Usefulness and pitfalls of F-18-FDG PET/CT for diagnosing extramedullary acute leukemia
Usefulness and pitfalls of F-18-FDG PET/CT for diagnosing extramedullary acute leukemia
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DOI：
10.1016/j.ejrad.2015.11.019
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发表时间：
2016-01-01
影响因子：
3.3
通讯作者：
Wang, Quan-shi
中科院分区：
文献类型：
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作者：
Zhou, Wen-lan;Wu, Hu-bing;Wang, Quan-shi
目的：鉴别急性白血病（AL）是否有髓外侵犯是非常重要的，尤其是在复发的患者中。材料与方法：对9例初治AL患者和70例疑似AL复发患者进行PET/CT检查，所有患者均经骨髓活检确诊为AL。髓外病变的诊断是根据病理学、体格检查和影像学技术（包括磁共振成像（MRI）和PET/CT）和/或脑脊液（CSF）细胞学检测和临床随访的组合来确定的。在79例患者中，包括34例急性淋巴细胞白血病（ALL）和45例急性髓细胞白血病（AML），30例确诊为髓外AL，其中42例F18-FDG PET/CT显示髓外区F18-FDG阳性。其中28例诊断为髓外AL，14例诊断为非血液系统恶性肿瘤（假阳性疾病）。F-18-FDG PET/CT诊断AL髓外侵犯的敏感性、特异性和准确性分别为93.3%（28130）、71.4%（35149）和79.7%。髓外AL和假阳性病例之间病灶的F-18-FDG摄取无显著差异（SUVmax：6.66 ± 2.65 vs. 5.85 ± 1.88，t= 1.275，P= 0.206）。ALL和AML髓外AL的FDG摄取率亦无显著性差异（SUVmax：7.01 ± 2.82 vs.6.10 ± 2.29，t= 1.332，P = 0.188）。髓外AL的主要部位是脾脏、软组织、淋巴结、中枢神经系统、肝脏、睾丸和肾脏。48.2%（27156）的髓外AL病灶表现为弥漫性FDG摄取，假阳性病灶为6.25%（1116）（χ 2 =9.221，P = 0.002）。F-18-FDG PET/CT是一种敏感的，但对髓外AL的诊断无特异性，髓外病灶弥漫性F-18-FDG摄取可提示白血病的发生。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Purpose: It is very important to identify whether there is extramedullary involvement in acute leukemia (AL), especially in those with recurrent disease. This retrospective study aimed to assess the role of F-18-FDG PET/CT for diagnosing extramedullary AL.Materials and methods: PET/CT examinations were performed in 9 patients with newly diagnosed AL, and 70 patients suspected to have recurrent AL. All the patients were diagnosed with AL by bone marrow biopsy. The diagnosis of extramedullary lesions was established according to the combination of pathology, physical examination, and imaging techniques including magnetic resonance imaging (MRI) and PET/CT, and/or cerebrospinal fluid (CSF) cytologic testing, and clinical follow-up.Results: Of the 79 patients, including 34 acute lymphocytic leukemia (ALL) and 45 acute myeloid leukemia (AML) cases, 30 patients were diagnosed with extramedullary AL. F-18-FDG PET/CT demonstrated F-18-FDG positive lesions in the extramedullary regions in 42 patients. Among them, 28 patients were diagnosed to have extramedullary AL and the other 14 were diagnosed with non-hematological malignancies (false positive disease). The sensitivity, specificity, and accuracy of F-18-FDG PET/CT in diagnosing extramedullary involvement of AL were 93.3% (28130), 71.4% (35149), and 79.7%, respectively. The F-18-FDG uptake of lesions was not significantly different between extramedullary AL and false positive cases (SUVmax: 6.66 +/- 2.65 vs. 5.85 +/- 1.88, t= 1.275, P= 0.206). The FDG uptake of extramedullary AL between ALL and AML were also not significantly different (SUVmax: 7.01 +/- 2.82 vs. 6.10 +/- 2.29, t= 1.332,P= 0.188). The predominant locations of extramedullary AL were the spleen, soft tissue, lymph nodes, central nerve system, liver, testis, and kidney. A total of 48.2% (27156) of extramedullary AL lesions presented as diffuse FDG uptake compared with 6.25% (1116) in the false positive lesions (chi(2) =9.221, P = 0.002).Conclusion: F-18-FDG PET/CT is a sensitive, but not specific imaging modality for diagnosing extramedullary AL. Diffuse F-18-FDG uptake in extramedullary lesions may indicate leukemia involvement. (C) 2015 Elsevier Ireland Ltd. All rights reserved.