F-FDG PET/CT 对诊断气道受累的复发性多软骨炎及监测基于类固醇的治疗反应是否有用？
Is F-FDG PET/CT useful for diagnosing relapsing polychondritis with airway involvement and monitoring response to steroid-based therapy?
机构信息
The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, Guangdong Province, China.
The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.
出版信息
Arthritis Res Ther. 2019 Dec 12;21(1):282. doi: 10.1186/s13075-019-2083-8.
BACKGROUND
F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a promising tool for diagnosing relapsing polychondritis (RP). However, its usefulness in assessing RP with airway involvement is unknown.
OBJECTIVE
This study aimed to further evaluate and confirm the potency of F-FDG PET/CT in diagnosing RP with airway involvement and monitoring response to steroid-based therapy.
METHODS
A total of 30 patients from a dedicated respiratory centre, diagnosed with RP in accordance with McAdam, Damiani or Levine criteria, were included in this study. All patients underwent baseline F-FDG PET/CT, and 10 patients underwent second scans after 2.5-15 months of steroid-based therapy. Visual scores (VS) and maximal standard uptake values (SUV) were analysed.
RESULTS
In the initial scan, 83.3% (25/30) of patients were found to have FDG uptake in more than one cartilage. The median VS and SUV in the cartilages were 3 (range, 1-3) and 3.8 (range, 1.9-17.9), respectively. Positive rates for PET/CT-guided biopsy in nasal, auricular, and tracheal/bronchial cartilages were 100% (5/5), 88.9% (8/9), and 10.5% (2/19), respectively, but the positive biopsy rate in the auricular cartilage was 92.3% (12/13) even without PET/CT assessment. Based on biopsy-proven sites, the sensitivity of PET/CT was 55.6%, and the specificity was 5.3%. Compared with the baseline scan, the second scan showed much lower median VS (2 vs 3, respectively; p < 0.0001) and SUV (2.9 vs 3.8, respectively; p < 0.001). Of 10 patients who underwent second PET/CT, 8 had complete therapeutic response, while 2 had partial response.
CONCLUSION
F-FDG PET/CT assists in identifying multiple cartilage involvement in RP, but it seems neither a sensitive nor specific modality in diagnosing RP with airway involvement. Moreover, PET/CT has limited utility in locating biopsy sites and monitoring therapeutic response to corticosteroids.
背景
氟代脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）是诊断复发性多软骨炎（RP）的一种很有前途的工具。然而，其在评估气道受累的 RP 中的作用尚不清楚。
目的
本研究旨在进一步评估和证实 F-FDG PET/CT 在诊断气道受累的 RP 并监测基于类固醇的治疗反应方面的效力。
方法
共纳入 30 例来自专门呼吸中心的患者，根据 McAdam、Damiani 或 Levine 标准诊断为 RP。所有患者均进行基线 F-FDG PET/CT 检查，10 例患者在接受基于类固醇的治疗 2.5-15 个月后进行第二次扫描。分析视觉评分（VS）和最大标准摄取值（SUV）。
结果
在初始扫描中，83.3%（25/30）的患者发现有超过一个软骨有 FDG 摄取。软骨的中位数 VS 和 SUV 分别为 3（范围 1-3）和 3.8（范围 1.9-17.9）。鼻、耳和气管/支气管软骨的 PET/CT 引导活检阳性率分别为 100%（5/5）、88.9%（8/9）和 10.5%（2/19），但即使没有 PET/CT 评估，耳软骨的活检阳性率也为 92.3%（12/13）。根据活检证实的部位，PET/CT 的灵敏度为 55.6%，特异性为 5.3%。与基线扫描相比，第二次扫描的中位数 VS（分别为 2 和 3，p<0.0001）和 SUV（分别为 2.9 和 3.8，p<0.001）均明显降低。在接受第二次 PET/CT 的 10 例患者中，8 例完全治疗反应，2 例部分反应。
结论
F-FDG PET/CT 有助于识别 RP 中的多个软骨受累，但在诊断气道受累的 RP 方面似乎既不敏感也不特异。此外，PET/CT 在定位活检部位和监测皮质类固醇治疗反应方面的作用有限。
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