^18F-FDG PET-CT在淋巴瘤分期及疗效评价中的应用研究

目的探讨^18氟-氟代脱氧葡萄糖（^18F-FDG）PET—CT在淋巴瘤分期及疗效评价中的临床应用价值。方法回顾分析28例淋巴瘤患者（HL6例，NHL22例）在治疗前后进行^18F—FDG PET—CT对比检查的结果，并与增强CT及骨髓活检结果进行比较。结果治疗前68处病灶^18F—FDG PET—CT检出67个，检出率为98．5％，其中结内37个全部检出（100％），结外31个检出30个（96．8％）；增强CT则共检出病灶45个（66．2％），其中结内37个检出32个（86．5％），结外31个仅检出13个（41．9％）。6例（21．4％）的分期得到上调并改变了1例（3．6％）的治疗方案。治疗后32处病灶^18F—FDG PET—CT检出29个，检出率为90．6％，其中结内17个检出15个（88．2％），结外15个检出14个（93．3％）；增强CT则共检出病灶18个（56．3％），其中结内17个检出13个（76．5％）．结外15个仅检出5个（33．3％）。治疗后有2例（7．1％）的分期得到上调，8例（28．6％）下调，改变了8例（21．4％）的治疗方案。^18F—FDG PET—CT对淋巴瘤患者治疗前后结内病灶检出率与增强CT相似（P〈0．05），而结外病灶检出率则明显高于增强CT（P〉0．05）。28例中25例^18F—FDG PET—CT与骨髓穿刺结果一致。治疗后^18F—FDG PET—CT对复发的阳性预测值93．8％，阴性预测值为83．3％；增强CT的阳性预测值75％，阴性预测值50％。结论^18F—FDG PET—CT在淋巴瘤分期及疗效评价中具有重要的临床价值．有助于准确分期和残余病变性质的鉴别。

Evaluation of 18F-FDG PET-CT in staging and detectin residual masses of lymplionia

Objective To evaluatie fluorine - 18 fluorodeoxyglucose PET- CT in staging and detecting residual masses of lymphoma. Methods ^18F- FDG PET- CT imaging was performed in 28 patients with lymphoma（6 HL patients and 22 NHL patients）before and after treatment. The findings of ^18F - FDG PEr - CT images were analyzed qualitatively. ^18F - FDG PEr - CT images were compared with syn- chronous routine images, such as enhancement scan CT and bone marrow biopsy（BMB）. Results Forty - six studies were performed in 28 patients with lymphoma in this study（each study performed before and after treatment）. Without any treatment,the sensitivities of ^18F- FDG PET -CT and enhancement scan CT were 100% and 86.5% ,respectively（ P 〉 0.05） ,in detecting lymph nedes, and 96.8% and 41.9% ,respectively （ P 〈0.05）,in detecting extranodal manifestations, ^18F-FDG PET- CT led to change 21.4% in clinical staging and 3.6% in management. After treatment, the sensitivities of ^18F- FDG PET- CT and enhancement scan CT were 88.2 % and 76.5%, respectively（ P 〉 0.05） ,in detecting lymph nedes, and 93.3% and 33.3% ,respectively （ P 〈 0.05） ,in detecting extranodal manifestations, ^18F- FDG PET- CT led to change 35.7% in clinical staging and 28.6% in management. ^18F - FDG PET - CT and BMB produced equivalent results in 89.3% （25/28） of patients.The positive predictive value and negative predictive value of recurrence detected by ^18F- FDG PET- CT were 93.8% and 83.3%,while those by CT were 75% and 50% after therapy. Conclusions ^18F- FDG PET- CT imaging plays an important role in restaging and detecting residual masses of lymphoma. It is useful for differentiating active tumors from fibrosis and necrosis after treatment.