Sasaki Masayuki, Kuwabara Yasuo, Koga Hirofumi, Nakagawa Makoto, Chen Tao, Kaneko Kouichirou, Hayashi Kazutaka, Nakamura Katsumasa, Masuda Kouji
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Nucl Med. 2002 Jul;16(5):337-45. doi: 10.1007/BF02988618.
The aim of this study is to evaluate the clinical impact of whole-body FDG-PET for the pre-therapeutic evaluation of malignant lymphoma and compared to that of 67Ga-scintigraphy when added to non-RI examinations.
We examined 46 patients with malignant lymphoma including 42 newly diagnosed cases and 4 relapsed cases. Whole-body FDG-PET was started 63 minutes after the administration of FDG with ECAT EXACT HR+. The clinical stage of each patient was determined based on the results of a non-RI examination (consisting of physical examination, CT, gastrointestinal studies and bone marrow aspiration), 67Ga planar images and FDG-PET. Discrepant findings were verified based on the response to treatment and the findings of a follow-up examination more than 6 months after treatment. Finally, 152 nodal regions and 19 extranodal tissues were found to be involved by disease.
In the 152 nodal lesions, FDG-PET detected 54 nodal lesions in addition to 98 lesions detected by non-RI examinations, whereas 67Ga-scintigraphy detected 14 additional lesions. The sensitivity of non-RI, non-RI + 67Ga and non-RI + FDG was 64.5%, 73.7% and 100.0%, respectively. In 19 extranodal lesions, FDG-PET detected 5 extranodal lesions in addition to 13 lesions detected by non-RI examinations, whereas 67Ga-scintigraphy detected 1 additional lesion. The sensitivity of non-RI, non-RI + 67Ga and non-RI + FDG was 68.4%, 73.7% and 94.7%, respectively. When combining the FDG-PET findings with the non-RI findings, the improvement of the detectability was much higher than that when 67Ga findings were combined to the non-RI findings. For the staging of lymphoma, the non-RI and non-RI + 67Ga findings accurately diagnosed 76.1% and 80.4%, respectively, whereas the non-RI + FDG findings accurately diagnosed 82.6%. Finally, FDG-PET resulted in changes in the clinical management of 8 patients (17.4%).
FDG-PET offers more information in addition to the findings of conventional diagnostic methods than 67Ga-scintigraphy in order to accurately detect malignant lymphoma. FDG-PET can therefore play an important role in therapeutic decision making on lymphoma.
本研究旨在评估全身FDG-PET对恶性淋巴瘤治疗前评估的临床影响，并与非放射性检查加用67Ga闪烁显像的情况进行比较。
我们检查了46例恶性淋巴瘤患者，包括42例新诊断病例和4例复发病例。使用ECAT EXACT HR+在注射FDG后63分钟开始进行全身FDG-PET检查。根据非放射性检查（包括体格检查、CT、胃肠道检查和骨髓穿刺）、67Ga平面显像和FDG-PET的结果确定每位患者的临床分期。根据治疗反应和治疗后6个月以上的随访检查结果对不一致的发现进行核实。最后，发现152个淋巴结区域和19个结外组织有病变。
在152个淋巴结病变中，FDG-PET除检测到非放射性检查发现的98个病变外，还检测到54个淋巴结病变，而67Ga闪烁显像检测到另外14个病变。非放射性检查、非放射性检查+67Ga和非放射性检查+FDG的敏感性分别为64.5%、73.7%和100.0%。在19个结外病变中，FDG-PET除检测到非放射性检查发现的13个病变外，还检测到5个结外病变，而67Ga闪烁显像检测到另外1个病变。非放射性检查、非放射性检查+67Ga和非放射性检查+FDG的敏感性分别为68.4%、73.7%和94.7%。将FDG-PET结果与非放射性检查结果相结合时，可检测性的提高远高于将67Ga结果与非放射性检查结果相结合时。对于淋巴瘤分期，非放射性检查和非放射性检查+67Ga结果分别准确诊断了76.1%和80.4%，而非放射性检查+FDG结果准确诊断了82.6%。最后，FDG-PET导致8例患者（17.4%）的临床管理发生改变。
与67Ga闪烁显像相比，FDG-PET除了能提供传统诊断方法的结果外，还能提供更多信息，以便准确检测恶性淋巴瘤。因此，FDG-PET在淋巴瘤的治疗决策中可发挥重要作用。
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