| Part1.The Imaging Finding of 18F-FDG PET/CT on Extranodal LymphomaObjective:To study the incidence of extranodal lymphoma and the extranodal involvement of different pathological types to different organs.To preliminary classify the extranodal lesions according to the image features and classify the lesions by different organs.To realize the 18F-FDG PET/CT imaging performance of pretreatment and posttreatment extranodal lymphoma,so as to better diagnosis,differential diagnosis and clinical staging.Materials and methods:18F-FDG PET/CT images of 912 lymphoma patients with 1725 scans during 2007.04 to 2016.12 were analyzed,and 596 cases with 1065 scans of them were accompanied the extranodal lymphoma lesions.The extranodal lymphoma group involved 347 males and 249 females with onset age of 53.3±17.0(10?90)years.All of them were confirmed by pathology.Results:1.The non-Hodgkin's lymphoma(NHL)accounted for 88.5%(807/912)and theHodgkin's lymphoma(HL)accounted for 11.5%(105/912)of them.The extranodal organs involving rates respectively were 69.1%(558/807)of NHL,36.2%(38/105)of HL,and 65.4%(596/912)of all.2.The main extranodal lymphomas were ordered by incidence rates as follows:gastrointestinal lymphoma(179/596,30.0%),rhinal and pharyngeal lymphoma(161/596,27.0%),bony lymphoma(125/596,21.0%),tonsillar lymphoma(93/596,15.6%),splenic lymphoma(77/596,12.9%),pulmonary lymphoma(60/596,10.1%),etc.There were 196 cases of primary extranodal lymphoma(196/596,32.9%),and the gastrointestinal tract(99 cases),the tonsil(20 cases),central nervous system(16 cases),nose and pharynx(15 cases)were the most frequent involved sites.3.The common pathological types of extranodal lymphoma were mainly DLBCL(232/596,38.9%,the extranodal involving rate of similar type was 73.2%),unclassified NHL(77/596,12.9%,the extranodal involving rate was 61.1%),MALT lymphoma treated(44/596,7.4%,the extranodal involving rate was 100%),extranodal NK/T-cell lymphoma nasal type(42/596,7.0%,the extranodal involving rate was 100%),unclassified B-cell lymphoma(39/596,6.5%,the extranodal involving rate was 60.0%),follicular lymphoma(34/596,5.7%,the extranodal involving rate was 57.6%),unclassified T-cell lymphoma(21/596,3.5%,the extranodal involving rate was 77.8%),etc.4.The extranodal lymphoma were divided into primary and non-primary extranodal lymphoma according to the lesion locations and distributions.And the lesions were divided into single focal type and multifocal type(or diffuse type)based on the imaging performance of specific organ.There were same imaging character but different incidence,clinical feature,treatment and prognosis for the different category.The tumor showed on CT images as isodensity,or slightly low,or slightly high density lump,and uniform density without or less necrosis,generally without calcification,and on PET images as FDG uptake increased to different extent according to different pathological type and the size of the lesions.And the systemic multiple lesions were easy to distinguish from the other malignant tumors.5.All of the extranodal lymphoma were divided into six categories according their characteristics of different organs:(1)The central nervous system lymphoma lesions were often multifocal lesions with slightly high or equal density on CT images and increased FDG uptake on PET images,easy to identify from the other tumor;and the peripheral nerve lymphoma lesions were strip-like mass.All of them could be completely absorbed after treatment.(2)The rhinal and pharyngeal lymphoma lesions were often diffuse lesions,and some of them accompanied bone destruction,the most of them were a part of the systemic lesions.All of them could disappear completely after treatment.(3)The pulmonary lymphoma lesions characterized by polymorphism,and needed distinguish with the other tumors,tuberculosis and pneumonia.After treatment they could completely disappear or leave interstitial change.(4)The gastrointestinal tract lymphomas were the most common extranodal lymphomas,and more than half of them were primary extranodal lymphoma.The lesions were often huge and diffuse but less obstruction.They could completely disappear after treatment.(5)The lymphoma of bone could show bone destruction,slight sclerosis or normal on CT images,and manifest the single,multiple or diffuse increased FDG uptake on PET images.Some of them may leave bone sclerosis lesions or disappear completely after treatment.(6)The other organs lymphomas mainly showed as the uniform density soft tissue mass of substantive organs,and could disappear completely after treatment.Conclusion:The vast majority of extranodal lymphomas were NHL,and the common pathological types were DLBCL,unclassified NHL,MALT lymphoma,etc.The gastrointestinal tract,head and neck organs,and bone were the mainly involved extranodal organs.The 18F-FDG PET/CT could commendably evaluate the focal characteristic of extranodal lymphoma lesions,and accurately distinguish between the primary and the non-primary lymphoma lesions,and well differential diagnose the extranodal lymphoma from the other malignant tumors in virtue of the local display and systemic distribution of lesions.So the 18F-FDG PET/CT could provide the comprehensive,accurate and reliable imaging evidence for clinical lymphoma diagnosis and stage.Part 2.The Clinical Evaluation to Extranodal Lesions of Diffuse Large B-cell Lymphoma with 18F-FDG PET/CTObjective:To explore the value of evaluating clinical efficacy on DLBCL extranodal lesions with 18F-FDG PET/CTMaterials and methods:The 18F-FDG PET/CT imaging and complete clinical data of 232 cases with DLBCL extranodal lesions confirmed by surgery or biopsy from 2007.04 to 2016.12 were collected,including 128 males and 104 females with mean age of 54.9±15.8 years old,and the extranodal lesions were analyzed.One hundred and ten cases of them with more than one time's 18F-FDG PET/CT(2-9 times)were evaluated after treatment,including the interim evaluation of treatment to some of them,the PFS and OS survival analysis on a variety of factors to the initial treatment cases,the clinical analysis to the deteriorative or recurrent cases.Results:1.The common organs involved by DLBCL were the gastrointestinal tract(35.8%),bone(19.4%),nasal cavity and pharynx(18.5%),tonsil(17.7%),spleen(14.7%),central nervous system(9.5%),salivary glands(8.2%),lung(6.5%),etc.2.Fifty-nine cases were evaluated with 18F-FDG PET/CT in the middle of treatment cycle.The curative effect evaluation by 18F-FDG PET/CT in the middle and the end of the treatment cycle were compared by Kappa test,and they were good consistency(K = 0.5450).The difference of SUVOmax,SUV2-4max,?SUVmax,ASUVmax%on the different levels of stage,curative effect,IPI,Deauville,recurrence or not were compared respectively and the SUV2-4max??SUVmax??SUVmax%were significant differences in different levels of curative effect and IPI respectively,the SUVOmax,ASUVmax,?SUVmax%were significant differences in the different levels of recurrence or not.The ROC curve of ?SUVmax and?SUVmax%to curative effect of the end of the cycle were performed:the area under the ROC curve of ?SUVmax was 0.927,P=0.005,the best dividing value of?SUVmax was 6.2 with sensitivity of 78.3%and specificity of 100%;and the area under the ROC curve of ?SUVmax%was 0.813,P=0.040,the best dividing value of?SUVmax%was 24.9%with sensitivity of 97.8%and specificity of 75%.The?SUVmax and ASUVmax%were separated by the two best dividing value to perform the PFS and OS survival analysis respectively.And the PFS of the?SUVmax?6.2 group was longer than that of the SUVmax<6.2 group(P=0.023),but the OS of between them were no significant difference.All the PFS and OS of the ASUV max%?24.9%group were longer than that of the ?SUVmax%<24.9%group(P=0.000 and P=0.002).The results of curative effect evaluation by the ?SUVmax and ?SUVmax%best dividing value were good consistency with the results by Deauville score(K=0.5851,and K=0.5851,P<0.01).3.Seventy-eight initial treatment cases were divided by the factors such asclinical stage,primary or non-primary,curative effect,IPI,Deauville score,stem cell transplantation or not,operation or not respectively to perform the PFS and OS survival analysis.For PFS,the low stage group(group stage I and II)was longer than the high stage group(group stage ? and IV)(P=0.033),the primary group was longer than the non-primary group(P=0.031),the effective group was longer than the ineffective group(P=0.000),the low grade of Deauville group(1-3)longer than the high grade group(4-5)(P=0.000),but only the curative effect and the IPI were the impact factors on the PFS in the cox regression analysis.For OS,the low-risk of IPI group(0-2)was longer than the high-risk group(3-5)(P=0.020),and the low grade of Deauville group(1-3)was longer than the high grade group(4-5)(P=0.013),but none of factors were impact on the OS in cox regression analysis,that meant the poor predict effect to long-term survival.4.The clinical comprehensive analysis were performed on 45 cases with recurrence or progress lesions.The DLBCL recurrence lesions could appear at any extranodal organs,or only at lymph nodes.The effective rate(CR + PR,51.1%)of treatment to the recurrence or progress cases was lower than their initial treatment(73.3%),and the PFS of recurrent treatment was also significantly shorter than their initial treatment(paired t test,P<0.01).There were high surgical rate(33.3%,15/45)for initial treatment,while the high stem cell transplanted rate(57.8%,26/45)for recurrent treatment,and the PFS of stem cell transplanted cases longer than that of the cases without transplantation(P=0.047),but the transplant or not had no obvious effect on OS.The non recurrence group had the tendency of longer OS than the recurrence group but there were no significant difference.Conclusion:The gastrointestinal tract was the most common site of DLBCL extranodal lesions.The interim treatment evaluation of DLBCL could well predict therapeutic effect and intervene on the prognosis for the cases with poor effect could timely change the project,so as to improve outcome.The ?SUVmax and ?SUVmax%had certain predictive value to PFS and OS.Only the curative effect and IPI of multiple factors had predictive value to PFS,and a variety of factors on OS had no significant effect.The curative effect to the recurrent cases were lower than the initial treatment.We could evaluate the various periods of extranodal lymphoma course with 18F-FDG PET/CT,to help clinicians better understand the overall patient's condition. |
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