BACKGROUND: The presence of ischemic penumbra in hypertensive cerebral hemorrhage is the hot spot and still controversial. The value of 4,9-diaza-2, 3, 10, 10-tetramethydodecan-2, 11-dione dioxime (HL91) tagged with 99Tcm on detecting the hypoxic brain tissue surrounding the hypertensive cerebral hemorrhage nidus, which represents the penumbra is still waited for confirmation.OBJECTIVE: To investigate the value of 99Tcm-HL91 single photon emission computed tomography (SPECT)/CT imaging on detecting hypoxic tissue in the patients with hypertensive cerebral hemorrhage.DESIGN: Control study.SETTING: Department of Neurology, Jiangmen Municipal Central Hospital, Guangdong Province.PARTICIPANTS: This series included 22 patients with hypertensive cerebral hemorrhage examined between March 2004 and March 2005 in Jiangmen Municipal Central Hospital. All cases revealed sudden onset of the disease, presented with the history of hypertension. These patients were diagnosed with hypertension after admission. The hemorrhage occurred in the anterior circulation territory in all cases and the volume of hemorrhage ranged from 10 mL to 63 mL. Minimally invasive stereotaxic aspiration was performed in 3 cases, craniotomy debridement in 1 case, and expectant treatment in the remaining cases. The period of time from the symptom onset to the examination was form 12 hours to 1.5 years, including more than 1 month in 5 cases. Control group consisted of 6 cases were clinically diagnosed with melancholia and anxiety disorders. Cerebral hemorrhage and acute cerebral infarction were ruled out by integrated CT scan in these 6 cases.METHODS: All 22 patients with hypertensive cerebral hemorrhage and 6 normal controls underwent 99Tcm-HL91 SPECT imaging and combined with CT scan.MAIN OUTCOME MEASURES: ① Identification of radioactive concentrations at one side of the peripheral zone of the lesions by visual analysis on two consecutive slices at two different axial directions were considered aspositive hypoxic imaging. ② The other was ROI semi-quantification measuring radiocounting ratio (R) between the region of visible radioactive concentrations, the center of the nidus, and their contralateral mirror region. R ＜ 0.8 or R ＞ 1.2 was considered to be abnormal. ③ Hypoxic region was defined by integrated CT fused imaging, and its volume was calculated using Xelerix workstation. The volume of the hypoxic tissue and hemorrhage was computed by Duotian formula: length of the maximum cross-section of the hemorrhage × width × slice number × 1/2.RESULTS: All 28 patients were involved in the final analysis. ① Perihemorrhagic radioactive concentrations which represented positive hypoxic imaging was revealed on 99Tcm-HL91 SPECT imaging in 18 cases out of 22 patients with cerebral hemorrhage, and positive rate was 77.78%. Bilateral cerebral hemisphere showed symmetric negative imaging in 6 cases of the control group. ② The fused SPECT/CT images revealed hypoxic region was around the intracerebral hemorrhage, small portion was within the nidus of hemorrhage with irregular shape. R value was 1.75±0.10 in perihemorrhagic hypoxic region in 18 cases with positive imaging, and R value was 1.05±0.11 in the basal ganglia in the control group. There was statistically significant difference between the two groups (P ＜ 0.01). ③ There was a positive linear correlation between maximum volume of hematom and hypoxia volume (correlation coefficient: r=0.7517, P ＜ 0.01).CONCLUSION: Relying on the mechanism about demonstrating the hypoxic tissue on fused SPECT/CT imaging, the hypoxic tissue would represent the penumbra may exist in the territories located around the cerebral hemorrhage. The positive territories may be reversible, I.e. The important portion of the penumbra. 99Tcm-HL91 SPECT/CT imaging can detect the hypoxic tissue surrounding the cerebral hemorrhage. The volume of hypoxic tissue is correlated with the hemorrhagic volume. The procedure is promising and could be applied in clinic.

Purpose To explore the 18F-FDG PET/CT imaging features of adrenal lymphoma and to improve the diagnosis of this disease.Materials and Methods A total of 13 cases with pathology-proven adrenal lymphoma and PET/CT examinationfrom December 2012 to March 2016 were retrospectively reviewed,The contents including the extent,shape,size and density of the adrenal lymphoma as well as the SUVmax value and affected lymph gland were recorded.The region of interesting (ROI) was delineated with the SUVmax value being calculated,which was compared with pathological diagnosis.Results All 13 cases were non-Hodgkins lymphoma,12 of which were secondary lymphoma,with the other case being primary lymphoma.Nine cases were diffuse large B-cell lymphoma (DLBCL);2 cases were mantle cell lymphoma;2 cases were NK/T-cell lymphoma.In 10 cases there were bilateral adrenal involvement,and unilateral involvement in 3 casesincluding on 2 the left and 1 on the right.A total of 23 adrenal glands were involved,with soft masses in 13,soft nodules in 8 and adrenal thickening in 2.The lesions were well-defined in 10 cases.In 3 cases there were cystic changes or necrosis.No hemorrhage,calcification or fat was identified.Extra-adrenal involvement was discovered in 9 cases.Lymphadenopathy was seen in 10 cases involving the neck,mediastinum and retroperitoneum.Adrenal lesions showed intense FDG uptake on PET/CT with SUVmax ranging from 5.7 to 30.8 and mean SUVmax of 15.8±8.9.Conclusion Most of the adrenal lymphoma cases were diffuse large B-cell non-Hodgkin's lymphoma.The features of PET/CT include bilateral involvement,well-defined soft tissue mass with intense FDG uptake.PET/CT can differentiate primary and secondary adrenal lymphoma and help with treatment planning.

Objective:To evaluate the clinical value of 18F-FDG PET/CT findings in patients with T1-2 lung adenocarcinoma spread through air spaces (STAS). Methods:From June 2018 to June 2020, a total of 80 patients (36 males, 44 females; age: 19-84 (59.9±11.8) years) with surgically and pathologically confirmed T1-2 lung adenocarcinomas in Jiangmen Central Hospital were enrolled retrospectively. All patients underwent 18F-FDG PET/CT examination preoperatively and were divided into STAS positive and negative groups according to the histopathological diagnosis. Independent-sample t test, Mann-Whitney U test, χ2 test and Fisher exact test were used to analyze differences of gender, age, tumor biomarker, SUV max, SUV mean, features showed on high resolution CT (HRCT; including diameter, lesion location, morphology, density, lobulated sharp, spiculated sign, vacuole sign, air bronchgram sign, pleural traction and para-emphysema), and pathologic findings (micropapillary pattern, lymphvascular inversion, pleural inversion and lymph node metastasis) between the two groups, and then multivariate logistic regression was performed. The ROC curve was employed to evaluate the predictive value of parameters for STAS of T1-2 lung adenocarcinomas. Results:Among the 80 patients with T1-2 lung adenocarcinomas, 12 (15.0%) were STAS positive and 68 (85.0%) were STAS negative. Significant differences were shown in SUV max, SUV mean, micropapillary pattern, lymphvascular inversion and lymph node metastasis between the two groups ( z values: -2.60, -2.17; χ2 values: 29.56, 9.28, 17.40, P<0.001 or P<0.05). SUV max (odds ratio ( OR): 1.348 (95% CI: 1.071-1.695), P=0.011), micropapillary pattern ( OR=47.444 (95% CI: 4.592-490.214), P=0.001) and lymph node metastasis ( OR=8.201 (95% CI: 1.129-59.576), P=0.038) were independent risk factors for STAS positive in multivariation logistic regression analysis. The optimum cut-off value for SUV max was 3.85 in the ROC analysis with the AUC of 0.737 (95% CI: 0.614-0.859), the sensitivity of 11/12, the specificity of 55.9%(38/68) and the accuracy of 61.2%(49/80). The AUC of the SUV max combined with micropapillary pattern and lymph node metastasis was 0.945 (95% CI: 0.892-0.999) with the sensitivity of 11/12, the specificity of 88.2%(60/68) and the accuracy of 88.7%(71/80). Conclusions:The PET/CT characteristics may be useful in differentiating STAS status among patients with T1-2 lung adenocarcinoma. SUV max >3.85, pathological papillary pattern and lymph node metastasis are independent risk factors to predict STAS.

Objective    To evaluate the strategy of chemoradiotherapy following endoscopic R0 resection for esophageal cancer in M3-T1b stage. Methods    There were 45 esophageal cancer patients with M3-T1b stage with endoscopic R0 resection followed by additional chemoradiotherapy from ECETC (Esophageal Cancer Endoscopic Therapy Consortium) as a trial group with 34 males and 11 females at age of 61.37±7.14 years. There were 90 patients with esophagectomy from Fudan University Shanghai Cancer Center as a control group with 63 males and 27 females at age of 61.04±8.17 years. Propensity score match (1:2) was used to balance the factors: gender, age, position, depth of invasion and lymphovascular invasion (LVI), which may influence the outcomes. Overall survival (OS) rate, relapse free survival (RFS) rate, and local recurrence rate were compared between the two groups. Result    There was no statistical difference (HR=2.66 with 95%CI 0.87 to 8.11, P=0.179) in terms of OS rate between the two groups. One, two and three years overall survival rate of patients in the control group was 93%, 86%, and 84%, respectively. Nobody died in the trial group within 3 years after surgery. The RFS rate between the two groups didn’t significantly differ (HR=1.48, 95% CI 0.66 to 3.33, P=0.389). One, two and three years RFS rate of patients in the contorl group was 87%, 78%, and 76%, respectively, while 97%, 93%, and 73% in the trial group, respectively. The local recurrence rates between the two groups didn’t significantly differ either ( HR=0.53，95%CI 0.13 to 2.18, P=0.314). One, two and three years local recurrence rate of patients in the control group was 5%, 6% and 6%, respectively, while 0%, 0% and 21% in the trial group, respectively. Conclusion    Similar outcomes are found regarding OS, RFS and local recurrence rates between the two groups. The strategy of endoscopic R0 resection followed by additional chemoradiotherapy has prospect for the treatment of esophageal cancer in M3-T1b stage. And this kind of therapy may be provided for those with risk factors or can not tolerate surgery.