~(18)F-FDG PET-CT在风湿免疫系统疾病中的应用
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摘要
目的 :探讨~(18)F-FDG PET-CT在风湿免疫系统疾病诊断中的应用价值。方法 :回顾性分析行PET-CT检查且经临床诊断标准证实的32例风湿免疫系统疾病患者的临床资料及~(18)F-FDG PET-CT特征,观察病灶~(18)F-FDG摄取情况。结果:32例中,痛风3例,类风湿关节炎(RA)5例,多发性大动脉炎(TA)6例,强直性脊柱炎(AS)4例,成人Still病(AOSD)9例(其中2例合并AS),皮肌炎2例,风湿性多肌痛(PMR)3例。PET-CT表现:痛风表现为患病关节邻近软组织肿胀、关节腔积液,伴FDG代谢升高;RA表现为双侧肩关节、肘关节、髋关节、腕关节及部分近端掌指关节FDG摄取升高;TA表现为主动脉及主要分支血管管壁不均匀增厚,伴FDG代谢弥漫性升高;AOSD表现为骨髓FDG弥漫性摄取升高,脾脏FDG代谢高于肝脏,全身部分淋巴结肿大伴FDG代谢升高,部分关节FDG代谢升高;皮肌炎表现为双侧肩部、双侧胸锁乳突肌、双侧臀部肌肉FDG代谢轻度升高;PMR表现为双侧肩、双髋、双膝、双踝关节、耻骨联合、坐骨结节周围FDG摄取升高;AS 4例中2例表现为骶髂关节FDG代谢升高,2例双髋FDG代谢升高。结论:~(18)F-FDG PET-CT有助于风湿免疫系统疾病的早期诊断,可准确显示病变范围。
Objective:To investigate the characteristics of~(18)F-FDG PET/CT imaging in rheumatic diseases and its application in the diagnosis and early diagnosis of rheumatic immune system diseases. Methods:The clinical data and~(18)F-FDG PET/CT imaging features of 32 patients with rheumatic immune system diseases confirmed by clinical diagnostic criteria were analyzed retro-spectively to observe~(18)F-FDG uptake of the lesions. Results:Among all the 32 patients with rheumatic diseases:3 cases with gout,5 cases with rheumatoid arthritis(RA),6 cases with takayasu arteritis(TA),9 cases with adult onset Still 's disease(AOSD)(including 2 cases with ankylosing spondylitis),2 cases with dermatomyositis(DM),3 cases with polymyalgia rheumatica(PMR),4 cases with ankylosing spondylitis(AS). Features of PET/CT:Gout showed swelling of adjacent soft tissue,effusion of articular cavity and increased metabolism of FDG. The SUVmax was 4.1. RA showed increased uptake of FDG in bilateral shoulder joints,elbow joints,hip joints,wrist joints and some proximal metacarpophalangeal joints. The SUVmax was 4.3. TA showed uneven thickening of aorta and main branches,partial calcification and diffuse increase of FDG metabolism. The SUVmax was 5.4. AOSD showed that FDG uptake increased in bone marrow,FDG metabolism in spleen was higher than that in liver,partial lymph node enlargement with FDG metabolism increased,and partial FDG metabolism increased. The SUVmax was8.6. DM showed bilateral shoulder,bilateral sternocleidomastoid muscle and slight increase of FDG metabolism in bilateral hip muscles. The SUVmax was 4.8. PMR showed FDG uptake around bilateral shoulder,bilateral chest lock,hip,knee,ankle,pubic symphysis,lumbar spinous process,and ischium nodule. The SUVmax was 4.8. AS showed increased FDG metabolism in sacroiliac joint in 2 cases and increased FDG metabolism in 2 cases of double hip joint. The SUVmax was 3.8. Conclusion:~(18)F-FDG PET/CT imaging is helpful to the diagnosis of rheumatic immune system diseases,and it is of great value to the early diagnosis of rheumatic immune system diseases.
Objective:To investigate the characteristics of~(18)F-FDG PET/CT imaging in rheumatic diseases and its application in the diagnosis and early diagnosis of rheumatic immune system diseases. Methods:The clinical data and~(18)F-FDG PET/CT imaging features of 32 patients with rheumatic immune system diseases confirmed by clinical diagnostic criteria were analyzed retro-spectively to observe~(18)F-FDG uptake of the lesions. Results:Among all the 32 patients with rheumatic diseases:3 cases with gout,5 cases with rheumatoid arthritis(RA),6 cases with takayasu arteritis(TA),9 cases with adult onset Still 's disease(AOSD)(including 2 cases with ankylosing spondylitis),2 cases with dermatomyositis(DM),3 cases with polymyalgia rheumatica(PMR),4 cases with ankylosing spondylitis(AS). Features of PET/CT:Gout showed swelling of adjacent soft tissue,effusion of articular cavity and increased metabolism of FDG. The SUVmax was 4.1. RA showed increased uptake of FDG in bilateral shoulder joints,elbow joints,hip joints,wrist joints and some proximal metacarpophalangeal joints. The SUVmax was 4.3. TA showed uneven thickening of aorta and main branches,partial calcification and diffuse increase of FDG metabolism. The SUVmax was 5.4. AOSD showed that FDG uptake increased in bone marrow,FDG metabolism in spleen was higher than that in liver,partial lymph node enlargement with FDG metabolism increased,and partial FDG metabolism increased. The SUVmax was8.6. DM showed bilateral shoulder,bilateral sternocleidomastoid muscle and slight increase of FDG metabolism in bilateral hip muscles. The SUVmax was 4.8. PMR showed FDG uptake around bilateral shoulder,bilateral chest lock,hip,knee,ankle,pubic symphysis,lumbar spinous process,and ischium nodule. The SUVmax was 4.8. AS showed increased FDG metabolism in sacroiliac joint in 2 cases and increased FDG metabolism in 2 cases of double hip joint. The SUVmax was 3.8. Conclusion:~(18)F-FDG PET/CT imaging is helpful to the diagnosis of rheumatic immune system diseases,and it is of great value to the early diagnosis of rheumatic immune system diseases.
引文
[1]林庆衍,王秀琴,段利华,等.影响风湿性疾病患者就诊的相关因素分析[J].中华风湿病学杂志,2014,18(7):489-491.
[2]王冬艳,吴敏,邵晓梁,等.18F-FDG PET及PET/CT在风湿性疾病诊断及疗效监测中的应用[J].中华核医学与分子影像杂志,2014,34(3):257-260.
[3] Bieber JD,Terkeltaub RA. Gout:on the brink of novel therapeutic options for an ancient disease[J]. Arthritis&Rheumatism,2004,50:2400-2414.
[4] Scutellari PN,Orzincolo C. Rheumatoid arthritis’s equences[J].Eur J Radiol,1998,27(S1):S31-38.
[5] Palmer WE,Rosenthal DI,Schoenberg OI,et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose[J]. Radiology,1995,196:647-655.
[6] Beckers C,Ribbens C,AndréB,et al. Assessment of disease activity in rheumatoid arthritis with18F-FDG PET[J]. Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2004,45:956-964.
[7] Numano F,Okawara M,Inomata H,et al. Takayasu’s arteritis[J].Lancet,2000,356:1023.
[8] Ohara M,Shigematsu H,Tsutani Y,et al. Role of FDG-PET/CT in evaluating surgical outcomes of operable breast cancer--usefulness for malignant grade of triple-negative breast cancer[J]. Breast,2013,22:958-963.
[9] Wen D,Du X,Ma CS. Takayasu arteritis:diagnosis,treatment and prognosis[J]. International Reviews of Immunology,2012,31:462.
[10] Blockmans D,De Ceuninck L,Vanderschueren S,et al. Repetitive 18-fluoro-deoxyglucose positron emission tomography in isolated polymyalgia rheumatica:a prospetive study in 35 Patients[J]. Rheumatology(Oxford),2007,46:672-677.
[11] Pacheco CMC,Mínguez VM,Martínez CA,et al. Early diagnosis of large vessel vasculitis:usefulness of positron emission tomography with computed tomography[J]. Reumatología Clinica,2013,9:65.
[12] Webb M,Chambers A,AL-Nahhas A,et al. The role of18F-FDG PET in characterising disease activity in Takayasu arteritis[J].Eur J Nucl Med Mol Imaging,2004,31:624-634.
[13] Gerfaud-Valentin M,Jamilloux Y,Iwaz J,et al. Adult-onset Still’s disease[J]. Autoimmun Rev,2014,13:708-722.
[14]尤阳,轩昂,张杰,等.成人Still病18F-FDG PET/CT影像学表现[J].中华核医学与分子影像杂志,2017,37(1):39-40.
[15]中华医学会风湿病学分会.成人斯蒂尔病诊断及治疗指南[J].中华风湿病学杂志,2010,14(7):487-489.
[16] Yamaguchi M,Ohta A,Tsunematsu T,et al. Preliminary criteria for classification of adult Still's disease[J]. Journal of Rheumatology,1992,19:424.
[17] Yamashita H,Kubota K,Takahashi Y,et al. Clinical value of18F-fluoro-dexoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still’s disease:A seven-case series and review of the literature[J]. Modern Rheumatology,2013,24:645-650.
[18]胡炳彦,王金凤,高振辉.多发性肌炎/皮肌炎的现状研究[J].中外医疗,2017,36(1):195-198.
[19]裴蕾.[18F]FDG/PET/CT在皮肌炎诊断与治疗中的应用研究[D].北京:中国人民解放军医学院,2016.
[20] Chuang TY,Hunder GG,Ilstrup DM,et al. Polymyalgia rheumatica:A 10-year epidemiologic and clinical study[J]. Annals of Internal Medicine,1982,97:672.
[21] Rehak Z,Sprlakova-Pukova A,Bortlicek Z,et al. PET/CT imaging in polymyalgia rheumatica:praepubic18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis[J]. Radiology&Oncology,2017,51:8.
[22] Baba A,Uno K,Okuyama Y,et al. Giant cell arteritis with polymyalgia rheumatica on FDG-PET/CT[J]. Clin Case Rep,2017,5:1186-1187.
[23] Yamashita H,Kubota K,Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases[J]. Arthritis Research&Therapy,2014,16:1-12.
[24] Fong W,Holroyd C,Davidson B,et al. The effectiveness of a real life dose reduction strategy for tumour necrosis factor inhibitors in ankylosing spondylitis and psoriatic arthritis[J]. Rheumatology(Oxford),2016,55:1837-1842.
[2]王冬艳,吴敏,邵晓梁,等.18F-FDG PET及PET/CT在风湿性疾病诊断及疗效监测中的应用[J].中华核医学与分子影像杂志,2014,34(3):257-260.
[3] Bieber JD,Terkeltaub RA. Gout:on the brink of novel therapeutic options for an ancient disease[J]. Arthritis&Rheumatism,2004,50:2400-2414.
[4] Scutellari PN,Orzincolo C. Rheumatoid arthritis’s equences[J].Eur J Radiol,1998,27(S1):S31-38.
[5] Palmer WE,Rosenthal DI,Schoenberg OI,et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose[J]. Radiology,1995,196:647-655.
[6] Beckers C,Ribbens C,AndréB,et al. Assessment of disease activity in rheumatoid arthritis with18F-FDG PET[J]. Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2004,45:956-964.
[7] Numano F,Okawara M,Inomata H,et al. Takayasu’s arteritis[J].Lancet,2000,356:1023.
[8] Ohara M,Shigematsu H,Tsutani Y,et al. Role of FDG-PET/CT in evaluating surgical outcomes of operable breast cancer--usefulness for malignant grade of triple-negative breast cancer[J]. Breast,2013,22:958-963.
[9] Wen D,Du X,Ma CS. Takayasu arteritis:diagnosis,treatment and prognosis[J]. International Reviews of Immunology,2012,31:462.
[10] Blockmans D,De Ceuninck L,Vanderschueren S,et al. Repetitive 18-fluoro-deoxyglucose positron emission tomography in isolated polymyalgia rheumatica:a prospetive study in 35 Patients[J]. Rheumatology(Oxford),2007,46:672-677.
[11] Pacheco CMC,Mínguez VM,Martínez CA,et al. Early diagnosis of large vessel vasculitis:usefulness of positron emission tomography with computed tomography[J]. Reumatología Clinica,2013,9:65.
[12] Webb M,Chambers A,AL-Nahhas A,et al. The role of18F-FDG PET in characterising disease activity in Takayasu arteritis[J].Eur J Nucl Med Mol Imaging,2004,31:624-634.
[13] Gerfaud-Valentin M,Jamilloux Y,Iwaz J,et al. Adult-onset Still’s disease[J]. Autoimmun Rev,2014,13:708-722.
[14]尤阳,轩昂,张杰,等.成人Still病18F-FDG PET/CT影像学表现[J].中华核医学与分子影像杂志,2017,37(1):39-40.
[15]中华医学会风湿病学分会.成人斯蒂尔病诊断及治疗指南[J].中华风湿病学杂志,2010,14(7):487-489.
[16] Yamaguchi M,Ohta A,Tsunematsu T,et al. Preliminary criteria for classification of adult Still's disease[J]. Journal of Rheumatology,1992,19:424.
[17] Yamashita H,Kubota K,Takahashi Y,et al. Clinical value of18F-fluoro-dexoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still’s disease:A seven-case series and review of the literature[J]. Modern Rheumatology,2013,24:645-650.
[18]胡炳彦,王金凤,高振辉.多发性肌炎/皮肌炎的现状研究[J].中外医疗,2017,36(1):195-198.
[19]裴蕾.[18F]FDG/PET/CT在皮肌炎诊断与治疗中的应用研究[D].北京:中国人民解放军医学院,2016.
[20] Chuang TY,Hunder GG,Ilstrup DM,et al. Polymyalgia rheumatica:A 10-year epidemiologic and clinical study[J]. Annals of Internal Medicine,1982,97:672.
[21] Rehak Z,Sprlakova-Pukova A,Bortlicek Z,et al. PET/CT imaging in polymyalgia rheumatica:praepubic18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis[J]. Radiology&Oncology,2017,51:8.
[22] Baba A,Uno K,Okuyama Y,et al. Giant cell arteritis with polymyalgia rheumatica on FDG-PET/CT[J]. Clin Case Rep,2017,5:1186-1187.
[23] Yamashita H,Kubota K,Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases[J]. Arthritis Research&Therapy,2014,16:1-12.
[24] Fong W,Holroyd C,Davidson B,et al. The effectiveness of a real life dose reduction strategy for tumour necrosis factor inhibitors in ankylosing spondylitis and psoriatic arthritis[J]. Rheumatology(Oxford),2016,55:1837-1842.