摘要
目的分析比较胃黏膜相关淋巴组织(MALT)淋巴瘤患者^(18)F-脱氧葡萄糖(FDG)PET/CT影像学特点和消化内镜分型,并评估病灶最大标准摄取值(SUV max)反映肿瘤增殖活性及判断存在弥漫性大B细胞转化成分的价值。方法回顾性比较分析2012年12月至2019年1月间南京鼓楼医院36例[男19例、女17例,年龄(46.4±18.1)岁]未经治疗、病理确诊为胃MALT淋巴瘤患者的^(18)F-FDG PET/CT及消化内镜资料(分为慢性胃炎样型、凹陷型和隆起型)。通过目测法判断病灶为阳性(FDG摄取高于周围组织)或阴性(FDG摄取低于周围组织),摄取方式分为局限性和弥漫性,勾画病灶感兴趣区,记录SUV max,并采用单因素方差分析及最小显著差异t检验对3种类型病灶SUV max进行比较,采用Mann-Whitney U检验对发生弥漫性大B细胞转化与非转化病灶的SUV max进行比较。采用Spearman秩相关分析SUV max与细胞增殖核抗原Ki-67间的相关性,并通过受试者工作特征(ROC)曲线分析获得SUV max判断病灶存在弥漫性大B细胞转化成分的阈值。结果PET/CT阳性者15例,诊断准确性为41.7%(15/36),其中,对消化内镜分型为慢性胃炎样型的诊断准确性最低(4/16),凹陷型次之(6/15),而隆起型病灶最高(5/5)并多以局限性为主(4/5)。隆起型病灶SUV max(10.7±6.4)明显高于慢性胃炎样型(2.1±0.8)和凹陷型(2.7±1.4);F=13.010,均(P<0.05)。36例患者的病灶SUV max[2.7(1.8,5.0)]与Ki-67指数[10%(15%,40%)]呈正相关(rs=0.345,P=0.039)。存在弥漫性大B细胞转化成分病灶的SUV max明显高于不存在弥漫性大B细胞转化成分的病灶[9.4(3.1,14.8)与2.3(1.7,3.9);z=-3.044,P=0.002],且SUV max判断存在弥漫性大B细胞转化成分的阈值为6.5(曲线下面积为0.788,P=0.011)。结论^(18)F-FDG PET/CT在诊断隆起型病灶上优势明显,但对慢性胃炎样型及凹陷型效能欠佳。SUV max可用于辅助判断胃MALT淋巴瘤增殖活性及是否存在弥漫性大B细胞转化成分。
Objective To investigate ^(18)F-fluorodeoxyglucose(FDG)PET/CT imaging manifestations and digestive endoscopy of gastric mucosa-associated lymphoid tissue(MALT)lymphoma and evaluate whether maximum standardized uptake value(SUVmax)can reflect the tumor proliferation activity and diagnose the diffuse large B cell transformation.Methods ^(18)F-FDG PET/CT of 36 untreated histologically confirmed gastric MALT lymphoma patients(19 males,17 females,age(46.4±18.1)years)between December 2012 and January 2019 in Nanjing Drum Tower Hospital were reviewed retrospectively.A positive or negative PET was defined based on visual analysis.^(18)F-FDG uptake above surrounding tissues in the regions of interest defined by the nuclear physician was considered positive,while negative was definited if the ^(18)F-FDG uptake below surrounding tissues.Types of uptake included focal uptake and diffuse uptake.The characteristic findings of ^(18)F-FDG PET/CT and digestive endoscopy(3 types:chronic gastritis-like type,depressed type and protruding type)in the consecutive patients were evaluated.The region of interest was drawn and the maximum standardized uptake value(SUVmax)was measured.One-way analysis of variance and the least siginficant difference t test were used to compare the SUVmax of 3 types of lesions and Mann-Whitney U test was used for comparison of SUVmax between lesions with/without diffuse large B cell transformation.The correlation between SUVmax and Ki-67 was assessed by Spearman rank correlation analysis.Receiver operating characteristic(ROC)curve analysis was performed to calculate the optimal cut-off value for the diagnosis of diffuse large B cell transformation.Results Positive ^(18)F-FDG PET/CT were found in 15 patients and the diagnostic accuracy was 41.7%(15/36).^(18)F-FDG uptake results were positive for all protruding tumors(5/5)mainly with focal uptake(4/5),but only 4/16 for chronic gastritis-like type tumors and 6/15 for depressed type tumors.SUVmax of protruding type tumors(10.7±6.4)was significantly higher tha
作者
蒋冲
孙一文
滕月
来瑞鹤
李爱梅
Jiang Chong;Sun Yiwen;Teng Yue;Lai Ruihe;Li Aimei(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中华核医学与分子影像杂志》
CAS
CSCD
北大核心
2021年第11期660-663,共4页
Chinese Journal of Nuclear Medicine and Molecular Imaging
