The role of (13)N-ammonia in the differential diagnosis of gliomas and brain inflammatory lesions.
The role of (13)N-ammonia in the differential diagnosis of gliomas and brain inflammatory lesions.
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(13)N-氨在胶质瘤和脑炎性病变鉴别诊断中的作用。
DOI：
10.1007/s12149-018-1308-2
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发表时间：
2019
影响因子：
2.6
通讯作者：
Zhang Xiangsong
中科院分区：
文献类型：
--
作者：
Yi Chang;Shi Xinchong;Zhang Xuezhen;Luo Ganhua;Zhang Bing;Zhang Xiangsong
目的探讨13 N-NH3 PET/CT显像在胶质瘤和脑炎症鉴别诊断中的价值。所有患者在13 N-氨显像前均未接受任何治疗。所有患者均经立体定向活检或临床随访确诊。对13 N-氨显像结果进行目视和半定量分析。结果13 N-氨显像阳性率：炎症组29. 4%，低级别胶质瘤组51. 6%，高级别胶质瘤组91. 3%。诊断胶质瘤的敏感性、特异性和准确性分别为75.3%、55.8%和67.8%。半定量分析显示，炎性病变、低级别胶质瘤和高级别胶质瘤的T/G比值分别为0.88 ± 0.24、1.04 ± 0.43和1.43 ± 0.49。单因素方差分析显示，高级别胶质瘤的T/G比值显著高于低级别胶质瘤和炎症（P< 0.05），而低级别胶质瘤与炎症之间无统计学差异（P= 0.118）。在炎性病变中，感染性病变与脱髓鞘病变的T/G比值差异无统计学意义（P> 0.05）。ROC曲线分析显示T/Gratio区分胶质瘤和炎症的最佳截断值为1.21，AUC为0.78。其敏感性、特异性、准确性、阳性预测值和阴性预测值分别为52.9%、94.4%、65.3%、95.7%和45.9%。ROC曲线分析显示T/Gratio区分高级别胶质瘤和低级别胶质瘤的最佳截断值为1.06，AUC为0.78。其敏感性、特异性、准确性、阳性预测值和阴性预测值分别为81.5%、67.7%、76.5%、81.5%和67.7%。ROC曲线分析显示T/Gratio区分高级别胶质瘤与低级别胶质瘤和炎症的最佳截断值为1.19，AUC为0.84。结论13 N-氨显像对高级别胶质瘤与低级别胶质瘤及炎性病变的鉴别诊断有效，但对低级别胶质瘤与脑内炎性病变的鉴别诊断作用有限，准确性有待提高。
ObjectiveTo investigate the utility of13N-ammonia PET/CT imaging in the differential diagnosis of gliomas and brain inflammations.Methods13N-ammonia PET/CT imaging data of 77 patients with gliomas and 34 patients with brain inflammations were retrospectively analyzed. No patients received any treatment before13N-ammonia imaging. All the patients were diagnosed by stereotactic biopsy or clinical follow-up. Visual and semi-quantitative analysis was performed to analyze the results of13N-ammonia imaging. Finally, the uptake ratios of each lesion were calculated and its differences among different groups were tested with one-way ANOVA.Results29.4% inflammations, 51.6% low-grade gliomas and 91.3% high-grade gliomas were positive by visual analysis in13N-ammonia imaging. The sensitivity, specificity and accuracy for the diagnosis of gliomas were 75.3%, 55.8% and 67.8%, respectively. As for semi-quantitative analysis, theT/Gratios of inflammatory lesions, low-grade gliomas and high-grade gliomas were 0.88 ± 0.24, 1.04 ± 0.43 and 1.43 ± 0.49, respectively. One-way ANOVA revealed that theT/Gratios of high-grade gliomas were significantly higher than those of low-grade gliomas and inflammations (P< 0.05), but there was no statistical difference between low-grade gliomas and inflammations (P= 0.118). Among the inflammatory lesions,T/Gratios were not statistically different between infectious and demyelinating lesions (P> 0.05). ROC curve analysis showed that the optimal cut-off value ofT/Gratio in distinguishing gliomas from inflammations was 1.21 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 52.9%, 94.4%, 65.3%, 95.7% and 45.9%, respectively. ROC curve analysis showed that the optimal cut-off value ofT/Gratio in distinguishing high-grade gliomas from low-grade gliomas was 1.06 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 81.5%, 67.7%, 76.5%, 81.5% and 67.7%, respectively. ROC curve analysis showed that the optimal cut-off value ofT/Gratio in distinguishing high-grade gliomas from low-grade gliomas and inflammations was 1.19 with the AUC 0.84. The sensitivity, specificity, accuracy, PPV and NPV were 70.4%, 85.1%, 78.5%, 79.2% and 78.1%, respectively.Conclusions13N-ammonia imaging is effective in distinguishing high-grade gliomas from low-grade gliomas and inflammations, but its role in the differential diagnosis of low-grade gliomas and brain inflammatory lesions is limited, and the accuracy needs to be improved.