Radiology Department, Royal Marsden Hospital, London, UK.
University of Exeter Medical School, Exeter, UK.
Clin Radiol. 2021 Nov;76(11):789-800. doi: 10.1016/j.crad.2021.06.001. Epub 2021 Jun 30.
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in adults. It is a malignancy of CD5 B-cells characterised by small, mature-appearing lymphocytes accumulating in the blood, bone marrow, and lymphoid tissues. Richer transformation (RT) is an important adverse complication. Detection of RT is critical to allow initiation of appropriate therapy. CLL staging and response evaluation is complicated and nuanced. From our extensive tertiary centre experience of several hundred CLL cases over the last decade, we detail key computed tomography (CT) and positron-emission tomography (PET) imaging features of the natural history of CLL. The authors present an original imaging-based patient-management paradigm for the investigation of potential RT, which will inform global practice. Potential applications of whole-body diffusion weighted imaging, novel PET radiotracers, minimal residual disease, and ct-DNA are addressed.
慢性淋巴细胞白血病（CLL）是成人中最常见的白血病。它是一种以 CD5 B 细胞为特征的恶性肿瘤，表现为血液、骨髓和淋巴组织中积累的小而成熟的淋巴细胞。Richter 转化（RT）是一种重要的不良并发症。检测 RT 对于启动适当的治疗至关重要。CLL 的分期和反应评估复杂且微妙。根据我们过去十年在三级中心治疗的数百例 CLL 病例的丰富经验，我们详细描述了 CLL 自然史中关键的计算机断层扫描（CT）和正电子发射断层扫描（PET）成像特征。作者提出了一种基于影像学的潜在 RT 调查的患者管理范例，这将为全球实践提供信息。还讨论了全身弥散加权成像、新型 PET 放射性示踪剂、微小残留病和 ct-DNA 的潜在应用。
