A Study of the Role of 18F-Fluorodeoxyglucose PET/CT in Assessing the Progression of Arterial Inflammation in Patients with Diffuse Large B-Cell Lymphoma

doi:10.3969/j.issn.1673-5765.2025.02.010

Abstract

Abstract: Objective To evaluate the changes in arterial uptake of 18F-fluorodeoxyglucose (18F-FDG) before and at mid-chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL) through PET/CT, reflecting the changes in arterial inflammation during the chemotherapy process.
Methods Patients with DLBCL who were diagnosed and treated at the First Affiliated Hospital of Shandong Second Medical University between January 2021 and January 2023 were retrospectively and consecutively included in the study. All patients underwent 18F-FDG PET/CT examinations before and at mid-chemotherapy. The maximum target-to-background ratio (TBRmax) and mean target-to-background ratio (TBRmean) were used to evaluate the inflammation levels in the carotid and aortic arteries before and at mid-chemotherapy. The carotid artery evaluation sites included the whole carotid artery (CA-WH) and the most-diseased segment of the carotid (CA-MDS). The aortic artery evaluation sites included the ascending aorta, aortic arch, thoracic aorta, and abdominal aorta. The differences in CA-WH-TBRmax, CA-WH-TBRmean, CA-MDS-TBRmax, and CA-MDS-TBRmean of the left and right carotid arteries in the overall patients before and at mid-chemotherapy, as well as the differences in TBRmax and TBRmean of various parts of the aorta, were compared, respectively. Based on the results of ultrasonic examinations of carotid atherosclerotic plaques, patients were classified into three groups: the unstable plaque group, the stable plaque group, and the no plaque group. The changes in target-to-background ratio (ΔTBR) (mid-chemotherapy TBR-pre-chemotherapy TBR) of the left and right CA-WH-TBRmax and CA-WH-TBRmean among the three groups were compared respectively to evaluate the differences in the degree of carotid inflammation changes during chemotherapy.
Results A total of 85 patients with DLBCL were included in the study, including 26 patients (30.6%) in the unstable plaque group, 24 patients (28.2%) in the stable plaque group, and 35 patients (41.2%) in the no plaque group. In the overall patients, the bilateral CA-WH-TBRmax (left side P=0.015, right side P=0.034), CA-MDS-TBRmax (left side P<0.001, right side P=0.041), CA-MDS-TBRmean (left side P=0.029, right side P=0.008), and ascending aorta TBRmax (P=0.010) were significantly higher at mid-chemotherapy than pre-chemotherapy, with statistically significant differences. In the unstable plaque group, the left CA-WH-ΔTBRmax value was higher than that in the no plaque group (P=0.005), with a statistically significant difference. Additionally, the left CA-WH-ΔTBRmean in the unstable plaque group was higher than that in both the no plaque group (P=0.003) and the stable plaque group (P=0.025), with statistically significant differences.
Conclusions Chemotherapy can accelerate the progression of inflammation in bilateral carotid arteries and ascending aorta of patients with DLBCL. During the tumor follow-up, PET/CT technology can early identify the evolution of chemotherapy-related arterial inflammation, thus providing a basis for early clinical intervention in atherosclerosis.

Key words: Vascular inflammation; Atherosclerosis; Cardio-cerebrovascular disease; Positron emission tomography; Deoxyglucose

摘要： 目的通过PET/CT评估弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者化疗中期较化疗前动脉摄取18氟代脱氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG）水平的变化，反映患者化疗过程中动脉炎症的变化情况。
方法回顾性连续纳入2021年1月—2023年1月于山东第二医科大学第一附属医院诊治的DLBCL患者作为研究对象。所有患者均在化疗前及化疗中期进行了18F-FDG PET/CT检查。使用最大靶本底比（maximum target-to-background ratio，TBRmax）及平均靶本底比（mean target-to-background ratio，TBRmean）评估颈动脉和主动脉化疗前、化疗中期的动脉炎症水平。颈动脉评估部位包括颈动脉整体测量段（whole carotid artery，CA-WH）和颈动脉最严重病变段（most-diseased segment of the carotid，CA-MDS）；主动脉评估部位包括升主动脉、主动脉弓、胸主动脉和腹主动脉。分别比较整体患者化疗中期和化疗前左、右侧CA-WH-TBRmax、CA-WH-TBRmean、CA-MDS-TBRmax和CA-MDS-TBRmean，以及主动脉各部位的TBRmax和TBRmean的差异。根据超声检查的颈动脉粥样硬化斑块情况，将患者分为不稳定斑块组、稳定斑块组及无斑块组，分别比较3组患者左、右两侧CA-WH-TBRmax和CA-WH-TBRmean的Δ靶本底比（target-to-background ratio，TBR）（化疗中期TBR-化疗前TBR），评估3组化疗期间颈动脉炎症水平变化程度的差异。
结果共纳入85例DLBCL患者，其中不稳定斑块组26例（30.6%），稳定斑块组24例（28.2%），无斑块组35例（41.2%）。整体患者中，化疗中期双侧CA-WH-TBRmax（左侧P=0.015，右侧P=0.034）、CA-MDS-TBRmax（左侧P＜0.001，右侧P=0.041）、CA-MDS-TBRmean（左侧P=0.029，右侧P=0.008）、升主动脉TBRmax（P=0.010）较化疗前显著增高，差异有统计学意义。不稳定斑块组左侧CA-WH-ΔTBRmax较无斑块组（P=0.005）更高，差异具有统计学意义；不稳定斑块组左侧CA-WH-ΔTBRmean较无斑块组（P=0.003）、稳定斑块组（P=0.025）更高，差异均有统计学意义。
结论化疗可加速DLBCL患者双侧颈动脉及升主动脉炎症的进展，PET/CT技术能够识别化疗相关动脉炎症的演变，从而为临床早期干预动脉粥样硬化提供依据。

关键词: 血管炎症; 动脉粥样硬化; 心脑血管疾病; 正电子发射断层成像; 脱氧葡萄糖

CLC Number:

FAN Ping, LI Aiyuan, ZHAO Zhe, LI Xianjun, ZHAN Tongxia, XIE Hai. A Study of the Role of ¹⁸F-Fluorodeoxyglucose PET/CT in Assessing the Progression of Arterial Inflammation in Patients with Diffuse Large B-Cell Lymphoma[J]. Chinese Journal of Stroke, 2025, 20(2): 199-207.

范萍, 李爱媛, 赵喆, 李现军, 战同霞, 谢海. ¹⁸氟代脱氧葡萄糖PET/CT评估弥漫大B细胞淋巴瘤患者动脉炎症进展的作用研究[J]. 中国卒中杂志, 2025, 20(2): 199-207.

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A Study of the Role of ¹⁸F-Fluorodeoxyglucose PET/CT in Assessing the Progression of Arterial Inflammation in Patients with Diffuse Large B-Cell Lymphoma

¹⁸氟代脱氧葡萄糖PET/CT评估弥漫大B细胞淋巴瘤患者动脉炎症进展的作用研究

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