^18F-FDG PET／CT与大范围弥散磁共振成像评价非霍奇金淋巴瘤骨髓浸润的对比研究  

Comparison of ^18F- FDG PET/CT and large- scale DWI for evaluation of non- Hodgkin lymphoma bone marrow infiltration

作　　者：汤日杰[1] 桂思[1] 李建生[1] 张海南[1] 卢斌贵[1] 杨佩瑜[1] 付东海[1] 傅文海[1] 李伟[1] 蔡亮[2] 

机构地区：[1]广州医科大学附属肿瘤医院放射科,510095 [2]武警广东省总队医院核医学科

出　　处：《中华血液学杂志》2014年第3期231-235,共5页Chinese Journal of Hematology

摘　　要：目的比较^18F—FDG PET／CT和大范围弥散磁共振成像（DWI）对非霍奇金淋巴瘤（NHL）骨髓浸润的诊断价值。方法对79例初诊且病理证实NHL患者进行PET／CT、大范围DWI、骨髓病理检查，以骨髓病理检查作为金标准，对比PET／CT与大范围DWI对淋巴瘤骨髓浸润诊断的灵敏度、特异度、准确性、阳性预测率、阴性预测率，并分析各部位、各亚型NHL骨髓浸润的情况。结果79例NHL患者中，骨髓病理检查共检出骨髓浸润25例（57处骨髓）；PET／CT显示22例患者（56处骨髓）PDG代谢增高；大范围DWI显示25例患者（58处骨髓）呈异常高信号灶。PET／CT诊断骨髓浸润的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为80．0％、96．3％、91．1％、90．9％、91．2％，而大范围DWI检查分别为84．0％、92．6％、89．9％、84．0％、92．6％。通过ROC曲线比较，PET／CT的A：值为0．911，大范围DWI的A：值为0．883，两者之间差异无统计学意义（P〉0．05）。PET／CT及大范围DWI检测结果示：侵袭性NHL骨髓浸润率分别为30．4％（21／69）、33．3％（23／69），高于隋性NHL骨髓浸润率[10．0％（1／10）、20．0％（2／10）]（P〈0．05）。结论PET／CT、大范围DWI均对NHL骨髓浸润有较高的诊断价值。PET／CT、大范围DWI及骨髓病理检查三种方法联合应用，可提高骨髓浸润的检出率。Objective To compare the diagnostic value of ^18F-fiurodeoxyglueose-positron emission tomography/computed tomography （^18F-FDG PET/CT） and large-scale diffusion weighted imaging （DWI） for evaluation of non-Hodgkin lymphoma （NHL） bone marrow （BM） infiltration. Methods A total of 79 patients with pathologically diagnosed NHL underwent ^18F-FDG PET/CT, large- scale DWI and BM pathological examination. BM examination as the ＂gold standard＂, the performance （the sensitivity, specificity, accuracy, positive and negative predictive value） of ^18F-FDG PET/CT and large- scale DWI for evaluation of BM infiltration was compared and the risk of BM infiltration of different subtypes and sources of NHL was analyzed. Results 25 of 79 cases were diagnosed as BM infiltration by pathological examination with 57 BM sites. Abnormal high BM metabolisms were identified in 22 cases with 56 BM sites by ＇SF-FDG PET/CT and 25 cases with 58 BM sites by large-scale DWI. The sensitivity, specificity, accuracy, positive and negative predictive value of ^18F-FDG PET/CT were 80.0%, 96.3%, 91.1%, 90.9%, 91.2%, respectively. And they were 84.0%, 92.6%, 89.9%, 84.0%, and 92.6% by large-scale DWI, respectively. A receiver operating characteristic （ROC） analysis demonstrated that there was no statistical difference in ^18F-FDG PET/CT and large-scale DWI （P 〉 0.05）. The area under ROC curve for ^18F-FDG PET/CT and large-scale DWI were 0.911 and 0.883 respectively. The incidences of BM infiltration in aggressive NHL patients by ^18F-FDG PET/CT （21/69, 30.4%） and large-scale DWI （23/69, 33.3%） were higher than those （PET/CT： 10.0%; large-scale DWI： 20.0%; P〉0.05） in indolent NHL patients. Conclusion ^18F-FDG PET/CT and large-scale DWI had important clinical value in diagnosing BM infiltration of NHL. A combination of ^18F- FDG PET/CT, large- scale DWI and pathological examination could improve the positive rate of BM infiltration in NHL.

关 键 词：淋巴瘤 骨髓浸润 正电子发射计算机断层扫描 弥散磁共振成像 骨髓活检 

分 类 号：R733.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]