Brisset Josselin, Jamilloux Yvan, Dumonteil Stephanie, Lades Guillaume, Killian Martin, Gerfaud-Valentin Mathieu, Lemaire Anne, Chroboczek Tomasz, Liozon Eric, Gondran Guillaume, Sève Pascal, Monteil Jacques, Fauchais Anne-Laure, Ly Kim Heang
Service de Médecine Interne, CHU Dupuytren, 87000 Limoges, France.
Service de Maladies Infectieuses et Tropicales, CHU Dupuytren, 87000 Limoges, France.
J Clin Med. 2021 Jun 4;10(11):2489. doi: 10.3390/jcm10112489.
While the diagnosis of adult-onset Still's disease (AOSD) involves the exclusion of differential diagnoses, the characteristics and value of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography coupled with CT (PET/CT) in the management of AOSD remain poorly known. Our retrospective study included patients from four centers, fulfilling Yamaguchi or Fautrel criteria, who underwent a PET/CT during an active AOSD. Thirty-five patients were included. At the time of PET/CT, the Yamaguchi criteria were met in 23 of 29 evaluable cases. PET/CT showed bone marrow (74.3%), lymph node (74.3%), and splenic (48.6%) FDG uptake. Despite arthralgia or arthritis in most patients, joints were rarely the sites of 18F-FDG accumulation. The spatial distribution of 18F-FDG uptake was nonspecific, and its intensity could be similar to malignant disease. Lymph node or bone marrow biopsy was performed after PET/CT in 20 patients (57.1%). The intensity of bone marrow; splenic and lymph node hypermetabolism appeared to be correlated with disease activity. Abnormal PET/CT in the cervical lymph nodes and age ≥ 60 years seemed to be predictive factors for monocyclic evolution. The clinical value of PET/CT is not in direct diagnosis; but as an aid in excluding differential diagnoses by searching for their scintigraphic features and guiding biopsy.
虽然成人斯蒂尔病（AOSD）的诊断需要排除鉴别诊断，但18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描结合计算机断层扫描（PET/CT）在AOSD管理中的特征和价值仍鲜为人知。我们的回顾性研究纳入了来自四个中心、符合山口或法特雷尔标准、在AOSD活动期接受PET/CT检查的患者。共纳入35例患者。在PET/CT检查时，29例可评估病例中有23例符合山口标准。PET/CT显示骨髓（74.3%）、淋巴结（74.3%）和脾脏（48.6%）有FDG摄取。尽管大多数患者有关节痛或关节炎，但关节很少是18F-FDG聚集的部位。18F-FDG摄取的空间分布不具有特异性，其强度可能与恶性疾病相似。20例患者（57.1%）在PET/CT检查后进行了淋巴结或骨髓活检。骨髓、脾脏和淋巴结代谢亢进的强度似乎与疾病活动相关。颈部淋巴结PET/CT异常和年龄≥60岁似乎是单循环演变的预测因素。PET/CT的临床价值不在于直接诊断；而是通过寻找其闪烁显像特征来辅助排除鉴别诊断并指导活检。
