正电子发射计算机体层摄影和磁共振扩散加权成像评价淋巴瘤骨髓浸润的初步研究

摘要

目的：探讨正电子发射计算机体层摄影（ PET-CT）和磁共振扩散加权成像（ DWI）评价淋巴瘤骨髓浸润的临床价值。方法回顾性分析93例初治淋巴瘤患者的骨髓状况，其中行PETC-T检查61例，行DWI检查32例。以骨髓活检结果作为金标准，分析各病理类型淋巴瘤骨髓浸润的发生率及浸润部位，并比较PET-CT和DWI对不同病理类型淋巴瘤骨髓浸润的检出率。结果在93例淋巴瘤患者中，根据常规部位骨髓检查及PET-CT、DWI引导下的骨髓检查，共检出骨髓浸润39例。PET-CT诊断淋巴瘤骨髓浸润的敏感度、特异度、正确率、阳性预测值和阴性预测值分别为80．8％、88．6％、85．3％、84．0％和86．1％，DWI诊断淋巴瘤骨髓浸润的敏感度、特异度、正确率、阳性预测值和阴性预测值分别为84．6％、89．5％、87．5％、84．6％和89．5％。 PET-CT和DWI对侵袭性淋巴瘤骨髓浸润的检出率分别为37．5％（18／48）和38．1％（8／21），对惰性淋巴瘤骨髓浸润的检出率分别为23．1％（3／13）和27．3％（3／11）。 PET-CT对侵袭性淋巴瘤骨髓浸润的检出率略高于惰性淋巴瘤骨髓浸润，但差异无统计学意义（ P＝0．521）。 DWI对侵袭性淋巴瘤骨髓浸润的检出率略高于惰性淋巴瘤骨髓浸润，但差异无统计学意义（ P＝0．660）。 DWI对侵袭性淋巴瘤骨髓浸润和惰性淋巴瘤骨髓浸润的检出率均略高于PET-CT，但差异均无统计学意义（ P＝0．963， P＝1．000）。结论 PET-CT和DWI均对淋巴瘤骨髓浸润有较高的诊断价值；PET-CT和DWI对侵袭性淋巴瘤骨髓浸润和惰性淋巴瘤骨髓浸润的诊断价值一致；PET-CT和DWI均不可替代骨髓检查；联合影像学检查进行针对性的骨髓穿刺可进一步提高淋巴瘤骨髓浸润的检出率。%Objective To evaluate the clinical value of PET-CT and DWI for the detection of bone marrow infiltration of lymphoma .Methods The bone marrow samples of 93 untreated patients with pathologically diagnosed lymphoma were retrospectively analyzed . 61 patients underwent PET-CT examination, and other 32 underwent DWI examination .With bone marrow biopsy results as “gold standard”, the rates and sites of bone marrow infiltration of various lymphoma subtypes were analyzed , and the detection rates of the two imaging techniques were compared according to different lymphoma subtypes . Results 39 patients were diagnosed as bone marrow infiltration based on pathological examination of bone marrow biopsies from routine sampling sites and bone marrow pathological examination of biopsies guided by PET-CT and DWI.The sensitivity, specificity, accuracy, positive and negative predictive values of PET-CT for lymphoma bone marrow infiltration were 80.8%, 88.6%, 85.3%, 84.0%and 86.1%, respectively; for DWI examination, these rates were 84.6%, 89.5%, 87.5%, 84.6%and 89.5%, respectively.The detection rates of the two imaging techniques for aggressive lymphoma were 37.5%(18/48) and 38.1%(8/21), respectively, which were slightly higher than those for the indolent lymphoma [23.1%(3/13) and 27.3%(31/1)], although the differences were not statistically significant (P=0.521, P=0.660).For both aggressive lymphoma and indolent lymphoma , the detection rates of DWI were numerically slightly higher than those of PET-CT(P=0.963, P=1.000).Conclusions PET-CT and DWI have important and similar diagnostic value for bone marrow infiltration of lymphoma .None of PET-CT and DWI can replace bone marrow biopsy (BMB).However, image-guided bone marrow biopsies can improve the detection rate of bone marrow infiltration of lymphoma .