多层螺旋CT与18F-FDG PET/CT对孤立性肺结核空洞与癌性空洞的鉴别意义

doi:10.19871/j.cnki.xfcrbzz.2023.04.012

摘要/Abstract

摘要： 目的对比孤立性肺结核空洞与孤立性癌性空洞的多层螺旋CT征象与PET/CT半定量分析,探讨两者空洞的鉴别价值。方法回顾性分析2020年1月至2022年9月深圳市龙华区人民医院经病理与临床证实的38例孤立性肺结核性空洞患者（肺结核组）、28例癌性空洞患者（肺癌组）的临床资料,均行多层螺旋CT扫描,对比其临床基础资料、CT影像学表现。同时,收集江西省人民医院行¹⁸F-FDG PET/CT检查且经病理证实的孤立性肺结核性空洞患者（肺结核组）与孤立性癌性空洞患者（肺癌组）的临床资料,比较代谢特征。结果孤立性肺结核性空洞主要好发年龄为（36.32±14.68）岁,主要表现为厚壁且厚度均匀,病灶周围有卫星灶;孤立性癌性空洞好发年龄为（63.75±12.92）岁,多表现为厚壁（厚度大于肺结核）,内缘凹凸不平,内多见分隔,可见壁结节,空洞病灶周围见分叶、毛刺与磨玻璃密度征,形态学分型以Ⅳ型为主,部分可见转移征象。肺癌组患者空洞内分隔、内壁不光整、壁结节、支气管中断、厚壁空洞、分叶征、粗短毛刺征、磨玻璃密度征、伴转移征象比例高于肺结核组（P<0.05）,而卫星灶、细长毛刺征、洞壁钙化率低于肺结核组（P<0.05）。两患者性别、空洞部位、空洞平均直径及血管集束征、胸膜凹陷征比较差异无统计学意义（P>0.05）。肺癌组的SUVmax值为（11.41±6.55）,肺结核组的SUVmax值为（5.96±3.55）,两组差异有统计学意义（P=0.038）。鳞癌SUVmax值（13.66±7.20）>腺癌（10.28±5.60）,差异有统计学意义（P=0.293）。结论肺结核空洞与癌性空洞存在一定的影像学差异及代谢差异,多层螺旋CT与¹⁸F-FDG PET/CT能够准确鉴别孤立性肺结核空洞与癌性空洞。

关键词: 多层螺旋CT, 正电子发射计算机断层显像, 肺结核空洞, 癌性空洞, 鉴别诊断

Abstract: Objective The multi-slice spiral CT signs and PET/CT semi-quantitative analysis of the isolated tuberculosis cavity and cancerous cavity were compared to explore the differential value of the two cavities. Method 38 patients with single tuberculosis cavity and 28 patients with a lung cancer cavity confirmed by pathology and clinical records from January 2020 to September 2022 in People's Hospital of Longhua Shenzhen were retrospectively analyzed. MSCT scan was performed on all patients, the clinical basic data and CT imaging findings were compared. At the same time, the clinical data of isolated tuberculosis cavitary and lung cancer cavitary patients who were pathologically confirmed by ¹⁸F-FDG PET/CT examination in Jiangxi People's Hospital were collected, and the metabolic characteristics were compared. Result The main onset age of tuberculosis cavity was (36.32±14.68) years, and the main manifestations were thick wall and uniform thickness, with satellite foci around the lesion. The main onset age of cancerous cavity was (63.75±12.92) years. A carcinomatous cavern was mostly characterized by thick wall (thicker than the tuberculosis cavity), uneven inner margins, internal partitions, and wall nodules. Lobed、burr and ground glass density metastasis were seen. The proportions of intra-spacer, inner wall disjointed, wall nodule, bronchial signs were seen around the cavernous focus. The morphology was mainly type IV, and some signs of interruption, thick-walled cavity, lobed sign,stubble burr sign, ground glass density sign,andmetastasis sign in lung cancer cavity were higher than those in single tuberculosis cavity (P<0.05), while the proportions of the satellite foci, long thin burr sign,and wall calcification were lower than those in single tuberculosis cavity (P<0.05). There was no significant difference in gender、cavity site、cavity mean diameter 、vascular cluster sign and pleural depression sign between the two groups (P>0.05). The SUVmax value of lung cancer cavity group was (11.41±6.55), and that of the pulmonary tuberculosis cavity group was (5.96±3.55), with significant difference between the two groups (P=0.038). The SUVmax value of squamous cell carcinoma (13.66±7.20) >adenocarcinoma (10.28±5.60), the difference was not statistically significant (P=0.293). Conclusion There are some imaging and metabolic differences between the tuberculosis cavity and the cancerous cavity, multi-slice spiral CT combined with ¹⁸F-FDG PET/CT can accurately distinguish the tuberculosis cavity from the lung cancer cavity, which is worthy of clinical promotion and application.

Key words: Multi-slice spiral CT, Positron emission computed tomography, Tuberculosis cavity, Lung cancer cavity, Differential diagnosis

中图分类号:

R521

彭雪华, 陈彦孜, 姜红, 金爱芳, 骆柘璜. 多层螺旋CT与¹⁸F-FDG PET/CT对孤立性肺结核空洞与癌性空洞的鉴别意义[J]. 新发传染病电子杂志, 2023, 8(4): 54-59.

Peng Xuehua, Chen Yanzi, Jiang Hong, Jin Aifang, Luo Zhehuang. Significance of multi-slice spiral CT and ¹⁸F-FDG PET/CT in differentiating isolated pulmonary cavity from the cancerous cavity[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(4): 54-59.

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多层螺旋CT与¹⁸F-FDG PET/CT对孤立性肺结核空洞与癌性空洞的鉴别意义

Significance of multi-slice spiral CT and ¹⁸F-FDG PET/CT in differentiating isolated pulmonary cavity from the cancerous cavity

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