~(18)FDG PET/CT在皮肌炎/多发性肌炎伴恶性肿瘤诊断中的应用
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摘要
目的:探讨18F-脱氧葡萄糖(18FDG)正电子发射计算机断层显像(PET)/计算机断层显像(CT)在皮肌炎(DM)/多发性肌炎(PM)伴恶性肿瘤中的影像特点,为DM/PM的诊断提供依据。方法:收集2009—2015年北京协和医院收治的17例DM/PM并发肿瘤的患者和39例同期未并发肿瘤患者的临床资料和18FDG PET/CT影像资料,并进行分析。结果:56例DM/PM患者中并发肿瘤17例,包括淋巴瘤5例(其中3例为T细胞淋巴瘤),肺癌7例,甲状腺癌、乳腺癌、宫颈癌、肝脏神经内分泌肿瘤和胸腺瘤各1例,肿瘤病灶的18FDG摄取较高,最大标准摄取值(SUVmax)为1.47~22.93(7.67±6.60)。全部患者中22例患者18FDG PET/CT显像示全身肌肉弥漫性摄取升高,肌肉的SUVmax为0.71~2.93(1.43±0.68),其中9例患者(40.91%)伴有恶性病变;26例患者18FDG PET/CT显像示局部肌肉摄取升高,肌肉的SUVmax为1.06~8.74(2.62±1.65),其中6例患者(23.08%)伴有恶性病变;8例患者的18 FDG PET/CT显像示全身肌肉18FDG未见摄取升高,其中3例患者(37.50%)伴有恶性病变。15例并发间质性肺炎,其中2例患者(13.33%)伴有恶性病变。结论:肿瘤相关性DM的18FDG PET/CT影像表现有一定特征性,其中全身肌肉弥漫性摄取升高者肿瘤发病率最高;对可疑DM/PM伴恶性肿瘤患者,18 FDG PET/CT可以作为有效的辅助诊断方法。
Objective:To investigate the image characteristics of 18 F-fluorodeoxyglucose(18 FDG)positron emission tomography and computer tomography(PET/CT)in the patients with dermatomyositis(DM)or polymyositis(PM)associated with malignancy,and to provide basis for the diagnosis of DM/PM.Methods:The clinical data of inpatients diagnosed with DM/PM during 2009 to 2015in Peking Union Medical College Hospital were collected.The clinical manifestations and 18 FDG PET/CT wholebody scan were analyzed in the 17 patients with DM/PM complicated with tumor and 39 patients with DM/PM without tumor.Results:Among 56 patients with DM/PM,17 patients were complicated with maglignant tumor;there were 5 patients with lymphoma,7patients with lung cancer,1patient with thyroid carcinoma,1patient with breast cancer,1patient with cervical carcinoma,1patient with neuroendocrine tumor of liver,and 1patient with thymoma.The maximal standard uptake value(SUVmax)of malignant lesions was 1.47-22.93(7.67±6.60).There was diffuse increase of18 FDG uptake in the muscles in 22 patients,and the SUVmax was 0.71-2.93(1.43±0.68);there were9patients(40.91%)associated with malignancies.There was local increase of 18 FDG uptake in the muscles in26 patients,and the SUVmax was 1.06-8.74(2.62±1.65).There were 6patients(23.08%)associated with malignancies.There was normal level of 18 FDG uptake in the muscles in 8 patients;There were 3 patients(37.50%)associated with malignancies.There was 15 patients with interstitial pneumonia,and 2 patients(13.33%)associated with malignancies.Conclusion:The 18 FDG PET/CT image of tumor-associated DM/PM has the certain characteristics.The patients with diffuse increase of 18 FDG uptake in the muscles have the highest incidence rate of tumor.18FDG-PET/CT may become an effective method of assisted diagnosis for the patients with suspected DM/PM.
Objective:To investigate the image characteristics of 18 F-fluorodeoxyglucose(18 FDG)positron emission tomography and computer tomography(PET/CT)in the patients with dermatomyositis(DM)or polymyositis(PM)associated with malignancy,and to provide basis for the diagnosis of DM/PM.Methods:The clinical data of inpatients diagnosed with DM/PM during 2009 to 2015in Peking Union Medical College Hospital were collected.The clinical manifestations and 18 FDG PET/CT wholebody scan were analyzed in the 17 patients with DM/PM complicated with tumor and 39 patients with DM/PM without tumor.Results:Among 56 patients with DM/PM,17 patients were complicated with maglignant tumor;there were 5 patients with lymphoma,7patients with lung cancer,1patient with thyroid carcinoma,1patient with breast cancer,1patient with cervical carcinoma,1patient with neuroendocrine tumor of liver,and 1patient with thymoma.The maximal standard uptake value(SUVmax)of malignant lesions was 1.47-22.93(7.67±6.60).There was diffuse increase of18 FDG uptake in the muscles in 22 patients,and the SUVmax was 0.71-2.93(1.43±0.68);there were9patients(40.91%)associated with malignancies.There was local increase of 18 FDG uptake in the muscles in26 patients,and the SUVmax was 1.06-8.74(2.62±1.65).There were 6patients(23.08%)associated with malignancies.There was normal level of 18 FDG uptake in the muscles in 8 patients;There were 3 patients(37.50%)associated with malignancies.There was 15 patients with interstitial pneumonia,and 2 patients(13.33%)associated with malignancies.Conclusion:The 18 FDG PET/CT image of tumor-associated DM/PM has the certain characteristics.The patients with diffuse increase of 18 FDG uptake in the muscles have the highest incidence rate of tumor.18FDG-PET/CT may become an effective method of assisted diagnosis for the patients with suspected DM/PM.
引文
[1]银正民.北京肿瘤急症学[M].北京:人民卫生出版社,2000,615-616.
[2]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):344-347.
[3]Zampieri S,Valente M,Adami N,et al.Polymyositis,dermatomyositis and maligancy:A further in triguring link[J].Autoimmun Rev,2010,9(6):449-453.
[4]Maoz CR,Langevitz P,Livneh A,et al.High incidence of malignancies in patients with dermatomyositis and polymyositis:an 11-year analysis[J].Semin Arthritis Rheum,1998,27(5):319-324.
[5]Chen YJ,Wu CY,Huang YL,et al.Cancer risks of dermatomyositis and polymyositis:a nationwide cohort study in Taiwan[J].Arthritis Res Ther,2010,12(2):R70.
[6]苟丽娟,苏金梅,赵岩,等.皮肌炎和多发性肌炎伴发肿瘤临床特点及文献回顾[J].中华临床免疫和变态反应杂志,2012,6(4):295-299.
[7]邓紫玉,王云莉.皮肌炎/多发性肌炎合并恶性肿瘤14例临床分析[J].中国实用医药,2009,4(3):196-197.
[8]谢红付,朱武.皮肌炎患者合并恶性肿瘤的临床分析[J].临床皮肤科杂志,2000,29(1):22-23.
[9]Suh KJ,Park JK,Cho S,et al.Dermatomyositis in a patient with cholangiocarcinoma detected by an[18F]-fluorodeoxyglucose positron emission tomography/computed tomography scan[J].Cancer Res Treat,2015,47(1):1-5.
[10]Jayanthi MR,Basher RK,Bhadada SK,et al.A case of adult dermatomyositis with calcinosis universalis[J].J Nucl Med,2014,29(4):278-279.
[11]Chung WS,Lin CL,Sung FC,et al.Increased risk of venous thromboembolism in patients with dermatomyositis/polymyositis:a nationwide cohort study[J].Thromb Res,2014,134(3):622-626.
[12]Tanaka S,Ikeda K,Uchiyama K,et al.[18 F]FDG uptake in proximal muscles assessed by PET/CT reflects both global and local muscular inflammation and provides useful information in the management of patients with polymyositis/dermatomyositis[J].Rheumatology(Oxford),2013,52(7):1271-1278.
[13]Dalakas MC.Pathogenesis and therapies of immunemediated myopathies[J].Autoimmun Rev,2012,11(3):203-206.
[14]Chandesris MO,Durand JM,Gamby T,et al.Dermatomyositis with cutaneous necrosis revealing a fallopian tube carcinoma[J].Rev Med Int,2005,26(6):508-510.
[15]Grau JM,Miro O,Pedrol E,et al.Interstitial lung disease related to dermatomyositis.Comparative study with patients without lung involvement[J].J Bheumatol,1996,23(11):1921-1926.
[2]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):344-347.
[3]Zampieri S,Valente M,Adami N,et al.Polymyositis,dermatomyositis and maligancy:A further in triguring link[J].Autoimmun Rev,2010,9(6):449-453.
[4]Maoz CR,Langevitz P,Livneh A,et al.High incidence of malignancies in patients with dermatomyositis and polymyositis:an 11-year analysis[J].Semin Arthritis Rheum,1998,27(5):319-324.
[5]Chen YJ,Wu CY,Huang YL,et al.Cancer risks of dermatomyositis and polymyositis:a nationwide cohort study in Taiwan[J].Arthritis Res Ther,2010,12(2):R70.
[6]苟丽娟,苏金梅,赵岩,等.皮肌炎和多发性肌炎伴发肿瘤临床特点及文献回顾[J].中华临床免疫和变态反应杂志,2012,6(4):295-299.
[7]邓紫玉,王云莉.皮肌炎/多发性肌炎合并恶性肿瘤14例临床分析[J].中国实用医药,2009,4(3):196-197.
[8]谢红付,朱武.皮肌炎患者合并恶性肿瘤的临床分析[J].临床皮肤科杂志,2000,29(1):22-23.
[9]Suh KJ,Park JK,Cho S,et al.Dermatomyositis in a patient with cholangiocarcinoma detected by an[18F]-fluorodeoxyglucose positron emission tomography/computed tomography scan[J].Cancer Res Treat,2015,47(1):1-5.
[10]Jayanthi MR,Basher RK,Bhadada SK,et al.A case of adult dermatomyositis with calcinosis universalis[J].J Nucl Med,2014,29(4):278-279.
[11]Chung WS,Lin CL,Sung FC,et al.Increased risk of venous thromboembolism in patients with dermatomyositis/polymyositis:a nationwide cohort study[J].Thromb Res,2014,134(3):622-626.
[12]Tanaka S,Ikeda K,Uchiyama K,et al.[18 F]FDG uptake in proximal muscles assessed by PET/CT reflects both global and local muscular inflammation and provides useful information in the management of patients with polymyositis/dermatomyositis[J].Rheumatology(Oxford),2013,52(7):1271-1278.
[13]Dalakas MC.Pathogenesis and therapies of immunemediated myopathies[J].Autoimmun Rev,2012,11(3):203-206.
[14]Chandesris MO,Durand JM,Gamby T,et al.Dermatomyositis with cutaneous necrosis revealing a fallopian tube carcinoma[J].Rev Med Int,2005,26(6):508-510.
[15]Grau JM,Miro O,Pedrol E,et al.Interstitial lung disease related to dermatomyositis.Comparative study with patients without lung involvement[J].J Bheumatol,1996,23(11):1921-1926.