To compare the efficacy of [68Ga]Ga-FAPI-04 PET/CT in primary or recurrent tumors and metastatic lesions of epithelial ovarian cancer (EOC) with that of fluorine-18 fluorodeoxyglucose ([18F]F-FDG) PET/CT. Forty-nine patients (median age, 57 years; IQR, 51–66 years) with histologically proven primary or relapsed EOC were enrolled. Participants underwent [18F]F-FDG and [68Ga]Ga-FAPI-04 PET/CT. The detection rate, diagnostic accuracy, semiquantitative parameters, tumor staging, and clinical management of the tracers were compared. The diagnostic performance of [18F]F-FDG and [68Ga]Ga-FAPI-04 PET/CT was evaluated and compared using surgical pathology. Differences between methods regarding the peritoneal cancer index (PCI) using preoperative imaging, surgical PCI, and tumor markers (CA125, HE4) were also assessed regarding peritoneal metastases. Among the 49 patients, 28 had primary EOC; 21 had relapsed EOC. [68Ga]Ga-FAPI-04 PET/CT outperformed [18F]F-FDG PET/CT in detecting peritoneal metastases (96.8

目的 探讨炎症型肺浸润性黏液腺癌的CT表现,提高对本病的认识.方法 回顾性分析经手术病理或穿刺活检证实的11例炎症型肺浸润性黏液腺癌患者的临床、CT资料.结果 11例中8例为多发病灶,2例为单发病灶,1例首次检查为单发病灶,6个月复查时为双肺播散.11例均见一处或多处片状实变影,其中3例为单纯性实变影,8例为实变影伴磨玻璃影.实变影的密度不均匀,平均CT值21.4HU.11例中10例实变影中可见含气支气管影,含气支气管的形态不规则,表现为支气管僵直、支气管扩张、扭曲变形,2例可见局部明显增粗呈假空洞状.增强扫描后实变影强化不均匀,大部分区域为轻中度强化,动脉期CT值上升24.2HU,静脉期CT值上升23.6HU,2例实变影中可见局灶性的明显强化区,10例增强扫描患者均可见血管造影征.11例中1例可见胸腔积液,本组病例中没有肺门及纵膈淋巴结转移.结论 炎症型肺浸润性黏液腺癌CT表现上一定的特征,CT能够为本病的诊断提供非常有用的信息.

目的 探讨线上以案例为导向的教学法(case-based learning,CBL)结合教学实际,依托QQ群、腾讯会议和学习通平台在核医学理论教学中的应用效果.方法 选取2020年2—6月武汉大学临床医学专业188名学生作为试验组,以2019年2—6月166名学生作为对照组.试验组采用线上CBL教学法教学,对照组采取线下传统教学方法.同时对两组学生进行问卷调查及教学效果评估.结果 试验组学生的影像图片诊断及理论知识考试成绩高于对照组差异有统计学意义(P＜0.05).试验组学生中CBL教学能激发临床学习兴趣、调动学习兴趣和积极性,差异有统计学意义(P＜0.05).课程内容掌握程度虽仍存在个体差异,但试验组学生认为"基本理解""基本掌握"的认同人数占比高于对照组,差异有统计学意义(P＜0.05).结论 基于线上的CBL教学法在核医学教学过程中能培养学生的学习兴趣,激发学生的学习主动性、积极性、自主性,提高其临床应用能力.

Abstract Myxopapillary ependymoma is a rare tumor. Most of them occur exclusively in the conus medullaris, cauda equina, or filum terminale. Here, we present the 68Ga-FAPI PET/CT findings in a 37-year-old woman with presacral myxopapillary ependymoma.

Objective:To develop a radiolabeled peptide molecular tracer 99Tc m-His-Arg-Pro-Tyr-Ile-Ala-His ( 99Tc m-T7) targeting transferrin receptor and evaluate its micro SPECT/CT imaging effect in tumor-bearing nude mice models. Methods:The peptide probe 99Tc m-T7 was developed by indirect labeling method with the coordination of co-ligands N-tri (hydroxymethyl) methylglycine and ethylenediamine diacetate. The expression levels of TfR on the surface of human pancreatic PANC-1 tumor cells and human breast MX-1 tumor cells were measured through flow cytometry. Cell binding and competitive blocking assays was conducted to analyze the binding affinity and specificity of 99Tc m-T7 in vitro. Micro SPECT/CT imaging and biodistribution after the establishment of mouse xenograft models were performed in vivo to evaluate the affinity and feasibility of noninvasive tumor imaging. Radio-autograph assay and immunohistochemical staining were conducted to validate the correlation between the uptake of 99Tc m-T7 and expression of TfR in tumor tissues. Independent sample t-test was used for the comparison between the two groups. Results:The radiolabeled probe 99Tc m-T7 was successfully synthesized with a radiolabeling yield of greater than 95%. It exhibited great stability in vitro, with radiochemical purities of (95.3±0.3)% and (90.6±0.4)% after incubation in normal saline and fetal bovine serum for 4 hours, respectively. The results of flow cytometry showed that PANC-1 tumor cells overexpressed TfR on the surface with a high tendency to bind TfR monoclonal antibody ((98.9±0.1)%), whereas MX-1 tumor cells showed low TfR expression on the membrane((0.2±0.1)%). In vitro cell binding assay results showed that the binding rate of PANC-1 cells to 99Tc m-T7 reached a peak ((16.12±0.01)%) after 60 minutes of incubation, which was higher than that of MX-1 cells ((1.20±0.01)%), and the difference between them was statistically significant ( t=28.67, P<0.001). The results of cell competition inhibition experiment showed that the binding rate of PANC-1 blocking group to 99Tc m-T7 decreased to (2.40±0.01)%, which was significantly different from that of PANC-1 experimental group( t=26.91, P<0.001). The results of micro SPECT/CT imaging in nude mice bearing tumor showed that 99Tc m-T7 could be quickly cleared from the blood and mainly eliminated from the kidneys. PANC-1 tumor-bearing nude mice models showed clear tumor contour 30 minutes after injection of 99Tc m-T7, with a tumor-to-muscle ratio of 2.80±0.22. The results of biological distribution experiments showed that the uptake of 99Tc m-T7 by tumors and organs (percentage injection dose rate (%ID/g) per gram of tissue) was consistent with the imaging results, and the uptake of 99Tc m-T7 in PANC-1 cells ((0.55±0.18)%ID/g) was higher than that in MX-1 cells ((0.16±0.11)%ID/g), and the difference was statistically significant ( t=6.42, P<0.001). The radio-autograph assay showed that PANC-1 cells significantly absorbed 99Tc m-T7 compared with MX-1 cells 30 minutes after injection of 99Tc m-T7. The highest uptake in normal organs was observed in the kidney, followed by the liver. Hematoxylin-eosin and immunohistochemical staining revealed no obvious necrosis in the tumor parenchyma. The PANC-1 cells overexpressed TfR, and whereas the MX-1 cells had low TfR expression. Conclusion:A specific polypeptide molecular probe 99Tc m-T7 targeting TfR was successfully prepared, which has excellent imaging efficiency in tumor-bearing nude mice models, and is expected to provide a new imaging method for monitoring the expression of tumor TFR in vivo.

目的 观察滤波反投影法(FBP)、二维有序子集最大期望值法(2D-OSEM)及其参数对SPECT颞颌关节显像髁突代谢活性的影响.方法 回顾性分析197例因单侧髁突异常增生致偏颌畸形患者,分别以2D-OSEM及FBP算法对SPECT重建图像,前者子集数为2、4、8,迭代次数为4、8、16,后者应用巴特沃斯滤波器,设定截止频率为0.32,阶数为9.基于重建图像分别计算双侧髁突摄取百分率差值,评估髁突代谢活性;观察FBP和2D-OSEM算法子集数及迭代次数对双侧髁突摄取百分率差值及髁突代谢活性阳性率的影响.结果 双侧髁突摄取百分率差值在子集数为2、迭代次数为4的2D-OSEM重建图像中[9.00％(4.20％,16.90％)]与FBP重建图像中的差异无统计学意义(Z=-1.86,P=0.06),而在其余2D-OSEM图像中均高于FBP图像(P均＜0.01).子集数(F=16.85,P＜0.01)及迭代次数(F=34.29,P＜0.01)对 2D-OSEM重建图像中的双侧髁突摄取百分率差值存在显著主效应,且其间存在交互效应(F=13.14,P＜0.01),双侧髁突摄取百分率差值随子集数或迭代次数增加而增高.2D-OSEM(142/197,72.08％)与FBP(88/197,44.67％)重建图像的髁突代谢活性总阳性率差异有统计学意义(x2=30.91,P＜0.01).2D-OSEM重建图像中,子集数为4时,髁突代谢活性阳性率的平均值为53.80％,与子集数为2(50.93％)及8时(57.87％)差异均无统计学意义(x2=0.98、1.98,P=0.32、0.16);子集数为8时,髁突代谢活性阳性率平均值高于子集数为2时(x2=5.74,P=0.02);迭代次数为8时,髁突代谢活性阳性率的平均值为53.81％,与迭代次数为4(51.10％)及16(57.70％)时差异均无统计学意义(x2=0.87、1.82,P=0.35、0.18);迭代次数为16时,髁突代谢活性阳性率的平均值高于迭代次数为4时(x2=5.19,P=0.02).结论 采用FBP或2D-OSEM算法及不同参数行SPECT颞颌关节显像重建,髁突代谢活性存在差异.

Primary leiomyosarcoma of the bronchus is an extremely rare malignant neoplasm. A 29-year-old man presented with persisting cough and sputum over 1 month. Unenhanced and contrast-enhanced chest CT showed a nodular lesion in the main bronchus of the left lower lobe and multiple enlarged lymph nodes in the mediastinum. Preoperative staging F-FDG PET/CT scan displayed a hypermetabolic lesion of the known nodule and mild FDG uptake of mediastinal lymph nodes. The histological examination confirmed bronchial leiomyosarcoma and reactive hyperplasia in lymph nodes.

Myoepithelial carcinoma is an exceedingly rare malignant neoplasm that most frequently occurs in the salivary gland. We here report a case of myoepithelial carcinoma in a 57-year-old man. Unenhanced and contrast-enhanced CT scans showed an ill-defined, heterogeneous, contrast-enhancing mass in the left parapharyngeal space, which suggested malignancy. F-FDG PET/CT showed a hypermetabolic mass and multiple FDG-avid lymph nodes in the bilateral cervical regions. An incision biopsy was performed, and the pathological examination confirmed the mass to be a myoepithelial carcinoma.

A case of myelofibrosis secondary to systemic mastocytosis of 18F-FDG PET/CT imaging was reported. The characteristics of the disease were analyzed on the basis of clinical symptoms, laboratory examinations, imaging examinations, and bone trephine. The understanding of myelofibrosis and mastocytosis was deepened by literature review. Secondary myelofibrosis has numerous causes, one of which is mastocytosis. Mastocytosis is a blood system disease characterized by abnormal proliferation of mast cells in multiple tissues and organs. The histamine secreted by mast cells plays an important role in osteosclerosis. Lymphadenopathy characterized by enlarged liver and spleen is due to mast cell infiltration and extramedullary hematopoiesis. Symptoms of patients are also closely related to the chemical mediators secreted by mast cells.

Abstract Primary leiomyosarcoma of the bronchus is an extremely rare malignant neoplasm. A 29-year-old man presented with persisting cough and sputum over 1 month. Unenhanced and contrast-enhanced chest CT showed a nodular lesion in the main bronchus of the left lower lobe and multiple enlarged lymph nodes in the mediastinum. Preoperative staging 18F-FDG PET/CT scan displayed a hypermetabolic lesion of the known nodule and mild FDG uptake of mediastinal lymph nodes. The histological examination confirmed bronchial leiomyosarcoma and reactive hyperplasia in lymph nodes.

Multiple myeloma(MM) is a malignant B-cell neoplasm, primarily involving the bone marrow, and some may have extramedullary involvement. Imaging examination is an indispensable tool for comprehensive assessment of MM X-ray and CT have lower lesion detection rate, poor quantitative ability. PET/CT and MRI have great value in the assessment of MM, especially the application of 18F-FDG and other novel molecular probes, whole-body diffusion weighted imaging(DWI), dynamic contrast-enhanced(DCE) MRI and water-fat separation. The author will review the application and progress of PET/CT and MRI in MM. Key words: Multiple myeloma; Magnetic resonance imaging; Positron emission tomography computed tomography; Whole-body diffusion-weighted imaging

Objective:To label the protein Annexin Ⅴ for targeting apoptosis with radionuclide 99mTc,and to study pharmacokinetics of 99mTc(CO)3-Annexin Ⅴ in mice.Methods:The Tricarbonyl kit was used to prepare labelled precursor,and the Annexin Ⅴ was labeled with carbonyl technetium.Then,the labeling yield,radiochemical purity and stability of 99mTc(CO)3-Annexin Ⅴ were determined.The metabolic characteristics of 99mTc(CO)3-Annexin Ⅴ were assessed in healthy Kunming mice by the biodistribution studies.Results:The 99mTc(CO)3-Annexin Ⅴ was prepared successfully,with labeling yield of (57.21-±-2.83) ％,specific activity of (5.65±0.43) mCi/100 μg,and radiochemical purity more than 90％.99mTc(CO)3-Annexin Ⅴ had excellent stability and the radiochemical purity was also more than 90％ at 6 h in vitro.Biodistribution studies showed that the half-life of 99mTc(CO)3-Annexin Ⅴ was short in mice,manifested by about 40 and 60 percent of 99mTc(CO)3-Annexin Ⅴ that could be removed at 2 h and 4 h after injection,respectively.In addition,the kidney and liver were the main excretory organs of 99mTc(CO)3-Annexin Ⅴ in vivo.Conclusion:99mTc(CO)3-Annexin Ⅴ can be prepared successfully using Tricarbonyl kit with high labeling yield and simple method.It is a kind of apoptosis imaging agent with wide application prospect.

The author reports a case of small cell carcinoma of the cervix.The patient had a 7-day history of headache and a hard mass in the parietal region of the cranium on the right side as the first manifestation.Cranial CT scan showed a high-density nodule on the right parietal lobe,with a surrounding low-density edema and adjacent skull bone destruction;thus,intracranial tumor was considered.MRI brain scan showed a slightly longer T1 and T2 signal nodule,with edema in the right parietal lobe.The lesion was significantly enhanced after the application of contrast.The 18F-FDG PET/CT whole-body imaging showed a solid mass of cervix and slightly large bilateral pelvic lymph nodes and presented multiple bone destruction with high FDG uptake.The histopathological examination revealed small cell carcinoma of the cervix.Small cell carcinoma of the cervix has extremely low incidence,its clinical manifestation lacks specificity,and it is not easily detected at its early stage.Small cell carcinoma of the cervix is an aggressive tumor and commonly have early metastasis through lymph node and blood circulation,with a poor prognosis.The sensitivity of 18F-FDG PET/CT in detecting primary lesions and metastases,including lymph node,bone,and other occult lesions,is high.Thus,this method is valuable in the clinical management of the small cell carcinoma of the cervix.

Objective To evaluate the clinical diagnostic value of prospective electrocardiograph (ECG)-gating of CT cardiac angiography in congenital heart diseases of Chinese population through a Meta-analysis.Methods The articles were searched to study CT prospective ECG-gating in diagnosis of congenital heart disease from January 1995 to February 2016 in domestic and foreign publications.The study quality was assessed by the Quality Assessment for Diagnostic Accuracy Studies and the data extraction was performed.The software of Meta-disc1.4 was used for heterogeneity test.Different effect models were choosen according to the results of heterogeneity analysis.Meanwhile,this soft was used to calculate the sensitivity,specificity,likelihood ratio and its 95％ confidence interval (CI),respectively.The forest maps and summary receiver operator characteristic (SROC) curve were drawn.In addition,the area under curve (AUC) was calculated.Results Twelve articles were included in the Meta-analysis.The study included 1 431 congenital heart malformations confirmed by surgery or cardiac catheterization angiography.CT prospective ECG-gating technique had no heterogeneity in sensitivity and specificity of congenital heart disease.The total sensitivity,the total specificity,positive likelihood ratios,negative likelihood ratios and its 95％ CI of CT cardiac angiography were 96％ (95％ CI 94％ to 97％),100％ (95％ CI 100％ to 100％),365.94(95％ CI 231.18 to 579.26),0.04(95％ CI 0.03 to 0.05) with fixed effect model,respectively.The AUC of the SROC was 99.86％,Q =0.987 9.Conclusions Prospectively ECG-gating of CT cardiac angiography has high sensitivity and specificity in the diagnosis of congenital heart diseases.Its AUC of the SROC is large.It has high diagnostic value in congenital heart diseases.

Objective To analyze the reasons why the calculation of glomerular filtration rate (GFR) in unilateral kidney using Gates method is affected by different methods for defining contralateral kidney's region of interest (ROI),and to explore an improved Gates algorithm.Methods The imaging data of 125 patients receiving renal dynamic imaging and GFR measurement were retrospectively reprocessed and analyzed.An improved split renal GFR algorithm was proposed,and the correction and difference between the improved algorithm and Gates algorithm were analyzed.Results The split renal GFR measured with the improved algorithm and that measured with Gates algorithm showed a strongly positive correlation (r=0.999,P=0.000),and the total renal GFR was unvaried in the two algorithms.The split renal GFR of Gates algorithm had an obviously positive correlation with renal uptake rate (r=0.999,P=0.000),but the one-to-one relationship was not found between them.A completely positive correlation (r=1.000,P=0.000) and a one-to-one relationship were found between the split renal GFR of the improved algorithm and renal uptake rate.The total renal GFR of both algorithms also had a completely positive correlation with renal uptake rate (r=1.000,P=0.000).With the decreasing size of ROI in contralateral kidney,the GFR in unilateral kidney measured with Gates algorithm gradually decreased,but that measure with the improved algorithm did not alter.Conclusion The improved split renal GFR algorithm ensures that the total renal GFR of both kidneys will not be affected by the size of ROI and avoids the shortcoming of Gates algorithm (the interaction between split renal GFR),ensuring the repeatability and reliability of split renal GFR measurement.

ObjectiveThe aim of this study was to explore the targeting ability and metabolic characteristics of the technetium-99m-labeled single-domain antibody (99mTc-sdAb) EG2 targeting epidermal growth factor receptor (EGFR) through an in-vitro and in-vivo study. Materials and methodsThe sdAb EG2 was radiolabeled with 99mTc using a tricarbonyl kit. The EGFR expression level of A431 and OCM-1 cells was confirmed using immunofluorescence staining. Cell binding, blocking, uptake, and efflux studies were performed to investigate the binding specificity of 99mTc-sdAb EG2 in vitro. Single-photon emission computed tomography imaging and biodistribution studies were used to explore the targeting abilities and metabolic characteristics of 99mTc-sdAb EG2 in vivo. Results99mTc-sdAb EG2 was successfully prepared with labeling yields of 60–71% and specific activity of 1.83±0.29 GBq/mg (n=3). Immunofluorescence staining revealed high and low EGFR expression on the surface of A431 and OCM-1 cells, respectively. The binding affinity of 99mTc-sdAb EG2 to A431 cells was 43.53±1.89 nmol/l. 99mTc-sdAb EG2 uptake in A431 cells in vitro could be blocked by ∼19, 40, and 66% in the presence of excess unlabeled sdAb EG2 at 100, 500, and 1000 nmol/l, respectively. Single-photon emission computed imaging indicated that A431 tumor images could be clearly displayed at early scan time points after 99mTc-sdAb EG2 injection, even as early as 1 h. Biodistribution study showed that the A431 tumor uptake of 99mTc-sdAb EG2 was blocked by about 51% at 3 h after coinjecting excess of sdAb EG2. However, there were almost no OCM-1 tumor images at the corresponding scan time points and the OCM-1 tumor uptake was only 0.40±0.13% injected dose per gram of tissue (n=5) at 3 h. ConclusionThis study demonstrated that sdAb EG2 can effectively target EGFR in vitro and in vivo in tumors, suggesting that it could be used as a molecular probe for EGFR detection.

Purpose. To investigate the clinical value of 99Tcm-MDP SPECT for the diagnosis of unilateral condylar hyperplasia (UCH). Methods. One hundred forty-nine patients who underwent mandibular 99Tcm-MDP SPECT between January 2009 and December 2012 were studied, including 105 cases that were clinically suspected of UCH and 44 comparable cases without UCH as a control group. Results. Increased bone activity was observed in the affected condyles for all UCH patients. In the UCH group, the relative percentage uptake on the affected side was 59% (SD±4.3%), significantly higher than the 41% (SD±4.1%) uptake on the contralateral side (P<0.001). Similarly, the condyle/skull ratio was significantly higher for the affected side (1.66±0.63) than for the contralateral side (1.34±0.34, P<0.01. No significant difference was found in the control group between the left and right condyles. Values for the sensitivity (95%), specificity (61%), positive (84.4%) and negative (84.6%) predictive values, and accuracy (84.5%) for 99Tcm-MDP SPECT in the diagnosis of UCH were calculated. However, for the hyperplastic condyle, no correlation was observed between the thickness of each cartilage layer and the relative uptake in the SPECT image. Conclusion. 99Tcm-MDP SPECT is accurate for diagnosing UCH and can provide a reference for treatment options.

目的:制备新型凋亡显像剂99mTc-HYNIC-Tat49-57-DEVD,研究其在健康小鼠体内的生物学分布,为其进一步应用于核素凋亡显像奠定实验基础.方法:设计合成Caspase-3特异性底物多肽,经化学修饰后与穿膜肽HIV Tat49-57连接,采用间接标记法,在螯合剂联肼尼克酰胺(HYNIC)和协同配体三羟甲基甘氨酸及乙二胺二乙酸的作用下,将连接有穿膜肽的Caspase-3底物Tat49-57-DEVD予Na99mTcO4标记,检测标记物的放化纯及稳定性,并研究其在健康BALB/c小鼠体内不同时间点(0.5,1,2和6 h)的生物学分布.结果:合成的底物多肽经高效液相色谱及质谱分析鉴定为纯度≥99％的HYNIC-Tat49-57-DEVD干粉,标记产物99mTc-HYNIC-Tat49-57-DEVD的放化纯度为92.0％±1.6％,放置4h后其放化纯仍可达90.6％±1.4％.标记物在健康小鼠体内生物学分布实验显示其肾脏摄取值最高(0.5h其％ID/g值达5.93±0.08),肝脏次之,其余组织摄取较低.结论:显像剂99mTc-HYNICTat49-57-DEVD的制备方法可行,标记物稳定,在血液中的清除速度快,主要通过肝脏和肾脏排泄,为其进一步应用于体内凋亡显像奠定了基础.

目的：制备新型凋亡显像剂99mTc-HYNIC-Tat49-57-DEVD,研究其在健康小鼠体内的生物学分布,为其进一步应用于核素凋亡显像奠定实验基础。方法：设计合成Caspase-3特异性底物多肽,经化学修饰后与穿膜肽HIV Tat49-57连接,采用间接标记法,在螯合剂联肼尼克酰胺（HYNIC）和协同配体三羟甲基甘氨酸及乙二胺二乙酸的作用下,将连接有穿膜肽的Caspase-3底物Tat49-57-DEVD予Na99mTcO4标记,检测标记物的放化纯及稳定性,并研究其在健康BALB/c小鼠体内不同时间点（0.5,1,2和6h）的生物学分布。结果：合成的底物多肽经高效液相色谱及质谱分析鉴定为纯度≥99%的HYNIC-Tat49-57-DEVD干粉,标记产物99mTc-HYNIC-Tat49-57-DEVD的放化纯度为92.0%±1.6%,放置4h后其放化纯仍可达90.6%±1.4%。标记物在健康小鼠体内生物学分布实验显示其肾脏摄取值最高（0.5h其%ID/g值达5.93±0.08）,肝脏次之,其余组织摄取较低。结论：显像剂99mTc-HYNICTat49-57-DEVD的制备方法可行,标记物稳定,在血液中的清除速度快,主要通过肝脏和肾脏排泄,为其进一步应用于体内凋亡显像奠定了基础。