肺部良性结节样病变18F-FDG摄取不均匀性的特点分析

目的 观察肺部良性结节样病变对18F-FDG的摄取是否均匀，分析摄取不均匀性的特点，并探讨其是否有助于肺部良性结节样病变的鉴别诊断。 方法 收集18F-FDG PET/CT检查的肺部良性结节样病变患者60例，测量其最大标准化摄取值（SUV_max），并由2名有丰富经验的医师目测分析病灶对18F-FDG摄取不均匀性的特点，将不均匀形态分为不规则形摄取、部分不摄取、中心结节状摄取和边缘环状摄取，并分别作记录。同时观察指标还包括病灶部位、是否与邻近胸膜广基底粘连。 结果 60例肺部良性结节样病变单独以SUV_max≥2.5作为鉴别诊断标准时，误诊率为56.7%，PET/CT综合性诊断的误诊率为38.3%。其中40例18F-FDG摄取不均匀，包括不规则形摄取15例，部分不摄取17例，中心结节状摄取5例，边缘环状摄取3例。14例结核病变中，有10例病灶部位位于两肺上叶尖后段。24例病灶与邻近胸膜广基底粘连，在感染性病变中的比例更高（14/21）。 结论 肺部良性结节样病变出现18F-FDG摄取不均匀的比例较高，在鉴别诊断时可以作为观察指标之一。病灶存在胸膜广基底粘连时应考虑感染性病变可能。

18F-FDG uptake nonuniform characteristics in pulmonary benign nodules

Objective To observe whether the 18F-FDG uptake in pulmonary benign nodular lesions is uniform, and to analyze the nonuniform characteristics, and then to investigate whether it is helpful for differential diagnosis. Methods Sixty cases of pulmonary benign nodular lesions were collected with examination of 18F-FDG PET/CT. After measuring the maximum standardized uptake value (SUV_max), 2 senior radiologists visually analyzed the uniformity of 18F-FDG uptake, and the uneven shape was divided into irregular uptake, no uptake in part of nodule, center nodular uptake and edge ring uptake respectively. The location and wide basal adhesion to adjacent pleural were also recorded. Results With SUV_max≥2.5 as criteria for differential diagnosis the misdiagnostic rate was 56.7% and 38.3% with both SUV_max and CT signs in 60 cases of benign nodular lesions. Among 40 cases the 18F-FDG uptake was not uniform with the irregular uptake in 15 cases, no uptake partially in 17 cases, center intake in 5 cases and edge ring uptake in 3 cases. There were 10 cases with lesions located in the apicoposterior segment of both upper lobes of the 14 tuberculosis cases. In 24 cases the lesions adhered the adjacent pleural in broad base and infectious lesions had the higher proportion(14/21). Conclusions Ununiformity of 18F-FDG uptake often appears in pulmory benign nodular lesions, and may be a valuable sign in the differential diagnosis. Infectious lesions should be considered if nodular lesions presented with broad pleural adhesions.