FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study
FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study
复制标题
DOI：
10.1007/s12149-011-0470-6
复制
发表时间：
2011-06-01
影响因子：
2.6
通讯作者：
Murakami, Koji
中科院分区：
文献类型：
--
作者：
Kubota, Kazuo;Nakamoto, Yuji;Murakami, Koji
为评价2-[（18）F]氟-2-脱氧-d-葡萄糖正电子发射断层扫描（FDG-PET）诊断不明原因发热（FUO）的临床价值，我们对2006年7月至2007年12月在日本6家机构接受FDG-PET检查的81例FUO患者进行了回顾性研究。FDG摄取使用4级量表进行目视评估。FDG-PET评价FUO的有效性，提供额外的诊断信息，对治疗决策的临床影响（4级量表），并与最终诊断进行比较，诊断结果按4组最终诊断进行分析：感染、关节炎/血管炎/自身免疫性/胶原病（A/V）、肿瘤/肉芽肿（T/G）和其他/未知（O/U）。T/G的敏感性最高，其次为感染、A/V和O/U [分别为100%（7/7）、89%（24/27）、65%（11/17）、0%（0/1）]。临床影响和平均FDG评分显示出相同的趋势。感染的附加信息最高，其次是T/G、A/V和O/U [分别为76%（22/29）、75%（6/8）、43%（9/21）、23%（5/22）]。O/U组特异性高（84%，16/19），可准确排除活动性局灶性炎性疾病和恶性肿瘤。使用类固醇治疗发热似乎掩盖了病变并改变了结果，特别是在A/V组（21例A/V患者中8例类固醇使用者中有4例假阴性）。各医院各疾病的患病率显著影响FDG-PET诊断FUO的有效性。国立医院（NH）的平均FDG摄取评分和附加信息（分别为70%，31/44 vs. 30%，11/37）显著高于大学医院（UH）。NH组50%（22/44）的患者和UH组13.5%（5/37）的患者出现3级临床影响，其中FDG PET结果改变了临床决策。NH组和UH组结果的敏感性（91%，30/33; 63%，12/19）和特异性（60%，6/10; 86%，12/14）不同。总的敏感性为81%（42/52），特异性为75%（18/24）。NH组包括大量感染性疾病病例（50%，23/44），而UH组包括大量A/V病例（38%，14/37）和O/U病例（41%，15/37）。FDG-PET诊断FUO提供了额外的诊断信息，具有较高的临床影响，尤其是在感染性疾病患者中。它也有助于在不明或其他杂项疾病的情况下，允许排除局灶性活动性疾病。医院疾病的患病率显著影响FDG-PET诊断FUO的有效性。FDG-PET是一种有用的检查，根据患者和医院的特点，为FUO的管理提供不同程度的临床影响。
To evaluate the clinical value of 2-[(18)F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey.A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated.The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100%(7/7), 89%(24/27), 65%(11/17), 0%(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76%(22/29), 75%(6/8), 43%(9/21), 23%(5/22), respectively]. The O/U group showed a high specificity (84%, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70%, 31/44 vs. 30%, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50% (22/44) of the patients in the NH group and 13.5% (5/37) of the patients in the UH group. The sensitivity (91%, 30/33; 63%, 12/19) and specificity (60%, 6/10; 86%, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81% (42/52), specificity was 75% (18/24). The NH group included a large number of cases with infectious diseases (50%, 23/44), while the UH group included a large number of A/V cases (38%, 14/37) and O/U cases (41%, 15/37).FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in cases with unknown or other miscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. FDG-PET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.