成人Still病18F-FDG PET/CT影像特点及对疾病活动性的评估价值

Radiographic features of 18F-FDG PET/CT in the assessment of disease activity in adult-onset Still′s disease

目的探讨成人Still病(AOSD)的18F-脱氧葡萄糖(FDG)PET/CT影像表现以及最大标准摄取值(SUVmax)与疾病活动度之间的相关性。方法回顾性分析2015年5月至2018年6月期间南京大学医学院附属鼓楼医院22例[男6例、女16例;年龄19~73(41.5±16.3)岁]AOSD患者的资料,AOSD依据Yamaguchi标准诊断,患者均行18F-FDG PET/CT显像。总结AOSD显像特点,采用Spearman秩相关分析患者淋巴结、脾及骨髓SUVmax与实验室检查指标及临床活动度评分之间的相关性。结果18F-FDG PET/CT在22例AOSD患者的诊断流程中均有贡献。21例患者(95.5%)有淋巴结18F-FDG摄取增高,22例脾(100%)及骨髓(100%)均有18F-FDG摄取增高。此外,6例患者双侧肩关节(27.3%)、9例双侧颌下腺(40.9%)及7例双侧腮腺(31.8%)有18F-FDG摄取增高。AOSD患者淋巴结SUVmax与C反应蛋白(CRP)、血红细胞沉降率(ESR)呈正相关(rs值:0.622、0.538,均P<0.05),脾SUVmax与CRP、ESR呈正相关(rs值:0.543、0.475,均P<0.05),骨髓SUVmax与CRP、血浆中性粒细胞百分比呈正相关(rs值:0.497、0.431,均P<0.05)。然而,淋巴结、脾及骨髓SUVmax与临床活动度评分均无相关性(rs值:0.008、0.102、0.210,均P>0.05)。结论18F-FDG PET/CT能够在AOSD鉴别诊断及显示病变累及范围方面提供有价值的信息,在AOSD诊断流程中发挥重要作用。同时,SUVmax可能会在反映AOSD疾病活动度方面提供帮助,但仍需要大样本前瞻性研究结果支持。

Objective To investigate the characteristic findings of 18F-fluorodeoxyglucose(FDG)PET/CT in patients with adult-onset Still′s disease(AOSD)and the correlation between the maximum standardized uptake value(SUVmax)and clinical disease activity score as well as laboratory data.Methods Twenty-two patients(6 males,16 females,age range:19-73(41.5±16.3)years)with AOSD according to criteria set by Yamaguchi between May 2015 and June 2018 in Nanjing Drum Tower Hospital were recruited in the retrospective study.The characteristic findings of 18F-FDG PET/CT in the consecutive AOSD patients were evaluated.The correlation between SUVmax and clinical disease activity score as well as laboratory data was assessed with Spearman rank correlation analysis.Results PET/CT results contributed to the diagnosis of AOSD in all the 22 patients(100%).The accumulation of 18F-FDG was showed in lymph nodes of 21 patients(95.5%),and the spleen and bone marrow uptake were observed in all the 22 patients(100%).Besides,18F-FDG uptake was found in shoulder joint(n=6,27.3%),submaxillary glands(n=9,40.9%)and parotid glands(n=7,31.8%).The SUVmax of lymph nodes were significantly correlated with the C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)(rs values:0.622,0.538,both P<0.05).The SUVmax of spleen was significantly correlated with CRP and ESR levels(rs values:0.543,0.475,both P<0.05).The SUVmax of bone marrow was significantly correlated with the level of CRP and neutrophils(%)(rs values:0.497,0.431,both P<0.05).However,there was no correlation between the SUVmax and clinical disease activity score(rs values:0.008,0.102,0.210,all P>0.05).Conclusions Characteristics findings of 18F-FDG PET/CT imaging can provide useful information for differential diagnosis as well as extent assessment for AOSD,and play an important role in the diagnosis process of AOSD.18F-FDG PET/CT scan may be a helpful imaging technique for evaluation of disease activity in patients with AOSD but prospective study with large cohort of individuals are needed.