Carr R, Barrington S F, Madan B, O'Doherty M J, Saunders C A, van der Walt J, Timothy A R
Departments of Haematology, Histopathology, Clinical Oncology and The Clinical PET Centre, United Medical and Dental Schools of Guy's and St Thomas's, London, UK.
Blood. 1998 May 1;91(9):3340-6.
Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG "hot spots" distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.
正电子发射断层扫描（PET）是一种使用18氟-氟脱氧葡萄糖（FDG）的全身成像技术，肿瘤细胞对其摄取增加。已发表的研究表明，PET是淋巴瘤分期的有效方法，在检测结外病变方面比CT更敏感。本研究的目的是确定在常规分期PET扫描中一些淋巴瘤患者观察到的骨髓FDG摄取增加是否代表疾病累及骨髓。由三名独立观察者分析了50例霍奇金淋巴瘤（12例）和非霍奇金淋巴瘤（38例）患者的PET扫描，并使用视觉分级系统将骨髓分为正常或异常。对所有患者进行单侧髂嵴骨髓穿刺和活检。PET扫描与骨髓组织学在39例患者（78%）中一致，其中13例为一致阳性，26例为一致阴性。8例患者PET扫描显示FDG摄取增加，但分期活检为阴性；在这8例患者中的4例，PET扫描显示骨髓背景正常，远离活检部位有局灶性FDG“热点”。3例患者骨髓活检标本阳性，但PET扫描正常；这3例患者中有2例患有非霍奇金淋巴瘤，其恶性细胞在淋巴结或骨髓疾病部位不摄取FDG。因此，只有5例患者（10%）PET扫描与活检结果存在差异且无法完全解释。在全身分期PET扫描中对骨髓FDG摄取进行视觉解读可在很大比例的淋巴瘤患者中正确评估骨髓疾病状态。PET有可能减少分期骨髓活检的需求。
