| BackgroundIn recent years,the application value of 18F-fluorodeoxyglucose positron emission tomography(18F-FDG PET/CT)in the diagnosis,differential diagnosis,staging,efficary and prognosis evaluation of lymphoma has been widely concerned,even in Hodgkin’s lymphoma Lymphama(HL),diffuse large B-cell lymphoma(DLBCL)and follicular lymphoma(FL)were used as the standard examination to pre-treatment staging and efficary evaluation of the end of first-line treatment[1].Moreover,the maximum standardized uptake value(SUVmax)of 18F-FDG PET/CT metabolism-related parameters is considered to be related to the histological aggressiveness of lymphoma and is an independent prognostic factor of the above-mentioned lymphoma subtypes[2].Mantle cell lymphoma(MCL),a rare and special B-cell lymphoma subtype,which belongs to non Hodgkin’s lymphoma(NHL),was formally defined as aggressive lymphoma by Word Health Organization(WHO).Its incidence rate is low,and it is prevalent in the elderly.Early diagnosis is difficult so that most visiting patients are in the late stage of disease.With rapid progression,MCL is easy to relapse and has a poor prognosis,despite responsing to combination therapy.It has both the high invasiveness of aggressive lymphoma and the incurable nature of indolent lymphoma.At present,there are few studies on 18F-FDG PET/CT for rare subtype mantle cell lymphoma A few studies have proved that 18F-FDG PET/CT can improve the accuracy of MCL staging[3-5].18F-FDG PET/CT imaging has unique imaging features,the in-depth summary and analysis of MCL which as a special type of lymphoma will help to improve the accuracy of diagnosis,staging,efficacy evaluation and prognosis evaluation,so as to improve the prognosis of patients.objectiveThis study intends to retrospectively analyze the MCL cases undergoing 18F-FDG PET/CT examination in the PET Center of the Nuclear Medicine Department of Nanfang Hospital,aiming to summarize the 18F-FDG PET/CT imaging features of MCL and lay a foundation for the application of 18F-FDG PET/CT in the diagnosis,staging,efficacy evaluation and prognosis evaluation of MCL.Materials and methods1.Case screening.According to the criteria of inclusion and exclusion,the cases confirmed by pathology and examined by 18F-FDG PET/CT before treatment from August 2007 to January 2021 were selected.The clinical staging was performed by using Ann Arbor stage standard revised by Lugano,and the risk stratification was carried out according to the MCL international prognosis index(MIPI)established by the European MCL working group.The clinical data of 18F-FDG PET/CT were collected,including age,sex,course of disease,main clinical symptoms,laboratory examination results,tissue biopsy,bone marrow puncture and immunohistochemical results.The follow-up included the effective follow-up time,clinical treatment plan,treatment cycle,tissue biopsy and bone marrow puncture results during the treatment,and the results of reexamine 18F-FDG PET/CT.The therapeutic effect was evaluated according to the evaluation criteria of malignant lymphoma response proposed by sgkorova et al.2.Analyze and summarize the imaging features of 18F-FDG PET/CT.Three nuclear medicine physicians analyzed the images on PET/CT workstation case by case,confirmed the MCL lesions,recorded the lymph node invasion,including the location,maximum diameter,SUVmax and regional distribution of the invaded lymph nodes,and the invasion of extranodal organs or tissues,including the total number,location,size,SUVmax,PET findings and CT findings of the invaded extranodal organs or tissues.Objective to summarize the distribution characteristics of intranodal and extranodal lesions in MCL patients,analyze the maximum diameter,SUVmax and involved location of the lesions,and summarize the imaging features.3.Use SPSS 20.0 statistical software for data analysis.Objective to analyze the correlation between 18F-FDG PET/CT imaging features of MCL(SUVmax,bone marrow/spleen invasion,etc.)and clinical stage,risk group,laboratory examination results and curative effect,and preliminarily analyze the correlation between 18F-FDG PET/CT imaging features and 2-year progression free survival(PFS)and overall survival(OS).Results1.Clinical data.A total of 72 cases were selected as research objects.According to the Ann Arbor staging system revised by Lugano,64 cases were in advanced stage.According to the MIPI of MCL international prognostic index developed by European MCL working group,there were 32 cases in low-risk group,27 cases in medium risk group and 13 cases in high-risk group.After treatment,45 patients were reexamined with 18F-FDG PET/CT.According to sgkorová’s criteria,21 cases had complete remission(CR),10 cases had partial remission(PR),1 case had stable disease(SD),7 cases had progressive disease(PD)and 10 cases had recurrence.2.18F-FDG PET/CT imaging features.(1)Characteristics of lymph node lesions:72 cases of MCL showed multiple lymph node involvement,including 6 cases of simple intranodal invasion;the maximum diameter of involved lymph nodes was(4.53±3.07)cm,SUVmax was 8.26±4.99,and there was a significant positive correlation between them(P=0.000).The imaging distribution of the involved lymph nodes can be summarized into three types:① the most common,widely distributed throughout the body,involving both the left and right sides,which is basically consistent with the course of the lymph chain.② scattered distribution in many parts,jumping,or not related to the course of the lymph chain.③ limited distribution in a single part.(2)Extranodal invasion characteristics:65 cases of MCL had extranodal invasion,SUVmax of extranodal invasion was 6.14±3.71,SUVmax of intranodal invasion was significantly higher than that of extranodal invasion(P=0.000),and the two were positively correlated(P=0.000).Among them,16 cases were single organ or tissue invasion and 49 cases were multiple.Most common involved sites were spleen(40/72),bone marrow(27/72),parotid gland(20/72),tonsil(16/72)and gastrointestinal tract(16/72).The common extranodal lesions have the following imaging features:① Bone marrow involvement is often accompanied by splenic involvement.Bone marrow and spleen,liver,kidney and other abdominal parenchymal organs showed diffuse infiltration,manifested as diffuse and uniform increase of 18F-FDG uptake,showed no obvious density change only with abdominal parenchymal organ volume in varying degrees of swelling on CT.② Parotid gland,tonsil,lung and other head,neck and chest parenchymal organs were mostly focal infiltration and mostly bilateral symmetry or multiple.The focus on PET showed nodular,patchy or flaky.③ Most of the abdominal cavity organs were affected by colon,which showed multi segmental involvement.The affected gastric/intestinal wall could be ring wall diffuse thickening or local obvious thickening,forming a soft tissue mass.Most of the stomach/intestinal cavity had no stenosis.PET showed multiple nodular or massive hypermetabolic diseases along the gastric wall or intestinal tube.3.The relationship between the characteristics of 18F-FDG PET/CT and clinical manifestations.(1)In this study,bone marrow involvement was confirmed in 27 cases of MCL by bone marrow biopsy,and the incidence was 49.09%.The sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV)and accuracy of 18F-FDG PET/CT in detecting MCL bone marrow invasion were 81.48%,89.29%,88.00%,83.33%and 85.45%,respectively.(2)when 18F-FDG PET/CT showed bone marrow invasion(confirmed by bone marrow biopsy)and spleen invasion,they were mostly in the high-risk group of MCL(p=0.003,p=0.007),and were more likely to have lower HGB and PLT(all P<0.05).(3)After treatment,45 cases were reexamined with 18F-FDG PET/CT.The sensitivity,specificity,NPV,PPV and accuracy of reexamine 18F-FDG PET/CT in evaluating the efficacy of MCL were 80.95%,87.50%,85.00%,84.00%and 84.44%respectively.(4)The imaging findings of 18F-FDG PET/CT(the type of intranodal invasion,the maximum diameter of the invaded lymph nodes,SUVmax of intranodal lesions,the number of extranodal organs or tissues,SUVmax of extranodal lesions,bone marrow/spleen invasion or not)were not related to the therapeutic effect(all P>0.05).Univariate analysis showed that SUVmax of intranodal lesions had an effect on 2-year PFS of MCL patients(all P<0.05).The maximum diameter of invaded lymph nodes and SUVmax of intranodal lesions had an effect on 2-year OS of MCL patients(all P<0.05).Multivariate analysis showed that SUVmax of intranodal lesions was associated with 2-year PFS and OS of MCL(all P<0.05).ConclusionsThis study shows that MCL is a highly sensitive tumor type identified by FDG.18F-FDG PET/CT images of MCL show hypermetabolic lesions,and intranodal and extranodal lesions have certain distribution characteristics.Therefore,18F-FDG PET/CT can be used for the diagnosis,staging,curative effect evaluation of MCL,and has certain application potential in prognosis prediction. |
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