1.Impact of Smart Neuro Attenuation Correlation on the Quality and Standardized Uptake Value of Brain PET Imaging
Xiaonan SHAO ; Xiaoliang SHAO ; Xiaosong WANG ; Yuetao WANG
Chinese Journal of Medical Imaging 2015;(9):714-717
PurposeSmart neuro attenuation correlation (SNAC) is a new method of calculated attention correction. This paper aims to evaluate the impact of SNAC on the quality and standardized uptake value of brain imaging with PET/CT.Materials and Methods Fifty-eight patients who underwent systematic scan with18F-FDG PET/CT were analyzed retrospectively. CT attenuation correlation (CTAC) and SNAC brain PET images were reconstructed respectively. All images were analyzed by visual assessment and Scenium software and the results of the two methods were compared with regard to image contrast, homogeneity and mean SUV at different cerebral regions. Moreover, the correlation of the mean SUV of the two methods was further analyzed.Results There was no significant visual difference of contrast and uniformity between SNAC and CTAC. The Scenium analysis shows that the contrast of SNAC images were slightly higher than that of CTAC, but the difference were not statistically significant (4.19±1.11vs. 4.08±1.03,t=0.764,P>0.05). The uniformity of SNAC images were slightly lower than that of CTAC (1.00vs. 0.83). The mean SUV at various brain regions measured by SNAC was greater than that by CTAC, but both were significantly correlated (r=0.978,P<0.01), and the linear regression analysis also demonstrated that the results were consistent (R2=0.959). Compared with that measured by CTAC, the average percentage difference of SUV measured by SNAC was 8.45±4.71, but it varied greatly at 10 brain regions (-8.56-27.93). The analysis of variance presented significant differences in the average percentage difference of SUV at different brain regions (F=119.084,P<0.01), while the average percentage difference at the outer slices was greater than that at the central slices. Conclusion No significant difference exists in image quality between SNAC and CTAC. Although the mean SUV at different brain regions measured by SNAC may increase by various degrees, it is significantly associated with the results measured by CTAC. Moreover, SNAC simplifies the process of examination and reduces radiation dose, which is beneficial to patients as a qualitative method.
2.Analysis of evaluation indexes for prognosis of severe burn patients with sepsis
Feng ZHENG ; Daming WANG ; Ning LIU ; Xiaonan SHAO ; Xinyuan JIN
Chinese Critical Care Medicine 2017;29(4):327-331
Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.
3.Preliminary Application of18F-FDG PET/CT in Rheumatic Diseases
Dongyan WANG ; Yansong YANG ; Xiaonan SHAO ; Yuetao WANG
Chinese Journal of Medical Imaging 2015;(10):759-763,770
PurposeCurrent conventional imaging methods X-ray, CT, MRI and ultrasound for rheumatic diseases are mostly local site imaging, rather than systemic display, thus is difficult to show the whole picture of the diseases, this study aims to explore the18F-FDG PET/CT findings of rheumatic diseases and its preliminary clinical value. Materials and Methods18F-FDG PET/CT imaging findings and clinical data of 18 patients with rheumatic diseases confirmed by clinical diagnosis were retrospectively analyzed, and 18F-FDG uptake of lesions was observed.Results Among all the 18 patients with rheumatic diseases: four cases were with rheumatoid arthritis (RA), 5 cases with takayasu arteritis (TA), 2 cases with adult onset Still’s disease (AOSD), 1 case with polymyalgia rheumatica (PMR) and 6 cases with ankylosing spondylitis (AS). Findings of PET/CT: RA showed increased FDG uptake in multiple bigger joints such as shoulder joint, elbow, hip, wrist joint, and part palm finger joints, with no bone abnormalities in CT; TA displayed as diffusely increased uptake of FDG the aorta and its major branches vascular wall while CT showed multiple arterial wall irregular thickening with dot or strip calcification, and in one case, the vascular wall FDG uptake decreased obviously after one year treatment, the SUVmax of left clavicle dropped from 6.8 to 3.2; AOSD showed diffusely increased FDG uptake in spleen and bone marrow, while CT had no obvious spleen and bone abnormalities; PMR showed increased uptake of FDG in the atlantoaxial joint, shoulder joint, sternoclavicular joint, hip joint, pubic symphysis, ischial tuberosity and lesions around lumbar spinous process; only 1 case of 6 AS patients showed left acetabular articular surface hyperplasia and sclerosis with increased FDG uptake, while CT showed spinal multiple vertebral bone hyperplasia and sclerosis as bamboo change in all of 6 AS cases, with normal FDG metabolism. Conclusion18F-FDG PET/CT is helpful for the diagnosis of rheumatic diseases, because it can be used to display the lesion extent, reflect its activity, and also to evaluate the effect of the treatments.
4.Change of Human Cerebral Glucose Metabolism with Age and Gender by Using Scenium Software
Mei XU ; Rong NIU ; Xiaonan SHAO ; Xiaoliang SHAO ; Xiaosong WANG ; Yuetao WANG
Chinese Journal of Medical Imaging 2014;(9):659-663
Purpose To analyze the PET image of normal human brain by using Scenium software, so as to ifnd out the change of cerebral glucose metabolism with different age and gender. Materials and Methods Brain PET imaging data of 493 healthy males and 273 healthy females were collected in the study. The subjects were divided into 6 groups according to age:21-30 years group,31-40 years group, 41-50 years group, 51-60 years group, 61-70 years group and 71-82 years group. Each group was further subdivided according to gender. The brain areas were automatically outlined by Scenium and the mean standard uptake value (SUV) of each brain area was calculated and compared among groups. Results Most cerebral glucose metabolism of males at different age was significantly different (F=2.580-5.316, P<0.05), except temporal lobe in right side and cerebellum showed no difference (F=1.611-1.935, P>0.05); whilst difference in cerebral glucose metabolism of females at different age was not signiifcant (F=0.721-1.706, P>0.05). In male groups, cerebral glucose metabolism got peak at 31-40 years, and decreased signiifcantly at 51-60 years mainly involving areas like cinglulate gyrus, calcarine and surrounding cortex;and the groups after 61 years showed no signiifcant decrease. In female groups, cerebral glucose metabolism got peak at 31-40 years and showed no significant decrease along with age. Conclusion Cerebral glucose metabolism decreases unevenly after 40 years old. It drops significantly in males at 51-60 years whilst that in females is not obvious.
5.Clinical application of 18F-FDG PET/CT in Takayasu arteritis
Dongyan WANG ; Yuetao WANG ; Xiaoliang SHAO ; Min WU ; Yansong YANG ; Xiaosong WANG ; Xiaonan SHAO
Chinese Journal of Nuclear Medicine and Molecular Imaging 2016;36(4):340-344
Objective To investigate the characteristics of 18F-FDG PET/CT imaging in Takayasu arteritis (TA) and its clinical value.Methods Five male patients with TA in active phase (age range:65-82 years;mean age:(72.8±6.6) years) from November 2011 to August 2014 were retrospectively analyzed.All patients underwent 18F-FDG PET/CT imaging,and one of them who was in stable phase after one year's treatment underwent follow-up PET/CT imaging.The characteristics of the abnormal 18F-FDG uptake and SUVmax of lesions were analyzed.Another 5 age-and gender-matched patients with slightly elevated tumor markers and normal results of 18F-FDG PET/CT imaging in the same period were selected as the control group.Arteries were divided into 18 segments,including the ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right common carotid,the left/right subclavian,the left/right brachial,the superior mesenteric,the left/right common iliac,the left/right renal,and the left/right femoral,and their SUVmax were measured respectively.Paired t test was used to analyze the difference of SUVmax between TA group and the control group.Results (1) 18 F-FDG PET/CT imaging displayed diffused increase of radioactivity in the wall of aorta and its major branches in TA group,and CT showed multiple irregular thickening,punctate and banding calcification in arterial walls of those patients.The ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right subclavian,the left/right common carotid,and the left/right common iliac artery were all involved in 5 patients;the left/right brachial and the left/right femoral artery were involved in 4 patients and the superior mesenteric artery was involved in 2 cases.The SUVmax range was 1.4-7.6,the highest SUVmax was in the left subclavian artery (n=2),the right subclavian artery (n=1) and the abdominal aorta artery (n=2).(2)The SUVmax of TA group and the control group were 3.96±1.35 and 2.13±0.53,respectively(t=10.40,P<0.001).(3) As to the TA patient in stable phase after treatment,the FDG uptake of the wall of aorta and its major branches decreased obviously compared with that before treatment.The SUVmax of left subclavian artery decreased from 6.8 to 3.2.Conclusions 18F-FDG PET/CT is helpful in diagnosis of TA.It could accurately display the range of involved arteries,reflect the activity of the lesion and evaluate the therapeutic response.
6.Value of 18F-FDG PET/CT metabolic parameters of primary lesions for predicting occult lymph node metastasis in non-small cell lung cancer
Yunmei SHI ; Rong NIU ; Yuetao WANG ; Xiaoliang SHAO ; Feifei ZHANG ; Xiaonan SHAO ; Jianfeng WANG ; Xiaosong WANG ; Bao LIU ; Wenji YU
Chinese Journal of Nuclear Medicine and Molecular Imaging 2021;41(6):327-333
Objective:To investigate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters for occult lymph node metastasis (OLM) in non-small cell lung cancer (NSCLC). Methods:A total of 183 patients (72 males, 111 females; age (61.5±8.4) years) who underwent 18F-FDG PET/CT and preoperatively diagnosed with clinical N0 stage (cN0) in Third Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively enrolled. All patients underwent anatomical pulmonary resection with systematic lymph node dissections within 3 weeks after 18F-FDG PET/CT examinations. According to the presence or absence of lymph node metastasis, patients were divided into OLM positive (OLM+ ) group and OLM negative (OLM-) group. Parameters of primary lesions, such as the maximum diameter (D max), tumor sites, morphological features, maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), metabolic total volume (MTV), total lesion glycolysis (TLG), tumor SUV max to liver SUV mean (TLR max), tumor TLG to liver SUV mean (TLR TLG) were analyzed. Mann-Whitney U test and χ2 test were used to compare the parameters between groups. Multivariable logistic regression was used to analyze the independent risk factors for OLM. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of different parameters. Results:Among 183 patients, 25 (13.7%, 25/183) of them were diagnosed as OLM. In OLM+ group, 46 lymph nodes were pathologically positive for metastasis, including 15 N1 disease and 31 N2 disease. D max (2.9(2.3, 3.7) vs 2.3(1.7, 2.8) cm), lobulation ((76.0%(19/25) vs 37.3%(59/158)), SUV max (11.1(7.9, 17.7) vs 4.7(2.3, 9.2)), TLG (41.5(10.2, 91.1) vs 15.6(6.5, 23.8) ml), TLR max (4.7(3.5, 7.6) vs 2.1(0.9, 4.0)) and TLR TLG (18.1(5.0, 44.3) vs 6.1(3.0, 11.4) ml) of the primary lesions in OLM+ group were significantly higher than those in OLM-group ( z values: from -4.709 to -3.247, χ2=13.190, all P<0.05). Multivariable logistic regression analysis showed that TLR max (odds ratio ( OR)=15.145, 95% CI: 3.381-67.830, P<0.001) and D max ( OR=3.220, 95% CI: 1.192-8.701, P=0.021) were independent risk factors for OLM. TLR max yielded the highest area under curve (AUC; AUC=0.794) with the threshold of 3.12, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for predicting OLM were 92.0%(23/25), 63.3%(100/158), 67.2%(123/183), 28.4%(23/81) and 98.0%(100/102), respectively. Conclusions:TLR max of tumor is the independent risk factor for OLM in NSCLC patients. TLR max can sensitively predict OLM preoperatively in patients with NSCLC.
8.Genomic Correlates of Unfavorable Outcome in Locally Advanced Cervical Cancer Treated with Neoadjuvant Chemoradiation
Yuchun WEI ; Chuqing WEI ; Liang CHEN ; Ning LIU ; Qiuxiang OU ; Jiani C. YIN ; Jiaohui PANG ; Zhenhao FANG ; Xue WU ; Xiaonan WANG ; Dianbin MU ; Yang SHAO ; Jinming YU ; Shuanghu YUAN
Cancer Research and Treatment 2022;54(4):1209-1218
Purpose:
Neoadjuvant therapy modality can increase the operability rate and mitigate pathological risks in locally advanced cervical cancer, but treatment response varies widely. It remains unclear whether genetic alterations correlate with the response to neoadjuvant therapy and disease-free survival (DFS) in locally advanced cervical cancer.
Materials and Methods:
A total of 62 locally advanced cervical cancer (stage IB-IIA) patients who received neoadjuvant chemoradiation plus radical hysterectomy were retrospectively analyzed. Patients’ tumor biopsy samples were comprehensively profiled using targeted next generation sequencing. Pathologic response to neoadjuvant treatment and DFS were evaluated against the association with genomic traits.
Results:
Genetic alterations of PIK3CA were most frequent (37%), comparable to that of Caucasian populations from The Cancer Genome Atlas. The mutation frequency of genes including TERT, POLD1, NOS2, and FGFR3 was significantly higher in Chinese patients whereas RPTOR, EGFR, and TP53 were underrepresented in comparison to Caucasians. Germline mutations were identified in 21% (13/62) of the cohort and more than half (57%) had mutations in DNA damage repair genes, including BRCA1/2, TP53 and PALB2. Importantly, high tumor mutation burden, TP53 polymorphism (rs1042522), and KEAP1 mutations were found to be associated with poor pathologic response to neoadjuvant chemoradiation treatment. KEAP1 mutations, PIK3CA-SOX2 co-amplification, TERC copy number gain, and TYMS polymorphism correlated with an increased risk of disease relapse.
Conclusion
We report the genomic profile of locally advanced cervical cancer patients and the distinction between Asian and Caucasian cohorts. Our findings highlight genomic traits associated with unfavorable neoadjuvant chemoradiation response and a higher risk of early disease recurrence.
9.The value of circulating microRNA-1 in the early diagnosis of coronary atherosclerotic plaque rupture in patients with stable coronary heart disease
Tong SU ; Xiaonan SHAO ; Ling YANG ; Xiaopu ZHANG ; Chengjian YANG
Chinese Critical Care Medicine 2021;33(5):568-572
Objective:To evaluate the diagnostic value of circulating microRNA-1 (miR-1) in early coronary artery plaque rupture in patients with stable coronary artery disease (SCAD).Methods:A prospective cohort study was conducted. Sixty-seven patients with SCAD admitted to the department of cardiology of the Third Affiliated Hospital of Soochow University from January to June in 2019 were enrolled. All patients had completed coronary angiography (CAG), percutaneous coronary intervention (PCI) single stent implantation or only CAG was performed according to the CAG results. Blood samples were collected before (0 hour) and 3 hours after the procedure. The expression of plasma miR-1 was detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR), and electrocardiogram was used to detect cardiac troponin I (cTnI) levels. The difference of miR-1 and cTnI levels in PCI or CAG patients before and after procedure were compared, and the value for early diagnosis of coronary artery plaque rupture in SCAD patients was evaluated. The diagnostic efficacy was evaluated by the receiver operating characteristic curve (ROC curve).Results:There were 38 CAG patients and 29 PCI patients. There were no significant differences in gender, age, previous history (without hypertension history) and baseline data of cardiac function between the two groups. The expression of miR-1 after PCI was significantly higher than that before PCI [2 -ΔΔCt: 2.11 (1.56, 2.73) vs. 1.26 (1.07, 1.92), P < 0.01], and there was no significant difference in cTnI level before and after PCI [μg/L: 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), P > 0.05]. There were no significant differences in miR-1 and cTnI levels before and after procedure in the CAG group [miR-1 (2 -ΔΔCt): 1.09 (1.00, 1.40) vs. 1.21 (1.00, 1.71), cTnI (μg/L): 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), both P > 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) and 95% confidence interval (95% CI) of miR-1 in the diagnosis of coronary plaque rupture were 0.794 (0.687-0.900), P < 0.01, the sensitivity was 82.8%, the specificity was 68.4%, and the optimal cut-off value was 1.51. The AUC and 95% CI of the difference of miR-1 before and after operation (ΔmiR-1) were 0.704 (0.567-0.842), P = 0.004, the sensitivity was 62.1%, the specificity was 84.2%, and the optimal cut-off value was 0.39. The efficancy of miR-1 and ΔmiR-1 after procedure to diagnose coronary plaque rupture in patients with SCAD was similar ( Z = 1.287, P = 0.198). However, baseline miR-1 might not predict whether patients with SCAD need PCI or not (AUC = 0.630, P > 0.05). Multivariate binary Logistic regression analysis showed that increased postoperative miR-1 expression was an independent risk factor for coronary plaque rupture in SCAD patients [odds ratios ( OR) = 2.887, 95% CI was 1.044-7.978, P = 0.041]. Conclusion:Circulating miR-1 might have the value for early diagnosis of coronary artery plaque rupture in SCAD patients.
10.Postoperative paravertebral muscle degeneration and its correlations with health related quality of life in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion
Weiran HU ; Xiaonan WU ; Xinge SHI ; Haohao MA ; Hongqiang WANG ; Jia SHAO ; Kai ZHANG ; Kun GAO ; Yanzheng GAO
Chinese Journal of Orthopaedic Trauma 2022;24(10):910-915
Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.