Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China.
Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, China.
Int J Infect Dis. 2020 Apr;93:77-83. doi: 10.1016/j.ijid.2020.01.030. Epub 2020 Jan 23.
To improve the diagnostic efficacy of F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for Chinese patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO), with combined clinical parameters.
FUO/IUO patients who underwent a standard diagnostic work-up and F-FDG PET/CT scanning were enrolled and divided into a local uptake lesion subgroup and a non-specific abnormal uptake subgroup. Beneficial clinical parameters for improving the diagnostic efficacy of PET/CT were identified.
From January 2014 to January 2019, 253 FUO/IUO patients were studied. In total, 147 patients had local uptake lesions and 106 patients had non-specific abnormal uptake. In the local uptake lesion group, the positioning accuracy of PET/CT was 37.2% in grades 1 and 2, and 66.3% in grades 3 and 4. With the following combination of clinical parameters, the positioning accuracy increased to 75.0% and 90.0%, respectively: time from admission to performing PET/CT scanning <6.5 days and C-reactive protein level >95 mg/l. In the non-specific abnormal uptake group, the combination of sex (male), bicytopenia, and lactic dehydrogenase improved the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignancy from 64.3%, 69%, 60%, and 72.7%, respectively, to 83.3%, 81%, 81.4%, and 82.9%, respectively. With the combination of sex (male), white blood count, serum ferritin level, and hepatosplenomegaly, the infection prediction model had a sensitivity, specificity, PPV, and NPV of 78%, 76.2%, 76.6%, and 77.6%, respectively.
Combined clinical parameters improved the localization diagnostic value of F-FDG PET/CT in the local uptake lesion subgroup and the etiological diagnostic value in the non-specific abnormal uptake subgroup.
通过联合临床参数，提高 F-氟代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）对中国不明原因发热（FUO）和不明原因炎症（IUO）患者的诊断效能。
纳入接受标准诊断检查和 F-FDG PET/CT 扫描的 FUO/IUO 患者，并分为局部摄取病变亚组和非特异性异常摄取亚组。确定有助于提高 PET/CT 诊断效能的有益临床参数。
2014 年 1 月至 2019 年 1 月，共纳入 253 例 FUO/IUO 患者。其中，147 例患者有局部摄取病变，106 例患者有非特异性异常摄取。在局部摄取病变组中，PET/CT 的定位准确率在 1 级和 2 级为 37.2%，在 3 级和 4 级为 66.3%。以下临床参数的组合可将定位准确率分别提高至 75.0%和 90.0%：入院至行 PET/CT 扫描的时间<6.5 天和 C 反应蛋白水平>95mg/L。在非特异性异常摄取组中，性别（男性）、两系血细胞减少和乳酸脱氢酶的组合可使恶性肿瘤的诊断灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别从 64.3%、69%、60%和 72.7%提高至 83.3%、81%、81.4%和 82.9%。性别（男性）、白细胞计数、血清铁蛋白水平和肝脾肿大的组合使感染预测模型的灵敏度、特异性、PPV 和 NPV 分别为 78%、76.2%、76.6%和 77.6%。
联合临床参数提高了 F-FDG PET/CT 在局部摄取病变亚组中的定位诊断价值和在非特异性异常摄取亚组中的病因诊断价值。
