F-2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在淋巴瘤初始分期中评估骨髓浸润的效能
Efficacy of F-2-fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computerized Tomography for Bone Marrow Infiltration Assessment in the Initial Staging of Lymphoma.
作者信息
Öner Ali Ozan, Sürer Budak Evrim, Aydın Funda, Salim Ozan, Yücel Orhan Kemal, Akkaya Bahar, Toptaş Tayfur, Boz Adil, Yıldız Akın, Güngör Fırat, Undar Levent
机构信息
Afyon Kocatepe University Faculty of Medicine, Department of Nuclear Medicine, Afyonkarahisar, Turkey.
Antalya Training and Research Hospital, Clinic of Nuclear Medicine, Antalya, Turkey.
出版信息
Mol Imaging Radionucl Ther. 2017 Jun 1;26(2):69-75. doi: 10.4274/mirt.54376.
OBJECTIVE
Currently F-2-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computerized tomography (PET/CT) is being successfully used for staging and follow-up of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Various studies have demonstrated that PET/CT effectively detects bone marrow involvement (BMI) and is concordant with bone marrow biopsy (BMB) findings, thus it is deemed as a complementary method. This study was aimed to evaluateF-FDG-PET/CT efficiency for detection of BMI in HL and NHL.
METHODS
The study included 172 lymphoma cases who were admitted to Akdeniz University Medical School Department of Nuclear Medicine for initial staging with PET/CT. Visual and semiquantitative assessments were performed for PET/CT scan findings of the cases. The maximum standard uptake (SUV) value was the quantitative parameter used for F-FDG-PET scan. In visual assessment, bone marrow metabolic activity that is greater than the liver was considered as pathologic. For semiquantitative assessment, regions of interest were drawn for SUVmax estimation, which included iliac crest in cases with diffusely increased metabolic activity and the highest activity area in cases with focal involvement. BMB was considered as the reference test.
RESULTS
On visual assessment of all the cases, PET/CT was found to yield 31% sensitivity and 85% specificity rate for detection of BMI. On visual assessment of HL cases, sensitivity rate was determined as 80%, and specificity as 78%, while in NHL cases the corresponding values were 24% and 90%, respectively. On semiquantitative assessment of HL cases, considering SUV≥4, sensitivity was found as 80% and specificity as 68%. In NHL patients, considering SUV≥3.2, sensitivity rate was detected as 65% and specificity as 58%.
CONCLUSION
In this study, a moderately high concordance was observed between PET/CT and BMB findings. PET/CT appears to be a significant method for detecting BMI. Although PET/CT is not a substitute for BMB, we suggest it can be used as a guide to biopsy site and a complementary imaging technique for BMB.
目的
目前，氟代脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）已成功用于霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）的分期及随访。多项研究表明，PET/CT能有效检测骨髓受累情况（BMI），且与骨髓活检（BMB）结果一致，因此被视为一种辅助检查方法。本研究旨在评估F-FDG-PET/CT检测HL和NHL中BMI的效能。
方法
本研究纳入了172例淋巴瘤患者，这些患者因PET/CT进行初始分期而入住阿克德尼兹大学医学院核医学科。对患者的PET/CT扫描结果进行了视觉和半定量评估。最大标准摄取值（SUV）是用于F-FDG-PET扫描的定量参数。在视觉评估中，骨髓代谢活性高于肝脏被视为病理性的。对于半定量评估，绘制感兴趣区域以估计SUVmax，弥漫性代谢活性增加的病例包括髂嵴，局灶性受累的病例包括活性最高的区域。BMB被视为参考检查。
结果
在对所有病例的视觉评估中，发现PET/CT检测BMI的灵敏度为31%，特异度为85%。在对HL病例的视觉评估中，灵敏度为80%，特异度为78%，而在NHL病例中，相应的值分别为24%和90%。在对HL病例的半定量评估中，考虑SUV≥4时，灵敏度为80%，特异度为68%。在NHL患者中，考虑SUV≥3.2时，灵敏度为65%，特异度为58%。
结论
在本研究中，观察到PET/CT与BMB结果之间存在中等程度的高度一致性。PET/CT似乎是检测BMI的一种重要方法。虽然PET/CT不能替代BMB，但我们建议它可作为活检部位的指导以及BMB的辅助成像技术。
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