目的:探索n 18F-脱氧葡萄糖(FDG)PET/CT显像早期诊断淋巴瘤治疗相关心脏毒性(TACT)的价值及分析不同评估标准的诊断效能。n 方法:回顾性分析2009年11月至2018年10月在北京大学肿瘤医院行n 18F-FDG PET/CT显像的淋巴瘤患者，患者接受淋巴瘤标准化疗方案治疗。通过视觉法及半定量法[最大标准摄取值(SUVn max)]分析治疗前后心肌摄取n 18F-FDG情况，计算治疗后与治疗前SUVn max-心差值(ΔSUVn max-心)、%ΔSUVn max-心，以及治疗后SUVn max-心/SUVn max-纵隔比值、SUVn max-心/SUVn max-肝比值及SUVn max-心/SUVn max-本底(左侧臀肌)比值。以心电图(ECG)出现异常(早期TACT)为终点，利用受试者工作特征(ROC)曲线计算影像不同评估标准的最佳阈值，分析诊断效能。采用两独立样本n t检验及n χ2检验分析数据。n 结果:274例入组淋巴瘤患者的男女比为1.85∶1，中位年龄36岁；非霍奇金淋巴瘤(NHL)患者占78.1%(214/274)。治疗后，55.1%(151/274)的患者心肌为高摄取(高于肝摄取)，20.4%(56/274)为中度摄取(介于心血池摄取与肝摄取之间)，24.5%(67/274)为等摄取(低于心血池摄取)。ECG(+)组(n n＝71)与ECG(-)组(n n＝203)心肌摄取差异具有统计学意义[SUVn max分别为7.77±4.06和5.91±3.04(n t＝4.045，n P<0.01)]。ROC曲线示，治疗后SUVn max-心、ΔSUVn max-心、%ΔSUVn max-心及治疗后SUVn max-心/SUVn max-纵隔比值、SUVn max-心/SUVn max-肝比值及SUVn max-心/SUVn max-本底比值诊断早期TACT的最佳阈值为9.4、4.8、1.4、5.0、2.3及7.0，曲线下面积(AUC)分别为0.653、0.637、0.612、0.655、0.649和0.650。其中治疗后SUVn max-心/SUVn max-本底比值预测早期TACT的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为40.85%(29/71)、82.76%(168/203)、45.31%(29/64)、80.00%(168/210)及71.90%(197/274)。n 结论:18F-FDG PET/CT显像能早期诊断淋巴瘤TACT，若以治疗后SUVn max-心/SUVn max-本底比值7.0为阈值，n 18F-FDG PET/CT对早期TACT预测的特异性及阴性预测值均达到80%。n “,”Objective:To explore the role of n 18F-fluorodeoxyglucose (FDG) PET/CT in early detection of therapy-associated cardiotoxicity (TACT) in lymphoma patients and to analyze the diagnostic efficacy of different evaluation criteria.n Methods:Consecutive patients between November 2009 to October 2018 in Peking University Cancer Hospital were retrospectively enrolled. All patients underwent standard chemotherapy. Myocardial uptake of n 18F-FDG pre- and post-treatment were analyzed by visual interpretation and semi-quantitative (maximum standardized uptake value, SUVn max) methods. The value of pre-treatment SUVn max-heart -post-treatment SUVn max-heart (ΔSUVn max), %ΔSUVn max, and post-treatment SUVn max-heart/SUVn max-mediastinum, SUVn max-heart/SUVn max-liver and SUVn max-heart/SUVn max-background(left gluteal muscle) ratios were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cut-off values of those PET/CT imaging criteria for evaluating early TACT of lymphoma, taking electrocardiogram (ECG) positive as the end point. Independent-sample n t test and n χ2 test were performed.n Results:A total of 274 patients (median age was 36-year old), with the male-to-female ratio of 1.85∶1, were included, and 78.1%(214/274) of them had non-Hodgkin′s lymphoma (NHL). After treatment, 55.1%(151/274)of the patients had high myocardial uptake of n 18F-FDG (compared with liver uptake), 20.4%(56/274) of them had moderate myocardial uptake (between liver uptake and blood-pool uptake), and 24.5%(67/274) were with equal uptake (less than blood-pool uptake). There were significant differences in myocardial uptake between ECG-positive group (n n=71) and ECG-negative group (n n=203) ( SUVn max: 7.77±4.06 n vs 5.91±3.04; n t=4.045, n P<0.01). ROC curves showed that optimal thresholds of post-treatment SUVn max-heart, Δ SUV n max-heart, %ΔSUVn max-heart, and post-treatment SUVn max-heart/SUVn max-mediastinum, SUVn max-heart/SUVn max-liver and SUVn max-heart/SUVn max-background ratios were 9.4, 4.8, 1.4, 5.0, 2.3, 7.0 respectively. The corresponding areas under the curves (AUC) were 0.653, 0.637, 0.612, 0.655, 0.649 and 0.650, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of post-treatment SUVn max-heart/SUVn max-background ratio were 40.85%(29/71), 82.76%(168/203), 45.31%(29/64), 80.00%(168/210) and 71.90%(197/274).n Conclusion:18F-FDG PET/CT can early detect TACT in patients with lymphoma, and if using 7.0 as the threshold of post-treatment SUVn max-heart/SUVn max- background ratio, the specificity and negative predictive value of n 18F-FDG PET/CT for early prediction of TACT are up to 80%.n