Chen J, Li X L, Huang M
Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Clin Radiol. 2024 Mar;79(3):205-212. doi: 10.1016/j.crad.2023.12.012. Epub 2024 Jan 5.
To explore the utility of the 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron-emission tomography (PET)/computed tomography (CT) in the differential diagnosis of IgG4-related lymphadenopathy (IgG4-RLAD) and angioimmunoblastic T-cell lymphoma (AITL).
Retrospective analysis of F-FDG PET/CT imaging findings in clinically diagnosed IgG4-RLAD and AITL cases was undertaken to record the distribution, morphological characteristics, and imaging features of the affected lymph nodes, as well as FDG uptake of the spleen and bone marrow. Standardised uptake values normalised to lean body mass were evaluated for maximum (SUL), average (SUL), and peak values (SUL). Univariate and multivariate logistic regression was used to screen for statistically significant imaging findings to discriminate IgG4-RLAD from AITL.
Twenty-two cases of IgG4-RLAD (17 men, five women, median age 49.5 years) and 22 cases of AITL (16 men, six women, median age 55 years) were finally included in the analysis. There were no AITL patients with involvement of a single lymph node region. AITL patients had more involvement of the different nodal regions except cervical and pelvic nodal regions. A practical assessment method based on a combination of SUL/SUL, SUL, and the number of involved nodal regions, improved the performance for differential diagnosis between both groups with an overall classification accuracy of 90.9%.
F-FDG PET/CT is a useful tool for distinguishing AITL from IgG4-RLAD, and it can also help determine the optimal biopsy site for suspected cases of IgG4-RLAD or AITL, reduce the need for re-biopsy procedures, and enable physicians to develop timely treatment strategies.
探讨2-[F]-氟-2-脱氧-D-葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）在IgG4相关淋巴结病（IgG4-RLAD）与血管免疫母细胞性T细胞淋巴瘤（AITL）鉴别诊断中的应用价值。
对临床诊断的IgG4-RLAD和AITL病例的F-FDG PET/CT影像表现进行回顾性分析，记录受累淋巴结的分布、形态特征及影像特点，以及脾脏和骨髓的FDG摄取情况。评估以去脂体重标准化的标准化摄取值的最大值（SUL）、平均值（SUL）和峰值（SUL）。采用单因素和多因素逻辑回归筛选具有统计学意义的影像表现，以鉴别IgG4-RLAD与AITL。
最终纳入分析的有22例IgG4-RLAD患者（17例男性，5例女性，中位年龄49.5岁）和22例AITL患者（16例男性，6例女性，中位年龄55岁）。AITL患者无仅累及单一淋巴结区域的情况。AITL患者除颈部和盆腔淋巴结区域外，其他不同淋巴结区域受累更多。基于SUL/SUL、SUL和受累淋巴结区域数量相结合的实用评估方法，提高了两组间鉴别诊断的性能，总体分类准确率为90.9%。
F-FDG PET/CT是鉴别AITL与IgG4-RLAD的有用工具，还可帮助确定IgG4-RLAD或AITL疑似病例的最佳活检部位，减少再次活检的需求，并使医生能够及时制定治疗策略。
