Causes of False-Positive Results in 68Ga-Labeled Fibroblast Activation Protein Inhibitor PET/CT Imaging / 中国医学科学院学报

Objective To investigate the causes of false-positive results in the 68Ga-labeled fibroblast activation protein inhibitor (68Ga-FAPI-04) PET/CT imaging. Methods The imaging data of 547 patients undergoing 68Ga-FAPI-04 PET/CT examination in the Department of Nuclear Medicine of the Affiliated Hospital of Southwest Medical University from September 2020 to May 2021 were retrospectively collected.Two experienced nuclear medicine diagnostic physicians analyzed the clinical data,relevant imaging examinations,laboratory examinations,pathological results and follow-up results of the patients with false-positive results. Results The 68Ga-FAPI-04 PET/CT imaging of 547 patients showed false-positive results in 99 (18.1%) patients,including 56 males and 43 females.The postoperative pathological examination confirmed false-positive results in 13 patients,including 1 patient of thyroiditis,2 patients of pulmonary tuberculosis,1 patient of bone tuberculosis,2 patients of pulmonary inflammatory pseudotumor,1 patient of pulmonary sarcoidosis,1 patient of pulmonary benign fibroma,1 patient of organic pneumonia,2 patients of renal angiomyolipoma,1 patient of mass pancreatitis,and 1 patient of pancreatic mucinous cystadenoma.The medical history,relevant imaging examination,and long-term follow-up confirmed false-positive results in 86 patients.Specifically,the false-positive uptake in the neck,chest,abdomen,bone joint,and skin occurred in 8 (9.3%),13 (15.1%),5 (5.8%),57 (66.3%),and 3 (3.5%) patients,respectively.Inflammation-related uptake appeared in 83 (83.8%) patients with false-positive imaging results,of which arthritis (23 patients) and osteophyte (29 patients) were the most common.Sixteen (16.2%) patients showed the false-positive uptake related to fibroblasts. Conclusion 68Ga-FAPI-04 PET/CT imaging will show non-malignant tumor false-positive results,which are mainly associated with inflammation and fibroblasts.

Clinical Analysis of Pulmonary Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To study the clinical, imaging, and pathological features of pulmonary lymphoma.@*METHODS@#Patients with pulmonary lymphoma diagnosed by lung biopsy in Zhongda Hospital Affiliated to Southeast University from November 2013 to December 2020 were collected and divided into secondary pulmonary lymphoma (SPL) group and primary pulmonary lymphoma (PPL) group according to the primary site of lymphoma. The clinical characteristics, stages, imaging features, diagnostic methods and pathological types of the two groups were analyzed.@*RESULTS@#A total of 22 patients were included, 10 cases were PPL and 12 cases were SPL. The main symptoms of the two groups were cough, dyspnea and chest pain. The proportion of stage III/IV patients and international prognostic index (IPI) in SPL group were significantly higher than those in PPL group (P<0.05). Chest high-resolution computed tomography (HRCT) mainly showed masses, nodules and consolidation in both groups. The proportions of single mass and air bronchial sign in PPL group were significantly higher than those in SPL group, while the proportions of multiple nodules, mediastinal/hilar lymphadenopathy and pleural effusion were significantly lower (P<0.05). The max standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in PPL group were lower than those in SPL group, but the differences were not statistically significant (P>0.05). In PPL group, 8 cases were diagnosed by transbronchial lung biopsy (TBLB) and 2 cases by percutaneous lung puncture. In SPL group, 4 cases were diagnosed by TBLB, 7 cases by percutaneous lung puncture, and 1 case by surgery. 95.5% patients were diagnosed by non-surgical methods. The main pathological type of PPL was mucosa-associated lymphoid tissue (MALT) lymphoma, while that of SPL was diffuse large B-cell lymphoma (P<0.05).@*CONCLUSION@#The clinical symptoms of pulmonary lymphoma are nonspecific, but the chest HRCT has characteristic manifestations, which can also help to distinguish between SPL and PPL. 18F-FDG PET/CT is also a potential method to distinguish between SPL and PPL. TBLB and percutaneous lung puncture biopsy are reliable methods for the diagnosis of lung lymphoma. The main pathological type of PPL is MALT lymphoma, while that of SPL is diffuse large B-cell lymphoma.

Predictive value of the proportion of hibernating myocardium in total perfusion defect on reverse remodeling in patients with HFrEF underwent coronary artery bypass graft / 中华心血管病杂志

Objective: To evaluate the predictive value of the proportion of hibernating myocardium (HM) in total perfusion defect (TPD) on reverse left ventricle remodeling (RR) after coronary artery bypass graft (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) by 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with 18F-flurodeoxyglucose (FDG) gated myocardial imaging positron emission computed tomography (PET). Methods: Inpatients diagnosed with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2016 to January 2022 were prospectively recruited. MPI combined with 18F-FDG gated PET was performed before surgery for viability assessment and the patients received follow-up MPI and 18F-FDG gated PET at different stages (3-12 months) after surgery. Δ indicated changes (post-pre). Left ventricular end-systolic volume (ESV) reduced at least 10% was defined as RR, patients were divided into reverse remodeling (RR+) group and the non-reverse group (RR-). Binary logistic regression analysis was used to identify predictors of RR. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to assess the cut-off value for predicting RR. Additionally, we retrospectively enrolled inpatients with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2021 to January 2022 as the validation group, who underwent MPI and 18F-FDG gated PET before surgery. Echocardiography was performed before CABG and after CABG (3-12 months). In the validation group, the reliability of obtaining the cut-off value for the ROC curve was verified. Results: A total of 28 patients with HFrEF (26 males; age (56.9±8.7) years) were included in the prospective cohort. HM/TPD was significantly higher in the RR+ group than in the RR- group ((51.8%±17.9%) vs. (35.7%±13.9%), P=0.016). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of RR (Odds ratio=1.073, 95% Confidence interval: 1.005-1.145, P=0.035). ROC curve analysis revealed that HM/TPD=38.3% yielded the highest sensitivity, specificity, and accuracy (all 75%) for predicting RR and the AUC was 0.786 (P=0.011). Meanwhile, a total of 100 patients with HFrEF (90 males; age (59.7±9.6) years) were included in the validation group. In the validation group, HM/TPD=38.3% predicted RR in HFrEF patients after CABG with the highest sensitivity, specificity and accuracy (82%, 60% and 73% respectively). Compared with the HFrEF patients in the HM/TPD<38.3% group (n=36), RR and cardiac function improved more significantly in the HM/TPD≥38.3% group (n=64) (all P<0.05). Conclusions: Preoperative HM/TPD ratio is an independent factor for predicting RR in patients with HFrEF after CABG, and HM/TPD≥38.3% can accurately predict RR and the improvement of cardiac function after CABG.

Diagnostic Efficacy of 18F-FDG PET/CT in Detecting Bone Marrow Infiltration in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma / 生物医学与环境科学（英文）

OBJECTIVE@#Diffuse large B-cell lymphoma (DLBCL) is often associated with bone marrow infiltration, and 2-deoxy-2-(18F) fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) has potential diagnostic significance for bone marrow infiltration in DLBCL.@*METHODS@#A total of 102 patients diagnosed with DLBCL between September 2019 and August 2022 were included. Bone marrow biopsy and 18F-FDG PET/CT examinations were performed at the time of initial diagnosis. Kappa tests were used to evaluate the agreement of 18F-FDG PET/CT with the gold standard, and the imaging features of DLBCL bone marrow infiltration on PET/CT were described.@*RESULTS@#The total detection rate of bone marrow infiltration was not significantly different between PET/CT and primary bone marrow biopsy ( P = 0.302) or between the two bone marrow biopsies ( P = 0.826). The sensitivity, specificity, and Youden index of PET/CT for the diagnosis of DLBCL bone marrow infiltration were 0.923 (95% CI, 0.759-0.979), 0.934 (95% CI, 0.855-0.972), and 0.857, respectively.@*CONCLUSION@#18F-FDG PET/CT has a comparable efficiency in the diagnosis of DLBCL bone marrow infiltration. PET/CT-guided bone marrow biopsy can reduce the misdiagnosis of DLBCL bone marrow infiltration.

The impact of multimodality integrated positron emission tomography-computed tomography on improving the staging and management of head and neck malignancy: a cross- sectional study

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.

Aportes de la tomografía por emisión de positrones con 18F-fluorodesoxiglucosa/tomografía computada en el diagnóstico de compromiso extramedular por mieloma múltiple en Uruguay / 18F-fluorodesoxyglucose positron emission tomography/computed tomography in extramedullary multiple myeloma

BACKGROUND: 18F-fluorodesoxyglucose positron emission tomography/ computed tomography (PET-CT) has a high sensitivity and specificity to detect medullary and extramedullary lesions in multiple myeloma (MM). AIM: To describe the findings of PET-CT in extramedullary multiple myeloma (EMM) at diagnosis and at relapse, and correlate its results with clinical variables, response to treatment and survival. MATERIALS AND METHODS: Review of medical records and PET-CT reports of 39 patients with multiple myeloma (MM) who had at least one PET-CT study, treated between January 1, 2015, and January 1, 2019 at a clinical hospital. RESULTS: The Standard Uptake Values for each hypermetabolic lesion were not described in PET-CT reports. Fifteen patients had an EMM and in eight, without a previous clinical suspicion, PET-TC lead to the diagnosis. The mortality rate in the 39 patients with MM was 46%. Sixty seven percent of deaths occurred in patients with EMM. CONCLUSIONS: PET-TC was useful to diagnose EMM. However, a standardization in PETCT reports would be required to unify criteria. As previously reported, EMM had a greater aggressiveness and lower survival.

Progressive massive fibrosis in pneumoconiosis is mimicking lung malignancy on (18)F-FDGPET-CT: two cases report / 中华劳动卫生职业病杂志

Occupational pneumoconiosis is one of the main occupational diseases in China. Progressive massive fibrosis in pneumoconiosis should be distinguished from lung cancer for their similar imaging features which is often identified by (18)F-FDG PET-CT in clinic. Here we reported two cases of pneumoconiosis. Both of them were suspected of carrying malignant tumors by preoperative PET-CT exam, however, nodules in these two patients were all proved to be benign by intraoperative pathology which suggested that there is false-positive possibility in the distinguishment of pneumoconiosis nodules by (18)F-FDG PET-CT.

Pretreatment evaluation of 18F-FDG PET-CT in extranodal NK/T-cell lymphoma / 中华肿瘤杂志

Objective: To investigate the clinical value of pretreatment 18F-fluorodeoxy glucose positron emission tomography/computed tomography (18F-FDG PET-CT) in extranodal NK/T-cell lymphoma. Methods: Eighty-one patients with pathologically confirmed extranodal NK/T-cell lymphoma and pretreatment with PET-CT scan in Cancer Hospital, Chinese Academy of Medical Sciences from August 2006 to December 2017 were enrolled in the study. The clinical, follow-up and imaging data were analyzed retrospectively. The relationship between maximum standard uptake value (SUVmax) and prognosis were evaluated by Mann-Whitney U test and Spearman rank correlation analysis. Results: Among the 81 patients, 98.8% (80/81) were upper aerodigestive tract (UAT) involved. Lesions at extra-UAT sites were detected in 7 cases, involving parotid gland (n=1), breast (n=1), spleen (n=1), pancreas (n=1), skin and subcutaneous soft tissue (n=1), muscle (n=1), lung (n=2) and bone (n=3). Lymph node involvement were demonstrated in 33 cases. All of the lesions had increased uptake of PET, the median SUVmax was 8.6. PET-CT changed staging in 15 cases, and 12 cases were adjusted treatment methods. 21 cases were changed radiotherapy target because of PET-CT. The 1-, 2-year progression-free survival (PFS) rates were 88.7% and 80.3% while 1-, 2-year overall survival (OS) rates were 97.2% and 94.4% respectively. The median SUVmax of patients with local lymph nodes involvement was significantly higher than those without local lymph nodes involvement (P=0.007). The SUVmax was positively associated with Ann Arbor stage (r=0.366, P=0.001), lactate dehydrogenase (r=0.308, P=0.005) and Ki-67 level (r=0.270, P=0.017). The SUVmax was inversely associated with lymphocyte count (r=-0.324, P=0.003) and hemoglobin content (r=-0.225, P=0.043). Conclusions: Extranodal NK/T-cell lymphoma predominantly occurs in extra-nodal organs, mainly in the upper respiratory and gastrointestinal tracts, with marked FDG-addiction. Compared with conventional imaging, 18F-FDG PET-CT is sensitive and comprehensive in detecting extra-nodal NK/T-cell lymphoma involvement, assisting in accurate clinical staging and treatment planning. Pretreatment SUVmax is potential for prognosis evaluation since it is correlated with prognostic factors.

The correlation between metabolic parameters in (18)F-FDG PET-CT and solid and micropapillary histological subtypes in lung adenocarcinoma / 中华肿瘤杂志

Objective: Solid and micropapillary pattern are highly invasive histologic subtypes in lung adenocarcinoma and are associated with poor prognosis while the biopsy sample is not enough for the accurate histological diagnosis. This study aims to assess the correlation and predictive efficacy between metabolic parameters in (18)F-fluorodeoxy glucose positron emission tomography/computed tomography ((18)F-FDG PET-CT), including the maximum SUV (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and solid and micropapillary histological subtypes in lung adenocarcinoma. Methods: A total of 145 resected lung adenocarcinomas were included. The clinical data and preoperative (18)F-FDG PET-CT data were retrospectively analyzed. Mann-Whitney U test was used for the comparison of the metabolic parameters between solid and micropapillary subtype group and other subtypes group. Receiver operating characteristic (ROC) curve and areas under curve (AUC) were used for evaluating the prediction efficacy of metabolic parameters for solid or micropapillary patterns. Univariate and multivariate analyses were conducted to determine the prediction factors of the presence of solid or micropapillary subtypes. Results: Median SUV(max) and TLG in solid and papillary predominant subtypes group (15.07 and 34.98, respectively) were significantly higher than those in other subtypes predominant group (6.03 and 10.16, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for prediction of solid and micropapillary predominant subtypes [AUC=0.811(95% CI: 0.715~0.907) and 0.725(95% CI: 0.610~0.840), P<0.05]. Median SUV(max) and TLG in lung adenocarcinoma with the solid or micropapillary patterns (11.58 and 22.81, respectively) were significantly higher than those in tumors without solid and micropapillary patterns (4.27 and 6.33, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for predicting the presence of solid or micropapillary patterns [AUC=0.757(95% CI: 0.679~0.834) and 0.681(95% CI: 0.595~0.768), P<0.005]. Multivariate logistic analysis showed that the clinical stage (Stage Ⅲ-Ⅳ), SUV(max) ≥10.27 and TLG≥7.12 were the independent predictive factors of the presence of solid or micropapillary patterns (P<0.05). Conclusions: Preoperative SUV(max) and TLG of lung adenocarcinoma have good prediction efficacy for the presence of solid or micropapillary patterns, especially for the solid and micropapillary predominant subtypes and are independent factors of the presence of solid or micropapillary patterns.

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.

Correlation and Influencing Factors of SUVmax and Ki-67 in Non-Hodgkin Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To investigate the influencing factors of maximum standard uptake value (SUVmax) of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and nuclear antigen Ki-67 in non-Hodgkin lymphoma (NHL) and their correlation.@*METHODS@#The relationship between SUVmax, Ki-67 and gender, age, maximum lesion diameter, extranodal involvement, superficial and deep lymph node involvement, malignancy, B symptoms, clinical stage, lactate dehydrogenase (LDH) and international prognostic index (IPI) scores and their correlation were reviewed.@*RESULTS@#Among 185 NHL patients, 99 cases were aggressive B-cell NHL, 43 cases were indolent B-cell NHL, and 43 cases were T-cell NHL, respectively. Obviously, the SUVmax and Ki-67 of aggressive B-cell NHL were higher than those of indolent B-cell NHL and T-cell NHL (P<0.05), while indolent B-cell NHL were lower than those of T-cell NHL (P<0.05). SUVmax and Ki-67 were closely related to maximum lesion diameter, extranodal involvement, malignancy, LDH, and IPI scores (P<0.05). SUVmax was positively correlated with Ki-67 expression (r=0.615). According to the analysis of receiver operating characteristic (ROC), the results showed that the SUVmax and Ki-67 could reflect the aggressiveness of NHL accurately, with an AUC of 0.871 and 0.968.@*CONCLUSION@#SUVmax and Ki-67 are not affected by age, sex, B symptoms, clinical stage and so on, and are relatively objective quantitative parameters. SUVmax is positively correlated with Ki-67 expression in NHL. SUVmax and Ki-67 have certain value in clinical diagnosis of malignant degree of NHL.

Primary Malignant Melanoma of the esophagus in a 39-year-old Filipino male: A case report

@#Primary malignant melanoma of the esophagus (PMME) is an exceptionally rare condition, representing a mere 0.1 to 0.2% of esophageal cancers, and accounting for just 0.1 to 0.5% of all melanomas. This case involves a 39 -year-old Filipino male who sought medical attention after an episode of choking. Subsequently, endoscopy with biopsy revealed a mass in the distal third of the esophagus, ultimately diagnosed as PMME based on histopathology and immunohistochemistry. FDG-PET/CT scan revealed a hypermetabolic distal esophageal mass and a confluent upper paratracheal lymphadenopathy. He was initially treated with Pembrolizumab, Nivolumab, and Ipilimumab immunotherapy. However, post-treatment FDG PET/CT scans unveiled metabolic progression of the esophageal mass with new hypermetabolic cervical lymph nodes, necessitating a shift to carboplatin and paclitaxel chemotherapy. After two cycles, there was a notable metabolic regression of the mass and paratracheal node with metabolic resolution of the cervical lymph node. An additional 2 cycles of chemotherapy were given, aimed to further reduce the size of the tumor, however, a succeeding follow-up study revealed metabolic progression of the mass. Surgical resection of both the esophageal mass and paratracheal nodes became imperative. The aggressive characteristics, metastasis at early diagnosis, and lack of effective treatment have contributed to the poor prognosis of PMME. Total esophagectomy is the preferred method of treatment. Chemotherapy and immunotherapy may be used in advanced diseases but with variable efficacy. The utilization of FDG PET/CT scans plays a crucial role in both the initial staging and the ongoing assessment of treatment response in patients diagnosed with PMME. This advanced imaging modality offers valuable insights into the extent of the disease and aids clinicians in evaluating the effectiveness of the chosen therapeutic interventions. Given the rarity and challenges associated with PMME, a multidisciplinary approach integrating surgical, medical, and imaging strategies is essential for comprehensive patient care.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer / Valor prognóstico de parâmetros de PET/TC com 18F-FDG e variáveis histopatológicas em câncer de cabeça e pescoço

Abstract Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

PET-CT FDG en el diagnóstico y seguimiento de vasculitis de grandes vasos / Positron emission tomography-CT scan (PET-CT) in the diagnosis of large vessel vasculitis

Vasculitides are a broad group of diseases that can involve any kind of vessel in any organ. These can be classified according to the size of the affected vessels. The most used classification categorizes them in small, medium, and large vessel vasculitis. Large vessel vasculitis can be further divided in Takayasu arteritis and giant cell arteritis which can sometimes be indistinguishable, even with biopsy. Radiology plays an important role identifying distribution patterns and disease extension18. Fluorine-Fluorodeoxyglucose (FDG) PET-CT shows increased vessel wall FDG uptake in patients with active large vessel vasculitis. Multiple studies show that FDG PET-CT helps to identify the anatomic structures with the disease, as well as evaluate its progression with a high sensibility and specificity in non-treated patients with large vessel vasculitis.

Imágenes en endocarditis infecciosa: no todo es ecocardiografía / Imaging in infective endocarditis: not all is ultrasonography

Resumen La endocarditis infecciosa (EI) es una enfermedad de alta mortalidad, caracterizada por una infección endocárdica y frecuentes complicaciones multiorgánicas, que requiere un diagnóstico rápido y preciso, y un manejo agresivo, ya sea médico o quirúrgico. Su diagnóstico se realiza tomando en cuenta criterios bacteriológicos, clínicos y ecocardiográficos. Es objetivo de este artículo realizar una actualización del estudio imagenológico en paciente con EI, con especial énfasis en aquellos exámenes no ecocardiográficos disponibles en nuestro medio. En los últimos años, estudios de imagen avanzados han adquirido un rol creciente en su estudio inicial, particularmente la tomografía computada multicorte (TCMC) cardiaca y el positron emission tomography/computed tomography (PET/CT), y han sido recomendados como criterios diagnósticos en las guías recientes para el manejo de esta entidad. La TCMC cardiaca proporciona información anatómica detallada de las válvulas cardiacas y tejido perivalvular, identificando pseudoaneurismas, abscesos y dehiscencias valvulares. El PET/CT con F18-fluorodeoxiglucosa (F18-FDG) permite aumentar la sensibilidad en la detección de EI, y pesquisar con alta eficiencia fenómenos embólicos sistémicos, de elevada frecuencia en esta población. Ambos métodos prestan particular utilidad en EI de válvula protésica, donde la ecocardiografía presenta menor rendimiento diagnóstico. La resonancia magnética (RM) cerebral es el mejor método de imagen para descartar eventos isquémicos/embólicos del sistema nervioso central.

Abstract Infective endocarditis (IE) is an entity characterized by endocardial infection and frequent multiorgan complications, resulting in high mortality. It requires a rapid and accurate diagnosis, and a medical or surgical aggressive treatment. Currently, IE diagnosis rests on bacterial, clinical and ultrasonographic criteria. The objective of this article is to update the imaging study in patients with IE, with special emphasis on those non-echocardiographic examinations available in our environment. Last years, advanced imaging had achieved a growing role in IE diagnosis, especially cardiac multislice computed tomography (MSCT) and positron emission tomography/computed tomography (PET/CT), which have been recommended in recent clinical guidelines to be included as part of diagnostic criteria. Cardiac MSCT provides detailed anatomic information of cardiac valves and perivalve tissue, allowing identification of pseudoaneurysm, abscess and valve dehiscence. F18-FDG PET/CT increases sensitivity for IE detection and shows high accuracy in searching for extracranial systemic embolic events. Both MSCT and PET/CT have particular utility in cases of prosthetic valve endocarditis, where cardiac ultrasonography shows lower performance. Brain magnetic resonance imaging (MRI) is the best imaging method for evaluating ischemic/embolic events of central nervous system.

Correlation between PET/CT and CT in the staging prior to the treatment of head and neck squamous cell carcinoma / Correlação entre PET/TC e TC no estadiamento pré tratamento do carcinoma espinocelular de cabeça e pescoço

Abstract Introduction: Head and neck squamous cell carcinoma is the seventh most common malignant tumor. The advances in treatment have improved the global survival rates in the past years, although the prognosis is still grave. Objective: The aim of the present study is to evaluate the correlation between positron emission computed tomography and computed tomography at the time of staging a previously untreated head and neck squamous cell carcinoma, and to determine which of the two imaging techniques gives us more information at the time of initial diagnosis. Methods: Data from all patients diagnosed in our hospital of head and neck squamous cell carcinoma by a biopsy of any location or unknown primary tumor was collected, between January 2012 and July 2017. In all cases, computed tomography and positron emission computed tomography were performed with a maximum of 30 days difference between them and patients had not received any prior treatment to staging. The stage given to each case was compared based solely on the physical examination, only on the computed tomography/positron emission computed tomography, with respect to the stage given by the tumor board, observing the concordance obtained through Cramer's V statistical test. Results: We performed a comparative analysis obtaining a correlation of 0.729 between the stage given by the tumor board and the one assigned based on the physical examination without imaging techniques. When only using computed tomography as an imaging method, the correlation was 0.848, whereas with only the use of positron emission computed tomography it was estimated at 0.957. When comparing the statistical association between staging using exclusively one of the two imaging techniques, correlation was 0.855. Conclusion: Positron emission computed tomography is useful for the diagnosis of head and neck squamous cell carcinoma, improving the patient's staging especially when detecting cervical and distant metastases. Therefore, we consider that the use of positron emission computed tomography for the staging of patients with head and neck squamous cell carcinoma is a diagnostic test to be considered.

Resumo Introdução: O carcinoma espinocelular de cabeça e pescoço é o sétimo tumor maligno mais comum. Os avanços no tratamento melhoraram as taxas de sobrevida global nos últimos anos, embora o prognóstico ainda seja grave. Objetivo: Avaliar a correlação entre a tomografia computadorizada por emissão de pósitrons e a tomografia computadorizada no estadiamento de carcinomas espinocelulares da cabeça e pescoço não tratados previamente e verificar qual das duas técnicas de imagem nos fornece mais informações no momento do diagnóstico inicial. Método: Os dados de todos os pacientes diagnosticados em nosso hospital com carcinoma espinocelular de cabeça e pescoço por biópsia de qualquer região ou adenopatias de origem desconhecida foram colhidos no período entre janeiro de 2012 e julho de 2017. Em todos os casos, uma tomografia computadorizada e uma tomografia computadorizada por emissão de pósitrons foram realizadas com um máximo de 30 dias de diferença entre elas. Nenhum paciente deveria ter recebido tratamento antes do estadiamento. O estadiamento atribuído a cada caso foi comparado com base apenas no exame físico, pela tomografia computadorizada ou apenas pela tomografia computadorizada por emissão de pósitrons, com relação ao estadiamento concedido pela margem tumoral, observou-se a concordância obtida pelo teste estatístico de V de Cramer. Resultado: Realizamos a análise comparativa obtendo uma correlação de 0,729 entre o estadio concedido pela margem tumoral e aquele atribuído com base no exame físico sem técnicas de imagem. Usando apenas a tomografia computadorizada como método de imagem, a correlação foi de 0,848, enquanto que a correlação com a tomografia computadorizada por emissão de pósitrons foi estimada em 0,957. Ao comparar a associação estatística entre o estadiamento usando exclusivamente uma das duas técnicas de imagem, foi de 0,855. Conclusão: Tomografia computadorizada por emissão de pósitrons é útil para o diagnóstico de carcinoma espinocelular de cabeça e pescoço, melhora o estadiamento, especialmente na detecção de metástases cervicais e à distância. Portanto, concluimos que seu uso para o estadiamento de pacientes com carcinoma espinocelular de cabeça e pescoço é um exame diagnóstico a ser considerado.

Effects of Fluorodeoxyglucose Conjugated and Unconjugated Iron Oxide Magnetic Nanoparticles on Macrophages: a Pilot Study

Abstract The effects of fluorodeoxyglucose conjugated iron oxide magnetic nanoparticles (FDGMNP) on macrophages are presented using a yeast substrate. Iron oxide magnetic nanoparticles (MNP) were synthesized by partially reducing FeCl3, then conjugated with (3-aminopropyl) triethoxysilane (APTES) after silication with tetraethyl orthosilicate. Silanated MMP nanoparticles were combined with fluorodeoxyglucose (FDG). Fluorodeoxyglucose iron oxide magnetic nanoparticles (FDGMNP) and its unconjugated control (MNP) were added (1mL) to the cells from the murine macrophage-like, Abelson murine leukemia virus transformed cell line RAW 264.7 (American Type Culture Collection number TIB-71) cell culture wells at different concentrations from 90-3.6 μg/mL. Cells were placed on the magnet plate for 30 min before incubating at 37°C, 5% CO2 overnight. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tetrazolium) assay was performed to measure cell viability. Our results demonstrate that iron based nanoparticles can be linked to macrophages (elements of the immune system that attack bacteria) without the function of the macrophages being affected, ie no detrimental effects to the macrophages were evident in these experiments. We conclude that neither FDGMNP nor MNP had a detrimental effect on macrophage function.

Prognostic Value of / 中国实验血液学杂志

OBJECTIVE@#To investigate the prognostic value of metabolic parameters of @*METHODS@#The clinical data of 58 patients with DLBCL who were examined by @*RESULTS@#The SUV@*CONCLUSION@#MTV and TLG are independent risk factors for OS and PFS in patients with DLBCL, which may be valuable for prognosis of patients with DLBCL.

Association between inflammation activity of left atrial epicardial adipose tissue measured by 18F-FDG PET/CT and atrial fibrillation / 中华心血管病杂志

Objective: To explore the association between inflammation activity of left atrial epicardial adipose tissue (LA-EAT) measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and atrial fibrillation (AF). Methods: A total of 78 patients with AF, who underwent 18F-FDG PET/CT in the Nuclear Medicine Department of the Third Affiliated Hospital of Soochow University due to abnormally elevated levels of tumor indicators or malignant tumors from March 2018 to December 2019, were enrolled in this retrospective study. According to the examination date of PET/CT and basic characteristics of AF patients (gender, age), a 1∶1 propensity score matching was used to enroll a non-AF control group (78 patients). The maximum standard uptake value of left atrial epicardial tissue (LA-EAT FDG SUVmax) and total EAT volume (V-EAT) were measured by 18F-FDG PET/CT. Left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) were obtained by echocardiography. Blood lipids and biomarkers of inflammation were measured. The differences of clinical data and EAT-related indicators were compared between the AF group and control group. Logistic multivariate regression analysis was used to determine the related factors of AF. Then the receiver operating characteristic (ROC) curve was used to determine the cutoff value of LA-EAT FDG SUVmax on the diagnosis of AF. Univariate and multivariate logistic regression analysis were used to analyze the relationship between the increase of LA-EAT FDG SUVmax and AF. Results: The age was (66.9±10.2) years and there were 55 males (70.5%) in the AF group. The age was (66.9±8.0) years, and there were 52 males (66.7%) in the control group (both P>0.05). The LAD ((44.2±5.8) mm vs. (35.4±4.4) mm), V-EAT ((122.1±42.0) cm3 vs. (91.6±34.5) cm3), and LA-EAT FDG SUVmax ((1.6±0.3) vs. (1.4±0.2)) values were significantly higher, while LVEF ((60.1±4.7)% vs. (63.9±2.9)%) was lower in the AF group than in the control group (P all<0.001). Multivariate logistic regression analysis showed that LAD (OR=1.340, 95%CI 1.195-1.502), V-EAT (OR=1.016, 95%CI 1.001-1.031), and LA-EAT FDG SUVmax (OR=1.375, 95%CI 1.095-1.723) were positively correlated with AF, LVEF (OR=0.781, 95%CI 0.659-0.926) was negatively correlated with AF(P all<0.05). The area under the ROC curve of LA-EAT FDG SUVmax for diagnosis of AF was 0.680 (95%CI 0.597-0.764, P<0.001), and the best cut-off value was 1.415 with a sensitivity of 65.4% and specificity of 61.5%. After adjusting for high-density lipoprotein cholesterol, LVEF, LAD and V-EAT, LA-EAT FDG SUVmax≥1.415 was independently associated with AF (OR=2.982, 95%CI 1.122-7.926, P=0.010). Conclusions: The inflammatory activity of LA-EAT measured by 18F-FDG PET/CT is an independent risk factor of AF, and the increased inflammatory activity of LA-EAT is positively correlated with AF.