Objective To explore feasibility and clinical value of low dose computed tomography perfusion imaging (CTPI) in quantitative assessing proximal gastric cancer. Methods A total of 34 patients diagnosed with proximal gastric cancer (a proximal gastric cancer group) were enrolled prospectively in this study. The 25 normal parts of gastric fundus of the included patients constituted a control group. All the patients underwent the low dose CTPI before surgery. The total effective radiation dose was recorded, and a specific post-processing software was used to automatically generate the perfusion parameters values, including the time to peak (TTP), blood flow (BF), blood volume (BV), mean transmit time (MTT), and permeability (PMB). The perfusion parameters in the different histopathologic types and stages of the patients were compared. Receiver operating characteristic (ROC) curves were generated to compare their diagnosis performances. Results The histopathologic findings verified that there were 11 patients with T1+T2 stage and 23 patients with T3+T4 stage; 8 patients with signet ring cell carcinoma and 26 patients with adenocarcinoma; and 17 patients with lymphatic metastasis and 17 patients without lymphatic metastasis. ① Compared with the control group, the BF, BV, and PMB values were significantly higher and the MTT and TTP values were significantly lower in the proximal gastric cancer group. The area under the ROC curve (AUC) values of the BF, BV, PMB, MTT, and TTP in the diagnosing proximal gastric cancer was 0.955, 0.807, 0.987, 0.654, and 0.649 respectively. The BF and PMB represented the best diagnostic performances, and the BV was secondary in the ROC curve results. ② The BF value was significantly lower and the PMB value was significantly higher in the patients with signet ring cell carcinoma as compared with the patients with adenocarcinoma. However, the BV, MTT, and TTP values had no significant differences in both them. And the BF (AUC=0.986) had a better ability than the PMB (AUC=0.856) in the discriminating the histopathological type (P=0.047). ③ The PMB value in the patients with pathological stage T3 and T4 was significantly higher than that of the patients with pathological stage T1 and T2 (P=0.004), but the BF, BV, MTT, and TTP values had no differences in both them. The diagnosis value of the PMB in the discriminating the pathological stage was good with an AUC value of 0.814. ④ None of the parameters had significant difference between the patients with and without lymphatic metastasis (P>0.05). ⑤ The total effective radiation dose of each scan was 8.58 mSv, which was lower than that of the standard radiation dose of CTPI. ⑥ The rates of lymphatic metastasis and high T staging were not related to the histopathological type of the proximal gastric cancer (P>0.05). Conclusion Low dose CTPI used in this study could effectively reduce radiation dose, could quantitatively evaluate angiogenesis in proximal gastric cancer, and has a certain clinical value in identifying of histopathological type and evaluating of pathological stage.
Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.