[1]吕清湖,唐明灯,林端瑜,等.原发鼻咽淋巴瘤与鼻咽癌的18F-FDG PET/CT诊断与鉴别[J].国际放射医学核医学杂志,2017,41(3):166-172.[doi:10.3760/cma.j.issn.1673-4114.2017.03.002]
　Lyu Qinghu,Tang Mingdeng,Lin Duanyu,et al.Value of 18F-FDG PET/CT examination in the differential diagnosis of primary nasopharyngeal lymphoma and nasopharyngeal carcinoma[J].International Journal of Radiation Medicine and Nuclear Medicine,2017,41(3):166-172.[doi:10.3760/cma.j.issn.1673-4114.2017.03.002]
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原发鼻咽淋巴瘤与鼻咽癌的18F-FDG PET/CT诊断与鉴别(/HTML)
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
41
期数:
2017年第3期
页码:
166-172
栏目:
论著
出版日期:
2017-05-25

文章信息/Info

Title:
Value of 18F-FDG PET/CT examination in the differential diagnosis of primary nasopharyngeal lymphoma and nasopharyngeal carcinoma
作者:
吕清湖;  唐明灯;  林端瑜;  刘道佳;  李生栩
350014 福州, 福建省肿瘤医院(福建医科大学附属肿瘤医院)核医学科
Author(s):
Lyu Qinghu;  Tang Mingdeng;  Lin Duanyu;  Liu Daojia;  Li Shengxu
Department of Nuclear Medicine, the Fujian Province Tumor Hospital (the Tumor Hospital Affiliated to Fujian Medical University), Fuzhou 350014, China
关键词:
鼻咽肿瘤; 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; 鼻咽淋巴瘤
Keywords:
Nasopharyngeal neoplasms; Fluorodeoxyglucose F18; Positron-emission tomography; Tomography;  X-ray computed; Nasopharyngeal lymphoma
DOI:
10.3760/cma.j.issn.1673-4114.2017.03.002
摘要:
目的 探讨18F-FDG PET/CT在鉴别诊断原发鼻咽淋巴瘤（PNL）与鼻咽癌（NPC）中的价值。方法 回顾性分析经病理证实、检查前未经过肿瘤治疗的33例PNL和71例NPC患者的PET/CT资料，对鼻咽部病变形态、范围、周围浸润、体积、SUVmax及淋巴结浸润或转移情况进行对比分析，另单独选取PNL中的弥漫性大B细胞淋巴瘤（DLBCL）与NPC患者的鼻咽肿块体积、SUVmax进行比较。应用SPSS13.0软件进行独立样本t检验及四格表χ2检验。结果 33例PNL患者中20例病变呈弥漫性浸润鼻咽全壁（双侧对称14例、双侧不对称6例），未完全浸润全壁13例（单侧7例、双侧6例）；71例NPC患者中10例呈弥漫性浸润鼻咽全壁（双侧对称4例、双侧不对称6例），未完全浸润全壁61例（单侧39例、双侧22例）；PNL、NPC组累及全壁与不全、单侧与双侧、对称与不对称间差异均有统计学意义（χ2=23.75、10.38、16.74，均P<0.001）。PNL、NPC病变患者局限于鼻咽壁者分别有26、17例，累及深部结构者分别有7、54例，两者间差异有统计学意义（χ2=27.94，P<0.001）。PNL、NPC患者中，病变凸入鼻后孔的分别有21、24例，两者之间的差异有统计学意义（χ2=8.17，P<0.05）。PNL、DLBCL和NPC患者鼻咽肿块体积分别为（3.70±5.53）×104、（5.05±6.89）×104、（2.06±2.31）×104 mm3，PNL、DLBCL患者与NPC患者鼻咽肿块体积之间的差异均无统计学意义（t=1.63、1.85，均P>0.05）。PNL、DLBCL、NPC患者肿块SUVmax分别为12.00±6.34、14.26±6.42、10.09±4.41，PNL患者与NPC患者间差异无统计学意义（t=1.55，P>0.05），DLBCL患者与NPC患者间差异有统计学意义（t=2.67，P<0.05）。PNL患者中26例伴有咽旁或颈部淋巴结浸润，NPC患者中51例伴有咽旁或颈部淋巴结转移，淋巴结SUVmax、最大者长径、短径及平均直径间差异均无统计学意义（t=0.79、1.37、2.03、1.71，均P>0.05）。26例伴有咽旁或颈部淋巴结浸润的PNL患者中3例可见轻度坏死，51例伴有咽旁或颈部淋巴结转移的NPC患者中31例可见坏死，两者差异有统计学意义（χ2=16.94，P<0.001）。26例伴有咽旁或颈部淋巴结浸润的PNL患者中淋巴结融合5例，51例伴有咽旁或颈部淋巴结转移的NPC患者中淋巴结融合6例，两者间的差异无统计学意义（χ2=0.78，P>0.05）。结论 18F-FDG PET/CT在PNL及NPC鉴别诊断中具有一定价值。PET/CT主要通过病变形态、范围、深部结构浸润、淋巴结坏死等方面进行鉴别；不同病理亚型淋巴瘤可高于或低于NPC代谢，DLBCL代谢活性高于NPC；病变体积不能作为主要的鉴别诊断依据。
Abstract:
Objective To explore the value of 18F-FDG PET/CT examination in the differential diagnosis of primary nasopharyngeal lymphoma (PNL) and nasopharyngeal carcinoma (NPC). Methods PET/CT data of 33 patients with PNL and 71 patients with NPC who were confirmed histopathologically and had not undergone oncotherapy before examination were retrospectively analyzed. The form, range, invasion, volume, SUVmax of nasopharyngeal lesion, and lymphadenopathy involvement were analyzed comparatively. The SUVmax and volume of lesions that confirmed diffuse large B cell lymphoma(DLBCL) were compared with NPC. t-text and χ2-text with SPSS 13.0. Results Diffuse infiltration of all nasopharyngeal walls was detected in 20 of 33 patients with PNL(bilateral symmetry in 14 patients and asymmetry in 6) and 10 of 71 patients with NPC(bilateral symmetry in 4 patients and asymmetry in 6). Partial infiltration of nasopharyngeal walls was observed in 13 of 33 patients with PNL(unilateral invasion in 7 patients and bilateral invasion in 6) and 61 of 71 patients with NPC(unilateral invasion in 39 patients and bilateral invasion in 22). Statistical significances were found between diffuse and partial infiltration, unilateral and bilateral invasion, and symmetry and asymmetry of nasopharyngeal walls of PNL and NPC(χ2=23.75, 10.38, and 16.74, respectively; all P<0.001). Tumor limited to the nasopharyngeal wall was found in 26 patients with PNL and 17 patients with NPC. Meanwhile, deep-structure invasion was detected in 7 patients with PNL and 54 patients with NPC. Significant difference was found in tumor invasion between PNL and NPC(χ2=27.94; P<0.001). Tumor volumes of PNL, DLBCL, and NPC were 3.70±5.53×104, 5.05±6.89×104, and 2.06±2.31×104 mm3, respectively. No significant difference was found between tumor volume of PNL and DLBCL compared with NPC(t=1.63 and 1.85 respectively; both P>0.05). The SUVmax’s of PNL and NPC were 12.00±6.34, 14.26±6.42, and 10.09±4.41, respectively. No significant difference was found between the SUVmax’s of PNL and NPC(t=1.55; P>0.05). Significant difference was found between DLBCL and NPC(t=2.67; P<0.05). Lesions in 21 patients with PNL and 24 patients with NPC protruded into posterior nasal apertures, and significant difference was found between the two groups(χ2=8.17; P<0.05). A total of 26 patients with PNL had retropharyngeal or cervical lymphatic involvement. A total of 51 patients with NPC had retropharyngeal or cervical lymphatic metastasis. SUVmax, major diameter, minor diameter, and average diameter did not significantly differ from largest lymphatic involvement or metastasis in PNL and NPC(t=0.79, 1.37, 2.03, and 1.71, respectively; all P>0.05). Through CT imaging, lymphatic necrosis was detected in 3 of 26 patients with lymphatic involvement of PNL and 31 of 51 patients with lymphatic metastasis of NPC. Significant difference was found between the two groups(χ2=16.94; P<0.001). Lymphatic blend was detected in 5 patients with PNL and in 6 patients with NPC. No significant difference was found between the two groups(χ2=0.78; P>0.05). Conclusions PET/CT examination has a definite diagnosis value in patients with PNL and NPC. The differential diagnosis between PNL and NPC was mainly according to form, range, and invasion of nasopharyngeal lesion. The metabolic level of different pathological subtypes may be higher or lower than that of NPC. The metabolic activity of DLBCL was higher than that of NPC. The volume of nasopharyngeal lesion cannot be considered as a main basis to distinguish between PNL and NPC.

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备注/Memo

备注/Memo:
收稿日期:2017-02-27。
通讯作者:唐明灯,Email:tmd0603@126.com
更新日期/Last Update: 2017-06-28