18F-FDG符合线路SPECT/CT显像与胸腺上皮肿瘤组织学分型相关性的研究

摘要

Objective To investigate the relationship between 18F-FDG coincidence SPECT/CT and the world health organiza-tion malignant grade of thymic epithelial tumors (TET). Methods The 18F-FDG SPECT/CT imaging and CT imaging of seven-teen patients with pathologically proven thymic epithelial tumors were analyzed retrospectively and histological subtype. CT fea-tures,visual graded of 18F-FDG uptakes,radioactivity of the tumor,mediastinum and lung were recorded. Results There were seven patients classified into low-risk group (one type A,three type AB and three type B1) and ten patients were classified into high-risk group (two type B2, one type B3 and seven type C). WHO histological classification showed significant relationship with visual grade,T/L and T/M (Spearman correlation coefficients were 0.697,0.811 and 0.815, respectively. P value were 0.002,0.000 and 0.000). Accuracy was 88.2% for take visual grade higher than mediastinum as the cut-off to differentiate high-risk from low risk TET. There were no significant different between the two groups considering the CT findings including di-ameter, necrosis, calcification, lobulated, the infiltration of surrounded fat, metastasis, enhancement patten and tumor vessel. There were significant different between the two groups in visual grade(2.0 vs 3.7,P =0.001),T/L(5.4 vs 16.3,P =0.002) and T/M (1.2 vs 10.4, P =0.002). Conclusion There was significant relationship between FDG uptake and histological WHO classification of thymic epithelial tumors. Visual grade higher than mediastinum could be an easy and useful way to predict high-risk thymic epithelial tumors.%目的 探讨18F-FDG符合线路SPECT/CT显像与胸腺上皮肿瘤组织学分型的相关性.方法 2013年8月~2016年9月期间病理确诊的17例胸腺上皮肿瘤患者,回顾性分析患者治疗前的18F-FDG符合线路及CT图像.记录病理分型、CT征象、符合线路图像病灶目测分级和病灶放射性摄取值与纵隔及肺本底的比值(T/M和T/L).结果 低危组胸腺上皮肿瘤7例(A型胸腺瘤1例,AB型胸腺瘤3例,B1型胸腺瘤3例),高危组胸腺上皮肿瘤10例(B2型2例,B3型1例,胸腺鳞癌7例).WHO组织学分型与目测分级、T/L和T/M高度相关( r分别为0.697,0.811和0.815,P值为0.002,0.000和0.000),与肿瘤的长径和短径无明显相关.以目测肿块放射性高于纵隔诊断高危胸腺瘤的敏感性为100%,特异性为71.4%,准确率为88.2%,阳性预测值83.3%,阴性预测值100%.低危与高危胸腺上皮肿瘤组之间的CT表现包括肿块长径、短径、肿块有无坏死、钙化、分叶、肿块周围脂肪间隙是否清晰,有无淋巴结转移、胸膜转移、肺内转移、是否均匀强化和肿块内肿瘤血管在两组中无显著差异,而低危和高危组在SPECT/CT符合线路显像上肿块的目测分级(2.0 vs 3.7,P =0.001)、T/L(5.4 vs 16.3,P =0.002)和T/M(1.2 vs 10.4,P =0.002)有显著性差异.结论 胸腺上皮肿瘤组织学分型与肿块糖代谢摄取程度呈显著正相关,以18F-FDG符合线路显像肿块目测分级高于纵隔诊断高危胸腺瘤准确性高,为术前制定个体化的治疗方案提供有价值的信息.