13N-NH3、11C-MET和18F-FDG在脑胶质瘤诊断和评价中的比较

中华核医学与分子影像杂志 Pub Date : 2020-03-25 DOI:10.3760/CMA.J.CN321828-20190724-00141

Yali Long, Qiao He, Bing Zhang, Xinchong Shi, C. Yi

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Images were interpreted by visual evaluation (higher radioactive uptake in lesions than that in the contralateral normal brain parenchyma was considered as positive (+ ), equal/lower were considered as negative (-)) and semi-quantitative analysis (the maximum standardized uptake value (SUV) of lesion (L) to the mean SUV of normal white matter (WM) (L/WM ratio)). Receiver operating characteristic (ROC) curve analysis was used and the area under curves (AUCs) were calculated and compared. The diagnostic efficacies of 3 imaging methods and the combination for diagnosing gliomas and the abilities to differentiating high-grade gliomas (HGG) and low-grade gliomas (LGG) were compared. \n \n \nResults \nIn 90 patients, 30 HGG, 27 LGG, 10 non-glioma brain tumors and 23 non-neoplastic lesions (NNL) were diagnosed. On visual evaluation, the sensitivities for differentiating tumors from NNL were 62.7%(42/67), 94.0%(63/67) and 35.8% (24/67) for 13N-NH3, 11C-MET and 18F-FDG PET/CT respectively, while the specificities were 95.7%(22/23), 56.5% (13/23) and 65.2% (15/23), and the accuracies were 71.1%(64/90), 84.4%(76/90) and 43.3% (39/90). Taking the metabolic patterns of + /+ /+ , + /+ /- and + /-/- (11C-MET/13N-NH3/18F-FDG) as the diagnosis standard of tumor lesions, the specificity and accuracy of the combined method increased to 73.9%(17/23) and 88.9%(80/90) with the sensitivity remaining the same (94.0%, 63/67). ROC curve analysis (L/WM) showed that the sensitivity, specificity and AUC were 64.2%(43/67), 100%(23/23) and 0.819 for 13N-NH3 PET/CT, and 89.6%(60/67), 69.6%(16/23) and 0.840 for 11C-MET PET/CT (z=-0.316, P>0.05). 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引用次数: 0

摘要

目的比较13N-NH3、11c -蛋氨酸(MET)和18f -氟脱氧葡萄糖(FDG) PET/CT成像在疑似脑胶质瘤诊断和评价中的应用。方法2010年9月~ 2017年12月收治90例患者，其中男54例，女36例;年龄:(40.0±14.0)岁，临床诊断疑似神经胶质瘤，在中山大学第一附属医院行13N-NH3、11C-MET、18F-FDG PET/CT显像，前瞻性入选研究。所有患者均经组织学或临床及放射学随访证实。图像通过视觉评价(病变处放射性摄取高于对侧正常脑实质为阳性(+)，等/低为阴性(-))和半定量分析(病变处最大标准化摄取值(SUV) (L)与正常白质(WM)平均SUV (L/WM比))进行解释。采用受试者工作特征(ROC)曲线分析，计算曲线下面积(auc)并进行比较。比较3种影像学方法及联合诊断胶质瘤的诊断效果及对高级别胶质瘤(HGG)与低级别胶质瘤(LGG)的鉴别能力。结果90例患者中，HGG 30例，LGG 27例，非胶质瘤脑肿瘤10例，非肿瘤性病变23例。在视觉上，13N-NH3、11C-MET和18F-FDG PET/CT对NNL鉴别的敏感性分别为62.7%(42/67)、94.0%(63/67)和35.8%(24/67)，特异性分别为95.7%(22/23)、56.5%(13/23)和65.2%(15/23)，准确率分别为71.1%(64/90)、84.4%(76/90)和43.3%(39/90)。以+ /+ /+、+ /+ /-和+ /- - (11C-MET/13N-NH3/18F-FDG)的代谢模式作为肿瘤病变的诊断标准，联合方法的特异性和准确性分别提高到73.9%(17/23)和88.9%(80/90)，敏感性保持不变(94.0%，63/67)。ROC曲线分析(L/WM)显示，13N-NH3 PET/CT的敏感性、特异性和AUC分别为64.2%(43/67)、100%(23/23)和0.819,11C-MET PET/CT的敏感性、特异性和AUC分别为89.6%(60/67)、69.6%(16/23)和0.840 (z=-0.316, P < 0.05)。13N-NH3、11C-MET和18F-FDG PET/CT对高、低级别胶质瘤的鉴别准确率分别为86.0%(49/57)、87.7%(50/57)和93.0%(53/57)，AUC分别为0.896、0.928和0.964 (z值:-0.554 ~ 1.334,P值均为0.05)。结论13N-NH3 PET/CT对脑肿瘤与NNL的鉴别具有明显的高特异性和低敏感性。11C-MET PET/CT对脑肿瘤的检测有很高的应用价值。然而，像18F-FDG一样，在一些NNL中经常观察到高MET摄取。13N-NH3、11C-MET和18F-FDG PET/CT显像对胶质瘤的组织学分级均有价值，两者结合更有助于胶质瘤的准确诊断。关键词:胶质瘤;正电子发射断层扫描;断层扫描，x射线计算机;氨;蛋氨酸;脱氧葡萄糖

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Comparison of 13N-NH3, 11C-MET and 18F-FDG PET/CT imaging in the diagnosis and evaluation of cerebral glioma

Objective To compare the application of 13N-NH3, 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the diagnosis and evaluation of suspected cerebral glioma. Methods From September 2010 to December 2017, ninety patients (54 males, 36 females; age: (40.0±14.0) years) in the First Affiliated Hospital of Sun Yat-sen University with suspected glioma based on clinical diagnosis, who underwent 13N-NH3, 11C-MET and 18F-FDG PET/CT imaging, were prospectively enrolled in the study. All patients were confirmed by histology or clinical and radiological follow-up. Images were interpreted by visual evaluation (higher radioactive uptake in lesions than that in the contralateral normal brain parenchyma was considered as positive (+ ), equal/lower were considered as negative (-)) and semi-quantitative analysis (the maximum standardized uptake value (SUV) of lesion (L) to the mean SUV of normal white matter (WM) (L/WM ratio)). Receiver operating characteristic (ROC) curve analysis was used and the area under curves (AUCs) were calculated and compared. The diagnostic efficacies of 3 imaging methods and the combination for diagnosing gliomas and the abilities to differentiating high-grade gliomas (HGG) and low-grade gliomas (LGG) were compared. Results In 90 patients, 30 HGG, 27 LGG, 10 non-glioma brain tumors and 23 non-neoplastic lesions (NNL) were diagnosed. On visual evaluation, the sensitivities for differentiating tumors from NNL were 62.7%(42/67), 94.0%(63/67) and 35.8% (24/67) for 13N-NH3, 11C-MET and 18F-FDG PET/CT respectively, while the specificities were 95.7%(22/23), 56.5% (13/23) and 65.2% (15/23), and the accuracies were 71.1%(64/90), 84.4%(76/90) and 43.3% (39/90). Taking the metabolic patterns of + /+ /+ , + /+ /- and + /-/- (11C-MET/13N-NH3/18F-FDG) as the diagnosis standard of tumor lesions, the specificity and accuracy of the combined method increased to 73.9%(17/23) and 88.9%(80/90) with the sensitivity remaining the same (94.0%, 63/67). ROC curve analysis (L/WM) showed that the sensitivity, specificity and AUC were 64.2%(43/67), 100%(23/23) and 0.819 for 13N-NH3 PET/CT, and 89.6%(60/67), 69.6%(16/23) and 0.840 for 11C-MET PET/CT (z=-0.316, P>0.05). The accuracy for differentiating high and low grade glioma were 86.0% (49/57), 87.7%(50/57) and 93.0%(53/57) for 13N-NH3, 11C-MET and 18F-FDG PET/CT, with the AUC of 0.896, 0.928 and 0.964, respectively (z values: -0.554 to 1.334, all P>0.05). Conclusions 13N-NH3 PET/CT imaging has remarkably high specificity but low sensitivity for the differentiation of brain tumors from NNL. 11C-MET PET/CT imaging was found to be highly useful for detection of brain tumors. However, like 18F-FDG, high MET uptake is frequently observed in some NNL. 13N-NH3, 11C-MET and 18F-FDG PET/CT imaging all appear to be valuable for evaluating the histological grade of gliomas, and the combination of them is more useful for the accurate diagnosis of glioma. Key words: Glioma; Positron-emission tomography; Tomography, X-ray computed; NH3; Methionine; Deoxyglucose

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中华核医学与分子影像杂志核医学，分子影像

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期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.