| [Objective]1.To investigate the image presentationsof 18F-FDG PET/CT for different pathology subtypes of T and NK/T cell lymphoma,and quantitative analysis 18F-FDG uptake of different pathology subtypes of T and NK/T cell lymphoma in 18F-FDG PET/CT.2.To investigate the usefulness of 18F-FDG PET/CT imaging in evaluating the treatment outcome,monitoring recurrence and predicting prognosis of T and NK/T cell lymphoma.[Materials and methods]1.study objectiveA total of 168 patients with T and NK/T cell lymphoma from June 2006 to October 2016 were retrospectively analyzed,including 60 cases of NK/T cell lymphoma,40 cases of ALCL,14 cases of PTCL-NOS,17 cases of AITL,23 cases of TIBL,7 cases of EATL and 7 cases of SPTCL also.There are 115 men and 53 woman,aged from 3 to 81 years old,with a mean age of 38.16 years old.In 168 cases,84cases have B symptom,84 cases are not have B symptom.There patients should meet the following facts:1)according WHO lymphatic hematopoietic system tumor classification criteria,already established diagnosis of T and NK/T cell lymphoma.2)no other malignant tumor was observed during follow-up.3)has compete clinical data.There are 66 cases did several times 18F-FDG PET/CT after treatment.Among 44 cases of the posterior phase of chemotherapy 18F-FDG PET/CT were performed.Among 44cases of the posterior phase group(5?12 cycles of chemotherapy),3 cases of 5 cycles,17 cases of 6 cycles,8 cases of 7 cycles,12 cases of 8 cycles,2 cases of 10 cycles,2 cases of 12 cycles.2.Imaging modality and imaging agentThe examinations were carried out using a GE Discovery LS PET/CT scanner(GE,Healthcare,Waukesha,WI)and Biographm CTx PET/CT scanner(Siemens,Germany).The tracer 18F-FDG,was manufactured automated by the tracer synthesis system of FDG Microlab(GE,Healthcare,Waukesha,WI),with a radiochemical purity>95%.3.Imaging methods and conditionsAll the patients underwent PET/CT scans after fasting at least 6 hours prior to examination,detecting blood glucose,weighing,measuring height are required before injection imaging agent.18F-FDG with the dose of 5.5 MBq/kg was administrated intravenously via a T tube.After about 60 minutes of relaxed rest in a supine position in dark rooms without visual or acoustic stimulations,the patients were asked to urinated and were then placed into the PET/CT scanner for image acquisition.The image acquisition included non-enhanced CT scan and PET scan covered the range from the head to the middle thigh,if necessary,add to sweep the lower limbs,collection of 6 to 8 beds.And the CT scanning conditions were:voltage 120kv,current auto-mA,pitch 0.8,0.5seconds for tube lab rotation,1.2mm collimation width;PET emission scan used 3D acquisition,each scan time was 2 minutes per bed position.Patients with suspected intracranial metastases should be collected by the method of three-dimensional model of cerebaral,emission scanning 3min/beds;for solitary pulmonary nodules less than 3cm conduct thin-section CT scans,thickness of 1.25mm.4.Image reconstruction and fusionPET images were reconstructed by using a standard iterative algorithm(ordered subset expectation maximization)with CT data being used for attenuation correction.The CT images were reconstructed by using a standard method.The thickness of each slice of PET and CT after reconstruction was 4.25mm(Discovery LS)and 3.0mm(BiographmCTx).The acquired images of PET and CT were sent to the Xeleris(GE Medical Systems)and Syngo MMWP workstation for image registration and fusion.5.PET/CT Image analysisPET,CT and PET/CT images were interpreted independently by two experienced senior physicians of nuclear medicine.The following diagnostic criteria for:mediastinal blood pool activity is recommended as the reference background activity to define PET positivity,excluding physiologic uptake or inflammation.The maximal standardized uptake value acquired by sketching ROI region and automatically calculated by workstation.6.Clinical follow-upA total of 44 patients with T and NK/T cell lymphoma were followed-up for 23.59 months(2-120 months).The diagnosis of recurrent tumor and metastasis was established by pathologic examination,a variety of modality imaging and clinical followed-up.Progression-free survival,PFS,is for the period from the first 18F-FDG PET/CT performed after treatment to the recurrence and metastasis of T and NK/T cell lymphoma observed.7.Statistical analysisThe SUVmax data was expressed by mean ± standard devision(x±s).The statistical analysis adopted SPSS20.0 software.Categorical data were calculated by Fisher's exact test and Kruskal-Wallis H test,measurement data were calculated by t-test.P<0.05 was considered to have significant difference.[Result]1.The SUVmax uptake of different pathological subtypes of T and NK/T cell lymphoma.All of 168 patients with T and NK/T cell lymphoma,the lesions were high uptake of 18F-FDG.Analyzing the 18F-FDG uptake of seven different pathological subtypes,there are have siginifiance difference between seven subtypes(F=34.953,P<0.05).The 18F-FDG uptake of ALCL is higher than other five subtypes(t:3.34?4.82,P<0.05),but has not siginificant difference of EATL.Among other six subtypes the 18F-FDG uptake have not significant difference(t:0.02?1.91,P>0.05).2.The nodal invasion of different pathological subtypes of T and NK/T cell lymphoma.In 168 cases of T and NK/T cell lymphoma,68.45%(115cases)has nodal invasion.50.00%(30cases)NK/T cell lymphoma patients had 1 nodal invasion,85.00%(34 cases)ALCL patients had nodal invasion,92.86%(14cases)PTCL-NOS had nodal invasion,100.00%(17 cases)AITL had nodal invasion,78.26%(18cases)TLBL had nodal invasion,14.29%(1case)EATL had nodal invasion and 28.57%(2cases)SPTCL had nodal invasion.There have significant difference among different subtypes T and NK/T cell lymphoma(Fisher's exact test,P<0.01).AITL and PTCL-NOS nodal invasion rate are high,on the contrary,EATL and SPTCL nodal invasion rate are low.NK/T cell lymphoma nodal invasion rate is significantly lower than ALCL,PTCL-NOS,AITL(Fisher's exact test,P<0.05),whereas the correlation between TLBL,EATL,and SPTCL has no significant difference(Fisher's exact test,P>0.05).EATL nodal invasion rate is significantly lower than ALCL,PTCL-NOS,AITL,and TLBL(Fisher's exact test,P<0.05),however compared with NK/T cell lymphoma and SPTCL has no significant difference(Fisher's exact test,P>0.05).SPTCL nodal invasion rate is significantly lower than ALCL,PTCL-NOS,AITL and TLBL(Fisher's exact test,P<0.05),whereas the correlation between NK/T cell lymphoma and EATL has no significant difference(Fisher's exact test,P>0.05).The other subtypes nodal invasion rate has no significant difference(Fisher's exact test,P>0.05).Lymphoma nodal lesion distribution can be divide into three types:?limited nodal lesion invasion:only involvement limited nodal lesion;?multiple site nodal lesion invasion:nodal lesion scatter;?whole-body multiple lesion with diffuse distribution:nodal lesion distribution along drainage of lymphatic chain,the whole body lymph nodal extensive involvement.25 cases T and NK/T cell lymphoma nodal lesions were singe site.Among them,53.33%(16 cases)were NK/T cell lymphoma,20.59%(7 cases)were ALCL,7.69%(1case)was PTCL-NOS,100%(1ease)was EATL,0.00%in AITL,TIBL and SPTCL.43 cases T and NK/T cell lymphoma nodal lesions were multiple site.Among them,43.33%(13cases)were NK/T cell lymphoma,61.76%(21 cases)were ALCL,15.39%(2 cases)were PTCL-NOS,38.89%(7 cases)were TLBL,100%(2 cases)were SPTCL,0.00%in AITL and EATL.SPTCL violates multiple site nodal rate as highest as 100.00%,and AITL and EATL violate multiple site nodal rate as lowest as 0.00%.45 cases T and NK/T cell lymphoma nodal lesions were nodal lesion widespread invasion.3.34%(1case)was NK/T cell lymphoma,15.00%(6cases)were ALCL,76.92%(lOcases)were SPTCL-NOS,100.00%(17 cases)were AITL,61.11%(11 cases)were TLBL,0.00%in EATL and PTCL.Statistical analysis results show that different pathological subtypes of lymph nodes distribution of single site,multiple site and widespread invasion have significant difference(Fisher's exact test,P<0.05).AITL?PTCL-NOS and TLBL lymph node invasion more show the general widespread invasion(respectively 100.00%?76.92%?61.11%),EATL and SPTCL less show he general widespread invasion.In seven different pathologic subtypes,the following three kinds of lymph node invasion more special:EATL lymph nodes violation of single site(100.00%),SPTCL lymph nodes violation of multiple site(100.00%),AITL lymph nodes violation of general widespread(100.00%).3.The extra-nodal involvements of different pathological subtypes of T and NK/T cell lymphoma.In 168 cases of T and NK/T cell lymphoma,89.29%(150cases)has nodal invasion.Comparing and analyzing ten extra-nodal involvement organs about different pathological subtypes of T and NK/T cell lymphoma:(1)involving in lung:3.33%(2 cases)in NK/T cell lymphoma,7.50%(3cases)in ALCL,14.29%(2cases)in PTCL-NOS,23.53%(4 cases)in AITL,0.00%(Ocases)in TLBL,EATL and SPTCL.(2)involving in liver:11.67%(7 cases)in NK/T cell lymphoma,2.5%(1 case)in ALCL,21.43%(3 cases)in PTCL-NOS,17.65%(3cases)in AITL,0.00%(0 cases)in TLBL and EATL,14.20%(1 case)in SPTCL.(3)involving in spleen:23.33%(14 cases)in NK/T cell lymphoma,25.00%(10 case)in ALCL,71.43%(10 cases)in PTCL-NOS,58.82%(10 cases)in AITL,47.83%(11 cases)in TLBL,0.00%in EATLand14.20%(1 case)in SPTCL.(4)involving in bone or bone marrow:23.33%(14 cases)in NK/T cell lymphoma,47.50%(19 case)in ALCL,35.71%(5 cases)in PTCL-NOS,5.88%(1 cases)in AITL,69.57%(16 cases)in TLBL,0.00%in EATLand28.57%(2 case)in SPTCL.(5)involving in muscle:5.00%(3 cases)in NK/T cell lymphoma,5.00%(2 case)in ALCL,21.43%(3 cases)in PTCL-NOS,5.88%(1 cases)in AITL,13.04%(3 cases)in TLBL,0.00%in EATL and SPTCL.(6)involving in nasal cavity and nasopharynx:75.00%(45cases)in NK/T cell lymphoma,12.50%(5 case)in ALCL,28.57%(4 cases)in PTCL-NOS,5.88%(1 cases)in AITL,39.13%(9 cases)in TLBL,0.00%in EATL and SPTCL.(7)involving in parotid gland:6.67%(4 cases)in NK/T cell lymphoma,17.50%(7case)in ALCL,35.71%(5 cases)in PTCL-NOS,76.47%(13 cases)in AITL,34.78%(8cases)in TLBL,0.00%in EATL and SPTCL.(8)involving in intestinal tract:6.67%(4cases)in NK/T cell lymphoma,5.00%(2 case)in ALCL,14.29%(2cases)in PTCL-NOS,5.88%(1 cases)in AITL,0.00%in TLBL,100.00%in EATL,0.00%in SPTCL.(9)involving in subcutaneous tissue:13.33%(8cases)in NK/T cell lymphoma,12.50%(5case)in ALCL,0.00%in PTCL-NOS and AITL,8.70%(2cases)in TLBL,14.29%(1case)in EATL,100.00%(7cases)in SPTCL.(10)involving in serosa:3.33%(2cases)in NK/T cell lymphoma,5.00%(2case)in ALCL,21.43%(3cases)in PTCL-NOS,17.65%(3cases)in AITL,8.70%(2cases)in TLBL,respectively,14.29%(1case)in EATL and SPTCL.Seven different pathologic subtypes in the lung,liver,muscle and serous invasion rate are low,and there is no significant difference(Fisher's exact test,P>0.05).In other six organ invasion rate have significant difference(Fisher's exact test,P<0.05).The most common violated site is nasal cavity and nasopharynx?bone or bone marrow and spleen.The nasal cavity and nasopharynx violated mainly in NK/T cell lymphoma,in seven different pathological subtypes,NK/T cell lymphoma in nasal and nasopharynx significantly higher than the other six subtypes(Fisher's exact test,P<0.05).Bone and bone marrow violated most found in ALCL,TLBL and SPTCL,and all of EATL are not found.Parotid gland violated can be found in AITL and PTCL-NOS,and not in the EATL and SPTCL.Spleen violated most found in PTCL-NOS and AITL,and EATL rarely violated.In terms of intestinal violated,EATL is significantly higher than other subtypes,other six subtypes of intestinal invasion rate are low.In terms of intestinal violated,all SPTCL have subcutaneous tissue invasion,other six subtypes of subcutaneous tissue invasion rate is extremely low.In the common site of extra-nodal involvement of T and NK/T cell lymphoma,lung invaded performs bilateral lungs multiple nodular and patchy high 18F-FDG uptake shadows in PET/CT imaging.The characteristic of liver and spleen invaded is viscera enlarge and high 18F-FDG uptake,often without necrosis and density change.Bone invaded performs diffuse increased metabolism,CT in the corresponding parts has no bone marrow density change;the characteristic of bone marrow invaded is lesions show high 18F-FDG uptake,CT in the corresponding parts has osteolytic bone destruction or no bone density change.Nasal cavity and nasopharynx invaded PET/CT performs irregular space-occupied soft tissue,which border is clear and high 18F-FDG uptake.Parotid gland invaded PET/CT performed single or multiple nodular in parotid gland,and which have high 18F-FDG uptake.Intestinal invaded PET/CT performs intestinal wall irregularly thicken and have high 18F-FDG uptake,intestinal cavity performs aneurysmal dilatation.Subcutaneous tissue invaded PET/CT performs affected subcutaneous fat tissue nodular and sheet density increased,the corresponding parts increased metabolism.Serous invaded PET/CT performs serous focal or diffuse thicken,which have high 18F-FDG uptake,accompanied by serous cavity effusion.4.The stage of different pathological subtypes of T and NK/T cell lymphoma.According Ann Arbor,in 168 cases,? stage?? stage?? stage?? stage respectively have 14.88%(25cases),14.88%(25 cases),7.14%(12 cases),63.10%(106 cases).Among 25 cases ? stage T and NK/T cell lymphoma patients,13 cases in NK/T cell lymphoma,7 cases in ALCL,1 cases in TLBL,3cases in EATL,1 cases in SPTCL,0 cases in PTCL-NOS and AITL.Among 25 cases ? stage T and NK/T cell lymphoma patients,17 cases in NK/T cell lymphoma,5 cases in ALCL,3 cases in TLBL,0 cases in PTCL-NOS,AITL,EATL and SPTCL.Among 12 cases ?stage T and NK/T cell lymphoma patients,5 cases in NK/T cell lymphoma,6 cases in ALCL,1 case in SPTCL-NOS,0 cases in AITL,TLBL,EATL and SPTCL.Among 106 cases ? stage T and NK/T cell lymphoma patients,25 cases in NK/T cell lymphoma,22 cases in ALCL,13 case in SPTCL-NOS,17 cases in AITL,19 cases in TLBL,4 cases in EATL and 6 cases in SPTCL.There have significant difference in stage(H=14.075.16.580.33.163,P<0.05).In the patients of ? stage,ETAL is 42.86%.In the patients of ? stage,NK/T cell lymphoma is 28.33%.In the patients of ? stage,AITL and SPTCL-NOS as high as 100.00%and 92.86%.The patients ofTLBL and SPTCL also have more than 80.00%for ? stage.5.The value of PET/CT for T and NK/T cell lymphoma in curative effect evaluation and survival analysis.In 168 cases of T and NK/T cell lymphoma,66 patients had done several times 18F-FDG PET/CT after treatment.44 patients had done 18F-FDG PET/CT in the later phase(at least 5 cycle chemotherapy),3 cases of 5 cycles,17 cases of 6 cycles,8 cases of 7 cycles,12 cases of 8 cycles,2 cases of 10 cycles,2 cases of 12 cycles.Analyzing their results,15 patients in CF,8 patients in PR,21 patients in PD.In efficacy group,6 cases in ALCL,1 case in PTCL-NOS,2 cases in AITL,4 cases in TLBL,1 case in SPTCL,9 cases in NK/T cell lymphoma.In the inefficacy group,5 cases in ALTL,2 cases in PTCL-NOS,3 cases in AITL,1 case in TLBL.The SUVmax of the efficacy group before treatment is 15.84±12.26,the SUVmax of the efficacy group after treatment is 2.32±0.93.There is obvious statistical difference of the SUVmax before and after treatment in the efficacy group(t=5.10,P<0.05).The SUVmax of the inefficacy group before treatment is 12.80±5.54,the SUVmax of the inefficacy group after treatment is 11.80±6.31.There is no obvious statistical difference of the SUVmax before and after treatment in the inefficacy group(t=0.598,P>0.05).There is obvious statistical difference of the SUVmax between the efficacy group and the inefficacy group after treatment of 6 course at least in 44 patients(t=-6.815,P<0.05).The survival time of the efficacy group is 102.50±9.17 months,the survival time of the inefficacy group is 47.92±6.75 months.There is obvious statistical difference in survival time between the efficacy group and inefficacy group after treatment of 5 course at least in 44 patients(?~2=4.359,P<0.05).The three-year survival rate and five-year survival rate in efficacy group both are 82%,The three-year survival rate and five-year survival rate in inefficacy group both are 52%.There is statistical difference in three-year survival rate and five-year survival rate between the efficacy group and inefficacy group(P<0.05).[Conclusion]1.Different pathological subtypes of T and NK/T cell lymphoma had some difference in the 18F-FDG,nodal lesion distribution,extra-nodal involvements and stage on 18F-FDG PET/CT.2.The following three subtypes had an obvious specificity in the extra-node involvement:NK/T cell lymphoma frequently invades nasal cavity,the lymph nodes invade in single or multiple sites.EATL usually invades intestinal and limited nodal lesion,rarely invade parotid gland,nasopharynx and nasal cavity,bone or bone marrow and spleen.SPTCL always invades subcutaneous tissue and multiple nodal lesions,the uptake of 18F-FDG is lower than other six pathological subtypes.The most of SPTCL patients are IV stage.3.It is not obvious of other four kinds of pathological subtypes characteristics change,but there are still some differences between each other.AITL characterized by generalized body lymph node invasion,at the same time easily infringe spleen and parotid gland.All of the AITL patients are ? stage.SPTCL most are widely.distributed,easily to infringe spleen and about 30%patients violated nasal cavity,bone and parotid gland.The uptake of 18F-FDG in ALCL is highest in seven subtypes.ALCL lesions distribution is priority to bone or bone marrow and lymph node.The patients of ? stage are less.The uptake of 18F-FDG in TLBL is lower than other five pathological subtypes except SPTCL.The bone or bone marrow involved rate is high,the lesion distribution is scattered,lacking specificity.4.18F-FDG PET/CT imaging plays an very important role in evaluating the treatment outcome,monitoring relapse and predicting prognosis of T and NK/T cell lymphoma.It is helpful to establish personalized treatment planning. |
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