套细胞淋巴瘤在18F-FDG PET/CT中的显像特征及细胞形态学分型

doi:10.3969/j.issn.1674-8115.2024.12.009

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (12): 1561-1569.doi: 10.3969/j.issn.1674-8115.2024.12.009

• 论著 · 临床研究 • 上一篇

套细胞淋巴瘤在¹⁸F-FDG PET/CT中的显像特征及细胞形态学分型

任怡璇¹^,²(), 陈诚¹, 蔡铭慈³, 陈嘉敏¹, 杨欣欣¹, 王超², 林晓珠², 程澍³, 江旭峰¹^,²(), 陈东旭¹()

^1.江苏省无锡市新吴区新瑞医院核医学科，无锡 214000
^2.上海交通大学医学院附属瑞金医院核医学科，上海 200025
^3.上海交通大学医学院附属瑞金医院血液科，上海 200025

收稿日期:2024-06-18 接受日期:2024-08-27 出版日期:2024-12-28 发布日期:2024-12-28
通讯作者: 江旭峰,陈东旭 E-mail:renyixuan1994@163.com;jxf10885@rjh.com.cn;2796372336@qq.com
作者简介:任怡璇（1994—），女，主治医师，硕士；电子信箱：renyixuan1994@163.com。
基金资助:
无锡市新吴区新瑞医院院级科研项目(2024YJYB004)

Research on the characteristics of ¹⁸F-FDG PET/CT in mantle cell lymphoma and the discrimination between cellular morphological variants

REN Yixuan¹^,²(), CHEN Cheng¹, CAI Mingci³, CHEN Jiamin¹, YANG Xinxin¹, WANG Chao², LIN Xiaozhu², CHENG Shu³, JIANG Xufeng¹^,²(), CHEN Dongxu¹()

^1.Department of Nuclear Medicine, Wuxi Xinwu District Xinrui Hospital, Wuxi 214000, China
^2.Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^3.Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2024-06-18 Accepted:2024-08-27 Online:2024-12-28 Published:2024-12-28
Contact: JIANG Xufeng,CHEN Dongxu E-mail:renyixuan1994@163.com;jxf10885@rjh.com.cn;2796372336@qq.com
Supported by:
Wuxi Xinwu District Xinrui Hospital Scientific Research Project(2024YJYB004)

摘要/Abstract

摘要：

目的·分析¹⁸F-氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描技术（¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography，¹⁸F-FDG PET/CT）对于套细胞淋巴瘤（mantle cell lymphoma，MCL）的显像特点和诊断价值，并探索其在区分MCL经典型与侵袭性变型中的应用。方法·回顾性分析上海交通大学医学院附属瑞金医院116例经病理学确诊的初诊MCL患者的¹⁸F-FDG PET/CT显像及临床资料，分析淋巴结内外病灶的显像特点，评估¹⁸F-FDG PET/CT在诊断MCL骨髓和胃肠道浸润中的准确性，并分析经典型和侵袭性变型MCL的¹⁸F-FDG PET/CT特征及临床特征之间的差异。结果·116例患者中，100.0%的患者在¹⁸F-FDG PET/CT显像中有阳性表现，99.1%的患者有淋巴结异常，85.3%的患者有结外侵犯，其中脾脏、咽淋巴环、骨髓、胃肠道是最常见的结外侵犯部位。与骨髓穿刺结果比较，¹⁸F-FDG PET/CT对MCL骨髓侵犯的灵敏度、特异度以及准确率分别为43.4%、91.5%和66.0%。与胃镜、肠镜的活检结果比较，¹⁸F-FDG PET/CT对胃、肠道浸润的灵敏度分别为100.0%、94.1%，特异度分别为75.0%、100.0%，准确率分别为92.9%、94.7%。最大标准化摄取值（maximum standardized uptake value，SUV_max）和Ki-67指数在MCL经典型与侵袭性变型间差异显著，且SUV_max与Ki-67指数呈正相关。以SUV_max为10.4作为诊断阈值时，区分MCL经典型及侵袭性变型的灵敏度为73.9%，特异度为77.4%，AUC值为0.797。结论·¹⁸F-FDG PET/CT对MCL患者结内外病变具有较高的检出率，在骨髓浸润的诊断中具有较高的特异度，在胃肠道浸润的诊断中灵敏度和特异度均较高，可为MCL骨髓和胃肠道浸润提供非侵入性的、比较可靠的诊断信息，但仍不足以代替病理学检查。SUV_max与Ki-67指数呈正相关。应用SUV_max可以有效区分MCL经典型和侵袭性变型；当SUV_max>10.4时，侵袭性变型可能性更高，否则为经典型；SUV_max可为MCL的治疗策略的选择提供潜在帮助。

关键词: 套细胞淋巴瘤, ¹⁸F-氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描技术, 侵袭性变型

Abstract:

Objective ·To analyze the imaging characteristics and diagnostic value of ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) in mantle cell lymphoma (MCL) and explore its application to distinguishing between classic and aggressive variants of MCL. Methods ·A retrospective analysis was conducted on the ¹⁸F-FDG PET/CT images and clinical data of 116 pathologically confirmed, newly diagnosed MCL patients. The imaging features of intra- and extra-nodal lesions were summarized. The accuracy of ¹⁸F-FDG PET/CT in diagnosing bone marrow and gastrointestinal involvement in MCL was evaluated. Furthermore, differences in ¹⁸F-FDG PET/CT findings and clinical characteristics between the classic and aggressive variants of MCL were analyzed. Results ·Among the 116 patients, 100.0% showed positive findings on ¹⁸F-FDG PET/CT, with 99.1% exhibiting abnormal lymph nodes and 85.3% having extra-nodal involvement. The most common extra-nodal sites were the spleen, Waldeyer's ring, bone marrow, and gastrointestinal tract. Compared with bone marrow aspiration results, the sensitivity, specificity, and accuracy of ¹⁸F-FDG PET/CT for detecting bone marrow involvement in MCL were 43.4%, 91.5%, and 66.0%, respectively. When compared with endoscopic biopsy results, the sensitivity of ¹⁸F-FDG PET/CT for detecting gastric and intestinal involvement was 100.0% and 94.1%, respectively, with specificity of 75.0% and 100.0%, and accuracy of 92.9% and 94.7%, respectively. There were significant differences in the highest maximum standardized uptake value (SUV_max) and Ki-67 index between the classic and aggressive variants of MCL, with SUV_max positively correlated with Ki-67 index. By using SUV_max > 10.4 as the diagnostic threshold, the sensitivity and specificity for differentiating between the classic and aggressive variants of MCL were 73.9% and 77.4%, respectively, with an AUC value of 0.797. Conclusion ·¹⁸F-FDG PET/CT demonstrates a high detection rate for both intra- and extra-nodal lesions in MCL patients. It exhibits high specificity in diagnosing bone marrow involvement and high sensitivity and specificity in diagnosing gastrointestinal involvement, providing reliable non-invasive diagnostic information for MCL bone marrow and gastrointestinal involvement. However, it is not a substitute for pathological examination. Additionally, the positive correlation between SUV_maxand Ki-67 index allows SUV_maxto effectively differentiate between the classic and aggressive variants of MCL, with a higher SUV_max(>10.4) indicating a higher likelihood of the aggressive variant. These findings have clinical implications for treatment planning and prognosis assessment.

Key words: mantle cell lymphoma (MCL), ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT), aggressive variant

中图分类号:

R445.6

任怡璇, 陈诚, 蔡铭慈, 陈嘉敏, 杨欣欣, 王超, 林晓珠, 程澍, 江旭峰, 陈东旭. 套细胞淋巴瘤在¹⁸F-FDG PET/CT中的显像特征及细胞形态学分型[J]. 上海交通大学学报（医学版）, 2024, 44(12): 1561-1569.

REN Yixuan, CHEN Cheng, CAI Mingci, CHEN Jiamin, YANG Xinxin, WANG Chao, LIN Xiaozhu, CHENG Shu, JIANG Xufeng, CHEN Dongxu. Research on the characteristics of ¹⁸F-FDG PET/CT in mantle cell lymphoma and the discrimination between cellular morphological variants[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(12): 1561-1569.

图/表 8

表1 MCL在 18F-FDG PET/CT中阳性病灶分布及SUVmax

Tab 1 Distribution of positive lesion and SUVmax in MCL on 18F-FDG PET/CT

Site	Number/n	Percentage/%^①	SUV_max
Lymph node	115	99.1	8.75±5.47
Extranodal	99	85.3	9.52±5.36
Spleen	62	53.4	5.84±3.58
Waldeyer's ring	56	48.3	9.86±3.58
Bone marrow	30	25.9	4.85±2.00
Intestine	35	30.2	10.21±5.12
Stomach	27	23.3	7.64±3.38
Skin	11	9.5	7.65±2.28
Thyroid	9	7.8	5.5 (4.2,14.4)
Nasal cavity	2	1.7	8.10, 38.50
Parotid gland	2	1.7	4.6, 8.2
Scrotum	2	1.7	3.79, 15.70
Prostate	2	1.7	6.0, 10.2
Pancreas	1	0.9	3.7
Breast	1	0.9	7.0
Eyelid	1	0.9	6.7
Lung	1	0.9	3.4
Pleura	1	0.9	3.1
Gall bladder	1	0.9	8.0

表2 经病理学确诊的病灶与 18F-FDG PET/CT阳性病灶的SUVmax 值比较

Tab 2 Comparison of SUVmax values between pathologically diagnosed lesions and 18F-FDG PET/CT-positive lesions

Site	Pathologically confirmed		PET/CT-positive		t value	P value
Site	Number/n	SUV_max	Number/n	SUV_max	t value	P value
Lymph node	81	8.98±5.13	115	8.75±5.47	-0.291	0.771
Waldeyer's ring	18	9.20±4.36	56	9.86±3.58	0.643	0.522
Bone marrow	53	3.81±1.78	30	4.85±2.00	2.449	0.016
Stomach	10	9.06±4.71	27	7.64±3.38	-1.021	0.314
Intestine	17	10.09±6.41	35	10.21±5.12	0.073	0.942

图1 MCL患者脾脏 18F-FDG PET/CT显像Note： A. PET/CT showed increased, diffuse, uneven metabolism in the spleen. The arrows indicate a localized lesion of metabolic elevation without density change. B. PET/CT showed diffuse, uneven metabolism in the spleen. The arrows indicate a localized lesion of metabolic elevation with increased density. C. PET/CT showed an increase in diffuse, uniform spleen metabolism without density change.

Fig1 18F-FDG PET/CT imaging of the spleens in patients with MCL

表3 18F-FDG PET/CT与病理学诊断的MCL结果比较

Tab 3 MCL in 18F-FDG PET compared with pathological diagnosis

Site	Number/n	¹⁸F-FDG PET/CT	Pathologic diagnosis		Sensitivity/%	Specificity/%	PPV/%	NPV/%	Accuracy/%
Site	Number/n	¹⁸F-FDG PET/CT	MCL	Not MCL	Sensitivity/%	Specificity/%	PPV/%	NPV/%	Accuracy/%
Bone marrow	100	Positive (27)	23	4	43.4	91.5	85.2	58.9	66.0
Bone marrow	100	Negative (73)	30	43	43.4	91.5	85.2	58.9	66.0
Stomach	14	Positive (11)	10	1	100.0	75.0	90.9	100.0	92.9
Stomach	14	Negative (3)	0	3	100.0	75.0	90.9	100.0	92.9
Intestine	19	Positive (16)	16	0	94.1	100.0	100.0	66.7	94.7
Intestine	19	Negative (3)	1	2	94.1	100.0	100.0	66.7	94.7

图2 MCL患者的骨髓 18F-FDG PET/CT显像Note： A. MIP showed uniformly elevated diffuse metabolism in the axial bones and proximal long bones of the extremities. B. PET/CT showed an uneven increase in diffuse metabolism in the proximal medullary cavity of both femurs, accompanied by slight heterogeneity in density. C. MIP showed a diffuse and uneven increase in skeletal metabolism throughout the body.

Fig 2 18F-FDG PET/CT imaging of bone marrow in patients with MCL

图3 MCL患者不同部位病灶的 18F-FDG PET/CT显像Note： A. 18F-FDG PET/CT showed multifocal gastric wall thickening with increased metabolism in the body and antrum of the stomach (arrows). B. Sagittal view of 18F-FDG PET/CT showed diffuse increased metabolism in the ascending colon wall (arrows). C. 18F-FDG PET/CT showed diffuse thickening of the stomach wall in the body with increased metabolism, and nodules of soft tissue density in the gallbladder with slightly increased metabolism (arrows). D. 18F-FDG PET/CT showed diffuse mild hypermetabolism of the thyroid. E. PET/CT showed multiple subcutaneous nodules with increased metabolism (arrows). F. 18F-FDG PET/CT showed right scrotal nodules with increased metabolism (arrows).

Fig 3 18F-FDG PET/CT images of lesions at different sites in patients with MCL

表4 MCL经典型和侵袭性变型在 18F-FDG PET/CT和临床特征的差异比较

Tab 4 Comparison of differences between the typical type and aggressive variant of MCL in 18F-FDG PET/CT and clinical features

Characteristic	Classical type	Aggressive variant	t/χ² value	P value
Number/n(%)	93 (80.2)	23 (19.8)	‒	‒
Age/year	63.71±9.11	59.96±10.21	1.612	0.117
Ki-67/%	29.98±15.07	80.43±15.81	-14.243	<0.001
Proportion of Ⅲ‒Ⅳ stage/%	90.3	91.3	0.021	0.886
Proportion of bone marrow infiltration/%	51.9	57.1	0.186	0.669
SUV_max	9.02±4.79	15.40±7.90	-3.708	0.001
Minor axis of the largest lymph node/cm	2.27±1.18	2.54±1.99	-0.641	0.527
Proportion of increased spleen metabolism/%	50.5	72.7	43.608	0.061
Proportion of increased gastrointestinal metabolism/%	41.9	26.1	1.951	0.163

图4 SUVmax 在MCL中的临床价值分析Note： A. ROC curve of SUVmax in typical type and aggressive variant of MCL. B. Scatter plot for correlation analysis between Ki67 index and SUVmax.

Fig 4 Analysis of the clinical value of SUVmax in MCL

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套细胞淋巴瘤在¹⁸F-FDG PET/CT中的显像特征及细胞形态学分型

Research on the characteristics of ¹⁸F-FDG PET/CT in mantle cell lymphoma and the discrimination between cellular morphological variants

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