PET／CT显像恶性单发肺结节边缘征象与所对应区域18F-FDG代谢程度的关系研究

Study of the relevance between edge signs of malignant solitary pulmonary nodules and degree of radioactive 18F-FDG uptake on corresponding areas

目的 比较恶性单发肺结节边缘征象所在区域18F-FDG摄取程度的差异，分析肿瘤不同生长模式对18F-FDG摄取程度的影响。方法 回顾性分析经病理确诊的50例恶性单发肺结节患者的18F-FDG PET/CT显像资料，测定结节各边缘征象（包括分叶征、毛刺征、胸膜牵拉征及血管集束征）所在区域的平均标准化摄取值（SUVave）、最大标准化摄取值（SUVmax）及标准化摄取均峰差（ΔSUV）。应用多组间均数比较LSD法分析各边缘征象所在区域18F-FDG摄取是否存在差异。结果 50例恶性单发肺结节患者中，出现毛刺征者35例，SUVave=4.99±2.98，SUVmax=5.87±3.48，ΔSUV=0.88±0.67；出现分叶征者41例，SUVave=6.95±3.30，SUVmax=8.43±3.98，ΔSUV=1.48±1.04；出现胸膜牵拉征者26例，SUVave=4.45±2.03，SUVmax=5.40±2.45，ΔSUV=0.95±0.82；出现血管集束征者30例，SUVave=6.36±3.94，SUVmax=7.78±5.22，ΔSUV=1.42±1.52。分叶征组的SUVave、SUVmax及△SUV明显大于毛刺征组及胸膜牵拉征组，差异均有统计学意义（LSD法，P=0.008、0.006、0.015及P=0.002、0.003、0.049）；血管集束征组的SUVave及SUVmax明显大于胸膜牵拉征组，差异有统计学意义（LSD法，P=0.026、0.026）。结论 肿瘤不同生长模式的区域18F-FDG摄取程度存在差异，18F-FDG PET/CT显像能够很好地反映增殖性生长与浸润性生长在同一肿瘤不同区域分布的异质性。

Objective To investigate the differences in 18F-FDG uptake on different edge sign areas of malignant solitary pulmonary nodules and to analyze the effects of tumor biological growth pattern on radioactivity distribution of 18F-FDG. Methods Retrospective analysis of the data on 18F-FDG PET/CT images from 50 collected cases with malignant solitary pulmonary nodules was conducted to determine 18F-FDG uptake value, which is expressed as average standardized uptake value （SUVave）, maximum standardized uptake value （SUVmax）, and ΔSUV （SUVmax-SUVave）, at the region of interest to investigate the differences in radioactive 18F-FDG uptake on the positive edge sign areas of the nodules. Comparison of mean in multiple groups was conducted with LSD method. Results In 50 patients with malignant solitary pulmonary nodules, spicule signs occurred in 35 cases （SUVave=4.99±2.98; SUVmax=5.87±3.48; ΔSUV=0.88±0.67）; lobulation signs appeared in 41 cases （SUVave=6.95±3.30; SUVmax=8.43±3.98; ΔSUV=1.48±1.04）; pleural retraction signs developed in 26 cases （SUVave=4.45±2.03; SUVmax=5.40±2.45; ΔSUV=0.95±0.82）; vessel convergence signs materialized in 30 cases （SUVave=6.36±3.94; SUVmax=7.78±5.22; ΔSUV=1.42±1.52）. Compared with the spicule （LSD, P=0.008, 0.006, 0.015）, and pleural retraction sign groups （LSD, P=0.002, 0.003, 0.049）, SUVave, SUVmax, and ΔSUV of the lobulation sign group were much higher. Compared with the pleural retraction sign group, SUVave and SUVmax of the vessel convergence sign group were much higher （LSD, P=0.026, 0.026）. Conclusions Significant differences were observed in the distributions of radioactive 18F-FDG uptake between predominant proliferative and infiltrative areas. Thus, 18F-FDG PET/CT imaging can virtually reflect the heterogeneous distribution of proliferative and invasive areas in different tumor regions.