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Objective To evaluate the diagnostic efficiency and prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT for response assessment after treatment in patients with diffuse large B-cell lymphoma (DLBCL) when using the Deauville criteria and International Harmonization Project (IHP) criteria.Methods A total of 212 patients (119 males,93 males,average age:59.6(10-88) years) with DLBCL from February 2010 to June 2018 were analyzed.All subjects underwent restaging PET/CT after treatment.Images were evaluated with the IHP criteria,Deauville score of 3-5 (DC3) and Deauville score of 4-5 (DC4).The diagnostic efficiency of the 3 criteria for treatment effect was assessed and follow-up results were used as the gold standard.Spearman rank correlation analysis was used.Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier analysis and Cox proportional hazards model.Results The positive predictive value and accuracy of DC4 for treatment effect evaluation were 96.8％(61/63) and 94.3％(200/212),those of IHP criteria were 75.3％(67/89) and 87.7％(186/212)respectively,and those of DC3 were 82.9％ (68/82) and 92.0％ (195/212) respectively.IHP criteria results and Deauville scores were correlated(rs =0.926,P＜0.05).The 2-year PFS rates in IHP-,DC3-and CD4-positive groups were 78.7％,76.5％ and 69.8％,respectively,and those in IHP-,DC3-and CD4-negative groups were significantly higher (95.6％,94.7％,97.2％;x2=14.415,18.293 and 26.920,all P＜0.05).The similar results were found for OS rates (x2 =9.597,11.149 and 17.416,all P＜0.05).The 2-year PFS rates in Deauville score of 1,2,3,4,5 groups were 95.3％,91.7％,93.3％,88.9％ and 55.6％ respectively (x2 =48.199,P＜0.05).Cox-regression analysis showed significant correlation between Deauville criteria and 2-year PFS rate (P＜0.05).Conclusions PET/CT with DC4,DC3 and IHP criteria have high predictive values for treatment outcome,and DC4 is the best.Cox regression analysis shows significant risk of progression by Deauville criteria.
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Objective To explore the relationship between the maximum standardized uptake value ( SUVmax ) of 18 F-fluoromisonidazole ( FMISO) PET/CT and the pathological classification, differentiation, T stage and primary tumor volume of nasopharyngeal carcinoma ( NPC) . Methods A retrospective analysis was performed on 41 patients with NPC (31 males, age 18-74 years;10 females, age 35-67 years) who underwent head and neck 18 F-FMISO PET/CT from 2012 to 2015. The relationship between the clinicopath-ological parameters (pathological classification, differentiation, T stage, tumor volume) of primary lesion and SUVmax were analyzed. Mann-Whitney u test, approximate t test and Spearman correlation were used for data analysis. Results There was no significant difference in SUVmax between non-keratinizing carcinoma and squamous cell carcinoma ( u=183.5, P>0.05) , nor between the differentiated carcinoma and undiffer-entiated carcinoma( t'=-1.23, P>0.05) . SUVmax of T1-T2 primary tumor was significantly lower than that of T3-T4 tumor (1.52±0.43 vs 2.05±0.85; t'=-2.60, P<0.05), and SUVmax was correlated with primary tumor volume ( rs=0.488, P<0.05) . Conclusions The hypoxic degree is related with T stage and primary tumor volume in NPC. The combination analysis of T stage and tumor size will contribute to the assessment of oxygen level and prognosis of primary NPC.
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Objective To explore the identification of the hypoxia regions within the primary foci and imaging time selection in 18F-fluoromisonidazole (FMISO) imaging on patients with nasopharyngeal carcinoma (NPC).Methods From July 2013 to July 2014,44 NPC patients (33 males,11 females,age range:18-74(53.45± 12.88) years) underwent 18 F-FMISO PET/CT imaging,including 3 cases with twice imaging (totally 47 case times).Inaging data were acquired and reconstructed 2 and 4 h after the injection of 18 F-FMISO.1s F-FMISO PET/CT images were merged with MRI images obtained 1 week before to construct fusion images.The boundary of primary tumor was determined based on MRI.Visual analysis was performed and SUVmax of posterior cervical muscles,NPC primary foci was measured by 2 observers respectively.The uptake ratio of primary tumor to muscle (TMR) was calculated.The identify consistency of hypoxic region between two observers were evaluated by Kappa test and intraclass correlation coefficient (ICC).The image contrast was evaluated by Wilcoxon paired rank sum test of TMR.Results PET images and MRI images of NPC primary foci were successfully fused.Positive non-NPC tissues were identified by MRI.The visual recognition of hypoxic regions of the two observers for 2 and 4 h imaging were highly consistent (Kappa =0.931 and 0.965,both P＜0.001).There was a high degree of consistency between the SUVmax of posterior cervicalmuscles and that of primary tumors.ICCs of posterior cervical muscles in 2 and 4 h were 0.896 (95％ CI:0.814-0.942) and 0.924 (95％ CI:0.865-0.958),respectively.ICCs of primary tumors in 2 and 4 h were 0.991 (95％ CI:0.985-0.995) and 0.998 (95％ CI:0.996-0.999),respectively.TMRs (M(P25,P75))in 2 and 4 h were 1.560 (1.341,3.015) and 1.675 (1.387,3.001) respectively in 24 positive case times,and the difference was statistically significant (z=-2.557,P＜0.05).Conclusions Using fusion images of 18F-FMISO PET and MRI,hypoxic tissues within NPC primary foci can be accurately identified.There is a high degree of consistency within the visual and quantitative analysis of two observers.The image contrast of 18F-FMISO PET at 4 h is superior to that at 2 h.
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Objective To analyze the relevant factors influencing 18F-FDG uptake in the primary lesion of breast invasive ductal carcinoma (BIDC).Methods A total of 160 female patients underwent 18 F-FDG PET/CT examination from 2010 to 2015 and breast lesions were revealed.Lesions were divided into benign group (n =118) and malignant group (n =49,BIDC) according to pathological results.KruskalWallis H test and Mann-Whitney u test were performed to compare SUVmax of the two groups,and to investigate the relationship between the SUVmax of breast malignant lesion and patients' age as well as clinical pathological parameters including T stage,lymphatic vessel invasion,nuclear grade,route of metastasis,ER,PR,HER2 and Ki-67 expression,and subtype of breast cancer.The diagnostic efficiency of 18F-FDG PET/ CT in differentiating benign and malignant breast lesions was analyzed using ROC curve analysis.Results The SUVmax of BIDC was 6.09(3.88,9.26),higher than that of breast benign lesion (1.35 (0.95,2.35);u=341.0,P＜0.05).The SUVmax of BIDC showed statistically significant difference between groups with different T stage,with or without lymphatic vessel invasion,with different nuclear grade,different routes of metastasis and different Ki-67 expression (u:117.5-209.5,H=7.70,P＜0.01 or 0.05).For all breast lesions,lesions with the maximum diameter ≤ 2.0 cm and lesions with the maximum diameter ＞2.0 cm,the optimum cutoff values of SUVmax were ＞2.60,＞ 1.71 and ＞3.97,respectively.When the optimum cutoff values of SUVmax for breast lesions with the maximum diameter ≤2.0 cm were selected as ＞ 1.71 and ＞2.60,the Youden indexes were 0.66 and 0.61(z=0.566,P＞0.05).When the optimum cutoff values of SUVmax for breast lesions with the maximum diamter ＞2.0 cm were selected as ＞3.97 and ＞2.60,the Youden indexes were 0.89 and 0.81(z=0.748,P＞0.05).Conclusions T stage,lymphatic vessel invasion,nuclear grade,route of metastasis and Ki-67 expression of BIDC influence the uptake of 18F-FDG by tumor tissues.The SUVmax of the primary lesion of BIDC is related to the size of lesion,and thus the diagnostic threshold of SUVmax should be decreased appropriately for small lesions.
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Objective To synthesize 18F-FMISO and analyze the quality of the product.Methods 1-(2'-nitro-l'-imidazolyl)-2-O-tetrahydropyranyl-O-trluendulfonylpropanediol (NITIT) was taken as the precursor and simple one pot method was used.CFN-MPS-100 fluorine multifunction radiopharmaceutical chemical synthesis module was adopted to complete the radioactive fluorination reaction in a closed flat flask,and the crude product was purified by semi-preparative HPLC,the solvent was removed by rotary evaporation.Then 15 ml saline was added into the product to get 18F-FMISO injection.Radio-HPLC and radio-TLC were applied for quality control.Results 18F-FMISO was obtained in 60 min with the radiochemical yield of (32±5.0)％ (no decay corrected,n=25).The radiochemical purity was above 99.0％ and still above 98.5％ after 6 h.The radioactive concentration was above 1.11 × 1012 Bq/L.The product was colorless solution,with pH value of 7.0.The radioactive nuclear purity was more than 99％.The K222 was less than 25 μg/ml.Conclusion 18 F-FMISO could be synthesized with automatic synthesis method based on the CFN-MPS-100 fluorine multifunction module.The labeling rate,stability and chemical purity are high.
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Objective To investigate the value of gastrointestinal tract preparation with oral racean?isodamine tablets and isotonic mannitol in 18 F?FDG PET/CT imaging. Methods From July to September 2013, 129 patients with confirmed or suspected tumors who were referred for 18 F?FDG PET/CT imaging were divided into 2 groups. In the study group (30 males, 37 females, age (53.4±13.9) years), raceanisodam?ine tablets (10 mg) and 1 000-1 200 ml isotonic mannitol solution (2.5%) were orally taken at 10 min after in?jection of 18F?FDG;while in the control group (37 males, 25 females, age (60.0±12.8) years), 1 000-1 200 ml water was given. Mann?Whitney u test was used to compare the difference between the 2 groups in the filling degree of gastrointestinal lumen, delineation of tube wall, physiological uptake, matching degree of PET and CT images, delineation of mesentery, and the influence of gastrointestinal uptake on the identification of ab?dominal and pelvic lesions. χ2 test was used to compare the difference between the 2 groups in the uptake pattern of gastrointestinal tract and the incidence of side effects. Spearman correlation analysis was used to study the correlation between gastrointestinal lumen filling and PET/CT image matching. Results The gas?trointestinal lumen filling, delineation of tube wall, PET/CT image matching in the stomach, small intestine and colon (z: -5.096 to -2.665, all P0.05). There was statistically significant difference in the uptake pattern of small intestine between the two groups(χ2=12.884, P0.05). The incidence of transient diarrhea (20?9%, 14/67) was higher in the study group than that in the control group (4.8%, 3/62;χ2=7.256,P<0.01). Conclusions The abdominal PET/CT image quality is improved by gastrointestinal preparation with oral raceanisodamine tablets (10 mg) and 1 000-1 200 ml isoton?ic mannitol solution (2.5%).