正电子发射计算机断层成像及核磁共振弥散张量成像对脑胶质瘤复发与放射性脑损伤的鉴别诊断价值

Significance of PET/CT versus diffusion tensor MRI in the differential diagnosis of glioma recurrence and radiation-induced brain injury

目的探讨正电子发射计算机断层成像(PET/CT)及MRI弥散张量成像对脑胶质瘤复发与放射性脑损伤的鉴别诊断价值。方法选取2015年6月至2018年6月间中国人民武装警察部队海警总队医院收治的145例脑胶质瘤手术后放疗患者,所有患者放疗3~6个月后行PET/CT及MRI弥散张量成像复查。比较患者的临床资料、PET/CT指标及MRI弥散张量成像指标,通过绘制受试者工作特征(ROC)曲线分析各指标鉴别诊断脑胶质瘤复发与放射性脑损伤的价值。结果脑胶质瘤复发患者标准摄取值(SUV)、病灶正常组织比(L/N)、局部脑血容量(rCBV)、局部脑血流量(rCBF)、胆碱/肌酸比值(Cho/Cr)及Cho/N-乙酰天门冬氨酸比值(Cho/NAA)均高于放射性脑损伤,差异均有统计学意义(均P<0.05);SUV、L/N、rCBV、rCBF、Cho/Cr及Cho/NAA鉴别脑胶质瘤复发与放射性脑损伤的ROC曲线下面积(AUC)分别为0.874、0.828、0.952、0.928、0.853及0.905;rCBV鉴别脑胶质瘤复发与放射性脑损伤的AUC高于L/N和Cho/Cr,差异有统计学意义(P<0.05);rCBV鉴别脑胶质瘤复发与放射性脑损伤最佳截点为1.458,敏感度和特异度分别为90.8%和94.1%。结论脑胶质瘤复发患者SUV、L/N、rCBV、rCBF、Cho/Cr及Cho/NAA等指标明显升高,高于放射性脑损伤患者,MRI弥散张量成像指标鉴别脑胶质瘤复发与放射性脑损伤优于PET/CT,尤其是rCBV指标,更具临床价值。

Objective To explore the significance of positron emission tomography-computed tomography(PET/CT)versus diffusion tensor magnetic resonance imaging(MRI)in the differential diagnosis of glioma recurrence and radiation-induced brain injury.Methods A total of 145 patients with glioma treated at Chinese People’s Armed Police Force Marine Police Corps Hospital from June 2015 to June 2018 were selected.All the patients underwent PET/CT and diffusion tensor MRI reexamination at 3 to 6 months after the radiotherapy.The clinical data,PET/CT and diffusion tensor imaging indices were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the value of these indices in the differential diagnosis of glioma recurrence and radiation-induced brain injury.Results Standard uptake value(SUV),normal tissue ratio(L/N),regional cerebral blood volume(rCBV),regional cerebral blood flow(rCBF),choline/creatine ratio(Cho/Cr)and Cho/N-acetylaspartic acid ratio(Cho/NAA)were higher in patients with recurrent glioma than patients with radiation-induced brain injury(all P<0.05).The area under curve(AUC)for SUV,L/N,rCBV,rCBF,Cho/Cr and Cho/NAA in the differential diagnosis of glioma recurrence and radiation-induced brain injury was 0.874,0.828,0.952,0.928,0.853 and 0.905,respectively.AUC for rCBV was higher than that of L/N and Cho/Cr in the differential diagnosis of glioma recurrence and radiation-induced brain injury(all P<0.05).The best cut-off point for rCBV in the differential diagnosis of glioma recurrence from radiation-induced brain injury was 1.458,and the sensitivity and specificity was 90.8%and 94.1%,respectively.Conclusion SUV,L/N,rCBV,rCBF,Cho/Cr and Cho/NAA levels were significantly higher in patients with recurrent glioma than those with radiation-induced brain injury.Diffusion tensor imaging was superior to PET/CT in the differential diagnosis of recurrent glioma from radiation-induced brain injury,especially for rCBV.