原发性肺黏液腺癌^(18)F⁃FDG PET/CT与增强CT影像特征分析  

Analysis of the Features of ^(18)F⁃FDG PET/CT and Enhanced CT in Patients with Primary Pulmonary Mucinous Adenocarcinoma

作　　者：韩萍萍[1] 富丽萍 张凌[2] 冯宏响[3] 史艳芬[4] 郑玉民[1] HAN Pingping;FU Liping;ZHANG Ling;FENG Hongxiang;SHI Yanfen;ZHENG Yumin(Department of Nuclear Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Thoracic Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院核医学科,北京100029 [2]中日友好医院放射诊断科,北京100029 [3]中日友好医院胸外科,北京100029 [4]中日友好医院病理科,北京100029

出　　处：《协和医学杂志》2022年第2期270-276,共7页Medical Journal of Peking Union Medical College Hospital

摘　　要：目的对原发性肺黏液腺癌(primary pulmonary mucinous adenocarcinoma,PPMA)的^(18)F⁃脱氧葡萄糖(flu⁃orodeoxy glucose,FDG)正电子发射断层显像/计算机体层成像(positron emission tomography/computed tomography,PET/CT)与增强CT影像特征进行总结,以期为该病的临床诊疗提供参考。方法回顾性纳入2015年7月至2018年2月中日友好医院经手术或穿刺病理证实的全部PPMA患者。对其^(18)F⁃FDG PET/CT和增强CT影像学资料进行归纳、总结。结果共入选25例符合纳入和排除标准的PPMA患者,全部行^(18)F⁃FDG PET/CT显像检查,其中6例行增强CT扫描。^(18)F⁃FDG PET/CT显像示孤立性PPMA 7例、弥漫性多发PPMA 18例,前者形态学表现为肺部孤立性病灶,边缘可见分叶征与棘突,实性成分摄取^(18)F⁃FDG不均匀,空洞或囊性密度区对^(18)F⁃FDG低摄取或无摄取;弥漫性多发PPMA形态学表现为双肺多发病灶,分布、大小、形态不一,包括多发结节或团块5例,实变影5例,结节、团块、空洞、磨玻璃密度影、斑片影及实变影等多种形态占位混合存在8例。实变影为弥漫性多发PPMA最典型的形态学表现(11例),实变灶密度极不均匀,其内均含囊性密度区,CT值较低(-71~79 Hu),可见肺叶膨隆征(6例)、病理性支气管充气征(4例)、血管造影征(3例)、周围磨玻璃密度影(7例)。弥漫性多发PPMA对^(18)F⁃FDG摄取程度不一,囊性成分低于实性成分。增强CT示,4例呈不均匀强化,2例无强化。以结节、团块或空洞为主的病灶对^(18)F⁃FDG摄取程度与CT强化程度无线性相关;以实变影为主的病灶对^(18)F⁃FDG摄取程度与CT强化程度呈正相关。结论增强CT示PPMA病灶可无强化或不均匀强化。^(18)F⁃FDG PET/CT显像示PPMA病灶常表现为结节、斑片影等多种占位形式与实变影混合存在,可通过其特征性表现,包括肺叶膨隆、病理性支气管充气征、血管造影征以及代谢程度与病灶密度呈正相关�Objective To evaluate the value and characteristics of ^(18)F⁃FDG PET/CT and enhanced CT in primary pulmonary mucinous adenocarcinoma(PPMA),in order to provide reference for the clinical diagno⁃sis and treatment of the disease.Methods Data of enhanced CT and ^(18)F⁃FDG PET/CT imaging and clinical information of 25 patients with PPMA confirmed by pathology in China⁃Japan Friendship Hospital from July 2015 to February 2018 were retrospectively reviewed.Results A total of 25 PPMA patients were enrolled.Among them,25 patients underwent the examination of ^(18)F⁃FDG PET/CT imaging,and 6 cases underwent en⁃hanced CT scan.Seven cases had one lesion,which morphologically manifested as a solitary lung lesion with lobulation signs,spinous processes on the edge,and uneven uptake of ^(18)F⁃FDG with low or no uptake in hollow or cystic density areas;18 cases showed diffuse multiple lesions in both lungs with different distribution,size and shape,including 5 cases with multiple nodules/masses,5 with consolidations,and 8 with diversified le⁃sions including nodules,masses,cavities,ground glass opacities,patches,and consolidations.Consolidation shadow is the most typical morphological manifestation of diffusely multiple PPMA(11 cases).The density of consolidation foci was extremely uneven,and all of them contain areas of cystic density.They had low CT value(-71-79 Hu),and characteristic features were found,including pulmonary lobe bulging sign(6 cases),pathological air bronchus sign(4 cases),angiographic sign(3 cases)and surrounding ground glass density(7 cases).The uptake of ^(18)F⁃FDG varied with the density of lesions.The cystic component was lower than the solid component.Contrast⁃enhanced CT showed heterogeneous enhancement in 4 cases and no enhancement in 2 cases.The degree of ^(18)F⁃FDG uptake in lesions dominated by nodules,masses or cavities was not linearly corre⁃lated with the degree of CT enhancement,but that in lesions dominated by consolidation was positively correla⁃ted with the degree of

关 键 词：原发性肺黏液腺癌 计算机体层成像 脱氧葡萄糖 正电子发射断层显像 

分 类 号：R734.2[医药卫生—肿瘤]