上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

18F-FDG PET/CT显像在儿童神经母细胞瘤分期中的价值

李佳宁，傅宏亮，冯 方，吴书其，叶智轶   

  1. 上海交通大学 医学院附属新华医院核医学科， 上海 200092
  • 出版日期:2014-06-28 发布日期:2014-06-30
  • 作者简介:李佳宁（1970—）， 男， 副主任医师， 硕士; 电子信箱: jianinglishanghai@aliyun.com。

Value of 18F-PET/CT imaging in staging for children with neuroblastoma

LI Jia-ning, FU Hong-liang, FENG Fang, WU Shu-qi, YE Zhi-yi   

  1. Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2014-06-28 Published:2014-06-30

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摘要：

目的 评价18F-FDG PET/CT在儿童神经母细胞瘤（NB）分期中的应用价值。方法 回顾性分析确诊为NB的45例患儿病例资料，按治疗前后分为治疗前组（n=13）和治疗后组（n=32）。所有患者接受18F-FDG PET/CT显像，以最大标准摄取值（SUVmax）作为PET定量分析依据。结果 治疗前组所有原发灶均见FDG摄取增高（13/13，100%），治疗后组7例FDG摄取增高（7/32，21.9%）。PET/CT检出23例淋巴结转移（23/45，51.1%），其中局部淋巴结转移17例，伴或仅远处淋巴结转移13例；骨（或骨髓）转移18例（18/45，40.0%）；胸膜转移2例；肝转移1例；硬膜下转移3例；脑实质转移1例（部分患者同时存在多器官转移）。PET/CT显像后临床分期:在治疗前组中，4例分期改变（4/13，30.8%），其中1例Ⅱ期患者分期提高到Ⅳ期（1/2），3例Ⅲ期患者分期提高到Ⅳ期（3/5）；在治疗后组中，17例患者分期改变17/32，53.1%），0期患者因4例发现骨（或骨髓）转移，调高分期（4/14，28.6%），可疑Ⅰ期患者中，6例因原发灶区异常软组织影未摄取FDG，调低分期（6/7，85.7%），Ⅱ期患者1例发现盆腔FDG代谢增高结节，调高分期（1/3），Ⅲ期患者中2例分别发现骨及椎管内转移，调高分期（2/2）。结论 18F-FDG PET/CT可以提供客观的分期依据，提高了NB原始分期及再分期的准确性，其中再分期获益更大；Ⅲ期患者的分期改变最为显著；治疗后Ⅰ期患者分期明显调低。PET/CT改变分期的主要原因是对全身病灶检出的敏感性高；另一方面可以评估原发灶术后术区异常组织是否具有活性。

关键词: 儿童, 神经母细胞瘤, 分期, 体层摄影术, 发射型计算机, X线计算机, 脱氧葡萄糖

Abstract:

Objective To evaluate the clinical value of 18F-FDG PET/CT in staging for children with neuroblastoma (NB). Methods The data of 45 patients who were diagnosed as NB were retrospectively analyzed. Patients were divided into the pre-treatment group (n=13) and post-treatment group (n=32). All patients underwent 18F-flourodeoxyglucose (FDG) PET/CT imaging and the maximum standardized uptake value (SUV) was used as the basis for PET quantitative analysis. Results All
patients of the pre-treatment group showed increased FDG uptake at the primary site (13/13, 100%). Seven patients of the post-treatment group showed increased FDG uptake (7/32, 21.9%). Among 23 patients who were detected with lymph nodes metastasis (23/45, 51.1%), 17 with local lymph nodes metastasis, 13 with distant lymph node metastasis, 18 with bone (or bone marrow) metastasis (18/45, 40.0%), 2 with pleura metastasis, 1 with liver metastasis, 3 with meninges metastasis, 1 with brain metastasis (some patients with multi-organ metastasis). After PET/CT imaging, stages of 4 patients of the pre-treatment group changed (4/13, 30.8%). Among them, the stage of 1 patient upgraded from II to IV (1/2), stages of 3 patients upgraded from III to IV (3/5). Stages of 17 patients of the post-treatment group changed (17/32, 53.1%). Stages of 4 stage 0 patients were upgraded due to bone (or bone marrow) metastasis (4/14, 28.6%). Among suspected stage I patients, stages of 6 patients were degraded because abnormal tissues at primary sites had no FDG uptake (6/7, 85.7%). The stage of 1 stage II patient was upgraded because nodules with FDG uptake were found in abdomen (1/3). Stages of 2 stage III patients were upgraded due to bone metastasis and intraspinal metastasis (2/2). Conclusion 18F-FDG PET/CT can provide objective evidences for staging and improve the accuracy of initial staging and re-staging for NB. Re-staging can benefit more from the PET/CT. Stages of stage III patients change more significantly. Stages of stage I patients are degraded significantly after treatments. The main reason that PET/CT can change the stage is the high sensitivity for whole body lesion detection. PET/CT can also evaluate the activity of abnormal tissues in primary sites after operations.

Key words: child, neuroblastoma, staging, tomography, emission-computed, X-ray computed, deoxyglucose