摘要目的 探讨18氟-氟代脱氧葡萄糖(FDG)-正电子发射计算机断层显像(PET)在淋巴瘤分期和疗效评价中的应用价值.方法 回顾性分析179例淋巴瘤患者FDG-PET检测淋巴结和结外病变的结果,并与计算机断层显像(CT)和骨髓活检结果进行比较.采用国际工作组织淋巴瘤疗效标准(IWC)和修订完善的国际工作组织淋巴瘤疗效标准(IWC+PET)评估患者的疗效.结果 治疗前98例患者286处病灶FDG-PET检出219处,检出率为77%;其中结内215个病灶检出157个(73%),结外检出62个(87%);CT则共检出182个(64%),其中结内检出150个(70%),结外仅检出32个(45%).FDG-PET对结内、结外病灶的检m阳性检出率远高于CT(P＜0.01).治疗后81例患者104处病灶,FDG-PET阳性率和特异性分别为81%和68%;CT的阳性检出率和特异性分别为55%和33%,FDG-PET的阳性检出率和特异性高于CT(P＜0.01).IWC标准完全缓解(CR)或不确定的完全缓解(CRu)患者33例,其中8例(24%)复发,FDG-PET阴性患者复发率为21%,而FDG-PET阳性患者复发率为40%.33例患者使用IWC+PET标准重新评估,25例患者CR,其中5例复发(20%).179例患者中133例(74%)FDG-PET检查结果与骨髓活检结果一致,22例FDG-PET阳性患者骨髓活检阴性,FDG-PET的阳性检出率为52%,特异性为83%.结论 FDG-PET在淋巴瘤的分期和疗效评价中具有较高的阳性检出率和特异性,有助于患者准确分期和残余病变性质的鉴别.

abstractsObjective To evaluate the application of 18 F-fluorodeoxyglucose positron emission tomography(FDG-PET)to the staging and detecting residual masses of lymphoma.Methods The clinical data of 179 patients with iymphoma were analyzed retrospectively.The results of FDG-PET,computed tomography (CT)and bone marrow biopsy(BMB)were compared for detection of lymph node/extranodal lymphoid tissue and bone Inarrow infiltration.Therapeutic efficiency was assessed by International Workshop Criteria(IWC)and Revised Integrated International Workshop Criteria(IWC+PET).Results In the detection of 286 disease focuses in 98 patients before chemotherapy,the sensitivities of FDG-PET and CT were 73%and 70%(P＜0.01)in detecting nodal focus,and 87%and 45%(P＜0.01)in detecting extranodal lymphoma respectively.In detection of 104 lesions in 81 patients after chemotherapy,the sensitivities of FDG-PET and CT were 81%and 55%respectively(P＜0.01),and the specificities were 68%and 33%,respectively(P＜0.01)in detecting residual masses.According to IWC criteria,33 patients achieved complete response/unconfirmed complete response(CR/CRu),and 8(24%)relapsed.Patients with PET-positive residual masses had a relapse rate of 40%.whereas only 21%of those with no such masses relapsed.Based on IWC+PET criteria,25 patients achieved CR,with a relapse rate of 20%.Both FDG-PET and BMB produced positive resuits in 133/179(74%)patients.Twenty-two patients with positive FDG-PET results were not detected by BMB.The sensitivities and specificities of FDG-PET for BM infiltration were 52%and 83%.respectively.Conclusions FDG-PET is a high sensitive and specific technique in staging and detecting residual masses of lymphoma.