Volume 105 · Issue 22 · 2025

Molecular imaging can noninvasively visualize molecular functional information and perform multi-dimensional evaluation, gradually becoming an important means of evaluating cardiovascular diseases and having a positive impact on the diagnosis and treatment of cardiovascular diseases. In current molecular imaging study, to pay attention to cardiovascular frontier basic research, to screen novel molecular imaging targets, to study novel molecular imaging probes with clinical translational potential, to intergate novel imaging technqiues to extend clincial application of molecular imaging, and to construct systemical approach to explore natural history of cardiovascular disease based on molecular imaging, are four main aspects to promote technical development and clinical translation of cardiovascular molecular imaging.

Inflammation is a key pathological feature and significant pathogenic factor in the development and progression of cardiovascular diseases (CVD). Nuclear molecular imaging enables non-invasive visualization and quantification of CVD related inflammation, reflecting its pathological evolution. Nuclear molecular imaging plays a crucial role and holds immense potential in the precise diagnosis of inflammation in CVD. This review highlights the clinical applications and future prospects of nuclear inflammation imaging in vulnerable atherosclerotic plaques, acute myocardial infarction, infective endocarditis, large vessel vasculitis and cardiac sarcoidosis.

Since the first edition of "Chinese guideline for the diagnosis and treatment of lupus nephritis" launched in 2019, extensive clinical research has been conducted both domestically and internationally regarding the diagnosis, treatment and management of lupus nephritis, yielding substantial new evidence. Therefore, it is necessary to update the guideline. To this end, a guideline working group consisting of multidisciplinary experts was convened and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were employed to rate the quality of evidence and the strength of recommendations, in the form of "Recommendation" and "Practical point". The "Chinese guideline for the diagnosis, treatment and management of lupus nephritis (2025)" focused on updating the induction and maintenance treatment of lupus nephritis, and the treatment of special classes and refractory lupus nephritis. It also included the management of patients with lupus nephritis and the assessment and treatment of relevant complications. The current guideline aims to provide guidance and reference for clinicians in treatment decision-making and disease management.

To investigate the value of short-term ¹⁸F-fluorodeoxyglucose (FDG) total-body (TB) dynamic PET(dPET)-CT scanning in the diagnosis of Takayasu arteritis (TA).

A retrospective analysis was performed on 8 TA patients underwent dPET-CT scanning in the First Affiliated Hospital of Shandong First Medical University from March to October 2022, who met the diagnostic criteria for TA proposed by the American College of Rheumatology in 1990. Patients were divided into active inflammation and inactive inflammation groups according to National Institutes of Health (NIH) criteria. All patients underwent 1 h TB dPET scan and 2 h delayed scan, and 1 h static PET was reconstructed by dPET scan for 50-60 min, and nineteen regions of interest in the arterial wall were delineated for each patient. One hour dPET scan images were reconstructed into 10, 20, 30, 40 and 60 min K_i parameter images and compared with 1 h static and 2 h delayed PET images. The clinical data of patients in the active inflammation group and the inactive inflammation group were compared. The image quality of dPET and static PET at different scanning times [including lesion target ratio (TBR), lesion contrast-to-noise ratio (CNR)] and the detection rate of active lesions were compared.

A total of 152 branch vessels of 8 patients were included, including 3 males and 5 females, aged 21 to 40 years old. A total of 68 (89.5%) diseased blood vessels were detected in 4 patients in the active inflammation group, and a total of 50 (65.8%) diseased blood vessels were detected in 4 patients in the inactive inflammation group (P=0.001). The TBRs of dPET at 10, 20, 30, 40 and 60 min were 1.870 (1.301, 2.815), 2.991 (1.926, 4.265), 3.310 (2.308, 4.786), and 3.315 (2.333, 4.361), 2.986 (2.177, 4.344)), respectively. The CNRs were -0.799 (-1.356, 0.300), 0.691 (-0.212, 1.900), 1.563 (0.550, 2.778), 2.236 (1.012, 3.271), and 2.344 (1.324, 4.134), respectively. Both TBR and CNR gradually increased (both P_trend<0.001). Pairwise comparisons revealed that the dPET TBR at 30, 40, and 60 minutes and the dPET CNR at 40 and 60 minutes were all higher than those of the 1-hour static and 2-hour delayed PET, respectively (all P<0.001). The differences in the detection rates of diseased blood vessels between the active inflammation group and the inactive inflammation group at different scanning times of dPET, 1-hour static PET, and 2-hour delayed PET were all statistically significant (all P<0.05). Pairwise comparisons revealed that the detection rates of diseased blood vessels in the 30-and 40-minute dPET scans between the two groups of patients were 60.5% (46 lesions), 31.6% (24 lesions), 81.6% (62 lesions), and 44.7% (34 lesions), respectively. All were higher than 42.1% (32 pieces) and 9.2% (7 pieces) of 1-hour static PET (all P<0.05); the detection rates of diseased blood vessels in 40-minute dPET scans were both higher than 50.0% (38 lesions) and 30.3% (23 lesions) in 2-hour delayed PET scans (both P<0.001).

It is feasible to shorten the time of dPET scanning for the assessment of arterial activity in TA patients, and parametric images with higher image quality and diseased blood vessels detection rate can be obtained by dPET scanning for 30 min.

To explore the associations between stress-related neural activity (SNA) and major adverse cardiovascular events (MACE) in non-small cell lung cancer (NSCLC) patients based on [¹⁸F] Fludeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT).

Patients with pathologically confirmed diagnosis of NSCLC and with at least one-year follow up were retrospectively collected in Nanjing Jinling Hospital between January 2018 and December 2019. All the patients undergoing ¹⁸F-FDG PET-CT and chest CT at baseline. The maximum target-to-background ratio (TBR_max) values of amygdala, which represented as SNA, and bone marrow, which represented as bone marrow activity (BMA), coronary artery calcium volume and coronary artery calcium score (CACS) were measured. Patients were grouped according to presence or absence of MACE. The baseline clinical variable, SNA, BMA and CACS were compared between two groups. Patients were divided as low-and high-amygdala TBR_max groups according to the median of amygdala TBR_max. According to the CACS, patients with CACS=0 were classified as non-calcification group, while those with CACS>0 are classified into the calcification group. The Kaplan-Meier analysis was used to plot survival curves, the log-rank test was employed to compare intergroup differences in MACE incidence and the Cox proportional hazards model was performed to analyze risk factors for MACE.

A total of 94 NSCLC patients were included, aged (61.7±11.1) years and including 62 males (66.0%). There were 13 patients (13.8%) in the MACE goup and 81 patients (86.2%) in the non-MACE group. The amygdala TBR_max, coronary artery calcium volume and CACS in the MACE group were higer than those in non-MACE group. The follow-up time was [M (Q₁, Q₃), 41 (19, 58)] months. The cumulative incidence of MACE in the high-amygdala TBR_max group was higher than that in the low-amygdala TBR_max group (29.8% vs 2.6%, P=0.006). The cumulative incidence of MACE in the calcification group was higher than that in the noncalcification (39.9% vs 5.2%, P=0.010). Multivariate Cox regression analysis showed that compared with low-amygdala TBR_max group, the incidence rate of MACE increased in high-amygdala TBR_max group (HR_adj=11.832, 95%CI: 1.328-105.457, P=0.027). Further, patients were grouped according to amygdala TBR_max combined with CACS, high-amygdala TBR_max with CACS>0 group had increased risk for MACE compared to the remaining groups (HR_adj=18.613, 95%CI: 1.587-218.315, P=0.020).

SNA was associated with the incidence of MACE in NSCLC patients. The incidence of MACE in high-amygdala TBR_max group was higher than that in low-amygdala TBR_max group.

To analyze the effect of combined diabetes mellitus (DM) on the image quality of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET-CT myocardial metabolism imaging in patients with coronary artery disease (CAD).

A cross-sectional study was conducted. Patients with CAD who underwent myocardial viability assessment in the Department of Nuclear Medicine at Wuhan Union Hospital from December 2018 to June 2023 were retrospectively enrolled as study subjects. Prior to radiotracer injection, oral glucose and intravenous insulin were used to regulate blood glucose levels. Corridor 4DM software was utilized to review images. Image quality and semi-quantitative myocardial ¹⁸F-FDG uptake indices were analyzed. The image quality (IQ) was evaluated through visual assessment, which was rated on a scale from 0 to 4 points. And patients were divided into the good IQ group (0-2 points) and the poor IQ group (3-4 points). On fused PET-CT images, regions of interest were respectively delineated in the left ventricle, the blood pool and the right posterior lobe of the liver, and the semi-quantitative indices of myocardial ¹⁸F-FDG uptake were calculated, including the maximum standardized uptake value (SUV_max) and the mean standardized uptake value (SUV_mean) of the left ventricle, the myocardium-to-blood pool ratio (MBR) and the myocardium-to-liver ratio (MLR). Multivariate logistic regression model to analyze the factors affecting IQ.

A total of 135 CAD patients were enrolled, including 116 males and 19 females, aged (56±11) years. The ¹⁸F-FDG uptake indices of myocardium (SUV_max, SUV_mean, MBR, MLR) in the good IQ group were significantly higher than those in the poor IQ group, all P<0.001. And patients in good IQ group showed lower blood glucose levels during the oral glucose loading and intravenously injection of insulin protocol (all P<0.0.05). The combination of DM (OR=3.295, 95%CI: 1.109-9.792, P=0.032) and fasting blood glucose (OR=1.265, 95%CI: 1.018-1.572, P=0.034) were related factors affecting the quality of myocardial metabolic imaging.

The combination of DM significantly affect myocardial glucose uptake in CAD patients, resulting in poor image quality. It is crucial to prepare well before PET imaging and to actively manage blood sugar individually for patients with DM in clinical.

To explore the association of lean body mass (LBM), lean body mass index(LBMI), fat mass (FM) and fat mass index(FMI) with depressive symptoms in adults aged 65 and above in 18 longevity areas in China.

A cross-sectional study. The study participants were from the Chinese Longitudinal Healthy Longevity Biomarker Cohort Study, comprising elderly individuals aged 65 years and above. Demographic characteristics, lifestyle factors, physical function status, and disease history were collected. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). LBM and FM were measured to calculate LBMI and FMI, respectively. Participants were categorized into the depressive group and non-depressive group based on whether the PHQ-9 score≥10 points, and the differences in LBM, LBMI, FM, and FMI between the two groups were compared. Restricted cubic spline models were used to illustrate exposure-response relationships between LBM, LBMI, FM, FMI and the presence of depressive symptoms. Participants were categorized into low, moderate, and high groups based on the tertiles of LBM, LBMI, FM and FMI, respectively, and multivariable logistic regressions were applied to examine the associations of LBM, LBMI, FM, and FMI with depressive symptoms.

A total of 4 246 older adults were included, with 2 034 males (47.9%) and a mean age of (81.8±10.2) years. In the non-depressive group (n=4 008), the mean age was (81.9±10.2) years, with 1 957 males (48.8%). In the depressive group (n=238), the mean age was (80.8±9.6) years, with 77 males (32.4%). The LBM of the depvessive group was lower than that of the non-depressive group [(36.8±6.8) kg vs (39.0±7.5) kg, P<0.001]. Restricted cubic spline analysis indicated no non-linear exposure-response relationships between LBM, LBMI, FM, FMI, and the presence of depressive symptoms (all P>0.05). Multifactor logistic regression analysis showed that LBM and LBMI were negatively associated with the risk of depression (all P<0.05). Compared with the low LBM (or LBMI) group, the high LBM group (OR=0.458, 95%CI: 0.291-0.715) and the high LBMI group (OR=0.646, 95%CI: 0.442-0.939) had a lower likelihood of experiencing depressive symptoms. No statistically significant associations were found between FM, FMI, and depressive symptoms (all P>0.05).

Among adults aged 65 years and above in longevity regions of China, higher LBM and LBMI are negatively associated with the risk of depressive symptoms.

To analyze the association of the blood thallium exposure with lipid profile in Chinese adults aged 18-79 years.

From 2017 to 2018, 9 795 adults aged 18-79 years were enrolled in China National Human Biomonitoring (CNHBM). The information about their demographic characteristics, lifestyles, and physical examinations were collected. Fasting venous blood samples were collected to measure blood thallium level. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) concentrations were also under testing. Study subjects were divided into five groups (Q₁, Q₂, Q₃, Q₄ and Q₅) according to the blood thallium concentration. Weighed linear regression model was used to analyze the association of blood thallium and lipid levels. Restricted cubic spline (RCS) was used to analyze the dose-response relationship between blood thallium and lipid profile.

The weighed average age of the 9 795 participants was 47.42 (0.24) years, of which 4 912 were male. The median level of blood thallium M(Q₁,Q₃) was 0.03 (0.02,0.06) μg/L. The levels of TC, TG, LDL-C, and HDL-C were 5.12 (4.47, 5.84) mmol/L, 1.42 (1.02, 2.13) mmol/L, 2.90 (2.34, 3.52) mmol/L, and 1.37 (1.12, 1.68) mmol/L, respectively. Weighted linear regression model showed that thallium after natural logarithmic transformation was associated with TC and the β(95%CI) was 0.07 (0-0.13) (P=0.040). When TC was used as the dependent variable, compared with Q₁, the β(95%CI) of Q₂, Q₃, Q₄ and Q₅ were 0.13 (0.05-0.21), 0.12 (0.01-0.24), 0.12 (0.02-0.23) and 0.16 (0.03-0.30), respectively. When TG was used as the dependent variable, compared with Q₁, the β(95%CI) of Q₅ was 0.28 (0.13-0.42) (P<0.001). In the RCS model, blood thallium was positively and linearly associated with TC and TG levels (P_linear 0.006, and 0.004, respectively), and had a nonlinear dose-response relationship with HDL-C (P_non-linear=0.027).

Blood thallium exposure is associated with elevated TC and TG levels in Chinese adults aged 18-79 years. There is a nonlinear dose-response relationship between thallium and HDL-C.

This article reviews the clinical progress in the field of non-small cell lung cancer (NSCLC) therapy in 2024. Among neoadjuvant therapies, targeted therapy has achieved preliminary results for NSCLC with positive driver genes such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Perioperative immunotherapy significantly improved major pathological response rates and event-free survival in driver-negative NSCLC patients, making it the standard treatment option for resectable NSCLC. In postoperative adjuvant therapy, the ADAURA and ALINA studies established the status of adjuvant targeted therapy. For NSCLC patients with locally unresectable EGFR-sensitive mutations, consolidation therapy with EGFR inhibitors after radical chemoradiotherapy significantly improves progression-free survival (PFS) and is expected to become a new standard of treatment. In the treatment of advanced NSCLC, the third-generation ALK inhibitor loratinib has set a new PFS record for targeted therapy in patients with advanced NSCLC, setting a new benchmark for targeted therapy. Preliminary progress has also been made in targeted drugs for other mutations, antibody-conjugated drugs (ADCs), tumor vaccines, and cell therapies. The optimization of targeting, immunotherapy and combination strategies has promoted the individualized and precise development of NSCLC treatment, and will move towards a new era of more accurate and efficient treatment in the future.

In 2024, breast cancer drug research has made significant progress, providing more options and strategies for clinical treatment. In the field of human epidermal growth factor receptor 2 (HER2), antibody-conjugated drugs have performed outstanding, bringing new hope for post-line treatment. In terms of endocrine therapy, novel selective estrogen receptor degradants such as imlunestrant significantly improve progression-free survival in patients with estrogen receptor 1 (ESR1) mutations, promoting the development of precision medicine. In the field of triple-negative breast cancer, new drugs and regimens such as immunosuppressants and polyadenosine diphosphate ribose polymerase (PARP) inhibitors are constantly emerging, improving the therapeutic effect and reducing adverse reactions. These advances not only enrich the treatment of breast cancer, but also provide patients with more personalized treatment plans, which are expected to further improve the quality of life and survival of patients.

Cardiovascular disease is one of the leading causes of death worldwide, and early diagnosis and precise treatment are crucial. Iron oxide nanoparticles (IONPs) have shown great potential in basic research and clinical applications of cardiovascular diseases due to their good magnetic properties and biocompatibility. This paper systematically combs the cutting-edge progress of IONPs in the field of cardiovascular molecular imaging, focusing on its potential advantages and application value in realizing in vivo visualization of lesions as a highly sensitive MRI contrast agent, accurate molecular intervention as a targeted carrier, and dynamic monitoring of stem cell therapy as a cell tracer, which provides a new perspective for overcoming clinical difficulties such as identification of vulnerable plaques in coronary atherosclerosis and accurate evaluation of myocardial infarction injury and repair. The authors emphasize that the biocompatibility improvement and surface functionalization technology of IONPs make it show unique advantages in early diagnosis and precise treatment of cardiovascular diseases, but clinical translation is still limited by cross-scale imaging resolution bottlenecks and long-term biosafety verification. In this paper, the research progress of IONPs in the treatment of coronary atherosclerosis, myocardial infarction, myocarditis and cardiovascular stem cell is described in detail, and the challenges and future development trends of IONPs in the process of cardiovascular MR molecular imaging and clinical translation are discussed.

The patient was a 52-year-old female, Han nationality. He went to the community health service center for "right thigh root pain for 1 d", and was referred to the Radiology Department of Wuxi Eighth People's Hospital through the imaging medical consortium for bilateral hip MRI examination.