Seshadri Nagabhushan, Solanki Chandra K, Balan Kottekkattu
Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK.
Nucl Med Commun. 2008 Mar;29(3):277-82. doi: 10.1097/MNM.0b013e3282f3ea02.
(111)In-labelled leucocyte, imaging is often used to investigate patients with fever of unknown origin (FUO). Its diagnostic performance, however, has been variable and a broad range of sensitivities and specificities have been reported. The purpose of this investigation was to evaluate the usefulness of (111)In-labelled leucocytes scintigraphy in the detection of a cause of FUO in the light of a changing spectrum of diseases causing it and advances in investigational techniques.
Sixty-one patients with a clinical diagnosis of FUO underwent whole-body (111)In-troponolate-labelled leucocyte scintigraphy in our department over a 2-year period between February 2004 and February 2006. Of these, 54 patients were retrospectively reviewed to identify a cause of FUO. Other parameters such as C-reactive protein (CRP), leucocyte count and radiological findings were also evaluated.
Leucocyte scintigraphy was found to be true positive in 12 patients, true negative in 24 patients, false positive in 10 patients and false negative in eight patients. The overall sensitivity of scintigraphy was 60%, specificity 71%, positive predictive value 55%, and negative predictive value 75%. There was no difference in the scintigraphic sensitivity between patients with spontaneous FUO and those with post-operative FUO although the latter showed a higher specificity and PPV. CRP and leucocyte count did not differ significantly between patients with true positive and true negative scintigrams. Overall, 83% of patients with abnormal radiological examinations had positive findings on scintigraphy and 87% of patients with negative findings on radiology had normal scintigraphy.
Despite changes in disease spectrum and advances in investigational techniques, our results suggest that (111)In-leucocyte scintigraphy is still a useful technique in establishing the cause of FUO. A higher PPV of this test in post-operative situations makes it especially applicable in this category of patients. Equally, the higher NPV in patients with spontaneous FUO virtually excludes infection/inflammation. Finally, a higher pre-test probability based on the radiological tests seems to be important in the optimal use of leucocyte imaging.
铟 - 111标记白细胞显像常用于不明原因发热（FUO）患者的检查。然而，其诊断性能存在差异，已报道的敏感性和特异性范围较广。本研究旨在根据导致FUO的疾病谱变化和检查技术的进展，评估铟 - 111标记白细胞闪烁显像在检测FUO病因方面的实用性。
2004年2月至2006年2月的两年间，我们科室对61例临床诊断为FUO的患者进行了全身铟 - 111 - 曲托喹酚标记白细胞闪烁显像。其中，对54例患者进行回顾性分析以确定FUO的病因。还评估了其他参数，如C反应蛋白（CRP）、白细胞计数和影像学检查结果。
白细胞闪烁显像结果为真阳性12例，真阴性24例，假阳性10例，假阴性8例。闪烁显像的总体敏感性为60%，特异性为71%，阳性预测值为55%，阴性预测值为75%。自发性FUO患者和术后FUO患者的闪烁显像敏感性无差异，尽管后者显示出更高的特异性和阳性预测值。真阳性和真阴性闪烁显像患者的CRP和白细胞计数无显著差异。总体而言，83%影像学检查异常的患者闪烁显像有阳性发现，87%影像学检查阴性的患者闪烁显像正常。
尽管疾病谱发生了变化且检查技术有所进步，但我们的结果表明铟 - 111白细胞闪烁显像仍是确定FUO病因的有用技术。该检查在术后情况下较高的阳性预测值使其特别适用于此类患者。同样，自发性FUO患者较高的阴性预测值实际上排除了感染/炎症。最后，基于影像学检查的较高的检验前概率似乎对白细胞显像的最佳应用很重要。
