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

doi:10.3969/j.issn.1674-8115.2024.12.009

Abstract

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

CLC Number:

R445.6

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.

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References 28

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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

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

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

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

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

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

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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

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