^(18)F-FDG PET/CT代谢参数预测初诊多发性骨髓瘤细胞遗传学分级的价值

The value of^(18)F-FDG PET/CT metabolic parameters in predicting cytogenetic grading of multiple myeloma of initial diagnosis

目的:探讨^(18)F-氟脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层显像与计算机断层显像(PET/CT)代谢参数预测初诊多发性骨髓瘤(MM)细胞遗传学分级的价值。方法:收集在医院初次诊断为MM且影像和临床资料完备的86例MM患者资料。所有患者行骨髓穿刺后根据荧光原位杂交(FISH)技术检测结果分为高危细胞遗传学组(高危组,56例)和标危组(30例)。两组均于接受骨髓穿刺前或骨髓穿刺1周后行^(18)F-FDG PET/CT检查;根据多维尔评分法选取椎体、髂骨大于肝脏代谢参数40%、50%最大标准化摄取值(SUV_(max40)、SUV_(max50))、40%、50%平均瘦体重标准化摄取值(SUL_(mean40)、SUL_(mean50))及40%、50%标准化摄取值峰值(SUV_(peak40)、SUV_(peak50))的所有病灶为总阳性病灶,分析总阳性病灶平均值、总阳性病灶平均值与肝脏对应类型代谢参数的比值(T/N)预测高危细胞遗传学的独立因素。对预测价值最高的SUL_(mean50)T/N进行多因素Logistic回归分析。结果:高危组与标危组间代谢参数SUV_(max40)、SUV_(max50)、SUV_(meana40)、SUV_(mean50)、SUL_(mean40)、SUL_(mean50)、SUV_(max40)T/N、SUV_(max50)T/N、SUV_(mean40)T/N、SUV_(mean50)T/N、SUV_(peak40)T/N、SUV_(peak50)T/N、SUL_(max40)T/N、SUL_(max50)T/N、SUL_(mean40)T/N、SUL_(mean50)T/N、SUL_(peak40)T/N、SUL_(peak50)T/N差异均有统计学意义(Z=-2.243,Z=-3.448,Z=-2.243,Z=-3.466,Z=-2.138,Z=-4.204,Z=-2.134,Z=-4.173,Z=-2.931,Z=-2.741,Z=-3.797,Z=-3.933,Z=-2.283,Z=-4.467,Z=-2.347,Z=-4.485,Z=-3.371,Z=-3.239;P<0.05),代谢参数行受试者工作特征(ROC)曲线分析,SUV_(max50)为阈值的SUL_(mean50)T/N的ROC曲线下面积(AUC)为0.795,约登指数最大值为0.568,最佳截断点为1.013。基于方差膨胀系数(VIF)>10,提示代谢参数间存在共线性。连续变量和二分类变量SUL_(mean50)T/N均为预测MM高危细胞遗传学的独立危险因素(OR=57.538,OR=11.935;P<0.05),连续变量和二分类变量实验室检查指标血清乳酸脱氢酶(LDH)也是预测MM高危细胞遗传学的独立危险因素(OR=1.018,OR=1.017;P<0.05)。结论:MM在^(18)F-FDG PET/CT中T/N的代谢参数能较好地区分细胞遗传学分级,SUL_(mean50)T/N能较好地独立预测MM高危细胞遗传学,有望协助临床决策。

Objective:To explore the value of metabolic parameters of the^(18)F-fluorodeoxyglucose positron emission computed tomography/computed tomography(^(18)F-FDG PET/CT)in predicting cytogenetic grading of the multiple myeloma(MM)of initial diagnosis.Methods:The data of 86 MM patients with complete imaging and clinical data who were initially diagnosed as MM in hospital were retrospectively collected.All of patients were divided into high risk cytogenetics group(high risk group,56 cases)and standard risk group(30 cases)according to the detected results of fluorescence in situ hybridization after they underwent bone marrow aspiration.Both two groups underwent^(18)F-FDG PET/CT examination before and 1 week after they received bone marrow aspiration.The lesions of vertebral body and iliac bone,which were larger than 40%and 50%of the maximum standardized uptake value(SUV_(max40)and SUV_(max50))of metabolic parameters of liver,than 40%and 50%of the standardized uptake value(SUL_(mean40)and SUL_(mean50))of average lean weight,than the peak values of 40%and 50%of the standardized uptake value(SUV_(peak40)and SUV_(peak50))were selected as the total positive lesions according to Dowell scoring method.The independent factors of the mean of the totally positive lesion,and the ratio(T/N)of the mean of totally positive lesion to the metabolic parameters of the corresponding type of liver were analyzed in predicting the cytogenetics with high risk.The multivariate Logistic regression analysis was adopted to analyze the SUL_(mean50)T/N with highest predictive value.Results:There were significant differences in metabolic parameters included SUV_(max40),SUV_(max50),SUV_(mean40),SUV_(mean50),SUL_(mean40),SUL_(mean50),SUV_(max40)T/N,SUV_(max50)T/N,SUV_(mean40)T/N,SUV_(mean50)T/N,SUV_(peak40)T/N,SUV_(peak50)T/N,SUL_(max40)T/N,SUL_(max50)T/N,SUL_(mean40)T/N,SUL_(mean50)T/N,SUL_(peak40)T/N,SUL_(peak50)T/N between high risk group and standard risk group(Z=-2.243,Z=-3.448,Z=-2.243,Z=-3.466,Z=-2.138,Z=-4.204,Z=-2.134,Z=-4.173,Z=-2.931,Z=-2.741,Z=-3.797,Z=-3.933,Z=-2.283,Z=-4.467,Z=-2.347,Z=-4.485,Z=-3.371,Z=-3.239,P<0.05).The analysis of receiver operating characteristics(ROC)curve of metabolic parameters indicated that the area under curve(AUC)of SUL_(mean50)T/N which threshold value was SUV_(max50)was 0.795,and the maximum value of Youden index was 0.568,and the best cut-off point was 1.013.That variance inflation factor was larger than 10 indicated that there were collinearities among different metabolic parameters.Both the SUL_(mean50)T/N of the continuous variable and that of the two categorical variable were the independent risk factors of predicting high risk cytogenetics of MM,and the serum lactate dehydrogenase(LDH)of laboratory examination indicators also was the independent risk factor of predicting the high risk cytogenetics of MM(OR=1.018,OR=1.017,P<0.05),respectively.Conclusion:The metabolic parameters of T/N in^(18)F-FDG PET/CT can better distinguish cytogenetic grading of MM,and SUL_(mean50)T/N can better and independently predict MM high-risk cytogenetics,which is expected to assist clinical decision making.