Objective:To investigate the efficacy and prognostic value of baseline 18F-FDG PET/CT metabolism parameters in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy. Methods:From January 2012 to June 2020, 61 patients (19 males, 42 females; median age: 64 years) with stage Ⅲ-Ⅳ lung adenocarcinoma who underwent baseline 18F-FDG PET/CT imaging before EGFR-TKI monotherapy in 1 month in Beijing Hospital were retrospectively analyzed. The clinical data and metabolic parameters including SUV max, SUV max of lean body mass (SUL max), peak of SUV of lean body mass (SUL peak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the hottest lesions on PET were analyzed. Patients were followed up to obtain the efficacy evaluation, progression-free survival (PFS) and overall survival (OS). ROC curve analysis was performed to obtain the optimal cut-off value of metabolic parameters to predict disease remission and prognosis. Kaplan-Meier method, log-rank test and Cox proportional risk regression model were used to analyze the prognostic factors. Results:After EGFR-TKI monotherapy, 42.9%(24/56) patients were in disease remission. The optimal cut-off values for predicting disease remission of SUL peak, SUV max, SUL max, MTV, and TLG were 5.9, 13.1, 11.1, 10.6 ml and 99.6 g, respectively. The remission rates of patients with SUV max>13.1, MTV>10.6 ml and TLG>99.6 g were significantly higher than those of patients with SUV max≤13.1(51.2%(21/41) vs 3/15; χ2=4.37, P=0.037), MTV≤10.6 ml (9/12 vs 36.6%(15/41); χ2=5.53, P=0.019) and TLG≤99.6 g (10/13 vs 35.0%(14/40); χ2=6.96, P=0.008). The follow-up period for survival was 0.05-6.80 years, and 10.3%(6/58) patients had no disease progression, and 44.3%(27/61) patients died. The optimal cut-off values of SUL peak, SUV max, SUL max, MTV, and TLG for PFS were 11.2, 17.0, 13.7, 2.7 ml and 14.8 g, and those for OS were 5.6, 14.3, 8.8, 2.8 ml and 37.3 g, respectively. Patients with never-smoking, SUV max≤17.0 and SUL peak≤11.2 had longer PFS ( χ2 values: 3.87-7.37, all P<0.05); never-smoking history (hazard ratio ( HR)=2.29, 95% CI: 1.08-4.87, P=0.031) and SUL peak≤11.2 ( HR=2.67, 95% CI: 1.35-5.27, P=0.005) were independent predictors for PFS. Patients with stage Ⅲ+ ⅣA, SUV max≤14.3, SUL peak≤5.6, SUL max≤8.8 and TLG≤37.3 g had longer OS ( χ2 values: 5.78-8.83, all P<0.05); stage Ⅲ+ ⅣA ( HR=2.81, 95% CI: 1.08-7.32, P=0.034) and SUL max≤8.8 ( HR=9.66, 95% CI: 1.25-74.91, P=0.030) were independent predictors for OS. Conclusions:Baseline 18F-FDG PET/CT imaging has good prospect in clinical application in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before EGFR-TKI monotherapy. The higher baseline metabolic activity of tumor in the 18F-FDG PET/CT, the higher remission rate. Smoking history and SUL peak are independent predictors for PFS; SUL max and stage are independent predictors for OS.

Objective:To investigate the value of left ventricular systolic synchrony assessed by gated myocardial perfusion imaging(GMPI)in predicting major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD).Methods:In this retrospective study, clinical data from elderly patients who had completed a two-day assessment of resting-loading GMPI between September 2012 and February 2014 in Beijing Hospital were collected, including the summed stress score(SSS)for total ischemic burden, measured by GMPI, left ventricular ejection fraction(LVEF), peak filling rate(PFR), phase band width(PBW), phase standard deviation(PSD)and phase entropy(PE).Follow-up of MACE was conducted.Independent risk factors for MACE were analyzed using a multifactorial Cox proportional hazards regression model, and the cumulative MACE incidence was analyzed using the Kaplan-Meier survival curve.Results:A total of 427 subjects were enrolled, including 200(46.8%)men, with a mean age of 74.1±6.5(60-92)years and 323(75.6%)aged ≥ 70 years.The median follow-up time was 54.7 months.At the end of follow-up, MACE occurred in 47 patients(11.0%).Compared with the group without MACE, the incidences of hypertension, hyperlipidemia, and hyperuricemia were significantly higher( χ2=5.20, 5.62, 3.86, all P<0.05), LVEF and PFR were significantly lower( t=-5.51, -5.23, both P<0.001), and SSS, PSD, PBW, and PE were significantly higher( Z=4.78, t=5.14, 5.78, 5.62, all P<0.001)in the MACE group.The results of Cox proportional hazards regression model analysis suggested that age ≥ 70(hazard ratio: 2.57, 95% CI: 1.08-6.13), abnormal perfusion(hazard ratio: 2.60, 95% CI: 1.31-5.15), increased PSD(hazard ratio: 3.72, 95% CI: 1.72-8.05)and increased PE(hazard ratio: 4.09, 95% CI: 1.94-8.63)were independent risk factors for the occurrence of MACE(all P<0.05).Further analysis on 323 patients ≥ 70 years indicated that abnormal perfusion(hazard ratio: 2.96, 95% CI: 1.40-6.26), increased PSD(hazard ratio: 3.51, 95% CI: 1.56-7.89), and increased PE(hazard ratio: 4.49, 95% CI: 2.08-9.71)were independent risk factors for MACE( P<0.05 for all). Conclusions:Parameters of GMPI systolic synchrony analysis can very well identify the population at high risk of MACE in elderly patients with CHD.

Objective:To compare the performance of 11 glomerular filtration rate(GFR)equations in Chinese elderly hospitalized patients using dynamic renal imaging as the reference standard.Methods:The retrospective study involved patients aged 60 years and older who were admitted to Beijing Hospital between January, 2017, and January 2020.Glomerular filtration rate(GFR)was assessed through dynamic renal imaging for all participants.Estimated GFR(eGFR)was calculated using various equations based on serum creatinine and/or cystatin C levels, including All Age Spectrum(FAS), Berlin Initiative Study(BIS), Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI), Modification of Diet in Renal Disease Study(MDRD), MDRD in China(MDRDc), and Xiangya..Results:A total of 691 patients, of which 383 were males, with an age range of 60 to 90 years(mean age 71.9±7.7 years), were included in the study.Among the different equations used to estimate glomerular filtration rate(GFR)in ml·min -1·1.73m -2, the smallest deviations were observed with FAScys(2.48), FAScr-cys(3.07), CKD-EPIcys(4.20), and BIScr-cys(7.42).Conversely, the most accurate estimations were found with BIScr-cys(10.38), FAScr-cys(11.94), FAScys(12.08), CKD-EPIcr-cys(13.21), and CKD-EPIcys(13.51).The highest P30 values, indicating the proportion of estimates within 30% of the true GFR, were achieved by FAScr-cys(68.97%), FAScys(68.96%), CKD-EPIcys(63.22%), and BIScr-cys(61.67%).The equations with the lowest root mean square errors were BIScr-cys(9.73), CKD-EPIcr-cys(10.98), FAScr-cys(11.27), CKD-EPIcys(11.52), and FAScys(11.53).Specifically, the FAS equation showed higher accuracy in men, while BIScr-cys and CKD-EPIcys were more accurate in women.Among patients with chronic kidney disease(CKD), the P30 values for BIScr-cys, FAScys, and FAScr-cys were 86.96%, 83.33%, and 80.95% respectively.Notably, for patients with mGFR ≥ 30 ml/min, MDRDc overestimated GFR the most, whereas for patients with mGFR<30 ml/min, Xiangya exhibited the most significant overestimation of GFR. Conclusions:Among the equations tested, BIScr-cys, FAScys, and FAScr-cys demonstrated the highest accuracy and are therefore recommended for use in Chinese elderly hospitalized patients.

Objective:To investigate the effects of a psychological and behavioral intervention on carotid artery stenosis in patients undergoing stent implantation.Methods:Ninety-five patients with carotid artery stenosis who underwent stent implantation in Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital) from June 2020 to June 2021 were included in this study. They were randomly divided into observation group ( n = 48) and control group ( n = 47). The control group was given routine preoperative and postoperative treatment and nursing care. The observation group was given perioperative management, which was developed by medical experts to target patient's psychology and behavior, in addition to routine preoperative and postoperative treatment and nursing care. Self-Rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, heart rate and blood pressure pre- and post-surgery were compared between the two groups. Results:SAS score, SDS score, heart rate, systolic blood pressure and diastolic blood pressure post-surgery in the observation group were (43.22 ± 3.73) points, (34.71 ± 7.62) points, (63.22 ± 3.73) beats/min, (111.24 ± 8.53) mmHg and (73.43 ± 7.62) mmHg, respectively, which were significantly lower than those in the control group [(44.22 ± 4.12) points, (37.92 ± 6.91) points, (81.98 ± 4.14) beats/min, (130.43 ± 32.21) mmHg, and (78.52 ± 5.51) mmHg, all P < 0.05]. Conclusion:A psychological and behavioral intervention can guide patients to correctly understand carotid artery stenosis, eliminate adverse psychological factors such as fear and depression, and improve the quality of life of patients.

Objective:To study the value of ventilation/perfusion single-photon emission computed tomography(SPECT)in combination with a low-dose CT scan(SPECT/CT)in diagnosing pulmonary embolism(PE)in elderly patients.Methods:In this retrospective study, data were collected from 279 patients with suspected PE and undergone SPECT/CT between January 2015 and December 2019 at Beijing Hospital, with 163 aged ≥65(the elderly group)and 116 aged <65(the control group). Based on diagnosis confirmed during follow-up as the final diagnosis, the diagnostic efficacy of ventilation/perfusion SPECT/CT in the two age groups was examined.The diagnostic efficacy of ventilation/perfusion SPECT/CT and age-adjusted D-dimer in the elderly group was also compared.The diagnostic efficacy of ventilation/perfusion SPECT/CT and CT pulmonary angiography(CTPA)was compared in 43 elderly patients who had undergone both ventilation/perfusion SPECT/CT and CTPA.Results:The sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT in the elderly group were 96.10%(74/77), 91.86%(79/86)and 93.87%(153/163)in the elderly group and 96.43%(27/28), 94.31%(83/88)and 94.83%(110/116)in the control group, respectively, with no statistically significant difference between the two groups( χ2=0.000, 0.409, 0.116, P=1.000, 0.522, 0.733). The sensitivity, specificity and accuracy of age-adjusted D-dimer were 84.42%(65/77), 63.95%(55/86)and 73.62%(120/163), and were significantly different from those of ventilation/perfusion SPECT/CT(all P<0.05). Among 43 elderly patients undergone ventilation/perfusion SPECT/CT and CTPA, 1 was excluded because the diagnosis based on CTPA was uncertain.The diagnostic sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT were 96.55%(28/29), 92.31%(12/13)and 95.24%(40/42)and those of CTPA were 65.52%(19/29), 92.31%(12/13)and 73.81%(31/42). They had the same specificity, but there were significant differences in sensitivity and accuracy( P=0.012, 0.022). Conclusions:Ventilation/perfusion SPECT/CT has higher accuracy in the diagnosis of PE in elderly patients, compared with CTPA and age-adjusted D-dimer.

Objective:To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease.Methods:Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results:A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE ( χ2 values: 4.126, 6.021, both P<0.05); LVEF, PFR and absolute value of PER of patients with MACE were significantly lower ( t/ z values: 6.261, 5.683, -4.246, all P<0.05), while SSS, PSD, PBW and entropy were significantly higher ( t/ z values: 5.024, 5.874, 7.119, -6.405, all P<0.05). Cox proportional risk regression model showed that abnormal PBW(>80°), abnormal entropy(>58 J·mol -1·K -1) and SSS≥12 were independent risk factors for MACE (odds ratio( OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P<0.05). The 5-year cumulative MACE-free survival rates of abnormal PSD group(>26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions:PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification.

Objective:To investigate the role of preoperative 18F-fluorodeoxyglucose (FDG) PET/CT imaging in mid-long-term prognosis of patients with resectable non-small cell lung cancer (NSCLC). Methods:Seventy resectable NSCLC patients (35 males, 35 females, median age 64 years) in Beijing Hospital between April 2010 and August 2016 were enrolled into this retrospectively study. All patients underwent 18F-FDG PET/CT imaging followed by pulmonary resection with mediastinal or hilar lymph nodes dissection within 1 month. The findings of PET/CT imaging including characteristics of primary lesions and mediastinal or hilar lymph nodes (size and maximum standardized uptake value (SUV max) of primary lesion, SUV max and distribution of high metabolic lymph nodes (HML)) were analyzed, and patients were followed up. Survival outcome indicators were defined as overall survival (OS) and progression-free survival (PFS). Survival analysis was conducted by Kaplan-Meier method, log-rank method and Cox proportional hazard models to assess the predictive factors. Results:Patients were followed up for 0.9-8.2 years. Among 70 patients, 31.4% (22/70) had disease progression and 24.3% (17/70) died. As for OS, there were significantly differences between patients with SUV max of primary lesion≥10 and <10 (4.6 vs 7.6 years), with size of primary lesion >3 cm and ≤3 cm (4.8 vs 7.4 years), with unilateral mediastinal or hilar HML and bilateral sides or without HML (4.4 vs 7.4 years), with SUV max of mediastinal or hilar lymph nodes ≥5.0 and <5.0 (3.8 vs 7.3 years) ( χ2 values: 10.135-15.238, all P<0.01), as well as PFS (3.9 vs 6.7, 3.8 vs 6.6, 3.8 vs 6.4, 3.3 vs 6.3 years; χ2 values: 8.410-14.600, all P<0.01). Cox multivariate analysis demonstrated that the size and SUV max of primary lesion were independent predictive factors of OS and PFS (all P<0.01). Moreover, the distribution of mediastinal or hilar HML had marginal significance in predicting OS ( P=0.051). Conclusions:Size and SUV max of primary lesion in preoperative 18F-FDG PET/CT imaging are predictive factors for the survival of postoperative NSCLC. The distribution of the mediastinal or hilar HML may have significance for the survival prediction of postoperative NSCLC.

Objective:To explore the diagnostic value of 99Tc m-dimercaptosuccinic acid (DMSA) renal SPECT/CT imaging in adult upper urinary tract infection. Methods:From September 2017 to December 2019, 99Tc m-DMSA renal SPECT/CT imaging and clinical data of 109 patients (14 males, 95 females; age: 23-85(60.0±14.1) years) suspected of upper urinary tract infection from Beijing Hospital were retrospectively analyzed. Final clinical diagnosis was regarded as the diagnostic standard. The diagnostic efficacy of 99Tc m-DMSA renal SPECT/CT imaging was analyzed and compared with that of 99Tc m-DMSA renal SPECT imaging. The imaging features of SPECT/CT imaging in upper urinary tract infection were analyzed. The differences between the diagnostic methods were analyzed by using χ2 test or Fisher′s exact test. Results:Of 109 patients, 91 were diagnosed as upper urinary tract infection by 99Tc m-DMSA renal SPECT/CT imaging, with the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 100%(86/86), 78.26%(18/23), 94.51%(86/91), 18/18 and 95.41%(104/109), respectively. With the application of low-dose CT, the diagnostic specificity of SPECT/CT was significantly higher than that of SPECT (52.17% (12/23); P=0.014), and the causes of upper urinary tract infection were found in 5.81% (5/86) of patients with the help of CT. There were 10 (29.41%, 10/34) patients with chronic pyelonephritis had typical signs of renal scar on SPECT/CT imaging. Excluding the patients with typical renal scar, 11.54% (6/52) and 37.50% (9/24) of patients with acute and chronic pyelonephritis had decrease or defect focus≤2 ( χ2=6.987, P=0.008). Conclusions:99Tc m-DMSA renal SPECT/CT has good clinical value in the diagnosis of adult upper urinary tract infection. Compared with 99Tc m-DMSA renal SPECT, 99Tc m-DMSA renal SPECT/CT can effectively improve the diagnostic specificity and explore the causes of upper urinary tract infection such as urinary tract obstruction and stones.

Objective:To investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in detecting N 1 or N 2 metastasis of lymph node (LN) with different densities in patients with non-small cell lung cancer (NSCLC). Methods:A total of 118 patients (68 males, 50 females, age range: 27-87 (65.4±10.8) years) with N 0-N 2 M 0 NSCLC in Beijing Hospital between October 2007 and December 2017 were included in this study. All patients underwent 18F-FDG PET/CT, followed by surgery within 1 month. The pathological findings of the resected hilar mediastinal LN were taken as the gold standard, and ratios of LN metastasis were calculated for different density groups (calcification, partial calcification, hyper density, hypodensity/isodensity). The cut-off values of LN size (short diameter) and the maximum standardized uptake value (SUV max) in the detection of N 1 and N 2 metastases was determined by the receiver operating characteristic (ROC) curve, and the diagnostic efficiencies were calculated. Independent-sample t test, Mann-Whitney U test and χ2 test (partition of χ2) were used for data analysis. Results:A total of 433 LN has the histopathologic results: 365 LN was in stage N 0, 68 LN was in stage N 1-N 2. There were no metastases in calcification group (0/8). The metastatic LN proportions in partial calcification group (28.6%, 8/28), hypodensity/isodensity group (20.3%, 44/217) were significantly higher than that in the hyper density group (8.9%, 16/180; χ2 values: 7.369, 9.945, both P<0.017 (threshold for partition of χ2)). There was no significant difference between the partial group and hypodensity/isodensity group ( χ2=1.021, P>0.017). The SUV max of N 1+ N 2 group was significantly higher than that in N 0 group (6.94 (4.51, 11.36) vs 2.45 (1.93, 3.42); z=-10.388, P<0.01). According to the ROC curve, the cut-off value of SUV max in detecting hilar and mediastinal LN was 3.66. The diagnostic sensitivity, specificity and accuracy for N 1+ N 2 metastasis was 85.3%, 78.9%, 80.0% respectively. The cut-off values of SUV max for hypodensity/isodensity group and hyper density group were 3.66 and 2.79 respectively, and the corresponding sensitivities, specificities, accuracies and positive predictive values (PPV) were 93.2%, 86.7%, 88.0%, 64.1% vs 93.8%, 57.9% ( χ2=10.724), 61.1% ( χ2=7.326, P<0.01), 17.9%( χ2=32.971, P<0.01). The specificity of LN size (1.0 cm)+ SUV max was significantly higher that of LN size or SUV max alone (94.2% vs 80.9%, 86.7%; χ2 values: 14.048, 5.661, both P<0.05) in hypodensity/isodensity group. The specificity and accuracy of LN size (1.0 cm)+ SUV max were significantly higher those of SUV max alone ( χ2 values: 58.043, 37.037, both P<0.01) in hyper density group. Conclusions:18F-FDG PET/CT is useful in diagnosing the N 1+ N 2 metastases in hypodensity/isodensity LN, but has limitation in diagnosing the partial calcification LN. Combination of lymph node short diameter and SUV max cut-off value can improve the diagnostic specificity or accuracy of 18F-FDG PET/CT for hypodensity/isodensity and high density LN.

Objective To evaluate the diagnostic efficacy of the pulmonary perfusion tomography combined with low dose CT scan (Q SPECT/ CT) in detecting acute pulmonary embolism (PE) by compa-ring with pulmonary ventilation/ perfusion (V/ Q) SPECT imaging. Methods A total of 203 patients sus-pected with acute PE (88 males, 115 females, age range 19-94 years) from January 2013 to December 2015 were enrolled in this retrospective study. All patients underwent V/ Q SPECT and low dose CT scan. Final clinical diagnosis was regarded as the gold standard. The diagnostic consistency and diagnostic efficacy of Q SPECT/ CT were compared with those of V/ Q SPECT. χ2 test was used to compare the differences be-tween the two methods. Kappa analysis was used to analyze the agreement of them. Results The coinci-dence rate of Q SPECT/ CT and V/ Q SPECT was 94.09％(191/ 203), Kappa= 0.882, P<0.001. Among the 12 cases with inconsistent diagnosis, 9 were finally diagnosed as chronic obstructive pulmonary disease (COPD). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Q SPECT / CT in the diagnosis of PE were 95. 12％(78/ 82), 80.99％(98/ 121), 77.23％(78/ 101), 96.08％(98/ 102), 86. 70％ ( 176/ 203). The counterpart parameters of V/ Q SPECT were 95. 12％ ( 78/ 82), 90. 91％(110/ 121), 87.64％ (78/ 89), 96.49％ (110/ 114), 92.61％ (188/ 203). Compared with V/ Q SPECT, Q SPECT/ CT had the same sensitivity but lower specificity (χ2 = 4.928, P = 0.026). The positive predictive value, negative predictive value and accuracy of Q SPECT/ CT were lower than those of V/ Q SPECT, but there was no significant difference (χ2 values: 3.491, 0.000, 3.824, all P>0.05). Conclusion In the majority of patients with suspected acute PE, V/ Q SPECT scan can be replaced by Q SPECT/ CT, but it must be careful to select Q SPECT/ CT for patients with COPD history.