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Objective:To assess the imaging characteristics of muscle FDG metabolism, tumor incidence, and pulmonary interstitial changes in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody positivity in 18F-FDG PET/CT imaging, and the value of 18F-FDG PET/CT in differentiating anti-MDA5 antibody positive dermatomyositis. Methods:From June 2016 to July 2019, the PET/CT images of 75 patients with dermatomyositis (21 males, 54 females, age (52.3±14.3) years; 34 anti-MDA5 antibody positive and 41 anti-MDA5 antibody negative) and 30 healthy controls (10 males, 20 females; age (53.5±11.8) years) were retrospectively analyzed in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The SUV max of muscle was measured and the mean of SUV max (mSUV max) was calculated. Statistics of patients with dermatomyositis complicated with neoplastic lesions and the SUV max of pneumonia lesions in patients with dermatomyositis complicated with interstitial pneumonia was determined. Independent sample t test, one-way analysis of variance, Student-Newman-Keuls (SNK) test and χ2 test were used to analyze data. The ROC curve analysis was used to analyze the diagnostic efficacy of mSUV max for the differential diagnosis of anti-MDA5 antibody positive dermatomyositis. Results:The muscle mSUV max of the control group, anti-MDA5 antibody positive and negative groups were 0.39±0.05, 0.66±0.21 and 0.87±0.29 ( F=39.93, P<0.001), respectively. The muscle mSUV max of dermatomyositis patients was increased compared with healthy controls ( q values: 6.76, 12.63, both P<0.001), and the muscle mSUV max of anti-MDA5 antibody negative was higher than positive ( q=5.79, P<0.001). The AUC was 0.74, and the cut-off value of muscle mSUV max was 0.75 with the accuracy of 74.7%(56/75). Of 41 patients with negative anti-MDA5 antibody, there were 6 (14.6%) had malignant tumor, while there was no malignant tumor in patients with positive anti-MDA5 antibody (0/34; χ2=5.41, P=0.020). There were 11 patients (26.8%, 11/41) with anti-MDA5 antibody negative dermatomyositis complicated with interstitial pneumonia and 33 patients (97.1%, 33/34) with anti-MDA5 antibody positive dermatomyositis complicated with interstitial pneumonia ( χ2=37.81, P<0.001). FDG metabolism in anti-MDA5 antibody positive patients was higher than that in anti-MDA5 antibody negative patients (lesion SUV max: 3.65±1.83 and 2.38±1.27; t=2.13, P=0.039). Conclusions:The muscle FDG metabolism of anti-MDA5 antibody positive dermatomyositis patients is higher than that of healthy controls, but lower than that of anti-MDA5 antibody negative patients. The incidence of neoplastic lesions in patients with positive anti-MDA5 antibody is lower than that in patients with negative anti-MDA5 antibody. The proportion and severity of interstitial pneumonia are higher in patients with positive anti-MDA5 antibody than in those with negative anti-MDA5 antibody. 18F-FDG PET/CT has certain value on identifying anti-MDA5 antibody positive dermatomyositis.
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Objective:To compare the diagnostic efficacy of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT and 18F-fluorodeoxyglucose (FDG) PET/CT in TNM staging before radical prostatectomy. Methods:From July 2018 to December 2019, a total of 67 patients ((67.5±6.8) years) with prostate cancer diagnosed pathologically by radical surgery in Renji Hospital, School of Medicine, Shanghai Jiao Tong University were retrospectively enrolled. All patients underwent 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT whole-body scans before surgery. Results of PET/CT were compared with pathological diagnosis after surgery to compare the diagnostic efficiencies of 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT for preoperative TNM staging ( χ2 test). The differences of the maximum standardized uptake value (SUV max) in primary lesions between 2 imaging methods were compared by Mann-Whitney U test. Patients were divided into low-risk, intermediate-risk and high-risk for stratified analysis. Results:Among 67 patients, 9 were with low-risk, 19 were with intermediate-risk, 39 were with high-risk. For T staging, 59 (88.06%, 59/67) patients showed positive results by 68Ga-PSMA-11 PET/CT imaging, with median SUV max of 13.80(7.30, 22.40) for 67 patients; 31(46.27%, 31/67) patients showed positive results in 18F-FDG PET/CT imaging, with median SUV max of 4.00(3.10, 5.60) ( U=62, P<0.05). Stratifed analysis showed that the detection rate of 68Ga-PSMA-11 PET/CT was higher than that of 18F-FDG PET/CT in intermediate-risk patients (17/19 vs 6/19; χ2=4.920, P<0.05). Among 67 patients, 10 were diagnosed as N1 stage based on the pathological results. The sensitivities, specificities, accuracies, positive predictive values and negative predictive values of 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT for detecting positive regional lymph nodes were 6/10, 87.72%(50/57), 83.58%(56/67), 6/13, 92.59%(50/54) and 4/10, 89.47%(51/57), 82.09%(55/67), 4/10, 89.47%(51/57), respectively. 68Ga-PSMA-11 PET/CT detected 15 patients (22.39%, 15/67) with M1 stage, and 18F-FDG PET/CT identified 9 patients (13.43%, 9/67; χ2=35.436, P<0.05). Conclusions:As for T staging, the detection rate of 68Ga-PSMA-11 PET/CT in the intermediate-risk group is better than 18F-FDG PET/CT. In N and M staging, the detection rates of 68Ga-PSMA-11 PET/CT are higher than those of 18F-FDG PET/CT.
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Objective:To evaluate the value of visual analysis and standardized uptake value ratio (SUVR) during 18F-florbetapir (AV45) PET/CT brain imaging in diagnosis of β-amyloid (Aβ) deposition in patients with mild cognitive impairment (MCI) and Alzheimer′s disease (AD), and to explore the clinical ancillary value of the two indexes. Methods:From December 2018 to July 2019, a total of 47 subjects, including 5 (3 males, 2 females, age (58±13) years) normal controls (NC), 8 (2 males, 6 females, age (66±10) years) patients with AD and 34 (16 males, 18 females, age (70±7) years) patients with MCI were enrolled. All subjects underwent 18F-AV45 PET/CT scan. All images were evaluated by visual analysis and SUVR were calculated. The diagnostic efficiencies of visual analysis and SUVR were compared by McNemar test and Kappa test. One-way analysis of variance and Welch test were used to compare data differences. The best threshold value of SUVR was obtained by receiver operating characteristic (ROC) curve analysis. Results:The positive rate of Aβ deposition for all subjects was 46.81%(22/47) by SUVR analysis, and 38.30%(18/47) by visual analysis. There was no significant difference between the two methods ( χ2=33.15, P>0.05), and the consistency was good ( Kappa=0.83). Considering the clinical diagnosis as the"gold standard", the Aβ deposition obtained by visual analysis and SUVR analysis can effectively distinguish AD from NC, and the sensitivities were 7/8 vs 8/8, respectively, both specificities were 5/5( χ2=9.48, P>0.05), with good consistency ( Kappa=0.84). SUVR quantitative analysis could distinguish AD from NC, AD from MCI ( F values: 3.99-8.79, all P<0.01), but could not distinguish NC from MCI (all P>0.05). ROC curve analysis showed that the best threshold value of precuneus′ SUVR was 1.08 for the differential diagnosis of AD and NC; for the differential diagnosis of AD and MCI, the best threshold value of lateral temporal′s SUVR was 1.06. Conclusion:Visual analysis was consistent with SUVR′s qualitative determination during 18F-AV45 PET/CT imaging for brain Aβ deposition, while SUVR quantitative analysis could assist in the differential diagnosis of AD and NC, AD and MCI.
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Objective@#To investigate the metabolic patterns of 11C-2-beta-carbomethoxy-3-beta-(4-fluorophenyl)tropane (CFT) and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in patients with tremor and non-tremor Parkinson′s disease (PD).@*Methods@#From March 2018 to March 2019, 28 PD patients (19 tremor patients: 14 males and 5 females, age: (59.9±11.4) years; 9 non-tremor patients: 3 males and 6 females, age: (62.6±9.0) years) were enrolled. For the two groups, the 11C-CFT uptake values in caudate nucleus, anterior putamen and posterior putamen as well as 18F-FDG uptake values in all brain regions were calculated by regions of interest (ROI) method. Two-sample t test or Mann-Whitney u test were used to analyze the data.@*Results@#Caudate nucleus 11C-CFT uptake in PD patients with tremor was higher than that without tremor (3.03±0.51 vs 2.60±0.62; t=2.687, P<0.05). Yet thalamus glucose uptake of non-tremor PD patients showed more active than tremor patients (1.14±0.05 vs 1.10±0.03; t=3.449, P<0.01). Sorted by modified Hoehn-Yahr stage, tremor patients in advanced stage (stage≥2.5) were characterized by glucose uptake increase in the putamen and cerebellum compared with non-tremor advanced group (1.27±0.04 vs 1.21±0.05, 0.94±0.04 vs 0.86±0.08; t values: 2.695 and 2.492, both P<0.05). Metabolic decrease in the premotor areas was observed in tremor patients in advanced stage compared with early stage (1.07±0.02 vs 1.10±0.03; t=2.053, P<0.05).@*Conclusion@#11C-CFT and 18F-FDG PET/CT imaging can indicate different metabolic patterns between tremor and non-tremor PD, thus providing information for clinical practice and differential diagnosis.
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Objective To investigate the metabolic patterns of 11C-2-beta-carbomethoxy-3-beta-(4-fluorophenyl)tropane (CFF) and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in patients with tremor and non-tremor Parkinson's disease (PD).Methods From March 2018 to March 2019,28 PD patients (19 tremor patients:14 males and 5 females,age:(59.9±11.4) years;9 non-tremor patients:3 males and 6 females,age:(62.6±9.0) years) were enrolled.For the two groups,the 11C-CFT uptake values in caudate nucleus,anterior putamen and posterior putamen as well as 18F-FDG uptake values in all brain regions were calculated by regions of interest (ROI) method.Two-sample t test or Mann-Whitney u test were used to analyze the data.Results Caudate nucleus 11C-CFT uptake in PD patients with tremor was higher than that without tremor (3.03±0.51 vs 2.60±0.62;t =2.687,P＜0.05).Yet thalamus glucose uptake of non-tremor PD patients showed more active than tremor patients (1.14±0.05 vs 1.10±0.03;t =3.449,P＜0.01).Sorted by modified Hoehn-Yahr stage,tremor patients in advanced stage (stage≥2.5) were characterized by glucose uptake increase in the putamen and cerebellum compared with non-tremor advanced group (1.27±0.04 vs 1.21±0.05,0.94±0.04 vs 0.86±0.08;t values:2.695 and 2.492,both P＜0.05).Metabolic decrease in the premotor areas was observed in tremor patients in advanced stage compared with early stage (1.07±0.02vs 1.10±0.03;t=2.053,P＜0.05).Conclusion 11C-CFT and 18F-FDG PET/CT imaging can indicate different metabolic patterns between tremor and non-tremor PD,thus providing information for clinical practice and differential diagnosis.
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Objective To validate the quantitative accuracy of 99Tcm-pertechnetate (99 Tcm O4-)SPECT/CT imaging and its influencing factors (sphere size,radioactive concentration,reconstruction methods).Methods National Electrical Manufacturers Association (NEMA) International Electrotechnical Commission (IEC) body phantom with 99TcmO4-solution filled in 6 spheres (diameter:10,13,17,22,28,37 mm) and 1 cylinder (target/background ratio:10∶1) was used to assess the accuracy of uptake quantification.SPECT/CT was used for imaging data acquisition,and volume of interest (VOI) was drawn after the images being corrected and reconstructed.The radioactive concentrations of 6 spheres were measured and compared with the true radioactive concentrations,and quantitative accuracy of each sphere was calculated.The experiment was repeated for 12 times with the same method and different radioactive concentrations.Ordered-subsets expectation maximization (OSEM) reconstruction was performed with 2 or 5 iterations to process imaging data.CT VOI and nuclear medicine (NM) threshold methods were used for the delineation of VOI.Accuracy was compared by paired t test.Results The NM thresholds to get calculated volume close to the true volume were determined to be 40％,40％,50％,70％,80％,90％ for 6 spheres with diameters of 37,28,22,17,13,10 mm,respectively.Comparing 2 methods of VOI delineation (CT VOI and NM threshold),only the accuracy for 17 mm sphere was significantly different (t=5.89,P＜0.01).Five iterations group showed higher accuracy than 2 iterations group (t values:3.19-6.92,all P＜0.05).The average accuracies under 12 different radioactive concentrations were 102％,95％,80％,66％,27％,20％,respectively,for spheres in order from large size to small size.Conclusion The sphere volume and reconstruction method have effect on quantitative accuracy of 99TcmO4-SPECT/CT imaging,and spheres smaller than 17 mm is also significantly affected by partial volume effect.
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Objective To compare treatment response according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria in patients with colorectal liver metastases (CLM) who received neoadjuvant chemotherapy.Methods A total of 41 CLM patients (27 males,average age 68.48 years;14 females,average age 62.43 years) from January 2010 to September 2013 were included in this retrospective study.PET/CT scan was performed before chemotherapy and after 4-6 cycles′ chemotherapy.The baseline and the sequential follow-up 18F-FDG PET/CT of each patient were evaluated according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria.The response was categorized into 4 levels including CR,PR,SD,PD.PET/CT images were used for both metabolic and anatomic evaluation.The concurrent diagnostic CT or MRI images (performed within 1 week of PET/CT) were also utilized when needed.The agreements of criteria were analyzed using Kappa test.The response rate (RR) and disease control rate (DCR) were compared using χ2 test.Results The RR and DCR according to the PERCIST1.0,EORTC and RECIST1.1 criteria were 31.71％(13/41) and 63.41％(26/41),31.71％(13/41) and 60.98％(25/41),17.07％(7/41) and 68.29％(28/41),respectively.The general comparison of PERCIST1.0 and RECIST1.1,EORTC and RECIST1.1 criteria showed good agreements (κ values: 0.711,0.689).Significant difference was not found in the DCR(χ2=2.000,P>0.05) but found in the RR(χ2=6.000,P0.05),while the RR had significant difference(χ2=6.000,P0.05) but found in the RR(χ2=8.000,P<0.05) between PERCIST1.0 and WHO criteria.Conclusions In evaluating CLM treatment response,anatomical criteria and metabolic criteria have a good consistency.But metabolic criteria are more sensitive for RR evaluating.
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Objective To evaluate the predictive value of tumor metabolic indexes measured by 18F-FDG PET/CT in recurrence of stage Ⅰ NSCLC after surgery.Methods A total of 85 patients (44 males,41 females,age (62.46± 10.38) years) in Shanghai Renji Hospital with stage Ⅰ NSCLC,who underwent 18F-FDG PET/CT and subsequent surgical resection,were retrospectively enrolled from April 2006 to December 2011.Gender,age,tumor size,pathology,SUVmax,MTV and TLG of the primary tumor were selected as variables.ROC curve analysis was used to analyze the cut off value.The prognostic significance of parameters for recurrence-free survival (RFS) was evaluated by univariate and multivariate analyses.Survival analysis was analyzed by Kaplan-Meier method.Results During follow-up period,tumor recurrence occurred in 21 patients (24.7％,21/85) and 11 patients (12.9％,11/85) died.The median follow-up period was 44 months.The median values of SUVmax,MTV and TLG were 4.100,3.048 cm3 and 7.970,respectively.Cut off values of SUVmax,MTV and TLG were 7.115,4.701 cm3 and 12.015 according to ROC curve analysis.Univariate Cox analysis showed that SUVmax(x2 =22.091),MTV (x2 =4.941) and TLG(x2 =10.488) were associated with RFS(all P＜0.05).But gender,age,tumor size,and pathology were not independent risk factors of recurrence (x2=0.248-3.888,all P＞0.05).Multivariate Cox analysis revealed that SUVmax(=16.902,HR=15.426,P＜0.05) and TLG (x2=6.029,HR=4.054,P＜0.05) were independent prognostic factors for recurrence.Kaplan-Meier survival analysis showed that the period of RFS in high SUVmax (＞ 7.115) group (x2=32.545,P＜0.05) and in high TLG (＞12.015) group (x2=12.665,P＜0.05) were lower than those in low SUVmax group and low TLG group.Conclusion The SUVmax and TLG measured by 18F-FDG PET/CT have significant value for predicting the recurrence of stage Ⅰ NSCLC.