北京大学学报(医学版) ›› 2015, Vol. 47 ›› Issue (1): 175-180.

• 论著 • 上一篇    下一篇

18F-FDG PET/CT在不明原因发热中的诊断价值

康磊1*,徐小洁2*,范岩1△,王荣福1△,马超1,付占立1,张建华1,张旭初1   

  1. (1. 北京大学第一医院核医学科,北京100034;2. 中国人民解放军军事医学科学院生物工程研究所,北京100850)
  • 出版日期:2015-02-18 发布日期:2015-02-18

Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in fever of unknown origin

KANG Lei1*, XU Xiao-jie2*, FAN Yan1△, WANG Rong-fu1△, MA Chao1, FU Zhan-li1, ZHANG Jian-hua1, ZHANG Xu-chu1   

  1. (1. Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China; 2. Department of Medical Molecular Biology, Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100850, China)
  • Online:2015-02-18 Published:2015-02-18

摘要: 目的:评价18F-FDG PET/CT显像在不明原因发热(fever of unknown origin,FUO)诊断中的临床价值。方法:回顾分析2010年8月至2013年4月的51例FUO病例的FDG PET/CT检查结果。依据病理学、实验室检查或临床随访(大于3个月)得出最终病因诊断,通过定性及半定量方法对FDG PET/CT的诊断结果进行评价,统计学分析采用组间t检验。结果:51例FUO患者的最终诊断包括感染32例、恶性肿瘤9例、非感染性炎症7例以及不明原因3例。单独FDG PET显像对FUO的诊断结果中,真阳性27例(52.9%),假阳性14例(27.5%),假阴性 9例(17.6%),真阴性1例(2.0%)。相比之下,联合PET和CT检查的PET/CT显像诊断结果中,真阳性36例(70.6%),假阳性14例(27.5%),假阴性1例(2.0%),真阴性0例(0)。PET/CT诊断的灵敏度为97.3%(36/37),特异性为0(0/14),准确度为70.6%(36/51)。针对恶性肿瘤,PET或PET/CT的诊断灵敏度及准确度均达100.0%(9/9)。感染与恶性肿瘤病灶的最大标准化摄取值(maximum standardized uptake value,SUVmax)之间差异有统计学意义(3.7±2.7 vs. 7.7±3.5,P=0.001,t=3.6),提示SUVmax可能有助于发热病因的鉴别诊断。结论:FDG PET/CT不但能够在全身范围内发现、定位导致发热的潜在病灶,而且有助于FUO的病因诊断,特别是对恶性肿瘤的诊断。

关键词: 发热, 原因不明, 氟脱氧葡萄糖F18, 正电子发射断层显像术

Abstract: Objective: To evaluate the diagnostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in fever of unknown origin (FUO) in a Chinese hospital.  Methods: The records of 51 patients with FUO (32 men and 19 women; mean age 54 years with a range between 3 and 81 years) were analyzed retrospectively. All the patients were examined by 18F-FDG PET/CT scan and the results were compared with the final diagnosis which was established by additional procedures including pathology, laboratory examination, and clinical followup for more than 3 months. The t test was used for statistical analysis. Results: A final diagnosis was established for 48 patients, including 32 patients with infectious diseases, 9 with malignancies, and 7 with non-infectious inflammatory diseases. By FDG PET scan alone, the rates of true positive, false positive, false negative, and true negative were 52.9%, 27.5%, 17.6%, and 2.0%, respectively. By FDG PET/CT scan, the rates of true positive, false positive, false negative, and true negative were 70.6%, 27.5%, 2.0%, and 0, respectively. 18F-PET/CT had a sensitivity of 97.3% (36/37), specificity of 0 (0/14), and accuracy of 70.6% (36/51) in FUO, especially a high sensitivity and accuracy of 100% (9/9) in the diagnosis of malignant tumor. Moreover, the maximum standardized uptake value (SUVmax) in tumor was significant higher than that in infection (3.7±2.7 vs. 7.7±3.5, P=0.001, t=3.6), which implied that SUVmax might be useful in differential diagnosis in FUO. Conclusion: FDG PET/CT is a valuable imaging tool for the identification and location of the potential lesion in FUO and is helpful for the etiological diagnosis, especially in the diagnosis of malignant lesions.

Key words: Fever of unknown origin, Fluorodeoxyglucose F18, Positron-emission tomography

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