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Objective:To evaluate the value of 18F-prostate specific membrane antigen (PSMA)-3Q PET/CT imaging in prostate cancer patients with serum prostate specific antigen (PSA) less than 1.00 μg/L after radical prostatectomy. Methods:From May 2021 to August 2022, 18F-PSMA-3Q PET/CT images and clinical data of 58 patients with prostate cancer (age 52-82 years) after radical prostatectomy with PSA less than 1.00 μg/L in Chinese PLA General Hospital were analyzed retrospectively. According to the level of PSA, patients were divided into three groups (0-0.19 μg/L group, 0.20-0.49 μg/L group, and 0.50-0.99 μg/L group). 18F-PSMA-3Q PET/CT images were analyzed according to the standardized evaluation criteria of molecular imaging, and lesions with the scores of molecular imaging PSMA (miPSMA)≥1 were defined as recurrent or metastatic lesions. The detection rates of 18F-PSMA-3Q PET/CT for patients in different PSA level groups were compared ( χ2 test). The PSA levels of patients with positive and negative scans were compared by using independent-sample t test. Results:Of the 58 patients, 36(62.1%, 36/58) patients and 85 lesions were found by 18F-PSMA-3Q PET/CT. There was 91.7%(33/36) with oligofocal lesions (1≤number of foci≤3) and 8.3%(3/36) with multiple lesions (number of foci>3). According to the location, 5.2%(3/58) of the recurrent lesions were found in the prostatic bed, 39.7%(23/58) in the bone lesions, 37.9%(22/58) in the pelvic lymph nodes, 12.0%(7/58) in the retroperitoneal lymph nodes and 5.2%(3/58) in the left clavicular lymph node metastases. There were 15 cases in 0-0.19 μg/L group, 22 cases in 0.20-0.49 μg/L group, and 21 cases in 0.50-0.99 μg/L group. The detection rates of 18F-PSMA-3Q PET/CT in the above groups were 5/15, 59.1%(13/22) and 85.7%(18/21), respectively ( χ2=10.33, P=0.006). There was significant difference in PSA level between patients with positive ( n=36) and negative ( n=22) 18F-PSMA-3Q PET/CT scans ((0.48±0.28) vs (0.28±0.25) μg/L; t=2.67, P=0.010). Conclusions:18F-PSMA-3Q PET/CT can be used to detect the recurrence or metastasis in prostate cancer patients with PSA level lower than 1.00 μg/L after radical prostatectomy. In this kind of patients, the common sites of lesions are bone, pelvic lymph nodes, retroperitoneal lymph nodes, left clavicular lymph nodes and prostatic bed, and oligofocal patients are more common.
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Objective:To explore the application value of overall nursing intervention in PET/MR imaging in children with epilepsy.Methods:A total of 48 pediatric epilepsy patients who underwent PET/MR imaging in the Nuclear Medicine Department of the First Medical Center of the PLA General Hospital from July 2018 to October 2019 were enrolled. Among them, 24 patients with overall nursing intervention were used as the experimental group, and 24 patients were routine nursing intervention patients, who were served as the normal control group, and the examination time, Self-Rating Anxiety Scale (SAS) scores and patient satisfaction scores (filled in by the patient′s guardian) of the experimental group and the control group were collected and compared.Results:The inspection time of the experimental group was (15.1±0.5) min, significantly lower than (24.8±1.3) min of the control group ( tvalue was 32.940, P<0.01); the SAS score of the experimental group was (35.7±4.2) points, lower than(43.8±3.3) points of the control group ( tvalue was 7.357, P<0.01), and the patient satisfaction score was (92.8±5.5) points, higher than (69.8±11.1) points of the control group ( tvalue was 9.088, P<0.01 or 0.05). Conclusion:Overall nursing intervention in PET/MR imaging of pediatric patients with epilepsy can significantly cut down the examination time, reduce the anxiety of patients′ family members and improve the satisfaction of nursing care. It lays the foundation for clinicians to further accurately diagnose epilepsy foci and has important application value.
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Objective:To investigate the value of multiple parameters and the combined model based on 18F-fluorodeoxyglucose (FDG) PET/MR in the differential diagnosis of benign and malignant pancreatic tumors. Methods:A total of 76 patients (50 males, 26 females, age (45.2±18.0) years) with clinically suspected pancreatic tumor who underwent PET/MR between December 2012 and September 2020 in First Medical Center of Chinese PLA General Hospital were retrospectively selected. All patients had definitive diagnoses. PET/MR sequences included T 1 weighted imaging (WI; convention and contrast enhancement), T 2WI, diffusion weighted imaging (DWI) and 18F-FDG PET sequences. Morphological characteristics and scores of lesions in MRI were evaluated. Parameters including parameters of PET and DWI, as well as parameters derived from histogram analysis of apparent diffusion coefficient (ADC) and standardized uptake value (SUV) (maximum (max), minimum (min), mean, median, standard deviation (SD), skewness, kurtosis, entropy) were measured. Independent-sample t test or Mann-Whitney U test were used for data analysis. PET/MR combined model was measured based on logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to calculate the differential diagnosis efficacy of PET/MR multiparameters and combined model for benign and malignant lesions. Results:Among 76 patients, 55 were malignant and 21 were benign. (1) Visual evaluation. The main manifestations of pancreatic cancer were unclear margin, abnormal internal MR signal and enhancement, decreased ADC signal and increased radioactive uptake. The main manifestations of benign tumor lesions of pancreas were clear margin, even signal and enhancement, no reduction of ADC, decreased radioactive uptake. (2) Diagnostic efficacy. Multiparameter model established based on logistic regression analysis included SUV max, SUV SD, ADC entropy and ADC skewness. The efficiency of differential diagnosis for benign and malignant pancreatic tumors were shown as follows: multiparametric diagnostic model>ADC entropy>MR score>SUV max>SUV SD>ADC skewness. The multiparametric diagnostic model had the best diagnosis efficiency with the area under curve (AUC) of 0.86, the sensitivity of 69.1%(38/55), and the specificity of 100%(21/21) ( z=-8.73, P<0.001). Conclusions:MR score and multiple quantitative parameters obtained from 18F-FDG PET/MR can be used to differentiate benign and malignant pancreatic tumors. Compared with independent parameter of PET/MR, multiparametric model can further improve the diagnostic efficiency.
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Objective:To assess the value of 18F-fluorodeoxyglucose (FDG) PET/MR parameters and their changes in predicting and evaluating the curative effect in patients with locally advanced rectal cancer before and after neoadjuvant chemoradiotherapy (NCRT). Methods:From June 2017 to June 2020, 13 patients (9 males, 4 females; age (52.2±13.2) years) with locally advanced rectal cancer confirmed pathologically and underwent NCRT in Chinese PLA General Hospital were retrospectively enrolled. All patients performed the first PET/MR within one month before NCRT and the second PET/MR within one month before operation. PET/MR parameters including maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), metabolic tumor volume (MTV) 2.5, total lesion glycolysis (TLG), minimum apparent diffusion coefficient (ADC min), and their changing percentage (Δ) before and after NCRT were collected. Patients were divided into pathologically complete remission (pCR) group and non-pCR group or response group and non-response group according to the postoperative pathological results as the gold standard. Mann-Whitney U test and logistic regression analysis were used for data analysis. The cut-off values of related parameters and their diagnostic efficiencies were determined by receiver operating characteristic (ROC) curve analysis. Results:Of 13 patients, 5 reached pCR and 8 had histological reaction (response). There were no significant differences in parameters (SUV max, SUV mean, MTV 2.5, TLG, ADC min) between different groups before treatment ( U values: 8.00-19.00, all P>0.05). There were significant differences in SUV max, SUV mean, MTV 2.5, TLG and ΔADC min between pCR group and non-pCR group after treatment ( U values: 0.00-6.00, all P<0.05), but only SUV max was correlated with pCR after treatment (odds ratio ( OR)=0.335, 95% CI: 0.123-0.917, P=0.033). The area under curve (AUC) was 0.95 and the cut-off value of SUV max was 3.055, with the sensitivity of 100%, the specificity of 80.0% and the accuracy of 92.3%. There were significant differences in SUV max, SUV mean, TLG, ADC min, ΔSUV max and ΔADC min between the response group and non-response group after treatment ( U values: 0.00-6.00, all P<0.05), but only ΔSUV max was correlated with the response results ( OR=2.022, 95% CI: 1.100-4.130, P=0.048). The AUC was 0.90 and the cut-off value of ΔSUV max was 69.0%, with the sensitivity of 87.5%, the specificity of 80.0% and the accuracy of 84.6%. Conclusions:PET/MR has high accuracy in evaluating NCRT for locally advanced rectal cancer. SUV max is an independent predictor of pCR after treatment, while ΔSUV max is an independent predictor of histological reaction (response).
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Objective To evaluate the diagnostic efficiency of the parameters obtained from PET/MR in brain tumors.Methods In this prospective study,28 patients (21 males,7 females,age range: 6-82 years) with clinical suspicion of brain tumor from November 2012 to September 2015 underwent PET/MR multi-modality imaging.The examination of PET/MR included 11C-MET PET and multiple MR sequences.The qualities of images were estimated firstly.The ROC curve and the accuracy of SUVmax,ADCmean,rCBF and NAA/(Cho+Cre) ratio were calculated.The pathology or final clinical diagnosis was taken as the standard.The diagnostic efficiency of the multi-modality imaging was determined based on the cutoff values of the four parameters.Two-sample t test was used to analyze the differences of parameters between glioma group and inflammatory group.Results SUVmax,ADCmean,rCBF and NAA/(Cho+Cre) ratio were validated to be effective parameters in diagnosing brain tumors with the diagnostic accuracy of 89.3％(25/28),82.1％(23/28),78.6％(22/28) and 75.0％(21/28),respectively.The SUVmax exhibited the highest diagnostic accuracy,while the diagnostic efficiency of the combination of four parameters was superior to the separate parameter.The values of SUVmax,rCBF and NAA/(Cho+Cre) ratio were significantly different between glioma group(n=10) and inflammatory group(n=11;t values:-2.31,-3.11,-2.77,all P<0.05).Conclusions PET/MR can provide a one-stop examination with multi-modality imaging of brain.The obtained parameters SUVmax,ADCmean,rCBF and NAA/(Cho+Cre) ratio,especially their combination,have effective diagnostic values on brain tumor.
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Objective To evaluate the value of SUVmax/ADCmin obtained by 11 C?choline PET/MR imaging in the differential diagnosis of benign and malignant prostate disease. Methods Suspicious prostate cancer patients who underwent PET/MR before transperineal prostate biopsy in People′s Liberation Army General Hospital from April 2014 to January 2015 were observed. Prostate gland was divided into five dis?tricts. A ROI with the diameter of 1 cm was drawn at the highest radioactivity concentration and/or lowest ADC signal area in each district, and SUVmax , ADCmin and SUVmax/ADCmin were then calculated. Taking the pathological results as the gold standard, malignant and benign prostate disease districts were separated. Pearson correlation analysis and two?sample t test were used for statistical analysis. Results Biopsy pathol?ogy showed 9 cases were malignant ( 25 prostate cancer districts, and 20 benign prostate disease districts) , and 6 cases were benign (30 benign prostate disease districts). The SUVmax had a negative correlation with ADCmin( r=-0.521, P<0?05) . The SUVmax/ADCmin of benign and malignant districts was significantly dif?ferent(5.67±3.03 and 13?76±7.13; t=6.9, P<0.01). The ROC AUC for ADCmin, SUVmax and SUVmax/ADCmin were 0?880, 0?809 and 0.898. Using SUVmax/ADCmin of 7.78 as a cutoff, the sensitivity, specificity and accuracy of 11 C?choline PET/MR imaging for differentiating the benign and malignant prostate lesions were 84.0%(21/25), 86.0%(43/50) and 85.3%(64/75), respectively. Conclusions Simultaneous 11C?choline PET/MR could be used for detecting prostate cancer. SUVmax/ADCmin may serve as an effective diag?nostic indicator for differentiating benign and malignant prostate lesions.
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Objective To investigate the optimal workflow and protocol for integrated PET/MR by comparison with PET/CT.Methods A total of 228 patients were enrolled in this study for PET/CT and PET/MR evaluation on the same day.Six PET/MR protocols with different MR sequences but the same PET acquisition protocol were investigated and the optimal protocol was identified based on image quality,acquisition time and diagnostic performance.Results PET/MR workflow was similar to PET/CT,however,some special issues needed to be considered for PET/MR.Among the 6 protocols,protocol No.6 outperformed others for body and head regions.Types of artifacts were found more often in PET/MR than in PET/CT.Conclusions By optimizing the protocol,PET/MR could achieve almost the same diagnostic performance as PET/CT.However,the issues of long acquisition time and artifacts on PET/MR need to be further improved.
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<p><b>OBJECTIVE</b>To assess the value of contrast-enhanced ultrasonography (CEUS) and fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) in evaluating the stability of carotid atherosclerosis.</p><p><b>METHODS</b>Seventeen patients with 21 carotid artery plaques received examinations with CEUS. According to the nature of the plaques, the patients were divided into soft and mixed plaque group and hard and calcified plaque group. The maximal enhancement intensity of the plaques (I(MAX)) and maximal plaque density (D(MAX)) were measured to quantify the neovasculature. The patients also underwent concurrent ¹⁸F-FDG PET/CT, and ¹⁸F-FDG uptake was quantified by the mean standard uptake values (SUV(mean)), an index reflecting the inflammatory activity in the plaque. The findings in CEUS and PET/CT were comparatively analyzed for these cases.</p><p><b>RESULTS</b>The D(MAX) of the plaque in soft and mixed plaque group was significantly greater than that in hard and calcified plaque group (4.26±3.65 vs 1.41±1.47, P<0.05); the I(MAX) was also greater in the former group, but this difference was not statistically significant (26.83±19.61 vs 24.73±29.85, P=0.869). The soft and mixed plaques tended to have higher SUVmean than the hard and calcified plaques (1.70±0.45 vs 1.47±0.12, P=0.099). The values of I(MAX) and D(MAX) were not found to correlate to SUV(mean) in these patients.</p><p><b>CONCLUSION</b>CEUS can sensitively show the status of neovascularization within the carotid atherosclerosis plaques, and PET/CT reflects the inflammatory activity in the plaques. The combination of these two imaging modalities allows the evaluation of plaque stability in terms of neoangiogenesis and inflammatory activity.</p>