Sutinen E, Jyrkkiö S, Varpula M, Lindholm P, Grönroos T, Lehikoinen P, Teräs M, Minn H
Department of Oncology and Radiotherapy, Turku University Central Hospital, Finland.
J Nucl Med. 2000 Dec;41(12):1980-8.
Accurate staging is elementary for optimal management of malignant lymphoma. Advanced cases may be curable with multidrug chemotherapy combined with radiotherapy, whereas limited disease can sometimes be cured by local radiotherapy only. Recently, FDG imaging with whole-body PET (WB PET) has been introduced as an accurate method for staging lymphoma. We evaluated the usefulness of L-[methyl-11C]methionine (MET) in comparison with FDG as a tracer for nodal staging of lymphoma with WB PET.
Nineteen patients with untreated, histologically proven malignant lymphoma underwent WB PET imaging with MET and FDG within 1 wk before treatment. Fourteen patients had non-Hodgkin's lymphoma (NHL), and 5 had Hodgkin's disease (HD). Two of these 19 patients were excluded from the final analysis because of hyperglycemia. WB PET images using FDG and MET were visually compared by 3 independent interpreters, and the PET findings were correlated with the data on the basis of conventional staging studies.
Fifty-five of 178 lymph node regions were classified as diseased both by FDG PET and by CT, and 54 of 178 were classified as diseased both by MET PET and by CT. In addition, 11 lymph node regions that CT showed to be normal avidly accumulated FDG. Ten of these lymph node regions also had clear uptake of MET. Another 4 and 5 lymph node regions were enlarged at CT but were judged to be normal by FDG and MET PET, respectively. In nodal staging, both FDG PET and MET PET would have upstaged the disease in 3 patients. MET PET would also have downstaged the disease in 1 patient.
FDG and MET seem to be comparable in the detection of lymphoma by WB PET. However, visual interpretation of the images tends to be hampered more by physiologic accumulations of MET than by normal accumulations of FDG, and MET may be preferable to FDG in hyperglycemic patients undergoing staging studies with PET.
准确分期是恶性淋巴瘤最佳治疗的基础。晚期病例可通过多药化疗联合放疗治愈，而局限性疾病有时仅通过局部放疗即可治愈。近来，全身正电子发射断层显像（WB PET）的氟代脱氧葡萄糖（FDG）成像已作为淋巴瘤分期的一种准确方法被引入。我们评估了L-[甲基-11C]蛋氨酸（MET）与FDG相比，作为WB PET淋巴瘤淋巴结分期示踪剂的有效性。
19例未经治疗、组织学确诊为恶性淋巴瘤的患者在治疗前1周内接受了MET和FDG的WB PET成像。14例患者为非霍奇金淋巴瘤（NHL），5例为霍奇金病（HD）。这19例患者中有2例因高血糖被排除在最终分析之外。3名独立的解读人员对使用FDG和MET的WB PET图像进行了视觉比较，并将PET结果与基于传统分期研究的数据进行了关联。
178个淋巴结区域中有55个在FDG PET和CT上均被分类为病变，178个中有54个在MET PET和CT上均被分类为病变。此外，CT显示正常的11个淋巴结区域FDG摄取活跃。这些淋巴结区域中有10个MET摄取也清晰。另外分别有4个和5个淋巴结区域在CT上肿大，但FDG和MET PET判断为正常。在淋巴结分期中，FDG PET和MET PET均会使3例患者的疾病分期提高。MET PET还会使1例患者的疾病分期降低。
在WB PET检测淋巴瘤方面，FDG和MET似乎具有可比性。然而，与FDG的正常聚集相比，MET的生理聚集对图像的视觉解读造成的阻碍似乎更大，对于接受PET分期研究的高血糖患者，MET可能比FDG更可取。
