^(18)F-FDG PET/CT显像在多发性骨髓瘤中的诊断价值及影像学表现分型

Diagnostic Value and Imaging Characteristics of ^(18)F-FDG PET/CT in Multiple Myeloma

目的 探讨F-氟代脱氧葡萄糖正电子发射计算机断层显像/电子计算机断层扫描(F-fluorodeoxyglucose positron emission tomography/computed tomography,^(18)F-FDG PET/CT)在多发性骨髓瘤(multiple myeloma, MM)中的诊断价值及其影像学表现。方法 回顾性分析2015-01/2020-12月在作者医院经病理活检确诊为MM患者的^(18)F-FDG PET/CT检查资料,统计分析^(18)F-FDG PET/CT对MM病例的检出率,通过骨病变、髓外浸润性病变在显像中的形态、分布特点及病变的代谢特点,对MM的^(18)F-FDG PET/CT表现进行分型。结果^(18)F-FDG PET/CT显像对MM病变的检出率为95.24%,57.50%的病例累及20个以上局灶性病变或呈弥漫性病变,常见累及部位依次为脊椎35例(87.50%),骨盆31例(77.50%),肋骨30例(75.00%),其影像学分型包括:①骨质破坏代谢活跃型31例(73.81%),形态上以穿凿样或虫蚀样溶骨性改变(90.32%)和膨胀性骨质破坏(48.39%)多见,最大标准化摄取值(maximal standardized uptake value, SUVmax)范围2.9~11.7(5.1±3.26);②骨质破坏代谢正常型5例(11.90%);③骨髓弥漫代谢活跃型4例(9.52%),SUVmax范围6.1~10.2。本组经^(18)F-FDG PET/CT检出髓外病变7例(16.67%),累及部位包括淋巴结(5例)、脾脏(1例)、肝脏(1例)、肌肉(1例)。结论^(18)F-FDG PET/CT显像对MM有较高的检出率,不仅能显示包括骨质破坏型和骨髓弥漫型在内的骨病变,同时也能显示髓外病变,为临床后续治疗提供依据。

Objective To evaluate the diagnostic value and imaging characteristics ofF-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) in detection of multiple myeloma(MM). Methods^(18)F-FDG PET/CT imagings were retrospectively analyzed among patients with MM proved by bone marrow biopsy from January 2015 to December 2020 in author′s hospital. The detectable rate of^(18)F-FDG PET/CT in MM cases was counted and analyzed. The^(18)F-FDG PET/CT manifestations of MM were classified by morphological and distribution characteristics of bone lesions and extramedullary infiltrating lesions in imaging and metabolic characteristics of lesions. Results The detectable rate of^(18)F-FDG PET/CT in MM cases was 95.24%,and more than 20 focal or diffuse lesions were involved in 57.50% of these cases. The bone lesions most commonly affected vertebrae in 35 cases(87.50%), pelvis in 31 cases(77.50%) and ribs in 30 cases(75.00%) in sequence. The imaging characteristics included:① Bone destruction with active metabolism was found in 31 cases(73.81%), which morphologically performed as perforated or insect-etched lytic bone changes(90.32%) and expansive bone destruction(48.39%) most commonly, with maximal standardized uptake value(SUVmax) ranged in 2.9-11.7(5.1±3.26).② Bone destruction with normal metabolism was found in 5 cases(11.90%).③ Diffuse metabolically active lesion of bone marrow was found in 4 cases(9.52%), SUVmax ranged in 6.1-10.2. The extramedullary lesions were detected in 7 cases(16.67%), which involved in lymph nodes(5 cases), spleen(1 case), liver(1 case) and muscle(1 case). Conclusion^(18)F-FDG PET/CT has high detectable rate in MM, which can detect the bone lesions in both type of destruction and diffuse lesion of bone marrow, as well as detect extramedullary lesions, providing the accordance for clinical follow-up treatments.