Microvascular invasion (MVI) is a critical factor in predicting the recurrence and prognosis of hepatocellular carcinoma (HCC) after liver transplantation (LT). However, there is a lack of reliable preoperative predictors for MVI. The purpose of this study is to evaluate the potential of an 18F-FDG PET/CT-based nomogram in predicting MVI before LT for HCC. 83 HCC patients who obtained 18F-FDG PET/CT before LT were included in this retrospective research. To determine the parameters connected to MVI and to create a nomogram for MVI prediction, respectively, Logistic and Cox regression models were applied. Analyses of the calibration curve and receiver operating characteristic (ROC) curves were used to assess the model's capability to differentiate between clinical factors and metabolic data from PET/CT images. Among the 83 patients analyzed, 41

Objectives: The aim of this study was to demonstrate the interaction and influence of gestational age and parity on the lung volume and lung density through Computed Tomography (CT) imaging data among healthy pregnant women. Design: Retrospective cross-sectional study Setting: Two clinical sites in Wuhan Hubei Province. Sample: pregnant women and non-pregnant women. Methods： Linear mixed-effects regression model and generalized additive mixed model (GAMM) were taken to control the potential confounders and evaluate the interact effects of lung volume and lung density. Univariate analysis estimated the influence of gestational age and parity on the lung volume and lung density. Main Outcome Measures: Lung volume (left, right, total), lung density (left, right, total). Results: The total lung density of all patients in GAMM was significantly increased with gestational age (p<0.001). Univariate analysis showed that the absolute value of total lung volume decreases with the progression of gestation ( p=0.040), this tendency is also displayed in both the left lung and right volume. Lung volume of multipara in the third trimester was lower than the first trimester, and it had significant difference between T1 and T3 ( p=0.0196). Furthermore, this study found that the lung volume of multiparous women was lower that primiparous in the third trimester ( p=0.009). Nevertheless, the lung density increased with gestational age in primiparous, particularly in the third trimester ( p=0.007), the lung density of multipara was lower than nullipara ( p<0.001), more delivery times follow lower lung density, and there was a significant difference when compared with each parity state. During the third trimester, the lung density of multiparous declined when compared with primiparous ( p<0.001). Conclusion: Parity and gestation age tended to have an impact on the alterations of lung volume and lung density in physiological pregnant women. Lung density of multipara was lower than nullipara, more delivery times follow lower lung density, indicating parity was associated with lung density.

Fibroblast activation protein (FAP) is a promising diagnostic and therapeutic target in various solid tumors. This study aimed to assess the diagnostic efficiency of 68Ga-labeled FAP inhibitor (FAPI)-04 PET/CT for detecting lymph node metastasis in non-small cell lung cancer (NSCLC) and to investigate the correlation between tumor 68Ga-FAPI-04 uptake and FAP expression. Methods: We retrospectively enrolled 136 participants with suspected or biopsy-confirmed NSCLC who underwent 68Ga-FAPI-04 PET/CT for initial staging. The diagnostic performance of 68Ga-FAPI-04 for the detection of NSCLC was evaluated. The final histopathology or typical imaging features were used as the reference standard. The SUVmax and SUVmean, 68Ga-FAPI-avid tumor volume (FTV), and total lesion FAP expression (TLF) were measured and calculated. FAP immunostaining of tissue specimens was performed. The correlation between 68Ga-FAPI-04 uptake and FAP expression was assessed using the Spearman correlation coefficient. Results: Ninety-one participants (median age, 65 y [interquartile range, 58-70 y]; 69 men) with NSCLC were finally analyzed. In lesion-based analysis, the diagnostic sensitivity and positive predictive value of 68Ga-FAPI-04 PET/CT for detection of the primary tumor were 96.70% (88/91) and 100% (88/88), respectively. In station-based analysis, the diagnostic sensitivity, specificity, and accuracy for the detection of lymph node metastasis were 72.00% (18/25), 93.10% (108/116), and 89.36% (126/141), respectively. Tumor 68Ga-FAPI-04 uptake (SUVmax, SUVmean, FTV, and TLF) correlated positively with FAP expression (r = 0.470, 0.477, 0.582, and 0.608, respectively; all P ≤ 0.001). The volume parameters FTV and TLF correlated strongly with FAP expression in 31 surgical specimens (r = 0.700 and 0.770, respectively; both P < 0.001). Conclusion: 68Ga-FAPI-04 PET/CT had excellent diagnostic efficiency for detecting lymph node metastasis, and 68Ga-FAPI-04 uptake showed a close association with FAP expression in participants with NSCLC.

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

Trousseau's syndrome is a relatively rare reported event in immunotherapy-related clinical trials, mostly occurring in the early period of immune checkpoint inhibitor (ICI) therapy. Here, we report an unusual case of late and lethal Trousseau's syndrome during pembrolizumab maintenance therapy in a lung adenocarcinoma harboring tumor protein p53 (TP53) mutation. The patient has experienced severe coagulation abnormalities manifesting as cerebral infarction, partial infarction of both kidneys and spleen after 23 cycles of pembrolizumab use and was resistant to anticoagulants. The late occurrence of coagulation abnormalities in this case reveals a possible correlation between TP53 mutations and Trousseau's syndrome when patients are treated with ICIs.

Background: The target definition of consolidation radiotherapy (RT) for extensive stage small-cell lung cancer (ES-SCLC) has not been standardized. This study aimed to demonstrate the feasibility of post-chemotherapy based consolidation RT in ES-SCLC.Methods: All ES-SCLC patients without initial brain metastases who completed >= 4 cycles of systemic therapy at Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University from 2012 to 2021 were included in this retrospective study. We correlated the site of first recurrence to the post-chemotherapy-based radiation volume (small-field). Relapse pattern, progression-free survival (PFS) and overall survival (OS) were compared between those received and did not receive consolidation RT.Results: A total of 152 patients were followed up for a median of 31.7 months (interquartile range [IQR], 23.9- 39.6 months). The median PFS and OS of the cohort were 8.3 months (IQR, 6.1-11.2 months) and 16.2 months (IQR, 9.9-24.9 months), respectively. Thoracic consolidation RT served not only as an independent prognostic factor for improved PFS in the entire cohort, but also significantly prolonged OS in the subgroup without syn-chronous liver metastases. Small-field consolidation RT markedly reduced in-field recurrences (hazard ratio [HR], 0.28 [95% CI, 0.12-0.38]; P < 0.001) without increasing out-of-field recurrences (HR, 0.40 [95% CI, 0.13-1.16]; P = 0.080). No relapse was observed at the margin of the targets. Treatment-related toxicities were moderate, with grade 3 acute radiation pneumonia, radiation esophagitis, and bone marrow suppression rates of 8.3%, 3.1%, and 12.5%, respectively. No grade 5 toxicity occurred.Conclusion: Small-field consolidation RT based on post-chemotherapy volume is safe and can significantly im -prove local control in ES-SCLC.

ABSTRACT:Epithelioid hemangioendothelioma is a low- to intermediate-grade malignant vascular tumor with a slowly progressive course and unpredictable prognosis. We report a case of epithelioid hemangioendothelioma with pleura and bone metastases on 68 Ga-FAPI-04 PET/CT in a 65-year-old woman who underwent surgery and chemotherapy.

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.

Abstract In the present study, we here report a case of 71-year-old woman, with bone destruction of L5 vertebral body showing lower of SUVmax for FAPI compared to FDG PET/CT imaging. To our knowledge, this present case is the first study to reveal that 68Ga-FAPI had lower tumour-to-background ratio in detecting bone metastasis from PTCMCa-FV.

A 61-year-old man was admitted to our hospital with a 6-month history of intermittent coughing and non-massive hemoptysis. Chest computed tomography (Fig. 1A and D, B and E) showed two large thin-walled cavities in the both upper lung lobe (left, hollow arrow; right, solid arrows) with ground-glass patches around the cyst and a gas–liquid plane in the cystic cavity of the left upper lung lobe. Computed tomography pulmonary angiography (Fig. 1C and F) showed that the blood vessel had been pushed and displaced. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT (Fig. 2A–G) showed mild FDG avidity along the cyst wall (SUVmax 2.1–3.1). No other abnormal metabolic lesions were detected. Therefore, lung abscess or pulmonary inflammation was considered. The patient was administered anti-infection treatment; owing to its unsatisfactory outcome, surgery was proposed for definitive diagnosis and effective patient management. However, because of the impaired...

OBJECTIVE:To assess and compare the diagnostic performance of gallium-68-labelled fibroblast activation protein inhibitor ([68Ga]FAPI-04) and fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in gastrointestinal cancer.METHODS:Fifty-one patients who underwent both [18F]FDG and [68Ga]FAPI-04 PET/CT for initial staging or restaging were enrolled. Histopathological findings, typical radiological appearances, and clinical imaging follow-up were used as the reference standard. The diagnostic performance of the two tracers was calculated and compared. The maximum standardised uptake value (SUVmax), mean SUV (SUVmean), tumour-to-mediastinal blood pool ratio (TBR), and tumour-to-liver ratio (TLR) of primary and metastatic lesions were measured and compared between two imaging modalities.RESULTS:In patient-based analysis, [68Ga]FAPI-04 showed much better diagnostic sensitivity than [18F]FDG in detecting primary tumour (94.44% [17/18] vs. 61.11% [11/18]), postoperative recurrence and metastases (95.65% [22/23] vs. 69.57% [16/23]), and peritoneal carcinomatosis (100% [28/28] vs. 60.71% [17/28]) (all p < 0.05). In lesion-based analysis, [68Ga]FAPI-04 showed higher sensitivity than [18F]FDG for detecting lymph node metastases. In peritoneal carcinomatosis, the median SUVmax (12.12 vs. 7.18) and SUVmean (6.84 vs. 4.11) with [68Ga]FAPI-04 were significantly higher than those with [18F]FDG (all p < 0.005). The TBR and TLR of [68Ga]FAPI-04 were significantly higher than those of [18F]FDG for detecting primary tumour, lymph node, liver, and peritoneal metastases (all p < 0.005). Therapeutic management changed in 13 patients according to [68Ga]FAPI-04 PET/CT compared with conventional imaging.CONCLUSIONS:[68Ga]FAPI-04 is superior to [18F]FDG PET/CT for detecting primary tumour, postoperative recurrence and metastasis, and peritoneal carcinomatosis in gastrointestinal cancer.KEY POINTS:• [68Ga]FAPI-04 PET/CT showed significantly higher sensitivity than [18F]FDG PET/CT in the detection of primary tumour and postoperative recurrence and metastasis in patients with gastrointestinal carcinoma. • [68Ga]FAPI-04 PET/CT had obvious advantages over [18F]FDG PET/CT in the detection of peritoneal carcinomatosis from gastrointestinal carcinoma with a much higher FAPI uptake value, TBR, and TLR. • Although the median SUVmax and SUVmean of [68Ga]FAPI-04 were similar to those of [18F]FDG for the primary tumour, lymph node metastases, and liver metastases in gastrointestinal carcinoma, the TBR and TLR of the SUVmax and SUVmean were significantly higher on [68Ga]FAPI-04 PET/CT, causing the lesions to be displayed more clearly.

ABSTRACT:Carcinosarcoma of the esophagus is a rare malignant neoplasm. Here, we report a case of esophageal carcinosarcoma with lymphatic and pulmonary metastases on 18F-FDG PET/CT in a 64-year-old woman.

Background: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been widely used in clinical practice. However, the prognostic value of the pre-treatment standardized uptake value (SUV) for patients with small-cell lung cancer (SCLC) remains controversial. Purpose: To investigate the prognostic role of pre-treatment 18F-FDG PET on SCLC patients by meta-analysis. Material and Methods: Extensive literature searches of the PubMed, EMBASE, Web of Science, and Cochrane Library databases were conducted to identify literature published until 5 May 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with the pre-treatment maximum SUV (SUVmax). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across the studies. Subgroup analyses were performed to assess the robustness of the results. Results: Twelve studies with 1062 patients were included. The pooled HR for OS of 11 studies was 1.13 (95% confidence interval [CI]=1.05-1.22; P=0.001; I-2=0%) and the pooled HR for EFS of nine studies was 1.09 (95% CI=1.02-1.17; P=0.014; I-2=0%), indicating that patients with high SUVs may have poorer prognoses. Begg's test detected no significant publication bias. The prognostic role of the SUVmax remained similar in the subgroup analyses. Conclusion: Our meta-analysis indicated that the pre-treatment SUVmax of primary lesions can be an important prognostic factor for OS and EFS in patients with SCLC. A high SUVmax may indicate poorer prognosis.

Background: The identification of pancreatic carcinoma (PC) patients with poor prognosis is a priority in clinical oncology because of their high 5-year mortality. However, the prognostic value of pretreatment 18F-fluorodeoxyglucose (18F-FDG)- positron emission tomography (PET)/computed tomography (CT) parameters in PC patients is controversial and no consensus exists as to its predictive capability. This meta-analysis was performed to comprehensively explore the prognostic significance of 18F-FDG-PET/CT parameters in patients with pancreatic carcinoma. Methods: Extensive literature searches of the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted to identify literature published until March 5, 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with pretreatment maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across studies. Subgroup and sensitivity analyses were performed to assess the robustness of the results. Results: Sixteen studies including 1146 patients were identified. The pooled HRs for the probability of EFS were 1.90 (95% confidential interval (CI): 1.48–2.45) for SUVmax, 1.76 (95% CI: 1.20–2.58) for MTV, and 1.81 (95% CI: 1.27–2.58) for TLG. The pooled HRs for the probability of OS were 1.21 (95% CI: 1.12–1.31) for SUVmax, 1.56 (95% CI: 1.13–2.16) for MTV, and 1.70 (95% CI: 1.25–2.30) for TLG. A slight publication bias was detected using Begg test. After adjustment using the trim and fill procedure, the corrected HRs were not significantly different. The results of the subgroup analyses by SUVmax, MTV, and TLG showed that these factors may have similar prognostic significance. Conclusion: 18F-FDG-PET/CT parameters, such as SUVmax, MTV, and TLG, may be significant prognostic factors in patients with pancreatic carcinoma. 18F-FDG-PET/CT imaging could be a promising tool to provide prognostic information for these patients.

To retrospectively evaluate the diagnostic performance and complications of CT-guided percutaneous core needle biopsy (PCNB) for tuberculosis, analysis the influence factors of the diagnostic accuracy. From November 2005 to December 2015, through a retrospective review, 283 CT-guided PCNBs performed in 270 patients were identified. Final results were confirmed by definitive surgery or the clinical course. Influence factor, complication rate, diagnostic performance was investigated. Influencing factors of the diagnostic accuracy were analyzed by uni- and multivariate logistic regression analyses. 283 CT-guided PCNBs performed in 270 patients (181 men, 102 women; mean age, 53.6 years) were included. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-guided PCNB were 90.00%, 79.63%, 100.00%, 100.00%, 88.89%% respectively. Significant factors affecting accuracy was age (p < 0.05). Multivariate logistic regression analysis revealed that the risk of TB lesions receiving a false-negative diagnosis decreased for each additional year of subject age [OR = 0.96; P < 0.001]. The incidences of complications such as pneumothorax, needle bleeding and hemoptysis were 9.3%, 11.1% and 8.3%, respectively. CT-guided PCNB is efficient for the diagnosis of tuberculosis and is a safe diagnostic method.

BACKGROUND AND AIM:A matched-pair comparison was performed to compare the efficacy and safety of sublobar resection versus radiotherapy for high-risk elderly patients with Stage I non-small cell lung cancer (NSCLC). PATIENTS AND METHODS:We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE and manual searches. The meta-analysis was performed to compare overall survival, pattern of failure, and toxicity among the homogeneous studies. Subdivided analyses were also performed. RESULTS:Sixteen studies containing 11540 patients were included in the meta-analysis. Among these studies, 9 were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Sublobar resection, compared with radiotherapy (either conventional fraction radiation therapy or stereotactic body radiation therapy), significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p < 0.05). However, the difference in the pattern of failure and toxicity were not significant (all p > 0.05). CONCLUSIONS:Sublobar resection was associated with improved outcomes in high-risk elderly patients with Stage I NSCLC, which supports the need to compare both treatments in large prospective, randomized, controlled clinical trials.