Liu Junyi, Tang Ming, Zhu Dongling, Ruan Ge, Zou Sijuan, Cheng Zhaoting, Zhu Xiaohua, Zhu Yuankai
Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China.
Department of Radiology, Hospital, Hubei University, Wuhan, 430062, China.
EJNMMI Res. 2023 Oct 30;13(1):94. doi: 10.1186/s13550-023-01046-6.
Owing to the advances in diagnosis and therapy, survival or remission rates for lymphoma have improved prominently. Apart from the lymphoma- and chemotherapy-related somatic symptom burden, increasing attention has been drawn to the health-related quality of life. The application of F-fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) has been routinely recommended for the staging and response assessment of FDG-avid lymphoma. However, up till now, only a few researches have investigated the brain metabolic impairments in patients with pre-treatment lymphoma. The determination of the lymphoma-related metabolic brain pattern would facilitate exploring the tailored therapeutic regimen to alleviate not only the physiological, but also the psychological symptoms. In this retrospective study, we aimed to establish the diffuse large B-cell lymphoma-related pattern (DLBCLRP) of metabolic brain network and investigate the correlations between DLBCLRP and several indexes of the staging and response assessment.
The established DLBCLRP was characterized by the increased metabolic activity in bilateral cerebellum, brainstem, thalamus, striatum, hippocampus, amygdala, parahippocampal gyrus and right middle temporal gyrus and by the decreased metabolic activity in bilateral occipital lobe, parietal lobe, anterior cingulate gyrus, midcingulate cortex and medial frontal gyrus. Significant difference in the baseline expression of DLBCLRP was found among complete metabolic response (CMR), partial metabolic response (PMR) and progressive metabolic disease (PMD) groups (P < 0.01). DLBCLRP expressions were also significantly or tended to be positively correlated with international prognostic index (IPI) (r = 0.306, P < 0.05), lg(total metabolic tumor volume, TMTV) (r = 0.298, P < 0.05) and lg(total lesion glycolysis, TLG) (r = 0.233, P = 0.064). Though no significant correlation of DLBCLRP expression was found with Ann Arbor staging or tumor SUV (P > 0.05), the post-treatment declines of DLBCLRP expression were significantly positively correlated with Ann Arbor staging (r = 0.284, P < 0.05) and IPI (r = 0.297, P < 0.05).
The proposed DLBCLRP would lay the foundation for further investigating the cerebral dysfunction related to DLBCL itself and/or treatments. Besides, the expression of DLBCLRP was associated with the tumor burden of lymphoma, implying a potential biomarker for prognosis.
由于诊断和治疗技术的进步，淋巴瘤的生存率或缓解率显著提高。除了淋巴瘤及化疗相关的躯体症状负担外，与健康相关的生活质量也日益受到关注。F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（F-FDG PET/CT）已被常规推荐用于FDG摄取型淋巴瘤的分期和疗效评估。然而，迄今为止，仅有少数研究调查了初治淋巴瘤患者的脑代谢损害情况。确定淋巴瘤相关的代谢脑模式将有助于探索针对性的治疗方案，以缓解生理和心理症状。在这项回顾性研究中，我们旨在建立弥漫性大B细胞淋巴瘤相关的代谢脑网络模式（DLBCLRP），并研究DLBCLRP与分期及疗效评估的几个指标之间的相关性。
所建立的DLBCLRP的特征为双侧小脑、脑干、丘脑、纹状体、海马、杏仁核、海马旁回和右侧颞中回的代谢活性增加，以及双侧枕叶、顶叶、前扣带回、中央扣带回皮质和内侧额叶回的代谢活性降低。在完全代谢缓解（CMR）、部分代谢缓解（PMR）和进行性代谢疾病（PMD）组之间，DLBCLRP的基线表达存在显著差异（P < 0.01）。DLBCLRP表达也与国际预后指数（IPI）（r = 0.306，P < 0.05）、lg（总代谢肿瘤体积，TMTV）（r = 0.298，P < 0.05）和lg（总病变糖酵解，TLG）（r = 0.233，P = 0.064）显著或呈正相关趋势。虽然未发现DLBCLRP表达与Ann Arbor分期或肿瘤SUV有显著相关性（P > 0.05），但治疗后DLBCLRP表达的下降与Ann Arbor分期（r = 0.284，P < 0.05）和IPI（r = 0.297，P < 0.05）显著正相关。
所提出的DLBCLRP将为进一步研究与弥漫性大B细胞淋巴瘤本身和/或治疗相关的脑功能障碍奠定基础。此外，DLBCLRP的表达与淋巴瘤的肿瘤负荷相关，提示其可能是一种预后生物标志物。
