摘要
目的探讨薄壁囊腔型肺腺癌的18F-FDG PET显像和MSCT征象特点,以提高对该病的诊断准确性。方法回顾性分析2007年7月~2017年12月,影像学表现为囊性病变、囊壁厚度≤4mm、经病理证实为肺腺癌病例18例,其中男性15例,女性3例,平均年龄(63.83±11.97)岁。18例均有MSCT、18F-FDG PET/CT双时相显像,对PET/CT早期显像、延迟显像及滞留指数、基于SUVmax的肿瘤与对侧正常肺本底的比值变化率、病灶边缘分叶及胸膜尾征、血管束是否穿过囊壁、囊壁均匀程度及囊壁周围是否伴有磨玻璃等征象进行综合分析。结果所有18例病灶的早期显像平均SUVmax为1.81±0.92(对侧肺本底SUVmax为0.80±0.31),注药后2.0h延迟显像平均SUVmax为2.21±0.10(对侧肺本底SUVmax为0.54±0.23);平均双时相显像滞留指数为(25.87±21.96)%;△T/Nmax平均值为(87.72±53.96)%。病灶常规显像与延迟显像之间SUVmax差异有统计学意义,t=-5.205,P<0.05(P=0.003);与对侧肺本底SUVmax之间差异也有统计学意义,t=3.402,P<0.05(P=0.019);RI和△T/Nmax之间差异无统计学意义,t=-2.42,P>0.05(P=0.06)。MSCT征象发病部位,右肺下叶3例,右肺上叶9例,左肺下叶6例;病灶最大径平均值为(2.88±1.33)cm;病灶均呈边界清晰的类圆形或椭圆形囊样影,15例边缘有分叶,6例有胸膜尾征,15例有血管束穿过囊壁(6例分别有1条血管束穿过囊壁,6例分别有2条血管束穿过囊壁,3例有3条血管束穿过囊壁),12例囊周伴有磨玻璃改变,18例病例囊壁厚度均不均匀。结论肺内囊性病变具有一定CT特征,呈略高于本底的18F-FDG摄取增高,提示薄壁囊腔型肺腺癌可能。
Objective To discuss the characteristics of 18F-FDG PET and MSCT in pulmonary adenocarcinoma associated with cystic airspaces,and to improve the diagnostic accuracy.Methods Imaging data of 18 patients(15 males and 3 females,average age of 63.83±11.97 years)with imaging-performed cystic airspaces,thin wall(thickness less than or equal to 4 mm)and pathology-proven primary pulmonary adenocarcinoma from July 2007 to December 2017 were retrospectively analyzed.All 18 patients received dual-phase 18F-FDG PET and MSCT.All imaging data including findings and SUVmax on early and delayed PET/CT images,retention index of lesions(RI),rate of change of SUVmax ratio between tumor and contralateral lung background(△T/Nmax),lobulation,pleural indenlation sign,vessel passing through cystic wall,cystic wall uniformity,ground-glass opacity around lesions were comprehensively analyzed.Results 18 solitary pulmonary lesions associated with cystic airspaces showed patchy increased 18F-FDG uptake with mean SUVmax on early and delayed 18F-FDG PET/CT of 1.81±0.92 and 2.21±0.10,respectively.Mean SUVmax on contralateral lung background was 0.80±0.31 and 0.54±0.23,respectively.The mean retention index was(25.87±21.96)%.The mean△T/Nmax was(87.72±53.96)%.There was significant difference between SUVmax on early and delayed 18F-FDG PET/CT(t=-5.205,P=0.003);there was significant difference between SUVmax on early 18F-FDG PET/CT and contralateral lung background(t=3.402,P=0.019);no significant difference was found between in accuracy between RI and△T/Nmax(t=-2.42,P=0.06).MSCT findings 3 lesion were located in the right lower lobe,9 lesions were located in the right upper lobe,6 lesions were located in the left lower lobe;the mean maximum diameter of the lesions was(2.88±1.33)cm;the lesion presented a well-defined circular or oval cystic appearance;lobulations(n=15),pleu-ral indenlation sign(n=6),vessel passing through cystic wall(n=15)(6 cases had a vascular bundle passing through the cyst wall,6 cases had 2 vascular bundles passing through the cyst wall,3 cases had 3 vascular bundle passing through the cyst wall),12 cases had ground-glass opacity around lesions,all 18 cases had nonuniform thickness of the cyst wall.Conclusion The CT signs of pulmonary lesions associated with cystic airspaces and slightly increased 18F-FDG uptake in lesions(compared to the contralateral lung background)contributed to the differential diagnosis of cystic lung cancer.
作者
姜雯雯
李超伟
刘翠玉
房娜
曾磊
王艳丽
JIANG Wenwen;LI Chaowei;LIU Cuiyu;FANG Na;ZENG Lei;WANG Yanli(Department of PET/CT, The Second Affiliated Hospital of Qingdao University Medical Ldlege (Qingdao Central Hospital) Qingdao 266042, P.R.China)
出处
《医学影像学杂志》
2020年第7期1173-1176,共4页
Journal of Medical Imaging
作者简介
姜雯雯(1991-),女,山东威海人,毕业于潍坊医学院,本科学历,现青岛大学医学部硕士研究生在读,住院医师,主要从事PET/CT诊断工作;通讯作者:王艳丽,副主任医师,医学博士,硕士研究生导师,E-mail:wangyanli1105@163.com。
