淋巴瘤骨髓浸润的18F-FDG PET显像研究

目的 用^18F-脱氧葡萄糖（FDG）PET显像研究淋巴瘤细胞骨髓浸润。方法 恶性淋巴癌患者30例，其中非霍奇金淋巴瘤（NHL）20例、霍奇金病（HD）10例，进行全身^18F-FDG PET显像。局灶性边缘清楚的淋巴结相应区域^18F-FDG浓聚视为恶性淋巴结显影。利用灰度色标，视觉分析骨髓及肝脏内^18F-FDG浓聚情况。骨髓的^18F-FDG分布不均，摄取高于肝脏，判断为骨髓^18F-FDG摄取异常；骨髓的^18F-FDG分布均匀，摄取低于或等于肝脏，判断为骨髓^18F-FDG摄取正常。所有患者均行髂棘的骨髓活组织检查。结果 30例中18例有淋巴结摄取^18F-FDG；12例淋巴结摄取^18F-FDG阴性患者中，8例NHL，4例HD。有26例患者的骨髓^18F-FDG摄取情况与骨髓组织学检查结果一致，其中骨髓有淋巴细胞浸润7例，无淋巴细胞浸润19例。有3例骨髓组织学检查阴性的患者，^18F-FDG PET示骨髓^18F-FDG摄取异常、骨髓有淋巴细胞浸润；1例NHL患者，骨髓组织学检查阳性但^18F-FDG PET示骨髓^18F-FDG摄取正常。结论 ^18F-DG PET全身显像能正确评价骨髓淋巴细胞浸润情况，减少对淋巴瘤分期所进行的骨髓组织学检查。

Evaluation of bone marrow infiltration in lymphoma patients with 18F-FDG PET

Objective To investigate the efficacy of 18F-fluorodeoxyglucose (FDG) PET whole body scan as a alternative method to evaluate bone marrow infiltration in patients with malignant lymphoma. Methods Thirty patients with either non-Hodgkin's lymphoma (NHL; n=20) or Hodgkin's disease (HD; n=10) were studied by 18F-FDG PET scan following injection of 2.526 MBq/kg body weight 18F-FDG. Attenuation was performed in all cases. Visual analysis was used to detect lymph node and to evaluate the uptakes of 18F-FDG in the liver and marrow. Unilateral iliac crest marrow aspiration and biopsy were performed on all patients. Bone marrow that involved by the disease was represented by the increased marrow 18F-FDG uptake and graded as normal or abnormal using visual grading system through comparing the 18F-FDG uptake in the marrow and liver. Results PET scan showed 18/30 patients had 18F-FDG uptake at their lymph nodes. 18F-FDG bone marrow grading and marrow histology agreed in 26/30 patients, being concordant positive in 7 and concordant negative in 19 patients. In 3 patients the 18F-FDG uptake at the marrow were inhomogeneous with focal 18F-FDG hot spots but staging biopsy was negative. For 1 patient the marrow biopsy specimen was positive but the marrow grading by 18F-FDG uptake was negative. This patient had NHL whose malignant cells did not take up 18F-FDG at lymph node. Conclusions Marrow 18F-FDG uptake showed by PET study can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.