短期血糖水平升高与18F-FDG PET/CT显像异常肌肉摄取的关系

Association of Short-Term Elevated Blood Glucose Level with Abnormal Muscular Uptake on 18FFDG PET/CT Imaging

目的通过评估血糖短期变化情况,预测^(18)F-FDG PET/CT显像的肌肉异常摄取。资料与方法回顾性分析2019年1月—2020年6月于北京大学人民医院就诊的高血糖症PET/CT受检者100例,收集检查前3 d内基线空腹血糖(BGL_(基线))、检查前空腹血糖(BGL_(检查前))测定结果,计算变化率(K),使用受试者工作特征(ROC)曲线分析获得K值最佳截止点,通过K值预测患者出现肌肉异常摄取,并将其预测效能与指南中BGL_(检查前)≥11.0 mmol/L的标准进行比较。结果BGL_(检查前)>11.0 mmol/L者出现肌肉异常摄取的比例为56.3%(10/16),BGL_(检查前)8.3~11.0 mmol/L者出现肌肉异常摄取比例为23.8%(20/84)。ROC曲线分析显示,以K值≥20.0%判断PET/CT显像发生异常肌肉摄取,其敏感度、特异度、阳性预测值、阴性预测值及准确度分别为90.0%(27/30)、87.1%(61/70)、75.0%(27/36)、95.3%(61/64)和88.0%(88/100),敏感度、阴性预测值及准确度均优于指南标准(χ^(2)=18.049、8.715、6.368,P=0.000、0.003、0.012)。结论通过比较患者BGL_(基线)及BGL_(检查前),可以更好地预测PET显像出现肌肉异常摄取的风险,推荐临床采用。

Purpose To predict abnormal muscular uptake of ^(18)F-FDG PET/CT imaging by evaluating the short-term changes of blood glucose level.Materials and Methods A retrospective analysis was performed on 100 consecutive PET/CT patients with hyperglycemia during January 2019 to June 2020 in Peking University People's Hospital.The baseline fasting blood glucose level(BGL_(bl))within 3 days of PET scan and pre-examination fasting blood glucose level(BGL_(pe))were collected.The rate of change(K)was calculated based on BGL_(bl)and BGL_(pe).Abnormal muscular uptake areas and maximum SUVmax in PET images were measured and recorded.ROC analysis was used to obtain the optimal cut-off point of K value.Abnormal muscular uptake was predicted by K value,and its predictive efficacy was compared with the standard of BGL_(pe)≥11.0 mmol/L by the guideline.Results Abnormal muscular uptake occurred in 56.3%(10/16)of patients with BGL_(pe)higher than 11.0 mmol/L,and 23.8%(20/84)of patients with BGL_(pe)within 8.3-11.0 mmol/L.ROC analysis showed that if K value≥20.0%was used to predict abnormal muscular uptake on PET imaging,the sensitivity,specificity,positive prediction value,negative prediction value and accuracy were 90.0%(27/30),87.1%(61/70),75.0%(27/36),95.3%(61/64)and 88.0%(88/100),respectively.The sensitivity,negative predicted value and accuracy of this method were superior to BGL_(pe)≥11.0 mmol/L(χ^(2)=18.049,8.715 and 6.368,P=0.000,0.003,0.012).Conclusion It is recommended to use BGL_(bl)and BGL_(pe)to predict the risk of abnormal muscular uptake on PET imaging,and is recommended in clinic.