^(18)F-FDG PET/CT对13例肺部非典型性表现病例误诊分析

^(18)F-FDG PET/CT in pulmonary lesions with atypical manifestation: based on 13 misdiagnosed cases

目的分析18F-FDG PET/CT对肺部非典型性表现病变的误诊原因,以提高对此类病变诊断的准确性。方法回顾性分析于2009年1月至2011年6月在我院行18F-FDG PET/CT检查的13例肺部病灶患者误诊原因,其中4例为恶性肿瘤(细支气管肺泡癌3例,乳头状腺癌1例),9例为良性病变(炎性假瘤2例、结核瘤7例),均经穿刺活检或术后病理证实。结果 4例恶性病变18F-FDG PET/CT表现为肺内孤立性结节影3例,片状稍高密度影1例,肺内孤立性结节表现为边缘光滑2例,病灶边缘浅分叶1例,胸膜粘连2例;SUVmax1.9～4.2,片状稍高密度灶SUV值仅为1.9;结节直径为1.5～2.4 cm,平均2.0 cm;18F-FDG PET/CT诊断为炎性假瘤2例,结核瘤1例,局灶性炎症1例。9例良性病变均表现为肺内孤立结节,边缘光滑3例,与胸膜粘连3例,病灶边缘浅分叶4例,病灶内出现钙化点2例;SUVmax2.8～5.1;结节直径为1.8～3.2 cm,平均2.4 cm;18F-FDG PET/CT均诊断为周围型肺癌。结论在18F-FDG PET/CT全身显像中,肺部非典型性表现病变缺乏常规良恶性病变的诊断特点,应密切结合临床及其他检查综合分析,避免漏诊及误诊。

Objective To determine the diagnostic value of 18F-FDG PET/CT in pulmonary atypical manifestation in order to improve the diagnostic accuracy for such type of diseases.Methods A retrospective analysis was conducted on 13 cases with pulmonary lesions who received 18F-FDG PET/CT from Jan 2009 to Jun 2011 in our department,but were given wrong diagnosis.These lesions included 4 malignant tumors（3 bronchiolovalveolar carcinomas and 1 papillary adenoma）,and 9 benign lesions（2 inflammatory pseudotumors and 7 tuberculomas） according the results of needle biopsy or post-operation pathology.Results In 4 malignancies,18F-FDG PET/CT presented solitary pulmonary nodules in 3 cases（2 lesions were with smooth margin and 1 with slight lobulation in the edge,and there were 2 cases had pleural adhesion）,and patchy higher density shadow in 1 case.SUVmax ranged from 1.9 to 4.2,while that of the patchy shadow was only 1.9.Nodule diameter was from 1.5 to 2.4 cm,with an average of 2.0 cm.18F-FDG PET/CT misdiagnosed these 4 malignant tumors as 2 inflammatory pseudotumors,1 tuberculoma and 1 focal inflammation.All benign cases were solitary pulmonary nodules displayed by 18F-FDG PET/CT,of which 3 with smooth margin,3 pleural adhesion,4 slight lobulation in the edge and 2 calcification in lesion.Their SUVmax was 2.8 to 5.1 and nodule diameter was 1.8 to 3.2 cm with 2.4 cm in average.These were all misdiagnosed as peripheral lung cancer by 18F-FDG PET/CT.Conclusion In 18F-FDG PET/CT whole body imaging,pulmonary atypical manifestations lack conventional features for differential diagnosis.Clinical data and other auxiliary examinations should be carefully considered to avoid errors in diagnosis.