Medical Radiology and radiation safety Medical Radiology and radiation safety Медицинская радиология и радиационная безопасность 1024-6177 2618-9615 23952 10.12737/article_5c0b8d72a8bb98.40545646 Ядерная медицина Nuclear medicine Ядерная медицина Positron Emission Tomography in the Diagnosis and Monitoring of Lymphomas Позитронная эмиссионная томография в диагностике и мониторинге лимфопролиферативных заболеваний Чернов В. И. Chernov V. I.

доктор медицинских наук;

doctor of medical sciences;

 Дудникова Е. А. Dudnikova E. A. Гольдберг В. Е. Goldberg V. E.

доктор медицинских наук;

doctor of medical sciences;

 Кравчук Т. Л. Kravchuk T. L.

кандидат медицинских наук;

candidate of medical sciences;

 Данилова А. В. Danilova A. V. Зельчан Р. В. Zel'chan R. V.

кандидат медицинских наук;

candidate of medical sciences;

 Медведева А. А. Medvedeva A. A.

кандидат медицинских наук;

candidate of medical sciences;

 Синилкин И. Г. Sinilkin I. G.

кандидат медицинских наук;

candidate of medical sciences;

 Брагина О. Д. Bragina O. D.

кандидат медицинских наук;

candidate of medical sciences;

 Попова Н. О. Popova N. O.

кандидат медицинских наук;

candidate of medical sciences;

 Гольдберг А. В. Goldberg A. V. Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский Томский политехнический университет Томск Россия National Research Tomsk Polytechnic University Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation Национальный исследовательский институт онкологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук» Томск Россия Tomsk National Research Medical Center Tomsk Russian Federation 63 6 41 50 https://naukaru.ru/en/nauka/article/23952/view

В настоящее время ПЭТ и ПЭТ/КТ с 18F-ФДГ входят в стандарты диагностики и мониторинга лимфопролиферативных заболеваний. Для большинства лимфом характерно повышение метаболической активности и, как следствие этого, усиленная аккумуляция 18F-ФДГ. Применение ПЭТ/КТ позволяет уточнить стадию заболевания у 10–30 % пациентов, при этом чаще выявляются дополнительные опухолевые очаги, характерные для более распространенных стадий лимфом, что, в свою очередь, оказывает влияние на выбор тактики лечения и прогноз заболевания. Метод ПЭТ/КТ с 18F-ФДГ обладает преимуществом перед другими методами лучевой диагностики при выявлении поражений костного мозга у больных лимфомами. Показано, что ПЭТ/КТ с 18F-ФДГ, выполненная на ранних этапах проведения химиотерапии, позволяет отдифференцировать пациентов с благоприятным течением лимфомы, которым достаточно проведение стандартной терапии, и больных высокого риска, которым требуется более интенсивное лечение с применением высокодозных режимов химиотерапии. После завершения стандартной программной терапии у более чем 60 % пациентов с лимфомой Ходжкина (ЛХ) и 40 % с агрессивными неходжкинскими лимфомами (НХЛ) обнаруживается остаточная опухолевая масса, содержащая некротическую и/или фиброзную ткань и опухолевые клетки. Согласно литературным данным, ПЭТ с 18F-ФДГ позволяет выявлять остаточный опухолевый объем как стойкое повышение метаболической активности у 30–64 % таких пациентов. При этом у 62–100 % пациентов с гиперметаболическими очагами наблюдается рецидив после первой линии химиотерапии. Выявление пациентов с частичным ответом на химиотерапию говорит о необходимости продолжения лечения. На сегодняшний день ведутся разработки новых РФП для диагностики лимфом и оценки эффективности терапии. К таким перспективным РФП относится меченный фтором-18 фтортимидин, который отражает пролиферативную активность лимфомы, и 68Ga-CXCR4, тропный к хемокиновому пептиду CXCR4.

Currently, 18F FDG-PET and 18F FDG-PET/CT are widely used for diagnosis and monitoring of lymphomas. The majority of aggressive lymphomas are characterized by high glycolytic activity, which enables the visualization by using 18F FDG-PET/CT. The use of PET/CT makes it possible to clarify the stage of the disease in 10–30 % of patients, with additional tumor sites typical for advanced stage of lymphomas, which in turn effects on treatment and disease prognosis. The 18F FDG-PET/CT has the advantage over other methods of radiation diagnosis in detecting bone marrow lesions in patients with lymphomas. It has been shown that 18F FDG-PET/CT performed at early stages of chemotherapy allows differentiating patients with favorable lymphoma, which is sufficient for standard therapy and high-risk patients who require more intensive treatment with high-dose regimens of chemotherapy. After completion of therapy over 60 % of patients with HL and 40 % with aggressive non-Hodgkin’s lymphomas, have residual masses containing necrotic and/or fibrotic tissue and residual neoplastic cells. 18F FDG-PET and 18F FDG-PET/CT has been shown to be useful in identifying residual masses in 30–64 % of patients, by demonstration of persistent metabolic activity on FDG-PET. Between 62–100 % of patients with residual FDG-positive masses have been shown to relapse after first-line chemotherapy. Identification of patients with partial response to chemotherapy indicates the need for continued treatment. New radiopharmaceuticals for the diagnosis of lymphoma and evaluation of therapy effectiveness are developed. Such promising radiopharmaceuticals are 18F fluorothymidine, a biomarker of cellular proliferation and Ga-68 CXCR4, a chemokine receptor imaging biomarker.

 лимфопролиферативные заболевания лимфома Ходжкина неходжкинские лимфомы ПЭТ/КТ 18F-фтордезоксиглюкоза 18F-фтортимидин 68Ga-CXCR4 lymphomas Hodgkin’s lymphoma non-Hodgkin’s lymphomas PET/CT 18F-fluorodeoxyglucose 18F-fluorothymidine 68Ga-CXCR4

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