Service de médecine nucléaire, CHU de Nantes, Nantes, France.
Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1633-42. doi: 10.1007/s00259-010-1469-2. Epub 2010 Apr 29.
(18)F-fluorodeoxyglucose (FDG) PET is a non-invasive imaging technique recommended for the management of both diffuse large B-cell and Hodgkin's lymphomas. This retrospective study investigated the value of FDG PET for initial staging and its prognostic impact on patients with mantle cell lymphoma (MCL).
A total of 44 untreated MCL patients assessed by both conventional evaluations (CE) and FDG PET for initial staging were included. The maximum standardized uptake value (SUV(max)) in the most intense pathological area was recorded for each patient. Disease status after chemotherapy completion was assessed according to the International Workshop Criteria (IWC) for non-Hodgkin's lymphoma (NHL) response and IWC+PET.
FDG PET uptakes at diagnosis were abnormal in all cases. Compared to CT scan, nodal and extranodal sites were only detected by FDG PET. Due to insufficient sensibility for bone marrow (BM) and gastrointestinal (GI) involvement, FDG PET did not modify initial staging. Positive and negative predictive values of IWC+PET for relapse at 1 year were 62.5 and 100%. With a median follow-up of 21 months, only the International Prognostic Index (IPI) and IWC+PET modified both event-free survival (EFS) (p = .02 and .0001, respectively) and overall survival (p = .03 and .05, respectively) duration. When combining IPI and SUV(max) at diagnosis, we were able to identify patients with low (29%; no relapse/progression), intermediate (42%; median EFS: 37 months) and high risk (29%, median EFS: 22 months) (p = .004).
In MCL, FDG PET at diagnosis is complementary to CE, but BM and GI biopsies remain mandatory. IWC+PET criteria are highly efficient to identify patients with high risk for early relapse. Combining IPI and SUV(max) may predict patient outcome and warrant further prospective investigations towards designing risk-adapted strategies.
（18）F-氟代脱氧葡萄糖（FDG）PET 是一种非侵入性成像技术，推荐用于弥漫性大 B 细胞淋巴瘤和霍奇金淋巴瘤的治疗管理。本回顾性研究调查了 FDG PET 在初始分期中的价值及其对套细胞淋巴瘤（MCL）患者的预后影响。
共纳入 44 例未经治疗的 MCL 患者，这些患者均通过常规评估（CE）和 FDG PET 进行初始分期。为每位患者记录最强烈病理区域的最大标准化摄取值（SUV(max)）。根据非霍奇金淋巴瘤（NHL）反应的国际工作组标准（IWC）和 IWC+PET 评估化疗完成后的疾病状态。
所有病例的 FDG PET 摄取均异常。与 CT 扫描相比，FDG PET 仅可检测到淋巴结和结外部位。由于对骨髓（BM）和胃肠道（GI）受累的敏感性不足，FDG PET 并未改变初始分期。IWC+PET 对 1 年内复发的阳性和阴性预测值分别为 62.5%和 100%。中位随访 21 个月后，仅国际预后指数（IPI）和 IWC+PET 改变了无事件生存（EFS）（p =.02 和.0001）和总生存（p =.03 和.05）的持续时间。当结合诊断时的 IPI 和 SUV(max)时，我们能够识别低风险（29%；无复发/进展）、中风险（42%；中位 EFS：37 个月）和高风险（29%，中位 EFS：22 个月）的患者（p =.004）。
在 MCL 中，诊断时的 FDG PET 与 CE 互补，但 BM 和 GI 活检仍然是必需的。IWC+PET 标准能够高效识别早期复发风险高的患者。结合 IPI 和 SUV(max)可能预测患者的预后，并需要进一步进行前瞻性研究以制定风险适应策略。
