18F-FDG PET/CT显像联合HRCT对孤立性原发肺浸润性黏液腺癌的诊断价值

目的探讨孤立性原发肺浸润性黏液腺癌18F-FDG PET/CT显像和HRCT征象及两者联合对该病的诊断价值。方法回顾性分析经病理证实为浸润性黏液腺癌、有18F-FDG PET/CT双时相显像及病灶层面同机HRCT扫描资料的9例患者,对PET/CT早期、延迟显像及滞留指数、HRCT征象进行综合分析。结果HRCT图像上表现为2例呈实性结节、病灶周围无类似卫星灶样影,6例实性结节周围伴小点片及磨玻璃样影,1例为单纯磨玻璃样结节;分叶征(6例)、血管集束征(6例)、支气管充气征(4例)、空泡征(2例)、毛刺征(1例);18F-FDG PET/CT融合图像上8例病灶表现为不均匀FDG代谢增高,早期显像平均SUVmax为3.2±2.5,延迟现象SUVmax增高6例、降低2例,平均SUVmax为3.5±2.4,平均滞留指数为(10.4±29.3)%,9例均未见纵隔、双侧肺门淋巴结及其他部位转移征象,其18F-FDG PET/CT融合图像上18F-FDG摄取与HRCT相匹配,18F-FDG摄取相对集中于结节的实性区域,病灶磨玻璃区18F-FDG摄取不明显;综合手术病理结果等临床资料证实,9例均为T1N0M0期,与PET/CT分期一致。结论对于影像学检查发现肺孤立性占位患者,在单一影像学检查难以明确诊断的情况下,18F-FDG PET/CT双时相显像上病灶不均匀18F-FDG摄取相对集中于其实性区域的代谢方式与HRCT相联合,可辅助孤立性原发性肺浸润性黏液腺癌的诊断。

18F-FDG PET/CT with High-Resolution CT in the Diagnosis of Solitary Primary Pulmonary Invasive Mucinous Adenocarcinoma

Objective To discuss the value and characteristics of 18F-FDG PET/CT and high-resolution(HR)CT in solitary primary pulmonary invasive mucinous adenocarcinoma(IMA).Methods Imaging data of 9 patients(3 male and 6 female,age from 39 to 71 years,average age 59.3 years)with pathology-proven IMA from June 2013 to June 2017 were retrospectively analyzed.All nine patients received dual-phase 18F-FDG PET/CT and high resolution(HR)CT.All imaging data including findings on HRCT,findings and SUVmax on early and delayed PET/CT images,retention index of lesions were analyzed.Results All nine IMA were unilateral.2 solid nodules without peripheral satellite lesions,6 solid nodules with peripheral satellite lesions and ground-glass opacity,1 pure ground-glass opacity were identified.Lobulations(n=6),vessel convergences(n=6),air bronchogram(n=4),vacuole sign(n=2)and speculations(n=1)were seen as the morphological features of IMA on HRCT.8 IMA lesions showed patchy increased 18F-FDG uptake with mean SUVmax on early and delayed 18F-FDG PET/CT of 3.2±2.5 and 3.5±2.4,respectively.The mean retention index was(10.4±29.3)%.No metastasis in mediastinum,bilateral hilar lymph nodes or other sites was observed in 9 patients.18F-FDG uptake on integrated 18F-FDG PET/CT scan matched findings on HRCT.18F-FDG uptake of tumors relatively concentrated on substantial side of the lesions.No significant increase in 18F-FDG uptake was observed on ground-glass attenuations.The results were confirmed synthetically by surgical pathology and other clinical data and 9 IMA cases belonged to stage T1 N0 M0 group.They were consistent with the PET/CT staging.Conclusion To those patients with solitary pulmonary nodule(SPN)whose diagnosis cannot be confirmed by a single imaging examination,there are certain 18F-FDG PET/CT and HRCT imaging characteristics for IMA.18F-FDG PET/CT with HRCT are helpful to increase the confidence for the diagnosis of IMA.