背景:评估和比较[18F]FLT-PET与ceMRI对脑肿瘤或其他局灶性病变患者的诊断能力。
方法:这项回顾性研究纳入了121例疑似脑瘤或脑瘤手术后的患者(61例女性,60名男性,平均年龄37.3岁,范围1-80年)。所有患者均接受[18F]FLT-PET/MRI和钆造影剂应用。在118名患者中,做出了最终诊断,通过组织病理学或随访证实。整个研究组的ceMRI和[18F]FLT-PET之间建立了协议。Further,计算了ceMRI和[18F]FLT-PET的敏感性和特异性,以区分高级别与高级别低级肿瘤,高档vs.低度肿瘤与非肿瘤病变一起,并将高度肿瘤与所有其他已证实的病变区分开。
结果:[18F]119例(98%),FLT-PET和ceMRI表现一致。对64例经证实的神经胶质瘤患者的子集进行了更仔细的分析,PET和CEMRI的敏感性和特异性相同(90%和84%,分别)用于区分低级别肿瘤和高级别肿瘤,如果对比增强和[18F]FLT摄取被认为是高级别肿瘤的标志。对于区分高级别肿瘤与低级别肿瘤和非肿瘤性病因的病变(例如,炎性病变或治疗后的变化)通过视觉评估在93例患者的亚组中,PET和ceMRI的灵敏度均为90%,而PET的特异性(61%)略高于ceMRI(57%).通过接收机工作特性分析,敏感性和特异性分别为82%和74%,分别,当肿瘤中SUVmax的阈值设置为0.9g/ml时。
结论:我们证明了[18F]FLT积累与在ceMRI上可见的对比增强的普遍非常高的相关性,并且在区分高级别肿瘤和低级别肿瘤和其他病因病变的两种模式中具有相当的诊断率。
BACKGROUND: To evaluate and compare the diagnostic power of [18F]FLT-PET with ceMRI in patients with brain tumours or other focal lesions.
METHODS: 121 patients with suspected brain tumour or those after brain tumour surgery were enroled in this retrospective study (61 females, 60 males, mean age 37.3 years, range 1-80 years). All patients underwent [18F]FLT-PET/MRI with gadolinium contrast agent application. In 118 of these patients, a final diagnosis was made, verified by histopathology or by follow-up. Agreement between ceMRI and [18F]FLT-PET of the whole study group was established. Further, sensitivity and specificity of ceMRI and [18F]FLT-PET were calculated for differentiation of high-grade vs. low-grade tumours, high-grade vs. low-grade tumours together with non-tumour lesions and for differentiation of high-grade tumours from all other verified lesions.
RESULTS: [18F]FLT-PET and ceMRI findings were concordant in 119 cases (98%). On closer analysis of a subset of 64 patients with verified gliomas, the sensitivity and specificity of both PET and ceMRI were identical (90% and 84%, respectively) for differentiating low-grade from high-grade tumours, if the contrast enhancement and [18F]FLT uptake were considered as hallmarks of high-grade tumour. For differentiation of high-grade tumours from low-grade tumours and lesions of nontumorous aetiology (e.g., inflammatory lesions or post-therapeutic changes) in a subgroup of 93 patients by visual evaluation, the sensitivity of both PET and ceMRI was 90%, whereas the specificity of PET was slightly higher (61%) compared to ceMRI (57%). By receiver operating characteristic analysis, the sensitivity and specificity were 82% and 74%, respectively, when the threshold of SUVmax in the tumour was set to 0.9 g/ml.
CONCLUSIONS: We demonstrated a generally very high correlation of [18F]FLT accumulation with contrast enhancement visible on ceMRI and a comparable diagnostic yield in both modalities for differentiating high-grade tumours from low-grade tumours and lesions of other aetiology.