免疫闪烁扫描术在不明原因发热患者中的临床价值。

Clinical value of immunoscintigraphy in patients with fever of unknown origin.

作者信息

Meller J, Ivancevic V, Conrad M, Gratz S, Munz D L, Becker W

机构信息

Department of Nuclear Medicine, Georg August University of Göttingen, Germany.

出版信息

J Nucl Med. 1998 Jul;39(7):1248-53.

PMID:9669403

Abstract

UNLABELLED

The aim of our study was to evaluate the clinical value of immunoscintigraphy with the monoclonal antibody 99mTc-BW 250/183 in patients with fever of unknown origin (FUO). The antibody BW 250/183 is an immunoglobulin G1 subtype that binds to the antigen NCA-95, which is expressed on the cell membrane surface of granulocytes.

METHODS

We studied 51 patients who were referred with the diagnosis of FUO. Thirty-five percent of the patients suffered from infection, 17% had autoimmune diseases, 14% had neoplasms and 8% had other diseases. The remaining 28% of the patients did not have a diagnosis. Planar imaging was performed in all patients, and 19 patients underwent SPECT. In our analysis, both cold and hot spots were considered diagnostic.

RESULTS

Pyogenic infections were visualized correctly in 13 foci. The diagnosis of endocarditis (n = 4) could be determined only by SPECT. False-negative results were found in 4 patients and false-positive uptake was seen in 2 patients. No false-positive uptake or cold spots in the central bone marrow were found in patients with viral, granulomatous and autoimmune diseases or in those patients in whom no FUO cause was found in a 6-mo follow-up. In these patients, a negative scan did not change their diagnostic work-up. Cold spots in the central bone marrow were correctly interpreted in 5 of 6 patients. Sensitivity in detecting pyogenic foci was 73% and specificity was 97%. Positive and negative predictive values were 93% and 87%, respectively. Including areas of decreased uptake in the analysis, sensitivity for detecting an underlying inflammatory or malignant process for FUO was 81 % and specificity was 87%. Positive and negative predictive values were 81% and 87%, respectively.

CONCLUSION

Immunoscintigraphy with 99mTc-BW 250/183 in patients with FUO has clinical potential for the diagnosis and exclusion of pyogenic causes of FUO. Metastatic malignant disease and high-grade spondylodiskitis could be diagnosed early in a diagnostic work-up by a characteristic cold spot pattern in the bone marrow. SPECT is indispensible for scintigraphic imaging of endocarditis.

摘要

未标记

我们研究的目的是评估单克隆抗体99mTc - BW 250/183免疫闪烁显像在不明原因发热（FUO）患者中的临床价值。抗体BW 250/183是一种免疫球蛋白G1亚型，可与粒细胞细胞膜表面表达的抗原NCA - 95结合。

方法

我们研究了51例被诊断为FUO的患者。35%的患者患有感染，17%患有自身免疫性疾病，14%患有肿瘤，8%患有其他疾病。其余28%的患者未明确诊断。所有患者均进行了平面显像，19例患者接受了SPECT检查。在我们的分析中，冷区和热区均被视为有诊断意义。

结果

13个病灶中正确显示了化脓性感染。仅通过SPECT才能确定4例心内膜炎的诊断。4例患者出现假阴性结果，2例患者出现假阳性摄取。在病毒感染、肉芽肿性疾病、自身免疫性疾病患者或在6个月随访中未发现FUO病因的患者中，未发现中央骨髓有假阳性摄取或冷区。在这些患者中，阴性扫描并未改变他们的诊断检查。6例患者中有5例中央骨髓冷区得到正确解读。检测化脓性病灶的敏感性为73%，特异性为97%。阳性和阴性预测值分别为93%和87%。将摄取降低区域纳入分析后，检测FUO潜在炎症或恶性病变的敏感性为81%，特异性为87%。阳性和阴性预测值分别为81%和87%。