摘要
目的探讨蛋氨酸(11C-MET)PET显像对术前胶质瘤的分级判断及其对异柠檬酸脱氢酶1(IDH1)基因突变的预测价值。方法回顾性分析2012年2月至2017年11月间于华山医院PET中心行11C-MET PET显像的118例术前脑胶质瘤患者(男70例,女48例;中位年龄45岁,范围10~71岁;Ⅱ级65例、Ⅲ级34例、Ⅳ级19例),基于病灶对其11C-MET摄取值进行半定量分析,计算最大标准摄取值(SUVmax)、标准摄取峰值(SUVpeak)、病灶SUVmax/正常对侧脑皮质平均标准摄取值(TBR)。应用两独立样本t检验及单因素方差分析评价11C-MET脑PET显像对不同级别胶质瘤间的鉴别效能;并结合IDH1免疫组织化学染色结果,应用受试者工作特征(ROC)曲线进一步分析11C-MET PET半定量参数对IDH1基因突变状态的预测效能。结果低级别胶质瘤(LGG;Ⅱ级)与高级别胶质瘤(HGG;Ⅲ和Ⅳ级)组SUVmax(2.458±1.100和3.828±1.540;t=5.624,P<0.01)、SUVpeak(2.160±0.991和3.261±1.319;t=5.175,P<0.01)、TBR(2.283±0.942和3.434±1.395;t=5.328,P<0.01)差异均有统计学意义;Ⅱ、Ⅲ和Ⅳ级胶质瘤亚组的SUVmax(2.458±1.100、3.591±1.611和4.251±1.343;F=17.67,P<0.01)、SUVpeak(2.160±0.991、3.040±1.335和3.656±1.225;F=15.48,P<0.01)和TBR(2.283±0.942、3.010±1.242和4.192±1.358;F=22.73,P<0.01)间的差异均有统计学意义,SUVmax、SUVpeak、TBR分别在Ⅱ与Ⅲ级胶质瘤间、Ⅱ和Ⅳ级胶质瘤间,TBR在Ⅲ和Ⅳ级胶质瘤间的差异有统计学意义(均P<0.01)。单参数分析中,SUVmax预测IDH1突变效能最佳[曲线下面积(AUC)=0.808,z=7.193,P<0.01];多参数分析中,SUVmax+SUVpeak预测效能最佳(AUC=0.852,z=9.115,P<0.01)。Ⅱ级胶质瘤(n=55)中,IDH1基因突变者(n=41)的TBR低于IDH1基因野生型者(n=14;2.152±0.759与2.793±1.208;t=2.326,P=0.02),而含少突成分的胶质瘤患者(n=26)的TBR高于单纯IDH1突变者(n=18;2.383±0.825与1.854±0.478;t=2.447,P=0.02)。结论11C-MET脑PET显像半定量参数(SUVmax、SUVpeak、TBR)对术前脑胶质瘤有很好的分级判断效能。SUVmax作为单一参数对IDH1基因突变的预测效能最佳,SUVmax+SUVpeak的多参数预测效能最好。胶质瘤中含少突成分会使11C-MET摄取值增高,在一定程度上影响11C-MET对胶质瘤级别的判断效能。
Objective To assess the preoperative 11C-methionine(11C-MET)PET imaging in glioma grading efficacy and its predictive value for isocitrate dehydrogenase enzyme 1(IDH1)gene mutation status.Methods A total of 118 glioma cases(70 males,48 females;median age 45 years,age range:10-71 years;Ⅱgrade 65 cases,Ⅲgrade 34 cases,Ⅳgrade 19 cases)received 11C-MET PET imaging in PET Center of Huashan Hospital from February 2012 to November 2017 were retrospectively analyzed.Lesion-based semi-quantitative analysis was conducted on the 11C-MET imaging.Maximum standardized uptake value(SUVmax),peak standardized uptake value(SUVpeak),tumor-to-background ratio(TBR;SUVmax in lesion/mean standardized uptake value(SUVmean)in normal contralateral cortex)were calculated.Independent-sample t test and one-way analysis of variance were applied to assess the differentiating efficacy of 11C-MET PET imaging for different glioma groups.Based on IDH1 immunohistochemical staining results,predictive efficacy of 11C-MET PET diagnostic parameters on IDH1 mutation status in glioma patients was further analyzed with receiver operating characteristic(ROC)curve analysis.Results Low-grade glioma(LGG;gradeⅡ)group showed significant differences from high-grade glioma(HGG;gradeⅢ-Ⅳ)group in SUVmax(2.458±1.100 vs 3.828±1.540;t=5.624,P<0.01),SUVpeak(2.160±0.991 vs 3.261±1.319;t=5.175,P<0.01)and TBR(2.283±0.942 vs 3.434±1.395;t=5.328,P<0.01).SUVmax(2.458±1.100,3.591±1.611 and 4.251±1.343;F=17.67,P<0.01),SUVpeak(2.160±0.991,3.040±1.335 and 3.656±1.225;F=15.48,P<0.01)and TBR(2.283±0.942,3.010±1.242 and 4.192±1.358;F=22.73,P<0.01)were different in gradeⅡ,ⅢandⅣglioma subgroups.SUVmax,SUVpeak and TBR all showed significant differences between gradeⅡand gradeⅢgliomas,gradeⅡand gradeⅣgliomas,and there were also statistical differences between gradeⅢand gradeⅣglioma with TBR(all P<0.01).SUVmax indicated the best single-parameter prediction performance(area under curve(AUC)=0.808,z=7.193,P<0.01),while the SUVmax+SUVpeak showed the best performance(AUC=0.852,z=9.115,P<0.01).In the subgroup of gradeⅡ(n=55),TBR of patients with IDH1 gene mutation(n=41)was lower than that of patients with IDH1 wild-types(n=14;2.152±0.759 vs 2.793±1.208;t=2.326,P=0.02),while TBR of those with oligodendrogenic components(n=26)was higher than that of patients with IDH1 gene mutation only(n=18;2.383±0.825 vs 1.854±0.478;t=2.447,P=0.02).Conclusions Preoperative semi-quantitative parameters(SUVmax,SUVpeak,TBR)of 11C-MET brain PET imaging have satisfactory grading discrimination performance for glioma patients.SUVmax is the best predictor for IDH1 mutation as a single parameter,while SUVmax+SUVpeak showed the most optimized predictive ability.The oligodendrogenic components in glioma can increase the uptake of 11C-MET,which may affect the effectiveness of 11C-MET in determining glioma grade to some extent.
作者
周维燕
华逢春
肖见飞
李明
朱毓华
华涛
管一晖
Zhou Weiyan;Hua Fengchun;Xiao Jianfei;Li Ming;Zhu Yuhua;Hua Tao;Guan Yihui(PET Center of Huashan Hospital,Fudan University,Shanghai 200235,China)
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2020年第3期153-158,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
上海市科学技术委员会科研项目(18411952100,17411953500,16411968700)。
