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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG)positron-emission temography/computed tomography (PET/CT) examination to predict microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods The retrospective cohort study was conducted.The clinicopathological data of 51 HCC patients who were admitted to Changhai Hospital of the Second Military Medical University (32 patients) and Universal Medical Imaging Diagnostic Center (19 patients) from January 2013 to October 2017 were collected.Of 51 patients receiving postoperative pathological examination,21 diagnosed with positive MVI and 30 diagnosed with negative MVI were respectively allocated into the positive and negative MVI groups.All the patients received preoperative 1s F-FDG PET/CT examination and underwent surgery after related examinations.Two imaging doctors independently read films and made a semi-quantitative analysis.Observation indicators:(1) results of 18F-FDG PET/CT examination;(2) multivariate analysis and diagnostic value affecting MVI of HCC;(3) treatment and follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients' survival up to November 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the independent-sample t test.Measurement data with skewed distribution were described as M (Qn),and comparisons between groups were analyzed using the independent-sample rank sum test.Comparisons of count data were analyzed using the chisquare test.Logistic regression analysis was performed in variables with statistical significance.The inclusion criteria was 0.05 and exclusion criteria was 0.10 according to Backward (LR) method for screening variables.Receiver Operating Characeristic (ROC) curve analysis was used to evaluate the diagnostic value using MVI as a diagnostic standard.Results (1) Results of 18F-FDG PET/CT examination:of 51 HCC patients,tumors located in the right lobe,left lobe and caudate lobe of the liver were respectively detected in 37,12 and 2 patients.CT examinations of 51 HCC patients:HCCs showed the hypodense shadow or slightly hypodense shadow in liver and were round-like,and some of the larger lesions were irregularly conglomerate,with a relatively clear tumor-liver boundary;tumor necrosis area showed patchy and irregular lower density,with small lesions around the port of tumors.Of 51 patients,34 were positive on PET and 17 were negative on PET,and some necrotic areas showed no uptake and located in the center of tumors.There was no abnormal 18 F-FDG uptake in other parts of the whole body.The maximum diameter of tumor was (6± 3)cm.The maximum standardized uptake value (SUVmax),and ratio of SUVmax of tumor to SUVmax of liver (SUVmax T/L) in all the lesions were 6.38±4.91 and 2.42±1.93,respectively.The mean standardized uptake value (SUVmean),metabolism of volume (MTV),total lesion of glycolysis (TLG) of 40 patients were 4.30± 2.46,43.82 cm3 (8.97 cm3,219.13 cm3) and 165.73 (28.26,794.50),respectively,and software could not automatically delineate lesions in other 11 patients due to low metabolism.Delayed imaging was found in 21 patients,and the delayed SUVmax and retention index (RI) were 7.22±6.26,19.66％ (-7.10％,50.84％),respectively.The cases with positive and negative on PET were 18,3 in the positive MVI group and 16,14 in the negative MVI group,respectively,with a statistically significant difference between groups (x2=5.829,P＜0.05).The maximum diameter of tumor in the positive MVI group and negative MVI group was respectively (7.7±2.9)cm and (5.2±3.1)cm,with a statistically significant difference between groups (t=-2.930,P＜0.05).(2) Multivariate analysis and diagnostic value affecting MVI of HCC:the results of multivariate analysis showed that maximum diameter of tumor was an independent factor affecting MVI of HCC (OR=1.276,95％ confidence interval:1.028-1.585,P＜0.05).The area under the ROC curve of the maximum diameter of tumor was 0.723 using MVI as a diagnostic standard.The sensitivity,specificity and Youden index were respectively 90.5％,50.0％ and 0.405,with 4.55 cm as the critical value.(3) Treatment and followup:all 51 patients underwent tumor resection.Twenty-two patients were followed up for 25 months (range,12-46 months).The 1-and 2-year overall survival rates were 81.8％ (18/22) and 63.6％ (14/22),respectively.The 1-and 2-year tumor-free survival rates were 59.1％ (13/22) and 45.5％ (10/22),respectively.Conclusion The positive rate on PET of 18F-FDG PET/CT examination in HCC patients with positive MVI is higher than that in HCC patients with negative MVI,and the maximum diameter of tumor is an independent factor predicting MVI of HCC,with a certainly reference value.
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Objective To investigate the inhibitory effect of 188 Re-labeled BaGdF5-poly ( ethylene glycol) ( PEG) nanoparticles ( NPs) on hepatoma cells, and explore the application of the radiolabeled NPs for SPECT imaging. Methods BaGdF5-PEG NPs were synthesized by hydrothermal method, and were fur-ther radiolabeled with 188Re using diethylene triamine pentaacetic acid (DTPA) as a coupling agent. The human hepatoma cells SMCC 7721 were treated with different concentrations of BaGdF5-PEG NPs, 188 ReO-4 or 188Re-DTPA-BaGdF5 NPs (14.8, 74.0, 370.0×104 Bq/ml) for 24 h, and then the cell proliferation rates were measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. 188ReO-4 and 188 Re-DTPA-BaGdF5 NPs were administrated into normal rabbits via the ear vein, respectively. For the former, static SPECT/CT imaging were performed at 30, 60 min post-injection, and for the latter, dynamic SPECT images were captured within 10 min, and static SPECT/CT images at 30, 60, 120 min post-injec-tion. The rabbit VX2 tumor model was established, and a microcatheter was inserted into hepatic artery via the rabbit femoral artery, and then the mixture of 188 Re-DTPA-BaGdF5 NPs and lipiodol was injected into the tumor region. SPECT/CT imaging for VX2 tumor was performed at 30 min later. Data were analyzed by two-sample t test. Results The BaGdF5-PEG NPs were nearly square and the particle size was about 10 nm. The labeling yield of 188 Re-DTPA-BaGdF5 was 94.1％ at the optimum conditions. Moreover, it showed high stability in vitro and in vivo. In vitro, BaGdF5-PEG NPs did not exhibit obvious cytotoxicity even at a high concentration. Both 188 ReO-4 and 188 Re-DTPA-BaGdF5 could inhibit the proliferation of SMCC 7721 cells, but 188 Re-DTPA-BaGdF5 showed a significantly stronger inhibitory effect at the doses of 74.0 and 370.0×104 Bq/ml ( t values:4.21,4.09, both P<0.01) . In vivo, 188 ReO-4 was absorbed by maxillary glands and was quickly elimi-nated from blood via the kidneys. The 188 Re-DTPA-BaGdF5 NPs mainly accumulated in the liver and spleen. In addition, retention and accumulation of 188 Re-DTPA-BaGdF5 NPs in the liver tumor could be achieved by using transarterial intervention technique for drug delivery. Conclusion 188Re-DTPA-BaGdF5 NPs have cer-tain killing effects on hepatoma cells in vitro, and with the help of transarterial intervention technique, the NPs can be aggregated within liver tumor, where they not only can be used for SPECT imaging, but also have potential therapeutic effects.
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Objective To investigate the application of MRI targeting contrast agent ( P-Gd-Probe) for P selectin in evaluating the severity grades of acute pancreatitis (AP).Methods L-arginine solution (100mg/100kg) were intraperitoneally injected for 3 times once an hour to establish AP model in SD rats. Control group was injected with normal saline in a equal volume .All rats were divided into acute edematous pancreatitis (AEP) group (6 h and 12 h after model establishment)and acute necrotizing pancreatitis (ANP) group (24 h and 48 h after model establishment ) based on the pathology .The rats were examined by T 1 WI plain and enhanced scanning at 6 h, 12 h, 24 h and 48 h after injection , and P-Gd-probe was as the enhanced contrast agent.The signal noise ratio ( SNR) of the pancreas were measured before and after enhancement .Then the pancreas tissues were harvested for pathological examination and P selectin expression in pancreatic tissue was detected using immunohistochemical analysis .Results Inflammation was observed in pancreatic tissue at 6h after establishment , and became more serious as the modeling time extended .P selectin expression was increased as pancreatitis inflammation became more serious .The SNR of control group was stable before and after enhancement.The SNR before and after enhancement was 17.22 ±1.35 and 37.38 ±1.66 in AEP group, and 16.29 ±1.39 and 58.18 ±1.03 in ANP group.The SNR after enhancement was higher than that before enhancement, and the differences were significantly different ( t=-49.59 and -86.09, P<0.001 ). Conclusions Monoclonal antibody MRI contrast agent targeting P selectin is helpful in evaluating the severity of AP.
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Objective To evaluate the diagnostic value of the metabolic parameters for differentiating focal autoimmune pancreatitis (F-AIP) and pancreatic cancer (PC) by dual time 18F-FDG PET/CT scan.Methods Ten F-AIP patients and 20 PC patients in Changhai Hospital from May 2011 to November 2014 were enrolled in this study.All the AIP patients were histological confirmed or diagnosed by clinical follow up.The PC patients were histological confirmed and gender-and age-matched with F-AIP patients.50％ SUVmax was set as the threshold to fine-tune the boundary of interest.The extracted parameters included SUV SUV metabolic tumor volume (MTV),total lesion glycolysis (TLG),target-to-background ratio (TBR) and the retention indexes(RI) of all the parameters above.The PET/CT imaging features were also observed.Results The high metabolic lesions were observed in both F-AIP patients and PC patients.There were 6 F-AIP patients whose lesion was located in pancreas head,4 F-AIP patients whose lesion was located in pancreas body and tail.There were 12 PC patients whose lesion was located in pancreas head,8 PC patients whose lesion was located in pancreas body and tail.In F-AIP patients,2 cases had dilated pancreatic duct,6 had dilated biliary duct,8 had increased metabolism in mediastinal lymph node and 2 had abdominal lymphadenopathy,which were 8,5,5 and 14 cases in PC patients.The positive rate of mdeiastinal lymphadenopathy in F-AIP patients was statistically higher than that in PC patients,while the positivity rate of abdominal lymphadenopathy in AIP patients was lower than that in PC patients.The difference was statistically significant (both P ＜ 0.05).There were no statistical differences on the positivity rate of the dilated pancreatic duct,intra-and extra-hepatic bile duct between two groups.SUVmax,SUVmean and MTV in F-AIP were 5.37 ± 0.88,3.48 ± 0.66,21.79 ±15.60 in early stage and 6.45 ±1.51,4.23 ± 1.10,19.36 ± 14.63 in delayed stage,and those in PC were 8.31 ±3.08,5.41±1.95,9.26±8.35 in early stage,and 9.75±3.86,6.36±2.56,9.09±10.71 in delayed stage.SUVmax and SUVmean in F-AIP were lower than those in PC,whereas MTV were larger in F-AIP than that in PC.ROC curves for SUVmax,SUVmean and MTV were made.The AUC of SUV was the highest at 0.85,the cut-off value was 4.45,the corresponding sensitivity was 65％ and the specificity was 90％.TLG,TBR and RI of all the parameters were not statistically different in F-AIP and PC.Conclusions The 18F-FDG PET/CT metabolic parameters,such as SUVmax,SUVmean,MTV,could be of special diagnostic significance in discriminating F-AIP from PC.