^(18)F-FDG PET/CT诊断淋巴瘤及组织细胞坏死性淋巴结炎的价值

Value of ^(18)F-FDG PET/CT in Diagnosis of Lymphoma and Histiocytic Necrotizing Lymphadenitis

目的 比较组织细胞坏死性淋巴结炎(HNL)和淋巴瘤患者的临床表现和正电子发射计算机体层显像仪(PET/CT)表现,评价氟代脱氧葡萄糖正电子发射断层显像(^(18)F-FDG PET/CT)鉴别诊断HNL与淋巴瘤的价值。方法 回顾性分析2016年5月至2021年7月在郑州大学第一附属医院接受^(18)F-FDG PET/CT检查的164例经病理证实为淋巴瘤和HNL患者的临床表现、实验室特点以及^(18)F-FDG PET/CT表现。结果 HNL组发病年龄较淋巴瘤组低(P<0.001)。HNL组与淋巴瘤组在体温升高、皮疹、肌肉酸痛临床症状方面比较,差异有统计学意义(P<0.05);其他临床特征比较,差异无统计学意义(P>0.05)。实验室检查方面,HNL组的白细胞(WBC)、中性粒细胞计数均低于淋巴瘤组(P<0.05);HNL组较淋巴瘤组更易出现WBC减少和中性粒细胞减少(P<0.05);但两组C反应蛋白(CPR)、红细胞沉降率(ESR)比较,差异无统计学意义(P>0.05)。^(18)F-FDG PET/CT显像中HNL和淋巴瘤均见颈部淋巴结受累。淋巴瘤组受累淋巴结的最大长径大于HNL组(P<0.001)。两组脾SUV_(_(max))、骨髓SUV_(max)、脾大、脾代谢活跃、淋巴结SUV_(max)比较,差异无统计学意义(P>0.05);淋巴瘤组的MTV_(2.5),TLG_(2.5)、MTV_(40%)、TLG_(40%)均高于HNL组(P<0.001)。以TLG鉴别诊断HNL和淋巴瘤时,以Th_(40%)诊断效能最佳(P=0.001);以MTV鉴别诊断时,Th_(2.5)与Th_(40%)诊断效能差异无统计学意义(P=0.117)。结论 淋巴瘤及HNL的临床及^(18)F-FDG PET/CT表现相似,代谢参数结合淋巴结大小可对两者鉴别诊断提供帮助。

Objective To compare the clinical and PET/CT manifestations of histiocytic necrotiziong lymphadenitis(HNL) and lymphoma, and to evaluate the role and diagnostic value of^(18)F-FDG PET/CT in the differential diagnosis of HNL and lymphoma.Methods The clinical, laboratory and^(18)F-fluorodeoxy glucose positron emission tomography and computer tomography(^(18)F-FDGPET/CT) findings of 164 patients with pathologically proved lymphoma and tissue necrotizing lymphadenitis who underwent^(18)F-FDGPET/CT examination in the First Affiliated Hospital of Zhengzhou University from May 2016 to July 2021 were analyzed retrospectively.Results The onset age of HNL group was lower than that of lymphoma group(P<0.001). There was difference between HNL group and lymphoma group in clinical symptoms of temperature rise, rash and muscle soreness(P<0.05), there was no difference in other clinical characteristics(P>0.05). In laboratory examination, white blood cell(WBC) and neutrophil counts in HNL group were lower than those in lymphoma group(P<0.05). WBC and neutropenia decreased were more likely to occur in HNL group than in lymphoma group(P<0.05). However, there were no differences in C-reactive protein(CPR) and erythrocyte sedimentation rate(ESR) between the two groups(P>0.05). In^(18)F-FDG PET/CT imaging, both HNL and lymphoma showed cervical lymph node involvement. The maximum length and diameter of affected lymph nodes in lymphoma group was larger than that in HNL group(P<0.001). There were no differences between the two groups in spleen SUV_(max), bone marrow SUV_(max), splenomegaly, active spleen metabolism and lymph node SUV_(max)(P>0.05). The MTV_(2.5), TLG_(2.5), MTV_(40%)and TLG_(40%)in lymphoma group were higher than those in HNL group(P<0.001). When differential diagnosis of HNL and lymphoma was performed by TLG, Th_(40%)was the best(P=0.001). There was no difference in the diagnostic efficacy between Th_(2.5)and Th_(40%)in the differential diagnosis of MTV(P=0.117).Conclusion The clinical and^(18)F-FDG PET/CT manifestations of lymphoma and HNL are similar. Metabolic parameters combined with the size of lymph nodes can help in the differential diagnosis of both.