^18F-FDG PET/CT显像诊断非霍奇金淋巴瘤化疗后心肌损伤的价值  

Value of 18F-FDG PET/CT in the detection of the anthracycline induced cardiotoxicity in non-Hodgkin lymphoma

作　　者：周明舸 邱春 王建锋[1] 邵晓梁[1] 王跃涛[1] Zhou Mingge;Qiu Chun;Wang Jianfeng;Shao Xiaoliang;Wang Yuetao(Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,Changzhou First People′s Hospital,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科,213003

出　　处：《中华核医学与分子影像杂志》2020年第10期583-588,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81871381,81701734);江苏省“双创计划”人才项目;江苏省第五期“333工程”第三层次人才项目;常州市卫生健康委青年人才科技项目(QN201921)

摘　　要：目的探讨化疗前后^18F-脱氧葡萄糖(FDG)PET/CT显像左心室标准摄取值(SUVLV)能否用于诊断非霍奇金淋巴瘤(NHL)化疗后心肌损伤。方法回顾性分析2016年1月至2019年6月22例确诊为NHL并接受含蒽环类药物化疗方案治疗的患者[男13例,女9例,年龄(58±13)岁]资料。患者化疗前后均于常州市第一人民医院行门控心肌灌注显像(GMPI)及全身^18F-FDG PET/CT显像。利用化疗前后GMPI舒张功能减退情况判断是否存在化疗后心肌损伤,使用两独立样本t检验及配对t检验分析比较心肌损伤与未损伤患者化疗前后SUVLV的变化情况,使用受试者工作特征(ROC)曲线分析SUVLV能否用于诊断化疗后心肌损伤。结果相比于心肌未损伤患者(16例),心肌损伤患者(6例)化疗后左心室射血分数(LVEF)降低程度较大[ΔLVEF:(-5.8±7.5)%与(2.7±3.8)%;t=2.657,P<0.05]。心肌损伤患者化疗后SUVLV较化疗前有增高趋势[最大SUVLV(SUVLVmax):7.5±4.4与2.6±1.0,t=2.585,P<0.05;平均SUVLV(SUVLVmean):3.7±2.2与1.6±0.8;t=2.119,P>0.05],而心肌未损伤患者化疗前后SUVLV无明显差异(SUVLVmax:5.7±4.9与5.6±4.8,SUVLVmean:2.8±2.3与2.8±2.2;t值:0.130、0.069,均P>0.05)。相比于心肌未损伤患者,心肌损伤患者具有更高的ΔSUVLV(t值:2.494、2.163,均P<0.05)和更低的化疗前SUVLVmax(t=2.436,P<0.05)。ROC曲线分析示ΔSUVLVmax及ΔSUVLVmean具有诊断化疗后心肌损伤的价值,ΔSUVLVmax的曲线下面积(AUC)更高,为0.844(95%CI:0.673~1.000);当界值为1.1时,ΔSUVLVmax诊断心肌损伤的灵敏度为5/9,特异性为13/16。结论NHL患者化疗后心肌损伤与更高的ΔSUVLVmax、ΔSUVLVmean和更低的化疗前SUVLVmax相关,ΔSUVLVmax可作为诊断化疗后心肌损伤的指标。Objective To evaluate the value of standardized uptake value of the left ventricle(SUVLV)during^18F-fluorodeoxyglucose(FDG)PET/CT imaging in the detection of the cardiotoxicity of anthracycline in non-Hodgkin lymphoma(NHL).Methods Twenty-two patients(13 males and 9 females,age:(58±13)years)diagnosed as NHL from January 2016 to June 2019 were retrospectively enrolled in the study.All patients received chemotherapy regimens containing anthracycline.The gated myocardial perfusion imaging(GMPI)and whole body^18F-FDG PET/CT imaging were performed before and after chemotherapy in Changzhou First People′s Hospital.The significant reduction of diastolic function after chemotherapy measured by GMPI was defined as anthracycline induced myocardial injury.The SUVLV before and after chemotherapy and the changes(ΔSUVLV)in patients with or without myocardial injury were compared with independent-sample t test or paired t test.The receiver operating characteristic(ROC)curve analysis was used to determine whether SUVLV could be used to detect anthracycline induced myocardial injury.Results The reduction of LVEF after chemotherapy was more significant in myocardial injury group(n=6)than that in patients without myocardial injury(n=16;ΔLVEF:(-5.8±7.5)%vs(2.7±3.8)%,t=2.657,P<0.05).After chemotherapy,an increase was found in SUVLV of patients with myocardial injury(maximum SUVLV(SUVLVmax):7.5±4.4 vs 2.6±1.0,t=2.585,P<0.05;mean SUVLV(SUVLVmean):3.7±2.2 vs 1.6±0.8,t=2.119,P>0.05),but no differences were found in SUVLV of patients without myocardial injury(SUVLVmax:5.7±4.9 vs 5.6±4.8,SUVLVmean:2.8±2.3 vs 2.8±2.2;t values:0.130,0.069,both P>0.05).Compared with patients without myocardial injury,patients with myocardial injury had higherΔSUVLV(t values:2.494,2.163,both P<0.05)and lower pre-chemotherapy SUVLVmax(t=2.436,P<0.05).ROC curve analysis showed thatΔSUVLVmax andΔSUVLVmean could be used for the detection of chemotherapy induced cardiotoxicity,and higher area under curve(AUC)ofΔSUVLVmaxwas found(AUC=0.844,95%CI:0.

关 键 词：淋巴瘤 非霍奇金 心脏毒性 药物疗法 正电子发射断层显像术 体层摄影术 发射型计算机 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]