^(18)F-FDGPET/CT在风湿性疾病的初步应用

Preliminary Application of ^(18)F-FDG PET/CT in Rheumatic Diseases

目的目前X线、CT、MRI和超声对风湿性疾病大多表现为局部部位成像,难以显示风湿性疾病全身范围的疾病全貌,本文旨在探讨风湿性疾病18F-氟脱氧葡萄糖(18F-FDG)PET/CT显像特征及其初步应用价值。资料与方法回顾性分析经临床证实的18例风湿性疾病患者的临床资料及18F-FDG PET/CT显像特征,观察病灶18F-FDG摄取情况。结果 18例风湿性疾病患者中,类风湿关节炎(RA)4例,多发性大动脉炎(TA)5例,成人Still病(AOSD)2例,风湿性多肌痛(PMR)1例,强直性脊柱炎(AS)6例。PET/CT表现:RA表现为肩关节、肘关节、髋关节、腕关节等大关节及部分掌指关节等多个关节FDG摄取增高,CT未见骨质异常;TA表现为主动脉及其主要分支血管壁FDG弥漫性摄取增高,CT示多发动脉血管壁不均匀增厚、局部伴点条状钙化,其中1例规律治疗1年后,FDG摄取明显减低,其左侧锁骨下动脉SUVmax由6.8下降到3.2;AOSD表现为脾脏及骨髓FDG弥漫性摄取增高,CT未见脾脏及骨质异常;PMR表现为寰枢关节、肩关节、胸锁关节、髋关节、耻骨联合、坐骨结节以及腰椎棘突周围FDG摄取异常增高;6例AS仅有1例表现为左侧髋臼关节面骨质增生硬化伴FDG摄取增高,CT均表现为脊柱多发椎体骨质增生硬化,呈"竹节样"改变,FDG代谢基本正常。结论 18F-FDG PET/CT显像有助于风湿性疾病的诊断,准确显示病变范围,反映其活动性,并可用于疗效评估。

Purpose Current conventional imaging methods X-ray, CT, MRI and ultrasound for rheumatic diseases are mostly local site imaging, rather than systemic display, thus is difficult to show the whole picture of the diseases, this study aims to explore the 18F-FDG PET/CT findings of rheumatic diseases and its preliminary clinical value. Materials and Methods 18F-FDG PET/CT imaging findings and clinical data of 18 patients with rheumatic diseases confirmed by clinical diagnosis were retrospectively analyzed, and 18F-FDG uptake of lesions was observed. Results Among all the 18 patients with rheumatic diseases： four cases were with rheumatoid arthritis（RA）, 5 cases with takayasu arteritis（TA）, 2 cases with adult onset Still＇s disease（AOSD）, 1 case with polymyalgia rheumatica（PMR） and 6 cases with ankylosing spondylitis（AS）. Findings of PET/CT： RA showed increased FDG uptake in multiple bigger joints such as shoulder joint, elbow, hip, wrist joint, and part palm finger joints, with no bone abnormalities in CT; TA displayed as diffusely increased uptake of FDG the aorta and its major branches vascular wall while CT showed multiple arterial wall irregular thickening with dot or strip calcification, and in one case, the vascular wall FDG uptake decreased obviously after one year treatment, the SUVmax of left clavicle dropped from 6.8 to 3.2; AOSD showed diffusely increased FDG uptake in spleen and bone marrow, while CT had no obvious spleen and bone abnormalities; PMR showed increased uptake of FDG in the atlantoaxial joint, shoulder joint, sternoclavicular joint, hip joint, pubic symphysis, ischial tuberosity and lesions around lumbar spinous process; only 1 case of 6 AS patients showed left acetabular articular surface hyperplasia and sclerosis with increased FDG uptake, while CT showed spinal multiple vertebral bone hyperplasia and sclerosis as ＂bamboo＂ change in all of 6 AS cases, with normal FDG metabolism. Conclusion 18F-FDG PET/CT is helpful for the diagnosis of rheumatic diseases, because it can be used to display the lesion extent, reflect its activity, and also to evaluate the effect of the treatments.