18F-FDG PET/CT显像对结核性和癌性胸腹腔积液鉴别诊断的价值

VALUE OF 18F-FDG PET/CT IMAGING IN THE DIFFERENTIAL DIAGNOSIS OF TUBERCULOUS PLEURAL EFFUSION AND CANCEROUS PLEURAL AND PERITONEAL EFFUSION

目的探讨18F-FDG PET/CT显像对结核性和癌性胸腹腔积液鉴别诊断的价值。方法回顾性分析因胸腹腔积液行18F-FDG PET/CT检查或经18F-FDG PET/CT检查发现胸腹腔积液的患者,选取随访资料完整且临床最终确诊为结核性胸腹腔积液的患者(结核组)26例(首次PET/CT检查时均为活动期肺结核),以及确诊为肺癌合并癌性胸腹腔积液患者(肺癌组)22例,统计PET/CT显像肺内原发病灶、胸膜或腹膜病灶、胸腹腔积液的最大标准摄取值(SUVmax),观察肺门或纵隔、腹腔或腹膜后高代谢肿大淋巴结的情况。结果结核组18F-FDG PET/CT显像表现为弥漫代谢增高的胸腹膜和低代谢的胸腹腔积液,肺癌组则表现为局灶性不规则代谢增高的胸腹膜和较高代谢的胸腹腔积液。结核组和肺癌组原发灶SUVmax分别为2.88±1.00、6.38±2.20,两者比较差异有显著性(t=6.24,P<0.05);结核组患者胸腹膜FDG代谢弥漫性升高,肺癌组患者代谢局灶性升高,两者SUVmax比较差异无显著性(P>0.05);结核组胸腹腔积液SUVmax明显低于肺癌组(t=3.94,P<0.05);结核组患者腹腔或腹膜后高代谢肿大淋巴结明显少于肺癌组(χ^2=5.64,P<0.05)。结论相对较低的积液FDG代谢水平、轻度FDG代谢升高的肺内原发灶和弥漫性高代谢的胸腹膜是结核性胸腹腔积液18F-FDG PET/CT显像的显著特征,全面分析PET/CT显像特点可对结核性和癌性胸腹腔积液的鉴别诊断提供帮助。

Objective\To investigate the value of 18F-FDG PET/CT imaging in the differential diagnosis of tuberculous pleural and peritoneal effusion and cancerous pleural and peritoneal effusion.\Methods\A retrospective analysis was performed for the patients who underwent 18F-FDG PET/CT imaging due to pleural and peritoneal effusion or were found to have pleural and peritoneal effusion by 18F-FDG PET/CT imaging.A total of 26 patients with complete follow-up data who were diagnosed with tuberculous pleural and peritoneal effusion were enrolled as tuberculous group(with the active stage of pulmonary tuberculosis at initial 18F-FDG PET/CT imaging),and 22 patients who were diagnosed with lung cancer and cancerous pleural and peritoneal effusion were enrolled as lung cancer group.A statistical analysis was performed for primary lesions in lungs,pleural or peritoneal lesions,and the maximum standard uptake value(SUVmax)of pleural and peritoneal effusion on PET/CT imaging,and enlarged hypermetabolic lymph nodes were observed in the hilus of the lung,the mediastinum,the abdominal cavity,and the retroperitoneal space.\Results\The tuberculous group showed diffuse hypermetabolic pleuroperitoneum and hypometabolic pleural and peritoneal effusion on 18F-FDG PET/CT imaging,while the lung cancer group showed focal uneven hypermetabolic pleuroperitoneum and hypermetabolic pleural and peritoneal effusion.The SUVmax of primary lesion was 2.88±1.00 for the tuberculous group and 6.38±2.20 for the lung cancer group,and there was a significant difference between the two groups(t=6.24,P<0.05).The tuberculous group had diffusely increased FDG uptake in the pleuroperitoneum,while the lung cancer group had focally increased FDG uptake,and there was no significant difference in SUVmax between the two groups(P>0.05).The tuberculous group had a significantly lower SUVmax of pleural and peritoneal effusion than the lung cancer group(t=3.94,P<0.05).The tuberculous group had a signi-ficantly lower number of abdominal or retroperitoneal enlarged hypermetabolic lymph nodes than the lung cancer group(χ^2=5.64,P<0.05).\Conclusion\A relatively low level of FDG metabolism,primary intrapulmonary lesions with a mild increase in FDG metabolism,and diffuse hypermetabolic pleuroperitoneum are marked features of tuberculous pleural and peritoneal effusion on 18F-FDG PET/CT imaging,and a comprehensive analysis of PET/CT imaging features may help with the differential diagnosis of tuberculous pleural and peritoneal effusion and cancerous pleural and peritoneal effusion.