ISSN 1004-4140
CN 11-3017/P

袁磊磊, 陈谦, 乔真, 等. 18F-FDG PET/CT联合神经元抗体检测诊断神经系统副肿瘤综合征[J]. CT理论与应用研究, 2023, 32(2): 209-215. DOI: 10.15953/j.ctta.2022.070

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引用本文:

袁磊磊, 陈谦, 乔真, 等. 18F-FDG PET/CT联合神经元抗体检测诊断神经系统副肿瘤综合征[J]. CT理论与应用研究, 2023, 32(2): 209-215. DOI: 10.15953/j.ctta.2022.070

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YUAN L L, CHEN Q, QIAO Z, et al. Research on the Application Value of 18F-FDG PET/CT Combined with Neuronal Antibody Detection in the Diagnosis and Treatment of PNS Patients[J]. CT Theory and Applications, 2023, 32(2): 209-215. DOI: 10.15953/j.ctta.2022.070. (in Chinese)

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Citation:

YUAN L L, CHEN Q, QIAO Z, et al. Research on the Application Value of 18F-FDG PET/CT Combined with Neuronal Antibody Detection in the Diagnosis and Treatment of PNS Patients[J]. CT Theory and Applications, 2023, 32(2): 209-215. DOI: 10.15953/j.ctta.2022.070. (in Chinese)

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18F-FDG PET/CT联合神经元抗体检测诊断神经系统副肿瘤综合征

Research on the Application Value of 18F-FDG PET/CT Combined with Neuronal Antibody Detection in the Diagnosis and Treatment of PNS Patients

  • 摘要: 目的:探讨全身<sup<18</sup<F-FDG PET/CT联合神经元抗体检测在神经系统副肿瘤综合征(PNS)患者诊疗中的应用价值。方法:回顾性收集56例临床疑诊PNS患者的临床、神经副肿瘤抗体检测及全身<sup<18</sup<F-FDG PET/CT资料,对照病理及临床随访结果,利用ROC曲线评价PET/CT、神经元抗体及二者联合检测结果的诊断效能。结果:56例疑诊PNS患者中,共有肿瘤患者20例,其中肿瘤伴PNS 19例,肿瘤伴脊髓转移1例。<sup<18</sup<F-FDG PET/CT显像提示肿瘤或可能肿瘤23例,其中20例为真阳性,3例为假阳性(随访结果分别为反流性食管炎、反应性骨改变、颈部炎性病变),其余33例为真阴性;敏感度、特异度、准确度分别为100.0%、91.7%、94.6%。神经元抗体阳性33例,其中PNS伴肿瘤8例(抗Amphiphysin抗体脑炎3例,抗GABAB抗体脑炎2例,抗Yo抗体脑炎1例,抗Hu抗体脑炎2例),PNS不伴肿瘤25例(LGI1抗体脑炎10例,抗Amphiphysin抗体脑炎3例,抗Hu抗体脑炎1例,抗GABAB抗体脑炎3例,抗Yo抗体脑炎3例,抗CASPR2、GAD65、NMDA、PNMA及SOX1抗体脑炎各1例);神经元抗体阴性23例(其中伴肿瘤12例);敏感度、特异度、准确度分别为40.0%、30.6%、33.9%。两种联合检测结果的敏感度、特异度、准确度分别为100.0%、33.3%、57.1%,50.0%、94.4%、78.6%。ROC分析显示AUC分别为0.958(<i<P</i<<0.001;95%CI,0.904~1.000)、0.353(<i<P</i<>0.05;95%CI,0.199~0.506)、0.667(<i<P</i<<0.05;95%CI,0.528~0.806)及0.672(<i<P</i<<0.05;95%CI,0.514~0.830),<sup<18</sup<F-FDG PET/CT及两种联合检测方法具有统计学意义。结论:全身<sup<18</sup<F-FDG PET/CT可作为疑诊PNS患者无创筛查肿瘤的一线检查方法。

     

    Abstract: Objective: To explore the clinical value of whole-body <sup<18</sup<F-FDG PET/CT combined with neuroantibody detection in the diagnosis and treatment of paraneoplastic neurological syndromes  (PNS). Methods: Clinical, laboratory,  and imaging data of 56 hospitalized patients with suspected PNS who underwent systemic <sup<18</sup<F-FDG PET/CT and neuropathic tumor antibody detection were retrospectively collected and followed-up on. ROC curve analysis was performed to compare the diagnostic efficacy of PET/CT, neuronal antibodies, and their combined detection results. Results: Among the 56 patients with suspected PNS, there were 20 with malignant tumors, including 19 cases complicated with PNS and 1 patient with spinal cord metastasis which also le d to neurological symptoms. <sup<18</sup<F-FDG PET/CT imaging indicated tumors or possible tumors in 23 cases, of which 20 cases were true positive, 3 cases were false positive (the follow-up results were reflux esophagitis, reactive bone changes, or inflammatory lesions in the neck), and the remaining 33 cases were true negative. The sensitivity, specificity, and accuracy of PET/CT were 100%, 91.7%, and 94.6%, respectively. There were 33 cases with positive neuroantibodies, including 8 cases of tumors with PNS (3 cases with anti-amphiphysin antibody encephalitis, 2 cases with anti-GABAb antibody encephalitis, 1 case with anti-Yo antibody encephalitis, and 2 cases with anti-Hu antibody encephalitis). Moreover, there were 25 cases without tumors (10 cases with LGI1 antibody encephalitis, 3 cases with anti-amphiphysin antibody encephalitis, 1 case with anti-Hu antibody encephalitis, 3 cases with anti-GABAb antibody encephalitis, 3 cases with anti-Yo antibody encephalitis, 1 case with Anti-caspr2, 1 case with GAD65, 1 case with NMDA, 1 case with PNMA, and 1 case with SOX1 antibody (1 case each). Of these, 23 cases were negative (12 cases with tumor). The sensitivity, specificity, and accuracy of the neuronal antibody test were 40.0%, 30.6%, and 33.9%, respectively. Furthermore, the sensitivity, specificity, and accuracy of the combined detection were 100.0%, 33.3%, 57.1%, 50%, 94.4%, and 78.6%, respectively. ROC analysis showed that the AUC was 0.958 (<i<P</i<=0.000<0.05; 95% CI 0.904~1.000), 0.353  (<i<P</i<=0.070>0.05; 95% CI 0.199~0.506), 0.667 (<i<P</i<=0.040<0.05; 95% CI 0.528~0.806), and 0.672 (<i<P</i<=0.034<0.05; 95% CI 0.514~0.830). Conclusion: Whole-body 18F-FDG PET/CT has the potential to  be the first choice for noninvasive tumor screening in patients with suspected PNS.

     

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