FDG-PET显像技术在恶性淋巴瘤诊断与治疗中的应用

Applications of FDG-PET in diagnosis and treatment of malignant lymphoma

对大多数肿瘤而言,18F-FDGPET具有敏感性高、特异性强的优点。在淋巴结和结外淋巴瘤的诊断检出率、淋巴瘤分期和再分期、疗效预测和评估、检测微小残留病灶、监测复发和预后判断均优于CT或67Ga。PET常上调淋巴瘤分期(约40%),PET的检出效能随淋巴瘤的组织类型而变动,尤其对弥漫性大B细胞淋巴瘤(DLBCL)和霍奇金病诊断率高。对骨髓累及的检出PET/CT可补充骨髓活检(BMB),但不能取代BMB。PET较67Ga对脾淋巴瘤有更高的检出率。治疗早中期PET/CT是无进展生存期和总生存期独立的预后指标。FDG并非肿瘤特异性物质,FDG-PET存在假阳性和假阴性,需注意鉴别,可能时进行组织活检。

^18F - FDG PET possessed high sensitivity and specificity in most tumors including lymphoma. In lymphoma, PET/CT was better than CT and other imaging modalities in the detected rate of both nodal and extranodal lymphoma, the staging （pretreatment） and restaging （ to determine the extent of known or suspected recurrence or to as- sess response after completion of therapy）, the prediction and evaluation of therapeutic efficacy, the determine of minimal residual disease, monitoring relapse and the judgment of outcome. Often upstaging （ approximately 40% ） due to PET and detected efficacy of PET was variant along with pathological histology pattern of lymphoma, the reliability （ 〉90% positive on PET） particularly was in DLBCL and Hodgkin＇s disease. For detecting bone marrow involvement, ^18F -FDG PET may complement bone marrow biopsy （BMB）, but cannot replace BMB. FDG -PET had a superior ability to detect occult splenic disease that having isolated FDG - avid nodules in the spleen not detected with gallium imaging. Early interim FDG - PET was independent predictor of sarvival.