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目的评价正电子发射型计算机断层显像/X线计算机体层成像(PET/CT)对淋巴瘤患者治疗后残存病灶性质诊断的准确率。方法纳入2007年11月至2015年4月于我院经穿刺活检或切取活组织病理证实为淋巴瘤的患者,行18F-氟代脱氧葡萄糖(FDG)PET/CT显像后给予临床放化疗,治疗结束后再次显像发现摄取18 FFDG的残余病灶,根据Deauville五分法标准评分选择在2~4分之间的患者共43例(男性24例,女性19例),年龄11~71岁,其中霍奇金淋巴瘤26例,非霍奇金淋巴瘤15例,病理类型不详2例。根据多次行~(18)F-FDG PET/CT或其它影像学检查监测该残留病灶的预后。结果所有患者共发现71处残余病灶,通过临床及影像学监测,随访证实淋巴结残余病灶无肿瘤残余38例,有肿瘤残余33例。通过ROC曲线分析,确定最大标准摄取值(SUV_(max))评价霍奇金淋巴瘤和非霍奇金淋巴瘤淋巴结肿瘤残存的最佳临界值为2.43,该界值评价残存肿瘤的灵敏度为63.6%,特异度为78.9%,准确率为71.8%,阳性预测值为72.4%,阴性预测值为71.4%。以SUV_(max)>2.43作为判断肿瘤残余的临界值,真阳性21处,真阴性30处,假阳性8处,假阴性12处。结论对于淋巴瘤治疗后残存病灶的性质,PET/CT是有效的鉴别方法,半定量分析SUVmax可以作为一个客观指标评价残余肿瘤性质。
Objective To evaluate the diagnostic accuracy of positron emission tomography / computed tomography (PET / CT) for the diagnosis of residual lesions in patients with lymphoma. Methods Patients with lymphoma confirmed by biopsy or biopsy in our hospital from November 2007 to April 2015 were treated with chemoradiotherapy and radiotherapy after 18F-FDG PET / CT imaging. A total of 43 patients (24 males and 19 females), aged 11-71 years, were selected according to the Deauville’s five-point scale for patients who had a residual score of 18 FFDG after re-imaging at the end of treatment. Hodgkin’s lymphoma in which 26 cases, 15 cases of non-Hodgkin’s lymphoma, pathological type unknown in 2 cases. The prognosis of this residual lesion was monitored according to multiple 18 F-FDG PET / CT or other imaging studies. Results A total of 71 residual lesions were found in all patients. Surveillance showed that there were 38 residual tumor and 33 residual tumor in the residual lymph nodes. The best cut-off value of residual tumor in Hodgkin’s lymphoma and non-Hodgkin’s lymphoma was 2.43 by ROC curve analysis to determine the maximum standard uptake value (SUV max). The sensitivity of this cutoff value in evaluating residual tumor was 63.6 %, The specificity was 78.9%, the accuracy was 71.8%, the positive predictive value was 72.4%, and the negative predictive value was 71.4%. With SUV_ (max)> 2.43 as the threshold value for the determination of residual tumor, there are 21 true positives, 30 true negatives, 8 false positives and 12 false negatives. Conclusion PET / CT is an effective method to identify the nature of residual lesions after lymphoma treatment. Semi-quantitative analysis of SUVmax can be used as an objective indicator to evaluate the residual tumor characteristics.