18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(F-FDG-PET/CT)作为结核病评估和治疗监测临床工具的最新进展。

Updates on F-FDG-PET/CT as a clinical tool for tuberculosis evaluation and therapeutic monitoring.

作者信息

Yu Wei-Ye, Lu Pu-Xuan, Assadi Majid, Huang Xi-Ling, Skrahin Aliaksandr, Rosenthal Alex, Gabrielian Andrei, Tartakovsky Michael, Wáng Yì Xiáng J

机构信息

Shenzhen Center for Chronic Disease Control, Shenzhen 518055, China.

The Persian Gulf Nuclear Medicine Research Center, Bushehr University Of Medical Sciences, Bushehr, Iran.

出版信息

Quant Imaging Med Surg. 2019 Jun;9(6):1132-1146. doi: 10.21037/qims.2019.05.24.

Abstract

Tuberculosis (TB) is currently the world's leading cause of infectious mortality. The complex immune response of the human body to () results in a wide array of clinical manifestations, thus the clinical and radiological diagnosis can be challenging. F-fluorodeoxyglucose positron emission tomography (F-FDG-PET) scan with/without computed tomography (CT) component images the whole body and provides a metabolic map of the infection, enabling clinicians to assess the disease burden. F-FDG-PET/CT scan is particularly useful in detecting the disease in previously unknown sites, and allows the most appropriate site of biopsy to be selected. F-FDG-PET/CT is also very valuable in assessing early disease response to therapy, and plays an important role in cases where conventional microbiological methods are unavailable and for monitoring response to therapy in cases of multidrug-resistant TB or extrapulmonary TB. F-FDG-PET/CT cannot reliably differentiate active TB lesion from malignant lesions and false positives can also be due to other infective or inflammatory conditions. F-FDG PET is also unable to distinguish tuberculous lymphadenitis from metastatic lymph node involvement. The lack of specificity is a limitation for F-FDG-PET/CT in TB management.

摘要

结核病(TB)目前是全球感染性疾病致死的首要原因。人体对结核分枝杆菌的复杂免疫反应会导致多种多样的临床表现,因此临床和影像学诊断可能具有挑战性。带有或不带有计算机断层扫描(CT)成分图像的氟脱氧葡萄糖正电子发射断层扫描(F-FDG-PET)可对全身进行成像,并提供感染的代谢图谱,使临床医生能够评估疾病负担。F-FDG-PET/CT扫描在检测既往未知部位的疾病方面特别有用,并能选择最合适的活检部位。F-FDG-PET/CT在评估疾病对治疗的早期反应方面也非常有价值,在传统微生物学方法不可用的情况下以及在耐多药结核病或肺外结核病病例中监测治疗反应时发挥着重要作用。F-FDG-PET/CT无法可靠地区分活动性结核病灶与恶性病灶,假阳性结果也可能由其他感染性或炎症性疾病引起。F-FDG PET也无法区分结核性淋巴结炎与转移性淋巴结受累情况。缺乏特异性是F-FDG-PET/CT在结核病管理中的一个局限性。

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