PET/CT真正全身显像在结外NK/T细胞淋巴瘤(鼻型)患者中的应用价值  

The Application Value of True Whole-body PET/CT Scanning Protocol in Patients of Extranodal NK/T Cell Lymphoma

作　　者：李芳兰[1] 苏鸣岗[1] 石大志 梁釜铃 李林[1] LI Fang-lan;SU Ming-gang;SHI Da-zhi;LIANG Fu-ling;LI Lin(Department of Nuclear Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院核医学科,成都610041

出　　处：《四川大学学报（医学版）》2020年第2期245-251,共7页Journal of Sichuan University(Medical Sciences)

基　　金：四川省医学会科研课题(No.S17055)资助。

摘　　要：目的评价PET/CT真正的全身(true whole-body,TWB)显像较局限性全身(limited whole-body,LWB,头顶到大腿中份)显像增加的下肢远端这一显像范围对结外NK/T细胞淋巴瘤(鼻型)(extranodal natural killer/T-cell lymphoma,nasal type,ENKTL)患者的分期及随访评估的价值。方法收集2012年1月至2017年9月在我科行TWB PET/CT显像的ENKTL患者。根据患者检查目的不同分为两组,一组为分期组,即初诊时行TWB PET/CT评估分期的患者;另一组为随访组,即用TWB PET/CT行随访评估的患者。随访患者根据有无行TWB PET/CT初诊分期以及随访检查前有无临床确诊或怀疑的LWB范围内肿瘤进展(progressive disease, PD),再分为有TWB PET/CT分期无PD、有TWB PET/CT分期有PD、无TWB PET/CT分期无PD、无TWB PET/CT分期有PD4个亚组。比较分期组和随访组各亚组发现下肢远端(LWB范围外)非预期ENKTL病灶的百分率(P1),和各组因此改变分期、再分期/疗效评价结果的百分率(P2)。结果分期组患者225例,其中有200例(88.9%)肿瘤局限于LWB范围内,P1为11.1%(25例),P2为0.4%(1例)。对于随访组患者,有TWB PET/CT分期无PD亚组(n=85)、有TWB PET/CT分期有PD亚组(n=4)、无TWB PET/CT分期无PD亚组(n=43)、无TWB PET/CT分期有PD亚组(n=15)P1分别为1.2%、75.0%、0%、26.7%,P2分别为1.2%、0%、0%、13.3%。对于随访组患者,无论是否行初诊分期的TWB PET/CT检查,无PD组和有PD组的P1为0.8%vs. 36.8%(P <0.000 1),P2为0.8%vs. 10.5%,(P<0.000 1)。结论 ENKTL患者初诊分期不常规推荐行头顶到脚底的TWB PET/CT显像;临床没有肿瘤进展依据或有进展依据但TWB PET/CT初诊分期时病变局限在LWB范围内的随访患者,推荐随访时常规行头顶到大腿中份的LWB PET/CT;ENKTL患者初诊分期时未行TWB PET/CT了解下肢情况,如在随访检查前出现了LWB范围内肿瘤进展的依据,随访评估时推荐行TWB PET/CT评估全身肿瘤累及情况。Objective To assess the staging,restaging,and treatment strategy determination of extranoda NK/T cell lymphoma(ENKT)by PET/CT real body(true whole-body,TWB)imaging,which is superior to PET/CT limitation of the whole body(limited whole-body,LWB,from skull vertex to upper thighs)by adding‘dista lower extremity’images.Methods TWB 18F-FDG PET/CT studies performed for staging and follow-up of ENKTL patients between January 2012 and September 2017 were retrospectively reviewed.Patients in staging group received TWB PET/CT evaluation for staging at the first diagnosis.In follow-up group,patients received follow-up evalution with TWB PET/CT and progressive disease(PD)in the LWB range with or without clinical diagnosis or suspicion before follow-up examination,and then divided into four subgroups:staging(+)PD(-),staging(+)PD(+),staging(-)PD(-),staging(-)PD(+).Then the percentage of unexpected ENKTL lesions found at the distal extremity(outside the LWB range)(P1),and the percentage of changes in the staging,restaging/outcome evaluation(P2)in each group were recorded.Results Among the 225 patients in the staging group,200(88.9%)had tumors confined to LWB,while P1was 11.1%(25 cases)and P2 was 0.4%(1 case).In the follow-up group,the P1 in staging(+)PD(-)(n=85),staging(+)PD(+)(n=4),staging(-)PD(-)(n=43),staging(-)PD(+)goups(n=15)were 1.2%,75.0%,0%,26.7%,and P2 were1.2%,0%,0%,13.3%,respectively.In the follow-up group,regardless of whether the TWB PET/CT examination was performed at the initial diagnosis stage,P1 in PD(-)group and PD(+)group was 0.8 vs.36.8%(P<0.000 1),and P2 was0.8%vs.10.5%(P<0.000 1).Conclusion It is not recommended that the TWB PET/CT imaging from the top of the head to the bottom of the foot use for the first diagnosis of ENKTL patients.And for follow-up patients with no clinica evidence of tumor progression or with evidence of tumor progression but whose lesions were limited to LWB at the initia diagnosis of TWB PET/CT staging,LWB PET/CT from the top of the head to the middle of the thigh is recommended

关 键 词：正电子断层显像 结外NK/T细胞淋巴瘤(鼻型) 扫描范围 

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