^(18)F-FDG PET/CT显像在肺外结核诊断中的应用价值

The Application Value of ^(18)F-FDG PET/CT in Diagnosing of Extrapulmonary Tuberculosis

目的探讨肺外结核在^(18)F-FDG PET/CT显像的特点和征象,以提高对肺外结核的认识和诊断水平。方法回顾性分析经病理和实验室检查确诊为肺外结核的23例患者的^(18)F-FDGPET/CT资料,测量活性病灶SUV_(max),进行半定量分析。结果 23例肺外结核患者共41处病灶,有13例患者合并2种及以上多处肺外结核,除了1处肝结核和1处颅内结核,其余均表现为^(18)FFDG代谢不同程度增高,SUV_(max)2.9-28.3,根据肺外结核的发病部位大致分四大类:(1)淋巴结结核,主要表现为淋巴结不同程度的肿大,部分伴有钙化;(2)浆膜结核,包括胸膜和腹膜结核,主要以弥漫性增厚为主,部分呈结节样增厚;(3)骨结核,均呈溶骨性骨质破坏改变,部分伴椎间盘受累及椎旁脓肿形成;(4)脏器结核,肝、脾结核可见软组织结节及肿块影,输尿管结核可见管壁增厚、继发肾积水,附件结核主要表现为软组织增厚、输卵管迂曲增粗,回盲部结核表现为肠壁环形增厚,肠腔变窄,颅内结核表现为颅内多发结节灶伴周围水肿。另有一例患者同时出现右侧臀部软组织肿块影。结论 ^(18)F-FDGPET/CT全身显像有利于显示肺外结核的病变部位、形态及代谢特点,对肺外结核的早期诊断和鉴别诊断有一定的临床价值。

Objective To investigate the characteristics and signs of ^18F-FDG PET/CT imaging in extrapulmonary tuberculosis, so as to improve the understanding and diagnosis level of extrapulmonary tuberculosis. Methods The ^18F-FDG PET/CT data of 23 patients with extrapulmonary tuberculosis diagnosed by pathology and laboratory examinations were retrospectively analyzed. The SUVmax of the active lesion was measured with the results subject to the semi-quantitative analysis. Results There were a total of 41 lesions in 23 patients with extrapulmonary tuberculosis, 13 patients with multiple extrapulmonary tuberculosis. Except for one site of liver tuberculosis and one site of intracranial tuberculosis, the rest showed varying degrees of the increase in 18F-FDG metabolism, SUVmax2.9-28.3. According to the pathogenesis site, extrapulmonary tuberculosis was roughly divided into four types： （1） lymph node tuberculosis, mainly characterized by lymph nodes in varying degrees of swelling of which some were with calcification. （2）serous tuberculosis, including pleura and peritoneal tuberculosis, mainly characterized by the diffuse thickening （as a main phenomenon）, some nodular thickening. （3） bone tuberculosis, characterized by osteolytic bone destruction, some with intervertebral disc involvement and paraspinal abscess formation, （4） organ tuberculosis （liver and spleen tuberculosis was found with soft tissue nodules and masses; ureteral tuberculosis with wall thickening and secondary hydronephrosis, annex tuberculosis was mainly characterized by soft tissue thickening, tubal tortuous thickening, ileocecal tuberculosis was characterized by intestinal wall ring-shaped thickening, narrowing of intestinal cavity, intracranial tuberculosis was characterized by multiple intracranial nodules with peripheral edema. There was one patient with concurrent soft tissue mass in the right side of the buttock.Conclusion ^18F-FDG PET/CT imaging is helpful to show the location, morphology and metabolic characteristics of pulmonary tuberculosis, which is of great clinical value in the early diagnosis and differential diagnosis of extrapulmonary tuberculosis.