Panli Li

The Role of 18F-FDG PET/CT and MRI in Assessing Pathological Complete Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Purpose. We performed this meta-analysis to determine the utilities of 18F-FDG PET/CT and MRI in assessing the pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in the same cohort of patients with breast cancer. Methods. Two reviewers systematically searched on PubMed, Scopus, and Springer (from the beginning of 1992 to Aug. 1, 2015) for the eligible articles. Heterogeneity, pooled sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, and the summary receiver operating characteristic (SROC) curve were calculated to estimate the diagnostic efficacy of 18F-FDG PET/CT and MRI. Results. A total of 6 studies including 382 pathologically confirmed patients were eligible. The pooled sensitivity and specificity of 18F-FDG PET/CT were 0.86 (95% CI: 0.76–0.93) and 0.72 (95% CI: 0.49–0.87), respectively. Pooled sensitivity and specificity of MRI were 0.65 (95% CI: 0.45–0.80) and 0.88 (95% CI: 0.75–0.95), respectively. The area under the SROC curve of 18F-FDG PET/CT and MRI was 0.88 and 0.84, respectively. Conclusion. Study indicated that 18F-FDG PET/CT had a higher sensitivity and MRI had a higher specificity in assessing pCR in breast cancer patients. Therefore, the combined use of these two imaging modalities may have great potential to improve the diagnostic performance in assessing pCR after NAC.

Fluorine-18-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer after surgical resection: a systematic review and meta-analysis.

We aimed to explore the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) for detection of gastric cancer recurrence after surgical resection through a systematic review and meta-analysis. “PubMed”, EMBASE, Web of Knowledge and Springer, from the beginning of 2002 to Feb 2015, were searched for studies evaluating the diagnostic performance of 18F-FDG PET in detecting recurrent gastric cancer. We calculated sensitivities, specificities, diagnostic odds ratios and likelihood ratios, and constructed summary receiver operating characteristic curves. Fourteen studies (828 patients) were included. On a per-patient basis, the forest plots showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of 18F-FDG PET or PET/CT were 0.85 [95xa0% confidence interval (CI) 0.75–0.92], 0.78 (95xa0% CI 0.72–0.84), 3.9 (95xa0% CI 2.9–5.4), 0.19 (95xa0% CI 0.11–0.34), and 21 (95xa0% CI 9–47), respectively. On a per-lesion basis, the pooled sensitivity was 0.75 (95xa0% CI 0.61–0.86). The area under the SROC curve of PET/CT on the basis of per-patient was 0.86. 18F-FDG PET had great value in the detection of gastric cancer recurrence after surgical resection. The sensitivities of 18F-FDG PET were 85 and 75xa0%, respectively, on per-patient basis and on per-lesion basis.

64CuS-labeled nanoparticles: a new sentinel-lymph-node-mapping agent for PET–CT and photoacoustic tomography

Determining sentinel lymph node (SLN) status is critical to cancer staging and treatment decisions. Currently, in clinical practice, 99m Tc-radiocolloid-mediated planar scintigraphy and single-photon emission computed tomography (SPECT) are used to guide the biopsy and resection of SLNs. Recently, an emerging technique that combines positron emission tomography (PET) and photoacoustic tomography (PAT; PET-PAT) may offer accurate information in detecting SLNs. Herein, we report a kind of 64 CuS-labeled nanoparticle (64 CuS-NP) for the detection of SLNs with PET-PAT. We subcutaneously injected 64 CuS-NPs into the rats forepaw pads. After 24u2009h, the rats first draining axillary lymph nodes (i.e. the SLNs) could be clearly visualized with micro-PET (μPET)-CT. Rats were sacrificed after μPET-CT imaging, their axillary lymph nodes were surgically identified, and then PAT was employed to discover 64 CuS-NP-avid SLNs, which were embedded inside tissues. Biodistribution, autoradiography, and copper staining analyses confirmed the SLNs high uptake of 64 CuS-NPs. Our study indicates that 64 CuS-NPs are a promising dual-function agent for both PET-CT and PAT and could be used with multi-modal imaging strategies such as PET-PAT to identify SLNs in a clinical setting. Copyright

131I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

Purpose: Transcatheter hepatic artery embolization therapy is a minimally invasive alternative for treating inoperable liver cancer but recurrence is frequent. Multifunctional agents, however, offer an opportunity for tumor eradication. In this study, we were aim to synthesized poly (lactic-co-glycolic acid) (PLGA) microspheres encapsulating hollow CuS nanoparticles (HCuSNPs) and paclitaxel (PTX) that were then labeled with radioiodine-131 (131I) to produce 131I-HCuSNPs-MS-PTX. This compound combines the multi-theranostic properties of chemotherapy, radiotherapy and photothermal therapy. In addition, it can also be imaged with single photon emission computed tomography (SPECT) imaging and photoacoustic imaging. Methods: We investigated the value of therapeutic and imaging of 131I-HCuSNPs-MS-PTX in rats bearing Walker-256 tumor transplanted in the liver. After the intra-arterial (IA) injection of 131I-HCuSNPs-MS-PTX, 18F-Fluorodeoxyglucose (18F-FDG) micro-positron emission tomography/computed tomography (micro-PET/CT) imaging was used to monitor the therapeutic effect. PET/CT findings were verified by immunohistochemical analysis. SPECT/CT and photoacoustic imaging were performed to demonstrate the distribution of 131I-HCuSNPs-MS-PTX in vivo. Results: We found that embolization therapy in combination with chemotherapy, radiotherapy and photothermal therapy offered by 131I-HCuSNPs-MS-PTX completely ablated the transplanted hepatic tumors at a relatively low dose. In comparison, embolization monotherapy or combination with one or two other therapies had less effective anti-tumor efficacy. The combination of SPECT/CT and photoacoustic imaging effectively confirmed microsphere delivery to the targeted tumors in vivo and guided the near-infrared laser irradiation. Conclusion: Our study suggests that there is a clinical theranostic potential for imaging-guided arterial embolization with 131I-HCuSNPs-MS-PTX for the treatment of liver tumors.

The role of fluorine-18 fluorodeoxyglucose PET in prognosis evaluation for stem cell transplantation of lymphoma: a systematic review and meta-analysis.

The role of fluorine-18 fluorodeoxyglucose PET (18F-FDG PET) in prognostic evaluation of pre-stem cell transplantation (SCT) and post-SCT is still uncertain. A systematic review and meta-analysis were carried out to detect the prognostic power of 18F-FDG PET. ‘PubMed’, EMBASE, and Springer were searched for relevant articles. Subgroup analysis was carried out to evaluate the 18F-FDG PET in predicting the prognosis between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma. Finally, 17 studies that included 1192 patients were eligible, 16 studies for progression-free survival (PFS) and 12 studies for overall survival (OS). For the pre-SCT PET or PET/computed tomography scan, the combined hazard ratios (HRs) of PET for PFS and OS were 2.32 and 2.64, respectively. Subgroup analysis showed that the HRs of PFS for HL and non-Hodgkin lymphoma were 3.28 and 2.00, respectively. For the post-SCT PET scan, the combined HR for PFS was 4.61. The sensitivity analysis showed that exlcusion of any single study had no significant effect on HR. We found that 18F-FDG PET was especially effective in predicting pre-STC and post-STC prognosis. The patients with a negative PET scan had a better prognosis compared with those with a positive scan in PFS and OS. In the subgroup analysis, 18F-FDG PET had a higher value in predicting prognosis before SCT for HL patients.

Cerebral blood perfusion changes in amputees with myoelectric hands after rehabilitation: a SPECT computer-aided analysis

BackgroundRehabilitation, which is essential for amputees with myoelectric hands, can improve the quality of daily life by remodeling the neuron network. In our study, we aim to develop a cerebral blood perfusion (CBF) single-photon emission computed tomography computer-aided (SPECT-CA) detection scheme to automatically locate the brain’s activated regions after rehabilitation.ResultsFive participants without forearms (three male, two female, mean age 51xa0±xa012.89xa0years, two missing the right side, and three missing the left side) were included in our study. In the clinical assessment, all of the participants received higher scores after training. The results of the SPM analysis indicated that CBF in the precentral gyrus, postcentral gyrus, frontal lobe, temporal lobe and cerebellum was significantly different among the five participants (Pxa0<xa00.05). Moreover, SPECT-CA showed that the activated brain areas mainly included the precentral gyrus, postcentral gyrus, cerebellum and extensive cerebral cortex.ConclusionOur study demonstrated that the CBF SPECT-CA method can detect the brain blood perfusion changes induced by rehabilitation with high sensitivity and accuracy. This method has great potential for locating the remodeled neuron regions of amputees with myoelectric hands after rehabilitation.

131I Therapy in Patients with Differentiated Thyroid Cancer: Study of External Dose Rate Attenuation Law and Individualized Patient Management

BACKGROUNDnTherapy with radioactive iodine (131I) is a well established treatment method for postsurgical differentiated thyroid carcinoma (DTC). A fixed discharge time is generally set, regardless of individual differences in residual body radioactivity (RBA). This study aimed to investigate the RBA of each patient to find the attenuation law and to identify underlying factors in order to predict the time point for a safe, scientifically sound discharge plan.nnnMETHODSnA total of 231 DTC patients undergoing 131I treatment were all treated with 3.7 GBq (100 mCi) of 131I. RBA was estimated by measuring the external body dose rate (EDR) at a distance of 1u2009m from the body surface between 0 and 72 hours after oral administration of 131I. Data from each patient were used to establish a time-EDR value (h-μSv/h) curve. Software was developed to predict the time when a patients dose equivalent meets the national safety standard by including six time points between 40 and 60 hours. Several factors that might affect that time were analyzed.nnnRESULTSnThe EDR attenuation law in patients could be described with a double exponential decay model, and the cutoff value was set as 23.3u2009μSv/h, upon which the predictive software was developed. Students t-test showed there was no statistical difference between predicted values and the actual measured values (pu2009>u20090.05). Correlation analysis found that serum thyroglobulin, total triiodothyronine, total thyroxine, free triiodothyronine, free thyroxine, thyrotropin, 2- and 24-hour iodine uptake rate of the thyroid, scores of 99mTc-pertechnetate thyroid scan, scores of 131I whole-body scan, scores of ultrasound scan, and gastrointestinal residues were associated with attenuation speed. A further multiple linear regression analysis found that 24-hour iodine uptake (X1), residual thyroid grading by 131I whole-body scan (X2), blood free triiodothyronine (X3) and free thyroxine (X4) predominantly influenced the decline of the EDR. The regression equation was Ŷu2009=u20092.091X1 + 6.370X2 + 4.529X3 + 2.466X4 - 8.614 (Fu2009=u200944.03, pu2009<u20090.01).nnnCONCLUSIONSnAn effective and convenient method was created to measure and predict the individual safety time for discharge. This could play a significant role not only for scientific hospital discharge planning, rational use of medical resources, and better individualized management, but also in public radiation protection.

The combined therapeutic effects of 131 iodine-labeled multifunctional copper sulfide-loaded microspheres in treating breast cancer

Compared to conventional cancer treatment, combination therapy based on well-designed nanoscale platforms may offer an opportunity to eliminate tumors and reduce recurrence and metastasis. In this study, we prepared multifunctional microspheres loading 131I-labeled hollow copper sulfide nanoparticles and paclitaxel (131I-HCuSNPs-MS-PTX) for imaging and therapeutics of W256/B breast tumors in rats. 18F-fluordeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging detected that the expansion of the tumor volume was delayed (P<0.05) following intra-tumoral (i.t.) injection with 131I-HCuSNPs-MS-PTX plus near-infrared (NIR) irradiation. The immunohistochemical analysis further confirmed the anti-tumor effect. The single photon emission computed tomography (SPECT)/photoacoustic imaging mediated by 131I-HCuSNPs-MS-PTX demonstrated that microspheres were mainly distributed in the tumors with a relatively low distribution in other organs. Our results revealed that 131I-HCuSNPs-MS-PTX offered combined photothermal, chemo- and radio-therapies, eliminating tumors at a relatively low dose, as well as allowing SPECT/CT and photoacoustic imaging monitoring of distribution of the injected agents non-invasively. The copper sulfide-loaded microspheres, 131I-HCuSNPs-MS-PTX, can serve as a versatile theranostic agent in an orthotopic breast cancer model.

PET Radiopharmaceuticals in Oncology Beyond FDG

Several imaging modalities to diagnose cancer, which include computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, optical imaging, and gamma scintigraphy, have been previously used. For instance, CT and MRI provide considerable anatomic information about the location and the extent of tumors, but do not adequately differentiate residual or recurrent tumors from edema, radiation necrosis, or gliosis. On the other ultrasound images provide limited information about local and regional morphology with blood flow. Similarly optical imaging showed promising results, but did not demonstrate the ability to detect deep tissue penetration. Notably, radionuclide imaging modalities are diagnostic cross-sectional imaging techniques that map the location and concentration of radionuclide-labeled compounds. Moreover, molecular imaging agents are making it possible to “see” the molecular makeup of the tumor and its metabolic activity beyond tumor location, size, shape, and viability. Other technological limitations include nuclear images, which can provide a very accurate definition of metabolically active areas, but miss anatomic features. As a result, new imaging modalities have combined nuclear images with CT scans for treatment planning. The hybrid scanners combine anatomic and functional images taken during a single procedure, without having to reposition the patient between scans. In this chapter, multiple ligands beyond clinical standard 18F-fluorodexoyglucose are reviewed.

Lesion based diagnostic performance of dual phase 99m Tc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism

BackgroundWe aimed to evaluate the diagnostic performance of 99mTc-MIBI SPECT/CT and ultrasonography in patients with secondary hyperparathyroidism (SHPT), and explored the factors that affect the diagnostic performance.Methods99mTc-MIBI SPECT/CT and ultrasonography were performed in 50 patients with SHPT within 1 month before they underwent surgery. Imaging results were confirmed by the pathology. Pearson correlation analysis was used to determine the correlation of PTH level with clinical data. The optimal cutoff value for predicting positive 99mTc-MIBI results was evaluated by ROC analysis in lesions diameter.ResultsForty-nine patients had a positive 99mTc-MIBI imaging results and 39 patients had positive ultrasonography results. The sensitivities of 99mTc-MIBI and ultrasonography were 98.00% and 78.00%, respectively. A total of 199 lesions were resected in 50 patients. Among them, 183 lesions were proved to be parathyroid hyperplasia. On per-lesion basis analysis, the sensitivity and specificity of 99mTc-MIBI and ultrasonography were 59.34% and 75.00% vs 46.24% and 80.00%, respectively. The Pearson correlation analysis showed that the serum AKP and PTH level had a significant linear association (ru2009=u20090.699, Pu2009<u20090.001). The lesion diameter was a statistically significant predictive factor in predicting positive 99mTc-MIBI SPECT/CT. The optimal cutoff value for predicting positive 99mTc-MIBI results evaluated by ROC analysis in lesions diameter was 8.05xa0mm.ConclusionDual phase 99mTc-MIBI SPECT/CT imaging had a higher sensitivity in patients with SHPT than ultrasonography. Therefore, using 99mTc-MIBI positioning the lesion could be an effective method pre-surgical in patients with SHPT.