Comparison of the Value of PET/CT and Multimodal MRI in the Differential Diagnosis of Glioma Recurrence and Radiation Brain Injury

doi:10.12114/j.issn.1007-9572.2018.00.451

Abstract

Abstract: Background　The surgical clearance rate of gliomas is less than 30%.Postoperative combined radiotherapy is widely used in clinical practice，but the proportion of radioactive damage accounts for 20% of the total number of radiotherapy.Glioma recurrence is similar to signs of radiation-induced brain injury，but the treatment direction is quite different.How to accurately identify glioma recurrence and radiation-induced brain injury as early as possible is of great significance for subsequent treatment，and it is also the difficulty and focus of current treatment.Objective　To investigate the value of positron emission computed tomography（PET/CT） and multimodal magnetic resonance imaging（MRI） in the diagnosis of glioma recurrence and radiation-induced brain injury.Methods　From February 2016 to January 2017，153 patients with glioma in the Department of Oncology，Yinzhou Hospital Affiliated to Medical School of Ningbo University who underwent postoperative radiotherapy were recurited.PET/CT and multimodal MRI were performed 3 to 6 months after radiotherapy.The patients were followed up for 12 months after radiotherapy.According to the prognosis，they were divided into a good prognosis group and a poor prognosis group.The clinical data，PET/CT index 〔standard uptake value（SUV），lesion normal ratio（L/N）〕 and multimodal MRI index 〔（local cerebral blood volume（rCBV），mean transit time（rMTT），local cerebral blood flow（rCBF），choline/creatinine ratio（Cho/Cr），Cho/N-acetylaspartate ratio（Cho/NAA），apparent diffusion coefficient（ADC）〕 were compared.The receiver operating characteristic（ROC） curve was used to analyze the value of each index in identifying glioma recurrence and radiation-induced brain injury.Results　After the follow-up，6 patients were lost，and the data of 147 patients were collected.There were 107 patients with good prognosis and 40 patients with poor prognosis，including 21 patients with radiation-induced brain injury and 19 patients with glioma recurrence.There were no significant differences in gender，age，hypertension，diabetes，coronary heart disease，stroke detection rate，rMTT and ADC between the good prognosis group and the poor prognosis group（P>0.05）．The WHO pathological grade，SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in the poor prognosis group were higher than those in the good prognosis group（P<0.05）．There were no significant differences in gender，age，WHO pathological grade，hypertension，diabetes，coronary heart disease，stroke detection rate，rMTT and ADC between patients with glioma recurrence and radiation-induced brain injury（P>0.05）．SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in patients with glioma recurrence were higher than those in radiation-induced brain injury（P<0.05）．The AUC of SUV，L/N，rCBV，rCBF，Cho/Cr，Cho/NAA to identify glioma recurrence and radiation brain injury were 0.887，0.837，0.950，0.937，0.865，0.902.The AUC of rCBV for cerebral glioma recurrence and radiation-induced brain injury was higher than L/N and Cho/Cr（Z=4.173，P<0.001；Z=3.261，P<0.001）．The best cut-off point for rCBV to distinguish glioma recurrence and radiation brain injury was 1.442，the sensitivity and specificity was 90.48% and 94.74%，respectively.Conclusion　Among the patients who underwent postoperative radiotherapy，the SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in patients with poor prognosis are significantly increased.The above indicators in patients with glioma recurrence are higher than those in patients with radiation-induced brain injury.Multimodal MRI is better for distinguishing glioma recurrence and radiation-induced brain injury than PET/CT，especially rCBV，which can provide a basis for clinical treatment.

Key words: Glioma, Positron-emission tomography, Magnetic resonance imaging, Glioma recurrence, Radiation-induced brain injury

摘要： 背景　脑胶质瘤单纯依靠手术清除率低于30%，术后结合放疗在临床广泛应用，但放射性脑损伤比例占放疗总数的20%。脑胶质瘤复发与放射性脑损伤的体征表现相似，但治疗方法截然不同。如何尽早准确判别脑胶质瘤复发和放射性脑损伤对后续治疗意义重大，亦是当前治疗的难点并重点。目的　探讨正电子发射计算机断层显像（PET/CT）及多模态磁共振成像（MRI）鉴别脑胶质瘤复发与放射性脑损伤的价值。方法　选取2016年2月—2017年1月宁波大学医学院附属鄞州医院肿瘤科收治手术治疗后放疗的脑胶质瘤患者153例。放疗结束后3~6个月行PET/CT和多模态MRI复查，放疗结束后随访12个月，根据患者转归分为预后良好组及预后不良组。比较患者临床资料、PET/CT指标〔标准摄取值（SUV）、病灶正常组织比（L/N）〕及多模态MRI指标〔局部脑血容量（rCBV）、平均通过时间（rMTT）、局部脑血流量（rCBF）、胆碱/肌酸比值（Cho/Cr）、Cho/N-乙酰天门冬氨酸比值（Cho/NAA）、表观弥散系数（ADC）〕。绘制受试者工作特征（ROC）曲线分析各指标鉴别脑胶质瘤复发与放射性脑损伤的价值。结果　随访结束后，失访6例，共完整收集147例患者有效数据。预后良好组107例，预后不良组40例，其中放射性脑损伤21例，肿瘤复发19例。预后良好组与预后不良组患者性别、年龄、高血压、糖尿病、冠心病、脑卒中检出率、rMTT及ADC比较，差异均无统计学意义（P>0.05）。预后不良组患者世界卫生组织（WHO）病理分级、SUV、L/N、rCBV、rCBF、Cho/Cr及Cho/NAA高于预后良好组（P<0.05）。脑胶质瘤复发与放射性脑损伤患者性别、年龄、WHO病理分级、高血压、糖尿病、冠心病、脑卒中检出率、rMTT及ADC比较，差异均无统计学意义（P>0.05）。脑胶质瘤复发患者SUV、L/N、rCBV、rCBF、Cho/Cr及Cho/NAA高于放射性脑损伤（P<0.05）。SUV、L/N、rCBV、rCBF、Cho/Cr、Cho/NAA鉴别脑胶质瘤复发与放射性脑损伤的ROC曲线下面积（AUC）为0.887、0.837、0.950、0.937、0.865、0.902。rCBV鉴别脑胶质瘤复发与放射性脑损伤的AUC高于L/N、Cho/Cr（Z=4.173，P<0.001；Z=3.261，P<0.001），rCBV鉴别脑胶质瘤复发与放射性脑损伤的最佳截点为1.442，灵敏度、特异度分别为90.48%、94.74%。结论　手术治疗后放疗的预后不良的脑胶质瘤患者SUV、L/N、rCBV、rCBF、Cho/Cr及Cho/NAA明显升高，同时脑胶质瘤复发患者以上指标高于放射性脑损伤患者，多模态MRI指标对鉴别脑胶质瘤复发与放射性脑损伤能力较PET/CT更佳，尤以rCBV最佳，可为临床治疗提供依据。

关键词: 神经胶质瘤, 正电子发射断层显像术, 磁共振成像, 胶质瘤复发, 放射性脑损伤

CHEN Mengda,LI Qiang,WANG Youliang, et al. Comparison of the Value of PET/CT and Multimodal MRI in the Differential Diagnosis of Glioma Recurrence and Radiation Brain Injury　[J]. Chinese General Practice, 2019, 22(11): 1312-1318. DOI: 10.12114/j.issn.1007-9572.2018.00.451.
陈孟达,李强,王友良等. 正电子发射计算机断层显像与多模态磁共振成像鉴别脑胶质瘤术后肿瘤复发与放射性脑损伤的价值研究[J]. 中国全科医学, 2019, 22(11): 1312-1318. DOI: 10.12114/j.issn.1007-9572.2018.00.451.

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