^(18)F-FDG PET/CT的影像表现和代谢参数鉴别结外鼻型NK/T细胞淋巴瘤与鼻咽癌的价值

Value of^(18)F-FDG PET/CT imaging performance and metabolic parameters in the differential diagnosis of extranodal NK/T-cell lymphoma,nasal type and nasopharyngeal carcinoma

目的探讨^(18)F-氟脱氧葡萄糖(FDG)PET/CT的影像表现和代谢参数鉴别结外鼻型NK/T细胞淋巴瘤(ENKTCL)与鼻咽癌的临床价值。方法回顾性分析2020年4月至2023年6月于绵阳市第三人民医院行^(18)F-FDG PET/CT显像且经组织病理学检查证实的11例ENKTCL患者和22例鼻咽癌患者的影像资料和临床资料,其中男性19例、女性14例,年龄(50.6±16.8)岁。比较ENKTCL和鼻咽癌患者^(18)F-FDG PET/CT的影像表现和代谢参数,筛选用于ENKTCL与鼻咽癌患者鉴别诊断的因素。计量资料的比较采用两独立样本t检验;计数资料的比较采用Fisher确切概率法或卡方检验;采用多因素Logistic回归分析筛选鉴别两种疾病的影像表现和代谢参数;采用受试者工作特征(ROC)曲线评估^(18)F-FDG PET/CT鉴别诊断ENKTCL与鼻咽癌的效能。结果ENKTCL和鼻咽癌患者的^(18)F-FDG PET/CT均可表现为鼻咽部软组织增厚,ENKTCL患者病灶弥漫性生长的占比高于鼻咽癌患者(63.6%对18.2%),鼻咽癌较ENKTCL更易侵及颅底骨质(59.1%对9.1%),差异均有统计学意义(χ2=9.219、10.812,均P<0.05)。ENKTCL患者病灶的肿瘤代谢体积(MTV)[(122.64±29.29)cm3]、病灶糖酵解总量(TLG)[(311.06±66.73)g]高于鼻咽癌患者病灶的MTV[(29.05±8.16)cm3]、TLG[(73.69±18.75)g],差异均有统计学意义(t=3.078、3.424,均P<0.05)。多因素Logistic回归分析显示,颅底骨质侵犯和TLG可以鉴别ENKTCL与鼻咽癌(OR=94.513、0.988,95%CI:1.102~8104.704、0.980~0.996,均P<0.05)。ROC曲线评估^(18)F-FDG PET/CT对ENKTCL与鼻咽癌的鉴别诊断效能显示,曲线下面积为0.971(95%CI:0.933~1.000),灵敏度为90.9%,特异度为81.8%。结论^(18)F-FDG PET/CT的影像表现和代谢参数对鉴别ENKTCL与鼻咽癌具有一定价值。

Objective To discuss the clinical value of^(18)F-fluorodeoxyglucose(FDG)PET/CT imaging performance and metabolic parameters in distinguishing extranodal natural killer/T-cell lymphoma,nasal type(ENKTCL)from nasopharyngeal carcinoma.Methods The imaging and clinical data of 11 ENKTCL patients and 22 nasopharyngeal carcinoma petients confirmed by histopathological examination from April 2020 to June 2023 at the Third Hospital of Mianyang were included.The patients included 19 males and 14 females,aged(50.6±16.8)years.The^(18)F-FDG PET/CT imaging performance and metabolic parameters of patients with ENKTCL and nasopharyngeal carcinoma were compared for differential diagnosis between ENKTCL and nasopharyngeal carcinoma.Factors for differential diagnosis between ENKTCL and nasopharyngeal carcinoma patients were screened.Intergroup comparisons of measurement data were performed using independent sample ttest.Intergroup comparisons of counting data were performed using chi-square test or Fisher's exact probability method.Multivariate Logistic regression analysis was applied to screen and identify the imaging performance and metabolic parameters of the two diseases.The efficacy of^(18)F-FDG PET/CT in differential diagnosis between ENKTCL and nasopharyngeal carcinoma was assessed on the basis of the receiver operating characteristic(ROC)curve.Results The^(18)F-FDG PET/CT imaging performance of patients with ENKTCL and nasopharyngeal carcinoma revealed nasopharyngeal soft tissue thickening.The proportion of diffuse growth of lesions in ENKTCL patients was higher than that in nasopharyngeal carcinoma patients(63.6%vs.18.2%),and nasopharyngeal carcinoma was more likely to invading the skull base bone(59.1%vs.9.1%)compared to ENKTCL,differences were statistically significantly(χ2=9.219,10.812;both P<0.05).The metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of ENKTCL and nasopharyngeal carcinoma patients((122.64±29.29)cm3 vs.(29.05±8.16)cm3,(311.06±66.73)g vs.(73.69±18.75)g)were statistically significantly different(t=3.078,3.424;both P<0.05).Multivariate Logistic regression analysis demonstrated that skull base bone invasion and TLG could distinguish ENKTCL from nasopharyngeal carcinoma(OR=94.513,0.988;95%CI:1.102–8104.704,0.980–0.996;both P<0.05).The ROC curve to evaluate the diagnostic efficacy of^(18)F-FDG PET/CT between ENKTCL and nasopharyngeal cancer showed that the area under curve was 0.971(95%CI:0.933–1.000)with a sensitivity of 90.9%and specificity of 81.8%.Conclusion^(18)F-FDG PET/CT,by combining imaging performance and metabolic parameters,is of certain value in distinguishing ENKTCL and nasopharyngeal carcinoma.