18F-FDG PET/CT在造血干细胞移植后淋巴细胞增殖性疾病中的初步应用  

Preliminary application of 18F FDG-PET/CT in post-transplant lymphoproliferative disorders after hematopoietic stem cell transplantation

作　　者：张晓春[1] 王思云[1] 王淑侠[1] 邓宁虹 ZHANG Xiao-chun;WANG Si-yun;WANG Shu-xia;DENG Ning-hong(Department of Nuclear Medicine,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Guangzhou 510080,China;Department of Radiology,Zhuhai Hospital of Guangdong Provincial People’s Hospital,Zhuhai Guangdong 519000,China)

机构地区：[1]广东省人民医院(广东省医学科学院)核医学科,广东广州510080 [2]广东省人民医院珠海医院放射科,广东珠海519000

出　　处：《中国临床医学影像杂志》2019年第12期840-846,共7页Journal of China Clinic Medical Imaging

基　　金：华南理工大学中央高校基本科研业务专项资金(编号:2018MS28)

摘　　要：目的:评估18F-FDG PET/CT在造血干细胞移植后淋巴细胞增殖性疾病(Post-transplant lymphoproliferative disorder,PTLD)中的初步应用价值。方法:回顾性分析本院2008年1月-2017年12月曾行18F-FDG PET/CT检查的造血干细胞PTLD患者的资料。绘制患者临床信息的图表,研究患者18F-FDG PET/CT影像特征,并评价其在引导活检、疗效评估中的作用。结果:共纳入患者9例,6例经病理学检查确诊为PTLD,3例根据临床表现、EB病毒浓度升高、影像表现作出诊断。9例患者在造血干细胞移植后做共接受18次18F-FDG PET/CT扫描。在18F-FDG PET/CT图像上,包括淋巴结和结外两类病变,呈高代谢。有5例患者在18F-FDG PET/CT图像的引导下行组织病理活检,结果均为阳性,包括多形性2例,多形性伴局部弥漫性大B细胞淋巴瘤样变1例,弥漫性大B细胞淋巴瘤2例。1例患者根据触诊行颈部淋巴结活检,结果为PTLD阴性。有1例患者发现脑内多发病变,手术切除后病理提示为弥漫性大B细胞淋巴瘤。治疗结束后,6例行18F-FDG PET/CT扫描评估治疗效果的患者均表现为缓解。结论:18F-FDG PET/CT在造血干细胞PTLD患者的影像诊断、引导活检、疗效评估中有重要作用。Objective: To evaluate usefulness of fluorine-18 2-fluoro-2-deoxyglucose PET and computed tomography(18F-FDG PET/CT) in post-transplant lymphoproliferative disorder(PTLD) after hematopoietic stem cell transplantation(HSCT). Methods: From January 2008 to October 2017, the records of all patients that had undergone18F-FDG PET/CT for evaluation of PTLD after HSCT were analyzed retrospectively. A chart review of clinical information was performed, the imaging features of18F-FDG PET/CT were reported, and its role in guiding biopsy and evaluating treatment response following therapy was assessed. Results: A total of 9 patients(7 male and 2 female;18~35 years of age, average: 24 years) were identified. Among them, 6 cases were diagnosed as PTLD based on the pathological result, and another 3 had been treated for PTLD based on clinical findings, elevated EBV, and positive imaging findings. Nine patients had a total of 1818F-FDG PET/CT scans prior to or following HSCT. Both lymph nodal and extranodal sites of involvement could be detected on18F-FDG PET/CT images,which showed more lymph node lesions rather than extranodal lesions, and both types of lesions demonstrated increased18FFDG uptake. Five patients underwent biopsy guided by18F-FDG PET/CT images. The biopsy results of 5 cases were positive for PTLD, including polymorphic subtype in 2 cases, polymorphic subtype with local diffuse large B cell lymphoma change in1 case and diffuse large B-cell lymphoma in 2 cases. One patient underwent biopsy based on palpable cervical lymph nodes and the result was reactive hyperplasia of lymph nodes which was negative for PTLD. There was 1 patient with multiple involvement of the central nervous system which was diffuse large B cell lymphoma on final histology after resection. The corresponding therapeutic protocol was reviewed. Six patients underwent18F-FDG PET/CT scans to evaluate treatment response following therapy, and all were demonstrated improvement. Conclusion:18F-FDG PET/CT plays an important role in imaging diagnosis, gui

关 键 词：淋巴组织增殖性疾病 造血干细胞移植 氟脱氧葡萄糖F18 正电子发射断层显像术 

分 类 号：R457.7[医药卫生—治疗学] R557.4[医药卫生—临床医学]