Objective Toexploretheclinicaldiagnosisvalueofthehighfrequencycolordopplerultrasound(HFCDU)character-istiesofwristdamageinpatientswithrheumatoidarthritis(RA).Methods 78patientswithRA(RAgroup)werecollectedfrom June 2012 to December 2012 in the Affiliated Hospital of Inner Mongolia Medical University ,sonogram anatomy changes and syno-vial thickness of bilateral wrist were measured using colorul trasound ,meanwhile the respective data obtained from 50 healthy peo-ple undergoing physical examination(healthy control group);using color doppler flow imaging and color doppler energy ,synovial blood flow of artery resistance index (RI) and pulse index(PI) in synovial were measured and detected according to semi-quantitative method of alder ,and explord the correlations between RI and PI .Results (1)Among the 78 cases(156 joints) with RA ,join thy-drops(65 cases ,122 joints) ,inflammatory exudation(34 cases ,70 joints) ,synovium proliferation(78 cases ,153 joints) ,pannus(37 cases ,69 joints) and bony erosion(29 cases ,58 joints) were found.The thickness of synovial membrane of wrist in RA group was (3 .50 ± 1 .37)mm ,that in healthy control group was(1 .46 ± 0 .32)mm ,the different was statistically significant(P<0 .05) .(2) 64 cases among the 78 patients with RA were detected blood flow signals ,RI progressively reduced with blood flow grade the increas-ion which there was a negative correlation (r= -0 .79 ,P<0 .05);there was no significant correlation between PI and blood flow grade .(3) Ultrasound examination was more sensitive than rheumatoid factor (RF) and X-ray in detection rate of RA (P<0 .05) . Conclusion Ultrasound examination could detecte the pathological changes of wrist in patients with RA which is more sensitive than RF and X-ray ,and it could improve the detection rate of RA which contribute to early diagnosis and reasonable treatment for RA .

The early dynamic 18 F?FDG PET/CT can reflect perfusion, bio?distribution, uptake and excretion of 18 F?FDG in certain organs ( or lesions) in the early phase post injection. This imaging technique could be used to evaluate the organ ( or lesion) perfusion and to serve as a supplement for conventional 18 F?FDG PET/CT in the evaluation of glucose metabolism. This review summarizes the basic principle, imaging methods and clinical application of early dynamic 18 F?FDG PET/CT.

Objective To clarify PET image characteristic of spongiform leukoencephalopathy from heroin vapor inhalation and evaluate PET in the dignosis of the disease. Methods 18 F-FDG PET was performed in six patients with spongiform leukoencephalopathy from heroin vapor inhalation. They developed progressive cerebellar ataxia ,dysarthria and unresponsive in different degree respectively.They were a known drug abuser and had a history of heroin use for 1～3 years.Abstinence of heroin was performed from 1.5 to 3 months in the 2 patients .It was known that they took their heroin not by injection but by inhalation of heated heroin vapours,a method known as "chasing the dragon".Brain CT and MRI revealed some characteristics in all patients. Needle biopsy (n=2) was performed and pathological examination proved spongiform degeneration in the white matter. 13 N-ammonia PET was performed in 1 of 6 patients after 24 hours.Results Brain 18 F-FDG PET revealed bilateral and symmetrical 18 F-FDG accumulation decrease or defect areas invoving the internal capsule behind limb ,cerebral occipital lobes ,and cerebellar hemispheres(cerebellar white matter was severely involved).Brain 13 N-ammonia PET imaging demonstrated abnormal areas of decreased accumulation in the bilateral frontal lobes, bilateral temporal lobes , bilateral occipital lobes, bilateral cerebellar cortex and no 13 N-ammonia accumulation in the bilateral internal capsule behind limb and cerebellar white matter in 1 of 6 patients. The region of the lesion was larger than 18 F-FDG PET imaging in the same patient. Conclusion Spongiform leukoencephalopathy from heroin vapor inhalation has some characteristics on PET ,which are helpful for the diagnosis when combined addictive history.

Objective To investigate the clinical value of dual phase 18F-FDG PET/CT in the diagnosis of recurrent and metastatic bladder cancer after surgery. Methods The imaging data from 84 patients underwent the dual phase 18F-FDG PET/CT after surgery with known histories of bladder cancer were analyzed. Among the 84 patients, 16 had symptoms of recurrence, 24 had symptoms of metastasis and 44 didn′t have any symptom. The median interval time between the primary tumor resection and the PET/CT scan was 11.5 months (0.5 ~ 240 months). According to the PET/CT imaging procedures, all patients underwent whole body PET/CT scan at 60 minutes after IV injection of 18F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis by using oral 40 mg furosemide. The 18F-FDG PET/CT findings were compared with histopathologic examination results and (or) the clinical follow-up. All patients were followed up for more than six months. Results Results of detecting recurrence and metastasis of bladder cancer showed that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the dual phase FDG PET/CT imaging protocol were 91.7%(22/24), 95.0%(57/60), 94.0%(79/84), 88.0%(22/25), 96.6%(57/59) and 90.0%(27/30), 96.3%(52/54), 94.0%(79/84), 93.1%(27/29), 94.5%(52/55), respectively. Conclusion Dual phase FDG PET/CT can be used to detect the recurrence and metastasis with high accuracy, contributing to the restaging and follow-up in bladder cancer after surgery.

Objective To explore the diagnostic value of 18F-FDG PET/CT in the inflammatory bowel diseases (IBD).Methods The clinicopathological data of 75 patients(46 males,29 females;average age 38 years) with IBD confirmed by colonoscopy from March 2010 to March 2014 were reviewed retrospectively.Among the 75 patients,30 were with ulcerative colitis(UC) and 45 were with Crohn's disease (CD).All underwent whole-body 18F-FDG PET/CT imaging.Enteroscope and CRP examination were performed within 1 week before or after PET/CT imaging.The results of 18F-FDG PET/CT were compared with those of located CT and enteroscope (x2,t tests).Linear correlation analysis was used to analyze the relationship between CRP and the SUVmax of lesions presented in IBD.Results (1) 18 F-FDG PET/CT accurately detected 65 patients with IBD,while located CT diagnosed 55 patients with IBD.The diagnostic sensitivities were significantly different:86.7％ (65/75) vs 73.3％ (55/75),x2 =4.167,P＜0.05.(2) Among 65 patients with positive results in 18F-FDG PET/CT,lesions were consistent with those detected by endoscopy in 33 (33/75,44.0％)patients.Results of the 2 methods in 24 patients (24/75,32.0％)were not completely same,those in 8 patients (8/75,10.7％)were totally different.18F-FDG PET/CT detected 145 lesions,while enteroscope only detected 119 lesions.Diffuse high FDG uptake was shown in intestinal wall in 40 of 65 patients,and mild mucosa injury was showed by enteroscope in 18 patients (45.0％,18/40).(3)Fortyeight of 65 patients detected by PET/CT were proven clinically to be in active stage,and the rest were in stable stage.The SUVmax of active stage group (8.31±4.21) was significantly higher than that of the chronic stage group (6.36±3.15;t =2.033,P＜0.05).There was a linear correlation between CRP and SUVmax of patients in active stage(r=0.453,P＜0.01).Conclusions 18F-FDG PET/CT is helpful to assess the activity of IBD and may serve as a supplementary diagnosing tool to detect the lesions under the epithelium of bowel,which are often false-negative by enteroscope.

Purpose Synchronous multiple primary esophageal carcinomas may be undetected by gastroscopy. This study aims to assess the role of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting synchronous multiple primary esophageal carcinomas. Materials and Methods Thirteen patients with synchronous multiple primary esophageal carcinoma who underwent gastroscopy and 18F-FDG PET/CT within two weeks before treatment were retrospectively analyzed. Results Gastroscopy and 18F-FDG PET/CT detected 22 and 29 esophageal carcinomatous foci respectively, and the difference was statistically significant (Z=-2.333, P<0.05). All the 29 esophageal carcinomatous foci showed high 18F-FDG uptake with a SUVmax ranging from 3.1 to 20.1 (mean, 10.7±5.7). 18F-FDG PET/CT also detected surrounding organ invasion in 3 patients, lymphatic metastasis in 10 patients and distant metastasis in 3 patients. Conclusion 18F-FDG PET/CT detects more esophageal carcinomatous foci compared with gastroscopy in patients with synchronous multiple primary esophageal carcinomas and also performs the staging diagnosis, which may help in improving clinical management and prognosis.

Objective To assess the value of 18 F-FDG PET imaging in the localization of epileptic foci.Methods 18 F-FDG PET were performed in 22 patients with medically intractable epilepsy (15 males,7 females,mean years:19.0 years,mean duration:8.2 years). The open skull operations were undergone in 21 patients according to the results of 18 F-FDG PET, combining with scalp EEG and CT or/and MRI. 1 patient was refered for stereotactic operation. During operation,EcoG was detected for identifying the site of epileptogenic focus and lobectomy was performed . All specimens were examninated with the pathological tests. All patients were followed up for the curative effects. Results PET showed abnormalities in 21 patients(95.5%). Among them,single or multiple focal hypometabolisms were found in 20 patients and focal hypermetabolism in 1 patient. The scalp EEGs showed abnormalities in 17 patients(77.3%),but 8 of them did not showed clear latreralizing manifestations.The abnormalities were found on MR or/and CT in only 5 cases (22.7%).The epileptogenic foci detected by PET were consistent well with EcoG in 18cases(85.7%), consistent approximately in 2 cases and not consistent in 1 cases .Among 19 patients with abnormal PET findings , the pathological abnormalities were found in 18 cases (94.7%).No pathological abnormality was found in the patients with nomal PET imaing. After the open skull operations, 9 patients (42.9%) becomed seizure free . 9 patients (42.9%) had more than 50% seizure reduction and 3 patients (14.3%)showed no improvement. The patient treated with stereotactic operation also showed no significant improvement.Conclusion 18 F-FDG PET imaging is a sensitive and accurate modality to localizate the epileptic foci and has important clinical value in surgical therapy.

Objective To evaluate the complementary value of 11C-choline (CHO) PET/CT to 18F-FDG PET/CT in the staging of locally advanced nasopharyngeal carcinoma (NPC) and diagnosis of HCC.Methods From December 2007 to January 2010,15 patients with locally advanced NPC and 76 patients with HCC were prospectively enrolled into this study.The research was approved by the ethics committee,and all patients signed informed consents.Whole body 18 F-FDG PET/CT scans were performed on all patients and regional 11C-CHO PET/CT was conducted in 43 patients (15 with NPC,28 with HCC).A lesion with increased uptake of either 11 C-CHO or 18F-FDG was considered positive.SUVmax,tumor/brain (T/B) ratio and tumor/liver (T/L) ratio were calculated for semi-quantitative analysis.Two-sample t test,x2 test,Fisher exact test and linear correlation analysis were used for statistical analysis.Results (1) The lesion SUVmax of 18 F-FDG was higher compared to 11C-CHO (12.81 ± 5.00 vs 6.84 ± 2.76 ; t =6.416,P ＜0.01) in NPC patients.However,11C-CHO PET/CT had a much higher T/B ratio than 18F-FDG (18.62 ±7.95 vs 1.38 ±0.59 ; t =8.801,P ＜ 0.01).Significant correlation was found between the 2 tracers with regard to NPC lesion uptake (r =0.712,P ＜0.01).Compared with 18F-FDG PET/CT,11C-CHO PET/CT had better delineation of intracranial invasion in 50.0％ of patients (12/12 vs 6/12; x2 =8.000,P ＜0.05),skull base invasion in 4/14 patients and orbital invasion in 3/3 patients.(2) 18F-FDG PET/CT showed positive findings in 63.1％ (48/76) of HCC patients.In 28 HCC patients with negative findings on 18F-FDG PET/CT,11 C-CHO PET/CT was positive in 71.4％ (20/28) of patients.The dual-tracer PET/CT improved the diagnostic sensitivity (89.5％,68/76) of HCC compared with 18F-FDG PET/CT (63.1％,48/76) alone (x2 =14.559,P ＜0.01).11C-CHO PET/CT was more sensitive than 18F-FDG PET/CT for the detection of well differentiated HCC (6/9 vs 35.7％ (5/14) ; P =0.214).For the detection of moderately differentiated HCC,the sensitivity of 11C-CHO and 18F-FDG PET/CT was similar to each other (6/7vs 72.0％ (18/25),P =0.648).11C-CHO PET/CT was more sensitive than 18F-FDG for the detection of HCC lesions ＜5.0 cm (72.7％ (16/22) vs 42.1％ (16/38) ; x2 =5.249,P ＜0.05),especially for lesions ＜ 2.0 cm (5/7 vs 0/7; P =0.021).Conclusions 11 C-CHO PET/CT could improve the accuracy in T staging of NPC.It might also play a complementary role for 18 F-FDG PET/CT in the detection of HCC.

Purpose:The image information and technique of positron emitter nuclei generated by high energy X-ray photonuclear reactions with body tissues from MM50 is studied.It is explored to verify for dose delivery and location monitoring in tumor target after high energy photon radiation therapy with the image information.Materials and Methods:The technique is based on the photonuclear reactio-as in body tissues elemental composition ~(12)C,~(16)O and ~(14)N with high energy X-Ray,energies well above 20 MeV,resulting primarily in ~(11)C and ~(15)O but also ~(13)N.The induced positron activity distributions were scanned off-line in a PET/CT after irradiation.The activity distributions and position may be used to verify for dose delivery and location in tumor target.These radiations are similar to RT in three fields with some different dose delivery from TPS.The phantom began to be scanned off-line in a PET/CT a couple of minutes after irradiation.The scanning time is respectively 20 minutes and(2～5)mniutes for ~(12)C and ~(16)O.The levels of the beam energy are 10MV,25MV,50 MV.The extent of dose is 1.0 Gy～10.0 Gy.Since measured PET images change with time post irradiation,as a result of the different decay tim-es of the radionuclides,the signals from activated ~(12)C,~(16)O within the irradiated volume could be separated from each other.Most informationis obrained from the carbon and oxygen radionuclide's which the most abundant elements are in soft tissue.A brain phantom Rlade oneself was irradiated with high energy X-ray beams from IBA MM50.The 3D radiation treatment planning system,Nucletron-TPP 3.2,was used to calculate the delivered dose distributions.The phantom was directly simulated in the Nucletron-TPP after CT scan.PET/CT is fro-m GE Discovery LS Ⅱ.Resuits:It was confirmed that no activity was detected at 10 Mv X-ray energy,which was far below the energy threshold for photonuclear reactions.Totally 25 MV X-ray beams can produce photonuclear reactions and get to activity distributions images in PET/CT.It need to greater dose in order to good images information.For 50 MV X-ray beams,2 Gy-3 Gy dose,a normal RT dose,can get to activity distributions images.Conclusions:It was concluded that the PET-CT image acquired from the activity of the ~(15)O and ~(11)C positron emitter nuclei might provide the area and dose distribution information of 50 MV X-ray irradiation in a phantom.It can verify the in vivo dose delivery and location in tumor target after high energy X-ray RT.

Objective To evaluate the clinical value of 18 F?FDG PET/CT in the diagnosis of recur?rent and metastatic endometrial cancer. Methods A total of 62 patients with endometrial cancer from October 2004 to February 2014 were retrospectively analyzed. The diagnostic efficiency of 18 F?FDG PET/CT for the de?tection of recurrent and metastatic endometrial cancer was evaluated based on the results of pathological biopsy or clinical follow?up. Results There were 28 endometrial cancer cases with recurrence and metastasis, 9 ca?ses with a second primary cancer and without recurrence and metastasis of endometrial carcinoma. PET/CT imaging had false positive findings in 3 cases, false negative findings in 2 cases. The overall sensitivity, speci?ficity and accuracy of PET/CT for detection of recurrence and metastatic endometrial carcinoma were 93.3%(28/30), 90.6%(29/32), 91.9%(57/62), respectively. The sensitivity and specificity of PET/CT for the diagnosis of vaginal stump recurrence, lymph node metastasis and distant metastasis were 9/10 and 98. 1%(51/52), 95.7%(22/23) and 92.3%(36/39), 15/18 and 95.5%(42/44), respectively. Conclusion 18F?FDG PET/CT is a useful diagnostic tool for the detection of recurrent and metastatic endometrial cancer and a second primary cancer.