Nuclear Medicine Communications最新文献

Objective: The objective of this study was to investigate the utility of preoperative 18F-FDG PET/CT scanning in preoperative evaluation and surgical planning for pulmonary tuberculosis.

Methods: The study involved a retrospective analysis of clinical data and preoperative chest 18F-FDG PET/CT data of 24 patients with pulmonary tuberculosis who underwent pneumonectomy at the Shanghai Public Health Clinical Center between December 2017 and January 2022.

Results: All 24 patients successfully underwent chest 18F-FDG PET/CT imaging, and complete data pertaining to the maximum standardized uptake value, mean standardized uptake value, minimum standardized uptake value, total lesion glycolysis, and metabolic tumor volume were obtained. Surgical excision plans were finalized using the chest 18F-FDG PET/CT findings along with the conventional chest CT scans. Pneumonectomy was successfully completed in all 24 patients, and these included 13 cases of pulmonary lobectomy, two cases of total pneumonectomy, one case of combined pulmonary lobectomy, one case of segmentectomy, and seven cases of pulmonary wedge resection. The actual surgical procedures had a conformity rate of 100% to the preoperative surgical plans that were made. The intraoperative bronchial stump embedding rate was 69% (11/18 cases), the incidence rate of postoperative air leakage was 3.8% (1/24 cases), and there were no reported cases of postoperative bronchopleural fistula or death.

Conclusion: Preoperative 18F-FDG PET/CT scans had significant utility in surgical planning, the selection of surgical methods, and the formulation of postoperative antituberculosis treatment courses for patients with pulmonary tuberculosis. The use of 18F-FDG PET/CT shows considerable promise in being promoted clinically for the surgical management of patients with pulmonary tuberculosis.

Objective: This study aimed to assess the usefulness of thyroglobulin (Tg) after radioiodine (RAI) therapy in predicting excellent response (ER) to therapy in postoperative differentiated thyroid cancer (DTC).

Methods: A retrospective observational study was conducted on postoperative DTC patients who underwent RAI from August 2018 to December 2022. Various factors were analyzed to predict ER to treatment. This involved Tg under stimulation (sTg) before RAI, Tg immediately (imTg) 112 h post-RAI and imTg/sTg(rTg). Based on the efficacy of RAI, patients were categorized into two groups: ER and non-ER (NER). Univariate logistic analysis was utilized to compare parameters between the two groups, followed by binary logistic regression analysis on factors associated with ER. Receiver operating characteristic (ROC) curves were employed to evaluate the sensitivity, specificity, and optimal diagnostic cutoff points for parameters affecting ER.

Results: The analysis included 45 ER patients and 56 NER patients. Statistical significance was found in the binary logistic regression analysis for the number of lymph nodes in the lateral cervical region ( P  = 0.016), sTg ( P  = 0.021), and rTg ( P  ≤ 0.001) concerning ER. ROC curve analysis revealed that the rTg area under the curve was 0.845, with an optimal cutoff value of 11.78, sensitivity of 82.6%, and specificity of 74.5%.

Conclusion: Post-RAI therapy, significant value is demonstrated by rTg with high sensitivity and specificity. This provides a foundation for the evaluation and decisions about DTC treatment in advance.

Background: The study aimed to assess the role of 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) radiomics combined with clinical features using machine learning (ML) in predicting sarcopenia and prognosis of patients with diffuse large B-cell lymphoma (DLBCL).

Methods: A total of 178 DLBCL patients (118 and 60 applied for training and test sets, respectively) who underwent pretreatment 18 F-FDG PET/CT were retrospectively enrolled. Clinical characteristics and PET/CT radiomics features were analyzed, and feature selection was performed using univariate logistic regression and correlation analysis. Sarcopenia prediction models were built by ML algorithms and evaluated. Besides, prognostic models were also developed, and their associations with progression-free survival (PFS) and overall survival (OS) were identified.

Results: Fourteen features were finally selected to build sarcopenia prediction and prognosis models, including two clinical (maximum standard uptake value of muscle and BMI), nine PET (seven gray-level and two first-order), and three CT (three gray-level) radiomics features. Among sarcopenia prediction models, combined clinical-PET/CT radiomics features models outperformed other models; especially the support vector machine algorithm achieved the highest area under curve of 0.862, with the sensitivity, specificity, and accuracy of 79.2, 83.3, and 78.3% in the test set. Furthermore, the consistency index based on the prognostic models was 0.753 and 0.807 for PFS and OS, respectively. The enrolled patients were subsequently divided into high-risk and low-risk groups with significant differences, regardless of PFS or OS ( P  < 0.05).

Conclusion: ML models incorporating clinical and PET/CT radiomics features could effectively predict the presence of sarcopenia and assess the prognosis in patients with DLBCL.

Objective: The objective of this study is to investigate radioactive iodine therapy (RAIT) dose impact on survival and recurrence in patients with papillary thyroid cancer (PTC) with regional lymph node metastasis (N1).

Methods: A retrospective study of PTC patients with N1 disease from 2007 to 2011 at a tertiary academic hospital collected demographics, tumor characteristics, and RAIT treatment dose. RAIT dose was stratified by total dosage less than or greater than 150 mCi. Outcomes included recurrence, immediate RAIT side-effects, and mortality.

Results: A total of 60 N1a and 21 N1b patients were studied with a median follow-up of about 9 years. No statistically significant differences were found between N1a PTC patients who received high-dose vs low-dose RAIT in recurrence rate (6.9% vs 6.7%, P  > 0.999) or immediate RAIT side effects (6.9% vs 16.1%, P  = 0.426). There were no mortalities in the N1a group. For patients with N1b PTC, there were no differences between high-dose and low-dose RAIT in recurrence rate (41.7% vs 44.4%, P  > 0.999), mortality (0% vs 16.7%, P  = 0.375), or immediate RAIT side effects (8.3% vs 11.1%, P  > 0.999).

Conclusion: Dosages of RAIT ≥ 150 mCi do not appear to provide additional benefit in reducing recurrence compared to doses <150 mCi for N1a or N1b PTC patients. No differences in mortality or immediate RAIT side effects were observed between the two dosing regimens; however, interpretation is limited by low event rates. Large randomized trials are needed for further individualized recommendations regarding optimal RAIT dosage in N1 PTC.

Purpose: This study aimed to investigate the active phase of thyroid-associated ophthalmopathy (TAO), its correlations with clinical factors, serological tests, and orbital imaging parameters, and evaluate the diagnostic value of different orbital imaging target areas.

Methods: A total of 45 patients with thyroid-related eye disease underwent imaging, serological tests, and clinical data collection. Clinical Activity Score (CAS) assessment, diplopia scores, and NOSPECS grading were conducted. Radioactive counts of extraocular muscles and tear glands were measured. Computed tomography scans assessed exophthalmos and extraocular muscle thickening. Correlations and differences among study parameters and grades were evaluated using receiver operating characteristic curves.

Results: Active TAO correlated significantly with radioactive counts of muscles and tear glands, alkaline phosphatase (ALP), thyrotropin receptor antibody (TRAb), and age. Significant differences were found among NOSPECS grades for studied variables (except ALP and TRAb). Extraocular muscle thickening was confirmed as a reliable diagnostic criterion. High consistency was found between orbital imaging and CAS staging. Treatment showed varying degrees of improvement in active patients, while nonactive patients showed no progression during follow-up. Receiver operating characteristic curves demonstrated high diagnostic efficacy for tear gland radioactive counts.

Conclusion: Tear glands and extraocular muscles have high diagnostic value in TAO, with tear glands showing a higher value. Orbital imaging provides an objective and comprehensive assessment compared with CAS scoring alone. ALP, TRAb, and age also play significant roles in staging.

Objectives: Administration of sublingual glyceryl trinitrate (GTN) prior to resting radiotracer injection during myocardial perfusion imaging (MPI) has been advocated to aid detection of viable myocardium and increase the extent of reversible perfusion defects. However, GTN is also known to reduce resting left ventricular volume and could thus increase the transient ischaemic dilation (TID) ratio, independently of severe or extensive coronary artery disease. We aimed to determine if GTN administration causes an increase in the TID ratio.

Methods: Causal inference using propensity score matched analysis was used to assess the effect of GTN on TID ratios in subjects undergoing adenosine sestamibi MPI.

Results: From 597 consecutive patients undergoing MPI, we selected a treatment group of 51 who received 400 μg of sublingual GTN before resting sestamibi injection and 51 propensity score matched controls. Mean TID ratios were 1.24 in treated subjects and 1.10 in controls (mean difference 0.15; 95% CI, 0.05-0.25; P  = 0.0018). The mean difference in TID ratio fell progressively in each quartile of time elapsed between GTN administration and image acquisition. The proportion with TID ratios equal and greater than an abnormal threshold of 1.39 was 17.6% among the treated and 0% in controls ( P  = 0.0010). The effect on TID ratio was not restricted to those with moderate-to-severe stress perfusion defects or accompanied by greater reversible perfusion defects.

Conclusions: There is evidence of a cause-and-effect relationship between administering GTN before resting sestamibi injection and increased TID ratio on MPI. This may be a source of misleading false positive TID findings.

Background: Small-molecule biomacromolecules target tumor-specific antigens. They are employed as theranostic agents for imaging and treatment. Intravenous small-molecule radioligands exhibit rapid tumor uptake and excretion. However, systemic administration for peptide receptor radionuclide therapy still lacks the therapeutic index to completely treat solid tumors beyond palliation. We study intra-arterial delivery with tumor embolization of a small molecule as a means to deliver local intertumoral brachytherapy for curative internal ablation.

Results: 18F-fluorodeoxyglucose (FDG) was used as a surrogate for a small-molecule theranostic agent in a porcine renal tumor model, this tumor model is not known to specifically express human tumor antigens, but the model demonstrates similar vascularity. Angiography and micron particle embolization of the tumor arterioles were performed in a renal tumor model. Significantly more tumor uptake (2-4×), was observed for intra-arterial administration (IA) compared to intravenous (IV) (%ID/g = 44.41 ± 2.48 vs. 23.19 ± 4.65; P = 0.0342 at 1 min and 40.8 ± 2.43 vs. 10.94 ± 0.42; P = 0.018 at 10 min). At later time points, up to 120 min after injection, washout of the tracer from the tumor was observed, but the percent injected dose per gram remained elevated, with three times higher concentration of FDG with IA administration compared with IV, but the difference was not statistically significant. A trend towards diminished systemic percent injected dose per gram measured in the blood, liver, kidney, spleen, muscle, and urine for study IA compared to IV administration is observed.

Conclusion: Combining IA administration of a small-molecule radioprobe surrogate with embolization of the tumor's arterioles extending the time for interaction of the drug within the tumor by diminishing flow out of the tumor via the efferent capillaries significantly increases the first-pass uptake of the small-molecule drug within a tumor and decreases the radiation to normal nontumor tissues when compared with IV injection of the same drug. The minimally invasive drug delivery allows tumor-specific theranostic treatment of renal tumors with a brachytherapy-absorbed dose of radiation that is potentially curative.

Purpose: To develop a predictive model for identifying the higher-risk growth pattern of invasive lung adenocarcinoma using multiphase multidetector computed tomography (MDCT) and 18 F-fluorodeoxyglucose (FDG) PET radiomics.

Methods: A total of 203 patients with confirmed invasive lung adenocarcinoma between January 2018 and December 2021 were enrolled and randomly divided into training ( n  = 143) and testing sets ( n  = 60). Patients were classified into two groups according to the predominant growth pattern (lower-risk group: lepidic/acinar; higher-risk group: papillary/solid/micropapillary). Preoperative multiphase MDCT and 18 F-FDG PET images were evaluated. The Artificial Intelligence Kit software was used to extract radiomic features. Five predictive models [arterial phase, venous phase, and plain scan (AVP), PET, AVP-PET, clinical, and radiomic-clinical (Rad-Clin) combined model] were developed. The models' performance was assessed using receiver-operating characteristic (ROC) curves and compared using the DeLong test.

Results: Among the radiomics models (AVP, PET, and AVP-PET), the AVP-PET model [area under ROC curve (AUC) = 0.888] outperformed the PET model (AUC = 0.814; P  = 0.015) in predicting the higher-risk growth patterns. The combined Rad-Clin model (AUC = 0.923), which integrates AVP-PET radiomics and five independent clinical predictors (gender, spiculation, long-axis diameter, maximum standardized uptake value, and average standardized uptake value), exhibited superior performance in predicting the higher-risk growth pattern compared with radiomic models ( P  = 0.043, vs. AVP-PET; P  = 0.016, vs. AVP; P  = 0.002, vs. PET) or the clinical model alone (constructing based on five clinical predictors; AUC = 0.793; P < 0.001).

Conclusion: The combined Rad-Clin model can predict the higher-risk growth patterns of invasive adenocarcinoma (IAC). This approach could help determine individual therapeutic strategies for IAC patients by distinguishing predominant growth patterns with high risk.

Purpose: To study the feasibility and value of assessing patients with Graves' orbitopathy (GO) in 99mTc-diethylenetriamine pentaacetic acid (DTPA) orbital single photon emission computed tomography/computed tomography (SPECT/CT) with extraocular muscle maximum standardized uptake value (SUVmax).

Methods: A total of 235 patients underwent 99mTc-DTPA orbital SPECT/CT, including 176 patients with GO and 59 patients with Graves' disease (GD) as controls. The SUVmax of extraocular muscles, including right medial rectus muscle (RMR), right lateral rectus muscle (RLR), left medial rectus muscle (LMR), left lateral rectus muscle (LLR), was compared between groups, correlation analyses with clinical activity scores (CAS) and serological indices was performed, and the diagnostic efficacy was evaluated using receiver operating characteristic curves. The consistency of SPECT/CT and MRI in assessing extraocular muscle activity was compared.

Results: SUVmax in the extraocular muscles of active GO patients was significantly higher than in inactive GO patients and controls. In GO patients, SUVmax of the medial rectus (LMR most prominent) was higher than that of the lateral rectus. SUVmax correlated with CAS, thyroid-stimulating hormone, total cholesterol, low-density lipoprotein (positively) and free triiodothyronine and free thyroxine (negatively), but not with GO duration. The optimal cutoff values for distinguishing between active and inactive SUVmax were identified. RLR had high sensitivity and RMR had high specificity. SPECT/CT and MRI showed moderate agreement in assessing extraocular muscle activity in 87 GO patients, with high concordance.

Conclusions: The extraocular muscle SUVmax of 99mTc-DTPA orbital SPECT/CT may be used as an adjunct method in combination with CAS to more accurately assess GO activity, which can help in clinical diagnosis and individualized treatment.

Objective: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. The purpose of this study is to evaluate the prognostic predictors over 5 years in patients with CKD including haemodialysis.

Methods: In this multicenter, prospective cohort study performed with the Gunma-CKD SPECT Study protocol, 311 patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml/1.73 m2], including 50 patients on haemodialysis, undergoing stress Tc-99m-tetrofosmin SPECT for suspected ischaemic heart disease were followed for 5 years. MACCRE was evaluated, and summed stress score, summed rest score, summed difference score (SDS), left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were evaluated by electrocardiogram-gated SPECT.

Results: Of the 311 patients, 268 were followed for 5 years, and of those patients, 126 experienced MACCRE: cardiac death, n = 15; sudden death, n = 5, nonfatal myocardial infarction, n = 5; hospitalization for heart failure, n = 16; cerebrovascular accident, n = 9; revascularization, n = 49; renal events (haemodialysis initiation/kidney transplantation), n = 20 and other cardiovascular events, n = 7. In univariate Cox analysis, eGFR (P < 0.0001), haemoglobin (P = 0.001), SDS (P = 0.0001), LVEDV (P = 0.002), LVESV (P = 0.0003) and LVEF (P < 0.0001) were associated with MACCRE, and in multivariate Cox analysis, eGFR (P = 0.014) and SDS (P = 0.002) were strongly associated with MACCRE. In Kaplan-Meier analysis, the event-free survival rate for MACCRE was better in patients with SDS below 3 than in those with SDS of 3 or higher (P < 0.0001, log-rank test) and in patients with eGFR of 18 or higher than in those with eGFR below 18 (P < 0.0001, log-rank test).

Conclusion: In patients with CKD, SDS and eGFR are reliable prognostic markers for the occurrence of MACCRE over 5 years.