Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Rheumatology (Oxford). 2023 Oct 3;62(10):3323-3331. doi: 10.1093/rheumatology/kead071.
To assess the usefulness of [18F]-fluorodeoxyglucose (FDG)-PET/CT (i) to discriminate between primary SS (pSS) patients with and without lymphomas and (ii) to evaluate systemic disease activity in pSS.
ACR-EULAR-positive pSS patients who underwent FDG-PET/CT were included. Scans were visually evaluated and quantitative analysis was performed by measuring standardized uptake values (SUV) of salivary and lacrimal glands and systemic regions. Receiver operating characteristic curve analyses were performed to find SUV cut-off values to discriminate between lymphoma and non-lymphoma.
Of the 70 included patients, 26 were diagnosed with a pSS-associated lymphoma, mostly of the mucosa-associated lymphoid tissue type (23/26). Lymphoma patients showed higher FDG uptake in the parotid and submandibular glands, and more frequently showed presence of nodular lung lesions, compared with non-lymphoma patients. The accuracy of the maximum SUV (SUVmax) in the parotid and submandibular gland to predict lymphoma diagnosis was good, with optimal cut-off points of 3.1 and 2.9. After combining these three visual and quantitative findings (nodular lung lesions, parotid SUVmax > 3.1 and submandibular SUVmax > 2.9), sensitivity was 92% when at least one of the three features were present, and specificity was 91% in case at least two features were present. Furthermore, FDG-PET/CT was able to detect systemic manifestations in pSS patients, mostly involving lymph nodes, entheses and lungs.
FDG-PET/CT can assist in excluding pSS-associated lymphomas in patients without PET abnormalities, possibly leading to a decrease of invasive biopsies in suspected lymphoma patients. Furthermore, FDG-PET/CT is able to detect systemic manifestations in pSS and can guide to the best biopsy location.
评估 [18F]-氟代脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描（PET/CT）（i）区分原发性干燥综合征（pSS）伴和不伴淋巴瘤患者的有用性，以及（ii）评估 pSS 患者的全身疾病活动度。
纳入接受 FDG-PET/CT 的 ACR-EULAR 阳性 pSS 患者。对扫描进行视觉评估，并通过测量唾液腺和泪腺以及全身区域的标准化摄取值（SUV）进行定量分析。进行受试者工作特征曲线分析，以找到 SUV 截断值来区分淋巴瘤和非淋巴瘤。
在 70 名纳入的患者中，26 名被诊断为 pSS 相关淋巴瘤，主要为黏膜相关淋巴组织型（23/26）。与非淋巴瘤患者相比，淋巴瘤患者的腮腺和颌下腺摄取 FDG 更高，且更常出现结节性肺部病变。腮腺和颌下腺 SUVmax 预测淋巴瘤诊断的准确性较高，最佳截断点分别为 3.1 和 2.9。将这三个视觉和定量发现（结节性肺部病变、腮腺 SUVmax＞3.1 和颌下腺 SUVmax＞2.9）相结合，当至少存在三种特征中的一种时，敏感性为 92%，当至少存在两种特征时，特异性为 91%。此外，FDG-PET/CT 能够检测 pSS 患者的全身表现，主要涉及淋巴结、附着点和肺部。
FDG-PET/CT 可以帮助排除无 PET 异常的 pSS 相关淋巴瘤患者，可能导致疑似淋巴瘤患者的侵袭性活检减少。此外，FDG-PET/CT 能够检测 pSS 的全身表现，并能够指导最佳活检部位。
