^(18)F-FDG PET/CT联合神经元抗体检测诊断神经系统副肿瘤综合征

Research on the Application Value of^(18)F-FDG PET/CT Combined with Neuronal Antibody Detection in the Diagnosis and Treatment of PNS Patients

目的:探讨全身^(18)F-FDG PET/CT联合神经元抗体检测在神经系统副肿瘤综合征(PNS)患者诊疗中的应用价值。方法:回顾性收集56例临床疑诊PNS患者的临床、神经副肿瘤抗体检测及全身^(18)F-FDG PET/CT资料,对照病理及临床随访结果,利用ROC曲线评价PET/CT、神经元抗体及二者联合检测结果的诊断效能。结果:56例疑诊PNS患者中,共有肿瘤患者20例,其中肿瘤伴PNS 19例,肿瘤伴脊髓转移1例。^(18)F-FDG PET/CT显像提示肿瘤或可能肿瘤23例,其中20例为真阳性,3例为假阳性(随访结果分别为反流性食管炎、反应性骨改变、颈部炎性病变),其余33例为真阴性;敏感度、特异度、准确度分别为100.0%、91.7%、94.6%。神经元抗体阳性33例,其中PNS伴肿瘤8例(抗Amphiphysin抗体脑炎3例,抗GABAB抗体脑炎2例,抗Yo抗体脑炎1例,抗Hu抗体脑炎2例),PNS不伴肿瘤25例(LGI1抗体脑炎10例,抗Amphiphysin抗体脑炎3例,抗Hu抗体脑炎1例,抗GABAB抗体脑炎3例,抗Yo抗体脑炎3例,抗CASPR2、GAD65、NMDA、PNMA及SOX1抗体脑炎各1例);神经元抗体阴性23例(其中伴肿瘤12例);敏感度、特异度、准确度分别为40.0%、30.6%、33.9%。两种联合检测结果的敏感度、特异度、准确度分别为100.0%、33.3%、57.1%,50.0%、94.4%、78.6%。ROC分析显示AUC分别为0.958(P<0.001;95%CI,0.904~1.000)、0.353(P>0.05;95%CI,0.199~0.506)、0.667(P<0.05;95%CI,0.528~0.806)及0.672(P<0.05;95%CI,0.514~0.830),^(18)F-FDG PET/CT及两种联合检测方法具有统计学意义。结论:全身^(18)F-FDG PET/CT可作为疑诊PNS患者无创筛查肿瘤的一线检查方法。

Objective:To explore the clinical value of whole-body^(18)F-FDG PET/CT combined with neuroantibody detection in the diagnosis and treatment of paraneoplastic neurological syndromes(PNS).Methods:Clinical,laboratory,and imaging data of 56 hospitalized patients with suspected PNS who underwent systemic^(18)F-FDG PET/CT and neuropathic tumor antibody detection were retrospectively collected and followed-up on.ROC curve analysis was performed to compare the diagnostic efficacy of PET/CT,neuronal antibodies,and their combined detection results.Results:Among the 56 patients with suspected PNS,there were 20 with malignant tumors,including 19 cases complicated with PNS and 1 patient with spinal cord metastasis which also le d to neurological symptoms.^(18)F-FDG PET/CT imaging indicated tumors or possible tumors in 23 cases,of which20 cases were true positive,3 cases were false positive(the follow-up results were reflux esophagitis,reactive bone changes,or inflammatory lesions in the neck),and the remaining 33 cases were true negative.The sensitivity,specificity,and accuracy of PET/CT were 100%,91.7%,and 94.6%,respectively.There were 33 cases with positive neuroantibodies,including 8 cases of tumors with PNS(3 cases with anti-amphiphysin antibody encephalitis,2 cases with anti-GABAb antibody encephalitis,1 case with anti-Yo antibody encephalitis,and 2 cases with anti-Hu antibody encephalitis).Moreover,there were 25 cases without tumors(10 cases with LGI1 antibody encephalitis,3 cases with anti-amphiphysin antibody encephalitis,1 case with anti-Hu antibody encephalitis,3 cases with anti-GABAb antibody encephalitis,3 cases with anti-Yo antibody encephalitis,1 case with Anti-caspr2,1 case with GAD65,1 case with NMDA,1 case with PNMA,and 1 case with SOX1 antibody(1 case each).Of these,23 cases were negative(12 cases with tumor).The sensitivity,specificity,and accuracy of the neuronal antibody test were 40.0%,30.6%,and 33.9%,respectively.Furthermore,the sensitivity,specificity,and accuracy of the combined detection were 100.0%,33.3%,57.1%,50%,94.4%,and 78.6%,respectively.ROC analysis showed that the AUC was 0.958(P=0.000<0.05;95%CI 0.904~1.000),0.353(P=0.070>0.05;95%CI 0.199~0.506),0.667(P=0.040<0.05;95%CI0.528~0.806),and 0.672(P=0.034<0.05;95%CI 0.514~0.830).Conclusion:Whole-body^(18)F-FDG PET/CT has the potential to be the first choice for noninvasive tumor screening in patients with suspected PNS.