Department of Diagnostic Radiology, Kita-Harima Medical Center, Hyogo, Japan.
Department of Hematology and Oncology, Kita-Harima Medical Center, Hyogo, Japan.
Medicine (Baltimore). 2024 Mar 1;103(9):e37290. doi: 10.1097/MD.0000000000037290.
Accurate clinical staging is important in diffuse large B-cell lymphoma (DLBCL) to adapt to optimal therapy. Splenic involvement of DLBCL has been recently more detectable with the advancement of a diagnostic scan by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). Our clinical question is whether splenic involvement was adequately diagnosed by FDG-PET/CT imaging. This retrospective study aimed to determine the optimal index for evaluating splenic involvement in patients with DLBCL. Patients with newly diagnosed DLBCL who were examined with FDG-PET/CT at diagnosis and the end of induction chemotherapy (EOI) was enrolled. The splenic involvement with the splenic FDG uptake value higher than that of the liver at diagnosis or with the decrease of splenic uptake at EOI by visual evaluation was evaluated as positive. The calculative evaluation of splenic involvement, based on the data of standardized uptake value (SUV) of the spleen, used maximum SUV (SUVmax), mean SUV (SUVmean), spleen total lesion glycolysis (spleen TLG), and spleen length. A change in each index following induction chemotherapy was expressed as an index. Receiver operating characteristic analysis was used to set the cutoff value for each index. This study included 52 patients. Spleen TLG (0.904) showed the best accuracy, followed by SUVmax (0.885) and SUVmean (0.885), among the 5 indexes for splenic involvement at diagnosis. Splenic involvement was predicted with a higher accuracy level (0.923) when selecting the cases with values higher than the cutoff level on both spleen TLG and SUVmax. The decision at EOI was more suitable by selecting both positive cases of ∆ TLG and ∆ SUVmax. Obtaining both the positive spleen TLG and SUVmax is recommended at diagnosis to predict splenic involvement. The assessment by ∆ spleen TLG and ∆ SUVmax seems to be optimal.
准确的临床分期在弥漫性大 B 细胞淋巴瘤（DLBCL）中很重要，以适应最佳治疗。随着诊断扫描技术的进步，18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）可更精确地检测到 DLBCL 的脾脏受累。我们的临床问题是 FDG-PET/CT 成像是否能充分诊断脾脏受累。这项回顾性研究旨在确定评估 DLBCL 患者脾脏受累的最佳指标。招募了在诊断时和诱导化疗结束时（EOI）接受 FDG-PET/CT 检查的新诊断为 DLBCL 的患者。根据诊断时脾脏 FDG 摄取值高于肝脏或 EOI 时脾脏摄取值下降的视觉评估，将脾脏受累评估为阳性。根据脾脏标准化摄取值（SUV）的数据，通过计算评估脾脏受累，使用最大 SUV（SUVmax）、平均 SUV（SUVmean）、脾脏总病变糖酵解（spleen TLG）和脾脏长度。每个指数在诱导化疗后的变化用指数表示。使用接收者操作特征分析为每个指数设定截止值。这项研究包括 52 名患者。在诊断时，5 个脾脏受累指标中，脾脏 TLG（0.904）的准确性最高，其次是 SUVmax（0.885）和 SUVmean（0.885）。当选择脾脏 TLG 和 SUVmax 值均高于截止值的病例时，脾脏受累的预测准确性更高（0.923）。选择阳性病例时，在 EOI 做出的决策更合适，∆TLG 和∆SUVmax 均为阳性。建议在诊断时同时获得阳性的脾脏 TLG 和 SUVmax，以预测脾脏受累。评估∆spleen TLG 和∆SUVmax 似乎是最佳选择。
