ABSTRACT
Objective:To explore the application potential of 18F-Asp-Glu-val-Asp (DEVD)-Cys(StBu)-PPG(CBT)-AmBF 3 ( 18F-1; PPG: propargyl-glycine; CBT: 2-cyanobenzothiazole; AmBF 3: ammoniomethyl-trifluoroborate) PET imaging in early monitoring of triple-negative breast cancer (TNBC) radiotherapy response. Methods:Ten MDA-MB-231 tumor bearing nude mice models were constructed and divided into radiotherapy group ( n=5) and non-radiotherapy group ( n=5) by random sampling method. The radiotherapy group was treated with single irradiation at a dose of 8 Gy. 18F-1 microPET imaging was performed in the radiotherapy and non-radiotherapy groups, and the tumor uptake and muscle uptake in 2 groups at different time points (2.5, 7.5, 12.5, 17.5, 22.5, 27.5, 32.5, 37.5, 42.5, 47.5, 52.5, 57.5 min after injection) were analyzed. The specific uptake of the probe in apoptotic cells was verified by radioautography, HE staining and immunofluorescent staining. Repeated measures analysis of variance and one-way analysis of variance were used to analyze data. Results:18F-1 microPET imaging showed that there was significant difference between tumor uptake and muscle uptake in radiotherapy group ( F=20.27, P=0.011). The uptake of radiotherapy group was the highest at 7.5 min after injection ((4.64±0.35) percentage activity of injection dose per gram of tissue(%ID/g)). There was no significant difference between tumor uptake and muscle uptake in the non-radiotherapy group ( F=1.81, P=0.215). The tumor/muscle (T/M) ratio of radiotherapy group was higher than that of non-radiotherapy group ( F=31.95, P=0.005), with the highest at 47.5 min after injection (2.49±0.46). Radioautography showed that the tumor radioactivity in radiotherapy group was higher than that of muscle in radiotherapy group, and was also higher than tumor and muscle radioactivies in non-radiotherapy group ( F=116.79, P<0.001). HE staining and immunofluorescent staining verified that 18F-1 could specifically detect the activity of caspase-3 activated in tumor cells after radiotherapy. Conclusion:18F-1 can specifically recognize the activated caspase-3 after TNBC radiotherapy, and monitor radiotherapy response at the molecular level by apoptosis PET imaging.
ABSTRACT
Objective:To investigate the value of the extrahepatic bile duct and main pancreatic duct segment patterns on magnetic resonance cholangiopancreatography (MRCP) for differentiating the periampullary carcinoma (PAC).Methods:The clinicopathologic data of 125 patients with PAC who were admitted to Wuxi No.2 People’s Hospital from June 2013 to December 2021 were retrospectively analyzed, including 72 males and 53 females, aged (64.9±8.6) years. According to its anatomy, the extrahepatic bile duct (B) was divided into suprapancreatic and intrapancreatic (including ampullary) segments, and the main pancreatic duct (P) was divided into tail-body and head segments. MRCP patterns: i. the extrahepatic bile duct or main pancreatic duct visible without dilatation, ii. cutoff of the distal extrahepatic bile duct or main pancreatic duct with upstream dilatation, iii. cutoff of the intrapancreatic or head segment with upstream dilatation and remnant intrapancreatic or head segments invisible, iv. cutoff of the intrapancreatic or head segment with upstream dilatation and nondilated remnant intrapancreatic or head segments, were represented as 0, 1, 2, and 3, respectively. Segment patterns of B1/P0+ B1/P1, B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3, B3/P0, and B0/P0+ B2/P0 on MRCP were compared in PAC patients.Results:Of the 125 patients, there were 57 (45.6%) with pancreatic head carcinoma, 36 (28.8%) with ampullary carcinoma, 20 (16.0%) with distal cholangiocarcinoma, and 12 (9.6%) with periampullary duodenal carcinoma. Segment patterns of B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3 were found in 52 patients with pancreatic head carcinoma (91.2%, 52/57), with a significant difference between PAC (χ 2=110.66, P<0.001). Segment patterns of B1/P0+ B1/P1were found in 36 patients with ampullary carcinoma (100.0%, 36/36), fallowed by 11 (91.7%, 11/12) with periampullary duodenal carcinoma, with a significant difference between PAC (χ 2=129.95, P<0.001). Segment pattern of B3/P0 presented in 16 patients with distal cholangiocarcinoma (80.0%, 16/20), with a significant difference between PAC (χ 2=62.45, P<0.001). The segment patterns of B0/P0+ B2/P0 were only seen in 3 of 57(5.3%) patients with pancreatic head carcinoma. Conclusion:On MRCP, cutoff of the head segment with upstream dilatation and remnant head segment invisible or nondilated indicates the pancreatic head carcinoma. Cutoff of the intrapancreatic segment with upstream dilatation, remnant intrapancreatic segment visible, and main pancreatic duct nondilated, indicates the distal cholangiocarcinoma. And cutoff of the distal extrahepatic segment with upstream dilatation and main pancreatic duct dilatation or not, indicates the ampullary or periampullary duodenal carcinoma.
ABSTRACT
Objective:To investigate the clinical application value of computed tomography (CT) and magnetic resonance imaging (MRI) examination in preoperative evaluation of adjacent organ invasion for periampullary carcinomas (PACs).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 81 patients with PACs who were admitted to the Affiliated Wuxi No.2 People′s Hospital of Nanjing Medical University from September 2013 to June 2019 were collected. There were 52 males and 29 females, aged from 41 to 80 years, with an average age of 62 years. Observation indicators: (1) surgical and pathological outcomes; (2) evaluation of adjacent organ invasion on CT and MRI examination for PACs; (3) comparison of diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs; (4) auxiliary and feature images of adjacent organ invasion for PACs; (5) comparison between CT and MRI examination in assessing adjacent organ invasion for PACs. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers or percentages. Comparison between groups was analyzed using the Mann-Whitney U test.The receiver operating characteristic curve and area under curve were used to evaluate diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs. Consistency was compared using the κ test. Results:(1) Surgical and pathological outcomes: of the 81 patients, 76 underwent pancreatoduodenectomy, 5 underwent palliative gastrojejunostomy or biliary drainage combined with biopsy, including the pancreas, duodenum, or lymph nodes. Of the 81 patients, 35 had pancreatic head carcinoma including 26 with duodenal invasion and 9 without duodenal invasion; 23 had ampullary carcinoma including 17 with duodenal invasion, 4 with both duodenal invasion and pancreatic invasion, and 2 without duodenal invasion or pancreatic invasion; 17 had distal bile duct carcinoma (including papillary type in 4 patients and periductal infiltrative type in 13 patients), of which 8 had duodenal invasion, 1 had duodenal invasion and pancreatic invasion (pathological classification of the 9 patients was periductal infiltrative type), 8 had neither duodenal invasion nor pancreatic invasion; 6 had duodenal carcinoma including 4 with pancreatic invasion and 2 without pancreatic invasion. (2) Evaluation of adjacent organ invasion on CT and MRI examination for PACs: of the 35 patients with pancreatic head carcinoma, duodenal invasion was identified in 25 patients and no duodenal invasion in 10 patients on both CT and MRI examination. Of the 23 patients with ampullary carcinoma, duodenal invasion, pancreatic invasion, both duodenal invasion and pancreatic invasion, and neither duodenal invasion nor pancreatic invasion were identified in 17, 1, 4, and 1 patients on CT examination, respectively; the above indicators were identified in 15, 2, 4, and 2 patients on MRI examination. Of the 17 patients with distal bile duct carcinoma, pancreatic invasion, both duodenal invasion and pancreatic invasion, and neither duodenal invasion nor pancreatic invasion were identified in 8, 1, and 8 patients on CT examination, respectively; the above indicators were identified in 9, 1, and 7 patients on MRI examination. Of the 6 patients with duodenal carcinoma, pancreatic invasion and no pancreatic invasion were identified in 3 and 3 patients on both CT and MRI examination.(3) Comparison of diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs: two reviewers had good agreement in assessing adjacent organ invasion on CT examination for pancreatic head carcinoma, ampullary carcinoma, and distal bile duct carcinoma ( κ=0.868, 0.701, 0.881, P<0.05), but they had poor agreement for duodenal carcinoma ( κ=0.333, P>0.05). Meanwhile, two reviewers had good agreement in assessing adjacent organ invasion on MRI examination for pancreatic head carcinoma and ampullary carcinoma( κ=0.860, 0.747, P<0.05), and moderate agreement for distal bile duct carcinoma ( κ=0.643, P<0.05), but they had poor agreement for duodenal carcinoma ( κ=0.333, P>0.05). (4) Auxiliary and feature images of adjacent organ invasion for PACs: for the 25 patients who had pancreatic head carcinoma with duodenal invasion on CT and MRI examination, based on well filling in duodenum, 12 patients showed locally morphological change of lumen and flattened or disappeared duodenal mucosal folds on negative contrast CT cholangiopancreatography; 14 patients showed similar signs on T2 weighted imaging or magnetic resonance cholangiopancreatography. The 17 patients who had distal bile duct carcinoma with pancreatic invasion on CT and MRI examination were periductal infiltrative type. Pancreatic invasion manifested as local thickenness of ductal wall with marked enhancement and narrowed ductal lumen, which was indistinguishable from the pancreas, and the pancreatic parenchyma showed hyperdense or hyperintense signs similar with the lesion, like a "transmural" sign. One patient with both duodenal invasion and pancreatic invasion showed locally thickened and enhanced duodenal wall on both CT and MRI examination. Four patients, who had papillary type distal bile duct carcinoma with neither duodenal invasion nor pancreatic invasion, showed intraductal growing mass which had a discernible boundary to the pancreas and slighter enhancement than infiltrative type on both CT and MRI examination. (5) Comparison between CT and MRI examination in assessing adjacent organ invasion for PACs: CT examination evaluating adjacent organ invasion for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, and duodenal carcinoma had a sensibility of 92.3%, 90.5%, 88.9%, 75.0%, a specificity of 88.9%, 50.0%, 87.5%, 100.0%, an accuracy of 0.906, 0.702, 0.882, 0.875, respectively. MRI examination evaluating adjacent organ invasion for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, and duodenal carcinoma had a sensibility of 88.5%, 85.7%, 88.9%, 75.0%, a specificity of 77.8%, 50.0%, 75.0%, 100.0%, an accuracy of 0.831, 0.679, 0.819, 0.875. There was no significant difference in sensibility for pancreatic head carcinoma, distal bile duct carcinoma, or duodenal carcinoma between CT and MRI examination( χ2=3.140, 0.141, 0.444, P>0.05), while there was a significant difference in sensibility for ampullary carcinoma ( χ2=13.263, P<0.05). There was no significant difference in specificity for pancreatic head carcinoma, ampullary carcinoma, or distal bile duct carcinoma between CT and MRI examination( χ2=0.321, 2.000, 3.429, P>0.05). There was no significant difference in accuracy for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, or duodenal carcinoma between CT and MRI examination( Z=0.967, 0.273, 0.559, 0.000, P>0.05). Conclusion:CT and MRI examination can be used for preoperative evaluation of adjacent organ invasion for periampullary carcinoma, with similar performance in specificity and accuracy, however, CT examination has a higher sensibility for ampullary carcinoma.
ABSTRACT
Objective@#To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages.@*Results@#(1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as the first branch of IMA. The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm. (3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels: two patients of type Ⅳ were excluded from the 60 patients. On the 2D CT images of the rest 58 patients, 39 (67.2%) had LCA adjacent to IMV and 19 (32.8%) had LCA distal to IMV at the horizontal level of IMA root. On the 3D images of blood vessels in the rest 58 patients, 37 (63.8%) had the LCA located at the ventral side of IMV, and 21 (36.2%) had the LCA located at the dorsal side of the IMV.@*Conclusion@#Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches, which has high clinical application value.
ABSTRACT
Objective@#To prepare manganese-doped carbon quantum dots (Mn-CDs) dual-modal nanoprobe for fluorescent-magnetic imaging, and evaluate its characteristics and potential on fluorescence imaging and MRI.@*Methods@#Mn-CDs were synthesized at 150 ℃. The form, diameter, component, fluorescent capability, T1 relaxation rate, stability and cytotoxicity of Mn-CDs in vivo were verified. The fluorescence imaging of HO-8910 tumor-bearing mice was performed on small animal imager, and the whole-body enhanced imaging was performed on 3.0 T MRI scanner. One-way analysis of variance was used to analyze the data.@*Results@#The Mn-CDs with the diameter of (4.64±0.85) nm showed a well-defined spherical morphology. The fluorescent spectra of Mn-CDs exhibited that the excitation maximum was at 360 nm and the emission maximum was at 440 nm. The T1 relaxation rate was (3.26±0.04) mmol·L-1·s-1. The Mn-CDs had good stability of fluorescent and magnetic imaging capability at 0, 0.25, 0.5, 0.75, 1.0 and 2 months at room temperature with no significant differences of fluorescent and magnetic signals (F=1.566 and 0.987, both P>0.05). After injection of 200 μl Mn-CDs (15 g/L), mice were all alive and had no viscera damage. The tumor could be observed obviously on fluorescence imaging at 5 min. Enhanced MRI showed that the tumor was unevenly enhanced and Mn-CDs were mainly cleared away through urinary system.@*Conclusion@#Mn-CDs are stable and have good potential on fluorescence imaging and MRI, which provides a promising multimodal imaging method for tumor detection and monitoring.
ABSTRACT
Objective To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Mfiliated Wuxi Second People's Hospital of Nanjing Medical University from February 2018 to March 2019 were collected.There were 39 males and 21 females,aged from 45 to 81 years,with an average age of 67 years.All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation.The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering.The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction,and the CT images of venous vessels with small density difference were abstracted by region growing method.Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added.All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team,and were identified inferior mesenteric artery (IMA) and branches after being bared vessels,including anatomic course of left colonic artery (LCA),sigmoid artery (SA),and superior rectal artery (SRA).Observation indicators:(1) anatomic courses of IMA,LCA,SA,and SRA on the 3D images and their consistency with intraoperative anatomic courses;(2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels;(3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels.Measurement data were represented as Mean±SD,and count data were represented as absolute numbers and percentages.Results (1) Anatomic courses of IMA,LCA,SA and SRA on the 3D images and their consistency with intraoperative anatomic courses:of the 60 patients,31 (51.7％) had type Ⅰ anatomic course of IMA on the 3D images,with LCA and SA from the common trunk;9 (15.0％) had type Ⅱ,with LCA and SA from the common trunk;18 (30.0％) had type Ⅲ,with LCA,SA,and SRA from the common trunk;2 (3.3％) had type Ⅳ,with no LCA.The consistency of anatomic courses of IMA,LCA,SA,and SRA on the 3D images with intraoperative anatomic courses of bared IMA,LCA,SA,and SRA was 100.0％ (60/60).(2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels:of the 60 patients,49 (81.7％) had LCA as the first branch of IMA,11 (18.3％) had SRA or SA as the first branch of IMA.The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm.(3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels:two patients of type Ⅳ were excluded from the 60 patients.On the 2D CT images of the rest 58 patients,39 (67.2％) had LCA adjacent to IMV and 19 (32.8％) had LCA distal to IMV at the horizontal level of IMA root.On the 3D images of blood vessels in the rest 58 patients,37 (63.8％) had the LCA located at the ventral side of IMV,and 21 (36.2％) had the LCA located at the dorsal side of the IMV.Conclusion Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches,which has high clinical application value.
ABSTRACT
Objective To explore the feasibility of electrocardiogram (ECG)-gated coronary artery calcium scoring (CACS) CT scan for attenuation correction of 9gTcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (MPI) based on a hybrid SPECT/CT scanner.Methods From January 2017 to October 2017,a total of 110 subjects (61 males,49 females;age:(68.4±9.4) years) underwent ECG-gated MPI,ECG-gated CACS CT scan and conventional non-gated cardiac CT scan.The gated and non-gated CT scans were used for attenuation correction of MPI separately,then the relative percentage of radioactive distribution of left ventricular (LV) walls (anterior,lateral,inferior,septal and apex) based on different correction methods were compared,and the influences of CACS CT scan and conventional CT scan on visual assessment for myocardial ischemia were also compared.Paired t test and Kappa test were used to analyze the data.Results The relative radioactive distribution percentages of all LV walls in CACS CT corrected MPI and those in conventional CT corrected MPI were not statistically significant (t values:from-0.782 to 0.456,all P＞0.05).The weighted Kappa values of LV anterior,lateral,inferior,septal and apex from 2 types of corrected images between 2 physicians were 0.864 (95％ CI:0.749-0.979),0.795 (95％ CI:0.717-0.874),0.494(95％ CI:0.076-0.912),0.724(95％ CI:0.321-1.000),0.873 (95％ CI:0.764-0.982),respectively (all P＜0.01).Conclusion ECG-gated CACS CT scan can be used for attenuation correction of 99Tcm-MIBI MPI based on a hybrid SPECT/CT scanner.
ABSTRACT
Objective To fabricate manganese-doped carbon quantum dots(Mn-CDs)@anti-human epididymis protein 4(HE4)monoclonal antibody(Mn-CDs@Anti-HE4 mAb)dual-modal fluorescent-magnetic nanoprobe for ovarian cancer cells targeting imaging,and evaluate its potential on fluorescent imaging and MRL Methods Mn-CDs were synthesized at 150 ℃ with solvothermal method.The average diameter,fluorescent capability and MRI efficiency were determined.The cytotoxicity of Mn-CDs in vitro was evaluated by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium(MTS)assay with HO-8910 ovarian cancer stem cells and EA.hy926 human umbilical vein endothelial cells.Mn-CDs@Anti-HE4 mAb was fabricated with condensation reaction and characterized by ultraviolet(UV)absorption spectra.Fluorescence imaging and MRI in vitro was performed for cancer cell-targeting study.One-way analysis of variance and the least significant difference t test were used to analyze the data.Results The Mn-CDs with diameter of(4.64±0.85)nm showed a well-defined spherical morphology.The fluorescent spectra of Mn-CDs exhibited a typical excitation-dependent behavior with an excitation maximum at 360 nm and emission maximum at 440 nm.The T1 relaxation rate was(3.26±0.04)mmol ? L-1 ? s-1.The cytotoxicity tests in vitro showed that the survival rates of HO-8910 cells and EA.hy926 cells were both significantly different after treated with different concentrations of Mn-CDs(F= 1 947.509,260.174,both P<0.05),and there was no cytotoxicity in both HO-8910 cells and EA.hy926 cells at concentrations of MnCDs within 0-2.5 mg/ml(all P>0.05),while the survival rates of the two kinds of cells were descended with the increasing of concentration within 3.0-4.5 mg/ml(P<0.05).Mn-CDs@Anti-HE4 mAb could target HO-8910 cells on fluorescence imaging and MRI.Conclusions Mn-CDs@Anti-HE4 mAb,with good potential on fluorescence imaging,MRI and targeting ability,is successfully synthesized.It may provide a new method for early diagnosis of ovarian cancer.
ABSTRACT
Objective To explore the limits of fluid-inversion prepared diffusion weighted imaging (FLIPD) in detection of acute cerebral ischemic lesions.Methods From January 2012 to March 2014,forty-nine patients (33 males,16 females,age (55.6± 12.3) years) clinically diagnosed as transient ischemic attack (TIA) were included.Patients underwent brain MRI (conventional diffusion weighted imaging (DWI) and FLIPD) within 3 d after the onset of TIA.The detection ability of MRI with the two sequences was compared,and the relative signal intensity (rSI) and apparent diffusion coefficient (ADC) of acute ischemic lesions based on two sequences were compared.Kappa test and two-sample t test were used to analyze the data.Results A total of 87 acute ischemic lesions were detected in 21 patients by conventional DWI,and 54 were detected in 19 patients by FLIPD (Kappa=0.916,P＜0.05).The rSI of ischemic lesions on FLIPD was significantly lower than that on conventional DWI (1.37±0.22 vs 1.57±0.26;t=6.647,P＜0.001).The ADC value of ischemic lesions on FLIPD was slightly lower than that on conventional DWI:(0.54 ±0.10) ×10-3 mm2/s vs (0.57±0.13)×10-3 mm2/s (t=2.120,P＜0.05).The missed lesions on FLIPD were located in the white matter (n =18),cerebellum and brainstem (n =8),and the cortex (n =7).Conclusions A slight diffuse abnormality may be missed on FLIPD,so this method is not suitable for the detection of acute ischemic lesions.FLIPD technology still needs improvement.
ABSTRACT
Objective To investigate the application value of inferior vena cava venography in correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction in Budd-Chiari syndrome (BCS).Methods The retrospective cross-sectional study was conducted.The clinical data of 41 patients with BCS who were admitted to the Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2016 were collected.There were 29 males and 12 females,aged (53±10)years,with a range of 34-70 years.Forty-one BCS patients underwent computed tomography (CT),inferior vena cava CT venography and digital subtraction angiography (DSA) within 2 weeks.Balloon dilatation and (or) endovascular stent implantation of inferior vena cava were performed according to calcification morphology and location of the inferior vena cava obstruction detected by DSA.Observation indicators:(1) calcifications of inferior vena cava obstruction;(2) intraoperative situations of interventional therapy;(3) correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction;(4)follow-up and survival situations.Follow-up using outpatient examination of inferior vena cava venography was performed at 3,6,12,24,36,48 months postoperatively to detect postoperative clinical manifestations,complications and survival situations up to December 2018.Measurement data with normal distribution were represented as Mean±SD.Count data were represented as absolute number and comparison between groups was analyzed using the chi-square test.The likelihood ratio test was used to analyze the correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction.The degree of correlation was detected by Cramer's V contingency coefficient.Results (1)Calcifications of inferior vena cava obstruction:of 41 patients,17 had no calcification at the inferior vena cava obstruction and 24 had calcifications at the obstruction.Calcification location in 24 patients:there were 17,4 and 3 patients with proximal,distal,both proximal and distal calcifications at the inferior vena cava obstruction,respectively.Calcification morphology:punctate and irregular calcifications were detected in 20 and 4 patients,respectively.Calcification distribution:20,3 and 1 patients had scattered,cluster and diffuse distribution,respectively.(2) Intraoperative situations of interventional therapy:of 41 patients,21 underwent balloon dilatation and 20 underwent balloon dilatation combined with endovascular stent implantation.Two patients were detected hematoma at the puncture site of right femoral vein and treated using pressure dressing.One patient encountered rupture of balloon due to diffuse calcifications at the inferior vena cava obstruction and was improved after continual replace of balloon for 3 times.One patient had pulmonary embolism caused by detachment of the thrombosis at the distal obstruction during the balloon dilatation and was given anticoagulation therapy combined with thrombolytic therapy using large-dose of urokinase.The other 37 patients underwent successful interventional therapy without exceptional circumstances.(3) Correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction:of 24 patients with calcifications at the inferior vena cava obstruction,13 had membrane obstruction,7 had segmental obstruction and 4 had fenestrated membrane obstruction.Of 17 patients without calcifications at the inferior vena cava obstruction,3 had membrane obstruction,13 had segmental obstruction and 1 had fenestrated membrane obstruction.The likelihood ratio test showed that the subtypes of inferior vena cava obstruction were associated with calcifications at the obstruction (x2=9.293,P＜0.05),with the correlation coefficient V as 0.466.Further analysis showed a correlation between membrane obstruction of inferior vena cava and calcifications at the inferior vena cava obstruction (x2=8.121,P＜0.05),no correlation between segmental obstruction and calcifications at the inferior vena cava obstruction,also no correlation between fenestrated membrane obstruction and calcifications at the inferior vena cava obstruction (x2=3.395,0.004,P＞0.05).(4) Follow-up and survival situations:41 patients were followed up for 24.0-48.0 months,with a median time of 37.1 months.Postoperative ultrasound showed smooth backflow in the inferior vena cava,different degree of improvements in the lower limb swelling and varicosity in 38 patients.Embolisms in the inferior vena cava obstruction remained existent in 3 patients,1 of whom showed significant decreasing of embolisms.There were 2 patients found restenosis and undergoing endovascular stent implantation.All the 41 patients survived.Conclusions The subtypes of inferior vena cava obstruction are associated with calcifications at the obstruction in BCS.Inferior vena cava venography evaluating calcifications at the inferior vena cava obstruction in BCS can be helpful for diagnosing the subtypes of inferior vena cava obstruction and guiding its interventional therapy.
ABSTRACT
Objective To prepare manganese-doped carbon quantum dots ( Mn-CDs) dual-modal nanoprobe for fluorescent-magnetic imaging, and evaluate its characteristics and potential on fluorescence imaging and MRI. Methods Mn-CDs were synthesized at 150 ℃. The form, diameter, component, fluo-rescent capability, T1 relaxation rate, stability and cytotoxicity of Mn-CDs in vivo were verified. The fluores-cence imaging of HO-8910 tumor-bearing mice was performed on small animal imager, and the whole-body enhanced imaging was performed on 3.0 T MRI scanner. One-way analysis of variance was used to analyze the data. Results The Mn-CDs with the diameter of (4.64±0.85) nm showed a well-defined spherical morpholo-gy. The fluorescent spectra of Mn-CDs exhibited that the excitation maximum was at 360 nm and the emission maximum was at 440 nm. The T1 relaxation rate was (3.26±0.04) mmol·L-1·s-1. The Mn-CDs had good stability of fluorescent and magnetic imaging capability at 0, 0.25, 0.5, 0.75, 1.0 and 2 months at room tem-perature with no significant differences of fluorescent and magnetic signals ( F=1. 566 and 0. 987, both P>0. 05) . After injection of 200 μl Mn-CDs ( 15 g/L) , mice were all alive and had no viscera damage. The tumor could be observed obviously on fluorescence imaging at 5 min. Enhanced MRI showed that the tumor was unevenly enhanced and Mn-CDs were mainly cleared away through urinary system. Conclusion Mn-CDs are stable and have good potential on fluorescence imaging and MRI, which provides a promising multimodal im-aging method for tumor detection and monitoring.
ABSTRACT
Objective To evaluate the value of a novel laser navigation system (LNS) designed for a SPECT/ CT platform in improving efficiency of molecular imaging-guided percutaneous transthoracic needle biopsy (PTNB). Methods From January 2017 to October 2017, a total of 25 patients (17 males, 8 fe-males, age (58.9±10.8) years) with thoracic lesions suspicious for malignancy underwent 99 Tcm-methoxy-isobutylisonitrile (MIBI) SPECT/ CT-guided PTNB, and the hyperactivity areas were chosen as the sam-pling areas. Thirteen patients underwent traditional free hand puncture (control group), and 12 patients had LNS-assisted puncture (LNS group). The operation time, CT-guided times, average effective radiation dose of the two methods were compared. Two-sample t test was used to analyze the data. Results Comparing to control group, LNS-assisted PTNB puncture significantly reduced operation time ((7.6±2.2) vs (24. 2± 9. 8) min; t= 5.693, P<0.001), CT-guided times (1.9±0.9 vs 4.0±1.5; t= 4.108, P<0.001) and average effective radiation dose ((7.7±0.9) vs (10.5±2.1) mSv; t= 4.306, P<0.01). Conclusion The novel LNS is helpful in improving efficiency of molecular imaging-guided PTNB based on a SPECT/ CT platform.
ABSTRACT
Objective To compare the diagnostic efficiencies of different scanning schemes of dualphase 99Tcm-methoxyisobutylisonitrile (MIBI) planar imaging with or without SPECT/CT in the preoperative localization of parathyroid lesions.Methods Forty-two patients (20 males,22 females;average age (53.1 ± 14.8) years) with primary or secondary hyperparathyroidism who underwent parathyroidectomy from June 2011 to June 2016 were analyzed retrospectively.All patients underwent dual-phase 99Tcm-MIBI planar scan and dual-phase SPECT/CT scan.The images were collected according to the following 4 procedures:dualphase planar imaging (S1),dual-phase planar imaging+early-phase SPECT/CT (S2),dual-phase planar imaging+delayed-phase SPECT/CT (S3),dual-phase planar imaging+dual-phase SPECT/CT (S4).Pathological results were considered as the gold standard.A total of 168 parathyroid glands in 42 patients were evaluated by the 4 imaging procedures respectively.The diagnostic efficiencies were calculated and compared by x2 test.Results Seventy-eight abnormal parathyroid lesions were found.The diagnostic sensitivities of S1,S2,S3,S4 were 66.7％ (52/78),89.7％(70/78),69.2％(54/78),89.7％(70/78),and the accuracies were 78.6％ (132/168),94.0％ (158/168),85.1％ (143/168),94.0％ (158/168),respectively.The diagnostic accuracies of S2 and S4 were significantly higher than those of S1 and S3 (x2 values:17.027 and 7.176,both P＜0.01).Condusions The dual-phase planar imaging together with early-phase and dualphase SPECT/CT imaging have high diagnostic efficiencies in the preoperative localization of parathyroid lesions.Considering reducing radiation dose and examine time,the dual-phase planar imaging together with early-phase SPECT/CT is a better choice.
ABSTRACT
Objective To investigate a real-time imaging guided percutaneous transthoracic needle biopsy (PTNB) for thoracic masses with SPECT/CT.Methods From March to June 2016,a total of 12 patients (7 males,5 females;average age:(59.2± 13.2) years) with thoracic lesions suspicious for malignancy underwent 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT/CT-guided PTNB.The hot spot areas were chosen from the thorax 99Tcm-MIBI SPECT/CT images as the sampling targets.Subsequent guiding CT scans were repeatedly fused with the prior SPECT images to realize the real-time guiding of the biopsy needle puncture step by step,until reaching to the target margin.Masses were sampled after confirming that the needle tips reached planned areas.Pathological results,total time of examination,time of PTNB procedure,complication,CT radiation dosage were recorded.Results Based on 99Tcm-MIBI SPECT/CT results,biopsies targeted the most suspicious areas within lesions.All biopsy procedures yielded diagnostic results.Eleven patients had positive results of malignancy,and 1 patient with inflammation.There were no severe complications.Total time of examination was (74.3±10.4) min,and (33.5±9.1) min for PTNB.Radiation dosage of CT was (6.1±1.7) mSv,36％ of which was caused by CT-guiding ((2.2±1.0) mSv).Conclusion Multimodal of SPECT/CT fusion imaging is useful for thorax biopsy planning and guiding,and can increase overall performance of safety and feasibility.
ABSTRACT
Objective To investigate the value of CT in detecting incidental extracardiac findings (IEFs) when used for attenuation correction during SPECT/CT myocardial perfusion imaging (MPI).Methods A total of 520 patients (288 males,232 females,average age 65.8 years) who underwent SPECT/CT MPI between July 2014 and February 2016 were retrospectively analyzed.Low dose CT attenuation correction was used during MPI.IEFs of lung,mediastinum and chest wall,large blood vessels,spine,and part of upper abdomen were recorded independently.All findings were divided into three categories:IEFs requiting further examination and treatment measures taken immediately (group A),IEFs requiring follow-up or further examination (group B),IEFs need no further treatment (group C).Results IEFs (n =356) were observed in 52.31％ (272/520) of the patients,with 24 cases in group A (4.62％,24/520),105 cases in group B (20.19％,105/520) and 143 cases in group C (27.50％,143/520).There were 158 clinically significant IEFs in 129 patients (24.81％,129/520),including 5(0.96％,5/520) with newly diagnosed malignancy.Conclusion IEFs detected by CT used for attenuation correction during SPECT/CT MPI are not uncommon,including a few cases with clinically significant findings.
ABSTRACT
Objective To observe the distribution and variation of right colonic vessels,and investigate the clinical value of computed tomography angiography (CTA),computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People's Hospital of Nanjing Medical University between January 2015 and July 2017 were collected.Patients received preoperative plain and enhanced scans of abdominal and pelvic CT.The original images were reconstructed and fused by CTA and CTC,and then coming out with three-dimensional images of blood vessels and gut.Observation indicators:(1) branches of superior mesenteric artery (SMA);(2) positional relationship between SMA and superior mesenteric vein (SMV);(3) composition of gastrocolic venous trunk.Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard,with a good imaging performance.Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy,showing a coincidence rate of 100.0％ (38/38).(1) Branches of SMA:results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery,middle colonic artery and ileocolic artery were respectively 94.7％ (36/38),92.1％ (35/38) and 100.0％ (38/38).A right colonic artery was found in 28 patients.Ten patients had structure variation of right colonic artery,including 3 with 2 right colonic arteries and 2 without right colonic artery.The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients;the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients.(2) Positional relationship between SMA and SMV:results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0％ (38/38).The SMA in 20 patients was located in the ventral side of SMV;SMA in 18 patients was located in the dorsal side of SMV.(3) Composition of gastrocolic venous trunk:results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks,which belonged to four sources,including right colonic vein,middle colonic vein,fight gastric epiploic vein and anterior superior pancreaticoduodenal vein.Among 29 patients,18 had 2-or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein,middle colonic vein and right colonic vein;3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein;8 had 3-or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein,anterior superior pancreaticoduodenal vein,right colonic vein and middle colonic vein.Conclusion CTA,CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels,with a high clinical value.
ABSTRACT
Objective To evaluate the prevalence of extraosseous findings on integrated CT images of routine SPECT/CT bone imaging and its clinical incremental values. Methods A total of 843 patients (470 males, 373 females, age range: 26-92 years) who underwent SPECT/CT bone imaging during May 2013 to December 2015 were enrolled in this retrospective study. A modified C-RADS was used to classify the extraosseous findings to E1, E2, E3 and E4. χ2 test was used for data analysis. Results The CT images in 78.6%(663/843) of patients were normal or with no additional clinical significance (E1 and E2), and those in 21.4%(180/843) of patients might need further assessment (E3 and E4). The rate of E4 extraosseous findings in patients with malignancy was higher than that in patients without malignancy: 9.5%(59/622) vs 5.0%(11/221); χ2=4.352, P0.05. With age increasing, the prevalence of E4 finding increased and the rate was the highest in the patients over 80 years old (125%, 16/128). Seventy patients had E4 findings and chest masses and nodules were the most common, followed by the abdominal or pelvis lymph node enlargements. Conclusions Potentially important extraosseous findings are common on SPECT/CT. Systematic reviewing CT images and communicating the important unexpected findings to clinical physicians could enhance its clinical incremental values.