PET/CT在原发性骨淋巴瘤的诊断及分期中的价值

冯洪燕; 涂宁; 王科; 肖雄; 王超; 卜丽红

doi:10.16766/j.cnki.issn.1674-4152.002952

PET/CT在原发性骨淋巴瘤的诊断及分期中的价值

doi: 10.16766/j.cnki.issn.1674-4152.002952

武汉大学人民医院PET中心，武汉大学人民医院分子影像中心, 湖北武汉 430060

基金项目:

国家自然科学基金青年科学基金项目 81701735

详细信息

通讯作者:
卜丽红，E-mail：bulihongs@126.com

中图分类号: R738.1 R814.42
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出版历程
- 收稿日期: 2022-11-30
- 网络出版日期: 2023-05-31

Value of PET/CT on diagnosis and staging of primary bone lymphoma

PET Center, Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China

摘要

摘要: 目的原发性骨淋巴瘤(primary bone lymphoma, PBL)是一种少见的淋巴瘤类型，本研究主要分析PBL的¹⁸F-FDG PET/CT影像学征象，以期提高PBL的诊断及鉴别诊断的准确率，并进行准确分期从而指导临床进行精准治疗。方法回顾性分析武汉大学人民医院PET中心2018年3月—2020年10月检查的10例初诊原发性骨淋巴瘤患者的PET/CT、MRI影像征象及相关临床资料，男性7例，女性3例，年龄为29~73(46.0±7.4)岁，其中10例患者于治疗前行PET/CT检查，8例患者行局部MRI检查；以骨活检作为金标准，分析PBL的发生部位，并分析PET/CT对PBL累及病灶的检出率。结果 PBL患者临床症状以局部疼痛为主；10例PBL患者均为非霍奇金淋巴瘤，其中弥漫大B细胞淋巴瘤占5例。¹⁸F-FDG PET/CT在所有患者(10例)均呈高摄取，SUVmax为2.7~17.5(10.2±5.2)，其中8例患者为多发病灶(ⅣE期)，仅2例患者为单发病灶(ⅠE期)；4例患者仅累及四肢骨，2例患者仅累及中轴骨，4例患者同时累及轴心骨和四肢骨；其中6例患者病灶浸润周围软组织形成团块病灶。MRI影像缺乏特异性，以T₁WI等/低信号、T₂WI高/稍高信号为主，增强扫描呈中度强化。¹⁸F-FDG PET/CT病灶检出率为94.5%，MRI病灶检出率为89.1%。结论 ¹⁸F-FDG PET/CT全身显像能较好地显示骨骼受累的情况并准确判断是否存在上位引流淋巴结受累或结外病变，在PBL诊断及分期等方面有较好的临床应用价值。
- 原发性骨淋巴瘤 /
- ¹⁸F-FDG PET/CT /
- 核磁共振成像 /
- 诊断 /
- 分期
Abstract: Objective Primary bone lymphoma (PBL) is a rare type of malignant lymphoma. This study mainly analyzes the ¹⁸F-FDG PET/CT imaging signs of PBL in order to improve the accuracy of the diagnosis and differential diagnosis of PBL, and conduct accurate staging to guide accurate clinical treatment. Methods A total of 10 patients with untreated PBL were retrospectively enrolled from March 2018 to October 2020 in PET Center of People ' s Hospital of Wuhan University. We analyzed the PET/CT, MRI characteristic and clinical data of PBL patients. There were 7 males and 3 females. The range of age was 29-73 years old with the median age of 46.0±7.4. Ten patients underwent PET/CT examination and 8 patients underwent MRI scanning. Using bone biopsy results as gold standard, the sites of bone infiltration and the detection rates of the PET/CT and MRI were analyzed. Results The main clinical symptoms of PBL patients were bone pain at different locations. The types of pathology of patients all were non-Hodgkin ' s lymphoma, and diffuse large B cell lymphoma in 5 patients. The ¹⁸F-FDG PET/CT were high uptake in all of patients with SUVmax 2.7-17.5 (10.2±5.2). Multiple involved lesions were found in 8 patients, while 2 patients presented with a single involved lesion. Four patients were found to be located in extremity skeleton, 2 in the axial skeleton and 4 in the extremity skeleton and axial skeleton. PET/CT also found the lesions infiltrate to the surrounding soft tissue in 6 patients. MRI images lack specificity, the focus showed iso-intensity or low signal on T₁WI and slightly high or high signal on T₂WI, and enhanced scan showed moderate enhancement. The detection rate of the PET/CT and MRI for PBL were 94.5% and 89.1%, respectively. Conclusion ¹⁸F-FDG PET/CT has the ability to depict bone lesions, and upper draining lymph nodes and extra-nodal involvement. It has good clinical application value for diagnosis and staging of PBL.
- Primary bone lymphoma /
- ¹⁸F-FDG PET/CT /
- MRI /
- Diagnosis /
- Staging

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图 1 PLB PET/CT检查显示单发骨病灶伴周围软组织浸润

注：患者，女性，53岁，PBL患者病理类型：弥漫大B细胞淋巴瘤。¹⁸F-FDG PET/CT(A：MIP图；B和C：横断位CT、PET和PET/CT融合图)显示右侧髂骨溶骨型骨质破坏伴软组织浸润团块形成，病灶明显摄取¹⁸F-FDG，SUVmax：11.5(如箭头所示)；余全身未见其他骨骼受累。MRI(D)显示该病灶T₁WI呈等信号、T₂WI呈稍高信号，增强扫描中度不均匀强化。

Figure 1. PET/CT showed a single bone lesion with infiltration into surrounding soft tissue in PLB patient

下载: 全尺寸图片幻灯片

图 2 PLB患者PET/CT检查显示全身多发骨病灶

注：患者，女性，70岁，PBL患者病理类型：弥漫大B细胞淋巴瘤。¹⁸F-FDG PET/CT(A：MIP图；B和C：横断位CT和PET/CT融合图；D：矢状位CT和PET/CT融合图)显示全身多发骨骼(右侧锁骨头、左侧肩胛骨、右侧第7肋骨、左侧第2、10肋骨、胸5~7、9~12及腰1~4椎体和/或附件、骶1椎体、双侧髂骨、左侧坐骨结节及双侧股骨上段)骨质异常，以硬化型骨质破坏为主，病灶明显摄取¹⁸F-FDG，SUVmax：17.5。MRI(E和F)显示多发胸椎和腰椎见明显异常信号应，T₁WI呈低信号、T₂WI呈等信号，增强扫描中度强化。

Figure 2. PET/CT showed multiple bone lesions in PLB patient

下载: 全尺寸图片幻灯片

表 1 10例PBL患者的基本临床资料

Table 1. Clinical characteristic of 10 patients with primary lymphoma of bone

序号	性别	年龄(岁)	临床症状	发热	病理类型	LDH(U/L)	ALP(U/L)
1	男	32	四肢疼痛、无力	是	间变性大细胞淋巴瘤	176	115
2	女	47	左侧大腿疼痛	否	滤泡性淋巴瘤	197	70
3	男	46	右下肢疼痛	否	弥漫大B细胞淋巴瘤	185	101
4	男	72	四肢疼痛	否	B细胞源性淋巴瘤(浆细胞淋巴瘤可能)	295	103
5	男	75	全身乏力	否	弥漫大B细胞淋巴瘤	336	118
6	女	62	腰痛	否	B淋巴母细胞淋巴瘤/急性淋巴细胞白血病	146	65
7	男	73	咳嗽	否	B细胞源性淋巴瘤(浆细胞淋巴瘤可能)	137	62
8	女	53	左侧大腿疼痛	否	弥漫大B细胞淋巴瘤	158	125
9	女	70	全身疼痛	否	弥漫大B细胞淋巴瘤	124	259
10	男	29	右髋部疼痛	是	弥漫大B细胞淋巴瘤	319	135
注：LDH正常参考范围为120~250 U/L；ALP正常参考范围为45~125 U/L。

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表 2 10例PBL患者的影像学征象

Table 2. Imaging features of 10 patients with primary lymphoma of bone

序号	分期	病灶部位	PET/CT				MRI
序号	分期	病灶部位	病灶数目	CT骨质改变	软组织浸润	SUVmax	病灶数目	T1信号	T2信号	MRI增强
1	ⅣE	多发(中轴骨)	5	溶骨型	是	5.2	5	等信号	高信号	中度
2	ⅠE	单发(四肢骨)	1	溶骨型	是	6.8	1	等信号	稍高信号	中度
3	ⅣE	多发(四肢骨)	4	溶骨型	否	14.9	4	低信号	高信号	中度
4	ⅣE	多发(中轴骨)	8	硬化型	否	3.6	12	等信号	稍高信号	轻度
5	ⅣE	多发(四肢骨)		溶骨型	否	10.6
6	ⅣE	多发(中轴骨+四肢骨)	17	硬化型	是	16.7	13	低信号	稍高信号	中度
7	ⅣE	多发(中轴骨+四肢骨)		硬化型	否	2.7
8	ⅠE	单发(四肢骨)	1	溶骨型	是	11.5	1	低信号	稍高信号	中度
9	ⅣE	多发(中轴骨+四肢骨)	24	混合型	是	17.5	20	低信号	等信号	中度
10	ⅣE	多发(中轴骨+四肢骨)	10	混合型	是	12.4	10	低信号	稍高信号	轻度
注：PET/CT病灶检出率为94.5%，MRI病灶检出率为89.1%。

下载: 导出CSV

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