摘要
目的探讨18F-FDG PET/CT评价非霍奇金淋巴瘤(NHL)骨髓浸润的临床应用价值,并与骨髓活检(BMB)及流式细胞分析(FCM)进行比较。方法回顾性分析89例经病理证实且未经治疗的NHL患者18F-FDG PET/CT资料,其中侵袭性NHL76例,惰性NHL13例。所有患者均在18F-FDG PET/CT检查2周内接受BMB及FCM,对18F-FDG PET/CT显示骨髓局灶性18F-FDG摄取增高而BMB及FCM阴性患者,根据PET/CT所示骨髓异常部位再次行BMB确定骨髓是否受累。结果89例NHL患者中,根据BMB、FCM及PET/CT引导下再次BMB结果,共检出骨髓浸润26例,检出率为29.21%(26/89),PET/CT检出率为21.35%(19/89)。PET/CT诊断骨髓浸润的灵敏度为73.08%(19/26),特异度为96.83%(61/63),准确率为89.89%(80/89),阳性预测值为90.48%(19/21),阴性预测值为89.71%(61/68)。BMB及FCM检出率均为19.10%(17/89),PET/CT较BMB、FCM骨髓浸润检出率稍高,但差异无统计学意义(P>0.05)。将PET/CT、FCM及BMB三种方法联合诊断骨髓浸润,其检出率高于其中任意一种方法(P<0.05)。PET/CT对侵袭性NHL骨髓浸润的检出率22.37%(17/76)高于对惰性NHL骨髓浸润的检出率15.38%(2/13,P<0.05)。结论18F-FDG PET/CT在诊断NHL骨髓浸润中有较高的应用价值。对局灶性骨髓浸润患者,PET/CT有助于引导BMB部位,提高骨髓浸润的检出率。PET/CT未检出骨髓浸润的惰性NHL患者,应进一步行BMB及FCM检查。推荐PET/CT、FCM及BMB三种方法联合应用判断NHL骨髓浸润,从而更准确地进行分期、治疗及判断预后。
Objective To evaluate the clinical value of ^18F-FDG PET/CT for detection of bone marrow involvement in non-Hodgkin lymphoma （NHL）, and to compare it with bone marrow biopsy （BMB） and flow cytometry （FCM）. Methods Eighty-nine patients with pathologically proven NHL including 76 aggressive NHL and 13 indolent NHL underwent ^18F- FDG PET/CT imaging. All patients underwent BMB and FCM within 2 weeks of ^18 F-FDG PET/CT scan. When 18 F-FDG PET/CT revealed multiple foci of abnormal ^18 F-FDG uptake but with negative BMB and FCM, the repeat biopsy was per- formed guided by PET/CT. Results Final diagnosis of bone marrow involvement was made in 26 patients on the basis of composite criteria derived from BMB, FCM and PET/CT guiding repeat BMB （26/89, 29.21%）. The detection rate of PET/CT was 21.35% （19/89）. ^18F-FDG PET/CT revealed true-positive bone marrow involvement in 19 patients, while BMB and FCM revealed bone marrow involvement in 17 patients. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ^18 F-FDG PET/CT for detection bone marrow involvement was 73.08% （19/26）, 96.83% （61/63）, 89.89% （80/89）, 90.48% （19/21） and 89.71% （61/68）, respectively. The detection rate of bone marrow involvement by NHL for ^18 F-FDG PET/CT was higher than that for BMB and FCM （17/89, 19.10 %）, but there was no statistical difference （P〉0.05）, while the detection rate of bone marrow involvement by NHL for comprehensive method was higher than that for ^18F-FDG PET/CT, BMB and FCM （P〈0.05）. The detection rate of bone marrow in- volvement of aggressive NHL （17/76, 22.37%） for ^18F-FDG PET/CT was higher than that of indolent NHL （2/13, 15.38%, P〈0.05）. Conclusion ^18 F-FDG PET/CT has high clinical value in diagnosing bone marrow involvement of NHL. ^18 F-FDG PET/CT can be used to directly guide the site of BMB, when PET/CT demonstrates foci bone marrow in- volvement. While using PET/CT to detect bone marrow involvement of indolent NHL, BMB and FCM are still warranted. To detect bone marrow involvement by NHL, the combination of PET/CT, BMB and FCM is recommended.
出处
《中国介入影像与治疗学》
CSCD
2012年第7期539-543,共5页
Chinese Journal of Interventional Imaging and Therapy
基金
国家重大科学仪器设备开发专项(2011YQ03011409)
国家自然科学基金项目(81071183)
