肺黏液腺癌的CT及^(18)F-FDG符合线路SPECT显像的影像表现  

The CT and ^(18)F-FDG coincidence SPECT imaging findings of pulmonary mucinous adenocacinoma

作　　者：李多[1] 曹宝霞 吕平欣[1] 

机构地区：[1]首都医科大学附属北京胸科医院,北京101149

出　　处：《现代肿瘤医学》2016年第4期636-639,共4页Journal of Modern Oncology

摘　　要：目的:探讨肺黏液腺癌的CT及^(18)F-FDG符合线路SPECT显像的影像表现。方法:分析经病理证实的6例肺黏液腺癌患者的影像、病理及病例资料,6例患者均有^(18)F-FDG符合线路显像及诊断CT资料,其中4例有增强CT。结果:2例为广泛分布型,最大病变位于下叶或以下叶分布为主,均可见支气管充气征。4例为局灶型病变,位于上叶1例,下叶3例,病灶最大径2.1~7.0cm,仅1例为磨玻璃与实性混合密度,其余均为实变影,1例形成肿块样,其余3例为不规则片状,2例平扫内部可见低密度区,2例有空泡征,1例有毛刺,2例病灶周围有小结节或微结节。4例增强扫描的病例中3例可见血管造影征,1例广泛分布病变患者有纵隔淋巴结肿大。^(18)F-FDG符合线路SPECT显像结果为4例局灶型病变中,目测分级0级2例,1级1例,0-2级1例,2例广泛分布病变放射性摄取最高区目测分别为3级和4级。结论:肺黏液腺癌影像表现有一定的特征,好发于下叶,CT表现以实变、磨玻璃影为主,内可见支气管充气征、空泡征,增强扫描可见血管造影征,易发生肺内转移,表现为广泛播散性分布。局灶型黏液腺癌FDG摄取值低,容易误诊为良性病变,广泛分布型黏液腺癌表现为FDG高摄取,需要与感染性病变鉴别。Objective：To investigate the CT and F-FDG coincidence SPECT imaging findings of pulmonary mucinous adenocacinoma.Methods：Retrospectively reviewed the imagine findings and medical records of 6 patients histopathologically proved mucinous adenocacinoma.6 patients were all taken F-FDG coincidence SPECT and unenhanced CT scan,while 4 patients also had enhanced CT scan.Results：At CT,the tumor was widely distributed in 2cases,mainly at the lower lobes and all had air bronchogram sign.The other 4 were all localized mucinous adenocacinoma located at the lower lobes except one case located at the upper lobe.The tumors diameter was ranging 2.1 ~7.0 cm.All cases had air-space consolidation while one case had ground-glass opacity（GGO）.Only one case was lobulated in shape,the other were all irregular patch.Other CT findings of localized mucinous adenocacinoma including areas of lower density in the tumor（n=2）,bubble-like lucencies（n=2）,spicular（n=1）,small nodular a—round the tumor（n =2）.Angiogram sign was seen in 3 of the 4 patients who had enhanced CT scan.Mediastinum lymphadenopathy was seen in only 1 widely distribution patient.4 locolized mucinous adenocacinoma visual graded as grade 0 in 2 cases grade 1 in 1 case and 0-2 in 1 case.The 2 widely distributed cases were graded as 3 and 4 respectively.Conclusion：Pulmonary mucinous adenocacinoma had specific imaging findings including predilection to affect the lower lobe,the presence of bubble-like lucencies or air bronchogram and angiogram sign in air space consolidation or GGO,and with a higher prevalence of intrapulmonary metastases.Additionally,the ^（18）F-FDG uptake of locolized mucinous adenocacinoma is low,easily to misdiagnosis as benign lesion,while the ^（18）F-FDG uptake of widely distributed mucinous adenocacinoma is high,and need to distinguish with infection disease.

关 键 词：黏液腺癌 肺 体层摄影术 X线计算机 氟代脱氧葡萄糖 符合线路SPECT 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]