胃淋巴瘤的18F-FDG PET/CT表现与鉴别诊断-与胃癌比较

摘要

目的 通过比较分析原发性胃淋巴瘤与胃癌的18 F-FDG PET/CT影像学特点,分析其对二者的诊断和鉴别诊断价值.方法 回顾性分析经胃镜活检病理证实的13例胃淋巴瘤患者和43例胃癌患者的PET-CT图像,对病灶的最大厚度Suvmax值,CT值及肝脏CT值进行统计学对比分析.结果 胃淋巴瘤及胃癌的PET/CT均可表现以不同形式的胃壁增厚和显著增高的FDG代谢为主要特征,13例胃淋巴瘤患者中,4例(30.8％)呈Ⅰ型表现(胃壁弥漫性增厚伴FDG代谢显著增高),8例(61.5％)呈Ⅱ型表现(胃壁节段性增厚伴FDG代谢显著增高),1例(7.7％)呈Ⅲ型表现(胃壁局限性增厚伴FDG代谢增高)；SUVmax范围2.3～53.5,平均SUVmax=16.0；PET/CT评价:6例仅累及胃壁,4例累及胃壁和淋巴结,3例累及胃壁、淋巴结和其它脏器.43例胃癌患者中,2例(4.7％)呈Ⅰ型表现(胃壁弥漫性增厚伴FDG代谢显著增高),26例(60.5％)呈Ⅱ型表现(胃壁节段性增厚伴FDG代谢显著增高),15例(34.8％)呈Ⅲ型表现(胃壁局限性增厚伴FDG代谢增高)；SUVmax范围2.6～34.6,平均SUVmax=8.9,与胃淋巴瘤比较,两者SUVmax有显著统计学差异(P＜0.05). PET/CT评价:16例仅累及胃壁,14例累及胃壁和淋巴结,13例累及胃壁、淋巴结和其它脏器.结论 胃淋巴瘤的18F-FDG PET/CT表现以Ⅰ型和Ⅱ型更为多见,而胃癌则以Ⅱ型和Ⅲ型多见,且胃淋巴瘤SUVmax显著大于胃癌.因此,结合形态学和SUVmax有助于淋巴瘤与胃癌的诊断和鉴别诊断.%Objective The imaging characteristic of 18F-FDG PET/CT in patients with primary gastric lymphoma (PGL) and gastric carcinoma were investigated. The aim of this study was to approach the adequacy of 18 F-FDG PET/CT in diagnosis and differentiation from each other. Methods Thirteen patients with gastric lymphoma and 43 patients with gastric carcinoma underwent 18F-fluorodeoxyglucose (FDG) PET/CT examination before treatment. All these lesions were his-topathologically confirmed by endoscope. The maximal stamdord upthke value (SUVmax) . the maximal width and the CT value of the lesion, the CT value of the liuer were measured and analyzed. Results The PET/CT findings of PGL and gastric carcinoma both showed the characteristic of diverse thickened gastric wall with varying degrees of high FDG uptake. There were 4 and 2 in type Ⅰ (diffuse thickened gastric wall), 8 and 26 in type Ⅱ (segmental thickened gastric wall), 1 and 15 in typeⅢ (local thickened gastric wall) in PGL group and gastric carcinoma group, respectively. On PET/CT images findings for TNM staging, the number were 6 and 16 cases displayed only stomach involvement, 4 and 14 cases extra-lymph nodes involvement, 3 and 13 cases extra lymph nodes and organs involvement, respectively. Conclusion Type Ⅰ and typeⅡ findings of PET/CT are more often seen in gastric lymphoma, but type Ⅱ and type Ⅲ are more common in gastric carcinoma. And the SUVmax of PGL is significantly higher than that of gastric carcinoma. PET/CT is favorable to the diagnoseis and differentiation between PGL and gastric carcinoma.