Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
Ann Hematol. 2019 Apr;98(4):909-914. doi: 10.1007/s00277-018-3558-4. Epub 2018 Nov 20.
Recent studies have not only shown better prognosis of lymphoma with the advancement of therapeutic drug development, but also suggested more attention should be paid to drug-induced lung injury. Early diagnosis is critical for treatment of drug-induced lung injury. F-FDG-PET/CT, the standard imaging method for prognosis evaluation of Hodgkin's lymphoma and some non-Hodgkin's lymphoma, has also shown the potential for early detection of drug-induced lung injury in our study. A total of 579 lymphoma patients evaluated by F-FDG-PET/CT between June 2016 and March 2018 are studied retrospectively. Clinical and imaging characteristics are described in 32 patients (average age of 55), who were diagnosed with drug-induced lung injury. The incidence of drug-induced lung injury was 5.53% (32/579); most of the chemotherapy regimens include rituximab (90.63%, 29/32). Twelve patients demonstrated fever, cough, and dyspnea, and the other 20 had no significant symptoms. F-FDG-PET/CT showed multiple or diffused distribution of ground glass and patchy shadows, with increased FDG uptake in both lungs (SUV 2.28 ± 1.13, standardized uptake ratio-blood pool, SUR-BP = 0.59-4.07, median SUR-BP 1.32). SUV and SUR-BP in patients with symptoms (SUV 3.03 ± 1.33 and SUR-BP 2.12 ± 1.06) were significantly higher than in those without symptoms (SUV 1.84 ± 0.70 and SUR-BP 1.18 ± 0.48) (P = 0.002 for both SUV and SUR-BP). After temporary drug withdrawal, changing chemotherapy regimens, and corticosteroid usage, the pulmonary lesions in all patients were relieved, confirmed with chest CT. Drug-induced lung injury can be a co-finding during F-FDG-PET/CT assessment of lymphoma. With positive correlation between FDG uptake and symptoms, F-FDG-PET/CT provided value in early detection of lung injury in asymptomatic patients.
最近的研究不仅表明随着治疗药物的发展，淋巴瘤的预后有所改善，而且还表明应该更加关注药物引起的肺损伤。早期诊断对于药物引起的肺损伤的治疗至关重要。正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）是霍奇金淋巴瘤和一些非霍奇金淋巴瘤预后评估的标准影像学方法，我们的研究也表明其在早期检测药物引起的肺损伤方面具有潜力。回顾性分析了 2016 年 6 月至 2018 年 3 月期间接受 FDG-PET/CT 评估的 579 例淋巴瘤患者，描述了 32 例（平均年龄 55 岁）诊断为药物性肺损伤患者的临床和影像学特征。药物性肺损伤的发生率为 5.53%（32/579）；大多数化疗方案包括利妥昔单抗（90.63%，29/32）。12 例患者表现为发热、咳嗽和呼吸困难，其余 20 例患者无明显症状。FDG-PET/CT 显示双肺多灶或弥漫性分布的磨玻璃影和斑片状阴影，双肺 FDG 摄取增加（SUV2.28±1.13，标准化摄取值-血池比值 SUR-BP=0.59-4.07，中位数 SUR-BP1.32）。有症状患者（SUV3.03±1.33 和 SUR-BP2.12±1.06）的 SUV 和 SUR-BP 明显高于无症状患者（SUV1.84±0.70 和 SUR-BP1.18±0.48）（SUV 和 SUR-BP 均 P=0.002）。暂时停药、更改化疗方案和使用皮质类固醇后，所有患者的肺部病变均得到缓解，胸部 CT 证实。药物性肺损伤可在淋巴瘤 FDG-PET/CT 评估中同时发现。FDG 摄取与症状之间存在正相关，FDG-PET/CT 为无症状患者肺损伤的早期检测提供了价值。
