Li Qiang, Li Yuan, Yuan Hui, Yang Fujun, Huang Yan, Song Xiao, Jiang Lei
Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
Jpn J Radiol. 2023 Mar;41(3):312-321. doi: 10.1007/s11604-022-01351-5. Epub 2022 Oct 13.
Solitary and solid pulmonary tuberculosis (PTB) and non-small cell lung cancer (NSCLC) can present overlapping imaging features, causing diagnostic dilemmas. Hence, this study aimed to identify positron emission tomography (PET) morphological features derived from fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) images for a better differential diagnosis.
Clinical records and F-FDG PET/CT images of 175 patients confirmed with PTB and 311 patients with NSCLC were retrospectively reviewed. Parameters including patient demographics, PET-derived morphological features and metabolic parameters, and CT-derived morphological features were investigated. Logistic regression analysis was performed to assess the independent predictive factors associated with PTB.
PTB presented with more heterogeneous glucometabolism than NSCLC in PET imaging (50% vs 17%, P < 0.05), especially in lesions with a maximum diameter < 30 mm (39% vs. 5%, P < 0.05). NSCLC usually showed centric hypometabolism, whereas PTB more frequently presented with an eccentric metabolic pattern, mainly including piebald, half-side, lesser curvature, and greater curvature shapes. Multivariate logistic regression identified that glucometabolic heterogeneity, eccentric hypometabolism, smaller lesion size, calcification, satellite lesions, and higher CT value of the hypometabolic area were independently diagnostic factors for PTB.
Morphological features derived from F-FDG PET images helped distinguish solitary and solid PTB from NSCLC.
孤立性实性肺结核（PTB）与非小细胞肺癌（NSCLC）可呈现重叠的影像特征，导致诊断困境。因此，本研究旨在识别源自氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）图像的正电子发射断层扫描（PET）形态学特征，以实现更好的鉴别诊断。
回顾性分析175例确诊为PTB患者和311例NSCLC患者的临床记录及F-FDG PET/CT图像。研究参数包括患者人口统计学信息、PET衍生的形态学特征和代谢参数以及CT衍生的形态学特征。进行逻辑回归分析以评估与PTB相关的独立预测因素。
在PET成像中，PTB的葡萄糖代谢比NSCLC更不均匀（50%对17%，P<0.05），尤其是在最大直径<30 mm的病变中（39%对5%，P<0.05）。NSCLC通常表现为中心低代谢，而PTB更常呈现偏心代谢模式，主要包括花斑状、半侧、小弯和大弯形状。多因素逻辑回归分析确定，葡萄糖代谢不均匀性、偏心低代谢、病变较小、钙化、卫星灶以及低代谢区较高的CT值是PTB的独立诊断因素。
F-FDG PET图像衍生的形态学特征有助于鉴别孤立性实性PTB与NSCLC。
