不同骨髓FDG摄取诊断模式对初诊非霍奇金淋巴瘤骨髓浸润诊断价值的探讨  

Exploration of the diagnostic value of different bone marrow FDG uptake patterns in newly diagnosed non-Hodgkin lymphoma bone marrow infiltration

作　　者：彭艳 沈莹 陈红利 古流芳[2] 吴涛[1] 郑龙[1] 屈伟[1] PENG Yan;SHEN Ying;CHEN Hongli;GU Liufang;WU Tao;ZHENG Long;QU Wei(Department of Nuclear Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China;Department of Hematology,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院核医学科,陕西西安710004 [2]西安交通大学第二附属医院血液内科,陕西西安710004

出　　处：《现代肿瘤医学》2025年第3期459-466,共8页Journal of Modern Oncology

基　　金：陕西省自然科学基础研究计划项目(编号:2023JC-QN-0960)。

摘　　要：目的:评估^(18)F-FDG PET/CT在初诊非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)骨髓浸润(bone marrow infiltration,BMI)的表现模式,探讨不同FDG骨髓摄取模式对髓外浸润的诊断价值。方法:回顾性分析142例初诊NHL接受PET/CT检查的患者临床及影像学资料。采用两种FDG摄取评估模式,比较骨髓不同摄取模式的临床特征差异并分析PET/CT与骨髓活检(bone marrow biopsy,BMB)诊断骨髓浸润的价值。构建多因素Logistic诊断模型,评价三种模型的诊断效能。结果:142例患者在模型1中A组58例,B组51例,C组33例,C组BMB阳性率远高于A组及B组(P<0.017);在模型2中阳性组29例,阴性组113例,阳性组BMB阳性率高于阴性组(55.2%vs 25.7%,P=0.002)。诊断为骨髓浸润共58例,其中BMB^(+)44例,诊断的灵敏度、特异性、准确度分别为77.6%(45/58)、100%(84/84)、90.8%(129/142)。多因素Logistic回归分析:骨髓不同摄取模式、β2微球蛋白、Ki67值是骨髓浸润的独立危险因素(P<0.05),并纳入Logistic诊断模型。通过对比三种诊断模型诊断BMI对应的曲线下面积(area under curve,AUC)分别为0.804,0.750和0.915,其中Logistic-BMI模型的诊断性能优于模型1(Z=2.78,P=0.003)及模型2(Z=3.24,P<0.001),模型1与模型2两组诊断性能相似(Z=0.90,P=0.184),Logistic-BMI在总体人群中诊断骨髓浸润的灵敏度84.5%,特异性83.3%,准确性83.8%。结论:模型1操作简单、易行,诊断性能优于传统模式。Logistic-BMI模式,进一步提高PET/CT诊断骨髓浸润准确性,减少漏诊率。Objective:To evaluate the pattern of bone marrow infiltration(BMI) in newly diagnosed nonHodgkin lymphoma(NHL) using ^(18)E-FDG PET/CT,and to explore the diagnostic value of different FDG bone marrow uptake patterns for extramedullary infiltration.Methods:Retrospective analyzing of clinical and imaging data from142 patients who newly diagnosed with NHL and underwent PET/CT examination.Two modes of FDG uptake assessment were used to compare the clinical differences of different bone marrow uptake patterns and to analyze the value of PET/CT in diagnosing bone marrow infiltration in comparison with bone marrow biopsy(BMB).A multivariate Logistic diagnostic model was constructed to evaluate the diagnostic efficacy of the three models.Results:In model 1,among 142 patients,there were 58 in group A,51 in group B,and 33 in group C.The BMB positive rate in group C was significantly higher than that in group A and group B(P <0.017).In model 2,there were 29 positive cases and 113negative cases,with the BMB positive rate in the positive group being higher than that in the negative group(55.2%vs 25.7%,P=0.002).A total of 58 cases were diagnosed with bone marrow infiltration,of which 44 were BMB positive,and the diagnostic sensitivity,specificity,and accuracy were 77.6%(45/58),100 %(84/84),and 90.8%(129/142).Multivariate Logistic regression analysis showed that different bone marrow uptake patterns,β2-microglobulin,and Ki67 were independent risk factors for BMI(P <0.05),and were included in the Logistic diagnostic model.By comparing the areas under the curve(AUC) of the three diagnostic models for diagnosing BMI,which were 0.804,0.750 and 0.915,the diagnostic performance of the Logistic-BMI model was better than that of model 1(Z=2.78,P=0.003) and model 2(Z=3.24,P <0.001).The diagnostic performance of model 1 and model 2 was similar(Z=0.90,P=0.184).The Logistic-BMI model had a diagnostic sensitivity of 84.5%,specificity of 83.3%,and accuracy of 83.8% in diagnosing BMI.Conclusion:Model 1 is simple and easy to operate,with diag

关 键 词：淋巴瘤 正电子发射断层显像术 ^(18)F-FDG 骨髓浸润 骨髓活检 

分 类 号：R733.4[医药卫生—肿瘤]