Objective:To investigate the value of traditional metabolic parameters, CT features and intratumoral heterogeneity parameters measured by 18F-FDG PET/CT in predicting the mutation status of the epidermal growth factor receptor (EGFR) gene in patients with adenocarcinoma. Methods:A total of 147 patients (73 males, 74 females, age (59.8±10.2) years) with pathological confirmed adenocarcinoma between January 2016 and June 2020 in the Affiliated Hospital of Jining Medical University were retrospectively included. The differences of clinical data (smoking history, tumor location and clinical stage), CT features (maximum diameter, ground-glass opacity content, lobulation, speculation, cavitation, air-bronchogram, pleural retraction and bronchial cut-off sign), 18F-FDG PET/CT traditional metabolic parameters (SUV max, SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) and intratumoral heterogeneity parameters ( CV, heterogeneity index (HI)) were analyzed between patients with EGFR mutation and patients with EGFR wild-type. Independent-sample t test, Mann-Whitney U test and χ2 test were used to analyze the data. Multivariate logistic regression was used to analyze the predictors of EGFR mutation. ROC curve analysis was used to evaluate the predictive value of clinical and PET/CT information. Results:Among 147 patients, 87 were with EGFR mutation and 60 were with EGFR wild-type. There were significant differences in gender (male/female), smoking history (with/without), location (peripheral lesion/central lesion), pleural retraction (with/without), SUV max, SUV mean, TLG, CV and HI ( χ2 values: 4.72-23.89, z values: from -2.31 to 5.74, all P<0.05). Multivariate logistic regression analysis showed that smoking history (odds ratio ( OR)=0.167, 95% CI: 0.076-0.366; P<0.001), pleural retraction ( OR=1.404, 95% CI: 1.115-3.745; P=0.012), SUV max ( OR=0.922, 95% CI: 0.855-0.995; P=0.003), TLG ( OR=0.991, 95% CI: 0.986-0.996; P=0.001) and HI ( OR=0.796, 95% CI: 0.700-0.859; P<0.001) were predictors of EGFR mutation. ROC curve analysis showed the AUC of HI was 0.779, with the sensitivity of 76.67%(46/60) and the specificity of 79.31%(69/87). The predictive model was constructed by combining smoking history, pleural retraction, TLG, SUV max and HI, and the AUC was 0.908, with the sensitivity of 88.33%(53/60) and the specificity of 68.97%(60/87). The difference of AUCs between HI and the predictive model was statistically significant ( z=3.71, P<0.001). Conclusion:HI can predict EGFR mutations better, and the predictive value for EGFR mutations can be enhanced when combining HI with smoking history, pleural retraction, TLG and SUV max.

Objective:To investigate the clinical value of left ventricular shape index (SI) and eccentricity index (EI) in evaluating left ventricular remodeling.Methods:A retrospective analysis was performed on 324 patients (264 males, 60 females, age (62.5±11.8) years) diagnosed with myocardial infarction (MI) and 113 healthy controls (HC; 47 males, 66 females, age (57.8±10.7) years) who received gated myocardial perfusion imaging (GMPI) in First Hospital of Shanxi Medical University from January 2016 to September 2020. SI (end-diastolic SI (EDSI), end-systolic SI (ESSI)), EI and left ventricular function parameters (end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), summed motion score (SMS), summed thickening score (STS), peak ejection rate (PER) and peak filling rate (PFR)) were obtained by quantitative gated SPECT (QGS) software. Propensity score (PS) inverse probability of treatment weighting (IPTW) was used to balance the intergroup covariates. The differences and correlations of EDSI, ESSI, EI and left ventricular function parameters between patients in MI group and HC group were analyzed. ROC curve analysis was used to evaluate the values of EDV, EDSI, ESSI and EI alone and in combination in the assessment of left ventricular systolic function impairment. Data were analyzed by independent-sample t test, Pearson correlation and Spearman rank correlation analyses, and Delong test. Results:After IPTW, EDSI and ESSI in MI group ( n=319) were higher than those in HC group ( n=133; EDSI: 0.66±0.09 vs 0.60±0.06; ESSI: 0.59±0.11 vs 0.47±0.07; t values: 8.05, 14.67, both P<0.001), and EI was lower than that in HC group (0.81±0.06 vs 0.85±0.03; t=-8.93, P<0.001). In both groups, there were significant correlations between EDSI and ESSI ( r values: 0.928, 0.873), between EDSI, ESSI and EI ( r values: from -0.831 to -0.641), between EDSI, ESSI and LVEF ( r values: from -0.627 to -0.201), between ESSI and EDV, ESV and SMS ( rs values: 0.336-0.584), between ESSI and -PER, PFR ( rs values: from -0.406 to -0.402, r values: from -0.352 to -0.325) (all P<0.01). ROC curve analysis showed that EDV (AUC: 0.895) and ESSI (AUC: 0.839) had the highest efficacy in evaluating left ventricular systolic function impairment in MI group and HC group, respectively. EDV-EDSI-ESSI-(1-EI) had higher efficacy in the assessment of impaired left ventricular systolic function in MI group (AUC: 0.956), which was higher than that of EDV or EDV-EDSI or EDV-ESSI or EDV-(1-EI) ( z values: from -2.64 to -2.18, P values: 0.008-0.029); EDV-EDSI-ESSI-(1-EI) also had high efficacy in HC group (AUC: 0.911), which was higher than that of EDV or EDV-EDSI or EDV-(1-EI) ( z values: from -2.60 to -2.43, P values: 0.009-0.015). Conclusions:In MI patients, the increase of SI and the decrease of EI indicate the increase of left ventricular sphericity and the aggravation of left ventricular remodeling. SI and EI have certain clinical application values in evaluating left ventricular morphology, predicting left ventricular remodeling and left ventricular systolic function impairment.

Objective:To investigate whether the image quality of total-body PET/CT (TB PET/CT) with 1 min acquisition can meet the clinical diagnostic requirements.Methods:From May 2019 to September 2021, a total of 90 malignant tumor patients (60 males, 30 females, age 31-86 years) with primary lesions confirmed by pathological diagnosis in Zhongshan Hospital, Fudan University were respectively analyzed. All patients underwent conventional PET/CT (C PET/CT) scan with conventional clinical acquisition and TB PET/CT scan with 1 min acquisition after injecting 18F-FDG in random order. Paired t test or Wilcoxon signed rank test was used to analyze the image quality of these two scans. Results:SUV max of primary lesions in TB PET/CT group was significantly higher than that in C PET/CT group (15.9(7.9, 24.6) vs 12.5(5.8, 16.6); z=8.14, P<0.001), so were signal-to-noise ratio (SNR) of the blood pool, liver, muscles (9.3±3.0, 11.4(9.5, 14.2), 8.3(7.3, 10.1) vs 6.2±1.7, 9.4(7.7, 11.8), 6.0(4.9, 7.1)), tumor-to-blood pool ratio (TBR) (9.3(4.3, 14.8) vs 8.5(4.3, 11.1)), tumor-to-liver ratio (TLR) (6.7(3.0, 10.4) vs 6.1(2.9, 7.7)), tumor-to-muscle ratio (TMR) (23.2(11.5, 38.0) vs 18.3(9.6, 26.6); t=9.36, z values: 4.44-7.40, all P<0.001). Conclusion:The image quality of TB PET/CT scan with 1 min acquisition can meet the diagnostic requirements, and is better than the C PET/CT image quality with conventional clinical acquisition.

Objective:To explore the clinical efficacy of 125I seeds implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary liver cancer. Methods:A retrospective analysis of data from 40 patients with primary liver cancer at the Northern Theater General Hospital from January 2018 to December 2020 (26 males, 14 females, age 41 to 82 years) was performed. Among them, 21 patients were in treatment group and underwent 125I seeds implantation combined with TACE treatment, while 19 patients were in control group and received TACE treatment. Alpha-fetoprotein (AFP) levels between the two groups were compared, effective rate and disease control rate (DCR) of the two groups were analyzed, and overall survival (OS) and progression-free survival (PFS) were observed. Data were analyzed by using Mann-Whitney U test, χ2 test, Kaplan-Meier method and log-rank test. Results:Two months after 125I seeds implantation, the effective rates of treatment group and control group were 76.19%(16/21) and 8/19, respectively ( χ2=4.83, P=0.028); the DCRs were 90.48%(19/21) and 11/19, respectively ( χ2=4.21, P=0.040). AFP levels in both groups decreased significantly, with treatment group showing a greater decrease rate (0.87(0.84, 0.90) and 0.66(0.65, 0.67); z=5.42, P<0.001). No serious adverse reaction was observed in either group. The median OS of treatment group and control group were 18.2 and 10.6 months, respectively ( χ2=10.98, P=0.037); the median PFS of the two groups were 8.4 and 6.1 months, respectively ( χ2=7.54, P=0.041). Conclusion:125I seeds implantation combined with TACE treatment can exert a synergistic and enhancing effect in the treatment of primary liver cancer.

Objective:To investigate the application value of 99Tc m-dimercaptosuccinic acid (DMSA) renal static imaging to correct renal ROI and renal depth in measurement of glomerular filtration rate (GFR) of the injured-kidney in infants with congenital hydronephrosis. Methods:From January 2022 to November 2022, 30 infants with congenital hydronephrosis (25 males, 5 females, age 3.0(1.0, 5.5) months) in Nuclear Medicine Department of the Second Hospital of Shanxi Medical University were prospectively included. Sixty kidneys were divided into 3 groups according to the degree of hydronephrosis: normal group (7 left kidneys and 12 right kidneys), mild hydronephrosis group (10 left kidneys and 12 right kidneys) and moderate to severe hydronephrosis group (13 left kidneys and 6 right kidneys). The patients received 99Tc m-diethylenetriamine penta-acetic acid (DTPA) diuretic renal dynamic imaging and 99Tc m-DMSA renal static imaging within 3 days, and bilateral renal lateral acquisition was performed at the end of the imaging. The depths (cm) of kidneys measured based on the lateral image and Tonnesen′s formula were compared. The single kidney GFR (ml·min -1·1.73 m -2) measured after the renal ROI corrected, or renal depth corrected, or renal ROI-depth corrected by renal static imaging (aGFR single, dGFR single, adGFR single) was compared with that measured by Gates method (gGFR single). The one-way analysis of variance, the least significant difference- t test and Dunnett- t test were used for data analysis. Results:In different hydronephrosis groups, renal depths measured by dynamic imaging, static imaging and Tonnesen formulas were significantly different ( F values: 38.07-59.63, t values: 2.53-15.17, all P<0.05). There were no significant differences in renal depth between the two kinds of imaging in the normal group ( F values: 34.89, 54.30, both P<0.05; t values: 0.65, 1.60, both P>0.05). aGFR single of all groups were smaller than gGFR single, but the values were similar, and were not significantly different in normal kidneys ( F values: 3.02, 5.51, both P<0.05; t values: 0.12, 0.53, both P>0.05), while those in abnormal kidneys (left kidneys: 43.27±8.84 vs 46.19±7.88, F=9.75, t=2.18, both P<0.05; right kidneys: 39.87±10.25 vs 42.94±10.28, F=10.32, t=2.04, both P<0.05) and in mild (48.58±10.94 vs 51.08±11.44, F=10.34, t=2.04, both P<0.05), moderate to severe (34.41±8.84 vs 37.62±8.84, F=19.97, t=3.41, both P<0.05) hydronephrosis groups were different. The dGFR single was significantly higher than gGFR single in 3 (normal, mild, moderate to severe) hydronephrosis groups ( t values: 3.82, 3.39, 3.81, all P<0.01). adGFR single was between aGFR single and dGFR single, and adGFR single were significantly different from gGFR single in normal right kidneys, in abnormal kidneys and in mild and moderate to severe hydronephrosis groups ( t values: 2.25-3.12, all P<0.05). Conclusions:Renal static imaging corrected ROI can improve the accuracy of GFR measurement of the affected kidney, especially for children with moderate and severe congenital hydronephrosis. However, the GFR corrected for renal depth or ROI-depth are significantly different from the true GFR. The lateral kidney depth measured by static imaging is more accurate than that measured by dynamic imaging.

Objective:To explore whether multi-parametric MRI (mpMRI) combined with 68Ga-prostate specific membrane antigen (PSMA) PET/CT can improve the detection efficiency of clinically significant prostate cancer (csPCa). Methods:Clinical and imaging data of 152 patients (age (68.5±8.5) years) who underwent mpMRI and 68Ga-PSMA PET/CT examination for suspected prostate cancer in the First Affiliated Hospital of the Air Force Medical University from January 2021 to November 2022 were retrospectively analyzed, with the histopathological results from transrectal ultrasound guided biopsy as reference. Lesions with Gleason scores (GS) ≥3+ 4 from the biopsy were diagnosed with csPCa, and lesions with negative biopsy or GS 6 were diagnosed with non-csPCa. MpMRI was evaluated independently by two radiologists according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. The radioactive uptake of 68Ga-PSMA PET/CT in prostate lesions was evaluated by SUV max. The independent-sample t test, Mann-Whitney U test and χ2 test were used to compare differences between the two groups, and then multivariate logistic regression analysis was performed. ROC curves analysis was used to analyze the diagnostic efficacies of individual and combined factors and Delong test was used. Results:There were 85 csPCa and 67 non-csPCa confirmed. Prostate specific antigen (PSA), PI-RADS score and SUV max were significantly different between the csPCa group and the non-csPCa group ( χ2=68.06, U values: -7.66, -8.98, all P<0.001). Multivariate logistic regression analysis indicated that PI-RADS score (odds ratio ( OR)=3.424, 95% CI: 1.651-7.100) and SUV max ( OR=1.931, 95% CI: 1.403-2.658) were independent predictors of csPCa (both P<0.001). ROC curves analysis revealed that the cut-off value for diagnosing csPCa was 4 for PI-RADS score and 5.6 for SUV max. The accuracy of mpMRI and PET/CT alone in csPCa diagnosis was 80%(122/152) (AUC of 0.789(95% CI: 0.711-0.866) with the sensitivity and specificity of 91%(77/85) and 67%(45/67)), and 87%(132/152) (AUC of 0.876(95% CI: 0.817-0.936) with the sensitivity and specificity of 81%(69/85) and 94%(63/67)), respectively. Several joint models incorporating 68Ga-PSMA PET/CT with mpMRI data were investigated, the model of PI-RADS 5 or PI-RADS 3-4 and SUV max>5.6 showed better performance than mpMRI and PET/CT alone and other joint models ( z values: 2.01-3.64, all P<0.05), with the accuracy of 91%(138/152) (AUC of 0.910(95% CI: 0.857-0.962) with the sensitivity and specificity of 89%(76/85) and 93%(62/67)). Conclusion:MpMRI combined with 68Ga-PSMA PET/CT can significantly improve the detection efficiency of csPCa, with the principal effect being improved in risk stratification of PI-RADS 3-4 lesions in mpMRI.

Objective:To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′ disease (GD) after 131I therapy. Methods:Data of patients with GD (59 males, 214 females; age (37.4±11.4) years) who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed. Symptoms, signs and laboratory tests (serum free triiodothyronine (FT 3) and serum free thyroxine (FT 4)) of patients were observed to assess the efficacy of 131I treatment. Efficacy was divided into complete remission (CR), partial remission (PR), non-remission (NR) or relapse. The changes of thyroid function (ΔFT 3=FT 3 before treatment-FT 3 after treatment)/FT 3 before treatment×100%; ΔFT 4=FT 4 before treatment-FT 4 after treatment)/FT 4 before treatment×100%) 1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test, χ2 test, one-way analysis of variance and the least significant difference t test. ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD. Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy. Results:CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273) and 92.67%(253/273), respectively. After 1 month, CR rate of euthyroidism group ( n=95) was significantly higher than that of hyperthyroidism group ( n=178; 81.05%(77/95) vs 59.55%(106/178); χ2=4.60, P=0.032). ΔFT 3 and ΔFT 4 at the first month were statistically significant and decreased sequentially in the CR group ( n=183), PR group ( n=70), NR or relapse groups ( n=20; F values: 15.40, 12.54, both P<0.001). ROC curve analysis showed that patients with ΔFT 3≥73.64% and (or) ΔFT 4≥59.03% had a higher probability of achieving CR, with sensitivities of 84.3% and 86.7%, and specificities of 62.6% and 62.6%, respectively. Logistic regression analysis showed that 24 h radioactive iodine uptake (odds ratio ( OR)=1.095, 95% CI: 1.031-1.139), dose of 131I given per gram of thyroid tissue ( OR=1.562, 95% CI: 1.321-1.694), ΔFT 3 ( OR=1.354, 95% CI: 1.295-1.482), ΔFT 4 ( OR=1.498, 95% CI: 1.384-1.608) were factors affecting the outcome of patients with GD treated with 131I treatment (all P<0.05). Conclusion:Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.

Theranostics in nuclear medicine is an important direction for the precision medicine. Radionuclide therapy based on small molecules/peptides often requires high doses. Improving the utilization efficiency of radionuclides, optimizing the pharmacokinetics of radionuclide therapeutic molecular probes as well as increasing the target to non-target ratio have become the international hot frontiers in the field of radiotheranostics. Evans blue (EB) motif uses endogenous albumin as a reversible carrier, and the small molecule and polypeptide structure modified based on EB can effectively extend the half-life in the blood and substantially increase the uptake, accumulation and retention of radiopharmaceuticals in target lesions, and thereby enhance the therapeutic effect and reduce the dosage of nuclides. This article focuses on the research of EB modified radiopharmaceuticals for theranostics.

Fibroblast activation protein inhibitor (FAPI) has been the focus of nuclear medicine since its introduction. With the in-depth study of FAPI tracer, its clinical application in various non-malignant diseases has also been gradually reported. Many studies have confirmed its uptake in a variety of non-malignant diseases, which indicate that FAPI tracers have good application prospects. This article reviews the latest research status and clinical application of radiolabeled FAPIs in cardiovascular diseases, rheumatic immune diseases, immunoglobulin (Ig)G4-related diseases, renal fibrosis and other non-malignant diseases at home and abroad.

Neuroblastoma is the most common extracranial solid tumor in children. The prognosis of different stages varies greatly, and its risk staging system is completely based on imaging. Radionuclide imaging plays an important role in the diagnosis and staging of various tumors, and it is also of great significance in the early diagnosis and staging of neuroblastoma. At present, imaging agents used for neuroblastoma mainly include catecholamine receptor, glucose metabolism, somatostatin receptor, etc. This article mainly discusses the application value and research progress of these imaging agents in the diagnosis of neuroblastoma.