淋巴瘤患者化疗相关性脂肪肝组织FDG代谢变化的初步探讨
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摘要
目的:初步探讨淋巴瘤患者化疗相关性脂肪肝组织~(18)F-FDG的代谢分布变化。方法:纳入85例化疗前肝脏正常而化疗后出现脂肪肝的淋巴瘤患者,回顾性分析其化疗前PET/CT(PET0)和化疗后PET/CT(PET1)肝脏背景的代谢变化,记录每次PET/CT显像肝和脾的CT值,肝和纵隔血池标准摄取值(standard uptake value,SUV)、瘦体标准化摄取值(standard uptake value normalized to lean body mass,SUL),以及患者身高、体质量。脂肪肝定义为肝脏CT值≤42 HU,根据肝/脾CT值分为轻、中及重度脂肪肝。采用配对t检验、单因素分析及Games-Howell检验进行统计学分析。结果:85例患者PET0和PET1的体质量指数(body mass index,BMI)分别为22.6±3.9、22.6±3.9(P=0.828),肝脏SUVmean分别为2.21±0.43、1.98±0.51(P<0.001),肝脏SULmean分别为1.74±0.34、1.54±0.34(P<0.001)。轻、中及重度脂肪肝患者分别有41、29及15例。3组的肝脏SUVmean分别为2.15±0.46、1.88±0.59、1.68±0.31(P=0.004),SULmean分别为1.65±0.30、1.47±0.39、1.35±0.22(P=0.005)。从PET0到PET1,轻、中、重度脂肪肝组的SUVmean分别减低0.08±0.49、0.31±0.70、0.50±0.33(P=0.003),SULmean分别减低0.10±0.37、0.27±0.54、0.39±0.22(P=0.003)。两两比较,重度组比轻度组下降更明显(P=0.002)。结论:淋巴瘤患者化疗后脂肪肝的肝脏背景比化疗前正常肝脏减低,且脂肪肝越严重,减低越明显。
Objective: To determine the impact of chemotherapy-associated hepatic steatosis on liver uptake of ~(18)F-FDG in lymphoma patients. Methods: Lymphoma patients who developed hepatic steatosis after the initiation of standardized chemotherapies were recruited. PET/CT scans before(PET0) and after(PET1) chemotherapy were retrospectively reviewed. The hepatic and splenic mean CT attenuation, the hepatic and mediastinal standard uptake value(SUV) and standard uptake value normalized to lean body mass(SUL), and patients' height and body weight were recorded at PET0 and PET1 respectively. Hepatic steatosis was de?ned as liver CT≤42 HU, and then was divided into mild, moderate and severe degrees according to the ratio of hepatic CT/spleen CT.Paired t-test, one-way ANOVA test and Games-Howell test were adopted to determine the statistical differences. Results: A total of 85 patients were included. The values of body mass index(BMI), liver SUVmean, and liver SULmean at PET0 and PET1 were22.6±3.9 vs 22.6±3.9(P=0.828), 2.21±0.43 vs 1.98±0.51(P<0.001), 1.74±0.34 vs 1.54±0.34(P<0.001), respectively. Mild,moderate and severe hepatic steatosis was developed in 41, 29 and 15 patients after chemotherapy. The values of SUVmean and SULmean of liver background in three groups were 2.15±0.46 vs 1.88±0.59 vs?1.68±0.31(P=0.004), and 1.65±0.30 vs 1.47±0.39 vs 1.35±0.22(P=0.005), respectively. The reduction in liver FDG uptake from PET0 to PET 1 was 0.08±0.49, 0.31±0.70, and0.50±0.33 for SUVmean(P=0.003), and 0.10±0.37, 0.27±0.54, and 0.39±0.22 for SULmean(P=0.003) in mild, moderate and severe hepatic steatosis respectively. The reduction in liver background in severe hepatic steatosis was more obvious than that in mild hepatic steatosis(P=0.002). Conclusion: The lymphoma patients who developed hepatic steatosis after chemotherapy present with a decreased liver background in FDG PET scan. The more severe the hepatic steatosis is, the more signi?cant the reduction is.
Objective: To determine the impact of chemotherapy-associated hepatic steatosis on liver uptake of ~(18)F-FDG in lymphoma patients. Methods: Lymphoma patients who developed hepatic steatosis after the initiation of standardized chemotherapies were recruited. PET/CT scans before(PET0) and after(PET1) chemotherapy were retrospectively reviewed. The hepatic and splenic mean CT attenuation, the hepatic and mediastinal standard uptake value(SUV) and standard uptake value normalized to lean body mass(SUL), and patients' height and body weight were recorded at PET0 and PET1 respectively. Hepatic steatosis was de?ned as liver CT≤42 HU, and then was divided into mild, moderate and severe degrees according to the ratio of hepatic CT/spleen CT.Paired t-test, one-way ANOVA test and Games-Howell test were adopted to determine the statistical differences. Results: A total of 85 patients were included. The values of body mass index(BMI), liver SUVmean, and liver SULmean at PET0 and PET1 were22.6±3.9 vs 22.6±3.9(P=0.828), 2.21±0.43 vs 1.98±0.51(P<0.001), 1.74±0.34 vs 1.54±0.34(P<0.001), respectively. Mild,moderate and severe hepatic steatosis was developed in 41, 29 and 15 patients after chemotherapy. The values of SUVmean and SULmean of liver background in three groups were 2.15±0.46 vs 1.88±0.59 vs?1.68±0.31(P=0.004), and 1.65±0.30 vs 1.47±0.39 vs 1.35±0.22(P=0.005), respectively. The reduction in liver FDG uptake from PET0 to PET 1 was 0.08±0.49, 0.31±0.70, and0.50±0.33 for SUVmean(P=0.003), and 0.10±0.37, 0.27±0.54, and 0.39±0.22 for SULmean(P=0.003) in mild, moderate and severe hepatic steatosis respectively. The reduction in liver background in severe hepatic steatosis was more obvious than that in mild hepatic steatosis(P=0.002). Conclusion: The lymphoma patients who developed hepatic steatosis after chemotherapy present with a decreased liver background in FDG PET scan. The more severe the hepatic steatosis is, the more signi?cant the reduction is.
引文
[1]姜文奇,王华庆,高子芬,等.淋巴瘤诊疗学[M].北京:人民卫生出版社,2017.
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[8]ABIKHZER G,ALABED Y Z,AZOULAY L,et al.Altered hepatic metabolic activity in patients with hepatic steatosis on FDG PET/CT[J].AJR Am J Roentgenol,2011,196(1):176-180.180.
[9]KERAMIDA G,POTTS J,BUSH J,et al.Hepatic steatosis is associated with increased hepatic FDG uptake[J].Eur JRadiol,2014,83(5):751-755.
[10]LIN C Y,LIN W Y,LIN C C,et al.The negative impact of fatty liver on maximum standard uptake value of liver on FDG PET.[J].Clin Imaging,2011,35(6):437-441.
[11]LIU G,LI Y,HU P,et al.The combined effects of serum lipids,BMI,and fatty liver on 18F-FDG uptake in the liver in a large population from China:an 18F-FDG-PET/CT study[J].Nucl Med Commun,2015,36(7):709-716.
[12]SALOMON T,NGANOA C,GAC A C,et al.Assessment of alteration in liver 18F-FDG uptake due to steatosis in lymphoma patients and its impact on the Deauville score[J].Eur J Nucl Med Mol Imaging,2018,45(6):941-950.
[13]AMACHER D E,CHALASANI N.Drug-induced hepatic steatosis[J].Semin Liver Dis,2014,34(2):205-214.
[14]RABINOWICH L,SHIBOLET O.Drug induced steatohepatitis:an uncommon culprit of a common disease[J].Biomed Res Int,2015,2015(7):168905.
[15]BOELLAARD R,DELGADO-BOLTON R,OYEN W J,et al.FDG PET/CT:EANM procedure guidelines for tumour imaging:version 2.0.[J].Eur J Nucl Med Mol Imaging,2015,42(2):328-354.
[2]CHESON B D,FISHER R I,BARRINGTON S F,et al.Recommendations for initial evaluation,staging,and response assessment of Hodgkin and non-Hodgkin lymphoma:the Lugano classification[J].J Clin Oncol,2014,32(27):3059-3068.
[3]BARRINGTON S F,MIKHAEEL N G,KOSTAKOGLU L,et al.Role of imaging in the staging and response assessment of lymphoma:consensus of the International Conference on Malignant Lymphomas Imaging Working Group[J].J Clin Oncol,2014,32(27):3048-3058.
[4]JUWEID M E,STROOBANTS S,HOEKSTRA O S,et al.Use of positron emission tomography for response assessment of lymphoma:consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma.[J].J Clin Oncol,2007,25(5):571-578.
[5]PAQUET N,ALBERT A,FOIDART J,et al.Within-patient variability of 18F-FDG:standardized uptake values in normal tissues[J].J Nucl Med,2004,45(5):784-788.
[6]刘国兵,李艳丽,胡鹏程,等.PET/CT显像中肝脏18F-FDG摄取的影响因素[J].中华核医学与分子影像杂志,2015,35(6):506-508.
[7]ABELE J T,FUNG C I.Effect of hepatic steatosis on liver FDG uptake measured in mean standard uptake values[J].Radiology,2010,254(3):917-924.
[8]ABIKHZER G,ALABED Y Z,AZOULAY L,et al.Altered hepatic metabolic activity in patients with hepatic steatosis on FDG PET/CT[J].AJR Am J Roentgenol,2011,196(1):176-180.180.
[9]KERAMIDA G,POTTS J,BUSH J,et al.Hepatic steatosis is associated with increased hepatic FDG uptake[J].Eur JRadiol,2014,83(5):751-755.
[10]LIN C Y,LIN W Y,LIN C C,et al.The negative impact of fatty liver on maximum standard uptake value of liver on FDG PET.[J].Clin Imaging,2011,35(6):437-441.
[11]LIU G,LI Y,HU P,et al.The combined effects of serum lipids,BMI,and fatty liver on 18F-FDG uptake in the liver in a large population from China:an 18F-FDG-PET/CT study[J].Nucl Med Commun,2015,36(7):709-716.
[12]SALOMON T,NGANOA C,GAC A C,et al.Assessment of alteration in liver 18F-FDG uptake due to steatosis in lymphoma patients and its impact on the Deauville score[J].Eur J Nucl Med Mol Imaging,2018,45(6):941-950.
[13]AMACHER D E,CHALASANI N.Drug-induced hepatic steatosis[J].Semin Liver Dis,2014,34(2):205-214.
[14]RABINOWICH L,SHIBOLET O.Drug induced steatohepatitis:an uncommon culprit of a common disease[J].Biomed Res Int,2015,2015(7):168905.
[15]BOELLAARD R,DELGADO-BOLTON R,OYEN W J,et al.FDG PET/CT:EANM procedure guidelines for tumour imaging:version 2.0.[J].Eur J Nucl Med Mol Imaging,2015,42(2):328-354.