18F-FDG正子電腦斷層對於成年型史迪爾氏症發燒患者的潛在意義：病例探討與文獻回顧

Potential implication of 18F-FDG PET/CT in febrile patients with adult-onset Still’s disease: A case series and literature review

目的：儘管許多文獻敘述了成人型史迪爾氏症患者的18F-FDG正子電腦斷層的表現，但目前尚未得出明確結論。我們將呈現一系列接受18F-FDG正子電腦斷層檢查的成人型史迪爾氏症患者，進行發燒原因的檢查以及成人型史迪爾氏症疾病活動的評估。
方法：我們納入了在2017年至2022年期間在我們醫院完成18F-FDG正子電腦斷層檢查的五名符合成人型史迪爾氏症標準的患者。我們評估了FDG攝取量對於成人型史迪爾氏症患者的影像特徵，用以區別發燒原因屬於成人型史迪爾氏症疾病高活動度、活躍感染或者惡性腫瘤。此外我們回顧有關成人型史迪爾氏症的18F-FDG正子電腦斷層的相關文獻。
結果：我們有三位發燒患者的18F-FDG正子電腦斷層檢查結果呈陽性，暗示他們的成人型史迪爾氏症疾病為高活動度，接受高劑量皮質類固醇治療，部分患者同時給予生物學疾病修飾抗風濕藥物，治療後病情活動度有很大的改善。18F-FDG正子電腦斷層的影像特徵包括淋巴結、脾臟和/或骨髓FDG攝取量的增加。一位成人型史迪爾氏症患者因發燒和淋巴結腫脹，FDG攝取量在相關的淋巴結上很高，其淋巴切片結果為活動性感染。一位發燒的成人型史迪爾氏症患者的18F-FDG正子電腦斷層影像顯示子宮局部攝取量高，其診斷為子宮肉瘤。
結論：18F-FDG正子電腦斷層檢查為區分成人型史迪爾氏症患者與感染性疾病或惡性腫瘤的潛在工具，並可能有助於評估成人型史迪爾氏症的疾病活動度。

Objective: Although 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings have been described in patients with adult-onset Still’s disease (AOSD), conflicting results have been reported. This study aimed to present a series of patients with AOSD who underwent examinations of 18F-FDG PET/CT for fever survey and AOSD activity evaluation.
Methods: Five febrile patients diagnosed with AOSD who underwent 18F-FDG PET/CT at our hospital between 2017 and 2022 were enrolled. FDG uptake was evaluated for characteristic findings in patients with AOSD, differentiating them from high disease activity, active infection, or malignancy. In addition, the literature on 18F-FDG PET/CT findings in AOSD was reviewed.
Results: Three of our febrile patients who had positive 18F-FDG PET/CT findings were suspected of high AOSD activity, and their manifestation improved following a high dose therapy of corticosteroids with/without concomitant biologic disease-modifying antirheumatic drugs. The characteristic findings of 18F-FDG PET/CT included increased uptake in the lymph nodes, spleen, and/or bone marrow. One patient with AOSD who presented with fever and lymphadenopathy had intense uptake over the involved lymph nodes, and excision biopsy revealed active infection. The 18F-FDG PET/CT image in one febrile patient with AOSD demonstrated a high uptake over the uterus, and the diagnosis of uterine sarcoma was made.
Conclusions: 18F-FDG PET/CT may be a potential tool for differentiating AOSD from infectious disease or malignancy and may aid in evaluating AOSD activity.