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目的结核性与肿瘤性腹膜弥漫性病变的鉴别在临床上存在一定困难,本研究通过分析两者的18 F-FDG PET/CT特点,探讨18F-FDG PET/CT对两者的鉴别诊断价值。方法回顾性分析2009-02-15-2014-12-30武警后勤学院附属医院经病理或临床确诊的12例结核性腹膜炎(tuberculous peritonitis,TBP)、22例腹膜转移癌(peritoneal metastasis,PM)、16例原发性腹膜浆液性乳头状腺癌(primary serous papillary carcinoma of the peritoneal,PSPCP)和4例腹膜弥漫性恶性间皮瘤(diffuse peritoneal mesothelioma,DPM)的18F-FDG PET/CT表现。观察壁腹膜、大网膜、肠系膜的受累及代谢、腹水、淋巴结及转移灶以及其他伴随征象。对结核性与肿瘤性的腹膜受累情况、18 F-FDG代谢程度和腹水等情况行统计学分析;对淋巴结及转移灶等情况进行统计描述。结果 TBP以壁腹膜的光滑均匀增厚为主,肿瘤性病变以壁腹膜的结节状增厚为主,差异有统计学意义,χ~2=7.509,P=0.006。TBP以大网膜的污垢样改变为主,肿瘤性病变以大网膜结节状增厚及网膜饼形成为主,差异有统计学意义,χ~2=8.447,P=0.015。TBP以肠系膜的污垢样改变多见,肿瘤性病变以肠系膜的结节状增厚相对多见,但差异无统计学意义,χ~2=1.199,P=0.274。2组受累腹膜18 F-FDG代谢均增高,肿瘤性病变的摄取高于结核性病变,分别为14.7±5.7及10.7±4.2,差异有统计学意义,t=-2.252,P=0.029。肿瘤性病变腹水以中大量为主,结核性病变以中少量为主,结核性积液密度相对较高,肿瘤性积液的最大标准摄取值(maximum standardized uptake value,SUVmax)高于结核性积液,两者腹水量(χ~2=6.627,P=0.010)、密度(t=3.633,P=0.001)及SUVmax(t=2.184,P=0.033)差异均有统计学意义。同时,TBP与肿瘤性病变的淋巴结侵犯情况及其他征象亦存在不同。结论 18F-FDG PET/CT显像通过显示病灶的形态结构和代谢情况,并结合其他伴随征象,可提高腹膜弥漫性病变的诊断效率。
Objective To differentiate tuberculous and diffuse neoplastic peritoneal tumors in clinical practice. This study was to analyze the 18 F-FDG PET / CT features and to explore the value of 18F-FDG PET / CT in the differential diagnosis between them. Methods Retrospective analysis of 12 cases of tuberculous peritonitis (TBP), 22 cases of peritoneal metastasis (PM), pathologically or clinically diagnosed in the affiliated hospital of Armed Police Forces College of Public Health 2009-02-15-2014-12-30 16 cases of primary serous papillary carcinoma of the peritoneal (PSPCP) and 4 cases of diffuse peritoneal mesothelioma (DPM) by 18F-FDG PET / CT. Observe the peritoneum, omentum, mesenteric involvement and metabolism, ascites, lymph nodes and metastases and other accompanying signs. The tuberculous and neoplastic peritoneal involvement, 18F-FDG metabolism and ascites were analyzed statistically. The lymph nodes and metastases were statistically analyzed. Results TBP mainly consisted of smooth and even thickening of parietal peritoneum. Tumor - like lesions were predominantly nodular thickening of parietal peritoneum. The difference was statistically significant (χ ~ 2 = 7.509, P = 0.006). TBP mainly changed the fouling of the omentum. The main pathological changes of the lesions were omentum nodular thickening and membrane formation. The difference was statistically significant (χ ~ 2 = 8.447, P = 0.015). TBP in the mesentery of dirt-like changes more common, neoplastic lesions in mesentery nodular thickening is relatively common, but the difference was not statistically significant, χ ~ 2 = 1.199, P = 0.274.2 group involved peritoneal 18 F-FDG Metabolism was increased, and the uptake of tumor lesions was higher than that of tuberculous lesions (14.7 ± 5.7 and 10.7 ± 4.2, respectively), with a significant difference (t = -2.252, P = 0.029). Tumor neoplasms were mainly found in a large number of ascites, tuberculous lesions in a small amount, tuberculous effusion density was relatively high, tumor effusion maximum standard uptake value (SUVmax) higher than the tuberculous product (T = 3.633, P = 0.001) and SUVmax (t = 2.184, P = 0.033) in both groups were significantly higher than those in control group (χ ~ 2 = 6.627, P = 0.010) At the same time, TBP and tumor lesions of lymph nodes violations and other signs are also different. Conclusion 18F-FDG PET / CT imaging can improve the diagnostic efficiency of diffuse lesions of the peritoneum by displaying the morphological structure and metabolism of lesions and other accompanying signs.