^(18)FDG PET/CT在肺癌致异位ACTH综合征诊断中的应用  

Application of ^(18)FDG PET/CT in diagnosis of ectopic ACTH syndrome induced by lung cancer

作　　者：程欣[1] 马艳茹[1] 刘轶敏[1] 党永红[1] 邢海群[1] 胡楠[1] 

机构地区：[1]中国医学科学院北京协和医院核医学科,北京100730

出　　处：《吉林大学学报（医学版）》2015年第6期1275-1278,F0003,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金青年基金资助课题(81201121)

摘　　要：目的:探讨18F-脱氧葡萄糖(18FDG)正电子发射计算机断层显像(PET)/计算机断层显像(CT)在肺癌致异位促肾上腺皮质激素(ACTH)综合征(EAS)中的图像特点,提高EAS诊断的准确率。方法:8例经手术病理证实为肺癌的EAS患者,术前行18 FDG PET/CT躯干和脑显像,同期行鞍区脑核磁共振成像(MRI)、胸部高分辨CT显像、奥曲肽(OCT)全身显像和岩下窦静脉取血(IPSS)。对18 FDG PET/CT图像所示肺部病变行半定量分析,计算病变最大标准摄取值(SUVmax)及病变/正常肺组织SUVmax比值。结果:18例EAS包括2例类癌,4例不典型类癌,2例小细胞肺癌。8例IPSS患者ACTH水平中央与外周比较无明显差别。26例(75%)患者初诊时胸部CT示肺内结节,2例为不典型病变。5例同期MRI示垂体微腺瘤,2例(25%)OCT显像为阳性。38例(100%)肺部病变18FDG PET/CT表现为结节样、团块样或斑片样代谢增高,肿瘤的SUVmax为0.72~14.05(3.67±4.68),病变/正常肺组织SUVmax比值为1.69~27.54(8.14±9.63);8例双侧肾上腺均为团状代谢异常增高,同时4例提示垂体瘤。结论:肺癌是EAS的常见原因,其中以类癌多见,在18FDG PET中代谢多轻度增高,PET可以作为有效的定位辅助诊断方法。Objective To investigate the value of 18 F-fluorodeoxyglucose （18 FDG）positron emission tomography and computer tomography （PET/CT）in the diagnosis and localization of ectopic ACTH syndrome （EAS）induced by lung cancer,and to increase the accuracy rate of diagnosis of EAS.Methods 8 patients were histopathologically proven to be lung cancer.18 FDG PET/CT wholebody and brain scan were performed;magnetic resonance imaging （MRI）,99m Tc-octreotide （OCT）imaging and inferior petrosal sinus sampling （IPSS）were done in all patients.On 18 FDG PET/CT images,the SUVmax values of lesions and the SUVmax ratio of lesion tissue to normal lung tissue were calculated.Results ① 8 patients with EAS included 2 cases of carciniod,4 cases of atypical carciniod,and 2 cases of small cell lung cancer.The ACTH levels in inferior petrosal sinus and peripheral veins of 8 patients had no difference.②The chest CT showed there were pulmonary nodules in 6 cases （75%）,among them 2 cases were atypical lesions.5 cases of pituitary adenomas were found by MRI （25%）,and OCT imaging was positive in 2 cases （25%）.③The 18 FDG PET/CT showed nodular,mass like or patch samples with high metabolic activity in 8 cases （100%）of pulmonary lesions.The SUVmax of tumor was 0.72 to 14.05 （3.67±4.68）,and the ratio of SUVmax of lesion tissue to normal lung tissue was 1.69 to 27.54 （8.14 ± 9.63）.18 FDG hypermetabolism was found in 8 cases of bilateral adrenal hyperplasia,while 4 cases showed pituitary tumor.Conclusion Lung cancer is a common source of EAS,especially carcinoid.18 FDG PET may show lower glucose metabolism.18 FDG PET/CT should be used as an assisted method to diagnose EAS.

关 键 词：肺肿瘤 肺类癌 库欣综合征 异位促肾上腺皮质激素综合征 正电子发射计算机断层显像 18 F-脱氧葡萄糖 

分 类 号：R445.5[医药卫生—影像医学与核医学]