氟-18-脱氧葡萄糖正电子发射型计算机断层显影CT显像在儿童神经母细胞瘤临床分期中的意义  

Evaluation of 18F - fluorodeoxyglucose positronemission tomography/computed tomography imaging in child-hood neuroblastoma chinical staging

作　　者：陈莹[1] 马晓莉[1] 王希思[1] 于彤[2] 金眉[1] 赵文[1] 赵倩[1] 段超[1] 李兴军[1] 李立伟[3] 张大伟[1] 

机构地区：[1]儿童血液病与肿瘤分子分型北京市重点实验室,儿科学国家重点学科,儿科重大疾病研究教育部重点实验室,首都医科大学附属北京儿童医院血液肿瘤中心,100045 [2]儿童血液病与肿瘤分子分型北京市重点实验室,儿科学国家重点学科,儿科重大疾病研究教育部重点实验室,首都医科大学附属北京儿童医院影像中心,100045 [3]空军总医院核医学科,北京100142

出　　处：《中华实用儿科临床杂志》2017年第15期1149-1152,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：北京市科委首都特色专项经费资助（Z151100004015159）

摘　　要：目的探讨氟-18-脱氧葡萄糖正电子发射型计算机断层显影cT成像（18F-FDGPET／CT）在儿童神经母细胞瘤（NB）临床分期中的意义。方法选取2014年12月至2015年12月在首都医科大学附属北京儿童医院经组织病理学和临床特征诊断为NB的患儿，59例行18F—FDGPET／CT检查，比较胸骨及髂骨骨穿、髂骨活检、全身骨扫描、头颅磁共振成像（MRI）、局部CT及B超和血清乳酸脱氢酶及神经元特异性烯醇化酶，分析18F—FDGPET／CT与其他检查结果在原发瘤灶和转移瘤灶方面的异同。结果1．一般特征：59例患儿中男31例，女28例；原发瘤灶位于腹膜后44例（腹膜后＋后纵隔1例），后纵隔14例，左颈部1例；国际神经母细胞瘤分期系统（INSS）-I～Ⅳ分别为0、1、9和49例。2．18F—FDGPET／CT检查结果：最大标准摄取值（SUVmax）最大值：治疗前组（2．34±1．06）大于手术切除后组（1．08±0．50），差异有统计学意义（F=5．699，P=0．000）；骨髓转移1．5～2．9，局部淋巴结转移1．0～2．1。3．18F—FDGPET／CT与其他检查结果对比：骨转移中，有3例骨扫描未见异常，而PET／CT示多发骨骼骨髓弥散受累，2例骨扫描示骨转移，18F—FDGPET／CT示术后炎性反应及残留肿瘤组织侵犯临近椎间孔。18F、FDGPET／CT示34例骨髓转移，1例不除外骨髓转移，骨骼细胞学阳性30例。中枢转移方面：18F—FDGPET／CT示1例硬膜外转移，而头颅MRI示阴性；头颅MRI示9例颅骨转移，1例眼眶转移，1例脑膜转移，而18F—FDGPET／CT颅内未见异常。所有患儿均未见脑实质转移。同期LDH与原发瘤灶SUVmax最大值相关（rs=0．581，P〈0．01）。结论18F—FDG—PET／CT能较全面地显示NB患儿原发灶及转移灶的分布情况，对于NB患儿临床分期有重要作用，但在颅骨转移及中枢转移方面假阴性率高，需结合头颅MRI等检查提高检出率。Objective To explore the significance of 18F -fluorodeoxyglucose positronemission tomography/ computed tomography （ 18F - FDG PET/CT） scanning for childhood neuroblastoma clinical staging. Methods From December 2014 to December 2015,59 patients confirmed as NB in Beijing Children＇s Hospital, Capital Medical Univer- sity, and finding or clinical features were selected by histopathology. Those patients underwent lS F - FDG PET/CT, bone scan, cranial magnetic resonance image （ MRI）, bone marrow puncture （ two sites） and biopsy, regional CT, ultra- sound, serum tumor markers like lactic dehydrogenase and neuronspecific enolase. In comparison of is F - FDG PET/CT image findings with other detective methods, the differences were analyzed between the primary sites and metastasis were analyzed. Results （ 1 ） General features ： Out of 59 children with NB,31 were males,28 were females. Primary le- sions were as follows： 14 cases located in the postmediastinum, 44 cases in the retroperitoneum （1 case in retroperitoneum postmediastinum）,1 case in left neck. International Neuroblastoma Staging System I to IV：0, 1,9 and 49 cases, respectively. （ 2 ） is F - FDG PET - CT manifestations ： The maximum of standardized uptake value （SUVma ） ：before - treatment group was （2. 34 ± 1.06 ） which was larger than the post - surgery group value of （1.08 ± 0.50） , and the difference was significant（ F = 5. 699 ,P = 0. 000） ;bone marrow metastasis ranged from 1.5 to 2.9, regional lymphatic metastasis ranged from 1.0 to 2.1. （ 3 ） is F - FDG PET - CT imaging compared with other de- tection：in bone metastases, the whole body bone scan finding were normal in 3 cases ,while PET/CT showed dissemina- ted bone and bone marrow involvement and bone scanning showed 2 cases had metastases,combined with lS F - FDGPET/CT,which were considered as postoperative inflammatory reaction or residual tumor tissues invade adjacent inter- vertebral foramen. Bone cytology was positive in 30 cases, while P

关 键 词：神经母细胞瘤 体层摄影术 发射型计算机 单光子 氟脱氧葡萄糖F18 肿瘤分期 

分 类 号：R730.44[医药卫生—肿瘤]