摘要目的 探讨18F-FDG PET及高分辨率CT(HRCT)在细支气管肺泡癌(BAC)诊断及鉴别诊断中的价值.方法 回顾性分析具有完整临床资料的患者18例,其中病理检查确诊17例为BAC,1例经抗炎治疗后病灶消失.测量病灶标准化摄取值(SUV),分析病灶的影像学征象,比较单纯18F-FDG PET、HRCT及二者联合诊断的效能.结果 ①单发结节组5例,SUV为1.5～3.5,其中4例同时行HRCT,见毛刺征4例、分叶3例、胸膜凹陷征3例、血管集束征3例、空泡征2例、毛玻璃征1例.②局限性实变组6例,SUV为1.6～2.3,其中5例同时行HRCT,见毛玻璃征5例、胸膜凹陷征3例、空泡征2例、支气管充气征2例、血管集束征1例.③混合组4例,SUV为4.5～10.0,4例均同时行HRCT,见毛玻璃征2例、空泡征1例、胸膜凹陷征2例、支气管充气征3例.④肿块组1例,SUV为5.6,见分叶、空洞、胸膜凹陷征及血管集束征.⑤多发结节组1例,SUV为4.6,见分叶、细毛刺征.⑥假阳性组1例,病灶大小为2.1 cm×2.3 cm,SUV为1.2.结论 单发结节组、局限性实变组的病灶对18F-FDG摄取较低,易误诊,PET代谢显像结合HRCT有利于提高BAC诊断及鉴别诊断的准确率.

abstractsObjective To investigate the features and diagnostic values of 18F-FDG PET and high resolution CT(HRCT)in patients with bronchial alveolar carcinoma(BAC).Methods Seventeen cases with pathologically confirmed BAC and 1 case confirmed inflammation were studied retrospectively.The standardized uptake value(SUV)of the lesions were detected and 18F-FDG uptake characteristics were studied.The diagnostic values of 18F-FDG PET,HRCT and 18F-FDG PET combined with HRCT were analyzed.Results ① In the group of solitary nodule(n =5),SUV of lesions were 1.5-3.5.HRCT(4/5)demonstrated spiculated(4/4),lobulated(3/4),pleural indentation(3/4),vascular convergence(3/4),vacuole sign(2/4)and ground-glass sign(1/4).②In the group of lobar consolidation(n=6),SUV of lesions were 1.6-2.3.HRCT(5/6)demonstrated ground-glass(5/5),pleural indentation(3/5),vacuole sign(2/5),air bronchogram sign (2/5)and blood vessel convergency(1/5).③In the group of mixed shadow(n=4),SUV of lesions were 4.5-10.0.Ground-glass sign,vacuole sign,pleural tag and air bronchogram sign were seen in 2,1,2 and 3 cases respectively.④There was 1 case in the group of mass lesion.The SUV of lesion was 5.6,and HRCT demonstrated lobulated,cavity,pleural indentation and blood vessel convergency.⑤There was 1 case in the multi-nodular group,SUV was 4.6,lobulation and spiculation sign were found.⑥SUV was 1.2 in the false positive case,with the lesion size of 2.1 cm×2.3 cm.Conclusions Low uptake of 18F-FDG in solitary nodule and lobar consolidation groups might cause false negative in the diagnosis of BAC.To improve the diagnosis accuracy and to decrease misdiagnosis rate of BAC,combination of HRCT with 18F-FDG PET should be carried out.