18F-FDG Positron-Emission Tomography/Computed Tomography Findings of Radiographic Lesions Suggesting Old Healed Pulmonary Tuberculosis and High-risk Signs of Predicting Recurrence: A Retrospective Study
18F-FDG Positron-Emission Tomography/Computed Tomography Findings of Radiographic Lesions Suggesting Old Healed Pulmonary Tuberculosis and High-risk Signs of Predicting Recurrence: A Retrospective Study
复制标题
18F-FDG 正电子发射断层扫描/计算机断层扫描的放射学病变结果提示旧愈肺结核和预测复发的高风险迹象：一项回顾性研究
作者：
Yuanyuan Ji;C. Shao;Yong;Guangrui Shao;Jingsong Zheng
肺结核（PTB）是一种世界范围内常见的传染病，具有很高的死亡率和发病率，特别是在发展中国家。本研究分析了影像学病变提示陈旧性肺结核（OHPTB）的肿瘤患者的PET/CT表现，并进行了影像学随访，以发现和验证可能预测结核复发的PET/CT征象。对肿瘤患者进行回顾性分析。这些患者于2010年至2018年在我们中心接受了18 F-FDG PET/CT。通过PET/CT或CT对陈旧病灶的形态学变化进行随访，确认结核复发。最终研究共纳入238例具有完整病史的患者，22例患者发生OHPTB复发。我们发现复发组的PET/CT肺结核SUVmax显著高于未复发组[5.00（3.40，7.30）vs. 1.10（0.80，1.30），P < 0.001]。ROC曲线显示良好的区分度，AUC为0.980，确定的截断SUVmax值为2.15（敏感性为90.5%，特异性为97.2%，阳性预测值为76.0%，阴性预测值为99.1%）。肿瘤和抗肿瘤治疗均可导致患者免疫功能低下，并可能进一步导致OHPTB复发。18F-FDG PET阳性显像可预测OHPPT的复发。虽然可能存在假阳性，但18F-FDG PET可以大大缩小监测范围。影像学阴性对排除结核复发的可能性具有较高的可靠性。PET/CT在OHPTB并发结核病的治疗中具有重要的临床意义。
Pulmonary tuberculosis (PTB) is a common worldwide infection with high mortality and morbidity, especially in developing countries. This study analyzed PET/CT findings in tumor patients with radiographic lesions suggesting old healed pulmonary tuberculosis (OHPTB) and imaging follow-up to find and verify PET/CT signs that may predict tuberculosis recurrence. A retrospective analysis of the tumor patients was carried out. These patients underwent 18F-FDG PET/CT in our center from 2010 to 2018. Confirmation of tuberculosis recurrence was obtained by follow-up of morphological changes in old lesions by PET/CT or CT. In total, 238 patients with a complete medical history were included in the final study, and 22 patients experienced OHPTB recurrence. We found that the SUVmax of tuberculosis in PET/CT was significantly increased in the recurrence group compared to the non-recurrence group [5.00 (3.40, 7.30) vs. 1.10 (0.80, 1.30), P < 0.001]. The ROC curve showed good discrimination, with an AUC of 0.980, and a cut-off SUVmax value of 2.15 was identified (the sensitivity was 90.5%, the specificity was 97.2%, the positive predictive value was 76.0%, and the negative predictive value was 99.1%). Both the tumor and the anti-tumor treatment can cause the patient to be immunocompromised and might further cause the recurrence of OHPTB. Positive imaging on 18F-FDG PET can predict the recurrence of OHPPT. Although there might be a false positive, 18F-FDG PET can greatly narrow the monitoring range. A negative result on imaging has high reliability for eliminating the possibility of tuberculosis recurrence. PET/CT has important clinical significance in tuberculosis management in patients with concurrent OHPTB.