^(18)F-FDG PET/CT对多系统结节病与弥漫大B细胞淋巴瘤鉴别诊断的价值

Value of ^(18)F-FDG PET/CT in the differential diagnosis of multisystemic sarcoidosis from diffuse large B-cell lymphoma

目的:对比分析多系统结节病和弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)^(18)F-FDG PET/CT影像特征差异,探讨^(18)F-FDG PET/CT对二者的鉴别诊断价值。方法:选取2018年07月至2023年07月初诊于空军军医大学第二附属医院的15例结节病和39例DLBCL患者为研究对象,收集患者的临床病理资料及^(18)F-FDG PET/CT影像资料,对比分析PET/CT所示两组病变的影像特征、累及范围、受累淋巴结特征、病灶最大径和半定量参数最大标准化摄取值(maximum standardized uptake value,SUVmax)的差异。结果:结节病可见对称性累及纵隔、肺门淋巴结等特征性表现,无融合趋势,双肺/胸膜易受累。DLBCL淋巴结易融合成团,且易出现胃肠道结外侵犯。结节病组的纵隔、肺门淋巴结及双肺、胸膜的受累发生率高于DLBCL组,DLBCL易发生胃肠道累及(均P<0.05)。结节病组的淋巴结融合发生率低于DLBCL组(P<0.05),两组病变的淋巴结坏死率和钙化率差异无统计学意义(均P>0.05)。结节病组淋巴结最大径为(2.40±0.71)cm,小于DLBCL组(6.50±2.53)cm,结节病组SUVmax为8.12±4.15,低于DLBCL组19.93±7.54(均P<0.05)。结论:^(18)F-FDG PET/CT在结节病和DLBCL鉴别诊断中有重要价值,结合特征性表现、累及部位、病灶大小、融合趋势和半定量参数SUVmax,有助于二者的鉴别。

Objective:To compare and analyze the difference of ^(18)F-FDG PET/CT imaging features between multiple system sarcoidosis and diffuse large B-cell lymphoma(DLBCL),and to explore the value of ^(18)F-FDG PET/CT in the differential diagnosis of the two.Methods:A total of 15 cases of sarcoidosis and 39 cases of DLBCL,newly diagnosed in the Second Affiliated Hospital of Air Force Medical University from July 2018 to July 2023,were retrospectively analyzed.Clinicopathological data and ^(18)F-FDG PET/CT imaging data of the patients were collected.The imaging features,the areas of involvement,the lymph node features,the maximum diameter of the lesion and the semi-quantitative parametar maximum standardized uptake value(SUV max)of the two groups were compared and analyzed.Results:Sarcoidosis was characterized by symmetrical involvement of mediastinum and hilar lymph nodes without a tendency of fusion,and bilateral lungs/pleura were easily involved.DLBCL lymph nodes were prone to coalesce and extranodal invasion of gastrointestinal tract.The incidence of mediastinum,hilar lymph nodes,double lungs and pleura in sarcoidosis group was higher than that in DLBCL group,and DLBCL was prone to gastrointestinal involvement(all P<0.05).The incidence of lymph node fusion was lower in the sarcoidosis group than in the DLBCL group(P<0.05).There was no significant difference in lymph node necrosis rate and calcification rate between the two groups(all P>0.05).The maximum lymph node diameter in the sarcoidosis group was(2.40±0.71)cm,which was lower than that in the DLBCL group(6.50±2.53)cm.The SUV max in the sarcoidosis group was 8.12±4.15,which was lower than that in the DLBCL group(19.93±7.54)(all P<0.05).Conclusion:^(18)F-FDG PET/CT is of great value in the differential diagnosis of sarcoidosis and DLBCL.The combination of characteristic manifestations,involved location,lesion size,fusion trend and semi-quantitative parameter SUV max can help to distinguish them.