Regional brain glucose metabolism in patients with diffuse large B⁃cell lymphoma by PET⁃CT
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摘要:
目的：采用统计参数图（statistical parametric mapping，SPM）方法分析体部弥漫大B淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者脑葡萄糖代谢改变模式。方法：入选52例均无脑部受累的体部DLBCL患者以及52例性别、年龄匹配的健康体检者进行常规体部及脑部18氟-脱氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG），正电子发射计算机断层显像（PET-CT）检查。2组图像进行视觉分析后用SPM方法进行两组之间的t检验获得两组间有差异脑区的Talairach坐标值。测量患者体部肿瘤总体积（whole-body metabolic tumor volume，MTVwb）及肿瘤糖酵解总量（whole-body total lesion glycolysis，TLGwb），分析MTVwb、TLGwb与脑葡萄糖代谢改变之间的相关性。结果：DLBCL视觉可见脑皮层弥漫性、对称性的代谢减低，基底节区代谢相对增高。SPM分析结果显示，双侧额顶颞枕皮层广泛葡萄糖代谢减低（P < 0.001），仅中央前后回未受影响。右侧丘脑枕核葡萄糖代谢亦有所减低。DLBCL患者脑葡萄糖代谢增高的区域则广泛分布于除枕叶外的皮层下白质区、右侧海马区、左侧基底节、双侧苍白球及双侧小脑扁桃体区等部位。部分脑区SPM分析颞顶枕等部位可见小灶性脑区的葡萄糖代谢程度与MTVwb、TLGwb呈负相关（P < 0.001）。结论：DLBCL患者脑内葡萄糖代谢改变有较为特定的模式，并且一些脑区与体部肿瘤的葡萄糖代谢负荷存在负相关。在体部DLBCL的评价中有必要关注脑代谢的改变。
Abstract:
Objective：The aim of this study was to analyze the brain 18F-FDG PET-CT scan images of patients with Diffuse large B-cell lymphoma（DLBCL）without brain invasion by statistical parametric mapping（SPM）analysis. Methods：This retrospective study enrolled 52 DLBCL patients who underwent 18F-FDG PET-CT for the pre-treatment staging. The control subjects were 52 persons who underwent health checks with 18F-FDG PET-CT. All the patients and control subjects had no organic brain lesions and no lesions suggesting malignant tumors. The degree of regional cerebral glucose metabolism was evaluated on a voxel-by-voxel basis using SPM. The whole-body metabolic tumor volume（MTVwb）and the whole-body total lesion glycolysis（TLGwb）were measured，and the correlation between the level of cerebral glucose metabolism and MTVwb，TLGwb was analyzed. Results：Compared with the control subjects，visual analysis revealed extensive reduction in cortical glucose metabolim in some DLBCL patients. SPM showed that in DLBCL patients group，the FDG uptake in bilateral parietal，frontal lobe and occipital lobe were significantly lower than those in control group（P < 0.001）. White matter，right hippocampus，left basal ganglia，bilateral globus pallidus and cerebellar tonsil showed higher FDG uptake either. TLGwb and MTVwb of the body tumor load were negative correlated with some small locations in cortex. Conclusion：18F-FDG PET-CT scan can sensitively detect the abnormal regional cerebral glucose metabolism in DLBCL patients. Cerebral glucose metabolism changes should be considered when evaluating DLBCL.
