Objective To investigate the diagnostic efficacy of 13N-NH3 and 18F-FDG PET/CT in the evaluation of untreated gliomas.Methods A total of 45 consecutive patients (29 males,16 females;age range 14-75 years,average age (47.47± 15.64) years) with final diagnosis of glioma from August 2009 to May 2012 were retrospectively analyzed.PET/CT imaging was performed with both 18F-FDG and 13N-NH3.Imaging results were analyzed by tumor-to-gray matter (T/G) ratios.ROC curve analysis was conducted to determine the optimal T/G cutoff values between low-grade and high-grade gliomas.One-way analysis of variance was applied to assess the differential efficacy of the two tracers in different grade of glioma.Results Forty-eight separate lesions were identified (WHO grade Ⅱ,n=16;grade Ⅲ,n=12;and grade Ⅳ,n=20).The sensitivities of 13N-NH3 PET/CT and 18F-FDG PET/CT on predicting high-grade gliomas were 91％(29/32) and 66％ (21/32),respectively.The optimal T/G cutoff values for 18F-FDG and 13N-NH3 were 0.64 and 0.86 with the AUC of 0.910 and 0.943,respectively.The sensitivity and positive predictive value of predicting high-grade gliomas with optimal cutoff values were 84％ (27/32) and 93％ (27/29)for 18F-FDG PET/CT,those for 13N-NH3 PET/CT were 94％ (30/32) and 94％ (30/32),respectively.Conclusion 13N-NH3 PET/CT is superior to 18F-FDG PET/CT not only in separating low-grade gliomas from high-grade ones,but also in the detection of high-grade gliomas for better tumor to normal gray matter contrast.

Objective To investigate the clinical,laboratory,and neuroimaging characteristics of neuroacanthocytosis.Methods Eight patients with neuroacanthocytosis were retrospectively analysed.Acanthocytes were tested by peripheral blood smear,wet preparation with saline dilution,and scanning electron microscope.Results Two male and 6 female patients were included.The age at onset was between 10 and 35 years,with a mean age at onset of 22 years.Four patients firstly presented with oral-facial-lingual dystonia,3 patients firstly presented with involuntary movements of the distal limbs and experienced the oral facial dystonia during the course of disease,and 1 patient primary presented with a parkinsonian syndrome.Four patients had generalized tonic-clonic seizures were reported in 4 patients,and 4 patients had cognitive impairment.Hypotonia and hyporeflexia were reported in 6 patients.The peripheral blood smear revealed the presence of acanthocytes in 7 patients,in addition,wet preparation with saline dilution and scanning electron microscope revealed the presence of acanthocytes in the remaining one.All patients showed slightly elevated serum creatine kinase.Brain magnetic resonance imaging (MRI) showed variable atrophy of the bilateral caudate nuclei and putamen,with or without a rim of increased T2-intensity in 6 patients,but the films of 2 patients were read as normal.Electromyography and nerve conduction velocity were examined in 4 patients.The results indicated axonal damage in 2 patients,and were normal in the other 2 patients.Acanthocytosis was confirmed by peripheral blood smear in 7 cases,by wet preparation with saline dilution in 8 cases and by scanning electron microscope in 2 cases.Conclusions Neuroacanthocytosis is a progress neurodegenerative disorder mainly affected the basal ganglia. The clinical characteristics include oral facial dystonia,limbs chorea,cognitive impairment,and seizures. Brain MRI showed variable atrophy of the bilateral caudate nuclei and putamen.The peripheral blood smear,wet preparation with saline dilution,and scanning electron microscope methods of peripheral blood examination are critical in the diagnosis of neuroacanthocytosis.

Objective To investigate the usefulness of 13N-NH3 PET in detecting brain lesions which show hypometabolism on 18F-FDG PET.Methods 13N-NH3 PET imaging was performed for a prospective study in 18 patients with brain lesions that showed hypometabolism compared with normal brain tissue on 18F-FDG PET scans.Fourteen patients underwent 18 F-FDG PET imaging for initial diagnosis and 4 patients for detection of astrocytoma recurrence (13 males,5 females,age 20-68 (42.4 ± 12.6) years).Ten gliomas,1 metastatic tumor,1 dysembryoplastic neuroepithelial tumor (DNT) and 6 non-neoplastic lesions (including 3 cases of radiation necrosis,2 cases of encephalitic foci,and 1 case of ischemic lesion)were verified by histopathological examination (n =13) or clinical follow-up (n =5).The tumor-to-contralateral brain tissue ratios (T/C) were calculated by the ROI method.The diagnostic efficacy of 13N-NH3 PET was evaluated.Paired t test and two-sample t test were performed to analyze the differences of T/C between different groups.Results Seven (5 astrocytomas and 2 glioblastomas) of 12 brain tumors (sensitivity:58％,7/12) showed increased 13N-NH3 uptake (higher uptake than the contralateral brain tissue),while 3 low-grade gliomas,1 metastatic tumor,and 1 DNT showed decreased 13N-NH3 uptake (no uptake or lower uptake than the contralateral brain tissue).The uptake ratio of 13N-NH3 was significantly higher than that of 18 F-FDG (1.24 ± 0.66 vs 0.67 ± 0.24,t =-3.740,P ＜ 0.05) in the tumors.All six non-neoplastic lesions showed decreased 13N-NH3 uptake (specificity:6/6).The T/C ratios of 18F-FDG and 13N-NH3 in the non-neoplastic lesions were 0.68 ±0.15 and 0.70 ±0.19,respectively,and there was no significant difference between them (t =-0.246,P ＞ 0.05).The T/C ratio of 13N-NH3 in the tumors was significantly higher than that in the non-neoplastic lesions (1.24 ± 0.53 vs 0.70 ± 0.19,t =2.624,P ＜ 0.05).Conclusion 13N-NH3 PET imaging may be helpful to detect and differentiate brain tumors with hypometabolism as detected by 18 F-FDG PET imaging from non-neoplastic lesions with high specificity,especially for cerebral astrocytomas,but the sensitivity is relatively limited.

Objective To investigate the characteristics of regional cerebral glucose metabolism in patients with fatal familial insomnia(FFI) using 18F-fluorodeoxyglucose(18F-FDG) PET. Methods Patient 1 with symptoms for 2 months and patient 2 with symptoms for 6 months were studied by brain 18 F-FDG PET.Compared with 20 normal controls, the data were analyzed by visual analysis at first, and then each patient was compared with age-matched normal controls using statistical parametric mapping( SPM ). Results As compared with 10 normal controls, metabolic changes in patient 1 was characterized by hypometabolism in thalamus, parietal cortices, caudate nucleus, pre-frontal cortices and posterior cingulate gyrus ( t ＞ 2. 82,P ＜0. 01 ). In patient 2, these changes were more obvious (t ＞ 2. 82, P ＜ 0. 01 ) with metabolic decrease also shown in temporal and occipital cortices ( t ＞ 2. 82, P ＜ 0. 01 ). Conclusion In FFI patients, brain metabolism changes are mainly manifested as hypometabolism in thalamus and cerebral cortex. The metabolic changes in cerebral cortex will be more widely spread with the development of FFI. 18F-FDG PET imaging was a valuable method to evaluate patients with FFI.

Objective To evaluate the biodistribution and radiation-absorbed doses of main organs in healthy people with 13 N-ammonia.Methods Five healthy volunteers underwent whole-body PET and CT scans after injection of 666-814 MBq of 13 N-ammonia.The serial dynamic emission images of each healthy volunteer were acquired.ROI were drawn manually based on the transverse CT images and transferred to the corresponding PET slices.Radiation-absorbed doses were calculated using the medical internal radiation dosimetry (MIRD) method.Results The highest concentrations of 13 N-ammonia were found in the heart,liver and kidneys,followed by pancreas,brain,spleen and stomach.The organ of highest absorbed dose was heart with (7.14±3.63) × 10-3 mGy/MBq.The whole-body absorbed dose was (2.11±0.44) × 10 3 mGy/MBq.The whole-body effective dose was (6.58± 1.23) × 10-3 mSv/MBq.Conclusion As one of the most important myocardial perfusion tracers,the whole-body 13 N-NH3 · H2 O PET appears to be safe for humans.

Objective To investigate the expression of glutamine synthetase ( GS ) in prostate cancer and the utility of 13 N?NH3 PET/CT in detecting prostate cancer. Methods The uptake ratio of 13 N?NH3 and the expression of GS in PC3 and DU145 cells were measured by Western blot and PCR methods. A total of 34 patients with suspected prostate cancer underwent 13 N?NH3 PET/CT imaging and prostate biopsy. Immunohistochemistry staining of GS was performed and Gleason scores of tumors were evaluated. One?way analysis of variance, the least significant difference?t test and Spearman correlation analysis were used to an?alyze data. Results The uptake of 13 N?ammonia in PC3 and DU145 cells elevated along with the decrease of glutamine in medium. The expression of GS mRNA and protein also increased when glutamine was de?creased. In biopsy samples, the mean GS expression scores of prostate cancer, benign prostatic hyperplasia (BPH) and prostatitis were 7.76±2.57, 3.98±2.60, 3.34±0.36, respectively (F=36.85, t1=7.97, t2=4?45, all P<0.05), which had a weak correlation with Gleason scores (rs=0.52, P<0.05). In 34 patients, the mean SUVmax of prostate cancer segments (1.56±0.58 and 1.14±0.22;F=5.966, t1=2.63, t2=2.65, all P<0.05). There was a weak correlation between GS expression scores and the uptake of 13 N?ammonia in prostate cancer (rs=0.47, P<0.05). Conclusions Up?regulated expression of GS is common in prostate cancer cells. GS is the main reason for the uptake of 13 N?ammonia, which is a useful tracer for prostate cancer imaging.

Objective:To explore the application of OTSU-based self-attenuation correction PET (sacPET) reconstruction technology in 18F-florbetapir (AV45) imaging. Methods:From November 2018 to December 2019, 7 confirmed Alzheimer′s disease (AD) patients (4 males, 3 females, age (69.6±4.5)years) and 3 healthy controls (HC; 1 male, 2 females, age (68.0±4.6) years) were recruited prospectively for 18F-AV45 PET imaging in the First Affiliated Hospital of Sun Yat-Sen University. Original data collected by PET acquisition was processed with sacPET reconstruction and then compared with standard PET images by visual analysis and semi-quantitative analysis. Fisher exact test, Kappa test and Pearson correlation analysis were used to analyze data. Results:In HC group and AD group, the radioactive distribution showed by sacPET images and that by standard PET images were similar, and the contrast of gray-white matter in sacPET images was weaker than that in standard PET images. Moreover, the positive uptake area of the cortex in the AD group was smaller than that in standard PET images. Visual analysis showed 19 positive regions in sacPET images and 22 in standard PET images, with no statistical difference of positive rates of the sub-regions in the cortex between the two PET images (all P>0.05), and the overall consistency of 88.00% (44/50; Kappa=0.75 (95% CI: 0.57-0.94), P<0.05). Semi-quantitative analysis showed that the standardized uptake value ratio (SUVR) of frontal lobe and cingulate gyrus measured by sacPET was lower than that measured by standard PET (0.93±0.06 vs 0.96±0.06 and 0.99±0.04 vs 1.01±0.04; t values: 5.30 and 5.10, both P<0.01), while SUVR of parietal lobe, temporal lobe and occipital lobe measured by sacPET was higher than that measured by standard PET (0.78±0.08 vs 0.68±0.07, 0.97±0.07 vs 0.91±0.08 and 0.94±0.11 vs 0.71±0.12; t values: 6.27, 7.36 and 16.90, all P<0.01). The overall SUVR of sacPET images was significantly correlated with the standard PET images ( r=0.75, P<0.001). Conclusion:For 18F-AV45 imaging, sacPET reconstruction technology can obtain reliable and effective PET images without CT data, but its accuracy and precision still need to be improved.

Objective:To explore the relationship between vesicular monoamine transporter 2(VMAT2) density in the striatum and the non-motor symptoms(NMSs) in patients with Parkinson′s disease(PD).Methods:From December 2018 to December 2019, 29 normal controls (16 males, 13 females, age: (48.8±14.2) years), 31 patients with PD at the Hoehn-Yahr (mH-Y) Ⅱ stage (16 males, 15 females, age: (53.4±8.5) years) and 36 patients with PD at mH-Y Ⅲ stage (19 males, 17 females, age: (63.1±8.2) years) in the First Affiliated Hospital of Sun Yat-sen University were prospectively enrolled in this study. All subjects underwent 18F-fluoropropyl-(+ )-dihydrotetrabenazine( 18F-FP-(+ )-DTBZ, 18F-AV133) PET/CT imaging, then the specific uptake ratios (SURs) of striatal subregions were measured with the occipital cortex as the reference background region. The clinical data, laboratory data and imaging results were collected. The NMSs of each patient were evaluated with Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Parkinson′s Disease Sleep Scale (PDSS), Montreal Cognitive Assessment (MoCA), Parkinson′s Disease Quality of Life Questionnaire (PDQL) and Non-Motor Symptoms Scale (NMSS). The independent-sample t test and one-way analysis of variance (the least significant difference t test) were used to compare data differences. Finally, the association of the striatal SURs with the clinical symptom scores were evaluated with Pearson correlation analysis and multivariable stepwise regression analysis. Results:Significant differences were found in depression (3.51±1.34 vs 11.36±3.87), anxiety (2.35±1.45 vs 6.00±3.32), sleep disorder (132.90±12.26 vs 110.34±19.69) and life quality (7.58±3.37 vs 24.01±10.15) scores between the mH-Y stage Ⅱ and the stage Ⅲ patients ( t values: from -10.573 to 5.439, all P<0.05), while cognitive scores did not differ significantly between the 2 PD groups ( t=1.067, P>0.05). Compared with healthy control group (1.28±0.22), the PD groups displayed a more marked decrease of SURs in the bilateral putamen and in the caudate nucleus (0.65±0.16 and 0.31±0.14; F=83.11, P<0.05), and the SURs of patients at stage Ⅱ were higher than those of the patients at stage Ⅲ ( t=9.116, P<0.05). NMSs scores of PD patients, with the exception of cognition scores, were correlated with striatal SURs ( r values: from -0.647 to -0.426, all P<0.05). Regression analysis showed that total striatum SURs was the best predictor of PDSS and NMSS scores ( R2 values: 0.234, 0.378, both P<0.001), while contralateral caudate nucleus SURs were best predictor of HAMD scores ( R2=0.402, P<0.001). The SURs of contralateral putamen were best variables for predicting HAMA scores ( R2=0.204, P<0.001). Conclusion:The correlation between the decreased striatal VMAT2 and a broad spectrum of NMSs in patients with PD is established, suggesting that the defect in dopamine supply may be an early abnormality promoting mechanisms leading to the development of NMSs in PD.

Objective To validate the reproducibility of abnormal cerebral metabolic characteristics in PD patients from different medical centers using 18F-FDG PET imaging.Methods A total of 108 subjects who were referred for resting-state brain 18 F-FDG PET imaging were retrospectively reviewed.Thirtythree PD patients (15 males,18 females,age:38-79 years) and 33 age-matched healthy controls (15 males,18 females,age:40-77 years) underwent evaluation at Shanghai Huashan Hospital Affiliated to Fudan University.Seventeen PD patients (10 males,7 females,age:44-74 years) and 17 age-matched healthy controls (6 males,11 females,age:42-67 years) underwent evaluation at the First Affiliated Hospital of Sun Yat-sen University.SPM was used to investigate the cerebral metabolic characteristics of the patients with two-sample t test.Statistically significant voxels were obtained by using familywise error rate (FWE;P＜0.05).Two sets of PD patients with abnormal glucose metabolism of brain regions were obtained and the cerebral metabolic characteristics were compared.Results Regarding the PD patients from Shanghai Huashan Hospital,the features of cerebral glucose metabolism by SPM analysis were demonstrated as follows:increased metabolism was found in the region of pons,cerebellum,thalamus,putamen and pallidum,while decreased metabolism was displayed in the region of parietal lobe and occipital lobe.The increased regions referred to 8 110 voxels and decreased regions referred to 2 810 voxels (P＜0.05).The similar metabolic pattern was found in PD patients from the First Affiliated Hospital of Sun Yat-sen University.The increased metabolism was shown in the regions of pons,cerebellum,thalamus,putamen and pallidum,and referred to 15 573 voxels.The metabolism-decreased regions included parietal lobe,occipital lobe and frontal lobe,and referred to 3 945 voxels (P＜0.05).Conclusions 18F-FDG PET/CT imaging results demonstrate similar metabolic pattern in PD patients from different medical centers,in whom the metabolism-increased regions are found in the pons,cerebellum,thalamus and pallidum and decreased regions were demonstrated in the parietal lobe and occipital lobe.The reproducibility from 18F-FDG PET/CT imaging provides reliable evidence for the multi-center study in the differential diagnosis of PD.

Objective To investigate the clinical value of [11C]CFT PET in the diagnosis and severity assessment of Parkinson disease (PD). Methods Thirty-eight patients with PD at various Hoehn & Yahr (H&Y) stages were included and underwent a [11C]CFT PET scan. The correlation between [11C]CFT uptake and unified Parkinson disease rating scale part III (UPDRS III) of PD patients was evaluated by calculating Pearson’s regression coefficient. Statistical parametric mapping (SPM) analysis was performed to compare the difference of dopamine transporter (DAT) distribution between ear-ly and advanced PD patients. Results There was a significant reduction of [11C]CFT uptake in the bilateral striatum of PD patients. There was a significant negative correlation between clinical scores of UPDRS III, rigidity, bradykinesia, pos-ture, gait and [11C]CFT uptake in the striatum. The SPM analysis revealed a significant and asymmetric decrease of [11C] CFT uptake in the striatum, predominantly on the putamen and caudate nucleus contralateral to the onset limb, in the posterior area of ipsilateral putamen in early PD (H&Y 1-2) patients compared with the normal controls. There was a sig-nificant symmetric decrease of [11C]CFT uptake in both putamen and caudate nucleus in advanced PD (H&Y 3-5) pa- tients, compared with normal controls. Compared with early PD patients, the reduction of DAT was more severe in bilater-al caudate nucleus and the ipsilateral putamen in the advanced PD patients. Conclusions [11C]CFT PET is a sensitive biomarker in the diagnosis and assessment of disease severity of PD patients.