El-Najjar Inas, Montoto Silvia, McDowell Amy, Matthews Janet, Gribben John, Szyszko Teresa A
aCentre for Haemato-Oncology bDepartment of Nuclear Medicine, Centre for Molecular Oncology, Barts Cancer Institute cClinical PET Centre, Division of Imaging Sciences and Biomedical Engineering, Kings College London, St Thomas' Hospital, London, UK.
Nucl Med Commun. 2014 Mar;35(3):311-5. doi: 10.1097/MNM.0000000000000059.
The aim of the study was to investigate the value of fluorine-18-fluorodeoxyglucose ((18)F-FDG)-PET/computed tomography (CT) in identifying diffuse bone marrow (BM) involvement in follicular lymphoma using semiquantitative assessment.
This is a retrospective analysis of 41 patients with grade 1-3a follicular lymphoma who underwent (18)F-FDG-PET/CT, contrast-enhanced CT and bone marrow trephine biopsy (BMB) as part of staging. BM involvement on PET/CT was assessed by visual and semiquantitative analysis. Standardized uptake values (SUVmax) were measured at the sternum, at both iliac blades and at the T12 vertebra. An average of these four measurements was recorded as SUVav. The single highest overall SUVmax for the four bone sites, the SUVav and the ratios SUVav/mediastinal blood pool (MBP) and SUVav/liver were compared with the BMB result.
Focal bone uptake was identified on (18)F-FDG-PET/CT by visual analysis in six patients, including two cases in which the BMB was negative. Assessment of diffuse BM involvement on (18)F-FDG-PET/CT by visual analysis had a sensitivity and specificity of 31 and 92%, respectively. Semiquantitative analysis resulted in an improved sensitivity and specificity of 58 and 96%, respectively, when using SUVav greater than or equal to 2 as the cutoff. Using the ratio SUVav/MBP greater than or equal to 1 the sensitivity of (18)F-FDG-PET/CT to detect BM involvement improved to 83%.
Visual analysis is useful in determining focal bone involvement, whereas semiquantitative analysis using SUVav/MBP has a high sensitivity and specificity for predicting BM involvement in patients lacking focal bone lesions.
本研究旨在通过半定量评估，探讨氟-18-氟脱氧葡萄糖（（18）F-FDG）-正电子发射断层显像/计算机断层扫描（PET/CT）在识别滤泡性淋巴瘤弥漫性骨髓（BM）受累情况中的价值。
这是一项对41例1-3a级滤泡性淋巴瘤患者的回顾性分析，这些患者接受了（18）F-FDG-PET/CT、增强CT和骨髓穿刺活检（BMB）作为分期检查的一部分。通过视觉和半定量分析评估PET/CT上的骨髓受累情况。在胸骨、双侧髂骨和T12椎体测量标准化摄取值（SUVmax）。记录这四个测量值的平均值作为SUVav。将四个骨部位的单个最高总体SUVmax、SUVav以及SUVav/纵隔血池（MBP）和SUVav/肝脏的比值与BMB结果进行比较。
通过视觉分析在6例患者的（18）F-FDG-PET/CT上发现局灶性骨摄取，其中2例BMB结果为阴性。通过视觉分析评估（18）F-FDG-PET/CT上的弥漫性骨髓受累情况，敏感性和特异性分别为31%和92%。当使用SUVav大于或等于2作为临界值时，半定量分析的敏感性和特异性分别提高到58%和96%。使用SUVav/MBP大于或等于1时，（18）F-FDG-PET/CT检测骨髓受累情况的敏感性提高到83%。
视觉分析有助于确定局灶性骨受累情况，而使用SUVav/MBP的半定量分析对于预测无局灶性骨病变患者的骨髓受累情况具有较高的敏感性和特异性。
