^(18)F-FDG PET/CT评价肱骨头坏死

^(18)F-FDG PET/CT in the Evaluation of Osteonecrosis of the Humeral Head

目的探索肱骨头坏死的^(18)F-FDG PET/CT征象。资料与方法回顾性分析2014年9月—2021年5月北京大学第三医院11例肱骨头坏死患者的PET/CT及临床资料,总结肱骨头坏死的FDG代谢特点,测量最大标准化摄取值,观察病变CT及FDG代谢随时间的变化。结果11例均为淋巴瘤,男10例,女1例,中位年龄32.0(25.0~40.0)岁。共21个肱骨头病变,均为2期,平均最大标准化摄取值为1.34±0.38。10例累及双侧肱骨头,两侧病变最大标准化摄取值差异无统计学意义(t=0.256,P=0.803)。17个病变呈线状代谢增高,2个等代谢,2个代谢减低。10例伴股骨头坏死。10例患者(19个病变)2~62个月后末次复查PET/CT,2个病变代谢减低,密度增高;17个病变代谢未见变化,其中密度增高6个,密度未见变化11个。5例股骨头坏死进展。结论淋巴瘤患者肱骨头坏死大多累及双侧,呈线状FDG代谢增高,伴股骨头坏死。应用PET/CT评估淋巴瘤时,应注意识别肱骨头坏死的征象,做出正确诊断。

Purpose To explore the ^(18)F-FDG PET/CT features of osteonecrosis of the humeral head.Materials and Methods The PET/CT and clinical data of 11 patients with osteonecrosis of the humeral head in Peking University Third Hospital from September 2014 to May 2021 were retrospectively analyzed.The FDG metabolism characteristics of osteonecrosis of the humeral head were summarized.The maximum standardized uptake value(SUVmax)was measured,and the changes in CT and FDG metabolism of lesions with time were observed.Results All the patients(10 males and 1 female)included suffered from lymphoma,with a median age of 32.0(25.0,40.0)years old.Twenty-one humeral heads were involved,all of which were stage 2,with an average SUVmax of 1.34±0.38.In 10 cases involving the bilateral humeral head,there was no difference in SUVmax between the bilateral lesions(t=0.256,P=0.803).Seventeen lesions showed linear increased metabolism,2 with iso-metabolism,and 2 with decreased metabolism.Ten cases had accompanied osteonecrosis of the femoral head.In 10 patients(19 lesions),the last follow-up PET/CT 2 to 62 months after the initial diagnosis demonstrated that 2 lesions had decreased metabolism and increased density,17 lesions had no change in metabolism,of which 6 had increased density and 11 had no change in density.The osteonecrosis of the femoral head in five cases progressed.Conclusion Most of the osteonecrosis of the humeral head in patients with lymphoma involves both sides,with linear increased FDG uptake,and is accompanied by osteonecrosis of the femoral head.When PET/CT is used to evaluate lymphoma,attention should be paid to identifying signs of osteonecrosis of the humeral head and making a correct diagnosis.