肺癌性淋巴管炎的^(18)F-FDG PET/CT及同机HRCT研究

The study of ^(18)F-FDG PET/CT combing with HRCT in the diagnosis of pulmonary lymphangitic carcinomatosis

目的探讨^(18)F-FDG PET/CT结合同机HRCT对肺癌性淋巴管炎(pulmonary lymphangitic carcinomatosis,PLC)的诊断价值。方法回顾性分析经病理及临床确诊的52例PLC的^(18)F-FDG PET/CT及同机HRCT影像学表现,观察指标包括肺部PET、衰减校正CT及HRCT图像特点,测量患处SUVmean值、对侧正常肺组织SUVmean值、纵隔血池SUVmean值,并行统计分析。结果 52例PLC患者,男性32例,女性20例,年龄32~83岁,平均年龄62岁。累及单侧肺30例(58%),两肺22例(42%),局限性分布40例(77%),弥漫性分布12例(23%);患处SUVmean值(1.34±0.68),对侧正常肺组织SUVmean值(0.55±0.17),患处SUVmean值明显高于对侧正常肺组织(P<0.01);两肺弥漫分布性两侧患处各自SUVmean值/纵隔血池SUVmean值的比值、正常肺组织SUVmean值/纵隔血池SUVmean值的比值分别为(0.82±0.28)、(0.73±0.29)、(0.39±0.14),患处SUVmean值/纵隔血池SUVmean值的比值与正常肺组织SUVmean值/纵隔血池SUVmean值的比值之间有显著统计学差异(P<0.01)。52例PLC单纯经PET/CT诊断46例,特异性100%,敏感性88%,另6例经同机肺HRCT结合PET/CT全身成像及患处SUVmean值定量测量得以补充诊断。结论^(18)F-FDG PET/CT结合同机HRCT明显提高PLC诊断的敏感性、特异性。

Objective To assess the value of 18F-FDG PET/CT combing with HRCT in the diagnosis of pulmonary lymphangitic carcinomatosis（PLC）. Methods Integrated PET/CT and HRCT images of 52 patients（32 men,20 women,age,32~ 82 years,mean age,62 years） with PLC confirmed at the follow-up chest CT or histopathologic examination were analyzed retrospectively. The mean standardized uptake value（SUVmean） ratio was measured in the affected lungs,the normal lungs,and the mediastinal blood pool. Abnormal PET activity in the lungs was assessed. The CT images was reviewed to determine the presence,size,location,and extent of PLC. The data were analyzed to determine the sensitivity and specifcity of PET/CT for PLC. Results Among the 52 patients with PLC,30（58%）,22（42%）,40（77%）,and 12（23%） patients had unilateral,bilateral,focal,and diffuse PLC,respectively. The SUVmean ratioin the region of PLC（1. 34 ± 0. 68） was significantly greater than that in normal lung（0. 55 ± 0. 17）（P〈0. 01）. The SUVmean ratio ofbilateral lymphangitic lung to mediastinal blood pool that was（0. 82 ± 0. 28）,（0. 73 ± 0. 29） respectively was significantly greater than that of normal lung to blood pool that was（0. 39 ±0. 14）（P〈0. 01）. The specificity of PET/CT for PLC was 100%,and the sensitivity was 88%,additional diagnosis of PLC in 6 patients was made by HRCT in dependently. Conclusion 18F-FDG PET/CT combing with HRCT has high specificity and sensitivity in the detection of PLC.