Study on hemodynamics of high altitude polycythemia by 3D-ASL combined with CT cerebral perfusion / 中国辐射卫生

Objective To investigate the changes of CT cerebral perfusion (CTP) and the application value of nuclear magnetic resonance proton spin labeling (3D-ASL) and to conduct a comparative study. Methods Multi-slice spiral CT(MDCT) was used to study the changes of CTP in 22 patients with HAPC. Comparison of CT whole-brain perfusion technique and nuclear magnetic resonance proton spin labeling technique (3D-ASL) in hemodynamic changes of the brain in plateau polycythemia. Results With the aggravation of HAPC, CBF of cerebral cortex and white matter showed a downward trend. Except the white matter of frontal lobe and temporal lobe, the difference of HAPC among different diseases was statistically significant (P < 0.05). Along with the aggravation of, each part of the brain cortex and white matter CBV increase, white matter, and each part CBV difference had statistical significance between different condition (P < 0.05). With the aggravation of the disease, the MTT of cortex and white matter in all parts of the brain increased significantly, and the difference of MTT between different parts of the disease was statistically significant (P < 0.05). HAPC patients along with the aggravation of different level, rCBF is reduced, in addition to the parietal cortex, temporal and occipital white matter, white matter rCBF differences between different parts of different condition have statistical significance (P < 0.05). ROC curve was used to evaluate the diagnostic value of CTP and ASL. The two curves were close to each other, and CTP was slightly better than ASL. Conclusion With the progression of HAPC, cerebral blood flow decreased, blood volume increased, and average blood flow time prolonged in patients with different degrees of HAPC. CTP and ASL had similar effects, and the former had slightly better value.

Clinical value of 99Tcm-MIBI scintigraphy for bone lesions of indefinite diagnosis with 99Tcm-MDP bone imaging / 中华核医学与分子影像杂志

Objective To investigate the clinical value of 99Tcm-methoxyisobutylisonitrile (MIBI) double-phase imaging in differential diagnosis of bone lesions in tumor patients,which was indefinite in 99Tcm-methylene diphosphonate (MDP) bone imaging,and evaluate the correlation between 99Tcm-MIBI imaging and chemotherapy efficacy.Methods Fifty-two tumor patients (23 males,29 females,mean age 58 years) with bone isolated lesions(≤3) found by 99Tcm-MDP bone scintigraphy was enrolled from June 2014 to November 2015.Since the results of 99Tcm-MDP imaging were indefinite,99Tcm-MIBI double-phase (10 min and 30 min after injection of 99Tcm-MIBI) SPECT/CT imaging was then performed within 1 week.The final diagnosis was made according to results of more than two imaging modalities (CT,MRI,PET/CT) and/or follow-up (≥6 months).The diagnostic efficacy of 99Tcm-MIBI SPECT/CT imaging was calculated.The clinical dataof chemotherapy were also collected.Patients with bone metastasis were grouped as the treatment response.Retention index (RI) of metastatic lesions was calculated and compared between different groups using two-sample t test.The relationship between RI and chemotherapy efficacy was investigated by Spearman correlation analysis.Results A total of 12 benign lesions and 84 malignant lesions were eventually diagnosed.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and Youden index of 99Tcm-MIBI imaging were 96.43％(81/84),83.33％(10/12),97.59％(81/83),76.92％(10/13),and 0.80,respectively.The RI was statistically different between complete remission (CR)+partial remission (PR) group and stable disease (SD) + progressive disease (PD) group:-0.142± 0.036 vs-0.384± 0.067 (t =2.367,P＜0.05).The RI of 99Tcm-MIBI in bone metastases was positively correlated with the chemotherapy efficacy (rs =0.78,P＜0.01).Conclusions 99Tcm-MIBI imaging is helpful in differential diagnosis of bone lesions with indefinite diagnosis by 99Tcm-MDP bone imaging in tumor patients.99Tcm-MIBI RI of bone metastasis may predict the therapeutic response of chemotherapy efficacy.

Value of 99Tcm-Tilmanocept and 99Tcm-sulfur colloid SPECT/CT for the detection of sentinel lymph node in breast cancer patients / 中华核医学与分子影像杂志

Objective To evaluate the clinical value of 99Tcm-Tilmanocept(TMC) SPECT/CT for the detection of SLN by comparing with 99Tcm-sulfur colloid(SC) SPECT/CT. Methods From March 2016 to September 2016, a total of 160 patients (age range: 30-70 years), selected from Breast Surgery Department of Shandong Cancer Hospital, underwent SPECT/CT and planar imaging with either 99Tcm-TMC (TMC group, n=76) or 99Tcm-SC (SC group, n=84). The results of SLN SPECT/CT and planar imaging were compared. The positive rate of SLN in SPECT/CT was compared with operative results. One-way analysis of variance, χ2 test, and two-sample t test were used for data analysis. Results The radiochemical purity of 99Tcm-TMC (≥92%) had no significant difference in 4 h(F=0.720, P>0.05). In TMC group, the average number of SLN detected by SPECT/CT imaging was higher than that by planar imaging (1.34±0.64 vs 0.96±034; t=4556, P0.05). The average number of SLN detected by 99Tcm-TMC imaging was significantly lower than that detected by 99Tcm-SC (t=9.115, P<0.05). The intraoperative detection rates of SLN were 100% (76/76 and 84/84) in both groups. The average number of SLN detected during operation in TMC group was significantly lower than that in SC group (1.89±0.86 vs 3.05±1.29; t=6.642, P<0.01). In TMC group, the average number of SLN detected during operation was significantly higher than that detected by SPECT/CT(1.89±086 vs 1.34±0.64; t=4.492, P<0.05). In SC group, the average number of SLN detected during operation was significantly higher than that detected by SPECT/CT(3.05±1.29 vs 2.57±0.99; t=2.740, P<005). Conclusions SPECT/CT is superior to planar imaging for the detection and localization of SLN. 99Tcm-TMC is suitable for SLN imaging and intraoperative detection.

Internal mammary sentinel lymph node biopsy in breast cancer: accurate staging and individualized treatment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to determine the impact of routinely performed internal mammary sentinel lymph node biopsy (IM-SLNB) on the staging and treatment, and to analyze the success rate, complications and learning curve.</p><p><b>METHODS</b>All patients with biopsy-proven breast cancer who underwent sentinel lymph node biopsy between 2012 and 2014 were included in a prospective analysis. Internal mammary sentinel lymph node biopsy (IM-SLNB) was performed in all patients with IM-SLN visualized on preoperative lymphoscintigraphy and/or detected by intraoperative gamma probe detection. The adjuvant treatment plan was adjusted according to the current guidelines.</p><p><b>RESULTS</b>In a total of 349 patients, 249 patients (71.1%) showed internal mammary drainage. IM-SLNB was performed in 153 patients with internal mammary drainage, with a success rate of IM-SLNB of 97.4% (149/153). Pleural lesion and internal mammary artery bleeding were found in 7.2% and 5.2% patients, respectively. In 8.1% of patients (12/149) the IM-SLN was tumor positive. In the group of patients who underwent IM-SLNB, lymph node staging was changed in 8.1% of patients, and IMLNs radiotherapy was guided by these results, however, systemic treatment was changed in only 0.7% of the patients.</p><p><b>CONCLUSIONS</b>IM-SLNB has a high successful rate and good safety. Identification of internal mammary metastases through IM-SLNB may provide more accurate staging and guide the tailored internal mammary radiotherapy.</p><p><b>TRIAL REGISTRATION</b>ClinicalTrials. gov, NCT01642511.</p>

Validation study of the modified injection technique for internal mammary sentinel lymph node biopsy in breast cancer / 中华内分泌外科杂志

Objective To verify the accuracy of the modified technique for internal mammary sentinel lymph node biopsy ( IM-SLNB) in breast cancer .Methods In the validation study , the radiotracer was injected with the modified technique , and fluorescence tracer was injected into the peritumoral breast tissue .The radioac-tive IM-SLN was identified by preoperative lymphoscintigraphy and γprobe.The radioactive IM-SLN received bi-opsy during operation .The status of the fluorescence tracer was identified by the fluorescence imaging system . Results A total of 162 patients were enrolled from Sep .2013 to Dec.2014.IM-SLNB was performed in 110 pa-tients.The radiotracer and the fluorescence tracer were identified in the same IM-SLN in 94 cases, and the con-cordance rate was 85.5%(Case-base, Spearman coefficient correlation 0.823, P<0.001).Conclusion Dif-ferent tracers injected into the different sites of the intra-parenchyma can reach the same IM-SLN, proving the ac-curacy of the modified technique and the hypothesis of IM-SLN lymphatic drainage pattern ( IM-SLN receives not only the lymphatic drainage from the primary tumor area but the entire breast parenchyma ) .

Effects of different preparation methods and injection sites of 99Tcm-sulfur colloid on sentinel lymph node detection in breast cancer / 中华核医学与分子影像杂志

Objective To prospectively investigate the optimal setting for sentinel lymph node biopsy (SLNB) in patients with breast cancer by comparing the effects of different preparation methods and injection sites of 99Tcm-SC in sentinel lymph node (SLN) mapping and detection.Methods Two batches of 99Tcm-SC were prepared by boiling for 3 min (radiotracer 1) and 5 min (radiotracer 2),respectively.Radioactive chemical purity (RCP) and size of colloid particles were measured at 10 min,1 h,2 h and 4 h after the preparation.One hundred and forty-seven patients with breast cancer were involved and randomly divided into 3 groups.Group A consisted of 40 patients with periareolar injection of radiotracer 1,group B of 40 patients with periareolar injection of radiotracer 2,and group C of 67 patients with peritumoral injection of radiotracer 2.Lymphatic mapping was performed for all patients using SPECT/CT preoperatively and blue dye was subdermally injected over the tumor.The detection rate of the axillary and internal mammary SLN was recorded.One-way analysis of variance,independent two-sample t and x2 tests were used to analyze the data.Results There was no significant difference of RCP between the two radiotracers at 10 min,1 h,2 h and 4 h after preparation (t =-0.267,-0.794,0.826 and-0.977,all P＞0.05).Compared with radiotracer 1,the percentage of particles smaller than 100 nm in radiotracer 2 reduced significantly ((73.72±2.36) ％ vs (65.25±3.56)％,t=6.436,P＜0.05) and the mean effective particle size was significantly larger ((45.27±6.42) nm vs (75.59t7.04) nm,t=7.315,P＜0.05).In groups A,B and C,the detection rate of the internal mammary SLN was 70.0％ (28/40),47.5％ (19/40) and 17.9％ (12/67),respectively,with significant difference (x2=29.525,P＜0.05).In groups A,B and C,the detection rate of the axillary SLN was 100％ (40/40),95.0％ (38/40) and 97.0％ (65/67),respectively,without significant difference (x2 =2.686,P＞ 0.05).Conclusion For SLNB of patients with breast cancer,the axillary and internal mammary SLN could be better detected by SPECT/CT lymphatic mapping using radiotracer prepared with a shorter boiling time,via periareolar injection,and combined with subdermal injection of blue dye.

The correlation between FDG PET - CT metabolic tumor volume and prognosis in lung cancer / 中华放射肿瘤学杂志

Objective To assess the prognostic value of tumor burden measured by 18F-fluorodeoxy glucose-positron emission tomography ( FDG PET) imaging for stage Ⅲ NSCLC). Methods Fifty-six patients with lung cancer were analyzed, to whom staging PET-CT scans before treatment concurrent chemoradiotherapy and 2-year follow-up were performed. , Relationship between overall survival (OS) and metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) were determined.Results The estimated median OS for the cohort were 14. 5 months. Kaplan-Meier analysis showed that MTV had a significant effect on OS (x2 =5.42 ,P =0. 014). No significant relationship was found between SUVmax and OS ( x2 = 0. 74, P = 0. 391 ). According to multivariate Cox regression analysis, MTV and SUVmax wereassociatedwithincreaseddeath ( x2 = 5.54, P = 0.019; x2 = 4.47, P = 0.031 ). Conclusions This study shows that higher tumor burden assessed by PET MTV is an independent unfavorable prognostic factor in lung cancer, MTV is valuable for predicting overall survival and could be a prognostic factor.

The prognostic significance of FDG PET-CT standardized uptake value in patients with non-small cell lung cancer / 中华放射肿瘤学杂志

Objective To determine the prognostic value of standardized uptake value(SUV)of fluorodeoxyglucose(FDG)by positron emission tomography and computed tomography(PET-CT)in nonsmall cell lung cancer(NSCLC).Methods Forty-eight patients(39 male,9 female)with stage ⅢNSCLC were reviewed.All patients had at least two repeated FDG PET-CT scans either before and after therapy and the maximum standardized uptake value(SUVmax)of the primary lung lesion was calculated. Resuits Of the 45 eligible patients,after a median follow-up of 22.5 months(rang,13 to 35 months),24 patients had local and regional recurrenee or metastasis and 21 remain disease-free.The mean SUVmax of patients who had local recurrence or metastasis before and after treatment was 12.30±3.17 and 5.35±2.29,respectively.The mean SUVmax of patients who had no loeal recurrence or metastasis before and after treatment was 8.46±3.00 and 2.82±0.63,respectively.Significant differences(tbefore=4.15,Pbefore＜0.01;Pafter=4.88,Pafter＜0.01)in SUVmax were observed either before and after treatment.However,the percent change of SUVmax between pretreatment and post-treatment were not significiantly different(t=1.99,P＞0.05).Using the SUVbefore of 9.0 yielded 92% sensitivity,62% specificity,73% positive predictive value and 87%negaffve Dredictive value in predicting regional recurrence or metastasis. While using the SUVafter of 4.3 yielded 71% sensitivity,100% specificity,100% positive predictive valne and 72% negative Dredictive value. Conclusions PET-CT may have the potientials to predict response to therapy and the SUVmax is a significant predictor for recurrent or metastasis in patients of NSCLC.

Colon-specific delivery tablets of sodium 4-aminosalicylic acid / 药学学报

Aim To prepare a new oral colon-specific delivery formulation and to investigate the release profile in vitro and the colon-specific delivery property in vivo in dogs. Methods Sodium 4-aminosalicylic acid was selected as the model drug. The combination of Eudragit RL30D and RS30D were used as sustained-release film, and Eudragit FS30D used as enteric film, which was expected to release drug depending on pH and time. The release profile of tablets was studied in three phosphate buffers with the pH 6.5, 7.0 or 7.4 for 12 h after a simulated gastric presoak for 2 h in 0.1 mol · L-1 HCl. The tablets were radiolabelled with 99mTc to make their release times and positions in the gastrointestinal tract be followed using a gamma camera. Results For the in vitro study, there was no drug released in 0. 1 mol ·L- 1 HCl for 2 h, and release occurred slowly when pH was above 6.5. Drug was released faster while pH was higher. For the in vivo study, the coated tablets remained intact in the upper gastrointestinal tract, and drug release began after the colonic arrival. The uncoated tablets, however, disintegrated in the stomach of the dogs rapidly. Conclusion The coating could protect the drug until the tablets reached the ascending colon, where drug was released slowly for over 10 h.

Accuracy verification of PET-CT image fusion and its utilization in target delineation of radiotherapy / 中华放射肿瘤学杂志

Objective Evaluate the accuracy o f co-registration of PET and C T (PET-CT) images on line with phantom, and utilize it on patients to provide c l inical evidence for target delineation in radiotherapy. Methods A phantom with m arkers and different volume cylinders was infused with various concentrations of 18FDG, and scanned at 4?mm by PET and CT respectively. Aft er having been transmi tted into GE eNTEGRA and treatment planning system (TPS) workstations, the image s were fused and reconstructed. The distance between the markers and the errors were monitored in PET and CT images respectively. The volume of cylinder in PET and CT images were measured and compared by certain pixel value proportion deduc tion method. The same procedure was performed on the pulmonary tumor image in te n patients. Results eNTEGRA and TPS workstations had a good length linearity, b ut the fusion error of the latter was markedly greater than the former. Tumors i n different volume filled by varying concentrations of 18FDG required different pixel deduction proportion. The cylinder volume of PET and CT images were almost the same, so were the images of pulmonary tumor of ten patients. Conclusions T he accuracy of image co-registration of PET-CT on line may fulfill the clinica l demand. Pixel value proportion deduction method can be used for target delineati on on PET image.