¹⁸F⁃PSMA⁃1007 PET/CT 与 ¹⁸F⁃FDG PET/CT 在脑胶质瘤分级评估中的对比研究

【Abstract】 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.