^(18)F-FDG PET/CT在多发原发性中枢神经系统淋巴瘤及颅内多发胶质瘤鉴别诊断中的应用价值研究

Application value of^(18)F-FDG PET/CT in differential diagnosis of primary central nervous system lymphoma and multifocal cerebral gliomas

目的探讨^(18)F-FDG PE_(T/C)T鉴别诊断原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)及颅内多发胶质瘤(multifocal cerebral gliomas,MCG)的应用价值。方法回顾性收集2015年1月~2021年7月于首都医科大学附属北京天坛医院就诊并由穿刺活检病理证实的多发PCNSL患者(L组)和MCG患者(G组)的临床数据及影像学资料共55例,均行全身^(18)F-FDG PE_(T/C)T检查,包括:L组28例(病灶95个)及G组27例(病灶65个)。采用卡方检验比较两组病变发病部位差异;独立样本t检验对比分析肿瘤PET代谢参数SUVmax(SUVmax-_(T))及其与小脑灰质、大脑白质、大脑灰质的比值(SUVmax-_(T/C),SUVmax-_(T/W),SUVmax-_(T/G))以及病灶密度相关参数的差异;受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)分析参数诊断效能并计算截断值;Pearson相关性分析对两组病灶实性密度CT值与SUVmax进行分析。结果L组易累及中线及脑室旁结构,G组易发生囊变坏死,L组肿瘤代谢活性参数高于G组(P<0.05)。以病灶为单位进行ROC曲线分析,结果显示,SUVmax、SUVmax-_(T/C)、SUVmax-_(T/W)及SUVmax-_(T/G)的截断值、敏感性及特异性分别为:16.62、72.6%、87.7%,1.84、73.7%、90.8%,4.70、73.7%、84.6%,1.49、75.8%、92.3%;以患者为单位进行ROC曲线分析,结果显示,SUVmax、SUVmax-_(T/C)、SUVmax-_(T/W)及SUVmax-_(T/G)的截断值、敏感性及特异性分别为:18.18、89.3%、88.9%,2.11、89.3%、92.6%,5.76、85.7%、85.2%,1.62、92.9%、82.6%;P均<0.05。两组病变密度参数差异无统计学意义(P>0.05)。L组病变实性部分SUVmax与密度具有弱相关性(P<0.05),G组无明显相关性(P>0.05)。结论^(18)F-FDG PE_(T/C)T在多发PCNSL和颅内多发胶质瘤鉴别诊断中具有重要应用价值。

Objective To investigate the application value of^(18)F-FDG PET/CT in differential diagnosis of primary central nervous system lymphoma(PCNSL)and multifocal cerebral gliomas(MCG).Methods Clinical data and imaging data of 55 patients admitted to Beijing Tiantan Hospital from January 2015 to July 2021 with multiple PCNSL(group L)or MCG(group G)confirmed pathologically by biopsy were retrospectively collected.All the patients underwent whole-body^(18)F-FDG PET/CT examination.They were divided into two groups,28 cases(95 lesions)in group L and 27 cases(65 lesions)in group G.Chi-square was used to analyze the difference of lesion sites.Independent sample t test was used to analyze the differences of semi-quantitative parameters of PET.Receiver operator characteristic(ROC)curve was performed to analyze the diagnostic value of the parameters and the cut-off value was calculated.Pearson correlation analysis was performed between CT values of the solid part of lesions and SUVmax in the two groups.Results The group L was more likely to involve the midline and paraventricular structures(P<0.05).Group G was more likely to have cystic necrosis(P<0.05).The parameters related to tumor metabolic activity in group L were higher than those in group G(P<0.05).ROC curve analysis based on lesions showed that the cut-off value,sensitivity and specificity of SUVmax,SUvmax-_(T/C),SUvmax-_(T/W)and SUvmax-_(T/G)were as follows:16.62,72.6%,87.7%;1.84,73.7%,90.8%;4.70,73.7%,84.6%;1.49,75.8%,92.3%;ROC curve analysis based on patients showed that the values of above parameters were as follows:18.18,89.3%,88.9%;2.11,89.3%,92.6%;5.76,85.7%,85.2%;1.62,92.9%,82.6%with statistical significances(P<0.05).There were no significant differences in density-related parameters between the two groups(P>0.05).There was a weak correlation between the SUVmax and the solid part of the lesions in group L(P<0.05),and there was no significant correlation in the group G(P>0.05).Conclusion^(18)F-FDG PE_(T/C)T semi-quantitative parameters have important application values in differential diagnosis of PCNSL and MCG.