Kazama Toshiki, Faria Silvana C, Uchida Yoshitaka, Ito Hisao, Macapinlac Homer A
Division of Diagnostic Imaging, the University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Ann Nucl Med. 2008 Feb;22(2):111-4. doi: 10.1007/s12149-007-0089-9. Epub 2008 Mar 3.
The objective of this study was to evaluate the prevalence and positron emission tomography (PET) imaging features of pulmonary drug toxicity in patients with lymphoma during or just following chemotherapy.
A total of 677 PET scans on 460 patients with lymphoma (351 non-Hodgkin's lymphoma, 92 Hodgkin's disease, and 17 both Hodgkin's and non-Hodgkin's lymphoma) were performed for the evaluation of chemotherapy response. In 51 patients, abnormal accumulation on both sides of the chest was reported. A review of medical records, (18)fluorodeoxyglucose ((18)FDG)-PET scans, and chest computed tomography (CT) was performed, and cases with probable drug toxicity were identified. Inclusion criteria of probable drug toxicity were abnormal but symmetrical FDG accumulation in both lungs seen during or just following the completion of chemotherapy, the abnormal accumulation or corresponding abnormal CT findings resolved on subsequent studies, exclusion of clinical diagnosis of pneumonia, radiation pneumonitis, or lymphoma involvement.
In 10 patients (six men and four women, average age 47.3), 2.2% of cases, probable drug toxicity was identified. In all 10 cases, diffuse and subpleural-dominant FDG accumulation was seen on FDG-PET scans, and scattered or diffuse ground-glass opacities were observed on chest CT. Four patients reported symptoms, and six patients did not report any symptoms.
Diffuse and peripheral-dominant FDG accumulation in the lung, which may represent pulmonary drug toxicity, was not uncommon in patients with lymphoma who underwent chemotherapy. FDG-PET scan might be able to detect pulmonary drug toxicity in asymptomatic patients.
本研究的目的是评估淋巴瘤患者在化疗期间或化疗刚结束后肺部药物毒性的患病率及正电子发射断层扫描（PET）成像特征。
对460例淋巴瘤患者（351例非霍奇金淋巴瘤、92例霍奇金病、17例同时患有霍奇金淋巴瘤和非霍奇金淋巴瘤）共进行了677次PET扫描，以评估化疗反应。51例患者报告胸部两侧有异常积聚。对病历、（18）氟脱氧葡萄糖（（18）FDG）-PET扫描和胸部计算机断层扫描（CT）进行了回顾，并确定了可能存在药物毒性的病例。可能存在药物毒性的纳入标准为化疗期间或化疗刚结束时在双肺可见异常但对称的FDG积聚，后续研究中异常积聚或相应的异常CT表现消失，排除肺炎、放射性肺炎或淋巴瘤累及的临床诊断。
在10例患者（6例男性和4例女性，平均年龄47.3岁）中，确定了2.2%的病例可能存在药物毒性。在所有10例病例中，FDG-PET扫描可见弥漫性和以胸膜下为主的FDG积聚，胸部CT可见散在或弥漫性磨玻璃影。4例患者报告有症状，6例患者未报告任何症状。
肺部弥漫性和以周边为主的FDG积聚可能代表肺部药物毒性，在接受化疗的淋巴瘤患者中并不少见。FDG-PET扫描可能能够检测无症状患者的肺部药物毒性。
