Positron-emission tomography for hepatocellular carcinoma:Current status and future prospects

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer mortality worldwide.Various imaging modalities provide important information about HCC for its clinical management.Since positron-emission tomography(PET)or PET-computed tomography was introduced to the oncologic setting,it has played crucial roles in detecting,distinguishing,accurately staging,and evaluating local,residual,and recurrent HCC.PET imaging visualizes tissue metabolic information that is closely associated with treatment.Dynamic PET imaging and dual-tracer have emerged as complementary techniques that aid in various aspects of HCC diagnosis.The advent of new radiotracers and the development of immuno-PET and PET-magnetic resonance imaging have improved the ability to detect lesions and have made great progress in treatment surveillance.The current PET diagnostic capabilities for HCC and the supplementary techniques are reviewed herein.

Correlation of brain cell glucose metabolism and patient's condition in children with epileptic encephalopathy An assessment using fluorine-18-fluoro-2-deoxy-D-glucose positron emission computed tomography

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.

Retinal neurodegeneration in metabolic syndrome:a spectral optical coherence tomography study

AIM:To evaluate the effects of metabolic syndrome(Met S)on retinal neurodegeneration by optical coherence tomography(OCT).METHODS:Patients diagnosed as Met S were compared with the age and sex-matched healthy control group(CG).Waist circumference measurements,fasting serological biochemical tests,and systemic blood pressures of all participants were evaluated.The Met S group was divided into 3 subgroups according to the number of Met S components:hypertension,diabetes mellitus,dyslipidemia(low-,high-density lipoprotein,hypertriglyceridemia),and visceral obesity findings;3-component Met S3,4-component Met S4,and all-component Met S5.All patients underwent complete eye examination and spectral OCT retinal imaging.RESULTS:Totally 58 eyes of 58 patients were included in the Met S group and 63 eyes of 63 age and sex-matched healthy subjects were included in CG.Met S group was composed of 22 subjects in Met S3,21 subjects in Met S4,and 15 subjects in the Met S5 subgroup.Mean foveal thickness(Met S,218.7±23.1μm vs CG,228.8±21.9μm,P=0.015),mean inferior(Met S,283.4±17.0μm vs CG,288.7±38.4μm,P=0.002),superior(Met S,287.0±18.5μm vs CG 297.3±17.1μm,P=0.001),nasal(Met S 287.3±16.7μm vs CG 297.9±13.9μm,P=0.000)and temporal(274.5±17.6μm vs CG 285.6±13.6μm,P=0.000)thickness in the 3 mm Early Treatment of Diabetic Retinopathy Study(ETDRS)circle was significantly lower in the Met S group.There was no statistically significant difference in the mean inferior,superior,nasal,and temporal thickness of 6 mm ETDRS circle,total macular volume,peripapillary and macular retinal nerve fiber layer,macular ganglion cell layer with inner plexiform layer,and ganglion cell complex.No statistically significant difference was found in these values between the Met S3,Met S4,and the Met S5 groups.CONCLUSION:A significant reduction in central macular region thickness in Met S is detected and macular thickness is more susceptible to Met S induced neurodegeneration than peripapillary retinal nerve fiber layer.

Metabolic positron emission tomography imaging of cancer:Pairing lipid metabolism with glycolysis

The limitations of fluorine-18 fluorodeoxy-D-glucose (FDG) in detecting some cancers has prompted a longstanding search for other positron emission tomography (PET) tracers to complement the imaging of glycolysis in oncology, with much attention paid to lipogenesis based on observations that the production of various lipid and lipid-containing compounds is increased in most cancers. Radiolabeled analogs of choline and acetate have now been used as oncologic PET probes for over a decade, showing convincingly improved detection sensitivity over FDG for certain cancers. However, neither choline nor acetate have been thoroughly validated as lipogenic biomarkers, and while acetyl-CoA produced from acetate is used in de-novo lipogenesis to synthesize fatty acids, acetate is also consumed by various other synthetic and metabolic pathways, with recent experimental observations challenging the assumption that lipogenesis is its predominant role in all cancers. Since tumors detected by acetate PET are also frequently detected by choline PET, imaging of choline metabolism might serve as an alternative albeit indirect marker of lipogenesis, particularly if the fatty acids produced in cancer cells are mainly destined for membrane synthesis through incorporation into phosphatidylcholines. Aerobic glycolysis may or may not coincide with changes in lipid metabolism, resulting in combinatorial metabolic phenotypes that may have different prognostic or therapeutic implications. Consequently, PET imaging using dual metabolic tracers, in addition to being diagnostically superior to imaging with individual tracers, could eventually play a greater role in supporting precision medicine, as efforts to develop small-molecule metabolic pathway inhibitors are coming to fruition. To prepare for this advent, clinical and translational studies of metabolic PET tracers must go beyond simply estimating tracer diagnostic utility, and aim to uncover potential therapeutic avenues associated with these metabolic alterations.

Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positronemission tomography(18 F-FDG PET)scan for determining overall survival(OS)in breast cancer(BC)patients is controversial.AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years.METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008.PET positivity was determined by anatomical region of interest(AROI)findings for breast and axillary,sternal,and distant sites.The prognostic role of PET was examined as a qualitative binary factor(positive vs negative status)and as a continuous variable[maximum standard uptake value(SUVmax)]in multivariate survival analyses using Cox proportional hazards models.Among the 104 identified patients who received PET,36 were further analyzed for the SUVmax in the AROI.RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary(P=0.033),sternal(P=0.033),and combined PET-axillary/sternal(P=0.008)nodes.Poor disease-free survival was associated with PET-positive axillary status(P=0.040)and combined axillary/sternal status(P=0.023).Cox models confirmed the long-term prognostic value of combined PETaxillary/sternal status[hazard ratio(HR):3.08,95%confidence interval:1.42-6.69].SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25(P=0.048)and 1.54(P=0.029),corresponding to relative increase in the risk of death of 25%and 54%per SUVmax unit,respectively.In addition,the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor(P=0.027),with 1.94 HR,indicating a two-fold relative increase of mortality risk.CONCLUSION Preoperative PET is valuable for prediction of long-term survival.Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.

Findings of ¹⁸F-Fluorodeoxyglucose Positron-Emission Tomography in Methotrexate-Related Lymphoproliferative Disorder

Introduction: The use of methotrexate (MTX) for rheumatoid arthritis (RA) is increasing. However, the immune suppression state leads to the occurrence of lymphoproliferative disorder (MTX-LPD). The purpose of this study was to describe the findings of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in MTX-LPD patients, and compare it with non-MTX-related malignant lymphoma (ML). Materials and Methods: We retrospectively reviewed 11 MTX-LPD patients (9 female, mean age 68.3 years) and 21 ML patients (7 female, mean age 60.6 years) with a histopathological diagnosis. FDG-PET imaging was performed using a standard oncology procedure. We assessed the disease distribution based on FDG-PET images and measured the maximum standardized up take values (SUVmax) for each region. Results: Mean values of SUVmax in MTX-LPD and ML were 14.6 and 17.2, respectively (p = 0.49). In MTX-LPD, 55 lesions met the Cotswold classification, consisting of 37 nodal and 18 extranodal lesions. In ML, 82 lesions were found, consisting of 68 nodal and 14 extranodal lesions. MTX-LPD showed a higher incident of the involvement in extranodal lesions throughout the whole body (p < 0.001). Conclusion: Because this disease occurs widely throughout the whole body, we need to pay attention to the less frequent sites as well when performing PET imaging in patients with MTX-LPD.

Reduced macular thickness and vascular density in abnormal glucose metabolism patients:A meta-analysis of optical coherence tomography(OCT)and OCT angiography studies

Background:Alterations in macular thickness and vascular density before clinically visible diabetic retinopathy(DR)remain inconclusive.This study aimed to determine whether retinal manifestations in abnormal glucose metabolism(AGM)patients differ from those in the healthy individuals.Methods:PubMed,Embase,and Web of Science were searched between 2000 and 2021.The eligibility criteria were AGM patients without DR.Primary and secondary outcomes measured by optical coherence tomography(OCT)and OCT angiography(OCTA)were analyzed and expressed as standardized mean differences(SMDs)with 95%confidence intervals(CIs).A random-effects model was used in the data synthesis.The potential publication bias for the variables was evaluated using Egger’s test.Results:A total of 86 observational studies involving 13,773 participants and 15,416 eyes were included.OCT revealed that compared to healthy controls,the total macular thickness of AGM patients was thinner,including the thickness of fovea(-0.24,95%CI[-0.39,-0.08];P=0.002,I^(2)=87.7%),all regions of parafovea(-0.32,95%CI[-0.54,-0.11];P=0.003;I^(2)=71.7%)and the four quadrants of perifovea;the thickness of peripapillary retinal nerve fiber layer(pRNFL),macular retinal nerve fiber layer(mRNFL),and ganglion cell layer(GCL)also decreased.OCTA indicated that the superficial and deep vascular density decreased,the foveal avascular zone(FAZ)area enlarged,and the acircularity index(AI)reduced in AGM individuals.Conclusions:Retinal thinning and microvascular lesions have occurred before the advent of clinically detectable DR;OCT and OCTA may have the potential to detect these preclinical changes.Registration:PROSPERO;http://www.crd.york.ac.uk/prospero/;No.CRD42021269885.

Resuscitating acupuncture therapy for glucose metabolism in acute cerebral infarction of basal ganglia

BACKGROUND： Acupuncture can improve motor function in patients with cerebral infarction, and activate brain glucose metabolism in relevant brain areas. However, the association between encephalic region activation and acupuncture, as well as the clinical significance of activation remain unclear. OBJECTIVE： Through the use of positron emission tomography-computed tomography （PET-CT）, acute cerebral infarction patients were analyzed for global cerebral metabolism, cerebral infarction focus, peripheral edema, and pyramidal tract pathway changes, which were directly related to clinical symptoms. The influence of resuscitating acupuncture on cerebral glucose metabolism was analyzed in patients with acute cerebral infarction in basal ganglia. DESIGN, TIME AND SETTNG： Randomized, controlled, clinical trials were performed from March 2007 to October 2008 at the PET-CT Center of the General Hospital of Tianjin Medical University, China. PARTICIPANTS： Twelve patients with acute basal ganglia infarction were recruited from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin Chinese Medicine Hospital, and Affiliated Hospital of Medical College of Chinese People＇s Armed Police Force. METHODS： The cerebral infarcted patients were randomly assigned to acupuncture and control groups. In addition to routine treatment, the acupuncture group was treated by acupuncture at the main acupoints for resuscitation [Neiguan （PC 6）, Renzhong （DU 26）, and Sanyinjiao （SP 6）], while the control group received routine treatment. MAIN OUTCOME MEASURES： Before and after treatment, patients with acute cerebral infarction were evaluated for global brain, cerebral infarction focus, and surrounding edema and glucose metabolism in encephalic region of pyramidal tract conduction by 18-labeled fluorodeoxyglucose for PET-CT imaging. RESULTS： The resuscitating acupuncture therapy can significantly activate the metabolism of global brain, infarction center and surrounding edema in patients with cerebral infarction in basal ganglia, also has effects on the activation of glucose metabolism in the encephalic regions of pyramidal tract pathway （P 〈 0.05）. CONCLUSION： Resuscitating acupuncture was superior to routine treatment for significantly activating glucose metabolism in patients with acute cerebral basal ganglia infarction.

Positron emission tomography complete metabolic response as a favorable prog-nostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cis-platin/5-fluorouracil

BACKGROUND 18F-fluorodeoxyglucose-positron emission tomography(PET)/computed tomography is useful in diagnosing lymph node and distant metastases of esophageal cancer.However,its value for predicting survival is controversial.AIM To evaluate the value of PET complete metabolic response(CMR)as a prognostic predictor for esophageal cancer.METHODS Between June 2013 and December 2017,58 patients with squamous cell esophageal cancer who underwent neoadjuvant chemotherapy(NAC)in Oita University were enrolled in this retrospective cohort study.Tumors were clinically staged using fluorodeoxyglucose-PET/computed tomography before and after NAC.After NAC,maximal standardized uptake value≤2.5 was defined as PET-CMR,and maximal standardized uptake value>2.5 was defined as non-PET-CMR.We compared short-term outcomes between the PET-CMR group and non-PET-CMR group and evaluated prognostic factors by univariate and multivariate analyses.RESULTS The PET-CMR group included 22 patients,and the non-PET-CMR group included 36 patients.There were no significant differences in intraoperative and post operative complications between the two groups.Five-year relapse-free survival and overall survival in the PET-CMR group were significantly more favorable than those in the non-PET-CMR group(38.6 mo vs 20.8 mo,P=0.021;42.8 mo vs 25.1 mo,P=0.011,respectively).PET-CMR was a significant prognostic factor in terms of relapse-free survival by univariate analysis(hazard ratio:2.523;95%confidence interval:1.034–7.063;P<0.041).Particularly,PET-computed tomography negative N was an independent prognostic factor of relapse-free survival and overall survival by multivariate analysis.CONCLUSION PET-CMR after NAC is considered a favorable prognostic factor for esophageal cancer.Evaluation by PET-computed tomography could be useful in clinical decision making for esophageal cancer.

Molecular imaging and therapy targeting coppermetabolism in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the fifth most common cancer worldwide.Significant efforts have been devoted to identify new biomarkers for molecular imaging and targeted therapy of HCC.Copper is a nutritional metal required for the function of numerous enzymatic molecules in the metabolic pathways of human cells.Emerging evidence suggests that copper plays a role in cell proliferation and angiogenesis.Increased accumulation of copper ions was detected in tissue samples of HCC and many other cancers in humans.Altered copper metabolism is a new biomarker for molecular cancer imaging with position emission tomography(PET)using radioactive copper as a tracer.It has been reported that extrahepatic mouse hepatoma or HCC xenografts can be localized with PET using copper-64 chloride as a tracer,suggesting that copper metabolism is a new biomarker for the detection of HCC metastasis in areas of low physiological copper uptake.In addition to copper modulation therapy with copper chelators,short-interference RNA specific for human copper transporter 1(h Ctr1)may be used to suppress growth of HCC by blocking increased copper uptake mediated by h Ctr1.Furthermore,altered copper metabolism is a promising target for radionuclide therapy of HCC using therapeutic copper radionuclides.Copper metabolism has potential as a new theranostic biomarker for molecular imaging as well as targeted therapy of HCC.

Determination of Fragmentation Schemes and Metabolites of Fluorinated Histone Deacetylase Inhibitors for Use as Positron Emission Tomography Imaging Agents Using HPLC-MS/MS

High performance liquid chromatography coupled with tandem mass spectrometry was developed and validated as a method for the analysis of fluorinated histone deacetylase inhibitors (F-HDACi), and then employed to study their metabolism in biosystems. Four HDACi analogs labeled with the positron emission nuclide 18F constitute a group of potential positron emission tomography imaging agents, which were developed by the Institute of Nuclear Energy Research (INER) and coded as INER-1577 #1, #2, #3, and #4 during animal studies for the diagnosis of dementia. The performance of the method was found to be suitable for the determination of analog #3, and it was employed to determine the structures and fragmentation mechanisms of all four analogs and to study the biotransformations of analogs #3 and #4. The results indicated that the method used for the determination of analog #3 was suitable for determining the abundance of the analogs in chemical and biochemical tests with high precision, accuracy, reproducibility, and recovery. Weaknesses in the chemical bonding of the analogs were found to involve the fluoro, dimethylamino, and benzamide groups in a fragmentation mechanism deduced via tandem mass spectrometry. The metabolites of analogs #3 and #4 in rat liver microsomes and rat plasma were also identified to clarify their characteristic behaviors in biosystems. The major product of analogs #3 in liver microsomes was produced by hydroxylation of the benzylic carbon atom, but in rat plasma the metabolites of analog #3 were produced by hydrolysis of the benzamide group to give a diaminobiphenyl compound with the simultaneous replacement of a fluorine atom by a hydroxyl group. The metabolites of analog #4 in liver microsomes were produced by hydroxylation of the benzylic carbon atom and hydrolysis of the benzamide bond. The results of the studies characterized the chemical and biochemical behaviors of the series F-HADCi analogs.

EFFECT OF ELECTRO-SCALP ACUPUNCTURE ON GLUCOSE METABOLISM OF THE CEREBRAL REGIONS INVOLVING MENTAL ACTIVITY IN HEALTHY PEOPLE

Objective: To observe the effect of electro-scalp acupuncture on glucose metabolism of cerebral regions involving mental activity in healthy people. Methods: A total of 6 cases of volunteer healthy subjects (3 males and 3 females) ranging in age from 22 to 36 years were subjected to this study. Changes of cerebral glucose metabolism before and after electro-scalp acupuncture were observed by using positron emission tomography (PET) and semi-quantifying analysis method. Electro-scalp acupuncture stimulation (50 Hz, 2 mA) of Middle Line of Vertex (Ding zhongxian,顶中线,MS5), Middle Line of Forehead (Ezhongxian, 额中线,MS1) and bilateral Lateral Line 1 of Forehead (Epangyixian,额旁一线,MS2) was administered for 30 minutes. Then cerebral regions of interest (ROIs) were chosen and their average glucose metabolism levels (radioactivity of 18 fluorine deoxyglucose) were analyzed. Results: After administration of electro-scalp acupuncture, the glucose metabolism levels in bilateral frontal lobes and bilateral caudate nuclei, left cingulate gyrus and right cerebellum increased significantly in comparison with those of pre stimulation (P<0.05). Conclusion: Electro-scalp acupuncture of MSI, MS2 and MS5 can increase the glucose metabolism of certain cerebral regions involving mental activity in healthy subjects.

基于定量CT身体组分、^(18)F-FDG PET/CT显像预测手术联合新辅助化疗治疗早期乳腺癌预后的价值

目的 分析定量CT (QCT)身体组分、^(18)F-氟脱氧葡萄糖正电子发射型计算机断层显像(^(18)F-FDG PET-CT)对手术联合新辅助化疗(NAC)治疗早期乳腺癌患者预后的预测效能,为临床治疗提供参考。方法 选取2020年3月至2022年10月于南阳市第二人民医院接受手术联合NAC治疗的82例早期乳腺癌患者纳入研究,在NAC前和化疗1、3个周期后检测记录QCT参数[L_(1)、L_(2)水平的皮下脂肪面积(SFA)、内脏脂肪面积(VFA)、骨密度(BMD)、L_(3)水平的椎旁肌肉面积(TMA)]、^(18)F-FDG PET/CT显像的最大标准摄取值(SUV_(max))、肿瘤代谢体积(MTV)。NAC结束后进行手术,随访12个月(失访2例),依据有无复发转移分为预后良好组43例和预后不良组37例,比较不同预后患者的QCT参数、^(18)F-FDG PET/CT显像指标,采用受试者工作特征(ROC)曲线获取曲线下面积(AUC)分析其对早期乳腺癌患者预后的预测效能。结果化疗1个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(45.23±4.07) cm^(2)、(128.97±26.53) mg/m^(2)、(78.07±6.69) cm^(2)、(37.36±5.74) cm^(2),明显高于预后不良组的(42.52±3.32) cm^(2)、(112.54±25.82) mg/m^(2)、(73.73±7.25) cm^(2)、(32.94±5.31) cm^(2),差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(40.95±3.92) cm^(2)、(113.55±15.87) mg/m^(2)、(73.59±6.17) cm^(2)、(32.67±4.98) cm^(2),明显高于预后不良组的(37.51±3.56) cm^(2)、(95.18±17.45) mg/m^(2)、(70.30±5.14) cm^(2)、(28.52±4.42) cm^(2),差异均有统计学意义(P<0.05);化疗1个周期后,预后良好组患者的SUV_(max)、MTV分别为5.43±1.25、(3.86±0.87)×10^(4)mm,明显低于预后不良组的6.04±1.07、(4.27±0.85)×10^(4)mm,差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SUV_(max)、MTV分别为3.94±1.06、(2.61±0.70)×10^(4)mm,明显低于预后不良组的4.73±1.21、(3.05±0.93)×10^(4)mm,差异均有统计学意义(P<0.05);经ROC曲线分析结果显示,SFA、BMD、VFA、MA、SUV_(max)、MTV联合预测手术联合NAC治疗早期乳腺癌患者预后的AUC分别为0.898 (95%CI:0.809~0.954)、0.919 (95%CI:0.836~0.968)。结论 NAC过程中检测QCT参数、^(18)F-FDG PET/CT显像指标可预测手术联合NAC治疗早期乳腺癌患者的预后,联合预测的价值较高。

^(18)F-FDG与^(18)F-DPA-714 Micro PET/CT显像评价生酮饮食治疗阿尔茨海默病小鼠大脑代谢及神经炎症

目的探讨生酮饮食(KD)能否通过调节阿尔茨海默病模型小鼠大脑代谢及神经炎症促进认知。材料与方法将20只APP/PS1雄性小鼠随机分为KD组(APP/PS1+KD)与普通饮食组(APP/PS1),每组10只;同时以10只野生型C57BL/6雄性小鼠作为对照组。使用生酮饲料喂养APP/PS1+KD组,普通饲料喂养APP/PS1组和对照组,共4个月。连续喂养4周、4个月后,记录小鼠的血酮,并使用Morris水迷宫评估小鼠认知,再行^(18)F-FDG和^(18)F-DPA-714 micro PET/CT分别评估KD对阿尔茨海默病小鼠各脑区葡萄糖代谢及神经炎症的影响;完成PET/CT显像后取脑组织,选择海马CA1区制成石蜡切片进行免疫荧光检测胶质纤维酸性蛋白、离子化钙结合适配分子表达情况。结果4个月时,与对照组相比,APP/PS1组第3~4天逃避潜伏期显著延长(P<0.01、P<0.05)。与对照组相比,APP/PS1组在纹状体、海马、背侧丘脑、中央灰质、上丘、嗅球、中脑等脑区对^(18)F-FDG的标准化摄取值比值显著下降(P<0.05或P<0.01);与APP/PS1组相比,APP/PS1+KD组海马、背侧丘脑对^(18)F-FDG的标准化摄取值比值显著升高(P<0.01)。与对照组相比,APP/PS1组纹状体、海马、下丘脑等脑区对^(18)F-DPA-714的标准化摄取值比值显著上升(P<0.05或P<0.001);与APP/PS1组相比,APP/PS1+KD组降低了海马区相对^(18)F-DPA-714摄取(P<0.01)。与对照组、APP/PS1+KD组相比,APP/PS1组小鼠脑(海马)胶质纤维酸性蛋白、离子化钙结合适配分子表达显著升高(P均<0.01)。结论KD可通过提高APP/PS1小鼠大脑代谢并抑制神经炎症,促进其认知行为学改善。

基于^(18)F-FDG PET的帕金森病脑葡萄糖代谢特征的纵向研究

目的建立帕金森病(PD)不同时期的脑葡萄糖代谢模式,分析目标感兴趣区(ROI)随时间的变化规律,探讨不同时期ROI与认知或运动的关系。资料与方法收集帕金森进展标志物研究项目在线数据2010年6月—2022年9月42例早期PD患者的临床数据,并在基线、12、24、36和48个月行FDG PET成像。从该数据库中获得8例与PD患者同期的健康志愿者(对照组)数据。评估PD患者脑葡萄糖代谢的纵向变化及PD相关的脑区ROI与平均统一帕金森病评定量表评分的关系。结果PD患者位于额叶和顶叶联合区的活动相对减少,小脑、壳核和扣带回的活动相对增加。PD患者尾状核、壳核、苍白球和小脑的ROI最初高于对照组,随后下降;而扣带回、黑质的ROI与之相反。壳核、苍白球和尾状核代谢活性在36个月时与平均统一帕金森病评定量表评分呈正相关(r=0.6595、0.6787、0.7167,P均<0.05),而在24个月时呈负相关(r=-0.5418、-0.8789、-0.8876,P均<0.05)。结论本研究获得了早期PD的18F-FDG成像结果的5年纵向数据,PD患者尾状核、壳核和苍白球的糖代谢活性与平均统一帕金森病评定量表评分具有相关性。

^(18)F-FDG PET/CT原发灶代谢参数对肺腺癌临床分期的预测价值

目的:探讨基于^(18)F-脱氧葡萄糖(FDG)PET/CT代谢参数对肺腺癌临床分期的预测价值。方法:回顾性分析经病理确诊的86例肺腺癌患者的临床和影像资料。86例中早期组54例,进展期组32例。测量原发灶最大径、最大标准化摄取值(SUV_(max))、平均标准摄取值(SUV_(mean)),以相对阈值法(40%为阈值)测量肿瘤代谢体积(MTV)及糖酵解总量(TLG)。采用单因素及多因素logistic回归分析对进展期肺腺癌的危险因素进行分析,并生成相应的预测模型。通过ROC曲线分析各参数及模型预测进展期肺腺癌的价值。结果:进展期组中央型肺癌、有肺癌相关症状、血清癌胚抗原(CEA)≥5.00μg/L的构成比,以及原发灶最大径、SUV_(max)、MTV、TLG均大于早期组,差异均有统计学意义(均P<0.01)。多因素分析显示,有肺癌相关症状、血清CEA≥5.00μg/L、SUV_(max)均为进展期肺腺癌的独立危险因素(均P<0.01)。ROC曲线分析显示,各代谢参数对进展期肺腺癌均有良好的预测效能,其中以TLG的AUC最大,达0.782,最佳界值为14.27 g,敏感度为90.6%,特异度为61.1%。logistic回归模型诊断进展期肺腺癌的AUC为0.854(95%CI 0.773~0.934),敏感度、特异度和准确率分别为78.1%、79.6%和79.0%。结论:^(18)F-FDG PET/CT原发灶代谢参数对进展期肺腺癌具有良好的预测效能,联合临床特征能提高对肺腺癌临床分期的诊断效能,为临床提供指导。

静息态fMRI与18F-FDG PET/CT在诊断阿尔茨海默病中的应用

目的用18F-FDG PET/CT和静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)两种方法研究轻度认知障碍(mild cognitive impairment,MCI)及不同程度阿尔茨海默病(alzheimer'S disease,AD)的功能连接(functional connectivity,FC)、葡萄糖代谢的改变及差异。方法对MCI、不同程度AD患者及10名健康人行PET/CT和静息态fMRI。计算全脑116个脑区的FC和标准摄取值比(standard uptake value ratio,SUVR),以双样本t检验比较5组内任意2组间FC和SUVR值的差异,以Pearson法对FC、SUVR、简易精神状态量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)相互进行相关性分析。结果健康组与病例组、病例组之间均存在有差异的FC及SUVR值(P均<0.05)。FC与SUVR值存在显著相关性的脑区为左侧小脑9区(P<0.05);FC与MMSE、MoCA均无显著相关性(P>0.05)。SUVR与MMSE、MoCA存在显著相关性的脑区包括双侧海马、双侧楔前叶等脑区(P<0.05)。结论MCI、不同程度AD患者FC和SUVR值均存在差异,FC和葡萄糖代谢异常的脑区不仅在四大网络中,还出现在小脑中,18F-FDG与量表的相关性更好。

基于PET/CT不同勾画方法测量非小细胞肺癌原发灶代谢体积的差异性研究

目的:探讨基于PET/CT不同勾画方法对非小细胞肺癌(NSCLC)代谢参数测量的影响及可重复性分析。方法:回顾性分析79例经病理确诊的NSCLC患者资料,测量原发灶最大标准化摄取值(SUVmax),采取自适应迭代算法(AIA)、固定阈值法(以2.5、3、4为阈值)及相对阈值法(以40%、50%为阈值)测量肿瘤代谢体积(MTV)及糖酵解总量(TLG),比较不同勾画方法所获代谢参数的差异,并分析2位医师测量一致性。结果:不同勾画方法所测MTV差异有统计学意义(χ^(2)=14.759,P=0.011),而TLG差异无统计学意义(χ^(2)=3.013,P=0.698)。对于固定阈值法和相对阈值法,阈值越高,测得的MTV和TLG越小,其中相对阈值法测得的MTV和TLG较小。不同勾画方法测得的SUVmax、MTV和TLG可重复性均非常高。2位医师测量的SUVmax、MTV及TLG的一致性均极强(均ICC>0.99)。不同勾画方法中相对阈值法(以40%为阈值)无需手动调整次数占比最大,为18.32%,其勾画准确率最高,为91.14%,差异有统计学意义(χ^(2)=11.748,P=0.038)。结论:不同勾画方法测得的MTV、TLG的重复性非常高,但测得的MTV之间存在差异,其中以40%为阈值的勾画方法无需手动调整的次数最多,勾画准确率为91.14%,建议在临床工作中使用。

冠心病临界病变患者残余胆固醇/高密度脂蛋白胆固醇比值水平与冠脉CT血流储备分数的相关性

【目的】探讨冠状动脉粥样硬化性心脏病(冠心病)临界病变患者残余胆固醇/高密度脂蛋白胆固醇比值水平对冠脉CT血流储备分数(FFRct)的影响。【方法】本研究回顾性分析2022年1月1日-2022年12月31日中山大学附属第三医院心内科收治住院并行CCTA显示存在冠状动脉临界病变(管腔狭窄50%~70%)的219例患者为研究对象,其中临界病变血管304条。对以上纳入的冠脉临界病变血管行FFRct检查。FFRct以0.8为界,分为缺血组(FFRct≤0.8,N=108例)与非缺血组(FFRct>0.8,N=111例)。采用多因素Logistic回归分析探究冠心病临界病变患者FFRct≤0.8的影响因素;绘制受试者工作特征(ROC)曲线评估RC/HDL-C对FFRct≤0.8的预测价值;并通过Pear-son相关分析评估RC/HDL-C与FFRct之间是否存在相关性。【结果】缺血组中有糖尿病病史患者比例显著增高(P<0.001)。与非缺血组相比,缺血组患者RC、RC/HDL-C比值、Non-HDL-C、APOB、HbA1c、FPG水平显著增高(P<0.05)。Pearson相关性分析显示,RC/HDL-C比值、RC、Non-HDL-C、TC、TG、LDL-C、HDL-C、LP(a)、HbA1c、FPG均与FFRct值呈显著负相关(P<0.05)。单因素Logistic回归分析结果显示,糖尿病、RC、RC/HDL-C比值、Non-HDL-C、TG、LP(a)、HbA1c、FPG均与FFRct≤0.8均呈显著相关(P<0.05)。多因素Logistic回归分析表明,RC/HDL-C比值是FFRct≤0.80的预测因子(OR=4.682,95%CI 1.197~18.316,P<0.05)。【结论】冠状动脉粥样硬化性心脏病临界病变患者RC/HDL-C比值水平与FFRct≤0.8独立相关,RC/HDL-C比值可能成为评估冠状功能性缺血的潜在指标。

Deep learning model based on PET/CT and combination with Cox proportional hazard model for predicting progression of lung invasive adenocarcinoma after surgery

Objective To observe the efficacy of deep learning(DL)model based on PET/CT and its combination with Cox proportional hazard model for predicting progressive disease(PD)of lung invasive adenocarcinoma within 5 years after surgery.Methods The clinical,PET/CT and 5-year follow-up data of 250 patients with lung invasive adenocarcinoma were retrospectively analyzed.According to PD or not,the patients were divided into the PD group(n=71)and non-PD group(n=179).The basic data and PET/CT findings were compared between groups,among which the quantitative variables being significant different between groups were transformed to categorical variables using receiver operating characteristic(ROC)curve and corresponding cut-off value.Multivariant Cox proportional hazard model was used to select independent predicting factors of PD of lung invasive adenocarcinoma within 5 years after surgery.The patients were divided into training,validation and test sets at the ratio of 6∶2∶2,and PET/CT data in training set and validation set were used to train model and tuning parameters to build the PET/CT DL model,and the combination model was built in serial connection of DL model and the predictive factors.In test set,the efficacy of each model for predicting PD of lung invasive adenocarcinoma within 5 years after surgery was assessed and compared using the area under the curve(AUC).Results Patients'gender and smoking status,as well as the long diameter,SUV max and SUV mean of lesions measured on PET images,the long diameter,short diameter and type of lesions showed on CT were statistically different between groups(all P<0.05).Smoking(HR=1.787[1.053,3.031],P=0.031)and lesion SUV max>4.15(HR=5.249[1.062,25.945],P=0.042)were both predictors of PD of lung invasive adenocarcinoma within 5 years after surgery.In test set,the AUC of PET/CT DL model for predicting PD was 0.847,of the combination model was 0.890,of the latter was higher than of the former(P=0.036).Conclusion DL model based on PET/CT had high efficacy for predicting PD of lung invasive adenocarcinoma within 5 years after surgery.Combining with Cox proportional hazard model could further improve its predicting efficacy.