^18F-FDG PET在原发性肾上腺淋巴瘤中的作用

^18F-FDG PET imaging in primary adrenal lymphoma

目的探讨^18F—FDGPET（PET／CT）在原发性肾上腺淋巴瘤（PAL）中的作用。方法回顾性分析2005年10月至2009年8月确诊为PAL的3例患者。3例均为老年男性，双侧性NHL，治疗前均行超声、CT及PET（PET／CT）检查，并有组织病理学诊断资料。采用利妥昔单抗（rituximab）与环磷酰胺（cyclophosphamide）、表阿霉素（doxorubicin）、长春新碱（vincristine）、泼尼松（prednisone）组合（R—CHOP）方案化疗。治疗后1例进行了PET／CT的随访复查。^18F—FDGPET显像获得病灶SUVmax及与肝SUVmax的比值。结果3例均为双侧性弥漫大B细胞型PAL，骨髓穿刺阴性，R-CHOP方案化疗后，例1通过4次^18F—FDGPET复查随访、指导治疗，已存活1年7个月；例2伴有肾上腺皮质功能低下，6个月后死亡；例3年龄大（77岁），病情重，手术部分切除后化疗，12个月后死亡。结论PAL虽然恶性程度极高，但如能早期诊断，并进行^18F—FDGPET疗效监测、修正治疗方案，可延长患者生存期。

Objective To evaluate 18F-FDG PET/CT imaging in primary adrenal lymphoma （PAL）. Methods Three male patients with clinically diagnosed PAL, aged 59 to 77 years old, were examined bylSF-FDG PET/CT before histopathologic examination. The SUVmax ratio of tumor to liver （T/L） was calculated on ^18F-FDG PET images. All patients underwent R-CHOP （rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone） chemotherapy regimens. One patient had serial follow-up ^18F- FDG PET/CT post therapy. Results The final diagnosis of all 3 cases was bilateral diffuse large B-cell lymphoma. The pathologic results of bone marrow biopsy were negative. Case I was in disease remission based on four times of follow-up ^18F-FDG PET/CT. The patient＇s clinical follow-up was also negative and he was currently alive for more than 19 months. Case 2 was of late stage and suffered from adrenal insufficiency. He died 6 months after the diagnosis. Case 3 （ the eldest patient） was treated with partial excision followed by the chemotherapy. He died of lung infection 12 months after treatment. Conclusion ^18F-FDG PET/CT may be of important value for maximizing patient management and survival for patients with PAL, a rare and highly malignant disease.