Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France.
Internal Medicine Department 2, CH Ales-Cevennes, Ales, France.
J Intern Med. 2022 Jun;291(6):856-863. doi: 10.1111/joim.13452. Epub 2022 Jan 24.
Inflammation of unknown origin (IUO) is a challenging situation in internal medicine.
To describe the final diagnoses in IUO and assess the helpfulness of F-fluorodesoxyglucose positron emission tomography with computerized tomography ( F-FDG-PET/CT) in the diagnosis strategy.
A total of 317 IUO patients with F-FDG-PET/CT were enrolled. A diagnosis was reached in 228 patients: noninfectious inflammatory diseases (NIID) (37.5%), infectious diseases (18.6%), malignancies (7.9%), and non-systemic-inflammatory miscellaneous diseases (7.9%). The two leading causes of NIID were polymyalgia rheumatica and giant cell arteritis. F-FDG-PET/CT results were classified as true positive in 49.8% of patients and contributory in 75.1% of overall IUO patients (after the complete investigation set and a prolonged follow-up). In multivariate analysis, only C-reactive protein minimum level (≥50 mg/L) was associated with the contributory status of F-FDG-PET/CT.
Within the wide spectrum of IUO underlying diseases, F-FDG-PET/CT is helpful to make a diagnosis and to eliminate inflammatory diseases. Obese patients constitute a specific group needing further studies.
不明原因炎症（IUO）在内科领域是一种具有挑战性的情况。
描述 IUO 的最终诊断，并评估 F-氟代脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（ F-FDG-PET/CT）在诊断策略中的作用。
共纳入 317 例 IUO 患者行 F-FDG-PET/CT 检查。228 例患者得出诊断：非传染性炎症性疾病（NIID）（37.5%）、传染性疾病（18.6%）、恶性肿瘤（7.9%）和非系统性炎症性杂病（7.9%）。NIID 的两个主要病因是巨细胞动脉炎和风湿性多肌痛。F-FDG-PET/CT 结果在 49.8%的患者中为真阳性，在所有 IUO 患者（在完整的检查集和延长的随访后）中为 75.1%有帮助。多变量分析显示，只有 C 反应蛋白最低水平（≥50mg/L）与 F-FDG-PET/CT 的辅助状态相关。
在 IUO 潜在疾病的广泛谱中，F-FDG-PET/CT 有助于做出诊断并排除炎症性疾病。肥胖患者构成需要进一步研究的特定群体。
