18F-FDG PET/CT在POEMS综合征中的应用价值

Clinical Value of 18F-FDG PET/CT for Polyneuropathy,Organomegaly,Endocrinopathy,M Protein,and Skin Changes（ POEMS） Syndrome

目的总结POEMS综合征患者的临床特点及影像学表现,探讨氟代脱氧葡萄糖(^18F-FDG)PET/CT在该病中的应用价值。方法回顾性分析2014年9月至2018年9月在本院行PET/CT检查的10例经临床或病理证实的POEMS综合征患者的临床资料、实验室及影像学资料。结果10例患者中男6例,女4例,年龄(52.9±9.8)岁,主要临床表现为不同程度的四肢麻木,轻-中度的肝、脾、淋巴结肿大,皮肤色素沉着等。实验室检查:10例均存在M蛋白血症,9例血清血管内皮生长因子(VEGF)水平异常升高,4例甲状腺功能异常及2例促肾上腺皮质激素(ACTH)异常升高。^18F-FDG PET/CT影像学表现:10例患者均存在不同程度的骨病变,9例多发,1例单发,病灶共计198个,主要分布于脊椎、骨盆、肋骨等。所有骨病变中以硬化性最常见(157/198,79.3%),混合性次之(38/198,19.2%),溶骨性最少(3/198,1.5%)。FDG阳性病灶约22.7%(45/198),最大标准摄取值(SUVmax)为4.6±3.2,其中溶骨性骨病变SUVmax为10.8±10.0,混合性病变SUVmax为4.3±2.0,硬化性病变SUVmax为3.5±0.3。FDG阳性病灶以10 mm以上多见,FDG阴性病灶以5~10 mm多见。7例出现淋巴结病变者均伴FDG异常摄取,SUVmax为3.7±2.0。肝脏肿大者2例、脾肿大者6例。6例出现浆膜腔积液,其中4例多发,2例单发,均未见FDG异常摄取。结论^18F-FDG PET/CT可系统性地评估POEMS综合征的骨病变、淋巴结病变、肝、脾肿大、多浆膜腔积液等特点,对该病的早期诊断、活检定位及疗效评价方面具有重要临床价值。

Objective To summarize the clinical characteristics and imaging findings of patients with POEMS syn-drome,and to explore the application value of ^18F-FDG PET/CT in this disease.Methods From September 2014 to September 2018,the clinical materials,laboratory results and imaging appearances of 10 patients with POEMS syndrome confirmed by clinical and pathological results were retrospectively analyzed.PET/CT scan was performed before diagnosis Results The clinical features of 10 patients with POEMS syndrome(6 males,4 females;mean age:(52.9±9.8)years)mainly included polyneuropathy,organomegaly,endocrinopathy,and skin changes.Laboratory results of them revealed M protein in 10 patients,unusually elevated serum VEGF levels in 9 patients,abnormal thyroid function in 4 patients and ab-normal ACTH in 2 patients.The imaging findings of ^18F-FDG PET/CT:The skeletal manifestation on ^18F-FDG PET/CT for the patients with POEMS syndrome varied,presenting as both solitary(1)and multiple(9)bone lesions.A total of 198 bone lesions were found in 10 cases,followed by the spines,pelvis,and ribs etc.Most of the lesions showed purely scle-rotic(157/198,79.3%),with decreased frequency showing mixed characteristics(38/198,19.2%)and lytic(3/198,1.5%)changes.Forty-five lesions had increased FDG uptake with the average SUVmax of 4.6±3.2.The SUVmax for lytic changes was much higher than that for sclerotic changes(the lytic lesions,SUVmax 10.8±10.0;the mixed lesions,SUVmax 4.3±2.0;the sclerotic lesions,SUVmax 3.5±0.3).FDG-avid lesions were more common in patients with more than 10mm,while FDG-poor lesions in patients with 5-10mm.Seven patients showed enlarged and FDG-avid lymph nodes,and the SUVmax was 3.7±2.0.Two patients had hepatomegaly and six patients had splenomegaly.Serous cavity effusion oc-curred in 6 patients,including 4 cases with multiple occurrence and 2 cases with single occurrence,and no abnormal up-take of ^18F-FDG was observe.Conclusion ^18F-FDG PET/CT,a whole-body imaging mode,may systematically provide in-formation about bone lesions,lymphadenopathy,hepatosplenomegaly and serous cavity effusion,and the metabolic status of the lesions of patients with POEMS syndrome.^18F-FDG PET/CT has important clinical value in early diagnosis,biopsy lo-cation and efficacy evaluation in patients of POEMS syndrome.