^(18)F-FDG PET在探查临床“不明原因发热”中的应用

Application of ^(18)F-FDG PET study in FUO patients

目的:分析18F-FDGPET显像在临床寻找“不明原因发热”原因的应用价值。方法:24例符合“不明原因发热”诊断标准的住院病人,进行18F-FDGPET全身显像,结果提供给临床,帮助作病因诊断。结果:24例病人可分为3种情况:①18F-FDGPET显像阴性或不能提供临床诊断有效信息;②显像结果提供了有效信息,帮助临床诊断;③18F-FDGPET显像高度怀疑为恶性病灶。18F-FDGPET显像有助于临床诊断“不明原因发热”病因的阳性率可达58.3%(14?24),其中明确为恶性病变的占71.4%(10?14),包括淋巴瘤3例,白血病2例。良性病变28.6%(4?14),以感染和炎症为主。结论:18F-FDGPET显像有助于临床诊断“不明原因发热”的诊断。

Objective： To assess the clinical value of ^18F-FDG PET imaging in diagnosing fever of unknown origin（FUO）. Methods： Twenty-four in-patients diagnosed as FUO were enrolled in this study. They met the diagnostic criteria of FUO as fever higher than 38.3℃ documented on several occasions and persisting without diagnosis for at least 3 weeks in spite of investigation for at least 1 week. Whole body ^18F-FDG PET was performed in these patients. Final diagnosis was made when patients were discharged. Results： Twenty-four patients were divided into three groups according to the results of their ^18F- FDG PET imaging and the final diagnosis. ①^18F-FDG PET imaging from 10 cases can＇t provide useful information to clinical diagnosis. These included 8 cases of negative ^18F-FDG PET imaging. Among them, 1 case was diagnosed as collagen disease, 1 was vascular disease, 2 cases were disease of connective tissue and another 4 cases had no final diagnosis. 2 cases had positive imaging results but without clinical specificity, including 1 case with high metabolism in bilateral hilar regions and another one with uniform hyperplasia in bone marrow, Neither of them had final diagnosis; ②four cases got useful clinical information from ^18F-FDG PET imaging. These included hyper-metabolism lesions in bone marrow, detection of lymph nodes in neck and local hyper-metabolic lesions in liver. Final diagnosis were hepatic hemangioma with infection, myelodysplastic syndrome, myeloid leukemia, respectively; ③ten cases were strongly suspected as malignant diseases, including 1 case of colon leiomyosarcoma, 1 case of colon cancer and 1 case of nasopharyngeal cancer. 2 cases with multiple bone metastatic lesions with unknown origin. Five cases had remarkable F-FDG uptake in abdomen, among them, 3 cases were diagnosed as lymphoma and confirmed by pathology, 1 case was lymphadenitis and another case had inflammation of gallbladder fossa. Conclusion： ^18F-FDG PET imaging can make contribution to clinical diagnosis of FUO. The sensitivity was 58.3%（14/24）. Among them, malignant disease was as high as 71.4%（10/14） due to the case number of hematological malignant disease in the studied cohort.