18F-FDG PET/CT三种评价方法在初治弥漫大B细胞淋巴瘤患者骨髓受累中的诊断价值

Diagnostic value of three evaluation methods of 18F-FDG PET/CT in detecting bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma

目的 探讨18F-FDG PET/CT的三种评价方法在弥漫大B细胞淋巴瘤（DLBCL）患者骨髓受累中的诊断价值.方法 对2012年7月至2014年6月的77例初治DLBCL患者资料进行回顾性分析,所有患者均接受18F-FDG PET/CT显像、单侧髂骨骨髓穿刺活检.以骨髓穿刺活检组织病理学检查结果为参照,评价视觉比较法（髂骨骨髓FDG摄取高于正常肝脏组织）、骨髓最大标准摄取值（SUVmax）法（髂骨骨髓SUVmax≥2.5作为淋巴瘤骨髓受累的诊断阈值）、SUVmax比值法（髂骨骨髓SUVmax与正常肝脏组织SUVmax比值≥1作为淋巴瘤骨髓受累的诊断阈值）的诊断效能.结果 ①77例患者中男36例,女41例.Ann-Arbor分期I、Ⅱ、Ⅲ、Ⅳ期者分别为5、8、7、57例.②视觉比较法的诊断敏感性为100.00％,特异性为80.00％,阳性预测值为48.00％,阴性预测值为100.00％.③骨髓SUVmax法的诊断敏感性为75.00％,特异性为92.31％,阳性预测值为64.29％,阴性预测值为95.24％.④SUVmax比值法的诊断敏感度为100.00％,特异性为90.77％,阳性预测值66.67％,阴性预测值100.00％.结论 髂骨骨髓SUVmax与正常肝脏组织SUVmax比值≥1作为18F-FDG PET/CT的诊断阈值在DLBCL患者骨髓受累中具有良好的诊断价值.

Objective To evaluate three methods of 18F-FDG PET/CT in detecting bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma.Methods Seventy-seven patients with newly diagnosed diffuse large B-cell lymphoma from July 2012 to June 2014 were retrospectively analyzed.All patients received both 18F-FDG PET/CT scan and bone marrow biopsy in the region of the posterior iliac crests.There were three evaluation methods of 18F-FDG PET/CT to detect bone marrow infiltration,including visual comparison （the FDG uptake in bone marrow of iliac crests was higher than the normal liver tissue）,the maximal standardized uptake values （SUVmax） in bone marrow of iliac crests （more than or equal to 2.5）,the ratio of maximal standardized uptake values of iliac crests bone marrow to liver parenchyma intensity （more than 1）.All results were compared with the bone marrow biopsy.Results Visual comparison of 18F-FDG PET/CT could be used to diagnose bone marrow infiltration,with the sensitivity of 100.00％,specificity of 80.00％,positive predictive value of 48.00％,and negative predictive value of 100.00％.When the SUVmax of iliac crests was used as the diagnostic threshold,the sensitivity was 75.00％,with 92.31％ specificity,64.29％ positive predictive value,and 95.24％ negative predictive value.The ratio of SUVmax had the best diagnostic efficiency,with sensitivity of 100.00％,specificity of 90.77％,positive predictive value of 66.67％,and negative predictive value of 100.00％.Conclusions The ratio of SUVmax is a valuable diagnostic method in detecting diffuse large B-cell lymphoatic bone marrow involvement.