~(18)F-FDG PET/CT在肺神经内分泌肿瘤中的应用
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摘要
目的研究肺部神经内分泌肿瘤的~(18)F-FDG PET/CT图像特点,探讨~(18)F-FDG PET/CT的诊断价值。资料与方法回顾性分析26例经病理或手术证实的肺神经内分泌肿瘤患者的PET/CT图像特点。结果 26例患者中,典型类癌4例,不典型类癌8例,小细胞癌11例,大细胞神经内分泌癌3例;中央型病变15例,周围型11例;已发生转移16例。肿瘤平均直径(2.62±1.05)cm,最大标准化摄取值(SUVmax)为7.40±3.57;肿块CT征象:边缘光滑8例,分叶征14例,毛刺9例,胸膜牵拉6例,阻塞性炎症或肺不张11例,肿块内坏死4例;按照肿瘤类型不同,典型类癌、不典型类癌、小细胞癌、大细胞神经内分泌癌的肿瘤直径分别为(2.60±1.87)cm、(2.84±0.93)cm、(2.54±0.96)cm、(2.37±0.75)cm,平均肿瘤SUVmax分别为2.88±0.10、5.71±0.93、8.93±3.25、12.37±0.98,各种细胞学类型的肿瘤大小比较,差异无统计学意义(P>0.05);各组肿瘤SUVmax比较,差异有统计学意义(P<0.01)。结论 ~(18)F-FDG PET/CT在诊断肺神经内分泌肿瘤方面存在一定的优势,肿瘤的SUVmax值与其恶性程度(病理分级)呈正相关,但用于诊断体积小、分化良好的肿瘤尚存在局限性。
Purpose To study the characteristics of ~(18) F-FDG PET/CT images of pulmonary neuroendocrine tumors and to explore the diagnostic value of ~(18) F-FDG PET/CT. Materials and Methods The PET/CT characteristics of 26 patients with pulmonary neuroendocrine tumors confirmed by pathology or surgery were retrospectively analyzed. Results Of the 26 patients, 4 were typical carcinoid, 8 were atypical carcinoid, 11 were small cell carcinoma, 3 were large cell neuroendocrine carcinoma, 15 were central lesions,11 were peripheral lesions, and 16 were metastasis lesions. With the average diameter of the tumor(2.62±1.05) cm, the maximum standardized uptake value(SUVmax) was 7.40±3.57; CT signs of the mass: 8 cases with smooth margin, 14 cases with lobulation, 9 cases with burr, 6 cases with pleural traction, 11 cases with obstructive inflammation or atelectasis and 4 cases with necrosis in the masses.According to different tumor types, the tumor diameters of typical carcinoid, atypical carcinoid, small cell carcinoma and large cell neuroendocrine carcinoma were(2.60±1.87) cm,(2.84±0.93) cm,(2.54±0.96) cm, and(2.37±0.75) cm, respectively, mean tumor SUVmax were 2.88±0.10, 5.71±0.93, 8.93±3.25, and 12.37±0.98, respectively, and after comparison of the tumor sizes of various cytological types, the difference was not statistically significant(P>0.05). The difference of tumor SUVmax between the groups was statistically significant(P<0.01). Conclusion ~(18) F-FDG PET/CT shows some advantages in the diagnosis of neuroendocrine lung tumor,the value of tumor SUVmax is positively correlated to its grade malignancy(pathological grading), but for the diagnosis of small volume,well differentiated tumors, there are still limitations.
Purpose To study the characteristics of ~(18) F-FDG PET/CT images of pulmonary neuroendocrine tumors and to explore the diagnostic value of ~(18) F-FDG PET/CT. Materials and Methods The PET/CT characteristics of 26 patients with pulmonary neuroendocrine tumors confirmed by pathology or surgery were retrospectively analyzed. Results Of the 26 patients, 4 were typical carcinoid, 8 were atypical carcinoid, 11 were small cell carcinoma, 3 were large cell neuroendocrine carcinoma, 15 were central lesions,11 were peripheral lesions, and 16 were metastasis lesions. With the average diameter of the tumor(2.62±1.05) cm, the maximum standardized uptake value(SUVmax) was 7.40±3.57; CT signs of the mass: 8 cases with smooth margin, 14 cases with lobulation, 9 cases with burr, 6 cases with pleural traction, 11 cases with obstructive inflammation or atelectasis and 4 cases with necrosis in the masses.According to different tumor types, the tumor diameters of typical carcinoid, atypical carcinoid, small cell carcinoma and large cell neuroendocrine carcinoma were(2.60±1.87) cm,(2.84±0.93) cm,(2.54±0.96) cm, and(2.37±0.75) cm, respectively, mean tumor SUVmax were 2.88±0.10, 5.71±0.93, 8.93±3.25, and 12.37±0.98, respectively, and after comparison of the tumor sizes of various cytological types, the difference was not statistically significant(P>0.05). The difference of tumor SUVmax between the groups was statistically significant(P<0.01). Conclusion ~(18) F-FDG PET/CT shows some advantages in the diagnosis of neuroendocrine lung tumor,the value of tumor SUVmax is positively correlated to its grade malignancy(pathological grading), but for the diagnosis of small volume,well differentiated tumors, there are still limitations.
引文
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[13]Bucau M,Laurent-Bellue A,PotéN,et al.18F-FDG uptake in Well-Differentiated neuroendocrine tumors correlates with both Ki-67 and VHL pathway inactivation.Neuroendocrinology,2018,106(3):274-282.
[14]王剑杰,陈燕,李立伟.18F-FDG PET/CT评价肺癌纵隔淋巴结转移的准确性.中国医学影像学杂志,2015,23(3):204-208.
[15]李可心,孙红赞,辛军,等.18F-FDG PET/CT对早期宫颈癌盆腔高代谢淋巴结的个体化诊断.中国医学影像学杂志,2018,26(6):451-454.
[16]Moore W,Freiberg E,Bishawi M,et al.FDG-PET imaging in patients with pulmonary carcinoid tumor.Clin Nucl Med,2013,38:501-505.
[17]Stefani A,Franceschetto A,Nesci J,et al.Integrated FDGPET/CT imaging is useful in the approach to carcinoid tumors of the lung,2013:223.
[18]Squires IM,Adsay NV,Schuster DM,et al.Octreoscan versus FDG-PET for neuroendocrine tumor staging:a biological approach.Ann Surg Oncol,2015,22(7):2295-2301.
[2]刘小华,徐凯,李绍东,等.肺内神经内分泌癌CT表现.中国CT和MRI杂志,2014,12(6):29-32.
[3]张文玉,黄勇,申洪明,等.肺神经内分泌肿瘤的临床病理特征及影像学诊断.实用肿瘤杂志,2012,27(1):101-104.
[4]肺神经内分泌肿瘤病理诊断共识专家组.肺神经内分泌肿瘤病理诊断共识.中华病理学杂志,2017,46(1):9-13.
[5]National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology:neuroendocrine tumors(version 2.2018).https://www.nccn.org/professionals/.
[6]Chen SH,Chang YC,Hwang TL,et al.68Ga-DOTATOC and18F-FDG PET/CT for identifying the primary lesions of suspected and metastatic neuroendocrine tumors:a prospective study in Taiwan.J Formos Med Assoc,2018,117(6):480-487.
[7]Travis WD,Brambilla E,Burke AP,et al.WHOclassification of tumours of the lung,pleura,thymus and heart.4th ed.IARC Publications,Lyon,France:2015.
[8]聂敏,陈晨,辛华,等.肺神经内分泌肿瘤的CT表现.医学影像学杂志,2015,25(10):1785-1787.
[9]刘绍信,周永威,刘健.肺原发性神经内分泌肿瘤的CT表现.医学影像学杂志,2014,24(2):235-238.
[10]王丽华,郭佑民,李润民.肺神经内分泌癌的分类及影像学表现.国外医学:临床放射学分册,2002,25(1):9-13.
[11]郭丽娟,向颖,王红,等.肺神经内分泌肿瘤不同亚型CT特征差异研究.实用放射学杂志,2018,34(4):518-521.
[12]袁磊磊,王国强,李春林,等.FDG PET双时相显像临床应用进展.临床和实验医学杂志,2013,12(22):1853-1857.
[13]Bucau M,Laurent-Bellue A,PotéN,et al.18F-FDG uptake in Well-Differentiated neuroendocrine tumors correlates with both Ki-67 and VHL pathway inactivation.Neuroendocrinology,2018,106(3):274-282.
[14]王剑杰,陈燕,李立伟.18F-FDG PET/CT评价肺癌纵隔淋巴结转移的准确性.中国医学影像学杂志,2015,23(3):204-208.
[15]李可心,孙红赞,辛军,等.18F-FDG PET/CT对早期宫颈癌盆腔高代谢淋巴结的个体化诊断.中国医学影像学杂志,2018,26(6):451-454.
[16]Moore W,Freiberg E,Bishawi M,et al.FDG-PET imaging in patients with pulmonary carcinoid tumor.Clin Nucl Med,2013,38:501-505.
[17]Stefani A,Franceschetto A,Nesci J,et al.Integrated FDGPET/CT imaging is useful in the approach to carcinoid tumors of the lung,2013:223.
[18]Squires IM,Adsay NV,Schuster DM,et al.Octreoscan versus FDG-PET for neuroendocrine tumor staging:a biological approach.Ann Surg Oncol,2015,22(7):2295-2301.