肺外结核77例临床特点及^(18)F-脱氧葡萄糖正电子发射体层摄影术/CT影像特征分析  

Clinical characteristics and ^(18)F-FDG PET/CT imaging characteristics of 77 cases with extrapulmonary tuberculosis

作　　者：杨贵生 洪邓辉 陈子鑫[1] 曾丽婷[1] 陈杰文 黄伟鹏[1] Yang Guisheng;Hong Denghui;Chen Zixin;Zeng Liting;Chen Jiewen;Huang Weipeng(Department of Nuclear Medicine,Jieyang People′s Hospital,Guangdong 522000,China)

机构地区：[1]广东省揭阳市人民医院核医学科,522000

出　　处：《实用医学影像杂志》2022年第4期360-364,共5页Journal of Practical Medical Imaging

摘　　要：目的 探讨肺外结核(EPTB)的临床特点及^(18)F-脱氧葡萄糖正电子发射体层摄影术(^(18)F-FDG PET)/CT影像学特征。方法 回顾性分析揭阳市人民医院2017年9月至2021年3月经病理或临床随访证实77例EPTB患者的临床及PET/CT影像,使用视觉和半定量分析相结合的方法对图像病变性质进行判读。结果77例EPTB临床症状表现多样,呼吸系统症状中,最常见症状为咳嗽(25/77,31.2%);全身症状最常见主诉为发热(27/77,33.8%);另有9例表现为淋巴结肿大(9/77,11.2%);实验室检查结果:T-SPOT.TB阳性占82.8%(38/46);结核菌素试验(PPD)试验阳性占36.5%(19/52),其中PPD强阳性占9.6%(5/52);CA125升高3例;77例EPTB均^(18)F-FDG不同程度摄取。根据EPTB累及部位大致分为4类:淋巴结结核(32例),表现为淋巴结不同程度增大,5例伴钙化;浆膜结核(20例),表现为浆膜弥漫均匀增厚伴不等量浆膜腔积液,其中腹膜结核在MIP图上呈“围裙征”;骨关节结核(13例),表现为溶骨性骨质破坏,伴或不伴椎旁冷脓肿;髋、膝关节结核各1例,表现为关节滑膜增厚,关节间隙消失;其他器官结核(12例),肝、脾、肾、腮腺结核表现为等或低密度影;鼻咽及女性附件结核表现为软组织影;回盲部结核表现为肠壁增厚,肠腔狭窄。结论 PET/CT有助于全面、无创评估EPTB全身累及情况,淋巴结结核的“环形”摄取和腹膜结核的“围裙征”可能是EPTB较特异性表现,有助于提示诊断。Objective To investigate the clinical features of extrapulmonary tuberculosis(EPTB)and the imaging features of ^(18)F-fluorodeoxyglucose(^(18)F-FDG)PET/CT.Methods Clinical and PET/CT images of 77 patients with EPTB confirmed by pathological or clinical follow-up in Jieyang People′s Hospital from September 2017 to March2021 were retrospectively analyzed.The pathological properties of the images were interpreted by visual and semiquantitative analysis.Results The clinical symptoms of 77 EPTB patients were varied.Among the respiratory symptoms,cough was the most common symptom(31.2%).The most common chief complaint of systemic symptoms was fever(33.8%).There were 9 cases with lymph node enlargement(11.2%).The results of laboratory examination showed that T-SPOT.TB was positive in 82.8%(38/46).36.5%(19/52)were positive for PPD test,and 9.6%(5/52)were strongly positive for PPD.CA125 elevated in 3 cases.All 77 EPTB patients received^(18)F-FDG to varying degrees.According to the involved sites of EPTB,they were roughly divided into four categories:lymph node tuberculosis(32cases),with lymph node enlargement of varying degrees.Serous membrane tuberculosis(20 cases)was characterized by diffuse and uniform thickening of serous membrane with unequal amount of serous cavity effusion,in which peritoneal tuberculosis showed"apron sign"on MIP chart.Tuberculosis of the bone and joints(13 cases),presenting with lytic bone destruction with or without paravertebral cold abscess.One case with tuberculosis of hip and knee joint was presented as thickening synovium and disappearance of joint space.Tuberculosis of other organs(12 cases),liver,spleen,kidney and parotid gland showed isodensity or low density.Tuberculosis of the nasopharynx and female adnexa presents as soft tissue shadows.Ileocecal tuberculosis was characterized by thickening of the intestinal wall and narrowing of the intestinal cavity.Conclusion PET/CT is helpful for a comprehensive and non-invasive assessment of EPTB systemic involvement.The"circular"uptake of lymph

关 键 词：结核 正电子发射断层扫描及电脑断层扫描 图像解释 计算机辅助 

分 类 号：R521[医药卫生—内科学] R816.41[医药卫生—临床医学]