Hadithi Muhammed, Mallant Maarten, Oudejans Joost, van Waesberghe Jan-Hein T M, Mulder Chris J, Comans Emile F I
Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands.
J Nucl Med. 2006 Oct;47(10):1622-7.
Refractory celiac disease (RCD) can evolve into enteropathy-associated T-cell lymphoma (EATL). 18F-FDG PET has been reported to discriminate between RCD and EATL. Because prospective data are lacking, we designed a prospective study to evaluate the potential of 18F-FDG PET for detection of EATL in patients with RCD and compared the results with those obtained using abdominal CT in a referral center.
Between April 2003 and April 2005, 8 consecutive patients (median age, 66 y; range, 52-89 y) with EATL and 30 patients (median age, 61 y; range, 44-71 y) with RCD were included. CT and 18F-FDG PET were performed on all patients. Histologic evidence of EATL was identified in tissue samples obtained during upper gastrointestinal endoscopy or surgical resection.
Villous atrophy was found in all patients with RCD and all (except 1) patients with EATL in nontumoral mucosa. Histologic examination of 1 patient with EATL localized in the duodenum showed intraepithelial lymphocytosis only. 18F-FDG PET could reveal sites histologically proven to be EATL in all 8 patients, whereas CT showed normal findings in 1 patient with EATL. 18F-FDG PET detected unsuspected extraintestinal sites affected by EATL in 2 patients. CT showed abnormalities such as a thickened small-bowel wall or lymphadenopathy in 14 patients with RCD lacking evidence of EATL at follow-up. 18F-FDG PET findings were positive in 3 and equivocal in another 3 patients with RCD. 18F-FDG PET was more sensitive and specific than CT (100% vs. 87% and 90% vs. 53%, respectively).
Our data show that 18F-FDG PET is more sensitive in detecting EATL in patients with RCD than is CT. 18F-FDG PET, in addition to conventional CT, is recommended for evaluating patients with RCD.
难治性乳糜泻（RCD）可演变为肠病相关T细胞淋巴瘤（EATL）。据报道，18F-FDG PET可区分RCD和EATL。由于缺乏前瞻性数据，我们设计了一项前瞻性研究，以评估18F-FDG PET在检测RCD患者中EATL的潜力，并将结果与在一家转诊中心使用腹部CT获得的结果进行比较。
在2003年4月至2005年4月期间，纳入了8例连续的EATL患者（中位年龄66岁；范围52 - 89岁）和30例RCD患者（中位年龄61岁；范围44 - 71岁）。对所有患者进行了CT和18F-FDG PET检查。在上消化道内镜检查或手术切除获取的组织样本中确定了EATL的组织学证据。
在所有RCD患者以及除1例之外的所有EATL患者的非肿瘤性黏膜中均发现绒毛萎缩。1例十二指肠局部EATL患者的组织学检查仅显示上皮内淋巴细胞增多。18F-FDG PET能够在所有8例患者中显示经组织学证实为EATL的部位，而CT在1例EATL患者中显示正常结果。18F-FDG PET在2例患者中检测到了未被怀疑的受EATL影响的肠外部位。在随访中，CT在14例无EATL证据的RCD患者中显示出小肠壁增厚或淋巴结病等异常。18F-FDG PET检查结果在3例RCD患者中为阳性，在另外3例中为可疑。18F-FDG PET比CT更敏感和特异（分别为100%对87%和90%对53%）。
我们的数据表明，18F-FDG PET在检测RCD患者中的EATL方面比CT更敏感。除传统CT外，建议使用18F-FDG PET对RCD患者进行评估。
