Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.
Department of Radiology, German Cancer Research Center (Dkfz), Heidelberg, Germany.
BMC Med Imaging. 2020 Aug 7;20(1):94. doi: 10.1186/s12880-020-00493-0.
To analyse the influence of whole body (wb)-MRI on patient management compared to routine diagnostic tests in patients with fever of unknown origin (FUO).
Twenty-four patients with FUO, defined as illness of more than three weeks with fever greater than 38.3 °C, underwent wb-MRI at a 1.5 T MR-system. The MR-protocol consisted of the following sequences: axial T1 VIBE, coronal T2-TIRM and a coronal echoplanar diffusion weighted sequence (overall acquisition time 29:39 min:s). Furthermore, laboratory findings, chest-x-ray, abdominal ultrasound, CT-scans and/or PET-CT scans were evaluated and compared to the wb-MRI findings in regard to treatment changes.
Wb-MRI yielded a correct diagnosis in 70% of the patients. In 46% the inflammatory focus was exclusively detected by wb-MRI. Focus detection by wb-MRI led to a subsequent change of the clinical management in 92% of the patients. In 6 patients both a wb-MRI and a PET-CT were performed yielding the correct diagnosis in the same 4 of 6 patients for both imaging modalities.
Wb-MRI appears to be of value in the evaluation of FUO patients, allowing for optimized treatment by increasing diagnostic certainty. Due to its lack of nephrotoxicity and ionizing radiation it may be preferred over standard imaging techniques and PET-CT in the future. However, given the low number of patients in our trial, further prospective studies have to be performed to confirm our results.
分析全身 MRI（wb-MRI）对发热原因不明（FUO）患者与常规诊断性检查相比在患者管理方面的影响。
24 例 FUO 患者（定义为发热超过 3 周且体温>38.3°C）在 1.5T MR 系统上进行 wb-MRI 检查。MR 方案包括以下序列：轴位 T1 VIBE、冠状位 T2-TIRM 和冠状位弥散加权回波平面序列（总采集时间 29:39 分钟：秒）。此外，评估并比较了实验室检查结果、胸部 X 线、腹部超声、CT 扫描和/或 PET-CT 扫描与 wb-MRI 检查结果，以评估治疗改变。
wb-MRI 在 70%的患者中得出了正确的诊断。在 46%的患者中，炎症病灶仅通过 wb-MRI 检测到。wb-MRI 检测到病灶后，92%的患者随后改变了临床管理。在 6 例患者中，同时进行了 wb-MRI 和 PET-CT 检查，这两种影像学检查在 4 例患者中均得出了正确的诊断。
wb-MRI 似乎对 FUO 患者的评估有价值，通过提高诊断确定性，优化治疗。由于其无肾毒性和电离辐射，未来可能优于标准影像学技术和 PET-CT。然而，鉴于我们的试验中患者数量较少，需要进一步进行前瞻性研究来证实我们的结果。
