PET/CT在原发性骨淋巴瘤的诊断及分期中的价值

Value of PET/CT on diagnosis and staging of primary bone lymphoma

目的原发性骨淋巴瘤(primary bone lymphoma,PBL)是一种少见的淋巴瘤类型,本研究主要分析PBL的^(18)F-FDG PET/CT影像学征象,以期提高PBL的诊断及鉴别诊断的准确率,并进行准确分期从而指导临床进行精准治疗。方法回顾性分析武汉大学人民医院PET中心2018年3月—2020年10月检查的10例初诊原发性骨淋巴瘤患者的PET/CT、MRI影像征象及相关临床资料,男性7例,女性3例,年龄为29~73(46.0±7.4)岁,其中10例患者于治疗前行PET/CT检查,8例患者行局部MRI检查;以骨活检作为金标准,分析PBL的发生部位,并分析PET/CT对PBL累及病灶的检出率。结果PBL患者临床症状以局部疼痛为主;10例PBL患者均为非霍奇金淋巴瘤,其中弥漫大B细胞淋巴瘤占5例。^(18)F-FDG PET/CT在所有患者(10例)均呈高摄取,SUVmax为2.7~17.5(10.2±5.2),其中8例患者为多发病灶(ⅣE期),仅2例患者为单发病灶(ⅠE期);4例患者仅累及四肢骨,2例患者仅累及中轴骨,4例患者同时累及轴心骨和四肢骨;其中6例患者病灶浸润周围软组织形成团块病灶。MRI影像缺乏特异性,以T_(1)WI等/低信号、T_(2)WI高/稍高信号为主,增强扫描呈中度强化。^(18)F-FDG PET/CT病灶检出率为94.5%,MRI病灶检出率为89.1%。结论^(18)F-FDG PET/CT全身显像能较好地显示骨骼受累的情况并准确判断是否存在上位引流淋巴结受累或结外病变,在PBL诊断及分期等方面有较好的临床应用价值。

Objective Primary bone lymphoma(PBL)is a rare type of malignant lymphoma.This study mainly analyzes the ^(18)F-FDG PET/CT imaging signs of PBL in order to improve the accuracy of the diagnosis and differential diagnosis of PBL,and conduct accurate staging to guide accurate clinical treatment.Methods A total of 10 patients with untreated PBL were retrospectively enrolled from March 2018 to October 2020 in PET Center of People's Hospital of Wuhan University.We analyzed the PET/CT,MRI characteristic and clinical data of PBL patients.There were 7 males and 3 females.The range of age was 29-73 years old with the median age of 46.0±7.4.Ten patients underwent PET/CT examination and 8 patients underwent MRI scanning.Using bone biopsy results as gold standard,the sites of bone infiltration and the detection rates of the PET/CT and MRI were analyzed.Results The main clinical symptoms of PBL patients were bone pain at different locations.The types of pathology of patients all were non-Hodgkin's lymphoma,and diffuse large B cell lymphoma in 5 patients.The ^(18)F-FDG PET/CT were high uptake in all of patients with SUVmax 2.7-17.5(10.2±5.2).Multiple involved lesions were found in 8 patients,while 2 patients presented with a single involved lesion.Four patients were found to be located in extremity skeleton,2 in the axial skeleton and 4 in the extremity skeleton and axial skeleton.PET/CT also found the lesions infiltrate to the surrounding soft tissue in 6 patients.MRI images lack specificity,the focus showed iso-intensity or low signal on T_(1)WI and slightly high or high signal on T_(2)WI,and enhanced scan showed moderate enhancement.The detection rate of the PET/CT and MRI for PBL were 94.5%and 89.1%,respectively.Conclusion ^(18)F-FDG PET/CT has the ability to depict bone lesions,and upper draining lymph nodes and extra-nodal involvement.It has good clinical application value for diagnosis and staging of PBL.