Volume 103 · Issue 33 · 2023

PET/MRI integrates anatomical, functional and metabolic information, and is increasingly used in the field of clinical oncology, including early diagnosis of disease, local staging, detection of systemic metastases, evaluation of treatment efficacy and prognosis. In addition to fine anatomical structure, MRI multiparametric imaging can also provide functional information of the lesion. Combined with metabolic information of PET, MRI multiparametric imaging can better evaluate the benign and maligant lesions, tumor grade and extent of invasion, and identify tumor recurrence and radiation necrosis. The development of new PET tracers, optimization of MRI sequences and examination paths, combined with high-throughput image quantitative analysis methods, radiomics, artificial intelligence and other new technologies will further promote the application of PET/MRI in oncology.

Biological agents have been widely used in the treatment of many clinical diseases by targeting specific immune cells or cytokines. In the course of clinical use, biological agents can lead to secondary immune deficiency, which increases the risk of infection. At present, there are no evidence-based guidelines or management opinions on the differences of infections caused by various biological agents, how to identify infectious complications in the course of treatment with different biological agents at an early stage, and how to take effective and targeted prevention. This paper summarizes the infection complications and their characteristics that need to be paid attention to in the clinical introduction of biological agents, aiming to help clinicians make reasonable decisions for infection complications in the process of using biological agents, reduce the incidence of infection, and improve the success rate of diagnosis and treatment.

The standardization of surgical treatment has become indispensable in the overall outcome of esophageal cancer care in China, but there is a notable deficiency of clinical guidelines regarding esophageal surgery. The Chinese National Cancer Center organized esophageal surgery experts from the Chinese Association of Thoracic Surgeons (CATS), Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS), and Chinese Society for Disease of the Esophagus (CSDE) to develop and establish the Chinese Guidelines on Perioperative Management of Resectable Esophageal Cancer (2023 edition). This guideline comprehensively covers all aspects of surgical treatment for esophageal cancer, including conceptual clarification, preoperative diagnosis, clinical staging, indications for surgery, multidisciplinary comprehensive treatment, surgical treatment modalities, and perioperative management. A total of 39 critical clinical questions are categorized into six domains above. This guideline follows the globally accepted approach for developing recommendations and takes into account the most recent research evidence as well as China′s unique national circumstances. Its main aim is to serve as a comprehensive resource for standardizing the diagnosis and surgical treatment of esophageal cancer in China, with the ultimate goal of substantially improving the overall outcomes.

In March 2009, influenza A(H1N1) flu broke out and spread rapidly worldwide, and it has been circulating in local areas with various scales since then. Particularly, the outbreak and prevalence have occurred in China during 2023 extensively. At present, there is an absence of unified consensus on imaging diagnosis of severe influenza A (H1N1) flu pneumonia, which is not conducive to the standardized imaging diagnosis and clinical practice. Chinese experts including the Infection and Inflammatory Radiology Committee of the Chinese Research Hospital Association jointly formulate this consensus based on numerous references related to influenza A (H1N1) flu, meanwhile combining the methodological requirements of evidence-based medicine for guideline and standard formulation. This consensus aims to form a consensus on the diagnostic evidence, recommended imaging methods, diagnostic standard and differential diagnosis of severe influenza A(H1N1) flu pneumonia, and it is ought to provide clear diagnostic information and basis for relevant professional physicians and guide the clinical diagnosis and treatment of severe pneumonia caused by influenza A(H1N1) flu.

Cancer treatment-induced thrombocytopenia (CTIT) is a common adverse event during anti-tumor treatment, of which incidence is related to tumor classification, regimens, course of chemotherapy, etc. CTIT may result in a series of events including bleeding, dose intensity reduction, chemotherapy delay, and in severe cases, even the need for platelet transfusion, ultimately affecting the implementation of treatment plan, increasing the cost of treatment, reducing treatment effect and quality of life, and leading to a poor prognosis. The treatment of CTIT should first identify the cause, assess the risk of bleeding, and then adopt treatment strategies according to the cause and severity of CTIT. The main treatments of CTIT include platelet transfusion, application of various types of platelet-producing drugs, and measures to reduce the additional loss of platelets. Among them, platelet-producing drugs mainly refer to platelet-stimulating factors, including recombinant human thrombopoietin (rhTPO), recombinant human interleukin 11(rhIL-11), and thrombopoietin receptor agonists (TPO-RAs). In addition, traditional Chinese medicine also has some assistance in raising platelets. Pharmacological prophylaxis in high-risk patients may help reduce the incidence and severity of CTIT. This consensus aims to support Chinese oncologists in the diagnosis and treatment of CTIT in China, reduce the risk of bleeding and improve the quality of life of patients.

To investigate the effect of different respiratory motion correction methods on PET images during chest PET/MRI scans.

The data of 35 patients (24 males and 11 females, aged from 29 to 84 year) of pulmonary lesions with significantly high uptake in thoracic PET/MRI scan were retrospective collected from Jingling Hospital. Four different methods were used to reconstruct the PET data. Group A was the full-time 20 min without respiratory motion correction static acquisition (Static) as a control, group B was the end-expiration static collection (Q.Static), and group C was the multi-bins respiratory gating (Gated-Respiratory). In addition, the influence of the time being considered, group D was added for reconstruction in the first 1/3 period (6 min 40 s) of group A. Then, the maximum value (L-SUVmax) and the mean value (L-SUV_mean) of the SUV of the lesion, the mean value (B-SUV_mean) and the standard deviation (B-SUVsd) of the SUV of the background under each reconstruction results were measured, and for each lesion the signal-to-noise ratio (L-SNR) was calculated. In order to exclude the interference of the background, the mean of the relative SUV (L-dSUV_mean) of the L-SUV_mean relative to the B-SUV_mean was also calculated. Finally, One-Way Repeated Measures ANOVA was used, and the post-hoc pairwise comparison between groups was tested by Bonferroni′s modified test.

There was statistically significant difference among group B or group C compared to group A and group D in L-SUV_max, L-SUV_mean and L-dSUV_mean [L-SUV_max:group B vs group A or group D was 8.06±3.57 vs 7.73±3.45 or 7.61±3.50, group C vs group A or group D was 8.04±3.56 vs 7.73±3.45 or 7.61±3.50 (all P<0.05); L-SUV_mean: group B vs group A or group D was 4.12±1.78 vs 3.98±1.72 or 3.91±1.71, group C vs group A or group D was 4.13±1.78 vs 3.98±1.72 or 3.91±1.71 (all P<0.05); L-dSUV_mean: group B vs group A or group D was 3.52±0.16 vs 3.39±0.18 or 3.31±0.18, group C vs group A or group D was 3.53±0.18 vs 3.39±0.18 or 3.31±0.18 (all P<0.05)], but there was no statistically significant difference between group B and group C (all P>0.05). There were statistically significant differences between group D and group A in B-SUV_sd (0.07±0.00 vs 0.07±0.00, P=0.023) and L-SNR (69.80±44.57 vs 85.35±68.98, P=0.001). There was no statistically significant difference between group D and group A in L-SUV_max, L-SUV_mean, B-SUV_mean and L-dSUV_mean (all P>0.05).

There was no significant difference in PET image quality between the Q.static and Gated-Respiratory group, both of the two groups were better than the Static group which with no Gated-Respiratory motion correction. If non-respiratory gated Static is used, the PET acquisition time is recommended to be 6 min 40 s.

To investigate the application value of Gd-EOB-DTPA enhanced MRI based radiomics model in the differential diagnosis of iso-or hyperintensity HCC and focal nodular hyperplasia (FNH) in hepatobiliary phase.

A total of 88 patients with HCC or FNH confirmed by surgical or puncture pathology who underwent preoperative Gd-EOB-DTPA enhanced MRI (all lesions showed iso-or hyperintensity in hepatobiliary phase) between January 2015 and February 2023 in The First Affiliated Hospital of Soochow University and Nantong No.3 People′s Hospital were retrospectively evaluated, which including 58 males and 30 females, aged [M(Q₁, Q₃)]56 (40, 67) years, including 61 patients with HCC and 27 patients with FNH. The included cases were divided into training (43 cases of HCC, 19 cases of FNH) and validation cohort (18 cases of HCC, 8 cases of FNH) in the ratio of 7∶3 using the random seeding method. A total of 1 781 radiomics features were extracted from Gd-EOB-DTPA enhanced MRI in the arterial, portal and hepatobiliary phases, respectively. The independent three phase models, combined three phases model and combined clinical-radiomics model was established using Auto-Encoder (AE) and Native Bayes (NB) classifier, respectively. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of these models. DeLong test was used to compare the areas under curve (AUC).

In the validation cohort, the combined clinical-radiomics model had the highest AUC (AUC=0.938, 95%CI: 0.828-1.000). The AUC, accuracy, sensitivity, specificity of the clinical-radiomics combined model using AE classifier in the validation cohort were 0.896 (95%CI: 0.760-1.000), 88.5%, 88.9%, 87.5%. The AUC of the clinical-radiomics combined model using NB classifier in the validation cohort were 0.938 (95%CI: 0.828-1.000), 92.3%, 88.9%, 100.0%.

Gd-EOB-DTPA enhanced MRI combined clinical-radiomics model has certain value in preoperative differentiation of iso-or hyperintensity in the hepatobiliary phase HCC and FNH, with a high accuracy, sensitivity and specificity.

To compare the clinical efficacy of single/double ¹²⁵I-seed strands combined with biliary stents in the treatment of malignant obstructive jaundice.

Totally 67 cases of patients with malignant obstructive jaundice who received single/double¹²⁵I-seed strands combined with biliary stents implantation from September 2018 to December 2021 were analyzed retrospectively. Among them, 36 patients received single ¹²⁵I-seed strands combined with biliary stents (single strand group) and 31 patients received double ¹²⁵I-seed strands combined with biliary stents(double strands group). The technical success rate, clinical success rate, complications, biochemical and tumor indexes at 8 weeks after operation [total bilirubin (TB), direct bilirubin (DB), alanine transaminase (ALT), aspartate transaminase (AST), carbohydrate antigen 19-9 (CA19-9)], stent patency time (SP), median progression-free survival time (mPFS) and median survival time (mOS) were analyzed.

There was no significant difference (P>0.05) in technical success rate (100% vs 100%), clinical success rate (97.2% vs 96.8%) and major complications (5.6% vs 6.5%) between single strand group and double strands group. There were significant differences in TB, DB, ALT, AST and CA19-9 indicators between the two groups before and 8 weeks after operation (all P<0.05), but there was no significant difference in the difference value of preoperative and postoperative 8-week indicators between the two groups (all P>0.05).The SP and mPFS of double-stranded stents were longer than those of single-stranded stents.[8.6 months (95%CI:6.9-10.4) vs 6.2 months (95%CI:5.8-6.6), 3.2 months (95%CI:3.0-3.4) vs 3.0 months (95%CI:2.9-3.1), all P<0.05]. The mOS of single and double strands groups was 11.2 months (95%CI:8.3-14.1) and 13.4 months (95%CI:9.9-16.9) respectively, with no statistical difference (P=0.137).

Compared with single ¹²⁵I-seed strands, double ¹²⁵I-seed strands can prolong biliary SP and mPFS, but the long-term survival index still needs further observation.

To explore the effect of strengthening individualized nutrition education in the second trimester based on first trimester on blood glucose.

A retrospective study was conducted on 398 pregnant women aged (31.79±3.48) (23-41) years old who underwent an oral glucose tolerance test (OGTT) from October 2021 to December 2022 at Beijing Tsinghua Changgung Hospital. They were divided into two groups according to whether the women were re-visited in second trimester or not. The routine group consisted of 205 pregnant women aged between 24 and 41 (31.49±3.36) years old who only received the first trimester nutrition education and the strengthening group consisted of 193 pregnant women aged (31.92±3.97) (23-41) years old who received both the first and second trimester nutrition education. Then according to pre pregnancy body mass index (BMI), they were divided into normal (18.5 kg/m²≤BMI<24 kg/m²) and overweight (24 kg/m²≤BMI<28 kg/m²). The OGTT blood glucose level, the positive rate of gestational diabetes (GDM) and the weight gain during pregnancy were compared between the two groups with different BMI, in order to analyze the effect of strengthening nutrition education in the second trimester of pregnancy on blood glucose.

The differences between the two groups were not statistically significant in terms of the pregnant women′s age, proportion of pregnant women aged≥35, proportion of pre-pregnancy BMI and overweight, parity and early pregnancy blood glucose (all P>0.05). The blood glucose levels of OGTT at 0, 1, and 2 hour were (4.57±0.37), (8.41±1.70), and (7.28±1.51) mmol/L, respectively, lower than those in the routine group [(4.74±0.48), (9.44±1.55), and (8.27±1.58) mmol/L, respectively, all P<0.001]. The positive rate of GDM in the strengthening group was 35.23% (68/193), which was lower than that in the routine group (91.71%, 188/205) (P<0.001). After the BMI stratification, the OGTT blood glucose levels and the positive rate of GDM in the strengthening group were still lower than those in the routine group (all P<0.05). The weight gain with normal BMI in the early pregnancy in routine group was higher than that in the strengthening group (P=0.003), but there was no significant statistical difference in weight gain of overweight pregnant women at different gestational weeks (all P>0.05).

Strengthening a nutrition education about second trimester for pregnant women in the early stages of pregnancy can effectively improve blood glucose levels and reduce the positive rate of GDM.

This study analyzed the clinical and imaging data of 81 glioma patients who underwent brain synthetic MRI and diffusion weighted imaging (DWI) examination in the General Hospital of Ningxia Medical University from August 2020 to September 2021 to explore the value of synthetic MRI relaxation quantitative value in predicting the genotype of isocitrate dehydrogenase 1 (IDH1) in gliomas. There were 44 males and 37 females, those patients with an aged 50.0 (36.5, 59.0) years. The tumor pre-T₁, pre-T₂, pre-PD, post-T₁ and ADC values were obtained by outlining the region of interest (ROI). Univariate analysis was used to compare the differences of parameter values between groups, and the receiver operating characteristic was used to evaluate the diagnostic efficacy of each parameter value in predicting glioma IDH1 genotype. The results showed that the pre-T₁ and pre-PD values [M (Q₁, Q₃)] of IDH1m glioma were lower than those of IDH1w glioma [1 462.75 (1 306.41, 1 567.75) ms vs 1 532.83 (1 434.67, 1 617.67) ms, 84.18 (82.28, 86.41) pu vs 85.85 (84.65, 86.90) pu] (all P<0.05). The post-T₁ and ADC values of IDH1m glioma were higher than those of IDH1w glioma [1 054.50 (631.92, 1 262.63) ms vs 669.67 (535.17, 823.33) ms, 1.20 (0.86, 1.35) ×10^-3 mm²/s vs 0.80 (0.76, 0.93) ×10^-3 mm²/s] (all P<0.05). The AUC of the combined model (pre-T₁+pre-PD+post-T₁+ADC+Age) is 0.828 (95%CI:0.729-0.903). Synthetic MRI relaxation quantitative values are helpful to distinguish IDH1 genotypes in glioma. The diagnostic efficacy of the multi-parameter combined model based on pre-T₁, pre-PD, post-T₁, ADC, and age is better than that of the single parameter, and it can be used as an effective strategy to improve the differential diagnosis ability of gliomas molecular markers.

The patient, a 44-year-old male, was admitted to the hospital because "physical examination found that carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated for 1 week". Multiple metastases of medullary thyroid carcinoma were confirmed by pathological and imaging examination. The second-line application of platinib was effective, but refractory pleural effusion, intermittent chills and high fever occurred, and tuberculosis was finally diagnosed and anti-tuberculosis treatment was given. Treatment with platinib was resumed 2 months later. The patient is in good general condition and is being followed up regularly. During the whole course of treatment with targeted drugs such as platinib, attention should be paid to timely screening of infections such as tuberculosis, so as not to delay anti-tumor treatment.

Hydrogel is a soft, hydrophilic and biocompatible material composed of a large amount of water and cross-linked polymer network. As a substrate for organoid tissue culture, hydrogel can better simulate the microenvironment in vivo; As a drug delivery device, the release of the drug can be controlled in space and time; As a wound dressing, it can provide different functions depending on the complexity and dynamics of the wound; As a submucosal fluid pad material, it can provide assistance for endoscopic surgery; Hydrogel stents can not only physically support the lumen, but also exert therapeutic effects with local drug loading. The diversity of hydrogel functions offers more new possibilities for clinical strategies related to the digestive system. The purpose of this paper is to discuss the application and progress of hydrogel materials in digestive system and related diseases.

Stroke is a major public health problem, and carotid atherosclerotic plaque plays an important role in the occurrence of ischemic stroke. In the past, the degree of carotid artery stenosis was used as an independent risk factor to predict stroke. However, it is insufficient to predict the risk of stroke by the degree of stenosis alone. More studies have shown that stroke is closely related to carotid vulnerable plaque. Rapid development of imaging technology has made it possible to characterize vulnerable plaques in the carotid artery. MRI is the current gold standard for anatomical imaging of carotid plaques, which can accurately identify the component features of vulnerable plaques. Positron emission tomography (PET), as an important tool to characterize plaque activity, can provide information on plaque metabolic activity. PET/MRI combines the advantages of MRI and PET, which can simultaneously evaluate carotid vulnerable plaque, and is expected to provide a direct basis for the diagnosis, treatment decision and stroke prevention of carotid vulnerable plaque. This review summarizes the progress of MRI, PET, and PET/MRI techniques in the study of carotid vulnerable plaques, and discusses the current challenges of PET/MRI and possible future research directions.

Global obesity has reached epidemic levels in 2020. Obesity increases the incidence of a variety of chronic diseases, such as diabetes, cardiovascular disease, stroke, certain cancers, and obstructive sleep apnea. Energy imbalances resulting from increased caloric intake and reduced physical activity are one of the leading causes of obesity in adults. Lifestyle interventions such as diet and exercise become first-line treatments for obesity. Intermittent fasting is a meal pattern based on periodic fasting, i.e. alternating fasting and eating. Time-limited feeding (TRE) is a form of intermittent fasting where food is eaten daily over a specific period of time, typically in a time window of 8 to 12 h, with or without energy restriction. High body mass index (BMI) is a high risk factor for a variety of health problems. Studies have shown that weight loss can improve metabolism-related markers such as triglycerides, cholesterol, blood sugar, insulin, blood pressure, etc. TRE has been proven to be beneficial in various disease studies such as obesity. Therefore, this meta-analysis included 9 studies with a total of 665 patients (345 in TRE and 320 in controls) with BMI>25 kg/m²In adults aged 18 years and older, the objective was to assess changes in body weight, fat mass, and metabolic indexes after TRE intervention. The results showed that the weight loss was more pronounced in the TRE group compared with the control group (-1.28 kg, 95%CI：-2.05~-0.52，P =0.001), with a significant reduction in BMI (-0.34 kg/m²，95%CI：-0.64~0.04，P=0.03), with significant fat mass reduction (-0.72 kg, 95%CI：1.40~-0.03，P=0.04), decreased diastolic blood pressure (DBP) (-2.26 mmHg, 95%CI：-4.02~-0.50，P=0.01）。 However, there were no statistically significant differences between TRE and the control group in terms of lean body mass, systolic blood pressure, waist circumference, fasting blood glucose, fasting insulin, homeostatic model assessment-insulin resistance, total cholesterol, HDL, LDL, and triglycerides. Subgroup analysis found weight loss in the 8 h eating window group of TRE compared to the control group (P=0.007), whereas the difference was not statistically significant beyond the 8 h eating window (P=0.05）； Body weight loss and fat mass loss in the TRE intervention>12 weeks group (allP<0.05）； Weight loss in the TRE energy-restricted group (P<0.05）。

Esophageal cancer is the seventh most common cause of cancer incidence worldwide and the sixth most common cause of cancer-related death. For a large number of patients with early esophageal cancer, the 5-year survival rate of endoscopic treatment can reach more than 95%, which is comparable to surgical survival rate. Therefore, early endoscopic treatment is the key to improve the prognosis of esophageal cancer. Endoscopic mucosal dissection (ESD) is currently the preferred method for resection of superficial esophageal cancer. However, for esophageal lesions with lesion extent>3/4 week long, the stenosis rate after ESD exceeded 80%. The stenosis rate after ESD was 100% in patients with perimeter esophageal lesions. Esophageal radiofrequency ablation (RFA) is one of the earliest techniques applied to Barrett's esophageal ablation, which has the advantages of simplicity, safety and low esophageal stenosis rate. Therefore, the researchers retrospectively analyzed 105 patients with endoscopically treated early large-scale flat esophageal squamous cell carcinoma (ESCNs) (extending beyond 3/4 of the esophageal perimeter), compared the adverse events of ESD and RFA and the local control of tumor lesions, and then evaluated which method is more effective in treating full-week or near-full-week early esophageal squamous cell carcinoma. Sixty of these patients were treated with ESD and 45 with RFA. There were no significant differences between the two groups in mean age, body mass index (BMI), sex distribution, smoking and drinking habits, and evaluation of deep pretreatment of tumor invasion. Although patients receiving RFA had larger tumors (14.27 vs. 5.70 cm,P<0.05), but the ESD and RFA groups were comparable in terms of local control of tumor lesions and surgery-related complications. Twelve months after treatment, there was no statistically significant difference between the two groups in the local control of tumor lesions, with 58 (96.7%) of 60 patients in the ESD group and 43 (95.6%) of 45 patients in the RFA group having complete remission. There was no statistically significant difference between ESD and RFA in surgery-related complications such as hemorrhage, mediastinal emphysema, and perforation, but the stenosis rate was higher in ESD than in RFA (60% vs 31%,P<0.05）。 The ESD group compared with the RFA group had pain scores (2.27 vs. 2.60,P=0.239) and length of hospital stay (9.77 vs. 9.46,P=0.701) were not statistically significant; However, hospitalization costs were lower in the ESD group than in the RFA group (P<0.05）。