Šaponjski Jelena, Šobić-Šaranović Dragana, Odalović Strahinja, Stojiljković Milica, Pantović Jelena, Petrović Nebojša, Grozdić-Milojević Isidora, Artiko Vera
Center of Nuclear Medicine, Clinical Center of Serbia, Visegradska 26, 11000 Belgrade, Serbia.
Hell J Nucl Med. 2017 Sep-Dec;20 Suppl:37-44.
Positron emission tomography with computed tomography (F-FDG PET/CT) is a nuclear medicine diagnostic method which, unlike other technological modalities that asses anatomical features, detects increased glucose metabolism inside the cells, thus is very helpful in diagnosing cardiovascular infection and inflammation and also in therapy planning.
Aim of this study was to assess the significance of F-FDG PET/CT in detection of an active disease in patients with infection and inflammation of cardiovascular system.
In this cohort retrospective study 73 cardiovascular patients (56.9±15.3 years; 33 male and 40 female) with persistent symptoms of inflammatory syndrome were referred to F-FDG PET/CT in order to evaluate active disease. Biochemical blood analyses (erytrocite sedimentation, CRP, leukocytic formula), CT, MRI, ultrasound were performed in all the patients. Out of 73 patients, 7 had a second F-FDG PET/CT examination (62.1±12.3 years; 6 men and 1 woman) with a previous pathological PET/CT finding after which the therapy was changed. The degree of metabolic activity was analyzed visually and quantitatively using the maximal standardized uptake value (SUV). F-FDG PET/CT findings were considered positive in case of higher focal glucose accumulation in projection of heart and diffuse uptake in blood vessels' wall than accumulation in surrounding tissue and liver.
Vasculitis was diagnosed in 36 patients (49,3%), endocarditis in 23 (31,5%) and graft inflammation in 14 (19,2%). The results were compared to the gold standard, biopsy of the blood vessel and histopathological verification during surgical treatment, or clinical follow up. Forty nine patients with the sights of an increased FDG uptake were considered true positive (TP) (SUV5.7±2.9). In 21 patients F-FDG uptake was physiological and they were considered true negative (ТN). Two who used corticosteroid therapy which decreases inflammation, were false negative (FN), and only 1 false positive (FP) finding in the region of recent iatrogenic vein injury. Sensitivity of this method was 96.08±, specificity 95.45±, positive predictive value 98.0±, negative predictive value 91.3± and accuracy 95.89±.
Our results indicate that F-FDG PET/CT could be useful diagnostic method for the detection of sights of metabolically active disease in patients with persistent symptoms of infection and inflammation of cardiovascular system, as well as in monitoring therapy response.
正电子发射断层扫描与计算机断层扫描（F-FDG PET/CT）是一种核医学诊断方法，与其他评估解剖特征的技术方式不同，它能检测细胞内葡萄糖代谢增加的情况，因此在诊断心血管感染和炎症以及治疗规划方面非常有帮助。
本研究的目的是评估F-FDG PET/CT在检测心血管系统感染和炎症患者活动性疾病中的意义。
在这项队列回顾性研究中，73例有持续性炎症综合征症状的心血管患者（56.9±15.3岁；男性33例，女性40例）被转诊至F-FDG PET/CT检查以评估活动性疾病。所有患者均进行了血液生化分析（红细胞沉降率、CRP、白细胞分类）、CT、MRI、超声检查。73例患者中，7例（62.1±12.3岁；男性6例，女性1例）在之前PET/CT检查结果异常且治疗方案改变后进行了第二次F-FDG PET/CT检查。使用最大标准化摄取值（SUV）对代谢活性程度进行视觉和定量分析。如果心脏投影区域的局灶性葡萄糖积聚较高且血管壁有弥漫性摄取，高于周围组织和肝脏的摄取，则F-FDG PET/CT检查结果被视为阳性。
36例患者（49.3%）诊断为血管炎，23例（31.5%）为心内膜炎，14例（19.2%）为移植物炎症。将结果与金标准进行比较，金标准为血管活检、手术治疗期间的组织病理学验证或临床随访。49例FDG摄取增加的患者被认为是真阳性（TP）（SUV 5.7±2.9）。21例患者的F-FDG摄取为生理性，被认为是真阴性（TN）。2例使用了降低炎症的皮质类固醇治疗的患者为假阴性（FN），在近期医源性静脉损伤区域只有1例假阳性（FP）结果。该方法的敏感性为96.08±，特异性为95.45±，阳性预测值为98.0±，阴性预测值为91.3±，准确性为95.89±。
我们的结果表明，F-FDG PET/CT对于检测有心血管系统感染和炎症持续性症状患者的代谢活跃性疾病部位以及监测治疗反应可能是一种有用的诊断方法。
