Page 22 - 磁共振成像2024年7期电子刊

磁共振成像 2024年7月第15卷第7期 Chin J Magn Reson Imaging, Jul, 2024, Vol. 15, No. 7 特别关注｜｜Special Focus
PET/MR专题｜｜临床研究
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自身免疫性脑炎 F-FDG PET/MR表现的
初步研究

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王悦 ，白书维 ，张焱 ，黄干 ，张晨鹏 ，郝勇 ，刘建军 ，邵泓达 1
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作者单位 1.上海交通大学医学院附属仁济医院核医学科，上海 200127；2.上海临床研究中心，上海 200122；3.上海交通大学医学
院附属仁济医院神经内科，上海 200127
* 通信作者 刘建军, E-mail: nuclearj@163.com
中图分类号 R445.2；R512.3 文献标识码 A DOI 10.12015/issn.1674-8034.2024.07.003
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本文引用格式 王悦, 白书维, 张焱, 等. 自身免疫性脑炎 F-FDG PET/MR表现的初步研究[J]. 磁共振成像, 2024, 15(7): 15-20.
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[摘要] 目的 探索自身免疫性脑炎（autoimmune encephalitis, AE）患者 F-氟代脱氧葡萄糖（fludeoxyglucose, FDG）正电子
发射/磁共振计算机断层显像（positron emission tomography/magnetic resonance, PET/MR）表现，寻找提高疾病诊断效能的影像
学标记物。材料与方法 回顾性分析 25 例 AE 患者（AE 组）和 11 例健康对照（healthy controls, HC）（HC 组）的资料。所有研
究对象均采集头颅 F-FDG PET/MR 影像。首先，使用统计参数图 12（statistical parametric mapping 12, SPM12）处理包得出 AE
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组 FDG 摄取异常脑区。然后，使用后处理工作站多模态脑分析软件提取脑区体积/全脑体积（volume/total intracranial volume,
volume/TIV）和平均标准化摄取率（standardized uptake value ratio, SUVr）参数，比较 AE 组与 HC 组各个脑区 volume/TIV 和
SUVr 的组间差异，并分别选取 volume/TIV 和 SUVr 有显著差异的脑区绘制受试者工作特征（receiver operating characteristic,
ROC）曲线，计算单一定量参数及定量参数两两联合的诊断效能。最后，进行 DeLong 检验选择最佳模型，绘制联合诊断校准
曲线和决策曲线评估预测模型的准确性，置换检验用于评估统计量的显著性。结果 SPM12 的分析显示，AE 组脑干和小脑
FDG摄取增高（P<0.001），而双侧额叶、顶叶、右侧枕叶 FDG摄取减低（P<0.001）。脑结构分析结果显示岛叶、扣带回、距状
回 volume/TIV 减低（P<0.05），中扣带回、顶叶、楔叶、枕外侧回 SUVr 减低（P<0.05）。ROC 曲线分析发现左侧距状回的
volume/TIV 和左侧中扣带回的 SUVr联合诊断效能（曲线下面积=0.964）最高。DeLong 检验显示定量参数两两联合诊断效能与
单一参数诊断效能差异具有统计学意义（P<0.05）。校准曲线显示诊断模型的校准度一般，但决策曲线显示在一定风险阈值范围
内患者可获得比较高的净收益。置换检验显示 AE 组及 HC 组的左侧距状回的 volume/TIV 和左侧中扣带回的 SUVr之间差异具有
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统计学意义。结论 AE患者 F-FDG PET/MR存在某些特定脑区FDG代谢异常和脑体积改变，左侧距状回的volume/TIV和左侧
中扣带回SUVr两个参数联合是潜在诊断AE的生物学标记物。
[关键词] 脑炎；自身免疫性脑炎；影像学表现；正电子发射断层显像；磁共振成像
Preliminary study for F-FDG PET/MR findings of autoimmune encephalitis
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WANG Yue , BAI Shuwei , ZHANG Yan , HUANG Gan , ZHANG Chenpeng , HAO Yong , LIU Jianjun , SHAO Hongda 1
1 Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; Shanghai
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Clinical Research and Trial Center, Shanghai 200122, China; Department of Neurology, Renji Hospital, Shanghai Jiaotong University
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School of Medicine, Shanghai 200127, China
* Correspondence to LIU J J, E-mail: nuclearj@163.com
Received 22 Jan 2024, Accepted 13 May 2024; DOI 10.12015/issn.1674-8034.2024.07.003
ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 82171896).
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Cite this article as WANG Y, BAI S W, ZHANG Y, et al. Preliminary study for F-FDG PET/MR findings of autoimmune encephalitis
[J]. Chin J Magn Reson Imaging, 2024, 15(7): 15-20.
Abstract Objective: To investigate the image findings of autoimmune encephalitis (AE) based on F-fludeoxyglucose positron
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emission tomography/magnetic resonance ( F-FDG PET/MR) images and explore imaging markers that can improve the diagnostic
efficacy of AE. Materials and Methods: Twenty-five patients with AE (AE group) and 11 healthy controls (HC) group were included in
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this study. All subjects were undergoing head F-FDG PET/MR scan. The areas of brain abnormal FDG uptake in AE group were
obtained using statistical parametric mapping 12 (SPM12) processing package. The volume/total intracranial volume (volume/TIV) and
average standardized uptake value ratio (SUVr) of brain areas were extracted using multimodal brain analysis software, and statistical
analysis was performed to obtain the differences between the AE group and the HC group. Brain regions with significant differences in
volume/TIV and SUVr were selected respectively to make receiver operating characteristic (ROC) curves, and the diagnostic efficiency
of single parameters and their pairwise combinations were calculated. DeLong test was performed predict the best model. Calibration curve
and decision curve were drawn to evaluate the accuracy of the prediction model. Permutation testing was employed to evaluate the statistical
significance. Results: Analysis using SPM12 showed the abnormal FDG uptake areas in AE group increased in brain stem and cerebellum
(P<0.001), and decreased in bilateral frontal, parietal and right occipital lobes (P<0.001). The results of brain structural analysis showed
that the volume/TIV of insula, cingulate gyrus and talar gyrus decreased (P<0.05), SUVr decreased in the middle cingulate gyrus, parietal
lobe, cuneus and lateral occipital gyrus (P<0.05). The volume/TIV of the left talar gyrus and the SUVr of the left middle cingulate gyrus
were the two parameters with the most significant differences between the two groups. The ROC curve found that the combination of the
volume/TIV of the left talar gyrus and the SUVr of the left middle cingulate gyrus had the highest diagnostic efficiency (area under the
curve=0.964). DeLong test showed that there was a significant difference between the diagnostic efficacy of any two quantitative
parameters combined with any single parameter (P<0.05). The calibration curve showed that the calibration of the diagnostic model was
general, but the decision curve showed that patients could obtain relatively high net benefits within a certain risk threshold. Permutation
收稿日期 2024-01-22 接受日期 2024-05-13
基金项目 国家自然科学基金项目（编号：82171896）
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