^(18)F-FDG PET/CT对急性白血病骨髓移植术后髓内复发灶的诊断价值

Diagnostic value of ^(18)F-FDG PET/CT for the intramedullary relapse of acute leukemia after bone marrow transplantation

目的探讨18F-氟脱氧葡萄糖(FDG)PET/CT对急性白血病(AL)骨髓移植术后髓内复发灶的诊断价值,筛选可用于诊断其复发的半定量参数。方法回顾性分析2016年11月至2019年11月于河北燕达医院接受骨髓移植且疑为髓内复发的81例AL患者的18F-FDG PET/CT图像和病历资料,其中男性45例、女性36例,年龄3~55(25.14±15.07)岁。以骨髓活检的组织病理学检查结果为诊断复发的“金标准”,将患者分为复发组(41例)、无复发组(40例),测量并计算所有可疑复发病灶的最大标准化摄取值(SUV_(max))及肝脏本底SUV_(max),计算附肢骨SUV_(max)/中轴骨SUV_(max)和骨髓SUV_(max)/肝脏SUV_(max)比值,并以其不同的临界值和受试者工作特征(ROC)曲线进行分析,计算曲线下面积(AUC)和诊断复发的效能。以视觉判读法为参照,分析并计算18F-FDG PET/CT不同半定量参数诊断AL髓内复发灶的效能。2组间半定量参数的比较采用独立样本t检验;计数资料的比较采用Pearson卡方检验。结果81例AL患者中,复发组的中轴骨SUV_(max)高于无复发组(3.10±1.65对1.99±1.26,t=3.367,P=0.001);与无复发组比较,复发组的骨髓SUV_(max)/肝脏SUV_(max)比值(1.20±0.56对0.89±0.74)和附肢骨SUV_(max)/中轴骨SUV_(max)比值(1.58±1.38对0.79±0.37)均较高,且差异均有统计学意义(t=2.186、3.477,均P<0.05)。基于SUV_(max)的半定量指标的ROC曲线分析结果显示,以中轴骨SUV_(max)≥2.05作为判断髓内复发的标准时,其诊断AL复发的灵敏度、特异度和准确率分别为70.73%(29/41)、72.50%(29/40)和71.60%(58/81),AUC为0.770。视觉判读法结果显示,以多灶性摄取+弥漫性摄取18F-FDG为髓内复发的诊断标准时,其诊断AL复发的灵敏度、特异度和准确率分别为85.37%(35/41)、70.00%(28/40)和77.78%(63/81)。结论18F-FDG PET/CT视觉判读法是诊断AL复发简便、可靠的方法,具有较高的诊断效能,基于SUV_(max)的半定量参数分析是视觉判读法的重要补充。

Objective To explore the diagnostic efficacy of ^(18)F-fluorodeoxyglucose(FDG)PET/CT on intramedullary relapse of acute leukemia,and screening parameters that can be used to give the diagnosis.Methods The ^(18)F-FDG PET/CT imaging data of 81 patients(45 males and 36 females aged 3–55(25.14±15.07)years)who were clinically diagnosed with suspected intramedullary relapse of acute leukemia in Hebei Yanda Hospital from November 2016 to November 2019 were retrospectively analyzed.All the patients had received bone marrow transplantation.And the histopathological results of bone marrow biopsy were used as"golden standard"of intramedullary relapse.The patients were divided into relapse group(41 cases)and non-relapse group(40 cases).The maximum standardized uptake value(SUV_(max))of all the suspected recurrent lesions and SUV_(max) of normal liver background(liver SUV_(max))were measured and calculated.The ratio of appendicular skeleton SUV_(max) to that of axial skeleton and the ratio of axial skeleton SUV_(max) to that of normal liver background were calculated respectively.The different cut-off values and area under curve(AUC)based on receiver operating characteristic(ROC)curves were analyzed,and the diagnostic efficacy of ^(18)F-FDG PET/CT on relapse of acute leukemia was explored preliminarily.Visual interpretation was applied as a reference criterion to explore the diagnostic efficacy of ^(18)F-FDG PET/CT on the intramedullary relapse of acute leukemia based on different semiquantitative parameters.Differences in semiquantitative parameters between the two groups were compared by independent sample t-test for measurement data and Pearson chi-square test for qualitative data.Results Axial skeleton SUV_(max) of the relapse group was higher than that of the non-relapse group(3.10±1.65 vs.1.99±1.26,t=3.367,P=0.001).Meanwhile,compared with non-relapse group,the ratio of axial skeleton SUV_(max) to normal liver background SUV_(max)(1.20±0.56 vs.0.89±0.74),and the ratio of appendicular skeleton SUV_(max) to axial skeleton SUV_(max)(1.58±1.38 vs.0.79±0.37)were higher than that of relapse group.Both difference has statistics significance(t=2.186,3.477;both P<0.05).The ROC curve analysis of the semiquantitative index of SUV_(max) revealed that the sensitivity,specificity,and accuracy of relapse diagnosis were 70.73%(29/41),72.50%(29/40),and 71.60%(58/81),respectively(AUC=0.770),when axial skeleton SUV_(max)≥2.05 was used as the criterion of intramedullary relapse.When multifocal+diffuse increased ^(18)F-FDG uptake was used as the criterion of intramedullary relapse,visual evaluationbased results indicated sensitivity,specificity,and accuracy of 85.37%(35/41),70.00%(28/40),and 77.78%(63/81),respectively.Conclusions Visual evaluation based on ^(18)F-FDG PET/CT is a simple and reliable method for diagnosing acute leukemia relapse,and has high diagnostic efficacy.Based on SUV_(max) semi-quantitative parameter analysis is a useful supplement to visual evaluation.