CAJ | 학술논문

目的回顾性分析60例被PET-CT误诊为恶性肿瘤的结核病患者的临床及影像资料,分析误诊原因,以期提高结核病诊断的准确率并降低误诊翠,为临床提供更好的帮助.方法 (1)入选标准:所有患者均为PET-CT检查前未明确诊断,且PET-CT检查拟诊或不除外恶性肿瘤的患者.50例经手术切除、活检穿刺病理诊断证实；10例经诊断性抗结核治疗后多次随访,并根据病情转归及治愈情况临床确诊；(2)检查方法:静脉注射氟代脱氧葡萄糖(18 F-FDG)后行PET-CT全身显像,采用感兴趣区划定,测量病灶标准摄取值(Suy)最大值及平均值.在全身PET-CT扫描结束后,再行屏气状态下胸部CT螺旋扫描并进行2 mm肺窗HRCT图像重建.结果 (1)活动性结核误诊为肺癌30例；恶性淋巴瘤14例；恶性间皮瘤6例；肠癌3例；骨原发恶性肿瘤2例；肝癌、脾脏恶性肿瘤、卵巢癌、喉癌、鼻咽癌各1例.(2)实验室资料分析显示90.9％(20/22)和100.0％(13/13)的结核患者血清癌胚抗原(CEA)和CA199水平正常；100％(6/6)活动性结核伴有浆膜腔积液患者的血清CA125水平高于正常.(3) PET-CT影像特征及误诊原因:误诊为肺癌的结核病灶93.3％(28/30)呈高代谢结节或团块状.误诊为恶性淋巴瘤的淋巴结结核病以颈部淋巴结对称性累及最为常见,占85.7％(12/14).CT增强扫描示受累淋巴结结核病灶呈多发的边缘不均匀或环形强化,中央见坏死区,占87.5％ (7/8).结论活动性结核病灶对18F-FDG的高摄取是PET-CT将其误诊为恶性肿瘤的主要原因之一.只有对结核病的常见发生部位、分布特点及病灶影像特征进行全面研究,尤其是HRCT的应用,并密切结合实验室检查,才能全面掌握结核与肿瘤病变之间的细微差别,尽量减少漏、误诊率,提高诊断的准确性.
목적 회고성분석60례피PET-CT오진위악성종류적결핵병환자적림상급영상자료,분석오진원인,이기제고결핵병진단적준학솔병강저오진취,위림상제공경호적방조.방법 (1)입선표준:소유환자균위PET-CT검사전미명학진단,차PET-CT검사의진혹불제외악성종류적환자.50례경수술절제、활검천자병리진단증실；10례경진단성항결핵치료후다차수방,병근거병정전귀급치유정황림상학진；(2)검사방법:정맥주사불대탈양포도당(18 F-FDG)후행PET-CT전신현상,채용감흥취구화정,측량병조표준섭취치(Suy)최대치급평균치.재전신PET-CT소묘결속후,재행병기상태하흉부CT라선소묘병진행2 mm폐창HRCT도상중건.결과 (1)활동성결핵오진위폐암30례；악성림파류14례；악성간피류6례；장암3례；골원발악성종류2례；간암、비장악성종류、란소암、후암、비인암각1례.(2)실험실자료분석현시90.9％(20/22)화100.0％(13/13)적결핵환자혈청암배항원(CEA)화CA199수평정상；100％(6/6)활동성결핵반유장막강적액환자적혈청CA125수평고우정상.(3) PET-CT영상특정급오진원인:오진위폐암적결핵병조93.3％(28/30)정고대사결절혹단괴상.오진위악성림파류적림파결결핵병이경부림파결대칭성루급최위상견,점85.7％(12/14).CT증강소묘시수루림파결결핵병조정다발적변연불균균혹배형강화,중앙견배사구,점87.5％ (7/8).결론 활동성결핵병조대18F-FDG적고섭취시PET-CT장기오진위악성종류적주요원인지일.지유대결핵병적상견발생부위、분포특점급병조영상특정진행전면연구,우기시HRCT적응용,병밀절결합실험실검사,재능전면장악결핵여종류병변지간적세미차별,진량감소루、오진솔,제고진단적준학성.
Objective To analyze the pitfalls of 18F fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET-CT) scan in the diagnosis of 60 patients of tuberculosis mimicking malignancy.Methods The study included 60 patients with PET-CT diagnosis of probable malignancy.Fifty patients were proved to be tuberculosis by pathological examinations and 10 were diagnosed by clinical followup.The images of whole body were acquired at 60 min after administration of 222-555 MBq 18F-FDG.The PET-CT imaging characteristics and clinical data,including lesion size,distribution,standardized uptake value (SUV) were retrospectively analyzed.After the whole body scan of PET-CT,each patient had a chest spiral CT scan for detailed observation of lung lesions.Contrast enhanced CT (CECT) was performed in 8 patients.Results (1)Thirty patients were misdiagnosed as lung cancer,14 patients as malignant lymphoma,6 patients as malignant mesothelioma,3 as intestine carcinoma,2 as bone malignancy,1 patient as hepatocarcinoma,spleen malignancy,ovarian cancer,laryngocarcinoma and nasopharyngeal carcinoma respectively.(2) 90.9％ (20/22) of patients showed normal level of serum CEA and 100％ (13/13) of patients showed normal level of CA199.Increasing serum CA125 was found in all patients (6/6) with activeTB patients accompanied with ascites,pleural fluid and (or) pericardial effusion.(3) 93.3％ (28/30)active tuberculosis showed accumulated 18F-FDG which was incorrectly interpreted as malignancy.The most common sites of TB lymphadenopathy were bilateral cervical tissues,which was accounted for 85.7％(12/14).CECT revealed characteristics of peripheral enhancement and central necrosis in tubercular lymphadenopathy,which was 87.5％ (7/8).Conclusions The diverse manifestations of TB on imaging and high uptake of 18F-FDG on PET imaging result in misdiagnosis of malignancy.It is important for radiologists and nuclear medicine physicians to identify the common imaging features and patterns of TB to make a correct diagnosis.Integration of reconstruction HR CT,PET-CT and lab examinations may improve the diagnostic accuracy.