Professor of Radiology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, New York, United States.
Chief of Nuclear Medicine & Molecular Imaging Northwell Health Manhasset & New Hyde Park, New York, United States.
Curr Pharm Des. 2018;24(7):814-820. doi: 10.2174/1381612824666171129194507.
Fever of Unknown Origin, or FUO, is a challenging condition for patients and clinicians. In up to 50% of cases, no diagnosis is established. Patient workup begins with comprehensive history, physical examination and laboratory tests. Radionuclide imaging has been a second-line procedure. Gallium-67 citrate, which accumulates in infection, inflammation, and tumor, was for many years, the radionuclide test of choice in the workup of FUO. The 24-72 hours between injection and imaging, relatively high radiation dose to patients, and suboptimal image quality are significant disadvantages; imaging results are variable. Although labeled leukocyte imaging accurately localizes infection, infections cause only about 20%-40% of all FUO's. In most cases, this test is not helpful in identifying the source of the fever. Fluorine-18-fluorodeoxyglucose (FDG) uptake is related to cellular glucose metabolism. Increased FDG uptake is present in numerous hypermetabolic conditions, including tumor, infection, and noninfectious inflammation. FDG positron emission tomography (PET) and PET/computed tomography (CT) have rapidly assumed an increasingly important role in the diagnostic workup of patients with FUO. FDG is especially useful for localizing lesions and areas of interest for further evaluation. In contrast to gallium and labeled leukocyte imaging, FDG contributes useful information in children with FUO. Initially utilized as a second-line diagnostic tool in patients with FUO, recent data indicate that FDG contributes more diagnostically useful information than anatomic imaging like ultrasound and CT, which leads to earlier institution of appropriate therapy. These findings suggest that FDG imaging should be performed earlier, rather than later, in the diagnostic evaluation of the patient with FUO.
不明原因发热，或 FUO，是患者和临床医生面临的一项挑战。高达 50%的病例无法明确诊断。患者的检查首先包括全面的病史、体格检查和实验室检查。放射性核素显像是二线检查。镓-67 枸橼酸盐在感染、炎症和肿瘤中积聚，多年来一直是 FUO 检查的首选放射性核素检查。注射后 24-72 小时内进行成像，患者接受的辐射剂量相对较高，且图像质量不理想，这是显著的缺点；成像结果存在差异。虽然标记白细胞显像是感染的准确定位，但感染仅导致所有 FUO 的约 20%-40%。在大多数情况下，该检查无助于确定发热的来源。氟-18-氟脱氧葡萄糖（FDG）摄取与细胞葡萄糖代谢有关。在多种代谢活跃的情况下，包括肿瘤、感染和非感染性炎症，都会出现 FDG 摄取增加。氟-18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和 PET/计算机断层扫描（CT）在 FUO 患者的诊断检查中迅速发挥了越来越重要的作用。FDG 特别有助于定位病变和进一步评估的感兴趣区域。与镓和标记白细胞显影相比，FDG 在 FUO 患儿中提供了有用的信息。FDG 最初作为 FUO 患者的二线诊断工具，最近的数据表明，FDG 提供了比超声和 CT 等解剖成像更具诊断价值的信息，从而更早地开始适当的治疗。这些发现表明，在 FUO 患者的诊断评估中，FDG 成像应更早进行，而不是更晚。
