18FDG PET/CT在肺癌致异位ACTH综合征诊断中的应用

doi:10.13481/j.1671-587x.20150634

摘要/Abstract

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(SUV_max)及病变/正常肺组织SUV_max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SUV_max为0.72~14.05(3.67±4.68),病变/正常肺组织SUV_max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

程欣, 马艳茹, 刘轶敏, 党永红, 邢海群, 胡楠. ¹⁸FDG PET/CT在肺癌致异位ACTH综合征诊断中的应用[J]. 吉林大学学报(医学版), 2015, 41(06): 1275-1278.

CHENG Xin, MA Yanru, LIU Yimin, DANG Yonghong, XING Haiqun, HU Nan. Application of ¹⁸FDG PET/CT in diagnosis of ectopic ACTH syndrome induced by lung cancer[J]. Journal of Jilin University Medicine Edition, 2015, 41(06): 1275-1278.

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¹⁸FDG PET/CT在肺癌致异位ACTH综合征诊断中的应用

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

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