自体干细胞移植前后18F-FDG符合线路显像对非霍奇金淋巴瘤预后的评估价值

目的 探讨非霍奇金淋巴瘤(NHL)患者在自体干细胞移植(ASCT)前后行18F-脱氧葡萄糖(FDG)符合线路显像对于预测患者无进展生存期(PFS)的价值,并将结果 与CT检查进行对比分析.方法 29例经病理检查证实的NHL患者在ASCT前后均进行18F-FDG符合线路显像与CT检查,ASCT后随访时间均>1年.分别计算18F-FDG符合线路显像与CT检查的阳性预测值(PPV)、阴性预测值(NPV)和准确性,采用X2检验比较两者的结果 ,并采用Kaplan-Meier生存分析法行PFS分析.结果 ASCT前,18F-FDG显像的PPV、NPV和准确性分别为85.7%(12/14)、73.3%(11/15)和79.3%(23/29),高于CT检查的55.6%(10/18),45.5%(5/11)和51.7%(15/29);而在ASCT后,18F-FDG显像的PPV、NPV和准确性分别为92.3%(12/13)、75.0%(12/16)和82.8%(24/29),也分别高于CT检查的62.5%(10/16),53.8%(7/13)和58.6%(17/29);18?F-FDG显像和CT两者评价准确性差异有统计学意义(X2值分别为4.884和4.077,P均<0.05).ASCT前后18F-FDG显像阴性与阳性病例的PFS差异也有统计学意义(X2值分别为15.839和20.219,P均<0.005),而同期CT检查的阴性与阳性病例PFS差异无统计学意义(X2=2.468,P=0.116).ASCT前后,18F-FDG显像阴性和阳性患者的1年无进展生存率分别为86.7%(13/15)、87.5%(14/16)和28.6%(4/14)、23.1%(3/13).结论 ASCT前后18F-FDG符合线路显像均具有预测NHL预后的价值,且均优于CT检查.

Value of 18F-FDG coincidence SPECT imaging for predicting the clinical outcome of patients with non-Hodgkin's lymphoma prior to and after autoiogous stem cell transplantation

Objective Evaluation of therapeutic response in non-Hodgkin's lymphoma (NHL) pa-tients with autologous stem cell transplantation (ASCT) is of great clinical significance. But the exact role of 18F-fluorodeoxyglucose (FDG) imaging in NHL associated with ASCT is not clear. This study assessed the value of 18F-FDG coincidence SPECT imaging prior to and after ASCT for prediction of progression-free sur-vival (PFS) in NHL, as well as the predictive values of CT and 18F-FDG SPECT imaging in these patients. Methods 18F-FDG coincidence SPECT imaging and CT were performed in 29 patients with pathologically confirmed NHI. prior to and after ASCT. No patients were lost to follow-up earlier than 1 year after ASCT. Positive predictive value ( PPV), negative predictive value (NPV) and accuracy of 18 F-FDG coincidence SPECT imaging were compared to the results of CT using the X2-test. The results of 18F-FDG scans and CT were correlated with PFS using Kaplan-Meier survival analysis. Results 18F-FDG coincidence SPECT ima-ging before ASCT showed PPV, NPV and accuracy 85.7% ( 12/14), 73.3% ( 11/15 ) and 79.3% ( 23/29)] higher than CT 55.6% (10/18), 45.5% (5/11) and 51.7% (15/29), respectively]. After ASCT, 18F-FDG imaging also showed PPV, NPV and accuracy 92.3% (12/13), 75.0% (12/16) and 82.8% (24/29)] higher than CT62.5%(10/16), 53.8% (7/13) and 58.6% (17/29), respectively]. However, only the differences in accuracy between 18 F-FDG SPECT imaging and CT before and after ASCT were significant ( X2 =4.884, 4.077, all P<0.05). 18F-FDG imaging results before or after ASCT were strongly correlated with PFS (X2 =15.839, 20.219, all P<0.005, significant) but not CT(X2=2.468, P= 0.116, not significant). The 1-year PFS rate for 18F-FDG-negative patients was 86.7% ( 13/15 ) and 28.6% (4/14) for 18SF-FDG-positive patients before ASCT. The 1-year PFS rate for18F-FDG-negative patients was 87.5% (14/16) and 23.1% (3/13) for 18F-FDG-positive patients after ASCT. Conclusion 18F-FDG coincidence SPECT imaging before or after ASCT can be used to predict the post-ASCT outcome of NHL patients better than CT.