^(11)C-MET PET/CT筛查幕上较低级别胶质瘤IDH和1p/19q分子分型的应用价值  

Application of ^(11)C-MET PET/CT in screening isocitric dehydrogenase and 1p/19q status in supratentorial lower-grade gliomas

作　　者：张姝[1] 王凯[1] 杨子皓 乔真[1] 李晓桐 袁磊磊 艾林[1] Zhang Shu;Wang Kai;Yang Zihao;Qiao Zhen;Li Xiaotong;Yuan Leilei;Ai Lin(Department of Nuclear Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100054,China)

机构地区：[1]首都医科大学附属北京天坛医院核医学科,北京100054

出　　处：《首都医科大学学报》2022年第6期826-833,共8页Journal of Capital Medical University

基　　金：国家自然科学基金面上项目(7192054)。

摘　　要：目的评估^(11)C-蛋氨酸(^(11)C-methionine,^(11)C-MET)正电子发射型计算机断层显像/电子计算机断层显像(positron emission tomography/computed tomography,PET/CT)半定量参数在筛查幕上较低级别胶质瘤(lower-grade glioma,LrGG)异柠檬酸脱氢酶(isocitric dehydrogenase,IDH)突变以及1p/19q共缺失状态的应用价值。方法分析37例幕上较低级别胶质瘤患者术前^(11)C-MET PET/CT图像以及病理学资料。测量^(11)C-MET PET/CT图像上病灶最大肿瘤/正常组织摄取比值(maximum tumor/normal tissue uptake ratio,TNR_(max))、平均肿瘤/正常组织摄取比值(mean TNR,TNR_(mean))以及肿瘤/正常组织摄取比值峰值(peak TNR,TNR_(peak))。根据IDH基因突变以及1p/19q共缺失状态,将患者分为3组:IDH野生型(IDH^(wt)),IDH突变-1p/19q共缺失型(IDH^(mut) 1p/19q^(del))以及IDH突变-1p/19q非共缺失型(IDH^(mut) 1p/19q^(int))。比较不同分子分型的LrGG间的TNR_(max)、TNR_(mean)以及TNR_(peak)。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析单参数对于IDH突变和1p/19q共缺失状态的筛查效能。采用Logistic回归建立联合诊断模型,对预测概率进行ROC分析,评估多参数联合筛查效能。结果TNR_(max)、TNR_(mean)、TNR_(peak)在3组LrGG间的差异有统计学意义(P<0.05)。IDH^(wt)组TNR_(max)、TNR_(mean)、TNR_(peak)最高,其次为IDH^(mut) 1p/19q^(del)组,IDH^(mut) 1p/19q^(int)组最低。IDH wt LrGG的TNR_(max)、TNR_(mean)、TNR_(peak)均高于IDH^(mut) LrGG组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,TNR_(max)、TNR_(mean)、TNR_(peak)筛查LrGG IDH突变的曲线下面积(area under the curve,AUC)分别为0.827、0.847、0.807,以3.09、1.84和2.58为阈值,准确率分别为70.3%、75.7%和75.7%,采用Logistic回归分析构建的筛查模型能提高诊断准确率,AUC值为0.943,灵敏度、特异度和准确率分别为100%、83.3%和94.6%。TNR_(max)、TNR_(mean)、TNR_(peak)筛查LrGG 1p/19q共缺失的AUC分别为0.766�Objective To evaluate the value of ^(11)C-methionine(^(11)C-MET)positron emission tomography/computed tomography(PET/CT)in screening isocitric dehydrogenase(IDH)mutation and 1p/19q co-deletion status in supratentorial lower-grade glioma(LrGG).Methods The preoperative ^(11)C-MET PET/CT images and pathological data of 37 patients with lower-grade supratentorial glioma were retrospectively analyzed.The maximum tumor/normal tissue ratio(TNR_(max)),mean tumor/normal tissue ratio(TNR_(mean))and peak tumor/normal tissue ratio(TNR_(peak))of lesions on were measured.According to IDH gene mutation and 1p/19q co-deletion status,patients were divided into three groups:IDH wild type(IDH^(wt));IDH^(mut)ation-1p/19q co-deletion type(IDH^(mut) 1p/19q^(del))and IDH^(mut)ation-1p/19q^(int)act type(IDH^(mut) 1p/19q^(int)).TNR values of different molecular subtypes of LrGG were compared with each other.The differential diagnostic efficacy of semi-quantitative parameters for different molecular subtypes of LrGG was analyzed using receiver operating characteristic(ROC)curve.Logistic regression was used to establish a joint diagnostic model,and the ROC analysis was conducted to evaluate the predictive efficiency of joint diagnostic model.Results There were significant differences in TNR_(max),TNR_(mean) and TNR_(peak) among the three groups of LrGG(P<0.05).TNR_(max),TNR_(mean) and TNR_(peak) were the highest in the IDH^(wt) group,followed by the IDH^(mut) 1p/19q^(del) group.Semiquantitative values were the lowest in the IDH^(mut) 1p/19q^(int) group.The TNR_(max),TNR_(mean) and TNR_(peak) of IDH^(wt) LrGG were higher than those of IDH^(mut) LrGG,and the difference was statistically significant(P<0.05).The results of ROC analysis showed that the area under the curves(AUCs)of TNR_(max),TNR_(mean),and TNR_(peak) for screening IDH^(mut)ations were 0.827,0.847,and 0.807,with thresholds of 3.09,1.84,and 2.58,respectively,and the accuracy rates were 70.3%、75.7%and 75.7%,respectively.The screening model based on Logistic regression analysis c

关 键 词：较低级别胶质瘤 ^(11)C-蛋氨酸 正电子发射型计算机断层显像 异柠檬酸脱氢酶 1p/19q 

分 类 号：R445.6[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]