淋巴母细胞淋巴瘤^18F-FDG PET-CT影像学表现及临床特征

Imaging manifestations of 18SF-FDG PET-CT and clinical characteristics in lymphoblastic lymphoma

目的分析淋巴母细胞淋巴瘤（LBL）的18F—FDGPET．CT表现及临床特征。方法回顾性分析南京医科大学第一附属医院2009年7月至2017年6月经病理确诊的18例LBL患者的临床资料及18F—FDGPET。CT显像资料。分析PET．CT诊断LBL骨髓浸润的灵敏度、特异度及准确度。结果18例LBL患者中，男性12例，女性6例，中位年龄24．5岁（14—51岁）。T细胞LBL（T．LBL）11例，B细胞LBL（B．LBL）7例。-8F．FDGPET．CT显像均可见异常mF—FDG代谢增高灶，所有病灶的中位最大标准摄取值（suV。）为14．3（10．6，16．8）。结内病变最常见的累及部位为纵隔淋巴结，其中7例T．LBL患者形成纵隔巨大肿块。结外侵犯最常见的部位为骨髓，其中8例PET—CT表现为骨髓多灶性FDG摄取增高。结内、结外病灶的中位suv。。分别为15．0（9．0，18．2）、12．3（8．4，15．3），二者差异无统计学意义（Z=-0．867，P=0．386）；T-LBL、B．LBL患者的中位sUV。分别为14．1（9．2，15．9）、14．5（12．1，19．5），二者差异无统计学意义（Z=-0．679，P=0．497）。综合临床、18F—FDGPET．CT及骨髓活组织检查结果，12例患者确诊为淋巴瘤骨髓浸润。将骨髓多灶性FDG摄取增高和（或）弥漫性FDG摄取增高作为诊断骨髓浸润的标准，则PET—CT的灵敏度、特异度及准确度分别为91．7％（11／12）、66．7％（4／6）、83．3％（15／18），而骨髓活组织检查分别为50．0％（6／12）、100．0％（6／6）、66．7％（12／18）。结论LBL常见于年轻患者，男性多于女性，临床表现主要为淋巴结肿大，常侵犯骨髓。18F-FDGPET—CT表现具有一定的特征性，有助于LBL的诊断和分期。

Objective To explore the imaging presentation of lSF-FDG PET-CT and clinical characteristics of the patients with lymphoblastie lymphoma （LBL）. Methods The clinical and imaging data of 18 patients with newly diagnosed LBL in the First Affiliated Hospital with Nanjing Medical University from July 2009 to June 2017 were retrospectively analyzed. The sensitivity, specificity and accuracy of lSF-FDG PET-CT to diagnose bone marrow involvement （BMI） was calculated respectively. Results There were 18 LBL patients, including 12 male and 6 female with median age of 24.5 （14-51） years old. Eleven patients were T-LBL, and 7 patients were B-LBL. All lesions were presented with high 18F-FDG uptake on ISF-FDG PET-CT imaging, with a median SUV~= of 14.3 （10.6, 16.8）. The most frequent lymph node involvement site was mediastinal lymph nodes, and 7 T-LBL cases had jugular node involvement. The most frequent extranodal involvement site was bone marrow, with multifocal FDG accumulation in bone marrow on ~SF-FDG PET-CT imaging in 8 cases. The median SUV~ of node and extranodal involvement were 15.0 （9.0, 18.2）, 12.3 （8.4, 15.3）, and there was no significant difference （Z = -0.867, P = 0.386）. The median SUVm~ of T-LBL and B-LBL patients was 14.1 （9.2, 15.9）, 14.5 （12.1, 19.5） respectively, and there was no significant difference （Z = -0.679, P = 0.497）. According to clinical features, ISF-FDG PET-CT and bone marrow biopsy （BMB）, 12 patients were diagnosed as BMI. If muhifocal FDG accumulation and diffuse hypermetabolism of FDG in bone marrow were considered as the diagnosis criteria, the sensitivity, specificity and accuracy of PET-CT was91.7 % （11/12）, 66.7 % （4/6）, 83.3 % （15/18）, respectively. The parameters in BMB were 50.0 % （6/12）, 100.0 % （6/6）, 66.7 % （12/18）, respectively. Conclusions LBL mostly occurs in young men and its clinical manifestations include lymphadenectasis and invasion of bone marrow, lSF-FDG PET-CT has certain characteristics which are helpful to diagnose and staging.