Publication: 18F-2-fluoro-2-deoksi-D-glukoz pozitron emisyon tomografisi/bilgisayarlı tomografinin lenfomanın inisiyal evrelemesinde kemik iliği tutulumunun belirlenmesindeki rolü
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2017
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Amaç: Günümüzde 18F-2-fluoro-2-deoksi-D-glukoz (18F-FDG) pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/BT), Hodgkin lenfoma (HL) ve non-Hodgkin lenfomaların (NHL) evrelemesinde ve takibinde başarılı bir şekilde kullanılmaktadır. Değişik çalışmalarda PET/BT'nin kemik iliği tutulumunu göstermede etkinliği ve kemik iliği biyopsisi (KİB) ile uyumu gösterilmiş ve tamamlayıcı yöntem olarak kullanılması önerilmiştir. Biz de bu çalışmada HL ve NHL'de kemik iliği infiltrasyonunu değerlendirmede PET/BT'nin etkinliğini değerlendirmeyi amaçladık.Yöntem: Çalışmaya Akdeniz Üniversitesi Tıp Fakültesi Nükleer Tıp Anabilim Dalı'nda başlangıç evreleme için PET/BT tetkiki yapılan 172 lenfoma olgusu dahil edilmiştir. Olguların PET/BT tetkikinde görsel ve semikantitatif değerlendirme yapıldı.18F-FDGPET tetkikinde kantitatif parametre olarak maksimum standart uptake değeri (SUVmaks) kullanıldı. Görsel değerlendirmede karaciğerden daha yüksek metabolik aktivite gösteren kemik iliği aktivitesi patolojik olarak değerlendirildi. Semikantitatif değerlendirmede ise kemik iliğinde diffüz metabolik aktivite artışı gösteren olgularda iliak kanattan, fokal tutulumda ise en yüksek aktivite gösteren alandan ilgi alanı çizdirilerek SUVmaks değeri hesaplandı. KİB sonuçları referans olarak alınmıştır.Bulgular: Tüm olgular için görsel değerlendirmede PET/BT'nin kemik iliği infiltrasyonunu göstermede duyarlılığı %31, özgüllüğü %85 olarak saptanmıştır. HL olgularında görsel değerlendirmede duyarlılık %80, özgüllük %78; NHL olgularında ise duyarlılık %24, özgüllük %90 olarak bulunmuştur. Semikantitatif değerlendirmede HL'de SUVmaks>=4 alındığında duyarlılık %80, özgüllük %68 olarak saptanmıştır. NHL'de ise SUVmaks>=3,2 olarak belirlendiğinde duyarlılık %65, özgüllük %58 olarak bulunmuştur.Sonuç: Bu çalışmada, çok yüksek olmamakla birlikte, PET/BT bulguları ile KİB sonuçları arasında uyum izlendi. PET/BT görüntülemenin kemik iliği infiltrasyonu olup olmadığını göstermede etkili bir yöntem olduğunu görmekteyiz. PET/BT'nin, KİB'nin yerini almamakla birlikte, biyopsi yapılabilecek bölgeyi göstermede yönlendirici ve KİB'yi tamamlayıcı bir görüntüleme yöntemi olarak kullanılabileceğini düşünmekteyiz
Objective: Currently 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) is being successfully used for staging and follow-up of Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Various studies have demonstrated that PET/CT effectively detects bone marrow involvement (BMI) and is concordant with bone marrow biopsy (BMB) findings, thus it is deemed as a complementary method. This study was aimed to evaluate18FFDG-PET/CT efficiency for detection of BMI in HL and NHL. Methods: The study included 172 lymphoma cases who were admitted to Akdeniz University Medical School Department of Nuclear Medicine for initial staging with PET/CT. Visual and semiquantitative assessments were performed for PET/CT scan findings of the cases. The maximum standard uptake (SUVmax) value was the quantitative parameter used for 18F-FDG-PET scan. In visual assessment, bone marrow metabolic activity that is greater than the liver was considered as pathologic. For semiquantitative assessment, regions of interest were drawn for SUVmax estimation, which included iliac crest in cases with diffusely increased metabolic activity and the highest activity area in cases with focal involvement. BMB was considered as the reference test. Results: On visual assessment of all the cases, PET/CT was found to yield 31% sensitivity and 85% specificity rate for detection of BMI. On visual assessment of HL cases, sensitivity rate was determined as 80%, and specificity as 78%, while in NHL cases the corresponding values were 24% and 90%, respectively. On semiquantitative assessment of HL cases, considering SUVmax≥4, sensitivity was found as 80% and specificity as 68%. In NHL patients, considering SUVmax≥3.2, sensitivity rate was detected as 65% and specificity as 58%. Conclusion: In this study, a moderately high concordance was observed between PET/CT and BMB findings. PET/CT appears to be a significant method for detecting BMI. Although PET/CT is not a substitute for BMB, we suggest it can be used as a guide to biopsy site and a complementary imaging technique for BMB
Objective: Currently 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) is being successfully used for staging and follow-up of Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Various studies have demonstrated that PET/CT effectively detects bone marrow involvement (BMI) and is concordant with bone marrow biopsy (BMB) findings, thus it is deemed as a complementary method. This study was aimed to evaluate18FFDG-PET/CT efficiency for detection of BMI in HL and NHL. Methods: The study included 172 lymphoma cases who were admitted to Akdeniz University Medical School Department of Nuclear Medicine for initial staging with PET/CT. Visual and semiquantitative assessments were performed for PET/CT scan findings of the cases. The maximum standard uptake (SUVmax) value was the quantitative parameter used for 18F-FDG-PET scan. In visual assessment, bone marrow metabolic activity that is greater than the liver was considered as pathologic. For semiquantitative assessment, regions of interest were drawn for SUVmax estimation, which included iliac crest in cases with diffusely increased metabolic activity and the highest activity area in cases with focal involvement. BMB was considered as the reference test. Results: On visual assessment of all the cases, PET/CT was found to yield 31% sensitivity and 85% specificity rate for detection of BMI. On visual assessment of HL cases, sensitivity rate was determined as 80%, and specificity as 78%, while in NHL cases the corresponding values were 24% and 90%, respectively. On semiquantitative assessment of HL cases, considering SUVmax≥4, sensitivity was found as 80% and specificity as 68%. In NHL patients, considering SUVmax≥3.2, sensitivity rate was detected as 65% and specificity as 58%. Conclusion: In this study, a moderately high concordance was observed between PET/CT and BMB findings. PET/CT appears to be a significant method for detecting BMI. Although PET/CT is not a substitute for BMB, we suggest it can be used as a guide to biopsy site and a complementary imaging technique for BMB
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Hematoloji, Genel ve Dahili Tıp