The action of needling in acupoint therapy has to first be regulated and integrated by the brain, and then it affects the target organ and manifests its therapeutic effects, which is dependent on the specificity of th...The action of needling in acupoint therapy has to first be regulated and integrated by the brain, and then it affects the target organ and manifests its therapeutic effects, which is dependent on the specificity of the acupoints. The authors put forward the hypothesis of the ＂acupoint-related brain＂. Single-photon emission computed tomography was used to explore the activation of brain regions following true needling in true acupoint Waiguan （SJ 5）, sham needling in true acupoint Waiguan, true needling in a sham point, and sham needling in a sham point. The relative specificity of Waiguan in normal persons was analyzed by observing changes in regional cerebral blood flow. Compared with the sham needling in true acupoint group and sham needling in the sham point group, acupuncture at Waiguan can activate brain regions controlling movement. Compared with true needling in the sham point group, acupuncture at Waiguan can also activate brain regions controlling movement. The results suggest that the specificity of needling at an acupoint is related to certain activated cerebral functional regions, which are associated with the clinical application of the acupoint.展开更多
BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the prim...BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.展开更多
To investigate diagnostic accuracy of 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in chronic coronary artery disease. Sixty-seven patients with suspecte...To investigate diagnostic accuracy of 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in chronic coronary artery disease. Sixty-seven patients with suspected CAD were enrolled in the prospective study. All patients underwent myocardial perfusion scintigraphy in SPECT with dual isotopes of T1-201 and dipyridamole stress Tc-99m sestamibi. Rest and stress imaging protocol were performed in 2 hours by dose of 3 mCi TI-201 and 25 mCi Tc-99m sestamibi. The acquisition parameters includes LEHR collimator, energy peak of 72 and 167 keV for T1-201 and 140 keV for Tc-99m, 180-degree rotation from RAO to LPO, matrix size 64x64, and 25second/frame/64 frames. The 20-segment model of left ventricle was used in automatic quantitation software. Coronary angiography was used as gold standard. CAD was defined as 50% of lumen stenosis on coronary angiography. Rest TI-201/stress tc-99m sestamibi dual-isotope SPECT demonstrated a sensitivity of 94.59% and specificity of 70%, positive predictive value of 79.54% and negative predictive value of 91.3% in detection of coronary artery disease. Sensitivity and specificity for detecting multi-vessel coronary artery disease were 82.75% and 81.57% for the left anterior descending, 77.77% and 91.83% for left circumflex and 94.11% and 82% for right coronary artery. 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT has high sensitivity, specificity, positive predictive value and negative predictive value in detecting chronic coronary artery disease with greater than 50% stenosis assessed by coronary angiography Moreover, this imaging protocol gives high imaging quality, time-saving and convenience.展开更多
AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPEC...AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.展开更多
AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission com...AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.展开更多
Introduction:Fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)is a powerful tool for monitoring the response of diffuse large B-cell lymphoma(DLBCL)to therapy,but the crit...Introduction:Fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)is a powerful tool for monitoring the response of diffuse large B-cell lymphoma(DLBCL)to therapy,but the criteria to interpret PET/CT results remain under debate.We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment(QVTA)criteria compared with the Deauvil e criteria.Methods:In this retrospective study,final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauvil e and QVTA criteria.Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.Results:A total of 253 patients were enrol ed.The interpretation according to the Deauvil e criteria revealed that 181patients had negative PET/CT scan results and 72 had positive results.The 3 year overal survival(OS)rate was significantly higher in patients with negative scan results than in those with positive results(91.6%vs.57.5%,P<0.001).The72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria:29 had indeterminate results,and 43 had positive results.The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results(91.2%vs.33.5%,P<0.001)but was similar between patients with negative and indeterminate scan results(91.6%vs.91.2%,P=0.921).Conclusions:Compared with the Deauvil e criteria,using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results.The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.展开更多
Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty pa...Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.展开更多
Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outsi...Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.展开更多
BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography(18FDG-PET/CT)to the evaluation of response to first-...BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography(18FDG-PET/CT)to the evaluation of response to first-line gemcitabine plus cispla-tin-based chemotherapy in patients with metastatic bladder cancer.AIM To evaluate the response to Gemcitabine plus Cisplatin-based chemotherapy using 18FDG-PET/CT imaging in patients with metastatic bladder cancer.METHODS Between July 2007 and April 2019,79 patients underwent 18FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma(M-BCa).A total of 42 pa-tients(38 male,4 female)were included in the study,and all had been admi-nistered Gemcitabine plus Cisplatin-based chemotherapy.After completion of the therapy,the patients underwent a repeat 18FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria.Mean age was 66.1 years and standard deviation was 10.7 years(range:41–84 years).RESULTS Of the patients,seven(16.6%)were in complete remission,17(40.5%)were in partial remission,six(14.3%)had a stable disease,and 12(28.6%)had a pro-gressive disease.The overall response rate was 57.1 percent.CONCLUSION 18FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer.Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.展开更多
Intrahepatic cholangiocarcinoma(iCCA)is the second most common type of liver cancer after hepatocellular carcinoma,accounting for 15%of all primary liver neoplasms.In particular,iCCA is the most lethal tumor of these ...Intrahepatic cholangiocarcinoma(iCCA)is the second most common type of liver cancer after hepatocellular carcinoma,accounting for 15%of all primary liver neoplasms.In particular,iCCA is the most lethal tumor of these types,with the greatest increase in incidence in Western countries over the last decade(1,2).Local resection is the only treatment that can achieve cure,but resection rates remain low and survival is still limited to less than 1 year in the presence of locally unresectable or distant metastases(3).Its incidence and mortality have increased in recent years,and the total number of new cases is expected to increase up to 10-fold over the next two to three decades.In recent years,new treatments for iCCA have been developed and overall survival has improved.展开更多
The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and ca...The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and carotidendarterectomy （CEA）.展开更多
Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography(SPECT)and serum bone metabolic markers in patients with active rheumatoid arthritis(RA)....Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography(SPECT)and serum bone metabolic markers in patients with active rheumatoid arthritis(RA).Methods Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department展开更多
Tortuous hydraulic fractures(HFs) are likely to be created in heterogeneous formations such as conglomerates, which may cause sand plugging, ultimately resulting in poor stimulation efficiency. This study aims to expl...Tortuous hydraulic fractures(HFs) are likely to be created in heterogeneous formations such as conglomerates, which may cause sand plugging, ultimately resulting in poor stimulation efficiency. This study aims to explore HF growth behavior in conglomerate through laboratory fracturing experiments under true tri-axial stresses combined with computed tomography scanning and acoustic emission(AE) monitoring. The effects of gravel size, horizontal differential stress, and AE focal mechanisms were examined. Especially, the injection pressure and the AE response features during HF initiation and propagation in conglomerate were analyzed. Simple HFs with narrow microfractures are created in conglomerate when the gravels are considerably smaller than the specimen, whereas complex fractures are created when the gravels are similar in size to the specimen, even under high horizontal differential stresses. Breakdown pressure and AE rates are high when a HF is initiated from the high-strength gravel. A large pressure decline after the breakdown may indicate the creation of a planar and wide HF. Analyzing the focal mechanism indicates that the shear mechanism generally dominates with an increase in the HF complexity. Tensile events are likely to occur during HF initiation and are located around the wellbore. Shear events occur mainly around the nonplanar and complex matrix/gravel interfaces.展开更多
Understanding microcracking near coalesced fracture generation is critically important for hydrocarbon and geothermal reservoir characterization as well as damage evaluation in civil engineering structures. Dense and ...Understanding microcracking near coalesced fracture generation is critically important for hydrocarbon and geothermal reservoir characterization as well as damage evaluation in civil engineering structures. Dense and sometimes random microcracking near coalesced fracture formation alters the mechanical properties of the nearby virgin material. Individual microcrack characterization is also significant in quantifying the material changes near the fracture faces （i.e. damage）. Acoustic emission （AE） monitoring and analysis provide unique information regarding the microcracking process temporally, and infor- mation concerning the source characterization of individual microcracks can be extracted. In this context, laboratory hydraulic fracture tests were carried out while monitoring the AEs from several piezoelectric transducers. In-depth post-processing of the AE event data was performed for the purpose of under- standing the individual source mechanisms. Several source characterization techniques including moment tensor inversion, event parametric analysis, and volumetric deformation analysis were adopted. Post-test fracture characterization through coring, slicing and micro-computed tomographic imaging was performed to determine the coalesced fracture location and structure. Distinct differences in fracture characteristics were found spatially in relation to the openhole injection interval. Individual microcrack AE analysis showed substantial energy reduction emanating spatially from the injection interval. It was quantitatively observed that the recorded AE signals provided sufficient information to generalize the damage radiating spatially away from the injection wellbore.展开更多
Background:Intrahepatic cholangiocarcinoma(ICC)is a highly metastatic cancer.^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)enables sensitive tumor and metastasis detectio...Background:Intrahepatic cholangiocarcinoma(ICC)is a highly metastatic cancer.^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)enables sensitive tumor and metastasis detection.Our aim is to evaluate the influence of pre-treatment PET/CT on the N-and M-staging and subsequent clinical management in ICC patients.Methods:Between August 2010 and August 2018,660 consecutive ICC patients,without prior anti-tumor treatments nor other malignancies,were enrolled.The diagnostic performance of PET/CT on the N-and M-staging was compared with conventional imaging,and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated.Survival difference was compared between patients receiving PET/CT or not after propensity score matching.Results:Patients were divided into group A(n=291)and group B(n=369)according to whether PET/CT was performed.Among 291 patients with both PET/CT and conventional imaging for staging in group A,PET/CT showed significantly higher sensitivity(83.0%vs.70.5%,P=0.001),specificity(88.3%vs.74.9%,P<0.001)and accuracy(86.3%vs.73.2%,P<0.001)than conventional imaging in diagnosing regional lymph node metastasis,as well as higher sensitivity(87.8%vs.67.6%,P<0.001)and accuracy(93.5%vs.89.3%,P=0.023)in diagnosing distant metastasis.Overall,PET/CT improved the accuracy of preoperative staging from 60.1%to 71.8%(P<0.001),and modified clinical treatment strategy in 5.8%(17/291)of ICC patients,with unique roles in different tumor-node-metastasis(TNM)stages.High tumor-to-non-tumor ratio(TNR)predicted poor overall survival[hazard ratio(HR)=2.17;95%confidence interval(CI):1.49-3.15;P<0.001].Furthermore,patients performing PET/CT had longer overall survival compared with those without PET/CT(HR=0.74;95%CI:0.58-0.93;P=0.011)after propensity score matching.Conclusions:PET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients,and facilitated accurate tumor staging and optimal treatment allocation.展开更多
基金supported by the National 973 Program of China,No.2006CB504505the National Natural Science Foundation of China,No.90709027
文摘The action of needling in acupoint therapy has to first be regulated and integrated by the brain, and then it affects the target organ and manifests its therapeutic effects, which is dependent on the specificity of the acupoints. The authors put forward the hypothesis of the ＂acupoint-related brain＂. Single-photon emission computed tomography was used to explore the activation of brain regions following true needling in true acupoint Waiguan （SJ 5）, sham needling in true acupoint Waiguan, true needling in a sham point, and sham needling in a sham point. The relative specificity of Waiguan in normal persons was analyzed by observing changes in regional cerebral blood flow. Compared with the sham needling in true acupoint group and sham needling in the sham point group, acupuncture at Waiguan can activate brain regions controlling movement. Compared with true needling in the sham point group, acupuncture at Waiguan can also activate brain regions controlling movement. The results suggest that the specificity of needling at an acupoint is related to certain activated cerebral functional regions, which are associated with the clinical application of the acupoint.
文摘BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.
文摘To investigate diagnostic accuracy of 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in chronic coronary artery disease. Sixty-seven patients with suspected CAD were enrolled in the prospective study. All patients underwent myocardial perfusion scintigraphy in SPECT with dual isotopes of T1-201 and dipyridamole stress Tc-99m sestamibi. Rest and stress imaging protocol were performed in 2 hours by dose of 3 mCi TI-201 and 25 mCi Tc-99m sestamibi. The acquisition parameters includes LEHR collimator, energy peak of 72 and 167 keV for T1-201 and 140 keV for Tc-99m, 180-degree rotation from RAO to LPO, matrix size 64x64, and 25second/frame/64 frames. The 20-segment model of left ventricle was used in automatic quantitation software. Coronary angiography was used as gold standard. CAD was defined as 50% of lumen stenosis on coronary angiography. Rest TI-201/stress tc-99m sestamibi dual-isotope SPECT demonstrated a sensitivity of 94.59% and specificity of 70%, positive predictive value of 79.54% and negative predictive value of 91.3% in detection of coronary artery disease. Sensitivity and specificity for detecting multi-vessel coronary artery disease were 82.75% and 81.57% for the left anterior descending, 77.77% and 91.83% for left circumflex and 94.11% and 82% for right coronary artery. 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT has high sensitivity, specificity, positive predictive value and negative predictive value in detecting chronic coronary artery disease with greater than 50% stenosis assessed by coronary angiography Moreover, this imaging protocol gives high imaging quality, time-saving and convenience.
文摘AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.
文摘AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.
文摘Introduction:Fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)is a powerful tool for monitoring the response of diffuse large B-cell lymphoma(DLBCL)to therapy,but the criteria to interpret PET/CT results remain under debate.We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment(QVTA)criteria compared with the Deauvil e criteria.Methods:In this retrospective study,final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauvil e and QVTA criteria.Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.Results:A total of 253 patients were enrol ed.The interpretation according to the Deauvil e criteria revealed that 181patients had negative PET/CT scan results and 72 had positive results.The 3 year overal survival(OS)rate was significantly higher in patients with negative scan results than in those with positive results(91.6%vs.57.5%,P<0.001).The72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria:29 had indeterminate results,and 43 had positive results.The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results(91.2%vs.33.5%,P<0.001)but was similar between patients with negative and indeterminate scan results(91.6%vs.91.2%,P=0.921).Conclusions:Compared with the Deauvil e criteria,using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results.The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.
文摘Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.
基金supported by the Tehran University of Medical Sciences under Grant No.36291PET/CT and Cyclotron Center of Masih Daneshvari Hospital at Shahid Beheshti University of Medical Sciences。
文摘Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.
文摘BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography(18FDG-PET/CT)to the evaluation of response to first-line gemcitabine plus cispla-tin-based chemotherapy in patients with metastatic bladder cancer.AIM To evaluate the response to Gemcitabine plus Cisplatin-based chemotherapy using 18FDG-PET/CT imaging in patients with metastatic bladder cancer.METHODS Between July 2007 and April 2019,79 patients underwent 18FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma(M-BCa).A total of 42 pa-tients(38 male,4 female)were included in the study,and all had been admi-nistered Gemcitabine plus Cisplatin-based chemotherapy.After completion of the therapy,the patients underwent a repeat 18FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria.Mean age was 66.1 years and standard deviation was 10.7 years(range:41–84 years).RESULTS Of the patients,seven(16.6%)were in complete remission,17(40.5%)were in partial remission,six(14.3%)had a stable disease,and 12(28.6%)had a pro-gressive disease.The overall response rate was 57.1 percent.CONCLUSION 18FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer.Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.
文摘Intrahepatic cholangiocarcinoma(iCCA)is the second most common type of liver cancer after hepatocellular carcinoma,accounting for 15%of all primary liver neoplasms.In particular,iCCA is the most lethal tumor of these types,with the greatest increase in incidence in Western countries over the last decade(1,2).Local resection is the only treatment that can achieve cure,but resection rates remain low and survival is still limited to less than 1 year in the presence of locally unresectable or distant metastases(3).Its incidence and mortality have increased in recent years,and the total number of new cases is expected to increase up to 10-fold over the next two to three decades.In recent years,new treatments for iCCA have been developed and overall survival has improved.
文摘The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and carotidendarterectomy （CEA）.
文摘Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography(SPECT)and serum bone metabolic markers in patients with active rheumatoid arthritis(RA).Methods Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department
基金supported by the Major National Science and Technology Projects of China (No. 2016ZX05046004002 No. 2017ZX05039002-003)the National Basic Research Program of China (No. 2015CB250903)
文摘Tortuous hydraulic fractures(HFs) are likely to be created in heterogeneous formations such as conglomerates, which may cause sand plugging, ultimately resulting in poor stimulation efficiency. This study aims to explore HF growth behavior in conglomerate through laboratory fracturing experiments under true tri-axial stresses combined with computed tomography scanning and acoustic emission(AE) monitoring. The effects of gravel size, horizontal differential stress, and AE focal mechanisms were examined. Especially, the injection pressure and the AE response features during HF initiation and propagation in conglomerate were analyzed. Simple HFs with narrow microfractures are created in conglomerate when the gravels are considerably smaller than the specimen, whereas complex fractures are created when the gravels are similar in size to the specimen, even under high horizontal differential stresses. Breakdown pressure and AE rates are high when a HF is initiated from the high-strength gravel. A large pressure decline after the breakdown may indicate the creation of a planar and wide HF. Analyzing the focal mechanism indicates that the shear mechanism generally dominates with an increase in the HF complexity. Tensile events are likely to occur during HF initiation and are located around the wellbore. Shear events occur mainly around the nonplanar and complex matrix/gravel interfaces.
基金financial support for much of the early development of the AE analysis methods was provided by the U.S. Department of Energy (DOE) (Grant No. DE-FE0002760)
文摘Understanding microcracking near coalesced fracture generation is critically important for hydrocarbon and geothermal reservoir characterization as well as damage evaluation in civil engineering structures. Dense and sometimes random microcracking near coalesced fracture formation alters the mechanical properties of the nearby virgin material. Individual microcrack characterization is also significant in quantifying the material changes near the fracture faces （i.e. damage）. Acoustic emission （AE） monitoring and analysis provide unique information regarding the microcracking process temporally, and infor- mation concerning the source characterization of individual microcracks can be extracted. In this context, laboratory hydraulic fracture tests were carried out while monitoring the AEs from several piezoelectric transducers. In-depth post-processing of the AE event data was performed for the purpose of under- standing the individual source mechanisms. Several source characterization techniques including moment tensor inversion, event parametric analysis, and volumetric deformation analysis were adopted. Post-test fracture characterization through coring, slicing and micro-computed tomographic imaging was performed to determine the coalesced fracture location and structure. Distinct differences in fracture characteristics were found spatially in relation to the openhole injection interval. Individual microcrack AE analysis showed substantial energy reduction emanating spatially from the injection interval. It was quantitatively observed that the recorded AE signals provided sufficient information to generalize the damage radiating spatially away from the injection wellbore.
基金supported by project grants from the National Natural Science Foundation of China(Nos.91859105,and 81961128025)the Program of Shanghai Academic Research Leader(No.19XD1420700)+1 种基金the Science and Technology Commission of Shanghai Municipality(No.20JC1418900)the Shanghai Municipal Key Clinical Specialty.
文摘Background:Intrahepatic cholangiocarcinoma(ICC)is a highly metastatic cancer.^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)enables sensitive tumor and metastasis detection.Our aim is to evaluate the influence of pre-treatment PET/CT on the N-and M-staging and subsequent clinical management in ICC patients.Methods:Between August 2010 and August 2018,660 consecutive ICC patients,without prior anti-tumor treatments nor other malignancies,were enrolled.The diagnostic performance of PET/CT on the N-and M-staging was compared with conventional imaging,and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated.Survival difference was compared between patients receiving PET/CT or not after propensity score matching.Results:Patients were divided into group A(n=291)and group B(n=369)according to whether PET/CT was performed.Among 291 patients with both PET/CT and conventional imaging for staging in group A,PET/CT showed significantly higher sensitivity(83.0%vs.70.5%,P=0.001),specificity(88.3%vs.74.9%,P<0.001)and accuracy(86.3%vs.73.2%,P<0.001)than conventional imaging in diagnosing regional lymph node metastasis,as well as higher sensitivity(87.8%vs.67.6%,P<0.001)and accuracy(93.5%vs.89.3%,P=0.023)in diagnosing distant metastasis.Overall,PET/CT improved the accuracy of preoperative staging from 60.1%to 71.8%(P<0.001),and modified clinical treatment strategy in 5.8%(17/291)of ICC patients,with unique roles in different tumor-node-metastasis(TNM)stages.High tumor-to-non-tumor ratio(TNR)predicted poor overall survival[hazard ratio(HR)=2.17;95%confidence interval(CI):1.49-3.15;P<0.001].Furthermore,patients performing PET/CT had longer overall survival compared with those without PET/CT(HR=0.74;95%CI:0.58-0.93;P=0.011)after propensity score matching.Conclusions:PET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients,and facilitated accurate tumor staging and optimal treatment allocation.
