The usefulness of (18)F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD).
The usefulness of (18)F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD).
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DOI：
10.1186/s12885-016-2672-8
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发表时间：
2016-08-15
期刊：
影响因子：
3.8
通讯作者：
Tamaki N
中科院分区：
文献类型：
--
作者：
Watanabe S;Manabe O;Hirata K;Oyama-Manabe N;Hattori N;Kikuchi Y;Kobayashi K;Toyonaga T;Tamaki N
甲氨蝶呤相关淋巴增生性疾病(MTX-LPD)是一种良性淋巴组织增生性疾病或恶性淋巴瘤，发生在接受过MTX治疗的患者身上。在甲氨蝶呤治疗期间出现低密度脂蛋白血症的患者的初期治疗中应考虑停用甲氨蝶呤并进行短期观察。在此，我们评估了18F-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18F-FDGPET/CT)对MTX-LPD的诊断准确性和预测价值。我们对15例临床怀疑为MTX-LPD的患者进行了回顾性调查。用18F-FDGPET/CT和多排螺旋CT(MDCT)对324个解剖区域(207个结节和117个结外区域)进行了评估。每个解剖区域被分类为恶性或良性。用标准摄取值最大值(SUVmax)、全身代谢肿瘤体积(WBMTV)和全身病变糖酵解(WBTLG)半定量评价18F-FDG摄取，以探讨MTX停药后自发消退的预测因素。92/324个区域(28.4%)出现MTX-LPD病变。18F-FDG PET/CT的敏感性、特异性和准确性分别为90.2%、97.4%和95.4%，明显高于MDCT的59.8%、94.8%和84.9%。P <； 0.002)。停用MTX后，9/15例(60.0%)患者完全缓解(CR)。CR患者的SUVmax、WBMTV和WBTLG分别为9.2ml2.8~47.1、44.3ml(0~362.6)、181.8(0~2180.9)ml，与非CR患者分别为10.6(0~24.9)、15.7(0~250.1)、97.4(0~1052.1)ml，差异无统计学意义。停用MTX前的18F-FDGPET参数均不能预测停药后的CR。
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a benign lymphoid proliferation or malignant lymphoma in patients who have been treated with MTX. MTX withdrawal and observation for a short period should be considered in the initial management of patients who develop LPD while on MTX therapy. Here we evaluated the diagnostic accuracy and predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for MTX-LPD. We retrospectively investigated the cases of 15 patients clinically suspected of having MTX-LPD. A total of 324 anatomic regions (207 nodal and 117 extranodal regions) were assessed by 18F-FDG PET/CT and by multi-detector row CT (MDCT). Each anatomic region was classified as either malignant or benign. The uptake of 18F-FDG was assessed semi-quantitatively with the standardized uptake value maximum (SUVmax), the whole-body metabolic tumor volume (WBMTV), and the whole-body total lesion glycolysis (WBTLG) in order to investigate predictive factors of spontaneous regression after the withdrawal of MTX. MTX-LPD lesions were observed in 92/324 (28.4 %) regions. 18F-FDG PET/CT showed 90.2 % sensitivity, 97.4 % specificity, and 95.4 % accuracy, values which were significantly higher than those of MDCT (59.8, 94.8, and 84.9 %, respectively. p < 0.002). After the withdrawal of MTX, 9/15 patients (60.0 %) achieved complete response (CR). The SUVmax, WBMTV and WBTLG values of the CR patients were 9.2 (range 2.8–47.1), 44.3 (range 0–362.6) ml, 181.8 (range 0–2180.9) ml, respectively, which were not significantly different from those of the non-CR patients: 10.6 (range 0–24.9), 15.7 (range 0–250.1) ml, and 97.4 (range 0–1052.1) ml. Although 18F-FDG PET/CT was a useful tool to detect MTX-LPD lesions, none of the 18F-FDG PET parameters before the withdrawal of MTX could be used to predict CR after the withdrawal of MTX.