动态磁敏感对比灌注加权磁共振成像和 C-蛋氨酸 PET/CT 对高级别脑胶质瘤患者肿瘤复发与放射性损伤的鉴别诊断价值。
Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas.
机构信息
From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.).
Department of Medical Imaging (T.Y.), Cancer Hospital of China Medical University, Shenyang, China.
出版信息
AJNR Am J Neuroradiol. 2019 Feb;40(2):253-259. doi: 10.3174/ajnr.A5952. Epub 2019 Jan 17.
BACKGROUND AND PURPOSE
Both C-methionine PET/CT and DSC-PWI could be used to differentiate radiation injury from recurrent brain tumors. Our aim was to assess the performance of MET PET/CT and DSC-PWI for differentiation of recurrence and radiation injury in patients with high-grade gliomas and to quantitatively analyze the diagnostic values of PET and PWI parameters.
MATERIALS AND METHODS
Forty-two patients with high-grade gliomas were enrolled in this study. The final diagnosis was determined by histopathologic analysis or clinical follow-up. PWI and PET parameters were recorded and compared between patients with recurrence and those with radiation injury using Student tests. Receiver operating characteristic and logistic regression analyses were used to determine the diagnostic performance of each parameter.
RESULTS
The final diagnosis was recurrence in 33 patients and radiation injury in 9. PET/CT showed a patient-based sensitivity and specificity of 0.909 and 0.556, respectively, while PWI showed values of 0.667 and 0.778, respectively. The maximum standardized uptake value, mean standardized uptake value, tumor-to-background maximum standardized uptake value, and mean relative CBV were significantly higher for patients with recurrence than for patients with radiation injury. All these parameters showed a high discriminative power in receiver operating characteristic analysis. The optimal cutoff values for the tumor-to-background maximum standardized uptake value and mean relative CBV were 1.85 and 1.83, respectively, and corresponding sensitivities and specificities for the diagnosis of recurrence were 0.97 and 0.667 and 0.788 and 0.88, respectively. Areas under the curve for the tumor-to-background maximum standardized uptake value and mean relative CBV were 0.847 ± 0.077 and 0.845 ± 0.078, respectively. Combined assessment of the tumor-to-background maximum standardized uptake value and mean relative CBV showed the largest area under the curve (0.953 ± 0.031), with corresponding sensitivity and specificity of 0.848 and 1.0, respectively.
CONCLUSIONS
Both C-methionine PET/CT and PWI are equally accurate in the differentiation of recurrence from radiation injury in patients with high-grade gliomas, and a combination of the 2 modalities could result in increased diagnostic accuracy.
背景与目的
C-蛋氨酸 PET/CT 和 DSC-PWI 均可用于区分放射性脑损伤与脑肿瘤复发。本研究旨在评估 MET PET/CT 和 DSC-PWI 对高级别脑胶质瘤患者肿瘤复发与放射性脑损伤的鉴别诊断效能，并对 PET 和 PWI 参数的诊断价值进行定量分析。
材料与方法
本研究纳入 42 例高级别脑胶质瘤患者，最终诊断依据组织病理学分析或临床随访结果确定。记录并比较肿瘤复发患者与放射性脑损伤患者的 PWI 和 PET 参数，采用 Student t 检验进行统计学分析。应用受试者工作特征曲线和逻辑回归分析确定各参数的诊断效能。
结果
最终诊断为肿瘤复发 33 例，放射性脑损伤 9 例。基于患者的 PET/CT 诊断敏感度和特异度分别为 0.909 和 0.556，PWI 分别为 0.667 和 0.778。复发患者的最大标准化摄取值、平均标准化摄取值、肿瘤与背景最大标准化摄取值比值和平均相对脑血容量显著高于放射性脑损伤患者。上述各参数在受试者工作特征曲线分析中均具有较高的鉴别诊断效能。肿瘤与背景最大标准化摄取值比值和平均相对脑血容量的最佳截断值分别为 1.85 和 1.83，其诊断肿瘤复发的敏感度和特异度分别为 0.97 和 0.667，0.788 和 0.88；曲线下面积分别为 0.847±0.077 和 0.845±0.078。肿瘤与背景最大标准化摄取值比值和平均相对脑血容量联合评估的曲线下面积最大（0.953±0.031），其敏感度和特异度分别为 0.848 和 1.0。
结论
MET PET/CT 和 DSC-PWI 对高级别脑胶质瘤患者肿瘤复发与放射性脑损伤的鉴别诊断效能相当，联合应用两种方法可提高诊断准确性。
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