18F-FDG PET/CT评价非霍奇金淋巴瘤骨髓浸润

目的探讨^18F-FDG PET／CT评价非霍奇金淋巴瘤（NHL）骨髓浸润的临床应用价值，并与骨髓活检（BMB）及流式细胞分析（FCM）进行比较。方法回顾性分析89例经病理证实且未经治疗的NHL患者^18F-FDG PET／CT资料，其中侵袭性NHL76例，惰性NHL13例。所有患者均在^18F-FDG PET／CT检查2周内接受BMB及FCM，对^18F-FDG PET／CT显示骨髓局灶性^18F—FDG摄取增高而BMB及FCM阴性患者，根据PET／CT所示骨髓异常部位再次行BMB确定骨髓是否受累。结果89例NHL患者中，根据BMB、FCM及PET／CT引导下再次BMB结果，共检出骨髓浸润26例，检出率为29．21％（26／89），PET／CT检出率为21．35％（19／89）。PET／CT诊断骨髓浸润的灵敏度为73．08％（19／26），特异度为96．83％（61／63），准确率为89．89％（80／89），阳性预测值为90．48％（19／21），阴性预测值为89．71％（61／68）。BMB及FCM检出率均为19．10％（17／89），PET／CT较BMB、FCM骨髓浸润检出率稍高，但差异无统计学意义（P〉0．05）。将PET／CT、FCM及BMB三种方法联合诊断骨髓浸润，其检出率高于其中任意一种方法（P〈0．05）。PET／CT对侵袭性NHL骨髓浸润的检出率22．37％（17／76）高于对惰性NHL骨髓浸润的检出率15．38％（2／13，P〈0．06）。结论^18F-FDG PET／CT在诊断NHL骨髓浸润中有较高的应用价值。对局灶性骨髓浸润患者，PET／CT有助于引导BMB部位，提高骨髓浸润的检出率。PET／CT未检出骨髓浸润的惰性NHL患者，应进一步行BMB及FCM检查。推荐PET／CT、FCM及BMB三种方法联合应用判断NHL骨髓浸润，从而更准确地进行分期、治疗及判断预后。

18F-FDG PET for evaluation on bone marrow involvement in patients with non-Hodgkin lymphoma

Objective To evaluate the clinical value of ¹⁸F-FDG PET/CT for detection of bone marrow involvement in non-Hodgkin lymphoma (NHL), and to compare it with bone marrow biopsy (BMB) and flow cytometry (FCM). Methods Eighty-nine patients with pathologically proven NHL including 76 aggressive NHL and 13 indolent NHL underwent ¹⁸F-FDG PET/CT imaging. All patients underwent BMB and FCM within 2 weeks of ¹⁸F-FDG PET/CT scan. When ¹⁸F-FDG PET/CT revealed multiple foci of abnormal ¹⁸F-FDG uptake but with negative BMB and FCM, the repeat biopsy was performed guided by PET/CT. Results Final diagnosis of bone marrow involvement was made in 26 patients on the basis of composite criteria derived from BMB, FCM and PET/CT guiding repeat BMB (26/89, 29.21%). The detection rate of PET/CT was 21.35% (19/89). ¹⁸F-FDG PET/CT revealed true-positive bone marrow involvement in 19 patients, while BMB and FCM revealed bone marrow involvement in 17 patients. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ¹⁸F-FDG PET/CT for detection bone marrow involvement was 73.08% (19/26), 96.83% (61/63), 89.89% (80/89), 90.48% (19/21) and 89.71% (61/68), respectively. The detection rate of bone marrow involvement by NHL for ¹⁸F-FDG PET/CT was higher than that for BMB and FCM (17/89, 19.10%), but there was no statistical difference (P>0.05), while the detection rate of bone marrow involvement by NHL for comprehensive method was higher than that for ¹⁸F-FDG PET/CT, BMB and FCM (P<0.05). The detection rate of bone marrow involvement of aggressive NHL (17/76, 22.37%) for ¹⁸F-FDG PET/CT was higher than that of indolent NHL (2/13, 15.38%, P<0.05). Conclusion ¹⁸F-FDG PET/CT has high clinical value in diagnosing bone marrow involvement of NHL. ¹⁸F-FDG PET/CT can be used to directly guide the site of BMB, when PET/CT demonstrates foci bone marrow involvement. While using PET/CT to detect bone marrow involvement of indolent NHL, BMB and FCM are still warranted. To detect bone marrow involvement by NHL, the combination of PET/CT, BMB and FCM is recommended.