67％(23/ 30; χ2 = 8.297, P= 0.004) by MPI+CFR. Conclu-sion As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
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Objective To investigate the added value of CTAC for improving image quality and diagnostic efficiency of bone imaging in SPECT/CT.Methods Seventy-five patients (47 males,28 females,(56.6± 12.8) years) with abnormal uptake in planar whole-body bone scintigraphy underwent SPECT/CTfor differentiation of malignant from benign spinal lesions.NAC and CTAC SPECT images were classified based on 5-point scale (5:excellent,4:good,3:adequate,2:suboptimal,1:inadequate).The diagnostic confidence for both NAC and CTAC SPECT images were classified based on 4-point scale (4:definite,3:certain,2:equivocal,1:uninterpretable).The pathological results after surgery were used as gold standard to evaluate the added diagnostic value of CTAC for spinal lesions.Wilcoxon-signed rank sum test was used for data analysis.Results CTAC improved the image quality in 37.3％ (28/75) of patients,and downgraded in 2.7％ (2/75) of patients.The remaining 45 patients were unchanged (60.0％,45/75).SPECT with CTAC could significantly improve the image quality (z=-4.747,P＜0.001),but the overall diagnostic confidence was not increased (z=-1.000,P＞0.05).Conclusion CTAC can improve the image quality of spinal SPECT,especially useful in imaging with poorer quality,but it has no significant incremental value in diagnostic confidence.