CAJ | 학술논문

目的：总结分析18 F-脱氧葡萄糖（FDG）PET-CT对肺部良性病变的误诊原因，提高对良性病变形态学特征及显像特点的认识。方法：回顾性分析PET-CT误诊为恶性病变的33例肺部良性病变的PET-CT 影像资料，对病灶大小、分布、边缘、密度、周围伴随征象等CT表现进行分析，统计良性病变放射性浓聚的病例数，并对不同病理类型病变的SU-Vmax进行比较。结果：结核易发生于上叶尖后段（10／23）及下叶背段（5／23），真菌感染好发于下叶（3／3）。毛刺（15／33）及分叶征（12／33）常见，其中毛刺在炎性病变中多见（4／4），晕征在真菌感染中多见（3／3）；胸膜牵拉是常见的伴随征象（7／33）。结核、真菌感染、良性肿瘤、炎性病变各组平均 SUVmax 依次为5．54±4．18、4．63±1．28、6．23±1．32、2．07±1．44，组间差异无统计学意义（F＝2．36，P＝0．064），其中25例发生18F-FDG放射性浓聚，包括结核18例，真菌感染及良性肿瘤各3例，炎性病变1例。在误诊的33例良性病例中，18例因具有恶性CT 征象同时SUVmax≥2．5而作出诊断；8例仅因具有恶性CT征象而作出诊断；7例不具备典型的恶性CT征象，仅因SUVmax≥2．5作出诊断。结论：肺结核是最易误诊的肺部良性病变，误诊原因与不典型CT征象及FDG高代谢有关；正确认识不同性质良性病变的好发部位、特征性CT征象及放射性摄取特点对减少误诊有一定帮助。
목적：총결분석18 F-탈양포도당（FDG）PET-CT대폐부량성병변적오진원인，제고대량성병변형태학특정급현상특점적인식。방법：회고성분석PET-CT오진위악성병변적33례폐부량성병변적PET-CT 영상자료，대병조대소、분포、변연、밀도、주위반수정상등CT표현진행분석，통계량성병변방사성농취적병례수，병대불동병리류형병변적SU-Vmax진행비교。결과：결핵역발생우상협첨후단（10／23）급하협배단（5／23），진균감염호발우하협（3／3）。모자（15／33）급분협정（12／33）상견，기중모자재염성병변중다견（4／4），훈정재진균감염중다견（3／3）；흉막견랍시상견적반수정상（7／33）。결핵、진균감염、량성종류、염성병변각조평균 SUVmax 의차위5．54±4．18、4．63±1．28、6．23±1．32、2．07±1．44，조간차이무통계학의의（F＝2．36，P＝0．064），기중25례발생18F-FDG방사성농취，포괄결핵18례，진균감염급량성종류각3례，염성병변1례。재오진적33례량성병례중，18례인구유악성CT 정상동시SUVmax≥2．5이작출진단；8례부인구유악성CT정상이작출진단；7례불구비전형적악성CT정상，부인SUVmax≥2．5작출진단。결론：폐결핵시최역오진적폐부량성병변，오진원인여불전형CT정상급FDG고대사유관；정학인식불동성질량성병변적호발부위、특정성CT정상급방사성섭취특점대감소오진유일정방조。
Objective:In order to reduce false positive results,the misdiagnosed cases of pulmonary benign lesions by 18 F-fluorodeoxyglucose (FDG)PET/CT imaging were retrospective analyzed.Methods:CT appearance of 33 cases with clin-ically proved pulmonary benign lesions was retrospectively reviewed,including the lesion size,distribution,edges,density and associated findings.PET images were evaluated with standardized uptake value(SUV)and radioactivity distribution.SU-Vmax in lesions of different types of pathology were compared.Results:Tuberculoma was most frequently located in apico-posterior segment of the upper lobe(10/23)and posterior segment of the lower lobe(5/23),and pulmonary fungal disease mostly in the upper lobe(3/3).Spicule (15/33)and lobulation(12/33)were common.Spicule occurred in all inflammatory le-sions,and halo sign occurred in all pulmonary fungal diseases.Pleural retraction was common associated findings(7/33). High uptake of 18 F-FDG occurred in 25 cases,including 18 cases of tuberculoma,3 cases of fungal disease and benign tumor respectively,and 1 case of inflammatory lesion,SUVmax of which was 5.54±4.18,4.63±1.28,6.23±1.32,2.07±1.44 respectively.There was no significant difference in the above 4 groups.18/33 were falsely diagnosed because both of CT ap-pearance and high uptake in 18 F-FDG,8/33 because of CT appearance,and 7/33 because of high uptake in 18 F-FDG.Conclu-sion:Tuberculoma is the most common misdiagnosed pulmonary benign lesion in our study.It is helpful for reduce false di-agnosis of benign lesions by analyzing predilection site and CT appearance as well as radioactive uptake of every case.