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特发性肺间质纤维化(idiopathic pulmonary fibrosis,IPF)是指原因不明的以肺实质炎症(肺泡炎)和进行性肺间质纤维化为特征的肺病。近些年,IPF的发病率逐渐增高,病程进展快速,大多数IPF没有有效的治疗方法,预后差。高分辨率CT(high resolution CT,HRCT)是目前最常用的诊断和监测检查手段(阳性预测值为96%),现用的临床指南指出大多数IPF根据典型HRCT表现并结合临床和实验室检查可以确诊,少数不典型病例除外[1]。PET/CT作为一种放射性示踪剂显像检查广泛应用于肿瘤、心血管及神经等方面疾病,在炎性疾病中的应用也逐年增加。近期已有很多PET/CT应用于IPF的研究报道,发现HRCT表现异常的区域在PET上表现为放射性摄取增高[2-6],那么HRCT上未见异常的区域18F-FDG摄取有无异常?本研究测量IPF患者HRCT表现正常区域的PET图像18F-FDG摄取值,与没有肺部疾病患者的18F-FDG摄取值进行比较,旨在表明PET/CT在IPF诊断及治疗监测方面的优势。
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IPF组27例患者,其中肺部表现为磨玻璃密度影14例、网格影27例、蜂窝影13例,同一患者可有多种表现,以上表现均为放射性摄取增高,SUVmax值为2.32±1.10(图 1)。IPF组非病变区和对照组ROI的SUVmax、LT/MBmax、SUVmean、LT/MBmean及CT值见表 1,表内数据来自正态分布总体。IPF组非病变区域LT/MBmax(0.44±0.55 vs. 0.32±0.05),和LT/MBmean(0.55±0.38 vs. 0.33±0.05)均高于对照组(t=5.87和2.89,P均 < 0.05);但两组CT值(-836.59±32.33 vs. -837.99±29.90)比较,差异无统计学意义(t=-0.15,P > 0.05)(图 2)。
图 1 特发性肺间质纤维化患者18F-FDG PET/CT和高分辨率CT图 患者男性,68岁,图中,A:最大密度投影重建(MIP)图;B~D:分别为PET、CT和PET/CT显像图,图中显示双肺多发磨玻璃密度影及网格影,部分形成蜂窝影,以胸膜下较显著,相应病变区域可见18F-FDG代谢增高;E~G:高分辨率CT横断面、冠状面、矢状面图。结合HRCT在PET/CT图像病变区域画取ROI(红色圆圈),测量该ROI的SUVmax(SUVmax:5.004)。
Figure 1. 18F-FDG PET/CT and high resolution CT images of idiopathic pulmonary fibrosis patients
分组 SUVmax LT/MBmax SUVmean LT/MBmean CT值/HU IPF组非病变区 0.68±0.20 0.44±0.55 0.51±0.27 0.55±0.38 -836.59±32.33 正常对照组 0.42±0.06 0.32±0.05 0.34±0.06 0.33±0.05 -837.99±29.90 表 1 IPF组非病变区和对照组的ROI SUVmax、LT/MBmax、SUVmean、LT/MBmean与CT值的比较(x±s)
Table 1. Comparation the value of ROI SUVmax、LT/MBmax、SUVmean、LT/MBmean and CT between abnormal regions of IPF patients and control population(x±s)
图 2 特发性肺间质纤维化患者18F-FDG PET/CT和高分辨率CT图 患者男性,57岁,图中,A:最大密度投影重建(MIP)图;B~D:分别为PET、CT和PET/CT显像图,图中显示双肺胸膜下区磨玻璃密度影及网格影,相应病变区域可见18F-FDG代谢增高;E~F:高分辨率CT图,示双肺胸膜下区磨玻璃密度影及网格影。根据高分辨率CT在非病变区域画取ROI(红色圆圈),测量该ROI的CT值(E:-843.108,F:-841.307),在PET/CT相对应区域画取ROI,测量该ROI的SUVmax、SUVmean(SUVmax:0.560,SUVmean:0.509)。SUVmean:平均标准化摄取值。
Figure 2. 18F-FDG PET/CT and high resolution CT images of idiopathic pulmonary fibrosis patients
特发性肺间质纤维化HRCT病变区与非病变区18F-FDG PET/CT表现分析
18F-FDG PET/CT imaging analysis of regions with abnormal and normal pulmonary parenchyma on high resolution CT in idiopathic pulmonary fibrosis patients
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摘要:
目的 对比分析特发性肺间质纤维化(IPF)高分辨率CT(HRCT)上病变区域和非病变区域的PET/CT表现及其诊断价值。 方法 按照IPF的临床诊断标准,选取接受PET/CT检查并有完整资料的IPF病例及健康体检者各27例,规定病变区域为HRCT上表现为磨玻璃密度影、网格影及蜂窝影等区域,非病变区域为肉眼可观察到的密度低于病变区的最小密度区,测定病变区域的SUVmax,分别在IPE组非病变区域和对照组肺部HRCT横断面图像上画取ROI,测量其CT值,并在PET/CT图像相应位置画取ROI,测量SUVmax、平均标准化摄取值(SUVmean),计算与纵隔大血管主动脉弓血池(SUVmax、SUVmean)比值:肺组织/纵隔血池最大摄取比(LT/MBmax)和肺组织/纵隔血池平均摄取比(LT/MBmean)。采用独立样本t检验比较组间LT/MBmax、LT/MBmean及CT值差异。 结果 IPF组27例患者,其中肺部表现为磨玻璃密度影14例、网格影27例、蜂窝影13例,同一患者可有多种表现,以上表现均为放射性摄取增高,SUVmax值为2.32±1.10。IPF组非病变区域LT/MBmax(0.44±0.55 vs.0.32±0.05)和LT/MBmean(0.55±0.38 vs.0.33±0.05)均高于对照组(t=5.87和2.89,P均 < 0.05);但两组CT值(-836.59±32.33 vs.-837.99±29.90)比较,差异无统计学意义(t=-0.15,P>0.05)。 结论 IPF患者HRCT上显示的病变区与非病变区对18F-FDG摄取均增加,PET/CT在IPF诊断及治疗监测方面有一定优势。 -
关键词:
- 特发性肺纤维化 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 氟脱氧葡萄糖F18
Abstract:Objective To compare and analyze the PET signals at regions with abnormal and normal pulmonary parenchyma on high resolution CT(HRCT) in idiopathic pulmonary fibrosis(IPF) patients to explore the diagnostic value of PET/CT. Methods According to the standards for the clinical diagnosis of IPF, a total of 27 IPF patients(21 men and 6 women) and 27 control populations(19 men and 8 women) were randomly selected and recruited for PET/CT. The abnormal regions were described to show ground-glass appearance, reticulation, honeycombing, and so on. Normal regions corresponding to areas of minimal observed density were noted as distinct from the abnormal regions. The maximal standard uptake value(SUVmax) of the abnormal regions was measured. The ROI in HRCT images of the control population was placed in areas of each lung that were considered morphologically normal to measure the CT densities. The ROI was selected in PET/CT images at corresponding locations; the SUVmax and mean standard uptake value(SUVmean) were measured and used to calculate the aortic blood pool of mediastinal large blood vessels. The LT/MBmax, LT/MBmean, and CT densities of each ROI were analyzed by the independent sample t-test. Results Increased pulmonary 18F-FDG uptake was observed in 27 of 27 patients. The parenchymal patterns on HRCT at the site of high metabolism were ground-glass appearance(14/27), reticulation(27/27), and honeycombing(13/27). The LT/MBmax in the normal lung parenchyma of IPF patients was higher than in the control population[(0.44±0.55 vs. 0.32±0.05); t=5.87, P < 0.05]. The LT/MBmean in normal lung parenchyma of IPF was higher than in the controls[(0.55±0.38 vs. 0.33±0.05); t=2.89, P < 0.05]. The CT densities in normal lung parenchyma of IPF and control population were not significantly different[(-836.59±32.33 vs.-837.99±29.90); t=-0.15, P>0.05]. Conclusions IPF patients showed increased pulmonary uptake of 18F-FDG on PET in lung regions with abnormal and normal morphological appearances on HRCT. Therefore, PET/CT gives superior diagnosis and therapeutic monitoring. -
图 1 特发性肺间质纤维化患者18F-FDG PET/CT和高分辨率CT图 患者男性,68岁,图中,A:最大密度投影重建(MIP)图;B~D:分别为PET、CT和PET/CT显像图,图中显示双肺多发磨玻璃密度影及网格影,部分形成蜂窝影,以胸膜下较显著,相应病变区域可见18F-FDG代谢增高;E~G:高分辨率CT横断面、冠状面、矢状面图。结合HRCT在PET/CT图像病变区域画取ROI(红色圆圈),测量该ROI的SUVmax(SUVmax:5.004)。
Figure 1. 18F-FDG PET/CT and high resolution CT images of idiopathic pulmonary fibrosis patients
图 2 特发性肺间质纤维化患者18F-FDG PET/CT和高分辨率CT图 患者男性,57岁,图中,A:最大密度投影重建(MIP)图;B~D:分别为PET、CT和PET/CT显像图,图中显示双肺胸膜下区磨玻璃密度影及网格影,相应病变区域可见18F-FDG代谢增高;E~F:高分辨率CT图,示双肺胸膜下区磨玻璃密度影及网格影。根据高分辨率CT在非病变区域画取ROI(红色圆圈),测量该ROI的CT值(E:-843.108,F:-841.307),在PET/CT相对应区域画取ROI,测量该ROI的SUVmax、SUVmean(SUVmax:0.560,SUVmean:0.509)。SUVmean:平均标准化摄取值。
Figure 2. 18F-FDG PET/CT and high resolution CT images of idiopathic pulmonary fibrosis patients
表 1 IPF组非病变区和对照组的ROI SUVmax、LT/MBmax、SUVmean、LT/MBmean与CT值的比较(x±s)
Table 1. Comparation the value of ROI SUVmax、LT/MBmax、SUVmean、LT/MBmean and CT between abnormal regions of IPF patients and control population(x±s)
分组 SUVmax LT/MBmax SUVmean LT/MBmean CT值/HU IPF组非病变区 0.68±0.20 0.44±0.55 0.51±0.27 0.55±0.38 -836.59±32.33 正常对照组 0.42±0.06 0.32±0.05 0.34±0.06 0.33±0.05 -837.99±29.90 -
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