肺外结核39例临床表现与^18F-氟脱氧葡萄糖正电子发射计算机断层成像-CT的特点分析  

Characteristics of extrapulmonary tuberculosis in ^18F-2-fluoro-2-deoxy Dglucose positron emissiontomographycomputed tomography： experience from 39 cases

作　　者：刘桂超[1] 高硕[1] 蔡莉[1] 陈秋松[1] 

机构地区：[1]天津医科大学总医院PET／CT中心,300052

出　　处：《中华结核和呼吸杂志》2012年第3期184-188,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的肺外结核的临床与^18F-氟脱氧葡萄糖（”F-FDG）正电子发射计算机断层成像（PET）-CT表现多样，易与恶性病变相混淆，通过分析肺外结核的临床表现及^18F-FDGPET-CT的影像学特点，以提高肺外结核的诊断水平。方法回顾性分析2003-2011年天津医科大学总医院经病理确诊的肺外结核39例的临床表现和”F．FDGPET-CT图像，39例中男11例，女28例；年龄20-67岁，平均（60±18）岁，其中20-40岁8例，40-60岁15例，〉60岁16例；有结核病史者5例。采用目测和半定量分析相结合的方法，判断PET图像上病变的示踪剂浓集程度，结合相应层面低剂量CT图像和两者的融合图像判断病变性质。结果临床表现：发热13例，盗汗、乏力伴消瘦17例，胸腔积液7例，腹胀、腹部肿块6例，颈部肿物2例。实验室检查：低蛋白血症、ESR增快及PPD试验阳性15例，其中PPD强阳性4例，CAl25升高3例。PET-CT表现：淋巴结结核表现为体部单发或多发肿大淋巴结，部分可见融合或钙化，FDG显著浓集，部分FDG呈环形摄取；胸膜和腹膜结核表现为胸膜和腹膜增厚，部分呈结节样增厚，FDG显著不均匀浓集，以边缘及浆膜增厚处为著；骨结核均有不同程度的溶骨性骨质破坏，部分脊柱结核的椎旁软组织增厚，半数病灶可见FDG环形摄取；肠结核4例次均累及回盲部，肠壁呈环形或偏心性增厚，FDG呈局灶性、弥漫性等多种浓集形式；肾上腺结核表现为双侧肾上腺肿块样增厚，输卵管结核表现为右侧附件区结节影，肝结核表现为肝脏多发类圆形低密度灶，均可见FDG高摄取。结论^18F．FDGPET-CT检查有助于肺外结核与肿瘤的鉴别诊断。淋巴结结核和骨结核的PET-CT图像FDG环形摄取可能是特异性表现。对仍难与恶性病变鉴别的患者，病史、临床表现和其他检查结果及病理对诊断较为重要。The clinical manifestations and the imaging features in is F-2-fluoro-2-deoxy Dglucose positron emission tomography （18 F-FDG PET） of extrapulmonary tuberculosis were not specific and therefore it was difficult to be differentiated from malignancy. This paper tried to analyze the clinical characteristics and findings by lSF-FDG PETCT in extrapulmonary tuberculosis, in order to improve the diagnosis of this disease. Methods Thirtynine patients with extrapulmonary tuberculosis underwent 18^FFDG PETCT imaging from 2003 -2011. The diagnosis was confirmed by histopathologieal examination in all the cases. There were 11 males and 28 females, aging 20 - 67 （60 ＋ 18） years. A past history of tuberculosis was collected in 5 cases. The PET images were reviewed visually and scored semi-quantitatively with standardized uptake value. The lesions were judged by PET imaging features in conjunction with CT slices and the fused images. Results Fever was present in 13 cases, and night sweating, weakness and malaise in 17 cases. Pleural effusion was found in 7 cases. Abdominal distention and masses were found in 6 cases, while neck mass was present in 2 cases. Laboratory tests showed that hypoalbuminemia, sedimentation rate increase and positive tuberculin tests were present in 15 cases. CA125 was increased in 3 cases. In PETCT, lymph node tuberculosis manifested as single or multiple enlarged lymph nodes coalesced and calcified with significant FDG uptake, but ringlike FDGavidity was also found in some of the lymph nodes. Pleural or peritoneal tuberculosis showed heterogeneous or nodular thickening and in a radiotracer distribution. Bone tuberculosis manifested as osteolytic osseous destruction and paravertebral cold abscess,while focal radioagent ringlike intense uptake was present in half the cases. In patients with intestinal tuberculosis, ileocecal circumferential or eccentric thickening was observed, with focal or diffuse high FDG activity. Tuberculosis in adrenal gland, liver, and oviducts all showed lesions with h

关 键 词：结核 氟脱氧葡萄糖F 18 体层摄影术 发射型计算机 

分 类 号：R730.44[医药卫生—肿瘤]