克罗恩病的^18F-FDGPET／CT显像误诊原因分析  

Crohn＇s disease misdiagnosed as intestinal malignancy by ^18F-FDG PET/CT in six patients

作　　者：关炜[1] 王全师[1] 李洪生[1] 吴湖炳[1] 周文兰[1] Guan Wei;Wang Quartshi;Li Hongsheng;Wu Hubing;Zhou Wenlan(PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China （the first author＇s present address ： Department of Nuclear Medicine, the First People＇s Hospital of Foshan, Foshan 528000, China)

机构地区：[1]南方医科大学南方医院PET中心,广州510515

出　　处：《中华核医学与分子影像杂志》2018年第6期385-389,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的分析^18F－脱氧葡萄糖（FDG） PET/CT显像中克罗恩病（CD）被误诊为肠道恶性肿瘤的原因。方法收集2010年6月至2016年6月间本中心70例确诊CD患者[男48例，女22例；平均年龄（32.1±16.7）岁]的临床及18F－FDG PET/CT图像资料，选出其中的误诊病例，回顾性分析其发病部位、^18F－FDG代谢表现及形态学改变。结果70例CD患者中，共6例患者被误诊为肠道恶性肿瘤（4例误诊为结肠癌，2例误诊为肠淋巴瘤），最大标准摄取值（SUVmax）为7.8～29.8。4例被误诊为结肠癌者表现为局限且不规则的块状高代谢病灶，CT上块状病灶周围可见肠壁外局限性小气泡征；2例被误诊为肠淋巴瘤者表现为沿局部肠段管壁弥漫分布的高代谢病灶，CT表现为节段性肠壁弥漫性增厚，并见肠管僵直、肠间距增宽及肠腔边缘多发指样压迹等征象。结论单发不规则性块状高代谢病灶及肠壁弥漫性增厚伴代谢增高是导致CD误诊为肠道恶性肿瘤的原因，仔细观察病灶合并的其他间接CT征象有助于鉴别诊断。ObjectiveTo analyze the causes of Crohn′s disease （CD） misdiagnosed as intestinal malignancy by ^18F-fluorodeoxyglucose （FDG） PET/CT.MethodsThe clinical and 18F-FDG PET/CT data of 70 CD patients （48 males, 22 females; average age： （32.1±16.7） years） confirmed pathologically from June 2010 to June 2016 in PET Center of Nanfang Hospital were retrospectively reviewed. Patients misdiagnosed as malignancy were selected. The locations, morphologic and metabolic features were retrospectively analyzed.ResultsSix of seventy CD cases were misdiagnosed as intestinal malignancy （maximum standardized uptake value （SUVmax）： 7.8-29.8）. Among them, 4 patients were misdiagnosed as colonic carcinoma and 2 patients were misdiagnosed as intestinal lymphoma. All the intestinal lesions in 6 patients were FDG-avid, 4 patients that were misdiagnosed as colonic carcinoma presented as localized irregular mass with extra luminal wall air bubble sign on CT. Two cases that were misdiagnosed as intestinal lymphoma presented as segmental diffusive intestinal wall thickening companied with bowel stiffness, intestinal loops enlargement and finger-pressing pattern along the surface of the intestinal mucosa on CT.ConclusionsFDG-avid CD presenting as single localized irregular mass or segmental diffusive intestinal thickening can mimic intestinal malignancy. CT features are useful for differential diagnosis and reducing diagnostic errors.

关 键 词：CROHN病 正电子发射断层显像术 体层摄影术 X线计算机 误诊 脱氧葡萄糖 

分 类 号：R574.62[医药卫生—消化系统] R816.5[医药卫生—内科学]