肺大细胞神经内分泌癌的CT及PET/CT表现

CT and PET/CT manifestations of large-cell neuroendocrine carcinoma of the lung

目的探讨肺大细胞神经内分泌癌的cT与PET／CT影像学表现。方法回顾性分析11例（男性占10例，女性仅1例，年龄45～85岁，中位数63岁）经病理证实的肺大细胞神经内分泌癌的CT以及PET／CT影像表现，除1例行平扫外，其余10例行平扫及增强扫描，其中6例同时行PET／CT检查。结果根据病灶发生部位，分为周围型（n=8）、中央型（n=2）、纵隔型（n=1）。CT表现：病灶呈单发实性结节或肿块，直径约2．2～9．1cm（5．2±2．5），均呈浅或深分叶，边缘光滑（n=6），长短毛刺征（n=2），胸膜牵拉（n=2），厚壁空洞（n=2），增强后强化幅值约22～51HU（39．1±103），几乎完全液化坏死呈环形强化1例，1例合并阻塞性肺炎。PET／CT：SUV最大值约4．6—193（11．7±5．5）。伴肺门及纵隔淋巴结转移6例，肺内转移1例，肋骨转移1例。结论肺大细胞神经内分泌癌罕见，多见于老年吸烟男性。CT及PET／CT表现缺乏特异性，但当肺内结节或肿块呈分叶状而边缘较光滑，且PET／CT上病灶SUV值较高时，需考虑本病的可能。

Objective To investigate the CT and PET/CT features of large-cell neuroendocrine carcinoma （LCNEC）of the lung. Methods CT （lwithout, 10 without and with intravenous contrast ） and PET/CT （6） of 11 patients （10 men, 1 woman; age range： 45-85 years, median： 63 years ） with pathologically proven large-cell neuroendocrine carcinoma were analyzed retrospectively. Results The tumors were classified as peripheral （8）, central （2）, or mediastinal （1） according to their locations. CT demonstrated solitary solid nodules or masses with lobulation ranging from 2.2 to 9.1 cm （mean 5.2±2.5 cm） in diameter. Tumor margin was smooth （6）, spiculated （2）, or adherent to the pleura （2）. Two tumors presented as thick-walled cavities. The tumor density ranged from 22 to 51HU （39.1 ± 10.3 HU ） on contrast-enhanced CT. Central necrosis with rim enhancement （I） and obstructive pneumonia （1） were also seen. On PET/CT, the maximum SUV of tumors ranged from 4.6 to 19.3 （11.7 ± 5.5）. Mediastinal and hilar lymph node metastasis （6）, intrapulmonary metastasis （1）, and rib metastasis （1）were also demonstrated. Conclusions LCNEC is a rare pulmonary neoplasm more prevalent in elderly male smokers. The CT and PET/CT manifestations are non-specific. LCNEC should be considered as a differential diagnosis when a solid pulmonary nodule or mass demonstrates lobulation and smooth margin with high maximum SUV on PET/CT.