18F-FDG符合线路SPECT/CT显像在淋巴瘤诊断及初始分期中的意义  

Role of F-FDG SPECT/CT imaging in the diagnosis and initial staging of lymphoma

作　　者：童良前[1] 随燕芳 殷艳海 符礼青 钟佳玲 姜圣男 TONG Liang-qian;SUI Yan-fang;YIN Yan-hai;FU Li-qing;ZHONG Jia-ling;JIANG Sheng-nan(Department of Nuclear Medicine, the Affiliated Haikou Hospital of Central South University Xiangya School, Haikou 570208, Hainan, China;Department of Rehabilitation Medicine, the Affiliated Haikou Hospital of Central South University Xiangya School, Haikou 570208, Hainan, China;Department of Nuclear Medicine, the Affiliated Hainan Hospital of Hainan Medicine College, Haikou 570311, Hainan, China)

机构地区：[1]中南大学湘雅医学院附属海口医院核医学科,海南海口570208 [2]中南大学湘雅医学院附属海口医院康复医学科,海南海口570208 [3]海南医学院附属海南医院核医学科,海南海口570311

出　　处：《海南医学院学报》2020年第17期1337-1342,共6页Journal of Hainan Medical University

基　　金：国家自然科学基金项目(81960556);海南省卫生计生行业科研项目(18A200179)。

摘　　要：目的:探讨18F-FDG符合线路SPECT/CT显像在淋巴瘤病人诊断及初始分期中的意义。方法:回顾性分析2015年1月~2018年6月本院48例最终病理确诊为淋巴瘤并且确诊前行18F-FDG符合线路SPECT/CT显像的病人。(1)将病人按不同病理类型分成霍奇金淋巴瘤组、弥漫性大B细胞淋巴瘤组和其它非霍奇金淋巴瘤组,按有无结外组织侵犯分成结内组及结外组,按不同临床Ann Arbor分期分成I+Ⅱ期组和Ⅲ+Ⅳ期组,分别计算18F-FDG符合线路SPECT/CT显像及常规影像学检查(CI)对其的诊断效能,并比较不同组间T/N比值。(2)分别对48例病人进行临床Ann Arbor分期、18F-FDG符合线路SPECT/CT显像分期(SPECT/PET分期)及CI分期,对比SPECT/PET分期与CI分期效能,对比SPECT/PET分期与临床Ann Arbor分期的一致性情况。结果:(1)18F-FDG符合线路SPECT/CT显像的诊断符合率明显比CI高,差异有统计学意义(P<0.01)。(2)弥漫大B细胞淋巴瘤组及其它非霍奇金淋巴瘤组18F-FDG符合线路SPECT/CT显像的诊断符合率也高于CI的(P<0.05)。18F-FDG符合线路SPECT/CT显像对霍奇金淋巴瘤组、弥漫大B细胞淋巴瘤组及其它非霍奇金淋巴瘤组的诊断符合率之间无明显差异(P>0.05)。(3)18F-FDG符合线路SPECT/CT显像对结内组及结外组淋巴瘤的诊断符合率分别为100.0%(19/19)与21.1%(4/19)(χ^2=24.783,P=0.000)。(4)18F-FDG符合线路SPECT/CT显像与CI对分期较早(I+Ⅱ期组)的淋巴瘤诊断符合率分别为25%(2/8)与0(0/8)(χ^2=2.268,P=0.131),对分期较晚(Ⅲ+Ⅳ期组)的淋巴瘤诊断符合率分别为50%(20/40)与20%(8/40)(χ^2=7.912,P=0.002)。(5)不同病理分组之间、结内组与结外组之间、I+Ⅱ期组与Ⅲ+Ⅳ期组之间淋巴瘤病灶T/N比值无明显差异(P>0.05)。(6)18F-FDG符合线路SPECT/CT显像与CI对淋巴瘤初始分期总的符合率分别为79.2%(38/45)与64.4%(31/48)(χ^2=18.774,P=0.000);SPECT/PET分期与临床Ann Arbor分期的一致性较好(Kappa=0.696,P=0.000)。结论:18F-FDObjective To investigate the role of 18F-FDG SPECT/CT in the diagnosis and initial staging of lymphoma.Methods A retrospective analysis was carried out on 48 patients in Haikou Hospital from January 2015 to June 2018,who were pathologically diagnosed with lymphoma and had undergone 18F-FDG SPECT/CT before definite diagnosis.(1)Patients were divided into Hodgkin's lymphoma group,diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group according to pathological classification;and were divided into nodal lymphoma group and extranodal lymphoma group according to the occurence of invasion to the tissues beyond lymph node;and were divided into stage I+Ⅱgroup and stageⅢ+Ⅳgroup according to clinical Ann Arbor staging.The diagnostic consistencies of 18F-FDG SPECT/CT and conventional imaging(CI)in each group were evaluated,the T/N ratios of the lymphoma lesion were analyzed as well.(2)Clinical Ann Arbor staging,SPECT/PET staging and CI staging were performed in 48 patients,respectively.Then the efficacy of SPECT/PET staging and CI staging,as well as the consistency of SPECT/PET staging and clinical Ann Arbor staging were compared.Results(1)In this study,the diagnostic consistent rates of 18F-FDG SPECT/PET and CI were 45.8%(22/48)and 16.6%(8/48),respectively(χ^2=9.503,P=0.002<0.01).(2)The diagnostic consistent rate of 18F-FDG SPECT/PET in diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group was higher than that of CI(P<0.05).There was no statistical significance in the diagnostic consistent rates of 18F-FDG SPECT/PET between the Hodgkin's lymphoma group,diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group(χ^2=1.067,P=0.448>0.05).(3)The diagnostic consistent rates of 18F-FDG SPECT/PET in nodal group and extranodal group were 100.0%(19/19)and 21.1%(4/19)(χ^2=24.783,P=0.000<0.01),respectively.(4)The diagnostic consistent rates of 18F-FDG SPECT/PET and CI were 25%(2/8)and 0(0/8)for lymphoma at the early stage(stageⅠ+Ⅱgroup)(χ^2=2.268,P=0.131>0.05),and 5

关 键 词：淋巴瘤 分期 体层摄影术 发射型计算机 单光子 氟脱氧葡萄糖 

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