BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of patholo...BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of pathological grading before surgical intervention is crucial for optimizing treatment strategies and improving prognostic outcomes.AIM To investigate the distinguishing capability of fluorine-18-fluorodeoxyglucosepositron emission tomography/computed tomography(^(18)F-FDG PET/CT)-derived metabolic parameters between Edmondson grade Ⅱ and Ⅲ HCC and to assess their correlation with Ki67 expression levels.METHODS We retrospectively assessed the ^(18)F-FDG PET/CT imaging datasets from 32 patients with solitary HCC,all of whom had pathological confirmation of their diagnosis.Patients were categorized into Edmondson grade Ⅱ and Ⅲ groups according to pathological grading criteria.Comparative analyses were conducted on metabolic parameters,including maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),metabolic tumor volume(MTV),total lesion glycolysis(TLG),tumor-to-normal background ratio(TNR),and tumor-to-blood pool ratio(TBR),between the groups.Further,correlations between these parameters and Ki67 expression were investigated.RESULTS Significant differences were observed in SUV_(max),SUV_(mean),TLG,TNR,and TBR between Edmondson grade Ⅱ and Ⅲ HCC groups(P<0.05),whereas MTV was not significantly different(P=0.052).The maximum tumor diameter and Ki67 expression percentage significantly varied between the two groups(P<0.05).SUV_(max) yielded the largest area under the receiver operating characteristic curve,measuring 0.853(95%confidence interval:0.709-0.997,P=0.001).Using an optimal SUV_(max) cut-off of 10.95,the sensitivity and specificity for identifying Edmondson grade Ⅲ HCC were 66.7%and 100%,respectively.Notably,significant positive correlations were identified in terms of SUV_(max),SUV_(mean),TNR,TBR,and the percentage of Ki67 expression(P<0.01).Conversely,MTV,TLG,and maximum tumor diameter exhibited no significant association with Ki67 expression(P>0.05).CONCLUSION ^(18)F-FDG PET/CT-derived metabolic parameters,particularly SUV_(max),SUV_(mean),TNR,TBR,and TLG,are valuable in differentiating Edmondson grade Ⅱ and Ⅲ HCC,with SUV_(max) showing the optimal differential diagnostic efficacy.TLG is a three-dimensional volumetric parameter that holds some differential diagnostic potential,but it fails to display a distinct advantage.Moreover,increased ^(18)F-FDG uptake and Ki67 expression in tumor tissue correlate with poorer HCC prognoses,emphasizing their potential role in prognostic assessments.展开更多
We examined a total of 16 children with epileptic encephalopathy using fluorine-18-fluoro-2-deoxy-D-glucose （18F-FDG） positron emission computed tomography （PET）, magnetic resonance imaging （MRI） and electroence...We examined a total of 16 children with epileptic encephalopathy using fluorine-18-fluoro-2-deoxy-D-glucose （18F-FDG） positron emission computed tomography （PET）, magnetic resonance imaging （MRI） and electroencephalography. Children with infantile spasms showed significant mental retardation, severely abnormal electroencephalogram recordings, and bilateral diffuse cerebral cortex hypometabolism with I^F-FDG PET imaging. MRI in these cases showed brain atrophy, multi-micropolygyria, macrogyria, and porencephalia. In cases with Lennox-Gastaut syndrome, 18F-FDG PET showed bilateral diffuse glucose hypometabolism, while MRI showed cortical atrophy, heterotopic gray matter and tuberous sclerosis. MRI in cases with myoclonic encephalopathy demonstrated bilateral frontal and temporal cortical and white matter atrophy and 18F-FDG PET imaging showed bilateral frontal lobe atrophy with reduced bilateral frontal cortex, occipital cortex, temporal cortex and cerebellar glucose uptake. In children who could not be clearly classified, MRI demonstrated cerebral cortical atrophy and ~aF-FDG PET exhibited multifocal glucose hypometabolism. Overall, this study demonstrated that the degree of brain metabolic abnormality was consistent with clinical seizure severity. In addition, ~SF-FDG PET imaging after treatment was consistent with clinical outcomes. These findings indicate that ~SF-FDG PET can be used to assess the severity of brain injury and prognosis in children with epileptic encephalopathy.展开更多
Congenital hyperinsulinism(CHI) is a rare but complex heterogeneous disorder caused by unregulated secre-tion of insulin from the β-cells of the pancreas leading to severe hypoglycaemia and neuroglycopaenia. Swift di...Congenital hyperinsulinism(CHI) is a rare but complex heterogeneous disorder caused by unregulated secre-tion of insulin from the β-cells of the pancreas leading to severe hypoglycaemia and neuroglycopaenia. Swift diagnosis and institution of appropriate management is crucial to prevent or minimise adverse neurodevel-opmental outcome in children with CHI. Histologically there are two major subtypes of CHI, diffuse and focal disease and the management approach will significantly differ depending on the type of the lesion. Patients with medically unresponsive diffuse disease require a near total pancreatectomy, which then leads on to the de-velopment of iatrogenic diabetes mellitus and pancre-atic exocrine insufficiency. However patients with focaldisease only require a limited pancreatectomy to re-move only the focal lesion thus providing complete cure to the patient. Hence the preoperative differentiation of the histological subtypes of CHI becomes paramount in the management of CHI. Fluorine-18L-3, 4-hydroxy-phenylalanine positron emission tomography(18F-DOPA-PET) is now the gold standard for pre-operative differentiation of focal from diffuse disease and locali-sation of the focal lesion. The aim of this review article is to give a clinical overview of CHI, then review the role of dopamine in β-cell physiology and finally discuss the role of 18F-DOPA-PET imaging in the management of CHI.展开更多
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT),a functional imaging method,is usually performed on the entire torso,and regions of unexpected suspicious foc...BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT),a functional imaging method,is usually performed on the entire torso,and regions of unexpected suspicious focal hypermetabolism are not infrequently observed.Among the regions,colon,thyroid,and prostate were found to be the common organs in a recent umbrella review.Some studies reported that a high rate of malignancy was shown in incidentally identified focal hypermetabolic regions and suggested that further examinations should not be ignored.AIM To investigate the malignancy rate of incidental focal FDG uptake,useful PET parameters and their cutoffs in discrimination between malignant and benign lesions.METHODS Retrospectively,the final reports of 16510 F-18 FDG PET/CT scans performed at our hospital between January 2016 and March 2022 were reviewed to identify incidentally observed FDG uptake in the colon/rectum,thyroid,and prostate.The scans of patients with current or prior malignancies at each corresponding location,without the final reports of histopathology or colonoscopy(for colon and rectum)for the corresponding hypermetabolic regions,or with diffuse(not focal)hypermetabolism were excluded.Finally,88 regions of focal colorectal hypermetabolism in 85 patients(48 men and 37 women with mean age 67.0±13.4 years and 63.4±15.8 years,respectively),48 focal thyroid uptakes in 48 patients(12 men and 36 women with mean age 62.2±13.1 years and 60.8±12.4 years,respectively),and 39 focal prostate uptakes in 39 patients(mean age 71.8±7.5 years)were eligible for this study.For those unexpected focal hypermetabolic regions,rates of malignancy were calculated,PET parameters,such as standardized uptake value(SUV),capable of distinguishing between malignant and benign lesions were investigated,and the cutoffs of those PET parameters were determined by plotting receiver operating characteristic curves.RESULTS In the colon and rectum,29.5%(26/88)were malignant and 33.0%(29/88)were premalignant lesions.Both SUVmax and SUVpeak differentiated malignant/premalignant from benign lesions,however,no parameters could distinguish malignant from premalignant lesions.Higher area under the curve was shown with SUVmax(0.752,95%CI:0.649-0.856,P<0.001)and the cutoff was 7.6.In the thyroid,60.4%(29/48)were malignant.The majority were well-differentiated thyroid cancers(89.7%,26/29).The results of BRAF mutation tests were available for 20 of the 26 welldifferentiated thyroid cancers and all 20 had the mutation.Solely SUVmax differentiated malignant from benign lesions and the cutoff was 6.9.In the prostate,56.4%(22/39)were malignant.Only SUVmax differentiated malignant from benign lesions and the cutoff was 3.8.Overall,among the 175 focal hypermetabolic regions,60.6%(106/175)were proven to be malignant and premalignant(in colon and rectum)lesions.CONCLUSION Approximately 60%of the incidentally observed focal F-18 FDG uptake in the colon/rectum,thyroid,and prostate were found to be malignant.Of the several PET parameters,SUVmax was superior to others in distinguishing between malignant/premalignant and benign lesions.Based on these findings,incidental focal hypermetabolism should not be ignored and lead physicians to conduct further investigations with greater confidence.展开更多
AIM: To systematically review published data on the cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography(FDG-PET) or PET/computed tomography(PET/CT) in tumours other than lung cancer. METH...AIM: To systematically review published data on the cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography(FDG-PET) or PET/computed tomography(PET/CT) in tumours other than lung cancer. METHODS: A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through the 10th of October in 2013 was carried out. A search algorithm based on a combination of the terms:(1) "PET" or " PET/computed tomography(PET/CT)" or "positron emission tomography"; and(2) "cost-effectiveness" or "cost-utility" or "cost-efficacy" or "technology assessment" or "health technology assessment" was used. Only cost-effectiveness or cost-utility analyses in English language were included. Exclusion criteria were:(1) articles not within the field of interest of this review;(2) review articles, editorials or letters, conference proceedings; and(3) outcome evaluation studies, cost studies or health technology assessment reports. For each included study, information was col-lected concerning basic study, type of tumours evaluated, perspective/type of study, results, unit and comparison alternatives. RESULTS: Sixteen studies were included. Head and neck tumours were evaluated in 4 articles, lymphoma in 4, colon-rectum tumours in 3 and breast tumours in 2. Only one article was retrieved for melanoma, oesophagus and ovary tumours. Cost-effectiveness results of FDG-PET or PET/CT ranged from dominated to dominant. CONCLUSION: Literature evidence about the costeffectiveness of FDG-PET or PET/CT in tumours other than lung cancer is still limited. Nevertheless, FDGPET or PET/CT seems to be cost-effective in selective indications in oncology(staging and restaging of head and neck tumours, staging and treatment evaluation in lymphoma).展开更多
BACKGROUND Colon and rectal cancers are among the top five cancers worldwide in terms of their incidence and mortality rates.As the treatment options for cure include surgery even in specific advanced-stage cases,the ...BACKGROUND Colon and rectal cancers are among the top five cancers worldwide in terms of their incidence and mortality rates.As the treatment options for cure include surgery even in specific advanced-stage cases,the early detection of lesions is important for applying active treatment methods.Fluorine-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)is an established imaging study for many types of cancers;however,physiologic uptake in the gastrointestinal tract is a frequent finding and may interfere with lesion identification.Nevertheless,as unexpectedly observed focal colorectal F-18 FDG uptake may harbor malignant lesions,further examination must not be avoided.AIM To assess the clinical implications of unexpected focal colorectal F-18 FDG uptake by analyzing FDG PET parameters.METHODS A total of 15143 F-18 FDG PET/CT scans performed at our hospital between January 2016 and September 2021 were retrospectively reviewed to identify incidentally observed focal colorectal FDG uptake.Finally,83 regions showing focal colorectal FDG uptake with final histopathological reports from 80 patients(45 men and 35 women with mean ages of 66.9±10.7 years and 63.7±15.3 years,respectively)were eligible for inclusion in the present study.Each focal hypermetabolic colorectal region was classified as malignant,premalignant,or benign according to the histopathological report.PET parameters such as maximum and peak standardized uptake value(SUVmax and SUVpeak),metabolic tumor volume(MTV),mean SUV of the metabolic tumor volume(mSUVmtv),and total lesion glycolysis(TLG)were measured or calculated for the corresponding hypermetabolic regions.Parametric and nonparametric statistical comparisons of these parameters were performed among the three groups.Receiver operating characteristic curves were plotted to identify cut-off values.RESULTS The detection rate of incidental focal colorectal uptake was 0.53%(80/15,143).Of the 83 regions with unexpected focal colorectal hypermetabolism,28.9%(24/83)were malignant,32.5%(27/83)were premalignant,and 38.6%(32/83)were benign.Overall,61.4% of the regions had malignant or premalignant lesions.SUVmax,SUVpeak,and mSUVmtv differentiated malignant and/or premalignant lesions from benign lesions with statistical significance(P<0.05).mSUVmtv3.5 differentiated malignant from benign lesions,with the largest area under the curve(AUC)of 0.792 and a cut-off of 4.9.SUVmax showed the largest AUC of 0.758 with a cut-off value of 7.5 for distinguishing between premalignant and benign lesions.Overall,SUVmax with a cut-off value of 7.6(AUC:0.770,95% confidence interval(CI):0.668-0.872;sensitivity,0.686;specificity,0.688)was a superior parameter for distinguishing between malignant/premalignant and benign lesions or physiologic uptake.No parameters differentiated malignant from premalignant lesions.Moderate or weak positive correlations were observed between the long diameter of the malignant lesions and PET parameters such as SUVpeak and some mSUVmtv.CONCLUSION Approximately two-thirds(61.4%)of incidental focal hypermetabolic colorectal regions were malignant/premalignant lesions,for which SUVmax was an independent diagnostic parameter.Unexpected suspicious focal colorectal FDG uptake should not be avoided and consideration for further evaluation is strongly recommended not to miss the two-thirds.展开更多
Purpose: The purpose of this study was to assess solitary osteochondroma and hereditary multiple osteochondral exostoses (HMOCE) utilizing FDG PET and a triple time point protocol. Methods: Seven patients were consent...Purpose: The purpose of this study was to assess solitary osteochondroma and hereditary multiple osteochondral exostoses (HMOCE) utilizing FDG PET and a triple time point protocol. Methods: Seven patients were consented and recruited for PET evaluation of presumed benign osteochondroma. Following injection of 15 mCi of FDG, the lesion(s) of interest was imaged with PET-CT at 45 minutes post injection, whole body at 50 minutes post, and lesion of interest at 95 minutes post injection. A maximum standardized uptake value (SUVmax) was obtained for the lesion(s) of interest at each time point, and an SUVΔ was calculated for each lesion of interest from the first time point to the third time point. Results: 16 lesions from 7 patients were included in the study. Mean SUVmax for all 3 time points was 1.04 with a standard deviation of 0.50 (range 0.3 - 2.2). The mean SUV was 0.096 with a range of 0 - 0.4. Among the 3 patients with histologically confirmed osteochondromas, mean SUVmax was 0.67, with standard deviation of 0.23 and range of 0.3 to 1.0. The mean SUVΔ13 was 0.081 (range 0 - 0.4), mean SUVΔ12 was 0.10 (0 - 0.3), and mean SUVΔ23 was 0.11 (range 0 - 0.4) (p = 0.74). Conclusion: Benign lesions were found to not have progressively increasing uptake on multiple time point FDG PET. Until chondrosarcomas are evaluated using triple time point 18FDG PET, its applicability in the evaluation of osteochondroma versus malignant change remains uncertain.展开更多
A novel thiol-reactive bifunctional agent, an analogue of fluorobenzaldehyde-O-[6-(2,5-dioxo-2,5- dihydro-pyrrol-1-yl)-hexyl]oxime, (FBAM) has been synthesized. The new prosthetic group, [18F]- FBAMPy, replaces the 4-...A novel thiol-reactive bifunctional agent, an analogue of fluorobenzaldehyde-O-[6-(2,5-dioxo-2,5- dihydro-pyrrol-1-yl)-hexyl]oxime, (FBAM) has been synthesized. The new prosthetic group, [18F]- FBAMPy, replaces the 4-fluorophenyl moiety with a 2-fluoropyridinyl moiety leading to increased polarity (FBAM analytical HPLC R<sub>f</sub> = 6.4 min;FBAMPy R<sub>f</sub> = 4.8 min) while retaining the sulfur-reactive pendant. By altering the polarity of the molecule, this new prosthetic group should have significant impact in coupling it with small peptides and other biomolecules.展开更多
This study sought to investigate whether low dose dobutamine MRI can detect residual myocardial viability in patients with chronic myocardial infarction and left ventricular dysfunction. Methods. Eleven patients with ...This study sought to investigate whether low dose dobutamine MRI can detect residual myocardial viability in patients with chronic myocardial infarction and left ventricular dysfunction. Methods. Eleven patients with chronic myocardial infarction and left ventricular dysfunction were employed for identification of viable myocardium by cine MRI during dobutamine infusion. All patients underwent coronary angiography and left ventriculography, 18 FDG PET, MRI at rest and stress.The systolic wall thickening measured at rest and during stress was compared with the results of 18 FDG PET, respectively. Results. A significant difference of either dobutamine induced systolic wall thickening (SWth stress ) or dobutamine induced contractile reserve (ΔSWth= SWth stress - SWth rest ) was present between viable and scar regions (1 0±0 3 versus -0 3 ±0 1, P<0 01; 1 0±0 3 versus -0 2±0 2, P<0 01). Conclusions. Dobutamine induced contractile reserve can be predicted in the regions of akinesia or dyskinesia at rest when systolic wall thickening was 1 0 mm during dobutamine stimulation.展开更多
Abstract：Background Atherosclerotic plaque rupture is the primary mechanism of thrombosis which plays a key role in the onset of acute coronary syndromes. Detection of these plaques prone to rupture （vulnerable pla...Abstract：Background Atherosclerotic plaque rupture is the primary mechanism of thrombosis which plays a key role in the onset of acute coronary syndromes. Detection of these plaques prone to rupture （vulnerable plaque） could be clinically significant for prevention of cardiac events. It has been shown that high metabolism cells have a high uptake of fluorine-18 fluorodeoxyglucose （18F-FDG）. The objective of this study was to investigate the correlation of FDG uptake and the immuno-histochemistry parameters of plaques, and the effect of atorvastatin on vulnerable atherosclerotic plaque in a rabbit model.Methods Ten male New Zealand White rabbits were divided into three groups as follows： （1） normal control group （n=2,C group）： the animals were fed a standard diet at 120 g/d and were given water ad labium; （2） atherosclerosis group （n=4,As group）： animals were fed with high fat diet for 5 months after aortic endothelia damage; （3） treatment group （atherosclerosis ＋ atorvastatin, n=4, Statin group）： animals were fed with high fat diet for 5 months and then changed into normal chow plus atorvastatin （2.5 mg·d-1·kg-1） treatment for another 4 months. Then these four rabbits were imaged with fluorine-18 fluorodexyglucose positron emission tomography/computed tomography （PET/CT） and sacrificed for pathohistologic studies. FDG uptake by the aorta was expressed as target-to-background ratio （TBR）. Maximal standardized uptake value （SUV） was measured over the thoracic and abdominal aortas. The aortic smooth muscle cell （SMC） number, CD-14 antibody positive cell （macrophage） number and the ratio of the thickness of fibrous cap to the thickness of lipid core （cap-to-core ratio） in atherosclerotic plaques were analyzed.Results As group showed significantly higher uptake of FDG than C group （SUVs： 0.746±0.172 vs. 0.286±0.073, P 〈0.001）. After 4 months of atorvastatin treatment and the modification of diet, SUVs decreased significantly （Statin group：0.550±0.134, compared to As group, P 〈0.001）. However, no marked difference was found in TBR, the number of macrophages, the number of SMC and the cap-to-core ratio in the aortic segments between Statin group and As group.The correlation of aortic FDG uptake with SMC assessed by histopathology was negatively significant （r=0.57, P〈0.001）. When aortic FDG uptake was expressed as TBR, it correlated significantly （r=0.69, P 〈0.001） with the macrophage number, and also correlated significantly （r=0.78, P 〈0.001） with the cap-to-core ratio.Conclusion 18F-FDG PET/CT might serve as a useful non-invasive imaging technique for detection of atherosclerotic plaque and potentially permit monitoring of relative changes in inflammation within the atherosclerotic lesion.展开更多
基金Supported by National Natural Science Foundation of China,No.82171983Henan Provincial Science and Technology Research Project,No.242102311089.
文摘BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma(HCC)is crucial,and pathologic grading is a key prognostic determinant that affects patient prognosis.Therefore,accurate determination of pathological grading before surgical intervention is crucial for optimizing treatment strategies and improving prognostic outcomes.AIM To investigate the distinguishing capability of fluorine-18-fluorodeoxyglucosepositron emission tomography/computed tomography(^(18)F-FDG PET/CT)-derived metabolic parameters between Edmondson grade Ⅱ and Ⅲ HCC and to assess their correlation with Ki67 expression levels.METHODS We retrospectively assessed the ^(18)F-FDG PET/CT imaging datasets from 32 patients with solitary HCC,all of whom had pathological confirmation of their diagnosis.Patients were categorized into Edmondson grade Ⅱ and Ⅲ groups according to pathological grading criteria.Comparative analyses were conducted on metabolic parameters,including maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),metabolic tumor volume(MTV),total lesion glycolysis(TLG),tumor-to-normal background ratio(TNR),and tumor-to-blood pool ratio(TBR),between the groups.Further,correlations between these parameters and Ki67 expression were investigated.RESULTS Significant differences were observed in SUV_(max),SUV_(mean),TLG,TNR,and TBR between Edmondson grade Ⅱ and Ⅲ HCC groups(P<0.05),whereas MTV was not significantly different(P=0.052).The maximum tumor diameter and Ki67 expression percentage significantly varied between the two groups(P<0.05).SUV_(max) yielded the largest area under the receiver operating characteristic curve,measuring 0.853(95%confidence interval:0.709-0.997,P=0.001).Using an optimal SUV_(max) cut-off of 10.95,the sensitivity and specificity for identifying Edmondson grade Ⅲ HCC were 66.7%and 100%,respectively.Notably,significant positive correlations were identified in terms of SUV_(max),SUV_(mean),TNR,TBR,and the percentage of Ki67 expression(P<0.01).Conversely,MTV,TLG,and maximum tumor diameter exhibited no significant association with Ki67 expression(P>0.05).CONCLUSION ^(18)F-FDG PET/CT-derived metabolic parameters,particularly SUV_(max),SUV_(mean),TNR,TBR,and TLG,are valuable in differentiating Edmondson grade Ⅱ and Ⅲ HCC,with SUV_(max) showing the optimal differential diagnostic efficacy.TLG is a three-dimensional volumetric parameter that holds some differential diagnostic potential,but it fails to display a distinct advantage.Moreover,increased ^(18)F-FDG uptake and Ki67 expression in tumor tissue correlate with poorer HCC prognoses,emphasizing their potential role in prognostic assessments.
基金the National Natural Science Foundation of China, No. 81071046the Guangdong Provincial Science and Technology Program, No. 2009B030801250+1 种基金2010 Guangdong Provincial Science and Technology Program, No. 2010B031600159the Guangdong Province Natural Science Foundation, No. 7001205
文摘We examined a total of 16 children with epileptic encephalopathy using fluorine-18-fluoro-2-deoxy-D-glucose （18F-FDG） positron emission computed tomography （PET）, magnetic resonance imaging （MRI） and electroencephalography. Children with infantile spasms showed significant mental retardation, severely abnormal electroencephalogram recordings, and bilateral diffuse cerebral cortex hypometabolism with I^F-FDG PET imaging. MRI in these cases showed brain atrophy, multi-micropolygyria, macrogyria, and porencephalia. In cases with Lennox-Gastaut syndrome, 18F-FDG PET showed bilateral diffuse glucose hypometabolism, while MRI showed cortical atrophy, heterotopic gray matter and tuberous sclerosis. MRI in cases with myoclonic encephalopathy demonstrated bilateral frontal and temporal cortical and white matter atrophy and 18F-FDG PET imaging showed bilateral frontal lobe atrophy with reduced bilateral frontal cortex, occipital cortex, temporal cortex and cerebellar glucose uptake. In children who could not be clearly classified, MRI demonstrated cerebral cortical atrophy and ~aF-FDG PET exhibited multifocal glucose hypometabolism. Overall, this study demonstrated that the degree of brain metabolic abnormality was consistent with clinical seizure severity. In addition, ~SF-FDG PET imaging after treatment was consistent with clinical outcomes. These findings indicate that ~SF-FDG PET can be used to assess the severity of brain injury and prognosis in children with epileptic encephalopathy.
文摘Congenital hyperinsulinism(CHI) is a rare but complex heterogeneous disorder caused by unregulated secre-tion of insulin from the β-cells of the pancreas leading to severe hypoglycaemia and neuroglycopaenia. Swift diagnosis and institution of appropriate management is crucial to prevent or minimise adverse neurodevel-opmental outcome in children with CHI. Histologically there are two major subtypes of CHI, diffuse and focal disease and the management approach will significantly differ depending on the type of the lesion. Patients with medically unresponsive diffuse disease require a near total pancreatectomy, which then leads on to the de-velopment of iatrogenic diabetes mellitus and pancre-atic exocrine insufficiency. However patients with focaldisease only require a limited pancreatectomy to re-move only the focal lesion thus providing complete cure to the patient. Hence the preoperative differentiation of the histological subtypes of CHI becomes paramount in the management of CHI. Fluorine-18L-3, 4-hydroxy-phenylalanine positron emission tomography(18F-DOPA-PET) is now the gold standard for pre-operative differentiation of focal from diffuse disease and locali-sation of the focal lesion. The aim of this review article is to give a clinical overview of CHI, then review the role of dopamine in β-cell physiology and finally discuss the role of 18F-DOPA-PET imaging in the management of CHI.
文摘BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT),a functional imaging method,is usually performed on the entire torso,and regions of unexpected suspicious focal hypermetabolism are not infrequently observed.Among the regions,colon,thyroid,and prostate were found to be the common organs in a recent umbrella review.Some studies reported that a high rate of malignancy was shown in incidentally identified focal hypermetabolic regions and suggested that further examinations should not be ignored.AIM To investigate the malignancy rate of incidental focal FDG uptake,useful PET parameters and their cutoffs in discrimination between malignant and benign lesions.METHODS Retrospectively,the final reports of 16510 F-18 FDG PET/CT scans performed at our hospital between January 2016 and March 2022 were reviewed to identify incidentally observed FDG uptake in the colon/rectum,thyroid,and prostate.The scans of patients with current or prior malignancies at each corresponding location,without the final reports of histopathology or colonoscopy(for colon and rectum)for the corresponding hypermetabolic regions,or with diffuse(not focal)hypermetabolism were excluded.Finally,88 regions of focal colorectal hypermetabolism in 85 patients(48 men and 37 women with mean age 67.0±13.4 years and 63.4±15.8 years,respectively),48 focal thyroid uptakes in 48 patients(12 men and 36 women with mean age 62.2±13.1 years and 60.8±12.4 years,respectively),and 39 focal prostate uptakes in 39 patients(mean age 71.8±7.5 years)were eligible for this study.For those unexpected focal hypermetabolic regions,rates of malignancy were calculated,PET parameters,such as standardized uptake value(SUV),capable of distinguishing between malignant and benign lesions were investigated,and the cutoffs of those PET parameters were determined by plotting receiver operating characteristic curves.RESULTS In the colon and rectum,29.5%(26/88)were malignant and 33.0%(29/88)were premalignant lesions.Both SUVmax and SUVpeak differentiated malignant/premalignant from benign lesions,however,no parameters could distinguish malignant from premalignant lesions.Higher area under the curve was shown with SUVmax(0.752,95%CI:0.649-0.856,P<0.001)and the cutoff was 7.6.In the thyroid,60.4%(29/48)were malignant.The majority were well-differentiated thyroid cancers(89.7%,26/29).The results of BRAF mutation tests were available for 20 of the 26 welldifferentiated thyroid cancers and all 20 had the mutation.Solely SUVmax differentiated malignant from benign lesions and the cutoff was 6.9.In the prostate,56.4%(22/39)were malignant.Only SUVmax differentiated malignant from benign lesions and the cutoff was 3.8.Overall,among the 175 focal hypermetabolic regions,60.6%(106/175)were proven to be malignant and premalignant(in colon and rectum)lesions.CONCLUSION Approximately 60%of the incidentally observed focal F-18 FDG uptake in the colon/rectum,thyroid,and prostate were found to be malignant.Of the several PET parameters,SUVmax was superior to others in distinguishing between malignant/premalignant and benign lesions.Based on these findings,incidental focal hypermetabolism should not be ignored and lead physicians to conduct further investigations with greater confidence.
文摘AIM: To systematically review published data on the cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography(FDG-PET) or PET/computed tomography(PET/CT) in tumours other than lung cancer. METHODS: A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through the 10th of October in 2013 was carried out. A search algorithm based on a combination of the terms:(1) "PET" or " PET/computed tomography(PET/CT)" or "positron emission tomography"; and(2) "cost-effectiveness" or "cost-utility" or "cost-efficacy" or "technology assessment" or "health technology assessment" was used. Only cost-effectiveness or cost-utility analyses in English language were included. Exclusion criteria were:(1) articles not within the field of interest of this review;(2) review articles, editorials or letters, conference proceedings; and(3) outcome evaluation studies, cost studies or health technology assessment reports. For each included study, information was col-lected concerning basic study, type of tumours evaluated, perspective/type of study, results, unit and comparison alternatives. RESULTS: Sixteen studies were included. Head and neck tumours were evaluated in 4 articles, lymphoma in 4, colon-rectum tumours in 3 and breast tumours in 2. Only one article was retrieved for melanoma, oesophagus and ovary tumours. Cost-effectiveness results of FDG-PET or PET/CT ranged from dominated to dominant. CONCLUSION: Literature evidence about the costeffectiveness of FDG-PET or PET/CT in tumours other than lung cancer is still limited. Nevertheless, FDGPET or PET/CT seems to be cost-effective in selective indications in oncology(staging and restaging of head and neck tumours, staging and treatment evaluation in lymphoma).
文摘BACKGROUND Colon and rectal cancers are among the top five cancers worldwide in terms of their incidence and mortality rates.As the treatment options for cure include surgery even in specific advanced-stage cases,the early detection of lesions is important for applying active treatment methods.Fluorine-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)is an established imaging study for many types of cancers;however,physiologic uptake in the gastrointestinal tract is a frequent finding and may interfere with lesion identification.Nevertheless,as unexpectedly observed focal colorectal F-18 FDG uptake may harbor malignant lesions,further examination must not be avoided.AIM To assess the clinical implications of unexpected focal colorectal F-18 FDG uptake by analyzing FDG PET parameters.METHODS A total of 15143 F-18 FDG PET/CT scans performed at our hospital between January 2016 and September 2021 were retrospectively reviewed to identify incidentally observed focal colorectal FDG uptake.Finally,83 regions showing focal colorectal FDG uptake with final histopathological reports from 80 patients(45 men and 35 women with mean ages of 66.9±10.7 years and 63.7±15.3 years,respectively)were eligible for inclusion in the present study.Each focal hypermetabolic colorectal region was classified as malignant,premalignant,or benign according to the histopathological report.PET parameters such as maximum and peak standardized uptake value(SUVmax and SUVpeak),metabolic tumor volume(MTV),mean SUV of the metabolic tumor volume(mSUVmtv),and total lesion glycolysis(TLG)were measured or calculated for the corresponding hypermetabolic regions.Parametric and nonparametric statistical comparisons of these parameters were performed among the three groups.Receiver operating characteristic curves were plotted to identify cut-off values.RESULTS The detection rate of incidental focal colorectal uptake was 0.53%(80/15,143).Of the 83 regions with unexpected focal colorectal hypermetabolism,28.9%(24/83)were malignant,32.5%(27/83)were premalignant,and 38.6%(32/83)were benign.Overall,61.4% of the regions had malignant or premalignant lesions.SUVmax,SUVpeak,and mSUVmtv differentiated malignant and/or premalignant lesions from benign lesions with statistical significance(P<0.05).mSUVmtv3.5 differentiated malignant from benign lesions,with the largest area under the curve(AUC)of 0.792 and a cut-off of 4.9.SUVmax showed the largest AUC of 0.758 with a cut-off value of 7.5 for distinguishing between premalignant and benign lesions.Overall,SUVmax with a cut-off value of 7.6(AUC:0.770,95% confidence interval(CI):0.668-0.872;sensitivity,0.686;specificity,0.688)was a superior parameter for distinguishing between malignant/premalignant and benign lesions or physiologic uptake.No parameters differentiated malignant from premalignant lesions.Moderate or weak positive correlations were observed between the long diameter of the malignant lesions and PET parameters such as SUVpeak and some mSUVmtv.CONCLUSION Approximately two-thirds(61.4%)of incidental focal hypermetabolic colorectal regions were malignant/premalignant lesions,for which SUVmax was an independent diagnostic parameter.Unexpected suspicious focal colorectal FDG uptake should not be avoided and consideration for further evaluation is strongly recommended not to miss the two-thirds.
文摘Purpose: The purpose of this study was to assess solitary osteochondroma and hereditary multiple osteochondral exostoses (HMOCE) utilizing FDG PET and a triple time point protocol. Methods: Seven patients were consented and recruited for PET evaluation of presumed benign osteochondroma. Following injection of 15 mCi of FDG, the lesion(s) of interest was imaged with PET-CT at 45 minutes post injection, whole body at 50 minutes post, and lesion of interest at 95 minutes post injection. A maximum standardized uptake value (SUVmax) was obtained for the lesion(s) of interest at each time point, and an SUVΔ was calculated for each lesion of interest from the first time point to the third time point. Results: 16 lesions from 7 patients were included in the study. Mean SUVmax for all 3 time points was 1.04 with a standard deviation of 0.50 (range 0.3 - 2.2). The mean SUV was 0.096 with a range of 0 - 0.4. Among the 3 patients with histologically confirmed osteochondromas, mean SUVmax was 0.67, with standard deviation of 0.23 and range of 0.3 to 1.0. The mean SUVΔ13 was 0.081 (range 0 - 0.4), mean SUVΔ12 was 0.10 (0 - 0.3), and mean SUVΔ23 was 0.11 (range 0 - 0.4) (p = 0.74). Conclusion: Benign lesions were found to not have progressively increasing uptake on multiple time point FDG PET. Until chondrosarcomas are evaluated using triple time point 18FDG PET, its applicability in the evaluation of osteochondroma versus malignant change remains uncertain.
文摘A novel thiol-reactive bifunctional agent, an analogue of fluorobenzaldehyde-O-[6-(2,5-dioxo-2,5- dihydro-pyrrol-1-yl)-hexyl]oxime, (FBAM) has been synthesized. The new prosthetic group, [18F]- FBAMPy, replaces the 4-fluorophenyl moiety with a 2-fluoropyridinyl moiety leading to increased polarity (FBAM analytical HPLC R<sub>f</sub> = 6.4 min;FBAMPy R<sub>f</sub> = 4.8 min) while retaining the sulfur-reactive pendant. By altering the polarity of the molecule, this new prosthetic group should have significant impact in coupling it with small peptides and other biomolecules.
文摘This study sought to investigate whether low dose dobutamine MRI can detect residual myocardial viability in patients with chronic myocardial infarction and left ventricular dysfunction. Methods. Eleven patients with chronic myocardial infarction and left ventricular dysfunction were employed for identification of viable myocardium by cine MRI during dobutamine infusion. All patients underwent coronary angiography and left ventriculography, 18 FDG PET, MRI at rest and stress.The systolic wall thickening measured at rest and during stress was compared with the results of 18 FDG PET, respectively. Results. A significant difference of either dobutamine induced systolic wall thickening (SWth stress ) or dobutamine induced contractile reserve (ΔSWth= SWth stress - SWth rest ) was present between viable and scar regions (1 0±0 3 versus -0 3 ±0 1, P<0 01; 1 0±0 3 versus -0 2±0 2, P<0 01). Conclusions. Dobutamine induced contractile reserve can be predicted in the regions of akinesia or dyskinesia at rest when systolic wall thickening was 1 0 mm during dobutamine stimulation.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30972810）.
文摘Abstract：Background Atherosclerotic plaque rupture is the primary mechanism of thrombosis which plays a key role in the onset of acute coronary syndromes. Detection of these plaques prone to rupture （vulnerable plaque） could be clinically significant for prevention of cardiac events. It has been shown that high metabolism cells have a high uptake of fluorine-18 fluorodeoxyglucose （18F-FDG）. The objective of this study was to investigate the correlation of FDG uptake and the immuno-histochemistry parameters of plaques, and the effect of atorvastatin on vulnerable atherosclerotic plaque in a rabbit model.Methods Ten male New Zealand White rabbits were divided into three groups as follows： （1） normal control group （n=2,C group）： the animals were fed a standard diet at 120 g/d and were given water ad labium; （2） atherosclerosis group （n=4,As group）： animals were fed with high fat diet for 5 months after aortic endothelia damage; （3） treatment group （atherosclerosis ＋ atorvastatin, n=4, Statin group）： animals were fed with high fat diet for 5 months and then changed into normal chow plus atorvastatin （2.5 mg·d-1·kg-1） treatment for another 4 months. Then these four rabbits were imaged with fluorine-18 fluorodexyglucose positron emission tomography/computed tomography （PET/CT） and sacrificed for pathohistologic studies. FDG uptake by the aorta was expressed as target-to-background ratio （TBR）. Maximal standardized uptake value （SUV） was measured over the thoracic and abdominal aortas. The aortic smooth muscle cell （SMC） number, CD-14 antibody positive cell （macrophage） number and the ratio of the thickness of fibrous cap to the thickness of lipid core （cap-to-core ratio） in atherosclerotic plaques were analyzed.Results As group showed significantly higher uptake of FDG than C group （SUVs： 0.746±0.172 vs. 0.286±0.073, P 〈0.001）. After 4 months of atorvastatin treatment and the modification of diet, SUVs decreased significantly （Statin group：0.550±0.134, compared to As group, P 〈0.001）. However, no marked difference was found in TBR, the number of macrophages, the number of SMC and the cap-to-core ratio in the aortic segments between Statin group and As group.The correlation of aortic FDG uptake with SMC assessed by histopathology was negatively significant （r=0.57, P〈0.001）. When aortic FDG uptake was expressed as TBR, it correlated significantly （r=0.69, P 〈0.001） with the macrophage number, and also correlated significantly （r=0.78, P 〈0.001） with the cap-to-core ratio.Conclusion 18F-FDG PET/CT might serve as a useful non-invasive imaging technique for detection of atherosclerotic plaque and potentially permit monitoring of relative changes in inflammation within the atherosclerotic lesion.
