18F-FDG PET/CT在肺黏膜相关淋巴组织淋巴瘤与炎症型非小细胞肺癌鉴别诊断中的价值

Differential diagnostic value of 18F-FDG PET/CT between pulmonary mucosa-associated lymphoid tissue lymphoma and inflammatory-type non-small cell lung cancer

    摘要
  • 摘要:
    目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT的影像特征在肺黏膜相关淋巴组织（MALT）淋巴瘤及炎症型非小细胞肺癌（NSCLC）中的鉴别诊断价值。
    方法 回顾性分析2015年1月至2020年12月于福建医科大学附属协和医院行18F-FDG PET/CT、肺部表现为类炎症改变并经组织病理学检查确诊的21例肺MALT淋巴瘤患者男性13例、女性8例，年龄56~74（66.2±5.8）岁及33例炎症型NSCLC患者男性20例、女性13例，年龄48~84（64.6±9.6）岁的临床资料。手动勾画CT及PET的感兴趣区，测量病变最大截面的长径及短径、CT值、最大标准化摄取值（SUVmax）和峰值标准化摄取值（SUVpeak），分析影像征象（病变形态、支气管征、病变位置、淋巴结及脾脏的代谢情况）。采用χ2检验、独立样本t检验及校正t检验比较2组间的差异。
    结果 21例肺MALT淋巴瘤患者中，肿块型少于实变型（28.6%对71.4%），33例炎症型NSCLC患者中，肿块型多于实变型（57.6%对42.4%），二者的差异有统计学意义（χ2=4.342，P=0.037）；肺MALT淋巴瘤患者中空气支气管征的比例高于炎症型NSCLC患者（90.5%对75.8%），合并高代谢淋巴结的比例明显低于炎症型NSCLC（14.3%对48.5%），二者的差异均无统计学意义（ χ2= 0.996、3.288，均 P>0.05）；肺MALT淋巴瘤患者中单侧发病的比例低于双侧发病（23.8%对85.7%），炎症型NSCLC患者中，单侧发病的比例高于双侧发病（84.8%对15.2%），二者的差异有统计学意义（χ2=26.133，P<0.001）；肺MALT淋巴瘤患者中脾脏高代谢者11例（52.4%），炎症型NSCLC患者中未见脾脏高代谢者，二者的差异有统计学意义（χ2=21.708，P<0.001）。肺MALT淋巴瘤患者的长径和短径较炎症型NSCLC患者短 （5.89±2.14） cm对（6.26±2.75） cm、（3.88±1.98） cm对（4.21±1.56） cm，二者的差异均无统计学意义（t=−1.46、−1.87，均P>0.05）。肺MALT淋巴瘤患者的CT值高于炎症型NSCLC患者(45.4±10.5） HU对（21.6±50.1） HU，且差异有统计学意义（t=30.89，P<0.001）；肺MALT淋巴瘤患者的SUVmax和SUVpeak较炎症型NSCLC患者低（5.71±2.10）对（9.89±4.53）、（4.48±2.31）对（7.46±4.44），且差异均有统计学意义（t=−4.58、−3.23，均P<0.01）。
    结论 18F-FDG PET/CT对于肺MALT淋巴瘤和炎症型NSCLC的鉴别诊断具有重要的价值，其中SUVmax、SUVpeak、脾脏代谢情况以及CT图像中的病变形态、病变位置、CT值等可作为参考指标。

     

    Abstract:
    Objective To investigate the imaging features of 18F-fluorodeoxyglucose (FDG) PET/CT in pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and differential diagnosis value in inflammatory-type non-small cell lung cancer (NSCLC).
    Methods Retrospectively analyzed the clinical data of 21 patients with pulmonary MALT lymphoma (13 males and 8 females, aged 56~74(66.2±5.8) and 33 patients with inflammatory-type NSCLC (20 males and 13 females, aged 48~84(64.6±9.6)), respectively, who underwent 18F-FDG PET/CT from January 2015 to December 2020 at Fujian Medical University Union Hospital. In addition, the included patients were those whose lungs showed inflammation-like changes and were confirmed by histopathological examination. The CT and PET regions of interest were manually outlined. Then, the long and short diameters of the largest cross-sections of the lesions, CT values, maximum standardized uptake values (SUVmax), and peak standardized uptake values (SUVpeak) were measured. Moreover, the imaging signs (lesion morphology, bronchial signs, location of lesion onset, lymph node and spleen metabolism) were analyzed. The differences between the two groups were subsequently compared using the χ2 test, independent samples t-test, and corrected t-test.
    Results There were fewer masses than solids in 21 patients with pulmonary MALT lymphoma (28.6% vs.71.4%) and more masses than solids in 33 patients with inflammatory-type NSCLC (57.6% vs. 42.4%), with a statistically significant difference between the two groups (χ2=4.342, P=0.037); the proportion of bronchial signs was higher in patients with pulmonary MALT lymphoma than that in patients with inflammatory-type NSCLC (90.5% vs. 75.8%), and the proportion of combined hypermetabolic lymph nodes was significantly lower than that in inflammatory-type NSCLC (14.3% vs. 48.5%), with no statistically significant difference between the two group (χ2=0.996, 3.288; both P>0.05); there were fewer unilateral than bilateral morbidities in patients with pulmonary MALT lymphoma (23.8% vs. 85.7%) and more unilateral than bilateral in patients with inflammatory-type NSCLC (84.8% vs.15.2%), with a statistically significant difference between the two groups (χ2=26.133, P<0.001); 11 cases of splenic hypermetabolism in patients with pulmonary MALT lymphoma (52.4%) and none in inflammatory-type NSCLC, with a statistically significant difference between the two groups (χ2=21.708, P<0.001). The mean long and short diameters of patients with pulmonary MALT lymphoma were shorter than those of patients with inflammatory-type NSCLC (5.89±2.14) cm vs. (6.26±2.75) cm, (3.88±1.98) cm vs. (4.21±1.56) cm, with no statistically significant difference between the two groups (t=−1.46, −1.87; both P>0.05). CT values were higher in patients with pulmonary MALT lymphoma than that in patients with inflammatory-type NSCLC (45.4±10.5) HU vs.(21.6±50.1) HU, and the difference between them was statistically significant (t=30.89, P<0.001); SUVmax and SUVpeak were lower in patients with pulmonary MALT lymphoma than those in patients with inflammatory-type NSCLC (5.71±2.10) vs. (9.89±4.53), (4.48±2.31) vs. (7.46±4.44), and the differences between them were statistically significant (t=−4.58, −3.23; both P<0.01).
    Conclusions 18F-FDG PET/CT is of great value for the differential diagnosis of pulmonary MALT lymphoma and inflammatory-type NSCLC, in which SUVmax, SUVpeak, spleen metabolism, lesion morphology, lesion onset, and CT value in CT images can be used as reference indicators.

     

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