Research on the Application Value of 18F-FDG PET/CT Combined with Neuronal Antibody Detection in the Diagnosis and Treatment of PNS Patients
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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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Keywords:
- FDG /
- PET/CT /
- paraneoplastic syndrome /
- paraneoplastic antibody
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图 1 18F-FDG PET/CT检查、神经元抗体检测及联合检测1、2诊断PNS的ROC曲线分析
Figure 1. ROC curve analysis of 18F-FDG PET/CT, neuronal antibody detection, and combined detection 1 and 2
表 1 疑诊PNS患者神经元抗体检测结果分析
Table 1 Analysis of the detection results of the neuronal anstibodies in suspected PNS patients
神经元抗体
检测结果合并肿瘤情况 病例数/例 神经元抗体类型/病例数（例） 阳性 肿瘤患者 8 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 非肿瘤患者 25 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 阴性 肿瘤患者 12 — 非肿瘤患者 11 — 
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表 2 18F-FDG PET/CT检查、神经元抗体检测及联合检测1、2与病理及随访结果对照
Table 2 Comparison of 18F-FDG PET/CT, neuronal antibody detection, and combined detection 1 and 2 with the pathological and follow-up results
检查方法 病理及随访 敏感度/％ 特异度/％ 准确度/％ （+） （ − ） 合计 18F-FDG PET/CT检查 100.0 91.7 94.6 （+） 20 3 23 （ − ） 0 33 33 合计 20 36 56 神经元抗体检测 40.0 30.6 33.9 （+） 8 25 33 （ − ） 12 11 23 合计 20 36 56 联合检测1 100.0 33.3 57.1 （+） 20 24 44 （ − ） 0 12 12 合计 20 36 56 联合检测2 50.0 94.4 78.6 （+） 8 2 10 （ − ） 12 34 46 合计 20 36 56
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