18F-FDG PET/CT在鉴别不明原因发热病因中成人斯蒂尔病与淋巴瘤的价值

Value of 18F-FDG PET/CT imaging in differentiating adult-onset Still′s disease from lymphoma in the etiology of fever of unknown origin

    摘要
  • 摘要:
    目的 探讨18F-氟脱氧葡萄糖（FDG）PET/CT在鉴别不明原因发热（FUO）病因中成人斯蒂尔病（AOSD）与淋巴瘤的影像特征及其诊断价值。
    方法 回顾性分析2016年12月至2018年12月在上海交通大学医学院附属瑞金医院以FUO为临床诊断行18F-FDG PET/CT显像的患者295例男性103例、女性192例，年龄（42.9±16.1）岁，筛选出AOSD患者69例（男性11例、女性58例）和淋巴瘤患者36例（男性19例、女性17例）。比较这2种患者在18F-FDG PET/CT图像上骨髓、脾脏、淋巴结等的代谢参数差异。组间比较采用卡方检验或独立样本t检验。
    结果 AOSD患者骨髓的18F-FDG高代谢发生率62.3%（43/69）对16.7%（6/36），χ2=28.4，P<0.001及最大标准摄取值（SUVmax）（5.5±1.8 对 4.2±1.2，t=5.1，P<0.001）均高于淋巴瘤患者。AOSD患者脾肿大发生率虽然低于淋巴瘤患者37.7%（26/69）对61.1%（22/36），χ2=6.3，P=0.013，但其脾脏SUVmax与淋巴瘤患者的差异无统计学意义（4.3±1.7 对 4.1±2.6，t=0.9，P=0.344）。AOSD患者淋巴结SUVmax（6.2±5.7 对10.9±8.8，t=−3.1，P=0.003）、总病灶代谢体积MLV：（33.5±49.2） cm3对（80.3±399.2） cm3，t=−4.9，P<0.001及总病灶糖酵解总量TLG：（167.0±544.6） g 对（1304.0±3534.5） g，t=−4.3，P<0.001均低于淋巴瘤患者。
    结论 18F-FDG PET/CT可通过骨髓18F-FDG高代谢发生率和SUVmax、脾肿大发生率、淋巴结总MLV和总TLG等特征辅助鉴别FUO病因中的AOSD与淋巴瘤。

     

    Abstract:
    Objective To investigate the imaging features and diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in differentiating adult-onset Still′s disease (AOSD) from lymphoma in the etiology of fever of unknown origin (FUO).
    Methods A retrospective analysis was conducted on 295 patients (103 males and 192 females with an average age of 42.9±16.1) who underwent 18F-FDG PET/CT for FUO at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from December 2016 to December 2018. Sixty-nine patients with AOSD (11 males and 58 females) and 36 patients with lymphoma (19 males and 17 females) were enrolled. The metabolic parameters of the bone marrow, spleen, and lymph nodes on 18F-FDG PET/CT were compared between the groups. Chi-square test or independent sample t-test was used for intergroup comparison.
    Results The incidence of 18F-FDG hypermetabolism in the bone marrow (62.3% (43/69) vs. 16.7% (6/36); χ2=28.4, P<0.001) and maximum standardized uptake value (SUVmax: 5.5±1.8 vs. 4.2±1.2; t=5.1, P<0.001) in patients with AOSD were significantly higher than those in patients with lymphoma. Although the incidence of splenomegaly in patients with AOSD was lower than that in patients with lymphoma (37.7% (26/69) vs. 61.1% (22/36); χ2=6.3, P=0.013), no significant difference in the SUVmax of the spleen was found between the groups (4.3±1.7 vs. 4.1±2.6; t=0.9, P=0.344). The SUVmax of the lymph nodes (6.2±5.7 vs. 10.9±8.8; t=−3.1, P=0.003), total metabolic lesion volume (MLV: (33.5±49.2) cm3 vs. (80.3±399.2) cm3; t=−4.9, P<0.001), and total total lesion glycolysis (TLG: (167.0±544.6) g vs. (1304.0±3534.5) g; t=−4.3, P<0.001) were lower in patients with AOSD than those in patients with lymphoma.
    Conclusion 18F-FDG PET/CT can assist in differentiating AOSD from lymphoma in the etiology of FUO on the basis of the characteristics of the incidence of 18F-FDG hypermetabolism and SUVmax of the bone marrow, incidence of splenomegaly, and total MLV and total TLG of the lymph nodes.

     

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