18^F-FDG符合线路显像探测不明原因发热病灶的临床价值

Clinical value of 18^F-FDG coincidence imaging for patients with fever of unknown origin

目的探讨18^F-脱氧葡萄糖（FDG）双探头符合线路显像探测不明原因发热病灶的临床价值。方法对58例不明原因发热患者（体温超过38．3℃，发热持续时间至少3周）的18^F—FDG符合线路显像资料进行回顾性分析，将18^F—FDG符合线路显像结果与病理检查和随访结果进行比较；用感兴趣区（ROI）技术计算良恶性病变／正常组织放射性（L／B）比值，组间L／B比值比较采用t检验。结果48例（83％）患者有异常的18^F—FDG浓聚，其中20例为恶性病变，23例为感染或其他良性病变，5例未能确诊。58例中，10例（17％）符合线路显像阴性，其中4例为感染性疾病（2例尿路感染，2例淋巴结炎），3例为结缔组织和胶原病（1例风湿病，1例成人still病，1例系统性红斑狼疮），3例未能确诊。良恶性病灶的L／B比值分别为1．93±0．39和3．58±1．01，差异有统计学意义（t=6．955，P〈0．001）。结论符合线路显像可为探查不明原因发热患者的病灶提供有价值的临床信息。

Objective The aim of this study was to assess the clinical value of 18^F-fluorodeoxyglucose （FDG） coincidence imaging in the diagnosis of fever of unknown origin （FUO）. Methods Fifty-eight patients with FUO （temperature 〉 38.3℃ , fever more than 3 weeks） underwent SPECT imaging with 18^F- FDG. Region of interest （ROI） was drawn over the lesions （L） and eontralateral or adjacent normal tissue （B）. The radioactivity ratio L/B was calculated for both benign and malignant pathologies and compared by t test. Results In 48 patients （ 83 % ） , at least one site of abnormal 18^F-FDG accumulation on SPECT was found, which led to the final diagnosis of malignant disease in 20 patients, and infectious or other benign disease in 23 patients. Five patients remained unknown. Four in 10 （ 17% ） cases with negative 18^F-FDG SPECT were later proven as infectious disease （2 with urinary tract infection, 2 with lymphadenitis） ; 3 were found to have connective tissue and collagen disease （1 with rheumatism, 1 with adult onset still＇s disease, 1 with systemic lupus erythematosus） ; while the last 3 remained unknown. The L/B ratio of benign foci was 1.93 ± 0. 39, and that of malignant foci was 3.58 ±1.01 （ statistically significant difference with t = 6. 955, P 〈 0. 001 ）. Conclusion 18^F-FDG coincidence imaging is valuable in the diagnosis for FUO.