18F-FDG PET/CT在诊断多发性骨髓瘤中的临床应用

目的分析多发性骨髓瘤的PET/CT表现,探讨其在诊断多发性骨髓瘤中的作用。方法 19例经骨髓穿刺活检证实为多发性骨髓瘤患者,均行全身PET/CT检查,分析影像形态、功能代谢的特点,并测量平均标准摄取值(SUVmean)。结果 19例患者均表现为全身多发骨病变。CT共检出病灶221处(占全部骨骼病变的85.3%),表现为穿凿样、皂泡样溶骨改变,以中轴骨受累为主,一般位于骨髓腔内,较少形成软组织肿块及髓外侵犯。PET检查198处阳性病灶(76.4%),表现为全身多灶性18F-FDG摄取增高,SUVmean为3.1±1.4(范围1.3-7.4)。PET所示病灶大部分与CT匹配,少数病灶不匹配。PET/CT表现出一定特征,大致可分为:①部分病例中CT表现为多发骨质破坏,而PET累及的不均匀性代谢增高区与之不完全相符。②部分病灶CT未见明确骨质破坏,PET表现为代谢异常增高。③少数病灶CT示骨质破坏并局部软组织肿块形成时,PET显示代谢显著增高,且与CT基本相当。本组有2例常规骨穿阴性的患者在PET/CT引导下活检确诊为多发性骨髓瘤。结论 PET/CT对多发性骨髓瘤诊断具有重要价值,其引导下穿刺活检有利于提高诊断的灵敏度,尤其在常规骨穿假阴性病例中。

Clinical application of 18F-FDG PET/CT in diagnosis of multiple myeloma

Objective To investigate the features of 18F-FDG PET/CT for multiple myeloma(MM) and to explore the value of 18F-FDG PET/CT in the diagnosis of MM. Methods 18F-FDG PET/CT imaging findings were retrospectively analyzed in 19 patients with MM proved by bone marrow aspiration biopsy.SUVmean of those lesions were measured. Results All patients suffered from multiple lesions in bone.A total of 221 lesions(about 85.3% of all lesions) were found by CT,which showed as punched out or bubbly lytic destructions of bone.All lesions were mostly found in bone marrow of axial skeleton,and rarely formed soft tissue masses and extramedullary organ involvement.A total of 198 lesions(about 76.4%) in bone got focal 18F-FDG uptake increasing in PET and SUVmean was 3.1±1.4(1.3-7.4).PET of the lesions with hypermetabolism were generally matched with CT results,but not matched completely in some lesions.Characteristics of PET/CT images were categorized into three types: ①Multiple bone destructions were shown by CT in partial patients,which mismatched with the hypermetabolism lesions by PET.②Some lesions were found with hypermetabolism by PET,but no bone destructions in CT.③The bone destructions combined with soft tissue mass with hypermetabolism in PET were similar to CT results.Two patients with negative results by routine bone marrow aspiration were proved as MM by bone marrow biopsy guided by PET/CT. Conclusion 18F-FDG PET/CT imaging has an important value in diagnosing MM.Bone marrow aspiration biopsy guided by 18F-FDG PET/CT can improve the diagnostic sensitivity,especially in those false-negative patients.