^(18)F-FDG显像对淋巴瘤分期及疗效评价的价值

^(18)F-FDG PET imaging for staging and treatment evaluation in lymphoma

目的 探讨18F 脱氧葡萄糖 (FDG)PET和PET/CT显像在淋巴瘤诊断、分期及疗效评价中的价值。方法 10 7例淋巴瘤或淋巴瘤疑似患者行18F FDGPET或PET/CT显像 ,其中 16例多次行PET或PET/CT显像。所有患者皆经病理学检查确诊 ,随访时间 >6个月。结果 淋巴瘤 31例 ,PET显像阳性 30例 (96 .8%) ,7例淋巴结转移癌及活动性淋巴结结核PET显像均为阳性 ,淋巴瘤与原发灶不明的淋巴结转移癌及活动性淋巴结结核难以鉴别。 37%(10 / 2 7例 )初诊淋巴瘤PET显像多发现恶性病灶而提高临床分期。 16例淋巴瘤行多次PET显像 ,发现 8例治疗后病灶消失 ,2例缓解 ,1例肿瘤复发 ,5例无瘤生存 ,皆与临床相符。 5 3例淋巴瘤治疗后行PET显像 ,其中 8例临床确认有肿瘤复发或明显残余 ,PET显像均为阳性 ;4 5例临床疗效为完全缓解 (CR)和部分缓解 (PR)的患者中 ,PET显像阳性者 18例 ,3例肿瘤处于活跃状态 ,15例 (非霍奇金淋巴瘤 12例 ,霍奇金淋巴瘤 3例 )处于抑制状态 ,PET显像后改变了进一步临床治疗方案。结论 18F FDGPET显像对检测淋巴瘤的体内分布及分期灵敏、准确、全面 ,但难以与活动性淋巴结结核、原发灶不明的淋巴结转移癌相鉴别。18F FDGPET显像能灵敏、准确地检出淋巴瘤复发及残余病灶 ,对疗效评价及指导临床治疗有重要价?

Objective To investigate the clinical value of 18 F-fluorodeoxyglucose (FDG) PET imaging for the diagnosis,staging and treatment evaluation of lymphoma. Methods 18 F-FDG PET or PET/CT imaging were performed in 107 patients with lymphoma and suspected lymphoma. The final diagnosis were confirmed by pathology. All patients were followed up over 6 months. Results 18 F-FDG PET imaging was positive in 30 of 31 cases with lymphoma (96.8%),but were also positive in 7 case with lymph node activitied tuberculosis and lymph node metastasis with unknown primary site,thereby PET imaging could not differentiate between them. 18 F-FDG PET imaging upstaged in 37% of initial lymphoma patients. Successive PET imagings were performed in 16 cases ,it was find that the tumor eradicated in 8 cases,improved in 2 cases,relapsed in 1 case and 5 cases negative in all imagings,also the results of PET imaging were concordant with other clinical tests. In 53 patients PET imaging was repeated after treatment,among them PET imaging was still positive in 8 cases with recurrent or remnant tumor;in 45 cases with complete or partial remission,PET imaging was positive in 18 cases,among them tumor was active in 3 cases and mild suppressed in 15 cases,including 12 cases of non-Hodgkin's lymphoma and 3 case of Hodgkin's disease,therefore PET imaging changes the therapeutic regime. Conclusions PET imaging is a sensitive,accurate method and can delineate the tumor distribution of lymphoma in the body,but is difficult to differentiate lymphoma from lymph node activitied tuberculosis and lymph node metastasis with unknown primary site. Besides,PET imaging can also detect the recurrent or remnant tumor sensitively and accurately. There is also significant value for the therapeutic guide and evaluation.