Relationship between metabolic parameters of 18F-FDG PET-CT and clinical characteristics in newly diagnosed multiple myeloma / 白血病·淋巴瘤

Objective:To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and clinical characteristics in newly diagnosed patients with multiple myeloma (MM). Methods:The clinical data of 47 MM patients who underwent 18F-FDG PET-CT at initial diagnosis from June 2018 to December 2020 in the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The association of metabolic parameters of 18F-FDG PET-CT with the following clinical parameters including age, gender, disease classification, DS stage, international staging system (ISS) stage, hemoglobin, albumin, serum calcium, serum crearinine, lactate dehydrogenase, β 2-microglobulin, high-sensitivity C-reactive protein (hs-CRP), bone marrow plasma cell ratio, the number of lesions and extramedullary lesions. Results:Among 47 MM patients, in terms of tumor metabolic volume (MTV), patients at DS stage Ⅲ was higher than those at stage Ⅰ-Ⅱ [172.88 (42.69, 391.55) vs. 19.63 (4.24, 42.61), P < 0.001], patients with serum calcium ≥ 2.65 mmol/L was higher than those with serum calcium <2.65 mmol/L [310.71 (99.68, 549.62) vs. 58.00 (19.63, 248.34), P = 0.038], patients with hs-CRP ≥ 3.3 mg/L was higher than those hs-CRP < 3.3 mg/L [211.39 (57.79, 397.70) vs. 35.34 (7.91, 153.02), P = 0.002], and patients with the number of lesions >3 was higher than those with the number of lesions ≤ 3 [211.39 (57.79, 393.02) vs. 16.43 (5.12, 38.23), P < 0.001]. In terms of total lesion glycolysis (TLG) value, patients at DS stage Ⅲ was higher than those at stage Ⅰ-Ⅱ [460.44 (92.62, 1 113.85) vs. 46.68 (9.32, 89.89), P = 0.001], patients with bone marrow plasma cell ratio <10% was higher than those with bone marrow plasma cell ratio ≥10% [1 039.36 (615.28, 1 167.80) vs. 150.80 (45.36, 821.01), P = 0.031], patients with serum calcium ≥ 2.65 mmol/L was higher than those with serum calcium < 2.65 mmol/L [1 031.55 (251.87, 2 115.98) vs. 177.59 (45.82, 761.66), P = 0.033], patients with hs-CRP ≥ 3.3 mg/L was higher than those hs-CRP < 3.3 mg/L [487.40 (141.38, 1 107.02) vs. 63.44 (19.40, 634.31), P = 0.003], patients with lesion number >3 was higher than those with lesion number ≤3 [625.32 (150.80, 1 134.35) vs. 40.04 (10.96, 70.88), P < 0.001]. There were no statistically significant differences in the maximum standardized uptake value (SUV max) and mean standardized uptake value (SUV mean) among different clinical parameter groups (all P > 0.05). Conclusion:MTV and TLG in 18F-FDG PET-CT metabolic parameters can better reflect the characteristics of MM patients compared with SUV max and SUV mean.

Value of 18F-FDG PET/CT Imaging in Secondary Extramedullary Infiltration of Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the characteristics of 18F-FDG PET/CT images of multiple myeloma secondary extramedullary infiltration in order to improve recognition.@*METHODS@#Twenty-one patients with multiple myeloma secondary extramedullary infiltration confirmed by pathology or follow-up from January 2012 to October 2020 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. All the patients underwent 18F-FDG PET/CT imaging before treatment, and the PET/CT characteristics of extramedullary infiltration and bone marrow were analyzed.@*RESULTS@#Twenty-one patients included 12 males and 9 females, aged from 41 to 77 years old, with an average of 58.3±10.0; 9 cases of extramedullary infiltration involving lymph nodes; lung, stomach, spleen, and kidney were involved respectively in 2 cases; retroperitoneal, right auricle, subcutaneous nodule, and spinal meninges involvement were reported in each one case respectively. The maximum SUVmax value of extra-medullary lesions was 21.2, the minimum value was 2.1, and mean was 7.7±5.3. The maximum SUVmax value of bone marrow was 33.5, the minimum was 2.4, and mean was 6.6±3.6. There was no statistically significant difference in SUVmax value between extra-medullary lesions and bone marrow (Z=-1.195, P=0.232).@*CONCLUSION@#18F-FDG PET/CT not only has a good diagnostic value for multiple myeloma, but also a good evaluation value for secondary extramedullary infiltration, which provides reference for clinical treatment and prognosis.

The prognostic significance of the 18F-fluorodeoxyglucose positron emission tomography/computed tomography in early-stage nonsmall cell lung cancer

Context: The prognostic criteria for early-stage nonsmall cell lung cancer (NSCLC) wait to be explored. Aim: In this study, our aim was to evaluate the prognostic significance of the positron emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) value of the primary tumor in patients with a diagnosis of early-stage NSCLC who received surgical treatment. Settings and Design: This was a multicenter retrospective design. Materials and Methods: Patients who had been diagnosed with early-stage NSCLC and who underwent surgery for the condition were included in this study. The preoperative fluorodeoxyglucose (18F-FDG) PET/CT results of the patients were retrospectively accessed from their medical files. The disease-free survival (DFS) rates of patients who had SUVmax values above and below the determined cutoff value were compared. Statistical Analysis Used: SPSS version 22 and Kaplan–Meier method were used for statistical analysis. Results: A total of 92 patients were included in the study. The median age of the patients was 60 years (range: 36–79). The determined cutoff SUVmax value of the primary tumor was 13.6. A comparison of the DFS rates of the patients with an SUVmax value above and below 13.6 revealed a significant difference in patients with Stage I (22.9 months vs. 50.3 months; P = 0.02) and Stage II (28 months vs. 40.4 months; P = 0.04), Stage I + II (43.5 months vs. 26.1 months; P = 0,02), and Stage IIIA (14.7 months vs. 13.6 months; P = 0.92) NSCLC. Conclusions: We found that in early-stage NSCLC patients, the SUVmax value of the primary mass in 18F FDG PET/CT was a prognostic indicator for the DFS rates

Impact of 18F-FDG PET/CT on the staging of patients with non-small cell lung cancer

Background: Non-small cell lung cancer (NSCLC) accounts for approximately 80% of new diagnoses of pulmonary carcinoma. This study investigated the correlation between 18 F-fluorodeoxyglucose uptake in computerized tomography integrated positron emission tomography and tumor size, lymph node metastasis, and distant metastasis in patients with NSCLC.Methods: The records of 318 NSCLC patients (220 male, 98 females; mean age 60.94 years) were evaluated retrospectively.Results: 278 cases were adenocarcinomas; 28 squamous cell carcinomas; and 12 large cell carcinoma. When the cases were categorized according to tumor size (group 1, ≤3 cm; group 2, >3 and ≤5 cm; group 3, >5 cm), the maximum standardized uptake value (SUVmax) was significantly lower in groups 1 and 2 compared with group 3 (p<0,001 for each). Considering all cases, tumor SUVmax was not correlated with age, gender or histopathological type. Lymph node metastases were seen in 250 cases: 80.2% of these were adenocarcinomas, 71.4% squamous cell carcinomas, and 58.3% large cell carcinomas. Neither lymph node involvement nor distant metastases were correlated with tumor SUVmax, although lymph node size was positively correlated with lymph node SUVmax (r=0.758; p<0.001).Conclusions: SUVmax was significantly associated with tumor size, but not with distant metastases or lymph node involvement. Therefore, SUVmax on positron emission tomography is not predictive of the presence of metastases.

Can positron emission tomography - computed tomography imaging predict of metastases in patients with small cell lung cancer

Background: Small-cell lung cancer (SCLC) accounts for 15%-20% of all lung cancer cases. positron emission tomography - computed tomography (PET/CT) has become increasingly used as an initial staging tool in patients with SCLC. We aimed to explore the relationships between primary tumor 18F-FDG uptake measured as the maximum standardized uptake value (SUV max) and clinical stage at PET/CT for small cell lung cancer patients (SCLC).Methods: Patients with SCLC who underwent 18F-FDG PET/CT scans before the treatment were included in the study at Bach Mai hospital of Vietnam, from November 2014 to May 2018. The primary tumor and secondary lesion SUVmax was calculated; the tumor size was measured; the TNM status was determined mainly by FDG PET/CT imaging according to The 8th Edition of the TNM Classification for Lung Cancer were recorded. An evaluation was made of the linear relationship between tumor size, T stage, N stage, and M stages of the patients and their SUVmax using Spearman’s correlation.Results: Total 37 cases (34 men and 3 women; age range 38 - 81 years, median 64 years) were analyzed. The average of primary tumor size and SUVmax were 5.95±2.77 cm and 10.21±4.75, respectively. The SUVmax of primary tumor is significantly greater than that of nodal and distant organ metastasis (10.21±4.75 vs 8.20±4.35 and 6.44±3.17, p<0.01). There was a moderate correlation between SUVmax and tumor size (r =0.596, p<0.001), tumor stage (r = 0.502, p<0.01) but not significant with nodal stage (r =-0.218, p=0.194), metastasis stage (r = -0.055, p=0.747), and overall stage (r=-0.060, p=0.725).Conclusions: SUVmax was significantly correlated with tumor size, but not with distant metastases or lymph node involvement. Therefore, SUVmax on positron emission tomography is not predictive of the presence of metastases in patients with SCLC.

Correlations between maximum standardized uptake value measured via 18F-fluorodeoxyglucose positron emission tomography/computed tomography and clinical variables and biochemical indicators in adult lymphoma

Objectives: The aim of the current study was to investigate whether the maximum standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) could discriminate between aggressive and indolent non-Hodgkin lymphomas (NHLs) and correlations between the SUVmax and clinical variables and serum biochemical indicators in adult lymphoma. Methods: A total of 103 patients with lymphoma confirmed by biopsy, pretreatment 18F-FDG PET/CT scans, and a complete medical record were retrospectively enrolled in the study. Clinical variables that were evaluated included stage, pathological subtype, International Prognostic Index (IPI) score, and Ki-67 index, as well as serum biochemical indicators (e.g., lactate dehydrogenase [LDH] and erythrocyte sedimentation rate [ESR]) and metabolic parameters (e.g., SUVmax of the biopsy site on PET/CT). Correlations between SUVmax and clinical variables and serum biochemical indicators were investigated. Results: Of the 103 patients, 84 had NHL and 19 had Hodgkin lymphoma. The area under the receiver operating characteristic curve for examining the accuracy of SUVmax with regard to distinguishing between aggressive and indolent NHLs was 0.94 (95% confidence interval: 0.89–0.99), suggesting that SUVmax was a useful predictor of diagnosis. A cutoff value of 8.5 yielded a sensitivity of 76.3% and specificity of 92.0%. The SUVmax mean ± standard deviation of NHL (9.8 ± 6.0, range: 1.8–28.1) was higher than that of HL (7.5 ± 2.8, range: 3.5–13.9) (P = 0.016), but there was no statistically significant difference in SUVmax between NHL and HL (P > 0.05). SUVmax of the biopsy site was strongly positively correlated with Ki-67 index (r = 0.813, P < 0.001) and moderately positively correlated with IPI score (r = 0.332, P = 0.002), but it was not significantly correlated with clinical stage, LDH, or ESR (P > 0.05). Conclusions: 18F-FDG PET/CT may yield reliable measurements of tumor proliferation, and an SUVmax >8.5 may distinguish between aggressive and indolent NHLs. In adults with newly diagnosed lymphoma, SUVmax correlates with Ki-67 index and IPI score

Correlation of PET/CT metabolic makers with expression of immune cell markers in patients with lung adenocarcinoma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate the relationship between 18F-FDG PET/CT metabolic indicators and expression of immunocyte markers in lung adenocarcinoma patients, and to explore its significance in treatment and prognosis prediction for lung adenocarcinoma patients.Methods:Theclinicaldataof85lungadenocarcinomapatients,whoadmittedtoTianjinMedicalUniversityCancerInstituteand Hospital and underwent PET/CT examination from April 2008 to August 2014, were retrospectively analyzed. The expression levels of CD3, CD8, CD68, CD163, CD11c, Foxp3, PD-1 and PD-L1 were determined by immunohistochemistry. Correlations among immune markers (CD68+TAM), PET/CT metabolic parameters (SUVmax, SUVpeak and SUVmean) and tumor metabolic indicators (MTV , TLG) were analyzed using Pearson correlation analysis.The relationships between tumor metabolism, immune indicators and patients’survival outcomes were analyzed using the Kaplan-Meier method. Results: There was a remarkably negative correlation between SUVmax, SUVpeak, SUVmean and expression level of CD68+TAMs(r=-0.253,-0.265,-0.263,allP<0.05)butpositivecorrelationwithPD-1+TILs (r=0.427, 0.402, 0.395, all P<0.01) in lung adenocarcinoma patients. MTV and TLG were positively associated with Foxp3+ Tregs and PD-1+ TILs (r=0.313, 0.307, 0.29, 0.407, all P<0.01). Kaplan-Meier survival analysis showed that SUVmax, SUVmean, CD11c+DCs, PD-L1+ cells and TLG were all significantly associated with patients’prognosis (PFS or OS) (all P<0.05). Conclusion: Metabolism of tumor primary lesions is significantly correlated with tumor infiltrating immunocytes, and some of these indicators were associatedwithpatients’prognosis, suggesting that tumor metabolism and microenvironment immune status reflected by 18F-FDG PET/CTindicatorsmay have important reference value fortheimmunotherapyandprognosispredictionoflungadenocarcinoma patients.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age (63.1 ± 4.9) and baseline PSA (72.71 ± 173.15) ng/ml were enrolled.Their BMI mean (24.6 ± 3.0) kg/m2.Baseline testosterone of 14 patients was (4.72 ± 1.64) ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49 ± 9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D'Amico classification.Based on the basis of PSA(≤ 10 or ＞ 10) and Gleason score (≤6 or ＞ 6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP (r =0.434,P =0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli (14.78 ± 10.68 vs.8.17 ± 2.81,P =0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P =0.033) and the sensitivity was 88.9％.The specificity was 77.3％ when SUVmax ≥ 11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01 ± 5.40 vs.4.98 ± 2.11,P =0.007).Conclusions SUVmax measured on preoperative 68 Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

Preoperative assessment of malignant potential of gastrointestinal stromal tumor by dual-time-point 18F-fluorodeoxyglucose positron emission tomography imaging: Usefulness of standardized uptake value and retention index

Background: To evaluate the usefulness of preoperative imaging with F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for noninvasive risk assessment of gastrointestinal stromal tumor (GIST). Materials and Methods: A retrospective review including 32 patients with pathologically proven GIST. Preoperative FDG-PET scan results including maximum standardized uptake values (SUVs) of the GISTs at 1 h postinjection (SUV1) were available for all tumors and SUVs at 2 h postinjection (SUV2) were available for 22 tumors. When both SUV1 and SUV2 were available, a retention index (RI, %) was calculated, and the correlation of these PET parameters with the histopathologic results was analyzed. Results: SUV1 was significantly higher in tumors in the high-risk group (6.0 ± 2.7) compared to those in the low risk (3.0 ± 1.6) or very low-risk (2.7 ± 1.2) groups (P = 0.009 and 0.011, respectively). At a cutoff of 5.2, the SUV1 demonstrated sensitivity of 80% and a specificity of 89% for predicting high-risk GISTs. Tumor size was significantly correlated with SUV1 (r = 0.68, P < 0.001) and SUV2 (r = 0.66, P = 0.001), and SUV1, SUV2, and RI were significantly higher in tumors with mitotic index > 5/50 high-power field than in those with lower mitotic index. RI was significantly higher in tumors with C-kit mutation than in those with no C-kit mutation. Conclusion: SUV1 measured during preoperative FDG-PET imaging correlated well with malignant potential of GISTs, especially for high-risk versus Low-/very-low-risk tumors. RI values correlated well with mitotic counts and C-kit mutation, suggesting that this mutation may have some influence on tumor metabolism

Maximum standardized uptake value at pre-treatment PET in estimating lung cancer progression after stereotactic body radiotherapy

PURPOSE: This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. RESULTS: The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progressionfree survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). CONCLUSION: SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.

Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative ¹⁸F-FDG PET/CT / 대한핵의학회잡지

PURPOSE: This study evaluated the usefulness of semiquantitative and volumetric PET parameters for predicting prognosis in patients with advanced gastric cancer (AGC).METHODS: We enrolled 213 patients who underwent ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) prior to curative surgery for AGC. Maximum standardized uptake value (SUVmax) and tumor-to-liver uptake ratio (TLR) were measured in all patients. Metabolic tumor volume (MTV) and total lesion glycolysis were measured in volume-measurable patients. For further quantification of FDG uptake, we developed PET prognostic scores by combining SUVmax and MTV (1: low SUVmax/low MTV; 2: high SUVmax/low MTV; 3: high SUVmax/high MTV). Comparison of PET parameters between recurrence and non-recurrence groups was performed. Univariate and multivariate analyses for recurrence-free survival (RFS) and overall survival (OS) were subsequently performed.RESULTS: The recurrence rate was 32.4% (69/213 patients). Mean SUVmax and mean MTV of the recurrence group were significantly higher than those of the non-recurrence group (p = 0.026 and p = 0.025). TLR showed marginal significance (p = 0.051). In multivariate analysis for RFS including all patients, SUVmax (p = 0.022), TLR (p = 0.010), and PET score (p = 0.003) were independent prognostic factors. In post hoc analysis of PET score, significant differences in RFS were observed between PET scores 2 and 3 as well as scores 1 and 3. No significant difference in RFS was observed between scores 1 and 2. Only PET score was statistically significant for OS in univariate analysis. None of the PET parameters were statistically significant for OS in multivariate analysis.CONCLUSION: High SUVmax and high MTV of the primary tumor suggest a high risk of recurrence for AGC patients. Even if SUVmax is similar, the prognosis may vary depending on MTV. Combining PET parameters results in a better prediction for prognosis.

Minimum Standardized Uptake Value from Quantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography for Evaluation of Femoral Head Viability in Patients with Femoral Neck Fracture / 대한핵의학회잡지

PURPOSE: Bone single-photon emission computed tomography/computed tomography (SPECT/CT) has been widely used for evaluation of femoral head viability in patients with femoral neck fracture. The current study aimed to investigate utility of standardized uptake value (SUV) from quantitative bone SPECT/CT for assessment of femoral head viability.METHODS: From March 2015 to November 2018, quantitative bone SPECT/CT was performed in 9 patients with non-viable femoral head post femoral neck fracture and in 31 controls. Maximum (SUV(max)), mean (SUVmean), and minimum standardized uptake values (SUVmin) were measured over femoral head and neck. Mann-Whitney U test with Bonferroni correction was used to compare SUVs of ipsilateral and contralateral femurs from femoral neck fracture patients with those of control femurs.RESULTS: As for femoral head viability, SUV(max) and SUVmean were not significantly decreased in non-viable femoral heads compared to those in controls. Only the SUVmin was significantly reduced in non-viable femoral heads (mean ± standard deviation, 0.57 ± 0.38) than in controls (0.95 ± 0.26, p = 0.006) and contralateral femoral heads (1.36 ± 0.59, p = 0.008). The cutoff SUVmin of 0.61 (g/mL) yielded a sensitivity of 77.8% and specificity of 87.1% for detection of non-viable femoral heads (p = 0.006). Contralateral femoral necks of the femoral neck fracture patients showed significantly higher SUVmean and SUVmin (3.17 ± 1.20 and 1.64 ± 0.63) than those of controls (2.32 ± 0.53 and 1.04 ± 0.27; p = 0.021 and p = 0.002, respectively), which seemed to reflect weight bearing effect or metabolic derangement.CONCLUSIONS: The non-viable femoral heads from the femoral neck fracture showed significantly reduced SUVmin. Quantitative bone SPECT/CT holds promise for objective evaluation of femoral head viability.

Impact of syringe saline flush after injection of 18F-FDG on residual dose and standardized uptake value of liver / 中国医学影像技术

Objective: To investigate the impact of saline flush for syringe after 18F-FDG injection on the residual dose of 18F-FDG and the standardized uptake value (SUV) of liver during PET/CT examination. Methods: A total of 50 patients who underwent PET/CT examination were enrolled and divided into control group (n=25) and experimental group (n=25) according to different injection methods. Device system of the vein passage was established with 23 gauge scalp needle. In control group, the intravenous line was directly flushed with 5 ml physiological saline after 18F-FDG injection, while in experimental group, firstly the intravenous line was flushed with 1 ml saline, then the syringe was flushed with 2 ml saline, finally the intravenous line was flushed again with the residual 2 ml saline. The residual dose of 18F-FDG and SUVmean and SUVmax of liver were compared between the two groups. Results: The total residual dose ([0.22±0.08]mCi), syringe residual dose ([0.19±0.07]mCi) and intravenous channel residual dose ([0.03±0.02]mCi) in the experimental group were all lower than those in control group (all P0.05). Conclusion: Flushing the syringe can reduce residual dose of 18F-FDG injection. A small amount of radiopharmaceuticals retention in the syringe may not affect SUV for liver, but further standardization of the operation process of 18F-FDG injection is still necessary.

18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study

Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.

Evaluation of Hot Nodules of Thyroid Gland Using Tc-99m Pertechnetate: a Novel Approach Using Quantitative Single-Photon Emission Computed Tomography/Computed Tomography / 대한핵의학회잡지

Planar scintigraphy using Tc-99mpertechnetate is useful for snapshot evaluation of hot thyroid nodules, which are pathologically follicular adenoma and seldom, if ever, malignant. The autonomy of the hot nodules has been demonstrated by the presence of thyroid-stimulating hormone-dependent extra-nodular thyroid tissue besides the hot nodules. Here, we present two cases of hot thyroid nodules in patients who underwent quantitative single-photon emission computed tomography/computed tomography (SPECT/CT). In addition to the nodules, contralateral normal thyroid parenchyma was evaluated based on standardized uptake values. One patient had a traditional follicular adenoma suppressing other thyroid tissue, whereas the other patient seemed to have a nodule erupting from underlying hyperfunctioning, not suppressed, thyroid tissue. This novel approach using quantitative SPECT/CT unveils a new pathology of hot thyroid nodule that does not suppress, but coincides with hyperfunctioning thyroid tissue.

Prognostic value of PD-L1 expression in non-small cell lung carcinoma and its associa-tion with SUVmax / 中国肿瘤临床

Objective:Previous studies have shown an association between programmed death-ligand 1 expression(PD-L1)in non-small cell lung cancer(NSCLC)and clinical factors and that PD-L1 is positively correlated with TNM staging.This study aimed to explore the prognostic significance of PD-L1 and its correlation with the maximum standardized uptake value(SUVmax).Methods:Clinicopath-ological data and the follow-up information of the 122 de novo primary NSCLC patients were analyzed.PD-L1 expression was detected by immunohistochemistry in this 122 surgically resected non-small cell lung carcinoma tissues.Survival outcomes were analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model.Correlation between SUVmax and PD-L1 expression was analyzed using Spearman's rank correlation analysis.Results:Multivariate analysis revealed that PD-L1 expression(HR=4.518,95% CI:1.176-17.352,P=0.028)and tumor size(HR=1.404,95%CI:1.020-1.933,P=0.037)were independent risk factors for overall survival(OS) in early NSCLC patients.Sex,age,pathological type,CEA level,and SUVmax group had no obvious effect on OS(P 0.05)in early NSCLC patients.In univariate analyses,sex,pathological type,tumor size,and SUVmax group affected OS in stageⅢ-ⅣNSCLC patients.How-ever,age,CEA level,and PD-L1 expression had no effect on OS.PD-L1 expression was not an independent risk factor for OS in stageⅢ-ⅣNSCLC patients.The SUVmax group had no association with PD-L1 in all patients.Conclusions:PD-L1 expression is an independent risk factor for OS in early NSCLC patients but not in stageⅢ-Ⅳpatients.

Study of the relationship between brain injury and glucose metabolism in rat model of cardiac arrest / 中华急诊医学杂志

Objective To determine the relationship between brain injury and cerebral glucose metabolism in rat model of cardiac arrest. Methods Asphyxia-induced cardiac arrest model was established. Forty-two male Wistar rats were randomly assigned to sham or experimental groups. Rats in the CA4,CA6 and CA8 group were treated with cardiopulmonary resuscitation(CPR) 4 min, 6 min and 8 min after cardiac arrest, respectively. The maximum standardized uptake value (SUVmax) of glucose was detected by PET, and neural defi cit score (NDS) were evaluated at 24 h and 72 h after ROSC. The numbers of injured neurons and apoptotic cells and the protein level of hexokinase I (HXK I) were measured at 72 h after ROSC. Results SUVmax, NDS and the level of HXK I were all decreased after ROSC, and interestingly, this declination of these markers was correlated with the prolongation of the duration of CA, the longer duration of CA the more declination of these biomarkers. Accordingly, the number of injured neurons and apoptotic cells increased were correlated with duration of CA, and thus CA8 group had greater numbers of those cells than CA6 group and CA4 group (P<0.05),and CA6 group had greater numbers of those cells than CA4 group(P<0.05). In addition, the SUVmaxwas positively correlated with NDS(P<0.05), and negatively correlated with the numbers of injured neurons and apoptotic index(P<0.05). Conclusions The degree of brain injury is associated with cerebral glucose metabolism, and PET may become a novel method to assess the severity of brain damage after CA.

Value of 18F-FDG PET/CT in diagnosis of single space-occupying lesion of the liver / 中国肿瘤临床

Objective: To evaluate the diagnostic value of PET/CT in single space-occupying lesion of the liver hepatic disease. Meth-ods: Data of 177 patients from Tianjin Medical University Cancer Institute and Hospital between March 2012 and September 2017 with a single hepatic space-occupying lesion who had undergone 18F-FDG PET/CT were collected. CT values and the long and short di-ameters were measured in PACS system. A post-processing workstation was employed, and PETVCAR software was used to automati-cally measure the standardized uptake value (SUV) of the focal and the normal liver tissue. Afterward, T (SUV of the focal)/N (SUV of the normal liver tissue) ratios were calculated. Then, the diagnostic value of various parameters for different pathological types was an-alyzed. The correlation between two continuous variables was calculated using Pearson analysis. Results: The long and short diame-ters of the primary hepatic carcinoma were significantly larger than those of metastatic lesions (P<0.05). The positive rates of hepato-cellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and metastases were 67.6%, 95.2%, and 98.7%, respectively. All meta-bolic parameters of HCC were significantly lower than those of the other pathological types of liver cancer or metastases (P<0.05). The AUCs for diagnosis of ICC and metastases were higher than 0.5, but there was no statistical difference between the AUCs of different SUVs. Moreover, SUVmax was related to lesion size (r=0.535, P<0.001). Conclusions: 18F-FDG PET/CT has a high positive predictive val-ue and effective diagnostic function for ICC and metastasis, and the diagnostic efficacy for both is higher than that for HCC.

Observation and measurement of silicosis animal model by PET-CT / 中国职业医学

OBJECTIVE: To explore the feasibility of dynamic observation and measurement of living silicosis rat model by using small animal positron emission tomography( PET)-computed tomography( CT). METHODS: Specific pathogens free SD rats were divided into model group and control group. The silicosis rat model was established by one-time endotracheal injection of 30 g/L silica suspension,while the control group rats were injected of isopyknic 0. 9% sodium chloride solution. Six rats from each group were randomly selected for CT scan from 1st,2nd,3rd,4th,6th,8th and 12 th week after silica injection using the small animal PET-CT. CT value and standardized uptake value( SUV) of18F-fluorodeoxyglucose were measured. Lung tissue was collected for pathological sections. The levels of hydroxyproline( HYP) of lung tissue and serum transforming growth factor β1( TGF-β1) and interleukin-1( IL-1) were measured.RESULTS: Pathological sections of rats of model group showed inflammatory exudation,inflammation reduced and fibrosis increased with extended time. The results are identical with findings in PET-CT. Lung SUV of rats in model group in the1st-3rd weeks were higher than that in control group in the same time point( P < 0. 05) and decreased by the increasing time during the 1st-4 th weeks of dust injection( P < 0. 05). Lung CT values of model group in the 1st-12 th weeks were higher than that of control group in the same 7 time points( P < 0. 05) and decreased in the 1st-6th weeks and then increased in the 6th-12th weeks by the increasing time of dust injection( P < 0. 05). Lung coefficients and HYP levels of model group in the 7 time points were higher than that of control group in the same 7 time points( P < 0. 05). Lung coefficients decreased in 1st-4th weeks and lung HYP levels increased in 6th-12th weeks with the increasing time of dust injection( P < 0. 05). Excepted of the 3rd and 4th weeks,serum TGF-β1 levels of model group in other 5 time-points were higher than that of control group in the same 5 time points( P < 0. 05) and decreased in the 1st-4th weeks( P < 0. 05)then increased in the 4th-8th weeks( P < 0. 05) by the increasing time of dust injection. Serum IL-1 levels of model group in the 1st-4th weeks were higher than that of control group in the same 4 time points( P < 0. 05) and decreased by the increasing time of dust injection( P < 0. 05) and decreased by the increasing time of dust injection( P < 0. 05).CONCLUSION: Early inflammation and terminal fibrosis of living silicosis rat model could be observed effectively by small animal PET-CT,which can be used as a new approach for dynamic tracing silicosis in rat models.