【摘要】 目的应用氟标记的氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像及传统CT显像在弥漫大B细胞淋巴瘤（DLBCL）化疗中期治疗前分期及治疗2～4疗程后疗效评价,应用新的肿瘤评价系统PERCIST标准草案（PER-CIST）,将病例图像进行归一化和标准化后进行疗效评估。方法回顾分析我院2011年9月～2015年9月,在本科检查经病理确诊DLBCL 66例,均为初诊患者。66例患者均进行国际预后指数评分及分期,评价初诊患者分期及临床分期。在治疗前及化疗2～4个周期后行¹⁸F-FDG PET/CT显像及CT显像,依据中国DLBCL诊断与治疗指南（2013年版）,所有患者均根据行免疫化疗（R-CH0P）治疗方案,根据疗效分为有效组及无效组。PET/CT与传统影像CT比较灵敏度、特异性、准确率、阳性预测值及阴性预测值及化疗前后最大病灶标准化摄取值（SUVmax）。应用肿瘤评价系统PERCIST标准,对66例患者中21例行图像处理,得到完全代谢缓解（CMR）和代谢恶化（PMD）等对疗效进行评价。结果 1)本研究¹⁸F-FDG PET/CT与CT二者在灵敏度、准确率、阳性预测值及阴性预测值等方面比较,PET/CT比CT分别提高了17. 77%、21. 44%、5. 6%、86. 2%,差异均有统计学意义（X²=36. 43,P=0. 00;X²=45. 62,P=0. 00;X²=6. 25,P=0. 01;X²=30. 78,P=0. 00）; 2) 66例DLBCL患者化疗后:CT评价中的19名PR患者中,10位患者在PET/CT疗效评价标准中为重新修定为CR; CT评价27例CR患者中,8位患者PET/CT发现新增病灶; 3) DLBCL患者行化疗前、2～4疗程化疗后病灶SUVmax之间差异具有统计学意义（t=3. 58,P <0. 05）,治疗有效组SUVmax呈下降趋势,无效组呈上升趋势; 4)应用肿瘤评价系统PERCIST标准疗效评价,能够更好的从定量水平观察病变代谢水平变化,评价肿瘤是否有活性,进行中期疗效评价。结论在化疗中期对DLBCL患者行¹⁸F-FDG PET/CT显像对临床诊断、分期及疗效评价有较大的临床价值。更多还原

【Abstract】 Objective To explore the value of positron-emission tomography with fluoro-18-labeled fluorodeoxyglucose(¹⁸F-FDG) and conventional CT imaging for the clinical staging before treatment and curative effect evaluation after 2 ～ 4 courses oftreatment in diffuse large B cell lymphoma（ DLBCL）. Meanwhile,imaging results of incorporated patients were normalized andstandardized to evaluate the clinical efficacy by applying the updated draft standard of Response Evaluation Criteria in SolidTumors（ PECIST） for tumor evaluation. Methods A retrospective analysis was made by collecting 66 preliminarily diagnosedpatients with pathologically confirmed DLBCL in the department of our hospital from September 2011 to September 2015. The 66 patients had international prognostic index scoring and staging,and the staging and clinical staging of the preliminarily diagnosedpatients were evaluated subsequently. Before treatment and after 2 ～ 4 cycles of chemotherapy,¹⁸F-FDG PET/CT imaging and CTimaging were performed in all patients. According to the guidelines for diagnosis and treatment of DLBCL in China（ 2013 edi-tion）,all patients received immunochemotherapy regimen,rituximab combined with CHOP（ R-CHOP）. Patients were then divid-ed into the effective group and ineffective group based on the curative effect. The sensitivity,specificity,accuracy,positive pre-dictive value and negative predictive value,as well as standardized uptake value of the maximum lesion（ SUVmax） before and af-ter chemotherapy were compared in view of PET/CT and conventional CT imaging. Using the standard of PECIST for tumor evalua-tion system,21 of 66 patients underwent image processing to obtain the complete metabolic remission（ CMR） and progressivemetabolic disease（ PMD） for the evaluation of curative effect. Results 1) In the study,in the comparison between¹⁸F-FDGPET/CT and CT,sensitivity,accuracy,positive predictive value and negative predictive value using PET/CT were increased by17. 77%,21. 44%,5. 6% and 86. 2% than those by CT,respectively,and the statistical differences were significant（ X²=36. 43,P = 0. 00; X²= 45. 62,P = 0. 00; X²= 6. 25,P = 0. 01; X²= 30. 78,P = 0. 00）; 2) After chemotherapy in the 66 pa-tients with DLBCL,19 patients with PR evaluated by CT,10 patients were revised to CR in the clinical evaluation by applyingPET/CT standard. Additionally,in the 27 patients with CR evaluated by CT,8 patients were found to have new lesions with PET/CT; 3) Furthermore,there was statistical difference in the comparison of SUVmax in DLBCL patients before chemotherapy and af-ter 2 ～ 4 cycles of chemotherapy（ t = 3. 58,P < 0. 05）. In the effective group,SUVmax showed a downward trend,but the inva-lid group indicated an upward trend; 4) The application of PERCIST for the assessment of therapeutic effects could contribute tobetter observation of the change of metabolic level of tumor from the quantitative level,so as to evaluate whether the tumor was ac-tive or not,and thus to evaluate the medium-term therapeutic effect. Conclusion¹⁸F-FDG PET/CT imaging has great clinicalvalue for clinical diagnosis,staging and curative effect evaluation for DLBCL patients in the medium-term chemotherapy.更多还原