Objective To investigate the spiral CT findings in hemopathic patients with druginduced pulmonary injury.Methods CT images obtained in 11patients with drug-induced pulmonary injury were retrospectively analyzed.Six patients had antineoplastic agent-induced pulmonary injury and 5 patients had non-neoplastic agent-induced pulmonary injury (immunosuppressor in 2 patients,antifungal in 2 patients,antineoplastic immunomodulators in 1 patient).CT findings were reviewed by a chest radiologist.Results All 11patients had parenchymal abnormalities on MSCT scans,including ground-glass opacities( n =8 ),consolidation( n =5 ),interlobular septal thickening( n =3 ) and focal fibrosis ( n =2 ).The abnormalities were bilateral and asymmetric in all patients.They were mainly in the peripheral lung regions in 6 patients,in the central lung regions in four,and irregularly located in one.The abnormalities involved mainly the lower lung zones in six patients,the upper lung zones in two,and all lung zones homogeneously in three.One patient had fluid in bilateral pleural cavities.Three patients were given the same agent once more after the imaging turned to normal,and they presented with same clinical symptoms and similar but more serious imaging findings.Conclusions Drug-induced pulmonary injury usually manifests as areas of ground-glass opacity and consolidation,which most commonly involves the peripheral lungs and lower lung zones.Drug-induced pulmonary injury shows reproducible but more serious lesions when the patient is given the same agent once more.

Objective To assess the val ue of 18-fluorodeoxy glucose (~18F-FDG) positron emission tomography( PE T)-CT in the detection of malignant bone metastases. Methods Thirty-five out of 332 patients, 89 lesions were detected on ~18 F-FDG PET-CT and were interpreted separately on PET, combined CT, and fused PE T-CT images. Results Of the 89 lesions detected on PET- CT images, 68 were malignant and 21 were benign lesions. PET alone identified 62 malignant lesions and 17 benign lesions. The diagnostic sensitivity, specificit y, and accuracy of PET alone for diagnosis of bone metastases were 91.2% (62/68) , 81.0% (17/21), and 88.8% (79/89), respectively. The combined CT alone identifi ed 55 malignant lesions and 16 benign lesions. The diagnostic sensitivity, s pecificity, and accuracy of combined CT alone were 80.9% (55/68), 76.2% (16/21), and 79.8% (71/89), respectively. The fused PET-CT images identified 64 maligna nt and 19 benign lesions. The diagnostic sensitivity, specificity, and accuracy of the fused PET-CT were 94.1% (64/68), 90.5% (19/21), and 93.2% (83/89), respe ctively. Conclusion In the diagnosis of bone metastases, ~18F-FDG PET-CT imaging reduces the false positive rate and increases the specificity. ~18F-FDG PET-CT imaging is helpful in the differentiation o f bone metastases from benign lesions.

Objective:To investigate the relationships between severe, diffuse decrease in global brain 18F-fluorodeoxxglucose(FDG)uptake, whole-body total lesion glycolysis(TLG)and short-term death in elderly patients with newly diagnosed stage Ⅳ cancer. Methods:Clinical and 18FFDG PET/CT data of 24 elderly patients newly diagnosed stage Ⅳ cancer showing marked diffuse decrease in global brain FDG uptake(the decreased brain uptake group)were retrospectively enrolled.Sixteen elderly patients with newly diagnosed stage Ⅳ cancer but without decreased global brain FDG uptake(the no decreased brain uptake group)and 25 healthy subjects were enrolled as the control groups.Correlations between brain FDG uptake and whole-body TLG were analyzed.We followed up the final outcomes of all patients and analyzed the short-term prognostic value of these manifestations. Results:The decreased brain uptake group included 17 patients with stage Ⅳ lymphoma and 7 patients with stage Ⅳ malignant tumor of other types[15 males, age: (73±9)years], while the no decreased brain uptake group included 8 patients with stage Ⅳ lymphoma and 8 patients with stage Ⅳ malignant tumor of other types[12 males, age: (65±5)years]and the healthy control group included 25 subjects[13 males, age: (65±6)years]. Patients were older in the decreased brain uptake group than in the no decreased brain uptake group( t=3.8, P=0.001). The global brain SUV means of the decreased brain uptake group and the no decreased brain uptake group were 4.9±1.8 and 10.9±2.0, respectively( t=-9.8, P=0.000). The global brain total glycolysis(TG)values of the two groups were 1786.5±1162.5 and 2868.4±1424.5, respectively( t=-2.6, P=0.012). The whole-body TLG values of the two groups were 6825.5±4776.9 and 2919.5±2031.7, respectively( t=3.6, P=0.001). Pearson correlation analysis showed that brain FDG uptake was adversely correlated with whole-body TLG.We followed up the survival outcomes of the two groups.The median follow-up lengths of the two groups were 6 months and 10 months, respectively( χ2=3.7, P=0.054). Fourteen(14/24)patients died in the decreased brain uptake group while 9(9/16)died in the no decreased brain uptake group( χ2=0.017, P=0.896). However, 8 cases died within 1 month post PET/CT scan in the decreased brain uptake group while none died in the no decreased brain uptake group( χ2=4.7, P=0.029). Conclusions:Severe, diffuse decrease in 18F-FDG PET/CT uptake in the whole cerebral cortex is more common in elderly patients with newly diagnosed stage Ⅳ cancer, whose total tumor load is significantly higher than that of cancer patients without decrease in whole cerebral cortex FDG uptake.This uptake reduction may indicate poor short-term outcome and the probability of short-term death may be high.

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 investigate the value of 18F-PSMA PET/CT-derived prostate specific membrane antigen(PSMA)expression parameters, including maximum standardize uptake value(SUV max), PSMA receptor expressing tumor volume(PSMA-TV), and total lesion PSMA receptor expression(TL-PSMA), in predicting the risk of metastasis in elderly prostate cancer patients aged 60 years and older. Methods:Clinical data of 39 patients with prostate cancer diagnosed in our hospital from January 2019 to May 2021 and imaging data of 18F-PSMA PET/CT before treatment were analyzed retrospectively.PSMA-TV and TL-PSMA of primary tumor tissue were calculated from PET/CT images with 40% of the SUV max as the threshold value.The influence of 18F-PSMA PET/CT on clinical TNM staging was evaluated.The Mann-Whitney U test was used to compare the differences in values of various indicators between the groups with or without metastasis, including the total prostate-specific antigen(tPSA)level, Gleason score and PSMA expression parameters.The correlation of PSMA expression parameters with tPSA and Gleason score was analyzed.The area under the receiver operating characteristic(ROC)curve(AUC)was used to determine the predictive ability of different indicators for the risk of prostate cancer metastasis, and multivariate logistic regression analysis was used to screen for independent predictors of prostate cancer metastasis. Results:The Gleason score of 39 prostate cancer patients(median age: 67 years, age range: 60-83 years)was 7.0(7.0, 8.0), and the median prostate specific antigen(PSA)level was 14.83(7.37, 30.93)μg/L.There were 11 cases(28.2%)with metastasis(the metastasis group), and 28 cases(71.8%)without metastasis(the non-metastasis group). Based on PET/CT, the clinical N and M stages of five patients(12.8%)were changed, but two cases(5.1%)with pelvic lymph node metastasis were missed.The median ages of the metastasis group and the non-metastasis group were 63(60-79)years and 69(60-83)years, respectively, and the difference was not statistically significant( P=0.115). The metastasis group and the non-metastasis group had tPSA levels at 54.0(9.9, 75.8)μg/L and 10.2(6.8, 22.8)μg/L, the SUV max at 29.1(16.8, 35.3)and 7.7(6.0, 13.6), the PSMA-TV at 41.5(22.4, 90.9)cm 3 and 6.8(3.6, 9.3)cm 3, TL-PSMA at 279(139.7, 996.4)and 25.5(15.9, 37.0), Gleason scores at 8.0(7.0, 8.0)and 7.0(7.0, 8.0), respectively.There were statistically significant differences in tPSA( Z=-2.528, P=0.011), SUV max( Z=-4.151, P<0.001), PSMA-TV( Z=-3.995, P<0.001)and TL-PSMA( Z=-4.213, P<0.001)between the two groups.SUV max( r=0.537, P<0.01), PSMA-TV( r=0.496, P<0.01)and TL-PSMA( r=0.508, P<0.01)were all positively correlated with tPSA.Furthermore, SUV max( r=0.547, P<0.01), PSMA-TV( r=0.412, P<0.01)and TL-PSMA( r=0.433, P<0.01)were also positively correlated with Gleason score.ROC curve analysis showed that the AUCs of SUV max, PSMA-TV, TL-PSMA and tPSA in predicting prostate cancer metastasis were 0.932, 0.916, 0.938 and 0.763, respectively.Multivariate Logistic regression analysis showed that SUV max( OR=1.203, 95% CI: 1.001-1.445, P=0.049)was an independent predictor of prostate cancer metastasis. Conclusions:These PSMA expression parameters of 18F-PSMA PET/CT have a good value in predicting the risk of metastasis in elderly prostate cancer patients, and SUV maxmay serve as a potential molecular imaging indicator to independently predict prostate cancer metastasis.

OBJECTIVE： To establish a method for the content determination of sinapine thiocyanate， quercetin and kaempferol in rat plasma， and to study pharmacokinetics of Qili qiangxin capsule in rats in vivo. METHODS： HPLC-MS/MS method was adopted. The determination was performed on ZOBRAX XDB-C18 column with mobile phase consisted of 0.1％ formic acid solution and acetonitrile containing 0.1％ formic acid （gradient elution） at the flow rate of 0.45 mL/min. The sample size was 10 μL. Quantitative ions were sinapine thiocyanate with m/z 310.2→251.2， quercetin with m/z 301.1→150.7， kaempferol with m/z 286.2→242.0， internal standard chloramphenicol with m/z 320.9→ 151.9. 0.083， 0.167， 0.333， 0.667， 1， 1.5， 2， 3， 4， 6， 8， 12， 24 h after intragastric administration of Qili qiangxin capsule 1.3 g/kg， blood samples were collected via intraocular canthal venous plexus of 6 rats. The blood concentrations of sinapine thiocyanate， quercetin and kaempferol were determined. The pharmacokinetic parameters were calculated and fitted by using DAS 3.0 software. RESULTS： The linear range of sinapine thiocyanate， quercetin and kaempferol 0.05-100， 0.1-200， 0.1-200 ng/mL（r＝0.999 4， 0.999 7， 0.999 9）； RSDs of precision test and matrix effect were all less than or equal to 11.55％ （n＝6）， RE of stability test is less than or equal to 14.69％ （n＝3）. The pharmacokinetic parameter of sinapine thiocyanate， quercetin and kaempferol included that cmax were（1.35±0.62），（3.23±1.26），（5.27±1.66）      ng/mL； tmax were （1.50±0.00）， （0.67±0.00）， （0.67±0.00） h； t1/2 were （3.98±0.99），（3.33±0.41），（4.54±0.85） h； CL were （3 683.82±987.96）， （2 852.33±695.88），（1 611.85±129.59） mL/（h·kg）； AUC0-24 h were （3.98±1.21）， （10.96±3.42）， （13.59±5.35） h·ng/mL. CONCLUSIONS： Established method is highly sensitive， specific and reproducible， and suitable for the pharmacokinetic study of sinapine thiocyanate， quercetin and kaempferol in rat.