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Objective:To evaluate the value of PET/MR multiple parameters before treatment and MR-intravoxel incoherent motion (IVIM) parameters 4 weeks after concurrent chemoradiotherapy (CCRT) in predicting the prognosis of cervical cancer patients 6 months after treatment.Methods:From September 2017 to March 2019, 58 cervical cancer patients (age: 35-78 years) performed CCRT in Shengjing Hospital of China Medical University were retrospectively enrolled. PET/MR was performed before treatment, and MR-IVIM was performed at the end of the fourth week of treatment and 6 months after treatment. Patients were divided into complete response (CR) group and non-CR group according to the response evaluation criteria in solid tumors (RECIST). PET imaging parameters (maximum standardized uptake value (SUV max), metabolic tumor volume (MTV), total lesion glycolysis (TLG)), MR-IVIM parameters (slow diffusion coefficient (D), fast diffusion coefficient (D *), perfusion fraction (F), gross tumor volume (GTV), diffusion volume (DV)) before (referred to as 1) and after (at the end of the fourth week; referred to as 2) treatment and their percentage changes (ΔD, ΔD *, ΔF, ΔGTV, ΔDV) were measured. The parameters of PET and MR-IVIM were analyzed by the receiver operating characteristic (ROC) curve analysis. Multiple logistic regression was used to establish the combination prediction model of parameters before treatment and all parameters before and after treatment (Combination1 and Combination2 respectively), and the two models were compared by Delong test. Results:Of 58 patients, 37(63.79%) were CR, and 21 (36.21%) were non-CR. MTV (area under curve (AUC)=0.764, P<0.01), TLG (AUC=0.719, P<0.01), GTV 1 (AUC=0.761, P<0.01) and DV 1 (AUC=0.785, P<0.01) before treatment had positive effects on the treatment response, and the valuable parameters after treatment were D 2 (AUC=0.683, P<0.01), GTV 2 (AUC=0.861, P<0.01), DV 2 (AUC=0.891, P<0.01), ΔD (AUC=0.723, P<0.01), ΔGTV (AUC=0.768, P<0.01) and ΔDV (AUC=0.865, P<0.01). The best prediction model before treatment was DV 1 (Combination1; AUC=0.785, P=0.004). The best prediction model for all parameters before and after treatment was the combination pre-treatment of MTV, DV 2 and ΔD (Combination2; AUC=0.965, P<0.001). Combination2 was superior to Combination1 ( z=2.982, P=0.003). Conclusion:In evaluating the early prognosis of cervical cancer patients treated with CCRT, DV 1 has good predictive potential before treatment, while the combination of pre-treatment MTV with post-treatment DV 2 and ΔD has superior joint predictive potential and can provide help for patients′ personalized treatment.
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Objective:To explore the value of preoperative 18F-fluorodeoxyglucose(FDG) PET/CT parameters combined with coagulation parameters in predicting the recurrence after surgery in patients with early cervical cancer. Methods:A total of 120 patients(age range: 25-70 (47.9±8.5) years) with cervical cancer who underwent preoperative 18F-FDG PET/CT examination and blood coagulation index test in Shengjing Hospital of China Medical University between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into recurrent group and non-recurrent group according to the follow-up results. Independent-sample t test or Mann-Whitney U test was used to compare the differences of related parameters between the recurrent and non-recurrent patients. Then the receiver operating characteristic (ROC) curve analysis was performed, and univariate and multivariate Cox analyses were used to evaluate the predictive value of parameters. Results:The follow-up time was 2-60 months. There were 36 recurrent cases, accounting for 30.0% (36/120) of all patients. The mean standardized uptake value (SUV mean), peak of standardized uptake value (SUV peak) and total lesion glycosis (TLG) were significantly different between recurrent ( n=27) and non-recurrent ( n=62) subgroups of moderately differentiated patiens (8.90±3.00 vs 7.50±2.90, 12.00±3.70 vs 10.20±4.50, 144.48(43.79, 366.46) vs 60.23(28.46, 113.15) g; t values: 1.968, 2.063, U=547.000, all P<0.05); the maximum standardized uptake value (SUV max), SUV mean, SUV peak, TLG were significantly different between recurrent ( n=7) and non-recurrent ( n=12) subgroups of poorly differentiated patiens (16.10±4.70 vs 7.60±2.33, 8.70±2.10 vs 4.40±1.50, 13.30±4.40 vs 5.60±1.80, 140.37(131.44, 143.94) vs 31.64(15.84, 92.14) g; t values: 5.363, 4.829, 5.429, U=3.000, all P<0.05); D-dimer and fibrinogen (FIB) of recurrent and non-recurrent patients were also different (175.00(100.00, 256.00) vs 86.00(51.25, 115.25) mg/L, (3.10±0.50) vs (2.80±0.50) mg/L; U=619.500, t=2.962, both P<0.05). The ROC curve indicated that SUV max (area under curve (AUC)=0.651), SUV mean (AUC=0.650), SUV peak (AUC=0.675), TLG (AUC=0.703), D-dimer (AUC=0.795) and FIB (AUC=0.672) could predict the recurrence of the disease(all P<0.01). Univariate Cox analysis revealed that the International Federation of Gynecology and Obstetrics (FIGO) staging (hazard ratio ( HR)=2.363, 95% CI: 1.217-4.590), SUV max ( HR=4.855, 95% CI: 1.488-15.841), SUV mean ( HR=4.451, 95% CI: 1.573-12.597), SUV peak ( HR=7.190, 95% CI: 2.203-23.469), TLG ( HR=4.396, 95% CI: 2.238-8.633), D-dimer ( HR=4.761, 95% CI: 2.470-9.253) and FIB ( HR=3.196, 95% CI: 1.596-6.400) were predictive factors of recurrence (all P<0.05). Multivariate Cox analysis showed that D-dimer ( HR=2.974, 95% CI: 1.476-5.990) and SUV peak ( HR=3.826, 95% CI: 1.063-13.778) were the main predictors (both P<0.05). ROC curve of SUV peak combined with D-dimer showed the AUC of 0.841( P<0.01). Conclusions:SUV peak and D-dimer are main indexes to evaluate the recurrence after surgery in patients with cervical cancer. SUV peak combined with D-dimer have good predictive value for the recurrence of cervical cancer.
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Objective:To investigate the current funding landscape of medical artificial intelligence (AI) projects in National Natural Science Foundation of China (NSFC) from 2015 to 2019.Methods:From 2015 to 2019, AI-related projects in NSFC Medical Science Department were collected. Comprehensive analysis was performed in the projects information including year, title, supporting institution, fund type, research findings, etc.Results:NSFC has funded a total of 278 projects related to artificial intelligence, with the total funding amount of 139 million yuan. The number of projects and the funding amount were increasing year by year. Among these, 90% (249/278) were general programs and young scientist funds; 53% (148/278) of the projects were regionally distributed in Beijing, Shanghai and Guangdong; 66% (184/278) of the projects were imaging-related researches; the projects mainly focused on diseases with high incidence in China, including neoplastic diseases, cardiovascular and nervous system diseases.Conclusion:The AI-related projects funded by NSFC are characterized by rapid growth in number and fund amounts, wide coverage of disciplines, and diverse types of research diseases. However, the unbalanced distribution of regions, research fields, and supporting institutions demands more attention in future.
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Objective:To analyze the key projects in medical imaging and biomedical engineering area funded by national natural science foundation of China (NSFC) in the past ten years, so as to provide reference of application for scientific researchers.Methods:The funded projects through fund code H18 (medical imaging and biomedical engineering) of NSFC during 2010 to 2019 was analyzed. The funded fields, geographical distribution, research direction, applicants, supporting institutions, and the characteristics and trends of key researches were summarized.Results:A total of 68 projects were funded under H18, including 58 in projected area and 10 in non-projected area. The average funding rate was 19.0% (68/358) in the last ten years. Institutions of higher learning received 51 grants while scientific research institutes had 17. Thirty-seven supporting institutions received H18 key project funding, among which 22 received 1 grant and 15 received 2 or more. There were 51 (75%) male project leaders and 17 (25%) female leaders. The age of project leaders ranged from 35-66 years. Among the project leaders of H18 key funded projects, 52 leaders were approved once, and 8 were approved twice. The average interval between two approved key projects was 5.8 years.Conclusions:Since the establishment of the Department of Health Sciences in 2009, the sum of the fund and the number of the funded key projects in imaging medicine and biomedical engineering field have increased year by year. With the joint efforts of the majority of clinical workers and scientific researchers, research in this domain will achieve rapid development in our country.
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Objective:To analyze and discuss the implementation of the National Science Funds for Distinguished and Excellent Young Scientists in the past 10 years, and propose suggestions for future developments.Methods:The application and funding data of the National Science Funds for Distinguished and Excellent Young Scientists from 2010 to 2019 were collected. Both the distribution in each subdivision field and the age, gender, title and academic rank of the awardees were analyzed. The funds received before the Distinguished Young Scientists and the funds got after Excellent Young Scientists were discussed respectively.Results:There were Distinguished Young Scientists in field of medical imaging each year with an average funding rate of 10.3%(15/145). The funding rate of Excellent Young Scientists in field of medical imaging was higher than the average in the years of 2012-2014 and 2019. The application amounts of molecular imaging, MRI and medical imaging data processing and analyzing reached the top three positions. As far as the funding amount was concerned, ultrasound (4), molecular imaging (4) and MRI (3) for Distinguished Young Scientists, and medical imaging data processing and analyzing (6), molecular imaging (5) and MRI (4) for Excellent Young Scientists were in the first three priorities respectively. As far as the application and funding of the two projects were concerned, there was obvious difference among different supporting institutions. Certain similar growth characteristics remained for the project directors. Good accumulation of scientific achievements was demanded for the Distinguished Young Scientists. The Excellent Young Scientists grew well after being awarded.Conclusion:The National Science Funds for Distinguished and Excellent Young Scientists promote the development of medical imaging and help to cultivate the young talents.
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The growth of solid tumors can lead to changes in the hypoxic microenvironment of local tissues,and the most important regulatory factor is the hypoxia-inducible factors (HIFs).In the case of hypoxia,the downstream target genes regulated by HIF-1α regulation mainly are vascular endothelial growth factor (VEGF) and glucose transporter 1 (GLUT-1) genes,etc.In recent years,multimodality PET and MRI imaging technologies have been widely used in diagnosis of tumor diseases,and have confirmed that the parameters obtained by imaging are associated with the expression of tumor hypoxic related molecules.The molecular expression of HIF-1α within the tumor and its downstream target genes VEGF and GLUT-1 detected by PET and multifunctional MRI sequential were reviewed in this article.
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Objective To assess the correlation between standardized uptake value (SUV) and intravoxel incoherent motion (IVIM) parameters of primary cervical squamous cell carcinoma (CSCC) and pelvic metastatic lymph nodes in the use of hybrid PET/MR.Methods Forty-six CSCC patients in Shengjing Hospital from January 2015 to December 2015 were prospectively enrolled and divided into well-differentiated (G1) group,moderate-differentiated (G2) group and poorly-differentiated (G3) group.PET/MR examination with the multi-b-value diffusion-weighted imaging (DWI) sequence was performed before treatment.Maximum SUV (SUVmax) and mean SUV (SUVmean) were calculated.IVIM parameters,including the slow diffusion coefficient (D),fast diffusion coefficient (D*),perfusion fraction (f) were also measured.Pearson correlation analysis was used to evaluate the correlation between IVIM parameters and SUV(SUVmax,SUVmean).Results The D of G1,G2,G3 lesions and metastatic lymph nodes were (0.827± 0.232) × 10-3,(0.640±0.153) × 10-3,(0.563±0.090) × 10-3 and (0.772±0.246) × 10-3 mm2/s respectively.The f was 0.310±0.068,0.348±0.073,0.287±0.057 and 0.413±0.103 respectively.The D* was (9.241± 2.001) × 10-3,(9.408± 1.927) × 10-3,(9.715± 1.827) × 10-3 and (8.830± 1.632) × 10-3 mm2/s respectively.The SUVmax was 9.988±3.806,12.941±5.990,14.543±7.050 and 9.890±3.906 respectively.The SUVmean was 5.717±2.830,7.094±3.518,8.263±4.124 and 4.952±1.343 respectively.The D of G1 and G2 lesions had negative correlations with SUVmax and SUVmean(G1,r values:-0.816,-0.842;G2,r values:-0.528,-0.559;all P＜0.05);the f of G2 lesions had positive correlations with SUVmax and SUV (r values:0.554,0.550,both P＜0.05).Conclusions The SUVmax and SUV of the well-moderate differentiated CSCC are consistent with D and f,which reflect the cell density and the microvascular perfusion.PET/MRIVIM could provide important complementary information for treatment-monitoring and prognostic assessment of patients with cervical cancer.
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Objective To explore risk factors of pelvic lymph node (PLN) metastasis in cervical cancer,and to observe the value of PET/CT in diagnosis of PLN metastasis with qualitative and semi-quantitative evaluation.Methods Clinical data of 206 patients with cervical cancer who underwent PLN dissection were respectively analyzed.The age and BMI of patients,pathological type,depth of invasion and International Federation of Gynecology and Obstetrics (FIGO) stage of tumor,serum SCC level,lymph node status of PET/CT and tumor SUVmax were analyzed with univariate analysis.Multivariate analysis was performed for indicators with statistically significant variables.The accuracy,sensitivity and specificity of PET/CT in diagnosis of PLN metastasis of cervical cancer were calculated.Besides,the ratios of lymph node 'S SUVmax (SUVmaxLN) to SUVmax of primary tumor (SUVmaxL/T),to liver (SUVmaxL/H) and to arota (SUVmaxL/A) were recorded.ROC curves were plotted,whereas the areas under curve (AUC) were calculated to confirm the best diagnostic cutoff value.Results Univariate analysis showed that age,BMI,pathological type,depth of invasion,FIGO stage,serum SCC level,lymph node status of PET/CT and tumor SUVmax were important factors of PLN metastasis (all P＜0.05).Multivariate analysis revealed that serum SCC levels,depth of invasion,lymph node status of PET/CT and tumor SUVmax were independent predictors of PLN metastasis (P＜0.05).The sensitivity,specificity and accuracy of PET/CT in diagnosis of PLN metastasis was 54.90％ (28/51),91.61％ (142/155) and 82.52％ (170/206),respectively.The sensitivity of SUVmaxLN =4.19 was higher than SUVmax =2.5.No significant difference of SUVmaxLN with SUVmaxL/T,with SUVmaxL/H nor with SUVmaxL/A was found.Conclusion Serum SCC levels,depth of invasion,lymph node status of PET/ CT and tumor SUVmax are independent predictors of PLN metastasis.PET/CT has certain value in qualitative and semiquantitative analysis of cervical cancer PLN metastasis.
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Objective To explore the correlations among standardized uptake value (SUV) and clinicopathological features of cervical cancers,and to observe the association among SUV and expression level of vascular endothelial growth factor (VEGF) and Aquaporin-1 (AQP-1).Methods PET/CT imaging data were analyzed retrospectively in 56 patients with cervical cancer before surgery.The mean SUV (SUV),maximum SUV (SUVmax) and peak SUV (SUVpeak) were measured,and immunohistochemical method was used to detect the expression of VEGF and AQP-1.The relationships of SUV and expression level of VEGF,AQP-1 and clinicopathological features were analyzed.Results SUV SUVpeak and expression level of VEGF and AQP-1 were significantly different in different FIGO stages (all P＜0.05).SUVpeak and expression level of VEGF in tumors with maximum diameter ≥ 4 cm were higher than those in patients with tumors maximum diameter ＜4 cm (both P ＜0.05).SUVpeak and expression level of VEGF and AQP-1 in tumors with cervical stromal invasion depth ≥1/2 were significantly higher than those with cervical stromal invasion depth ＜ 1/2 (all P＜ 0.05).The expression level of VEGF and AQP-1 in patients with lymph node metastasis were higher than those without lymph node metastasis (both P ＜0.05).SUVpeak was correlated with expression level of VEGF (rs =0.529,P＜0.001) and AQP-1 (rs =0.356,P =0.007).Conclusion Preoperative SUVpeak of cervical cancer measured with PET/CT is correlated with clinicopathological features and can be used to guide individual treatment of patients with cervical cancer.
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Objective To compare the application value between PET/CT and PET/MR in diagnosing primary cervical cancer and pelvic lymph node metastasis.Methods Forty cases of cervical cancer were prospectively enrolled.PET/CT and PET/MR examinations were performed before treatment.All imaging data were evaluated by two experienced radiologists.The diagnostic consistency and difference of PET/CT and PET/MR were evaluated with Cohen's Kappa and paired Chi-square test.ROC curve was adopted to observe the value in diagnosing pelvic lymph node metastasis of cervical cancer.The lesions' visibility and diagnostic confidence of metastatic lymph nodes on PET/CT and PET/MR images were compared with Wilcoxon signed ranks test.Results Compared with the gold standard,the diagnostic consistency of PET/MR staging was much higher than that of PET/CT (x2 =10.286,P=0.002).The area under ROC curve of PET/CT and PET/MR on lymph node metastasis had no significant difference (Z=0.83,P＞0.05).No significant differences in lesion visibility between PET/CT and PET/MR images were detected in the evaluation of metastatic lymph nodes (P=0.157),while PET/MR revealed higher values regarding diagnostic confidence (P=0.014).Conclusion Both PET/CT and PET/MR provide high diagnostic value in detecting primary cervical cancer,but PET/MR has greater diagnostic superiority in the correct identification of cervical cancer stage and pelvic lymph node metastasis.PET/MR is expected to be a new technique for replacement of PET/CT in evaluation of cervical lesions.
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Rapid development of MRI has gradually evolved from morphological imaging to functional imaging.Functional MRI can provide pathophysiological information more than morphological information,such as molecular and metabolic information.The application value of functional MRI in cervical cancer has become a hotspot in recent years.The research progresses of functional MRI in cervical cancer were reviewed in this article.
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Rapid development of MRI has gradually evolved from morphological imaging to functional imaging.Functional MRI can provide pathophysiological information more than morphological information,such as molecular and metabolic information.The application value of functional MRI in cervical cancer has become a hotspot in recent years.The research progresses of functional MRI in cervical cancer were reviewed in this article.
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Objective To investigate cortical activation patterns for covert and overt picture naming with functional magnetic resonance imaging (fMRI). Methods fMRI data were collected on 24-27 years old volunteers during performance of covert and overt picture naming. After statistical postprocessing analysis, head movement data were compared across tasks and average neural activation maps were available for both tasks. Results Mean and maximal translations of head movement in covert picture naming were less than those in overt picture naming, but the difference has no statistical significance (P=0.23). It was shown that covert picture naming involved an orchestration of bilateral occipital gyri and cerebellums, bilateral supplementary motor area, postcentral gyri, inferior frontal gyrus and anterior cingulate cortex. Activations in overt picture naming included those in covert naming (but more intensive), bilateral precentral gyri and posterior superior temporal gyri, left anterior superior temporal gyrus, bilateral thalamus, basal ganglia, and left insula. Conclusion Covert and overt picture naming are two different tasks involving different neural processing networks and levels. They can not be taken as substitutes for each other.
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Objective To evaluate dynamic CT and PET-CT features of normal dog liver after radiofrequency ablation(RFA)correlated with the time-related histopathological changes.Methods Fifteen hybrid adult dogs in good health condition were evenly divided into 5 groups(the immediate,1 st,2 nd,4 th and 8 th week group)according to random digits table methods.Twice RFA was performed for each dog liver.The dogs after RFA underwent CT and PET-CT scanning respectively at the time point defined for each group.All dogs were executed through intravenous injection of klorvess liquid after scanning.Liver samples were histologically examined.All images were assessed to determine the ratios(r_(p/p))which referred to the comparison of rimlike enhancement or tracer uptake in the periphery of the necrosis to that in normal liver parenchyma.Those imaging results were compared and correlated with histopathological findings.Results For the immediate group after RFA procedure,central ablation lesions appeared coagulation necrosis and surrounding sinusoids engorged with blood.On the images of enhanced CT,marked rimlike enhancement was noticed in peripheral ablation lesions.While PET-CT showed decreased ~(18)F-FDG uptake surrounded by homogeneous tracer distribution.For the 1 st-4 th week group,central necrosis was gradually getting more severe.Infiltration of the inflammatory cells,granulation tissue formation and fibrous tissue restoration were noticed in peripheral ablation lesions.Rimlike enhancement and increased glucose metabolism appeared surrounding the lesions on CT and PET-CT,especially in the 1st to 2nd week groups.For the 8 th week group after RFA,the enhancement or hypermetabolism metioned above disappeared when perilesional tissue regeneration became more obvious.From the dynamic curve of changes on enhanced CT,marked enhancement occurred in the immediate group after ablation(r_(p/p)=1.34±0.21),reached its peak at the 1st week group(r_(p/p)=1.39±0.20),and then declined gradually.The metabolic changes on PET-CT showed a typical single peak curve,with the peak at the 1st week group(r_(p/p)=1.19±0.09)and similar even metabolism at the immediate and 8 th week group.Conclusions Both CT and PET-CT imaging can well correlate with the histopathological changes after RFA in the normal liver.To avoid the interference of inflammatory reaction when differentiating normal liver tissue from residual tumor,it is better to take radiology examination immediately and 8 weeks after RFA.PET-CT probably has advantages over CT immediately after RAF.After 1 week,PET-CT and CT may have similar diagnostic efficacy.
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Seizures may be the first or sometimes the only manifestation of patients with glioma in clinics. The aim of operation is to eliminate epilepsy far beyond mere resection of tumor mass. The underlyling mechanisms of glioma-associated epileptogenesis are poorly understood. Recently the theory of amino-acid like neurotransmitters in chemical synapse is gradually accepted. However, the molecular mechanisms remain to be further investigated on how glutamate release is regulated and how synaptic homeostasis in peripheral neurons is kept or disturbed. So detailed studies are needed to clarify specific molecular target and provide proper evidence for optimal antiepileptic drugs in glioma-associated epileptoge-nesis.