Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
BMC Med Imaging. 2022 Dec 26;22(1):227. doi: 10.1186/s12880-022-00959-3.
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nerve system caused by the John Cunningham virus. On MRI, PML may sometimes appear similar to primary central nervous system lymphoma (PCNSL) and glioblastoma multiforme (GBM). The purpose of this pilot study was to evaluate the potential of amide proton transfer (APT) imaging for differentiating PML from PCNSL and GBM.
Patients with PML (n = 4; two men; mean age 52.3 ± 6.1 years), PCNSL (n = 7; four women; mean age 74.4 ± 5.8 years), or GBM (n = 11; 6 men; mean age 65.0 ± 15.2 years) who underwent APT-CEST MRI between January 2021 and September 2022 were retrospectively evaluated. Magnetization transfer ratio asymmetry (MTR) values were measured on APT imaging using a region of interest within the lesion. Receiver operating characteristics curve analysis was used to determine diagnostic cutoffs for MTR.
The mean MTR values were 0.005 ± 0.005 in the PML group, 0.025 ± 0.005 in the PCNSL group, and 0.025 ± 0.009 in the GBM group. There were significant differences in MTR between PML and PCNSL (P = 0.023), and between PML and GBM (P = 0.015). For differentiating PML from PCNSL, an MTR threshold of 0.0165 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100% (all). For differentiating PML from GBM, an MTR threshold of 0.015 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 90.9%, 80.0%, and 100%, respectively.
MTR values obtained from APT imaging allowed patients with PML to be clearly discriminated from patients with PCNSL or GBM.
进行性多灶性白质脑病（PML）是一种由约翰·坎宁安病毒引起的中枢神经系统脱髓鞘疾病。在磁共振成像（MRI）上，PML 有时可能与原发性中枢神经系统淋巴瘤（PCNSL）和多形性胶质母细胞瘤（GBM）相似。本初步研究旨在评估酰胺质子转移（APT）成像在鉴别 PML 与 PCNSL 和 GBM 中的潜在价值。
回顾性分析了 2021 年 1 月至 2022 年 9 月期间接受 APT-CEST MRI 检查的 PML（n=4；2 名男性；平均年龄 52.3±6.1 岁）、PCNSL（n=7；4 名女性；平均年龄 74.4±5.8 岁）和 GBM（n=11；6 名男性；平均年龄 65.0±15.2 岁）患者。使用病变内感兴趣区测量 APT 成像上的磁化转移率不对称（MTR）值。使用受试者工作特征曲线分析确定 MTR 的诊断截止值。
PML 组的平均 MTR 值为 0.005±0.005，PCNSL 组为 0.025±0.005，GBM 组为 0.025±0.009。PML 组与 PCNSL 组之间（P=0.023）以及 PML 组与 GBM 组之间（P=0.015）的 MTR 存在显著差异。当将 MTR 阈值设定为 0.0165 时，鉴别 PML 与 PCNSL 的诊断灵敏度、特异性、阳性预测值和阴性预测值均为 100%（均）。当将 MTR 阈值设定为 0.015 时，鉴别 PML 与 GBM 的诊断灵敏度、特异性、阳性预测值和阴性预测值分别为 100%、90.9%、80.0%和 100%。
从 APT 成像获得的 MTR 值可清晰地区分 PML 患者与 PCNSL 或 GBM 患者。
