BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The ex...BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The exact etiology of this condition remains unclear.Neutrophils play a critical role in IBD pathogenesis.Translocator protein(TSPO),a mitochondrial protein linked to immune responses,has demonstrated potential as an inflammatory marker.However,its role in IBD remains underexplored.AIM To investigate the role of TSPO in IBD pathogenesis,particularly in neutrophils.METHODS Bioinformatics analyses of Gene Expression Omnibus datasets(GE75214,GSE94648,GSE156776)assessed TSPO expression in IBD patients.TSPO expression was evaluated in human IBD samples,neutrophiles and a chronic colitis mouse model.Neutrophil function was examined in 18 samples using reactive oxygen species(ROS)production and neutrophil extracellular trap(NET)formation assays.Positron emission tomography-computed tomography(PET-CT)imaging and histology from 12 mice revealed TSPO expression in colitis.PET-CT and immunofluorescence staining assessed TSPO expression in brain under neuroinflammation condition.RESULTS Bioinformatics analysis revealed elevated TSPO expression in the intestinal mucosa and peripheral blood of patients with IBD,especially in neutrophils.This was confirmed by quantitative real-time polymerase chain reaction and immunohistochemical staining,which showed a significant upregulation of TSPO in active IBD.Neutrophils from patients with UC and CD exhibited higher TSPO expression,which correlated with increased ROS production and NET formation.In a mouse model of dextran sodium sulfate-induced chronic colitis,TSPO was upregulated in the colonic neutrophils and brain tissues,indicating its systemic involvement.PET-CT imaging showed enhanced TSPO uptake in the inflamed colon and brain regions,particularly in the microglia,highlighting neuroinflammation.CONCLUSION TSPO is significantly upregulated in neutrophils in IBD and contributes to intestinal inflammation.Its elevated expression in gut highlights its potential as a promising therapeutic target for IBD.展开更多
BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence...BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence suggests that electroacupuncture(EA)at ST36 modulates gastrointestinal function;however,the precise neuromolecular pathways underlying its efficacy in DGP remain incompletely defined.AIM To elucidate the neural mechanisms underlying EA at ST36 improving DGP gastric motility through the nucleus tractus solitarius(NTS)-vagal axis.METHODS The DGP model was established via a single high-dose intraperitoneal injection of 2%streptozotocin combined with an 8-week high-sugar/high-fat diet.Interventions included EA at ST36,pharmacological modulation[choline acetyltransferase(ChAT)agonist polygalacic acid(PA)and inhibitor antagonist alpha-NETA],and subdiaphragmatic vagotomy.Post-intervention observations included body weight and blood glucose levels.Gastric emptying was evaluated using phenol red assays,gastric slow-wave recordings,and dynamic positron emission tomography-computed tomography imaging.Histopathological analysis(hematoxylineosin staining)and molecular assessments(Western blot,immunofluorescence)were performed to quantify gastric smooth muscle-associated factors[neuronal nitric oxide synthase(nNOS),cluster of differentiation 117(C-kit),stem cell factor(SCF)]and vagal targets[ChAT,α7 nicotinic acetylcholine receptor(α7nAChR)]in the ST36 acupoint region,L4-L6 spinal segments,and NTS.Gastrointestinal peptides[gastrin(Gas),motilin(MLT)and vasoactive intestinal peptide(VIP)]were measured via enzyme-linked immunosorbent assay.RESULTS The study found that EA significantly increased the rate of gastric emptying,restored the slow-wave rhythms of the stomach,and improved the architecture of the smooth muscles in the stomach.This was evidenced by a reduction in inflammatory infiltration and an increase in the expression of nNOS,C-kit,and SCF.Mechanistically,EA activated vagal targets(ChAT andα7nAChR)at ST36,transmitting signals via spinal segments L4-L6 to the NTS,subsequently regulating gastrointestinal peptides(Gas,MLT,VIP)and restoring interstitial cells of Cajal(ICCs)function via subdiaphragmatic vagal efferent pathways.It is crucial to note that subdiaphragmatic vagotomy led to the abrogation of EA-induced enhancements in gastric motility and ICC recovery,thereby confirming the indispensable role of vagal efferent signalling.CONCLUSION EA provides a novel molecular mechanism for improving gastrointestinal motility in DGP via a peripheral stimulation(ST36),spinal afferent(L4-L6),brainstem integration(NTS),vagal efferent(gastric)circuit.展开更多
Background： The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery （VATS） combined with positron emitted tomography （PET）-computed tomography ...Background： The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery （VATS） combined with positron emitted tomography （PET）-computed tomography （CT） in the diagnosis of patients with early （Stage 1） sarcoidosis. Methods： From 1995 to 2006, seven patients （two males, five females）, with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis （mediastinal or hilar lymph nodes involvements without lung involvement） by histological examination of intrathoracic lymph nodes （LNs） and/or lung parenchyma taken＇from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results： All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion： VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic altermative of transbronchial lung biopsy （TBLB）, and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.展开更多
BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment.Positron emission tomography-computed tomography(PET-CT)is routinely performed as a follow-up study ...BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment.Positron emission tomography-computed tomography(PET-CT)is routinely performed as a follow-up study in cancer patients after therapy.Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.AIM To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.METHODS Our prospective study received Institutional Review Board approval.Written informed consent was obtained from all patients,who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study,between March 2015 and April 2019.Patients with advanced glenohumeral arthrosis,metastatic disease or other mass in the shoulder,or shoulder arthroplasty were excluded.Patterns of shoulder capsule 18F-fluorodeoxyglucose(FDG)uptake were noted.Standard Uptake Value(SUV)max and SUVmean values were measured at rotator interval(RI)and deltoid muscle in bilateral shoulders.Normalized SUV(SUV of RI/SUV of deltoid muscle)was also calculated.We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders.Covariates were age,gender,and therapy type(surgery,chemotherapy,radiation).Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age,SUV measurements between symptomatic and asymptomatic patients.Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status,after adjusting for covariates.Statistical significance level was set at P<0.05.RESULTS Of 252 patients initially enrolled for the study(mean age 66 years,67 symptomatic),shoulder PET-CT data were obtained in 200 patients(52 were excluded due to exclusion criteria above).The most common cancer types were lymphoma(n=61),lung(n=54)and breast(n=53).No significant difference was noted between symptomatic and asymptomatic patients in terms of age,gender,proportion of patients who had surgical therapy and radiation therapy.A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder(65%vs 48%,P=0.012).No such difference was seen for the left shoulder.In both shoulders,SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders(Left SUVmax 2.0 vs 1.6,SUVmean 1.6 vs 1.3,both P<0.002;Right SUVmax 2.2 vs 1.8,SUVmean 1.8 vs 1.5,both P<0.01).For lung cancer patients,bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders.For other cancer patients,symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.CONCLUSION In symptomatic patients metabolic activities in RI were higher than asymptomatic patients.Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.展开更多
This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man.A literature review was conducted to explore recent advances in detecting,diagnosing,and treating intraocul...This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man.A literature review was conducted to explore recent advances in detecting,diagnosing,and treating intraocular metastatic malignancies.Positron emission tomographycomputed tomography played a crucial role in identifying primary sites and systemic metastases.Local treatment combined with systemic therapy effectively reduced tumor size,preserved useful vision,and improved the patient’s survival rate.A comparison was made of the characteristics of iris metastases from esophageal cancer and lung cancer,including age,gender,tumor characteristics,and treatment.The challenges associated with diagnosis and treatment are discussed,highlighting the implications for clinical practice.展开更多
BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of mu...BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.展开更多
BACKGROUND Bone is one of the common sites of metastasis from prostate carcinoma.Bone scintigraphy(BS)is one of the most sensitive imaging modalities currently used for bone metastatic work-up.Skeletal metastasis in p...BACKGROUND Bone is one of the common sites of metastasis from prostate carcinoma.Bone scintigraphy(BS)is one of the most sensitive imaging modalities currently used for bone metastatic work-up.Skeletal metastasis in prostate carcinoma commonly involves pelvic bones but rarely involves extrapelvic-extraspinal sites.AIM To retrospectively analyze the BS data to determine the pattern of skeletal metastases in the prostate carcinoma.METHODS This retrospective observational study involves patients with biopsy-proven prostate carcinoma referred for BS for staging assessment.Patients with abnormal BS were evaluated for the pattern of skeletal involvement and data were pre-sented in descriptive format in the form of percentages.RESULTS A total of 150 patients with biopsy-proven prostate cancer who were referred for staging were included in the study.Thirteen of 150 patients(8.67%)had no abnormal uptake on planar images,ruling out metastatic disease.Twenty-four patients(16%)had heterogeneous uptake in the spine with distribution charac-teristic of degenerative disease and no scan pattern of metastatic disease.Thirty patients(20%)had multifocal uptake involving both pelvic and extra pelvic bones on planar images typical for skeletal metastasis and were considered metastatic.Eighty-three out of 150 patients(55.3%)had increased tracer uptake,which was indeterminate,thus,single photon emission computed tomography-computed tomography(SPECT-CT)was acquired,which showed 51 with metastatic disease,31 benign lesions,and one indeterminate finding.Seven of 150 patients had exclusive pelvic bone uptake,which was found to be metastatic in 4/7 patients in SPECT-CT.Fifty six out of 150 patients showed exclusive extrapelvic tracer uptake,of which only 3 had vertebral metastatic disease.None of the patients with increased uptake exclusively in the extrapelvic-extraspinal location was metastatic.CONCLUSION The incidence of exclusive extrapelvic skeletal metastatic disease in prostate carcinoma is 2%(excluding one patient with indeterminate findings).Further,none of the patients in the current study had exclusive extrapelvic-extraspinal metastasis.Thus,exclusive extrapelvic-extraspinal focal abnormality on planar BS carries a very low probability of metastatic disease and hence,further imaging or SPECT-CT can be safely avoided in such cases.展开更多
One of the leading causes of cancer-related death is gastrointestinal cancer,which has a significant morbidity and mortality rate.Although preoperative risk assessment is essential for directing patient care,its biolo...One of the leading causes of cancer-related death is gastrointestinal cancer,which has a significant morbidity and mortality rate.Although preoperative risk assessment is essential for directing patient care,its biological behavior cannot be accurately predicted by conventional imaging investigations.Potential pathophysiological information in anatomical imaging that cannot be visually identified can now be converted into high-dimensional quantitative image features thanks to the developing discipline of molecular imaging.In order to enable molecular tissue profile in vivo,molecular imaging has most recently been utilized to phenotype the expression of single receptors and targets of biological therapy.It is expected that molecular imaging will become increasingly important in the near future,driven by the expanding range of biological therapies for cancer.With this live molecular fingerprinting,molecular imaging can be utilized to drive expression-tailored customized therapy.The technical aspects of molecular imaging are first briefly discussed in this review,followed by an examination of the most recent research on the diagnosis,prognosis,and potential future clinical methods of molecular imaging for GI tract malignancies.展开更多
Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniq...Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.展开更多
The purpose of this article is to provide a pictorial review of the findings and interpretative pitfalls about focal fluorodeoxyglucose(FDG)uptake in the absence of corresponding computer tomography(CT)lesion or abnor...The purpose of this article is to provide a pictorial review of the findings and interpretative pitfalls about focal fluorodeoxyglucose(FDG)uptake in the absence of corresponding computer tomography(CT)lesion or abnormality on an integrated positron emission tomography(PET)-CT.The integrated CT images in the PET-CT scanner allow correct co-registration and fused imaging of anatomical and functional data.On FDG PET-CT imaging,a real pathologic process often demonstrates abnormal uptake associated with a visible corresponding CT lesion or abnormality.When focal uptake is seen on PET imaging but no corresponding anatomic abnormality is visualized on the integrated CT,one should always be aware of possible mis-registration or mismatch of the PET and CT images due to the patient’s respiratory or body motion.While most of the hot spots in the absence of corresponding anatomic abnormalities are artefactual or secondary to benign etiologies,some may represent small sized or early staged neoplasm or metastases,especially in the gastrointestinal tract and skeletons.Caution should be exercised to simply diagnose a pathology based on the presence of the uptake only,or exclude the disease based on the absence of anatomic abnormality.展开更多
Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. ...Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. Herein, we report preliminary data from a phase I/II study testing the combination of cetuximab with inductive chemotherapy, followed by concurrent CRT （CCRT） in Chinese patients with stage III NSCLC. Methods： Eligibility criteria were Zubrod performance status （PS） 0-1, forced expiratory volume in 1 second （FEV1） 〉_1.2 L and adequate organ function. Enrolled patients received weekly cetuximab （initial dose of 400 mg/m2 on day 1 of week 1 and a maintenance dose of 250 mg/m2 on week 2 to the end of CCRT） with cisplatin/vinorelbine （NP） chemotherapy （every 3 weeks for 2 cycles from week 2, followed by two cycles of concomitant NP chemotherapy and intensity-modulated thoracic radiotherapy （TRT） （60-66 Gy/2 Gy）. The primary endpoints were toxicity and feasibility. All patients received positron emission tomography- computerized tomography （PET-CT） scans within the 2 weeks prior to enrollment. Univariate analyses were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumor-node- metastasis （TNM） stage, PS and smoking status and survival. Survival curves were generated for different populations using the Kaplan-Meier method and compared using a log-rank test. Results： Seventeen patients were enrolled and 16 completed the full regime. The overall response rate （ORR） was 58.8% and 82.3% after the induction and CCRT phases, respectively. With a median follow-up duration of 27.6 months, the median survival was 27.6 months [95% confidence interval （CI）： 11.3-43.9 months] with 1- and 2-year survival rates of 88.2% （95% CI, 60.6-96.9%） and 58.8% （95% CI, 60.6-77.8%）, respectively. Three patients remain progression-free to date, and the median progression-free survival （PFS） was 13.5 months （95% CI, 6.8-20.2 months）. No treatment-related death occurred; however, 76% of the patients experienced grade 3＋ adverse events （AEs）, including nansea/vomiting, intestinal obstruction, and esophagitis （〈6%）, while other AEs were mostly of hematological nature （71%）. The cut-off values for SUV-T and SUV-TOTAL were 11 and 20, respectively. Univariate analyses revealed SUV-TOTAL （P=0.027）, SUV-T （P=0.025）, and PS （P=0.006） as potential survival predictors, with a hazard ratio （HR） of 3.4, 3.7, and 9.9, respectively. Conclusions： The combination of cetuximab with induction chemotherapy followed by CCRT appears feasible and promising. Local and locoregional maximal SUVs, defined by 18F-FDG PET-CT scanning, may represent a prognostic indicator for long-term survival for these patients, which warrants further study.展开更多
Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination reveale...Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination revealed left abductor nerve palsy,craniocerebral magnetic resonance imaging(MRI)showed intracranial metastatic tumor,and positron emission tomography-computer tomography(PET-CT)tracing of the original lesion detected the primary liver cancer.This paper provides clinical data for intracranial metastasis of primary liver cancer and the possible pathogenesis and mechanism of sudden diplopia.展开更多
Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma(MM)from other monoclonal plasma cell diseases.Conventional radiography represents the refer...Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma(MM)from other monoclonal plasma cell diseases.Conventional radiography represents the reference standard for diagnosis of MM due to its wide availability and low costs despite its known limitations such as low sensitivity,limited specificity and its inability to detect extraosseous lesions.Besides conventional radiography,newer cross-sectional imaging modalities such as whole-body low-dose computed tomography(CT),whole-body magnetic resonance imaging(MRI)and18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of MM.Whole-body low-dose CT is used increasingly,replacing conventional radiography at selected centers,due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions.The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and18F-FDG PET/CT.According to current evidence,MRI is the most sensitive method for initial staging while18F-FDG PET/CT allows monitoring of treatment of MM.There is an evolving role for assessment of treatment response using newer MR imagingtechniques.Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.展开更多
Over recent years,[18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography(FDG-PET/CT)has proven its role as a staging modality in patients with non-small cell lung can...Over recent years,[18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography(FDG-PET/CT)has proven its role as a staging modality in patients with non-small cell lung cancer(NSCLC).The purpose of this review was to present the evidence to use FDG-PET/CT for response evaluation in patients with NSCLC,treated with epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitors(TKI).All published articles from 1November 2003 to 1 November 2013 reporting on 18FFDG-PET response evaluation during EGFR-TKI treatment in patients with NSCLC were collected.In total 7studies,including data of 210 patients were eligible for analyses.Our report shows that FDG-PET/CT responseduring EGFR-TKI therapy has potential in targeted treatment for NSCLC.FDG-PET/CT response is associated with clinical and radiologic response and with survival.Furthermore FDG-PET/CT response monitoring can be performed as early as 1-2 wk after initiation of EGFR-TKI treatment.Patients with substantial decrease of metabolic activity during EGFR-TKI treatment will probably benefit from continued treatment.If metabolic response does not occur within the first weeks of EGFR-TKI treatment,patients may be spared(further)unnecessary toxicity of ineffective treatment.Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.展开更多
Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative rese...Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical <sup>18</sup>F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.展开更多
Helicobacter pylori (H. pylori ) is a pathogen and the most frequent cause of gastric ulcers. There is also a close correlation between the prevalence of H. pylori infection and the incidence of gastric cancer. We pre...Helicobacter pylori (H. pylori ) is a pathogen and the most frequent cause of gastric ulcers. There is also a close correlation between the prevalence of H. pylori infection and the incidence of gastric cancer. We present the case of a 38-year-old woman referred by her primary care physician for screening positron emission tomography-computed tomography (PET-CT), which showed a nodular strong accumulation point with standardized uptake value 5.6 in the gastric fundus. Gastroscopy was then performed, and a single arched ulcer, 12 mm in size, was found in the gastric fundus. Histopathological examination of the lesion revealed chronic mucosal inflammation with acute inflammation and H. pylori infection. There was an obvious mitotic phase with widespread lymphoma. Formal anti-H. pylori treatment was carried out. One month later, a gastroscopy showed a single arched ulcer, measuring 10 mm in size in the gastric fundus. Histopathological examination revealed chronic mucosal inflammation with acute inflammation and a very small amount of H. pylori infection. The mitotic phase was 4/10 high power field, with some heterotypes and an obvious nucleolus. Follow-up gastroscopy 2 mo later showed the gastric ulcer in stage S2. The mucosal swelling had markedly improved. The patient remained asymptomatic, and a follow-up PET-CT was performed 6 mo later. The nodular strong accumulation point had disappeared. Follow-up gastroscopy showed no evidence of malignant cancer. H. pylori-associated severe inflammation can lead to neoplastic changes in histiocytes. This underscores the importance of eradicating H. pylori , especially in those with mucosal lesions, and ensuring proper follow-up to prevent or even reverse early gastric cancer.展开更多
AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a...AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.展开更多
Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluor...Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as <sup>11</sup>C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.展开更多
AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches usin...AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.展开更多
AIM: To evaluate the influence of baseline maximum standardized uptake value(SUVmax) on survival in a cohort of patients, undergoing positron emission tomography-computed tomography(PET-CT) scan for esophageal carcino...AIM: To evaluate the influence of baseline maximum standardized uptake value(SUVmax) on survival in a cohort of patients, undergoing positron emission tomography-computed tomography(PET-CT) scan for esophageal carcinoma. METHODS: The pre-treatment SUVmax numeric reading was determined in patients with confirmed esophageal or junctional cancer having PET-CT scan during the time period 1st January 2007 until 31 st July 2012. A minimum follow up of 12 mo was required. Patients were subdivided into quartiles according to SUVmax value and the influence of SUVmax on survival was assessed using univariate and multivariate analysis. The following pre-treatment factors were investigated: patient characteristics, tumor characteristics and planned treatment. RESULTS: The study population was 271 patients(191male) with esophageal or junctional carcinoma. The median age was 65 years(range 40-85) and histologic subtype was adenocarcinoma in 197 patients and squamous carcinoma in 74 patients. The treatment intent was radical in 182 and palliative in 89 patients. SUVmax was linked to histologic subtype(P = 0.008), tumor site(P = 0.01) and Union for International Cancer Control(UICC) stage(P < 0.001). On univariate analysis, prognosis was significantly associated with SUVmax(P = 0.001), T-stage(P < 0.001) and UICC stage(P < 0.001). On multivariate analysis, only T-stage and UICC stage remained significant. CONCLUSION: Pretreatment SUVmax was not a useful marker in isolation for determining prognosis of patients with esophageal carcinoma.展开更多
基金Supported by National Natural Science Foundation of China,No.82300604Science and Technology Innovation Action Plan Star Project Application Guide/Star Project Incubation(Yangfan Special Program)of Shanghai,No.24YF2727600.
文摘BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The exact etiology of this condition remains unclear.Neutrophils play a critical role in IBD pathogenesis.Translocator protein(TSPO),a mitochondrial protein linked to immune responses,has demonstrated potential as an inflammatory marker.However,its role in IBD remains underexplored.AIM To investigate the role of TSPO in IBD pathogenesis,particularly in neutrophils.METHODS Bioinformatics analyses of Gene Expression Omnibus datasets(GE75214,GSE94648,GSE156776)assessed TSPO expression in IBD patients.TSPO expression was evaluated in human IBD samples,neutrophiles and a chronic colitis mouse model.Neutrophil function was examined in 18 samples using reactive oxygen species(ROS)production and neutrophil extracellular trap(NET)formation assays.Positron emission tomography-computed tomography(PET-CT)imaging and histology from 12 mice revealed TSPO expression in colitis.PET-CT and immunofluorescence staining assessed TSPO expression in brain under neuroinflammation condition.RESULTS Bioinformatics analysis revealed elevated TSPO expression in the intestinal mucosa and peripheral blood of patients with IBD,especially in neutrophils.This was confirmed by quantitative real-time polymerase chain reaction and immunohistochemical staining,which showed a significant upregulation of TSPO in active IBD.Neutrophils from patients with UC and CD exhibited higher TSPO expression,which correlated with increased ROS production and NET formation.In a mouse model of dextran sodium sulfate-induced chronic colitis,TSPO was upregulated in the colonic neutrophils and brain tissues,indicating its systemic involvement.PET-CT imaging showed enhanced TSPO uptake in the inflamed colon and brain regions,particularly in the microglia,highlighting neuroinflammation.CONCLUSION TSPO is significantly upregulated in neutrophils in IBD and contributes to intestinal inflammation.Its elevated expression in gut highlights its potential as a promising therapeutic target for IBD.
基金Supported by the Natural Science Foundation of Hunan Province,China,No.2023JJ30462Hunan Provincial Department of Science and Technology,No.2023SK2045,No.22JBZ007 and No.Z2023JB01Graduate Research and Innovation Projects of Hunan Province,No.2024CX031.
文摘BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence suggests that electroacupuncture(EA)at ST36 modulates gastrointestinal function;however,the precise neuromolecular pathways underlying its efficacy in DGP remain incompletely defined.AIM To elucidate the neural mechanisms underlying EA at ST36 improving DGP gastric motility through the nucleus tractus solitarius(NTS)-vagal axis.METHODS The DGP model was established via a single high-dose intraperitoneal injection of 2%streptozotocin combined with an 8-week high-sugar/high-fat diet.Interventions included EA at ST36,pharmacological modulation[choline acetyltransferase(ChAT)agonist polygalacic acid(PA)and inhibitor antagonist alpha-NETA],and subdiaphragmatic vagotomy.Post-intervention observations included body weight and blood glucose levels.Gastric emptying was evaluated using phenol red assays,gastric slow-wave recordings,and dynamic positron emission tomography-computed tomography imaging.Histopathological analysis(hematoxylineosin staining)and molecular assessments(Western blot,immunofluorescence)were performed to quantify gastric smooth muscle-associated factors[neuronal nitric oxide synthase(nNOS),cluster of differentiation 117(C-kit),stem cell factor(SCF)]and vagal targets[ChAT,α7 nicotinic acetylcholine receptor(α7nAChR)]in the ST36 acupoint region,L4-L6 spinal segments,and NTS.Gastrointestinal peptides[gastrin(Gas),motilin(MLT)and vasoactive intestinal peptide(VIP)]were measured via enzyme-linked immunosorbent assay.RESULTS The study found that EA significantly increased the rate of gastric emptying,restored the slow-wave rhythms of the stomach,and improved the architecture of the smooth muscles in the stomach.This was evidenced by a reduction in inflammatory infiltration and an increase in the expression of nNOS,C-kit,and SCF.Mechanistically,EA activated vagal targets(ChAT andα7nAChR)at ST36,transmitting signals via spinal segments L4-L6 to the NTS,subsequently regulating gastrointestinal peptides(Gas,MLT,VIP)and restoring interstitial cells of Cajal(ICCs)function via subdiaphragmatic vagal efferent pathways.It is crucial to note that subdiaphragmatic vagotomy led to the abrogation of EA-induced enhancements in gastric motility and ICC recovery,thereby confirming the indispensable role of vagal efferent signalling.CONCLUSION EA provides a novel molecular mechanism for improving gastrointestinal motility in DGP via a peripheral stimulation(ST36),spinal afferent(L4-L6),brainstem integration(NTS),vagal efferent(gastric)circuit.
文摘Background： The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery （VATS） combined with positron emitted tomography （PET）-computed tomography （CT） in the diagnosis of patients with early （Stage 1） sarcoidosis. Methods： From 1995 to 2006, seven patients （two males, five females）, with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis （mediastinal or hilar lymph nodes involvements without lung involvement） by histological examination of intrathoracic lymph nodes （LNs） and/or lung parenchyma taken＇from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results： All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion： VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic altermative of transbronchial lung biopsy （TBLB）, and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.
文摘BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment.Positron emission tomography-computed tomography(PET-CT)is routinely performed as a follow-up study in cancer patients after therapy.Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.AIM To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.METHODS Our prospective study received Institutional Review Board approval.Written informed consent was obtained from all patients,who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study,between March 2015 and April 2019.Patients with advanced glenohumeral arthrosis,metastatic disease or other mass in the shoulder,or shoulder arthroplasty were excluded.Patterns of shoulder capsule 18F-fluorodeoxyglucose(FDG)uptake were noted.Standard Uptake Value(SUV)max and SUVmean values were measured at rotator interval(RI)and deltoid muscle in bilateral shoulders.Normalized SUV(SUV of RI/SUV of deltoid muscle)was also calculated.We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders.Covariates were age,gender,and therapy type(surgery,chemotherapy,radiation).Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age,SUV measurements between symptomatic and asymptomatic patients.Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status,after adjusting for covariates.Statistical significance level was set at P<0.05.RESULTS Of 252 patients initially enrolled for the study(mean age 66 years,67 symptomatic),shoulder PET-CT data were obtained in 200 patients(52 were excluded due to exclusion criteria above).The most common cancer types were lymphoma(n=61),lung(n=54)and breast(n=53).No significant difference was noted between symptomatic and asymptomatic patients in terms of age,gender,proportion of patients who had surgical therapy and radiation therapy.A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder(65%vs 48%,P=0.012).No such difference was seen for the left shoulder.In both shoulders,SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders(Left SUVmax 2.0 vs 1.6,SUVmean 1.6 vs 1.3,both P<0.002;Right SUVmax 2.2 vs 1.8,SUVmean 1.8 vs 1.5,both P<0.01).For lung cancer patients,bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders.For other cancer patients,symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.CONCLUSION In symptomatic patients metabolic activities in RI were higher than asymptomatic patients.Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.
基金Supported by the National Natural Science Foundation of China (No.81900912)Fundamental Research Funds for the Central Universities (No.YCJJ20230109).
文摘This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man.A literature review was conducted to explore recent advances in detecting,diagnosing,and treating intraocular metastatic malignancies.Positron emission tomographycomputed tomography played a crucial role in identifying primary sites and systemic metastases.Local treatment combined with systemic therapy effectively reduced tumor size,preserved useful vision,and improved the patient’s survival rate.A comparison was made of the characteristics of iris metastases from esophageal cancer and lung cancer,including age,gender,tumor characteristics,and treatment.The challenges associated with diagnosis and treatment are discussed,highlighting the implications for clinical practice.
基金Supported by the Technology Innovation Leading Program of Shaanxi,No.2023KXJ-095the Shaanxi Provincial People's Hospital Science and Technology Talent Support Program for Elite Talents,No.2021JY-38 and No.2021JY-50the Shaanxi Provincial People's Hospital Science and Technology Development Incubation Foundation,No.2023YJY-39.
文摘BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.
文摘BACKGROUND Bone is one of the common sites of metastasis from prostate carcinoma.Bone scintigraphy(BS)is one of the most sensitive imaging modalities currently used for bone metastatic work-up.Skeletal metastasis in prostate carcinoma commonly involves pelvic bones but rarely involves extrapelvic-extraspinal sites.AIM To retrospectively analyze the BS data to determine the pattern of skeletal metastases in the prostate carcinoma.METHODS This retrospective observational study involves patients with biopsy-proven prostate carcinoma referred for BS for staging assessment.Patients with abnormal BS were evaluated for the pattern of skeletal involvement and data were pre-sented in descriptive format in the form of percentages.RESULTS A total of 150 patients with biopsy-proven prostate cancer who were referred for staging were included in the study.Thirteen of 150 patients(8.67%)had no abnormal uptake on planar images,ruling out metastatic disease.Twenty-four patients(16%)had heterogeneous uptake in the spine with distribution charac-teristic of degenerative disease and no scan pattern of metastatic disease.Thirty patients(20%)had multifocal uptake involving both pelvic and extra pelvic bones on planar images typical for skeletal metastasis and were considered metastatic.Eighty-three out of 150 patients(55.3%)had increased tracer uptake,which was indeterminate,thus,single photon emission computed tomography-computed tomography(SPECT-CT)was acquired,which showed 51 with metastatic disease,31 benign lesions,and one indeterminate finding.Seven of 150 patients had exclusive pelvic bone uptake,which was found to be metastatic in 4/7 patients in SPECT-CT.Fifty six out of 150 patients showed exclusive extrapelvic tracer uptake,of which only 3 had vertebral metastatic disease.None of the patients with increased uptake exclusively in the extrapelvic-extraspinal location was metastatic.CONCLUSION The incidence of exclusive extrapelvic skeletal metastatic disease in prostate carcinoma is 2%(excluding one patient with indeterminate findings).Further,none of the patients in the current study had exclusive extrapelvic-extraspinal metastasis.Thus,exclusive extrapelvic-extraspinal focal abnormality on planar BS carries a very low probability of metastatic disease and hence,further imaging or SPECT-CT can be safely avoided in such cases.
文摘One of the leading causes of cancer-related death is gastrointestinal cancer,which has a significant morbidity and mortality rate.Although preoperative risk assessment is essential for directing patient care,its biological behavior cannot be accurately predicted by conventional imaging investigations.Potential pathophysiological information in anatomical imaging that cannot be visually identified can now be converted into high-dimensional quantitative image features thanks to the developing discipline of molecular imaging.In order to enable molecular tissue profile in vivo,molecular imaging has most recently been utilized to phenotype the expression of single receptors and targets of biological therapy.It is expected that molecular imaging will become increasingly important in the near future,driven by the expanding range of biological therapies for cancer.With this live molecular fingerprinting,molecular imaging can be utilized to drive expression-tailored customized therapy.The technical aspects of molecular imaging are first briefly discussed in this review,followed by an examination of the most recent research on the diagnosis,prognosis,and potential future clinical methods of molecular imaging for GI tract malignancies.
文摘Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.
文摘The purpose of this article is to provide a pictorial review of the findings and interpretative pitfalls about focal fluorodeoxyglucose(FDG)uptake in the absence of corresponding computer tomography(CT)lesion or abnormality on an integrated positron emission tomography(PET)-CT.The integrated CT images in the PET-CT scanner allow correct co-registration and fused imaging of anatomical and functional data.On FDG PET-CT imaging,a real pathologic process often demonstrates abnormal uptake associated with a visible corresponding CT lesion or abnormality.When focal uptake is seen on PET imaging but no corresponding anatomic abnormality is visualized on the integrated CT,one should always be aware of possible mis-registration or mismatch of the PET and CT images due to the patient’s respiratory or body motion.While most of the hot spots in the absence of corresponding anatomic abnormalities are artefactual or secondary to benign etiologies,some may represent small sized or early staged neoplasm or metastases,especially in the gastrointestinal tract and skeletons.Caution should be exercised to simply diagnose a pathology based on the presence of the uptake only,or exclude the disease based on the absence of anatomic abnormality.
文摘Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. Herein, we report preliminary data from a phase I/II study testing the combination of cetuximab with inductive chemotherapy, followed by concurrent CRT （CCRT） in Chinese patients with stage III NSCLC. Methods： Eligibility criteria were Zubrod performance status （PS） 0-1, forced expiratory volume in 1 second （FEV1） 〉_1.2 L and adequate organ function. Enrolled patients received weekly cetuximab （initial dose of 400 mg/m2 on day 1 of week 1 and a maintenance dose of 250 mg/m2 on week 2 to the end of CCRT） with cisplatin/vinorelbine （NP） chemotherapy （every 3 weeks for 2 cycles from week 2, followed by two cycles of concomitant NP chemotherapy and intensity-modulated thoracic radiotherapy （TRT） （60-66 Gy/2 Gy）. The primary endpoints were toxicity and feasibility. All patients received positron emission tomography- computerized tomography （PET-CT） scans within the 2 weeks prior to enrollment. Univariate analyses were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumor-node- metastasis （TNM） stage, PS and smoking status and survival. Survival curves were generated for different populations using the Kaplan-Meier method and compared using a log-rank test. Results： Seventeen patients were enrolled and 16 completed the full regime. The overall response rate （ORR） was 58.8% and 82.3% after the induction and CCRT phases, respectively. With a median follow-up duration of 27.6 months, the median survival was 27.6 months [95% confidence interval （CI）： 11.3-43.9 months] with 1- and 2-year survival rates of 88.2% （95% CI, 60.6-96.9%） and 58.8% （95% CI, 60.6-77.8%）, respectively. Three patients remain progression-free to date, and the median progression-free survival （PFS） was 13.5 months （95% CI, 6.8-20.2 months）. No treatment-related death occurred; however, 76% of the patients experienced grade 3＋ adverse events （AEs）, including nansea/vomiting, intestinal obstruction, and esophagitis （〈6%）, while other AEs were mostly of hematological nature （71%）. The cut-off values for SUV-T and SUV-TOTAL were 11 and 20, respectively. Univariate analyses revealed SUV-TOTAL （P=0.027）, SUV-T （P=0.025）, and PS （P=0.006） as potential survival predictors, with a hazard ratio （HR） of 3.4, 3.7, and 9.9, respectively. Conclusions： The combination of cetuximab with induction chemotherapy followed by CCRT appears feasible and promising. Local and locoregional maximal SUVs, defined by 18F-FDG PET-CT scanning, may represent a prognostic indicator for long-term survival for these patients, which warrants further study.
文摘Intracranial metastasis of liver cancer is rare,and diplopia as the first manifestation is even more rare.This article aims to introduce a patient with sudden diplopia in a middle-aged man.Physical examination revealed left abductor nerve palsy,craniocerebral magnetic resonance imaging(MRI)showed intracranial metastatic tumor,and positron emission tomography-computer tomography(PET-CT)tracing of the original lesion detected the primary liver cancer.This paper provides clinical data for intracranial metastasis of primary liver cancer and the possible pathogenesis and mechanism of sudden diplopia.
文摘Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma(MM)from other monoclonal plasma cell diseases.Conventional radiography represents the reference standard for diagnosis of MM due to its wide availability and low costs despite its known limitations such as low sensitivity,limited specificity and its inability to detect extraosseous lesions.Besides conventional radiography,newer cross-sectional imaging modalities such as whole-body low-dose computed tomography(CT),whole-body magnetic resonance imaging(MRI)and18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of MM.Whole-body low-dose CT is used increasingly,replacing conventional radiography at selected centers,due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions.The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and18F-FDG PET/CT.According to current evidence,MRI is the most sensitive method for initial staging while18F-FDG PET/CT allows monitoring of treatment of MM.There is an evolving role for assessment of treatment response using newer MR imagingtechniques.Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.
文摘Over recent years,[18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography(FDG-PET/CT)has proven its role as a staging modality in patients with non-small cell lung cancer(NSCLC).The purpose of this review was to present the evidence to use FDG-PET/CT for response evaluation in patients with NSCLC,treated with epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitors(TKI).All published articles from 1November 2003 to 1 November 2013 reporting on 18FFDG-PET response evaluation during EGFR-TKI treatment in patients with NSCLC were collected.In total 7studies,including data of 210 patients were eligible for analyses.Our report shows that FDG-PET/CT responseduring EGFR-TKI therapy has potential in targeted treatment for NSCLC.FDG-PET/CT response is associated with clinical and radiologic response and with survival.Furthermore FDG-PET/CT response monitoring can be performed as early as 1-2 wk after initiation of EGFR-TKI treatment.Patients with substantial decrease of metabolic activity during EGFR-TKI treatment will probably benefit from continued treatment.If metabolic response does not occur within the first weeks of EGFR-TKI treatment,patients may be spared(further)unnecessary toxicity of ineffective treatment.Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.
文摘Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical <sup>18</sup>F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.
文摘Helicobacter pylori (H. pylori ) is a pathogen and the most frequent cause of gastric ulcers. There is also a close correlation between the prevalence of H. pylori infection and the incidence of gastric cancer. We present the case of a 38-year-old woman referred by her primary care physician for screening positron emission tomography-computed tomography (PET-CT), which showed a nodular strong accumulation point with standardized uptake value 5.6 in the gastric fundus. Gastroscopy was then performed, and a single arched ulcer, 12 mm in size, was found in the gastric fundus. Histopathological examination of the lesion revealed chronic mucosal inflammation with acute inflammation and H. pylori infection. There was an obvious mitotic phase with widespread lymphoma. Formal anti-H. pylori treatment was carried out. One month later, a gastroscopy showed a single arched ulcer, measuring 10 mm in size in the gastric fundus. Histopathological examination revealed chronic mucosal inflammation with acute inflammation and a very small amount of H. pylori infection. The mitotic phase was 4/10 high power field, with some heterotypes and an obvious nucleolus. Follow-up gastroscopy 2 mo later showed the gastric ulcer in stage S2. The mucosal swelling had markedly improved. The patient remained asymptomatic, and a follow-up PET-CT was performed 6 mo later. The nodular strong accumulation point had disappeared. Follow-up gastroscopy showed no evidence of malignant cancer. H. pylori-associated severe inflammation can lead to neoplastic changes in histiocytes. This underscores the importance of eradicating H. pylori , especially in those with mucosal lesions, and ensuring proper follow-up to prevent or even reverse early gastric cancer.
文摘AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.
文摘Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as <sup>11</sup>C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.
文摘AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.
文摘AIM: To evaluate the influence of baseline maximum standardized uptake value(SUVmax) on survival in a cohort of patients, undergoing positron emission tomography-computed tomography(PET-CT) scan for esophageal carcinoma. METHODS: The pre-treatment SUVmax numeric reading was determined in patients with confirmed esophageal or junctional cancer having PET-CT scan during the time period 1st January 2007 until 31 st July 2012. A minimum follow up of 12 mo was required. Patients were subdivided into quartiles according to SUVmax value and the influence of SUVmax on survival was assessed using univariate and multivariate analysis. The following pre-treatment factors were investigated: patient characteristics, tumor characteristics and planned treatment. RESULTS: The study population was 271 patients(191male) with esophageal or junctional carcinoma. The median age was 65 years(range 40-85) and histologic subtype was adenocarcinoma in 197 patients and squamous carcinoma in 74 patients. The treatment intent was radical in 182 and palliative in 89 patients. SUVmax was linked to histologic subtype(P = 0.008), tumor site(P = 0.01) and Union for International Cancer Control(UICC) stage(P < 0.001). On univariate analysis, prognosis was significantly associated with SUVmax(P = 0.001), T-stage(P < 0.001) and UICC stage(P < 0.001). On multivariate analysis, only T-stage and UICC stage remained significant. CONCLUSION: Pretreatment SUVmax was not a useful marker in isolation for determining prognosis of patients with esophageal carcinoma.
