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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 300 -305. doi: 10.3877/cma.j.issn.1674-6902.2022.03.003

论著

硬化性肺细胞瘤的MSCT特征及18F-FDGPET/CT表现
张曦1, 秦显莉2, 符海杰1, 张静娜3, 张晔3, 韩一飞1,†()   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院放射科
    2. 400037　重庆，陆军（第三）军医大学第二附属医院核医学科
    3. 400038　重庆，陆军（第三）军医大学生物医学工程与影像学院医学信息与医学图像学教研室
  • 收稿日期:2021-10-05 出版日期:2022-06-25
  • 通信作者: 韩一飞
  • 基金资助:
    国家自然科学基金青年基金项目(81802253)

Pulmonary sclerosing pneumocytoma of the lung: MSCT and 18F-FDG PET/CT imaging characteristics

Xi Zhang1, Xianli Qin2, haijie Fu1, Jingna Zhang3, Ye Zhang3, Yifei Han1,†()   

  1. 1. Department of Radiology, XinQiao Hospital, the Third Military Medical University, Chongqing 400037, China
    2. Department of Nuclear Medicine, XinQiao Hospital, the Third Military Medical University, Chongqing 400037, China
    3. Department of Medical Informatics and Medical Image, College of Biomedical Engineering and Image, Chongqing 300038, China
  • Received:2021-10-05 Published:2022-06-25
  • Corresponding author: Yifei Han
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引用本文：

张曦, 秦显莉, 符海杰, 张静娜, 张晔, 韩一飞. 硬化性肺细胞瘤的MSCT特征及18F-FDGPET/CT表现[J]. 中华肺部疾病杂志(电子版), 2022, 15(03): 300-305.

Xi Zhang, Xianli Qin, haijie Fu, Jingna Zhang, Ye Zhang, Yifei Han. Pulmonary sclerosing pneumocytoma of the lung: MSCT and 18F-FDG PET/CT imaging characteristics[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(03): 300-305.

目的

分析肺硬化性肺细胞瘤(pulmonary sclerosing pneumocytoma, PSP)的临床特征、多层螺旋CT(multislice spiral computed tomography, MSCT)和18F-FDGPET/CT特征，提高PSP术前诊断水平及认识。

方法

选择2013年9月至2021年11月我院经手术病理证实后55例PSP患者，分析临床及影像学特征，包括48例CT平扫、33例CT增强、19例18F-FDGPET/CT全身显像，进一步分析病灶分布、形态、大小、伴随征象、代谢摄取结果，进一步分析了病灶最大直径与最大标准化摄取值(SUVmax)相关性。

结果

MSCT显示病灶多为单发(94.5%)，边界光滑(89%)，呈圆形或椭圆形(85.5%)，平均直径25.6 mm。CT主要征象包括贴边血管征(45.5%)、晕征(12.7%)、空气新月征(16.4%)和钙化(41.8%)。增强扫描延迟期趋向均匀持续强化。19例PSP病灶SUVmax，平均值为(2.87±1.20)，病灶SUVmax与最大长径呈显著正相关(R＝0.51，P<0.001)。

结论

"血管贴边征"、"空气新月征"、"晕征"、"钙化"等特征性PSP患者具有特征性MSCT表现，PSP病灶18F-FDG PET/CT以中低代谢摄取为主，其大小可能与摄取FDG增加有关，MSCT影像征象、18F-FDG PET/CT代谢摄取为正确诊断PSP提供了理论依据。

关键词: 肺硬化性肺泡细胞瘤, 体层摄影术, 正电子发射断层成像, 多层螺旋CT, 氟代脱氧葡萄糖
Objective

To describe the detailed clinical, to analyze the detailed clinical features, Imaging Characteristics of PSP under multislice spiral computed tomography (MSCT), and 18F-fluorodeoxy glucose positron emission tomography (18F-FDG PET/CT) , in order to improve the preoperative diagnosis.

Methods

A total of 55 patients with PSP confirmed by surgical pathology were included, 48 cases received CT plain scan, 33 cases received CT enhanced scan and 19 cases received 18F-FDGPET/CT imaging. The distribution, morphology, size, clinicoradiological signs and metabolic uptake results of lesions were further analyzed. the relationship between maximum standardized uptake value (SUVmax) and maximum diameter of lesions were observed.

Results

Most patients had a single lesion (94.5%), smooth boundary (89%), and round or oval shape (85.5%), and the mean diameter was 25.6 mm. The mainCT signs included vessel marginal sign (45.5%), halo sign (12.7%), air crescent sign (16.4%) and calcification (41.8%). Delayed phase of Enhanced scanning tends to be continuous and homogeneous enhanced. Besides, The mean maximum standardized uptake value on FDG PET of 19 patients was (2.87±1.20). the maximum standardized uptake value (SUVmax) of 19 patients were significantly positively correlated with the maximum diameter of lesions (R=0.51, P<0.001).

Conclusion

Imaging Characteristics of PSP in MSCT is special, such as vessel marginal sign, halo sign, air crescent sign and calcification. And the 18F-FDGPET/CT scan revealed hypometabolic FDG uptake in the patients with PSP, which may be related to the increased uptake of FDG. MSCT imaging signs and 18F-FDGPET/CT metabolic uptake provide a theoretical basis for the correct diagnosis of PSP.

Key words: Pulmonary sclerosing hemangioma, Tomography, Positron-emission tomography, Multislice spiral computed tomography, 18F-FDG
图1 PSP典型影像征象分析；注：A：平扫病灶内斑点状钙化；B：平扫病灶周围见晕征及血管贴边征显示；C病灶内见空气新月征D增强扫描病灶边缘见血管贴边征
表1 PSP患者病灶影像学征象
影像学征象 例数 百分比(%)
部位(单发病灶)    
  右肺上叶 8 14.5
  右肺中叶 5 9.0
  右肺下叶 11 20.0
  左肺上叶 8 14.5
  左肺下叶 16 29.1
  跨右中上叶 2 3.6
  跨右中下叶 1 1.8
  跨左肺上下叶 1 1.8
部位(多发病灶)    
  右肺中上叶 1 1.8
  右肺上叶、左肺 1 1.8
  双肺 1 1.8
形态    
  圆形或类圆形 47 85.5
  不规则型 8 14.5
大小    
  肿块型 16 29.1
  结节型 39 70.9
影像学特征    
  钙化 23 41.8
  空气新月征 9 16.4
  贴面血管征 25 45.5
  晕征 7 12.7
图2 女，47岁，右肺下叶内基底段PSP，CT平扫纵膈窗、动脉期及延迟期(图A-C)，病灶密度较均匀，呈类圆型，近肺门区、见贴胸膜征显示，三期CT值分别为32.3 Hu、54.6 Hu、82.8 Hu，呈渐进性均匀明显强化。术后病理结果显示，病灶以乳头状区及血管样区为主(图D)
图3 女，16岁(表2例6)，A、B：CT增强扫描图像显示右肺中上叶多发结节状、不规则异常强化团块影，延迟期呈持续强化；C：18F-FDG PET/CT检查显示最大病灶表现为FDG的明显摄取(SUVmax为5.7)；D：经病理证实为多发PSP，双肺门、纵膈无淋巴结转移
图4 相关性分析显示：19例PSP患者病灶最大直径与SUVmax呈显著正相关，R＝0.51，P<0.001
表2 PSP患者18F-FDG PET/CT表现
序号 年龄 性别 大小(cm) 定性评估 SUVmax 形态学
1 55 F 1.5 1 1.3 1
2 58 F 1.3 2 1.6 2
3 51 F 1.3 2 1.7 1
4 53 F 4.2 3 3.6 1
5 35 M 2.2 2 1.7 1
6 16 F 6.6 3 5.7 2
7 42 F 2.3 2 2.1 1
8 56 F 3 2 2.4 1
9 49 F 2.2 3 2.5 1
10 65 F 3.5 3 4.1 2
11 71 F 2.5 3 2.5 1
12 48 F 2.3 1 0.2 1
13 64 F 3.6 3 3.4 1
14 49 F 2.1 3 3.5 1
15 42 F 2.7 3 3.7 1
16 68 F 2.5 2 1.7 1
17 58 F 2.6 3 4 1
18 49 F 2.8 3 4.2 2
19 45 M 3.5 2 2 1
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