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    基于肿瘤代谢异质性的18F–FDG PET/CT在不同级别脑胶质瘤和原发性中枢神经系统淋巴瘤鉴别诊断中的应用

    The application value of 18F-FDG PET/CT in the differential diagnosis of different grades of gliomas and primary central nervous system lymphomas based on tumor metabolic heterogeneity

      摘要
    • 摘要:
      目的： 探讨18F脱氧葡萄糖（18F–FDG）正电子发射计算机断层显像（PET/CT）中肿瘤代谢参数对不同级别胶质瘤与原发性中枢神经系统淋巴瘤（PCNSL）的鉴别诊断价值。
      方法： 回顾性分析30例经病理诊断为脑胶质瘤和PCNSL 病人（共56个病灶）的术前一般资料和18F–FDG PET/CT图像。分析病灶形态学（长径、瘤周水肿、占位效应）和代谢参数（最大标准摄取值SUVmax、平均标准摄取值SUVmean、肿瘤与本底放射性摄取比值TBR、肿瘤代谢体积MTV）的组间差异；运用受试者工作特征曲线（ROC）分析各参数的诊断效能并计算截断值。
      结果： 脑胶质瘤与PCNSL在肿瘤长径、瘤周水肿、占位效应方面差异均无统计学意义（P ＞ 0.05）。PCNSL的代谢参数SUVmax、SUVmean、TBR、MTV均明显高于胶质瘤（P ＜ 0.01）；不同级别胶质瘤亚组对比显示WHO 4级胶质瘤明显高于WHO 2级和3级胶质瘤（P ＜ 0.01），WHO 3级胶质瘤代谢参数与WHO 2级胶质瘤相仿（P ＞ 0.05）。ROC曲线显示SUVmax、SUVmean、TBR、MTV鉴别胶质瘤和PCNSL的曲线下面积（AUC）分别为0.875、0.865、0.791、0.657；截断值、敏感性和特异性分别为：（19.40、82.1%、91.6%），（12.95、77.8%、89.7%），（1.64、70.4%、72.4%），（16.50、66.7%、62.1%）（P ＜ 0.05）。
      结论： 基于肿瘤代谢异质性的18F–FDG PET/CT对不同级别胶质瘤与PCNSL具有重要鉴别诊断价值。

       

      Abstract:
      Objective To investigate the application value of tumor metabolic parameters derived from 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in differentiating between various grades of gliomas and primary central nervous system lymphoma (PCNSL).
      Methods A retrospective analysis was conducted on the preoperative general data and 18F-FDG PET/CT images of 30 patients (with a total of 56 lesions) pathologically diagnosed as glioma and PCNSL. The differences of the lesion morphology (long diameter, peritumoral edema and space-occupying effect) and metabolic parameters maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), tumor-background radioactive uptake ratio (TBR), tumor metabolic volume (MTV) were analyzed. The diagnostic efficacy of each parameter was analyzed using the receiver operating characteristic curve (ROC), and the cut-off values were calculated.
      Results There was no statistical significance in the tumor long diameter, peritumoral edema and space-occupying effect between glioma and PCNSL (P ＞ 0.05). The metabolic parameters (SUVmax, SUVmean, TBR and MTV) of PCNSL were significantly higher than those of glioma (P ＜ 0.01). The comparison of glioma subgroups of different grades showed that the metabolic parameters in WHO grade 4 glioma were significantly higher than those in WHO grade 2 and 3 glioma (P ＜ 0.01), and the metabolic parameters of WHO grade 3 glioma were similar to those of WHO grade 2 glioma (P ＞ 0.05). The ROC curve showed that the areas under the curve (AUC) of SUVmax, SUVmean, TBR, and MTV in differentiating glioma from PCNSL were 0.875, 0.865, 0.791, and 0.657, respectively. The cut-off values, sensitivity and specificity were (19.40, 82.1% and 91.6%), (12.95, 77.8% and 89.7%), (1.64, 70.4% and 72.4%) and (16.50, 66.7% and 62.1%), respectively (P ＜ 0.05).
      Conclusions The 18F-FDG PET/CT, based on the analysis of tumor metabolic heterogeneity, has important value in the differential diagnosis of different grades gliomas and PCNSL.

       

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