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The aim of this study is to investigate the value of pre-treatment 18F-FDG PET/CT in predicting the pathological characteristic of HCC and recurrence after liver transplantation (LT). A total of 34 patients who underwent 18F-FDG PET/CT before LT for HCC and did not receive any other treatment were retrospectively enrolled in the study. The maximal standard uptake value of the tumor (T-SUVmax), normal liver tissues (L-SUVmax), and mediastinal blood pool (B-SUVmax) were derived, followed by the calculations of the T-SUVmax/L-SUVmax (T/L) and the T-SUVmax/B-SUVmax (T/B) ratios. Combined with the post-transplantation pathological results and ROC curve, the performance in predicting the pathological characteristic and the recurrence after LT were evaluated. The AUCs for T-SUVmax, T/L, and T/B in predicting the pathological grade of tumors were 0.820, 0.784, and 0.806, respectively. Alternatively, the AUCs for T-SUVmax, T/L, and T/B in predicting the recurrence after LT were 0.865, 0.899, and 0.931, respectively. The individual cutoff values were 5.0, 1.7, and 2.2, corresponding to a predication accuracy of 88.2%, 85.3%, and 88.2%, respectively. In addition, the AUCs for T/B in predicting microvascular invasion (mVI) and liver capsular invasion (LCI) were 0.825 and 0.788, respectively. The pre-treatment 18F-FDG PET/CT is effective for predicting recurrence of HCC after LT. In addition, it demonstrates values for predicting the pathological characteristic of HCC such as pathological grade, mVI, and LCI.

The objective was to dynamically monitor the progression of atherosclerotic plaques in ApoE−/− mice with 18F–NaF PET imaging. The ApoE−/− mice were used to develop atherosclerosis models, and the C57BL/6 J mice were used as control. 18F–NaF PET was performed when the mice were 12, 20, and 30 weeks of age. Serum lipids and lipoproteins profiles, inflammatory cytokines, and calcification factors were tested by ELISA. The lipid distribution, morphology, and calcification of plaque were evaluated by Oil Red O, HE, and alizarin red staining. The correlation between imaging and the extent of calcification was analyzed by Pearson correlation analysis. The uptake of 18F–NaF in the aorta was gradually increased with each weekly extension. Compared with the ApoE−/− mice at the age of 12 weeks and 20 weeks, the levels of lipoprotein, inflammatory cytokines, and calcification factors were higher at 30 weeks. In Oil Red O, HE, and alizarin red staining, the extent of the lipid area and calcification increased with time. The correlation analysis showed that the uptake of 18F–NaF in the aorta was related to the extent of calcification. 18F–NaF may dynamically monitor the progression of atherosclerotic plaques and ongoing microcalcification formation.

This study aimed to dynamically monitor myocardial cell death using 99m Tc-Duramycin single-photon emission computed tomography/computed tomography (micro-SPECT/CT) imaging in acute myocardial infarction (AMI) and the anti-apoptosis effect of atorvastatin for cardioprotection. Mice were randomized into three groups: AMI group, AMI with atorvastatin treatment (T-AMI) group, and sham group. Three groups of model mice were randomly selected at day 1 (D1), day 3 (D3), and day 7 (D7) day after surgery with 99m Tc-Duramycin micro-SPECT/CT imaging. The lesion-to-normal myocardial tissue ratio (L/N) average values were 2.62 on D1, 3.89 on D3, and 1.20 on D7 for the uptake of 99m Tc-duramycin in the infarcted region in the AMI group. The sham group presented no positive imaging in myocardium, and the L/N average values were 1.09, 1.14, and 1.10 on D1, D3, and D7, respectively. Meanwhile, 99m Tc-linear-duramycin imaging showed no radioactive uptake in the infarction region. The T-AMI group imaging showed tracer uptake decreased obviously compared to the uptake in the infarcted region in AMI mice. 99m Tc-Duramycin SPECT/CT imaging allowed non-invasive monitoring of myocardial cell death in a mouse model of AMI and an assessment of atorvastatin anti-apoptosis effect for cardioprotection by in vivo molecular imaging.

The present study aimed to investigate the prognostic value of intra-tumor metabolic heterogeneity on 2-[18F] Fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for patients with gastric cancer. Fifty-five patients with advanced gastric cancer that had received neoadjuvant chemotherapy and radical surgery were included. Clinicopathological information, 18F-FDG PET/CT before chemotherapy, pathological response, recurrence or metastasis, progression-free survival (PFS), and overall survival (OS) of the patients were collected. The maximum, peak, and mean standardized uptake values (SUVmax, SUVpeak, and SUVmean), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index-1 (HI-1) was calculated as SUVmean divided by the standard deviation, and heterogeneity index-2 (HI-2) was evaluated through linear regressions of MTVs according to different SUV thresholds. Associations between these parameters and patient survival outcomes were analyzed. None of the parameters on PET were associated with tumor recurrence. Pathological responders had significantly smaller TLR, MTV and HI-2 values than non-responders (P = 0.017, 0.017 and 0.013, respectively). In multivariate analysis of PFS, only HI-2 was an independent factor (hazard ratio [HR] = 2.693, P = 0.005) after adjusting for clinical tumor-node-metastasis (TNM) stage. In multivariate analysis of OS, HI-2 was also an independent predictive factor (HR = 2.281, P = 0.009) after adjusting for tumor recurrence. Thus, HI-2 generated from baseline 18F-FDG PET/CT is significantly associated with survival of patients with gastric cancer. Preoperative assessment of HI-2 by 18F-FDG PET/CT might be promising to identify patients with poor prognosis.

Hepatic epithelioid hemangioendothelioma (HEHE) is a low-to-intermediate-grade malignant mesenchymal tumor. The diagnostic and prognostic values of 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to patients with HEHE have not been fully validated. Patient survival outcomes (including overall survival [OS] and progression-free survival [PFS]), lesions characteristics and semi-quantitative parameters, in terms of maximum standardized uptake value (SUVmax), peak SUV (SUVpeak), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) on 18F-FDG PET/CT of 20 cases with HEHE were measured and analyzed. A total of 310 liver lesions were detected (excluding the diffuse-type lesions in 3 cases). Most lesions had higher SUVmax in delayed imaging than in early imaging (P = 0.013). Patients with multiple organs involved had higher death rate (P = 0.022), higher progression rate (P = 0.020), shorter OS (P = 0.011), larger lesion SUVmax (P = 0.048) and TLG (P = 0.033) than those with only liver involved. The area under curves (AUCs) from the receiver operating characteristic (ROC) curve analysis were 0.960, 0.949, 0.980 and 0.960 for SUVmax, SUVpeak, TLG and MTV, respectively, in predicting OS (P = 0.005, 0.008, 0.001 and 0.024, respectively). For predicting PFS, the AUCs were 0.791, 0.824, 0.857 and 0.813 (P = 0.036, 0.019, 0.010 and 0.024), respectively. Dual-time-point imaging may improve lesions detectability. Patients with multiple organ involved had worse prognosis. The higher SUVmax, SUVpeak, TLG and MTV of lesions, the worse prognosis of patients were found.

OBJECTIVE. The purpose of this article is to describe the clinical applications of a total-body PET scanner and discuss future expectations. CONCLUSION. PET has been widely used in the fields of oncology, neurology, and cardiology. However, current PET scanners have limitations, including long scanning time, low signal-to-noise ratio, and high dose of ionizing radiation. Total-body PET with a long scan range provides solutions to these problems, markedly increasing the sensitivity of the system.

Pulmonary nodules risk classification in adenocarcinoma is essential for early detection of lung cancer and clinical treatment decision. Improving the level of early diagnosis and the identification of small lung adenocarcinoma has been always an important topic for imaging studies. In this study, the authors propose a deep convolutional neural network (CNN) with scale-transfer module (STM) and incorporate multi-feature fusion operation, named STM-Net. This network can amplify small targets and adapt to different resolution images. The evaluation data were obtained from the computed tomography (CT) database provided by Zhongshan Hospital Fudan University (ZSDB). All data have a pathological label and their lung adenocarcinomas risk are classified into four categories: atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma. The authors' deep learning network STM-Net was trained and tested for the risk stage prediction. The accuracy and the average area under the receiver operating characteristic curve achieved by their method are 95.455% and 0.987 for the ZSDB dataset. The experimental results show that STM-Net largely boosts classification accuracy on the pulmonary nodules classification compared with state-of-the-art approaches. The proposed method will be an effective auxiliary to help physicians diagnosis pulmonary nodules risk classification in adenocarcinoma in early-stage.

Programmed cell death-ligand 1 (PD-L1) is expressed on tumor cells (TC) and tumor-infiltrating immune cells (IC). We conducted a retrospective study to investigate the relationship between PD-L1 expression on TC/IC and 18F-FDG uptake in patients with surgically resected non-small cell lung cancer (NSCLC). Total 362 NSCLC patients (297 adenocarcinoma and 65 squamous cell carcinoma) who underwent preoperative 18F-FDG-PET/CT imaging were analyzed retrospectively. Immunohistochemistry analysis was performed for PD-L1 expression on TC and IC in NSCLC specimens with 28–8 antibody. The cut-off value of 5% for defining PD-L1 positivity was determined according to previous trials. The association between PD-L1 expression and clinicopathological variables were analyzed, including age, gender, smoking status, tumor diameter, lymph node metastasis, stage and the maximum standardized uptake value (SUVmax). PD-L1 positive expression was 50.8% (184/362) in NSCLC patients. Its positive expression on TC and IC were 24.3% (88/362) and 42.5% (154/362), respectively. SUVmax was significantly higher in patients with PD-L1 positive expression on TC or IC than that with negative. Multivariate analysis demonstrated that PD-L1 expression were correlated with SUVmax. The best cut-off value of SUVmax for PD-L1 expression on TC/IC was 8.5 [area under the curve (AUC) = 0.607, 95% CI 0.549–0.665, P = 0.001, sensitivity 50.5% and specificity 71.4%] determined by ROC curve. High SUVmax is linked to PD-L1 expression on TC and IC in our patients with surgically resected non-small cell lung cancer. 18F-FDG-PET/CT imaging may be used to predict the PD-L1 expression on TC and IC in NSCLC patients.

How miRNAs play a role in collateral formation of chronic total occlusion (CTO) patients and in predicting myocardial perfusion has not been investigated. In this study, we screened circulating miRNAs in CTO and stable coronary artery disease patients using high-throughput sequencing and found 42 differential expressed miRNAs, including miR-329, miR-494 and miR-495, which belong to 14q32 miRNAs gene cluster. The down regulation of miR-329, miR-494 and miR-495 was confirmed in an independently larger cohort. Then in vitro and in vivo study, we demonstrated that miR-495 inhibited angiogenesis and collateral formation through Notch1 pathway. Finally we came back to a clinical view and found that miR-329, miR-494 and miR-495 were able to predict whether myocardial perfusion can be improved in CTO patients after revascularization. These data indicate that miRNAs are involved into the collateral formation of CTO patients and could be potentially biomarkers to help individualise therapeutic decisions.

This study aimed to assess the value of 18F-FDG PET/CT and carbohydrate antigen 19-9 (CA 19-9) levels in predicting lymph node micrometastases in patients with pancreatic cancer. A total of 160 patients with pancreatic carcinoma were included in the study from 2012 to 2017. All patients underwent surgical treatment and PET/CT scans as well as tests to measure CA 19-9 levels before surgery. The PET/CT scans were evaluated by 2 nuclear medicine physicians who were blinded to the clinical information and were compared to the postsurgical pathological findings. Logistic regression analysis was performed to determine the variables that could predict lymph node micrometastases. Receiver operating characteristic (ROC) curves were utilized to find the best cutoff value of the variables related to predicting lymph node micrometastases. The maximum standardized uptake value (SUVmax) of the primary tumor and CA 19-9 level were potent predictors for determining the lymph node status. The best SUVmax and CA 19-9 cutoff values for predicting lymph node micrometastases were 7.05 (sensitivity = 71.2%, specificity = 76.6%) and 240.55 U/ml (sensitivity = 62.1%, specificity = 79.8%), respectively. Patients with pancreatic cancer with a tumor SUVmax ≥ 7.05 or a CA 19-9 value ≥ 240.55 are likely to have lymph node micrometastases.

Background This study aimed to investigate the prognostic value of volumetric parameters on 18F- fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in gastric-cancer patients, according to the expression status of c-MET (MET proto-oncogene, receptor tyrosine kinase), which was previously unclear. Methods The study included 61 patients with advanced gastric cancer. Data on the baseline 18F-FDG PET/CT, clinical-pathological information, progression-free survival (PFS), and overall survival (OS) were collected. The maximum standardized uptake value (SUVmax), peak SUV (SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of gastric tumors in situ were measured on PET/CT. The expression status of c-MET was recorded based on immunohistochemical staining. Associations between the parameters on PET/CT and patients’ survival outcomes were analyzed in relation to expression status of c-MET. Results Patients with positive c-MET expression had significantly shorter PFS (11.5 vs. 17.6 months, P = 0.039) and OS (17.0 vs. 24.3 months, P = 0.043), and had gastric tumors with a larger MTV (70.8 ± 53.11 vs. 41.1 ± 52.32, P = 0.034) and TLG (428.39 ± 442.95 vs. 205.7 ± 354.40, P = 0.039), compared with those with negative c-MET expression. However, SUVmax (9.6 ± 7.40 vs. 8.0 ± 4.91, P = 0.335) and SUVpeak (7.7 ± 5.99 vs. 6.62 ± 4.08, P = 0.438) were similar between these two patient groups. In patients with c-MET-positive tumors, MTV and TLG were independent factors in predicting patient OS after correction by distant metastasis (hazards ratio = 1.014 and 1.002, respectively; P = 0.024 and 0.027, respectively), while these associations were not significant in patients with c-MET-negative tumors. Conclusions Patients with c-MET-positive gastric cancer had higher MTV and TLG values compared to those with c-MET-negative gastric cancer. In patients with c-MET-positive gastric cancer, volumetric parameters on 18F-FDG PET/CT have prognostic value for patient overall survival.

Background PET/MR is transferring from a powerful scientific research tool to an imaging modality in clinical routine practice. Whole body PET/MR screening usually takes 30–50 minutes to finish, during which a few factors might induce patient discomfort and further cause degraded image quality. The aim of this report is to investigate the patients' perception of the imaging procedure and its correlation with image quality. Methods One hundred and twenty patients (63 males and 57 females, average age = 51.3 years, range 22–70 years) who had been diagnosed with cancer or had previous history of cancer were recruited and scanned with a simultaneous PET/MR system. A questionnaire was given to all patients retrospectively after the PET/MR scan, which has nine questions to assess patients' feeling of the scan on a Likert scale scoring system (1–5, 1 as most satisfied). All PET/MR images were also visually examined by two experts independently to evaluate the quality of the images. Six body locations were assessed and each location was evaluated also with a Likert scale scoring system (1–5, 5 as the best quality). Mann–Whitney U­test was used for statistical analysis to check if there is significant correlation between image quality and patient perceptions. Results With a total of 120 patients, 118 questionnaires were filled and returned for analysis. The patients’ characteristics were summarized in Table 4. The statistics of the patients’ perception in the questionnaire were illustrated in Tables 5–7. Statistical significant correlations were found between MR image quality and patients’ characteristics/perception. Conclusion Our results show that PET/MR scanning is generally safe and comfortable for most of the patients. Statistical analysis does not support the hypothesis that bad patient’s perception leads to degraded image quality.

Background The epidemiology and cause of ossification of the spinal ligaments (OSL) remains obscure. To date, there is no study that comprehensively evaluates the prevalence, distribution, and concomitance of each type of OSL by CT among general Chinese population. We therefore aimed to comprehensively investigate epidemiological characteristics of OSL using whole spine CT in the Chinese population and examine the factors that correlate with the presence of OSL. Methods Ossification of the posterior longitudinal ligament (OPLL), ligamentum flavum (OLF), anterior longitudinal ligament (OALL), nuchal ligament (ONL), and diffuse idiopathic skeletal hyperostosis (DISH) were evaluated from the subjects who underwent PET/CT for the purpose of cancer screening in our hospital. Prevalence, distribution, and concomitance of OSL were reviewed. Logistic regression analysis was performed to identify the risk factors of OSL. Results A total of 2000 subjects (1335 men and 665 women) were included. The prevalence rate of cervical OPLL (C-OPLL) was 4.1%, thoracic OPLL (T-OPLL) 2.25%, lumbar OPLL (L-OPLL) 0.8%, thoracic OLF (T-OLF) 37.65%, lumbar OLF (L-OLF) 1.45%, ONL 31.5%, DISH 3.85%. The most commonly involved level was C5 for C-OPLL, T1 for T-OPLL, T10 for T-OLF, and T8/9 for OALL. 21% of subjects with C-OPLL had T-OPLL, 44% of C-OPLL had T-OLF, 38% of T-OPLL had C-OPLL, 53% of T-OPLL had T-OLF, 44% of L-OPLL had T-OPLL, and 56% of L-OPLL had T-OLF. The average age of OSL-positive subjects was significantly higher than that of OSL-negative subjects. The results of the multiple regression analysis revealed that males had a strong association with DISH (odds ratio, 3.15; 95% confidence interval, 1.27–7.78; P = 0.013). Conclusion The prevalence of OSL in the Chinese was revealed. Tandem ossification is not uncommon in people with OSL. There is a high incidence of multiple-regional OPLL in the whole spine. Approximately half of the subjects with OPLL coexist with T-OLF. For patients with clinical symptoms induced by OPLL, thorough evaluation of whole spine using CT is recommended.

The aim of this study was to evaluate the role of dual-time point 18F-FDG PET/CT imaging in the primary diagnosis and staging of hilar cholangiocarcinoma (HCCA). Dual-time point FDG PET/CT findings, including early phase whole-body scanning and abdominal delayed phased performed 1 and 2 h after radiotracer injection, respectively, were retrospective reviewed in 69 patients conformed HCCA by histology. PET/CT was evaluated based on visual interpretation and the semiquantitative index of SUVmax and tumor-to-normal liver tissue ratio (TNR) for both early and delayed images. For all 69 HCCA patients, the mean SUVmax of the lesion and TNR in delayed phase was significantly higher than that in early phase (6.1 ± 4.7, 2.2 ± 1.7, vs 5.1 ± 3.4, 1.6 ± 1.1; P

To evaluate the prognostic value of bone marrow (BM) imaging pattern and other imaging findings assessed by 18F-FDG PET-CT in multiple myeloma(MM) and to find out the image interpretation cut-off to define different BM tracer uptake pattern. We retrospectively studied PET-CT examinations and clinical data of 100 healthy individuals and 172 newly diagnosed MM patients. A BM uptake > liver SUVmean was selected as the positivity cut-off of pathological uptake in BM after comparing BM uptake in normal control and MM patients. With this interpretation cut-off, we defined the BM FDG uptake pattern as four types: normal, focal, diffuse, and mixed. The clinical correlation and prognostic value of BM uptake pattern were evaluated. The findings were validated in an independent prospective cohort with 72 MM patients. In MM cohort, 34.9% patients had focal BM uptake pattern, 3.5% had diffuse pattern, 38.4% had mixed pattern, and 23.3% had normal BM uptake. Diffuse/mixed pattern was correlated with clinical and imaging parameters indicating high tumor burden, and inferior progression free survival (PFS; 3-year-PFS 26.8%) and overall survival (OS; 3-year-OS 50.6%). BM uptake pattern was an independent prognostic factor and diffuse/mixed pattern was associated with inferior OS (P = 0.037, HR 7.16) and PFS (P = 0.015, HR 7.77). The prognostic value of BM uptake pattern was also confirmed in validation set. We propose an FDG uptake higher than liver as the positivity cut-off to discriminate between physiological and pathological uptake in BM and defined four BM FDG uptake pattern. BM FDG uptake pattern is a reliable prognostic predictor of MM.

SNA001 is a novel recombinant human thyroid stimulating hormone (rhTSH). rhTSH has long been approved in several countries to facilitate monitoring and ablation of thyroid carcinoma without hypothyroidism caused by thyroid hormone withdrawal (THW). To assess the safety, tolerance, pharmacokinetics and pharmacodynamics properties of SNA001, the two-period (SNA001 period and THW period), dose-ascending study in well-differentiated thyroid cancer (DTC) patients was designed.Three doses (0.45 mg, 0.9 mg, and 1.35 mg) of SNA001 were intramuscularly injected, twice in the SNA001 period to stimulate iodine-131 uptake and thyroglobulin (Tg) release. Twenty-four hours after the last dose of SNA001, iodine-131 (111~185MBq) was administrated, followed by whole-body scan (WBS) 48 hours later. THW period began just after SNA001 washout and lasted for about 3~6 weeks. When TSH level was above 30 mU/L, iodine-131 (111~185MBq) was administrated, followed by a WBS and Tg detection 48 hours later.Twenty-four DTC patients after thyroidectomy were enrolled, mean peak concentrations of SNA001 in 0.45 mg, 0.9 mg, 1.35 mg groups were 18.5, 26.7, and 37.0 ng/mL (about 244.7, 354.2 and 489.6 mU/L) respectively, within 28~32 hours after first dose of SNA001. SNA001 was metabolized in a dose-dependent manner. The results of WBS and Tg release in the SNA001 period were compared with those in THW period. Compared to Tg level in baseline, the Tg levels in SNA001 and THW periods were increased, with 78% of subjects showing higher Tg levels in the THW period. 100% of the patients had concordant qualitative results of the scans within two periods in three groups. Symptoms of hypothyroidism were relieved in the SNA001 period compared with THW period, though there was no significant difference in most of the scale scores. There were no serious adverse events related to SNA001, the most common adverse event were gastrointestinal symptoms, of mild and transient nature.Thus, SNA001 promises to be a safe and effective method to stimulate iodine-131 uptake and Tg secretion during monitoring and ablation for DTC without the disadvantages of incidental hypothyroidism.

BACKGROUND: The controversy regarding optimal clinical T2N0 esophageal cancer treatment ultimately stems from the clinical staging modalities’ inaccuracy. Because most inaccuracies lie in clinical T2 to pathological T1, it is vital to discriminate whether the muscularis propria is invaded. METHODS: We investigated the association between the primary tumor maximal standard uptake value (SUVmax), and the pathological features and overall survival. We attempted to construct a discriminative model through logistic regression analysis. RESULTS: A total of 140 cN0 esophageal squamous cell carcinoma (ESCC) patients were enrolled. Primary tumor SUVmax differed significantly in paired pathological T categories (P65), biopsy differentiation grades (well or moderately vs. poorly vs. unknown), and primary tumor SUVmax (continuous) were independent risk factors for invasion depth. Subsequently, the age categories, the biopsy differentiation grade categories, and the primary tumor SUVmax categories (≤7.4 vs. >7.4) were included in the logistic regression analysis to construct a discriminative model, showing a good performance in discriminating pT2–3 vs. pT1 in terms of accuracy 87.1%, sensitivity 93.6%, specificity 73.9%, and area under the curve (AUC) 0.887 [95% confidence interval (CI): 0.822 to 0.951]. Of these factors, biopsy differentiation grades and primary tumor SUVmax showed significant differences in overall survival (P

We report a rare case of pancreatic collision tumor of solid pseudopapillary tumor and neuroendocrine tumor in a 43-year-old woman. A pancreatic mass was found by abdominal ultrasound. A mainly cystic mass with solid component progressive enhancement was revealed using abdominal enhanced CT. Staging 18F-FDG PET/CT demonstrated a pancreatic tail mass with an increased uneven 18F-FDG uptake. Distal pancreatectomy was performed. Postoperatively, the mass was diagnosed as pancreatic collision tumor of solid pseudopapillary tumor and neuroendocrine tumor.

Background: Primary liver cancer, around 90% are hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. Summary: Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) in 2018, additional high-quality evidence has emerged with relevance to the diagnosis, staging, and treatment of liver cancer in and outside China that requires the guidelines to be updated. The new edition (2019 Edition) was written by more than 70 experts in the field of liver cancer in China. They reflect the real-world situation in China regarding diagnosing and treating liver cancer in recent years. Key Messages: Most importantly, the new guidelines were endorsed and promulgated by the Bureau of Medical Administration of the National Health Commission of the People’s Republic of China in December 2019.

Aim Radium-223, a targeted alpha therapy, is approved widely for the treatment of patients with metastatic castrate-resistant prostate cancer, based on a pivotal phase 3 study in predominantly white patients. We investigated the efficacy and safety of radium-223 in Asian patients with castrate-resistant prostate cancer and metastatic bone disease. Methods This multicenter, prospective, single-arm, open-label phase 3 trial evaluated the efficacy and safety of the standard radium-223 regimen (55 kBq/kg every 4 weeks for six cycles) in patients from Asian countries. The primary endpoints were the safety and overall survival. Results A total of 226 patients were enrolled and received at least one dose of radium-223. Median overall survival was 14.0 months (95% confidence interval [CI], 11.2-17.4). Median time to total alkaline phosphatase and prostate-specific antigen progression were 7.5 (95% CI, 6.8-7.7) and 3.6 (95% CI, 3.1-3.7) months, respectively. Median skeletal-related event-free survival was 26.0 months (95% CI, 12.6-not reached). Grade ≥3 treatment-emergent adverse events were reported in 103 (46%) of 226 patients, with anemia being the most common event (34 [15%] patients). Grade ≥3 drug-related treatment-emergent adverse events occurred in 39 (17%) of 226 patients. Serious treatment-emergent adverse events were reported in 65 (29%) of 226 patients. Seven (3%) patients had an adverse event leading to death; none were considered to be related to radium-223. Conclusion The results of this study support the use of the standard radium-223 regimen for the treatment of Asian patients with castrate-resistant prostate cancer and symptomatic bone metastases.

Extended lymph node involvement could indicate limited survival benefit from neoadjuvant chemoradiotherapy with surgery in resectable locally advanced esophageal cancer. However, the threshold of node involvement is unclear.We retrospectively measured and calculated metabolic parameters derived fromA total of 67 patients were enrolled in the study. The MTVp with thresholds as 3.0, 3.5, 4.0, 4.5 and 5.0 were significantly correlated with clinical T categories (Spearman's rank correlation coefficient, all P 0.0001) and clinical tumor length categories (Spearman's rank correlation coefficient, all P ≤ 0.005). However, the MTVn were marginally correlated with clinical lymph node categories (P = 0.023). Among the 31 (31/67, 46.3%) patients with MTVn as 0 (R-MTB as 100.00%), 5 (5/5, 100.0%) were initially restaged as cLym- (MTVn as 0, R-MTB as 100.00%), while 26 (26/62, 41.9%) were initially restaged as cLym + (MTVn 0, R-MTB 100.00%). After nCRT, 43 (64.2%) patients achieved ypN0. The univariate and multivariate regression revealed that R-MTB (≤ 106.00% vs. 106.00%) was an independent factor associated with ypN + status (OR 0.093, 95%CI 0.023-0.378, P = 0.001).The preliminary study revealed a great heterogeneity in clinical lymph node categories in esophageal cancer. It suggested that R-MTB was significantly associated with ypN status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer. The findings with the indications needed to be further studied in a prospective study with a large patient cohort.

The aim of this study was to investigate the correlation of coronary flow reserve (CFR) assessed by rest/stress myocardial perfusion imaging with dynamic single-photon emission computed tomography (SPECT) with intracoronary pressure-derived fractional flow reserve (FFR) in patients with single-vessel coronary artery disease (CAD). Patients with suspected or known stable CAD who were referred for invasive coronary angiography were prospectively enrolled. Both invasive FFR and SPECT were performed in subjects with single-vessel intermediate coronary stenosis. A cutoff value of

To investigate the added value of dual-time-point 18F-FDG PET/CT imaging in the diagnosis of colorectal cancer liver metastases (CRLM). One hundred and eight patients with CRLM preoperatively underwent a dual-time-point 18F-FDG PET/CT scan. All hepatic lesions were diagnosed by histopathology. The diagnostic sensitivity of 18F-FDG PET/CT for CRLM was calculated on early scan and delayed scan, respectively. The McNemar test was used to test the differences of the sensitivity and the specificity between early scan and delayed scan. On a per-patient basis, no significant difference in sensitivity was found between early scan and delayed scan (92.93% vs. 96.97%, P = 0.125). The per-patient specificity of early and delayed scans was 77.78%. On a per-lesion basis, overall sensitivity of delayed scan was significantly higher than that of early scan (83.49% vs. 76.61%, P 10 mm, there was no significant difference in sensitivity between early and delayed scans (92.73% vs. 95.15%, P = 0.125). Of the detected 182 liver metastatic lesions on delayed scan, the SUVmax on delayed scan was significantly higher than that on early scan (12.13 ± 7.13 vs. 9.16 ± 4.74, P

Lymphoma is a malignant tumor originated from the lymphatic hematopoietic system. It is mainly manifested as painless lymph node enlargement, hepatosplenomegaly, the involvement of all tissues and organs of the body, accompanied by fever, night sweat, weight loss, itching, and other systemic symptoms. The tumor cells are classified into non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). The incidence of NHL is much higher than that of HL, which is the sum of a group of independent diseases with strong heterogeneity. Pathologically, it is mainly lymphocytes, tissue cells, or reticular cells with different degrees of differentiation. Depending on the origin of the lymphocytes, they can be classified as B-cell, T-cell, and NK-cell lymphomas.

To investigate the association between metabolic parameters of dual time point 18F-FDG PET/CT imaging and Kirsten rat sarcoma (KRAS) mutation status in colorectal liver metastases (CRLM). Forty-nine colorectal cancer patients with 87 liver metastatic lesions were included in this retrospective study. KRAS gene mutation tests were also performed for all the patients. The maximum standardized uptake value (SUVmax) was measured for each hepatic metastatic lesion on both early and delayed scans, and the change of SUVmax (ΔSUVmax) and retention index (RI) were calculated. Uni-variate and multi-variate analyses were employed to determine the relationship between any PET/CT parameters and KRAS mutation status. Thirty-seven (42.5%) liver metastatic lesions harboring KRAS mutations were identified. The SUVmax of CRLM with KRAS mutation both on early and delayed scans was significantly higher than those with wild-type KRAS (10.7 ± 6.0 vs. 7.8 ± 3.3, P = 0.002; 15.5 ± 10.1 vs. 10.0 ± 4.2, P

Objective Vesicular acetylcholine transporter (VAChT) is a rate-limiting factor for synaptic acetylcholine transport. Our study focused on whether [18 F] VAT, a novel positron emission tomography (PET) tracer, could be used in detecting cognitive deficits in epilepsy. Methods Morris water maze test was used to evaluate learning and memory deficits in pilocarpine-induced chronic epilepsy rats 12 weeks after status epilepticus. Interictal [18 F] VAT PET was performed 13 weeks after status epilepticus to evaluate the level of VAChT in cholinergic pathways compared with [18 F] fluorodeoxyglucose PET. The association between VAChT levels and memory measures was analyzed. Neuropathological tests were performed. Results Epileptic rats exhibited significant memory deficits in Morris water maze test. [18 F] VAT uptake decreased in septum, hippocampus, thalamus, and basal forebrain, and correlated to memory function. Of note, the level of VAChT in basal forebrain significantly decreased, yet no glucose hypometabolism was detected. Immunofluorescence and Western blot demonstrated decreased expression of VAChT in hippocampus and basal forebrain in the epilepsy group, but no change of expression of acetyltransferase or activity of acetylcholinesterase was detected. Significance [18 F] VAT PET is a promising method to test the level of VAChT as a valuable biomarker for memory deficits in pilocarpine-induced chronic epileptic rats.

Coronary artery disease (CAD) is a major cause of death worldwide. It is significantly important to assess the coronary lesion and its pathophysiological relevance comprehensively. Coronary computed tomography angiography (CTA) or myocardial perfusion imaging alone suffers from some limitations in the evaluation of CAD. Through the integration and spatial colocalization of complementary morphological and functional information, the results of published hybrid single-photon emission computed tomography (SPECT)/CTA studies in patients with CAD are promising for detecting functionally relevant coronary artery lesion and evaluating the relationship between diseased coronary artery, coronary artery anomaly, myocardial bridging, or coronary calcification and myocardial ischemia. Compared with other diagnostic procedures, such as CTA, myocardial perfusion imaging alone, and side-by-side SPECT-CTA analysis, SPECT/CTA imaging has incremental value in the evaluation of CAD. Hybrid SPECT/CTA imaging can provide the physicians with more clinical evidence that helps with the treatment strategy decision-making process, thus acting as a gatekeeper to reduce unnecessary invasive examinations and revascularization procedures. In addition, follow-up SPECT/CTA fusion imaging plays a role in predicting prognosis by displaying clearly the relationship between postoperative vessel and myocardial blood supply. However, several limitations should be considered, including the increased radiation exposure, the limited number of patients, and the lack of a uniform gold standard. More data are needed to better specify the role of hybrid SPECT/CTA imaging in the management of CAD.

A 48-year-old woman was experiencing abdominal pain and melena for 3 months. Because of these symptoms combined with increased level of tumor marker CA125, possible abdominal malignancy was considered, and an FDG PET/CT was performed to assess occult tumor. The images revealed multiple hypermetabolic lesions along the peritoneal surface. Pathological examination after biopsy demonstrated low-grade epithelioid peritoneal mesothelioma.

Primary endometrial hepatoid adenocarcinoma is a rare tumor. We present a case of a 64-year-old woman with vaginal bleeding for 2 months and a markedly elevated serum α-fetoprotein of 3931 ng/mL. Hysteroscopic segmental curettage revealed endometrial adenocarcinoma. A pelvic MRI was performed for local tumor invasion, which showed only endometrial mass. An abdominal enhanced CT showed no liver lesion, which excluded primary hepatic carcinoma. Staging F-FDG PET/CT demonstrated a hypermetabolic mass in the endometrium. A total hysterectomy with bilateral salpingo-oophorectomy and regional lymphadenectomy were performed. Postoperatively, the mass was diagnosed as primary endometrial hepatoid adenocarcinoma.

Apoptosis is a key factor in unstable plaques. The aim of this study is to evaluate the utility of visualizing atherosclerotic plaques with radiolabeled duramycin and Annexin V. ApoE−/− mice were fed with a high-fat diet to develop atherosclerosis, C57 mice as a control. Using a routine conjugation protocol, highly pure [99mTc]duramycin and [99mTc]Annexin V were obtained, which were applied for in vitro cell assays of apoptosis and in vivo imaging of atherosclerotic plaques in the animal model. Oil Red O staining, TUNEL, hematoxylin-eosin (HE), and CD68 immunostaining were used to evaluate the deposition of lipids and presence of apoptotic macrophages in the lesions where focal intensity positively correlated with the uptake of both tracers. [99mTc]duramycin and [99mTc]Annexin V with a high radiochemical purity (97.13 ± 1.52 and 94.94 ± 0.65 %, respectively) and a well stability at room temperature were used. Apoptotic cells binding activity to [99mTc]duramycin (Kd, 6.92 nM and Bmax, 56.04 mol/1019 cells) was significantly greater than [99mTc]Annexin V (Kd, 12.63 nM and Bmax, 31.55 mol/1019 cells). Compared with [99mTc]Annexin V, [99mTc]duramycin bound avidly to atherosclerotic lesions with a higher plaque-to-background ratio (P/B was 8.23 ± 0.91 and 5.45 ± 0.48 at 20 weeks, 15.02 ± 0.23 and 12.14 ± 0.22 at 30 weeks). No plaques were found in C57 control mice. Furthermore, Oil Red O staining showed lipid deposition areas were significantly increased in ApoE−/− mice at 20 and 30 weeks, and TUNEL and CD68 staining confirmed that the focal uptake of both tracers contained abundant apoptotic macrophages. This stable, fast clearing, and highly specific [99mTc]duramycin, therefore, can be useful for the quantification of vulnerable atherosclerotic plaques.

// Jun Zhou 1, 2, 3 , Yanli Li 1, 2, 3 , Yiqiu Zhang 1, 2, 3 , Guobing Liu 1, 2, 3 , Hui Tan 1, 2, 3 , Yan Hu 1, 2, 3 , Jie Xiao 1, 2, 3 , Hongcheng Shi 1, 2, 3 1 Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China 2 Nuclear Medicine Institute of Fudan University, Shanghai 200032, China 3 Shanghai Institute of Medical Imaging, Shanghai 200032, China Correspondence to: Hongcheng Shi, email: shihongcheng163@163.com Keywords: positron emission tomography/computed tomography, high-resolution computed tomography, lung cancer, invasive adenocarcinoma, ground-glass opacity nodule Received: September 08, 2016 Accepted: February 13, 2017 Published: February 21, 2017 ABSTRACT To investigate the performance of combined 18F-FDG Positron Emission Tomography/Computed Tomography with high-resolution CT for differentiating invasive adenocarcinoma from adenocarcinoma in situ (pre-invasive lesion) or minimally invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules. This retrospective study enrolled 58 consecutive stage IA pulmonary adenocarcinoma patients with solitary ground-glass opacity nodules. The characteristics and measurements of the ground-glass opacity nodules as pure ground-glass opacity nodules and mixed ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma and invasive adenocarcinoma groups on Positron Emission Tomography/Computed Tomography and high-resolution CT were compared and analyzed. Ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma group preferentially manifested as pure ground-glass opacity nodule ( p 0.38 and SUV max > 1.46 in mixed ground-glass opacity nodule when compared to those of SUV max > 0.95 alone or consolidation/tumor ratio> 0.39 alone (both p > 0.05). For a mixed ground-glass opacity nodule combined consolidation/tumor ratio > 0.38 and SUV max > 1.46 appears to better predict invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules.

Summary Aim: The aim of this study was to investigate the added value of SPECT/spiral CT versus SPECT or CT alone in the differential diagnosis of solitary skeletal lesions.Methods: This was a retrospective study on a total of 69 patients who had a solitary skeletal “hot spot” that could not be definitively diagnosed using planar scintigraphy. Thus, SPECT/ spiral CT was performed on the indeterminate lesions. SPECT, CT and SPECT/spiral CT images were independently interpreted by two experienced doctors who have both identification of CT and nuclear medicine. Each lesion was graded on a 4-point diagnostic scale (1: benign, 2: likely benign, 3: likely malignant, 4: malignant). The final diagnosis of each lesion was based on pathological confirmation after surgery within 3 weeks of the bone scan.Results: Final diagnoses based on the pathological results revealed that 43 of the 69 patients were diagnosed with malignancy, and the remaining 26 patients were diagnosed as having benign lesions. For SPECT and CT scans, both of the reviewers rated 55.1% (38/69) and 37.7 % (26/69) of lesions as equivocal, with the help of SPECT/CT, 33.3 % (23/69) of lesions were rated as equivocal. The diagnostic accuracies of SPECT, CT alone and SPECT/CT were 66.7 % (46/69),82.6 % (57/69) and 85.5 %(59/69), respectively. The kappa scores for the degree of agreement between SPECT, CT alone or SPECT/CT with pathological results were 0.185 (p = 0.054), 0.612 (p < 0.001) and 0.671 (p < 0.001), respectively.Conclusion: Compared with SPECT or imaging alone, SPECT/ spiral CT imaging was more accurate and valuable in the differential diagnosis of solitary skeletal lesions and resulted in significantly fewer equivocal findings.

Objective: To investigate the therapeutic efficacy of intratumoral injection of 125I-AA98 mAb for hepatocellular carcinoma (HCC) and its therapy efficacy assessment by 99mTc-HYNIC-duramycin and 99mTc-HYNIC-3PRGD2 SPECT/CT imaging.Methods: HCC xenograft tumor mice models were injected intratumorally with a single dose of normal saline, 10 microcurie (μCi) 125I-AA98 mAb, free 125I, AA98 mAb, 80 μCi 125I-AA98 mAb, and 200 μCi 125I-AA98 mAb. 99mTc-HYNIC-duramycin and 99mTc-HYNIC-3PRGD2 micro-SPECT/CT imaging were performed on days 3 and 7, respectively. The T/M ratio for each imaging was compared with the corresponding immunohistochemical staining at each time point. The relative tumor inhibition rates were documented.Results: In terms of apoptosis, the 200 μCi group demonstrated the highest apoptotic index (11.8 ± 3.8%), and its T/M ratio achieved by 99mTc-HYNIC-duramycin imaging on day 3 was higher than that of the normal saline group, 80 μCi group, 10 μCi group and free 125I group on day 3, respectively (all P < 0.05). On day 3, there was a markedly positive correlation between T/M ratio from 99mTc-HYNIC-duramycin imaging and apoptotic index by TUNEL staining (r = 0.6981; P < 0.05). Moreover, the 200 μCi group showed the lowest T/M ratio on 99mTc-HYNIC-3PRGD2 imaging (1.0 ± 0.5) on day 7 (all P < 0.05) comparing to other groups. The T/M ratio on day 7 was not correlated with integrin ανβ3 staining (P > 0.05). The relative inhibitory rates of tumor on day 14 in the AA98 mAb, 10 μCi, 80 μCi, free 125I, and 200 μCi groups were 26.3, 55.3, 60.5, 66.3, and 69.5%, respectively.Conclusion:125I-AA98 mAb showed more effective apoptosis induced ability for CD146 high expression Hep G2 HCC cells and hold the potential for HCC treatment. Moreover, 99mTc-HYNIC-Duramycin (apoptosis-targeted) imaging and 99mTc-HYNIC-3PRGD2 (angiogenesis-targeted) imaging are reliable non-invasive methods to evaluate the efficacy of targeted treatment of HCC.

Brown adipose tissue (BAT) dissipates metabolic energy and mediates non-shivering thermogenesis, thereby boosting energy expenditure. Increasing BAT mass and activity is expected to be a promising strategy for combating obesity; however, few medications effectively and safely recruit and activate BAT in humans. Berberine (BBR), a natural compound, is commonly used as a nonprescription drug to treat diarrhea. Here, we reported that 1-month BBR intervention increased BAT mass and activity, reduced body weight, and improved insulin sensitivity in mildly overweight patients with non-alcoholic fatty liver disease. Chronic BBR treatment promoted BAT development by stimulating the expression of brown adipogenic genes, enhanced BAT thermogenesis, and global energy expenditure in diet-induced obese mice and chow-fed lean mice, Consistently, BBR facilitated brown adipocyte differentiation in both mouse and human primary brown preadipocytes. We further found that BBR increased the transcription of PRDM16, a master regulator of brown/beige adipogenesis, by inducing the active DNA demethylation of PRDM16 promoter, which might be driven by the activation of AMPK and production of its downstream tricarboxylic acid cycle intermediate α-Ketoglutarate. Moreover, chronic BBR administration had no impact on the BAT thermogenesis in adipose-specific AMPKa1 and AMPKa2 knockout mice. In summary, we found that BBR intervention promoted recruitment and activation of BAT and AMPK–PRDM16 axis was indispensable for the pro-BAT and pro-energy expenditure properties of BBR. Our findings suggest that BBR may be a promising drug for obesity and related metabolic disorders in humans partially through activating BAT.

The present study explored the 18-kDa translocator protein radioligand 18F-PBR06 as a PET imaging biomarker for diagnosis of inflammation and compared it with 18F-FDG for differentiation of inflammation and lung tumors in animals. 18F-PBR06 was synthesized with an average decay-corrected radiochemical yield of 30–40% (end of synthesis, EOS), and the radiochemical purity was greater than 99%. The inflammation-to-blood ratio of 18F-PBR06 (3.53 ± 0.26) was higher than the tumor-to-blood ratio (1.77 ± 0.35) (P

A 69-year-old woman had gradually worsening abdominal discomfort over a year. A pancreatic mass was revealed by abdominal CT. The patient underwent FDG PET/CT for staging, which demonstrated the hypermetabolic pancreatic mass with multiple liver metastases. The lesion was pathologically confirmed as pancreatic adenosquamous carcinoma after biopsy.

Thyroid metastasis from hepatocellular carcinoma (HCC) is very rare. We present a case of a 41-year-old man with a markedly elevated serum α-fetoprotein (2,297 ng/mL) and a left neck mass 6 months after a hepatolobectomy for a primary HCC. F-FDG PET/CT imaging showed a focal uptake in the left thyroid lobe corresponding to a mass. The patient underwent a left hemithyroidectomy. Subsequent pathology confirmed HCC metastasis to the thyroid.

BACKGROUND The aim was to compare the detect ability of three sequential 131I whole-body scans (tri-WBS) on the second, third, and fourth day after 131I therapy for metastatic thyroid cancer. METHODS Differentiated thyroid cancer patients who received oral high-dose 131I therapy underwent routinely tri-WBS on the second, third, and fourth day after total or near-total thyroidectomy in Zhongshan Hospital, Fudan University. We enrolled 137 patients with 261 tri-WBSs in this study between January 2015 and November 2017. The inclusion criteria was that at least one metastasis was found in the tri-WBS. We classified radioactive uptake of metastatic lesions by visual assessment into three grades: grade 0 = no uptake, grade 1= suspicious uptake, and grade 2 = definite uptake. The fourth day 131I WBS images were also compared with concurrent pre-therapeutic 99mTc-pertechnetate WBS images when available. We also analyzed the serum Tg levels of probably statistical difference in the patients with only lymph node, lung, bone, and multiple metastases when they underwent the first radioiodine ablation. RESULTS A total of 722 metastatic accumulations were identified in the final decisions, including 293 lymph node metastases, 261 nodular pulmonary metastases, 49 diffuse bilateral pulmonary metastases, 106 bone metastases, and 13 other metastases. The differences of intensity of uptake in sequential three day images were significant in visualization of lymph node metastasis (χ2=124.432, P

Inflammation and calcification concomitantly drive atherosclerotic plaque progression and rupture and are the compelling targets for identifying plaque vulnerability. However, current imaging modalities for vulnerable atherosclerotic plaques are often limited by inadequate specificity and sensitivity. Here, we show that natural H-ferritin nanocages radiolabeled with technetium-99m (99mTc-HFn) can identify and accurately localize macrophage-rich, atherosclerotic plaques in living mice using combined SPECT and CT. Focal 99mTc-HFn uptake was observed in the atherosclerotic plaques with multiple high-risk features of macrophage infiltration, active calcification, positive remodeling, and necrosis on histology and in early active ongoing lesions with intense macrophage infiltration. The uptake of 99mTc-HFn in plaques enabled quantitative measuring of the dynamic changes of inflammation during plaque progression and anti-inflammation treatment. This strategy lays the foundation of using bioengineered endogenous human ferritin nanocages for the identification of vulnerable and early active plaques as well as potential assessment of anti-inflammation therapy.

A 41-year-old woman presented with abdominal distention, inappetence, and rapid emaciation for 1 month. Diffuse bulky gastric wall thickening with lymph nodes enlargement and peritoneal nodules were revealed using abdominal CT. Staging F-FDG PET/CT performed after admission demonstrated intensely diffuse FDG uptake in stomach, FDG-avid lymph nodes, and peritoneal nodular lesions. Postoperatively, these lesions were diagnosed as diffuse large B-cell lymphoma.

A 32-year-old woman presented with 3 months' history of rapid enlargement of the left breast and superficial ulceration. Staging F-FDG PET/CT performed after admission demonstrated a hypermetabolic mass in the left breast, with smaller hypermetabolic areas in the left axillary and internal mammary lymph nodes, as well as in the sternum. Postoperatively, the mass was diagnosed as metaplastic squamous cell carcinoma of the breast.

Background The efficacy of susceptibility-weighted imaging (SWI) for detecting intracranial bleeds (ICBs) in patients with mild traumatic brain injury (MTBI) has not been directly compared to that of T2*-weighted gradient-recalled-echo imaging (T2*WI). Further, its prognostic value for MTBI patients remains unproven. Purpose To compare the sensitivity of ICB identification between SWI and T2*WI and examine the prognostic value of SWI for MTBI patients. Material and Methods T2*WI, SWI, and clinical information of 63 MTBI patients were collected. Sensitivity was compared between T2*WI and SWI for ICB identification, and statistical analysis was conducted to understand the correlations between SWI and clinical characteristics. Results ICBs were detected in more patients (47 vs. 35, P Conclusion SWI is more sensitive than T2*WI in detecting hemorrhagic foci in MTBI patients and may offer valuable prognostic information regarding these patients, for example, information on PCS. Further, cerebral parenchymal hemorrhage may affect long-term outcomes in MTBI patients.

PURPOSE The aim of this study was to evaluate the role of gated myocardial perfusion SPECT (GMPS) phase parameters (phase SD and histogram bandwidth) in predicting the short-term response to cardiac resynchronization therapy (CRT) as left ventricle (LV) remodeling and the long-term effect as all-cause mortality or cardiac transplantation and hospitalization for heart failure. PATIENTS AND METHODS This prospective observational study included 63 consecutive patients undergoing CRT from May 2008 to April 2014. Before CRT, patients underwent evaluation of New York Heart Association functional class, standard 12-lead ECG, Tc-MIBI GMPS, and 2-dimensional echocardiography. The patients were grouped according to complete left bundle-branch block (CLBBB). Follow-up was done every 6 months after pacemaker implantation. The short-term end point was reverse LV remodeling in 6 to 12 months follow-up, and the long-term primary end point was all-cause mortality or cardiac transplantation. The secondary end point was hospitalization for heart failure. RESULTS Reverse LV remodeling showed in 60.9% (39/63) patients (74.5% CLBBB [35/47] vs 25.0% non-CLBBB [4/16], P < 0.001). Phase SD less than 55 degrees, CLBBB, and left atrium diameter were independent predictive factors for reverse LV remodeling. At a median follow-up of 39.76 months, there were 17 deaths and 2 transplantations (17.0% CLBBB vs 68.8% non-CLBBB, P < 0.001). Seventeen patients required hospitalization more than once for heart failure, and 2 underwent heart transplantation (14.9% CLBBB vs 62.5% non-CLBBB, P < 0.001). Multivariate logistic regression showed that only CLBBB was an independent predictive factor for both end points. CONCLUSIONS The GMPS parameters were not independent predictive factors for all-cause mortality or cardiac transplantation and hospitalization for heart failure.

OBJECTIVES The aim of the study was to investigate the combined effects of serum lipids, BMI, and fatty liver on the liver uptake of fluorine-18 fluorodeoxyglucose ((18)F-FDG). METHODS A total of 676 individuals were retrospectively studied. The mean standardized uptake value (SUV) was used to quantify liver (18)F-FDG uptake. Univariate analyses and multivariate regression models identified variables that predicted the mean liver SUV before and after dichotomizing participants into low and high BMI groups. RESULTS The mean liver SUV (1.831 ± 0.417) differed significantly among nutritional categories (P = 0.005) and degrees of fatty liver (P < 0.001). An increase in mean liver SUV was noted in individuals with mild and moderate fatty liver compared with normal individuals and in overweight individuals compared with underweight individuals, whereas a downward trend was identified in both individuals with severe fatty liver and those who were obese. BMI had the strongest association with severity of fatty liver (r = 0.443, P < 0.001). Triglyceride, HDL, apolipoprotein-A, age, and BMI were independent variables predicting liver SUV mean in the whole population, whereas fatty liver severity presented as an independent variable only in the low BMI population (P = 0.031). CONCLUSION BMI, age, triglyceride, HDL, and apolipoprotein-A were independent variables predicting liver (18)F-FDG uptake. Mild and moderate degree of fatty liver had a positive effect on liver (18)F-FDG uptake, whereas a severe degree of fatty liver negatively affected (18)F-FDG uptake. Attention should be paid to liver metabolism in patients with fatty liver before using liver as the comparator in determining focal (18)F-FDG uptake elsewhere within the abdomen.

This study attempted to evaluate the feasibility of 99m Tc-labeled glucarate ( 99m Tc-GLA) imaging in non-small cell lung cancer (NSCLC) and the potential tumor uptake mechanism. Cell lysates from two NSCLC cell lines, H292 and H1975, were immunoblotted with anti-glucose transporter 5 (GLUT5) antibody for Western blotting. Thereafter, the two cell lines were used to examine cellular uptake of 99m Tc-GLA with or without fructose. SPECT/CT imaging studies were performed on small animals bearing H292 and H1975 tumors. Biodistribution studies were also conducted to achieve accurate tissue uptake of this tracer in two tumor models. Hematoxylin & eosin (H&E) staining and GLUT5, Ki67 and cytokeratin-7 (CK-7) immunohistochemistry (IHC) analysis were further investigated on tumor tissues. In Western blotting, H292 cells showed higher levels of GLUT5 compared to the H1975 cells. Meanwhile, the in vitro cell assays indicated GLUT5-dependent uptake of 99m Tc-GLA in H292 and H1975 cells. The fructose competition assays showed a significant decrease in 99m Tc-GLA uptake by H292 and H1975 cells when fructose was added. The 99m Tc-GLA accumulation was as much as two-fold higher in H292 implanted tumors than in H1975 implanted tumors. 99m Tc-GLA exhibited rapid clearance pharmacokinetics and reasonable uptake in human NSCLC H292 (1.69±0.37 ID%/g) and H1975 (0.89±0.06 ID%/g) implanted tumors at 30min post injection. Finally, the expression of GLUT5, Ki67 and CK-7 on tumor tissues also exhibited positive correlation with the in vitro cell test results and in vivo SPECT/CT imaging results in xenograft tumors. Both in vitro and ex vivo studies demonstrated that the uptake of 99m Tc-GLA in NSCLC is highly related to GLUT5 expression. Imaging and further IHC results support that 99m Tc-GLA could be a promising SPECT imaging agent for NSCLC diagnosis and prognosis evaluation.

Multi functional probes possessing magnetic resonance imaging and single-photon emission computed tomography properties are favorable for the molecular imaging of cancers. In this study, ultra small super paramagnetic iron oxide nanoparticles, about 3.5 nm in size, were synthesized by the polyol method. The particles were functionalized using c(RGDyC) peptides and labeled with 99mTc to prepare molecular imaging probes for detecting tumor angiogenesis. The probes demonstrated good T1 (r1 = 8.2 s(-1) mM(-1)) and reasonable T2 contrast effects (r2 = 20.1 s(-1) mM(-1)) and could specifically target avβ3-positive cells, inducing more cell ingestion, unlike that in case of the control probes [functionalized with scrambled c(RADyC) peptides]. After the probes were injected into the mice bearing H1299 lung tumors, T1/T2-weighted magnetic resonance imaging and single-photon emission computed tomography revealed that they addressed tumor angiogenic vessels, which were distributed mainly in the peripheral region of tumors. Biodistribution studies indicated that tumor accumulation of the probes was significant [13.8 ± 9.6%ID/g (p < 0.01), which is more than that of the control probes, 4.5 ± 1.9%ID/g], and could be inhibited by free RGD peptides (6.0 ± 2.8%ID/g, p < 0.01). Our study demonstrated that the dual-contrast (T1/T2) magnetic resonance and dual-modal imaging probe based on ultra small superparamagnetic iron oxide nanoparticles is very promising for the molecular imaging of tumor angiogenesis.