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The value of ~(18)F-FDG PET/CT on the detection and staging of natural killer/T cell lymphomas

Hu-bing, WU ; Quan-shi, WANG ; Ming-fang, WANG ; Hong-sheng, LI ; Wen-lan, ZHOU ; Xiang-hua, YE ; Qiao-yu, WANG

Chinese Journal of Nuclear Medicine.2010;30(1):19-22. doi:10.3760/cma.j.issn.0253-9780.2010.01.005

Objective To investigate the value of ~(18)F-fluorodeoxyglucose (FDG) PET/CT on the detection and staging of natural killer (NK)/T cell lymphomas.Methods Thirteen new and 2 recurrent csses of NK/T cell lymphoma were inchded in this study and they all underwent wllole-body ~(18)F-FDG PET/CT scans.A lesion with intense ~(18)F-FDG uptake was taken as positive for disease involvement and semiquantitative metabolic assessment was performed with the maximum standardized uptake value(SUV_(max)).All patients were followed for more than 6 months.The t-test was used to analyze the semi-quantitative data statistics.Results (1) ~(18)F-FDG PET/CT had 100%positive detection rate for NK/T cell lymphom.Of 11 cases with disease involvement of the nasal region.PET/CT detected 10.either in the nasal cavity or in the nasopharynx,6 with extra-nasal infiltration,and 7 with regional nodal metastasis.There were 4 non-nasal cases and PET/CT detected one or multiple extra-nasal lymphoma lesions.The SUV_(max) of nasal and extra-nasal lesions was 12.42±9.25,9.54±7.12,respectively,with no significant difference(t=1.120,P＞0.05).(2)Two cases(2/15)diagnosed of this disease by PET/CT were initially referred as investigation of fever of unknown origin.For the remaining 13/15 known cases,PET/CT detected more "unsuspected" lymphoma lesions in 7 cases and affected the staging in 6 patients.The ~(18)F-FDG uptake (SUV_(max))of Ⅰ-Ⅱ stage patients was mildly lower than that of Ⅲ-Ⅳ stage patients,but no significant difference was observed (t=0.757,P＞0.05).Conclusions NK/T cell lymphoma is an intensely ~(18)F-FDG-avid tumor.~(18)F-FDG PET/CT is an effective imaging tool for detection and staging of this disease.

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The diagnostic value of comparison of ~(18)F-FDG PET/CT with contrast-enhanced CT in detecting primary hepatic carcinoma and postoperative recurrence

Xiao-yan, WANG ; Xiang-song, ZHANG ; Zhi-feng, CHEN ; Fang, LI ; Zi-ping, LI ; Guo-hui, RAO ; Xin-chong, SHI ; ping, HU

Chinese Journal of Nuclear Medicine.2010;30(1):15-18. doi:10.3760/cma.j.issn.0253-9780.2010.01.004

Objective To compare diagnostic value of ~(18)F-fluoredeoxyglucose (FDG) PET/CT with contrast-enhanced CT in detecting primary hepatic carcinoma and postoperative recurrence.Methods Twenty-five cases of primary hepatic carcinoma or postoperative recurrent tumor underwent whole-body ~(18)F-FDG PET/CT and contrast-enhanced CT within one week's interval.They were retrospectively reviewed and the difierences between these two modalities were investigated.Results Of these 25 cases,there were 13 cases with primary hepatocellular carcinoma.1 case with intrahepatic cholangiocarcinoma and 11 cases with postoperative recurrence.The sensitivity of 18 F-FDG PET/CT and contrast-enhanced CT in diagnosing primary hepatic carcinoma was 78.6%(11/14) and 92.9%(13/14),and sensitivity in diagnosing postoperative recurrent was 100.0%(11/11) and 63.6%(7/11) respectively.Conclusion Contrast-enhanced CT may have a slight advantage over PET/CT in detecting primary hepatic carcinoma,but ~(18)F-FDG PET/CT combined with contrast-enhanced CT has even greater accuracy.Meanwhile,~(18)F-FDG PET/CT has better diagnostic accuracy in detection of postoperative recurrent tumor.

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Metabolic and anatomic characteristics of bronchioloalveolar carcinoma on 18F-FDG PET/CT

Yong-ju, GAO ; Szabo, ZSOLT

Chinese Journal of Nuclear Medicine.2009;29(4):238-241. doi:10.3760/cma.j.issn.0253-9780.2009.04.008

Objective The aims were to investigate the value of 18F-fluorodeoxyglucose (FDG) PET/CT in the diagnosis of bronehioloalveolar carcinoma (BAC) and its metabolic and anatomic features in differentiating from non-BAC adenocareinoma (non-BAC AC ). Methods This was a retrospective 18F-FDG PET/CT study on a consecutive series of 87 patients (32 BAC, 55 non-BAC AC) with 110 pathology-proven lesions. The maximum standardized uptake value ( SUVmax) was calculated for all lesions. Tumor's location, morphology and margins, internal structures were analyzed on CT. Statistical analysis compared the mean SUVmax between the two groups, analysed the relationship between tumor subtype and features on CT and compared the diagnostie aeeuraeies with PET alone, CT alone and PET/CT. The t-test, McNemar test, Fisher exact test were used to analyze the data using SPSS 12.0. Results Significant differences were found between mean SUVmax in a total of 47 lesions with BAC and 63 lesions with non-BAC AC (1.51±0.17 vs 6.28± 3.04, t=-10.374, P <0.0001 ). Pure ground glass density, which was foued in BAC, was the most significant CT feature in distinguishing tumor types ( Fisher exact test, P<0.0001 ). Diagnos-tic accuracies were 88% (28/32) with PET/CT, 47% (15/32) with PET and 66% (21/32) with CT. Differences in aeeuraeies between PET and PET/CT and between CT and PET/CT were statistically signifi-cant (P= 0.001,0.039 ). Conclusions Diagnostie accuracy can be higher by understanding the function-al eharaeteristies on PET and anatomical features on CT. The presence of persistent ground glass in a lesion on CT is a significant feature for BAC and should raise the suspicion of this tumor type even in cases of low 18F-FDG activity.

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The value of rACC in diagnosing dementia of Alzheimer type with 11C-PIB PET

Da-fu, YU ; A.Mintun MARK

Chinese Journal of Nuclear Medicine.2009;29(4):263-267. doi:10.3760/cma.j.issn.0253-9780.2009.04.015

Objective Beta-amyloid (AB) plaque is one of the most important hallmarks of Alzhe-imer disease (AD). [N-methyl-11C]-[4'-methylaminophenyl]-6-hydroxybenzothiazole (11C-PIB) can have a strong binding potential (BP) of AB plaques in the brains of patients with dementia of Alzheimer type (DAT). This study was to investigate the value of rostral anterior cingnlate cortex (rACC) in diagnosing human AD with 11C-PIB PET imaging. Methods All the subjects were enrolled through ads by Washington University School of Medicine (WUSM) in USA. Clinical dementia rating (CDR) was the practical grading standard for AD. There were 129 cases of normal control (HC) with CDR =0 and 40 cases of AD patients with CDR >0 (but there were only 120 HC cases and 34 DAT patients with data of rACC PIB BP. All 169 cases had PIB BP data of other studied cerebral subregions). Brain subregions were localized with MRI. PET imaging was performed immediately after intravenous injection of11C-PIB. MRI and PET images were aligned and fused with the help of software. BP was calculated using the Logan graphical analysis and the cerebellar cortex as the reference tissue. The distribution characters of 11C-PIB BP in rACC were analyzed and compared with other brain subregions studied by other scholars with the same research cases. The corre-lation analysis, t-test or variance analysis were calculated with SPSS 11.5. Results rACC PIB BP of 120 HC and 34 AD patients was calculated, rACC PIB BP was statistically linear and positively correlated with CDR significantly (BP=0.2865±0.442,CDR=0.143±0.290,r=0.545,P<0.01). There was no sta-tistical difference among the rACC PIB BP of DAT patients (0.6719±0.1545 vs 0.8933±0.0880,inde-pendent-samples t-test in both groups of CDR =0.5and1, indicated t=-1.245,P>0.05), but signifi-cant difference was found between rACC PIB BPs of HC and DAT patients (0.1589±0.0219 vs 0.7370±0.1125, independent-samples t-test in both group of CDR=0 and>0,indicatedt=-7.998, P<0.01). The threshold of rACC PIB BP for differentiating DAT was 0.4592, greater than what could be thought as suffering from DAT with sensitivity 67.65 % (23/34) and specificity 88.33% (106/120). The BP values of both groups partially overlap each other. In all the studied cerebral subregions, the highest 3 subregions in mean PIB BP of DAT patients or in the difference of mean PIB BP between DAT patients and HC group were precuneus, rACC and prefrontal cortices. Conclusion rACC PIB BP can be used to differentiate DAT patients from normal persons; rACC, precuneus and prefrontal cortices are together the most sensitive brain subregions in the diagnosing DAT.

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99Tcm-dextran lymphoscintigraphy in evaluation of breast cancer-related lymphedema

Guan-sheng, TONG ; Wen-bin, SHEN ; Wan-de, GENG ; Zhe, WEN ; Jun, FAN

Chinese Journal of Nuclear Medicine.2010;30(5):324-328. doi:10.3760/cma.j.issn.0253-9780.2010.05.012

Objective To investigate the imaging characteristics of lymphoscintigraphy in postoperative breast cancer patients and evaluate its diagnostic value in breast cancer-related lymphedema (BCRL).Methods Seventy-nine breast cancer patients who underwent mastectomy and axillary lymph node dissection were studied. Patients ( n = 158 ) were divided into the study ( affected arms, n = 79 ) and control groups ( contralateral arms, n = 79). After subcutaneous injection of 99Tcm-dextran via the first interphalangeal space, lymphoscintigraphy was performed at 10 min, 1,3, 6 h respectively. Sensitivity and specificity of lymphoscintigraphy for detection of BCRL were calculated. Results There were significant differences in the amount of visualized lymph nodes, lymphatic integrity and backflow pattern between the two groups.Lymphatic drainage was preserved in 96.2% (76/79) of the contralateral arms and only 5.1% (4/79) of affected arms. 87.3% (69/79) and 74.7% (59/79) of control arms had ≥2 lymph nodes in axilla and supraclavicular regions, respectively; while none ( 0/79 ) and 5.1% (4/79) of the affected arms had ≥ 2lymph nodes in both regions, respectively. Four backflow patterns of radiotracer in subcutis were observed in the affected arms: normal (2.5% , 2/79), dilatated (55.7%, 44/79), diffused (36.7%, 29/79) and without backflow (5.1%, 4/79 ). The sensitivity and specificity of "lymphatic integrity" and "backflow pattern" on lymphoscintigraphy for detecting BCRL were 97.5% (77/79) and 96.2% (76/79), 94.8%(73/77) and 100.0% (81/81), respectively. Conclusion Lymphoscintigraphy is a noninvasive, accurate and effective imaging modality for the evaluation of BCRL.

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Clinical factors related to bone metastases from breast cancer

Wei-hong, ZHANG ; Gang-long, TIAN ; Ji-min, HE ; Feng-fei, ZHOU ; Hong-xia, GUAN ; Cong-ming, GAO ; Ping-xin, L(U)

Chinese Journal of Nuclear Medicine.2010;30(5):320-323. doi:10.3760/cma.j.issn.0253-9780.2010.05.011

Objective To study the clinical and imaging features of patients with bone metastases from breast cancer and identify the factors related to the incidence of bone metastases. Methods Three hundred and thirty-four patients with breast cancer were recruited into this study. Whole-body 99Tcm-methylene disphosphonate (MDP) bone scan, clinical staging, pathological, immunohistochemical and serological test results were analyzed retrospectively. χ2 test was used for statistical analysis. Results The incidence rate of bone metastases for patients with and without lymph node metastases was 71% (152/214) and 22. 5% (27/120), respectively (χ2 =72.80, P =0.000). The incidence rate of bone metastases from infiltrated non-specified and specified breast cancer was 69% (203/294) and 41.7% (5/12), respectively (χ2 =3. 97, P=0.046). Alkaline phosphatase (ALP) was elevated in 28.5% (51/179) and 14.9%(11/74) of patients with and without bone metastases, respectively (χ2 = 5. 25, P = 0.022 ). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, CA19-9 increased in 68.7% ( 123/179) and 27.0% (20/74) of patients with and without bone metastases, respectively (χ2 = 37. 03, P =0. 000). Conclusions The incidence of bone metastases from breast cancer is correlated to pathological types of primary tumor and lymph node metastases. Bone metastases occurs more frequently in patients with infiltrated, non-specified, primary cancer and with lymph node metastases. Serum ALP, CEA, CA15-3,CA125, CA19-9 might be the tumor makers for early diagnosis of bone metastases from breast cancer.

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Clinical investigation on the alteration of 99Tcm-MIBI washout rate in ischemic myocardium

Bu-lin, DU ; Na, LI ; Ya-ming, LI ; Ya-fu, YIN ; Xue-na, LI ; De-shun, LI

Chinese Journal of Nuclear Medicine.2010;30(5):291-294. doi:10.3760/cma.j.issn.0253-9780.2010.05.002

Objective To investigate the changes of early and delayed washout rates of 99Tcm-methoxyisobutylisonitrile (MIBI) in ischemic heart disease (IHD), and to explore the value of 99Tcm-MIBI SPECT in evaluating impairment of ischemic myocardial cells. Methods Patients diagnosed of IHD with three-vessel stenosis ( ≥50% ) without myocardial infarction based on angiography (CAG) underwent 99Tcm-MIBI static planar and gated SPECT imaging. The early (90 min after the intravenous injection) and delayed (4 h after the intravenous injection) washout rates of 99Tcm-MIBI and left ventricular ejection fraction (LVEF) of IHD patients and normal subjects were compared using t-test. Linear correlation analysis was performed between the early, delayed washout rates and LVEF measured by gated SPECT. Results Statistically significant lower early washout rate of 99Tcm-MIBI was observed in IHD group than control group: (13.44 ± 2.87 )%vs ( 17.32 ± 4.92) %, t = 2.384, P ＜ 0.05, but higher delayed washout rate of 99Tcm-MIBI was observed in IHD group than control group: (19.24 ±4.71)% vs (15.23 ±3.81)%, t= -2.246, P＜0.05. LVEF in IHD group was significantly lower than that in control group: (55.71 ±7.97)% vs (67.75 ±5.43)%, t =-4.418, P ＜0.01. There were no correlations between the early/delayed washout rates and LVEF, respectively in IHD patients (r = -0.212, P ＞ 0.05; r =0.352, P ＞ 0.05, respectively). Conclusion 99Tcm-MIBI washout rate may reflect myocardial cell impairment due to IHD.

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Preliminary clinical study of 99Tcm-HL91 imaging in bone metastasis

Bao-ping, LIU ; Rong-hu, MAO ; Xing-min, HAN

Chinese Journal of Nuclear Medicine.2008;28(4):251-252.

Objective 99Tcm-4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime(HL91),a new type of hypoxic agents,accumulates in tumor hypoxic tissue specifically.The aim of this study was to evaluate the value of 99Tcm-HL91 imaging in the diagnosis of bone metastasis.Methods Nineteen cases with bone metastasis(without any treatment)and 8 cases with benign lesions underwent SPECT imaging at 4 h after injection of 740 MBq of 99Tcm-HL91 along with 99Tcm-methylene diphosphonic acid(MDP)imaging.Regions of interest(ROIs)were drawn in tumor tissue and contralateral normal tissue respectively,and the radioactivity ratios of tumor-to-normal(T/N)were calculated.The t-test was used for data analysis with SPSS 11.0.Results There were visible uptake of 99Tcm-HL91 in 79 out of 85 focuses in 19 patients of bone metastasis;however,there was no obvious uptake of 99Tcm-HL91 in 12 focuses of 8 patients of benign lesions.Significant difference existed between the T/N values of malignant(1.877±0.288)and benign lesions[(0.735±0.236);t=13.065,P＜0.05].However,the T/N value of bone metastasis from lung cancer did not differ with that from prostate cancer(1.915±0.344 and 1.825±0.175,respectively;t=1.378,P＞0.05).Conclusion The results indicated that 99Tcm-HL91 was useful in diagnosing the malignant and benign bone lesions.

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Clinical study of bone imaging in 117 cases with primary hyperparathyroidism

Rui-sen, ZHU ; Qiong, LUO ; Han-kui, LU ; Li-bo, CHEN ; Quan-yong, LUO

Chinese Journal of Nuclear Medicine.2010;30(1):38-41. doi:10.3760/cma.j.issn.0253-9780.2010.01.010

Objective To analyze the characteristics of bone scintigraphy in 117 cases with primary hyperparathyroidism (PHPT).Methods Of these 117 cases (50 males and 67 females),there were 116 parathyroid adenomas and 1 parathyroid cancer.Mean age was 61.1(12-86) years old.All had ~(99)Tc~m-methylene diphosphonate (MDP) bone scintigraphy.The bone images could be classified into 4 categories.Category Ⅰ:normal;category Ⅱ:localized abnormal,which could be subcategorized as Ⅱ A with skull and mandible involvement,and Ⅱ B with Ⅱ A characteristics plus metabolic derangement;category Ⅲ:systemic,whole-body incmased tracer uptake;category Ⅳ:systemic plus localized metabolic derangement.Data were analyzed statistically with X~2 and t-test (isolated samples).Results According to the scintigraphic findings,there were 47 cases(40.17%)of category Ⅰ,35 cases(29.91%) category Ⅱ (21/35cases Ⅱ A and 14/35 cases Ⅱ B),30 cases (25.64%) category Ⅲ,and 5 cases (4.27%) category Ⅳ.Combining categories Ⅱ、Ⅲ and Ⅳ together,there were 70 abnormal cases.These patients had history of abnormal bone images such as bone fracture (39 cases,55.71%),calculus (8 cases,11.43%),bone fracture plus calculus(7 cases,10.00%),osteoporosis (51 cases,72.86%) or ostalgia(26 cases,37.14%);however,in the 47 cases of category Ⅰ,only 1 (2.13%),0,0,10(21.28%)and 10 cases (21.28%),respectively,were found.Therefore.these case history characteristics were statistically significant (X~2=11.152,P=0.01).The tumor size,parathyroid hormone (PTH),blood calcium,blood phosphorus in the patients of abnormal PHPT categories Ⅱ to Ⅲ were(14.52±13.72)cm~3,(731.67±618.40)ng/L,(3.05±0.29) mmol/L and (0.71±0.14) mmol/L,respectively.with statistically significant difference compared to category Ⅰ:(0.78±1.33) cm~3,(112.04±62.98)ng/L,(2.56±0.42) mmol/L and (1.03±0.36)mmol/L(t=-5.724,-5.741,-7.274 and -6.451;all P＜0.01).Conclusions (1)Bone scintigraphy was normal in 40% of PHPT patients.(2)The bone images of PHPT could be classified into 4 categories and each could reflect the duration and severity of the disease status on bone.(3)The bone imaging characteristic could be useful for differential diagnostic purposes.

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Correlation study between ~(18)F-FDG uptake and hypoxia inducible factor-1α level,microvessel density in human gliomas

Li, CAI ; Chuan, ZHANG ; Yan-sheng, LI ; Da-cheng, LI ; Xi-ling, XING ; Shuo, GAO

Chinese Journal of Nuclear Medicine.2010;30(1):10-14. doi:10.3760/cma.j.issn.0253-9780.2010.01.003

Objective To investigate the correlation between ~(18)F-fluorodeoxyglucose (FDG) uptake and hypoxia inducible factor1α (HIF-1α) level,microvessel density (MVD) in human gliomas.Methods ~(18)F-FDG PET scan was performed preoperatively in 41 patients with gliomas (including 23 highgrade and 18 low-grade tumors).The ratios of maximum standardized uptake value(SUV_(max))between tumor (T)and contralateral white matter (WM) were calculated (T/WM).Immunohistochemical stain methods were used to evaluate the level of HIF-1α and measure the MVD in tumors.Correlation analysis between SUV_(max) of T/WM and HIF-1α level,MVD wag performed.The t-test,one-way ANOVA test,Spearman rank correlation and Wilcoxon signed-rank test were calculated using SPSS 11.5 software.Results (1)The SUV_(max) of T/WM,HIF-1α level and MVD in high-grade and low-grade tumors groups were 3.39±1.43,95.7% and 44.13±16.1 vs 1.46±0.55.55.6% and 18.83±7.07,respectively.The difierences of SUV_(max) of T/WM,HIF-1α level and MVD between two groups were statistically significant (t=-5.921,z=-3.938,t=-6.745,all P＜0.05).(2)Among 41 gliomas,the strong positive expression of HIF-1α was observed in 8,mederate in 9,weak in 15 and negative expression was found in 9,SUV_(max) of T/WM and MVD increased with increasing HIF-1α level.The differences of SUV_(max) of T/WM and MVD among 4 different groups were statistically significant (F=7.41,P＜0.05).(3) The MVD of all gliomas was ranged from 9.76 to 94.52,which correlated with SUV_(max) of T/WM(r=0.759,P＜0.05).Conclusions The SUV_(max) of T/WM correlates with HIF-1α level and MVD in gliomas.Therefore,~(18)F-FDG PET provides preoperatively a noninvasive assessment of hypoxia or angiogenesis in human glionma.

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