Abstract Background The aim of the present study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative 18F‐FDG PET/CT imaging parameters in predicting patient outcomes in thymic epithelial tumors (TETs). Methods This retrospective study included 100 patients diagnosed with TETs who underwent pretreatment 18F‐FDG PET/CT. The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index‐1 (HI‐1; standard deviation [SD] divided by SUVmean) and heterogeneity index‐2 (HI‐2; linear regression slopes of the MTV according with different SUV thresholds), were evaluated as heterogeneity indices. Associations between these parameters and patient survival outcomes were analyzed. Results The univariate analysis showed that Masaoka stage, TNM stage, WHO classification, SUVmax, SUVmean, TLG, and HI‐1 were significant prognostic factors for progression‐free survival (PFS), while MTV, HI‐2, age, gender, presence of myasthenia gravis, and maximum tumor diameter were not. Subsequently, multivariate analyses showed that HI‐1 (p < 0.001) and TNM stage (p = 0.002) were independent prognostic factors for PFS. For the overall survival analysis, TNM stage, WHO classification, SUVmax, and HI‐1 were significant prognostic factors in the univariate analysis, while TNM stage remained an independent prognostic factor in multivariate analyses (p = 0.024). The Kaplan Meier survival analyses showed worse prognoses for patients with TNM stages III and IV and HI‐1 ≥ 0.16 compared to those with stages I and II and HI‐1 < 0.16 (log‐rank p < 0.001). Conclusion HI‐1 and TNM stage were independent prognostic factors for progression‐free survival in TETs. HI‐1 generated from baseline 18F‐FDG PET/CT might be promising to identify patients with poor prognosis.

目的 观察18 F-FDG PET/CT检测淋巴结转移癌原发灶的价值.方法 回顾性分析133例接受18 F-FDG PET/CT检查的淋巴结转移癌患者,以临床综合诊断结果为标准,与淋巴结免疫组织化学结果对比,评估PET/CT检出淋巴结转移癌原发灶的效能.结果 18F-FDG PET/CT检出淋巴结转移癌原发灶的敏感度、特异度、假阳性率、假阴性率、阳性预测值及阴性预测值分别为84.09％(37/44)、82.02％(73/89)、17.98％(16/89)、15.91％(7/44)、69.81％(37/53)及91.25％(73/80),淋巴结免疫组织化学分别为41.03％(16/39)、69.15％(65/94)、30.85％(29/94)、58.97％(23/39)、35.56％(16/45)及73.86％(65/88),前者的敏感度高于后者(P<0.001);18 F-FDG PET/CT及淋巴结免疫组织化学检出淋巴转移癌原发灶的曲线下面积分别为0.83和0.62.结论 18F-FDG PET/CT用于检测淋巴结转移癌原发灶具有一定临床应用价值.

患者女，57岁，15 d前受凉后出现咳嗽、胸闷、哮喘等症状，运动后上述症状加重，无发热，偶有咳嗽伴白痰及右胸痛。患者曾于8年前行"腹膜后巨大肿瘤"手术，病理示"高分化脂肪肉瘤"。实验室检查(括号内为正常参考值范围)：中性粒细胞百分数80.9%(40.0%~75.0%)，WBC、RBC计数及PLT均正常；血清真菌D葡聚糖171.11(0~100.00) ng/L；结核感染T细胞斑点试验(T－SPOT)阴性对照孔0，阳性对照孔正常，抗原A(ESAT－6)孔17(0~6)，抗原B(CFP－10)孔12(0~6)；红细胞沉降率54(0~20) mm/1 h；C反应蛋白64.20(0~10.00) mg/L；腺苷脱氢酶11(0~22) U/L；胸腔积液常规：蛋白质定性(++)，体液有核细胞数482(0~300)×10 6/L。胸部CT示：右侧胸膜增厚，右侧胸腔积液，右肺膨胀不全。 18F－FDG PET/CT[德国Siemens Biograph TruePoint64(52环)]显像(图1)示：右侧胸膜弥漫性增厚代谢明显增高；腹盆腔内巨大不规则脂肪密度肿块局部代谢轻度增高，密度不均匀，其内有成熟的脂肪组织、纤维分隔及软组织密度影。为进一步明确病变类型，行CT引导下右侧胸膜病变穿刺活组织检查示：(胸膜)恶性肿瘤，结合病史及基因检测，符合去分化脂肪肉瘤。免疫组织化学：AE1/AE3(灶+)，甲状腺转录因子－1(－)，细胞角蛋白7(－)，人骨髓内皮细胞标志物－1(－)，葡萄糖转运蛋白(Glut)－1(+)，癌胚抗原(－)，细胞增殖核抗原Ki－67(局灶约40%+)，D2－40(+)，CD34(－)，信号转导及转录激活蛋白6(+)，Friend白血病整合素1(+)，CD31(部分+)，结蛋白(+)，平滑肌肌动蛋白(+)，CD99(+)，B细胞淋巴瘤2(+)，上皮膜抗原(－)。荧光原位杂交检测结果：MDM2基因扩增。

Objective To compare focal metabolic activity of single Kikuchi disease（KFD） and KFD complicated with autoimmune disease. Methods Eighteen patients with pathologically confirmed KFD who underwent 18 F-FDG PET/CT were divided into single KFD group（n=9） and KFD complicated autoimmune disease group（n=9）. The systemic involvements were observed, and the clinical data, laboratory tests and metabolic parameters were compared between groups. Results The clinical data and laboratory tests were not significant different between groups（all P＞0.05）. PET/CT showed multiple lymph node abnormalities throughout the body in KFD patients, including the neck, axilla, mediastinum, splenic hilum, retroperitoneum, parietal iliac vessels and groin, as well as bone marrow and spleen. There was no significant difference of the site of lymph node involvements, the location of the highest FDG uptake lymph nodes nor the proportion of enlarged spleen between groups（all P＞0.05）. The tumor metabolic volume（MTV） 40% and total lesion glycolysis（TLG） 40% , the mean standard uptake value（SUV） of spleen and the maximum SUV of bone marrow were all higher in KFD complicated autoimmune disease group than those in single KFD group（all P＜0.05）. Conclusion Metabolic parameters of the affected lymph nodes, spleen and bone marrow in KFD patients complicated with autoimmune disease were different from those in single KFD patients.

目的 对比18F-成纤维细胞激活蛋白抑制剂(FAPI)-04与18F-FDGPET/CT诊断腹膜转移癌(PC)的价值.方法 前瞻性纳入42例疑诊PC患者行全身18F-1,4,7-三氮杂环壬烷-N,N',N"-三乙酸(NOTA)-FAPI-04和18F-FDG PET/CT检查,以病理学结果为金标准,比较2种显像的PC指数(PCI)、病灶最大标准摄取值(SUVmax)及靶-背景比(TBR)差异;绘制受试者工作特征曲线,评估2种显像诊断PC效能.结果42例中,病理确诊31例PCo18F-NOTA-FAPI-04诊断PC的敏感度、特异度和准确率分别为93.55％、72.73％和88.10％,18F-FDG PET/CT分别为74.19％、54.55％和69.05％,前者的敏感度及准确率均高于后者(P均＜0.05);以前者所获PCI、所测PC的SUVmax、TBR均高于后者(P均＜0.001).分别以 2.31 及 2.52 为 FAPI-SUVmax、FDG-SUVmax的截断值,18 F-NOTA-FAPI-04 及18F-FDG PET/CT 诊断PC的曲线下面积(AUC)分别为0.839及0.630,差异有统计学意义(P=0.002);分别以1.60及0.73为FAPI-TBR、FDG-TBR的截断值,18F-NOTA-FAPI-04及18F-FDG PET/CT诊断PC的AUC分别为0.856及0.604,差异亦有统计学意义(P=0.005).结论18F-NOTA-FAPI-04PET/CT 诊断 PC 较18F-FDGPET/CT 更具优势.

Objective:To compare the clinical utility of 18F-prostate specific membrane antigen (PSMA)-1007 and 18F-FDG PET/CT imaging in newly diagnosed hepatocellular carcinoma (HCC). Methods:From April 2022 to July 2022, 17 patients (14 males, 3 females, age 36-73(54.4±10.1) years) with newly diagnosed HCC who underwent 18F-FDG and 18F-PSMA-1007 PET/CT imaging within 3 d in the First Affiliated Hospital of Zhengzhou University were prospectively enrolled. ROIs were drawn from normal liver tissue (L), abdominal aorta (A), right gluteus medius (M), and SUV max of these regions were compared with the SUV max of primary tumor (T). Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to analyze the data. Results:18F-FDG PT/CT, 18F-PSMA-1007 PET/CT and enhanced MRI detected 1(0, 2), 2(1, 5) and 2(1, 4) tumor lesions of the liver in each patient respectively ( H=7.10, P=0.029), and 18F-PSMA-1007 detected more lesions than 18F-FDG ( P=0.024). Although SUV max of 18F-PSMA-1007 in HCC was significantly higher than that of 18F-FDG (25.7(17.1, 45.1) vs 6.3(2.9, 12.4); z=3.39, P=0.001), there was no significant difference of T/L ratio between 18F-PSMA-1007 and 18F-FDG PET/CT imaging (2.7(2.1, 4.7) vs 1.6(1.0, 4.5); z=0.52, P=0.602). T/A and T/M ratios were significantly higher in 18F-PSMA-1007 PET/CT imaging than those in 18F-FDG PET/CT imaging ( z values: 3.15, 3.53, P values: 0.002, <0.001). 18F-PSMA-1007 PET/CT imaging found high uptake foci in the liver and ribs in 2 cases, which were pathologically confirmed as bone metastasis of HCC, while those lesions were not found by 18F-FDG imaging. Conclusion:Compared with 18F-FDG, 18F-PSMA-1007 PET/CT demonstrates higher tumor uptake, more intrahepatic tumors foci and distant bone metastases.

1212 Objectives: To explore the value of 18F-FDG PET / CT in the diagnosis of renal inflammatory diseases. Methods: From January 2011 to December 2019, 18F-FDG PET/CT imaging data of 11 cases with renal inflammatory disease diagnosed by pathology were analyzed retrospectively, including 5 males and 6 females, aged 40-75 years with an average of 60.5 ± 9.8 years. Manifestations of 18F-FDG PET / CT were observed and SUVmax was measured. Results: Among the 11 patients, there were 7 cases of pyogenic nephritis and inflammatory pseudotumor, among which 6 cases showed high uptake, SUVmax was 13.3 ± 7.8, and 1 case showed uptake similar to renal parenchyma; There were 1 case of ANCA related nephritis and 3 cases of IgG4 related nephropathy, all of which showed high diffuse uptake of both kidneys, with SUVmax of 6.0 and 7.2 ± 4.0,respectively. The sensitivity of 18F-FDG PET/CT in the diagnosis of renal inflammatory diseases was 90.9% (10 / 11). Conclusions: FDG can sensitively detect hidden infection in the whole body, which plays an important role in the qualitative and staging of renal inflammatory disease.

发生于心脏的副神经节瘤临床少见,同时描述该疾病MRI及 PET/CT 影像学表现的文献更为罕见. 现将郑州大学第一附属医院收治的一例发生于心脏的副神经节瘤的多模态显像结果报道如下.

Objective:To investigate 18F-fluorodeoxyglucose( 18F-FDG)positron emission tomography(PET)/computed tomography(CT)multimodal imaging features and clinical manifestations of renal lymphoma. Methods:A retrospective study was performed on 99 cases of patients with renal lymphoma who were admitted in the department of Nuclear Medicine, the first Affiliated Hospital of Zhengzhou University and underwent 18F-FDG PET/CT from January 2011 to December 2018.There were 69 males and 30 females, with an average age of(45±23)years old, ranging from 3 to 86 years old.Renal function indexes(creatinine, urea, uric acid)were detected in the laboratory, the expression of 18F-FDG PET/CT was observed, and the maximum standard value(SUV max)was measured.The enhancement mode and MRI signal characteristics of patients undergoing enhanced CT or MRI were observed. Results:Creatinine in 10 cases had different degrees of elevation(117 ~ 389 μmol/L); urea in 17 cases had different degrees of elevation(8.40~50.35 μmol/L); uric acid in 15 cases had different degrees of elevation(441~1 044 μmol/L). There were 35 cases of multinodular type, SUV max was 14.92±8.69.There were 22 cases of solitary lesion type, the SUV max was 12.25±5.78.There were 12 cases of retroperitoneal infiltration, SUV max was 16.53±8.01.There were 5 cases of perirenal type, SUV max was 11.16±3.54.There were 3 cases of renal sinus type, SUV max was 9.57±4.45.There were 17 cases with diffuse infiltration, SUV max was 10.04±5.44.The SUV max of the mixed forms in 5 cases was 14.32±6.92.There was no significant difference in SUV max between different types of renal lymphoma( P>0.05). Enhanced CT was performed in 60 patients and MRI in 5 patients.Enhanced CT showed no or mild to moderate progressive delayed enhancement and even density, 6 cases with slight necrosis or cystic change, 6 cases of enhanced CT failed to detect renal lesions.MRI plain scan showed low, equal or slightly high signal on T1WI, equal or low signal on T2WI, and significantly high signal on diffusion weighted imaging.All lesions were detected. Conclusion:18F-FDG PET/CT imaging of renal lymphoma has high diagnostic sensitivity and plays an important role in the diagnosis and staging.

1577 Objectives: To explore the diagnostic value of 18F-FDG PET/CT delayed imaging after induced diuresis for bladder tumor. Methods: Seventy-eight patients(55 males,23 females;age range 13—93 years)with pathologically confirmed bladder tumor were retrospectively analyzed.All patients underwent standard 18F-FDG PET/CT followed by a delayed(2.0—4.0h later)pelvic imaging after forced diuresis using intravenous injection furosemide(40mg). To evaluate the clearance of bladder and the results of 18F-FDG PET/CT findings to evaluate the value of the delayed diuretic imagings in bladder tumor. Results: Good clearance was obtained in 96.2% of patients(75/78).There were 73 malignant (58 urothelium carcinomas and the other pathological types)and 5 benign tumor.On delayed diuretic imagings of 18F-FDG PET/CT, 70 of 73 malignant lesions showed increased metabolism of 18F-FDG and the other 3 were false negative;while the 5 benign tumors showed no abnormal 18F-FDG uptake.The sensitivity,specificity,and accuracy of delayed pelvic imaging were 70/73,5/5,75/78,respectively.The delayed diuretic imagings improved clinical stages in 40 patients. Conclusions: 18F-FDG PET/CT delayed imaging after diuresis has a high diagnostic efficacy for bladder tumor.

以高钙血症为首发症状的B 细胞性淋巴瘤的相关报道较为少见,同时描述其PET/CT影像学表现的文献更为少见. 现将郑州大学第一附属医院收治的以重度高钙血症为首发症状的一例B 细胞性淋巴瘤患者报道如下,并结合相关文献就其可能的发病机制进行阐述.

目的:探讨应用18 F-FDG PET/CT显像最大标准摄取值(SUVmax)鉴别肾细胞癌(RCC)不同病理分型的临床应用价值.方法:回顾性分析经手术或组织活检病理确诊为RCC的87例患者(其中肾透明细胞癌63例、肾乳头状癌13例、嫌色细胞癌11例)PET/CT显像资料,经采集图像信息获取肿瘤病灶的SUVmax值和肿瘤最长径,比较不同病理分型肾癌(肾透明细胞癌、肾乳头状癌、嫌色细胞癌)之间SUVmax的差异、不同Fuhrman分级以及不同临床分期(有无远处转移)肾透明细胞癌的SUVmax的差异.结果:不同病理分型的RCC患者SUVmax差异有统计学意义(肾乳头状癌>肾透明细胞癌>嫌色细胞癌,P<0.05);低级别肾透明细胞癌与高级别肾透明细胞癌SUVmax及最长径差异有统计学意义(P<0.05);合并转移的肾透明细胞癌与无转移的肾透明细胞癌SUVmax及最长径差异有统计学意义(P<0.05).结论:18F-FDG PET/CT显像SUVmax对鉴别RCC的病理分型、肾透明细胞癌分级及评估临床分期及预后有重要的指导意义.

Objective To investigate the effect of dexmedetomidine on early postoperative cognitive func-tion in elderly patients undergoing liver resection. Method Fifty-four ASAⅡ~Ⅲelderly patients scheduled for liver resection were divided into 3 groups(18 in each group):the control group(group C),group D1 and group D2. The levels of serum 8-iso-PGF2α,IL-6,TNF-α and S100β protein were measured,and Da-jvO2,CjvO2and CERO2were calculated at the time before operation and at the end of operation,respectively.Incidence of postoper-ative cognitive dysfunction(POCD)were recorded within seven days after operation. Results Compared with the time before operation,levels of serum 8-iso-PGF2α,IL-6,TNF-α,S100β protein and Da-jvO2,CERO2of patients in 3 groups significantly increased at the end of operation(P < 0.05,respectively). The levels of serum 8-iso-PGF2α,IL-6,TNF-α,S100β protein and Da-jvO2,CERO2of patients decreased in group D1 and D2 than those in group C at the end of operation(P<0.05).Incidence of POCD in group D1 and D2 was lower than that of group C (P<0.05).Conclusion Dexmedetomidine can decrease the incidence of POCD for the elderly patients undergo-ing liver resection,the potential mechanism is that dexmedetomidine can reduce oxidative stress response,inhibit inflammatory response in patients and improve the cerebral oxygen metabolism during the operation.

OBJECTIVE:In the follow-up of patients with differentiated thyroid cancer (DTC), several patients had elevated serum levels of antithyroglobulin antibody (TgAb), undetectable serum thyroglobulin (Tg), and negative radioiodine whole body scan (131I-WBS). We describe the use of neck ultrasonography (US) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging in these patients to investigate this clinically challenging problem and propose treating.SUBJECTS AND METHODS:A total of 49 DTC patients with elevated serum levels of TgAb (>115IU/mL), undetectable Tg and negative 131I-WBS were divided into two groups (positive and negative) according to the neck US findings. Differences in the rate of recurrence between the two groups were investigated. The diagnostic value of 18F-FDG PET/CT in these patients was evaluated.RESULTS:Among the 49 patients, the rate of recurrence of patients with positive neck US was 50%, which was significantly higher than that of patients with negative neck US (17.24%; P=0.014). The sensitivity, specificity, and positive predictive values of 18F-FDG PET/CT imaging in diagnosing the clinical status of these patients were 93.33%, 70.59% and 58.33%, respectively. After the 18F-FDG PET/CT scan, clinical management was changed in 14 patients. Nine patients were operated and five underwent 131I ablation therapy.CONCLUSION:In the 49 DTC patients with elevated serum levels of TgAb but negative findings in serum Tg and in 131I-WBS, neck US and 18F-FDG PET/CT imaging supported the clinical diagnosis and suggested subsequent treatment.

Objective To observe the clinical application value of propofol target-controlled infusion combined with sufentanil in pediatric tonsillectomy.Methods Ninety children scheduled for tonsillectomy were randomly divided into two groups,with 45 cases in each group.The observation group received propofol target-controlled infusion combined with sufentanil,and the control group was treated with sevoflurane combined with sufentanil.The vital signs of children,anesthetic effect and adverse effects were observed.Results In the two groups,the MAP,HR were significant decreased and there was no insignificant difference between the two groups before the endotracheal intubation after inducting.The operation duration and extubation time between two two groups had no significant difference(P>0.05);while the recovery time in the observation group was significant shorter than that in the control group,and the score of five minutes after extubation OAA/S,the former was higher than the latter(P<0.05).The emergence agitation,bucking and other adverse reation in the observation group were significant less than those in the control group(P<0.05).Conclusions When propofol target-controlled infusion combined with sufentanil applied in pediatric tonsillectomy,which is safe,effective and has low rate of adverse reation.

Objective To compare effects of fentanyl and sufentanil on hemodynamics and oxyhemoglobin saturation on fiberoptic bronchoscopy. Methods Sixty patients were scheduled for fiberoptic bronchoscopy were randomly divided into A group and B group (n=30). Ten munites before examination, patients in group A received intravenous fentanyl (2 μg/kg) and in group B received intravenous sufentanil (0.2 μg/kg). The HR, NBP and SpO 2 were recorded before drug injection, before examination, 5 munites during examination and 5 minutes after examination. Results Both groups, the HR and BP were significant increased in different degree and SpO 2 were insignificant difference during examination. Compare with two groups, the values of HR, SBP, DBP, MBP and SpO 2 were insignificant difference in each time. Conclusion Both fentanyl and sufentanil are effective for fiberoptic bronchoscopy and there were similar effect.

目的 观察研究应用腰硬联合阻滞复合丙泊酚静脉麻醉在下肢手术中的临床效果. 方法 选取我院行下肢手术的100例患者,根据麻醉方法随机分为2组,对照组患者进行腰硬联合阻滞麻醉,实验组患者进行腰硬联合阻滞复合丙泊酚静脉麻醉,观察2组患者麻醉前后血压、心率的变化情况,临床麻醉效果以及不良反应发生率. 结果 实验组术中血压和心率与对照组变化无明显差异;实验组的麻醉起效时间、感觉阻滞时间、运动阻滞时间、总阻滞时间以及苏醒时间显著低于对照组,不良反应发生率也显著低于对照组. 结论 腰硬联合阻滞复合丙泊酚静脉麻醉在下肢手术中的临床应用具有显著作用,在麻醉应用中占有关键性地位.