Guerra-García Pilar, Hirsch Steffen, Levine Daniel S, Taj Mary M
Pediatric Oncology, The Royal Marsden Hospital, Sutton, UK.
Pediatric Hematology and Oncology, University Hospital 12 de Octubre, Madrid, Spain.
Pediatr Blood Cancer. 2017 Dec;64(12). doi: 10.1002/pbc.26685. Epub 2017 Jun 14.
Post-transplant lymphoproliferative disorder (PTLD) is a well-known complication following prolonged immunosuppression. Contrary to other lymphomas, there is no standardized imaging approach to assess PTLD either at staging or for response to therapy. Positron emission tomography/computed tomography (PET/CT) is an imaging modality that has proven to be useful in lymphoma. However, there is still limited data concerning its use in pediatric PTLD. Our study evaluates the use of PET/CT in pediatric PTLD at our institution.
To assess the role of PET/CT in pediatric PTLD, we reviewed the pediatric patients with PTLD who had undergone PET/CT at our institution between 2000 and 2016.
Nine patients were identified. Six had PET/CT at diagnosis. All lesions seen on CT were identified with PET/CT. Fourteen PET/CTs were done during treatment. Eight PET/CTs were negative, including three where CT showed areas of uncertain significance. In these cases, PET/CT helped us to stop treatment and the patients remain in remission after a long follow-up (mean 74.3 months; range 12.4-180.9 months). PET/CT revealed additional disease in two cases, therefore treatment was intensified. Six biopsies and close follow-up was done to confirm PET/CT results. In one case, PET/CT did not identify central nervous system involvement demonstrated on magnetic resonance imaging.
PET/CT may have an important role in the staging and follow-up of pediatric PTLD. In our cohort, PET/CT was helpful in staging and assessing treatment response and in clarifying equivocal findings on other imaging modalities.
移植后淋巴细胞增殖性疾病（PTLD）是长期免疫抑制后的一种常见并发症。与其他淋巴瘤不同，在分期或评估治疗反应时，尚无标准化的影像学方法来评估PTLD。正电子发射断层扫描/计算机断层扫描（PET/CT）是一种已被证明在淋巴瘤中有用的成像方式。然而，关于其在儿童PTLD中的应用数据仍然有限。我们的研究评估了PET/CT在我们机构儿童PTLD中的应用。
为了评估PET/CT在儿童PTLD中的作用，我们回顾了2000年至2016年间在我们机构接受PET/CT检查的儿童PTLD患者。
共确定9例患者。6例在诊断时进行了PET/CT检查。CT上发现的所有病变均被PET/CT识别。治疗期间进行了14次PET/CT检查。8次PET/CT检查结果为阴性，其中3次CT显示意义不确定的区域。在这些病例中，PET/CT帮助我们停止治疗，患者经过长时间随访（平均74.3个月；范围12.4 - 180.9个月）后仍处于缓解状态。PET/CT在2例中发现了额外的疾病，因此加强了治疗。进行了6次活检并密切随访以确认PET/CT结果。在1例中，PET/CT未识别出磁共振成像显示的中枢神经系统受累情况。
PET/CT在儿童PTLD的分期和随访中可能具有重要作用。在我们的队列中，PET/CT有助于分期和评估治疗反应，并澄清其他成像方式上的模糊发现。
