肺孤立性大细胞神经内分泌癌的^(18)F-FDG PET/CT显像表现

^(18)F-FDG PET/CT Imaging Characteristics of Solitary Pulmonary Large Cell Neuroendocrine Carcinoma

目的探讨肺孤立性大细胞神经内分泌癌(LCNEC)的^(18)F-FDG PET/CT影像学特点。方法回顾性分析行^(18)F-FDG PET/CT显像证实为肺内孤立性病灶,经手术切除病理证实为LCNEC的患者23例。发病年龄为57~83岁,平均(64.91±6.37)岁;其中男20例,女3例。由两名副主任医师对病灶大小、形态、密度、内部及边缘情况、^(18)F-FDG代谢情况进行综合评价。结果23例患者病灶位于右肺上叶10例,右肺下叶4例,左肺下叶6例,左肺上叶3例;病灶最大径范围为0.5~10.1 cm,平均(3.54±2.60)cm;CT值范围为28~58 HU,平均(37.51±9.16)HU;病灶呈边界清晰的圆形或类圆形17例,3例形态不规则,分叶12例,与胸膜呈宽基底9例,胸膜凹陷2例,血管贴边征8例,杵状指改变2例,支气管截断征1例,血管集束征1例,空泡征1例;最大标准摄取值(SUVmax)范围为2.3~29.39,平均为10.50±5.99;病灶CT值与SUVmax间差异无统计学意义(P=0.431,P>0.05);病灶大小与SUVmax之间差异有统计学意义(P=0.005,P<0.05)。结论肺内孤立性边界清晰的圆形或类圆形肿块或结节、伴或不伴分叶,虽然在MSCT图像上可表现为贴边血管征、与胸膜宽基底、杵状指等良性征象,但^(18)F-FDG显像呈明显高摄取。综合影像表现可考虑有LCNEC可能。

Objective To discuss the imaging characteristics of^(18)F-FDG PET/CT in the large cell neuroendocrine carcinomas(LCNEC)of the lung.Methods Imaging data of 23 patients(20 male and 3 female,age from 57 to 83 years,average age 64.91±6.37 years)with pathology-proven LCNEC from June 2007 to June 2019 were retrospectively analyzed.All patients received^(18)F-FDG PET/CT and all lesions showed solitary pulmonary nodules.The size,shape,density,internal and marginal conditions of the lesions were evaluated comprehensively by two deputy chief physicians.Results The right upper lobes were involved in 10 of 23 patients and the right lower lobes were involved in 4 of 23 patients.The left lower lobes were involved in 6 of 23 patients and the left upper lobes were involved in 3 of 23 patients.The tumour largest diameter ranged from 0.5 to 10.1 cm(3.54±2.60)cm,mean±standard deviation).The range of CT value was from 28 to 58 HU(37.51±9.16)HU,mean±standard deviation).17 cases showed clearly defined circular or quasi-circular lesions and 3 cases showedirregular contour.Cases included 2 cases of pleural depression,8 cases of vascular welting sign,2 cases of clubbing sign,1 case of bronchus truncation sign,1 case of vascular clustering sign,and 1 case of vacuole sign.The difference between the CT value and SUVmax of lesions was statistically significant(P=0.431,P<0.05).The difference between the size and SUVmax of lesions was statistically significant(P=0.005,P<0.05).Conclusion Certain solitary well-defined nodules or masses showed round or nearly roundshape,with or without lobulation.Although they can be demonstrated on MSCT images as benign signs such as welt vessel,connected with the pleura by a wide base and clubbing signs,the^(18)F-FDG imaging showed significantly high uptake.Combined with theimagingfindings,the possibility of LCNEC could be considered.