BackgroundThe majority of early-onset familial Alzheimer's disease is caused by mutations in the presenilin 1 (PSEN1) gene.ObjectiveTo investigate the pathogenic mechanism of the novel nucleotide mutations of the PSEN1 gene in early-onset familial Alzheimer's disease.MethodsWe describe a Chinese family with autosomal dominant early-onset Alzheimer's disease. Gene sequencing revealed that the 417th nucleotide in the exon 5 of the PSEN1 gene had changed from G to C. This resulted in methionine being substituted by isoleucine at codon 139. To support that the novel mutation was pathological, we transfected lentiviruses that overexpressed wild-type and mutant PSEN1 gene sequences into SH-SY5Y cells to construct a cell model.ResultsThe present study showed that the PSEN1 M139I mutation led to an increase in the Aβ42/Aβ40 ratio. In addition, this mutation induced the expression of β-site APP-cleaving enzyme 1 (BACE-1). Analysis of the steady-state mechanism showed that the PSEN1 M139I mutation cells were more susceptible to endoplasmic reticulum stress and apoptosis under hydrogen peroxide induction than the wild type cells were.ConclusionsIn this study, we demonstrate that the PSEN1 M139I nucleotide mutation a new mutation that, can increase the ratio of intracellular Aβ42 and Aβ42/Aβ40, and increase endoplasmic reticulum stress to promote apoptosis. This supports that the PSEN1 M139I mutation is a pathological mutation.

BackgroundRisk stratification is essential for optimizing treatment in locally advanced rectal cancer (LARC), particularly for identifying suitable candidates for total neoadjuvant therapy (TNT). Conventional MRI-based staging has limited sensitivity in capturing tumor microenvironment (TME) heterogeneity, which may lead to undertreatment of high-risk patients or overtreatment of low-risk subgroups. This study aimed to develop a nomogram integrating MRI-based habitat heterogeneity and peritumoral radiomics to improve risk stratification in LARC.MethodsA multicenter retrospective cohort of 290 LARC patients (training set, n=178; external test set, n=112) was analyzed. Tumor volumes and peritumoral regions (1, 2, and 3 mm margins) were delineated on high-resolution MRI scans using 3D Slicer. Habitat heterogeneity was quantified via K-means clustering (k=3) of intratumoral radiomic features. Radiomic features were filtered and reduced using LASSO regression. Logistic regression (LR) and support vector machine (SVM) classifiers were used to build intratumoral, peritumoral, and habitat models. The better-performing model between the intratumoral and habitat models was combined with the optimal peritumoral model and clinical variables to construct a nomogram. Calibration curves assessed agreement between predicted and observed high-risk LARC. Model performance was evaluated using area under the curve (AUC), sensitivity, specificity, and decision curve analysis (DCA).ResultsLR classifiers outperformed SVM classifiers and were therefore selected for the intratumoral, peritumoral, and habitat models. The habitat and peritumoral (3 mm) models showed superior performance compared with the intratumoral and peritumoral (1 mm) models and were integrated with clinical variables into a nomogram. The nomogram achieved excellent performance in both training (AUC, 0.928) and test cohorts (AUC, 0.817), surpassing single-feature models. Calibration curves demonstrated good agreement between predicted and observed high-risk LARC. DCA showed the nomogram provided higher net benefit across a broad range of threshold probabilities.ConclusionBy characterizing the spatial heterogeneity of the tumor microenvironment, an MRI-derived nomogram integrating habitat heterogeneity, peritumoral (3 mm) radiomic features, and clinical variables was developed to facilitate precise risk stratification and personalized TNT decision-making for LARC.

Background:Dual-time-point (DTP) 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging has been associated with an enhanced diagnostic yield in various malignancies. Nevertheless, there is a lack of data on the use of delayed imaging in patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate the correlation between the semiquantitative parameters of DTP 18F-FDG PET/CT scan and histological grades of HCC. Methods:The data of 40 patients with HCC who underwent DTP 18F-FDG PET/CT scan were retrospectively analyzed. The maximum standardized uptake value of tumor (SUVmax) and normal liver tissue (SUVavg) were measured for both time points. The tumor to normal liver tissue ratio (SUVratio) and changes in SUVratio (ΔSUVratio) between early and delayed images were calculated. These values were compared and evaluated for correlation between the semiquantitative parameters and histological grades of HCC (I, II, and III). Results:SUVmax [3.50 (2.80, 4.80) vs. 3.10 (2.70, 4.38), P=0.001] and SUVratio [1.89 (1.41, 2.49) vs. 1.67 (1.25, 2.22), P<0.001] on delayed images were significantly higher than those on early images. In contrast, SUVavg was significantly lower in delayed scan [1.90 (1.70, 2.10) vs. 2.10 (1.90, 2.40), P<0.001]. The delayed imaging had less influence on the SUV values of well-differentiated HCC. SUVratio2 and ΔSUVratio differed significantly across grades (all P<0.05), with good positive correlations to histological grades (r=0.660 and r=0.689, both P<0.001). Conclusions:Delayed 18F-FDG PET/CT imaging significantly enhances tumor visualization and provides reliable semiquantitative metrics (SUVratio2 and ΔSUVratio) for HCC grading. These findings underline the clinical utility of DTP imaging in non-invasive tumor differentiation and treatment planning.

Primary malignant bone tumors of the spine are exceedingly rare, with solitary bone plasmacytoma (SBP) representing approximately 30% of all cases. Radiological assessments are crucial for localizing SBP and for ruling out a diagnosis of multiple myeloma (MM). Imaging features resembling a “mini-brain” appear to be distinctive for SBP. Vertebral lesions accompanied by adjacent disc space involvement typically suggest spinal infections, while the potential for SBP involvement is often overlooked. We present a case of a 61-year-old female with SBP who exhibited thoraco-lumbar spine destruction and adjacent disc space involvement. The patient sought treatment at our medical center due to lumbodorsal pain radiating bilaterally to the inguinal regions. Radiological findings revealed an osteolytic lesion involving the intervertebral disc, making it challenging to distinguish between tumor and inflammation. A biopsy of the vertebral lesion confirmed the diagnosis of SBP, which was further supported by laboratory results. Post-diagnosis, the patient underwent radiotherapy, receiving a total dose of 4000 Gy, which alleviated her symptoms. We also provide a comprehensive literature review on SBP with disc involvement to aid both clinical and radiological diagnoses.

Key Clinical Message:In recent years, it is necessary to Redo-TAVR for the patients with bioprosthetic valve degeneration. This case report described a unique instance to successfully Redo-TAVR a patient with bioprosthetic valve degeneration, in addition, with left cerebral infarction and renal insufficiency. Abstract:Over time, more and more patients have bioprosthetic valve degeneration either used in SAVR or TAVR. In order to solve the produced problems due to the degenerated bioprosthetic valve, Redo-TAVR was increasingly popular due to its safe and efficiency especially for the high risk and complicated symptoms patients. In this case, the patient with left cerebral infarction and renal insufficiency has exhibited severe regurgitation and obvious neoplasm around the previous replaced aortic valve. For the patient with complicated symptoms, we did not image for this patient and only used CT to determine the position and angle for the Redo-TAVR on the base of metal stent for the previous replaced aortic valve. During the Redo-TAVR process, for fear of the obvious neoplasm slipping from the previous replaced aortic valve to embolism of important organs, before carrying out the Redo-TAVR, cerebral protection device, temporary pacemaker, and coronary artery protection device were utilized in order to avoid the damage for the important organs from the obvious neoplasm slipping from the previous replaced aortic valve. The surgery was successful and the patient recovered well. The patient's symptoms of chest tightness and suffocation have been greatly reduced.

Background: Patients with lymphoma receive multiple positron emission tomography/computed tomography (PET/CT) exams for monitoring of the therapeutic response. With PET imaging, a reduced level of injected fluorine-18 fluorodeoxyglucose ([F-18]FDG) activity can be administered while maintaining the image quality. In this study, we investigated the efficacy of applying a deep learning (DL) denoising-technique on image quality and the quantification of metabolic parameters and Deauville score (DS) of a low [F-18]FDG dose PET in patients with lymphoma. Methods: This study retrospectively enrolled 62 patients who underwent [F-18]FDG PET scans. The low-dose (LD) data were simulated by taking a 50% duration of routine-dose (RD) PET list-mode data in the reconstruction, and a U-Net-based denoising neural network was applied to improve the images of LD PET. The visual image quality score (1 = undiagnostic, 5 = excellent) and DS were assessed in all patients by nuclear radiologists. The maximum, mean, and standard deviation (SD) of the standardized uptake value (SUV) in the liver and mediastinum were measured. In addition, lesions in some patients were segmented using a fixed threshold of 2.5, and their SUV, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) were measured. The correlation coefficient and limits of agreement between the RD and LD group were analyzed. Results: The visual image quality of the LD group was improved compared with the RD group. The DS was similar between the RD and LD group, and the negative (DS 1-3) and positive (DS 4-5) results remained unchanged. The correlation coefficients of SUV in the liver, mediastinum, and lesions were all >0.85. The mean differences of SUVmax and SUVmean between the RD and LD groups, respectively, were 0.22 [95% confidence interval (CI): -0.19 to 0.64] and 0.02 (95% CI: -0.17 to 0.20) in the liver, 0.13 (95% CI: -0.17 to 0.42) and 0.02 (95% CI: -0.12 to 0.16) in the mediastinum, and -0.75 (95% CI: -3.42 to 1.91), and -0.13 (95% CI: -0.57 to 0.31) in lesions. The mean differences in MTV and TLG were 0.85 (95% CI: -2.27 to 3.98) and 4.06 (95% CI: -20.53 to 28.64) between the RD and LD groups. Conclusions: The DL denoising technique enables accurate tumor assessment and quantification with LD [F-18]FDG PET imaging in patients with lymphoma.

患者2年前行经导管主动脉瓣瓣中瓣置换术治疗重度主动脉瓣狭窄,术后并发中度瓣周漏(PVL),后进展为重度PVL、纽约心脏病协会(NYHA)心功能分级Ⅳ级、慢性心力衰竭.进行经导管介入封堵术成功封堵多漏口,PVL改善为轻-中度.半年后复查,NYHA心功能分级Ⅱ级、PVL改善为轻度,治疗效果满意.本例提示经导管主动脉瓣置换术(TAVR)术前影像评估应对PVL进行可能性分析,预计发生概率较大时,可针对性选择瓣膜以预防或改善PVL,并做好同期PVL封堵术准备;充分利用CT 3D重建、计算机辅助3D打印技术对多隧道PVL直观、立体和精准显示,对于合理选择封堵器和导丝,指导封堵策略,提高手术成功率具有重要价值.

In recent decades, natural products from marine organisms have been widely studied for the treatment of various breast cancers. Among them, polysaccharides have been favored by researchers because of their good effects and safety. In this review, polysaccharides from marine algae including macroalgae and microalgae, chitosan, microorganisms such as marine bacteria and fungi, and starfish are addressed. Their anticancer activities on different breast cancers and action mechanisms are discussed in detail. In general, polysaccharides from marine organisms are potential sources of low side-effect and high efficiency anticancer drugs for development. However, further research on animals and clinical research are needed.

Objective To observe the effects of pHLIP[pH（low） insertion peptide]-P1AP on the proliferation of triplenegative breast cancer（TNBC） MDA-MB-231 cells. Methods Fluorescent-labeled pHLIP-P1AP was designed and synthesized. Protease-activated receptor 1（PAR1） expression on the surface of MDA-MB-231 cells and human MCF10A mammary epithelial cells were observed. The binding between fluorescent-labeled pHLIP-P1AP and MDA-MB-231 cells under different pH values（pH=7.4, 6.0） was analyzed. The effects of pHLIP-P1AP on the proliferation of MDA-MB-231 cells was analyzed under the conditions of pH 7.4 and 6.0. Results pHLIP-P1AP was successfully synthesized and fluorescentlabeled. PAR1 was highly expressed on the surface of MDA-MB-231 cells. In an acidic environment（pH 6.0）, fluorescentlabeled pHLIP-P1AP and MDA-MB-231 cells had a high binding ability. In an acidic environment（pH 6.0）, pHLIP-P1AP significantly inhibited the proliferation of MDA-MB-231 cells. With 0.5 μg, 1 μg, 2 μg, 4 μg, and 8 μg of pHLIP-P1AP,the cell proliferation inhibition rates were 3.39%, 5.27%, 14.29%, 22.14%, and 35.69%, respectively. Conclusion PAR1was highly expressed on the surface of MDA-MB-231 cells. pHLIP-P1AP can effectively target MDA-MB-231 cells in an acidic environment and inhibit the growth of MDA-MB-231 cells. Therefore, pHLIP-P1AP is expected to be a valuable new drug in the treatment of TNBC.

The pH (low) insertion peptide (pHLIP) family can target the tumor microenvironment (TME). If pHLIP can be labeled with radioiodine, the imaging and treatment of tumors can be considered. However, tyrosine and tryptophan can bind with iodine in the insertion region of pHLIP, and radioiodine labeling may affect the formation of α-helix structures in acidic environments; therefore, it is necessary to adjust the structure of pHLIP. This study aims to develop an 125I-labeled pH (low) insertion peptide variant 7-like peptide (pHLIP (Var7) LP) for imaging the TME in MDA-MB-231 triple-negative breast cancer (TNBC) xenograft tumor models. Based on pHLIP (Var7), a new peptide sequence, pHLIP (Var7) LP, was obtained by the sequence modification method and then characterized. The binding of pHLIP (Var7) LP to MDA-MB-231 cells was analyzed. pHLIP (Var7) LP was labeled with 125I by the iodogen iodination method. Serial biodistribution studies and small-animal single photon emission computed tomography (SPECT)/computed tomography (CT) imaging in subcutaneous MDA-MB-231 TNBC-bearing mice were performed using [125I] I-pHLIP (Var7) LP. A novel peptide, pHLIP (Var7) LP, has the characteristics of an α-helix structure, electronegativity, and amphiphilicity. Circular dichroism (CD) spectroscopy showed that the peptide presented a typical pH-dependent transition from an unstructured conformation to an α-helix structure when the pH was reduced from 8.0 to 4.0. The relative fluorescence intensities of 5-carboxytetramethylrhodamine (5-TAMRA)-pHLIP(var7) LP at pH = 6.0, 6.6, and 7.4 were 100.00 ± 5.98%, 72.10 ± 4.65%, and 13.72 ± 1.41%, respectively. The distribution of [125I] I-pHLIP (Var7) LP in tumors reached the highest level (8.7 ± 1.6% ID/g) at 2 h after injection, and the tumor-to-muscle ratios and tumor-to-blood ratios increased with time. Of the measured off-target organs, the stomach, kidney, and bladder showed higher uptake levels. SPECT imaging revealed rapid and sustained tumor uptake of [125I] I-pHLIP (Var7) LP in breast cancer-bearing mice. This study showed that [125I]I-pHLIP (Var7)LP had rapid and sustained tumor uptake in MDA-MB-231 TNBC and provided a new method for TNBC imaging and further treatment.

The study describes an unusual case that a patient with previous history of adenocarcinoma of sigmoid colon who has developed chronic suppurative cholecystitis and peritonitis was misdiagnosed as metastasis. This case is presented to illustrate the importance of considering benign etiologies that may mimic metastatic disease when interpreting positron emmision tomography (PET)/CT scans.

[18F]AlF-NOTA-octreotide was evaluated for its biodistribution and dosimetry and demonstrated good safety, good tolerance, in vivo pharmacokinetics, and specific uptake in somatostatin receptor 2 (SSTR2)-positive tumors. This study aimed to improve the automated radiolabeling of NOTA-octreotide with [18F]AlF2+ and optimize the radiochemical yield (RCY) of [18F]AlF-NOTA-octreotide. The labeling procedure was optimized by changing the amounts of peptide and AlCl3, the labeling buffers. To simplify the process of preparing the solution, the reagent of the precursor (NOTA-octreotide 0.2 mg) and AlCl3·6H2O (27 µL 4 mM) were made into freeze-dried kit in advance. NOTA-octreotide was labeled with [18F]AlF2+ with a 55% yield in 40 min. This method can be used to effectively improve RCY and meet clinical requirements.

Objective:To establish and validate a malignant risk prediction model of solitary pulmonary nodules (SPNs) with pulmonary fibrosis in long-term smokers based on 18F-flurodeoxyglucose (FDG) PET/CT. Methods:PET/CT images of 222 SPNs combined with pulmonary fibrosis which were shown in integrated CT scan in 169 patients (all males; age 68(63, 75) years) were analyzed retrospectively. All patients were examined in PET/CT Center of the Affiliated Hospital of Qingdao University from January 2011 to December 2019 and all had definite smoking history. The benign and malignant nodules were judged according to the pathological diagnosis or follow-up imaging data of lung lesions (follow-up≥2 years). The clinical characteristics (age, smoking index), morphological characteristics (longest diameter of lesion, density, location, distribution, relative position of fibrosis, spiculation, lobulation, calcification, vacuole, vascular convergence, pleural indentation, emphysema and severity of bilateral pulmonary fibrosis) and metabolic characteristics (maximum standardized uptake value (SUV max)) of the benign and malignant lesions were analyzed by χ2 test and Mann-Whitney U test. Then multivariate logistic regression analysis was applied to select independent risk factors of malignant nodules, and a risk prediction model was established and verified by the area under the receiver operating characteristic (ROC) curve and k-fold cross validation ( k=10) respectively. Results:Among 169 patients, 222 SPNs were detected (157 malignant nodules, 65 benign nodules). Univariate analysis showed that smoking index, speculation, lobulation, vascular convergence sign, calcification, emphysema, nodule size, relative position of nodule and fibrosis, SUV max and severity of bilateral pulmonary fibrosis were significantly different between the benign and malignant nodules ( z values: 2.514-9.858, χ2 values: 4.353-18.442, all P<0.05). Result of multivariate logistic regression analysis showed that calcification, vascular convergence and SUV max were the independent risk factors of malignant nodules combined with pulmonary fibrosis (odds ratio ( OR): 0.048-2.534, all P<0.05). The risk prediction model was as follow: P=1/(1+ e - x), x=-1.839-3.033×calcification+ 0.930×vascular convergence+ 0.754×SUV max(with calcification/vascular convergence=1, without calcification/vascular convergence=0). The area under ROC curve was 0.932(95% CI: 0.895-0.969), and the sensitivity and specificity of the model were 87.9% and 86.2%, respectively. Results of k-fold cross validation showed that the prediction accuracy of 10 test sets was 0.847±0.075, and was 0.862±0.010 in training sets. Conclusions:Calcification, vascular convergence and SUV max are independent risk factors of malignant SPNs combined with pulmonary fibrosis in long-term asymptomatic smokers. The model based on the above variables presents high diagnostic efficiency in diagnosing malignant SPNs.

痛风是由于尿酸盐沉积产生的异质代谢性疾病,严重者可导致关节残疾引起肾功能损伤,但若能早期诊断该病或可逆转.众所周知,痛风不同时期有不同的临床表现和影像学表现.一般而言,在痛风早期,其双轨征特征明显,特异性高,适合采用超声法进行检测;在痛风反复发作期及慢性期,适合采用X线平片、CT和MRI等影像技术进行检测,其中MRI能够精确评价痛风石的大小和内部结构;而双能CT(DECT)能够识别关节周围、肌腱、软组织中的尿酸盐结晶等,因此应该根据不同需要选择适合的影像学检测方法.另外,鉴于医学科技发展趋势,未来痛风影像学发展将会利用云计算、大数据、人工智能等技术构建智能医学影像诊断系统,将朝着图像融合、智能化诊疗方向不断拓展.

目的 探讨冠状动脉造影定量分析(QCA)、支架精显(StentViz)和血管内超声(IVUS)在经皮冠状动脉介入术(PCI)中评价支架可视性和膨胀性的应用.方法 收集2016年5月至2018年11月同时接受StentViz和IVUS检查的PCI患者30例.分别在QCA、StentViz和IVUS图像中对植入的33枚支架最小直径、最大直径进行测量,计算支架偏心指数,并进行不同方法间比较分析.对33枚支架共143幅StentViz影像作支架可视性分级评价.结果 QCA测量的支架最小直径、最大直径均显著大于StentViz、IVUS测量(P＜0.05),支架偏心指数均显著低于StentViz、IVUS测量(P＜0.05);StentViz测量的上述指标与IVUS测量比较,差异无统计学意义(P＞0.05).StentViz与IVUS测量的支架最小直径相关性(r=0.956)优于QCA与IVUS测量的相关性(r=0.776).StentViz测量的支架最小直径与QCA测量相比,同IVUS测量具有更好的一致性.143幅StentViz图像中支架可视性评价显示,支架显示优82.1％(评分4分),良15.3％(2～3分),差2.6％(0～1分).结论 StentViz可显著提高冠状动脉内支架可视性,与QCA相比在测量支架直径方面同IVUS具有更好的相关性和一致性.

1 临床资料 患者 男,73岁.因"发作性胸痛20年,进行性加重1周",于2019年10月10日在青岛大学附属医院就诊.现病史:患者近20年反复出现无明显诱因胸痛,夜间平卧入睡无憋醒,2016年6月于本院心内科给予前降支置入支架一枚,病情仍未缓解.既往病史:高血压病史20年;冠心病史6年,4年前行冠状动脉左前降支近端支架置入术.入院查体:主动脉听诊区可闻及舒张期杂音,P2稍亢,伴分裂,股动脉枪击音(-).超声心动图示:左心室扩大,左心室舒张末期内径6.2 cm,左心室射血分数38％,左心室壁节段性运动异常;主动脉瓣四叶式畸形,主动脉瓣重度反流(图1～2).冠状动脉造影示:左前降支支架通畅(图3).胸腹部增强CT结果及相关测量数据显示:瓣环为椭圆形,周长67 mm,平均内径21.3 mm,瓣膜见点状钙化;四叶式法氏窦(图4)周长124.2 mm,直径分别为34.5 mm、31.0 mm、32.5 mm、30.7 mm,左冠状动脉高度20.4 mm,右冠状动脉高度13.2 mm,胸腹主动脉未见明显异常,双侧股动脉最小直径≥7.6 mm.该患者心功能不全(美国纽约心脏病协会心功能分级Ⅲ级),纠正后反复再发,伴夜间阵发性呼吸困难.美国心胸外科学会评分系统示手术的病死率为9.32％,外科手术风险极高危,且四叶式主动脉瓣(quadricuspid aortic valve,QAV)罕见.经青岛大学附属医院心脏瓣膜团队评估,决定选择经导管主动脉瓣置入术(transcatheter aortic vale implantation,TAVI)进行瓣膜置入.

Purpose Lymphovascular invasion (LVI) impairs surgical outcomes in lung adenocarcinoma (LAC) patients. Preoperative prediction of LVI is challenging by using traditional clinical and imaging parameters. The purpose of this study was to investigate the value of the radiomics nomogram integrating clinical factors, CT features, and maximum standardized uptake value (SUVmax) to predict LVI and outcome in LAC and to evaluate the additional value of the SUVmax to the PET/CT-based radiomics nomogram. Methods A total of 272 LAC patients (87 LVI-present LACs and 185 LVI-absent LACs) with PET/CT scans were retrospectively enrolled, and 160 patients with SUVmax ≥ 2.5 of them were used for PET radiomics analysis. Clinical data and CT features were analyzed to select independent LVI predictors. The performance of the independent LVI predictors and SUVmax was evaluated. Two-dimensional (2D) and three-dimensional (3D) CT radiomics signatures (RSs) and PET-RS were constructed with the least absolute shrinkage and selection operator algorithm and radiomics scores (Rad-scores) were calculated. The radiomics nomograms, incorporating Rad-score and independent clinical and CT factors, with SUVmax (RNWS) or without SUVmax (RNWOS) were built. The performance of the models was assessed with respect to calibration, discrimination, and clinical usefulness. All the clinical, PET/CT, pathologic, therapeutic, and radiomics parameters were assessed to identify independent predictors of progression-free survival (PFS). Results CT morphology was the independent LVI predictor. SUVmax provided better discrimination capability compared with CT morphology in the training set ( P < 0.001) and test set ( P = 0.042). A total of 1409 CT and PET radiomics features were extracted and reduced to 8, 8, and 10 features to build the 2D CT-RS, 3D CT-RS, and the PET-RS, respectively. There was no significant difference in AUC between the 2D-RS and 3D-RS ( P > 0.05), and 2D CT-RS showed a relatively higher AUC than 3D CT-RS. The CT-RS, the CT-RNWOS, and the CT-RNWS showed good discrimination in the training set (AUC [area under the curve], 0.799, 0.796, and 0.851, respectively) and the test set (AUC, 0.818, 0.822, and 0.838, respectively). There was significant difference in AUC between the CT-RNWS and CT-RNWOS ( P = 0.044) in the training set. Decision curve analysis (DCA) demonstrated the CT-RNWS outperformed the CT-RS and the CT-RNWOS in terms of clinical usefulness. Furthermore, DCA showed the PETCT-RNWS provided the highest net benefit compared with the PET-RNWS and CT-RNWS. PFS was significantly different between the pathologic and RNWS-predicted LVI-present and LVI-absent patients ( P < 0.001). Carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), pathologic LVI, histologic subtype, and SUVmax were independent predictors of PFS in the 244 CT-RNWS-predicted cohort; and CA125, NSE, pathologic LVI, and SUVmax were the independent predictors of PFS in the 141 PETCT-RNWS-predicted cohort. Conclusions The radiomics nomogram, incorporating Rad-score, clinical and PET/CT parameters, shows favorable predictive efficacy for LVI status in LAC. Pathologic LVI and SUVmax are associated with LAC prognosis.

目的:探讨乳腺癌术前TNM分期对术后18F-FDG PET/CT阳性显像即转移的影响.方法:随访2012年—2016年间于我院P E T/C T中心进行检查的乳腺癌术后患者,并剔除假阳性与假阴性病例,最终纳入研究病例共计100例.以术后PET/CT显像结果为诊断标准,将全部患者分为转移组与未转移组,分析术前TNM分期对术后18F-FDG PET/CT阳性显像的影响.结果:100例患者中,转移患者71例,未转移患者29例.根据AJCC第7版乳腺癌TNM分期:原位癌(Tis期)及肿瘤大小为T1期的患者共54例,其中转移35例,未转移19例;T2期的患者共46例,转移36例,未转移10例;淋巴结转移状态N0期共28例,其中转移13例,未转移15例;N1期共27例,转移19例,未转移8例;N2期共26例,转移21例,未转移5例;N3期共19例,转移18例,未转移1例.单因素分析中,N分期是术后早期转移的影响因素(χ2=14.620,t=0.002<0.05);T1与T2期的术后转移率差别无统计学意义.二项l o g i s t i c s回归分析显示,术前淋巴结分期为N1、N2、N3期的患者术后发生转移概率大于分期为N0期的患者(O R=2.937,5.385,29.077,P=0.03,0.04,0.02<0.05).T分期在回归分析中P均大于0.05,没有统计学意义.结论:术前N分期越高术后发生转移的风险越高,应尽早干预.对直径5cm以下的肿瘤其肿瘤大小与术后转移无关,即肿瘤的增大不会增加转移的风险,可作为手术的适应症.

目的 探讨18F-氟代脱氧葡萄糖(18 F-FDG) PET/CT代谢参数在头颈部鳞状细胞癌(HNSCC)病人预后评估中的价值.方法 2011年11月-2016年3月于我中心行18 F-FDG PET/CT检查的HNSCC病人34例,随访时间为21～72个月,平均(37.5±14.2)个月.分析原发灶最大标准化摄取值(SUVtumor)、淋巴结转移瘤SUVmax(SUVLN)及SUVLN/SUVtumor对病人总生存期(OS)的预测价值.应用ROC曲线确定各代谢参数预后评估的最佳界值点和诊断效能,采用Kaplan-Meier法及Log-rank检验进行单因素生存分析.结果 34例HNSCC包括鼻咽癌16例,喉咽癌14例,口咽癌3例以及舌癌1例.存活组和死亡组SUVtumor、SUVLN/SUVtumor比较,差异均无显著性(P＞0.05);两组SUVLN比较,差异有显著性(t=2.792,P＜0.05).根据ROC,SUVLN预测HNSCC的OS最佳界值点为14.52 (AUC=0.757,95％CI=0.583～0.931,P＜0.05);SUVLN/SUVtumor预测OS最佳界值点为0.79(AUC=0.702,95％CI =0.526～0.878,P＜0.05).预测病人OS选用SUVLN效能最佳,其最佳界值点对应诊断特异度为90.00％;诊断灵敏度最高的参数为SUVLN/SUVtumor,其最佳界值点对应诊断灵敏度为85.70％.采用Logrank检验对生存函数进行组间比较,淋巴结转移瘤相关代谢参数(SUVLN,SUVLN/SUVtumor)可有效预测HNSCC病人OS(x2=16.028、4.372,P＜0.05);SUVtum.r无法有效预测病人OS(P＞0.05).结论 淋巴结转移瘤相关代谢参数对HNSCC病人的预后具有较高的评估价值,而原发灶的代谢参数则评估价值较低.

目的 探讨18F-FDG PET/CT全身显像在颈部淋巴结转移瘤中寻找原发灶的临床应用价值.方法 回顾性分析于青岛大学附属医院行18F-FDG PET/CT检查且病理确诊颈部淋巴结转移瘤的患者87例.分析颈部淋巴结转移瘤的病理类型及原发灶组织器官来源,18F-FDG PET/CT诊断原发灶的灵敏度、特异度、准确度、阳性预测值和阴性预测值.结果 颈部淋巴结转移瘤病理类型包括鳞状细胞癌49例(56.3％)、腺癌23例(26.4％)、小细胞癌6例(6.9％)、其他9例(10.3％).经病理确诊原发灶71例(81.6％):其中咽部肿瘤32例(喉咽15例、鼻咽14例、口咽3例)(44.4％)、肺癌16例(22.5％)、食管癌6例(8.5％)、子宫癌3例(4.2％)、扁桃体癌3例(4.2％)、其他恶性肿瘤11例(15.5％).原发灶病理构成:鳞状细胞癌43例(60.6％)、腺癌19例(26.8％)、小细胞癌6例(8.5％)、其他3例(4.2％).18F-FDG PET/CT全身显像正确诊断63例.灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为:88.7％ (63/71)、31.3％ (5/16)、85.1％ (63/74)、38.5％ (5/13)、78.2％ (68/87).结论 颈部淋巴结转移瘤的原发灶主要集中在咽部、肺、食道等,以鳞癌、腺癌为主,18F-FDG PET/CT全身显像寻找原发灶具有较高的灵敏度和阳性预测值;确诊或可疑颈部淋巴结转移瘤时寻找原发灶可首选18F-FDG PET/CT全身显像.