O‘TKIR LIMFOBLASTIK LEYKOZDA TIMUSNING INVOLYUTSIYASI VA LEYKEMIK INFILTRATSIYANING PET/CT VA MRI BILAN BAHOLANISHI (KLINIK-MORFOLOGIK KORRELYATSIYA)
Keywords:
Kalit so’zlar: o‘tkir limfoblastik leykoz, T-ALL, timus involyutsiyasi, leykemik infiltratsiya, 18F-FDG PET/CT, diffuzion-vaznli MRI, ADC, prognostik biomarker, minimal qoldiq kasallikAbstract
Maqsad: O‘tkir limfoblastik leykoz (O‘LL), xususan T-hujayrali variantda (T-ALL) timusning involyutsiya darajasi va leykemik infiltratsiyani 18F-FDG PET/CT va diffuzion-vaznli MRI yordamida baholash, ularni gistopatologik va klinik natijalar bilan korrelyatsiya qilish. Material va metodlar: 2022–2025 yillarda diagnostika qilingan 46 bemor (27 T-ALL, 19 B-ALL; yoshi 3–42 yosh) retrospektiv tahlil qilindi. Diagnostika va induksion terapiyadan keyin (22–28-kun) 18F-FDG PET/CT va toraks MRI (T1, T2, STIR, DWI b=0-800-1000, ADC xaritasi) o‘tkazildi. Timus hajmi (3D-volyumetrik segmentatsiya, sm³), SUVmax, TLG, ADCmean va ADCmin o‘lchandi. 18 bemorda timus biopsiyasi materiallari gistopatologik va immunogistokimyoviy (TdT, CD1a, CD3, CD99, Ki-67) tekshiruvdan o‘tkazildi. Natijalar: T-ALL bemorlarida diagnostika vaqtida timus hajmi 48,7 ± 21,3 sm³ (B-ALLda 8,4 ± 4,1 sm³; p<0,001), SUVmax 9,8 ± 3,4. Terapiyadan keyin timus hajmi T-ALLda 64,2 %, B-ALLda 81,7 % ga kamaydi. ADCmean 0,74 ± 0,12 dan 1,41 ± 0,18 × 10⁻³ mm²/s ga oshdi (p<0,001). Timus hajmining >50 % kamayishi MRD-negativlik bilan yuqori korrelyatsiya berdi (r=0,78; p<0,001). SUVmax ≥8,5 va ADC ≤0,82 bo‘lgan bemorlarda 2 yillik omon qolish 61 % ni, qolganlarda 92 % ni tashkil etdi (p=0,012). Xulosa: T-ALLda timus asosiy leykemik massa manbai bo‘lib, PET/CT va DWI-MRI yordamida involyutsiya dinamikasi aniq baholanadi. Timus hajmi va ADC qiymatlari terapiya samaradorligi va prognostik biomarker sifatida taklif etiladi.
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