Nuclear Medicine and Molecular Imaging

  • 제42권5호
  • /
  • Pages.369-374
  • /
  • 2008
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  • 1869-3474(pISSN)
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  • 1869-3482(eISSN)
대한핵의학회 (The Korean Society of Nuclear Medicine)
권호 표지

말초성 T 세포 림프종의 병기 설정시 F-18 FDG PET/CT의 유용성

Usefulness of F-18 FDG PET/CT in Staging of Peripheral T Cell Lymphoma

  • 강윤희 (전북대학교 의학전문대학원 핵의학교실) ;
  • 임석태 (전북대학교 의학전문대학원 핵의학교실) ;
  • 김동욱 (전북대학교 의학전문대학원 핵의학교실) ;
  • 정환정 (전북대학교 의학전문대학원 핵의학교실) ;
  • 손명희 (전북대학교 의학전문대학원 핵의학교실) ;
  • 임창열 (전북대학교 의학전문대학원 내과학교실)
  • Kang, Yun-Hee (Department of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Lim, Seok-Tae (Department of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Kim, Dong-Wook (Department of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Jeong, Hwan-Jeong (Department of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Sohn, Myung-Hee (Department of Nuclear Medicine, Chonbuk National University Medical School) ;
  • Yim, Chang-Yeol (Department of Internal Medicine, Chonbuk National University Medical School)
  • 발행 : 2008.10.31
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초록

목적: F-18 FDG PET/CT는 비호지킨 림프종 환자의 병기를 결정하는데 높은 민감도와 특이도를 보인다. 그러나 말초성 T 세포 림프종 환자를 평가하는데 있어 F-18 FDG PET/CT의 유용성에 대한 연구는 많지 않다. 따라서 말초성 T세포 림프종, 특히 지연성 피부 T세포 림프종 환자에서의 F-18 FDG PET/CT의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 조직검사를 통해 지연성 피부 T세포 림프종과 비피부성 T세포 림프종으로 진단 후 병기결정을 위하여 F-18 FDG PET-ET를 시행받은 25명의 환자(남:여=17:8, 나이 $53.7{\pm}14.8$세)를 대상으로 하였다. PET/CT에서 모든 비정상 병변의 최대 표준섭취계수(p-SUV)를 측정하고 피부 병변과 비피부 병변으로 구분하여 섭취정도를 비교하였다. 결과: 총 25명의 환자 중 6명은 피부성 T세포 림프종(피부 T세포 림프종 5명, 림프종양 구진증 1명)이었고, 19명은 비피부성 T세포 림프종(상세불명의 말초성 T세포 림프종 10명, 림프절외 NK/T세포 림프종 3명, 장 병변 T 세포 림프종 2명, 피하지방층염양 T세포 림프종 1명, 이형성 거대세포 림프종 3명)이었다. 조직학적으로 지연 피부성 T 세포 림프종으로 진단된 피부 병변에서 6명의 환자 모두 의미있는 FDG 섭취 소견은 보이지 않았다. 그러나 피부성 T 세포 림프종을 가진 2명의 환자는 림프종 침범으로 생각되는 비피부성 병변(림프절)이 CT에서 보였고 이 병변들에 FDG 섭취 증가 양상을 보였다.(p-SUV=$4.26{\pm}0.37$). 비피부성 T 세포 림프종 환자에서는 CT에서 관찰된 모든 림프종 병변에 FDG 섭취 증가 양상을 보였다(p-SUV=$8.52{\pm}5.00)$. 이와 같이 말초성 T세포 림프종 환자에서 피부 병변과 비피부성 병변 사이의 FDG 섭취 정도는 큰 차이를 보였다. 결론: PET/CT는 지연성 피부 T세포 림프종 환자에서 피부 병변을 평가하는 데는 제한점을 갖는다. 그러나 피부 T세포 림프종과 비피부성 T세포 림프종 모두에서 비피부성 병변을 평가하여 병기 결정하는 데는 PET/CT가 유용하였다.

Purpose: F-18 FDG PET/CT has excellent sensitivity and specificity for staging non-Hodgkin lymphomas, but to the author's knowledge few studies to date have evaluated FDG PET/CT in peripheral T cell lymphoma. We evaluated the usefulness of F-18 FDG PET/CT in staging of patients with peripheral T cell lymphoma, especially indolent cutaneous T cell lymphomas. Materials and Methods: Twenty five patients (M:F=17:8, age $53.7{\pm}14.8$ yrs) with biopsy-proven indolent cutaneous T cell (CL) or noncutaneous T cell lymphomas (NCL) underwent PET/CT scans for staging at baseline. Peak standardized uptake values (p-SUV) of all abnormal foci were measured and compared between cutaneous and noncutaneous lesions. F-18 FDG PET/CT was performed on 6 patients with indolent CL and on 19 patients with NCL. Results: All 6 patients with indolent CL had no significant FDG avidity in the skin despite histologically positive cutaneous lesions. However, FDG avidity appeared in extracutaneous lesions (lymph nodes) in two patients with CL where CT imaging suggested lymphoma involvement (mean p-SUV $4.26{\pm}0.37$ in noncutaneous lesions in CL). In NCL, FDG avidity was demonstrated in all lesions where CT imaging suggested lymphoma involvement (mean p-SUV, $8.52{\pm}5.00$ in noncutaneous lesions in NCL). Conclusion: F-18 FDG PET/CT has the limitation of usefulness for the evaluation of the skin in indolent CL. In contrast, F-18 FDG PET/CT is sensitive in staging evaluation of extracutaneous lesions regardless of CL or NCL.

키워드

참고문헌

  1. Lee HJ, Im JG, Goo JM, Kim KW, Choi BI, Chang KH, et al. Peripheral T-cell lymphoma: Spectrum of imaging findings with clinical and pathologic features. Radiographics 2003;23:7-28 https://doi.org/10.1148/rg.231025018
  2. Savage KJ, Chhanabhai M, Gascoyne RD, Connors JM. Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol 2004;15:1467-75 https://doi.org/10.1093/annonc/mdh392
  3. Musson R, Radstone CR, Horsman JM, Hancock H, Goepel JR, Hancock BW. Peripheral T cell lymphoma: The Sheffield Lymphoma Group experience (1977-2001). Int J Oncol 2003;22: 1363-8
  4. Schoder H, Noy A, Gonen M, Weng L, Green D, Erdi YE, et al. Intensity of F-18 fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non- Hodgkin's lymphoma. J Clin Oncol 2005;23:4643-51 https://doi.org/10.1200/JCO.2005.12.072
  5. Miketic LM, Chambers TP, Lembersky BC. Cutaneous T-cell lymphoma: Value of CT in staging and determining prognosis. AJR 1993;160:1129-32 https://doi.org/10.2214/ajr.160.5.8470594
  6. Jhanwar YS, Straus DJ. The role of PET in lymphoma. J Nucl Med 2006;47:1326-34
  7. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood 2005;205:3768-85
  8. Bass JC, Korobkin MT, Cooper KD, Kane NM, Platt JF. Cutaneous T-cell lymphoma: CT in evaluation and staging. Radiology 1993; 186:273-8 https://doi.org/10.1148/radiology.186.1.8416579
  9. Yun MJ. The role of FDG PET in malignant lymphoma. Korean J Nucl Med 2002;36;53-63
  10. Mikosch P, Gallowitsch HJ, Zinke-Cerwenka W, Heinisch M, Pipam W, Eibl M, et al. Accuracy of whole-body F-18 FDG PET for restaging malignant lymphoma. Acta Med Austriaca 2003;30:41- 7 https://doi.org/10.1046/j.1563-2571.2003.03003.x
  11. Endo K, Oriuchi N, Higuchi T, Iida Y, Hanaoka H, Miyakubo M, et al. PET and PET/CT using F-18 FDG in the diagnosis and management of cancer patients. Int J Clin Oncol 2006;11:286-96 https://doi.org/10.1007/s10147-006-0595-0
  12. Tatsumi M, Cohade C, Nakamoto Y, Fishman EK, Wahl RL. Direct comparison of FDG PET and CT findings in patients with lymphoma: initial experience. Radiology 2005;237:1038-45 https://doi.org/10.1148/radiol.2373040555
  13. Bar-Shalom R, Yefremov N, Haim N, Dann EJ, Epelbaum R, Keidar Z, et al. Camera-based FDG PET and Ga-67 SPECT in evaluation of lymphoma: Comparative study. Radiology 2003;227: 353-60 https://doi.org/10.1148/radiol.2272020195
  14. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32 https://doi.org/10.1148/radiol.2312021185
  15. Schoder H, Larson SM, Yeung HW. PET/CT in oncology: Integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med 2004;45:72-81
  16. Kresnik E, Gallowitsch HJ, Mikosch P, Wurtz F, Alberer D, Hebenstreit A, et al. F-18 FDG positron emission tomography in the early diagnosis of enterocolitis: Preliminary results. Eur J Nucl Med Mol Imaging 2002;29:1389-92 https://doi.org/10.1007/s00259-002-0901-7
  17. Israel O, Mor M, Guralnik L, Gaitini D, Zachs Y, Keidar Z, et al. The new technology of combined transmission and emission F-18 FDG tomography (FDG-PET) in the diagnosis and management of cancer patients. Clin Positron Imaging 2000;3:143 https://doi.org/10.1016/S1095-0397(00)00055-8
  18. Schiepers C, Hoh CK. Positron emission tomography as a diagnostic tool in oncology. Eur Radiol 1998;8:1481-94 https://doi.org/10.1007/s003300050579
  19. Pai MS, Cho YK, Jung SA, Shim KN, Lee HS. Colonic uptake patterns of F-18 FDG PET in asymptomatic adults: Comparison with colonic findings. Korean J Nucl Med 2005;39:15-20
  20. Valencak J, Becherer A, Der-Petrossian M, Trautinger F, Raderer M, Hoffmann M. Positron emission tomography with F-18 2-fluoro- D-2-deoxyglucose in primary cutaneous T-cell lymphomas. Haematologica 2004;89:115-6
  21. Tsai EY, Taur A, Espinosa L, Quon A, Johnson D, Dick S, et al. Staging accuracy in mycosis fungoides and Sézary syndrome using integrated positron emission tomography and computed tomography. Arch Dermatol 2006;142:577-84 https://doi.org/10.1001/archderm.142.5.577