Liu Yiyan
Department of Radiology, Nuclear Medicine Service, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.
Nucl Med Commun. 2017 Apr;38(4):319-324. doi: 10.1097/MNM.0000000000000652.
Primary bone lymphoma (PBL) is one of the rarest primary bone malignancies. Very limited data are available on the role of fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT in PBL.
Overall, 16 relevant patients had F-FDG PET/CT for staging or staging/restaging PBL. The cases with extraskeletal lesions such as lymphadenopathy or with osseous involvements in disseminated lymphoma were excluded on the basis of the definition of PBL. F-FDG PET/CT findings were correlated to pathologic and/or anatomic image information.
F-FDG PET/CT was positive with markedly increased uptake in all known PBL lesions, with a sensitivity of 100%. In 15 of 16 (93.8%) cases, the bone lesions infiltrated the adjacent soft tissue with visible soft tissue components. Except for known primary bone lesion, F-FDG PET/CT showed additional 24 bone lesions in seven patients, which accounted for 44% of all cases. With maximum standardized uptake value of 2.5 as a cutoff for differentiating residual lymphoma from metabolically inactive disease on restaging scan, the sensitivity, specificity, positive predictive value, and negative predictive value of F-FDG PET/CT for PBL were 100% (4/4), 75% (9/12), 57% (4/7), and 100% (9/9), respectively. The diagnostic accuracy of restaging F-FDG PET/CT was 81% (13/16). Two of three false-positive scans were because of post-therapeutic osteonecrosis.
F-FDG PET/CT is sensitive for showing PBL that is typically highly F-FDG avid and has the ability to depict extraskeletal soft tissue involvement and additional bone lesions on staging. More importantly, F-FDG PET/CT may accurately and reliably evaluate therapeutic response with excellent sensitivity and negative predictive value. However, false-positive F-FDG uptake poses a concern on restaging PET/CT. Post-therapeutic osteonecrosis is a potential source of false-positive findings on F-FDG PET/CT.
原发性骨淋巴瘤（PBL）是最罕见的原发性骨恶性肿瘤之一。关于氟-18-氟脱氧葡萄糖（F-FDG）PET/CT在PBL中的作用，现有数据非常有限。
总体而言，16例相关患者接受了F-FDG PET/CT检查，用于PBL的分期或再分期。根据PBL的定义，排除了伴有骨骼外病变（如淋巴结病）或播散性淋巴瘤伴有骨受累的病例。F-FDG PET/CT检查结果与病理和/或解剖图像信息相关。
F-FDG PET/CT在所有已知的PBL病变中均呈阳性，摄取明显增加，敏感性为100%。16例中的15例（93.8%）骨病变浸润至相邻软组织，可见软组织成分。除已知的原发性骨病变外，F-FDG PET/CT在7例患者中还显示了另外24处骨病变，占所有病例的44%。以最大标准化摄取值2.5作为再分期扫描时区分残留淋巴瘤与代谢无活性疾病的临界值，F-FDG PET/CT对PBL的敏感性、特异性、阳性预测值和阴性预测值分别为100%（4/4）、75%（9/12）、57%（4/7）和100%（9/9）。再分期F-FDG PET/CT的诊断准确性为81%（13/16）。三例假阳性扫描中有两例是由于治疗后骨坏死。
F-FDG PET/CT对显示典型的高F-FDG摄取的PBL敏感，并且能够在分期时描绘骨骼外软组织受累情况及额外的骨病变。更重要的是，F-FDG PET/CT可以以优异的敏感性和阴性预测值准确可靠地评估治疗反应。然而，F-FDG摄取假阳性在PET/CT再分期时是一个问题。治疗后骨坏死是F-FDG PET/CT假阳性结果的一个潜在来源。
