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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (5): 853-859. doi: 10.19723/j.issn.1671-167X.2024.05.016

• 论著 • 上一篇    下一篇

18F-FDG PET/CT在风湿免疫病中的应用

钟华1, 李原2, 徐丽玲1, 白明欣1, 苏茵1,*()   

  1. 1. 北京大学人民医院风湿免疫科，风湿病机制及免疫诊断北京市重点实验室，北京 100044
    2. 北京大学人民医院核医学科，北京 100044
  • 收稿日期:2021-07-28 出版日期:2024-10-18 发布日期:2024-10-16
  • 通讯作者: 苏茵 E-mail:suyin0921@163.com
  • 基金资助:
    北京市科技计划(Z191100006619111)

Application of 18F-FDG PET/CT in rheumatic diseases

Hua ZHONG1, Yuan LI2, Liling XU1, Mingxin BAI1, Yin SU1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Beijing 100044, China
    2. Department of Nuclear Medicine, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-07-28 Online:2024-10-18 Published:2024-10-16
  • Contact: Yin SU E-mail:suyin0921@163.com
  • Supported by:
    the Beijing Scientific Program(Z191100006619111)

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摘要：

目的: 探索分析 18F-脱氧葡萄糖正电子发射断层显像/计算机体层扫描技术(18F-flurodeoxyglucose positron emission tomography/computed tomography, 18F-FDG PET/CT)在风湿免疫病中的应用现状。方法: 纳入2012年1月至2018年12月期间于北京大学人民医院风湿免疫科住院并进行 18F-FDG PET/CT检查的患者，回顾性分析 18F-FDG PET/CT检查技术在风湿免疫病中的临床应用情况及其影像学特征。结果: 共486例风湿免疫科的住院患者行 18F-FDG PET/CT检查，占全院行PET/CT检查总例数的5.30%，其中女性304例(62.55%)，男性182例(37.45%)，男女比例为1 ∶1.67，平均年龄(53.21±18.81)岁，45~65岁年龄段患者的比例(227/486，46.71%)最高。风湿免疫科患者行PET/CT检查的主要目的依次为排除肿瘤(55.56%)、协助明确诊断(24.60%)及评估病情(19.84%)。74例患者的PET/CT检查结果提示恶性肿瘤，327例患者提示风湿免疫病，其中292例对疾病的提示诊断具有参考作用，25例患者提示感染性疾病，60例患者的检查结果无明确提示意义。有10例风湿免疫病患者在治疗后复查PET/CT进行了随访，缓解病例的检查结果显示，18F-FDG代谢活性降低以及代谢增高病灶的范围缩小。结论: 18F-FDG PET/CT在风湿免疫病中的应用日益广泛，尤其在排除恶性肿瘤方面具有重要价值，同时对疑难病例的辅助诊断具有一定参考作用。

关键词: 氟脱氧葡萄糖F18, 正电子发射断层显像计算机体层摄影术, 风湿性疾病, 鉴别诊断

Abstract:

Objective: To explore the application of 18F-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in rheumatic diseases, to compare these different imaging features, and to describe the current PET/CT imaging status in clinical practice. Methods: A total of 486 cases in our department from January 2012 to December 2018 were enrolled in this study, and 18F-FDG PET/CT examination was performed in all the patients. The clinical use of 18F-FDG PET/CT was retrospectively analyzed to discuss the clinical application and its imaging characteristics of rheumatic diseases. Categorical data were used to ascertain prevalence statistics, whereas continuous data were used to delineate means and standard deviations. Independent sample t test, Chi square test and Mann-Whitney U test were used for statistical analysis. A P-value of < 0.05 was considered significant. Results: (1) From 2012 to 2018, totally 486 patients in the Department of Rheumatology and Immunology underwent 18F-FDG PET/CT examination, accounting for 5.30% of the total number of PET/CT examinations in the whole hospital. In this study, 304 of the 486 patient were female (62.55%), 182 of them were male (37.45%), the average age of the patients was (53.21±18.81) years, and the proportion of the patients aged 45-65 (227/486, 46.71%) was the highest group. (2) Three leading purposes of the PET/CT examination in our department were to exclude cancers (55.56%), assist in diagnosis (24.60%) and evaluate the disease activity (19.84%). (3) Of the 486 patients who underwent 18F-FDG PET/CT, 327 cases might indicate a differential diagnosis of rheumatic disease, of which, 292 cases were highly suggestive of diagnosis, including 61 cases of myositis, 60 cases of vasculitis, 37 cases of adult still's disease, 32 cases of IgG4 related diseases, 30 cases of rheumatoid arthritis, 22 cases of Sjögren's syndrome, 22 cases of systemic lupus erythematosus, and 9 cases of rheumatic polymyalgia; the remaining 35 cases only prompted the possibility of autoimmune disease. Of the 486 patients, 74 cases suggested the diagnosis of cancers, 25 cases indicated the diagnosis of infectious diseases, while 60 cases could not show any diagnostic values. Ten patients with rheumatic disease were followed up with a post-treatment repeat PET/CT, and the findings in remission showed reduced 18F-FDG metabolic activity as well as a reduction in the extent of metabolic hypertrophic lesions. Conclusion: There are some typical sign of 18F-FDG PET/CT for diffuse connective tissue diseases, therefore 18F-FDG PET/CT has auxi-liary effect on the classification diagnosis of rheumatic diseases, especially for the exclusion of cancers.

Key words: Fluorodeoxyglucose F18, Positron emission tomography computed tomography, Rheumatic disease, Differential diagnosis

中图分类号: 

  • R593.2

表1

18F-FDG PET/CT检查患者的年龄和性别构成"

Age/years Total Male, n (%) Female, n (%) Z P
< 45 136 45 (33.09) 91 (66.91)
45-65 227 87 (38.33) 140 (61.67) 1.268 0.898
>65 123 50 (40.65)

表2

18F-FDG PET/CT影像学诊断在风湿免疫科住院"

Diagnostic classification n %
Infectious diseases 25 5.14
  Lung infection 8 1.65
  Necrotizing lymphadenitis 4 0.82
  Brucella infection 2 0.41
  Bone and joint prosthesis infection 1 0.21
  Kidney abscess 1 0.21
  Unknown location 9 1.85
Rheumatic diseases 327 67.28
  Dermatomyositis 45 9.26
  Adult onset Still’s disease 37 7.61
  IgG4 related disease 32 6.58
  Rheumatoid arthritis 30 6.17
  Takayasu’s arteritis 25 5.14
  Sjögren’s syndrome 22 4.53
  Systemic lupus erythematosus 22 4.53
  Behcet syndrome 14 2.88
  ANCA-associated vasculitis 10 2.06
  Polymyalgia rheumatica 9 1.85
  Retroperitoneal fibrosis 8 1.65
  Systemic sclerosis 4 0.82
  Other types of inflammatory myopathy 16 3.29
  Other types of systemic vasculitis 11 2.26
  Other types of arthritis 7 1.44
  Other connective tissue diseases 35 7.20
Cancers 74 15.23
  Lymphoma 33 6.79
  Lung cancer 13 2.67
  Genitourinary tumors 8 1.65
  Hematologic tumors 6 1.23
  Gastrointestinal tumors 4 0.82
  Other types of malignant tumors 10 2.06
No clear indications 60 12.35

表3

风湿免疫科住院患者行 18F-FDG PET/CT检查的目的"

Diseases Total Exclude cancers, n (%) Assist in diagnosis, n (%) Evaluate condition, n (%)
Myositis 61 53 (86.89) 7 (11.48) 1 (1.64)
Adult onset Still’s disease 37 20 (54.05) 16 (43.24) 1 (2.70)
IgG4 related disease 32 9 (28.13) 10 (31.25) 13 (40.63)
Rheumatoid arthritis 30 20 (66.67) 10 (33.33) 0 (0)
Takayasu’s arteritis 25 3 (12.00) 1 (4.00) 21 (84.00)
Sjögren’s syndrome 22 16 (72.73) 5 (22.73) 1 (4.55)
Systemic lupus erythematosus 22 14 (63.64) 5 (22.73) 3 (13.64)
Behcet syndrome 14 1 (7.14) 3 (21.43) 10 (71.43)
Polymyalgia rheumatica 9 4 (44.44) 5 (55.56) 0 (0)

图1

大动脉炎 18F-FDG PET/CT检查的特征表现"

图2

皮肌炎 18F-FDG PET/CT检查的特征表现"

图3

成人Still’s病 18F-FDG PET/CT检查的特征表现"

图4

风湿性多肌痛 18F-FDG PET/CT检查的特征表现"

图5

干燥综合征 18F-FDG PET/CT检查的特征表现"

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ISSN 1671-167X
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