Diagnostic accuracy of 13N-ammonia PET, 11C-methionine PET and 18F-fluorodeoxyglucose PET: a comparative study in patients with suspected cerebral glioma
Diagnostic accuracy of 13N-ammonia PET, 11C-methionine PET and 18F-fluorodeoxyglucose PET: a comparative study in patients with suspected cerebral glioma
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DOI：
10.1186/s12885-019-5560-1
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发表时间：
2019-04-08
期刊：
影响因子：
3.8
通讯作者：
Zhang, Xiangsong
中科院分区：
文献类型：
--
作者：
He, Qiao;Zhang, Linqi;Zhang, Xiangsong
背景：神经胶质瘤患者的治疗取决于病变的性质和肿瘤的组织学分级。使用 N-13-氨 (NH3)、C-11-甲硫氨酸 (MET) 和 F-18-氟脱氧葡萄糖 (FDG) 的正电子发射断层扫描 (PET) 已用于评估脑肿瘤。我们的目的是比较它们对疑似脑胶质瘤患者的诊断准确性。方法：前瞻性地将 90 名根据既往 CT/MRI 疑似脑胶质瘤并接受 NH3 PET、MET PET 和 FDG PET 的患者纳入该研究。参考标准是通过组织学或临床和放射学随访建立的。通过目视评估和使用病变与正常白质摄取比（L/WM 比）进行半定量分析来解释图像。 结果：最终诊断出 30 例高级别胶质瘤（HGG）、27 例低级别胶质瘤（LGG）、10 例非胶质瘤和 23 例非肿瘤性病变（NNL）。在视觉评估中，NH3 PET区分肿瘤与NNL的敏感性和特异性分别为62.7%（42/67）和95.7%（22/23），MET PET为94.0%（63/67）和56.5%（13/23），FDG为35.8%（24/67）和65.2%（15/23）宠物。半定量分析显示，在 NH3 和 MET PET 中，脑肿瘤的 L/WM 比率均显着高于 NNL（均 P < 0.001）。 NH3 的敏感性、特异性和曲线下面积 (AUC) 分别为 64.2、100% 和 0.819。 MET 为 89.6、69.6% 和 0.840。此外，HGG 中 NH3、MET 和 FDG PET 的 L/WM 比值均显着高于 LGG（均 P < 0.001）。示踪剂的预测（通过 ROC）准确度（括号中显示的 AUC）对于 NH3 为 86.0% (0.896)，对于 MET 为 87.7% (0.928)，对于 FDG 为 93.0% (0.964)。结论：NH3 PET对脑肿瘤与NNL的鉴别具有较高的特异性，但对LGG的检测敏感性较低。人们发现 MET PET 对于检测脑肿瘤非常有用。然而，与 FDG 一样，在一些 NNL 中经常观察到高 MET 摄入量。 NH3、MET 和 FDG PET 对于评估神经胶质瘤的组织学分级似乎都很有价值。
Background: The treatment of patients with glioma depended on the nature of the lesion and on histological grade of the tumor. Positron emission tomography (PET) using N-13-ammonia (NH3), C-11-methionine (MET) and F-18-fluorodeoxyglucose (FDG) have been used to assess brain tumors. Our aim was to compare their diagnostic accuracies in patients with suspected cerebral glioma.Methods: Ninety patients with suspicion of glioma based on previous CT/MRI, who underwent NH3 PET, MET PET and FDG PET, were prospectively enrolled in the study. The reference standard was established by histology or clinical and radiological follow-up. Images were interpreted by visual evaluation and semi-quantitative analysis using the lesion-to-normal white matter uptake ratio (L/WM ratio).Results: Finally, 30 high-grade gliomas (HGG), 27 low-grade gliomas (LGG), 10 non-glioma tumors and 23 non-neoplastic lesions (NNL) were diagnosed. On visual evaluation, sensitivity and specificity for differentiating tumors from NNL were 62.7% (42/67) and 95.7% (22/23) for NH3 PET, 94.0% (63/67) and 56.5% (13/23) for MET PET, and 35.8% (24/67) and 65.2% (15/23) for FDG PET. On semi-quantitative analysis, brain tumors showed significantly higher L/WM ratios than NNL both in NH3 and MET PET (both P < 0.001). The sensitivity, specificity and the area under the curve (AUC) by receiver operating characteristic (ROC) analysis, respectively, were 64.2, 100% and 0.819 for NH3; and 89.6, 69.6% and 0.840 for MET. Besides, the L/WM ratios of NH3, MET and FDG PET in HGG all significantly higher than that in LGG (all P < 0.001). The predicted (by ROC) accuracy of the tracers (AUC shown in parentheses) were 86.0% (0.896) for NH3, 87.7% (0.928) for MET and 93.0% (0.964) for FDG. While no significant differences in the AUC were seen between them.Conclusion: NH3 PET has remarkably high specificity for the differentiation of brain tumors from NNL, but low sensitivity for the detection of LGG. MET PET was found to be highly useful for detection of brain tumors. However, like FDG, high MET uptake is frequently observed in some NNL. NH3, MET and FDG PET all appears to be valuable for evaluating the histological grade of gliomas.