Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:To analyze the clinical value of 18F-FDG PET/MR for precise localization of epileptogenic foci in patients with refractory epilepsy. Methods:From February 2019 to December 2021, 81 patients (52 males, 29 females; age (30.0±10.9) years) with refractory epilepsy confirmed in Ruijin Hospital Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. All patients underwent preoperative PET/MR exam, and the possible position of the epileptogenic foci were determined by PET/MR imaging and pre-surgical evaluation, then the stereoelectroencephalography (SEEG) electrodes were implanted. Surgery was performed, and outcome was assessed by using a modified Engel classification two years after surgery. χ2 test was used to compare the detection rates of MRI and PET/MR fusion imaging in localizing epileptogenic foci and the detection rates of epileptogenic foci in temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) by PET/MR. Results:MRI correctly localized seizure foci in 38 patients, with the detection rate of 46.91%(38/81), while PET/MR detected seizure foci in 73 patients, with the detection rate of 90.12%(73/81; χ2=35.05, P<0.001). There were 63 TLE and 18 ETLE patients. The detection rate of PET/MR in localizing seizure foci in TLE patients was 95.24%(60/63), which was significantly higher than that in ETLE patients (13/18; χ2=5.94, P=0.015). After 2 years follow-up, the postoperative efficacy rate of TLE patients with Engel grades Ⅰ-Ⅱ was 76.19%(48/63), which was 13/18 of ETLE patients ( χ2=0.12, P=0.731). Conclusion:Hybrid PET/MR imaging can accurately locate epileptogenic foci, especially for MRI negative lesions, which provides precision imaging information for surgical planning and improves surgical success rate.

Objective:To explore the added value of T 1-weighted stack-of-stars volumetric interpolated body examination (StarVIBE) sequence on PET/MR image quality. Methods:A retrospective analysis was performed on 60 patients (42 males, 18 females; age 11-86 (58±12) years) who underwent 18F-FDG PET/MR examination and with positive PET results in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from April 2020 to April 2021. All patients completed StarVIBE sequence collection, and volumetric interpolated body examination (VIBE) sequence was used as control. StarVIBE and VIBE sequence images were evaluated independently using five-point method by two physicians. The evaluation was carried out from six aspects: lesion display, lesion boundary display, vascular around lesions display, fusion level with PET image, image artifact and overall image quality. Wilcoxon signed rank test was used to compare the image quality of the two sequences, and Kappa test was performed to assess the consistency of the image quality scores between the two physicians. Results:There were 26 cases with cervical lesions, 14 cases with chest lesions, 7 cases with abdomen lesions and 13 cases with pelvic lesions. The scores of lesion display (4.0(3.8, 4.5) vs 3.5(3.0, 4.0)), lesion boundary display (4.0(4.0, 4.0) vs 3.0(3.0, 3.5)), vascular around lesions display (5.0(4.0, 5.0) vs 4.0(3.5, 4.5)), fusion level with PET image (5.0(5.0, 5.0) vs 4.5(4.0, 5.0)), image artifact (4.5(4.0, 5.0) vs 4.5(4.0, 5.0)) and overall image quality (5.0(4.0, 5.0) vs 4.0(4.0, 4.0)) of StarVIBE sequences were better than those of VIBE sequences ( z values: 3.77-6.54, all P<0.001). On the vascular around the lesions display, the scores of StarVIBE were significantly better than those of VIBE sequence in the neck (5.0(4.5, 5.0) vs 3.0(2.7, 3.5); z=4.49, P<0.001) and chest (4.5(4.3, 4.7) vs 4.0(3.6, 4.3); z=3.10, P=0.002). As for image quality, the scores of StarVIBE were also significantly better than those of VIBE in neck (5.0(4.5, 5.0) vs 4.0(3.7, 4.5); z=4.36, P<0.001) and chest (5.0(5.0, 5.0) vs 4.0(4.0, 4.5); z=3.02, P=0.003). In abdominal lesions, the score of StarVIBE was higher than that of VIBE in blood vessels (4.5(3.5, 5.0) vs 4.0(3.5, 4.5); z=2.07, P=0.038), and there was no difference between score of overall image quality (4.0(3.7, 4.5) vs 4.0(3.5, 4.5); z=0.27, P=0.785). The score of overall image quality of pelvic StarVIBE sequence was better than that of VIBE sequence (5.0(4.5, 5.0) vs 4.0(4.0, 4.5); z=2.12, P=0.034). Kappa value of image quality score between two physicians was 0.554, indicating moderate consistency. Conclusion:In whole-body PET/MR imaging, StarVIBE sequence can significantly improve the image quality of cervical, thoracic and pelvic lesions when comparing with VIBE sequence.

Objective:To investigate the correlation between preterm infants with brain injury and the proportion of lymphocyte subsets, especially γδ-T cells in the postnatal peripheral blood, and to determine the predictive potential of γδ-T cells in the early peripheral blood in brain injury.Methods:It was a prospective study involving 106 preterm infants with gestational age less than 34 weeks who were delivered in the Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University from January 1, to June 1, 2021.Relative levels of γδ-T , CD4 + T, CD8 + T, CD3 + T and total lymphocyte subsets in peripheral blood collected within the first 24 hours after birth were measured by flow cytometry.Recruited infants were divided into brain injury group (36 cases) and non-brain injury group (70 cases) according to serial cranial ultrasound and magnetic resonance imaging(MRI) at the corrected gestational age of 36-37 weeks.Differences in general conditions and the proportion of lymphocyte subsets between groups were compared by the t-test or Chi- square test.Patients in brain injury group were further divided into intracranial hemorrhage(ICH) group(8 cases), periventricular leukomalacia (PVL) group (6 cases)and diffuse white matter damage (WMD) group(22 cases). The proportion of lymphocyte subsets among the different groups was compared by One- Way ANOVA, followed by the LSD- t test. Results:The proportion of γδ-T cells in postnatal peripheral blood of preterm infants at 24 hours after birth in brain injury group was significantly lower than that of non-brain injury group [(0.09±0.12)% vs.0.15±0.13)%, t=-2.445, P=0.016]. No significant differences in the proportion of the CD4 + and CD8 + T cell subsets were found between them.Both preterm infants in PVL group and WMD group had a significantly lower proportion of γδ-T cells at 24 hours after birth compared to that of the non-brain injury group [(0.03±0.05)%, (0.07±0.09)% and (0.15±0.13)%], respectively, ( t=-2.190, -2.659, all P<0.05). Conclusions:γδ-T cells in early postnatal peripheral blood may be involved in the development of brain injury in preterm infants and they had early predictive value for preterm infants at high risk of brain injury, especially the leukomalacia and diffuse white matter injury.

Background::Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen.Methods::This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People’s Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed.Results::Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q 1-Q 3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only. Conclusions::Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.

Objective:To explore the diagnostic and grading value of combination of 68Ga -1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid- D-Phe1-Tyr3-Thr8-octreotide ( 68Ga-DOTA-TATE) and 18F-flurodeoxyglucose ( 18F-FDG) dual probes in multi-parameter positron emission tomography (PET)/magnetic resonance (MR) imaging in pancreatic neuroendocrine neoplasm (PNEN). Methods:From April 9th, 2020 to February 24th, 2022, in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the clinical data and the imaging of 68Ga-DOTA-TATE PET/MR and 18F-FDG PET/MR of 59 patients with pancreatic tumors (27 male, 32 female, aged 22 to 75 years old(51.8±13.3) years old), confirmed by surgical or biopsy pathology were retrospectively analyzed. All the cases were divided into PNEN group (42 cases) and non-PNEN group (17 cases) according to pathological results. Among which 39 patients with PNET were further divided into grade 1 group (G1 group, 27 cases) and grade 2 group (G2 group, 12 cases). Non-zero parameters were selected via the least absolute shrinkage and selection operator (LASSO) regression approach, and a logistic regression model was established by combination of the selected features and the corresponding non-zero coefficients. The measurement data with non-normal distribution were compared by Mann-Whitney U test. The receiver operating characteristic (ROC) curve were used to detemine the optimal cut off value to assess the dignostic efficiency. Results:Compared with those of non-PNEN group, the parameters of PNEN group increased, which included maximum standard uptake value of 68Ga-DOTA-TATE(SUV Gmax, 46.70 (22.37, 76.35) vs. 7.12 (4.75, 8.64)), mean standard uptake value of 68Ga-DOTA-TATE(SUV Gmean, 25.50 (13.18, 43.90) vs. 3.65 (2.89, 4.69)), peak standard uptake value of 68Ga-DOTA-TATE (SUV Gpeak, 27.17 (12.39, 46.97) vs. 5.46 (4.12, 6.56)), total lesion somatostatin receptor (SSR) expression (TLSRE, 68.21 (32.52, 440.96) vs. 26.02 (14.87, 69.57)), SUV Gmax/maximum standard uptake value of 18F-FDG (SUV Fmax, 12.71 (3.80, 21.70) vs. 1.10 (0.52, 2.35)), tumor to background ratio of 68Ga-DOTA-TATE (TBR G, 13.31 (5.54, 22.38) vs. 1.57 (1.31, 2.66)), tumor to liver ratio of 68Ga-DOTA-TATE(T/L G, 6.54 (2.90, 9.63) vs. 0.74 (0.65, 0.94)), tumor to spleen ratio of 68Ga-DOTA-TATE (T/S G, 2.36 (0.97, 3.70) vs. 0.25 (0.23, 0.38)), tumor to mediastinum ratio of 68Ga-DOTA-TATE (T/M G, 104.41 (34.03, 206.52) vs. 16.00 (12.87, 21.46)), SUV Gmax/minimum apparent diffusion coeffecient (ADC min, 55.14 (22.50, 96.37) vs. 6.76 (4.39, 12.76)) and SUV Gmean/ADC min (34.57 (13.47, 55.13) vs. 3.57 (2.46, 6.81)), and the differences were statistically significant ( U=28.00, 25.00, 32.00, 198.00, 54.00, 31.00, 28.00, 19.00, 10.00, 56.00 and 44.00, all P<0.01). The area under the curve (AUC) and diagnostic accuracy of dual-probe PET/MR imaging in the diagnosis of PNEN and non-PNEN were 0.941 and 96.6%, respectively. The AUC and diagnostic accuracy of model Y 1 in the diagnosis of PNEN and non-PNEN were 0.959 and 96.6%, respectively. There was no significant difference in AUC between model Y 1 and dual-probe PET/MR imaging in PNEN diagnosis ( P>0.05), however combining model Y 1 could improve the accuracy of PNEN diagnosis (100.0%). Compared with those of PNET G1 group, the parameters of G2 Group were higher, which included the maximum diameter of tumor (2.69 cm (2.08 cm, 5.00 cm) vs. 1.50 cm (1.20 cm, 2.50 cm)), metabolic tumor volume (MTV, 7.56 mL (4.45 mL, 53.57 mL) vs. 2.16 mL (1.22 mL, 5.48 mL)), total lesion glycolysis (TLG, 22.24 (11.95, 189.85) vs. 3.81 (2.11, 18.67)), tumor to background ratio of 18F-FDG (TBR F, 2.94 (2.00, 3.96) vs. 1.48 (1.29, 3.72)), tumor to liver ratio of 18F-FDG (T/L F, 2.32 (1.35, 2.98) vs. 1.08 (0.90, 2.17)) and SSR-expressing tumor volume (SRETV, 8.00 (3.06, 40.00) vs. 1.91 (0.95, 4.88)), and the differences were statistically significant ( U=66.00、66.00、77.00、93.00、90.00、65.50, all P<0.05). The maximum diameter of tumor was the best single parameter for the differential diagnosis of PNET G2 and G1, AUC was 0.796 and the cutoff value was 1.90 cm. The model Y 2, which combined the maximum diameter of tumor and TBR G had an AUC of 0.835 for the differential diagnosis of PNET G2 and G1. There was no significant difference in AUC between the maximum diameter of tumor and model Y 2 ( P>0.05). However the combination of the maximum diameter of tumor and model Y 2 could improve the accuracy of differential diagnosis of PNET G2 and G1 (94.87%). Conclusion:The combination of multi-parameter of 68Ga-DOTA-TATE and dual-probe 18F-FDG PET/MR imaging can improve the diagnostic and grading accuracy of PNEN, which may be helpful in the selection of clinical treatment for patients.

Objective:To explore the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/MR imaging for liver metastasis. Methods:A retrospective analysis of 75 cases (46 males, 29 females; age (58.9±14.3) years) with suspected liver metastases from January 2020 to October 2020 in Ruijin Hospital were performed. All patients underwent PET/MR and enhanced upper abdominal CT scans. Diagnostic efficacies of enhanced CT, PET, MR and PET/MR for liver metastases (based on lesions and patients respectively) were calculated and compared (McNemar test).Results:A total of 306 liver lesions were detected in 75 patients, of which 179 lesions in 45 patients were confirmed as liver metastases through follow-up or pathology. In lesion-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 74.9%(134/179), 60.3%(108/179), 98.9%(177/179) and 100%(179/179), with specificities of 96.9%(123/127), 100%(127/127), 92.9%(118/127) and 92.1%(117/127), respectively. The diagnostic efficacy of PET/MR was significantly higher than that of enhanced CT and PET ( χ2 values: 51.000 and 81.000, both P<0.001), but there was no statistical difference between PET/MR and MR ( χ2=2.000, P=0.368). In patient-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 82.2%(37/45), 84.4%(38/45), 95.6%(43/45) and 100%(45/45), with specificities of 86.7%(26/30), 100%(30/30), 70.0%(21/30) and 70.0%(21/30), respectively. The diagnostic efficacies of enhanced CT and PET were statistically different from PET/MR ( χ2 values: 13.000 and 16.000, both P<0.05), but there was no statistical difference between MR and PET/MR ( χ2=2.000, P=0.368). Conclusions:Compared with enhanced CT, PET and MR, 18F-FDG PET/MR has a higher detective rate for liver metastases. The overall diagnostic efficacy of 18F-FDG PET/MR is better than enhanced CT and PET alone, but similar to MR.

Purpose: We aimed to identify the anterolateral ligament (ALL) tears in anterior cruciate ligament (ACL)-deficient knees using standard 1.5-Tesla magnetic resonance imaging (MRI). Methods: We included all patients who underwent primary ACL reconstruction at our center between 2012 and 2015. Exclusion criteria included patients with multiple ligament injuries, lateral collateral ligament, posterolateral corner, and infections, and patients who underwent MRI more than 2 months after their injury. All patients (n = 148) had ACL tears that were subsequently arthroscopically reconstructed. The magnetic resonance (MR) images of the injured knees performed within 2 months of injury were reviewed by a musculoskeletal radiologist and an orthopedic surgeon. The patients were divided into two groups. The first group of patients had MRI performed within 1 month of injury. The second group of patients had MRI performed 1–2 months after the index injury. Both assessors were blinded and the MR mages were read separately to assess the presence of ALL, presence of a tear and the location of the tear. Based on their readings, interobserver agreement (kappa statistic (K)), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared. Results: The ALL was identified in 100% of the patients. However, there was a discrepancy of up to 15% in the identification of tear of the ALL. In the first group in which MRI scans were performed within 1 month of injury, the ALL tear was identified by the radiologist in 92% of patients and by the surgeon in 90% of patients (Κ = 0.86). In the second group in which MRI scans were performed within 1–2 months of the injury, the ALL tear was identified by the radiologist in 78% of patients and by the surgeon in 93% of patients (K = 0.62). Conclusion The ALL can be accurately identified on MRI, but the presence and location of ALL tear and its location cannot be reliably identified on MRI. The accuracy in identification and characterization of a tear was affected by the interval between the time of injury and the time when the MRI was performed.Level of evidence: Diagnostic, level IIIb, retrospective.

Purpose: We aimed to identify the anterolateral ligament (ALL) tears in anterior cruciate ligament (ACL)-deficient knees using standard 1.5-Tesla magnetic resonance imaging (MRI). Methods: We included all patients who underwent primary ACL reconstruction at our center between 2012 and 2015. Exclusion criteria included patients with multiple ligament injuries, lateral collateral ligament, posterolateral corner, and infections, and patients who underwent MRI more than 2 months after their injury. All patients (n = 148) had ACL tears that were subsequently arthroscopically reconstructed. The magnetic resonance (MR) images of the injured knees performed within 2 months of injury were reviewed by a musculoskeletal radiologist and an orthopedic surgeon. The patients were divided into two groups. The first group of patients had MRI performed within 1 month of injury. The second group of patients had MRI performed 1–2 months after the index injury. Both assessors were blinded and the MR mages were read separately to assess the presence of ALL, presence of a tear and the location of the tear. Based on their readings, interobserver agreement (kappa statistic (K)), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared. Results: The ALL was identified in 100% of the patients. However, there was a discrepancy of up to 15% in the identification of tear of the ALL. In the first group in which MRI scans were performed within 1 month of injury, the ALL tear was identified by the radiologist in 92% of patients and by the surgeon in 90% of patients (Κ = 0.86). In the second group in which MRI scans were performed within 1–2 months of the injury, the ALL tear was identified by the radiologist in 78% of patients and by the surgeon in 93% of patients (K = 0.62). Conclusion The ALL can be accurately identified on MRI, but the presence and location of ALL tear and its location cannot be reliably identified on MRI. The accuracy in identification and characterization of a tear was affected by the interval between the time of injury and the time when the MRI was performed.Level of evidence: Diagnostic, level IIIb, retrospective.