摘要目的 探讨氟-18-脱氧葡萄糖正电子发射型计算机断层显像/CT成像(18F-FDG PET/CT)在儿童神经母细胞瘤(NB)临床分期中的意义.方法 选取2014年12月至2015年12月在首都医科大学附属北京儿童医院经组织病理学和临床特征诊断为NB的患儿,59例行18F-FDG PET/CT检查,比较胸骨及髂骨骨穿、髂骨活检、全身骨扫描、头颅磁共振成像(MRI)、局部CT及B超和血清乳酸脱氢酶及神经元特异性烯醇化酶,分析“F-FDG PET/CT与其他检查结果在原发瘤灶和转移瘤灶方面的异同.结果 1.一般特征:59例患儿中男31例,女28例;原发瘤灶位于腹膜后44例(腹膜后+后纵隔1例),后纵隔14例,左颈部1例;国际神经母细胞瘤分期系统(INSS)-Ⅰ～Ⅳ分别为0、1、9和49例.2.18 F-FDG PET/CT检查结果:最大标准摄取值(SUVmax)最大值:治疗前组(2.34±1.06)大于手术切除后组(1.08±0.50),差异有统计学意义(F =5.699,P=0.000);骨髓转移1.5 ～2.9,局部淋巴结转移1.0～2.1.3.18 F-FDG PET/CT与其他检查结果对比:骨转移中,有3例骨扫描未见异常,而PET/CT示多发骨骼骨髓弥散受累,2例骨扫描示骨转移,18 F-FDG PET/CT示术后炎性反应及残留肿瘤组织侵犯临近椎间孔.18 F-FDG PET/CT示34例骨髓转移,1例不除外骨髓转移,骨骼细胞学阳性30例.中枢转移方面:18F-FDG PET/CT示1例硬膜外转移,而头颅MRI示阴性;头颅MRI示9例颅骨转移,1例眼眶转移,1例脑膜转移,而18F-FDG PET/CT颅内未见异常.所有患儿均未见脑实质转移.同期LDH与原发瘤灶SUVmax最大值相关(一=0.581,P＜0.01).结论 18F-FDG-PET/CT能较全面地显示NB患儿原发灶及转移灶的分布情况,对于NB患儿临床分期有重要作用,但在颅骨转移及中枢转移方面假阴性率高,需结合头颅MRI等检查提高检出率.

abstractsObjective To explore the significance of 18 F-fluorodeoxyglucose positronemission tomography/ computed tomography (18F-FDG PET/CT) scanning for childhood neuroblastoma clinical staging.Methods From December 2014 to December 2015,59 patients confirmed as NB in Beijing Children's Hospital,Capital Medical University,and finding or clinical features were selected by histopathology.Those patients underwent 18 F-FDG PET/CT,bone scan,cranial magnetic resonance image (MRI),bone marrow puncture (two sites) and biopsy,regional CT,ultrasound,serum tumor markers like lactic dehydrogenase and neuronspecific enolase.In comparison of 18F-FDG PET/CT image findings with other detective methods,the differences were analyzed between the primary sites and metastasis were analyzed.Results (1) General features:Out of 59 children with NB,31 were males,28 were females.Primary lesions were as follows:14 cases located in the postmediastinum,44 cases in the retroperitoneum (1 case in retroperitoneum + postmediastinum),1 case in left neck.International Neuroblastoma Staging System Ⅰ to Ⅳ:O,1,9 and 49 cases,respectively.(2)18F-FDG PET-CT manifestations:The maximum of standardized uptake value (SUVmax):before-treatment group was (2.34 ± 1.06) which was larger than the post-surgery group value of (1.08 ± 0.50),and the difference was significant(F =5.699,P =0.000);bone marrow metastasis ranged from 1.5 to 2.9,regional lymphatic metastasis ranged from 1.0 to 2.1.(3)18F-FDG PET-CT imaging compared with other detection:in bone metastases,the whole body bone scan finding were normal in 3 cases,while PET/CT showed disseminated bone and bone marrow involvement and bone scanning showed 2 cases had metastases,combined with 18 F-FDG PET/CT,which were considered as postoperative inflammatory reaction or residual tumor tissues invade adjacent intervertebral foramen.Bone cytology was positive in 30 cases,while PET/CT showed 34 patients with bone marrow metastasis,and 1 case was suspicious.In central metastasis,1 case of PET/CT showed epidural metastasis,while cranial MRI was negative;Cranial MRI showed 9 cases had skull metastasis,1 case had orbital metastasis,1 case had meningeal metastases;while 18F-FDG PET/CT showed no abnormality.All children had no parenchymal metastasis.Corresponding tumor markers as LDH was related to the maximum value of primary tumor focal SUVmax (rs =0.581,P ＜ 0.01).Conclusions 18 F-FDG PET/CT can fully display the distribution of primary sites and metastases,and can be served as medical imaging evidence for both the diagnosis and staging of neuroblastoma.But as for cranial bone and central metastasis,it has high false negative rate.Clinical practice should be combined with cranial MRI to improve relevance ratio.