Left Pulmonary and Mediastinal Lymphnode Tuberculosis Misdiagnosed as Lymphatic Metastasis from Lung Cancer on 18-fluoro-deoxy-glucose-positron emission tomography_West China Medical Journal

Authors：

LIU Yanbin , YANG Yanjia , LI Yaxin ,  LIU Kai

Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Kai, Email: dr_liuyanbin@yahoo.com.cn

Keywords：

结核; 正电子发射断层扫描; 18氟-脱氧葡萄糖

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目的　探讨结核病在18氟-脱氧葡萄糖（18F-FDG）正电子发射断层扫描术（PET）中的影像学表现，提高对PET/CT在肺部包块诊断作用的认识，减少误诊。方法　回顾分析2010年3月收治的1例肺结核合并纵隔淋巴结结核病患者的误诊及诊断治疗经过，分析误诊原因并总结诊治经验，结合文献复习肺部包块在PET/CT中的表现及临床特点。结果　患者为肺部包块伴纵隔淋巴结包块，胸部CT提示肺癌伴纵隔淋巴结转移，PET/CT也考虑左肺下叶肺癌伴淋巴结转移。最后经纵隔镜淋巴结活检确诊结核，并抗结核治疗好转。结论　结核等感染性疾病常可导致18F-FDG的摄取增加而造成PET/CT阳性结果，因此在18F-FDG PET/CT呈现阳性结果时须注意鉴别病变良恶性，其中高标准摄入值包块尤其需要注意与结核病相鉴别。

Citation： LIU Yanbin,YANG Yanjia,LI Yaxin,LIU Kai. Left Pulmonary and Mediastinal Lymphnode Tuberculosis Misdiagnosed as Lymphatic Metastasis from Lung Cancer on 18-fluoro-deoxy-glucose-positron emission tomography. West China Medical Journal, 2012, 27(10): 1474-1477. doi: Copy

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14.	Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules[J]. J Clin Oncol, 1998, 16(3): 1075-1084.
15.	Hara T, Kosaka N, Suzuki T, et al. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study[J]. Chest, 2003, 124(3): 893-901.
16.	赵军, 林祥通, 管一晖, 等. 结核病18F-FDG PET图像表现的多样性[J]. 中华核医学杂志, 2003, 23(s1):37-39.
17.	Kim IJ, Lee JS, Kim SJ, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity[J]. Eur J Nucl Med Mol Imaging, 2008, 35(4): 808-814.

1. 　Spiro SG, Niederman M, Yew WW, et al. Year in review 2009: respiratory infections, tuberculosis, pleural diseases and lung cancer[J]. Respirology, 2010, 15(3): 562-572.
2. 　杨明, 储成凤, 刘斌, 等. 非钙化型肺结核瘤的动态CT增强研究[J]. 东南大学学报(医学版), 2006, 25(6): 451-453.
3. 　Tateishi U, Kusumoto M, Akiyama Y, et al. Role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma[J]. Chest, 2002, 122(4): 1280-1284.
4. 　Christensen JA, Nathan MA, Mullan BP, et al. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT[J]. AJR Am J Roentgenol, 2006, 187(5): 1361-1367.
5. 　Zhuang H, Alavi A. 18 Fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation[J]. Semin Nucl Med, 2002, 32(1): 47-59.
6. 　Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients[J]. Eur J Nucl Med, 1996, 23(10): 1409-1415.
7. 　Forstrom LA, Dunn WL, Mullan BP, et al. Biodistribution and dosimetry of [(18)F]fluorodeoxyglucose labelled leukocytes in normal human subjects[J]. Nucl Med Commun, 2002, 23(8): 721-725.
8. 　Goo JM, Im JG, Do KH, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases[J]. Radiology, 2000, 216(1): 117-121.
9. 　Kostakoglu L, Agress H Jr, Goldsmith SJ. Clinical role of FDG PET in evalutaion of cancer patients[J]. Radiographics, 2003, 23(2): 315-340.
10. 　Chang JM, Lee HJ, Goo JM, et al. False positive and false negative FDG-PET scans in various thoracic diseases[J]. Korean J Radiol, 2006, 7(1): 57-69.
11. 　苗积生, 刘进军, 吴吉勇, 等. 肺良性病变18F-FDG符合线路SPECT显像[J]. 中华核医学杂志, 2001, 21(1): 12-13.
12. 　屈婉莹, 周前. 提高PET显像在肺癌诊治中的应用水平[J]. 中华核医学杂志, 2003, 23(1): 5-7.
13. 　Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis[J]. JAMA, 2001, 285(7): 914-924.
14. 　Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules[J]. J Clin Oncol, 1998, 16(3): 1075-1084.
15. 　Hara T, Kosaka N, Suzuki T, et al. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study[J]. Chest, 2003, 124(3): 893-901.
16. 　赵军, 林祥通, 管一晖, 等. 结核病18F-FDG PET图像表现的多样性[J]. 中华核医学杂志, 2003, 23(s1):37-39.
17. 　Kim IJ, Lee JS, Kim SJ, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity[J]. Eur J Nucl Med Mol Imaging, 2008, 35(4): 808-814.

West China Medical Journal

Left Pulmonary and Mediastinal Lymphnode Tuberculosis Misdiagnosed as Lymphatic Metastasis from Lung Cancer on 18-fluoro-deoxy-glucose-positron emission tomography

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