氟-18α-甲基酪氨酸PET在胶质瘤患者中的临床价值：与氟-18氟脱氧葡萄糖PET的比较
Clinical value of fluorine-18α-methyltyrosine PET in patients with gliomas: comparison with fluorine-18 fluorodeoxyglucose PET.
作者信息
Horiguchi Keishi, Tosaka Masahiko, Higuchi Tetsuya, Arisaka Yukiko, Sugawara Kenichi, Hirato Junko, Yokoo Hideaki, Tsushima Yoshito, Yoshimoto Yuhei
机构信息
Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
出版信息
EJNMMI Res. 2017 Dec;7(1):50. doi: 10.1186/s13550-017-0298-8. Epub 2017 May 31.
BACKGROUND
We investigated the relationship between metabolic activity and histological features of gliomas using fluorine-18α-methyltyrosine (F-FAMT) positron emission tomography (PET) compared with fluorine-18 fluorodeoxyglucose (F-FDG) PET in 38 consecutive glioma patients. The tumor to normal brain ratios (T/N ratios) were calculated, and the relationships between T/N ratio and World Health Organization tumor grade or MIB-1 labeling index were evaluated. The diagnostic values of T/N ratios were assessed using receiver operating characteristic (ROC) curve analyses to differentiate between high-grade gliomas (HGGs) and low-grade gliomas (LGGs).
RESULTS
Median T/N ratio of F-FAMT PET was 2.85, 4.65, and 4.09 for grade II, III, and IV gliomas, respectively, with significant differences between HGGs and LGGs (p = 0.006). Both T/N ratio (p = 0.016) and maximum standardized uptake value (p = 0.033) of F-FDG PET showed significant differences between HGGs and LGGs. ROC analysis yielded an optimal cut-off of 3.37 for the T/N ratio of F-FAMT PET to differentiate between HGGs and LGGs (sensitivity 81%, specificity 67%, accuracy 76%, area under the ROC curve 0.776). Positive predictive value was 84%, and negative predictive value was 62%. T/N ratio of F-FAMT PET was not correlated with MIB-1 labeling index in all gliomas, whereas T/N ratio of F-FDG PET was positively correlated (r = 0.400, p = 0.013). Significant positive correlation was observed between T/N ratios of F-FDG and F-FAMT (r = 0.454, p = 0.004), but median T/N ratio of F-FAMT PET was significantly higher than that of F-FDG PET in all grades of glioma.
CONCLUSIONS
The T/N ratio of F-FAMT uptake has high positive predictive value for detection of HGGs. F-FAMT PET had higher T/N ratio, with better tumor-normal brain contrast, compared to F-FDG PET in both LGGs and HGGs. Therefore, F-FAMT is a useful radiotracer for the preoperative visualization of gliomas.
背景
我们在38例连续的胶质瘤患者中，使用氟-18α-甲基酪氨酸（F-FAMT）正电子发射断层扫描（PET）与氟-18氟脱氧葡萄糖（F-FDG）PET相比较，研究了胶质瘤的代谢活性与组织学特征之间的关系。计算肿瘤与正常脑的比值（T/N比值），并评估T/N比值与世界卫生组织肿瘤分级或MIB-1标记指数之间的关系。使用受试者操作特征（ROC）曲线分析评估T/N比值在区分高级别胶质瘤（HGG）和低级别胶质瘤（LGG）方面的诊断价值。
结果
F-FAMT PET的T/N比值中位数在Ⅱ级、Ⅲ级和Ⅳ级胶质瘤中分别为2.85、4.65和4.09，HGG和LGG之间存在显著差异（p = 0.006）。F-FDG PET的T/N比值（p = 0.016）和最大标准化摄取值（p = 0.033）在HGG和LGG之间也显示出显著差异。ROC分析得出F-FAMT PET的T/N比值区分HGG和LGG的最佳截断值为3.37（敏感性81%，特异性67%，准确性76%，ROC曲线下面积0.776）。阳性预测值为84%，阴性预测值为62%。在所有胶质瘤中，F-FAMT PET的T/N比值与MIB-1标记指数无相关性，而F-FDG PET的T/N比值呈正相关（r = 0.400，p = 0.013）。F-FDG和F-FAMT的T/N比值之间存在显著正相关（r = 0.454，p = 0.004），但在所有级别胶质瘤中，F-FAMT PET的T/N比值中位数显著高于F-FDG PET。
结论
F-FAMT摄取的T/N比值对检测HGG具有较高的阳性预测价值。与F-FDG PET相比，F-FAMT PET在LGG和HGG中均具有更高的T/N比值以及更好的肿瘤与正常脑对比度。因此，F-FAMT是一种用于胶质瘤术前可视化的有用放射性示踪剂。
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