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Comparison of 68Ga-Pentixafor and 18F-FDG PET/CT imaging in a case of gastric mucosa-associated lymphoid tissue lymphoma

  • Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China

  • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent tumor that most commonly occurs in the gastric mucosa. The authors presents a patient with gastric MALT lymphoma who underwent imaging with 18F-fluorodeoxyglucose(FDG) PET/CT and 68Ga-Pentixafor PET/CT. By analyzing and comparing clinical symptoms, conventional imaging findings, and 18F-FDG and 68Ga-Pentixafor PET/CT images, it deepens the understanding of gastric MALT lymphoma imaging with 68Ga-Pentixafor among clinical physicians.
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  • [1] Filip PV, Cuciureanu D, Diaconu LS, et al. MALT lymphoma: epidemiology, clinical diagnosis and treatment[J]. J Med Life, 2018, 11(3): 187−193. DOI: 10.25122/jml-2018-0035.
    [2] Kuo SH, Cheng AL. Helicobacter pylori and mucosa-associated lymphoid tissue: what's new[J]. Hematology Am Soc Hematol Educ Program, 2013, 2013: 109−117. DOI: 10.1182/asheducation- 2013.1.109.
    [3] Perry C, Herishanu Y, Metzer U, et al. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma[J]. Eur J Haematol, 2007, 79(3): 205−209. DOI: 10.1111/j.1600-0609.2007.00895.x.
    [4] 蒋冲, 孙一文, 滕月, 等. 胃黏膜相关淋巴组织淋巴瘤 18F-FDG PET/CT影像学与消化内镜对照研究[J]. 中华核医学与分子影像杂志, 2021, 41(11): 660−663. DOI: 10.3760/cma.j.cn321828-20200623-00249.Jiang C, Sun YW, Teng Y, et al. Comparison of 18F-FDG PET/CT and digestive endoscopy findings in gastric mucosa-associated lymphoid tissue lymphoma[J]. Chin J Nucl Med Mol Imaging, 2021, 41(11): 660−663. DOI: 10.3760/cma.j.cn321828-20200623-00249.
    [5] Schöder H, Noy A, Gönen M, et al. Intensity of 18Fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin's lymphoma[J]. J Clin Oncol, 2005, 23(21): 4643−4651. DOI: 10.1200/JCO.2005.12.072.
    [6] Buck AK, Serfling SE, Lindner T, et al. CXCR4-targeted theranostics in oncology[J]. Eur J Nucl Med Mol Imaging, 2022, 49(12): 4133−4144. DOI: 10.1007/s00259-022-05849-y.
    [7] Chatterjee S, Azad BB, Nimmagadda S. The intricate role of CXCR4 in cancer[J]. Adv Cancer Res, 2014, 124: 31−82. DOI: 10.1016/B978-0-12-411638-2.00002-1.
    [8] Stollberg S, Kämmerer D, Neubauer E, et al. Differential somatostatin and CXCR4 chemokine receptor expression in MALT-type lymphoma of gastric and extragastric origin[J]. J Cancer Res Clin Oncol, 2016, 142(11): 2239−2247. DOI: 10.1007/s00432-016-2220-6.
    [9] Duell J, Krummenast F, Schirbel A, et al. Improved primary staging of marginal-zone lymphoma by addition of CXCR4-directed PET/CT[J]. J Nucl Med, 2021, 62(10): 1415−1421. DOI: 10.2967/jnumed.120.257279.
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Comparison of 68Ga-Pentixafor and 18F-FDG PET/CT imaging in a case of gastric mucosa-associated lymphoid tissue lymphoma

    Corresponding author: Chong Jiang, jiangc_nju@163.com
  • Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received Date: 2023-06-21
  • Available Online: 2024-04-01

Abstract: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent tumor that most commonly occurs in the gastric mucosa. The authors presents a patient with gastric MALT lymphoma who underwent imaging with 18F-fluorodeoxyglucose(FDG) PET/CT and 68Ga-Pentixafor PET/CT. By analyzing and comparing clinical symptoms, conventional imaging findings, and 18F-FDG and 68Ga-Pentixafor PET/CT images, it deepens the understanding of gastric MALT lymphoma imaging with 68Ga-Pentixafor among clinical physicians.

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    1.   患者资料

    • 患者男性，75岁，2019年7月出现上腹部隐痛并伴呕吐物呈咖啡色。胃镜检查结果为胃溃疡，经对症治疗症状缓解。之后，患者反复出现上腹部隐痛，2019年7月行胃镜下活检确诊为胃黏膜相关淋巴组织（mucosa-associated lymphoid tissue，MALT）淋巴瘤，未接受治疗。2023年1月，患者再次出现上腹部疼痛并伴黑便。2023年5月，患者于我院门诊行无痛胃镜检查，发现胃体部巨大溃疡和近胃角溃疡（图1）。腹部增强CT示胃体部上壁增厚，符合胃淋巴瘤的影像特征（图1）。

      Figure 1.  Gastric endoscopy and abdominal enhanced CT images of a patient (male, 75 years old) with gastric mucosa-associated lymphoid tissue lymphoma

      患者分别行18F-FDG 和68Ga-Pentixafor PET/CT显像（图2）。18F-FDG PET/CT示胃体部上壁增厚，最厚处约为1.3 cm，伴18F-FDG代谢轻、中度增高，SUVmax=3.94，影像改变与MALT淋巴瘤相符；腹膜后和心膈角区可见多个大小不等的淋巴结，最大者的长径约为1.10 cm，18F-FDG摄取未见异常增高。68Ga-Pentixafor PET/CT示胃体及胃角部胃壁增厚，伴68Ga-Pentixafor摄取异常增高，SUVmax=15.53；腹膜后和心膈角区淋巴结的68Ga-Pentixafor摄取异常增高，SUVmax=11.10及SUVmax=6.58。

      Figure 2.  18F-FDG and 68Ga-Pentixafor PET/CT imagings of a patient (male, 75 years old) with gastric mucosa-associated lymphoid tissue lymphoma

    2.   讨论

    • MALT淋巴瘤是非霍奇金淋巴瘤的一种亚型，起源于黏膜相关淋巴组织，通常发生在消化道、呼吸道、眼部和其他黏膜组织中[1]。MALT淋巴瘤的发病机制与慢性炎症、感染和自身免疫疾病有关。长期的感染或慢性炎症会导致黏膜组织中的淋巴细胞发生异常增殖，最终形成肿瘤。最常见的MALT淋巴瘤类型是胃MALT淋巴瘤，其与幽门螺旋杆菌感染密切相关[2]。

      18F-FDG PET/CT对胃MALT淋巴瘤的诊断灵敏度不高。有研究结果表明，18F-FDG PET/CT对胃MALT淋巴瘤的诊断灵敏度仅为38.9%[3]。我们的前期研究结果也表明，18F-FDG PET/CT对胃MALT淋巴瘤的诊断灵敏度仅为41.7%[4]，其原因可能是18F-FDG的摄取程度与肿瘤的恶性程度密切相关，但由于MALT淋巴瘤属于惰性淋巴瘤[5]，故其对18F-FDG的摄取较低；此外，胃部组织对18F-FDG有较高的生理性摄取，可能会掩盖病灶的摄取。

      近年来，选择靶向CXC趋化因子受体4（C-X-C chemokine receptor 4，CXCR4）的放射性示踪剂68Ga-Pentixafor作为一种新型显像剂引起了广泛的关注[6]。CXCR4在多种类型的肿瘤细胞中高度表达，包括血液系统肿瘤、多发性骨髓瘤、乳腺癌、肺癌、卵巢癌等[7]。研究结果表明，胃MALT淋巴瘤细胞中CXCR4的表达水平较高，因此使用68Ga-Pentixafor PET/CT可以很好地对胃MALT淋巴瘤进行显像[8]。相较于18F-FDG，68Ga-Pentixafor 能够特异性地与CXCR4受体结合，从而更准确地定位和评估MALT淋巴瘤患者的病变范围[9]。本研究中，通过对比18F-FDG PET/CT和68Ga-Pentixafor PET/CT的显像结果，我们发现68Ga-Pentixafor PET/CT显像的灵敏度更高。相较于18F-FDG，胃MALT淋巴瘤病灶对68Ga-Pentixafor 的摄取明显增高，胃壁摄取的范围更广泛，摄取程度也更高；胃周间隙、腹膜后和心膈角区的受累淋巴结对68Ga-Pentixafor的摄取也增高，这为肿瘤分期和治疗方案的制定提供了更全面的信息。

      综上所述，相对于18F-FDG PET/CT，68Ga-Pentixafor PET/CT在胃MALT淋巴瘤的显像中具有更高的灵敏度，能够提供更准确的定位，可评估MALT淋巴瘤患者的病变范围，对于指导治疗决策具有重要的临床意义。

      利益冲突　所有作者声明无利益冲突

      作者贡献声明　向镛兆负责命题的提出与设计、病例的收集与分析、论文的撰写；蒋丽莎、苏鸣岗负责命题的设计、论文的修订；王海涛负责图像的处理；蒋冲负责命题的设计、论文的审阅

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