惰性淋巴瘤大细胞转化的~(18)F-FDG PET/CT影像研究(附8例分析)

目的:探讨~(18)F-FDG PET/CT对惰性淋巴瘤大细胞转化的诊断价值.方法:回顾性分析8例惰性淋巴瘤转化前后~(18)F-FDG PET/CT影像,其中男性5例,女性3例,平均年龄53.5岁;8例转化前后均经病理及免疫组化染色证实.结果:8例惰性淋巴瘤最终均转化为弥漫大B细胞型淋巴瘤;其中6例由黏膜相关淋巴组织边缘区B细胞淋巴瘤(MALT)转化;1例由滤泡性淋巴瘤(FL)转化;1例由霍奇金结节性淋巴细胞为主性淋巴瘤(NLPHL)转化.转化前病灶~(18)F-FDG摄取呈轻度增高或无增高,平均SUV为2.2±1.0;转化后病灶~(18)F-FDG摄取明显增高,平均SUV为4.7±1.9;转化后病灶平均SUV明显高于转化前(P<0.01).结论:惰性淋巴瘤以小细胞为主,其增殖活性低,核分裂不明显,葡萄糖代谢水平较低,在PET/CT上病灶呈低摄取;转化成大细胞淋巴瘤增殖活性高,核分裂明显,葡萄糖代谢水平明显增高,提示~(18)F-FDG PET/CT随访可帮助判断惰性淋巴瘤发生大细胞转化.

PET/CT Evaluation of Indolent Lymphoma Transformation

Purpose: To discuss the significance of PET/ CT modality in evaluate of the large cell transformation from indolent lymphoma. Methods: Eight cases of indolent lymphoma PET/ CT images before and after transformation were retrospectively analyzed. These patients consisted of 5 men and 3 women and the mean age is 53.5. The transformation of indolent lymphoma was confirmed by pathological and immunohistochemical exams. Results: Eight cases of indolent lymphoma consisted of 6 cases of mu-coMa - associated lymphoid tissue lymphoma(MALT), 1 case of follicular lymphoma(FL) and 1 case of nodular lymphocyte predominance Hodkin' s lymphoma(NLPHL) .All indolent lymphoma cases trans-formed into diffuse large B cell lymphoma(DLBCL) . The FDG uptake of lesions showed slight or mild ac-cumulation pre - transformation(SUVave = 2.2 ± 1.0) distinctly different from post - transformation (SUVave = 4.7 ± 1.9). There were statistically significance of FDG uptake value existed before and after transformation. Conclusion: Indolent lymphoma which characterized as small cell predominance, whose proliferative activity and metabolism of glucose were lower resulted in FDG uptake slight accumulation. However when transformed into progressive lymphoma which characterized large cell predominance whose proliferative activity and metabolism of glucose were higher, they showed intense FDG uptake in PET/ CT imaging. PET/ CT will be helpful to suggest lymphoma transformation when increase of FDG uptake value of indolent lymphoma in follow - up exam was found.