| 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 |
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| 引用本文： | 袁磊磊,陈谦,乔真,李晓桐,樊迪,张巍,艾林.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. |
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| 作者姓名： | 袁磊磊 陈谦 乔真 李晓桐 樊迪 张巍 艾林 |
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| 作者单位： | 首都医科大学附属北京天坛医院核医学科, 北京100070 |
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| 基金项目： | 国家自然科学基金（SAACQ为配位基“双显像功能”羰基锝标记抗生素分子探针在EGFR高表达肿瘤靶向治疗机制中的基础研究（81601519））；北京市医院管理局“青苗”计划专项（FDG PET/CT在继发性噬血细胞综合征患者中的临床应用价值研究（QML20170106））；北京市属医院科研培育计划（半定量99mTc-GSA SPECT/CT评估肝癌肝切除术前患者肝脏储备功能的研究（PX2017035））。 |
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| 摘 要： | 目的:探讨全身18F-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18F-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。18F-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（P<0.001；95％CI，0.904～1.000）、0.353（P>0.05；95％CI，0.199～0.506）、0.667（P<0.05；95％CI，0.528～0.806）及0.672（P<0.05；95％CI，0.514～0.830），18F-FDG PET/CT及两种联合检测方法具有统计学意义。结论:全身18F-FDG PET/CT可作为疑诊PNS患者无创筛查肿瘤的一线检查方法。
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| 关 键 词： | FDG PET/CT 副肿瘤综合征 副肿瘤抗体 |
| 收稿时间： | 2022-04-21 |
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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| Affiliation: | Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China |
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| Abstract: | Objective: To explore the clinical value of whole-body 18F-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 18F-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. 18F-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 (P=0.000<0.05; 95% CI 0.904~1.000), 0.353 (P=0.070>0.05; 95% CI 0.199~0.506), 0.667 (P=0.040<0.05; 95% CI 0.528~0.806), and 0.672 (P=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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