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Objective:To assess the value of 18F-FDG PET/CT imaging and relevant factors in the interim therapeutic and prognostic evaluation of primary gastrointestinal lymphoma (PGIL) patients. Methods:From January 2008 to January 2018, 41 patients with B-cell PGIL (24 males, 17 females; age: 26-84 years) confirmed by pathology in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively included. 18F-FDG PET/CT was performed before chemotherapy and radiotherapy and after 3-4 courses of chemotherapy. There were 17 cases of mucosa-associated lymphoid tissue (MALT) lymphoma and 24 cases of diffuse large B-cell lymphoma (DLBCL). Mann-Whitney U test was used to compare the differences of metabolic parameters (SUV max, metabolic tumor volume (MTV), total lesion glycolysis (TLG)) before treatment between MALT lymphoma and DLBCL patients. ROC curve analysis was used to analyze the predictive abilities of different parameters for progression-free survival (PFS), and Cox regression analysis was used to analyze the influencing factors for PFS. Results:The median follow-up time of 41 patients was 25 (6-84) months, with the 3-year PFS rate of 55.9% and the overall survival (OS) rate of 80.2%. The baseline SUV max (23.2±11.9), MTV (260.7(66.2, 740.7) cm 3) and TLG (1 902.9(592.2, 8 418.1) g) in DLBCL were significantly higher than those in MALT lymphoma (7.9(6.2, 9.8), 45.9(28.4, 104.2) cm 3, 121.1(72.8, 295.6) g; z values: -4.02, -3.10, -3.92, all P<0.05). ΔSUV max in DLBCL patients (AUC=0.80, P=0.012), ΔSUV max% (AUC=0.89, P=0.007; AUC=0.80, P=0.012), ΔMTV%(AUC=0.91, P=0.005; AUC=0.77, P=0.026) and ΔTLG% (AUC=0.87, P=0.011; AUC=0.77, P=0.026) in MALT lymphoma and DLBCL patients before and after treatment were predictive factors of PFS. Multivariate analysis showed that ΔSUV max% was an independent factor for PFS of MALT lymphoma (hazard ratio ( HR)=17.192, 95% CI: 2.035-145.245, P=0.009), while ΔMTV% and ΔTLG% were factors for PFS of DLBCL (both HR=7.556, 95% CI: 1.968-29.016, P=0.003). Conclusions:There are significant differences in metabolic parameters between MALT lymphoma and DLBCL before treatment. Interim PET/CT is effective for the prediction of prognosis of MALT lymphoma and DLBCL.
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Objective:To explore the value of SPECT/CT imaging on programmed death receptor 1 ligand (PD-L1) expression in patients with non-small cell lung cancer (NSCLC) based on 99Tc m labeled anti-PD-L1 nanoantibodies (NM-01). Methods:From January 2019 to March 2020, a total of 14 patients (11 males, 3 females; age: (61.9±11.0) years) with pathologically confirmed NSCLC in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were prospectively enrolled. NM-01 were labeled with 99Tc m, and patients were recruited for SPECT/CT imaging 2 h after injection with 99Tc m-NM-01((359.1±68.0) MBq). The differences of SUV max in primary and metastatic lesions between PD-L1 positive and negative patients were compared by independent sample t test. The correlation between the SUV max and PD-L1 expression of primary lesions was analyzed by Pearson correlation analysis. Results:Of 14 patients, 6 were PD-L1 positive and 8 were PD-L1 negative. 99Tc m-NM-01 showed obviously increased uptake in kidneys and liver, while mildly increased uptake in spleen and bone marrow. The SUV max of primary lesions was 4.69±1.88 and the SUV max of metastatic lesions was 2.04±1.32. The SUV max of primary lesions in PD-L1 positive patients was significantly higher than that of PD-L1 negative patients (5.99±1.99 vs 3.72±1.10; t=5.98, P=0.039). There was no significant difference in the SUV max of metastatic lesions between PD-L1 positive and negative patients (1.66±1.03 vs 2.35±1.46; t=-1.77, P=0.084). The SUV max of primary lesions was positively correlated with PD-L1 expression ( r=0.648, P=0.042). Conclusion:99Tc m-NM-01 can demonstrate the expression of PD-L1 in primary and metastatic lesions in NSCLC.
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Objective To assess the value of 18F-fluorodeoxyglucose (FDG) PET/CT in the staging,interim therapeutic and prognostic evaluation of mucosa-associated lymphoid tissue (MALT) lymphoma.Methods Thirty-six MALT lymphoma patients (20 males,16 females;average age:61.7 years) confirmed by pathology from January 2008 to January 2018 were retrospectively analyzed.18F-FDG PET/CT were performed before chemotherapy and radiotherapy for staging.The detective sensitivity was evaluated.The staging results of gastric MALT lymphoma and extragastric MALT lymphoma by PET/CT were compared with Fisher exact probability method.PET/CT was performed in 17 of 36 patients after 4 courses of chemotherapy,and 17 patients were divided into positive group (≥≥4) and negative group (＜4) according to scores of Deauville 5-point scale.The progression-free survival (PFS) was evaluated using Kaplan-Meier survival analysis.Results FDG-positive lesions were found in 31 of 36 patients with the sensitivity of 86.1％ (31/36).The results of PET/CT were negative in stage Ⅰ patients.In stage]Ⅱ-Ⅳ patients,the results of 18F-FDG PET/CT combined with bone marrow biopsy were in accordance with the results of clinical staging.The accuracy of PET/CT in staging of gastric MALT lymphoma patients was 9/17,which was significantly lower than that of extragastric MALT lymphoma patients (17/19;P=0.025).The PFS of negative group evaluated by interim PET/CT was longer than that of positive group (x2 =4.16,P＜0.05).The 2-year PFS rates of the 2 groups were (85.7± 13.2)％ and (27.8 ±21.3)％,respectively.The PFS of patients with low expression of Ki-67 was significantly longer than that of patients with high Ki-67 expression (x2=4.22,P＜0.05).Conclusions In stage]Ⅱ-Ⅳ MALT patients,18F-FDG PET/CT combined with bone marrow biopsy can improve the staging accuracy.The staging accuracy of PET/CT in extragastric MALT lymphoma is significantly higher than that of gastric MALT lymphoma.PET/CT and Ki-67 can provide effective information on the prognostic evaluation for patients with MALT lymphoma.
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Objective To investigate the prognostic value of △SUV and Deauville 5-point scoring (5-PS) in patients with DLBCL.Methods Thirty-nine patients (20 males,19 females;median 58 (23-85) years) with pathologically confirmed DLBCL were retrospectively analyzed from January 2009 to April 2015.PET/CT imaging was performed before and after 4 courses of chemotherapy.The optimum cutoff values of △SUVmax and its decline proportion (△SUVmax％) were calculated by ROC curve,and then the Kaplan-Meier analysis and Cox regression analysis were performed in patients with different △SUVmax and △SUVmax％.Patients were also evaluated by the observers using Deauville 5-PS,Kaplan-Meier analysis and Cox regression analysis were performed in patients with scores ≥ 4 and those with scores ＜ 4.x2 test and Spearman correlation analysis were used.Results (1) There were 10 patients (25.64％,10/39) with progressed disease within the 2 year-follow-up.The △SUVmax,△SUVmax％ of progressed group were markedly lower than those of non-progressed group:9.55± 11.90 vs 15.61±7.86,71.66％ (33.90％-78.91％) vs 87.83％(76.51％-92.43％);t=-2.37,z=-3.25,both P＜0.05.(2)The optimum cutoff values of the △SUVmax,△SUVmax％ were 11.2 and 72.88％ respectively.(3) The patients with △SUVmax ＜ 11.2,△SUVmax％ ＜72.88％ or Deauville 5-PS≥4 showed shorter PFS and △SUVmax％ was proved to be an independent prognostic factor(x2 =5.734,14.821,5.851,all P＜0.05).(4) △SUVmax％ and Deauville 5-PS were correlated (rs =-0.633,P＜0.001).Conclusions △SUV and Deauville 5-PS could be used for prognosis prediction in DLBCL patients and △SUVmax％ might be an independent predictive factor.The values of △SUVmax ％ and Deauville present a negative relationship.
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Objective To investigate the value of 18F-FDG PET/CT for the detection of primary malignancy in patients with cervical lymph node metastases from unknown origin.Methods Seventy-eight patients (48 males,30 females,average age (56.4± 14.7) years) who were diagnosed as cervical lymph node metastases from unknown origin by fine needle aspiration underwent 18F-FDG PET/CT from 2007 to 2012.ROI was drawn with SUVm~ calculated.The distribution of the lymph nodes was classified according to the standard levels Ⅰ to Ⅵ,as well as the retropharyngeal and supraclavicular stations.The short axis of lymph node was defined as the lesion size.The final diagnosis was confirmed by pathology and clinical follow-up.Data collection and interpretation included identification of primary malignancy,pathologic types of primary tumors,distribution,size and SUVmax of the metastatic lymph nodes.One-way analysis of variance and linear correlation analysis were used for data analysis.Results In 78 subjects,75 were diagnosed as having malignant and 3 as benign lymph nodes by excisional biopsy.18F-FDG PET/CT detected primary malignancy in 56 cases (71.8％,56/78).In these 56 cases,57.1％(32/56) had head and neck cancer with metastatic lymph nodes mainly distributed in levels Ⅱ,Ⅲ and Ⅳ (90.6％,29/32).The remaining 24/56 (42.9％) patients had primary malignancy of the trunk with metastatic lymph nodes primarily involving supraclavicular fossa (95.8％,23/24).There was no statistical difference in size and SUVmax of lymph node among different primary locations or pathological types (F=0.037-2.413,all P＞0.05).Conclusion 18FFDG PET/CT may play an important role in the detection of primary cancers for patients with metastatic cervical lymph nodes from unknown origin.
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As a functional imaging method, positron emission tomography (PET) is widely used in tumor diagnosis, pathological classification, stage assessment, and clinical outcome evaluation. Combination of metabolic information acquired from ~(18)F-fluorodeoxyglucose (~(18)F-FDG) PET with pathological grading results is helpful for further defining the grade of sarcomas and predicting prognosis. ~(18)F-FDG PET appears to be superior to other imaging modalities in detecting bone metastases or pulmonary metastases of sarcoma patients, so it could be used in clinical staging and restaging of sarcoma. Tumor-to-background ratio (TBR) and standardized uptake value (SUV) are two important parameters for quantitative analysis and are helpful for assessing chemotherapy response of tumor. PET imaging offers important information to help maximize the clinical benefit of patients with sarcoma. This article reviews the clinical value of ~(18)F-FDG PET and ~(18)F-FDG PET/CT in diagnosis of sarcoma.