| Objectives To compare the 18F-FDG PET/CT results of patients with different pathologic subtypes of lymphoma before and after treatment, and the results were compared with traditional image, perform a quantitative analysis of maximal standardized uptake value(SUVmax) and retention indices(RI), explore significance of 18F-FDG PET/CT imaging in evaluating curative effect of different pathologic subtypes of lymphoma, provide assistance and guidance to the formulation of further treatment regimen, and boost the clinical application of PET/CT.Methods The data of lymphoma patients that underwent PET/CT examination before and after treatment who were included into our department for the recent 4 years were collected. According to the principle of voluntariness, the lymphoma patients that had undergone PET/CT examination before examination were randomly selected, and another PET/CT examination was performed after 2 to 4-course treatment. All lymphoma lesions including lymph node lesions and extranodal lesions were noted, the results were compared with integrated 64-slices spiral CT equipped by PET/CT. The SUVmax and RI of lymphoma lesions of 43 patients were measured. In combination with the patients’ pathological biopsy, the SUVmax and RI of lesions(including lymph node lesions and extranodal lesions) of different subtypes of lymphoma before treatment and the SUVmax after treatment were compared and a statistical analysis was made. The experimental data were expressed by “`x ±s”, the t test was adopted for thecomparison of mean values between the two groups, and the analysis of variance was adopted for the comparison of mean values between the groups. All patients were followed up for at least 3 months.Results(1) Before treatment, the PET/CT examination found that, for all patients, 209 lymphoma lesions(including lymph node lesions and extranodal lesions) wer found; after treatment, PET/CT recheck indicated the presence of 36 lesions, in comparison, 64-slices spiral CT found 169、25 lesions before and after treatment. After treatment, among the 43 patients, 23 achieved complete remission(CR)(HL patients achieved CR), 16 achieved partial remission(PR), 1 was at the state of stable disease(SD), and 3 achieved disease progression(PD). The pathological results from surgery, live resection or puncture biopsy indicated, among the 46 patients, 6 patients had the finalized diagnosis of Hodgkin’s lymphoma(HL), 37 had the finalized diagnosis of nonHodgkin’s lymphoma(NHL), and the latter 37 patients included 21 patients with diffuse large B lymphoma, 6 patients with follicular lymphoma, 2 patients with mantle cell lymphoma, 3 patients with Burkitt’s lymphoma, 2 patients with peripheral t cell lymphoma, 1 patient with extranodal marginal zone lymphoma and 2 patients with nasopharynx NK/T cell lymphoma.(2) A statistical analysis was made on the SUVmax and RI of all lesions before treatment as well as the SUVmax of lesions after treatment, and a paired sample t test was performed on the SUVmax before and after treatment: the SUVmax of NHL and NL lesions before treatment was 8.8 ± 4.4 and 7.0 ± 3.5 respectively, the lesions RI before treatment was(42 ± 27)% and(36 ± 16)% respectively, and there was no statistical significance in SUVmax and RI differences before treatment of the two(t=0.825, 1.211, P > 0.05); the SUVmax value of lesions of NHL patients after treatment was 3.4±0.7, an obvious decrease when compared with before treatment, and the difference in SUVmax before and after treatment was of statistical significance(t =3.456, P < 0.01).(3) Before treatment, among the 37 NHLpatients, 4 patients were at stage I, 13 patients were at stage II, 13 patients were at stage III and 7 patients were at stage IV, the corresponding SUVmax were 9.7 ±5.8, 8.1 ±3.4, 8.5 ±3.6 and 9.0 ±4.4, the mean RI was(33±20)%,(46±34)%,(41±26)% and(47±29)%, and there was no statistical significance in the difference in SUVmax and RI of lesions of NHL at different clinical stages(F=1.025); before treatment, among the 6 HL patients, no statistical analysis was made because the clinical staging was relatively early(4 patients were at stage I and 2 patients were at stage II).(4) The SUVmax and RI of all lesions(including the lymph gland lesion and the extranodal lesion) of each different subtype of NHL before treatment and the SUVmax of lesions after treatment were counted. The SUVmax before treatment and after treatment of 21 patients with diffuse large B cell lymphoma and the RI before treatment were 12.6 ±4.7, 5.1 ±1.9(2 patients with PD after treatment), and(56 ± 24)%; 6 patients with follicular lymphoma: 3.4±1.9, 1.5±0.4, and(12±5)%; 2 patients with mantle cell lymphoma: 7.6, 2.3, and 45%; 3 patients with Burkitt’s lymphoma: 11.9, 6.8(1 patient with PD after treatment), and 65%; 1 patient with extranodal marginal zone lymphoma: 2.5, 1.8, and 3%; 2 patients with peripheral t cell lymphoma: 10.8, 2.3, and 23%; 2 patients with nasopharynx NK/T cell lymphoma: 9.7, 2.6, and 35%.Conclusion PET/CT gain an obvious advantage in terms of sensitivity and specificity over traditional CT image in detecting lymphoma lesions before and after treatment. There was no statistical significance in difference of SUVmax and RI of NHL and HL lesions before treatment; there was no statistical significance in difference of SUVmax and RI between the NHL lesions of different clinical staging before treatment; the SUVmax and RI of the HL and majority of NHL subtypes of a high malignancy and high invasiveness before treatment were relatively high, and the SUVmax after treatment dropped significantly. the SUVmax and RI of the minority of indolent lymphomas with low invasiveness before treatment were relatively low, and the SUVmax after treatmentdropped insignificantly. The 18F-FDG PET/CT imaging has a higher sensitivity and specificity when compared with traditional imaging methods in terms of staging before treatment, judgment of invasiveness and the evaluation of curative effect and prognosis, and is of help to guide the rational formulation of treatment regimen. |
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