磁共振全身扩散加权成像结合T2WI抑脂序列与FDG-PET/CT在初发淋巴瘤分期及病灶检出的对比研究

doi:10.16150/j.1671-2870.2021.06.005

摘要/Abstract

摘要：

目的: 比较磁共振全身扩散加权成像（whole body-diffusion weighted imaging,WB-DWI）结合T2WI抑脂序列（fat saturation T2-weighted imaging, FS-T2WI）及正电子发射计算机体层显像仪（positron emission tomography and computed tomography,PET/CT）在初发淋巴瘤分期诊断中的应用价值。方法: 回顾性分析2014年5月至2020年9月上海交通大学医学院附属瑞金医院血液科收治的初发、未经治疗且经病理证实的淋巴瘤患者25例,其中24例为非霍奇金淋巴瘤,1例为霍奇金淋巴瘤。患者分别行磁共振WB-DWI结合FS-T2WI序列及¹⁸F-氟代脱氧葡萄糖（¹⁸F-fluorodeoxyglucos,¹⁸F-FDG）PET/CT检查。以临床标准为金标准（由临床、病理、影像、骨髓穿刺及6个月随访结果综合分析,参照Ann-Arbor分期法）,比较2种检查方法在病灶的检出及分期间的一致性。结果: 采用PET/CT、磁共振WB-DWI结合FS-T2WI序列检查评估了500处淋巴结区域,其中有466处检出结果相同,2种检查方法对结内病灶的诊断差异无统计学意义（P>0.05）,具有较高的一致性（K=0.807）。采用PET/CT及磁共振WB-DWI结合FS-T2WI序列评估了450处结外脏器,其中有444处检出结果相同,2种检查方法对结外病灶的诊断差异无统计学意义（P>0.05）,具有较高的一致性（K=0.857）。25例患者中20例采用2种检查方法获得的分期相同,具有良好的一致性（K=0.731）。与临床分期相比,PET/CT检查低估了3例患者的分期,而磁共振WB-DWI结合FS-T2WI检查诊断此3例分期正确。磁共振WB-DWI结合FS-T2WI检查低估了2例患者的分期,而PET/CT检查诊断此2例分期正确。结论: 磁共振WB-DWI结合FS-T2WI序列扫描与FDG-PET/CT检查对初发淋巴瘤病灶的检出及分期间具有较好的一致性,而WB-DWI结合FS-T2WI序列扫描无电离辐射、无需注射对比剂,在淋巴瘤分期中可与PET/CT检查相互补充。

关键词: 全身扩散加权成像, 正电子发射计算机体层显像仪, 淋巴瘤, 分期诊断

Abstract:

Objective: To compare the application value of magnetic resonance whole body diffusion weighted ima-ging(MR WB-DWI) combined with FS-T2WI sequence and PET/CT in detection of disease lesion and staging in newly dia-gnosed lymphoma. Methods: A total of 25 patients with newly diagnosed lymphoma and without a history of treatment for lymphoma admitted to Department of Hematology in Shanghai Ruijin Hospital from May 2014 to September 2020 were retrospectively analyzed. All the patients were histologically confirmed, including 24 cases of non-Hodgkin lymphoma and 1case of Hodgkin lymphoma. MR WB-DWI with FS-T2WI and ¹⁸F-FDG PET/CT were performed and coincidence of results between the two techniques in lesion detection and disease staging were compared. The clinical criterion was taken as the gold standard (comprehensive analysis of clinical, pathological, imaging, bone marrow puncture and 6-month follow-up results, referring to Ann-Arbor staging method). Results: Results of WB-DWI with FS-T2WI in 466 node regions out of 500 areas were congruen with those of PET/CT (K=0.807, P>0.05), there were no significant difference between two techniques in detection of intranodal lesions. The two imaging techniques agreed on 444 organs out of 450 organs analyzed (K=0.857, P>0.05). The stages based on WB-DWI with FS-T2WI was concordant with those of PET/CT in 20 patients out of 25 patients (K=0.731, P>0.05). Compared with clinical stage, PET/CT underestimated disease stage in 3 cases and WB-DWI combined with FS-T2WI underestimated disease in 2 cases. Conclusions: WB-DWI combined FS-T2WI sequence have high consistency with ¹⁸F-FDG PET/CT in lesions detection and disease staging in newly diagnosed lymphoma, and could serve as a suppliment of PET/CT.

Key words: Whole body-diffusion weighted imaging, PET/CT, Lymphoma, Staging diagnosis

中图分类号:

R733.4

岳婧婧, 宋琦, 江旭峰, 王黎, 赵维莅, 严福华. 磁共振全身扩散加权成像结合T2WI抑脂序列与FDG-PET/CT在初发淋巴瘤分期及病灶检出的对比研究[J]. 诊断学理论与实践, 2021, 20(06): 540-546.

YUE Jingjing, SONG Qi, JIANG Xufeng, WANG Li, ZHAO Weili, YAN Fuhua. Comparison of magnetic resonance whole body diffusion weighted imaging with FS-T2WI and FDG-PET/CT for initial staging and detection of lesion in newly diagnosed lymphoma[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 540-546.

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WB-DWI结合 FS-T2WI分期	PET/CT分期
WB-DWI结合 FS-T2WI分期	Ⅰ	Ⅱ	Ⅲ	Ⅳ	合计
Ⅰ	4	1			5
Ⅱ		4			4
Ⅲ		1	6	1	8
Ⅳ	1		1	6	8
合计	5	6	7	7	25