18F-FDG PET/CT在结外鼻型自然杀伤/T细胞淋巴瘤中的应用价值

摘要

目的 观察结外鼻型自然杀伤/T细胞淋巴瘤(ENKTL)的18F-FDG PET/CT表现特点,并探讨PET/CT在ENKTL诊断和分期中的价值.方法 回顾性分析20例(男12例,女8例,中位年龄53岁)在2012年1月至2016年3月于无锡市第四人民医院行18F-FDG PET/CT检查的ENKTL患者资料(包括活组织病理检查、PET/CT、体格检查、血液学检查、CT及MRI等其他影像学检查、骨髓穿刺等).其中11例为初诊患者,9例为治疗后患者.患者最终诊断均经病理及免疫组织化学检查证实.分析统计患者的分期结果.采用Mann-Whitneyu检验比较初诊与治疗后复发或进展患者SUVmax,以Sperman相关分析检验受浸润淋巴结大小与SUVmax的关系.结果 ENKTL好发于鼻腔、鼻咽部、皮肤,可浸润全身各脏器.所有病灶在PET/CT中均表现为FDG高摄取,初诊患者SUVmax为6.5(4.3,10.4);治疗后复发或进展患者7例,SUVmax为5.4(3.4,8.9),前者明显高于后者(u=6 853.500,z=-2.039,P＜0.05).受浸润淋巴结直径与SUVmax间相关性较弱(rs=0.290,P＜0.01),说明通过淋巴结大小判断其是否受ENKTL细胞浸润不准确.11例初诊患者的PET/CT分期均与最终临床分期相符,传统影像学方法(CT、MRI)分期仅6例与最终临床分期相符.结论 PET/CT对ENKTL的诊断及分期较传统影像学方法更具优势;PET/CT检查范围应包括四肢,以免遗漏病灶.%Objective To analyze the image characteristics and clinical value of 18F-FDG PET/CT in patients with extranodal nasal type natural killer/T-cell lymphoma (ENKTL).Methods From January 2012 to March 2016,20 ENKTL patients (12 males,8 females;median age 53 years) who underwent whole-body 18F-FDG PET/CT were enrolled in this retrospective study.Eleven patients were newly diagnosed,and 9 were previously treated.Clinical data were collected for histopathology and bone marrow biopsy,laboratory results,PET/CT and radiological findings such as CT or MRI.The final diagnosis was based on histopathology and immunohistochemistry.Mann-Whitney u test was used to compare the SUVmax of newly diagnosed patients and patients with recurrence or disease progression after therapy.Spearman correlation analysis was used to explore the relation between diameter of tumor-invaded lymph nodes and SUVmax.Results ENKTL could be found in all parts of the body,but more frequently in the nasal cavity,nasopharynx and skin.All lesions showed high uptake of FDG on PET/CT.The SUVmax of newly diagnosed patients was significantly higher than that of patients (n=7) with recurrence or disease progression:6.5(4.3,10.4) vs 5.4(3.4,8.9);u=6 853.500,z=-2.039,P＜0.05).The diameter of tumor-invaded lymph nodes showed weakly positive correlation with SUVmax(rs =0.290,P＜0.01),suggesting that invasion of ENKTL might not be accurately evaluated by the size of lymph nodes.The staging by PET/CT was concordant with clinical final staging in 11 newly diagnosed patients,while the staging by CT or MRI was only correct in 6 patients.Conclusions PET/CT is superior to conventional imaging modalities in diagnosis and staging for patients with ENKTL.Since some lesions might be found in the limbs,limbs should be included in the scan field.