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Radiomics can quantitatively analyze and process large amounts of image features from medical image data to quantify tumor heterogeneity and non-invasively evaluate tumor biological behavior. Radiomics in nuclear medicine, especially in PET is developing rapidly. This article reviews the application of radiomics in the tumor identification and prognosis evaluation, and discusses the challenges and prospects for radiomics, in order to raise the awareness of radiomics in PET.
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Objective:To investigate the value of 18F-FDG PET/CT metabolic parameters in predicting perineural invasion (PNI) in patients with non-metastatic rectal cancer. Methods:From August 2012 to April 2020, 81 patients (51 males, 30 females, median age: 63 years) who received PET/CT examination and pathologically confirmed as rectal cancer in the Affiliated Hospital of Qingdao University were retrospectively analyzed. The 18F-FDG PET/CT metabolic parameters including SUV max, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), and clinicopathological factors including gender, age, carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, maximum tumor diameter, degree of differentiation, T stage, lymph node metastasis, and TNM stage were recorded. Mann-Whitney U test and χ2 test were used to compare the differences of each parameter between PNI positive group and PNI negative group. Multivariate logistic regression was used to analyze the independent predictor of positive PNI. ROC curve was used to analyze its predictive efficacy. Results:Of 81 patients, 32(39.51%) were PNI positive and 49(60.49%) were PNI negative. There were significant differences of T stage ( χ2=10.73, P=0.010), lymph node metastasis ( χ2=6.21, P=0.013), TNM stage ( χ2=7.61, P=0.022), MTV (14.6(10.4, 24.7)and 9.0(5.4, 14.5) cm 3; U=-3.48, P=0.001) and TLG (108.588(72.749, 182.707) and 65.365(35.593, 117.682) g; U=-2.79, P=0.005) between PNI positive group and PNI negative group. Multivariate logistic regression analysis showed that MTV was the independent predictor of positive PNI in non-metastatic rectal cancer patients (odds ratio ( OR)=1.130, 95% CI: 1.025-1.245, P=0.014). The optimal threshold of MTV was 9.53 cm 3 and AUC was 0.73 with the sensitivity of 81.82%(27/33) and the specificity of 59.18%(29/49). Conclusion:18F-FDG PET/CT metabolic parameter MTV can predict PNI in non-metastatic rectal cancer with high sensitivity.
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Objective:To establish and validate a malignant risk prediction model of solitary pulmonary nodules (SPNs) with pulmonary fibrosis in long-term smokers based on 18F-flurodeoxyglucose (FDG) PET/CT. Methods:PET/CT images of 222 SPNs combined with pulmonary fibrosis which were shown in integrated CT scan in 169 patients (all males; age 68(63, 75) years) were analyzed retrospectively. All patients were examined in PET/CT Center of the Affiliated Hospital of Qingdao University from January 2011 to December 2019 and all had definite smoking history. The benign and malignant nodules were judged according to the pathological diagnosis or follow-up imaging data of lung lesions (follow-up≥2 years). The clinical characteristics (age, smoking index), morphological characteristics (longest diameter of lesion, density, location, distribution, relative position of fibrosis, spiculation, lobulation, calcification, vacuole, vascular convergence, pleural indentation, emphysema and severity of bilateral pulmonary fibrosis) and metabolic characteristics (maximum standardized uptake value (SUV max)) of the benign and malignant lesions were analyzed by χ2 test and Mann-Whitney U test. Then multivariate logistic regression analysis was applied to select independent risk factors of malignant nodules, and a risk prediction model was established and verified by the area under the receiver operating characteristic (ROC) curve and k-fold cross validation ( k=10) respectively. Results:Among 169 patients, 222 SPNs were detected (157 malignant nodules, 65 benign nodules). Univariate analysis showed that smoking index, speculation, lobulation, vascular convergence sign, calcification, emphysema, nodule size, relative position of nodule and fibrosis, SUV max and severity of bilateral pulmonary fibrosis were significantly different between the benign and malignant nodules ( z values: 2.514-9.858, χ2 values: 4.353-18.442, all P<0.05). Result of multivariate logistic regression analysis showed that calcification, vascular convergence and SUV max were the independent risk factors of malignant nodules combined with pulmonary fibrosis (odds ratio ( OR): 0.048-2.534, all P<0.05). The risk prediction model was as follow: P=1/(1+ e - x), x=-1.839-3.033×calcification+ 0.930×vascular convergence+ 0.754×SUV max(with calcification/vascular convergence=1, without calcification/vascular convergence=0). The area under ROC curve was 0.932(95% CI: 0.895-0.969), and the sensitivity and specificity of the model were 87.9% and 86.2%, respectively. Results of k-fold cross validation showed that the prediction accuracy of 10 test sets was 0.847±0.075, and was 0.862±0.010 in training sets. Conclusions:Calcification, vascular convergence and SUV max are independent risk factors of malignant SPNs combined with pulmonary fibrosis in long-term asymptomatic smokers. The model based on the above variables presents high diagnostic efficiency in diagnosing malignant SPNs.
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Objective To develop a model of malignant risk prediction of solitary pulmonary nodules(SPN) with the metabolic characteristics of the lesion.Methods A total of 362 patients (291 malignant cases and 71 benign cases;194 males,168 females;median age:61 years) who underwent PET/CT imaging from January 2013 to July 2017 were analyzed.The diagnosis of malignant SPN was based on pathological results,and that of benign SPN was based on pathological or follow-up results.Differences of clinical/imaging characteristics in patients with benign and those with malignant SPN were analyzed.Risk factors were screened by multivariate non-conditional logistic regression analysis.The self-verification of the model was done by the receiver operating characteristic (ROC) curve analysis,out-of-group verification was performed by k-fold cross-validation.Results There were statistically significant differences in age,maximum standardized uptake value (SUVmax),size,lobulation,spiculation,pleural traction,vessel connection,calcification,vacuole,and emphysema between patients with benign and malignant nodules (all P＜0.05).The risk factors for malignant nodules included age,SUVmax,size,lobulation,calcification and vacuole.The odds ratio (OR) values (95％ CI) were 1.040(1.007-1.075),1.612(1.287-2.017),1.149(1.074-1.230),4.650(2.138-10.115),0.216(0.085-0.548),and 3.043(1.302-7.111),respectively.The logistic regression model was as follows:P=1/(1+e-x),x=-5.583+0.039×age+0.477×SUVmaxx+0.139×size+1.537×lobulation-1.532×calcification+ 1.1 13×vacuole.The estimated area under the curve (AUC) for the model was 0.915(95％ CI:0.883-0.947),sensitivity was 89.7％,specificity was 78.9％.K-fold cross-validation showed that the training accuracy was 0.899±0.011,the predictive accuracy was 0.873±0.053.Conclusions The risk factors for malignant nodules included age,SUVmax,size,lobulation,calcification and vacuole.After verification,the model has a satisfactory accuracy.It may help clinics make accurate decisions.
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Objective To provide reference for the adjustment of provincial health insurance directory by comparing the differences between 2017 and 2009 edition of National Health Insurance Directory(NHID) and exploring the characteristics of NHID adjustment. Methods The Excel 2016 was used to carry out a comparative analysis of the drugs included in the two editions of NHID from the 4 aspects such as classification,drug name,dosage form and payment range. Results The adjustments of NHID in 2017 include drug variety,payment range,drug classification and coding.A total of 339 drugs were added, of which 133 were chemical drugs with a growth rate of 11.4%,and 206 were Traditional Chinese Medicine with a growth rate of 20.0%.In addition,dosage form was added in 149 drug varieties.The adjustment mainly focuses on chronic diseases such as hypertension and diabetes,serious diseases such as cancer,innovative drugs,and pediatric drugs. Conclusion The adjustment of 2017 edition of NHID embodied the policy thinking of "filling,selecting,supporting innovation and encouraging competition". Moreover,the drug classification,name and coding are more scientific and reasonable.
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Objective To analyze the expression of glucose transport protein (Glut)-l,Glut-3 and hexokinase (HK)-Ⅱ in non-small-cell lung cancer (NSCLC) lesions and pulmonary inflammatory lesions and discuss the correlation of them with 18F-fluorodeoxyglucose (FDG) uptake.Methods Twenty-four patients with NSCLC and 22 patients with pulmonary inflammatory lesions (25 males,21 females;age range:37-81 years) who underwent PET/CT from November 2012 to May 2016 were retrospectively analyzed.All patients had surgery and were confirmed by pathology.The expression of Glut-1,Glut-3 and HK-Ⅱ in the lesions was detected by immunohistochemistry.Immunohistochemical staining scores and maximum standardized uptake value (SUVmax) were calculated.One-way analysis of variance,the least significant difference t test,two-sample t test and Spearman correlation analysis were used.Results The SUVmax of NSCLC lesions was 8.71 ± 7.62,higher than that of pulmonary inflammatory lesions (3.29 ± 2.16;t =3.220,P＜ 0.05).Immunohistochemical staining scores of Glut-1,Glut-3 and HK-Ⅱ were 3.75±0.99,4.04±1.00 and 4.00±0.78 for NSCLC lesions respectively,and were all higher than those of pulmonary inflammatory lesions (2.32±0.65,2.89±0.83,2.41±0.50;t values:5.340,5.160,8.130,all P＜0.01).The expression of Glut-1 and HK-Ⅱ was positively correlated with SUVmax in NSCLC lesions (rs values:0.414,0.457,both P＜0.05).The expression of Glut-1,Glut-3 and HK-Ⅱ was not correlated with SUVmax(rs values:0.392,0.070,-0.066,all P＞0.05),but the expression of Glut-3 was higher than that of Glut-1 and HK-Ⅱ (F=4.123,t values:0.970,0.150,all P＜0.05) in pulmonary inflammatory lesions.Conclusions The expression of Glut-1,Glut-3 and HK-Ⅱ is higher in NSCLC lesions than that in pulmonary inflammatory lesions.Glut-1 and HK-Ⅱ are the important factors for 18F-FDG uptake in NSCLC.Glut-3 may play an important role in 18F-FDG uptake in pulmonary inflammatory lesions.
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Objective To compare the accuracy, image quality and radiation dose between prospective ECG?gated sequential and high?pitch acquisition on 128?slice dual?source CT (DSCT) angiography in infants and children with congenital heart disease (CHD). Methods Ninety?two children with CHD from October 2011 to February 2013 were prospectively enrolled and assigned into two groups according to random number table. Forty?six patients underwent DSCT angiography with sequential mode, and the other 46 patients were examined with high?pitch mode. With surgical and/or DSA results as the standard, the diagnostic accuracy and sensitivity of the two groups for the intracardiac structures, extracadiac and coronary artery anomalies were evaluated, and the comparison was analyzed by Fisher exact test. A 5?grade scoring system was used to interpret the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries. Interobserver agreement on grades of image quality was assessed by Kappa statistics. The image quality scores were compared using the Mann?Whitney U test. The Student t test or the Mann?Whitney U test was used to analyze the differences between the two groups regarding to patients' age, weight , heat rate, CT attenuation, image noise and SNR in the ascending aorta and the pulmonary trunk as well as radiation dose. Results All 92 patients successfully underwent DSCT angiography. The diagnostic accuracies of intracardiac anomalies by high?pitch group and sequential group were 95.65%(88/92) and 99.28%(274/276), showed significant difference between the two groups (P0.05) .There was no significant difference in the diagnostic accuracy and sensitivity of extracadiac anomalies between the two groups (P>0.05). The diagnostic accuracies of coronary artery anomalies by high?pitch group and sequential group were 93.48%(43/46) and 100.00%(46/46), showed no significant difference between the two groups (P>0.05), but there was significant difference in the sensitivity of coronary artery anomalies (50.00%(3/6) , 100.00% (11/11)) (P0.05). The median image quality scores of intracardiac structures and proximal and middle segments of coronary arteries respectively by high?pitch group were 4.00 and 3.00, and 5.00 and 4.00 respectively by sequential group. The image quality of intracardiac structures (U=594.500, P<0.05) and proximal and middle segments of coronary arteries (U=397.500, P<0.05) was significantly better in the sequential group than that in the high?pitch group. There was no significant difference between the two groups in CT attenuation, noise and SNR of the ascending aorta and pulmonary trunk. The mean effective doses of the high?pitch group and the sequential group were(0.27±0.11)and(0.39±0.17)mSv, and showed significant difference between the two groups (t=4.316, P<0.05). Conclusions Both sequential and high?pitch mode of 128?slice DSCT angiography provide high accuracy for the assessment of CHD in infants and children, while the high?pitch mode, though with some image quality declined, shows further significantly lower radiation dose.
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BACKGROUND:In recent years, stem cel therapy for early osteonecrosis of the femoral head has become an alternative method, but the quality of stem cels is a key to the therapeutic outcomes. OBJECTIVE:To evaluate the proliferative ability and directional differentiation ability of autologous bone marrow mesenchymal stem cels in a rat model of steroid-induced femoral head necrosis. METHODS:Twenty Sprague-Dawley rats were randomly divided into control and observation groups with ten in each group. An animal model of steroid-induced femoral head necrosis was built in the observation group, and then bone marrow mesenchymal stem cels from rats in both two groups were isolated and cultured. Cel counting kit-8 was used to detect proliferation of passage 3 cels. Bone marrow mesenchymal stem cels at passage 3 were selected in the two groups for osteogenic and adipogenic induction. Alkaline phosphatase staining and alizarin red staining were adopted at 7 and 14 days of osteogenic induction, and oil red O staining as performed at 21 days of adipogenic induction. RESULTS AND CONCLUSION:The absorbance values of bone marrow mesenchymal stem cels were lower in the observation group than the control group at 1, 3, 5 days of culture, but there was no significant difference between two groups (P > 0.05). Until the 7th day of culture, the absorbance value and alkaline phosphatase activity in the observation group were significantly lower than that in the control group (P < 0.05). Additionaly, there were fewer calcium nodules and lipid droplets in the observation group compared with the control group. These findings suggest that the proliferative ability and directional differentiation ability of autologous bone marrow mesenchymal stem cels from a rat model of steroid-induced femoral head necrosis are both decreased.