HIV 感染者中恶性淋巴瘤与炎症性淋巴结病的临床特征及 F-FDG PET/CT 鉴别。
Clinical features and F-FDG PET/CT for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.
机构信息
Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
出版信息
BMC Infect Dis. 2022 Jul 27;22(1):646. doi: 10.1186/s12879-022-07640-8.
BACKGROUND
It is vital to distinguish between inflammatory and malignant lymphadenopathy in human immunodeficiency virus (HIV) infected individuals. The purpose of our study was to differentiate the variations in the clinical characteristics of HIV patients, and apply F-FDG PET/CT parameters for distinguishing of malignant lymphoma and inflammatory lymphadenopathy in such patients.
METHODS
This retrospective cross-sectional study included 59 consecutive HIV-infected patients who underwent whole-body F-FDG PET/CT. Of these patients, 37 had biopsy-proven HIV-associated lymphoma, and 22 with HIV-associated inflammatory lymphadenopathy were used as controls. The determined parameters were the maximum of standard uptake value (SUV), SUV of only lymph nodes (SUV), the most FDG-avid lesion-to-liver SUV ratio (SUR), laboratory examinations and demographics. The optimal cut-off of F-FDG PET/CT value was analyzed by receiver operating characteristic curve (ROC).
RESULTS
Considering the clinical records, the Karnofsky Performance Status (KPS) scores in patients with inflammatory lymphadenopathy were obviously higher than those in patients with malignant lymphoma (P = 0.015), whereas lymphocyte counts and lactate dehydrogenase (LDH) were obviously lower (P = 0.014 and 0.010, respectively). For the F-FDG PET/CT imaging, extra-lymphatic lesions, especially digestive tract and Waldeyer's ring, occurred more frequently in malignant lymphoma than inflammatory lymphadenopathy. Furthermore, the SUR and SUV in malignant lymphoma were markedly higher than those in inflammatory lymphadenopathy (P = 0.000 and 0.000, respectively). The cut-off point of 3.1 for SUR had higher specificity (91.9%) and relatively reasonable sensitivity (68.2%) and the cut-off point of 8.0 for the SUV had high specificity (89.2%) and relatively reasonable sensitivity (63.6%).
CONCLUSION
Our study identified the distinctive characteristics of the clinical manifestations, the SUR, SUV and detectability of extra-lymphatic lesions on F-FDG PET, and thus provides a new basis for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.
背景
在人类免疫缺陷病毒（HIV）感染者中，区分炎症性和恶性淋巴结病至关重要。我们的研究目的是区分 HIV 患者的临床特征变化，并应用 F-FDG PET/CT 参数来区分此类患者的恶性淋巴瘤和炎症性淋巴结病。
方法
这项回顾性的横断面研究纳入了 59 例接受全身 F-FDG PET/CT 的连续 HIV 感染患者。其中 37 例经活检证实为 HIV 相关淋巴瘤，22 例 HIV 相关炎症性淋巴结病患者作为对照。确定的参数包括最大标准摄取值（SUV）、仅淋巴结 SUV、最 FDG 摄取病变与肝脏 SUV 比值（SUR）、实验室检查和人口统计学特征。通过受试者工作特征曲线（ROC）分析 F-FDG PET/CT 值的最佳截断值。
结果
考虑到临床记录，炎症性淋巴结病患者的卡氏功能状态（KPS）评分明显高于恶性淋巴瘤患者（P=0.015），而淋巴细胞计数和乳酸脱氢酶（LDH）明显较低（P=0.014 和 0.010）。对于 F-FDG PET/CT 成像，恶性淋巴瘤比炎症性淋巴结病更常出现淋巴结外病变，特别是消化道和瓦尔德耶环。此外，恶性淋巴瘤的 SUR 和 SUV 明显高于炎症性淋巴结病（P=0.000 和 0.000）。SUR 的截断值为 3.1 时具有较高的特异性（91.9%）和相对合理的敏感性（68.2%），SUV 的截断值为 8.0 时具有较高的特异性（89.2%）和相对合理的敏感性（63.6%）。
结论
本研究确定了 F-FDG PET 中 HIV 感染患者临床表现、SUR、SUV 和淋巴结外病变检出的特征，为区分恶性淋巴瘤和炎症性淋巴结病提供了新的依据。
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