|关键词||不明原因发热 噬血细胞性淋巴组织增生症 正电子发射计算机断层扫描|
|其他题名||18F-FDG PET/CT used for diagnosing fever of unknown origin and hemophagocytic lymphohistiocytosis|
目的：探讨18F-FDG PET/CT对不明原因发热（fever of unknown origin，FUO）病因诊断的价值，分析并发噬血细胞性淋巴组织增生症（hemophagocytic lymphohistiocytosis，HLH）时有无特征性影像表现。
方法：回顾性分析156例FUO患者的18F-FDG PET/CT资料，其中包括35例合并HLH者。影像分析包括观察全身有无异常结构改变或FDG摄取，发现病灶时判断病变性质；测量肝脏、脾脏、骨髓及脑的最大标准摄取值(Maximum standard uptake value,SUVmax)。依据最终临床诊断分析FUO的病因及并发HLH的几率；评价18F-FDG PET/CT对FUO病因诊断效能；分析合并与未合并HLH的FUO患者的肝、脾、骨髓、脑皮质及基底节FDG摄取有无变化。
Objective: To investigate the etiologic diagnostic value of 18F-FDG PET/CT in patients with fever of unknown origin (FUO) and identify acteristic imaging feature of hemophagocytic lymphohistiocytosis (HLH) accompanied with FUO.
Method: Data from 156 patients with FUO who underwent 18F- FDG PET/CT were retrospectively studied, 35 of them were accompanied with HLH. PET/CT image was interpreted in each patient, according to the structural or metabolic changes as well as the clinical information. Maximum standard uptake value (SUVmax) was measured in liver, spleen, bone marrow and brain, respectively. The etiology of FUO was analyzed and incidence of HLH was calculated, according to the final clinical diagnosis. Differential diagnostic efficiency of 18F- FDG PET/CT was accessed. FDG uptake in liver, spleen, bone marrow, cerebral cortex and basal ganglia was compared among HLH, FUO and control group.
Result: In this study, FUO was commonly seen in the state of infectious disease, connective tissue disease, malignant tumor, etc. Firstly, 18F-FDG PET/CT yielded relatively high diagnostic value in excluding malignancy, with sensitivity of 90.0%, specificity of 96.8%, and accuracy of 95.5%, respectively. PET/CT was positive in 92.5% of infectious disease and 94.1% of connective tissue disease, respectively. Incidence of FUO accompanied with HLH was 22.4% in this group. Increased FDG uptake in spleen and bone marrow and decreased
FDG uptake in brain was figured in FUO patients accompanied with or without HLH. However, more significant decreased uptake in cerebral cortex was found in FUO patients with HLH than those without HLH (t=-2.775, P=0.006).
Conclusion: In the clinical diagnostic procedure of FUO, 18F-FDG PET/CT is helpful in etiologic differential diagnosis, as well as in surveillance of HLH.
|王璐. 18F-FDG PET/CT用于诊断不明原因发热与噬血细胞性淋巴组织增生症[D]. 北京大学第二临床医学院. 北京大学,2016.|