18F-FDG PET/CT对多系统结节病与淋巴瘤的鉴别诊断价值

目的探讨18F-FDG PET/CT对多系统结节病与非霍奇金淋巴瘤的鉴别诊断价值。方法结节病组25例与非霍奇金淋巴瘤20例,均经病理检查证实且未行相关治疗。18F-FDG PET/CT检查后通过目视法确定病变区域并分析代谢区形态特点。结果结节病组淋巴结肿大25例,短径(2.07±0.86)cm,SUV max 7.88±3.83,结外器官累及22例。淋巴瘤组淋巴结肿大18例,短径(3.05±1.63)cm,SUV max 7.68±4.58,结外器官累及15例。两组淋巴结大小比较有统计学差异(t=3.174,P=0.003),而SUV max无差异(t=0.110,P=0.913)。结节病常累及胸部淋巴结及肺组织(χ2=9.586,P=0.003;χ2=12.640,P=0.001),淋巴瘤则更常侵犯骨骼(χ2=11.520,P=0.001)。肿大淋巴结的对称性分布结节病较明显(χ2=5.993,P=0.014),而淋巴结融合淋巴瘤更多见(χ2=15.901,P=0.000)。结论肿大淋巴结的SU-Vmax值不能用于鉴别结节病与非霍奇金淋巴瘤。淋巴结的对称性分布、大小、融合趋势,病变好发部位及临床与影像学不匹配现象,有助于两者的鉴别。

Clinical Value of 18F-FDG PET/CT in the Differential Diagnosis between Multiple Systemic Sarcoidosis and Lymphoma

Objective To explore the value of lSF-fluorodeoxyglucose （FDG） PET/CT in the differential diagnosis be- tween Multiple Systemic Sarcoidosis （MSS） and non-Hodgkin＇s lymphoma （NHL）. Methods Twenty-five patients with MSS and 20 patients with NHL were enrolled in this study. All patients with pathologically confirmed underwent 18F-FDG PET/CT examina- tion before treatment. The regions and the metabolism features of the lesions in PET/CT were observed and analyzed with routine visual method. Results Enlargement of LNs were found in MSS and NHL group （25 vs. 18）. So were involvements of Extra-nod- al organs （22 vs. 15）. There was a significant difference between MSS and NHL in Shock diameter of LNs[ （2.07 ±0.86）cm vs （3.05 ± 1.63）cm,t =3. 174,P =0.003] ,but no difference in SUV max （7.88 ±3.83 vs.7.6g ±4.58,t =0. 110,P =0.913）. Thoracic LNs and lung tissue were most commonly involved in MSS（ X2 = 9. 586, P = 0.003;X2 = 12. 640 ,P = 0.001 ）, in contrast bone morrow in NHL（ X2 = 11. 520 ,P = 0.001 ）. Symmetric distributions of enlarged LNs in MSS were more common than in NHL （X2 = 5. 993 ,P = 0.014） ,whereas merged LNs in NHL （X2 = 15. 901 ,P = 0. 000）. Conclusion It is useless to difference MSS from NHL by SUVmax of enlarged LNs. Enlarged LNs expression, such as distribution and size and merge trend, and the probability of involved organs and mismatched phenomenon between clinic and imaging, play important roles in distinguishing between MSS and NHL.