18F-FDG PET/CT在颅内原发性中枢神经系统淋巴瘤诊断中的价值

Diagnostic value of 18F-FDG PET/CT in intracranial primary central nervous system lymphoma

    摘要
  • 摘要:
    目的 探讨18F-FDG PET/CT显像视觉和半定量分析在颅内原发性中枢神经系统淋巴瘤(PCNSL)诊断中的价值。
    方法 回顾性分析2011年5月至2018年12月于郑州大学第一附属医院行18F-FDG PET/CT检查的45例颅内PCNSL患者男性26例、女性19例，年龄（57.49±2.54）岁的影像资料，并分别与52例脑胶质瘤和60例脑转移瘤患者进行对比，采用视觉分析3组患者的病灶分布和形态特征，半定量分析最大标准化摄取值（SUVmax）、肿瘤与对侧相应部位脑组织SUVmax的比值（T/WM），评价18F-FDG PET/CT在颅内PCNSL诊断中的价值。2组间半定量结果的比较采用独立样本t检验和校正后t检验，2组间诊断效能的比较及鉴别诊断阈值的判断采用受试者工作特征（ROC）曲线进行分析。
    结果 视觉分析结果显示，颅内PCNSL以高摄取18F-FDG的幕上、单发、结节状或团块状病灶为多见，水肿、占位效应及瘤内继发改变不明显。半定量分析结果显示，与脑胶质瘤和脑转移瘤相比，颅内PCNSL的SUVmax最高（脑胶质瘤：9.96±0.48；脑转移瘤：11.97±0.58；颅内PCNSL：26.42±1.17，t=13.02、11.07，均P=0.000），T/WM亦最高（脑胶质瘤：2.99±0.09；脑转移瘤：2.60±0.08；颅内PCNSL：4.37±0.10，t=10.13、13.88，均P=0.000），且差异均有统计学意义。当SUVmax=15.8时，颅内PCNSL与脑胶质瘤鉴别诊断的ROC曲线下面积（AUC）最大（0.982），而当SUVmax=16.8时，颅内PCNSL与脑转移瘤鉴别诊断的AUC最大（0.946）；T/WM=3.395为颅内PCNSL与脑胶质瘤鉴别诊断的最佳阈值，T/WM＝3.220为颅内PCNSL与脑转移瘤鉴别诊断的最佳阈值。
    结论 18F-FDG PET/CT显像可以作为传统影像学诊断颅内PCNSL的有效补充，同时在颅内PCNSL与脑胶质瘤和脑转移瘤的鉴别诊断方面具有显著优势。

     

    Abstract:
    Objective To investigate the diagnostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT visual and semi-quantitative analyses in intracranial primary central nervous system lymphoma (PCNSL).
    Methods PET/CT images of 45 patients with PCNSL who underwent 18F-FDG PET/CT examination in the Department of Nuclear Medicine of the First Affiliated Hospital of Zhengzhou University from May 2011 to December 2018 (26 males and 19 females, 57.49±2.54 years old) were retrospectively reviewed and compared with 52 cases of gliomas and 60 cases of brain metastases to evaluate the value of 18F-FDG PET/CT in the diagnosis of intracranial PCNSL. The lesion distribution and morphological characteristics of the 3 groups of patients were visually analyzed, and the maximum standardized uptake value (SUVmax) and the ratio of SUVmax of tumor to white matter (T/WM) were semi-quantitatively analyzed. The mean comparison between the two groups was performed using independent sample t test and adjusted t test. The comparison of the diagnostic efficacy between the two groups and the judgment of the differential diagnosis threshold were performed using receiver operating characteristic (ROC) curve analysis.
    Results Visually, intracranial PCNSL showed a very high uptake of 18F-FDG in single, focal nodule or mass lesions mostly located in the supratentorial brain. The space-occupying effects of edema, as well as cystic degeneration, were not obvious in PCNSL. Semi-quantitative analysis showed that intracranial PCNSL had the highest SUVmax (gliomas: 9.96±0.48, brain metastases: 11.97±0.58, PCNSL: 26.42±1.17) and T/WM (gliomas: 2.99±0.09, brain metastases: 2.60±0.08, PCNSL: 4.37±0.10) among the three types of tumors with statistical differences (t=13.02 and 11.07, t=10.13 and 13.88, all P=0.000). In the differential diagnosis of intracranial PCNSL and glioma, the area under the ROC curve (AUC) analysis reached the largest value at the SUVmax of 15.8. The AUC for PCNSL and metastatic tumor peaked at the SUVmax of 16.8. The T/WMs of 3.395 and 3.220 were considered the optimal thresholds for the differential diagnosis of intracranial PCNSL from gliomas and brain metastases, respectively.
    Conclusion 18F-FDG PET/CT imaging can effectively complement the traditional diagnosis of intracranial PCNSL, especially in the differential diagnosis of PCNSL from gliomas and brain metastases.

     

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