结核性与恶性腹膜弥漫性病变的^18F-FDG PET/CT影像特征分析

目的 分析结核性与恶性腹膜弥漫性病变的^18F-FDG PET/CT表现,探讨PET/CT的诊断及鉴别诊断价值.方法 回顾性对比分析经病理和（或）临床证实的10例结核性腹膜炎、29例恶性腹膜病变（包括13例原发性腹膜浆液性乳头状腺癌、16例腹膜转移癌）的^18F-FDG PET/CT表现.观察和记录指标：（1）壁腹膜、大网膜、肠系膜的受累情况;（2）腹腔积液情况;（3）淋巴结改变;（4）其他脏器伴随征象.对结核组与恶性组的受累腹膜^18F-FDG代谢程度、腹腔积液密度及^18F-FDG浓聚程度差异行两样本t检验.结果 结核性腹膜炎多为壁腹膜弥漫均匀增厚伴大网膜及肠系膜“污迹样”改变,^18F-FDG分布较均匀;恶性腹膜病变多为壁腹膜、大网膜及肠系膜明显不规则增厚,呈多发结节状及饼状改变,^18F-FDG分布不均匀.两组受累腹膜^18F-FDG代谢均增高,结核性腹膜炎SUVmax为12.74±9.75,恶性腹膜病变SUVmax为12.45±7.40,两者之间的差异无统计学意义（t=0.099,P＞0.05）.恶性腹膜病变患者腹腔积液密度低于结核性腹膜炎患者,恶性腹膜病变患者的CT值为（11.34±3.55）HU、结核性腹膜炎患者的CT值为（14.4±2.37）HU,两者之间的差异有统计学意义（t=2.53,P＜0.05）;腹腔积液^18F-FDG浓聚程度高于结核性腹膜炎患者,恶性腹膜病变患者SUVmax为2.10±0.65、结核性腹膜炎患者SUVmax为1.61±0.35,两者之间的差异有统计学意义（t=-2.278,P＜0.05）;恶性腹膜病变患者T/NT为0.77±0.18、结核性腹膜炎患者T/NT为0.58±0.12,两者之间的差异有统计学意义（t=-3.084,P＜0.05）.结论 ^18F-FDG PET/CT显像可同时显示腹膜病变的形态学和功能代谢改变,并全面显示其他脏器的伴随征象,综合分析其特征,有助于提高病变的诊断准确率.

Analysis of 18F-FDG PET/CT imaging features of tuberculous and cancerous diffuse peritoneal lesions

Objective To analysis the ^18F-FDG PET/CT features of tuberculous and cancerous diffuse peritoneal lesions and evaluate the value of ^18F-FDG PET/CT in diagnosing and differentiating the lesions.Methods The ^18F-FDG PET/CT features of 10 tuberculous peritonitis,13 primary serous papillary carcinoma of the peritoneum and 16 peritoneal metastases were retrospectively reviewed,which had been confirmed by clinic and / or histopathology.Four indicators were observed and graded：（1） ^18F-FDG PET/CT features of parietal peritoneum,greater omentum and mesentery; （2）features of ascites; （3）enlargement of lymph nodes; （4）accompanying signs of other organs.Two sample t test was used to differentiate the ^18F-FDG uptake of peritoneal lesions,the density and ^18F-FDG concentration of ascites between tuberculous peritonitis and cancerous peritonitis.Results The typical ^18F-FDG PET/CT features of tuberculous peritonitis was uniformity thickening of parietal peritoneum,mesenteric and omental stains like change,widely and even distribution of the peritoneal ^18F-FDG,while the cancerous peritonitis was obvious uneven thickening of parietal peritoneum,mesenteric and omental nodules and pie-shape changes,uneven distribution of the peritoneal ^18F-FDG.The ^18F-FDG uptake was increased in all peritoneal lesions,and there are no significant difference between the tuberculous group （SUVmax=12.74±9.75） and the cancerous group （SUVmax=12.45 ±7.40） （t=0.099,P〉0.05）.The density of malignant ascitesCTavg=（11.34±3.55） HU] was obvious lower than tuberculous ascitesCTavg=（14.4±2.37）HU] （t=2.5,P〈0.05）.The ^18F-FDG concentration in malignant ascites （SUVmax =2.10 ±0.65,T/NT =0.77 ±0.18） was obvious higher than tuberculous ascites （SUVmax=1.61±0.35,T/NT=0.58±0.12） （t=-2.278,-3.084,both P〈0.05）.Conclusion The ^18F-FDG PET/CT imaging can show the morphology and metabolic changes of peritoneal lesions,and fully display the lesions in the whole body.It is important to analyze ^18F-F