PET/CT在原发中枢神经系统淋巴瘤诊断中的价值
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摘要
目的分析18F-FDG PET/CT在原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)中的诊断价值及其影像特点。方法回顾分析解放军总医院经病理证实的22例PCNSL及21例高级别胶质瘤患者的PET/CT影像表现及临床资料,对两种脑肿瘤的最大标准摄取值(SUVmax)进行比较。结果 22例PCNSL患者中,病理为弥漫大B型20例,外周T细胞型2例;22例PCNSL患者中,单发病变13例、多发病变9例,其中,单发病灶分布于基底节区4例、丘脑3例、脑室内2例、鞍区1例、小脑1例、额叶及颞叶各1例。22例PCNSL患者PET/CT显像均表现为异常FDG摄取均匀增高,呈结节状、团块状或束带状表现,SUVmax值为:28. 70±8. 61,其中,12例患者同时行18F-FLT PET/CT联合显像表现为FLT摄取增高,而正常脑皮层一般不摄取FLT,这样就形成了较好的肿瘤与正常脑皮层(T/N)的对比。同机CT以等或高密度为主,CT值为:41. 99±4. 63Hu,其中4例病变内见坏死区及囊变;继发征象:轻度水肿15例、中线移位10例、脑室受压16例。21例高级别胶质瘤患者PET/CT显像表现为FDG摄取不均匀增高,SUVmax值为:11. 37±1. 48,病变周围水肿较明显。PCNSL患者的SUVmax高于高级别胶质瘤患者,两者比较差异具有统计学意义(t=1. 86,P <0. 05)。结论原发中枢神经系统淋巴瘤在18F-FDG PET/CT显像中具有一定的影像学表现特点,可与高级别胶质瘤进行鉴别,而18F-FLT和18F-FDG PET/CT联合显像有助于提高PCNSL诊断及鉴别诊断的准确性。
Objective To evaluate the diagnostic value of18 F-FDG PET/CT in primary central nervous system lymphoma(PCNSL) and its characteristics. Methods The PET/CT imaging manifestations and clinical details were analyzed retrospectively in 22 PCNSL and 21 high grade glioma cases which were confirmed by pathology of the PLA general hospital. The maximum standardized uptake value(SUVmax) was compared between two types of diseases. Results Of the 22 patients with PCNSL,20 patients had histopathological biopsy as the diffuse large B-cell lymphoma and 2 patients had the peripheral T-cell lymphoma. Among these22 cases of PCNSL,13 patients had a single lesion,while the other 9 had multiple ones. Of 22 cases,the single lesion was distributed in the basal ganglia in 4 cases,thalamus in 3 cases,ventricle in 2 case,saddle area in 1 case,cerebellum in 1 case,frontal and temporal lobes in 1 case. The PET/CT imaging of 22 patients with PCNSL showed an unusually high uptake of18 F-FDG shaped as nodular,crumb,or bunch of ribbon,and there even an uptake in the lesion,the average SUVmax of which was 28. 70 ± 8. 61. The 12 patients which underwent18 F-FLT PET/CT imaging were also presented with FLT increased uptake and had a better target vs non-target ratio(T/N). The 22 cases of PCNSL were isodense or hyperdense in transverse CT images,including 4 cases of cystic necrosis,15 cases of slightly edema,10 cases of midline shift,16 cases of ventrcles compression. The mean CT value was 41. 99 ± 4. 63 Hu. The uptake of FDG of high grade glioma was increased in 21 patients,and the SUVmax was 8. 3-16. 2; the uptake of tracer in lesion was not homogeneous,and the flake edema could be seen around the lesion. The SUVmax of PCNSL patients was higher than that of high grade glioma; there was statistically significant difference of SUVmax between PCNSL and high grade glioma(t = 1. 86,P < 0. 05). Conclusion18 F-FDG PET/CT of PCNSL has certain imaging characteristic manifestations and clinical features,which can be used for differential diagnosis with high grade glioma.18 F-FDG combined with18 F-FLT in PET/CT imaging can help to improve the accuracy of the diagnosis of PCNSL.
Objective To evaluate the diagnostic value of18 F-FDG PET/CT in primary central nervous system lymphoma(PCNSL) and its characteristics. Methods The PET/CT imaging manifestations and clinical details were analyzed retrospectively in 22 PCNSL and 21 high grade glioma cases which were confirmed by pathology of the PLA general hospital. The maximum standardized uptake value(SUVmax) was compared between two types of diseases. Results Of the 22 patients with PCNSL,20 patients had histopathological biopsy as the diffuse large B-cell lymphoma and 2 patients had the peripheral T-cell lymphoma. Among these22 cases of PCNSL,13 patients had a single lesion,while the other 9 had multiple ones. Of 22 cases,the single lesion was distributed in the basal ganglia in 4 cases,thalamus in 3 cases,ventricle in 2 case,saddle area in 1 case,cerebellum in 1 case,frontal and temporal lobes in 1 case. The PET/CT imaging of 22 patients with PCNSL showed an unusually high uptake of18 F-FDG shaped as nodular,crumb,or bunch of ribbon,and there even an uptake in the lesion,the average SUVmax of which was 28. 70 ± 8. 61. The 12 patients which underwent18 F-FLT PET/CT imaging were also presented with FLT increased uptake and had a better target vs non-target ratio(T/N). The 22 cases of PCNSL were isodense or hyperdense in transverse CT images,including 4 cases of cystic necrosis,15 cases of slightly edema,10 cases of midline shift,16 cases of ventrcles compression. The mean CT value was 41. 99 ± 4. 63 Hu. The uptake of FDG of high grade glioma was increased in 21 patients,and the SUVmax was 8. 3-16. 2; the uptake of tracer in lesion was not homogeneous,and the flake edema could be seen around the lesion. The SUVmax of PCNSL patients was higher than that of high grade glioma; there was statistically significant difference of SUVmax between PCNSL and high grade glioma(t = 1. 86,P < 0. 05). Conclusion18 F-FDG PET/CT of PCNSL has certain imaging characteristic manifestations and clinical features,which can be used for differential diagnosis with high grade glioma.18 F-FDG combined with18 F-FLT in PET/CT imaging can help to improve the accuracy of the diagnosis of PCNSL.
引文
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[11]CAN N,ULUBAY H,YAKUPOGLU H,et al. 18F-FDG avid primary CNS lymphoma located in the ventricles[J]. Clin Nucl Med,2011,36(2):138-140.
[12]KAWASE Y,YAMAMOTO Y,KAMEYAMA R,et al. Comparison of11C-methionine PET and 18F-FDG PET in patients with primary central nervous system lymphoma[J]. Mol Imaging Biol,2011,13(6):1284-1289.
[13]YAMAGUCHI S,HIRATA K,KOBAYASHI H,et al. The diagnostic role of(18)F-FDG PET for primary central nervous system lymphoma[J]. Ann Nuel Med,2014,28(7):603-609.
[14]FERDOVA E,FERDA J,BAXA J,et a1. Assessment of Grading in newlydiagnosed glioma using18F-Fluorothymidine PET/CT[J].Antieaneer Res,2015,35(2):955-959.
[15]SAGA T,KAWASHIMA H,ARAKI N,et a1. Evaluation of primary brain tumors with FLT-PET:usefulness and limitations[J]. Clin Nucl Med,2006,31(12):774-780.
[16]JENKINS C N,COLQUHOUN I R. Characterization of primary intracranial lymphoma by computed tomography:an analysis of 36cases and a review of the literature with particular reference to calcification haemorrhage and cyst formation[J]. Clin Radiol,1998:53(6):428-434.
[17]刘红艳,张雪林,陈燕萍,等.原发性中枢神经系统淋巴瘤的影像学表现与病理对照[J].南方医科大学学报,2009,29(2):333-336.
[18]MAYERHOEFER M E,KARANIKAS G,KLETTER K,et al. Evaluation of diffusion-weighted magnetic resonance imaging for follow-up and treatment response assessment of lymphoma:results of an 18F-FDGPET/CT controlled prospective study in 64 patients[J]. Clin Cancer Res,2015,21(11):2506-2513.
[2]TANG Y Z,BOOTH T C,BHOGAL P,et a1. Imaging of primary central nervous system lymphoma[J]. Clin Radiol,2011,66(8):768-777.
[3]JANG S J,LEE K H,LEE J Y,et a1.(11)C-methionine PET/CT and MRI of primary central nervous system diffuse large B-cell lymphoma before and after high-dose methotrexate[J]. Clin Nucl Med,2012,37(10):e241-244.
[4]REIM ANN A J,RINCK D,BIRINCI-AYDOGAN A,et al.Dualsource Computed Tomography:advances of improved temporal resolution incoronary plaque imaging[J]. Invest Radiol,2007,42(3):196-203.
[5]KAWAI N,MIYAKE K,YAMAMOTO Y,et al. 18F-FDG PET in the Diagnosis and Treatment of Primary Central Nervous System Lymphoma[J]. Biomed Res Int,2013,2013:247152.
[6]周维燕,文剑波,华逢春,等. 18F-脱氧葡萄糖PET/CT与弥散加权成像在原发性中枢神经系统淋巴瘤中的相关性研究[J].肿瘤影像学,2016,25(3):257-262.
[7]Mc NAMARA S. Treatment of primary brain tumours in adults[J].Nurs Stand,2012,27(14):42-47.
[8]MORRIS P G,ABREY L E. Therapeutic challenges in primary CNS lymphoma[J]. Lancet Neurol,2009,8(6):58l-592.
[9]刘鸿良,刘婷,马超,等.原发中枢神经系统淋巴瘤20例临床特点与预后分析[J].中国实验血液学杂志,2015,23(1):111-118.
[10]胡裕效,摇朱,卢光明,等.原发性中枢神经系统淋巴瘤的多模态医学影像学评估[J].实用癌症杂志,2013,28(2):199-202.
[11]CAN N,ULUBAY H,YAKUPOGLU H,et al. 18F-FDG avid primary CNS lymphoma located in the ventricles[J]. Clin Nucl Med,2011,36(2):138-140.
[12]KAWASE Y,YAMAMOTO Y,KAMEYAMA R,et al. Comparison of11C-methionine PET and 18F-FDG PET in patients with primary central nervous system lymphoma[J]. Mol Imaging Biol,2011,13(6):1284-1289.
[13]YAMAGUCHI S,HIRATA K,KOBAYASHI H,et al. The diagnostic role of(18)F-FDG PET for primary central nervous system lymphoma[J]. Ann Nuel Med,2014,28(7):603-609.
[14]FERDOVA E,FERDA J,BAXA J,et a1. Assessment of Grading in newlydiagnosed glioma using18F-Fluorothymidine PET/CT[J].Antieaneer Res,2015,35(2):955-959.
[15]SAGA T,KAWASHIMA H,ARAKI N,et a1. Evaluation of primary brain tumors with FLT-PET:usefulness and limitations[J]. Clin Nucl Med,2006,31(12):774-780.
[16]JENKINS C N,COLQUHOUN I R. Characterization of primary intracranial lymphoma by computed tomography:an analysis of 36cases and a review of the literature with particular reference to calcification haemorrhage and cyst formation[J]. Clin Radiol,1998:53(6):428-434.
[17]刘红艳,张雪林,陈燕萍,等.原发性中枢神经系统淋巴瘤的影像学表现与病理对照[J].南方医科大学学报,2009,29(2):333-336.
[18]MAYERHOEFER M E,KARANIKAS G,KLETTER K,et al. Evaluation of diffusion-weighted magnetic resonance imaging for follow-up and treatment response assessment of lymphoma:results of an 18F-FDGPET/CT controlled prospective study in 64 patients[J]. Clin Cancer Res,2015,21(11):2506-2513.