原发性肺黏膜相关淋巴组织淋巴瘤的18F-FDG PET/CT影像学表现

18F-FDG PET/CT manifestation of primary pulmonary mucosa-associated lymphoid tissue lymphoma

目的分析原发性肺黏膜相关淋巴组织(MALT)淋巴瘤的18F-FDG PET/CT影像学表现,提高对原发性肺MALT淋巴瘤的认识及诊断能力。方法回顾性分析2006年11月至2017年4月经病理确诊的9例原发性肺MALT淋巴瘤患者(男性6例、女性3例,中位年龄59岁)的临床资料及18F-FDG PET/CT显像资料,记录病灶的部位、数量、密度、大小、形态及最大标准化摄取值(SUVmax),以及纵隔及肺门淋巴结等情况;分析影像信息并同时进行相关文献复习。结果9例原发性肺MALT淋巴瘤患者18F-FDG PET/CT表现分为3型:实变型4例、肿块型3例、弥漫肺炎型2例。实变型表现为大小、受累范围不等的实变影;肿块型表现为单发或多发、边缘毛糙的实性肿块影;弥漫肺炎型表现为肺叶内或双肺弥漫的斑片、团块样软组织密度影。在9例患者中可见支气管充气征8例(部分伴有支气管扩张)、三角型灌注征3例、病灶向中心聚拢4例、钙化2例、胸腔积液2例、肺门及纵隔淋巴结肿大2例。所有病灶18F-FDG代谢不均匀增高,中位SUVmax为6.0(2.6~8.3);2例弥漫肺炎型纵隔及肺门淋巴结18F-FDG摄取异常增高,SUVmax分别为13.0、4.7。结论原发性肺MALT淋巴瘤的18F-FDG PET/CT表现常为斑片状致密影,多见实变影,内部常见支气管充气征,18F-FDG轻度摄取,结合相对缓慢的病程,可考虑为原发性肺MALT淋巴瘤。

Objective To analyze 18F-FDG PET/CT manifestation of primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and improve the understanding and diagnosis of primary pulmonary MALT lymphoma. Methods The clinical data and 18F-FDG PET/CT data of 9 patients with primary pulmonary MALT lymphoma confirmed by pathology were retrospectively analyzed. Two senior PET/CT diagnostic physicians independently reviewed the films and recorded the location, number, density, size, morphology, and maximum standardized uptake value (SUVmax) of the lesions, as well as the mediastinal and hilar lymph nodes. Based on the data obtained, the image information was analyzed and related literatures were reviewed. Results Nine cases of primary pulmonary MALT lymphoma 18F-FDG PET/CT were divided into three types: consolidation shadows(n=4), solitary mass (n=3), and diffuse pneumonia (n=2). The type of consolidation shadows manifested as consolidation shadows with different size and involvement range. The type of mass manifested as single or multiple solid masses with rough edges, and the type of diffuse pneumonia manifested as diffuse plaques and clumps of soft tissue density shadows in the pulmonary lobe or both lungs. Signs of air bronchogram (n=8), signs of perfusion (n=3), calcification (n=2), pleural effusion(n=2) and mediastinal and hilar lymphadenopathy (n=2) were found in 9 patients. Lesions gathered at the center was seen in 4 patients. All lesions showed heterogeneous 18F-FDG uptake;the median SUVmax was 6.0 (2.6–8.3). Radioactive concentration of mediastinal and hilar lymphadenopathy was found in 2 cases of patients with diffuse pneumonia;SUVmax were 13.0, 4.7. Conclusion 18F-FDG PET/CT manifestation of primary pulmonary MALT lymphoma was solitary mass or consolidation shadows with signs of air bronchogram and heterogeneous 18F-FDG uptake. Combined with relatively slow progression, such manifestation can be considered primary pulmonary MALT lymphoma.