18F-FDGPET-CT在非霍奇金淋巴瘤结外病灶检测及精确分期中的应用

Application of 18F-FDG PET-CT in detection and accurate staging of extranodal non-Hodgkin lymphoma

目的探讨18F—FDGPET—CT在检测非霍奇金淋巴瘤（NHL）结外病灶及精确分期中的应用价值。方法回顾性分析94例初诊NHL患者的PET—CT结果，比较PET—CT与其他影像学检查对NHL结外病灶检出的一致性以及精确分期情况。结果PET．CT检出受累病灶432处，其中淋巴组织及器官占73．8％（319／432），最大标准摄取值（SUVmax）平均13．4（3．4～33．4）；结外病灶占26-2％（1t3／432），SUVmax平均13．5（3．1，55．0）。PET-CT与CT对于淋巴组织及器官病灶的检出一致率为95％，而对于结外病灶的检出一致率仅为54．9％。PET—CT对于软组织、骨骼以及胃肠道病灶的检出率高于CT，但对于骨髓病灶的检出率低于骨髓细胞学检查。根据PET—CT结果再分期，29例（31．0％）调整分期，其中分期上调者占75．9％（22／29），引起分期上调的原因主要是PET—CT对于软组织、骨骼等病灶的检出率高；分期下调者占24．1％（7／29），引起分期下调的原因主要是PET-CT对于非肿瘤性原因引起的淋巴结及脾脏增大或浆膜腔积液的分辨力强。结论18F-FDGPET-CT能够提高NHL结外病灶的检出率，特别是对于骨和软组织等弥漫性非肿块型病灶，有利于精确分期。

Objective To investigate the value of 18SF-FDG PET-CT in detection and accurate staging of extranodal non-Hodgkin lymphoma （NHL）. Methods The results of PET-CT of 94 patients with NHL were retrospectively analyzed. The consistency of checking out lesions and accurate staging by PET-CT were compared with those by other imaging examination in extranodal NHL. Results 432 lesions were checked out by PET-CT, including 319 （73.8 %） lymphoid tissues and organs with the average SUVmax of 13.4 （3.4- 33.4）, and 113 （26.2 %） extranodal lesions with the average SUVmax of 13.5 （3.1-55.0）. The detection consistent rate between CT and PET-CT for lymphoid tissues and lymph organ lesions was 95 %, while the consistent rate of the extranodal lesions was only 54.9 %. The detection rates of PET-CT for soft tissue, bone and gastrointestinal lesions were higher than those of CT, but the detection rate for the bone marrow lesion was lower than that for the bone marrow cytology. According to the results of PET-CT, the stages of 29 patients （31.0 %） were re-adjusted, including up-regulated for 75.9 % （22/29） because of high detection rates of PETCT for soft tissue and skeletal lesions, and down-regulated for 24.1% （7/29） mainly due to the strong resolution capability of PET-CT for detection of non-neoplastic lymph nodes and spleen increasing or effusion. Conclusion ISF-FDG PET-CT can improve the detection rate of NHL extranodal lesions, especially for diffuse non-mass lesions in bone and soft tissues, which facilitates the accurate lymphoma staging.