^(18)F-FDG PET和PET/CT在肾上腺病变鉴别诊断中的作用

The value of fluorodeoxyglucose positron emission tomography in differentiating malignant from benign lesions in patients with adrenal masses

目的:探讨18F-脱氧葡萄糖(FDG)PET或PET/CT显像在肾上腺病变鉴别诊断中的应用价值。方法:25例肾上腺占位患者均行18FDG PET或PET/CT图像,检查后1月内19例经手术切除,6例经穿刺活检获得病理结果,25例均有同期术前CT增强扫描。按照肾上腺占位是否产生内分泌症状分为有功能病变组(组A,8例)和无功能病变组(组B,17例),对18FDG PET或PET/CT图像所示肾上腺病变行半定量分析,计算肾上腺病变SUVm ax值及肾上腺病变/肝脏SUV-m ax比值。结果:1.有功能病变组的临床多表现为库欣综合征和高血压,良性病变SUVm ax为5.04±2.07,恶性病变的SUVm ax为8.33±2.57.良性肾上腺病变/肝脏SUVm ax的比值为2.52±0.62,恶性肾上腺病变/肝脏SUVm ax的比值为2.92±1.03。良性病变的大小为3.26±1.01 cm,明显小于恶性病变(7.80±1.82 cm)。2.无功能病变组,恶性病变的SUVm ax为11.39±7.96明显高于良性病变(1.93±0.54)。恶性肾上腺病变/肝脏SUVm ax的比值为4.51±2.92,明显高于良性肾上腺病变/肝脏SUVm ax的比值(0.76±0.20)。良性病变的大小为2.25±0.69 cm,小于恶性病变(5.62±3.95 cm)。结论:对于无功能的肾上腺病变,18FDG PET和PET/CT是鉴别诊断其良恶性的一种非常好的办法。而对于有功能的肾上腺病变,在综合其临床表现和影像学特点的前提下依靠病变的大小和SUVm ax,18FDG PET和PET/CT仍然可以鉴别诊断其良恶性。

Objective：To explore the value of 18F-fluorodeoxyglucose（18FDG） positron emission tomography（PET）or PET computer tomography（PET/CT） in distinguishing benign from malignant lesions in patients with adrenal masses.Methods： 18FDG PET（or PET/CT）imagings were performed for 25 patients with adrenal lesions,and all cases had the homochronous enhanced CT scans.Subsequently histopathological results were obtained within 1 month.Semiquantiative analysis of metabolic changes in adrenal masses was done by calculating the maximal standard uptake value（SUVmax） and the SUVmax ratio of adrenal mass to liver.Results： The cases were divided into 2 groups： groupA which include 8 of 25 cases with symptoms（Cushing′s syndrome or high blood pressure） caused by abnormal endocrinal secretion of adrenal mass and groupB which include 17 of 25 cases without symptoms.In groupA,The size of benign lesions（3.26±1.01 cm） was obviously smaller than that of malignant ones（7.80±1.82 cm）,the average SUVmax（5.04±2.07） and the SUVmax ratio of adrenal mass to liver（2.52±0.62） of benign masses is a little lower than that of malignant ones respectively（8.33±2.57,2.92±1.03）.In groupB,The size,the average SUVmax and the ratio of SUVmax adrenal mass/SUVmax liver in benign lesions（2.25±0.69 cm,1.93±0.54,0.76±0.20） were all obviously less than that of malignant ones respectively（5.62±3.95 cm,11.39±7.96,4.51±2.92）.Conclusion： For the patients without endocrinal symptoms,malignant adrenal lesions could be differentiated from benign masses simplely by18FDG PET imaging,but for the patients with endocrinal symptoms,the differentiation could not Only according to the SUVmax of 18FDG PET,but need refer to the clinical backgroud and other imaging modality such as enhanced CT scan.