- 期刊
False Positive Result of Dual Phase 18F-FDG PET/CT Imaging in a Patient with Xanthogranulomatous Cholecystitis
黃色肉芽腫性膽囊炎之雙相氟－18-去氧葡萄糖正子斷層造影：偽陽性病例報告
摘要
一位61歲男性病患因爲右上腹部疼痛與肝功能指數升高至本院求診。腹部斷層掃描顯示－腫瘤位於肝臟左葉並侵犯鄰近的肝臟與腹膜，伴隨腫瘤指數CA19-9升高，因此懷疑此腫瘤有可能是膽囊癌。雙相氟－18-去氧葡萄糖正子斷層造影顯示此腫瘤有異常之FDG攝取，第一次標準攝取值(SUV)爲11.2，第斗次標率攝取值(SUV)稍微增高爲11.7，故判讀為惡性腫瘤。隨後此病患接受開刀治療，病理報告顯示此腫瘤是黃色肉芽腫性膽囊炎。黃色肉芽腫性膽囊炎是一種少見的破壞性膽囊發炎病變，是膽囊慢性炎症的特殊類型，與惡性膽囊癌極爲相似，但鮮少侵犯鄰近器官，此病變只能經病理檢查後才能確定診斷。這個個案呈現罕見黃色肉芽腫性膽囊炎伴隨肝臟、腹膜與橫結腸之侵犯，且造成偽陽性氟－18-去氟葡萄糖正子斷層造影。
並列摘要
A 61-year-old man visited our hospital due to a history of right upper abdominal pain and abnormally elevated liver function test. An abdominal CT scan showed a tumor in the segment 4 of liver. Either gall bladder cancer with invasion to liver and peritoneum or hepatocellular carcinoma (HCC) was impressed. According to the imaging findings and elevated CA 19-9 level (43.7 U/mL), gallbladder cancer was considered first. Dual phase fluorine-18-fluorodeoxyglucose (18F-FDG) combined positron emission tomography (PET)/computed tomography (CT) imaging revealed abnormal metabolic activity in the lesion with a high maximal standardized uptake value of 11.2 in early scan and slightly increased to 11.7 in delayed scan. The result of PET/CT was compatible with gallbladder cancer. He received operation and was diagnosed by histopathological examination as having a xanthogranulomatous cholecystitis (XGC). XGC is a destructive inflammatory disease of the gallbladder, mimicking an advanced gallbladder carcinoma and rarely involving adjacent organs. The diagnosis is usually possible only after pathological examination. We reported a case of XCG with uncommon pattern of invading liver, omentum and transverse colon and caused false positive results on 18F-FDG PET/CT imaging. Therefore, 18F-FDG PET/CT results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesion.
延伸閱讀
- Lin, L. F., Wang, S. Y., Tsai, Y. J., Shueng, P. W., Lo, C. Y., Hsu, Y. P., & Shiau, Y. C. (2012). 氟-18去氧葡萄糖正子電腦斷層造影偵測早期華特氏壺腹癌術後肝轉移. 核子醫學暨分子影像雜誌, 25(1), 39-43+vii. https://www.airitilibrary.com/Article/Detail?DocID=P20141124001-201203-201905270007-201905270007-39-43+vii
- Kuo, Y. S., Lein, H. H., Huang, S. H., Sun, C. M., & Hsieh, P. J. (2016). 胰臟旁與膽道結核在氟化去氧葡萄糖正子電腦斷層造影中仿似胰臟腫瘤：病例報告和診斷方法之文獻回顧. 核子醫學暨分子影像雜誌, 29(1), 23-29. https://doi.org/10.6332/ANMMI.2901.003
- Tsai, S. C., Yang, C. C., Chou, D. A., Wu, H. S., & Kuo, C. L. (2005). 以無嗎啡介入之肝膽掃描診斷蓄膿性膽石性膽囊炎：一個偽陰性病例報告. 核子醫學雜誌, 18(2), 117-120. https://doi.org/10.6332/ANMS.1802.007
- 黃鶴聯（2014）。發展[18F]FBuEA與[123I]IOFA作為大鼠神經膠質瘤 與膽管癌之造影〔博士論文，國立清華大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0016-2912201413541321
- Wang, Y. C., Kao, T. W., Lu, K. C., & Chu, P. L. (2018). 次發性副甲狀腺功能亢進的腹膜透析病人以金黃色條紋小腸表現之鈣化性腹膜炎：個案報告. 輔仁醫學期刊, 16(3), 147-152. https://doi.org/10.3966/181020932018091603006