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多发性骨髓瘤(multiple myeloma,MM)是一种由浆细胞异常增殖引起的恶性血液疾病,是仅次于非霍奇金淋巴瘤的第2大常见的血液系统恶性肿瘤,约占血液系统恶性肿瘤的10%。MM在中老年人群中的发病率较高,确诊时患者的中位年龄为66岁,只有2%的患者确诊时年龄在40岁以下[1]。MM以血清或尿液中出现过量的单克隆免疫球蛋白、轻链或重链片段为特征,临床上以高钙血症、肾功能损害、贫血、骨骼损害和感染等为主要表现,前4种表现在临床上被称为“螃蟹标准”(CRAB)。骨病是MM的典型特征,其影像学表现多样,可为弥漫性或局灶性骨浸润、髓外病变(extramedullary disease,EMD)等。
18F-FDG PET/CT因可显示细胞水平上的葡萄糖代谢情况而成为评估和监测MM病灶代谢变化的首选功能显像方法,且已被纳入国际骨髓瘤工作组(International Myeloma Working Group,IMWG)制定的最新的MM诊断标准中[2]。相较于其他影像学检查方法,18F-FDG PET/CT反映的病灶糖摄取变化可帮助临床医师更早地评估治疗反应,并进一步预测预后。18F-FDG PET/CT还可与灵敏度高的骨髓监测技术联合使用以提高检测骨髓内外的微小残留病(minimal residual disease,MRD)的能力。此外,18F-FDG PET/CT能够通过对隐匿性溶骨病患者进行监测,从而推测冒烟型MM(smoldering myeloma,SMM)进展为活动性MM的时间;且作为一种全身显像技术,其对疑似髓外浆细胞瘤和孤立性骨浆细胞瘤的初步诊断也有一定价值。我们对PET/CT在MM中的临床应用及进展进行综述,以期提高临床医师对PET/CT在MM诊疗中临床价值的认识,从而进一步发挥PET/CT在MM临床决策中的重要作用。
PET/CT在多发性骨髓瘤中的临床应用及进展
Clinical application and progress of PET/CT in multiple myeloma
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摘要: 多发性骨髓瘤(MM)是一种浆细胞恶性增殖性疾病,异常增生的克隆性浆细胞可累及骨骼系统或髓外,进而造成组织或器官损伤。18F-氟脱氧葡萄糖(FDG)PET/CT可以监测全身葡萄糖代谢,故已成为评估MM病况的主要影像学方法之一。笔者就18F-FDG PET/CT在MM诊断、分期、疗效评估和预后预测中的临床应用作一综述,并分析了其局限性,同时,对新型分子探针在MM中的应用进行了介绍和展望,以期提高临床医师对PET/CT在MM诊疗中临床价值的认知,进一步发挥PET/CT在MM临床决策中的重要作用。
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关键词:
- 多发性骨髓瘤 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 诊断 /
- 预后 /
- 疗效评估
Abstract: Multiple myeloma (MM) is a proliferous plasma cell malignancy. Abnormal proliferation of clonal plasma cells could not only involve skeletal system but also invade extramedullary and cause tissues or organs damage. 18F-fluorodeoxyglucose (FDG) PET/CT has become one of the most primary imaging methods for condition evaluation of MM by monitoring systemic glucose metabolism. The authors review the clinical application of 18F-FDG PET/CT in the diagnosis, staging, efficacy evaluation and prognosis prediction of MM, analyze its limitations, also introduce and prospect the application of new molecular probes in MM, in order to improve the clinicians' understanding of the clinical value of PET/CT in the diagnosis and treatment of MM, and further play the essential role of PET/CT in the clinical decision-making of MM. -
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