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自身免疫性脑炎18F-FDG PET/MR表现的初步研究OA北大核心CSTPCD

Preliminary study for 18F-FDG PET/MR findings of autoimmune encephalitis

中文摘要英文摘要

目的 探索自身免疫性脑炎(autoimmune encephalitis,AE)患者18F-氟代脱氧葡萄糖(fludeoxyglucose,FDG)正电子发射/磁共振计算机断层显像(positron emission tomography/magnetic resonance,PET/MR)表现,寻找提高疾病诊断效能的影像学标记物.材料与方法 回顾性分析25例AE患者(AE组)和11例健康对照(healthy controls,HC)(HC组)的资料.所有研究对象均采集头颅18F-FDG PET/MR影像.首先,使用统计参数图12(statistical parametric mapping 12,SPM12)处理包得出AE组FDG摄取异常脑区.然后,使用后处理工作站多模态脑分析软件提取脑区体积/全脑体积(volume/total intracranial volume,volume/TIV)和平均标准化摄取率(standardized uptake value ratio,SUVr)参数,比较AE组与HC组各个脑区volume/TIV和SUVr的组间差异,并分别选取volume/TIV和SUVr有显著差异的脑区绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算单一定量参数及定量参数两两联合的诊断效能.最后,进行DeLong检验选择最佳模型,绘制联合诊断校准曲线和决策曲线评估预测模型的准确性,置换检验用于评估统计量的显著性.结果 SPM12的分析显示,AE组脑干和小脑FDG摄取增高(P<0.001),而双侧额叶、顶叶、右侧枕叶FDG摄取减低(P<0.001).脑结构分析结果显示岛叶、扣带回、距状回volume/TIV减低(P<0.05),中扣带回、顶叶、楔叶、枕外侧回SUVr减低(P<0.05).ROC曲线分析发现左侧距状回的volume/TIV和左侧中扣带回的SUVr联合诊断效能(曲线下面积=0.964)最高.DeLong检验显示定量参数两两联合诊断效能与单一参数诊断效能差异具有统计学意义(P<0.05).校准曲线显示诊断模型的校准度一般,但决策曲线显示在一定风险阈值范围内患者可获得比较高的净收益.置换检验显示AE组及HC组的左侧距状回的volume/TIV和左侧中扣带回的SUVr之间差异具有统计学意义.结论 AE患者18F-FDG PET/MR存在某些特定脑区FDG代谢异常和脑体积改变,左侧距状回的volume/TIV和左侧中扣带回SUVr两个参数联合是潜在诊断AE的生物学标记物.

Objective:To investigate the image findings of autoimmune encephalitis (AE) based on 18F-fludeoxyglucose positron emission tomography/magnetic resonance (18F-FDG PET/MR) images and explore imaging markers that can improve the diagnostic efficacy of AE. Materials and Methods:Twenty-five patients with AE (AE group) and 11 healthy controls (HC) group were included in this study. All subjects were undergoing head 18F-FDG PET/MR scan. The areas of brain abnormal FDG uptake in AE group were obtained using statistical parametric mapping 12 (SPM12) processing package. The volume/total intracranial volume (volume/TIV) and average standardized uptake value ratio (SUVr) of brain areas were extracted using multimodal brain analysis software,and statistical analysis was performed to obtain the differences between the AE group and the HC group. Brain regions with significant differences in volume/TIV and SUVr were selected respectively to make receiver operating characteristic (ROC) curves,and the diagnostic efficiency of single parameters and their pairwise combinations were calculated. DeLong test was performed predict the best model. Calibration curve and decision curve were drawn to evaluate the accuracy of the prediction model. Permutation testing was employed to evaluate the statistical significance. Results:Analysis using SPM12 showed the abnormal FDG uptake areas in AE group increased in brain stem and cerebellum (P<0.001),and decreased in bilateral frontal,parietal and right occipital lobes (P<0.001). The results of brain structural analysis showed that the volume/TIV of insula,cingulate gyrus and talar gyrus decreased (P<0.05),SUVr decreased in the middle cingulate gyrus,parietal lobe,cuneus and lateral occipital gyrus (P<0.05). The volume/TIV of the left talar gyrus and the SUVr of the left middle cingulate gyrus were the two parameters with the most significant differences between the two groups. The ROC curve found that the combination of the volume/TIV of the left talar gyrus and the SUVr of the left middle cingulate gyrus had the highest diagnostic efficiency (area under the curve=0.964). DeLong test showed that there was a significant difference between the diagnostic efficacy of any two quantitative parameters combined with any single parameter (P<0.05). The calibration curve showed that the calibration of the diagnostic model was general,but the decision curve showed that patients could obtain relatively high net benefits within a certain risk threshold. Permutation test showed that there were significant differences in volume/TIV of the left calcarine gyrus and SUVr of the left middle cingulate gyrus between AE group and HC group. Conclusions:Multiple brain regions with FDG metabolism abnormalities and brain volume changes are found in 18F-FDG PET/MR of AE patients. The combination of the volume/TIV of the left talar gyrus and the SUVr of the left middle cingulate gyrus is a potential biomarker of diagnosing AE.

王悦;白书维;张焱;黄干;张晨鹏;郝勇;刘建军;邵泓达

上海交通大学医学院附属仁济医院核医学科,上海 200127上海临床研究中心,上海 200122上海交通大学医学院附属仁济医院神经内科,上海 200127

临床医学

脑炎自身免疫性脑炎影像学表现正电子发射断层显像磁共振成像

encephalitisautoimmune encephalitisimaging findingspositron emission tomographymagnetic resonance imaging

《磁共振成像》 2024 (007)

15-20 / 6

国家自然科学基金项目(编号:82171896) National Natural Science Foundation of China(No.82171896).

10.12015/issn.1674-8034.2024.07.003

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