Department of Nuclear Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Clin Rheumatol. 2022 Mar;41(3):839-846. doi: 10.1007/s10067-021-05965-4. Epub 2021 Oct 21.
To explore the significance of Fluorine-18 labeled fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in diagnosing connective tissue diseases (CTDs) in fever of unknown origin (FUO) or inflammation of unknown origin (IUO) patients.
Clinical and image data of 242 consecutive FUO/IUO patients who underwent PET/CT examination and eventually diagnosed CTDs were retrospectively analyzed, including distribution of diseases, clinical characteristics, and PET/CT imaging findings. The role of FDG PET/CT in differential diagnosis of CTDs was evaluated through clinical questionnaire survey.
Patients diagnosed as CTDs accounted for 48.1% of FUO/IUO patients. Among them, adult-onset Still's disease was most frequently diagnosed. Other common diseases included systemic vasculitis, undifferentiated connective tissue disease, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and polymyalgia rheumatica. On FDG PET/CT examination, 97.9% of the patients had positive findings. Inflammatory lesions were detected in 66.5% and non-specific abnormal uptakes were found in 31.4%. Detected lesions distributed consistently with corresponding susceptible organs and tissues in various diseases. Clinical questionnaire results shown that FDG PET/CT excluded malignant tumors, focal infections, or other typical CTDs in 45.5% of the patients; indicated important diagnostic clues or appropriate biopsy sites in 20.6% of patients; and directly suggested the diagnosis of a CTD in 33.1% of patients.
FDG PET/CT could reveal inflammatory lesions in organs and tissues that reflect the clinical characteristics in different CTDs, thus providing an objective evidence for differential diagnosis, classification, and treatment decision of these diseases. Key Points • FDG PET/CT is a useful tool for differential diagnosing connective tissue diseases among patients with fever of unknown origin/inflammatory of unknown origin.
探讨氟-18 标记氟代脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在诊断发热原因不明（FUO）或炎症原因不明（IUO）患者的结缔组织疾病（CTD）中的意义。
回顾性分析 242 例连续行 PET/CT 检查并最终诊断为 CTD 的 FUO/IUO 患者的临床和影像学资料，包括疾病分布、临床特征和 PET/CT 影像学表现。通过临床问卷调查评估 FDG PET/CT 在 CTD 鉴别诊断中的作用。
诊断为 CTD 的患者占 FUO/IUO 患者的 48.1%。其中，成人斯蒂尔病最为常见。其他常见疾病包括系统性血管炎、未分化结缔组织病、类风湿关节炎、特发性炎性肌病、系统性红斑狼疮和巨细胞动脉炎。在 FDG PET/CT 检查中，97.9%的患者有阳性发现。66.5%的患者有炎症性病变，31.4%的患者有非特异性异常摄取。在各种疾病中，检测到的病变与相应的易感器官和组织分布一致。临床问卷调查结果显示，FDG PET/CT 在 45.5%的患者中排除了恶性肿瘤、局灶性感染或其他典型的 CTD；在 20.6%的患者中提示了重要的诊断线索或适当的活检部位；在 33.1%的患者中直接提示了 CTD 的诊断。
FDG PET/CT 可以显示反映不同 CTD 临床特征的器官和组织中的炎症性病变，为这些疾病的鉴别诊断、分类和治疗决策提供客观依据。
关键点
• FDG PET/CT 是诊断发热原因不明/炎症原因不明患者结缔组织疾病的有用工具。
