目的：评估18F-FDG PET/CT在造血干细胞移植后淋巴细胞增殖性疾病（Post-transplant lymphoproliferative disorder，PTLD）中的初步应用价值。方法：回顾性分析本院2008年1月—2017年12月曾行18F-FDG PET/CT检查的造血干细胞PTLD患者的资料。绘制患者临床信息的图表，研究患者18F-FDG PET/CT影像特征，并评价其在引导活检、疗效评估中的作用。结果：共纳入患者9例，6例经病理学检查确诊为PTLD，3例根据临床表现、EB病毒浓度升高、影像表现作出诊断。9例患者在造血干细胞移植后做共接受18次18F-FDG PET/CT扫描。在18F-FDG PET/CT图像上，包括淋巴结和结外两类病变，呈高代谢。有5例患者在18F-FDG PET/CT图像的引导下行组织病理活检，结果均为阳性，包括多形性2例，多形性伴局部弥漫性大B细胞淋巴瘤样变1例，弥漫性大B细胞淋巴瘤2例。1例患者根据触诊行颈部淋巴结活检，结果为PTLD阴性。有1例患者发现脑内多发病变，手术切除后病理提示为弥漫性大B细胞淋巴瘤。治疗结束后，6例行18F-FDG PET/CT扫描评估治疗效果的患者均表现为缓解。结论：18F-FDG PET/CT在造血干细胞PTLD患者的影像诊断、引导活检、疗效评估中有重要作用。
Abstract
Objective: To evaluate usefulness of fluorine-18 2-fluoro-2-deoxyglucose PET and computed tomography(18F-FDG PET/CT) in post-transplant lymphoproliferative disorder(PTLD) after hematopoietic stem cell transplantation(HSCT). Methods: From January 2008 to October 2017, the records of all patients that had undergone 18F-FDG PET/CT for evaluation of PTLD after HSCT were analyzed retrospectively. A chart review of clinical information was performed, the imaging features of 18F-FDG PET/CT were reported, and its role in guiding biopsy and evaluating treatment response following therapy was assessed. Results: A total of 9 patients(7 male and 2 female; 18~35 years of age, average: 24 years) were identified. Among them, 6 cases were diagnosed as PTLD based on the pathological result, and another 3 had been treated for PTLD based on clinical findings, elevated EBV, and positive imaging findings. Nine patients had a total of 18 18F-FDG PET/CT scans prior to or following HSCT. Both lymph nodal and extranodal sites of involvement could be detected on 18F-FDG PET/CT images, which showed more lymph node lesions rather than extranodal lesions, and both types of lesions demonstrated increased 18F-FDG uptake. Five patients underwent biopsy guided by 18F-FDG PET/CT images. The biopsy results of 5 cases were positive for PTLD, including polymorphic subtype in 2 cases, polymorphic subtype with local diffuse large B cell lymphoma change in 1 case and diffuse large B-cell lymphoma in 2 cases. One patient underwent biopsy based on palpable cervical lymph nodes and the result was reactive hyperplasia of lymph nodes which was negative for PTLD. There was 1 patient with multiple involvement of the central nervous system which was diffuse large B cell lymphoma on final histology after resection. The corresponding therapeutic protocol was reviewed. Six patients underwent 18F-FDG PET/CT scans to evaluate treatment response following therapy, and all were demonstrated improvement. Conclusion: 18F-FDG PET/CT plays an important role in imaging diagnosis, guided biopsy and therapeutic evaluation of PTLD patients after hematopoietic stem cell transplantation.
关键词
淋巴组织增殖性疾病 /
造血干细胞移植 /
氟脱氧葡萄糖F18 /
正电子发射断层显像术
Key words
Lymphoproliferative disorders /
Hematopoietic stem cell transplantation /
Fluorodeoxyglucose F18;
中图分类号：
Ｒ457.7
Ｒ557.4
Ｒ817.4
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基金
华南理工大学中央高校基本科研业务专项资金（编号：2018MS28）。
