Optimization of 18F-FDG PET/CT semi-quantitative diagnostic model for children with autoimmune encephalitis with epilepsy and negative MRI
Objective To investigate the value of 8F-FDG PET/CT imaging in the diagnosis of suspected autoimmune encephalitis(AE)in children with epilepsy and negative MRI.Methods From May 2019 to August 2022,94 suspected AE children(49 males,45 females;age 1-15 years)with epilepsy and negative MRI who underwent brain 18F-FDG PET/CT imaging at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.All patients were divided into AE and non-AE groups based on clinical final diagnosis.The effectiveness of visual diagnosis was evaluated.The cortical lesion extent score(S),and SUVmax,SUVmean and minimum of SUV(SUVmin)of cortical lesions(L),basal ganglia(B)and thalamus(T)were measured and SUV ratios(SUVR)of L/B or L/T were obtained.Independent-sample t test or Mann-Whitney U test was used to analyze data.Binary logistic regres-sion analysis was used to screen the diagnostic factors of AE,and a diagnostic model was established.The diagnostic efficiency was evaluated by ROC curve analysis and Delong test.Results There were 53 cases in AE group and 41 cases in non-AE group.Based on visual analysis,the sensitivity,specificity and accuracy of 18F-FDG PET/CT for AE were 100％(53/53),43.9％(18/41)and 75.5％(71/94),respectively.Differ-ences of LSUVmax,LSUVmean,LSUVmin,L/BSUVRmax,L/BSUVRmean,L/BSUVRmin,L/TSUVRmax,L/TSUVRmean,L/TSUVRmin and S between AE and non-AE groups were statistically significant(z=-6.74,t values:from-8.51 to-3.97,all P＜0.001).ROC curve analysis showed that the AUC of L/BSUVRmax was the highest(0.914)among visual analysis and semi-quantitative parameters.Logistic regression analysis showed that S(odds ratio(OR)=11.40,95％CI:2.18-59.52,P=0.004),L/BSUVRmax(0R=13.19,95％CI:2.11-82.51,P=0.006)and L/TSUVRmax(OR=9.66,95％CI:1.57-59.55,P=0.015)were independent diagnostic factors for AE.Regression model was established:P=1/(1+e-x),x=2.433×S+2.580×L/BSUVRmax+2.267×L/TSUVRmax-3.802.The AUC of this model was 0.948,with the sensitivity,specificity and accuracy of 98.1％(52/53),90.2％(37/41)and 94.7％(89/94),respectively.The diagnostic efficacy of the optimized scoring system was consist-ent with the pre-optimization model,and were both superior to L/BSUVRmax(both z=2.01,both P=0.040).Conclusion The diagnostic model and scoring system based on the semi-quantitative analysis of 18F-FDG PET/CT have better diagnostic efficacy for AE and are superior to semi-quantitative parameters alone.
Autoimmune diseases of the nervous systemChildEpilepsyPositron-emission tomographyFluorodeoxyglucose F18
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NSTL
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