背景:进行性多灶性白质脑病(PML)是由约翰·坎宁安病毒引起的中枢神经系统脱髓鞘疾病。核磁共振成像,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。这项初步研究的目的是评估酰胺质子转移(APT)成像区分PML与PCNSL和GBM的潜力。
方法:PML患者(n=4;两名男性;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),对2021年1月至2022年9月期间接受APT-CESTMRI检查的GBM(n=11;6名男性;平均年龄65.0±15.2岁)进行回顾性评估.使用病变内的感兴趣区域在APT成像上测量磁化传递比不对称性(MTRasym)值。接收器工作特性曲线分析用于确定MTRasym的诊断截止值。
结果:PML组的MTRasym平均值为0.005±0.005,PCNSL组0.025±0.005,GBM组0.025±0.009。PML和PCNSL的MTRasym差异有统计学意义(P=0.023)。PML和GBM之间(P=0.015)。为了区分PML和PCNSL,0.0165的MTRasym阈值给出了诊断灵敏度,特异性,正预测值,阴性预测值为100%(全部)。为了区分PML和GBM,0.015的MTRasym阈值给出了诊断灵敏度,特异性,正预测值,阴性预测值为100%,90.9%,80.0%,100%,分别。
结论:从APT成像获得的MTRasym值允许将PML患者与PCNSL或GBM患者清楚区分开来。
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 (MTRasym) 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 MTRasym.
The mean MTRasym 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 MTRasym between PML and PCNSL (P = 0.023), and between PML and GBM (P = 0.015). For differentiating PML from PCNSL, an MTRasym threshold of 0.0165 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100% (all). For differentiating PML from GBM, an MTRasym threshold of 0.015 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 90.9%, 80.0%, and 100%, respectively.
MTRasym values obtained from APT imaging allowed patients with PML to be clearly discriminated from patients with PCNSL or GBM.