孤立性肺结核球的18F-FDG PET/CT影像学表现

摘要

目的：探讨孤立性肺结核球(PTM)的18 F-脱氧葡萄糖(FDG) PET/CT影像学表现。方法：回顾性分析23例经病理或临床证实为孤立性PTM患者的18F-FDG PET/CT影像学资料，所有患者均经注射18F-FDG 60 min后行螺旋CT平扫和PET显像，分别对PTM进行形态学分析和标准摄取值(SUV)半定量分析。结果：23例病例中，CT平扫显示孤立性PTM直径为1.11～5. 10 cm，平均2.48 cm;结节边缘光滑者16例，结节内有空洞者4例、钙化者3例；同时合并纵隔、肺门或腋窝淋巴结增大者6例。本组患者中17例发生18F-FDG摄取，其中11例表现为肺内结节局限性18F-FDG浓聚，6例表现为肺内结节和增大淋巴结18 F-FDG浓聚，平均SUVmax为4.01±1.89；12例18F-FDG摄取阳性的患者经抗结核治疗后病灶缩小；6例未发生18F-FDG摄取的患者，经CT随访12个月病灶无明显变化。结论：18F-FDG PET/CT对孤立性PTM的诊断具有重要价值，确诊有赖于穿刺活检或手术病理。%Objective:To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT imaging findings in patients with solitary pulmonary tuberculoma(PTM). Methods:To analyze the 18F-FDG PET/CT findings of 23 patients with solitary PTM retrospectively. All of the patients were confirmed by pathology or clinical data. All patients underwent non-contrast spiral CT scanning and PET imaging 60min after the injection of 18F-FDG,and were interpreted by morphological analysis and semi-quantitative analysis of standardized uptake value(SUV). Results:In the 23 patients, the findings of non-contrast spiral CT showed that the diameter of these lesions ranged from 1. 11～5. 10cm with an average diameter of 2. 48cm. The lesions had smooth edge in 16, cavity in 4 and calcification in 3. The pulmonary lesions co-existed with mediastinal, hilar or axillary lymphadenopathy in 6 cases. 17 of 23 patients showed 18F-FDG uptake at PET imaging. 11 of these 17 patients showed local 18F-FDG uptake in lung nodules,6 showed 18F-FDG uptake in lung nodules and lymph nodes. The average SUVmax of the lesions were 4. 01±l. 89. Through antitubercular treatment, the lesions size of 12 patients with 18F-FDG uptake were decreased. The lesions size of 6 patients without 18F-FDG uptake did no change by CT follow-up for 12 months. Conclusions:18 F-FDG PET/CT is of great value in the diagnosis of solitary PTM. However, the definite diagnosis should be depended on the pulmonary biopsy or postoperative pathology.