Song Lan, Miao Hui, Zhu Zhenchen, Zhu Huijuan, Wang Jinhua, Xing Xiaoping, Zhu Zhaohui, Jiang Yuanyuan, Feng Ruie, Xiao Yu, Duan Lian, Sui Xin, Liu Qingxing, Wang Linjie, Chen Shi, Song Wei, Jin Zhengyu, Lu Lin
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
Insights Imaging. 2024 Aug 1;15(1):187. doi: 10.1186/s13244-024-01775-9.
Pulmonary neuroendocrine neoplasms (NENs) are the most frequent cause of ectopic adrenocorticotropic hormone syndrome (EAS); lung infection is common in EAS. An imaging finding of infection in EAS patients can mimic NENs. This retrospective study investigated EAS-associated pulmonary imaging indicators.
Forty-five pulmonary NENs and 27 tumor-like infections from 59 EAS patients (45 NEN and 14 infection patients) were included. Clinical manifestations, CT features, F-FDG, or Ga-DOTATATE-PET/CT images and pathological results were collected.
High-sensitivity C-reactive protein (p < 0.001) and expectoration occurrence (p = 0.04) were higher, and finger oxygen saturation (p = 0.01) was lower in the infection group than the NENs group. Higher-grade NENs were underrepresented in our cohort. Pulmonary NENs were solitary primary tumors, 80% of which were peripheral tumors. Overlying vessel sign and airway involvement were more frequent in the NENs group (p < 0.001). Multifocal (p = 0.001) and peripheral (p = 0.02) lesions, cavity (p < 0.001), spiculation (p = 0.01), pleural retraction (p < 0.001), connection to pulmonary veins (p = 0.02), and distal atelectasis or inflammatory exudation (p = 0.001) were more frequent in the infection group. The median CT value increment between the non-contrast and arterial phases was significantly higher in NENs lesions (p < 0.001). Receiver operating characteristic curve analysis indicated a moderate predictive ability at 48.3 HU of delta CT value (sensitivity, 95.0%; specificity, 54.1%).
Chest CT scans are valuable for localizing and characterizing pulmonary lesions in rare EAS, thereby enabling prompt differential diagnosis and treatment. CRITICAL RELEVANCE STATEMENT: Thin-slice CT images are valuable for the localization and identification of pulmonary ectopic adrenocorticotropic hormone syndrome lesions, leading to prompt differential diagnosis and effective treatment.
Lung tumor-like infections can mimic neuroendocrine neoplasms (NENs) in ectopic adrenocorticotropic hormone syndrome (EAS) patients. NENs are solitary lesions, whereas infections are multiple peripheral pseudotumors each with identifying imaging findings. Typical CT signs aid in localization and creating an appropriate differential diagnosis.
肺神经内分泌肿瘤（NENs）是异位促肾上腺皮质激素综合征（EAS）最常见的病因；肺部感染在EAS中很常见。EAS患者的感染影像学表现可类似NENs。本回顾性研究调查了与EAS相关的肺部影像学指标。
纳入了59例EAS患者（45例NEN患者和14例感染患者）的45个肺NENs和27个肿瘤样感染。收集临床表现、CT特征、F-FDG或Ga-DOTATATE-PET/CT图像及病理结果。
感染组的高敏C反应蛋白（p < 0.001）和咳痰发生率（p = 0.04）较高，而指脉氧饱和度（p = 0.01）低于NENs组。高级别NENs在我们的队列中代表性不足。肺NENs为孤立性原发肿瘤，其中80%为周围型肿瘤。NENs组中血管征和气道受累更常见（p < 0.001）。感染组多灶性（p = 0.001）和周围性（p = 0.02）病变、空洞（p < 0.001）、毛刺征（p = 0.01）、胸膜凹陷（p < 0.001）、与肺静脉相连（p = 0.02）以及远端肺不张或炎性渗出（p = 0.001）更常见。NENs病变在平扫与动脉期之间的CT值中位数增加值显著更高（p < 0.001）。受试者工作特征曲线分析表明，CT值差值为48.3 HU时具有中等预测能力（敏感性为95.0%；特异性为54.1%）。
胸部CT扫描对于罕见EAS中肺部病变的定位和特征性诊断有价值，从而能够迅速进行鉴别诊断和治疗。关键相关性声明：薄层CT图像对于肺部异位促肾上腺皮质激素综合征病变的定位和识别有价值，有助于迅速进行鉴别诊断和有效治疗。
在异位促肾上腺皮质激素综合征（EAS）患者中，肺部肿瘤样感染可类似神经内分泌肿瘤（NENs）。NENs为孤立性病变，而感染为多个周围型假肿瘤，各有其特征性影像学表现。典型的CT征象有助于定位并做出恰当的鉴别诊断。
