11C-蛋氨酸PET/CT在脑干胶质瘤诊断及治疗中的价值  

The value of 11C-methionine PET/CT in diagnosis and treatment of brain stem glioma

作　　者：武玉亮[2] 李德岭[2] 王亚明[3] 于海 乔真[1] 陈谦[1] 王凯[1] 艾林[1] 张力伟[2] Zhao Xiaobin;Wu Yuliang;Li Deling;Wang Yarning;Yu Hai;Qiao Zhen;Chen Qian;Wang Kai;Ai Lin;Zhang Liwei(Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Bering 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院核医学科,100050 [2]首都医科大学附属北京天坛医院神经外科,100050 [3]中国人民解放军海军总医院神经外科

出　　处：《中华神经外科杂志》2018年第4期338-343,共6页Chinese Journal of Neurosurgery

基　　金：2016年度科技创新基地培育与发展工程子项目（2060288）;国家自然科学基金（81527805）;国家“十二五”科技支撑计划（2014BAI04801,2015BAI12B04）;北京市医院管理局临床医学发展专项（ZYLX201608）;北京市自然科学基金（7161004）

摘　　要：目的 探讨11C-蛋氨酸正电子发射断层显像术/CT （MET-PET/CT）在判断脑干胶质瘤（BSG）级别（WHO分级）和指导手术中的价值.方法 前瞻性纳入2015年1月至2016年12月首都医科大学附属北京天坛医院神经外科经头颅MRI疑诊为BSG的患者63例.其中20例仅行立体定向活检术和MET-PET/CT检查;43例行肿瘤切除术者,按随机数字表法分为基于MET-PET/CT的多模态导航组（21例）和基于MRI导航组（22例）.比较MET-PET/CT的相关参数[MET的标准化最大摄取值（SUVmax）、平均摄取值（SUVmean）、最大摄取比（TBRmax）、平均摄取比（TBRmean）及总体摄取值（TLMU）]在高、低级别胶质瘤中的差异及其诊断BSG级别的准确性,比较不同导航方法切除高级别胶质瘤比率的差异.结果 63例中,WHO分级为低级别胶质瘤者26例,高级别者37例.术前行MET-PET/CT检查的41例结果显示,与低级别胶质瘤患者比较,高级别胶质瘤者的SUVmax、SUVmean、TBRmax、TBRmean均增高,差异均有统计学意义（均P＜0.01）;TLMU差异无统计学意义（P=0.506）.SUVmax、SUVmean、TBRmax、TBRmean诊断高级别胶质瘤的准确度分别为70.7％（29/41）、63.4％（26/41）、80.5％ （33/41）、73.2％ （30/41）;特异度均为91.7％（11/12）.多模态导航组切除高级别胶质瘤的比率为81.0％（17/21）,高于MRI导航组的36.4％ （8/22） （P =0.005）.43例手术患者的中位随访时间为12.9（0.3 ～25.6）个月,多模态导航组与MRI导航组的中位生存时间差异无统计学意义（11.9个月对比14.1个月,P=0.289）.结论 MET-PET/CT的参数与肿瘤的级别有关,诊断肿瘤级别的准确度和特异度均较高;与MRI导航比较,多模态导航能指导切除更多的高级别肿瘤组织.Objective To explore the value of 11C-methionine （MET）-PET/CT in grading brain stem glioma （BSG） and guiding its microsurgical resection.Methods A prospective study population comprised 63 patients who underwent MRI scans demonstrating suspicious BSG at Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University from January 2015 to December 2016.Among them,20 patients only received stereotactic biopsy and MET-PET/CT scanning.The remaining 43 patients included 22 who underwent tumor resection under multi-modality guidance based on MET-PET/CT and 21 who received MR-guided resection.Semi-quantitative parameters including the maximal standardized uptake value （SUVmax）,mean SUV （SUVmean）,maximal tumor-to-background ratio （TBRmax）,mean TBR （TBRmean） and total lesion methionine uptake （TLMU） obtained from presurgical MET-PET/CT images were compared between higher and lower tumor grading and their accuracy for indicating tumor grading.The ratio of high grade glioma resection was compared between 2 cohorts of patients.Results Out of all 63 patients,37 had high grade gliomas and the other 26 patients had low grade gliomas.The SUVmax,SUVmean,TBRmax and TBRmean of high grade gliomas were higher than those of low grade gliomas （all P 〈 0.01）,while TLMU showed no significant difference between 2 cohorts （P =0.506）.The accuracy for diagnosis of high grade glioma was 70.7% （29/41）,63.4% （26/41）,80.5% （33/41） and 73.2% （30/41）,respectively,and the specificity was 91.7% （11/12）.Multiple modality-guided group had larger ratio of high grade tumor resection than MRI-guided group （81.0% vs.36.4%,P =0.005）.Forty-three patients undergoing microsurgical resection were followed up for an average of 12.9 months （0.3-25.4 months）,and the median survival time in multiple modality-and MRI-guided cohorts were 11.9 and 14.1 months,respectively （P =0.289）.Conclusions MET-PET/CT parameters are associated with histological grade and demonstrate good accuracy

关 键 词：脑干肿瘤 神经胶质瘤 正电子发射断层显像术 11-蛋氨酸 

分 类 号：R730.44[医药卫生—肿瘤]