不同PET/CT显像剂在胶质瘤诊断中的系统分析

doi:10.3969/j.issn.1004-583X.2023.04.002

摘要/Abstract

摘要：

目的评价不同放射性显像剂PET/CT显像在脑胶质瘤中的诊断价值。方法通过中英文数据库,分别检索不同显像剂显像对脑胶质瘤的诊断性临床试验,提取文献中的真阳性、假阳性、真阴性、假阴性等原始数据,通过软件(Meta-Discl 1.4)进行数据合并分析,分别合并计算不同显像剂的PET/CT显像诊断胶质瘤的敏感性(sensitivity,SEN)、特异性(specific,SPE)、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnostic odds ratio,DOR)以及SROC曲线下面积(area under SROC curve,AUC)等。结果最终共纳入14篇文献,其中分别有9篇描述¹⁸F-FDG显像,8篇描述¹¹C-MET,3篇描述¹⁸F-FET显像,1篇描述¹³N-NH₃显像,1篇描述¹⁸F-FLT 显像。对¹⁸F-FDG、11C-MET、¹⁸F-FET进行数据合并分析并比较,结果显示¹¹C-MET与¹⁸F-FET PET/CT显像诊断胶质瘤的SEN及诊断性能(AUC值)均显著高于¹⁸F-FDG(P<0.05),但3组之间的SPE、PLR、NLR及DOR差异均无统计学意义(P>0.05)。结论 ¹¹C-MET与¹⁸F-FET PET/CT显像对脑胶质瘤的诊断优于¹⁸F-FDG PET/CT显像。

关键词: 神经胶质瘤, PET/CT, ¹⁸F-氟脱氧葡萄糖, ¹¹C-蛋氨酸, ¹⁸F-氟乙基-酪氨酸

Abstract:

Objective To evaluate the diagnostic value of positron emission tomography/computed tomography (PET/CT) imaging with different radionuclide agents in the diagnosis of gliomas.Methods Diagnostic clinical trials of different imaging agents for gliomas were searched in the Chinese and English language databases. Original data like the true positive, false positive, true negative and false negative were extracted from eligible literatures. Meta - Discl 1.4 was used data analysis. The sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under SROC curve (AUC) of PET/CT imaging using different imaging agents in the diagnosis of glioma were calculated. Results A total of 14 eligible literatures were included, involving 9 describing ¹⁸F-fluorodeoxyglucos (¹⁸F-FDG) imaging, 8 describing ¹¹C-Methionine (¹¹C-MET) imaging, 3 describing ¹⁸F-fluoro-ethyl-L-tyrosine (¹⁸F-FET) imaging, 1 describing ¹³N-NH₃ imaging, and 1 describing O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FLT) imaging. The data of ¹⁸F-FDG, ¹¹C-MET and ¹⁸F-FET were analyzed and compared. The results showed that the SEN and diagnostic performance (AUC value) of ¹¹C-MET and ¹⁸F-FET PET/CT for gliomas were significantly higher than those of ¹⁸F-FDG (P<0.05). However, there were no significant differences in SPE, PLR, NLR and DOR between groups (P>0.05). Conclusion ¹¹C-MET and ¹⁸F-FET PET/CT imaging are superior to ¹⁸F-FDG PET/CT imaging in the diagnosis of gliomas.

Key words: glioma, PET/CT, ¹⁸F-FDG, ¹¹C-methionine, ¹⁸F-FET

中图分类号:

R730.264

刘菲, 林志春, 岳建兰, 尹亮, 黄世明. 不同PET/CT显像剂在胶质瘤诊断中的系统分析[J]. 临床荟萃, 2023, 38(4): 302-307.

Liu Fei, Lin Zhichun, Yue Jianlan, Yin Liang, Huang Shiming. Meta-analysis of different positron emission tomography/computed tomography imaging agents in the diagnosis of gliomas[J]. Clinical Focus, 2023, 38(4): 302-307.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.04.002

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I4/302

图/表 5

参考文献 30

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作者	发表时间	国家	年龄	设计方法	金标准	病例入组时间	QUADAS
作者	发表时间	国家	年龄	设计方法	金标准	病例入组时间	是	否/不清楚
龙亚丽^[9]	2020	中国	40.0±14.0	回顾性	组织病理、随访	2010.09-2017.12	12	2
饶良俊^[10]	2014	中国	37.7±15.9	回顾性	组织病理	2009.12-2013.03	12	2
理东丽^[11]	2011	中国	38.5(6-79)	回顾性	组织病理	2005-2008	12	2
Shaw^[12]	2019	Australia	44(24-74)	回顾性	组织病理	2009.05-2016.01	13	1
Yoon^[13]	2014	Korea	50±13.8	回顾性	组织病理	2003.02-2006.12	11	3
Miyake^[14]	2012	Japan	52±18.1	回顾性	组织病理	2006.04-2011.10	13	1
Lau^[15]	2010	Australia	37(24-69)	回顾性	组织病理、随访	2004-2006	12	2
Ghany^[16]	2015	Egypt	40(24-60)	回顾性	组织病理	2014.07-2015.03	11	3
Plotkin^[17]	2010	Germany	44(26-65)	前瞻性	组织病理	不详	10	4
赵晓斌^[18]	2018	中国	2-66	前瞻性	组织病理	2015.01-2016.10	11	3
Tietze^[19]	2015	Denmark	52 (31-64)	回顾性	组织病理	不详	10	4
Tateishi^[20]	2014	Japan	54(19-81)	前瞻性	组织病理	2010.12-2012.12	11	3
Boss^[21]	2010	Germany	51(34-73)	回顾性	组织病理	2008.08-2009.11	13	1
Pichler^[22]	2010	Austria	50±19	回顾性	组织病理、随访	2006.01-2008.12	12	2

作者	发表时间	国家	年龄	设计方法	金标准	病例入组时间	QUADAS
作者	发表时间	国家	年龄	设计方法	金标准	病例入组时间	是	否/不清楚
龙亚丽^[9]	2020	中国	40.0±14.0	回顾性	组织病理、随访	2010.09-2017.12	12	2
饶良俊^[10]	2014	中国	37.7±15.9	回顾性	组织病理	2009.12-2013.03	12	2
理东丽^[11]	2011	中国	38.5(6-79)	回顾性	组织病理	2005-2008	12	2
Shaw^[12]	2019	Australia	44(24-74)	回顾性	组织病理	2009.05-2016.01	13	1
Yoon^[13]	2014	Korea	50±13.8	回顾性	组织病理	2003.02-2006.12	11	3
Miyake^[14]	2012	Japan	52±18.1	回顾性	组织病理	2006.04-2011.10	13	1
Lau^[15]	2010	Australia	37(24-69)	回顾性	组织病理、随访	2004-2006	12	2
Ghany^[16]	2015	Egypt	40(24-60)	回顾性	组织病理	2014.07-2015.03	11	3
Plotkin^[17]	2010	Germany	44(26-65)	前瞻性	组织病理	不详	10	4
赵晓斌^[18]	2018	中国	2-66	前瞻性	组织病理	2015.01-2016.10	11	3
Tietze^[19]	2015	Denmark	52 (31-64)	回顾性	组织病理	不详	10	4
Tateishi^[20]	2014	Japan	54(19-81)	前瞻性	组织病理	2010.12-2012.12	11	3
Boss^[21]	2010	Germany	51(34-73)	回顾性	组织病理	2008.08-2009.11	13	1
Pichler^[22]	2010	Austria	50±19	回顾性	组织病理、随访	2006.01-2008.12	12	2

作者	病例数	显像剂	注射剂量	显像间隔时间	TP	FP	FN	TN	SEN	SPE	ACC	PPV	NPV
龙亚丽^[9]	90(54/36)	¹⁸F-FDG	5.18 MBq/kg	30 min	24	8	43	15	35.82%	65.22%	43.33%	75.00%	25.86%
		¹¹C-MET	7.4 MBq/kg	5 min	63	10	4	13	94.03%	56.52%	84.44%	86.30%	76.47%
		¹³N-NH₃	7.4 MBq/kg	5 min	42	1	25	22	62.69%	95.65%	71.11%	97.67%	46.81%
饶良俊^[10]	60(37/23)	¹⁸F-FDG	370~555 MBq	40 min	18	6	18	18	50.00%	75.00%	60.00%	75.00%	50.00%
		¹¹C-MET	370~555 MBq	10 min	35	2	1	22	97.22%	91.67%	95.00%	94.59%	95.65%
理东丽^[11]	44(26/18)	¹⁸F-FDG	259~444 MBq	50~60 min	13	2	13	16	50.00%	88.89%	65.91%	86.67%	55.17%
		¹¹C-MET	370~555 MBq	10 min	24	3	2	15	92.31%	83.33%	88.64%	88.89%	88.24%
Shaw^[12]	33(22/11)	¹⁸F-FDG	不详	45 min	13	3	9	11	59.09%	78.57%	66.67%	81.25%	55.00%
Yoon^[13]	60(35/25)	¹⁸F-FDG	5.18 MBq/kg	60 min	37	2	11	10	77.08%	83.33%	78.33%	94.87%	47.62%
Miyake^[14]	54(26/18)	¹⁸F-FDG	147~295 MBq	45 min	24	4	21	5	53.33%	55.56%	53.70%	85.71%	19.23%
		¹¹C-MET	113~389 MBq	10 min	41	10	2	1	95.35%	9.09%	77.78%	80.39%	33.33%
		¹⁸F-FLT	129~236 MBq	40 min	42	8	3	2	93.33%	20.00%	80.00%	84.00%	40.00%
Lau^[15]	21(14/7)	¹⁸F-FDG	400 MBq	60 min	4	1	11	9	26.67%	90.00%	52.00%	80.00%	45.00%
		¹⁸F-FET	400 MBq	60 min	14	0	1	10	93.33%	100.00%	96.00%	100.00%	90.91%
Ghany^[16]	16(9/7)	¹⁸F-FDG	8~15 mCi	40~45 min	8	1	1	6	88.89%	85.71%	87.50%	88.89%	85.71%
Plotkin^[17]	15(6/9)	¹⁸F-FDG	300 MBq	60 min	4	2	2	7	93.33%	100.00%	96.00%	100.00%	90.91%
		¹⁸F-FET	200 MBq	10 min	5	8	1	1	66.67%	77.78%	73.33%	66.67%	77.78%
赵晓斌^[18]	41(不详)	¹¹C-MET	555~740 MBq	10~15 min	18	1	11	11	62.07%	91.67%	70.73%	94.74%	50.00%
Tietze^[19]	13(7/6)	¹¹C-MET	500 MBq	20 min	7	3	0	3	100.00%	50.00%	76.92%	70.00%	100.00%
Tateishi^[20]	14(不详)	¹¹C-MET	370 MBq	20 min	6	3	0	5	100.00%	62.50%	78.57%	66.67%	100.00%
Boss^[21]	10(不详)	¹¹C-MET	585~764 MBq	30 min	3	5	0	2	100.00%	28.57%	50.00%	37.50%	100.00%
Pichler^[22]	88(44/44)	¹⁸F-FET	185 MBq	30 min	34	6	2	13	94.44%	68.42%	85.45%	85.00%	86.67%

作者	病例数	显像剂	注射剂量	显像间隔时间	TP	FP	FN	TN	SEN	SPE	ACC	PPV	NPV
龙亚丽^[9]	90(54/36)	¹⁸F-FDG	5.18 MBq/kg	30 min	24	8	43	15	35.82%	65.22%	43.33%	75.00%	25.86%
		¹¹C-MET	7.4 MBq/kg	5 min	63	10	4	13	94.03%	56.52%	84.44%	86.30%	76.47%
		¹³N-NH₃	7.4 MBq/kg	5 min	42	1	25	22	62.69%	95.65%	71.11%	97.67%	46.81%
饶良俊^[10]	60(37/23)	¹⁸F-FDG	370~555 MBq	40 min	18	6	18	18	50.00%	75.00%	60.00%	75.00%	50.00%
		¹¹C-MET	370~555 MBq	10 min	35	2	1	22	97.22%	91.67%	95.00%	94.59%	95.65%
理东丽^[11]	44(26/18)	¹⁸F-FDG	259~444 MBq	50~60 min	13	2	13	16	50.00%	88.89%	65.91%	86.67%	55.17%
		¹¹C-MET	370~555 MBq	10 min	24	3	2	15	92.31%	83.33%	88.64%	88.89%	88.24%
Shaw^[12]	33(22/11)	¹⁸F-FDG	不详	45 min	13	3	9	11	59.09%	78.57%	66.67%	81.25%	55.00%
Yoon^[13]	60(35/25)	¹⁸F-FDG	5.18 MBq/kg	60 min	37	2	11	10	77.08%	83.33%	78.33%	94.87%	47.62%
Miyake^[14]	54(26/18)	¹⁸F-FDG	147~295 MBq	45 min	24	4	21	5	53.33%	55.56%	53.70%	85.71%	19.23%
		¹¹C-MET	113~389 MBq	10 min	41	10	2	1	95.35%	9.09%	77.78%	80.39%	33.33%
		¹⁸F-FLT	129~236 MBq	40 min	42	8	3	2	93.33%	20.00%	80.00%	84.00%	40.00%
Lau^[15]	21(14/7)	¹⁸F-FDG	400 MBq	60 min	4	1	11	9	26.67%	90.00%	52.00%	80.00%	45.00%
		¹⁸F-FET	400 MBq	60 min	14	0	1	10	93.33%	100.00%	96.00%	100.00%	90.91%
Ghany^[16]	16(9/7)	¹⁸F-FDG	8~15 mCi	40~45 min	8	1	1	6	88.89%	85.71%	87.50%	88.89%	85.71%
Plotkin^[17]	15(6/9)	¹⁸F-FDG	300 MBq	60 min	4	2	2	7	93.33%	100.00%	96.00%	100.00%	90.91%
		¹⁸F-FET	200 MBq	10 min	5	8	1	1	66.67%	77.78%	73.33%	66.67%	77.78%
赵晓斌^[18]	41(不详)	¹¹C-MET	555~740 MBq	10~15 min	18	1	11	11	62.07%	91.67%	70.73%	94.74%	50.00%
Tietze^[19]	13(7/6)	¹¹C-MET	500 MBq	20 min	7	3	0	3	100.00%	50.00%	76.92%	70.00%	100.00%
Tateishi^[20]	14(不详)	¹¹C-MET	370 MBq	20 min	6	3	0	5	100.00%	62.50%	78.57%	66.67%	100.00%
Boss^[21]	10(不详)	¹¹C-MET	585~764 MBq	30 min	3	5	0	2	100.00%	28.57%	50.00%	37.50%	100.00%
Pichler^[22]	88(44/44)	¹⁸F-FET	185 MBq	30 min	34	6	2	13	94.44%	68.42%	85.45%	85.00%	86.67%

项目	¹⁸F-FDG (n=9)	¹¹C-MET (n=8)	¹⁸F-FET (n=3)	Z值	P值
敏感度	53%	91%	93%	47.86	<0.001
特异度	77%	66%	63%	2.182	0.143
PLR	2.11	2.67	2.77	0.075	0.928
NLR	0.61	0.16	0.16	7.021	0.006
DOR	4.04	21.94	16.99	0.228	0.799
AUC	0.75	0.93	0.97	25.700	<0.001