摘要
目的通过1例神经淋巴瘤病(NL)患者的诊断及文献复习,总结18F-氟代脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像(PET/CT)对NL的诊断价值。方法介绍1例经病理证实的弥漫大B细胞淋巴瘤伴周围神经病患者的临床表现和18F-FDG PET/CT显像结果,与传统影像学检查手段MRI和CT相比较,并结合既往文献进行复习。结果患者为38岁女性,因"左胸背疼痛2个月"就诊,胸椎增强MRI检查示胸4椎体左侧附件、左侧第5后肋骨质破坏,不排除肿瘤可能。18F-FDG PET/CT示胸4、5椎体左侧椎间孔区根块状放射性摄取增高影。病灶沿着左侧第5肋骨肋间神经呈束带状、短条状放射性摄取增高,胸骨左旁第2前肋间可见一类圆形放射性摄取增高灶。后者穿刺活检病理示弥漫大B细胞淋巴瘤(A型)。病变累及第4、5胸椎左侧神经根及左侧第5肋间神经,临床诊断为NL。经对症化疗后复查18F-FDG PET/CT,原异常放射性浓聚影消失。文献复习也显示PET/CT较MRI及CT有较高的阳性显示率,能更好地反映全身情况,对早期诊断NL有所帮助。结论 18F-FDG PET/CT是一种早期诊断NL有效和敏感的检查方法,特别是在患者有恶性血液病史,临床出现周围神经症状,其他检查手段阴性的情况下。与MRI等传统影像学检查手段相比,18F-FDG PET/CT能更直观地反映NL的病情程度,并准确反映受累神经数目、范围、病灶大小、形态和肿瘤活性,可为穿刺活检提供重要信息。
Objective To explore the value of FDG PET-CT in the diagnosis of neurolymphomatosis（NL）. Methods The clinical manifestation and FDG PET/CT imaging results in a patient with diffuse large B cell lymphoma accompanying peripheral neuropathy, which was confirmed by pathological examination, were introduced. The images as shown by PET/CT were compared with the findings of traditional imaging including MRI and CT. Relevant literature was reviewed. Results A 38-year female patient complaining of left chest-back pain for 2 months came to hospital for treatment. An enhanced MRI of thoracic vertebrae showed osseous destruction on the left side of 4th thoracic vertebra and left posterior segment of 5th rib, and it was primarily diagnosed as a tumor. FDG PET/CT revealed a massively increased radioactive uptake in inter vertebral foramen of left 4th, 5ththoracic vertebrae. The lesion was shown as an increase in uptake of radio-active substance along the left 5th intercostal nerve in the form of bundle or threads. A round-like nodule with increased radioactive uptake was observed in the left parasternal 2nd intercostal space. A CT-guided percutaneous needle biopsy of the nodule revealed a diffuse large B-cell lymphoma（A type）. The lesion was shown to involve 4th, 5th thoracic vertebrae and left 5th intercostal ner ve. It was diagnosed as NL. Repeated FDG PET imaging after chemotherapy showed normal radioactive distribution in the site of primary lesion area. Conclusions PET/CT is effective and sensitive in the diagnosis of NL, especially in patient with a history of malignant hematologic disease with clinical symptoms concerning peripheral nerve, accompanied by negative results with other examinations. Comparing with MRI, PET/CT can reveal involvement of peripheral nerve earlier, better reflect the degree of pathological condition, and reveal the number of nerves involved, as well as size and morphology of the lesion. It can reveal the active lesions of NL, and provide the target for needle biopsy.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2016年第1期31-35,共5页
Medical Journal of Chinese People's Liberation Army
基金
supported by the National Natural Science Foundation of China(30200116)
