Incidental Detection of Urinary Leakage on FDG PET/CT Imaging.

ABSTRACT: A 57-year-old woman previously diagnosed as cervical cancer underwent an 18 F-FDG PET/CT scan for restaging. A pelvic encapsulated effusion with intense FDG accumulation was incidentally revealed. The tracer activity was similar to that of urine, indicating presence of urinary leakage. Subsequent CT urography confirmed the complete avulsion of the right distal ureter.

Life-Threatening Involvement of Bilateral Pulmonary Arteries in Behçet Disease on FDG PET.

ABSTRACT: A 29-year-old man with Behçet disease exhibiting lower-limb swelling and dyspnea underwent 18 F-FDG PET/CT. The imaging revealed bilateral pulmonary artery involvement, and pulmonary artery aneurysms and mural thrombus were confirmed by CT pulmonary angiography. This case underscores the utility of 18 F-FDG PET in identifying life-threatening vasculitis complications in Behçet disease.

[A review on cardiac positron emission tomography/magnetic resonance imaging in diagnosis of cardivascular diseases].

There are various examination methods for cardiovascular diseases. Non-invasive diagnosis and prognostic information acquisition are the current research hotspots of related imaging examinations. Positron emission tomography (PET)/magnetic resonance imaging (MRI) is a new advanced fusion imaging technology that combines the molecular imaging of PET with the soft tissue contrast function of MRI to achieve their complementary advantages. This article briefly introduces several major aspects of cardiac PET/MRI in the diagnosis of cardiovascular disease, including atherosclerosis, ischemic cardiomyopathy, nodular heart disease, and myocardial amyloidosis, in order to promote cardiac PET/MRI to be more widely used in precision medicine in this field.

Retroperitoneal Liposarcoma on 99mTc-DTPA Renal Scintigraphy.

Retroperitoneal liposarcoma is usually large and can press on other organs. We report a case of a 66-year-old woman with a history of retroperitoneal liposarcoma resection who presented to the emergency department with abdominal pain. Ultrasonography revealed a large abdominal mass with renal displacement. Dynamic renal scintigraphy with Tc-DTPA was conducted to evaluate renal function. However, severe impairment of the right kidney function and abnormal tracer accumulation were observed during the examination. SPECT/CT was performed; 2 kidneys were successfully localized, and the recurrence of tumor was correctly detected.

Impacts of time interval on 18F-FDG uptake for PET/CT in normal organs: A systematic review.

BACKGROUND: To perform a systematic review of the effect of time interval on 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG) uptake in normal organs. METHODS: PubMed, EMBASE, Ovid, and Cochrane databases were searched to identity all potential eligible literature. The study characteristics and relevant data were extracted and analyzed. We adopted the effect size (ES) and the coefficient of determination (R) to best measure the magnitude of the relation between time interval and 18F-FDG uptake in normal organs. RESULTS: Seven articles and 860 participants were included. The time interval on liver and mediastinal blood pool were relatively medium (R=0.01-0.03, ES = -0.57 and -0.60) but noticeable (R = 0.06, ES = -0.68 and -0.39), respectively. The uptake of 18F-FDG on cerebellum, spleen, bone marrow, muscle, bowel, and adipose remains to be verified as the rare studies. In addition, other factors such as body mass index and blood glucose level appeared to be important which also affect 18F-FDG uptake in normal organs. CONCLUSION: The impact of time interval on SUVs in liver and mediastinal blood pool were relatively medium but clinically noticeable. More studies need to be done to solve the relation between the SUVs of other organs and time interval.

A false-positive I-131 finding of duodenum diverticulum in thyroid cancer evaluation by SPECT/CT: A case report.

RATIONALE: Iodine-131 (I-131) is a sensitive marker for the detection of differentiated thyroid cancer (DTC). I-131 whole-body scintigraphy (WBS) has been used widely in evaluation of DTC patient. However, I-131 WBS exists many false-positive uptake of I-131 because radioiodine uptake can also be seen in healthy tissue or in a variety of benign and malignant non-thyroidal tumors. PATIENT CONCERNS: A 44-year-old woman with a papillary thyroid carcinoma for the purpose of ablation therapy after a total thyroidectomy. I-131 WBS showed intensive uptake by thyroid remnant. Meanwhile, a focus of increased activity was seen in right upper abdomen. DISGNOSES, INTERVENTIONS AND OUTCOMES: Based on an I-131 single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging combining a Tc-99m pertechnetate dynamic SPECT scan and SPECT/CT fusion imaging with oral administration of iodine contrast agent, a descending duodenum diverticulum was diagnosed. This patient was then treated with conservative treatment, such as diet regulation, rest, appropriate use of antacids and antispasmodic agents, etc. So far, she recovered uneventfully with no any complications. LESSONS: Duodenum diverticulum is a rare false-positive uptake of I-131, it might be a diagnostic challenge when there are many false-positive uptake of I-131 in evaluation of DTC. So it must be significant to be familiar with these physiologic and pathologic variants of I-131 uptake and make further efforts to accurately interpret radioiodine scintigraphy results.

Muscle Involvement of Multiple Myeloma Revealed by FDG PET/CT.

Extramedullary myeloma can occur in variety of organs; however, muscle involvement is rarely reported. Here we present a case of a multiple myeloma patient with muscle involvement found by F-FDG PET/CT, which is sensitive in detecting extramedullary lesions of multiple myeloma. Plasmacytoma was confirmed by pathological biopsy afterwards.

[Primary study on fluro [ 19F] berberine derivative for human hepatocellular carcinoma targetting in vitro].

[ 18F]HX-01, a Fluorine-18 labeled berberine derivative, is a potential positron emission tomography (PET) tumor imaging agent, while [ 19F]HX-01 is a nonradioactive reference substance with different energy state and has the same physical and chemical properties. In order to collect data for further study of [ 18F]HX-01 PET imaging of hepatocellular carcinoma in vivo, this study compared the uptake of [ 19F]HX-01 by human hepatocellular carcinoma and normal hepatocytes in vitro. The target compound, [ 19F]HX-01, was synthesized in one step using berberrubine and 3-fluoropropyl 4-methylbenzenesulfonate. Cellular uptake and localization of [ 19F]HX-01 were performed by a fluorescence microscope in human hepatocellular carcinoma HepG2, SMMC-7721 and human normal hepatocyte HL-7702. Cellular proliferation inhibition and cell cytotoxicity assay of the [ 19F]HX-01 were conducted using cell counting kit-8 (CCK-8) on HepG2, SMMC-7721 and HL-7702 cells. Fluorescent microscopy showed that the combining ability of [ 19F]HX-01 to the carcinoma SMMC-7721 and HepG2 was higher than that to the normal HL-7702. Cellular proliferation inhibition assay demonstrated that [ 19F]HX-01 leaded to a dose-dependent inhibition on SMMC-7721, HepG2, and HL-7702 proliferation. Cell cytotoxicity assay presented that the cytotoxicity of [ 19F]HX-01 to SMMC-7721 and HepG2 was obviously higher than that to HL-7702. This in vitro study showed that [ 19F]HX-01 had a higher selectivity on human hepatocellular carcinoma cells (SMMC-7721, HepG2) but has less toxicity to normal hepatocytes (HL-7702). This could set up the idea that the radioactive reference substance [ 18F]HX-01 may be worthy of further development as a potential molecular probe targeting human hepatocellular carcinoma using PET.

[18F-Berberine Derivatives: a Potential Molecular Imaging Agent for Tumor Targeting by PET/CT Tumor].

Cancer is one of the main causes of death for human beings. Clinical oncologists increasingly rely upon imaging for diagnosis, stage, response assessment, and follow-up in cancer patient. However, 18F-FDG is not a tumor specific agent, inflammation and infection also have intensive uptake of 18F-FDG, resulting in false positive diagnosis, and some tumors have low uptake of 18F-FDG or even do not uptake 18F-FDG, leading to false negative diagnosis. So it is urgent to develop non-18F-FDG novel tumor targeting agent. Recently, a large number of researches in vitro have demonstrated that berberine has anti-tumor activity against a variety of tumor cells by inducing tumor cell apoptosis through inhibition of mitochondrial respiratory chain etc. So far, there is no credible evidence of berberine targeting in tumor in vivo. We proposed a hypothesis that berberine has the characteristics of tumor targeting biodistribution in vivo, and verified the proposal by 18F-berberine PET/CT imaging in VX2 muscle tumor-bearing rabbit model. In this review, we intend to give an overview of the progress of berberine anticancer, the structural bases of berberine anticancer and the uderlying molecular mechanisms of berberine anticancer indentified so far. We also introduce the first visualization of 18F labeled berberine derivatives targeting tumor in VX2 muscle tumor-bearing rabbit model by PET/CT. These breakthrough findings suggest that 18F-berberine derivatives as a potential PET/CT tumor targeted molecular imaging agent may have important implications for cancer targeting therapy, molecular imaging and modernization of Traditional Chinese Medicine.

Haloemodin as novel antibacterial agent inhibiting DNA gyrase and bacterial topoisomerase I.

Drug-resistant bacterial infections and lack of available antibacterial agents in clinical practice are becoming serious risks to public health. We synthesized a new class of haloemodins by modifying a traditional Chinese medicine component, emodin. The novel haloemodin exerts strong inhibitory activity on bacterial topoisomerase I and DNA gyrase, and not on the topoisomerases of human origin. In principle, it shows remarkable antibacterial activities against laboratory and clinically isolated Gram-positive bacteria, including vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus. We further expanded its antibacterial spectrum into against Gram-negative bacteria with the assistance of polymyxin B nonapeptide, which helps haloemodin to penetrate through the bacterial outer membrane. Finally, the therapeutic effect of haloemodin in vivo was confirmed in curing S. aureus-induced keratitis on rabbit model. With distinctive structural difference from the antibiotics we used, the haloemodins are of value as promising antibacterial pharmacophore, especially for combat the infections caused by drug-resistant pathogens.

The combinational effect of vincristine and berberine on growth inhibition and apoptosis induction in hepatoma cells.

The use of vincristine, a known antitumor agent, in hepatoma therapy is limited particularly because of its toxic effect. Meanwhile, berberine has drawn increasing attention to its antineoplastic effect in recent years. In view of the advantages of combinational drug treatment reported in anti-cancer chemotherapy, we evaluated the effects of co-treatment of vincristine and berberine on hepatic carcinoma cell lines in this study. We find that combinational usage of these two drugs can significantly induce cell growth inhibition and apoptosis even under a concentration of vincristine barely showing cytotoxicity in the same cells when used alone. The underlying mechanism about this combinational effect was addressed in this study by monitoring the signals related to mitochondrial function, apoptotic pathway and endoplasmic reticulum stress. Our results suggest a new value of berberine as a potential adjuvant agent in cancer chemotherapy and provide a hopeful approach for developing hepatoma therapy by utilizing the combinational effect of vincristine and berberine.

[Nuclear cardiology: the present functions and future perspectives].

For the past decade, the diagnosis and treatment of coronary artery disease (CAD) has shifted from the traditional model by evaluating coronary artery stenosis with morphological imaging methods to a novel model by focusing on the detection of ischemia for risk stratification. The myocardial perfusion imaging (MPI) using stress single photon emission computed tomography (SPECT) has become the most commonly used stress imaging technique for the diagnosis and treatment of patients with suspected or known CAD. It has got strong supports, including those of the American College of Cardiology, American Heart Association, American Society of Nuclear Cardiology (ACC/AHA/ASNC) and other numerous clinical guidelines. They all stressed that the SPECT MPI is recommended to be used as the "gate keeper" to coronary angiography in order to prevent unnecessary intervention test and save the cost. However, in China the introduction and application of nuclear cardiology was late and highly unbalanced. This leads to the lack of understanding of nuclear cardiology in some clinicians, and there often is misunderstanding on correct selection of coronary angiography, cardiac CT, CT coronary angiography and others for diagnosis and treatment of CAD which results in a trend of over-application of these traditional techniques. In this article, we will focus on the status of nuclear cardiology, including SPECT, positron emission tomography (PET) MPI in the patients with CAD for the diagnosis of ischemia, risk stratification and management decision-making, and also compare it with the traditional morphological imaging techniques. In addition, we will briefly introduce the recent advances in cardiac hybrid imaging and molecular imaging. The aim of this paper is to popularize the knowledge of nuclear cardiology, and promote the rational application of nuclear cardiology in China.

[Differentiation of malignant and benign superficial lymph nodes by dual time point 18F-FDG PET].

OBJECTIVE: To evaluate the value of dual time point 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in differentiating malignant and benign superficial lymph nodes. METHODS: Sixty-eight patients with ninety superficial lymph nodes were examined. Whole body 18F-FDG PET imaging was performed one hour (early) after FDG injection and repeated one hour (delayed) later but only for the interesting areas. The maximum standardized uptake value (SUVmax) was determined for each of the node on both early and delayed images (SUV early and SUV delayed, respectively). Retention index (RI) was then calculated. The cutoff values of SUV early, SUV delayed and RI were determined by receiver operating characteristic (ROC) analyses. The efficacy of each parameter was also analyzed by ROC analyses. RESULTS: The histopathology examinations confirmed 51 malignant nodes and 39 benign nodes. The SUV early (x +/- s) for benign nodes and malignant nodes were 3.26 +/- 1.62 and 8.04 +/- 5.56, respectively (P=0.000). The SUV delayed for benign nodes and malignant nodes were 3.93 +/- 2.11 and 9.82 +/- 6.29, respectively (P=0.000). The RI for benign nodes and malignant nodes were 19.1 +/- 22.5 and 24.8 +/- 18.8, respectively (P=0.191). The cutoff values of SUV early, SUV delayed and RI were 4.3, 4.8 and 18, respectively. The cutoff values of SUV early, SUV delayed and RI produced a sensitivity of 71%, 78% and 63%, a specificity of 87%, 85% and 46%, and an accuracy of 78%, 80% and 57%, respectively. The ROC analyses illustrated that the diagnostic efficacy of SUV early, SUV delayed was higher than RI (P<0.001). However, there was no difference in diagnostic efficacy between SUV early, and SUV delayed (P=0.409). CONCLUSION: Dual-time point 18F-FDG PET does differentiate benign and malignant superficial lymph nodes effectively.

Lung sequestration and Pott disease masquerading as primary lung cancer with bone metastases on FDG PET/CT.

The chest x-ray from a 37-year-old man with a history of back pain showed a mass in the left lower lung, which prompted an FDG PET/CT study to evaluate the nature of the mass and possible metastases. The images revealed peripherally increased FDG activity in the left lower lung mass. In addition, there was intense FDG activity in 2 adjacent thoracic vertebrae on PET images corresponding to the regions of bone destruction on the concurrent CT. Therefore, a possible diagnosis of lung carcinoma with bone metastases was suggested. However, subsequent tests demonstrated that the left lung mass was in fact a lung sequestration, whereas the spinal lesions were due to Pott disease (tuberculous spondylitis).

[Preparation and quality control of 99mTc labeled MDR1 oligonucleotide DNAs].

The aim of this study is to explore the optimal labeling condition of technetium-99m labeled antisense oligonucleotides (ASON) DNA and sense oligonueleotides (SON) DNA against multi-drug resistance gene-1 (MIDR1) mRNA, to prepare its two-step icefrozen kits, and to perform the quality control of technetium-99m labeled ASON and SON DNAs and its two-step icefrozen kits. A 20 mer single-stranded ASON sequence and its SON sequence against MDR1 mRNA were synthesized respectively, both of the ASON and SON DNAs were uniform phosphorothioated for this investigation with a primary amine on the 5'-end via a six-carbon alkyl linker, and then were labeled with technetium-99m by conjugating with the bifunctional chelator S-Acetyl NHS-MAG3 to form ASON- and SON-MAC3 DNAs. The optimal labeling condition was explored by varying the amount of ASON- and SON-MAG3 DNAs, SnCl2.2H2O and buffer, the pH value in the reaction medium was also adjusted. The technetium-99m labeled ASON and SON DNAs' two-step icefrozen kits were developed. The radiochemical purities, labeling stability of ASON- and SON-MAG3 DNAs in vivo and vitro were measured, and stability of the two-step icefrozen kits were also studied. The recycled rates of ASON- and SON-MAG3 DNAs were over 70% (n >6), the two-step icefrozen kits of ASON- and SON-MAG3 DNAs were colourless ice crystal. The radiochemical purities of technetium-99m labeled ASON- and SON-MAG3 DNAs were over 92 %. The radiochemical purities were over 90% after stored at room temperature for 24 hours. The kits were stable within 6 months when stored at 0 degrees C, the radiochemical purities of technetium-99m labeled ASON- and SON-MAG3 DNAs were still over 90%. The two-step icefrozen kits of ASON- and SON-MAG3 DNAs were successfully developed. The radiochemical purities were all over 90%. The labeling method was simple, feasible and efficient with good stability.

[Experimental study of 99mTc-antisense DNA for tumor imaging].

This study was performed to explore the feasibility of antisense imaging with radiolabeled antisense oligonucleotides DNA in tumored nude mice in vivo. Two different tumor cell lines, KB-G2 and KB-31,were used; both antisense and control sense DNAs were administrated intratumorally. The hybridization activities analysis of MAG3 conjugated DNAs oligonucleotides was demonstrated by Polyacrylamide Gel Electrophoresis. The whole body imaging was performed 22 h after administration of radiolabeled antisense and control sense DNAs at 1.0 microg DNAs (100 microCi) in 100 microl per animal. Then the animals were sacrificed at 24 h after administration and the organs and tissues were dissected and weighed; the radioactivity of each sample was detected by r-counter; injection dose percentage per gram tissue (%ID/g) was calculated and the biodistribution obtained. Both MAGS conjugated oligonucleotides DNAs and natural oligonucleotides DNAs have the same hybridization activities. The whole body images demonstrate improved targeting of antisense DNAs vs sense DNAs in the KB-G2 but not the KB-31 animals. Tumor levels in the KB-G2 animals were significantly higher for the antisense DNAs vs sense DNAs (14.7 vs 8.5% ID/g) while this difference (8.6 vs 4.3% ID/g) was insignificant in the KB-31 animals. Evidence for tumor targeting in vivo by an antisense in that mechanism has been obtained; statistically higher tumor accumulations of the 99mTc-antisense DNA were observed when compared to the control 99mTc-sense DNA. The successful localization of antisense DNA in tumor demonstrates that antisense tumor targeting in vivo is feasible even though improvement in tumor delivery and normal tissue clearance are needed for practical antisense imaging.

Age-related changes in the metabolic activity and distribution of the red marrow as demonstrated by 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography.

OBJECTIVES: The objective of the study was to determine age-related changes occurring in red marrow with regard to its distribution and the degree of its metabolic activity by whole-body 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET). METHODS: This retrospective study included 112 patients (56 male, 56 female, mean age 40 years, range 2-85) who underwent whole-body FDG-PET scans for assessment of disorders that were determined not to affect red marrow activity. These patients were categorized into the following groups with equal gender distribution: 0-15 years (12 individuals), 16-25 years (20), 26-35 years (10), 36-45 years (20), 46-55 years (14), 56-65 years (16), 66-75 years (14), and 76-85 years (6). Whole-body FDG-PET images were performed at 60 min after the intravenous administration of 0.14 mCi/kg of FDG. By employing a dedicated whole-body PET scanner. Maximal standardized uptake value (SUV(max)) was calculated from three consecutive transverse sections of the upper thirds of the humeri and femora, manubrium of the sternum, 12th thoracic and 5th lumbar vertebra and anterior superior iliac crests of the pelvis. All available results from other imaging examinations [magnetic resonance imaging (MRI), computed tomography (CT), and conventional radiolography], laboratory data, biopsies, and the clinical course of these subjects were reviewed to make certain that the bone marrow sites examined were free of any known pathologies. RESULTS: SUV(max) in the extremities showed significant decline with aging (correlation coefficient of -0.60 to -0.67, p < 0.01). In contrast, a weak correlation was noted in the axial skeletal activity with advancing age (correlation coefficient of -0.28 to -0.48, p < 0.05). CONCLUSIONS: These data suggest that FDG metabolic activity of the red marrow in the extremities decline significantly with normal aging, while that of the axial skeleton show minimal decrease related to this biologic phenomenon. These findings are of value in assessing the effects of hematological and other disorders in the distribution and the metabolic activity of this important tissue and testing therapeutic interventions that are employed for treating such maladies.

Structural and functional imaging of normal bone marrow and evaluation of its age-related changes.

A number of noninvasive imaging techniques have been used for the evaluation of bone marrow, including magnetic resonance imaging (MRI) and bone marrow scintigraphy. The appearance of bone marrow on MRI varies considerably depending on the proportion of red and yellow marrow, and the composition of the red marrow and its distribution with relation to age and sex. The composition of bone marrow also can vary under physiological and pathological conditions. MRI is a highly sensitive technique for evaluating the bone marrow, but it is limited in its practical use for whole-body bone marrow screening. Bone marrow scintigraphy with radiolabeled compounds such as technetium-99m-labeled nanocolloid and monoclonal antibodies has the advantage of evaluating the entire bone marrow, and has been used for the diagnosis of various bone marrow disorders. In addition, (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging can be used to evaluate bone marrow metabolism and disease and to provide information about the state of the primary tumor, lymph nodes, and distant metastases. Understanding of the appearance of normal bone marrow, including age- and sex-specific differences with each of these imaging modalities, is essential to permit accurate diagnosis of benign and malignant bone marrow disorders. We present a review of MRI and scintigraphy of normal bone marrow with some emphasis on FDG-PET imaging in assessing marrow activity in normal and abnormal states and also present preliminary data regarding normal age-related changes in bone marrow through use of FDG-PET, as well as the role of segmentation of bone marrow on MRI for quantitative calculation of the metabolic volumetric product for red marrow metabolism using FDG-PET.