60例活动性结核正电子发射体层摄影-CT误诊为恶性肿瘤的分析  

Pitfalls of fluorodeoxyglucose positron-emission tomography-CT in tuberculosis mimicking malignancy in 60 patients

作　　者：王欣璐[1] 尹吉林[1] 张金赫[1] 欧阳习[1] 周崝[1] 全江涛[1] 张伟标[1] 郑辉[1] 

机构地区：[1]广州军区广州总医院核医学科PET-CT中心,510010

出　　处：《中华放射学杂志》2013年第1期34-38,共5页Chinese Journal of Radiology

基　　金：广东省自然科学基金项目（1015100100200016）

摘　　要：目的回顾性分析60例被PET-CT误诊为恶性肿瘤的结核病患者的临床及影像资料，分析误诊原因，以期提高结核病诊断的准确率并降低误诊率，为临床提供更好的帮助。方法（1）入选标准：所有患者均为PET-CT检查前未明确诊断，且PET-CT检查拟诊或不除外恶性肿瘤的患者。50例经手术切除、活检穿刺病理诊断证实；10例经诊断性抗结核治疗后多次随访，并根据病情转归及治愈情况临床确诊；（2）检查方法：静脉注射氟代脱氧葡萄糖（^18F-FDG）后行PET-CT全身显像，采用感兴趣区划定，测量病灶标准摄取值（SUV）最大值及平均值。在全身PET-CT扫描结束后，再行屏气状态下胸部CT螺旋扫描并进行2mm肺窗HRCT图像重建。结果（1）活动性结核误诊为肺癌30例；恶性淋巴瘤14例；恶性间皮瘤6例；肠癌3例；骨原发恶性肿瘤2例；肝癌、脾脏恶性肿瘤、卵巢癌、喉癌、鼻咽癌各1例。（2）实验室资料分析显示90．9％（20／22）和100．0％（13／13）的结核患者血清癌胚抗原（CEA）和CA199水平正常；100％（6／6）活动性结核伴有浆膜腔积液患者的血清CA125水平高于正常。（3）PET-CT影像特征及误诊原因：误诊为肺癌的结核病灶93．3％（28／30）呈高代谢结节或团块状。误诊为恶性淋巴瘤的淋巴结结核病以颈部淋巴结对称性累及最为常见，占85．7％（12／14）。CT增强扫描示受累淋巴结结核病灶呈多发的边缘不均匀或环形强化，中央见坏死区，占87．5％（7／8）。结论活动性结核病灶对^18F-FDG的高摄取是PET-CT将其误诊为恶性肿瘤的主要原因之一。只有对结核病的常见发生部位、分布特点及病灶影像特征进行全面研究，尤其是HRCT的应用，并密切结合实验室检查，才能全面掌握结核与肿瘤病变之间的细微差别，尽量减少漏、误诊率，提高诊断的准确性。Objective To analyze the pitfalls of ^18SF fluorodeoxyglucose （FDG） positron emission tomography/computer tomography （PET-CT） scan in the diagnosis of 60 patients of tuberculosis mimicking malignancy. Methods The study included 60 patients with PET-CT diagnosis of probable malignancy. Fifty patients were proved to be tuberculosis by pathological examinations and 10 were diagnosed by clinical follow- up. The images of whole body were acquired at 60 rain after administration of 222--555 MBq ^18F-FDG. The PET-CT imaging characteristics and clinical data, including lesion size, distribution, standardized uptake value （SUV） were retrospectively analyzed. After the whole body scan of PET-CT,eaeh patient had a chest spiral CT scan for detailed observation of lung lesions. Contrast enhanced CT （ CECT ） was performed in 8 patients. Results （1）Thirty patients were misdiagnosed as lung cancer, 14 patients as malignant lymphoma,6 patients as malignant mesothelioma,3 as intestine carcinoma,2 as bone malignancy, 1 patient as hepatocarcinoma, spleen malignancy, ovarian cancer, laryngocarcinoma and nasopharyngeal carcinoma respectively. （2） 90. 9% （20/22） of patients showed normal level of serum CEA and 100% （13/13） of patients showed normal level of CA199. Increasing serum CA125 was found in all patients （6/6） with activeTB patients accompanied with ascites, pleural fluid and （or） pericardial effusion. （ 3 ） 93.3% （ 28/30 ） active tuberculosis showed accumulated ^18F-FDG which was incorrectly interpreted as malignancy. The most common sites of TB lymphadenopathy were bilateral cervical tissues, which was accounted for 85.7% （12/14）. CECT revealed characteristics of peripheral enhancement and central necrosis in tubercular lymphadenopathy,which was 87.5% （7/8）. Conclusions The diverse manifestations of TB on imaging and high uptake of ^18F-FDG on PET imaging result in misdiagnosis of malignancy. It is important for radiologists and nuclear medicine physicians to identify th

关 键 词：结核 肺 肺肿瘤 淋巴瘤 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R521[医药卫生—内科学]