肺实性结节性粘液腺癌CT特征及18 F-FDG特点与相关病理基础研究

A research on pulmonary solid-nodular mucinous adenocarcinoma involved its features of CT finding,metabolic characteristics of 18 F-FDG and related pathological basis

目的探讨肺实性结节性粘液腺癌(pulmonary nodular mucinous adenocarcinoma,PNMA)CT影像特征和18氟-脱氧葡萄糖(18 F-FDG)代谢特点,分析其与病理的相关性并探讨其诊断价值。方法回顾性分析于我院接受CT平扫及动态增强扫描并经病理证实为肺实性结节性粘液腺癌的患者35例,其中10例行18 F-FDG PET/CT检查。分析总结结节强化特点(分别测量PNMA平扫平均CT值及静脉期平均CT值,计算静脉期与平扫间CT差值)、形态学特点及18 F-FDG代谢特点,与病理学改变进行对比研究。结果35例PNMA中21例,CT差值大于20 HU,组织病理学表现为密集排列的富含黏液蛋白的肿瘤细胞,中央纤维化。6例CT差值<5 HU,病理显示肺泡腔及间质充满黏液蛋白。32例结节周围不伴卫星灶;结节边缘毛刺16例,分叶征32例,胸膜牵拉征17例,血管集束征12例及伴有空泡13例;结节胸膜下分布34例;PET/CT示无放射性摄取3例,2例SUVmax<2.5,5例SUVmax>5.0。结论PNMA CT影像表现为中重度强化、周围不伴有卫星灶、边缘分叶的胸膜下结节,18 F-FDG PET/CT检查中18 F-FDG代谢无特异性,上述征象在诊断原发肺实性结节性粘液腺癌中有重要价值。

Objective To investigate the features of computed tomography(CT)and metabolic characteristics of 18 F-fluorodeoxyglucose positron emission tomography(18 F-FDG PET/CT)as well as its diagnostic value in pulmonary solid-nodular mucinous adenocarcinoma(PNMA).Methods We analyzed retrospectively 35 patients who had PNMA proved by pathology underwent both non-enhanced CT and enhanced CT scan in our hospital.Among them,10 patients were performed 18 F-FDG PET/CT simultaneously.The intensified pulmonary nodulars were analyzed by the CT value on plain CT,the CT value on venous phase after enhancement,and the difference value between them.The morphologic features of the nodules and the nodular features of FDGuptake on 18 F-FDG PET/CT were analyzed as well as the related pathological changes.Results Among the 35 cases of PNMA after enhancement,21 cases of PNMA had different CT value greater than 20 hounsfield unit(HU).Central fibrosis and tumor cells densely packed with much were mainifestated in histopathology in the 21cases.6 cases of PNMA had difference CT value less than 5 HU,and alveolus as well as interstitials were filled withmucoprotein in pathology.The numerical values of no satellite lesions,spicule sign,lobulation sign,pleural retraction sign,vascular convergence sign,vacuole sign,and subpleural distribution were 32(91.4%),16(45.7%),32(91.4%),17(48.5%),12(34.2%),13(37.1%),and 34(97.1%)respectively on CT viewing.The numerical values of nouptake,SUVmax<2.5,and SUVmax>5.0 were 3,2,and 5 respectively on 18 F-FDG PET/CT.Conclusion The imaging features of PNMA were moderate or intensive enhancement,no satellite lesions,lobulation sign,pleural retraction sign on CT and no specificity on 18 F-FDG PET/CT.The imaging features of PNMA had great value in diagnosis of PNMA.