Prostate cancer ranks second among the causes of death of malignant tumors in middle-aged and elderly men. A considerable number of patients are not easily detected in early-stage prostate cancer. Although traditional imaging examinations are of high value in the diagnosis and staging of prostate cancer, they also have certain limitations. With the development of nuclear medicine instruments and molecular probes, molecular imaging is playing an increasingly important role in the diagnosis and treatment of prostate cancer. Positron emission tomography and computed tomography (PET/CT) using prostate-specific membrane antigen (PSMA) as a probe has gained increasing recognition. This article will review the latest progress in the application of PET/CT using probes for targeting PSMA to imaging and treatment of prostate cancer, in order to provide a theoretical basis for the application of probes for targeting PSMA in the diagnosis and treatment of prostate cancer.
Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis．Methods By summarized current situation and advancement of serum fibrotic markers, ultrasound, CT and MRI in assessing liver fibrosis, we investigated their value and limitations. Results In addition to diagnosis, non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis. For liver fibrosis, however, non-invasive methods can not monitor effectively reaction to therapy and progression. Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis, and reduce the need of liver biopsy.
Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
ObjectiveTo establish and internally validate a predictive model for poorly differentiated adenocarcinoma based on CT imaging and tumor marker results. MethodsPatients with solid and partially solid lung nodules who underwent lung nodule surgery at the Department of Thoracic Surgery, the Affiliated Brain Hospital of Nanjing Medical University in 2023 were selected and randomly divided into a training set and a validation set at a ratio of 7:3. Patients' CT features, including average density value, maximum diameter, pleural indentation sign, and bronchial inflation sign, as well as patient tumor marker results, were collected. Based on postoperative pathological results, patients were divided into a poorly differentiated adenocarcinoma group and a non-poorly differentiated adenocarcinoma group. Univariate analysis and logistic regression analysis were performed on the training set to establish the predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the model's discriminability, the calibration curve to assess the model's consistency, and the decision curve to evaluate the clinical value of the model, which was then validated in the validation set. ResultsA total of 299 patients were included, with 103 males and 196 females, with a median age of 57.00 (51.00, 67.25) years. There were 211 patients in the training set and 88 patients in the validation set. Multivariate analysis showed that carcinoembryonic antigen (CEA) value [OR=1.476, 95%CI (1.184, 1.983), P=0.002], cytokeratin 19 fragment antigen (CYFRA21-1) value [OR=1.388, 95%CI (1.084, 1.993), P=0.035], maximum tumor diameter [OR=6.233, 95%CI (1.069, 15.415), P=0.017], and average density [OR=1.083, 95%CI (1.020, 1.194), P=0.040] were independent risk factors for solid and partially solid lung nodules as poorly differentiated adenocarcinoma. Based on this, a predictive model was constructed with an area under the ROC curve of 0.896 [95%CI (0.810, 0.982)], a maximum Youden index corresponding cut-off value of 0.103, sensitivity of 0.750, and specificity of 0.936. Using the Bootstrap method for 1000 samplings, the calibration curve predicted probability was consistent with actual risk. Decision curve analysis indicated positive benefits across all prediction probabilities, demonstrating good clinical value. ConclusionFor patients with solid and partially solid lung nodules, preoperative use of CT to measure tumor average density value and maximum diameter, combined with tumor markers CEA and CYFRA21-1 values, can effectively predict whether it is poorly differentiated adenocarcinoma, allowing for early intervention.
Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.
Objective To evaluate the accuracy of preoperative 64 multidetector spiral computed tomography (MDCT) in the diagnosis of stage Ⅳ gastric cancer. Methods The data of patients with stage Ⅳ gastric cancer between July 2007 and April 2008 were collected. Twenty-nine patients underwent preoperative 64 MDCT were retrospectively analyzed. All computed tomography scans were prospectly analyzed by 2 abdominal radiologists separately. Pathological tumor stage was based on TNM stage according to the revised Japanese Classification of Gastric Carcinoma from the Japanese Gastric Cancer Association. All CT results were compared with clinical, surgical and histopathologic results. Results The 65.2% (15/23), 47.8% (11/23) and 70.8% (17/24) of the stage Ⅳ patients were accurately predicted of T, N and M stage, respectively. Moreover, 58.6% (17/29) of the stage Ⅳ patients were accurately predicted of TNM stage. But 6/9 cases with peritoneal metastases were not detected by preoperative 64 MDCT. Conclusion The 64 MDCT is a promising technique for detection and preoperative staging of stage Ⅳ gastric cancer. It was difficult to detect peritoneal metastases, but it may not increase the rate of exploratory laparotomy.
ObjectivesTo investigate the influence of scanning parameters (tube voltages and tube currents) on image quality and corresponding radiation doses with simulated lung nodules in chest CT.MethodsThe anthropomorphic chest phantoms with 12 simulated, randomly placed nodules of different diameters and densities in the chest were scanned by different scanning parameters. The detection rate, degree of nodular deformation, image quality (with both subjective and objective evaluation) and the corresponding radiation doses were recorded and evaluated, and the correlation between nodule detection rate, degree of nodular deformation, radiation dose and image quality using different scanning parameters was analyzed.ResultsThe image quality improved with the increase of tube voltage and tube current (P<0.05). When the tube current was constant, the CT values of the vertebral decreased gradually with the increase of tube voltages (P<0.05); however, significant difference was not detected in CT values of the lung field (P>0.05). When the tube current was 100 mAs, the lung nodules with CT values of +100 HU and ?630 HU showed statistical difference when using different tube voltage (P<0.05); but there was no significant difference in nodules of ?800 HU (P=0.57). When tube voltage was 100 kV and 120 kV each, it was possible to detect all lung nodules with a detection rate of 100%. The detection rate was 33% and 66% in 3 mm diameter when the tube current was 80 kV/15 mA and 80 kV/20 mA, respectively. The nodules deformation in nodules with a CT value of ?630 HU and diameter less than 5 mm was the most prominent (P<0.05). After analyzing the relationship between image quality and radiation doses using different tube voltages, we established a system of correlation equations: 80 kV: Y=2.625X+0.038; 100 kV: Y=14.66X+0.158; 120 kV: Y=18.59X+0.093.ConclusionsThe image quality improves with the increase of tube current and tube voltage, as well as the corresponding radiation doses. By reducing the tube voltage and increasing the tube current appropriately, the radiation doses can be reduced. Follow-up CT examination of pulmonary ground glass nodules should apply the same tube voltage imaging parameters, so as to effectively reduce the measurement error of nodule density and evaluate the change of nodules more accurately.
ObjectiveTo explore the impact of different monochromatic reconstruction on image quality of early lesions of coronavirus disease 2019 (COVID-19).MethodsThe chest spectral CT images of 11 patients confirmed as COVID-19 in West China Hospital of Sichuan University between January and February 2020 were retrospectively analyzed. A total of 34 inflammatory lesions were found in the 11 cases. Seven groups of images were reconstructed from the raw data for each patient, including the conventional polychromatic image and different monochromatic images of 40-140 keV (with intervals of 20 keV). CT and standard deviation (SD) values of all lesions were measured to calculate the signal-noise ratio (SNR) and contrast-noise ratio (CNR). The image quality was subjectively scored by two radiologists, and the differences in image quality among different monochromatic groups and the polychromatic group were compared.ResultsWith the increase of X-ray energy, the CT values and SD values of reconstructed images in monochromatic groups gradually decreased, and the SNRs and CNRs gradually increased, and the differences between adjacent two groups were all statistically significant (P<0.001). In the range of 80-140 keV, the SD values of different monochromatic groups were lower than that of the polychromatic group, and the SNRs and CNRs were higher than those of the polychromatic group, and the pairwise comparison results showed statistically significant differences (P<0.001). The 120 keV-reconstructed image had the highest subjective score, and the difference from that of the polychromatic image was statistically significant (P<0.05).ConclusionsDifferent monochromatic reconstruction of spectral CT can significantly reduce the image noise in early COVID-19 lesions, and improve the image quality. Combining subjective and objective evaluation of images, the 120 keV-reconstructed monochromatic image shows the best early lesions of COVID-19 and is of great significance for early clinical screening.
ObjectiveTo explore the clinical significance of quantitative CT measurement of pulmonary vascular indexes in chronic obstructive pulmonary disease (COPD).
MethodsFifty-three stable COPD patients who were diagnosed in our hospital between May 2013 and February 2015 were recruited in the study. The HRCT results were analyzed, and the pulmonary vascular indexes were measured including the main pulmonary artery diameter (mPAD), axial diagonal mPAD, sagittal mPAD, right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD) and etc. The % CSA<5 (the percent of total cross-sectional area of the vascular with cross-sectional area less than 5 mm2 to total area of the lung) was calculated with Image J 1.48. The % LAA[volume percentage of low attenuation areas (<-950 HU)] representing degree of emphysema was calculated with GE ADW 4.5. Lung function test and questionnaires including CAT, mMRC, SGRQ and frequency of acute exacerbation of COPD (AECOPD) were completed and collected.
ResultsIn COPD patients, the mPAD,axial diagonal mPAD, sagittal mPAD, RPAD and LPAD were positively correlated with % LAA respectively (r=0.36, 0.33, 0.43, 0.45, 0.33) and % CSA<5 was negatively correlated with % LAA (r=-0.37). mPAD was positively correlated with CAT, SGRQ and frequency of AECOPD respectively (r=0.52, 0.29, 0.35), and negatively correlated with FEV1% pred (r=-0.30).% CSA<5 was negatively correlated with CAT, SGRQ and frequency of AECOPD, respectively (r=-0.29,-0.30,-0.29), and positively correlated with FEV1% pred (r=0.28). The multivariate linear regression analysis revealed a linear relationship of mPAD with body mass index,% LAA and CAT. There was also linear relationships between axial diagonal mPAD, sagittal mPAD, RPAD and % LAA, CAT, respectively, and linear relationships between % CSA<5 and FEV1% pred,% LAA. The P value were all less than 0.05.
ConclusionQuantitative CT measurement of cross-sectional area of small pulmonary vessels and pulmonary artery diameter are associated with clinical indexes in COPD patients, which will provide a new appraoche for the disease assessment of COPD patients.
Objective To evaluate the feasibil ity and cl inical significance of the computed tomography angiography (CTA) for the latissimus dorsi muscle (LDM) flap transplantation. Methods From September 2007 to August 2008, 3 cases of soft tissue defects in l imbs were treated with LDM flap transplantation. Three patients included 2 males and 1 female whowere 23 to 42 years old. All of soft tissue defects were caused by trauma. The locations were the forearm in 2 cases and the leg in 1 case. The area of defect was 17 cm × 8 cm-20 cm × 10 cm. All cases received CTA to observe the distribution and anastomosis of thoracodorsal artery. Subsequently, three-dimensional computer reconstruction were carried out to display the stereoscopic structure of the LDM flap and to design the LDM flap before operation. Results The anatomy characteristic of LDM flap can be displayed accurately by the three-dimensional reconstruction model. The distribution of thoracodorsal artery in 3 cases of flaps was in concordance with preoperative design completely. All the flaps were excised successfully, the area of the flap was 19 cm × 10 cm-22 cm × 12 cm. All the transferred flaps survived completely. All cases were followed up from 4 months to 12 months. The color and texture of the flaps were good. Conclusion The three-dimensional reconstructive images can provide visible, stereoscopic and dynamic anatomy for cl inical appl ication of LDM flap. The digitized three-dimensional reconstructive models of LDM flap structures can be appl ied in cl inical training and pre-operative design.
