肌肉转移癌的^(18)F-FDG PET/CT影像表现及临床特征研究

Imaging and clinical features of muscle metastases demonstrated on ^(18)F-Fluorodeoxyglucose positron emission tomography/computed tomography

目的探讨肌肉转移癌(MMs)的氟-18-脱氧葡萄糖正电子发射断层成像/X线计算机体层成像(^(18)F-FDG PET/CT)影像特征、原发肿瘤来源及转移频率、不同肿瘤的常见肌肉转移部位。方法对行^(18)F-FDG PET/CT检查并最终诊断为MMs的103例肿瘤患者资料进行回顾性分析。测量肌肉转移灶的最大标准摄取值(SUV_(max)),分析MMs的原发肿瘤来源及常见累及部位。统计同期检查的与MMs原发肿瘤同类型的肿瘤患者总人数,分析各原发肿瘤肌肉转移的发生频率及常见转移部位。结果 5 195例肿瘤患者中有103例患者伴有肌肉转移,^(18)F-FDG PET/CT共检出MMs病灶206处,平均SUV_(max)为8.0±4.7(2.2～24.4),不同原发肿瘤及不同部位的MMs病灶SUV_(max)差异无统计学意义(P=0.530),同机X线计算机体层成像(CT)仅检出肌肉转移灶62处(30.1%)。103例MMs患者中95例(92.2%)同时伴肌肉外其他组织及脏器转移,有8例(7.8%)患者仅发生肌肉转移。MMs的原发肿瘤以肺癌(37.9%)、结直肠癌(9.7%)、宫颈癌(7.8%)和乳腺癌(7.8%)最为常见,而肾癌(6.12%)、宫颈癌(5.67%)和胰腺癌(5.56%)发生肌肉转移的频率最高。MMs最常累及的部位是椎旁肌肉(31.1%)、四肢肌肉(20.9%)、臀部肌肉(13.6%)和胸壁肌肉(10.7%),单个肌肉中以竖脊肌(14.1%)和腰大肌(13.1%)累及频率最高。不同肿瘤常见的肌肉转移部位不同,其中肺癌最常肌肉转移部位是四肢肌肉(33.3%),结直肠癌(40%)和宫颈癌(54.5%)最常肌肉转移部位是腰大肌,乳腺癌最常肌肉转移部位是胸大小肌(90%)。结论 MMs病灶在PET/CT检查中均表现为氟-18-脱氧葡萄糖(^(18)F-FDG)摄取。MMs最常见的原发肿瘤是肺癌,最常见转移部位是椎旁肌肉群,特别是竖脊肌;不同原发肿瘤表现出不同的MMs发生频率和转移部位,肌肉转移频率最高的是肾癌。少数病例可发生单纯的肌肉转移。

Objective To investigate the feature of muscle metastases (MMs) and the origin and frequency of primary tumor in patients with MMS detected by 18F-fludeoxyglucose ( 18F-FDG) positron-emission tomography/computed tomography (PET/CT). Methods The PET/CT imaging database of patients with pathologically proven MMS in our institution from November 2009 to October 2014 was retrospective reviewed. The maximum standardized uptake value (SUV max ) of MMS were obtained. Additionally,the origin and frequency of primary tumor and the common metastatic sites in patients with MMS were analyzed statistically. Results 5 195 patients with different primary tumors were investigated by PET/CT imaging. In 103 patients,MMS were identified. In these 103 patients,206 MMs lesions were identified by 18 F-FDG PET/CT,while only 62(30.1%) lesions could be detected by the CT on the same unit. All of these lesions were appeared as areas of high 18 F-FDG uptake in PET/CT,the average SUV max of these lesions was 8.0±4.7 (range,2.2 to 24.4).There was no significant difference in SUV max of MMs lesions in different primary tumors and different sites( P =0.53).There were concurrent metastases to internal organs or other tissues in 95(92.2%) of the 103 patients with MMs,and eight patients (7.8%) presented metasta- ses tomusculature only. The most common primary malignancies were lung (37.9%),colorectal (9.7%),cervical (7.8%),and breast cancers (7.8%),While kidney (6.12%),cervical (5.67%),pancreatic (5.56%) and urinary bladder cancer (4.76%) had a higher frequency of muscle metastasis. MMs were mostly localized in the paravertebral (20.9%),lower extremities (13.6%) and thoracic wall musculature (10.7%),and specific to individual muscle,MMs were localized most frequently in the erector spinae (14.1%) and psoas major (13.1%). The common sites of MMs vary from tumor to tumor. Lung cancer frequently metastasized to the muscles of extremities (33.3%);colorectal cancer (40%) and cervical cancer (54.5%) frequently metastasized to the psoas major;and breast cancer frequently metastasized to the pectoralis major and minor (90%). Conclusion All of MMs lesions were appeared as areas of high 18 F-FDG uptake in PET/CT image. The most common primary tumors of MMs were lung cancer,and the most common metastatic site of muscle was paravertebral musculature,particularly in the erector spinae. Different primary malignancies showed different metastatic frequency and localizations of MMs,and the neoplasm with the greast propensity to metastasize to musculature is kidney cancer. Only a few cases presented metastases to musculature only.