Moog F, Bangerter M, Kotzerke J, Guhlmann A, Frickhofen N, Reske S N
Department of Nuclear Medicine, University of Ulm, Germany.
J Clin Oncol. 1998 Feb;16(2):603-9. doi: 10.1200/JCO.1998.16.2.603.
Bone marrow involvement in patients with malignant lymphoma is considered a sign of generalized disease with less favorable prognosis. Bone marrow biopsy (BMB), which represents the standard diagnostic procedure, however, is associated with a high rate of false-negative findings, which may lead to errors in management. The present study was undertaken to investigate the efficacy of positron emission tomography (PET) with 18-F-fluorodeoxyglucose (FDG-PET) as a new method to evaluate bone marrow involvement in patients with malignant lymphoma.
Seventy-eight consecutive, untreated patients with either non-Hodgkin's lymphoma (NHL; n = 39) or Hodgkin's disease (HD; n = 39) were prospectively evaluated. Static FDG-PET imaging was performed following application of 270 MBq (F-18)-FDG. Attenuation correction was performed in 63 of 78 patients. Visual evaluation was performed by two examiners unaware of the clinical data. Material for BMB (70 bilateral, 8 unilateral) was obtained from the posterior iliac crest. Discordant results of PET and biopsy were settled, when possible, on the basis of further biopsy or magnetic resonance imaging (MRI).
In addition to seven concordant positive and 57 concordant negative findings, biopsy revealed another four cases with bone marrow involvement not detectable by FDG-PET analysis (+5.1%). On the contrary, PET showed bone marrow areas of intensive FDG uptake that suggested bone marrow lymphoma in 10 patients with negative biopsies (+12.8%). In eight patients, FDG-PET findings were confirmed by either histologic verification (n = 4), MRI (n = 2), polymerase chain reaction (PCR) for rearranged immunoglobulin H sequences (n = 1), or clinical presentation (n = 1). Two cases remained unresolved.
The results indicate that FDG-PET has a high potential to detect bone marrow involvement in malignant lymphoma. Besides confirming lesions found at BMB, FDG-PET provided additional information, which, in eight of 78 patients (10.3%), led to an upgrade of the tumor stage.
恶性淋巴瘤患者的骨髓受累被认为是疾病广泛播散的标志，预后较差。骨髓活检（BMB）是标准的诊断方法，然而其假阴性率较高，可能导致治疗失误。本研究旨在探讨18F-氟脱氧葡萄糖正电子发射断层显像（PET）作为评估恶性淋巴瘤患者骨髓受累的新方法的有效性。
对78例未经治疗的非霍奇金淋巴瘤（NHL；n = 39）或霍奇金病（HD；n = 39）患者进行前瞻性评估。静脉注射270 MBq（F-18）-FDG后行静态FDG-PET显像。78例患者中的63例进行了衰减校正。由两名不了解临床资料的检查者进行视觉评估。BMB取材（70例双侧，8例单侧）取自髂后嵴。PET与活检结果不一致时，尽可能通过进一步活检或磁共振成像（MRI）来解决。
除7例结果一致的阳性和57例结果一致的阴性外，活检还发现另外4例骨髓受累，FDG-PET分析未检测到（+5.1%）。相反，PET显示10例活检阴性患者的骨髓区域有强烈的FDG摄取，提示骨髓淋巴瘤（+12.8%）。8例患者中，FDG-PET结果通过组织学证实（n = 4）、MRI（n = 2）、重排免疫球蛋白H序列的聚合酶链反应（PCR）（n = 1）或临床表现（n = 1）得到确认。2例仍未解决。
结果表明，FDG-PET检测恶性淋巴瘤骨髓受累有很大潜力。除了证实BMB发现的病变外，FDG-PET还提供了额外信息，在78例患者中有8例（10.3%）导致肿瘤分期上调。
