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Prognostic value of metabolic tumor volume on 18F-FDG PET/CT imaging in patients with pancreatic cancer

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):408-412. doi:10.3760/cma.j.issn.2095-2848.2016.05.007

Objective To evaluate the prognostic value of MTV measured by pretreatment 18F-FDG PET/CT imaging in patients with pancreatic cancer (PC).Methods The clinical data of 52 patients (31 males,21 females,median age 58.5 years) with pathologically or clinically proved PC from January 2011 to October 2014 were retrospectively analyzed.Serum CA19-9 was measured within 1 week before PET/CT examination.SUVmax and MTV were measured respectively,and PET/CT staging was obtained simultaneously.All patients were followed up until January 2015.The CA19-9,MTV,SUVmax,PET/CT staging and clinical factors(age,gender,treatment methods) were assessed by ROC curve analysis,Kaplan-Meier analysis and multivariate Cox model.Results The median survival time of 52 patients was (11.20±7.25) months.ROC curve analysis showed that the AUC of MTV,SUVmax and CA19-9 were 0.735,0.614 and 0.527 respectively.Kaplan-Meier survival analysis manifested that the survival times were significantly different between patients with different MTV (＜ 12.14 cm3 vs ≥ 12.14 cm3),different SUVmax (＜ 8.95 vs ≥ 8.95),different PET/CT staging and different treatment methods (x2 =4.272-11.693,all P＜0.05).The survival time of patients with MTV ＜ 12.14 cm3 and that of patients with MTV ≥ 12.14 cm3 were (13.44±8.40) and (7.00± 4.82) months,respectively.Cox single-factor analyses indicated that MTV,PET/CT staging and SUVmax were risk factors of survival,the hazard ratios (HR) were 0.393,0.503,0.547 respectively (P=0.002,0.020,0.027).Cox multi-factor analyses indicated that MTV and PET/CT staging were independent risk predictors of survival.Conclusion MTV and PET/CT staging are significant factors in prognosis prediction of patients with PC,which would be helpful to make individual treatment for patients with high risks.

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Design and application of information management system of nuclear medicine

Song CHEN ; Yaming LI ; Chunqi HAN ; Kun YUE ; Wei SHAO ; Hui ZENG

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):461-463. doi:10.3760/cma.j.issn.2095-2848.2016.05.018

Information management system of nuclear medicine (IMSNM) is an important part of modem medical information system.It is used for the scientific management of clinical works,and classification and storage of patient data and examination data (words and images).With the help of IMSNM,standardization,automation and digitization of clinical operation protocols,the scientific and normalized management,the unification of image storage and viewing could be achieved.The IMSNM plays an important role in the health care,education and scientific research.This study mainly describes the design and application of IMSNM.

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Change of pre-ablative thyroid-stimulating hormone after thyroid hormone withdrawal and its response to 131I therapy in patients with low to intermediate risk differentiated thyroid cancer

Xin LI ; Teng ZHAO ; Wen GAO ; Hui LI ; Chen WANG ; Yansong LIN

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):389-393. doi:10.3760/cma.j.issn.2095-2848.2016.05.003

Objective To investigate the relationship between the change of pre-ablative TSH after thyroid hormone withdrawal(THW) and the response of subsequent 131I therapy in patients with low to intermediate risk DTC after total or near total thyroidectomy.Methods A total of 120 DTC patients (38 males,82 females,age (40.8±10.9) years) were enrolled in this retrospective study.Serial TSH levels determined on the day of THW and on the day of receiving 131I ablative therapy were monitored,which were marked as TSH1 and TSH2 accordingly.The THW duration (t) was recorded,the change of TSH was defined as △TSH and the change rate of TSH was calculated (V=△TSH/t).The responses to 131I therapy were classified as excellent response (ER),indeterminate response (IDR),biochemical incomplete response (BIR) and structural incomplete response (SIR) according to ATA guideline.According to the TSH2(mU/L) levels,patients were divided into G1 group (30≤TSH2＜60),G2 group (60≤TSH2＜90),G3 group (90≤TSH2＜ 120),G4 group (120≤TSH2＜150) and G5 group (TSH2 ≥ 150).Clinical and pathological features,THW duration,the change rate of TSH,residual thyroid,131 I dose and follow-up time were compared among these groups.In order to evaluate the relationship between response to 131I ablation and change rate of TSH,patients were divided into V1 group (V≤2.5),V2 group (2.5＜V≤5.0) and V3 group (V＞5.0),and their responses to 131I ablation were compared.Patients were classified into RI group (including ER and IDR)and R2 group (including BIR and SIR),the differences of clinical and pathological features,131I doses between the two groups were explored.Furthermore,logistic regression was performed to identify factors associated with BIR and SIR.Results Patients with male gender (x2=11.863),younger age (F =4.975),and faster TSH change rate (H =44.911) and lower thyroid residue (H =18.159) achieved a higher value of TSH2(all P＜0.05).G3 group presented the highest rate of ER (83.8％,31/37).The percentage of ER + IDR in V2 group was higher than those in V1 group and V3 group,which was 92.4％ (61/66),85.7％ (18/21) and 5/7,respectively,but the difference was not significant (U=407.5,P＞0.05).TSH2 level (OR=0.835) and pre-ablative Tg level (OR =1.196) were independent factors in predicting BIR and SIR (both P＜0.05).Conclusions The changing rate of TSH before 131 I ablation may not be associated with the response to 131I therapy in patient with low to intermediate risk DTC,while the level of TSH2 does.Patients with TSH2 ranging from 90 to 120 mU/L could be of help in achieving a better clinical response.

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Correlation between external dose equivalent rate and residual radioactivity in patients with differentiated thyroid carcinoma after 131I therapy

Renfei WANG ; Jian TAN ; Guizhi ZHANG ; Yajing HE

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):394-397. doi:10.3760/cma.j.issn.2095-2848.2016.05.004

Objective To investigate the correlation between external dose equivalent rate (EDER)and residual radioactivity in DTC patients after 131I therapy.Methods A total of 70 DTC patients (15 males,55 females;average age (45.7±12.8) years) who received 131I therapy from January 2015 to May 2015 were reviewed.Patients were divided into remnant ablation group (Group 1,43 patients) and the group of therapy for persistent disease (Group 2,27 patients).The determination of dose equivalent rate at 1,2 and 3 m from the patients was performed at 1,6,18,24,30,42,48,54,66 and 72 h after the administration of 131 I.Simultaneously,the residual radioactivity was estimated through collecting their urine and monitoring the excretion of radioactivity.The correlation between EDER and residual radioactivity was analyzed.Results The functions of standard EDER (μSv · h-1 · MBq-1) at 1 m from the patients of Group 1 and Group 2 were H=0.044 77e-0.063 8t +0.015 04e-0.396t.and H=0.039 71e-0.0629t +0.014 12e-0.325t,respectively.And the functions of residual radioactivity (MBq) of the two groups were A =A0(0.84e-0.061 7t+ 0.16e-0.158 4t)and A =Ao(0.69e-0.087 7t+ 0.31e-0.047 3t),respectively.There was a positive correlation between EDER and residual radioactivity in DTC patients after the administration of 131I (r=0.95,P＜0.001).The fitting function of the dose equivalent rate at 1 m from the patients was H(μSv/h)=0.048A (MBq).Conclusions The residual radioactivity in DTC patients after 131 I therapy can be estimated by determining the EDER.The dose equivalent rate at 1 m from the patients of lower than 19.2 μSv/h can be used as the limitation of radiation isolation.

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Preparation of 99Tcm-MAG3-VEGF125-136 polypeptide and its biodistribution and imaging in osteosarcoma mice

Min CHEN ; Xiaomei LIU ; Lingge WEI ; Peng FU ; Ainan GUO

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):450-453. doi:10.3760/cma.j.issn.2095-2848.2016.05.015

Objective To synthesize 99Tcm labeled VEGF fragment (VEGF125-136) and evaluate its biodistribution and imaging in the nude mice bearing human osteosarcoma,in order to find a probe to improve the early diagnosis and targeted therapy of osteosarcoma.Methods VEGF125-136 was synthesized by conventional solid phase synthesis method,and directly coupled with MAG3 to form MAG3-VEGF125-136,then MAG3-VEGF125-136 was labeled with 99Tcm.The osteosarcoma bearing nude mice were randomly divided into four groups by random number table and studied for 99Tcm-MAG3-VEGF125-136 distribution at 0.5,1,2,4 h,respectively.The other 10 osteosarcoma bearing nude mices were divided into the experimental group and competitive inhibition group,and underwent radionuclide imaging.The T/NT ratio was calculated.Data were analyzed using two-sample t test.Results The radioactive labeling rate was greater than 95％,radiochemical purity was still greater than 85％ after 12 h in room temperature.The 99Tcm-MAG3-VEGF125-136 was cleared fast in blood and mainly excreted through the kidneys and liver.Tumor uptake of 99Tcm-MAG3-VEGF125-136 was highest at 1 h with (0.28±0.02) ％ID/g.The T/NT ratios of experimental group at 0.5,1,2,4 h were 1.07±0.10,3.10±0.19,2.63±0.14,1.90±0.09,respectively.In competitive inhibition group,no obvious radioactivity concentration was observed in tumors.The T/NT ratios were 0.99± 0.05,1.06± 0.06,0.98±0.03,0.97±0.03 at 0.5,1,2,4 h respectively.The T/NT ratios were significantly different between the two groups at 1,2,4 h (t=22.52,26.36 and 22.31,all P＜0.05),but no significant difference was observed at 0.5 h (t =1.44,P＞0.05).Conclusion 99Tcm-MAG3-VEGF125-136 has high labeling efficacy,good stability and high specificity to osteosarcoma.It can be used as an agent for early diagnosis and therapy monitoring in osteosarcoma.

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The antioxidant effects of 99Tc-MDP on the brain of D-galactose induced aged mice

Xiuqing XUE ; Jian ZHENG ; Yiwei WU

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):454-457. doi:10.3760/cma.j.issn.2095-2848.2016.05.016

Objective To observe the antioxidant effects of 99Tc-MDP on the brain of aged mice induced by D-galactose.Methods A total of 48 healthy female Kunming mice were divided into 6 groups by random number table method:normal control group,model group,vitamin E (Vit E) group,groups treated with low,middle and high dosages of 99Tc-MDP.Except the normal control group,mice of each group were injected with 10％ D-galactose saline subcutaneously in the neck for 42 d.At the same time,the 99Tc-MDP groups were given different dosages of 99Tc-MDP (1.75× 10-5,3.50× 10-5,0.70× 10-4 μg/g according to the body mass) respectively into abdominal cavity twice a day.Vit E group was given Vit E by intragastric administration from the first day.The model group was injected with saline every day.After behavioral testing,mice serum samples and brain tissue samples were collected for the determination of superoxide dismutase (SOD),malondialdehyde (MDA),glutathione peroxidase (GSH-Px) and monoamine oxidase (MAO)levels.Then the mice were sacrificed and the brain tissue was taken for HE staining.The independent-sample t test was used for data analysis.Results The mice model was established successfully.SOD levels in brain tissue of groups injected with low,middle,high dosages of 99Tc-MDP,Vit E group were (19.06± 6.44),(20.41±4.02),(22.24±3.76),(24.71±5.09) U/mgprot,respectively,all of which were higher than that of the model group((11.32±2.90) U/mgprot;t=3.099 6-6.504 6,P＜0.05 or ＜0.01).There were similar results for GSH-Px (t =2.214 1-4.145 7,P＜0.05 or ＜0.01).MDA and MAO levels in brain tissue of 99Tc-MDP groups were lower than those of the model group (t =2.140 3-3.057 8,all P＜0.05).Compared to normal control group,the hippocampus in model group showed reduced cell number and layers,disordered structure,with part of the cells in smaller volume and abnormal nuclear shape.In Vit E group and the three 99Tc-MDP groups,no significant change of neuron was observed compared with normal control group,the degeneration and necrosis of hippocampal cells were mild compared with model group,the cell number and morphology were normal,and the structures were clear.Conclusion 99Tc-MDP may increase the activities of SOD,GSH-Px and reduce the levels of MDA and MAO in brain tissue of aged mice,thus it may be helpful in delaying the brain aging.

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Radionuclide molecular probe for the diagnosis and target therapy of malignant melanoma

Hongyan FENG ; Xiaoli LAN ; Yongxue ZHANG

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):470-473. doi:10.3760/cma.j.issn.2095-2848.2016.05.022

Early diagnosis and accurate staging are important for planning therapeutic intervention to improve outcomes in patients with malignant melanoma (MM).Noninvasive molecular imaging has been extensively studied in cancer diagnosis,staging,therapeutic evaluation,and prognosis.Several radiopharmaceuticals have been developed to diagnose and treat MM,such as monoclonal antibodies,melanocortin receptors,benzamide (BZA) and BZA analogs.In this review,the characteristics and limitations of these radionuclide molecular probes are summarized and discussed.

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Application of ultrasensitive thyroglobulin assays in the follow-up of differentiated thyroid carcinoma

Weijun WEI ; Chentian SHEN ; Hongjun SONG ; Zhongling QIU ; Quanyong LUO

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):474-478. doi:10.3760/cma.j.issn.2095-2848.2016.05.023

DTC is the most common endocrine carcinoma and its routine treatment consists of total thyroidectomy and 131I thyroid remnant ablation.Currently,standard follow-up for DTC comprises Tg measurement and neck ultrasound as well as an additional radioiodine scan when indicated.As thyroid cells are assumed to be the only source of Tg in serum,circulating Tg serves as an excellent marker of persistent or recurrent disease in DTC follow-up.With the development of highly sensitive Tg assays,now it is possible to detect very low Tg concentrations which reflect minimal amounts of thyroid tissue without the need for TSH stimulation.This review is to introduce clinical implications of highly sensitive Tg assays.

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Analysis of relevant factors influencing 18F-FDG uptake in primary lesion of breast invasive ductal carcinoma

Qiaoling XU ; Xuyang YOU ; Chunjing YU ; Najing WU ; Weixing WAN

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):413-419. doi:10.3760/cma.j.issn.2095-2848.2016.05.008

Objective To analyze the relevant factors influencing 18F-FDG uptake in the primary lesion of breast invasive ductal carcinoma (BIDC).Methods A total of 160 female patients underwent 18 F-FDG PET/CT examination from 2010 to 2015 and breast lesions were revealed.Lesions were divided into benign group (n =118) and malignant group (n =49,BIDC) according to pathological results.KruskalWallis H test and Mann-Whitney u test were performed to compare SUVmax of the two groups,and to investigate the relationship between the SUVmax of breast malignant lesion and patients' age as well as clinical pathological parameters including T stage,lymphatic vessel invasion,nuclear grade,route of metastasis,ER,PR,HER2 and Ki-67 expression,and subtype of breast cancer.The diagnostic efficiency of 18F-FDG PET/ CT in differentiating benign and malignant breast lesions was analyzed using ROC curve analysis.Results The SUVmax of BIDC was 6.09(3.88,9.26),higher than that of breast benign lesion (1.35 (0.95,2.35);u=341.0,P＜0.05).The SUVmax of BIDC showed statistically significant difference between groups with different T stage,with or without lymphatic vessel invasion,with different nuclear grade,different routes of metastasis and different Ki-67 expression (u:117.5-209.5,H=7.70,P＜0.01 or 0.05).For all breast lesions,lesions with the maximum diameter ≤ 2.0 cm and lesions with the maximum diameter ＞2.0 cm,the optimum cutoff values of SUVmax were ＞2.60,＞ 1.71 and ＞3.97,respectively.When the optimum cutoff values of SUVmax for breast lesions with the maximum diameter ≤2.0 cm were selected as ＞ 1.71 and ＞2.60,the Youden indexes were 0.66 and 0.61(z=0.566,P＞0.05).When the optimum cutoff values of SUVmax for breast lesions with the maximum diamter ＞2.0 cm were selected as ＞3.97 and ＞2.60,the Youden indexes were 0.89 and 0.81(z=0.748,P＞0.05).Conclusions T stage,lymphatic vessel invasion,nuclear grade,route of metastasis and Ki-67 expression of BIDC influence the uptake of 18F-FDG by tumor tissues.The SUVmax of the primary lesion of BIDC is related to the size of lesion,and thus the diagnostic threshold of SUVmax should be decreased appropriately for small lesions.

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Prognostic value of △SUV and Deauville 5-point scoring in patients with diffuse large B-cell lymphoma

Yan GAO ; Jinhua ZHAO ; Jianhua SONG ; Xiang CHEN ; Changcun LIU ; Yiwen SUN

Chinese Journal of Nuclear Medicine and Molecular Imaging.2016;36(5):420-425. doi:10.3760/cma.j.issn.2095-2848.2016.05.009

Objective To investigate the prognostic value of △SUV and Deauville 5-point scoring (5-PS) in patients with DLBCL.Methods Thirty-nine patients (20 males,19 females;median 58 (23-85) years) with pathologically confirmed DLBCL were retrospectively analyzed from January 2009 to April 2015.PET/CT imaging was performed before and after 4 courses of chemotherapy.The optimum cutoff values of △SUVmax and its decline proportion (△SUVmax％) were calculated by ROC curve,and then the Kaplan-Meier analysis and Cox regression analysis were performed in patients with different △SUVmax and △SUVmax％.Patients were also evaluated by the observers using Deauville 5-PS,Kaplan-Meier analysis and Cox regression analysis were performed in patients with scores ≥ 4 and those with scores ＜ 4.x2 test and Spearman correlation analysis were used.Results (1) There were 10 patients (25.64％,10/39) with progressed disease within the 2 year-follow-up.The △SUVmax,△SUVmax％ of progressed group were markedly lower than those of non-progressed group:9.55± 11.90 vs 15.61±7.86,71.66％ (33.90％-78.91％) vs 87.83％(76.51％-92.43％);t=-2.37,z=-3.25,both P＜0.05.(2)The optimum cutoff values of the △SUVmax,△SUVmax％ were 11.2 and 72.88％ respectively.(3) The patients with △SUVmax ＜ 11.2,△SUVmax％＜72.88％ or Deauville 5-PS≥4 showed shorter PFS and △SUVmax％ was proved to be an independent prognostic factor(x2 =5.734,14.821,5.851,all P＜0.05).(4) △SUVmax％ and Deauville 5-PS were correlated (rs =-0.633,P＜0.001).Conclusions △SUV and Deauville 5-PS could be used for prognosis prediction in DLBCL patients and △SUVmax％ might be an independent predictive factor.The values of △SUVmax ％ and Deauville present a negative relationship.

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