ISSN 1004-4140
CN 11-3017/P
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)
.| 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) .
|
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.
| [1] |
YAN J, CHEN Z, LIANG Y, et al. Anti-CV2/CRMP5 antibody-positive paraneoplastic neurological syndromes with chronic intestinal pseudo-obstruction in a small-cell lung cancer patient: A case report and literature review[J]. The Journal of International Medical Research, 2020, 48(12): 1220774018.
|
| [2] |
SUNDERMANN B, SCHRODER J B, WARNECKE T, et al. Imaging workup of suspected classical paraneoplastic neurological syndromes: A systematic review and retrospective analysis of 18F-FDG-PET-CT[J]. Academic Radiology, 2017, 24(10): 1195−1202. doi: 10.1016/j.acra.2017.03.022
|
| [3] |
SHEIKHBAHAEI S, MARCUS C V, FRAGOMENI R S, et al. Whole-body 18F-FDG PET and 18F-FDG PET/CT in patients with suspected paraneoplastic syndrome: A systematic review and Meta-analysis of diagnostic accuracy[J]. Journal of Nuclear Medicine, 2017, 58(7): 1031−1036. doi: 10.2967/jnumed.116.183905
|
| [4] |
BINKS S, Uy C, HONNORAT J, et al. Paraneoplastic neurological syndromes: A practical approach to diagnosis and management[J]. Practical Neurology, 2022, 22(1): 19−31. doi: 10.1136/practneurol-2021-003073
|
| [5] |
LAMBERT N, LUTTERI L, SADZOT B, et al. Paraneoplastic neurological syndromes[J]. Revue Médicale de Liège, 2021, 76(5/6): 413−418.
|
| [6] |
FU P, HE L, TANG N, et al. A single center retrospective study of paraneoplastic neurological syndromes with positive onconeural antibodies[J]. Journal of Clinical Neuroscience, 2021, 89: 336−342. doi: 10.1016/j.jocn.2021.05.027
|
| [7] |
冉艳萍. 儿童中枢神经系统副肿瘤综合征的研究进展[J]. 国际儿科学杂志, 2020,47(8): 552−555. doi: 10.3760/cma.j.issn.1673-4408.2020.08.009
RAN Y P. Research progress of paraneoplastic syndrome of central nervous system in children[J]. International Journal of Pediatrics, 2020, 47(8): 552−555. (in Chinese). doi: 10.3760/cma.j.issn.1673-4408.2020.08.009
|
| [8] |
OPALINSKA M, SOWA-STASZCZAK A, WEZYK K, et al. Additional value of 18F-FDG PET/CT in detection of suspected malignancy in patients with paraneoplastic neurological syndromes having negative results of conventional radiological imaging[J]. Journal of Clinical Medicine, 2022, 11(6): 1537.
|
| [9] |
DALMAU J, GEIS C, GRAUS F. Autoantibodies to synaptic receptors and neuronal cell surface proteins in autoimmune diseases of the central nervous system[J]. Physiological Reviews, 2017, 97(2): 839−887. doi: 10.1152/physrev.00010.2016
|
| [10] |
MASSA F, FILIPPI L, BENEDETTI L, et al. FDG PET Unveils the course of paraneoplastic cerebellar degeneration: A semiquantitative analysis[J]. Clinical Nuclear Medicine, 2021, 46(6): e327-e328.
|
| [11] |
刘磊, 杨文秋, 王保平, 等. 貌似运动神经元病的神经系统副肿瘤综合征1例报告及文献分析[J]. 中风与神经疾病杂志, 2021, 38(3): 258-259.
LIU L, YANG W Q, WANG B P, et al. A case report and literature analysis of paraneoplastic syndrome of nervous system resembling motor neuron disease[J]. Journal of Stroke & Neuropathy, 2021, 38(3): 258-259. (in Chinese).
|
| [12] |
孙江, 王兴臣, 姬琳, 等. 以周围神经病变为首发症状的神经系统副肿瘤综合征1例报道并文献复习[J]. 中华全科医学, 2021, 19(12): 2158-2159.
SUN J, WANG X C, JI L, et al. A case report of paraneoplastic syndrome with peripheral neuropathy as the first symptom and literature review[J]. Chinese Journal of General Practice, 2021, 19(12): 2158-2159. (in Chinese).
|
| [13] |
KRISTENSEN S B, HESS S, PETERSEN H, et al. Clinical value of FDG-PET/CT in suspected paraneoplastic syndromes: A retrospective analysis of 137 patients[J]. European Journal of Nuclear Medicine and Molecular Imaging, 2015, 42(13): 2056−2063. doi: 10.1007/s00259-015-3126-2
|
| [14] |
伊骏飞, 郝洪军, 刘琳琳, 等. 神经系统副肿瘤综合征与神经副肿瘤抗体分析[J]. 中国神经免疫学和神经病学杂志, 2020,27(2): 104−108. doi: 10.3969/j.issn.1006-2963.2020.02.005
YI J F, HAO H J, LIU L L, et al. Analysis of paraneoplastic syndrome in nervous system and its antibody[J]. Chinese Journal of Neuroimmunology and Neuropathy, 2020, 27(2): 104−108. (in Chinese). doi: 10.3969/j.issn.1006-2963.2020.02.005
|
| [15] |
ISHIKAWA H, SHINDO A, NIWA A, et al. Long-term MRI changes in a patient with Kelch like protein 11-associated paraneoplastic neurological syndrome[J]. Journal of the Neurological Sciences, 2021, 28(12): 4261-4266.
|
| [16] |
MASANGKAY N, BASU S, MOGHBEL M, et al. Brain 18F-FDG-PET characteristics in patients with paraneoplastic neurological syndrome and its correlation with clinical and MRI findings[J]. Nuclear Medicine Communications, 2014, 35(10): 1038-1046.
|
| [17] |
康磊, 徐小洁, 马超, 等. FDG PET/CT在诊断神经系统副肿瘤综合征的研究进展[J]. 中国肿瘤临床, 2014,41(10): 667−670. doi: 10.3969/j.issn.1000-8179.20140196
KANG L, XU X J, MA C, et al. Research progress of FDG PET/CT in diagnosis of paraneoplastic syndrome of nervous system[J]. Chinese Journal of Oncology, 2014, 41(10): 667−670. (in Chinese). doi: 10.3969/j.issn.1000-8179.20140196
|
| [18] |
GRAUS F, DALMOU J, RENE R, et al. Anti-Hu antibodies in patients with small-cell lung cancer: Association with complete response to therapy and improved survival[J]. Journal of Clinical Oncology, 1997, 15(8): 2866−2872. doi: 10.1200/JCO.1997.15.8.2866
|
Supported by: Beijing Renhe Information Technology Co. Ltd 
DownLoad: