^(18)F-FDG PET-CT对多发性骨髓瘤的诊断价值

Value of 18F-FDG PET-CT in diagnosing multiple myeloma

目的探讨18F-FDG PET-CT对多发性骨髓瘤(MM)的诊断价值。方法回顾分析经病理证实的27例MM患者的PET-CT资料,分别记录病灶骨质破坏的部位并按骨质破坏形态进行分类,同时测量其最大SUV值(SUVmax)。结果 27例MM患者中有26例PET-CT检出病灶(阳性率为96.3%),共检出病灶354个。PET和CT同时检出60.2%(213/354)的病灶,34处病灶仅在PET检出(34/354,9.6%),而107处病灶仅在CT检出(107/354,30.2%)。PET-CT表现分三型:①骨质疏松型(4例),表现为骨质密度减低,骨皮质变薄或断续不连,可合并胸腰椎压缩骨折,肋骨病理性骨折,PET示轻度代谢异常增高,SUVmax均值为3.5±1.0。②骨质破坏型(20例),表现为骨质破坏、病理性骨折、软组织肿块等,PET示大部分为中低代谢,SUVmax均值为3.1±1.0,合并软组织肿块时为高代谢,SUVmax均值为5.3±1.7。③骨质硬化型(3例),表现为骨质密度增高,破坏与硬化混合存在或骨质破坏周围有硬化缘,PET示轻度代谢异常增高,SUVmax均值为3.5±1.2。结论 PET-CT对于MM的诊断及评价全身累及范围具有一定价值。

Objective To investigate the value of 18F-fluorodeoxyglucose（18F-FDG） PET-CT in diagnosing multiple myeloma（MM）.Methods The PET-CT findings of 27 patients with MM proved pathologically were retrospectively analyzed.Destructive site of bone lesions were recorded and classified according to the damage patterns.The maximum standard uptake values（SUV max） were measured.Results 26 of 27（96.3%） patients were confirmed by PET-CT.Total 354 lesions were detected.The positive rate was 60.2%（213/354） both by PET and CT.34 lesions were detected by PET（34/354,9.6%） and 107 lesions in CT（107/354,30.2%）,respectively.The lesions were classified into 3 types according to theirs manifestation in PET-CT.① Type osteoporosis（4 cases）： bone density decreased and bone cortex became thinner or discontinuous,combined with thoracolumbar vertebral compression fractures or pathologic fractures of ribs.PET showed increased mild metabolic abnormalities,the mean of SUV max was of 3.5±1.0.②Type bone destruction（20 cases）： bone was destroyed or appeared as pathological fracture with soft tissue mass,etc.PET showed increased low to mild metabolic abnormalities,the mean of SUV max was 3.1±1.0,it would be higher if when soft tissue mass was combined,that was 5.3±1.7.③ Type bone sclerosis（3 cases）： bone density increased and mixed destruction and sclerosis appeared in lesions.Sclerosis margin could be found around the destructions.PET showed increased mild metabolic abnormalities,the mean of SUV max was 3.5±1.2.Conclusion PET-CT has a certain value both in diagnosis of MM and evaluation of systemic involvement.