多模态成像技术在脑胶质瘤复发诊断中的应用与价值

Application and value of multi-modality imaging technology in the diagnosis of glioma recurrence

目的:探讨^(18)F-FDG PET/CT、^(11)C-MET PET/CT、增强MRI三种多模态影像技术在脑胶质瘤复发中的临床应用及诊断价值。方法:回顾性分析2018年1—8月北京天坛医院神经外科怀疑脑部胶质瘤复发的60例患者的资料,60例患者均行^(18)F-FDG PET/CT与^(11)C-MET PET/CT颅脑显像,术前均行MRI检查。以术后病理及活检穿刺结果为金标准,对大脑病灶侧摄取异常区域进行感兴趣区(Region of interest,ROI)勾画,计算并比较病灶摄取的半定量参数,以及与对侧灰质和白质的比值关系。统计学采用χ^(2)检验或两独立样本t检验分析数据,对所有图像进行对比分析和评估。结果:60例患者中复发者50例,其中32例表现为^(18)F-FDG有单发或多发放射性摄取,考虑为胶质瘤复发,另28例未见异常摄取增高;47例^(11)C-MET局部摄取增高,考虑胶质瘤病变,3例^(11)C-MET摄取轻度增高,综合考虑为放射性坏死,另10例未见异常,但其中1例术后病理为低级别胶质瘤复发;增强MRI检查中46例为阳性患者,14例为阴性患者,但其中3例患者为假阳性,8例为假阴性。^(18)F-FDG与^(11)C-MET PET/CT脑显像及MRI对复发病灶诊断的灵敏度分别为64%(32/50)、94%(47/50)、86%(43/50);特异性分别为100%(10/10)、70%(7/10)、60%(6/10);准确性分别为70%(42/60)、90%(54/60)、81%(49/60)。^(11)C-MET PET/CT显像中,肿瘤/灰质比值均值和肿瘤/白质比值均值分别为1.91±0.69和2.92±1.22,均显著高于^(18)F-FDG PET/CT显像的肿瘤/灰质比值均值(1.05±0.51)和肿瘤/白质比值均值(1.66±0.62)(P<0.05)。结论:^(11)C-MET PET/CT在三种多模态成像技术中,对胶质瘤术后复发病灶的诊断优于^(18)F-FDG PET/CT以及增强MRI检查。

Objective: To explore the clinical application and diagnostic value of three multi-modality imaging technology of^(18)F-FDG PET/CT,^(11)C-MET PET/CT, contrast-enhanced MRI in the diagnosis of glioma recurrence. Methods: This study retrospectively analyzed 60 patients with suspected recurrence of brain glioma in Beijing Tiantan Hospital range from January2018 to August 2018. They all underwent^(18)F-FDG PET/CT and^(11)C-MET PET/CT brain imaging, and preoperative MRI examination. Using the postoperative pathological or biopsy as the gold standard, the abnormal uptake area of the brain lesion was delineated as the region of interest(ROI), the semi-quantitative parameters of the lesion uptake were calculated and compared, as well as the ratio between lesions and contralateral gray/white matter. Chi-square test or two independent samples ttest was used to analyze and compare the image data. Results: Fifty out of the 60 patients relapsed, 32 of which showed single or multiple^(18)F-FDG radioactive uptake, which were considered as glioma recurrence;another 15 cases with non-obvious^(18)F-FDG uptake but increased^(11)C-MET uptake were consider as glioma lesions;3 cases of^(11)C-MET uptake were slightly increased, considered as radionecrosis. In patients with MR enhancement, 46 patients were positive and 14 were negative, but there were 3 false positive cases and 8 false negative cases. The sensitivity, specificity and accuracy of^(18)F-FDG,^(11)C-MET PET/CT and MRI in the diagnosis of recurrent lesions was 64%(32/50), 94%(47/50), 86%(43/50);100%(10/10), 70%(7/10),60%(6/10);70%(42/60), 90%(54/60), 81%(49/60), respectively. In^(11)C-MET imaging, the tumor/gray matter ratio and tumor/white matter ratio were 1.91±0.69 and 2.92±1.22, respectively, which were significantly higher than those of^(18)F-FDG imaging(tumor/gray matter ratio: 1.05±0.51, tumor/white matter ratio: 1.66±0.62, both P<0.05). Conclusion: Among the three multimodal imaging techniques,^(11)C-MET PET/CT is superior to^(18)F-FDG PET/CT and MRI in the diagnosis of glioma postoperative recurrent lesions.