¹⁸F-氟代咪唑脱氧葡萄糖正电子发射断层扫描可能有助于胶质母细胞瘤与低级别胶质瘤的鉴别。
¹⁸F-Fluoromisonidazole positron emission tomography may differentiate glioblastoma multiforme from less malignant gliomas.
机构信息
Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan.
出版信息
Eur J Nucl Med Mol Imaging. 2012 May;39(5):760-70. doi: 10.1007/s00259-011-2037-0. Epub 2012 Feb 4.
PURPOSE
Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor and its prognosis is significantly poorer than those of less malignant gliomas. Pathologically, necrosis is one of the most important characteristics that differentiate GBM from lower grade gliomas; therefore, we hypothesized that (18)F fluoromisonidazole (FMISO), a radiotracer for hypoxia imaging, accumulates in GBM but not in lower grade gliomas. We aimed to evaluate the diagnostic value of FMISO positron emission tomography (PET) for the differential diagnosis of GBM from lower grade gliomas.
METHODS
This prospective study included 23 patients with pathologically confirmed gliomas. All of the patients underwent FMISO PET and (18)F-fluorodeoxyglucose (FDG) PET within a week. FMISO images were acquired 4 h after intravenous administration of 400 MBq of FMISO. Tracer uptake in the tumor was visually assessed. Lesion to normal tissue ratios and FMISO uptake volume were calculated.
RESULTS
Of the 23 glioma patients, 14 were diagnosed as having GBM (grade IV glioma in the 2007 WHO classification), and the others were diagnosed as having non-GBM (5 grade III and 4 grade II). In visual assessment, all GBM patients showed FMISO uptake in the tumor greater than that in the surrounding brain tissues, whereas all the non-GBM patients showed FMISO uptake in the tumor equal to that in the surrounding brain tissues (p ≤ 0.001). One GBM patient was excluded from FDG PET study because of hyperglycemia. All GBM patients and three of the nine (33%) non-GBM patients showed FDG uptake greater than or equal to that in the gray matter. The sensitivity and specificity for diagnosing GBM were 100 and 100% for FMISO, and 100 and 66% for FDG, respectively. The lesion to cerebellum ratio of FMISO uptake was higher in GBM patients (2.74 ± 0.60, range 1.71-3.81) than in non-GBM patients (1.22 ± 0.06, range 1.09-1.29, p ≤ 0.001) with no overlap between the groups. The lesion to gray matter ratio of FDG was also higher in GBM patients (1.46 ± 0.75, range 0.91-3.79) than in non-GBM patients (1.07 ± 0.62, range 0.66-2.95, p ≤ 0.05); however, overlap of the ranges did not allow clear differentiation between GBM and non-GBM. The uptake volume of FMISO was larger in GBM (27.18 ± 10.46%, range 14.02-46.67%) than in non-GBM (6.07 ± 2.50%, range 2.12-9.22%, p ≤ 0.001).
CONCLUSION
These preliminary data suggest that FMISO PET may distinguish GBM from lower grade gliomas.
目的
多形性胶质母细胞瘤（GBM）是最具侵袭性的原发性脑肿瘤，其预后明显差于低级别胶质瘤。从病理学上看，坏死是 GBM 与低级别胶质瘤区分的最重要特征之一；因此，我们假设（18）F 氟米索硝唑（FMISO），一种缺氧成像的放射性示踪剂，在 GBM 中积累，但不在低级别胶质瘤中积累。我们旨在评估 FMISO 正电子发射断层扫描（PET）对 GBM 与低级别胶质瘤进行鉴别诊断的诊断价值。
方法
这项前瞻性研究纳入了 23 例经病理证实的脑胶质瘤患者。所有患者均在一周内接受 FMISO PET 和（18）F-氟脱氧葡萄糖（FDG）PET 检查。静脉注射 400MBq FMISO 后 4 小时采集 FMISO 图像。通过视觉评估肿瘤摄取情况。计算病变与正常组织的比值和 FMISO 摄取量。
结果
23 例胶质瘤患者中，14 例诊断为 GBM（2007 年 WHO 分级的 IV 级胶质瘤），其余 9 例诊断为非 GBM（5 例 III 级和 4 例 II 级）。在视觉评估中，所有 GBM 患者的肿瘤摄取均高于周围脑组织，而非 GBM 患者的肿瘤摄取均与周围脑组织相等（p ≤ 0.001）。1 例 GBM 患者因高血糖而被排除在 FDG PET 研究之外。所有 GBM 患者和 9 例非 GBM 患者中的 3 例（33%）的 FDG 摄取均高于或等于灰质。FMISO 诊断 GBM 的灵敏度和特异性分别为 100%和 100%，FDG 分别为 100%和 66%。GBM 患者 FMISO 摄取的小脑病变比值（2.74 ± 0.60，范围 1.71-3.81）高于非 GBM 患者（1.22 ± 0.06，范围 1.09-1.29，p ≤ 0.001），两组之间无重叠。GBM 患者 FDG 的病变与灰质比值（1.46 ± 0.75，范围 0.91-3.79）也高于非 GBM 患者（1.07 ± 0.62，范围 0.66-2.95，p ≤ 0.05）；然而，范围的重叠并没有在 GBM 和非 GBM 之间进行明确的区分。GBM 的 FMISO 摄取量（27.18 ± 10.46%，范围 14.02-46.67%）大于非 GBM（6.07 ± 2.50%，范围 2.12-9.22%，p ≤ 0.001）。
结论
这些初步数据表明，FMISO PET 可能有助于区分 GBM 和低级别胶质瘤。
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