18F－FDG与18F－FLT PET/CT诊断脑胶质瘤综合治疗后复发的对比研究

Comparison on the diagnostic values of lSF-FDG and lSF-FLT PET/CT in patients with suspicious recurrence of glioma after multimodal treatment

目的比较18F－FDG与18F－FLT PET/CT诊断脑胶质瘤综合治疗后复发的价值。 方法回顾性分析2012年1月至2015年6月因增强MRI发现可疑复发灶在福建省肿瘤医院行18F－FDG与18F－FLT PET/CT显像的20例脑胶质瘤患者（男13例、女7例，年龄12～73岁）资料，所有可疑复发灶均经病理或临床随访证实为脑胶质瘤复发或治疗相关良性病变（TRBC），根据初次手术病理将脑胶质瘤复发分为低级别脑胶质瘤（LGG）复发组和高级别脑胶质瘤（HGG）复发组。对18F－FDG与18F－FLT PET/CT图像进行半定量分析，计算T/NT比值。多组间2种显像剂T/NT比值比较采用单因素方差分析和最小显著差异t检验。通过ROC曲线分析比较18F－FDG与18F－FLT PET/CT对脑胶质瘤复发的诊断效能。 结果20例患者中14例为脑胶质瘤复发，6例为TRBC。HGG复发组、LGG复发组与TRBC组18F－FDG PET/CT显像的T/NT比值分别为2.31±0.86、1.32±0.86与1.32±0.64，HGG复发组与TRBC组的差异有统计学意义（F＝3.671，t＝－2.471；P〈0.05）；HGG复发组、LGG复发组与TRBC组18F－FLT PET/CT显像的T/NT比值分别为8.94±3.14、7.18±3.29与1.92±1.20，HGG复发组与TRBC组，LGG复发组与TRBC组的差异均有统计学意义（F＝13.301，t值：－5.150和－2.360；均P〈0.05）。ROC曲线分析显示，18F－FDG与18F－FLT T/NT比值鉴别脑胶质瘤复发的最佳阈值分别为1.62和4.58，对应的灵敏度为11/14、13/14，特异性为5/6、6/6，准确性为16/20、19/20，差异均无统计学意义（χ2值：1.167、1.091和2.057，均P〉0.05）。 结论18F－FLT PET/CT显像鉴别脑胶质瘤复发的诊断效能略优于18F－FDG，但差异没有统计学意义。

Objective To compare the diagnostic values of lSF-FDG and ISF-FLT PET/CT in pa- tients with suspicious recurrence of glioma after multimodal treatment. Methods A total of 20 patients （ 13 males, 7 females; age range： 12-73 years） with glioma who underwent lSF-FDG and lSF-FLT PET/CT due to abnormal enhancement on MRI from January 2012 to June 2015 were enrolled in this retrospective study. According to the pathological or follow-up results, patients were divided into therapy-related benign changes （TRBC） group and recurrent glioma group, the later was subdivided into initial low-grade glioma （LGG） group and initial high-grade glioma（HGG） group. T/NT ratios of lSF-FDG and 1SF-FLT between HGG （LGG） group and TRBC group were compared using one-way analysis of variance and the least significant difference t test. ROC curve analysis was conducted to calculate the differential diagnostic efficiency of 1SF- FDG and lSF-FLT between TRBC and recurrent glioma. Results A total of 14 patients were proved as recur- rent glioma and 6 patients as TRBC. The mean 18F-FDG T/NT ratios of HGG group, LGG group and TRBCgroup were 2.31±0.86, 1.32±0.86 and 1.32±0.64, respectively. The 18F-FDG T/NT ratio of the HGG group was significantly higher than that of the TRBC group（F=3.671, t=-2.471, P〈0.05）. The mean lSF-FLT T/NT ratios of HGG group, LGG group and TRBC group were 8.94±.14, 7.18±3.29 and 1.92±1.20, re- spectively（F= 13.301, t values： -5.150 and -2.360, both P〈0.05）. The optimal T/NT cutoff values for lSF- FDG and lgF-FLT PET/CT were 1.62 and 4.58, respectively. The sensitivity, specificity and accuracy of detecting recurrent glioma with optimal T/NT cutoff value were 11/14, 5/6 and 16/20 for aSF-FDG PET/ CT, and those for 18F-FLT PET/CT were 13/14, 6/6 and 19/20, respectively. No significant difference was observed between the diagnostic effieiencies of the two imaging modalities （Xz values： 1.167, 1. 091 and 2. 057; all P〉0.05）. Conclusion There were no statistical significances between 18F-FDG and 18F-FLT PET/CT on the differential diagnosis of glioma recurrence.