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单发肺结节是影像学诊断中最常见的临床问题之一,同时也是 18F-FDG PET/CT 诊断工作中经常遇见的问题,但就目前而言,即使有 PET/CT 这样的高端诊断仪器,总体来看 18F-FDG PET/CT 显像对肺结节定性诊断的正确率较单纯 CT 诊断并无明显提升。究其原因,除了与单发恶性肺结节在 CT 上的表现复杂多样,所表现的征象与炎性肺结节有较多重叠相关外,也与 18F-FDG PET/CT 显像上恶性结节呈非特异性 18F-FDG 摄取,与炎性结节的 18FFDG 摄取有较多的类似有关。CT 影像对肺结节的诊断主要是通过观察结节的各种边缘征象来分析其良恶性的,恶性结节的边缘征象主要包括:毛刺征、分叶征、胸膜牵拉征及血管集束征。但在 18F-FDG PET/CT 显像上,不同边缘征象所在区域的 18F-FDG 代谢程度是否一致,是否与边缘征象存在一定联系,则是值得探讨的问题,也具有重要的临床意义。笔者通过总结 50 例恶性肺结节的 18F-FDG PET/CT 显像资料,同机对比 CT 上显示恶性肺结节的边缘征象与 PET 上对应部位 18F-FDG 的代谢程度,分析不同边缘征象所在区域 18F-FDG 摄取程度的差异,从而明确各种边缘征象与所对应区域 18F-FDG 摄取程度的关系。
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50例恶性单发肺结节所在肺叶情况为:右肺上叶14例、右肺中叶2例、右肺下叶10例、左肺固有上叶13例、左肺舌叶3例、左肺下叶8例。结节最大径(d)情况为: 1.0 cm < d ≤ 2.0 cm者8例、2.0 cm < d ≤3.0 cm者15例、3.0 cm < d ≤ 4.0 cm者17例、4.0 cm < d ≤5.0 cm者10例。结节出现边缘征象情况为:出现1个边缘征象者9例、2个边缘征象者14例、3个边缘征象者13例、4个边缘征象者14例。50例恶性单发肺结节出现边缘征象及对应区域18F-FDG摄取情况具体见表 1。
所在肺叶 结节大小(长×宽×高)cm×cm×cm 结节总体SUVave 毛刺征 分叶征 胸膜牵拉征 血管集束征 SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV R1 3.7×3.5×3.9 3.7 3.7 4 0.3 4.5 5.1 0.6 3.6 3.9 0.3 4.8 6 1.2 R1 2.0×1.8×1.5 2.4 2.1 2.7 0.6 - - - 1.6 1.8 0.2 - - - R2 2.l×l.5×1.5 1.1 1.2 1.3 0.1 - - - - - - 0.7 0.8 0.1 R1 1.8×1.6×0.7 3.3 - - - - - - 1.8 2 0.2 4.2 5.3 1.1 R1 2.1×2.3×2.5 1.6 1.6 1.7 0.1 - - - - - - 2.4 2.7 0.3 L1 2.8×1.8×1.7 6.3 - - - 6.1 9.7 3.6 - - - - - - R1 2.2×2.0×1.7 2.4 2.2 2.5 0.3 2.8 3 0.2 2.1 2.4 0.3 - - - R1 2.1×1.6×3.0 4.9 4.3 4.8 0.5 5.8 7.2 1.4 3.8 4.1 0.3 - - - L1 2.9×2.7×2.4 11.3 8.9 1.8 1.9 13.4 14.7 1.3 7.2 7.8 0.6 9.8 14.7 4.9 R1 2.5×2.6×3.1 1.7 - - - 2.6 2.9 0.3 - - - 2.4 2.6 0.2 R1 2.4×1.7×1.8 4.6 3.4 4.5 1.1 5.1 6.6 1.5 - - - 2.2 2.5 0.3 R3 3.3×3.2×4.0 9.4 - - - 9.8 14.1 4.3 - - - 6.5 7.9 1.4 R1 4.3×4.8×4.5 5.1 4.6 5.7 1.1 5.9 7.5 1.6 4.7 5.2 0.5 3.6 4.1 0.5 L1 2.5×1.5×1.9 5 4.3 5.2 0.9 5.8 7.8 2 3 3.6 0.6 - - - L1 2.8×3.3×5.0 4.4 3.5 4.8 1.3 4.6 5.5 0.9 4.1 4.8 0.7 2.7 3.1 0.4 L2 3.1×2.5×2.3 4.1 3.1 4.1 1 5.2 6.4 1.2 2.7 3 0.3 5.6 5.7 0.1 L1 1.5×1.4×1.8 3.9 - - - 4 4.5 0.5 - - - 2 2.2 0.2 L1 1.8×1.3×1.2 3 - - - 3.9 4.4 0.5 2.5 3.2 0.7 1.9 2.1 0.2 R3 2.9×1.9×2.1 4.6 2.9 3.3 0.4 5.5 7 1.5 - - - - - - R3 1.6×1.6×1.9 5.7 - - - 5.7 8 2.3 - - - - - - R3 2.8×2.7×3.8 7 6.3 6.8 0.5 7.6 8.8 1.2 7.7 8.7 1 6.9 8.6 1.7 R1 1.9×1.3×1.4 5.7 4.6 5.8 1.2 6.6 8.9 2.3 5 6.4 1.4 6.6 8.9 2.3 R3 2.1×2.7×3.6 4.7 - - - 5.4 6.7 1.3 4.2 4.9 0.7 - - - L1 2.4×3.2×2.0 3.3 2.6 3 0.4 4 4.6 0.6 - - - - - - L3 3.0×2.2×2.6 3 - - - 4.5 4.7 0.2 - - - 3.2 3.6 0.4 R3 3.4×3.0×3.6 5 3.1 3.6 0.5 6.3 7 0.7 2.3 2.8 0.5 7.2 8.9 1.7 R1 3.3×4.6×5.0 5.8 5.7 6.7 1 7.5 9.8 2.3 - - - 4.5 5.1 0.6 R2 1.7×1.9×1.8 7 8.6 9.4 0.8 9.1 1.1 1 - - - 1.2 11.1 0.9 R3 2.8×2.4×4.2 7.3 6.5 6.8 0.3 8.1 8.9 0.8 7.7 8.7 1 8.1 8.9 0.8 L1 2.9×2.2×2.5 6.6 6.6 7.8 1.2 - - - 7 7.9 0.9 7 8.1 1.1 R3 2.8×2.9×1.9 6.4 - - - 9 1.1 1.1 - - - - - - L3 3.8×3.4×3.5 6.3 7.2 8.7 1.5 - - - 9.4 11.9 2.5 9.9 12.6 2.7 R1 4.3×3.7×4.0 5 4.1 4.7 0.6 6.4 8.5 2.1 4.8 5.5 0.7 - - - L3 3.2×2.5×2.0 5.7 - - - 6.3 6.8 0.5 - - - - - - L3 2.1×2.0×1.5 4.6 2.3 2.9 0.6 7.5 8.4 0.9 4.3 4.9 0.6 4.6 5.2 0.6 L2 3.0×4.8×4.5 5.9 - - - 6.1 6.9 0.8 5.2 6.7 1.5 - - - L3 3.7×4.3×4.0 5.2 5.6 7.1 1.5 7.2 8.9 1.7 4.8 7.2 2.4 7.2 9.6 2.4 R3 2.1×2.1×1.5 2.1 2.1 2.5 0.4 - - - - - - - - - L3 3.3×4.0×3.2 7.2 - - - 7.2 9 1.8 - - - - - - L1 4.6×4.4×4.5 16.1 14.3 15.8 1.5 18.7 21.1 2.4 - - - 15.9 19.8 3.9 L3 3.6×5.0×4.7 4.3 4 4.3 0.3 5.7 7.1 1.4 - - - 5.3 5.9 0.6 L2 4.4×4.8×4.6 1.8 11 13 2 14.4 18.7 4.3 5.5 7.3 1.8 12.5 13.8 1.3 R1 3.3×3.3×3.3 3.9 3.7 3.9 0.2 4.3 5.1 0.8 3 3.3 0.3 5.4 6.4 1 L1 3.5×2.9×4.0 11.3 1.5 12.5 2 12.7 14.1 1.4 - - - 13.3 16.4 3.1 L1 2.2×1.7×2.3 5.8 - - - 5.8 7.1 1.3 4.8 6.1 1.3 - - - L3 3.3×3.8×3.8 5.2 - - - 5.9 7.4 1.5 - - - - - - L1 2.2×2.0×1.8 5.3 5.8 6.9 1.1 - - - - - - - - - R3 3.2×2.2×3.1 4.6 5.1 5.7 0.6 5.1 5.7 0.6 - - - - - - R1 1.5×1.2×1.3 1.1 1.3 1.3 0.0 - - - - - - - - - L1 3.7×3.8×3.5 7.9 7.8 10.9 3.1 12.7 16.7 4 2.8 6.3 3.5 14.2 20.7 6.5 注:表中,Rl:右肺上叶;R2:右肺中叶;R3:右肺下叶;LI:左肺固有上叶;L2:左肺舌叶:L3:左肺下叶;SUVave; 平均标准化摄取值;SUVmax:最大标准化摄取值;“-”表示该征象缺如。 表 1 50例恶性单发肺结节出现的边缘征象及对应区域SUVave、SUVmax及ΔSUV情况
Table 1. Edge signs and SUYave, SUVmax and ΔSUV of malignant solitary pulmonary nodules on the corresponding areas in 50 studied cases
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50例单发肺结节病例中,出现毛刺征者35例,SUVave=4.99±2.98,SUVmax=5.87±3.48,ΔSUV=0.88±0.67;出现分叶征者41例,SUVave=6.95±3.30,SUVmax=8.43±3.98,ΔSUV=1.48±1.04;出现胸膜牵拉征者26例,SUVave=4.45±2.03,SUVmax=5.40±2.45,ΔSUV=0.95±0.82;出现血管集束征者30例,SUVave=6.36±3.94,SUVmax=7.78±5.22,ΔSUV=1.42±1.52。分叶征组的SUVave、SUVmax及ΔSUV明显大于毛刺征组及胸膜牵拉征组,差异有统计学意义(LSD法,P=0.008、0.006、0.015及P=0.002、0.003、0.049),见图 2及图 3;血管集束征组的SUVave及SUVmax明显大于胸膜牵拉征组,差异有统计学意义(LSD法,P=0.026、0.026),见图 4。
图 2 左上肺恶性肺结节18F-FDG PET/CT显像图
Figure 2. 18F-FDG PET/CT imaging of malignant solitary pulmonary nodules in the upper left lung of a 54-year old male patient
PET/CT显像恶性单发肺结节边缘征象与所对应区域18F-FDG代谢程度的关系研究
Study of the relevance between edge signs of malignant solitary pulmonary nodules and degree of radioactive 18F-FDG uptake on corresponding areas
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摘要:
目的比较恶性单发肺结节边缘征象所在区域18F-FDG摄取程度的差异,分析肿瘤不同生长模式对18F-FDG摄取程度的影响。 方法回顾性分析经病理确诊的50例恶性单发肺结节患者的18F-FDG PET/CT显像资料,测定结节各边缘征象(包括分叶征、毛刺征、胸膜牵拉征及血管集束征)所在区域的平均标准化摄取值(SUVave)、最大标准化摄取值(SUVmax)及标准化摄取均峰差(ΔSUV)。应用多组间均数比较LSD法分析各边缘征象所在区域18F-FDG摄取是否存在差异。 结果50例恶性单发肺结节患者中,出现毛刺征者35例,SUVave=4.99±2.98,SUVmax=5.87±3.48,ΔSUV=0.88±0.67;出现分叶征者41例,SUVave=6.95±3.30,SUVmax=8.43±3.98,ΔSUV=1.48±1.04;出现胸膜牵拉征者26例,SUVave=4.45±2.03,SUVmax=5.40±2.45,ΔSUV=0.95±0.82;出现血管集束征者30例,SUVave=6.36±3.94,SUVmax=7.78±5.22,ΔSUV=1.42±1.52。分叶征组的SUVave、SUVmax及ΔSUV明显大于毛刺征组及胸膜牵拉征组,差异均有统计学意义(LSD法,P=0.008、0.006、0.015及P=0.002、0.003、0.049);血管集束征组的SUVave及SUVmax明显大于胸膜牵拉征组,差异有统计学意义(LSD法,P=0.026、0.026)。 结论肿瘤不同生长模式的区域18F-FDG摄取程度存在差异,18F-FDG PET/CT显像能够很好地反映增殖性生长与浸润性生长在同一肿瘤不同区域分布的异质性。 -
关键词:
- 孤立性肺结节 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 边缘征象 /
- 标准化摄取值
Abstract:ObjectiveTo investigate the differences in 18F-FDG uptake on different edge sign areas of malignant solitary pulmonary nodules and to analyze the effects of tumor biological growth pattern on radioactivity distribution of 18F-FDG. MethodsRetrospective analysis of the data on 18F-FDG PET/CT images from 50 collected cases with malignant solitary pulmonary nodules was conducted to determine 18F-FDG uptake value, which is expressed as average standardized uptake value (SUVave), maximum standardized uptake value (SUVmax), and ΔSUV (SUVmax-SUVave), at the region of interest to investigate the differences in radioactive 18F-FDG uptake on the positive edge sign areas of the nodules. Comparison of mean in multiple groups was conducted with LSD method. ResultsIn 50 patients with malignant solitary pulmonary nodules, spicule signs occurred in 35 cases (SUVave=4.99±2.98; SUVmax=5.87±3.48; ΔSUV=0.88±0.67); lobulation signs appeared in 41 cases (SUVave=6.95±3.30; SUVmax=8.43±3.98; ΔSUV=1.48±1.04); pleural retraction signs developed in 26 cases (SUVave=4.45±2.03; SUVmax=5.40±2.45; ΔSUV=0.95±0.82); vessel convergence signs materialized in 30 cases (SUVave=6.36±3.94; SUVmax=7.78±5.22; ΔSUV=1.42±1.52). Compared with the spicule (LSD, P=0.008, 0.006, 0.015), and pleural retraction sign groups (LSD, P=0.002, 0.003, 0.049), SUVave, SUVmax, and ΔSUV of the lobulation sign group were much higher. Compared with the pleural retraction sign group, SUVave and SUVmax of the vessel convergence sign group were much higher (LSD, P=0.026, 0.026). ConclusionsSignificant differences were observed in the distributions of radioactive 18F-FDG uptake between predominant proliferative and infiltrative areas. Thus, 18F-FDG PET/CT imaging can virtually reflect the heterogeneous distribution of proliferative and invasive areas in different tumor regions. -
表 1 50例恶性单发肺结节出现的边缘征象及对应区域SUVave、SUVmax及ΔSUV情况
Table 1. Edge signs and SUYave, SUVmax and ΔSUV of malignant solitary pulmonary nodules on the corresponding areas in 50 studied cases
所在肺叶 结节大小(长×宽×高)cm×cm×cm 结节总体SUVave 毛刺征 分叶征 胸膜牵拉征 血管集束征 SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV SUVave SUVmax ΔSUV R1 3.7×3.5×3.9 3.7 3.7 4 0.3 4.5 5.1 0.6 3.6 3.9 0.3 4.8 6 1.2 R1 2.0×1.8×1.5 2.4 2.1 2.7 0.6 - - - 1.6 1.8 0.2 - - - R2 2.l×l.5×1.5 1.1 1.2 1.3 0.1 - - - - - - 0.7 0.8 0.1 R1 1.8×1.6×0.7 3.3 - - - - - - 1.8 2 0.2 4.2 5.3 1.1 R1 2.1×2.3×2.5 1.6 1.6 1.7 0.1 - - - - - - 2.4 2.7 0.3 L1 2.8×1.8×1.7 6.3 - - - 6.1 9.7 3.6 - - - - - - R1 2.2×2.0×1.7 2.4 2.2 2.5 0.3 2.8 3 0.2 2.1 2.4 0.3 - - - R1 2.1×1.6×3.0 4.9 4.3 4.8 0.5 5.8 7.2 1.4 3.8 4.1 0.3 - - - L1 2.9×2.7×2.4 11.3 8.9 1.8 1.9 13.4 14.7 1.3 7.2 7.8 0.6 9.8 14.7 4.9 R1 2.5×2.6×3.1 1.7 - - - 2.6 2.9 0.3 - - - 2.4 2.6 0.2 R1 2.4×1.7×1.8 4.6 3.4 4.5 1.1 5.1 6.6 1.5 - - - 2.2 2.5 0.3 R3 3.3×3.2×4.0 9.4 - - - 9.8 14.1 4.3 - - - 6.5 7.9 1.4 R1 4.3×4.8×4.5 5.1 4.6 5.7 1.1 5.9 7.5 1.6 4.7 5.2 0.5 3.6 4.1 0.5 L1 2.5×1.5×1.9 5 4.3 5.2 0.9 5.8 7.8 2 3 3.6 0.6 - - - L1 2.8×3.3×5.0 4.4 3.5 4.8 1.3 4.6 5.5 0.9 4.1 4.8 0.7 2.7 3.1 0.4 L2 3.1×2.5×2.3 4.1 3.1 4.1 1 5.2 6.4 1.2 2.7 3 0.3 5.6 5.7 0.1 L1 1.5×1.4×1.8 3.9 - - - 4 4.5 0.5 - - - 2 2.2 0.2 L1 1.8×1.3×1.2 3 - - - 3.9 4.4 0.5 2.5 3.2 0.7 1.9 2.1 0.2 R3 2.9×1.9×2.1 4.6 2.9 3.3 0.4 5.5 7 1.5 - - - - - - R3 1.6×1.6×1.9 5.7 - - - 5.7 8 2.3 - - - - - - R3 2.8×2.7×3.8 7 6.3 6.8 0.5 7.6 8.8 1.2 7.7 8.7 1 6.9 8.6 1.7 R1 1.9×1.3×1.4 5.7 4.6 5.8 1.2 6.6 8.9 2.3 5 6.4 1.4 6.6 8.9 2.3 R3 2.1×2.7×3.6 4.7 - - - 5.4 6.7 1.3 4.2 4.9 0.7 - - - L1 2.4×3.2×2.0 3.3 2.6 3 0.4 4 4.6 0.6 - - - - - - L3 3.0×2.2×2.6 3 - - - 4.5 4.7 0.2 - - - 3.2 3.6 0.4 R3 3.4×3.0×3.6 5 3.1 3.6 0.5 6.3 7 0.7 2.3 2.8 0.5 7.2 8.9 1.7 R1 3.3×4.6×5.0 5.8 5.7 6.7 1 7.5 9.8 2.3 - - - 4.5 5.1 0.6 R2 1.7×1.9×1.8 7 8.6 9.4 0.8 9.1 1.1 1 - - - 1.2 11.1 0.9 R3 2.8×2.4×4.2 7.3 6.5 6.8 0.3 8.1 8.9 0.8 7.7 8.7 1 8.1 8.9 0.8 L1 2.9×2.2×2.5 6.6 6.6 7.8 1.2 - - - 7 7.9 0.9 7 8.1 1.1 R3 2.8×2.9×1.9 6.4 - - - 9 1.1 1.1 - - - - - - L3 3.8×3.4×3.5 6.3 7.2 8.7 1.5 - - - 9.4 11.9 2.5 9.9 12.6 2.7 R1 4.3×3.7×4.0 5 4.1 4.7 0.6 6.4 8.5 2.1 4.8 5.5 0.7 - - - L3 3.2×2.5×2.0 5.7 - - - 6.3 6.8 0.5 - - - - - - L3 2.1×2.0×1.5 4.6 2.3 2.9 0.6 7.5 8.4 0.9 4.3 4.9 0.6 4.6 5.2 0.6 L2 3.0×4.8×4.5 5.9 - - - 6.1 6.9 0.8 5.2 6.7 1.5 - - - L3 3.7×4.3×4.0 5.2 5.6 7.1 1.5 7.2 8.9 1.7 4.8 7.2 2.4 7.2 9.6 2.4 R3 2.1×2.1×1.5 2.1 2.1 2.5 0.4 - - - - - - - - - L3 3.3×4.0×3.2 7.2 - - - 7.2 9 1.8 - - - - - - L1 4.6×4.4×4.5 16.1 14.3 15.8 1.5 18.7 21.1 2.4 - - - 15.9 19.8 3.9 L3 3.6×5.0×4.7 4.3 4 4.3 0.3 5.7 7.1 1.4 - - - 5.3 5.9 0.6 L2 4.4×4.8×4.6 1.8 11 13 2 14.4 18.7 4.3 5.5 7.3 1.8 12.5 13.8 1.3 R1 3.3×3.3×3.3 3.9 3.7 3.9 0.2 4.3 5.1 0.8 3 3.3 0.3 5.4 6.4 1 L1 3.5×2.9×4.0 11.3 1.5 12.5 2 12.7 14.1 1.4 - - - 13.3 16.4 3.1 L1 2.2×1.7×2.3 5.8 - - - 5.8 7.1 1.3 4.8 6.1 1.3 - - - L3 3.3×3.8×3.8 5.2 - - - 5.9 7.4 1.5 - - - - - - L1 2.2×2.0×1.8 5.3 5.8 6.9 1.1 - - - - - - - - - R3 3.2×2.2×3.1 4.6 5.1 5.7 0.6 5.1 5.7 0.6 - - - - - - R1 1.5×1.2×1.3 1.1 1.3 1.3 0.0 - - - - - - - - - L1 3.7×3.8×3.5 7.9 7.8 10.9 3.1 12.7 16.7 4 2.8 6.3 3.5 14.2 20.7 6.5 注:表中,Rl:右肺上叶;R2:右肺中叶;R3:右肺下叶;LI:左肺固有上叶;L2:左肺舌叶:L3:左肺下叶;SUVave; 平均标准化摄取值;SUVmax:最大标准化摄取值;“-”表示该征象缺如。 -
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