| PET/CT真正全身显像在结外NK/T细胞淋巴瘤（鼻型）患者中的应用价值 |
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| 引用本文： | 李芳兰,苏鸣岗,石大志,梁釜铃,李林. PET/CT真正全身显像在结外NK/T细胞淋巴瘤（鼻型）患者中的应用价值[J]. 四川大学学报(医学版), 2020, 51(2): 245-251. DOI: 10.12182/20200360104 |
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| 作者姓名： | 李芳兰 苏鸣岗 石大志 梁釜铃 李林 |
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| 作者单位： | 四川大学华西医院 核医学科 （成都 60041） |
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| 摘 要： | 目的 评价PET/CT真正的全身(true whole-body，TWB)显像较局限性全身（limited whole-body，LWB，头顶到大腿中份）显像增加的下肢远端这一显像范围对结外NK/T细胞淋巴瘤（鼻型）（extranodal natural killer/T-cell lymphoma，nasal type，ENKTL）患者的分期及随访评估的价值。 方法 收集2012年1月至2017年9月在我科行TWB PET/CT显像的ENKTL患者。根据患者检查目的不同分为两组，一组为分期组，即初诊时行TWB PET/CT评估分期的患者；另一组为随访组，即用TWB PET/CT行随访评估的患者。随访患者根据有无行TWB PET/CT初诊分期以及随访检查前有无临床确诊或怀疑的LWB范围内肿瘤进展（progressive disease, PD），再分为有TWB PET/CT分期无PD、有TWB PET/CT分期有PD、无TWB PET/CT分期无PD、无TWB PET/CT分期有PD4个亚组。比较分期组和随访组各亚组发现下肢远端（LWB范围外）非预期ENKTL病灶的百分率（P1），和各组因此改变分期、再分期/疗效评价结果的百分率（P2）。 结果 分期组患者225例，其中有200例（88.9%）肿瘤局限于LWB范围内，P1为11.1%（25例），P2为0.4%（1例）。对于随访组患者，有TWB PET/CT分期无PD亚组（n=85）、有TWB PET/CT分期有PD亚组（n=4）、无TWB PET/CT分期无PD亚组（n=43）、无TWB PET/CT分期有PD亚组（n=15）P1分别为1.2%、75.0%、0%、26.7%，P2分别为1.2%、0%、0%、13.3%。对于随访组患者，无论是否行初诊分期的TWB PET/CT检查，无PD组和有PD组的P1为0.8% vs. 36.8%（P <0.000 1），P2 为0.8% vs. 10.5%，（P<0.000 1）。 结论 ENKTL患者初诊分期不常规推荐行头顶到脚底的TWB PET/CT显像；临床没有肿瘤进展依据或有进展依据但TWB PET/CT初诊分期时病变局限在LWB范围内的随访患者，推荐随访时常规行头顶到大腿中份的LWB PET/CT；ENKTL患者初诊分期时未行TWB PET/CT了解下肢情况，如在随访检查前出现了LWB范围内肿瘤进展的依据，随访评估时推荐行TWB PET/CT评估全身肿瘤累及情况。
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| 关 键 词： | 正电子断层显像 结外NK/T细胞淋巴瘤（鼻型） 扫描范围 |
| 收稿时间： | 2019-09-12 |
The Application Value of True Whole-body PET/CT Scanning Protocol in Patients of Extranodal NK/T Cell Lymphoma |
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| LI Fang-lan,SU Ming-gang,SHI Da-zhi,LIANG Fu-ling,LI Lin. The Application Value of True Whole-body PET/CT Scanning Protocol in Patients of Extranodal NK/T Cell Lymphoma[J]. Journal of Sichuan University. Medical science edition, 2020, 51(2): 245-251. DOI: 10.12182/20200360104 |
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| Authors: | LI Fang-lan SU Ming-gang SHI Da-zhi LIANG Fu-ling LI Lin |
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| Affiliation: | Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China |
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| Abstract: | Objective To assess the staging, restaging, and treatment strategy determination of extranodal NK/T cell lymphoma (ENKT) by PET/CT real body (true whole-body, TWB) imaging, which is superior to PET/CT limitation of the whole body (limited whole-body, LWB, from skull vertex to upper thighs) by adding ‘distal lower extremity’ images. Methods TWB 18F-FDG PET/CT studies performed for staging and follow-up of ENKTL patients between January 2012 and September 2017 were retrospectively reviewed. Patients in staging group received TWB PET/CT evaluation for staging at the first diagnosis. In follow-up group, patients received follow-up evalution with TWB PET/CT and progressive disease (PD) in the LWB range with or without clinical diagnosis or suspicion before follow-up examination, and then divided into four subgroups: staging (+) PD (－), staging (+) PD (+), staging (－) PD (－), staging (－) PD (+). Then the percentage of unexpected ENKTL lesions found at the distal extremity (outside the LWB range) (P1), and the percentage of changes in the staging, restaging/outcome evaluation (P2) in each group were recorded. Results Among the 225 patients in the staging group, 200 (88.9%) had tumors confined to LWB, while P1 was 11.1% (25 cases) and P2 was 0.4% (1 case). In the follow-up group, the P1 in staging (+) PD (－)(n=85), staging (+) PD (+)(n=4), staging (－) PD (－)(n=43), staging (－) PD (+) goups (n=15) were 1.2%, 75.0%, 0%, 26.7%, and P2 were 1.2%, 0%, 0%, 13.3%, respectively. In the follow-up group, regardless of whether the TWB PET/CT examination was performed at the initial diagnosis stage, P1 in PD (－) group and PD (+) group was 0.8 vs. 36.8% (P<0.000 1), and P2 was 0.8% vs. 10.5% (P<0.000 1). Conclusion It is not recommended that the TWB PET/CT imaging from the top of the head to the bottom of the foot use for the first diagnosis of ENKTL patients. And for follow-up patients with no clinical evidence of tumor progression or with evidence of tumor progression but whose lesions were limited to LWB at the initial diagnosis of TWB PET/CT staging, LWB PET/CT from the top of the head to the middle of the thigh is recommended for routine follow-up. For ENKTL patients, TWB PET/CT was not performed at the initial stage of diagnosis to detect the condition of lower limbs. If the evidence of tumor progression in the LWB range appeared before the follow-up examination, TWB PET/CT was recommended for the follow-up evaluation to evaluate the systemic tumor involvement. |
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