F-FDG PET/CT在惰性与侵袭性非霍奇金淋巴瘤鉴别诊断中的价值：328例患者的研究
Value of F-FDG PET/CT in discrimination between indolent and aggressive non-Hodgkin's lymphoma: A study of 328 patients.
作者信息
Alobthani Galal, Romanov Victor, Isohashi Kayako, Matsunaga Keiko, Watabe Tadashi, Kato Hiroki, Tatsumi Mitsuaki, Shimosegawa Eku, Hatazawa Jun
机构信息
Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.
出版信息
Hell J Nucl Med. 2018 Jan-Apr;21(1):7-14. doi: 10.1967/s002449910701. Epub 2018 Mar 20.
OBJECTIVE
Non-Hodgkin's lymphoma (NHL) cases with inconclusive biopsy findings are not infrequently referred for fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT). We searched for maximum standardized uptake value (SUVmax) cut-off values that could discriminate between indolent and aggressive NHL in conventional non-time of flight (non-TOF) F-FDG PET/CT and TOF F-FDG PET/CT.
SUBJECTS AND METHODS
Retrospectively, 328 patients were selected by the following inclusion criteria: biopsy-proven NHL with no more than one histopathological type; new cases with less than 90 days between obtaining biopsy and F-FDG PET/CT scanning; recurrent cases with time interval more than six months since the last therapy with no history of transformation; and blood glucose less than 150mg/dL. Two hundred forty six (246) selected patients were scanned with non-TOF PET/CT, and 82 patients were scanned with TOF F-FDG PET/CT.
RESULTS
The SUVmax of NHL tends to be higher in TOF F-FDG PET/CT than non-TOF F-FDG PET/CT. New aggressive NHL had significantly higher SUVmax than new indolent NHL in both, non-TOF F-FDG PET/CT (13.6±7.7g/mL vs. 5.3±3.4g/mL, P<0.0001) and TOF F-FDG PET/CT (20.5±9.8g/mL vs. 6.6±4.7g/mL, P<0.0001). A receiver operating characteristic curve analysis for new cases in non-TOF F-FDG PET/CT (n=204), demonstrated SUVmax of 10g/mL as the most balanced cut-off between aggressive and indolent NHL, with the area under the curve (AUC) of 86%, specificity of 94%, and sensitivity of 71%. While SUVmax of 13g/mL was the most balanced cut-off for new cases in TOF F-FDG PET/CT (n=57), with AUC of 91%, specificity of 95.5%, and sensitivity of 77%.
CONCLUSION
Both SUVmax>10g/mL in non-TOF F-FDG PET/CT and >13g/mL in TOF F-FDG PET/CT were highly suggestive of an aggressive nature of NHL, while there was an overlap between indolent and aggressive NHL in the lower SUVmax levels.
目的
活检结果不明确的非霍奇金淋巴瘤（NHL）病例常被转诊进行氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）检查。我们探寻了在传统非飞行时间（非TOF）F-FDG PET/CT和TOF F-FDG PET/CT中能够区分惰性和侵袭性NHL的最大标准化摄取值（SUVmax）临界值。
对象与方法
回顾性选取328例患者，纳入标准如下：经活检证实为NHL且组织病理学类型不超过一种；活检与F-FDG PET/CT扫描间隔时间少于90天的新发病例；自上次治疗后时间间隔超过6个月且无转化史的复发病例；血糖低于150mg/dL。246例入选患者接受了非TOF PET/CT扫描，82例患者接受了TOF F-FDG PET/CT扫描。
结果
TOF F-FDG PET/CT中NHL的SUVmax往往高于非TOF F-FDG PET/CT。在非TOF F-FDG PET/CT（13.6±7.7g/mL对5.3±3.4g/mL，P<0.0001）和TOF F-FDG PET/CT（20.5±9.8g/mL对6.6±4.7g/mL，P<0.0001）中，新诊断的侵袭性NHL的SUVmax均显著高于新诊断的惰性NHL。对非TOF F-FDG PET/CT（n=204）中的新发病例进行的受试者工作特征曲线分析显示，SUVmax为10g/mL是侵袭性和惰性NHL之间最平衡的临界值，曲线下面积（AUC）为86%，特异性为94%，敏感性为71%。而TOF F-FDG PET/CT（n=57）中新发病例的最平衡临界值为SUVmax 13g/mL，AUC为91%，特异性为95.5%，敏感性为77%。
结论
非TOF F-FDG PET/CT中SUVmax>10g/mL以及TOF F-FDG PET/CT中SUVmax>13g/mL均高度提示NHL具有侵袭性，而在较低SUVmax水平时，惰性和侵袭性NHL之间存在重叠。
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