^(18)F脱氧葡萄糖-PET/CT在不明原因发热中的诊断价值综述

Value of ^(18)F fluorodeoxyglueose-positron emission tomography/computed tomography in the diagnosis of fever of unknown origin

不明原因发热(fever of unknown origin,FUO)定义为病程超过3周,体温>38.3℃,住院1周仍然诊断未明的发热。FUO的病因大致可分为感染、肿瘤、非感染炎性疾病及其他。近年来FUO病因的疾病谱发生变化,感染和肿瘤性疾病所占比例下降,而非感染性炎性疾病和诊断不明的比例增高。18氟脱氧葡萄糖(^(18)F FDG)不仅可在肿瘤细胞中聚积,同样可聚积于其他感染或非感染性炎症细胞中,故18氟脱氧葡萄糖正电子发射断层显像/计算机体层扫描(^(18)F FDG-PET/CT)逐渐用于FUO的病因诊断。PET/CT对FUO诊断的敏感性和特异性分别为67%~100%和33%~97%,但由于FUO分类标准不统一、病例来源不同、研究类型不同,要对这些研究进行综合分析较困难,总体来说PET/CT可帮助45%~67%的FUO患者确诊。推荐对淋巴结肿大、血红蛋白降低、CRP升高的FUO患者早期进行PET/CT检查,有助于诊断及鉴别诊断。

Fever of unknown origin （FUO） is defined as fever of 38.3 0（2 or higher, lasting more than 3 weeks, and undiagnosed at 1 week after admission. The etiology of FUO can be divided into infection, tumor, non-infectious inflammatory diseases and miscellaneous. The spectrum of diseases has changed greatly. The proportion of infections and neoplastic diseases decreased, while non-infectious inflammatory diseases and undiagnosed diseases accounted for the increase in the proportion. 18F fluorodeoxyglucose （FDG） can not only accumulate in tumor cells, but also in other infectious or non-infectious inflammatory cells, thus ^18F FDG- positron emission tomography/computed tomography （PET/CT） has been used in the etiological diagnosis of FUO. The sensitivity and specificity of PET/CT for FUO are 67%-100% and 33%-97% respectively. While it is difficult to make a comprehensive analysis of these studies due to the distinct FUO classification standard, case source, types of researches and so on. Generally PET/CT can help determine diagnosis in 45%-67% of patients. PET/CT can be recommended for patients with FUO who have adenopathy, low hemoglobin or increased CRP in early stage as an examination used for diagnosis and differential diagnosis.