骨髓^(18)F-FDG摄取模式在初诊弥漫大B细胞淋巴瘤诊断骨髓浸润的价值  

Value of Bone Marrow ^(18)F-FDG Uptake Pattern of PET/CT in Diagnosis of Bone Marrow Infiltration in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma

作　　者：李旭[1] 陈聪霞[1] 姚稚明[1] 秦嵩[1] 郭悦[1] Li Xu;Chen Congxia;Yao Zhiming(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院,100730

出　　处：《医学研究杂志》2021年第10期101-105,110,共6页Journal of Medical Research

基　　金：北京医院院内基金资助项目(BJ-2015-111)。

摘　　要：目的探讨初诊弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者骨髓不同氟18标记的氟代脱氧葡萄糖(fludeoxyglucose,^(18)F-FDG)摄取情况诊断淋巴瘤骨髓浸润的价值。方法回顾性分析行PET/CT检查的初诊DLBCL住院患者图像,根据有、无异常骨髓^(18)F-FDG摄取增高分为骨髓阳性组和骨髓正常组,前者又分为局灶组、弥漫组、局灶伴弥漫组。所有患者均行骨髓活检(bone marrow biopsy,BMB)。以骨髓局灶性^(18)F-FDG摄取增高为PET/CT诊断骨髓浸润的标准。以PET/CT诊断骨髓浸润或BMB病理提示骨髓浸润为最终临床诊断骨髓浸润的标准。计数数据分析用χ^(2)检验,计量数据分析用t检验。结果共有114例患者纳入研究,其中,骨髓正常组、局灶组、弥漫组、局灶伴弥漫组病例分别占51.8%、10.5%、28.1%、9.6%。骨髓正常组和局灶组BMB活检病理均为阴性,弥漫组和局灶伴弥漫组分别有15.6%、36.4%病例BMB为骨髓浸润(P=0.000)。4组的骨髓/肝SUVmax比值分别为0.84±0.11、4.21±2.51、1.52±0.67和7.69±4.23(P=0.000)。骨髓淋巴瘤浸润以最终临床诊断确定,ROC工作曲线发现骨髓正常组和弥漫组患者的诊断骨髓浸润最佳临界点为骨髓/肝SUVmax比值1.69。结论初诊DLBCL骨髓^(18)F-FDG摄取局灶性增高被公认为是淋巴瘤骨髓浸润的典型表现。骨髓^(18)F-FDG摄取弥漫增高也提示浸润骨髓可能。骨髓单纯弥漫^(18)F-FDG摄取增高的患者,骨髓/肝SUVmax比值1.69可能是作为预测BMB骨髓浸润结果的诊断临界点。骨髓^(18)F-FDG摄取弥漫增高者相较于单纯灶性增高者,在常规活检的部位,更容易获得BMB阳性结果。Objective To assess the value of different bone marrow(BM)^(18)F-FDG uptake patterns in diagnosis of bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods This research retrospectively analyzed newly diagnosed DLBCL patients in Beijing Hospital.According to BM ^(18)F-FDG uptake patterns,the patients were divided into BM positive group and BM normal group.The BM positive group was further divided into focal group,diffuse group and focal+diffuse group.BMB was underwent in all patients,and the biopsy site was routine posterior superior iliac crest.Focal BM uptake was used as the standard for PET/CT diagnosis of BM infiltration.BM infiltration diagnosed by PET/CT or BMB was the final clinical diagnosis of BM infiltration.The differences among groups were compared by using independent-sample t-test orχ^(2) test.ROC working curve was used to find the cut-off point.Results Among 114 eligible patients,there were 51.8%,10.5%,28.1%,9.6%in the BM normal group,focal group,diffuse group and focal+diffuse group,respectively.BMB pathology results were negative in all patients of the BM normal group and focal group,meanwhile,15.6%and 36.4%patients in the diffuse group and focal+diffuse group diagnosed BM infiltration by BMB(P=0.000).The ratio of BM SUVmax and liver SUVmax(BM/L SUVmax)were 0.84±0.11,4.21±2.51,1.52±0.67 and 7.69±4.23 in the above four groups,respectively(P=0.000).With the final clinical diagnosis as the gold standard for BM infiltration,the cut-off point for BM/L SUVmax was 1.69 in the BM normal group and diffuse group.Conclusion Diffuse BM pattern in newly diagnosed suggests that lymphoma may infiltrate BM.In newly diagnosed DLBCL patients with diffuse BM pattern alone,BM/L SUVmax 1.69 can be used as the diagnostic cut-off point to predict BMB positive.Compared with the focal BM uptake pattern,patients with diffuse BM pattern were more easier to obtain BMB positive results at the site of routine biopsy.

关 键 词：^(18)F-FDG PET/CT DLBCL 骨髓 骨髓活检 骨髓浸润 

分 类 号：R445.6[医药卫生—影像医学与核医学]