Letertre Simon, Fesler Pierre, Zerkowski Laetitia, Picot Marie-Christine, Ribstein Jean, Guilpain Philippe, Le Moing Vincent, Mariano-Goulart Denis, Roubille Camille
Department of Internal Medicine, Lapeyronie University Hospital, CHU Montpellier, University of Montpellier, 34090 Montpellier, France.
PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CEDEX 05, 34295 Montpellier, France.
J Clin Med. 2021 Aug 26;10(17):3831. doi: 10.3390/jcm10173831.
To explore the diagnostic contribution of the F-FDG-PET/CT in a population of patients with classical fever of unknown origin (FUO), to pinpoint its place in the diagnostic decision tree in a real-life setting, and to identify the factors associated with a diagnostic F-FDG-PET/CT.
All adult patients (aged ≥ 18 years) with a diagnosis of classical FUO who underwent an F-FDG-PET/CT in the University Hospital of Montpellier (France) between April 2012 and December 2017 were included. True positive F-FDG-PET/CT, which evidenced a specific disease causing FUO, were considered to be contributive.
Forty-four patients with FUO have been included (20 males, 24 females; mean age 57.5 ± 17.1 years). Diagnoses were obtained in 31 patients (70.5%), of whom 17 (38.6%) had non-infectious inflammatory diseases, 9 had infections (20.5%), and 3 had malignancies (6.8%). F-FDG-PET/CT was helpful for making a final diagnosis (true positive) in 43.6% of all patients. Sensitivity and specificity levels were 85% and 37%, respectively. A total of 135 investigations were performed before F-FDG-PET/CT, mostly CT scans (93.2%) and echocardiography (59.1%), and 108 after F-FDG-PET/CT, mostly biopsies (including the biopsy of a temporal artery) (25%) and MRIs (34%). In multivariate analysis, the hemoglobin level was significantly associated with a helpful F-FDG-PET/CT ( = 0.019, OR 0.41; 95% CI (0.20-0.87)), while the CRP level was not associated with a contributive F-FDG-PET/CT.
F-FDG-PET/CT may be proposed as a routine initial non-invasive procedure in the diagnostic workup of FUO, especially in anemic patients who could be more likely to benefit from F-FDG-PET/CT.
探讨¹⁸F-氟脱氧葡萄糖正电子发射断层显像/计算机断层扫描（¹⁸F-FDG-PET/CT）对经典型不明原因发热（FUO）患者群体的诊断贡献，明确其在实际临床诊断决策树中的位置，并确定与¹⁸F-FDG-PET/CT诊断相关的因素。
纳入2012年4月至2017年12月期间在法国蒙彼利埃大学医院接受¹⁸F-FDG-PET/CT检查且诊断为经典型FUO的所有成年患者（年龄≥18岁）。¹⁸F-FDG-PET/CT检查结果为真阳性，即证实存在导致FUO的特定疾病，则认为该检查有诊断贡献。
共纳入44例FUO患者（男性20例，女性24例；平均年龄57.5±17.1岁）。31例患者（70.5%）获得了诊断，其中17例（38.6%）患有非感染性炎症性疾病，9例患有感染（20.5%），3例患有恶性肿瘤（6.8%）。¹⁸F-FDG-PET/CT对所有患者中的43.6%做出最终诊断（真阳性）有帮助。敏感性和特异性水平分别为85%和37%。在¹⁸F-FDG-PET/CT检查前共进行了135项检查，主要是CT扫描（93.2%）和超声心动图检查（59.1%），¹⁸F-FDG-PET/CT检查后进行了108项检查，主要是活检（包括颞动脉活检）（25%）和磁共振成像（MRI）检查（34%）。多因素分析显示，血红蛋白水平与¹⁸F-FDG-PET/CT检查有帮助显著相关（P = 0.019，比值比0.41；95%可信区间（0.20 - 0.87）），而C反应蛋白（CRP）水平与¹⁸F-FDG-PET/CT有诊断贡献无关。
¹⁸F-FDG-PET/CT可作为FUO诊断检查中的常规初始无创检查方法，特别是对于可能更有可能从¹⁸F-FDG-PET/CT检查中获益的贫血患者。
