肺外结核病^(18)F-FDG PET/CT影像表现分析

Image performance of ^(18)F-FDG PET/CT inextrapulmonary tuberculosis

目的探讨肺外结核病^(18)F-FDG PET/CT影像表现,提高对其全面认识。方法回顾性分析深圳武警医院和江西省人民医院收治的12例肺外结核病患者的^(18)F-FDG PET/CT图像资料,10例经病理证实为结核,1例腹水中找到结核杆菌,1例经临床综合诊断,经抗结核治疗后复查^(18)F-FDG PET/CT病灶消失。结果 5例淋巴结结核,4例骨关节结核,2例胸腹膜结核,1例肠结核。5例淋巴结结核表现为不同程度增大淋巴结影,边缘模糊,部分融合,不同程度结节状放射性摄取。2例为肿瘤术后,被误诊为转移,其中1例伴有肺结核。骨关节结核主要表现为溶骨性骨质破坏,伴或不伴冷脓肿形成,部分表现为^(18)F-FDG高摄取而无骨质破坏。1例为胸椎结核,1例为多骨结核,1例为肺结核伴多发淋巴结结核、多骨结核、脾脏结核。1例为胸锁关节结核。2例胸腹膜结核表现为不同程度胸腹腔积液,胸腔积液未见放射性摄取,腹腔积液周围见线状、小结节状放射性摄取。1例肠结核伴有肺结核,表现为回盲部肠壁结节状增厚,边缘模糊,结节状放射性摄取。结论肺外结核病常表现为放射性摄取,影像表现与代谢活性都与肿瘤相似,易被误诊。

Objective To investigate the image performance of 18F-FDG PET/CT in extrapulmonary tuberculosis and to improve its overall understanding.Methods 12 extrapulmonary tuberculosis patients were enrolled in this study,of which 10 were diagnosed by histopathology,1 by witness of tuberculosis bacillus in ascites sample and 1 by clinical data.All patients underwent whole body 18F-FDG PET/CT imaging.Results Lymphatic tuberculosis(5 cases),Osteoarticular tuberculosis(4 cases),Pleural and peritoneal tuberculosis(2 cases),Intestinal tuberculosis(1 case)were confirmed.Lymphatic tuberculosis was found to be with lymph node enlargement(edge blur,partial fusion)and different degree of FDG uptake.Osteoarticular tuberculosis was found to have osteolytic destruction,with or without cold abscess,of which 2 cases showed high FDG uptake without bone destruction,1 case of thoracic tuberculosis,1 case of multiple bone tuberculosis,1 case of pulmonary tuberculosis with multiple lymphnode tuberculosis,osteoarticular tuberculosisand spleen tuberculosis,and 1 case of sternoclavicular joint tuberculosis.Pleural and peritoneal tuberculosis were present with different degree of pleural and peritoneal effusion.pleural effusion showed no FDG uptake,peritoneal effusion showed lines and nodules FDG uptake.1intestinal tuberculosis with pulmonary tuberculosis,nodular thickening in ileocecal junction(Blurred the surrounding fat),nodules FDG uptake.Conclusion Extrapulmonary tuberculosis usually showed FDG uptake,imaging and metabolic activity are similar to tumors and can be easily misdiagnosed.