免疫功能正常的原发性中枢神经系统淋巴瘤患者的 F-FDG PET/CT：与胶质母细胞瘤的鉴别诊断及与 DWI 的相关性。
F-FDG PET/CT in immunocompetent patients with primary central nervous system lymphoma: Differentiation from glioblastoma and correlation with DWI.
机构信息
PET Center, Huashan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China.
Department of Radiology, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China.
出版信息
Eur J Radiol. 2018 Jul;104:26-32. doi: 10.1016/j.ejrad.2018.04.020. Epub 2018 Apr 22.
OBJECTIVES
F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is useful for the detection of cancerous lesions, and FDG uptake is related to the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) of extracranial tumors. The purpose of our study was to investigate the ability of FDG PET/CT in distinguishing primary central nervous system lymphoma (PCNSL) from glioblastoma multiforme (GBM) and to explore the relationship between F-FDG uptake and the ADC in patients with PCNSL.
METHODS
We reviewed 92 patients (40 with PCNSL and 52 with GBM) who underwent FDG PET/CT scans at disease onset. The maximum standardized uptake value (SUVmax), tumor to normal contralateral cortex activity (T/N) ratio, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of tumor lesions were calculated. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic performance for FDG PET-related parameters to differentiate PCNSL from GBM. Twenty-eight patients with PCNSL (with 34 lesions) also underwent diffusion-weighted imaging. Pearson's correlation analysis was used to assess the relation between SUV- and ADC-derived parameters.
RESULTS
The SUVmax, T/N ratio, SUVmean, and TLG values were significantly higher in PCNSL than in GBM. Comparative ROC analysis indicated that the SUVmax had a greater area under the curve (AUC) of 0.910 than the T/N ratio (0.905, P = .85), SUVmean (0.836, P = .0006), or TLG (0.641, P < 0.0001). The T/N ratio had the highest specificity (94.23%) for differentiating PCNSL from GBM, while the SUVmax had the most optimal sensitivity (92.31%). Further combined analysis of the indices did not significantly improve the AUC. Moderate inverse correlations between the SUVmax, SUVmean, TLG, and the ADC ratio (rADC) were found in PCNSLs (r = -0.526, P = .002; r = -0.504, P = .004; and r = -0.483, P = .006; respectively).
CONCLUSIONS
The SUVmax and T/N ratio may be reliable measures for differentiating PCNSLs from GBMs. Additionally, FDG metabolism indices were inversely proportional to the rADCs of PCNSL lesions.
目的
氟-18 脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）有助于检测癌性病变，并且 FDG 摄取与源自颅外肿瘤的扩散加权成像（DWI）的表观扩散系数（ADC）有关。本研究的目的是探讨 FDG PET/CT 区分原发性中枢神经系统淋巴瘤（PCNSL）与多形性胶质母细胞瘤（GBM）的能力，并探讨 PCNSL 患者中 F-FDG 摄取与 ADC 之间的关系。
方法
我们回顾了 92 名（40 名 PCNSL 和 52 名 GBM）在疾病发作时接受 FDG PET/CT 扫描的患者。计算了肿瘤病变的最大标准化摄取值（SUVmax）、肿瘤与对侧正常皮质活性比（T/N）、SUVmean、代谢肿瘤体积（MTV）和总肿瘤糖酵解（TLG）。生成受试者工作特征（ROC）曲线，以确定 FDG PET 相关参数区分 PCNSL 和 GBM 的诊断性能。28 名 PCNSL 患者（34 个病灶）也接受了扩散加权成像。采用 Pearson 相关分析评估 SUV-和 ADC 衍生参数之间的关系。
结果
PCNSL 的 SUVmax、T/N 比值、SUVmean 和 TLG 值明显高于 GBM。比较 ROC 分析表明，SUVmax 的曲线下面积（AUC）为 0.910，高于 T/N 比值（0.905，P=0.85）、SUVmean（0.836，P=0.0006）或 TLG（0.641，P<0.0001）。T/N 比值对区分 PCNSL 和 GBM 的特异性最高（94.23%），而 SUVmax 的敏感性最高（92.31%）。进一步联合分析这些指标并没有显著提高 AUC。在 PCNSL 中发现 SUVmax、SUVmean、TLG 与 rADC 之间存在中等程度的负相关（r=−0.526，P=0.002；r=−0.504，P=0.004；r=−0.483，P=0.006）。
结论
SUVmax 和 T/N 比值可能是区分 PCNSL 和 GBM 的可靠指标。此外，FDG 代谢指标与 PCNSL 病变的 rADC 呈反比。
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