皮下脂膜炎样T细胞淋巴瘤的^(18)F-FDG PET/CT表现及临床分析

^(18)F-FDG PET/CT Manifestation and Clinical Analysis of Subcutaneous Panniculitis-Like T-Cell Lymphoma

目的:探讨皮下脂膜炎样T细胞淋巴瘤(subcutaneous panniculitis-like T-cell lymphoma,SPTCL)的临床表现、^(18)F-FDGPET/CT显像特点及预后。方法:回顾性分析经病理确诊的7例SPTCL患者的^(18)F-FDGPET/CT显像及临床资料。结果:多发性皮肤损伤6例,病变多位于躯干和四肢;1例单发,位于面部;5例伴有疼痛,3例伴有溃疡,2例淋巴结受累,2例结外受侵。躯干皮肤病灶的SUVmax为3.9(1.0-10.1),四肢病灶的SUVmax为3.8(1.1-11.3),二者之间差异无统计学意义(Z=-0.248,P=0.804);皮肤病灶CT值>0HU组的SUVmax明显高于CT值≤0HU组[7.0(3.0-11.3)vs 1.8(1.0-6.9);Z=-7.523,P=0.000]。所有皮肤病灶、受累淋巴结及结外软组织病灶的SUVmax分别为SUVmax为3.9(1.0-11.3)、5.2(2.1-13.1)和6.2(4.0-11.4),差异有统计学意义(P<0.05);结外软组织病灶的SUVmax明显高于皮肤病灶(P<0.05),却与受累淋巴结的SUVmax差异无统计学意义(P>0.05);皮肤病灶的SUVmax与受累淋巴结的SUVmax差异亦无统计学差异(P>0.05)。7例SPTCL患者中,死亡4例,均为多发,其中3例伴发噬血细胞综合征(HPS),3例皮肤病灶SUVmax中位数≥3.0,2例淋巴结及结外脏器受侵。结论:SPTCL临床无特征性,^(18)F-FDGPET/CT可以提供病变的发生部位、范围、受累程度及肿瘤细胞的恶性程度,能够帮助临床对患者的预后进行预判,为临床制定合理有效的治疗方案提供依据。

Objective： To explore the clinical presentation,imaging characteristics of 18F-FDG PET/CT and prognosis of patients with subcutaneous panniculitis-like T-cell lymphoma（ SPTCL）. Methods： The images and clinical data of 7 patients with pathologically confirmed SPTCL who underwent 18F-FDG PET/CT were retrospectively analyzed.Results： Six patients displayed multiple subcutaneous nodules or deeply seated plaques,most commonly on the extremities and trunk,and one patient showed a single lesion on his face. The ulceration of nodules occurred in 3 cases,and the lesions were painful in 5 cases. Both nodal and extranodal involvements were found in 2 cases,respectively. The SUVmax of cutaneous lesions in extremities and trunk were 3. 8（ 1. 1-11. 3） and 3. 9（ 1. 0-10. 1）,with out significant difference（ Z =-0. 248,P〈0. 05）,but significant difference was observed between the SUVmax cutaneous lesions with the CT value 0HU group and that of CT value≤0HU group [7. 0（ 3. 0-11. 3） vs 1. 8（ 1. 0-6. 9）; Z =-7. 523,P〈0. 01]. The SUVmax of all cutaneous lesions,nodal and extranodal involvement were 3. 9（ 1. 0-11. 3）,5. 2（ 2. 1-13. 1） and 6. 2（ 4. 0-11. 4）,respectively,with significant difference（ P〈0. 05）. The SUVmax of extranodal involvement was apparently higher than that of cutaneous lesions（ P〈0. 05）. However,no significant difference of the SUVmax was observed between nodal and extranodal involvement（ P 0. 0. 5）,also between nodal involvement and cutaneous lesions（ P〈0. 05）. Among 7 cases,4 were died of multiple cutaneous lesions,and accompanied by hemophagocytic syndrome（ HPS） in 3 cases,with median SUVmax of cutaneous lesions exceeded 3. 0 in 3 cases,and nodal and extranodal involvement in 2 cases. Conclusion： The clinical manifestation of SPTCL is non-specific. 18F-FDG PET/CT is useful for defining the distribution and extent,finding visceral involvement,judging the malignant degree,predicting the prognosis,and making effective therapeutic plan.