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原发性肺黏液腺癌18F-FDG PET/CT与增强CT影像特征分析

韩萍萍 富丽萍 张凌 冯宏响 史艳芬 郑玉民

韩萍萍, 富丽萍, 张凌, 冯宏响, 史艳芬, 郑玉民. 原发性肺黏液腺癌18F-FDG PET/CT与增强CT影像特征分析[J]. 协和医学杂志, 2022, 13(2): 270-276. doi: 10.12290/xhyxzz.2021-0705
引用本文: 韩萍萍, 富丽萍, 张凌, 冯宏响, 史艳芬, 郑玉民. 原发性肺黏液腺癌18F-FDG PET/CT与增强CT影像特征分析[J]. 协和医学杂志, 2022, 13(2): 270-276. doi: 10.12290/xhyxzz.2021-0705
HAN Pingping, FU Liping, ZHANG Ling, FENG Hongxiang, SHI Yanfen, ZHENG Yumin. Analysis of the Features of 18F-FDG PET/CT and Enhanced CT in Patients with Primary Pulmonary Mucinous Adenocarcinoma[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(2): 270-276. doi: 10.12290/xhyxzz.2021-0705
Citation: HAN Pingping, FU Liping, ZHANG Ling, FENG Hongxiang, SHI Yanfen, ZHENG Yumin. Analysis of the Features of 18F-FDG PET/CT and Enhanced CT in Patients with Primary Pulmonary Mucinous Adenocarcinoma[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(2): 270-276. doi: 10.12290/xhyxzz.2021-0705

原发性肺黏液腺癌18F-FDG PET/CT与增强CT影像特征分析

doi: 10.12290/xhyxzz.2021-0705
详细信息
    通讯作者:

    郑玉民,E-mail:yuminzhengcn@163.com

  • 中图分类号: R734.2

Analysis of the Features of 18F-FDG PET/CT and Enhanced CT in Patients with Primary Pulmonary Mucinous Adenocarcinoma

More Information
  • 摘要:   目的  对原发性肺黏液腺癌(primary pulmonary mucinous adenocarcinoma,PPMA)的18F-脱氧葡萄糖(fluorodeoxy glucose,FDG)正电子发射断层显像/计算机体层成像(positron emission tomography/computed tomography, PET/CT)与增强CT影像特征进行总结,以期为该病的临床诊疗提供参考。  方法  回顾性纳入2015年7月至2018年2月中日友好医院经手术或穿刺病理证实的全部PPMA患者。对其18F-FDG PET/CT和增强CT影像学资料进行归纳、总结。  结果  共入选25例符合纳入和排除标准的PPMA患者,全部行18F-FDG PET/CT显像检查,其中6例行增强CT扫描。18F-FDG PET/CT显像示孤立性PPMA 7例、弥漫性多发PPMA 18例,前者形态学表现为肺部孤立性病灶,边缘可见分叶征与棘突,实性成分摄取18F-FDG不均匀,空洞或囊性密度区对18F-FDG低摄取或无摄取;弥漫性多发PPMA形态学表现为双肺多发病灶,分布、大小、形态不一,包括多发结节或团块5例,实变影5例,结节、团块、空洞、磨玻璃密度影、斑片影及实变影等多种形态占位混合存在8例。实变影为弥漫性多发PPMA最典型的形态学表现(11例),实变灶密度极不均匀,其内均含囊性密度区,CT值较低(-71~79 Hu),可见肺叶膨隆征(6例)、病理性支气管充气征(4例)、血管造影征(3例)、周围磨玻璃密度影(7例)。弥漫性多发PPMA对18F-FDG摄取程度不一,囊性成分低于实性成分。增强CT示,4例呈不均匀强化,2例无强化。以结节、团块或空洞为主的病灶对18F-FDG摄取程度与CT强化程度无线性相关;以实变影为主的病灶对18F-FDG摄取程度与CT强化程度呈正相关。  结论  增强CT示PPMA病灶可无强化或不均匀强化。18F-FDG PET/CT显像示PPMA病灶常表现为结节、斑片影等多种占位形式与实变影混合存在,可通过其特征性表现,包括肺叶膨隆、病理性支气管充气征、血管造影征以及代谢程度与病灶密度呈正相关等,与肺部感染性疾病进行鉴别诊断。
    作者贡献:韩萍萍负责病例收集、PET/CT图像解读、论文撰写;富丽萍负责PET/CT图像解读、论文修订;张凌负责CT图像解读;冯宏响提供病例并协助论文修订;史艳芬负责病理图片解读;郑玉民负责病例收集、PET/CT图像解读、论文修订。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  原发性肺黏液腺癌患者18F-FDG PET/CT显像特征

    A.单发团块:患者男性,66岁,右肺下叶不均匀密度团块,大小3.2 cm×3.9 cm,病灶实性成分18F-FDG摄取增高(红色箭头),囊性成分18F-FDG摄取减低(蓝色箭头);B.弥漫性多发病灶(有“母瘤”):患者男性,77岁,右肺中叶较大结节,呈分叶状,边缘可见毛刺征,18F-FDG摄取显著增高(“母瘤”,红色箭头);双肺另可见散在磨玻璃密度小结节,18F-FDG摄取轻度增高(十字交叉);C. 弥漫性多发病灶(无“母瘤”):患者女性,21岁,双肺多发不规则结节,18F-FDG摄取不同程度增高,未见“母瘤”;D.实变影:患者女性,70岁,左肺上叶舌段实变影,18F-FDG摄取程度不一,实性成分(红色箭头)摄取度远高于囊性成分(蓝色箭头),SUVmax为18.0;E.实变影:患者男性,65岁,右肺下叶实变影整体密度低,18F-FDG摄取亦较低,SUVmax为2.2
    18F-FDG:18F-脱氧葡萄糖;PET/CT:正电子发射断层显像/计算机体层成像;SUVmax:最大标准摄取值

    图  2  原发性肺黏液腺癌患者实变影PET/CT显像特征(箭头)

    A.实变影密度不均匀,含有较多囊性密度区;B.肺叶膨隆征;C.病理性支气管充气征;D.血管造影征
    PET/CT:同图 1

    图  3  原发性肺黏液腺癌患者增强CT与18F-FDG PET/CT显像

    A. 单发结节:患者男性,62岁,右肺下叶实性结节(红色十字交叉),周边可见磨玻璃成分,18F-FDG轻度摄取(SUVmax:1.5),增强CT示强化明显(ΔHu:73);B.多发空洞:患者男性,69岁,双肺多发空洞,最大者位于左肺上叶(蓝色十字交叉),增强CT无明显强化,18F-FDG摄取不均匀增高(SUVmax:7.2~16.6); C. 实变影:患者女性,50岁,右肺下叶实变影,边缘可见强化,18F-FDG摄取高(红色箭头,SUVmax:6.5);病灶内无强化部分无18F-FDG摄取(蓝色箭头)
    18F-FDG、PET/CT、SUVmax:同图 1

    表  1  原发性肺黏液腺癌患者18F-FDG PET/CT和增强CT图像特征(n=6)

    患者
    编号
    PET/CT图像特征 SUVmax 增强CT
    图像特征
    CT强化程度
    (ΔHu)
    1 孤立性结节 1.5 不均匀强化 73
    4 多发结节/团块 2.0 无强化 -
    9 弥漫性多形态占位(多发空洞及结节) 16.6 无强化 -
    14 弥漫性多形态占位(含实变影) 5.5 不均匀强化 57
    17 实变影 6.5 不均匀强化 66
    25 弥漫性多形态占位(含实变影) 4.1 不均匀强化 11
    18F-FDG、PET/CT、SUVmax:同图 1;-:不适用
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-10-21
  • 录用日期:  2021-11-25
  • 刊出日期:  2022-03-30

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