Annals of Nuclear Medicine

, Volume 33, Issue 1, pp 61–67 | Cite as

The role of 13N-ammonia in the differential diagnosis of gliomas and brain inflammatory lesions

  • Chang Yi
  • Xinchong Shi
  • Xuezhen Zhang
  • Ganhua Luo
  • Bing Zhang
  • Xiangsong ZhangEmail author
Original Article



To investigate the utility of 13N-ammonia PET/CT imaging in the differential diagnosis of gliomas and brain inflammations.


13N-ammonia PET/CT imaging data of 77 patients with gliomas and 34 patients with brain inflammations were retrospectively analyzed. No patients received any treatment before 13N-ammonia imaging. All the patients were diagnosed by stereotactic biopsy or clinical follow-up. Visual and semi-quantitative analysis was performed to analyze the results of 13N-ammonia imaging. Finally, the uptake ratios of each lesion were calculated and its differences among different groups were tested with one-way ANOVA.


29.4% inflammations, 51.6% low-grade gliomas and 91.3% high-grade gliomas were positive by visual analysis in 13N-ammonia imaging. The sensitivity, specificity and accuracy for the diagnosis of gliomas were 75.3%, 55.8% and 67.8%, respectively. As for semi-quantitative analysis, the T/G ratios of inflammatory lesions, low-grade gliomas and high-grade gliomas were 0.88 ± 0.24, 1.04 ± 0.43 and 1.43 ± 0.49, respectively. One-way ANOVA revealed that the T/G ratios of high-grade gliomas were significantly higher than those of low-grade gliomas and inflammations (P < 0.05), but there was no statistical difference between low-grade gliomas and inflammations (P = 0.118). Among the inflammatory lesions, T/G ratios were not statistically different between infectious and demyelinating lesions (P > 0.05). ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing gliomas from inflammations was 1.21 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 52.9%, 94.4%, 65.3%, 95.7% and 45.9%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas was 1.06 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 81.5%, 67.7%, 76.5%, 81.5% and 67.7%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas and inflammations was 1.19 with the AUC 0.84. The sensitivity, specificity, accuracy, PPV and NPV were 70.4%, 85.1%, 78.5%, 79.2% and 78.1%, respectively.


13N-ammonia imaging is effective in distinguishing high-grade gliomas from low-grade gliomas and inflammations, but its role in the differential diagnosis of low-grade gliomas and brain inflammatory lesions is limited, and the accuracy needs to be improved.


Glioma Brain inflammation 13N-ammonia PET-CT 



This work was funded by Science and Technology Planning Project of Guangdong Province (2017B020210001), Science and Technology Program of Guangzhou (201607010353), Innovation Key Fund of Guangdong Province (2016B030307003), National Natural Science Foundation of China (81501509), Training program of the Major Research Plan of Sun Yat-Sen University (17ykjc10).


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Copyright information

© The Japanese Society of Nuclear Medicine 2018

Authors and Affiliations

  • Chang Yi
    • 1
  • Xinchong Shi
    • 1
  • Xuezhen Zhang
    • 2
  • Ganhua Luo
    • 1
  • Bing Zhang
    • 1
  • Xiangsong Zhang
    • 1
    Email author
  1. 1.Department of Nuclear MedicineThe First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  2. 2.Department of Nuclear MedicineThe No.1 People’s hospital of FoshanFoshanChina

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