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淋巴瘤是儿童及青少年中除白血病、脑和中枢神经系统以外的第三大恶性肿瘤,约占所有儿科恶性肿瘤的10%~15%,其中非霍奇金淋巴瘤(Non-Hodgkins lymphoma,NHL)占60%,霍奇金淋巴瘤(Hodgkins lymphoma,HL)占40%[1]。HL更多侵犯淋巴结和脾脏,多表现为无痛性淋巴结肿大,其中多达80%的病例涉及颈部淋巴结。儿童及青少年淋巴瘤与成人淋巴瘤在多个方面有着明显的不同,混合细胞型和结节硬化型是青春期前期HL的两种主要组织病理学亚型,而青少年HL主要以结节硬化型为主[2];小儿NHL多为高度侵袭性淋巴瘤,较成人NHL更易侵犯结外组织,如骨髓和中枢神经系统[3]。儿童及青少年淋巴瘤的预后也优于成人,HL和NHL的五年生存率分别为95%和78%[4]。及时地诊断、准确的分期和疗效评价对儿童及青少年淋巴瘤预后有重要的价值。这其中,影像学评价在儿童及青少年淋巴瘤的诊疗中起着重要的作用。
18F-FDG PET/CT是利用18F标记的FDG作为示踪记,以图像方式从分子水平显示机体及病灶组织的代谢状况,从而进行疾病的诊断。实现了PET的功能代谢显像与CT解剖结构显像相融合,不仅可以获得功能和代谢等分子信息,还具有较高的空间分辨力和准确性。除此之外,18F-FDG PET/CT可以根据SUV对治疗后的疗效进行半定量分析。在最常见的侵袭性小儿NHL中,超过97%的患者具有18F-FDG的摄取[5],HL患者100%具有18F-FDG的摄取[6]。近年的研究显示,18F-FDG PET/CT在儿童及青少年淋巴瘤中的分期、疗效监测、随访方面具有重要的价值,同时一次显像可以全身评估是否需要进一步的化疗及外放射治疗,以避免不必要的与治疗有关的并发症及提高生存率。
18F-FDG PET/CT在儿童及青少年淋巴瘤诊治中的应用价值
Value of 18F-FDG PET/CT for diagnosing and treating childhood and adolescent lymphoma
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摘要: 儿童及青少年淋巴瘤占所有儿科恶性肿瘤的10%~15%,其多为高度侵袭性肿瘤,较成人更易侵犯结外组织。准确的分期以及早期疗效评价对儿童及青少年淋巴瘤患者具有重要价值。传统影像学方法(超声、CT、MRI及67Ga成像)在其诊治过程中存在一定的局限性,18F-FDG PET/CT是将PET的功能代谢显像与CT的解剖结构显像相融合的一种新型成像技术。笔者通过对18F-FDG PET/CT检查在儿童及青少年淋巴瘤中的分期、疗效评级、随访中的作用作一综述,发现18F-FDG PET/CT在淋巴结、脾脏监测方面具有更高的灵敏度,可通过一次显像发现更多的病灶,在分期方面的准确性优于传统影像学方法。同时,因其代谢改变早于解剖形态的改变,能更早期、准确地评估疗效,对残留病灶的性质进行判断。由于其较低的复发率,需权衡在随访过程中监测复发及辐射暴露之间的利弊关系。
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关键词:
- 正电子发射断层显像计算机体层摄影术 /
- 氟脱氧葡萄糖F18 /
- 淋巴瘤 /
- 儿童 /
- 青少年
Abstract: Childhood and adolescent lymphomas account for 10%-15% of all pediatric cancers. Most cases of pediatric lymphoma involve highly aggressive tumors and extranodal sites. As such, accurate staging and early assessment of therapeutic response are of great value for lymphoma in children and adolescents. Conventional imaging modalities (e.g., ultrasound, CT, MRI, and 67Ga) present some limitations in their diagnosis and treatment. 18F-FDG PET/CT is a new imaging technique that combines the functional data of PET with the morphological information of CT. This article reviews the current role of 18F-FDG PET/CT in the staging, efficacy evaluation, and follow-up of childhood and adolescent lymphoma and finds that 18F-FDG PET/CT is more sensitive than other imaging techniques in monitoring lymph nodes and the spleen. By imaging more lesions, the accuracy of 18F-FDG PET/CT for staging is better than that achieved by traditional imaging methods. At the same time, because of its metabolic changes earlier than the anatomical changes, assessing treatment efficacy promptly and accurately, as well as determining the nature of residual lesions, may be possible. Because of its lower recurrence rate, the trade-offs between monitoring recurrence and radiation exposure during the follow-up period must be weighed. -
[1] Ferrari C, Niccoli AA, Merenda N, et al. Pediatric Hodgkin Lymphoma: Predictive value of interim 18F-FDG PET/CT in therapy response assessment[J/OL]. Medicine (Baltimore), 2017, 96(5): e5973[2018-01-07]. https://www.ncbi.nlm.nih.gov/pubmed/28151888. DOI: 10.1097/MD.0000000000005973. [2] Agrawal K, Mittal BR, Bansal D, et al. Role of 18F FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin's lymphoma[J]. Ann Nucl Med, 2013, 27(2):146-151. DOI:10.1007/s12149-012-0665-5. [3] Chung EM, Pavio M. Pediatric Extranodal Lymphoma[J]. Radiol Clin North Am, 2016, 54(4):727-746. DOI:10.1016/j.rcl.2016.03. 004. [4] Uslu L, Donig J, Link M, et al. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies[J]. J Nucl Med, 2015, 56(2):274-286. DOI:10.2967/jnumed.114.146290. [5] Rosolen A, Perkins SL, Pinkerton CR, et al. Revised International Pediatric Non-Hodgkin Lymphoma Staging System[J]. J Clin Oncol, 2015, 33(18):2112-2118. DOI:10.1200/JCO.2014.59.7203. [6] Weiler-Sagie M, Bushelev O, Epelbaum R, et al. 18F-FDG avidity in lymphoma readdressed:a study of 766 patients[J]. J Nucl Med, 2010, 51(1):25-30. DOI:10.2967/jnumed.109.067892. [7] Bakhshi S, Radhakrishnan V, Sharma P, et al. Pediatric nonlymphoblastic non-Hodgkin lymphoma:baseline, interim, and posttreatment PET/CT versus contrast-enhanced CT for evaluation——a prospective study[J]. Radiology, 2012, 262(3):956-968. DOI:10.1148/radiol.11110936. [8] Kabickova E, Sumerauer D, Cumlivska E, et al. Comparison of 18F-FDG-PET and standard procedures for the pretreatment staging of children and adolescents with Hodgkin's disease[J]. Eur J Nucl Med Mol Imaging, 2006, 33(9):1025-1031. DOI:10.1007/s00259-005-0019-9. [9] Uslu L, Donig J, Link M, et al. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies[J]. J Nucl Med, 2015, 56(2):274-286. DOI:10.2967/jnumed.114.146290. [10] Bakhshi S, Bhethanabhotla S, Kumar R, et al. Posttreatment PET/CT rather than interim PET/CT using Deauville Criteria predicts outcome in pediatric Hodgkin lymphoma:a prospective study comparing PET/CT with conventionalImaging[J]. J Nucl Med, 2017, 58(4):577-583. DOI:10.2967/jnummed.116.176511. [11] Paulino AC, Margolin J, Dreyer Z, et al. Impact of PET-CT on involved field radiotherapy design for pediatric Hodgkin lymphoma[J]. Pediatr Blood Cancer, 2012, 58(6):860-864. DOI:10.1002/pbc.23273. [12] Zapata CP, Cuglievan B, Zapata CM, et al. PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies[J/OL]. Pediatr Blood Cancer, 2018, 65(2)[2018-01-07]. https://www.ncbi.nlm.nih.gov/pubmed/28901637. DOI: 10.1002/pbc.26814. [13] Hassan A, Siddique M, Bashir H, et al. 18F-FDG PET-CT imaging versus bone marrow biopsy in pediatric Hodgkin's lymphoma:a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement[J]. Eur J Nucl Med Mol Imaging, 2017, 44(7):1198-1206. DOI:10.1007/s00259-017-3647-y. [14] Kluge R, Kurch L, Montravers F, et al. FDG PET/CT in children and adolescents with lymphoma[J]. Pediatr Radiol, 2013, 43(4):406-417. DOI:10.1007/s00247-012-2559-z. [15] Cheng G, Chen W, Chamroonrat W, et al. Biopsy versus FDG PET/CT in the initial evaluation of bone marrow involvement in pediatric lymphoma patients[J]. Eur J Nucl Med Mol Imaging, 2011, 38(8):1469-1476. DOI:10.1007/s00259-011-1815-z. [16] Purz S, Mauz-Körholz C, Körholz D, et al.[18F]Fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin's lymphoma[J]. J Clin Oncol, 2011, 29(26):3523-3528. DOI:10.1200/JCO.2010.32.4996. [17] Kluge R, Körholz D. Role of FDG-PET in Staging and Therapy of Children with Hodgkin Lymphoma[J]. Klin Padiatr, 2011, 223(6):315-319. DOI:10.1055/s-0031-1287834. [18] Cheng G, Servaes S, Zhuang H. Value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan versus diagnostic contrast computed tomography in initial staging of pediatric patients with lymphoma[J]. Leuk Lymphoma, 2013, 54(4):737-742. DOI:10.3109/10428194.2012.727416. [19] Kiratli PÖ, Tuncel M, Bar-Sever Z. Nuclear Medicine in Pediatric and Adolescent Tumors[J]. Semin Nucl Med, 2016, 6(4):308-323. DOI:10.1053/j.semnuclmed.2016.01.004. [20] Seth R, Puri K, Singh P, et al. The role of fluorodeoxyglucose positron emission tomography-computerized tomography in resolving therapeutic dilemmas in pediatric Hodgkin lymphoma[J]. Indian J Nucl Med, 2012, 27(3):141-144. DOI:10.4103/0972-3919.112717. [21] Riad R, Omar W, Kotb M, et al. Role of PET/CT in malignant pediatric lymphoma[J]. Eur J Nucl Med Mol Imaging, 2010, 37(2):319-329. DOI:10.1007/s00259-009-1276-9. [22] Wahl RL, Jacene H, Kasamon Y, et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors[J]. J Nucl Med, 2009, 50 Suppl 1: S122-150. DOI: 10.2967/jnumed.108.057307. [23] Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma[J]. J Clin Oncol, 2007, 25(5):579-586. DOI:10.1200/JCO. 2006.09.2403. [24] 覃春霞, 兰晓莉. PET/CT在恶性淋巴瘤疗效评估中的应用[J].临床内科杂志, 2015, 32(3):166-169. DOI:10.3969/j.issn.1001-9057.2015.03.006.
Qin CX, Lan XL. Application of PET/CT in the evaluation of malignant lymphoma[J]. J Clin Intern Med, 2015, 32(3):166-169. DOI:10.3969/j.issn.1001-9057.2015.03.006.[25] Bailly C, Eugène T, Couec ML, et al. Prognostic Value and Clinical Impact of 18FDG-PET in the Management of Children with Burkitt Lymphoma after Induction Chemotherapy[J/OL]. Front Med (Lausanne), 2014, 1: 54[2018-01-06]. https//www.ncbi.nlm.nih.gov/pmc/articles/PMC4292173. DOI: 10.3389/fmed.2014.00054. [26] Ilivitzki A, Radan L, Ben-Arush M, et al. Early interim FDG PET/CT prediction of treatment response and prognosis in pediatric Hodgkin disease-added value of low-dose CT[J]. Pediatr Radiol, 2013, 43(1):86-92. DOI:10.1007/s00247-012-2517-9. [27] Depas G, De Barsy C, Jerusalem G, et al. 18F-FDG PET in children with lymphomas[J]. Eur J Nucl Med Mol Imaging, 2005, 32(1):31-38. DOI:10.1007/s00259-004-1604-z. [28] Furth C, Steffen IG, Erdrich AS, et al. Explorative analyses on the value of interim PET for prediction of response in pediatric and adolescent non-Hodgkin lymphoma patients[J]. EJNMMI Res, 2013, 3(1):71. DOI:10.1186/2191-219X-3-71. [29] Hutchings M, Loft A, Hansen M, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma[J]. Blood, 2006, 107(1):52-59. DOI:10.1182/blood -2005-06-2252. [30] Bhojwani D, McCarville MB, Choi JK, et al. The role of FDG-PET/CT in the evaluation of residual disease in paediatric non-Hodgkin lymphoma[J]. Br J Haematol, 2015, 168(6):845-853. DOI:10.1111/bjh.13219. [31] Furth C, Steffen IG, Amthauer H, e t al. Early and late therapy response assessment with[18F]fluorodeoxyglucose positron emission tomography in pediatric Hodgkin's lymphoma:analysis of a prospective multicenter trial[J]. J Clin Oncol, 2009, 27(26):4385-4391. DOI:10.1200/JCO.2008.19.7814. [32] Levine JM, Weiner M, Kelly KM. Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate[J]. J Pediatr Hematol Oncol, 2006, 28(11):711-714. DOI:10.1097/01.mph.0000243648.66734.eb. [33] Meany HJ, Gidvani VK, Minniti CP. Utility of PET scans to predict disease relapse in pediatric patients with Hodgkin lymphoma[J]. Pediatr Blood Cancer, 2007, 48(4):399-402. DOI:10.1002/pbc.20797. [34] Longo DL. Treatment of advanced Hodgkin lymphoma:the more things change, the more they stay the same[J]. J Clin Oncol, 2013, 31(6):660-662. DOI:10.1200/JCO.2012.44.7235. [35] Nievelstein RA, van Ufford HM Q, Kwee TC, et al. Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma[J]. Eur Radiol, 2012, 22(9):1946-1954. DOI:10.1007/s00330-012-2447-9. [36] Voss SD, Chen L, Constine LS, et al. Surveillance computed tomography imaging and detection of relapse in intermediate- and advanced-stage pediatric Hodgkin's lymphoma:a report from the Children's Oncology Group[J]. J Clin Oncol, 2012, 30(21):2635-2640. DOI:10.1200/JCO.2011.40.7841. [37] Rathore N, Eissa HM, Margolin JF, et al. Pediatric Hodgkin lymphoma:are we over-scanning our patients[J]. Pediatr Hematol Oncol, 2012, 29(5):415-423. DOI:10.3109/08880018.2012.684198. [38] Eissa HM, Allen CE, Kamdar K, et al. Pediatric Burkitt's lymphoma and diffuse B-cell lymphoma:are surveillance scans required[J]. Pediatr Hematol Oncol, 2014, 31(3):253-257. DOI:10.3109/08880018.2013.834400. [39] Voss SD. Surveillance imaging in pediatric Hodgkin Lymphoma[J]. Curr Hematol Malig Rep, 2013, 8(3):218-225. DOI:10.1007/s11899-013-0168-z. [40] Nievelstein RA, van Ufford HM Q, Kwee TC, et al. Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma[J]. Eur Radiol, 2012, 22(9):1946-1954. DOI:10.1007/s00330-012-2447-9. [41] Abdel RH, Sedky M, Hamoda A, et al. Role of FDG-PET scan in the management of pediatric mature B cell non-Hodgkin's lymphoma. CCHE experience[J]. J Egypt Natl Canc Inst, 2016, 28(2):95-99. DOI:10.1016/j.jnci.2016.03.003. [42] Juweid ME. FDG-PET/CT in lymphoma[J]. Methods Mol Biol, 2011, 727:1-19. DOI:10.1007/978-1-61779-062-1_1. [43] Schäfer JF, Gatidis S, Schmidt H, et al. Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology:initial results[J]. Radiology, 2014, 273(1):220-231. DOI:10.1148/radiol.14131732. [44] Daldrup-Link H. How PET/MR Can Add Value For Children With Cancer[J]. Curr Radiol Rep, 2017, 5(3):15. DOI:10.1007/s40134-017-0207-y.
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