正电子发射计算机断层显像-CT在肺结核活动性评价中的价值

影像学一直是结核病活动性评价的重要方法之一,¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像(PET)-CT能反映细胞的葡萄糖代谢程度,可以从代谢角度结合形态学层面综合评价结核病的活动性。¹⁸F-FDG PET-CT有可能识别出结核分枝杆菌潜伏感染者中处于亚临床状态的患者。陈旧性结核病灶无¹⁸F-FDG摄取的患者复发风险低。¹⁸F-FDG PET-CT能早期评估抗结核治疗效果,标准化摄取值(standard uptake value,SUV)降低表明治疗效果好,无¹⁸F-FDG摄取可能提示治疗达到了杀灭结核分枝杆菌的效果,¹⁸F-FDG PET-CT有望作为抗结核新药疗效评价及确定治疗时间截点的检查方法。本文中,笔者即对¹⁸F-FDG PET-CT识别结核分枝杆菌潜伏感染者,以及评价结核病患者抗结核治疗疗效、预后等方面的应用与价值进行综述。

Value of PET-CT in the evaluation of pulmonary tuberculosis activity

Imaging plays an important role in the evaluation of tuberculosis activity. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET-CT provides both metabolic and morphology information of tuberculosis. ¹⁸F-FDG-PET-CT can indicate the degree of glucose metabolism of cells, which could be used to comprehensively evaluate the activity of tuberculosis combined with morphological features. ¹⁸F-FDG-PET-CT may identify subclinical pulmonary tuberculosis in patients with latent tuberculosis infection. Patients with obsolete pulmonary tuberculosis without ¹⁸F-FDG uptake have low risk of recurrence. ¹⁸F-FDG-PET-CT can early evaluate the effect of anti-tuberculosis treatment, the decrease of standard uptake value (SUV) indicates effective treatment, and no ¹⁸F-FDG uptake may indicate that the Mycobacterium tuberculosis have been killed because of the treatment. ¹⁸F-FDG PET-CT may be used as an examination method to evaluate the efficacy of new anti-tuberculosis drugs and determine the endpoint of treatment time. This paper reviews the application and value of ¹⁸F-FDG PET-CT in identifying latent tuberculosis infection and evaluating the efficacy and prognosis of anti-tuberculous therapy in tuberculosis patients.