Alkhawtani Rayan H M, Noordzij Walter, Glaudemans Andor W J M, van Rijn Rozemarijn S, van der Galiën Hilde T, Balink Hans, Nijland Marcel, Adams Hugo J A, Huls Gerwin, van Meerten Tom, Kwee Thomas C
Departments of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center.
Department of Hematology, Medical Center Leeuwarden, Leeuwarden.
Nucl Med Commun. 2018 Jun;39(6):572-578. doi: 10.1097/MNM.0000000000000840.
This study aims to investigate whether clinical, laboratory, and fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT findings can discriminate between mediastinal Hodgkin's lymphoma and primary mediastinal B-cell lymphoma (PMBCL).
This retrospective study included 56 patients (42 with mediastinal Hodgkin's lymphoma and 14 with PBMCL). Differences in clinical, laboratory, and F-FDG PET/CT metrics were assessed between Hodgkin's lymphoma and PMBCL.
Lactate dehydrogenase (LDH) and F-FDG PET/CT-based maximum tumor diameter, lesion-to-liver ratio maximum standardized uptake value (SUVmax), and lesion-to-liver ratio peak standardized uptake value (SUVpeak) were all significantly higher (P<0.001) in PMBCL than in Hodgkin's lymphoma, and PMBCL also significantly more frequently (P=0.001) exhibited necrosis on F-FDG PET/CT than Hodgkin's lymphoma. LDH, maximum tumor diameter, lesion-to-liver ratio SUVmax, and lesion-to-liver ratio SUVpeak yielded areas under the receiver operating characteristic curve of 0.968 [95% confidence interval (CI): 0.923-1.000], 0.866 (95% CI: 0.765-0.968), 0.875 (95% CI: 0.776-0.975), and 0.874 (95% CI: 0.771-0.976), respectively. LDH (with cutoff of 236 U/l) achieved sensitivity and specificity of 81.6 and 100%, respectively; maximum tumor diameter (with cutoff of 9.98 cm) achieved sensitivity and specificity of 87.2 and 78.3%, respectively; lesion-to-liver ratio SUVmax (with cutoff of 7.12) achieved sensitivity and specificity of 94.9 and 64.3%, respectively; lesion-to-liver ratio SUVpeak (with cutoff of 11.45) achieved sensitivity and specificity of 97.4 and 64.3%, respectively; and the presence of necrosis achieved sensitivity and specificity of 78.6 and 74.4%, respectively, in discriminating PMBCL from Hodgkin's lymphoma.
LDH levels and several F-FDG PET/CT findings (tumor size, presence of necrosis, and degree of F-FDG uptake) are helpful in discriminating mediastinal Hodgkin's lymphoma from PMBCL.
本研究旨在探讨临床、实验室及氟-18-氟脱氧葡萄糖（F-FDG）PET/CT检查结果能否鉴别纵隔霍奇金淋巴瘤与原发性纵隔B细胞淋巴瘤（PMBCL）。
本回顾性研究纳入56例患者（42例纵隔霍奇金淋巴瘤患者和14例PMBCL患者）。评估霍奇金淋巴瘤与PMBCL在临床、实验室及F-FDG PET/CT指标方面的差异。
PMBCL患者的乳酸脱氢酶（LDH）水平、基于F-FDG PET/CT的最大肿瘤直径、病灶与肝脏比值的最大标准化摄取值（SUVmax）以及病灶与肝脏比值的峰值标准化摄取值（SUVpeak）均显著高于霍奇金淋巴瘤患者（P<0.001），且PMBCL患者在F-FDG PET/CT上出现坏死的频率也显著高于霍奇金淋巴瘤患者（P=0.001）。LDH、最大肿瘤直径、病灶与肝脏比值SUVmax以及病灶与肝脏比值SUVpeak的受试者操作特征曲线下面积分别为0.968[95%置信区间（CI）：0.923-1.000]、0.866（95%CI：0.765-0.968）、0.875（95%CI：0.776-0.975）和0.874（95%CI：0.771-0.976）。LDH（临界值为236 U/l）的敏感性和特异性分别为81.6%和100%；最大肿瘤直径（临界值为9.98 cm）的敏感性和特异性分别为87.2%和78.3%；病灶与肝脏比值SUVmax（临界值为7.12）的敏感性和特异性分别为94.9%和64.3%；病灶与肝脏比值SUVpeak（临界值为11.45）的敏感性和特异性分别为97.4%和64.3%；坏死的存在在鉴别PMBCL与霍奇金淋巴瘤时的敏感性和特异性分别为78.6%和74.4%。
LDH水平及多项F-FDG PET/CT检查结果（肿瘤大小、坏死情况及F-FDG摄取程度）有助于鉴别纵隔霍奇金淋巴瘤与PMBCL。
