Cross-modality PET/CT and contrast-enhanced CT imaging for pancreatic cancer

AIM:To explore the diagnostic value of the crossmodality fusion images provided by positron emission tomography/computed tomography(PET/CT) and contrast-enhanced CT(CECT) for pancreatic cancer(PC).METHODS:Data from 70 patients with pancreatic lesions who underwent CECT and PET/CT examinations at our hospital from August 2010 to October 2012were analyzed.PET/CECT for the cross-modality image fusion was obtained using Ture D software.The diagnostic efficiencies of PET/CT,CECT and PET/CECT were calculated and compared with each other using aχ2 test.P<0.05 was considered to indicate statistical significance.RESULTS:Of the total 70 patients,50 had PC and 20had benign lesions.The differences in the sensitivity,negative predictive value(NPV),and accuracy between CECT and PET/CECT in detecting PC were statistically significant(P<0.05 for each).In 15 of the 31patients with PC who underwent a surgical operation,peripancreatic vessel invasion was verified.The differences in the sensitivity,positive predictive value,NPV,and accuracy of CECT vs PET/CT and PET/CECT vs PET/CT in diagnosing peripancreatic vessel invasionwere statistically significant(P<0.05 for each).In 19of the 31 patients with PC who underwent a surgical operation,regional lymph node metastasis was verified by postsurgical histology.There was no statistically significant difference among the three methods in detecting regional lymph node metastasis(P>0.05for each).In 17 of the 50 patients with PC confirmed by histology or clinical follow-up,distant metastasis was confirmed.The differences in the sensitivity and NPV between CECT and PET/CECT in detecting distant metastasis were statistically significant(P<0.05 for each).CONCLUSION:Cross-modality image fusion of PET/CT and CECT is a convenient and effective method that can be used to diagnose and stage PC,compensating for the defects of PET/CT and CECT when they are conducted individually.

Comparison of diagnostic accuracy between ^(18)F-FDG PET and PET/CT for pulmonary neoplasm

Aimed at comparing diagnostic accuracy of 18F-FDG PET with PET/CT for pulmonary neoplasm, a study based on multi-center clinical trial of the diagnoses, in randomized and semi-blind ways, was executed from January 2006 to June 2007. It included 55 patients, i.e. 16 with histopathologically proved lung tumors, 16 with tuberculosis and 23 with benign lesions (inflammation, pseudotumor, granuloma, fibrosis and others). The histopathologic and clinic results were served as reference standard. Statistical significances in pulmonary nodule diagnosis between 18F-FDG PET and PET/CT were determined with 95% confidence interval obtained by ROC analysis. The 18F-FDG PET detected lung neoplasm with a sensitivity of 87.5% (14/16), a specificity of 59.0% (23/39), an accuracy of 67.3% (37/55) and a positive-likelihood ratio of 2.13. The 18F-FDG PET/CT detected lung neoplasm with a sensitivity of 93.8% (15/16), a specificity of 61.5% (24/39), an accuracy of 70.9% (39/55) and a positive-likelihood ratio of 2.43. The area under curves (AUC) of 18F-FDG PET and PET/CT were 0.803±0.068 and 0.799±0.063, respectively. It can be concluded that the diagnostic accuracy for malignant pulmonary nodules between 18F-FDG PET and PET/CT was not statistically different.

PET/CT with ¹⁸F-PSMA in Patients with Prostate Cancer, Review of the Initial Experience

METHOD: We carry out an observational study where reviewed the PET/CT studies with PSMA marked with Fluor-18 (18F) carried out from February 2019 to September 2020. We analyzed the average value of hepatic uptake SUV lean average (SUVlave), acquisition time, age, reason from the study, focal, multifocal and diffuse prostate uptake, analysis of the location of metastases, level of prostate specific antigen (PSA), we describe uptakes of non-prostate origin and focal uptakes in ribs without anatomical representation. RESULTS: The average hepatic SUVlave was 9.7, the acquisition times were variable (52 - 183 minutes) without alterations in the white-background relationship, the most frequent indication for the study was staging, the uptake in ribs without anatomical representation were considered benign with certain characteristics, PET/CT has the ability to detect neoplastic activity with low PSA levels in lymph nodes < 5 mm and bone metastatic status. CONCLUSION: PET/CT with 18F-PSMA has advantages over bone scan and computed tomography of the abdomen and pelvis for the staging of prostate cancer.

Preliminary PET/CT Study of ^(18)F-FDG Uptake in Cervical and Supraclavicular Brown Adipose Tissue

OBJECTIVE The clinical use of PET/CT in oncology has led to the realization that 18F-FDG uptake in brown adipose tissue(BAT) can be a common cause of potentially misleading false-positive PET scans.The goal of this study was to study 18F-FDG uptake in cervical and supraclavicular regions and its characteristics with PET/CT.METHODSAll the PET/CT scans obtained at our institutionfrom July 2007 to January 2008 were retrospectively reviewed forincreased 18F-FDG uptake in BAT.The cases in which increased18F-FDG in cervical and supraclavicular regions was not localizedto a so -tissue mass or lymph node or muscle on the CT images,were included in this study.The following features were recorded:body weight,body mass index(BMI) and maximal standardizeduptake value(SUVmax).In these selected patients,the BAT uptake in other area of the body was also recorded.RESULTS PET/CT scans were obtained in 457 patients(259 males and 198 females).In all of the scans,cervical and supraclavicular BAT uptake was observed in 12 patients(2 males and 10 females) and was typically bilateral,symmetric and intense.The range of the SUVmax was 3.6～12.82(mean 6.9 ± 2.6).BAT uptake was more common in females than in males,showing a significant difference(P = 0.004).Although 18F-FDG uptake in BAT occurred more o en in underweight patients with low BMI,there was no difference in the body weight(P = 0.607) or BMI(P = 0.491) of these patients with hypermetabolic BAT compared with controls.CONCLUSION Hypermetabolic BAT uptake can be localized in cervical and supraclavicular regions with it occurring more commonly in females compared to males.Knowledge of this potential pitfall with PET/CT is important in improving diagnostic interpretation and accurate staging.

The role of radiotherapy in patients with refractory Hodgkin’s lymphoma after treatment with brentuximab vedotin and/or immune checkpoint inhibitors

Background:Approximately 10%–30%of patients with Hodgkin’s lymphoma(HL)experience relapse or refractory(R/R)disease after first-line standard therapy.Brentuximab vedotin(BV)and immune checkpoint inhibitors(ICIs)have important roles in the salvage treatment of R/R HL.However,subsequent treatment for HL refractory to BV and/or ICI treatment is challenging.Methods:We retrospectively analyzed patients in two institutions who had R/R HL,experienced BV or ICI treatment failure,and received radiotherapy(RT)thereafter.The overall response rate(ORR),duration of response(DOR),progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Overall,19 patients were enrolled.First-line systemic therapy comprised doxorubicin,bleomycin,vinblastine,and dacarbazine(ABVD,84.2%);AVD plus ICIs(10.5%);and bleomycin,etoposide,doxorubicin,cyclophosphamide,vincristine,procarbazine,and prednisone(BEACOPP,5.3%).After first-line therapy,15(78.9%)and four patients(21.1%)had refractory disease and relapsed,respectively.After R/R HL diagnosis,six(31.6%),two(10.5%),and 11(57.9%)patients received BV and ICIs concurrently,BV monotherapy,and ICI monotherapy,respectively.All patients received intensity-modulated RT(n=12,63.2%)or volumetric modulated arc therapy(VMAT;n=7,36.8%).The ORR as well as the complete response(CR)rate was 100%;the median DOR to RT was 17.2 months(range,7.9–46.7 months).Two patients showed progression outside the radiation field;one patient had extensive in-field,out-of-field,nodal,and extranodal relapse.With a median follow-up time of 16.2 months(range,9.2–23.2 months),the 1-year PFS and OS were 84.4%and 100%,respectively.PFS was associated with extranodal involvement(P=0.019)and gross tumor volume(P=0.044).All patients tolerated RT well without adverse events of grade≥3.Conclusion:RT is effective and safe for treating HL refractory to BV or ICIs and has the potential to be part of a comprehensive strategy for HL.

Clinical-radiomics predictors to identify the suitability of transarterial chemoembolization treatment in intermediate-stage hepatocellular carcinoma:A multicenter study

Background: Although transarterial chemoembolization(TACE) is the first-line therapy for intermediatestage hepatocellular carcinoma(HCC), it is not suitable for all patients. This study aimed to determine how to select patients who are not suitable for TACE as the first treatment choice. Methods: A total of 243 intermediate-stage HCC patients treated with TACE at three centers were retrospectively enrolled, of which 171 were used for model training and 72 for testing. Radiomics features were screened using the Spearman correlation analysis and the least absolute shrinkage and selection operator(LASSO) algorithm. Subsequently, a radiomics model was established using extreme gradient boosting(XGBoost) with 5-fold cross-validation. The Shapley additive explanations(SHAP) method was used to visualize the radiomics model. A clinical model was constructed using univariate and multivariate logistic regression. The combined model comprising the radiomics signature and clinical factors was then established. This model’s performance was evaluated by discrimination, calibration, and clinical application. Generalization ability was evaluated by the testing cohort. Finally, the model was used to analyze overall and progression-free survival of different groups. Results: A third of the patients(81/243) were unsuitable for TACE treatment. The combined model had a high degree of accuracy as it identified TACE-unsuitable cases, at a sensitivity, specificity, and area under the receiver operating characteristic curve(AUC) of 0.759, 0.885, 0.906 [95% confidence interval(CI): 0.859-0.953] in the training cohort and 0.826, 0.776, and 0.894(95% CI: 0.815-0.972) in the testing cohort, respectively. Conclusions: The high degree of accuracy of our clinical-radiomics model makes it clinically useful in identifying intermediate-stage HCC patients who are unsuitable for TACE treatment.

Role of nesfatin-1 in a rat model of visceral hypersensitivity

AIM: To explore the role of nesfatin-1 on irritable bowel syndrome (IBS)-like visceral hypersensitivity. METHODS: The animal model of IBS-like visceral hypersensitivity was induced by intracolonic infusion of 0.5% acetic acid (AA) in saline once daily from postnatal days 8-21. Experiments were performed when rats became adults. The visceral sensitivity of rats was evaluated by abdominal withdrawal reflex (AWR) and electromyographic (EMG) activity of the external oblique muscle to graded colorectal distension. The content of nesfatin-1 in serum was determined using enzyme-linked immunosorbent assay. After implantation of an intracerebroventricular (ICV) cannula and two electrodes into the external oblique muscle, model rats were randomly divided into four groups. Animals then received ICV injection of 8 μg of anti-nesfatin-1/ nucleobindin-2 (NUCB2), 50 μg of α-helical cortico-tropin releasing factor (CRF) 9-41 (non-selective CRF receptor antagonist), 50 μg of NBI-27914 (selective CRF1 receptor antagonist) or 5 μL of vehicle. After 1 h of ICV administration, visceral sensitivity of each group was measured again, and comparisons between groups were made. RESULTS: Rats treated with AA showed higher mean AWR scores and EMG activity at all distension pressures compared with controls (P < 0.05). On histopathologic examination, no evidence of inflammation or abnormalities in structure were noted in the colon of either control or AA-treated groups. Myeloperoxidase values were not significantly different between the two groups. The level of nesfatin-1 in serum was significantly higher in the AA-treated group than in the control group (5.34 ± 0.37 ng/mL vs 4.81 ± 0.42 ng/mL, P < 0.01). Compared with rats injected with vehicle, rats which received ICV anti-nesfatin-1/NUCB2, α-helical CRF9-41 or NBI-27914 showed decreased mean AWR scores and EMG activity at all distension pressures (P < 0.05). CONCLUSION: Nesfatin-1 may be associated with IBS-like visceral hypersensitivity, which may be implicated in brain CRF/CRF1 signaling pathways.

Computed tomography, magnetic resonance imaging, and Fdeoxyglucose positron emission computed tomography/computed tomography findings of alveolar soft part sarcoma with calcification in the thigh: A case report

BACKGROUND Alveolar soft part sarcoma(ASPS)is an extremely rare malignant sarcoma,accounting for less than 1%of all soft-tissue sarcomas.However,limited information is available on multimodal imaging[computed tomography(CT),magnetic resonance imaging(MRI),and positron emission computed tomography/computed tomography(PET/CT)]of ASPS.CASE SUMMARY This study reports a case of a 35-year-old female patient with ASPS of the left thigh with lung metastasis.The patient presented with a 1-year history of a palpable mass in the lower extremity,which exhibited rapid growth for 3 wk.CT,MRI,and F-deoxyglucose PET/CT examinations were performed.CT showed a slightly hypodense or isodense mass with patchy calcifications.On MRI examination,the mass manifested hyperintensity on T1-weighted,T2-weighted,and diffusion-weighted images with some signal voids.PET/CT images demonstrated an intensely hypermetabolic mass in the left thigh and hypermetabolic nodules in lungs.CONCLUSION ASPS should be considered as a possible diagnosis when a slow-growing mass is detected in the soft tissue of the extremities,with hyperintensity and numerous signal voids on T1-weighted,T2-weighted,and diffusion-weighted images and intense F-deoxyglucose uptake on PET/CT.ASPS can have calcifications on CT.

An atlas of glucose uptake across the entire human body as measured by the total-body PET/CT scanner:a pilot study

Glucose uptake differs in organs and tissues across the human body.To date,however,there has been no single atlas providing detailed glucose uptake profiles across the entire human body.Therefore,we aimed to generate a detailed profile of glucose uptake across the entire human body using the uEXPLORER positron emission tomography/computed tomography scanner,which offers the opportunity to collect glucose metabolic imaging quickly and simultaneously in all sites of the body.The standardized uptake value normalized by lean body mass(SUL)of 18F-fluorodeoxyglucose was used as a measure of glucose uptake.We developed a fingerprint of glucose uptake reflecting the mean SULs of major organs and parts across the entire human body in 15 healthy-weight and 18 overweight subjects.Using the segmentation of organs and body parts from the atlas,we uncovered the significant impacts of age,sex,and obesity on glucose uptake in organs and parts across the entire body.A difference was recognized between the right and left side of the body.Overall,we generated a total-body glucose uptake atlas that could be used as the reference for the diagnosis and evaluation of disordered states involving dysregulated glucose metabolism.