目的 对比18F-前列腺特异性膜抗原（18F-PSMA）-1007 正电子发射体层摄影（PET）/CT与18F-脱氧葡萄糖（18F-FDG）PET/CT在脑胶质瘤分级诊断中的应用价值。 方法 回顾性队列研究。纳入2022年8月—2023年3月西安交通大学第一附属医院脑胶质瘤患者32例，其中男16例、女16例，年龄19~79（50.3±13.2）岁。患者术前均行头颅18F-PSMA-1007 PET/CT和18F-FDG PET/CT检查，2次扫描间隔时间均<1周；均接受颅内占位切除术治疗，术后病理WHO分级Ⅱ级14例、Ⅲ6例、Ⅳ级12例。根据WHO分级将患者分为2组：Ⅲ~Ⅳ级18例为高级别胶质瘤（HGG）组，Ⅱ级14例为低级别胶质瘤（LGG）组。观察指标：（1）比较HGG组和LGG组在18F-PSMA-1007 PET/CT和18F-FDG PET/CT图像中病灶最大标准摄取值（SUVmax）、肿瘤/背景比值（TBR）的差异，统计2种不同示踪剂PET/CT显像在诊断HGG和LGG时的灵敏度、特异度和准确度。绘制受试者操作特征曲线并计算曲线下面积（AUC），评估2种示踪剂在胶质瘤分级中的诊断效能。（2）统计HGG组和LGG组中18F-PSMA-1007 PET/CT和18F-FDG PET/CT能够清晰显示病灶边界的病例数，比较2种显像方法在显示病灶边界清晰度上的差异。 结果 LGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax分别为0.69±0.32、8.87±3.20，TBR分别为1.05±0.45、0.89±0.30；HGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax分别为5.39±3.88、11.85±3.54，TBR分别为12.99±10.60、1.25±0.54。LGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax、TBR均小于HGG组，差异均有统计学意义（P值均<0.05）。18F-PSMA-1007 PET/CT的SUVmax和TBR对HGG和LGG分级诊断的灵敏度、特异度、准确度和AUC均高于18F-FDG PET/CT。18F-PSMA-1007 PET/CT中TBR的AUC最高，为0.988（95%可信区间 0.960~1.000），相应的阈值为2.15；18F-FDG PET/CT TBR的AUC最低，为0.694（95%可信区间 0.512~0.877），相应的阈值为0.97。18F-PSMA-1007 PET/CT图像上HGG组和LGG组清晰显示病灶边界的病例均高于18F-FDG PET/CT图像，差异均有统计学意义（P=0.039、0.016）。 结论 18F-PSMA-1007 PET/CT在胶质瘤分级诊断中具有潜在的诊断价值。与18F-FDG PET/CT相比，18F-PSMA-1007 PET/CT在区分高级别和低级别脑胶质瘤时，具有更高的灵敏度、特异度、准确度和诊断效能，可更清晰地描绘病变边界。 Objective This work aims to compare the application value of 18F-prostate specific membrane antigen (PSMA)-1007 positron emission tomography/computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT in the grading of gliomas. Methods A retrospective cohort study was conducted on the data of 32 patients with gliomas who underwent head 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT examinations at the PET Center of the First Affiliated Hospital of Xi'an Jiaotong University from August 2022 to March 2023. The data included 16 males and 16 females, with an age range of 19-79 years (50.3±13.2). All patients underwent intracranial mass resection surgery, and postoperative pathological grading were as follows: 14 patients were classified as WHO grade Ⅱ, 6 patients were classified as grade Ⅲ, and 12 patients were classified as grade Ⅳ. According to the WHO grading, the patients were divided into two groups: 18 patients with grades Ⅲ to Ⅳ were categorized as the high-grade glioma (HGG) group, and 14 patients with grade Ⅱ were categorized as the low-grade glioma (LGG) group. The observation indicators were as follows: (1) Observe the differences in the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of lesions in 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT images between the HGG group and the LGG group statistically analyze the sensitivity, specificity, and accuracy of the two different tracer PET/CT imaging methods in differentiating between HGG and LGG and utilize the receiver operating characteristic curve and calculate the area under the curve (AUC) to assess the diagnostic performance of two tracers in the grading of gliomas. (2) Count the number of cases in which the lesion boundaries were clearly delineated by 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT in the HGG group and the LGG group, and compare the differences in the clarity of lesion boundary delineation between the two imaging methods. Results In the LGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 0.69±0.32 and 8.87±3.20, respectively, whereas the TBR values were 1.05±0.45 and 0.89±0.30, respectively. In the HGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 5.39±3.88 and 11.85±3.54, respectively, whereas the TBR values were 12.99±10.60 and 1.25±0.54, respectively. In the LGG group, the SUVmax and TBR values for 18F-FDG PET/CT and 18F-PSMA-1007 PET/CT were significantly lower than those of the HGG group (all P values <0.05). SUVmax and TBR of 18F-PSMA-1007 PET/CT showed higher sensitivity, specificity, accuracy, and AUC for distinguishing HGG and LGG compared with those of 18F-FDG PET/CT. In 18F-PSMA-1007 PET/CT, the TBR had the highest AUC of 0.988 (with a 95% confidence interval ranging from 0.960 to 1.000), and the corresponding threshold value was 2.15. By contrast, the TBR's AUC in 18F-FDG PET/CT was the lowest at 0.694 (with a 95% confidence interval ranging from 0.512 to 0.877), with the corresponding threshold value of 0.97. 18F-PSMA-1007 imaging showed a higher number of cases with clearly delineated lesion borders in the HGG and LGG groups compared with 18F-FDG imaging, with statistically significant differences (P=0.039 and 0.016, respectively). Conclusion 18F-PSMA-1007 PET/CT imaging demonstrates potential value in the diagnostic grading of gliomas. Compared with 18F-FDG PET/CT, 18F-PSMA-1007 PET/CT has higher sensitivity, specificity, accuracy and diagnostic effectiveness in distinguishing high-grade and low-grade gliomas, and can more clearly delineate the lesion boundaries.
Comparative study of18F-PSMA-1007 PET/CT and18F-FDG PET/CT in the grading assessment of gliomas
Objective This work aims to compare the application value of 18F-prostate specific membrane antigen (PSMA)-1007 positron emission tomography/computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT in the grading of gliomas. Methods A retrospective cohort study was conducted on the data of 32 patients with gliomas who underwent head 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT examinations at the PET Center of the First Affiliated Hospital of Xi'an Jiaotong University from August 2022 to March 2023. The data included 16 males and 16 females, with an age range of 19-79 years (50.3±13.2). All patients underwent intracranial mass resection surgery, and postoperative pathological grading were as follows: 14 patients were classified as WHO grade Ⅱ, 6 patients were classified as grade Ⅲ, and 12 patients were classified as grade Ⅳ. According to the WHO grading, the patients were divided into two groups: 18 patients with grades Ⅲ to Ⅳ were categorized as the high-grade glioma (HGG) group, and 14 patients with grade Ⅱ were categorized as the low-grade glioma (LGG) group. The observation indicators were as follows: (1) Observe the differences in the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of lesions in 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT images between the HGG group and the LGG group statistically analyze the sensitivity, specificity, and accuracy of the two different tracer PET/CT imaging methods in differentiating between HGG and LGG and utilize the receiver operating characteristic curve and calculate the area under the curve (AUC) to assess the diagnostic performance of two tracers in the grading of gliomas. (2) Count the number of cases in which the lesion boundaries were clearly delineated by 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT in the HGG group and the LGG group, and compare the differences in the clarity of lesion boundary delineation between the two imaging methods. Results In the LGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 0.69±0.32 and 8.87±3.20, respectively, whereas the TBR values were 1.05±0.45 and 0.89±0.30, respectively. In the HGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 5.39±3.88 and 11.85±3.54, respectively, whereas the TBR values were 12.99±10.60 and 1.25±0.54, respectively. In the LGG group, the SUVmax and TBR values for 18F-FDG PET/CT and 18F-PSMA-1007 PET/CT were significantly lower than those of the HGG group (all P values <0.05). SUVmax and TBR of 18F-PSMA-1007 PET/CT showed higher sensitivity, specificity, accuracy, and AUC for distinguishing HGG and LGG compared with those of 18F-FDG PET/CT. In 18F-PSMA-1007 PET/CT, the TBR had the highest AUC of 0.988 (with a 95% confidence interval ranging from 0.960 to 1.000), and the corresponding threshold value was 2.15. By contrast, the TBR's AUC in 18F-FDG PET/CT was the lowest at 0.694 (with a 95% confidence interval ranging from 0.512 to 0.877), with the corresponding threshold value of 0.97. 18F-PSMA-1007 imaging showed a higher number of cases with clearly delineated lesion borders in the HGG and LGG groups compared with 18F-FDG imaging, with statistically significant differences (P=0.039 and 0.016, respectively). Conclusion 18F-PSMA-1007 PET/CT imaging demonstrates potential value in the diagnostic grading of gliomas. Compared with 18F-FDG PET/CT, 18F-PSMA-1007 PET/CT has higher sensitivity, specificity, accuracy and diagnostic effectiveness in distinguishing high-grade and low-grade gliomas, and can more clearly delineate the lesion boundaries.
GliomaPositron emission tomography/computed tomograph18F-fluorodeoxyglucoseProstate specific membrane antigen
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