【摘要】 目的探讨肺部肿瘤患者纵隔内良性淋巴结的PET/CT特征。方法分析术前全身18 F-FDG PET/CT检查发现肺内病灶、并接受根治性手术及系统淋巴结清扫术的73例患者,其中恶性肿瘤61例,良性病变12例,记录淋巴结短径、CT值、SUVmax等,对纵隔内淋巴结进行定性诊断,并与术后病理结果相对照。结果肺部良恶性病变患者纵隔内良性淋巴结的分布情况相似。PET/CT综合分析法对纵隔内良性淋巴结诊断的准确率较高(561/574,97.74%);13个淋巴结误诊为恶性,主要原因在于淋巴结肉芽肿性炎及肺癌伴发感染造成的淋巴结的反应性增生,后者SUVmax低于淋巴结肉芽肿性炎(P=0.27)。在SUVmax≥2.5的纵隔内良性淋巴结中,其短径(X1)与SUVmax(Y)关系密切(P<0.05),回归方程为Y=0.354 X1;1例中低分化鳞癌所造成的反应性增生淋巴结自肺门沿淋巴引流路径分布。结论 PET/CT综合分析法诊断对纵隔内良性淋巴结的准确率较高;对SUVmax≥2.5的纵隔内淋巴结,应主要根据淋巴结的短径加以判断,短径<1.0cm为良性淋巴结;肺癌造成的反应性增生淋巴结的分布与肺癌淋巴结转移路径相似。更多还原

【Abstract】 Objective To explore PET/CT features of benign mediastinal lymph nodes in patients with lung lesions. Methods Data of 73patients with lung lesions,including 61with malignant lung tumors and 12with benign lung lesions who underwent preoperative whole body 18F-FDG PET/CT and radical resection of lung lesions and lymph node system operation were analyzed.The short diameter,CT value and SUVmax of lymph nodes were recorded,then the lymph nodes were qualitative diagnosed using comprehensive PET/CT analysis and compared with pathological findings.Results Benign mediastinal lymph nodes distributed similarly in patients of benign and malignant lung lesions.The diagnostic accuracy of comprehensive PET/CT analysis for benign mediastinal lymph nodes was 97.74%(561/574),while 13lymph nodes were misdiagnosed as malignant ones,mainly for granulomatous inflammation and lung malignancies associated with infection caused by reactively mediastinal lymph nodes hyperplasia,and SUVmax of the latter was lower than the former(P= 0.27).Among benign mediastinal lymph nodes with SUVmax≥2.5,the short axis(X1)closely related to SUVmax(Y,P< 0.05,Y=0.354 X1).In 1patient with middle-low differentiated squamous carcinoma,hyperplasia of reactivity lymph nodes distributed along lymph drainage of the lung.Conclusion Comprehensive PET/CT analysis on mediastinal benign lymph nodes has high diagnostic accuracy of benign mediastinal lymph nodes in patients with lung lesions.For lymph nodes with SUVmax ≥2.5,those with short diameter less than 1.0cm should be regarded as benign.Distribution of reactively lymph node hyperplasia caused by lung cancer is similar to lymph node metastasis.更多还原