^(18)F-FDG PET/CT显像在原发性中枢神经系统淋巴瘤诊断中的应用

Application of ^(18)F-FDG PET-CT imaging in diagnosis of primary central nervous system lymphoma

目的:探讨18F-FDG PET/CT在原发性中枢神经系统淋巴瘤(PCNSL)的诊断和鉴别诊断中的价值,阐明其影像学表现特点,为临床选择治疗方法提供参考和依据。方法:回顾性分析经病理证实的8例PCNSL、19例胶质瘤和28例脑转移瘤患者的18F-FDG PET/CT影像资料及免疫组织化学结果;对3种疾病的半定量最大标准摄取值(SUVmax)进行比较。结果:PCNSL 18F-FDG PET/CT显像表现为结节状、团块状、束带状异常放射性摄取浓聚,病灶内示踪剂摄取均匀,与周围组织分界不清,但水肿少见。胶质瘤18 F-FDG PET/CT显像的放射性摄取程度取决于其病理类型,一般低级别胶质瘤脱氧葡萄糖(FDG)摄取减低,SUVmax为2.2~4.3;高级别胶质瘤FDG摄取增高,SUVmax为9.3~17.2;病灶内示踪剂摄取欠均匀,且瘤周水肿范围较严重。典型脑转移瘤18F-FDG PET/CT显像表现为病灶放射性摄取增高,灶周伴大片状水肿。PCNSL患者的SUVmax高于脑转移瘤患者(P<0.05),PCNSL与胶质瘤患者SUVmax比较差异无统计学意义(P>0.05)。结论:PCNSL患者18F-FDG PET/CT显像具有一定的影像学特征,可与其他中枢神经系统肿瘤进行鉴别诊断。

Objective To investigate the value of 18F-FDG PET/CT imaging in the diagnosis and differential diagnosis of the primary central nervous system lymphoma（PCNSL）,and to illustrate the characteristics of imaging findings,and to provide the reference and basis for clinical treatment.Methods A retrospective analysis of 55 cases of 18F-FDG PET/CT image data and immunohistochemical results including 8cases of PCNSL,19 cases of gliomas and 28 patients with cerebral metastatic carcinoma confirmed by pathology was performed;the maximum standardized uptake value（SUV8max）was compared between three kinds of diseases.Results PCNSL 1F-FDG PET/CT performed as an abnormal radioactivity uptake showed strong together as nodular,crumb,bunch of ribbon,and the surrounding tissue boundary was not clear and the edema was rare.The radioactivity uptake of glioma in 18F-FDG PET/CT imaging depended on the pathological types,and the uptake of fluoredeoxyglucose（FDG）of generally low grade glioma was reduced,and the SUVmax was 2.2-4.3;the uptake of FDG of high grade glioma was increased,and the SUVmax was 9.3-17.2;the uptake of tracer in lesion was not homogeneous,and the flake edema could be seen around the lesions.Typical cerebral metastatic carcinoma performed as the increasing uptake of the radioactivity lesions,and the flake edema could be seen around the lesions.The SUVmaxof PCNSL patients was higher than that of cerebral metastatic carcinoma patients（P〈0.05）;there was no statistically significant difference of SUVmax beweteen PCNSL and glioma patients（P〉0.05）.Conclusion The18F-FDG PET/CT imaging of PCNSL patients has certain imaging characteristics,which can be used for differential diagnosis with other central nervous system tumors.