18F-FDG符合线路显像在恶性淋巴瘤诊断及疗效判断中的应用

目的 探讨^18F-脱氧葡萄糖(FDG)双探头符合线路显像在淋巴瘤诊断及疗效判断中的应用。方法 对病理检查证实的56例恶性淋巴瘤患者行^18F-FDG显像，并与同期CT、MRI或B超等影像检查结果(CI)进行对比分析。56例患者中治疗前9例，化疗中21例，放化疗后10例，术后复查16例。结果 ①9例治疗前患者中7例^18F-FDG显像阳性，8例CI检查阳性。^18F-FDG显像与CI显示的病灶部位基本一致。②21例化疗患者中12例^18F-FDG显像阳性，15例CI阳性，有3例患者CT示有肿大淋巴结，但FDG摄取未见异常。③对16例淋巴瘤术后患者行^18F-FDG显像寻找术后残余病灶，发现3例FDG异常摄取。④10例放化疗后患者中4例FDG摄取异常(纵隔2例，骨2例)。⑤对7例同期行^18F-FDG显像与骨显像的患者进行分析，发现两者所示骨病灶部位不尽一致。结论 ^18F-FDG显像是恶性淋巴瘤诊断、分期及疗效观察的重要手段之一，可及时发现手术后肿瘤残余、复发。^18F-FDG显像与骨显像相互补充，可提高诊断恶性淋巴瘤骨髓浸润的灵敏度。CT同机图像融合技术能帮助定位肿瘤。     

18F-FDG PET显像用于鼻咽癌诊断及分期

目的 探讨^18F-脱氧葡萄糖（FDG）PET显像在鼻咽癌诊断中的价值。方法 回顾性分析33例鼻咽癌患者的^18F-FDG PET显像效果。其中初诊患者4例，治疗后29例。行常规头颈部或全身^18F-FDG PET显像。结果 ①33例患者中，鼻咽部有恶性病灶（原发或复发病灶）者16例，PET灵敏度为100％，假阳性2例，特异性为88．3％，准确性为93．9％。与PET显像前的21例CT或MRI结果相比较，PET3检出鼻咽部恶性病灶10例，较CT或MRI多检出2例。②33例中22例有转移灶，PET检出20例（90．9％），较PET显像前的其他检查多检出5例；PET显像和PET显像前的其他检查皆有3例假阳性。在检出转移病灶数方面，PET显像多发现1处或多处转移灶有13例，PET显像少发现转移灶的2例。结论 ^18F-FDG PET显像灵敏、准确、全面，在鼻咽癌的诊断、早期复发灶及全身转移灶检出方面有重要价值。     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

18F-FDG显像对淋巴瘤分期及疗效评价的价值

目的探讨18F-脱氧葡萄糖(FDG)PET和PET/CT显像在淋巴瘤诊断、分期及疗效评价中的价值.方法 107例淋巴瘤或淋巴瘤疑似患者行18F-FDG PET或PET/CT显像,其中16例多次行PET或PET/CT显像.所有患者皆经病理学检查确诊,随访时间>6个月.结果淋巴瘤31例,PET显像阳性30例(96.8%),7例淋巴结转移癌及活动性淋巴结结核PET显像均为阳性,淋巴瘤与原发灶不明的淋巴结转移癌及活动性淋巴结结核难以鉴别.37%(10/27例)初诊淋巴瘤PET显像多发现恶性病灶而提高临床分期.16例淋巴瘤行多次PET显像,发现8例治疗后病灶消失,2例缓解,1例肿瘤复发,5例无瘤生存,皆与临床相符.53例淋巴瘤治疗后行PET显像,其中8例临床确认有肿瘤复发或明显残余,PET显像均为阳性;45例临床疗效为完全缓解(CR)和部分缓解(PR)的患者中,PET显像阳性者18例,3例肿瘤处于活跃状态,15例(非霍奇金淋巴瘤12例,霍奇金淋巴瘤3例)处于抑制状态,PET显像后改变了进一步临床治疗方案.结论 18F-FDG PET显像对检测淋巴瘤的体内分布及分期灵敏、准确、全面,但难以与活动性淋巴结结核、原发灶不明的淋巴结转移癌相鉴别.18F-FDG PET显像能灵敏、准确地检出淋巴瘤复发及残余病灶,对疗效评价及指导临床治疗有重要价值.     

18F-FDG和18F-FET PET脑显像诊断垂体腺瘤

目的 比较^18F-脱氧葡萄糖(FDG)和^18F-酪氨酸(FET)PET显像对垂体腺瘤的诊断价值。方法 正常对照者7例同期行^18F-FDGPET脑显像和^13N-NH3PET脑血流显像。20例垂体腺瘤患者行^18F-FDG PET脑显像，其中10例同期行^18F-FETPET脑显像，并参照近期MRI结果进行分析。加例患者均行经口鼻蝶窦垂体腺瘤切除术，术后行病理检查及免疫组织化学分型。结果①正常对照组垂体^18F-FDG摄取明显低于周围组织。②对于分泌激素和无分泌功能的垂体腺瘤，^18F-FDGPET和^18F-FETPET均可显示病灶。③垂体腺瘤在^18F-FDG显像中多表现为均匀的放射性摄取增高，而^18F-FET。显像则多表现为散在的摄取增高，与MRI所示等瓦长T2或稍长瓦长T2信号的肿瘤组织分布相似。④7例微腺瘤^18F-FDG PET检出5例，MRI检出3例。⑤不同激素分泌型和无分泌功能垂体腺瘤的瘤体大小、激素水平与^18F-FDG或^18F-FET显像标准摄取值(SUV)间无明显相关。结论 ^18F-FDG和^18F-FET PET脑显像均可显示垂体腺瘤,而以前者更佳。     

18F-FDG PET显像在发热待查患者中筛查淋巴瘤的价值

目的　探讨18F 脱氧葡萄糖 (FDG)PET显像在长期发热患者中筛查淋巴瘤的价值。方法　对 5 9例长期发热患者 (发热持续时间至少 3周 ,测 3次体温超过 38 3℃ )的18F FDGPET显像资料进行回顾性分析 ,将18F FDGPET显像诊断结果与病理检查及随访结果进行比较。结果　 5 9例长期发热患者中有 8例PET显像示恶性淋巴瘤可能 ,最后均经病理检查确诊为淋巴瘤 ,其中 2例为霍奇金淋巴瘤 ,6例为非霍奇金淋巴瘤。结论　PET显像示长期发热的淋巴瘤患者其病变淋巴结可在正常范围内 (<1 0cm或在体内较深部位 )。对长期发热患者 ,18F FDGPET显像可初步筛查淋巴瘤及排除其他肿瘤 ,可为穿刺活组织检查提供定位信息。     

18F-FDG符合线路显像与67Ga显像诊断结节病的对比研究

目的 对比分析^18F-脱氧葡萄糖(FDG)符合线路显像(FDG显像)和^67Ga显像对结节病的诊断和疗效监测的价值。方法 17例结节病患者行^18F-FDG显像，其中11例行^67Ga显像。以目测法判断纵隔和肺门淋巴结放射性摄取程度，明显超过周围肺组织本底水平者为阳性。结果 11例未治疗的结节病患者^18F-FDG显像均阳性，其中7例行^67Ga显像者影像特征与^18F-FDG显像相似；^18F-FDG、^67Ga显像均阳性的2例患者，治疗后X线片示病灶吸收，再次显像均为阴性；^18F-FDG显像本底较低且显像效果较好。3例已治疗者X线片示病灶吸收，^18F—FDG显像均阴性，其中2例行^67Ga显像也阴性。3例临床诊断为结节病者，^18F-FDG显像阳性，其中2例^67Ga显像也阳性(1例治疗后2种显像仍呈阳性，而X线片示纵隔肺门肿大淋巴结缩小)。结论 ^18F-FDG符合线路显像比^67Ga显像效果好,对结节病诊断和治疗效果监测有较好的应用价值。     

18F-FDG PET全身显像时颈背部肌肉对称性浓聚分析

目的 分析^18F-脱氧葡萄糖(FDG) PET全身显像时部分患者颈部及胸椎两旁肌肉局限性代谢增高的显像特点及规律。方法 回顾性分析行^18F-FDG PET全身显像者1600例。受检者禁食4h后，按体重5．55MBq／kg静脉注入^18F-FDG，坐位松弛状态下休息50min后，用Siemens ECAT EXACTHR’PET仪进行采集。结果 1600例受检者中，共有9例10次显示双侧颈根部及双侧锁骨上区对称性放射性浓聚，同时均伴有胸椎两侧对称性点状浓聚。1例5d后行镇静剂介入显像，颈锁部及胸椎旁高代谢灶基本消失。结论 肌肉紧张可使少数患者颈部及胸椎两旁肌肉局限性^18F-FDG摄取增高。认识其显像特征有利于避免误诊。     

18F-FDG PET与67Ga全身显像对淋巴瘤分期的临床价值

目的探讨^18F-脱氧葡萄糖(FDG)P田显像与^67Ga全身显像对淋巴瘤患者分期的临味价值。方法经组织病理检查诊断为淋巴瘤的23例患者，治疗前均行^18F—FDG PEF显像与^67Ga全身显像。PET显像为静脉注射^18F-FDG 111～185MBq(按体重2．22MBq／kg)，45～50min后行全身显像。^67Ga全身显像为静脉注射370MBq^67Ga，48～72h后行前位和后位颈、胸、腹和盆腔局部全身显像。图像分析采用定性分析方法，有异常放射性摄取增高的部位为阳性病变。结果^18F-FDGP田显像23例患者均阳性，共发现53个病灶；^67Ga全身显像示19例(82．6％)阳性，发现44个病灶(83．0％)。肿瘤病灶35．8％(19个)在头颈部，20．8％(11个)在腹部，34．0％(18个)在纵隔，9．4％(5个)在盆腔。^18F-FDG PET与^67Ga全身显像结果比较示，在19例患者中44个病灶两者显像结果一致。PET显像发现的53个病灶中，^67Ga全身显像有9个病灶阴性，分别位于头颈部(1个)、腹部(4个)、盆腔(2个)和腋窝(2个)，病灶直径范围为0．6～3．2cm。结论^18F-FDG PET显像在淋巴瘤分期中明显优于^67Ga全身显像。^67Ga显像诊断的灵敏度受病灶大小和位置的影响较PET显像更明显。     

18 F-FDG PET显像对不同亚型淋巴瘤的诊断价值

目的：探讨^18F-脱氧葡萄糖(FDG)PET显像对霍奇金淋巴瘤(HL)和以世界卫生组织(WHO)分类标准分类的不同亚型非霍奇金淋巴瘤(NHL)的诊断价值。方法：对236例淋巴瘤(62例HL和174例NHL)患者的FDG PET全身显像结果进行回顾性分析，并与WHO病理分型的结果比较。结果：PET显像对淋巴瘤的检出阳性率为94％(221／236例)，对HL和NHL的阳性率分别为97％(60／62例)和93％(161／174例)。在不同NHL亚型中，8例套细胞淋巴瘤，99％(76，77例)的弥漫性大B细胞淋巴瘤(DLBCL)，95％(55／58例)的滤泡性淋巴瘤(FL)，73％(8／11例)的淋巴结边缘区淋巴瘤(MZL)，2／3例黏膜相关性(MALL型)结外边缘区B细胞淋巴瘤(MALT-MZL)，5／8例的无其他特征外周T细胞淋巴瘤(PTCL)，2／3例的伯基特淋巴瘤(BL)，2例间变性大细胞性淋巴瘤和覃样肉芽肿、小淋巴细胞性淋巴瘤和NK／T细胞型淋巴瘤各1例FDG摄取异常，而13例(3例MZL，3例PTCL，3例FL，MALT-MZL、DLBCL、BL和前体T淋巴母细胞淋巴瘤各1例)未见异常FDG分布。结论：^18F-FDG PET显像对常见的NHL亚型检出阳性率较高，对相对少见的NHL亚型检出阳性率较低。     

Usefulness of 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Patients with High-Grade Non-Hodgkin’s Lymphoma

Purpose

To assess the usefulness of ¹⁸F-fluorodeoxyglucose PET/CT in the detection of bone marrow (BM) involvement of high-grade non-Hodgkin’s lymphoma (NHL).

Methods

One hundred twenty patients with newly diagnosed diffuse large B-cell lymphoma or peripheral T-cell lymphoma between January 2007 and June 2011, who received BM trephine biopsy and ¹⁸F-FDG PET/CT before chemotherapy, were included in this retrospective study. We reviewed their ¹⁸F-FDG PET/CT images and bone marrow biopsy (BMB) results. After reviewing the images, we reviewed the medical records and radiological findings of interesting patients.

Results

There were 23 ¹⁸F-FDG PET/CT scans in which the marrow was considered to be abnormal (either positive or equivocal), and 97 ¹⁸F-FDG PET/CT scans were regarded as having negative FDG uptake. Of 120 patients, 100 (83.3 %) had a concordant result of BM interpretation between ¹⁸F-FDG PET/CT and BMB, and the remaining 20 patients had discordant results. Among 23 patients with either positive or equivocal ¹⁸F-FDG PET/CT scans, 1 of 12 patients with ‘positive’ ¹⁸F-FDG PET/CT had a lymphomatous involvement on BMB. In contrast, 10 of 11 patients with ‘equivocal’ BM hypermetabolism were reported as having positive involvement by BMB. Patients with abnormal ¹⁸F-FDG PET/CT had significantly higher mSUV_highest than those with normal FDG-PET/CT.

Conclusions

¹⁸F-FDG PET/CT and BMB are complementary techniques in assessing the presence of BM involvement in patients with high-grade NHL. The increasing availability of ¹⁸F-FDG PET/CT will raise the need for additional biopsy for FDG-avid lesions, especially in patients with negative standard BMBs. ¹⁸F-FDG PET/CT can be useful as a decision-making tool for determining whether to perform a standard BMB or targeted biopsy to the FDG-avid lesion as an initial staging procedure. A direct bone biopsy for FDGpositive bone lesions should be included in staging guidelines in future. In ¹⁸F-FDG PET/CT-negative cases, BMB is still a powerful procedure, but BMB alone is insufficient for full evaluation of BM.     

Can [18F]fluorodeoxyglucose positron emission tomography imaging complement biopsy results from the iliac crest for the detection of bone marrow involvement in patients with malignant lymphoma?

OBJECTIVES: To assess the usefulness of [18F]fluorodeoxyglucose positron emission tomography in the detection of bone marrow involvement in malignant lymphoma, and its impact in clinical management. METHODS: One hundred and six consecutive patients with a confirmed diagnosis of lymphoma, referred for staging or restaging of Hodgkin's lymphoma (n=18) or non-Hodgkin's lymphoma (n=88), were reviewed retrospectively. A positron emission tomography scan and bone marrow biopsy of the iliac crest were performed in all patients. The assessment of bone marrow involvement by lymphoma was confirmed by histology and/or progression of bone marrow lesions in clinical follow-up. RESULTS: In 28 of 106 patients, bone marrow involvement was found. Positron emission tomography was more sensitive (86%) than bone marrow biopsy (57%). Positron emission tomography and bone marrow biopsy were concordant by positive correlation in 12 of 28 cases (43%) and by negative correlation in 77 of 78 cases (99%). Ten cases of non-Hodgkin's lymphoma and two cases of Hodgkin's lymphoma with positive positron emission tomography results and an initial negative bone marrow biopsy showed clinical progression of the bone marrow lesions and/or subsequent positive histology. These were considered as false-negative results for bone marrow biopsy. In seven of the 12 positive cases with negative bone marrow biopsy, positron emission tomography uptake distant from the site of the biopsy was seen. In four cases of follicular lymphoma, the bone marrow biopsy was positive and the positron emission tomography scan was normal. CONCLUSIONS: Positron emission tomography and bone marrow biopsy are complementary in assessing the presence of bone marrow involvement in patients with malignant lymphoma. In our series, positron emission tomography was more sensitive than bone marrow biopsy in Hodgkin's and non-Hodgkin's lymphoma, except in follicular lymphoma.     

Splenic and bone marrow increased 18F-FDG uptake in a PET scan performed following treatment with G-CSF

We present the case of an 11 year-old Caucasian girl who presented chest pain of 12 weeks evolution, with no other symptoms and a negative physical examination. Lactate dehydrogenase levels were increased to 797 U/l, whereas beta-2-microglobulin (BM2) levels were normal. The thoracic CT showed a bulky mediastinal mass that occupied the pretracheal, paratracheal and right prevascular regions. The gallium scintigraphy showed high uptake in the mediastinic region; the bone scintigraphy was negative. Biopsy of the mediastinal mass revealed the presence of diffuse large B-cell non-Hodgkin's lymphoma. Treatment included 4 cycles of chemotherapy followed by 7 days of subcutaneous granulocyte colony-stimulating factor (G-CSF, Lenogastrim) at a dose of 5 mg/Kg/day. Following treatment, a CT scan was performed to evaluate response, finding a calcification of the mass without significant reduction of the overall size. Because CT was inconclusive in the assessment of response to therapy, a 18F-FDG PET scan was performed. The 18F-FDG PET scan did not show any pathological uptake in the mediastinum but revealed a splenic and bone marrow diffusely increased 18F-FDG uptake. The differential diagnosis included a secondary effect induced by G-CSF therapy as one of the main possibilities, but other possibilities such as a malignant infiltration by lymphoma could not be discarded. Therefore, a second 18F-FDG PET scan was performed 3 months later. This study showed no pathological findings, with a normal 18F-FDG uptake in the spleen and bone marrow. Thus, the benign and reactive nature of the splenic and bone marrow 18F-FDG increased uptake found in the previous study was confirmed. We consider that the stimulating effect that G-CSF therapy has on the spleen and bone marrow must be taken into account when performing a 18F-FDG PET scan, as it can be an important source of false-positive results.     

Role of 18F-FDG PET/CT in staging and follow-up of lymphoma in pediatric and young adult patients

OBJECTIVE: To assess the role of 18F-Fluorodeoxyglucose (18F-FDG) PET/CT in pediatric patients with Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS: 31 patients, mean age 12.9 +/- 5.1, HD (n = 24), and NHL (n = 7) underwent 18F-FDG PET/CT at diagnosis (n = 31 studies) and later in the course of the disease (n = 75 studies). The findings of PET/CT were correlated with diagnostic CT and clinical follow-up. RESULTS: PET/CT findings resulted in a change of disease staging in 10 patients (32.3%), upstaging in 7 (22.6%) and downstaging in 3 (9.6%). On a lesion analysis, 164 disease sites were detected by PET/CT of which 38 were overlooked by DCT.At mid-treatment, PET was negative in 28 out of 31 patients (90%) with negative predictive value of 96% as all latter patients except for 1, were disease free (mean 15.4 +/- 8.8 months). The positive predictive value of persistent increased 18F-FDG uptake was 100% as 3 patients with latter findings had active disease. On the CT part, 76 residual masses were identified in 22 patients. Increased 18F-FDG uptake was detected in 11 masses in 4 patients who had active disease. Remaining 65 PET negative masses were false positive findings. The positive predictive value of residual CT mass was 14%. CONCLUSIONS: PET/CT is associated with change in staging in approximately 1 out of 3 pediatric patients with HD and NHL. When used for monitoring response to treatment, a negative study is associated with disease-free period, even when residual mass is detected. A positive PET study indicates residual malignant disease.     

全身MRI与PET/CT在淋巴瘤骨髓浸润诊断及预后中的作用

淋巴瘤是一种血液系统恶性肿瘤。淋巴瘤骨髓浸润(BMI)使疾病分期上升至IV期, 是疾病进展、预后较差的标志。常规部位的骨髓活检(BMB)具有创伤性, 且检出率低。PET/CT与全身MRI的出现, 丰富了BMI的检测手段。PET/CT与全身MRI对于淋巴瘤, 尤其是侵袭性淋巴瘤BMI均具有较高的检出率, 二者孰高孰低, 尚未定论。对于红骨髓、良性骨髓病变(炎症等)、淋巴瘤BMI病灶以及肿瘤治疗后骨髓的变化与骨髓残留或复发病灶, 全身MRI很难区分, 而PET/CT却可以很好地鉴别这些病灶。但是, PET/CT存在电离辐射; 对于惰性淋巴瘤的BMI, 超出PET/CT分辨率的病灶, 可能出现假阴性; 某些情况会限制PET/CT的使用, 包括18F-FDG生理性摄取量可能发生改变的正常组织、18F-FDG摄取相关性炎症、高血糖或高胰岛素血症导致的18F-FDG分布的改变、肿瘤患者治疗后出现的骨髓活化等。然而, 这些情况可以使用全身MRI。因此, 全身MRI和PET/CT相辅相成, 优势互补, 但二者均不能代替BMB。对于常规BMB阴性, 但影像学提示阳性的患者, 在影像学引导下进行BMB, 可以提高BMI的检出率。另外, 全身MRI阳性的淋巴瘤BMI患者与全身MRI阴性的淋巴瘤BMI患者相比, 前者预后可能较差。     

Detection of Richter's transformation of chronic lymphocytic leukemia by PET/CT.

Our objective was to evaluate the accuracy of PET/CT for the diagnosis of Richter's transformation of chronic lymphocytic leukemia (CLL) to diffuse large cell lymphoma. METHODS: A retrospective study was performed of 37 patients with CLL who underwent 18F-FDG PET/CT at our institution between March 2003 and July 2005. All PET/CT scans were reviewed in consensus by 2 diagnostic radiologists. Sites of abnormal 18F-FDG uptake with a maximum standardized uptake value (SUVmax) of greater than 5 were considered highly suggestive of Richter's transformation. The PET/CT findings were correlated with histologic findings from bone marrow or lymph node biopsy performed within 6 wk of PET/CT and with clinical follow-up. RESULTS: The 37 patients (26 men and 11 women; mean age, 61 y, range, 40-82 y) underwent 57 PET/CT scans. In 10 (91%) of 11 patients with Richter's transformation, PET/CT detected sites of abnormal 18F-FDG uptake having an SUVmax of greater than 5. Richter's transformation was missed in 1 patient who had only low-grade 18F-FDG uptake (SUVmax < 5). Nine patients had false-positive PET/CT findings; in 3 of these patients, alternative malignancies were diagnosed (Hodgkin's disease; metastatic neuroendocrine carcinoma; non-small cell lung cancer). In all remaining patients, PET/CT correctly excluded Richter's transformation. For the specific diagnosis of Richter's transformation of CLL to diffuse large B-cell lymphoma, PET/CT had overall sensitivity, specificity, and positive and negative predictive values of 91%, 80%, and 53% and 97%, respectively. CONCLUSION: PET/CT can detect Richter's transformation of CLL to diffuse large B-cell lymphoma with a high sensitivity and a high negative predictive value.     

^18F-FDG PET-CT在淋巴瘤分期及疗效评价中的应用研究

目的探讨^18氟-氟代脱氧葡萄糖（^18F-FDG）PET—CT在淋巴瘤分期及疗效评价中的临床应用价值。方法回顾分析28例淋巴瘤患者（HL6例，NHL22例）在治疗前后进行^18F—FDG PET—CT对比检查的结果，并与增强CT及骨髓活检结果进行比较。结果治疗前68处病灶^18F—FDG PET—CT检出67个，检出率为98．5％，其中结内37个全部检出（100％），结外31个检出30个（96．8％）；增强CT则共检出病灶45个（66．2％），其中结内37个检出32个（86．5％），结外31个仅检出13个（41．9％）。6例（21．4％）的分期得到上调并改变了1例（3．6％）的治疗方案。治疗后32处病灶^18F—FDG PET—CT检出29个，检出率为90．6％，其中结内17个检出15个（88．2％），结外15个检出14个（93．3％）；增强CT则共检出病灶18个（56．3％），其中结内17个检出13个（76．5％）．结外15个仅检出5个（33．3％）。治疗后有2例（7．1％）的分期得到上调，8例（28．6％）下调，改变了8例（21．4％）的治疗方案。^18F—FDG PET—CT对淋巴瘤患者治疗前后结内病灶检出率与增强CT相似（P〈0．05），而结外病灶检出率则明显高于增强CT（P〉0．05）。28例中25例^18F—FDG PET—CT与骨髓穿刺结果一致。治疗后^18F—FDG PET—CT对复发的阳性预测值93．8％，阴性预测值为83．3％；增强CT的阳性预测值75％，阴性预测值50％。结论^18F—FDG PET—CT在淋巴瘤分期及疗效评价中具有重要的临床价值．有助于准确分期和残余病变性质的鉴别。     

基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤复发诊断中的应用价值

目的 基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤(HL)复发诊断中的应用价值。 方法 基于Deauville标准, 回顾性分析24例治疗结束后5~27个月, 临床可疑复发的HL患者, 对其18F-FDG PET/CT显像结果进行评分判断, 并与淋巴结活检和(或)骨髓活检病理结果进行对照分析。 结果 病理结果证实17例复发、3例淋巴结反应性增生、1例肺癌并纵隔淋巴结转移、3例未见明确复发。18F-FDG PET/CT诊断HL复发的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为100%、50%、85%、100%和87%。 结论 基于Deauville标准18F-FDG PET/CT在HL复发诊断中具有重要的临床应用价值。     

18F-FDG PET for evaluation of bone marrow infiltration in staging of lymphoma: a meta-analysis.

The ability of PET with (18)F-FDG to evaluate bone marrow infiltration in patients with lymphoma has been a matter of extensive investigation with controversial results. Therefore, we aimed to evaluate systematically, with a meta-analysis, the diagnostic performance of (18)F-FDG PET in this setting. METHODS: Relevant studies were identified with MEDLINE and EMBASE searches (last update, August 2004). Data on the diagnostic performance of (18)F-FDG PET were combined quantitatively across eligible studies. We estimated weighted summary sensitivities and specificities, summary receiver-operating-characteristic (SROC) curves, and weighted summary likelihood ratios. We also conducted separate analyses according to various subgroups. Bone marrow biopsy (BMB) was used as the reference standard. RESULTS: Thirteen eligible nonoverlapping studies, which enrolled a total of 587 patients, were included in the meta-analysis. The independent random-effects weighted estimates of sensitivity and specificity against BMB were 51% (95% confidence interval [CI], 38%-64%) and 91% (95% CI, 85%-95%), respectively. Results were consistent in the SROC curve: a sensitivity of 51% corresponds to a specificity of 92%, whereas a specificity of 91% corresponds to a sensitivity of 55%. The weighted positive likelihood ratio (LR+) was 5.75 (95% CI, 348-9.48) and the negative likelihood ratio (LR-) was 0.67 (95% CI, 0.55-0.82). Six of 12 patients with positive (18)F-FDG PET and negative initial biopsy were found to have bone marrow involvement when biopsy was performed at the sites with positive imaging signals. Subgroup analyses showed better sensitivity in patients with Hodgkin's disease and in aggressive histologic types of non-Hodgkin's lymphoma than in patients with less aggressive histologic types and in studies using unilateral BMB compared with those using bilateral biopsy. CONCLUSION: This meta-analysis showed that (18)F-FDG PET has good, but not excellent, concordance with the results of BMB for the detection of bone marrow infiltration in the staging of patients with lymphoma. (18)F-FDG PET may complement the results of BMB and its performance may vary according to the type of lymphoma.     

18F-FDG PET/CT bone/bone marrow findings in Hodgkin’s lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging

Purpose

Accurate staging of Hodgkin’s lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. ¹⁸F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant ¹⁸F-FDG PET/CT.

Methods

Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and ¹⁸F-FDG PET/CT. Results of BMB were not available at the time of ¹⁸F-FDG PET/CT imaging.

Results

Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on ¹⁸F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on ¹⁸F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy ¹⁸F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient.

Conclusion

¹⁸F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging.