原发性结节肿块型肺黏液腺癌的CT及^(18)F-FDG PET/CT表现

CT and^(18)F-FDG PET/CT manifestations of primary nodular-mass type lung mucinous adenocarcinoma

目的探讨原发性结节肿块型肺黏液腺癌的^(18)F-FDG PET/CT及CT增强表现。方法选取30例原发性结节肿块型肺黏液腺癌患者的病理、临床及影像资料。所有患者均行^(18)F-FDG PET/CT检查,其中21例行CT增强扫描,分析病灶HRCT征象、代谢及增强扫描强化特点。结果30例原发性结节肿块型肺黏液腺癌中,混杂磨玻璃结节9例(30.00%),实性病灶21例(70.00%)。24例(80.00%)位于胸膜下,23例(76.67%)位于肺下叶。轻度强化6例,中度强化13例,明显强化2例。PET/CT显像中病灶SUVmax值范围为0.57~19.70,14例病灶SUVmax值小于2.50,6例病灶SUVmax值为2.50~5.00,10例病灶SUVmax值大于5.00。8例病灶内可见无强化或无代谢的液性区域,有代谢的区域集中于轻度或中度强化的实性成分区域。9例混杂磨玻璃结节中,8例实性成分含量较多的病灶表现为均匀一致的低摄取,1例病灶表现为代谢区域集中于实性成分而磨玻璃成分无代谢的特点。结论原发性结节肿块型肺黏液腺癌好发于双肺下叶及胸膜下,增强扫描以轻中度强化居多,大部分病灶具备肺腺癌的一般征象。表现为混杂磨玻璃结节的病灶常代谢不活跃,部分病灶内可见无强化或无代谢的液性区域,结合病灶的HRCT征象、CT增强及PET/CT代谢特点对诊断肺黏液腺癌有一定的提示意义。

Objective To investigate the manifestations of primary nodular-mass type lung mucinous adenocarcinoma in ^(18)F-FDG PET/CT and enhanced HRCT.Methods The pathological,clinical and imaging data of 30 patients with primary nodulamass type lung mucinous adenocarcinoma were selected.All patients underwent^(18)F-FDG PET/CT,and 21 of them underwent enhanced CT scan.The HRCT features,metabolism and enhancement characteristics of the lesion were analyzed.Results There were 9 cases(30.00%)of mixed ground glass nodules and 21 cases(70.00%)of solid lesions.24 cases(80.00%)were located under the pleura,and 23 cases(76.67%)were located in the lower lobe of the lung.The lesions showed mild enhancement in 6 cases,moderate enhancement in 13 cases,and obvious enhancement in 2 case.The SUVmax value of the lesions ranged from 0.57 to 19.70,14 lesions were less than 2.5,6 lesions were 2.5 to 5,and 10 lesions were greater than 5.In 8 cases,there were liquid areas with no enhancement or non-metabolism,and the metabolic areas were concentrated in the solid component areas with mild or moderate enhancement.Among the 9 mixed ground-glass nodules,8 lesions with more solid components showed uniform low uptake,and 1 lesion showed that the metabolic area was concentrated in the solid components and the ground glass components were not metabolized.Conclusion Primary nodular-mass type mucinous lung adenocarcinoma is mainly located in the lower lobes and subpleura of the lung,most of the lesions are mild to moderate enhancement on enhanced CT scan.Most of the lesions have general signs of lung adenocarcinoma.Lesions presenting as mixed ground-glass nodules are often metabolically inactive,non-enhancing or non-metabolized fluid areas could be seen in some lesions.Combining the HRCT signs,CT enhancement and metabolic characteristics of the lesions could contribute to the diagnosis of primary lung mucinous adenocarcinoma.