结节病18F-FDG符合线路显像胸部淋巴结的特征表现

目的探讨结节病纵隔、肺门淋巴结18氟-氟代脱氧葡萄糖(18F-FDG)代谢显像的特征表现。方法分析20例18F-FDG符合线路显像,示纵隔及双肺门多发淋巴结葡萄糖代谢增高,首先诊断为结节病或建议进一步检查除外结节病的病例。临床经气管镜、纵隔镜取材病理、X线胸片、CT、血清血管紧张素转化酶等实验室检验,确诊为结节病及慢性阻塞性肺疾病。结果 20例患者中,确诊为结节病16例;慢性阻塞性肺疾病4例。16例结节病患者中纵隔及双肺门淋巴结均多发肿大,葡萄糖代谢均异常增高,双肺门淋巴结对称性肿大最为显著,呈"八"字型分布,串珠样,其中15例右肺门相对大于左侧。纵隔多组淋巴结肿大,其中14例以右上纵隔为著。4例慢性阻塞性肺疾病,肺门淋巴结葡萄糖摄取均增高,其中1例为单侧,4例中2例纵隔淋巴结摄取增高,肺门淋巴结未见对称性"八"字分布,纵隔及肺门淋巴结均为散在分布。结论18F-FDG葡萄糖代谢显像表现出的纵隔及肺门淋巴结特征,为临床诊断Ⅰ、Ⅱ期结节病提供了一个重要的诊断依据。依据此特征,综合临床表现及其它检查,对诊断结节病,鉴别肺门淋巴结核、淋巴瘤及肺门转移性肿瘤等有很大帮助。

The characteristics of thoracic lymph node of sarcoidosis in 18F-FDG coincidence imaging

Objective To investigate the characteristic sign of mediastinal and hilar lymph node of sarcoidosis patient in 18F-FDG coincidence imaging.Methods Twenty patients were included in this study.The 18F-FDG coincidence imaging of these patients showed multiple high 18F-FDG uptake in mediastinal and hilar lymph node.The preliminary diagnosis was suspicious of sarcoidosis.The final diagnosis was sarcoidosis or chronic obstructive pulmonary disease（COPD） after biopsy from bronchoscope and mediastinoscope,X-ray,CT,and laboratory examination（angiotensin-converting enzyme,etc）.Results The final diagnosis of 16 patients was sarcoidosis,while the final diagnosis of other 4 patients was COPD.The 18F-FDG coincidence imaging of 16 sarcoidosis patients showed multiple mediastinal and hilar lymph node enlargement,abnormally high uptake of 18F-FDG.The distribution of 18F-FDG was symmetric,in the shape of Chinese word ＂eight＂.The lymph node of right hilar of these sarcoidosis patients was larger than that of left hilar.The mediastinal lymph node of all patients was enlarged.The enlargement of right upper mediastinal lymph node in 14 patients was obvious.The uptake of 18F-FDG of hilar lymph node in 4 COPD patients was high.The 18F-FDG uptake in one COPD patient was unilateral.The uptake of two COPD patients was bilateral,however,the distribution did not show the symmetric characteristics.The 18F-FDG uptake of COPD patients was disperse.Conclusion The characteristic sign of mediastinal and hilar lymph node in 18F-FDG coincidence imaging can provide an important evidence of stage I and II sarcoidosis.Combining other clinical signs and examinations with 18F-FDG coincidence imaging can help the diagnosis of sarcoidosis,differential diagnosis of hilar lymph node tuberculosis,lymphoma,and hilar metastatic tumor.