使用18F-FDG或3'-脱氧-3'-18F-氟胸苷检测滤泡性淋巴瘤的转化。
18F-FDG or 3'-deoxy-3'-18F-fluorothymidine to detect transformation of follicular lymphoma.
作者信息
Wondergem Marielle J, Rizvi Saiyada N F, Jauw Yvonne, Hoekstra Otto S, Hoetjes Nikie, van de Ven Peter M, Boellaard Ronald, Chamuleau Martine E D, Cillessen Saskia A G M, Regelink Josien C, Zweegman Sonja, Zijlstra Josée M
机构信息
Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
Department of Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
出版信息
J Nucl Med. 2015 Feb;56(2):216-21. doi: 10.2967/jnumed.114.149625. Epub 2015 Jan 15.
UNLABELLED
Considering the different treatment strategy for transformed follicular lymphoma (TF) as opposed to follicular lymphoma (FL), diagnosing transformation early in the disease course is important. There is evidence that (18)F-FDG has utility as a biomarker of transformation. However, quantitative thresholds may require inclusion of homogeneous non-Hodgkin lymphoma subtypes to account for differences in tracer uptake per subtype. Moreover, because proliferation is a hallmark of transformation, 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) might be superior to (18)F-FDG in this setting. To define the best tracer for detection of TF, we performed a prospective a head-to-head comparison of (18)F-FDG and (18)F-FLT in patients with FL and TF.
METHODS
(18)F-FDG and (18)F-FLT PET scans were obtained in 17 patients with FL and 9 patients with TF. We measured the highest maximum standardized uptake value (SUVmax), defined as the lymph node with the highest uptake per patient, and SUVrange, defined as the difference between the SUVmax of the lymph node with the highest and lowest uptake per patient. To reduce partial-volume effects, only lymph nodes larger than 3 cm(3) (A50 isocontour) were analyzed. Scans were acquired 1 h after injection of 185 MBq of (18)F-FDG or (18)F-FLT. To determine the discriminative ability of SUVmax and SUVrange of both tracers for TF, receiver-operating-characteristic curve analysis was performed.
RESULTS
The highest SUVmax was significantly higher for TF than FL for both (18)F-FDG and (18)F-FLT (P < 0.001). SUVrange was significantly higher for TF than FL for (18)F-FDG (P = 0.029) but not for (18)F-FLT (P = 0.075). The ability of (18)F-FDG to discriminate between FL and TF was superior to that of (18)F-FLT for both the highest SUVmax (P = 0.039) and the SUVrange (P = 0.012). The cutoff value for the highest SUVmax of (18)F-FDG aiming at 100% sensitivity with a maximum specificity was found to be 14.5 (corresponding specificity, 82%). For (18)F-FLT, these values were 5.1 and 18%, respectively. When the same method was applied to SUVrange, the cutoff values were 5.8 for (18)F-FDG (specificity, 71%) and 1.5 for (18)F-FLT (specificity, 36%).
CONCLUSION
Our data suggest that (18)F-FDG PET is a better biomarker for TF than (18)F-FLT PET. The proposed thresholds of highest SUVmax and SUVrange should be prospectively validated.
未标注
鉴于转化型滤泡性淋巴瘤（TF）与滤泡性淋巴瘤（FL）的治疗策略不同，在疾病进程早期诊断转化很重要。有证据表明，（18）F-FDG可作为转化的生物标志物。然而，定量阈值可能需要纳入同质的非霍奇金淋巴瘤亚型，以考虑各亚型示踪剂摄取的差异。此外，由于增殖是转化的标志，在这种情况下，3'-脱氧-3'-（18）F-氟胸苷（（18）F-FLT）可能优于（18）F-FDG。为了确定检测TF的最佳示踪剂，我们对FL和TF患者进行了（18）F-FDG和（18）F-FLT的前瞻性直接比较。
方法
对17例FL患者和9例TF患者进行了（18）F-FDG和（18）F-FLT PET扫描。我们测量了最高最大标准化摄取值（SUVmax），定义为每位患者摄取最高值的淋巴结，以及SUVrange，定义为每位患者摄取最高值和最低值的淋巴结之间的差异。为减少部分容积效应，仅分析大于3 cm³（A50等剂量线）的淋巴结。在注射185 MBq的（18）F-FDG或（18）F-FLT后1小时进行扫描。为确定两种示踪剂的SUVmax和SUVrange对TF的鉴别能力进行了受试者操作特征曲线分析。
结果
对于（18）F-FDG和（18）F-FLT，TF的最高SUVmax均显著高于FL（P < 0.001）。对于（18）F-FDG，TF的SUVrange显著高于FL（P = 0.029），但对于（18）F-FLT则不然（P = 0.075）。对于最高SUVmax（P = 0.039）和SUVrange（P = 0.012），（18）F-FDG区分FL和TF 的能力优于（18）F-FLT 的能力。发现旨在达到100%敏感性并具有最大特异性时，（18）F-FDG最高SUVmax的临界值为14.5（相应特异性为82%）。对于（18）F-FLT，这些值分别为5.1和18%。当将相同方法应用于SUVrange时，（18）F-FDG的临界值为5.8（特异性为71%），（18）F-FLT的临界值为1.5（特异性为36%）
结论
我们的数据表明，（18）F-FDG PET作为TF的生物标志物比（18）F-FLT PET更好。所提出的最高SUVmax和SUVrange阈值应进行前瞻性验证。
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