基于（11）C-蛋氨酸 PET 的容积测量在脑胶质瘤患者中的预后价值。
Prognostic value of volume-based measurements on (11)C-methionine PET in glioma patients.
机构信息
Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, Japan, 060-8638,
出版信息
Eur J Nucl Med Mol Imaging. 2015 Jun;42(7):1071-80. doi: 10.1007/s00259-015-3046-1. Epub 2015 Apr 8.
PURPOSE
(11)C-methionine (MET) PET is an established diagnostic tool for glioma. Studies have suggested that MET uptake intensity in the tumor is a useful index for predicting patient outcome. Because MET uptake is known to reflect tumor expansion more accurately than MRI, we aimed to elucidate the association between volume-based tumor measurements and patient prognosis.
METHODS
The study population comprised 52 patients with newly diagnosed glioma who underwent PET scanning 20 min after injection of 370 MBq MET. The tumor was contoured using a threshold of 1.3 times the activity of the contralateral normal cortex. Metabolic tumor volume (MTV) was defined as the total volume within the boundary. Total lesion methionine uptake (TLMU) was defined as MTV times the mean standardized uptake value (SUVmean) within the boundary. The tumor-to-normal ratio (TNR), calculated as the maximum standardized uptake value (SUVmax) divided by the contralateral reference value, was also recorded. All patients underwent surgery (biopsy or tumor resection) targeting the tissue with high MET uptake. The Kaplan-Meier method was used to estimate the predictive value of each measurement.
RESULTS
Grade II tumor was diagnosed in 12 patients (3 diffuse astrocytoma, 2 oligodendroglioma, and 7 oligoastrocytoma), grade III in 18 patients (8 anaplastic astrocytoma, 6 anaplastic oligodendroglioma, and 4 anaplastic oligoastrocytoma), and grade IV in 22 patients (all glioblastoma). TNR, MTV and TLMU were 3.1 ± 1.2, 51.6 ± 49.9 ml and 147.7 ± 153.3 ml, respectively. None of the three measurements was able to categorize the glioma patients in terms of survival when all patients were analyzed. However, when only patients with astrocytic tumor (N = 33) were analyzed (i.e., when those with oligodendroglial components were excluded), MTV and TLMU successfully predicted patient outcome with higher values associated with a poorer prognosis (P < 0.05 and P < 0.01, respectively), while the predictive ability of TNR did not reach statistical significance (P = NS).
CONCLUSION
MTV and TLMU may be useful for predicting outcome in patients with astrocytic tumor.
目的
（11）C-蛋氨酸（MET）PET 是一种用于诊断脑胶质瘤的成熟诊断工具。研究表明，肿瘤中的 MET 摄取强度是预测患者预后的有用指标。由于 MET 摄取比 MRI 更能准确地反映肿瘤的扩张，我们旨在阐明基于体积的肿瘤测量与患者预后之间的关系。
方法
研究对象为 52 例新诊断为脑胶质瘤的患者，在注射 370MBq MET 后 20 分钟进行 PET 扫描。使用对侧正常皮质活性 1.3 倍的阈值对肿瘤进行轮廓勾画。代谢肿瘤体积（MTV）定义为边界内的总体积。总病变蛋氨酸摄取（TLMU）定义为边界内的 MTV 乘以平均标准化摄取值（SUVmean）。还记录了肿瘤与正常组织的比值（TNR），其计算方法为最大标准化摄取值（SUVmax）除以对侧参考值。所有患者均针对高 MET 摄取的组织进行了手术（活检或肿瘤切除术）。采用 Kaplan-Meier 法估计各项测量的预测价值。
结果
诊断为 2 级肿瘤 12 例（弥漫性星形细胞瘤 3 例，少突胶质细胞瘤 2 例，少突星形细胞瘤 7 例），3 级肿瘤 18 例（间变性星形细胞瘤 8 例，间变性少突胶质细胞瘤 6 例，间变性少突星形细胞瘤 4 例），4 级肿瘤 22 例（均为胶质母细胞瘤）。TNR、MTV 和 TLMU 分别为 3.1±1.2、51.6±49.9ml 和 147.7±153.3ml。当所有患者进行分析时，这三项测量均无法根据生存情况对脑胶质瘤患者进行分类。然而，当仅对星形细胞瘤患者（N=33）进行分析时（即排除少突胶质细胞成分的患者），MTV 和 TLMU 成功地预测了患者的预后，较高的值与较差的预后相关（P<0.05 和 P<0.01），而 TNR 的预测能力则未达到统计学意义（P=NS）。
结论
MTV 和 TLMU 可能有助于预测星形细胞瘤患者的预后。
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