肺外结核^(18)F-FDG-PET/CT误诊分析  

Analysis of Misdiagnosis in Extrapulmonary Tuberculosis By ^(18)F-FDG-PET/CT

作　　者：邱大胜[1] 胡晓燕[1] 彭辽河[1] 李杰[1] 朱佳[1] 周静[1] 丁九荣[1] 

机构地区：[1]湖北省肿瘤医院PET/CT中心,430079

出　　处：《临床放射学杂志》2012年第11期1567-1571,共5页Journal of Clinical Radiology

摘　　要：目的探讨肺外结核的18F-FDG-PET/CT表现并分析肺外结核误诊原因。方法回顾性分析25例18F-FDG-PET/CT误诊为恶性肿瘤的肺外结核患者资料。结果 25例18F-FDG-PET/CT误诊恶性肿瘤中23例经病理证实结核,2例经临床诊断性治疗最终诊断为结核,包括8例骨关节结核,10例胸腹膜结核,7例淋巴结结核。8例骨关节结核中4例为胸椎结核,2例关节结核,另2例全身骨骼广泛受侵。4例胸椎结核呈溶骨性破坏,邻近软组织肿胀及软组织肿块,18F-FDG-PET示病变椎体呈明显放射性浓聚影,标准摄取最大值(SUVmax)=3.56～12.58。2例全身广泛骨质破坏,CT示全身多发骨质破坏,软组织肿块不明显,PET是全身骨骼弥漫性放射性浓聚影。关节软组织结核2例:CT示左侧腰大肌脓肿,1例左侧腰大肌脓肿向下延伸至左侧髋关节,骨盆左侧及左侧髋关节软组织肿块,PET呈大片状不均放射性浓聚影,SUVmax=4.36～8.23。胸膜腹膜结核10例中有1例为胸膜腹膜结核,9例为腹膜结核,CT表现为腹膜及胸膜均匀增厚并伴有不同程度的胸腹腔积液。增厚的腹膜及胸膜呈条状放射性浓聚影,SUVmax=2.56～6.23,9例腹膜结核患者肠系膜内可见多发软组织密度结节及小斑片影,即"污秽征"。淋巴结结核7例:CT表现为对称性两侧纵隔、肺门多发淋巴结增大,最大径1.5～8.0 cm,SUVmax=10.5。结论肺外结核的18F-FDG-PET/CT表现没有特征性,与恶性肿瘤鉴别困难。在充分分析PET/CT征象的基础上结合临床及实验室检查,才能最大限度地减少肺外结核的误诊。Objective To investigate the 18 F-FDG-PET/CT findings of extrapulmonary tuberculosis and to analyze the reasons of misdiagnosis in extrapulmonary tuberculosis.Methods The 18 F-FDG-PET/CT imaging findings of 25 cases misdiagnosed as malignant tumors were retrospectively analyzed.Results In 25 cases,23 cases of tuberculosis were confirmed by pathology,2 cases of tuberculosis were confirmed by clinical therapy.25 cases of extrapulmonary tuberculosis included bone and joint tuberculosis in 8 cases（tuberculosis of thoracic vertebra in 4 cases,widespread tuberculosis of whole body skeleton in 2 cases,joint and soft tissue tuberculosis in 2 cases）,pleural or peritoneal tuberculosis in 10 cases,lymphnode tuberculosis in 7 cases.Tuberculosis of thoracic vertebra in 4 cases showed destruction of osteolysis with soft tissue mass or swelling.18 F-FDG-PET demonstrated high metabolic activity lesions in these thoracic vertebra,the maximum standard uptake values（SUVmax） of these lesions were ranged 3.56 to 12.58.CT showed multiple destruction of bone all over the body without obvious soft tissue mass in 2 cases,and PET demonstrated high metabolic activity lesions widespread in bones of whole body.In 2 cases of joint and soft tissue tuberculosis,CT showed psoas abscess,which downward to the left hip join and left pelvis,and soft tissue mass surrounding the hip joint.PET demonstrated high metabolic activity lesions（SUVmax=4.36-8.23）.In 10 cases of pleural or peritoneal tuberculosis,pleura and peritoneum were both involved in 1 case,and only peritoneum was involved in 9 cases.CT showed pleura or peritoneum was thickened with pleural effusion or ascites.PET demonstrated strip like lesions with high metabolic activity（SUVmax=2.56-6.23） in the thickened pleura or peritoneum.In 7 cases of lymph node tuberculosis,CT showed multiple lymphadenectasis in both hilums and mediastinum which diameter was 1.5-8.0 cm,and SUVmax on the PET were about 10.5.Conclusion The 18 F-FDG-PET/CT findings of extrapulmonary tuberculosis are

关 键 词：肺外结核 误诊 脱氧葡萄糖 正电子发射断层显像 X线计算机 

分 类 号：R52[医药卫生—内科学]