结核性与恶性腹膜弥漫性病变的18F-FDG PET/CT影像特征分析

Analysis of 18F-FDG PET/CT imaging features of tuberculous and cancerous diffuse peritoneal lesions

    摘要
  • 摘要:
    目的 分析结核性与恶性腹膜弥漫性病变的18F-FDG PET/CT表现，探讨PET/CT的诊断及鉴别诊断价值。
    方法 回顾性对比分析经病理和（或）临床证实的10例结核性腹膜炎、29例恶性腹膜病变（包括13例原发性腹膜浆液性乳头状腺癌、16例腹膜转移癌）的18F-FDG PET/CT表现。观察和记录指标：（1）壁腹膜、大网膜、肠系膜的受累情况；（2）腹腔积液情况；（3）淋巴结改变；（4）其他脏器伴随征象。对结核组与恶性组的受累腹膜18F-FDG代谢程度、腹腔积液密度及18F-FDG浓聚程度差异行两样本t检验。
    结果 结核性腹膜炎多为壁腹膜弥漫均匀增厚伴大网膜及肠系膜“污迹样”改变，18F-FDG分布较均匀；恶性腹膜病变多为壁腹膜、大网膜及肠系膜明显不规则增厚，呈多发结节状及饼状改变，18F-FDG分布不均匀。两组受累腹膜18F-FDG代谢均增高，结核性腹膜炎SUVmax为12.74±9.75，恶性腹膜病变SUVmax为12.45±7.40，两者之间的差异无统计学意义（t=0.099，P＞0.05）。恶性腹膜病变患者腹腔积液密度低于结核性腹膜炎患者，恶性腹膜病变患者的CT值为（11.34±3.55）HU、结核性腹膜炎患者的CT值为（14.4±2.37）HU，两者之间的差异有统计学意义（t=2.53，P＜0.05）；腹腔积液18F-FDG浓聚程度高于结核性腹膜炎患者，恶性腹膜病变患者SUVmax为2.10±0.65、结核性腹膜炎患者SUVmax为1.61±0.35，两者之间的差异有统计学意义（t=-2.278，P＜0.05）；恶性腹膜病变患者T/NT为0.77±0.18、结核性腹膜炎患者T/NT为0.58±0.12，两者之间的差异有统计学意义（t=-3.084，P＜0.05）。
    结论 18F-FDG PET/CT显像可同时显示腹膜病变的形态学和功能代谢改变，并全面显示其他脏器的伴随征象，综合分析其特征，有助于提高病变的诊断准确率。

     

    Abstract:
    Objective To analysis the 18F-FDG PET/CT features of tuberculous and cancerous diffuse peritoneal lesions and evaluate the value of 18F-FDG PET/CT in diagnosing and differentiating the lesions.
    Methods The 18F-FDG PET/CT features of 10 tuberculous peritonitis, 13 primary serous papillary carcinoma of the peritoneum and 16 peritoneal metastases were retrospectively reviewed, which had been confirmed by clinic and / or histopathology. Four indicators were observed and graded:(1)18F-FDG PET/CT features of parietal peritoneum, greater omentum and mesentery; (2)features of ascites; (3)enlargement of lymph nodes; (4)accompanying signs of other organs. Two sample t test was used to differentiate the 18F-FDG uptake of peritoneal lesions, the density and 18F-FDG concentration of ascites between tuberculous peritonitis and cancerous peritonitis.
    Results The typical 18F-FDG PET/CT features of tuberculous peritonitis was uniformity thickening of parietal peritoneum, mesenteric and omental stains like change, widely and even distribution of the peritoneal 18F-FDG, while the cancerous peritonitis was obvious uneven thickening of parietal peritoneum, mesenteric and omental nodules and pie-shape changes, uneven distribution of the peritoneal 18F-FDG. The 18F-FDG uptake was increased in all peritoneal lesions, and there are no significant difference between the tuberculous group(SUVmax=12.74±9.75) and the cancerous group(SUVmax=12.45±7.40)(t=0.099, P > 0.05). The density of malignant ascitesCTavg=(11.34±3.55)HU was obvious lower than tuberculous ascitesCTavg=(14.4±2.37)HU(t=2.5, P < 0.05). The 18F-FDG concentration in malignant ascites(SUVmax=2.10±0.65, T/NT=0.77±0.18)was obvious higher than tuberculous ascites(SUVmax=1.61±0.35, T/NT=0.58±0.12)(t=-2.278, -3.084, both P < 0.05).
    Conclusion The 18F-FDG PET/CT imaging can show the morphology and metabolic changes of peritoneal lesions, and fully display the lesions in the whole body. It is important to analyze 18F-FDG PET/CT features of disuse peritoneal lesions in order to improve the accuracy of diagnosing the diffuse peritoneal lesions.

     

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