Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
Acad Radiol. 2018 Apr;25(4):453-460. doi: 10.1016/j.acra.2017.10.024. Epub 2017 Dec 1.
This study aimed to determine the diagnostic utility of standardized uptake values (SUV) and apparent diffusion coefficients (ADC) for assessment of focal and diffuse bone marrow involvement in patients with malignant lymphoma.
Sixty treatment-naive patients (28 males; mean age 51.2 ± 16.7 years) with histologically proven lymphoma, who underwent fludeoxyglucose (F) positron emission tomography-computed tomography ([F18]-FDG-PET/CT) and whole-body diffusion-weighted imaging (WB-DWI) within 7 days, and also routine bone marrow biopsy, were included in this institutional review board-approved, retrospective study. The maximum SUV (SUVmax) on [F18]-FDG-PET/CT, and the mean ADC (ADCmean, ×10 mm/s) on whole-body-DWI, were extracted from focal lesions, or, in their absence, from the thoracic (Th8) and lumbar vertebral bodies (L4), the sacral bone (S1), and the iliac crest. Lesion-to-liver-ratios (SUVmax-ratio) were calculated. Pearson correlation coefficients were used to assess the correlation between SUVmax-ratios and ADCmean values.
Bone marrow involvement was observed in 16 of 60 patients (8 of 16 with diffuse infiltration). The SUVmax-ratio cutoff value was 95.25% for focal and 70.2% for diffuse bone marrow involvement (sensitivity/specificity of 87.5%/86.4% and 100%/43.2%, respectively). The ADCmean cutoff value was 0.498 for focal and 0.401 for diffuse bone marrow involvement (sensitivity/specificity of 100%/90.9% and 87.5%/56.8%, respectively). No significant correlations were found between SUVmax-ratios and ADCmean values in the different groups.
With the liver as reference tissue, quantitative [F18]-FDG-PET/CT may be useful to differentiate bone marrow involvement from normal bone marrow in patients with lymphoma, even though the specificity for diffuse marrow involvement is rather low. Quantitative DWI can be used only to distinguish focal bone marrow lesions from normal bone marrow.
本研究旨在确定标准化摄取值（SUV）和表观扩散系数（ADC）在评估恶性淋巴瘤患者局灶性和弥漫性骨髓受累中的诊断效用。
本回顾性研究共纳入 60 例未经治疗的淋巴瘤患者（28 例男性；平均年龄 51.2±16.7 岁），这些患者均在 7 天内行氟脱氧葡萄糖（F）正电子发射断层扫描-计算机断层扫描（[F18]-FDG-PET/CT）和全身弥散加权成像（WB-DWI）检查，且均行常规骨髓活检。从局灶性病变中提取最大 SUV（SUVmax），或在缺乏局灶性病变时，从胸 8 椎体（Th8）、腰 4 椎体（L4）、骶骨（S1）和髂嵴提取 SUV（SUVmax），从全身弥散加权成像中提取平均 ADC（ADCmean，×10mm/s）。计算病灶与肝脏比值（SUVmax-ratio）。采用 Pearson 相关系数评估 SUVmax-ratio 与 ADCmean 值之间的相关性。
60 例患者中有 16 例（8 例为弥漫性浸润）观察到骨髓受累。局灶性和弥漫性骨髓受累的 SUVmax-ratio 截断值分别为 95.25%和 70.2%（敏感性/特异性分别为 87.5%/86.4%和 100%/43.2%）。局灶性和弥漫性骨髓受累的 ADCmean 截断值分别为 0.498 和 0.401（敏感性/特异性分别为 100%/90.9%和 87.5%/56.8%）。在不同分组中，SUVmax-ratio 与 ADCmean 值之间未发现显著相关性。
以肝脏为参照组织，定量[F18]-FDG-PET/CT 可能有助于区分淋巴瘤患者骨髓受累与正常骨髓，尽管弥漫性骨髓受累的特异性较低。定量 DWI 仅可用于区分局灶性骨髓病变与正常骨髓。
