^(13)N-NH_3和^(18)F-FDG PET-CT联合显像在原发性颅内肿瘤中的应用价值  

Application of ^(13)N-ammonia and ^(18)F-FDG dual-tracer PET-CT in primary brain tumors

作　　者：赵彬良 史新冲[1] 郑梓杰 易畅[1] 罗淦华 张祥松[1] ZHAO Bin-Hang;SHI Xin-chong;ZHENG Zi-jie;YI Chang;LUO Gan-hua;ZHANG Xiang-song(Department of Nuclear Medicine,The First Affiliated Hospital of Sun Yat-Sen University,Guangdong 510080,China)

机构地区：[1]中山大学附属第一医院核医学科,广东广州510080

出　　处：《影像诊断与介入放射学》2018年第4期295-300,共6页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金资助项目(81501509);广州市科技计划基金资助项目(201607010353)

摘　　要：目的探讨^(13)N-NH_3(^(13)N-ammonia)与^(18)F-FDG(^(18)F-fluorodeoxyglucose)两种示踪剂的联合显像鉴别不同类型的原发性颅内肿瘤的应用。方法回顾性分析79例原发性脑肿瘤病例,包括12例I级脑膜瘤(benign meningioma,BMEN),5例Ⅱ~Ⅲ级脑膜瘤(invasive meningioma,I-MEN),15例Ⅱ级胶质瘤(low-grade glioma,LGG),32例高级别胶质瘤(high-grade glioma,HGG)以及15例原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL),分别进行^(18)F-FDG和^(13)N-NH_3PET-CT显像,以肿瘤/脑灰质的放射性计数比值(tumor-to-gray matter ratios,T/G值)为半定量分析指标,采用方差分析比较五组肿瘤摄取^(18)F-FDG和^(13)N-NH_3的差异;通过判别函数分析两种示踪剂联合使用的鉴别诊断效果。结果两种示踪剂联合PET显像对五组脑肿瘤(B-MEN、I-MEN、LGG、HGG、PCNSL)的判别符合率分别为83.33%、25.00%、93.75%、71.88%和86.67%;两种示踪剂联合PET显像的整体判别符合率为78.48%,高于单用^(18)F-FDG和^(13)N-NH_3PET显像的判别符合率(63.29%、58.23%)。结论 ^(13)N-NH_3和^(18)F-FDG PET联合显像有助于鉴别不同病理组织类型的原发性脑肿瘤,显著提高诊断的准确性。Objective To investigate the value of ^13N-ammonia and ^18F-fluorodeoxyglucose （FDG） in differential diagnosis of primary brain tumors. Methods 79 patients with benign meningiomas （12）, invasive meningiomas （5）, low-grade gliomas （15）, high-grade gliomas （32）, and primary central nervous system lymphomas （15） underwent 13N-ammonia and 18F-FDG PET-CT. Semi-quantitative analysis of tumor-to-gray matter ratios was used to evaluate tracer uptakes among the five tumor groups. After calculating canonical discriminant functions, cross validation was performed to evaluate the differential efficacy of dual tracers. Results Discriminant analysis showed diagnostic accuracy of ^13N-ammonia and ^18F-FDG PET-CT to be 83.33% for benign meningioma, 25.00% for invasive meningioma, 93.75% for low-grade glioma, 71.88% for high-grade glioma, and 86.67% for primary central nervous system lymphoma. The overall accuracy of the dual tracer （78.48%） was higher than that of 18F-FDG （63.29%） and ^13N-ammoni （58.23%） PET-CT. Conclusion ^13N-ammonia and ^18F-FDG dual tracer PET-CT has potential in characterizing the metabolic phenotypes of brain tumors.

关 键 词：13N标记的氨水 ^18F 2-氟-2-脱氧-D-葡萄糖 脑肿瘤 双示踪剂 正电子发射计算机断层成像 

分 类 号：R739.41[医药卫生—肿瘤] R730.44[医药卫生—临床医学]