MRI联合^(18)F-FDG PET和^(11)C-MET PET对颅内肿胀性脱髓鞘病变与胶质瘤的鉴别诊断作用

MRI combined with ^(18)F-FDG PET and^(11)C-MET PET in differentiating tumefactive demyelinating lesion and glioma

目的探讨MRI联合^(18)F-脱氧葡萄糖(^(18)F-FDG)PET和^(11)C-蛋氨酸(^(11)C-MET)PET显像对颅内肿胀性脱髓鞘病变与胶质瘤的鉴别诊断价值。方法纳入经病理学直接证实或内科保守治疗间接证实的14例颅内肿胀性脱髓鞘病变患者和17例胶质瘤患者,采用MRI观察病变与周围正常脑组织界限,T1WI、T2WI和扩散加权成像(DWI)信号强度,强化征象(包括环状强化和开环状强化等),占位效应,周围脑水肿,病变中心静脉扩张,胼胝体受累,病变中心坏死,灰质受累情况;^(18)F-FDG PET和^(11)C-MET PET显像对代谢程度进行视觉分析。结果 MRI显示,颅内肿胀性脱髓鞘病变患者占位效应0级8例(8/14)、Ⅰ级4例(4/14)、Ⅱ级1例(1/14)、Ⅲ级1例(1/14),周围脑水肿Ⅰ度12例(12/14)、Ⅱ度2例(2/14);胶质瘤患者占位效应0级2例(2/17)、Ⅰ级6例(6/17)、Ⅱ级7例(7/17)、Ⅲ级2例(2/17),周围脑水肿Ⅰ度7例(7/17)、Ⅱ度10例(10/17),组间差异均有统计学意义(Fisher确切概率法:P=0.032,0.024)。^(18)F-FDG PET和^(11)C-MET PET显像对颅内肿胀性脱髓鞘病变与胶质瘤的鉴别诊断差异无统计学意义(Fisher确切概率法:P=0.182,0.081)。结论 MRI显示的占位效应和周围脑水肿可以用于鉴别诊断颅内肿胀性脱髓鞘疾病与胶质瘤,PET-CT对症状类似胶质瘤的颅内肿胀性脱髓鞘病变无明确诊断价值。

Objective To explore the value of MRI combined with 18F-fluoro-2-deoxy-D-glucose （18F-FDG） PET and 11C-methionine （11C-MET） PET on differentiating tumefactive demyelinating lesion （TDL） and glioma.Methods Fourteen cases of TDL and 17 cases of glioma were confirmed by pathology directly or internal medicine treatment.MRI was used to observe the lesion boundary,T1WI,T2WI and diffusion weighted imaging （DWI） signal intensity,enhancement （including ring enhancement and open-ring enhancement,etc.）,mass effect,peripheral edema,and the presence of central venectasia,corpus callosum engagement,central necrosis and gray matter engagement.18F-FDG PET and 11C-MET PET were used to calculate relative uptake values.Results Among all TDL cases,MRI showed that mass effect of 8 cases （8/14） were grade 0,4 cases （4/14） grade Ⅰ,one case （1/14） was grade Ⅱ and one case （1/14） gradeⅢ;the peripheral edema of 12 cases （12/14） were grade Ⅰ and 2 cases （2/14） grade Ⅱ.Among all glioma cases,the mass effect of 2 cases （2/17） were grade 0,6 cases （6/17） grade Ⅰ,7 cases （7/17） grade Ⅱ and 2 cases （2/17） grade m;the peripheral edema of 7 cases （7/17） were grade Ⅰ and 10 cases （10/17） grade Ⅱ.The differences between TDL and glioma were statistically significant （Fisher＇s exact probability：P =0.032,0.024）.18F-FDG PET and 11C-MET PET were not statistically significant in differentiating TDL and glioma （Fisher＇s exact probability：P =0.182,0.081）.Conclusions Mass effect and peripheral edema showed in MRI can be used for the differential diagnosis of TDL and glioma.The value of PET-CT in differentiating TDL and glioma is unsure.