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Objective:To investigate whether the intratumoral heterogeneity measured by preoperative 18F-fluorodeoxyglucose (FDG) PET/CT could predict regional lymph node metastasis (LNM) in patients with clinical (c)N0 colorectal cancer. Methods:A total of 70 patients with cN0 colorectal cancer were consecutively enrolled from January 2012 to December 2019. All patients underwent 18F-FDG PET/CT followed by radical resection of colorectal cancer within one month. Whether the regional LNM existed was confirmed pathologically. Volume of interest (VOI) was drawn with the threshold of the standardized uptake value (SUV) of 2.5. The area under the cumulative SUV histograms curve (AUC-CSH) of the primary lesion was calculated by PMOD software, as well as the maximum SUV (SUV max), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Differences of AUC-CSH and metabolic parameters between groups were compared by using independent-sample t test and Mann-Whitney U test. Whether AUC-CSH was the independent predictor of regional LNM was analyzed with multivariate logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of AUC-CSH. Results:Among 70 patients with cN0 colorectal cancer, 16(22.9%) patients were pathologically confirmed to have regional LNM. The AUC-CSH of metastasis group was significantly lower than that of non-metastasis group (0.372±0.089 vs 0.464±0.121; t=2.831, P=0.006). There were no significant differences in SUV max(21.0±9.6 vs 23.9±10.9), MTV (33.0(20.8, 50.2) vs 28.3(16.0, 47.1) cm 3) and TLG (203.3(117.2, 467.5) vs 184.5(105.6, 434.3) g) of the primary tumor between those two groups( t=0.980, U values: 0.517, 0.028, all P>0.05). The multivariate logistic regression analysis showed AUC-CSH was the independent predictor of regional lymph node matastasis (odds ratios ( OR)=5.04, 95% CI: 1.37-18.60, P=0.015). The ROC curve analysis showed the area under the curve of AUC-CSH was 0.73 (95% CI: 0.59-0.86, P=0.006). When the cut-off value of AUC-CSH was 0.409, the sensitivity and specificity of predicting regional LNM was 12/16 and 66.7%(36/54), respectively. Conclusions:The intratumoral heterogeneity of primary tumor is strongly associated with regional LNM in cN0 colorectal cancer. AUC-CSH measured by preoperative 18F-FDG PET/CT has a potential in prediction of regional LNM in patients with cN0 colorectal cancer.
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Objective:To evaluate the value of standardized uptake value of the left ventricle (SUV LV) during 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the detection of the cardiotoxicity of anthracycline in non-Hodgkin lymphoma (NHL). Methods:Twenty-two patients(13 males and 9 females, age: ( 58±13 ) years) diagnosed as NHL from January 2016 to June 2019 were retrospectively enrolled in the study. All patients received chemotherapy regimens containing anthracycline. The gated myocardial perfusion imaging (GMPI) and whole body 18F-FDG PET/CT imaging were performed before and after chemotherapy in Changzhou First People′s Hospital. The significant reduction of diastolic function after chemotherapy measured by GMPI was defined as anthracycline induced myocardial injury. The SUV LV before and after chemotherapy and the changes (ΔSUV LV ) in patients with or without myocardial injury were compared with independent-sample t test or paired t test. The receiver operating characteristic (ROC) curve analysis was used to determine whether SUV LV could be used to detect anthracycline induced myocardial injury. Results:The reduction of LVEF after chemotherapy was more significant in myocardial injury group ( n=6) than that in patients without myocardial injury ( n=16; ΔLVEF: (-5.8±7.5)% vs (2.7±3.8)%, t=2.657, P<0.05). After chemotherapy, an increase was found in SUV LV of patients with myocardial injury (maximum SUV LV (SUV LVmax): 7.5±4.4 vs 2.6±1.0, t=2.585, P<0.05; mean SUV LV (SUV LVmean): 3.7±2.2 vs 1.6±0.8, t=2.119, P>0.05), but no differences were found in SUV LV of patients without myocardial injury (SUV LVmax: 5.7±4.9 vs 5.6±4.8, SUV LVmean : 2.8±2.3 vs 2.8±2.2; t values: 0.130, 0.069, both P>0.05). Compared with patients without myocardial injury, patients with myocardial injury had higher ΔSUV LV ( t values: 2.494, 2.163, both P<0.05) and lower pre-chemotherapy SUV LVmax ( t=2.436, P<0.05). ROC curve analysis showed that ΔSUV LVmax and ΔSUV LVmean could be used for the detection of chemotherapy induced cardiotoxicity, and higher area under curve (AUC) of ΔSUV LVmaxwas found (AUC=0.844, 95% CI: 0.673-1.000). When the threshold value was 1.1, the sensitivity and specificity of ΔSUV LVmax in the detection of myocardial injury were 5/6 and 13/16, respectively. Conclusions:Higher ΔSUV LVmax and ΔSUV LVmean, as well as lower baseline SUV LVmax are correlated with cardiotoxicity of anthracycline. ΔSUV LVmax has a potential for the diagnosis of anthracycline induced cardiotoxicity in patients with NHL.
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Objective To compare the value of interim and end-of-treatment 18F-fluorodeoxyglucose (FDG) PET/CT for the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).Methods A total of 116 DLBCL patients (male ∶female=1 ∶ 1.32,average age:(57.87± 15.89) years) whose initial treatment was rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone(R-CHOP),were enrolled from 2008 to 2016.All patients underwent pre-treatment,interim and end-of-treatment 18F-FDG PET/CT.End points were progression-free survival (PFS) and overall survival (OS).Correlation between metabolic parameters including maximum standardized uptake value (SUVmax),metabolic tumor volume (MTV),total lesion glycolysis (TLG),Deauville score (DS),△SUVmax,△MTV,△TLG in the interim PET/CT and those in the end-of-treatment PET/CT was analyzed with Pearson correlation analysis.The ability of metabolic parameters to assess the prognosis was evaluated by receiver operating characteristic(ROC) curve analysis.The survival was analyzed by Kaplan-Meier method and hazard ratio (HR) was calculated by Cox regression model.Results The r values for △SUVmax,△MTV,△TLG of interim and end-of-treatment PET/CT were 0.630,0.912,0.955,respectively (all P＜0.01).One hundred and four cases (89.7％,104/116)had the same DS in the interim and end-of-treatment PET/CT,and the r value for DS between two PET/CT scans was 0.733 (P＜0.01).The interim metabolic parameters were superior to that at the end of treatment in evaluating the progression.The 5-year PFS (83.1％ vs 35.9％,P＜0.01;HR =5.969,P＜0.01) and OS (95.7％ vs 75.5％,P＜0.01;HR=8.161,P＜0.05) rates were significantly higher in DS 1-3 group than those in DS 4-5 group.Conclusions Interim PET/CT is effective for the prediction of prognosis in DLBCL patients with R-CHOP treatment.Patients with complete remission in the interim can omit the end-of-treatment PET/CT.
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Objective·To explore the diagnostic value of 9 mTc-sestamibi (9 mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) and ultrasonography in hyperparathyroidism. Methods·Fifty patients with hyperparathyroidism were included. 9 mTc-MIBI SPECT/CT was performed before operations in all patients, while ultrasonography was performed in 33 patients. The diagnostic efficiency was calculated for both imaging methods in comparison to pathological data. Results·Serum parathyroid hormone (PTH) levels were 352.0 (141.5-846.0) pg/mL and 1792.0 (1018.5-2358.5) pg/mL, respectively, in primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT), while maximum diameters of lesion were 14.5 (9.0-20.9) mm and 10.0 (8.0-12.6) mm, respectively (both P<0.01). The accuracy of SPECT/CT were 97.7% and 62.5%, respectively (P<0.01), in PHPT and SHPT. In 33 patients, the sensitivity and accuracy of SPECT/CT were 66.3% and 74.2%, respectively, whereas the sensitivity and accuracy of ultrasonography were 45.7% and 61.4%, respectively (both P<0.05). Conclusion·Serum PTH levels were higher, while maximum diameters of lesion were longer in PHPT than that in SHPT, and the diagnostic efficiency was also higher in PHPT than that in SHPT. In the other hand, the sensitivity and accuracy of SPECT/CT were higher than that of ultrasonography.