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 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.

Objective:To investigate the effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with coronary heart disease.Methods:Sixty elderly patients,who were diagnosed as coronary heart disease and underwent gastric cancer operation,were randomly divided into 2 groups (n=30):the dexmedetomidine group (Dex group) and the control group.In the Dex group,dexmedetomidine was administered intravenously at 0.5 μtg/(kg.h) after a bolus infusion at 0.5 μg/kg for 10 min before anesthesia induction.In the control group,equal volume of normal saline was infused instead of dexmedetomidine.The 2 groups received the same anesthesia treatment.The venous bloods were collected at the preoperative 0 h and postoperative 24 h.The concentrations of cardiac troponin (cTnⅠ),N-terminal pro-brain natriuretic peptide (NT-proBNP) and hypersensitive C-reactive protein (hs-CRP) were determined.The ECG was monitored at the above time and the postoperative incidence of cardiac adverse events was recorded.Results:The levels of cTnⅠ,NT-proBNP and hs-CRP in serum were elevated in the 2 groups after the operation.Compared with the control group,the levels of cTnⅠ,NT-proBNP and hs-CRP were significantly decreased in the Dex group (P＜0.05).Compared with the control group,the incidence ofbradycardia were significantly increased,while the myocardial ischemia and tachycardia were significantly decreased in the Dex group during the operation (P＜0.05);the incidence of silent myocardial ischemia and arrhythmia was significantly reduced at 3 days after operation in the Dex group (P＜0.05).Conclusion:Dexmedetomidine could decrease the incidence of cardiac adverse events in elderly patients with coronary heart disease.

Objective To investigate the value of 18F-FDG PET/CT in the evaluation of treatment response and prognosis for patients.with recurrent uterine cervical cancer.Methods Forty-five patients with recurrent uterine cervical cancer underwent 18F-FDG PET/CT before and after treatment from October 2004 to December 2014,and their PET/CT results were retrospectively analyzed.Treatment response was categorized as complete metabolic response (CMR),partial metabolic response (PMR),stable metabolic disease (SMD) and progressive metabolic disease (PMD) according to PET response criteria in solid tumors (PERCIST).Kaplan-Meier survival analysis was used.The difference of progression-free survival (PFS) between patients with and without PMD was compared by x2 test.The PFS difference among patients with different SUVmax on pretreatment PET/CT was also compared byx2 test.Results After treatment,22.2％ (10/45) of patients were categorized as CMR,22.2％(10/45) as PMR,4.4％(2/45) as SMD and 51.1％ (23/45) as PMD by post-treatment 18F-FDG PET/CT.Thirty-two patients had long-term (6-64 months) clinical follow-up.The PFS was 1-64 months and the median PFS was 5 months.The patients without PMD had a significantly better PFS than those with PMD(12.2 vs 4.2 months,x2 =7.223,P＜0.01).Patients with lesion SUVmax＜7.5 on pretreatment PET/CT had a better PFS than those with SUVmax ≥7.5 (16.3 vs 5.9 months,x2 =5.415,P＜0.05).Conclusion 18F-FDG PET/CT is useful forthe evaluation of treatment response and prognosis in patients with recurrent cancer of the uterine cervix.

Objective To establish a diagnostic model based on 18F-FDG PET/CT and clinical data and assess its diagnostic potency for characterizing SPN.Methods From November 2004 to May 2014,164 patients with SPN who underwent 18F-FDG PET/CT scan were retrospectively analyzed.The patients'clinical factors (age,gender,history of smoking and history of malignancy),information on CT (diameter,location and spiculated edge of the lesion) and metabolic information on PET imaging were collected to establish a diagnostic model by using the binary logistic regression.Then,the optimal operating point (OOP)of the established model was set.The diagnostic potencies of the established model and PET were assessed by ROC curve.Results Malignancy was diagnosed in 104 of 164 SPN patients.The rest 60 patients had benign diseases.The factors of age,spiculation(0:no spiculation,1:obvious spiculation) and metabolic information(0:≤ mediastinal blood pool,1:＞mediastinal blood pool) were demonstrated to be useful for the establishment of the model (x2 =5.486,16.240,33.855,all P＜0.05).However,the factors of gender,history of smoking,the diameter and location of lesions showed no influence for the model (x2 =2.452,0.453,0.127,0.390,all P＞0.05) and rejected from the model established.The history of malignancy was excluded from statistical analysis because there were only 2 patients with history of malignancy.The established model was as follows:P=1/(1+e-Z),z=-5.512+0.061xage+2.208xspiculation+3.767×metabolic increase.The ROC AUC of the established model and PET using two-point scoring scale (TPSS) for charactering SPN were 0.92(95％ CI:0.87-0.96)and 0.80(95％ CI:0.73-0.86).The model had higher diagnostic efficacy compared with TPSS (z=4.369,P＜0.05).When P=0.796 7 was set as an OOP,the diagnostic sensitivities of the model and PET for charactering SPN were 91.3％ (95/104) and 94.2％ (98/104) respectively,and no significant difference was found between them (x2 =0.800,P＞0.05).However,significant difference was found between the diagnostic specificities of them (80.0％ (48/60) vs 65.0％ (39/60);x2 =7.111,P＜0.05).Conclusions A new diagnostic model for characterizing SPN based on the information from 18FFDG PET,thin-section CT and clinical data is successfully established.Its sensitivity for diagnosis of lung cancer is high,and its specificity is superior to PET using with TPSS.This model has a potential value for clinical application.

OBJECTIVETo investigate the clinical value of dual-phase (18)F-FDG PET/CT with oral diuretics in preoperative staging of bladder cancer.

METHODSThe imaging data were analyzed of 73 patients with bladder cancer undergoing preoperative dual-phase (18)F-FDG PET/CT with oral diuretic between May, 2003 and May, 2012. All the patients underwent whole-body PET/CT scan 60 min after intravenous injection of 270-350 MBq of (18)F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis using oral furosemide (40 mg). All the patients underwent subsequent radical cystectomy, and (18)F-FDG PET/CT findings were compared with the histopathologic results to evaluate the value of dual-phase (18)F-FDG PET/CT in preoperative staging.

RESULTSThe concordance rate of dual-phase FDG PET/CT-based bladder cancer staging with the histopathologic results was 63.0% in the 73 patients, and was 100% (7/7) for pT4 bladder cancers. With dual-phase FDG PET/CT, the detection rate was 75.0% (6/8) for lymph node metastases, 100% (4/4) for distant metastases, and 100% (4/4) for other concurrent primary malignancies.

CONCLUSIONThough with limited accuracy in T-staging of pTa, pT1, pT2, and pT3 bladder cancer, dual-phase FDG PET/CT has important clinical value in staging of pT4 bladder cancer and in N-staging, M-staging and detection of other concurrent primary malignancies.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell ; diagnostic imaging ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Radiopharmaceuticals ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; diagnostic imaging ; pathology

OBJECTIVETo investigate the tumor targeting efficacy of (18)F-AlF-NOTA-PRGD2, a novel radiotracer of Arginine-glycine-aspartic acid (RGD) peptides.

METHODS(18)F-AlF-NOTA-PRGD2 was synthesized in one-step by conjugating NOTA-PRGD2 with (18)F-AlF at 100 degrees celsius;. The tumor targeting efficacy and in vivo biodistribution profile of (18)F-AlF-NOTA-PRGD2, following intravenous injection via the tail vein, were evaluated in a nude mouse model bearing subcutaneous U87MG glioblastoma xenograft by radioactivity biodistribution assessment, PET/CT and microPET/CT.

RESULTSNOTA-PRGD2 was (18)F-fluorinated successfully in one-step with a yield of 17%-25% within 15-20 min. Radioactivity biodistribution study confirmed the tumor-targeting ability of (18)F-AlF-NOTA-PRGD2 in the tumor-bearing mice. At 1 and 2 h following injection, (18)F-AlF-NOTA-PRGD2 uptake in the tumor reached 4.14∓1.44 and 2.80∓1.18 % ID/g (t=1.910, P=0.070) with tumor/brain ratios of 2.95∓0.61 and 5.21∓2.62, respectively (t=-1.686, P=0.167). Both PET/CT and microPET/CT were capable of showing the radioactivity biodistribution of (18)F-AlF-NOTA-PRGD2 in the mouse model and clearly displayed the tumor, but microPET/CT showed a much better image quality.

CONCLUSION(18)F-AlF-NOTA-PRGD2 prepared by one-step radiosynthesis can selectively target to the tumor, demonstrating its potential as a good radiotracer for tumor imaging.

Animals ; Cell Line, Tumor ; Fluorine Radioisotopes ; Glioblastoma ; diagnostic imaging ; Humans ; Mice ; Mice, Nude ; Oligopeptides ; Positron-Emission Tomography ; methods ; Radioactive Tracers

Objective To investigate the tumor targeting efficacy of 18F-AlF-NOTA-PRGD2, a novel radiotracer of Arginine-glycine-aspartic acid (RGD) peptides. Methods 18F-AlF-NOTA-PRGD2 was synthesized in one-step by conjugating NOTA-RGD2 with 18F-AlF at 100℃. The tumor targeting efficacy and in vivo biodistribution profile of 18F-AlF-NOTA-RGD2, following intravenous injection via the tail vein, were evaluated in a nude mouse model bearing subcutaneous U87MG glioblastoma xenograft by radioactivity biodistribution assessment, PET/CT and microPET/CT. Results NOTA-RGD2 was 18F-fluorinated successfully in one-step with a yield of 17%-25%within 15-20 min. Radioactivity biodistribution study confirmed the tumor-targeting ability of 18F-AlF-NOTA-PRGD2 in the tumor-bearing mice. At 1 and 2 h following injection, 18F-AlF-NOTA-PRGD2 uptake in the tumor reached 4.14 ± 1.44 and 2.80 ± 1.18%ID/g (t=1.910, P=0.070) with tumor/brain ratios of 2.95 ± 0.61 and 5.21 ± 2.62, respectively (t=-1.686, P=0.167). Both PET/CT and microPET/CT were capable of showing the radioactivity biodistribution of 18F-AlF-NOTA-PRGD2 in the mouse model and clearly displayed the tumor, but microPET/CT showed a much better image quality. Conclusion 18F- AlF- NOTA- PRGD2 prepared by one- step radiosynthesis can selectively target to the tumor, demonstrating its potential as a good radiotracer for tumor imaging.

Objective To investigate the clinical value of dual-phase 18F-FDG PET/CT with oral diuretics in preoperative staging of bladder cancer. Methods The imaging data were analyzed of 73 patients with bladder cancer undergoing preoperative dual-phase 18F-FDG PET/CT with oral diuretic between May, 2003 and May, 2012. All the patients underwent whole-body PET/CT scan 60 min after intravenous injection of 270-350 MBq of 18F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis using oral furosemide (40 mg). All the patients underwent subsequent radical cystectomy, and 18F-FDG PET/CT findings were compared with the histopathologic results to evaluate the value of dual-phase 18F-FDG PET/CT in preoperative staging. Results The concordance rate of dual-phase FDG PET/CT-based bladder cancer staging with the histopathologic results was 63.0%in the 73 patients, and was 100%(7/7) for pT4 bladder cancers. With dual-phase FDG PET/CT, the detection rate was 75.0%(6/8) for lymph node metastases, 100%(4/4) for distant metastases, and 100%(4/4) for other concurrent primary malignancies. Conclusion Though with limited accuracy in T-staging of pTa, pT1, pT2, and pT3 bladder cancer, dual-phase FDG PET/CT has important clinical value in staging of pT4 bladder cancer and in N-staging, M-staging and detection of other concurrent primary malignancies.

Objective We propose a method using total variation (TV) regularization in deconvolution for partial volume correction in PET imaging. In the degraded image model, we used TV regularization procedure in Van Cittert (VC) and Richardson-Lucy (RL) deconvolution algorithms. These methods were tested in simulated NCAT images and images of NEMA NU4-2008 IQ phantom and tumor-bearing mouse scanned by Simens Invoen microPET. The simulated experiment and tumor-bearing mouse experiment showed that the algorithms using TV regularization provided superior qualitative and quantitative appearance compared with traditional VC and RL algorithms. When the mean intensity of the tumor increased by (10 ± 1.8)%, the SD increase percentage was decreased from 49.98%to 14.26%and from 42.76%to 4.70%, suggesting the efficiency of the proposed algorithms for reducing PVEs in PET.