PET／CT诊断恶性淋巴瘤对肝和（或）脾的侵犯

Detection of malignant iymphoma with invasion in liver and spleen using PET/CT imaging

目的根据恶性淋巴瘤侵犯肝和（或）脾的PET／CT影像学表现，总结肝和（或）脾内病变累及的特点，为以后正确诊断提供依据。方法41例累及肝和（或）脾的恶性淋巴瘤患者，共进行52例次全身PET／CT检查，追踪分析这些患者的临床资料及PET／CT影像表现，以期发现恶性淋巴瘤侵犯肝和（或）脾的规律。所有病例均由组织病理学检查证实，其中包括非霍奇金淋巴瘤（NHL）38例，霍奇金淋巴瘤（HL）2例，胃黏膜相关淋巴组织淋巴瘤1例。静脉注射^18F-脱氧葡萄糖（FDG）222～555MBq 1 h后行PET／CT显像。测定肿瘤体积和平均标准摄取值（SUVmax），并与PET／CT检查中单纯CT平扫（41例）结果进行对照。结果淋巴瘤侵犯肝和脾的表现形式明显不同。（1）有30例（30／41）患者肝受累及，肝侵犯以肝实质内结节或肿块状病变和肝门部淋巴结受累，并形成体积较大的肿块压迫和侵犯邻近的肝实质最为常见。（2）有23例（23／41）患者脾受侵犯，脾侵犯以脾体积明显增大，PET显示整个脾代谢弥漫性均匀性增高为主要表现。（3）除全身淋巴结组织和肝、脾侵犯以外，还有一些少见部位的累及：肺内13例、骨皮质和骨髓内12例、胃9例、胸膜6例、皮下软组织5例等。结论PET／CT可以较准确地发现恶性淋巴瘤对肝、脾的侵犯，并准确显示病灶大小、形态和分布，为淋巴瘤的诊断和准确分期提供帮助。

Objective The detection of malignant lymphoma with invasion in liver and spleen using PET/CT has not been well documented in the literature. This study aimed to investigate the usefulness of PET/CT in this regard and to compare it with plain CT. Methods Forty-one pathologically confirmed malignant lymphoma patients with liver and spleen invasion were recruited into this study. Among all patients, there were 38 non-Hodgkin＇s lymphoma （ NHL）, 2 Hodgkin＇s lymphoma （HL） and 1 gastric mucosa associated lymphoma. PET/CT imaging was recorded 1 h after injection of 296 ～ 444 MBq ^18F-fluorodeoxyglucose （FDG）. Results （1） There were 30 （30/41） patients with liver invasion, including hepatic nodules, mass and portal nodes. The mass was large to invade surrounding liver parenchyma. （2） There were 23 （23/41） patients with spleen invasion. The spleen was enlarged and demonstrated diffused hyper-metabolism. （3） Other invasion included： lung （n = 13 ）, cortical bone and marrow （n = 12）, stomach （n = 9） , pleural （n = 6）, and subcutaneous soft tissue （ n = 5） and so on. Conclusion PET/CT could accurately diagnose the invasion in liver and spleen of malignant lymphoma, which was of potential role on the diagnosis and staging of lymphoma.