| 22例结节型肺隐球菌病18F-FDG PET/CT 显像的回顾性分析 |
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| 引用本文： | 李生栩,唐明灯,林端瑜,刘道佳,张杰平,吕清湖.22例结节型肺隐球菌病18F-FDG PET/CT 显像的回顾性分析[J].国际放射医学核医学杂志,2020,44(1):37-44. |
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| 作者姓名： | 李生栩 唐明灯 林端瑜 刘道佳 张杰平 吕清湖 |
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| 作者单位： | 福建省肿瘤医院，福建医科大学附属肿瘤医院核医学科，福州350014 |
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| 摘 要： | 目的 分析结节型肺隐球菌病（PC）患者的18F-氟脱氧葡萄糖（FDG）PET/CT显像特点。 方法 回顾性分析2011年1月至2017年1月于福建省肿瘤医院经病理确诊的PC患者22例，其中男性17例、女性5例，年龄（54.77±7.93）岁。所有患者均行18F-FDG PET/CT显像，分析结节的数目、大小、分布、最大标准摄取值（SUVmax）及结节征象。计量资料的比较采用t检验或Pearson相关性分析，不同组别结节征象的差异比较采用χ2检验、连续校正χ2检验或Fisher确切概率法。 结果 ① 22例PC患者的PET/CT显像共发现235个结节，18F-FDG代谢增高结节130个，SUVmax（3.5±2.9）与直径（0.9±0.5） cm]呈正相关（r=0.702，P=0.000）。② 结节分布以右肺（57.4%，135/235）、下叶（64.3%，151/235）、肺野外带或胸膜下（80.0%，188/235）多见。③ 9例免疫功能受损宿主的代谢增高结节SUVmax（5.7±4.7）高于13例非免疫功能受损宿主（3.0±2.0），且差异有统计学意义（t=2.731，P=0.011）；前者（17.5%，10/57）的宽基底贴胸膜征象高于后者（6.2%，11/178），而后者（25.3%，45/178）的晕征高于前者（10.5%，6/57），差异均有统计学意义（χ2=7.911、4.628，P=0.005、0.031）。④ 单个肺叶受累和多个肺叶受累的患者各为11例，前者的代谢增高结节SUVmax（5.6±3.4）高于后者（3.2±2.7），且差异有统计学意义（t=2.652，P=0.016）；前者出现分叶征、毛刺征、胸膜凹陷征的比例均高于后者，差异均有统计学意义（χ2=32.911、47.022、17.395，均P<0.01）。⑤ 误诊和正确诊断的患者各为11例，前者的代谢增高结节SUVmax（5.0±4.6）高于后者（3.2±2.4），差异无统计学意义（t=16.825，P=0.106）；分叶征、毛刺征、胸膜凹陷征出现的比例前者均高于后者，差异均有统计学意义（χ2=9.570、35.951、5.720，均P<0.05）；后者（26.2%，50/191）晕征的比例高于前者（2.3%，1/44），且差异有统计学意义（χ2=12.027，P=0.000）。 结论 结节型PC患者PET/CT显像的SUVmax与直径呈正相关。晕征是诊断的可靠征象。对于单个肺叶受累者，类肿瘤征象及18F-FDG代谢增高的表现易造成误诊。
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| 关 键 词： | 隐球菌病 肺疾病，真菌性 氟脱氧葡萄糖F18 正电子发射断层显像计算机体层摄影术 最大标准化摄取值 |
| 收稿时间： | 2019-03-19 |
Retrospective analysis of 18F-FDG PET/CT imaging in 22 cases of nodular type pulmonary cryptococcosis |
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| Shengxu Li,Mingdeng Tang,Duanyu Lin,Daojia Liu,Jieping Zhang,Qinghu Lyu.Retrospective analysis of 18F-FDG PET/CT imaging in 22 cases of nodular type pulmonary cryptococcosis[J].International Journal of Radiation Medicine and Nuclear Medicine,2020,44(1):37-44. |
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| Authors: | Shengxu Li Mingdeng Tang Duanyu Lin Daojia Liu Jieping Zhang Qinghu Lyu |
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| Affiliation: | Department of Nuclear Medicine, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, China |
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| Abstract: | Objective To investigate the 18F-fluorodeoxyglucose (FDG) PET/CT imaging characteristics of pulmonary cryptococcosis (PC). Methods A retrospective study was performed in 22 patients with PC (17 male and 5 female; aged 54.77±7.93 years), confirmed through etiology or pathological examination from January 2011 to January 2017 in Fujian Provincial Cancer Hospital. 18F-FDG PET/CT was performed. The number, size, distribution, maximum standardized uptake value (SUVmax), and nodule sign of the nodules were analyzed. T test or Pearson correlation analysis was used in the comparison in measurement data. The differences in nodule signs among the different groups were determined by χ2 test, continuous correction χ2 test, or Fisher exact probability method. Results ① A total of 235 nodules were found by 18F-FDG PET/CT imaging in the 22 cases of PC patients with the diameter of (0.7±0.5) cm. Of these nodules, 130 showed high 18F-FDG metabolism with an SUVmax of (3.5±2.9) and a diameter of (0.9±0.5) cm. A positive correlation was found between the two (r=0.702, P=0.000). Meanwhile, 105 nodules showed no 18F-FDG metabolism with a diameter of (0.3±0.1) cm. The diameter in the group with high 18F-FDG metabolism was greater than that in the group without 18F-FDG metabolism, and the difference was statistically significant (t=13.621, P=0.000). ② The nodules were mainly found in the right lung (57.4%, 135/235), lower lobe (64.3%, 151/235), and outer zone or subpleura (80.0%, 188/235). ③ The SUVmax in the nine cases of immunocompromised host with high 18F-FDG metabolism was 5.7±4.7 higher than that in the 13 cases of non-immunocompromised host (SUVmax was 3.0±2.0), and the difference was statistically significant (t=2.731, P=0.011). The ratio of wide base posted to the pleural sign was 17.5 (10/57) of the former and higher the 6.2% (11/178) of the latter. The ratio of halo sign was 25.3% (45/178) in the latter and higher than the former of 10.5% (6/57). All the differences were statistically significant (χ2=7.911, 4.628; P=0.005, 0.031). ④ The nodules of the group with high 18F-FDG metabolism accounted for 80% (16/20) and 53% (114/215), respectively, in the each of 11 cases of one lobe or multiple lobar involvement patients. The former SUVmax was 5.6±3.4 and higher than the latter of 3.2±2.7. The difference was statistically significant (t=2.652, P=0.016). The lobulation sign (35%, 7/20), spicule sign (30%, 6/20), and pleural indentation sign (15%, 3/20) in the former were higher than the 3.3% (7/215), 0.9% (2/215) and 0.9% (2/215) in the latter, respectively. The difference was statistically significant (χ2=32.911, 47.022, 17.395, all P<0.01). ⑤ The SUVmax of the 21 nodules with high 18F-FDG metabolism in the 44 nodules found in the 11 misdiagnosed cases was 5.0±4.6, which was higher than 3.2±2.4 in the 11 other correctly diagnosed cases where 191 nodules were found, including 109 nodules with high 18F-FDG metabolism. The difference was not statistically significant (t=16.825, P=0.106). The lobulation sign, spicule sign and pleural indentation sign in the former were 15.9% (7/44), 18.2% (8/44), 6.8% (3/44) respectively, which are higher than the 3.7% (7/191), 0.0% (0/191), and 1.0% (2/191) in the latter. The difference was statistically significant (χ2=9.570, 35.951, 5.720; all P<0.05). The halo sign was 26.2% (50/191) in the latter, and higher than the 2.3% (1/44) in the former. The difference was statistically significant (χ2=12.027, P=0.000). Conclusions The SUVmax of the nodules is positively correlated with diameter in cases of PC by 18F-FDG PET/CT imaging. Halo sign is a reliable sign of diagnosis. The resembling tumor signs and the high 18F-FDG metabolism, caused the 18F-FDG PET/CT imaging to misdiagnose easily in patients of PC with single lobe involvment. |
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