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非霍奇金淋巴瘤(non-Hodgkin lymphoma, NHL)是最常见的血液系统恶性肿瘤,其中,弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma, DLBCL)是NHL最常见的亚型,约占NHL的30%~40%[1]。在利妥昔单抗联合环磷酰胺+阿霉素+长春新碱+泼尼松(R-CHOP)作为一线治疗方案后,DLBCL的治愈率已大大提升[2],但仍有约1/3的患者对标准治疗方案的反应差或出现早期复发,并且挽救治疗的效果不佳,从而导致这部分患者预后不良[3-4]。因此,精准分期及准确评估治疗效果对于DLBCL患者来说非常重要。
影像学检查在淋巴瘤患者的诊疗过程中必不可少,18F-FDG PET/CT检查既能提供病灶的解剖学信息,又能显示病灶的代谢特征,在DLBCL的分期、再分期、侵袭性评估和疗效监测上具有不可替代的作用,近年来其临床应用日益广泛[2, 5]。18F-FDG PET/CT图像重建后获取的代谢参数在DLBCL诊疗中的价值已经越来越受到重视,SUVmax、代谢肿瘤体积(metabolic tumor volume, MTV)和病灶糖酵解总量(total lesion glycolysis, TLG)是临床和基础研究中最常用的代谢参数,其中MTV是对具有高糖酵解活性肿瘤组织的体积测量,当同一患者具有多个代谢病灶时,将所有病灶的MTV相加得到的总代谢肿瘤体积(TMTV)来表示高糖酵解活性肿瘤组织的体积。淋巴瘤 18F-FDG PET/CT及PET/MR显像临床应用指南(2021版)[6]指出,DLBCL基线18F-FDG PET/CT代谢参数MTV具有强大的预后预测价值。目前已有许多团队对MTV在DLBCL预后预测中的价值进行了研究,但在如何将其具体应用于临床实践中还存在一些争议,本文就18F-FDG PET/CT代谢参数MTV在DLBCL预后预测中的价值进行综述。
18F-FDG PET/CT代谢参数MTV在弥漫大B细胞淋巴瘤预后预测中的研究进展
Research progress of 18F-FDG PET/CT metabolic parameter MTV in the prognosis prediction of diffuse large B-cell lymphoma
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摘要: 弥漫大B细胞淋巴瘤(DLBCL)是最常见的血液系统恶性肿瘤之一,常规采用利妥昔单抗联合环磷酰胺+阿霉素+长春新碱+泼尼松的治疗方案已将DLBCL的治愈率提高,但是不同患者的预后差异较大,目前预测预后的方法存在一定的局限性。18F-氟脱氧葡萄糖(FDG)PET/CT已广泛应用于DLBCL的诊疗中,其代谢参数代谢肿瘤体积(MTV)是DLBCL预后强有力的预测因子,但如何将MTV更好地应用于临床尚存在一些争议,笔者就MTV在DLBCL预后预测中的研究进展进行综述。
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关键词:
- 淋巴瘤,大B细胞,弥漫性 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 预后 /
- 代谢肿瘤体积
Abstract: Diffuse large B-cell lymphoma (DLBCL) is one of the most common hematologic malignancies, and the conventional application of Rituximab in combination with cyclophosphamide + adriamycin + vincristine + prednisone treatment regimen has increased the cure rate of DLBCL, but the prognosis varies widely among patients. The current methods for predicting prognosis have some limitations. 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used in the diagnosis and treatment of DLBCL, and its metabolic parameter metabolic tumor volume (MTV) is a strong predictor. However, there are still some controversies on how to better apply MTV in clinical practice. This paper reviews the research progress of MTV in predicting the prognosis of DLBCL. -
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