吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (06): 1275-1278.doi: 10.13481/j.1671-587x.20150634

• 影像学 • 上一篇    下一篇

18FDG PET/CT在肺癌致异位ACTH综合征诊断中的应用

程欣, 马艳茹, 刘轶敏, 党永红, 邢海群, 胡楠   

  1. 中国医学科学院 北京协和医院核医学科, 北京 100730
  • 收稿日期:2015-08-03 发布日期:2016-01-11
  • 通讯作者: 程欣,副主任医师(Tel:010-69155513,E-mail:chengxin72@sohu.com) E-mail:chengxin72@sohu.com
  • 作者简介:程欣(1972-),女,内蒙古自治区通辽市人,副主任医师,医学博士,主要从事神经内分泌肿瘤方面的研究。
  • 基金资助:

    国家自然科学基金青年基金资助课题(81201121)

Application of 18FDG PET/CT in diagnosis of ectopic ACTH syndrome induced by lung cancer

CHENG Xin, MA Yanru, LIU Yimin, DANG Yonghong, XING Haiqun, HU Nan   

  1. Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2015-08-03 Published:2016-01-11

摘要:

目的:探讨18F-脱氧葡萄糖(18FDG)正电子发射计算机断层显像(PET)/计算机断层显像(CT)在肺癌致异位促肾上腺皮质激素(ACTH)综合征(EAS)中的图像特点,提高EAS诊断的准确率。 方法:8例经手术病理证实为肺癌的EAS患者,术前行18FDG PET/CT躯干和脑显像,同期行鞍区脑核磁共振成像(MRI)、胸部高分辨CT显像、奥曲肽(OCT)全身显像和岩下窦静脉取血(IPSS)。对18FDG PET/CT图像所示肺部病变行半定量分析,计算病变最大标准摄取值(SUVmax)及病变/正常肺组织SUVmax比值。 结果:18例EAS包括2例类癌,4例不典型类癌,2例小细胞肺癌。8例IPSS患者ACTH水平中央与外周比较无明显差别。26例(75%)患者初诊时胸部CT示肺内结节,2例为不典型病变。5例同期MRI示垂体微腺瘤,2例(25%)OCT显像为阳性。38例(100%)肺部病变18FDG PET/CT表现为结节样、团块样或斑片样代谢增高,肿瘤的SUVmax为0.72~14.05(3.67±4.68),病变/正常肺组织SUVmax比值为1.69~27.54(8.14±9.63);8例双侧肾上腺均为团状代谢异常增高,同时4例提示垂体瘤。 结论:肺癌是EAS的常见原因,其中以类癌多见,在18FDG PET中代谢多轻度增高,PET可以作为有效的定位辅助诊断方法。

关键词: 肺肿瘤, 肺类癌, 库欣综合征, 异位促肾上腺皮质激素综合征, 正电子发射计算机断层显像, 18F-脱氧葡萄糖

Abstract:

Objective To investigate the value of 18F-fluorodeoxyglucose(18FDG) positron emission tomography and computer tomography(PET/CT) in the diagnosis and localization of ectopic ACTH syndrome(EAS) induced by lung cancer, and to increase the accuracy rate of diagnosis of EAS. Methods 8 patients were histopathologically proven to be lung cancer. 18FDG PET/CT wholebody and brain scan were performed; magnetic resonance imaging(MRI), 99mTc-octreotide(OCT) imaging and inferior petrosal sinus sampling(IPSS) were done in all patients. On 18FDG PET/CT images, the SUVmax values of lesions and the SUVmax ratio of lesion tissue to normal lung tissue were calculated. Results ① 8 patients with EAS included 2 cases of carciniod, 4 cases of atypical carciniod, and 2 cases of small cell lung cancer. The ACTH levels in inferior petrosal sinus and peripheral veins of 8 patients had no difference.②The chest CT showed there were pulmonary nodules in 6 cases (75%), among them 2 cases were atypical lesions. 5 cases of pituitary adenomas were found by MRI(25%), and OCT imaging was positive in 2 cases (25%).③ The 18FDG PET/CT showed nodular, mass like or patch samples with high metabolic activity in 8 cases (100%) of pulmonary lesions. The SUVmax of tumor was 0.72 to 14.05 (3.67±4.68), and the ratio of SUVmax of lesion tissue to normal lung tissue was 1.69 to 27.54 (8.14± 9.63). 18FDG hypermetabolism was found in 8 cases of bilateral adrenal hyperplasia, while 4 cases showed pituitary tumor. Conclusion Lung cancer is a common source of EAS, especially carcinoid. 18FDG PET may show lower glucose metabolism. 18FDG PET/CT should be used as an assisted method to diagnose EAS.

Key words: lung neoplasms, pulmonary carcinoid, Cushing syndrome, ectopic adrenocorticotrophic hormone syndrome, positron emission tomography, 18F-fluorodeoxyglucose

中图分类号: 

  • R445.5