左肺結核伴縱隔淋巴結結核經18氟-脫氧葡萄糖正電子發射斷層掃描術誤診肺癌淋巴結轉移_《華西醫學》

作者：

劉焱斌 , 楊彥佳 , 李雅馨 ,  劉凱

四川大學華西醫院感染性疾病中心（成都，610041）;

關鍵詞：

結核正電子發射斷層掃描 18氟-脫氧葡萄糖

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目的　探討結核病在18氟-脫氧葡萄糖（18F-FDG）正電子發射斷層掃描術（PET）中的影像學表現，提高對PET/CT在肺部包塊診斷作用的認識，減少誤診。方法　回顧分析2010年3月收治的1例肺結核合并縱隔淋巴結結核病患者的誤診及診斷治療經過，分析誤診原因并總結診治經驗，結合文獻復習肺部包塊在PET/CT中的表現及臨床特點。結果　患者為肺部包塊伴縱隔淋巴結包塊，胸部CT提示肺癌伴縱隔淋巴結轉移，PET/CT也考慮左肺下葉肺癌伴淋巴結轉移。最后經縱隔鏡淋巴結活檢確診結核，并抗結核治療好轉。結論　結核等感染性疾病常可導致18F-FDG的攝取增加而造成PET/CT陽性結果，因此在18F-FDG PET/CT呈現陽性結果時須注意鑒別病變良惡性，其中高標準攝入值包塊尤其需要注意與結核病相鑒別。

引用本文： 劉焱斌,楊彥佳,李雅馨,劉凱. 左肺結核伴縱隔淋巴結結核經18氟-脫氧葡萄糖正電子發射斷層掃描術誤診肺癌淋巴結轉移. 華西醫學, 2012, 27(10): 1474-1477. doi: 復制

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3.	Tateishi U, Kusumoto M, Akiyama Y, et al. Role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma[J]. Chest, 2002, 122(4): 1280-1284.
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5.	Zhuang H, Alavi A. 18 Fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation[J]. Semin Nucl Med, 2002, 32(1): 47-59.
6.	Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients[J]. Eur J Nucl Med, 1996, 23(10): 1409-1415.
7.	Forstrom LA, Dunn WL, Mullan BP, et al. Biodistribution and dosimetry of [(18)F]fluorodeoxyglucose labelled leukocytes in normal human subjects[J]. Nucl Med Commun, 2002, 23(8): 721-725.
8.	Goo JM, Im JG, Do KH, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases[J]. Radiology, 2000, 216(1): 117-121.
9.	Kostakoglu L, Agress H Jr, Goldsmith SJ. Clinical role of FDG PET in evalutaion of cancer patients[J]. Radiographics, 2003, 23(2): 315-340.
10.	Chang JM, Lee HJ, Goo JM, et al. False positive and false negative FDG-PET scans in various thoracic diseases[J]. Korean J Radiol, 2006, 7(1): 57-69.
11.	苗積生, 劉進軍, 吳吉勇, 等. 肺良性病變18F-FDG符合線路SPECT顯像[J]. 中華核醫學雜志, 2001, 21(1): 12-13.
12.	屈婉瑩, 周前. 提高PET顯像在肺癌診治中的應用水平[J]. 中華核醫學雜志, 2003, 23(1): 5-7.
13.	Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis[J]. JAMA, 2001, 285(7): 914-924.
14.	Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules[J]. J Clin Oncol, 1998, 16(3): 1075-1084.
15.	Hara T, Kosaka N, Suzuki T, et al. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study[J]. Chest, 2003, 124(3): 893-901.
16.	趙軍, 林祥通, 管一暉, 等. 結核病18F-FDG PET圖像表現的多樣性[J]. 中華核醫學雜志, 2003, 23(s1):37-39.
17.	Kim IJ, Lee JS, Kim SJ, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity[J]. Eur J Nucl Med Mol Imaging, 2008, 35(4): 808-814.

1. 　Spiro SG, Niederman M, Yew WW, et al. Year in review 2009: respiratory infections, tuberculosis, pleural diseases and lung cancer[J]. Respirology, 2010, 15(3): 562-572.
2. 　楊明, 儲成鳳, 劉斌, 等. 非鈣化型肺結核瘤的動態CT增強研究[J]. 東南大學學報(醫學版), 2006, 25(6): 451-453.
3. 　Tateishi U, Kusumoto M, Akiyama Y, et al. Role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma[J]. Chest, 2002, 122(4): 1280-1284.
4. 　Christensen JA, Nathan MA, Mullan BP, et al. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT[J]. AJR Am J Roentgenol, 2006, 187(5): 1361-1367.
5. 　Zhuang H, Alavi A. 18 Fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation[J]. Semin Nucl Med, 2002, 32(1): 47-59.
6. 　Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients[J]. Eur J Nucl Med, 1996, 23(10): 1409-1415.
7. 　Forstrom LA, Dunn WL, Mullan BP, et al. Biodistribution and dosimetry of [(18)F]fluorodeoxyglucose labelled leukocytes in normal human subjects[J]. Nucl Med Commun, 2002, 23(8): 721-725.
8. 　Goo JM, Im JG, Do KH, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases[J]. Radiology, 2000, 216(1): 117-121.
9. 　Kostakoglu L, Agress H Jr, Goldsmith SJ. Clinical role of FDG PET in evalutaion of cancer patients[J]. Radiographics, 2003, 23(2): 315-340.
10. 　Chang JM, Lee HJ, Goo JM, et al. False positive and false negative FDG-PET scans in various thoracic diseases[J]. Korean J Radiol, 2006, 7(1): 57-69.
11. 　苗積生, 劉進軍, 吳吉勇, 等. 肺良性病變18F-FDG符合線路SPECT顯像[J]. 中華核醫學雜志, 2001, 21(1): 12-13.
12. 　屈婉瑩, 周前. 提高PET顯像在肺癌診治中的應用水平[J]. 中華核醫學雜志, 2003, 23(1): 5-7.
13. 　Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis[J]. JAMA, 2001, 285(7): 914-924.
14. 　Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules[J]. J Clin Oncol, 1998, 16(3): 1075-1084.
15. 　Hara T, Kosaka N, Suzuki T, et al. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study[J]. Chest, 2003, 124(3): 893-901.
16. 　趙軍, 林祥通, 管一暉, 等. 結核病18F-FDG PET圖像表現的多樣性[J]. 中華核醫學雜志, 2003, 23(s1):37-39.
17. 　Kim IJ, Lee JS, Kim SJ, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity[J]. Eur J Nucl Med Mol Imaging, 2008, 35(4): 808-814.

《華西醫學》

左肺結核伴縱隔淋巴結結核經18氟-脫氧葡萄糖正電子發射斷層掃描術誤診肺癌淋巴結轉移

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《華西醫學》

左肺結核伴縱隔淋巴結結核經18氟-脫氧葡萄糖正電子發射斷層掃描術誤診肺癌淋巴結轉移

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