| ObjectiveThe diagnosis of adult onset Still’s disease (AOSD) is usually difficult due to the lack of specific clinical manifestation. The manifestations of 18F-fluorodeoxyglueose positron emission tomography/computed tomography (18F-FDG PET/CT) in AOSD are summarized and compared with the patients with lymphoma. The purpose of this paper was to investigate the value of PET/CT in the diagnosis and differential diagnosis of AOSD.MethodsAOSD patient and lymphoma patients with fever were enrolled and both groups have underwent 18F-FDG PET/CT. The clinical features,laboratory examination and the maximum standard uptake value (SUVmax) of liver, spleen, bone marrow, lymph node were collected. Then we analysed the main PET/ CT manifestations, the influence factor of SUVmax and correlation between SUVmax and laboratory indexes in AOSD. Compared with lymphoma, we analysed similar or different manifestation of PET/CT between the two groups. Determine the cutoff point of SUVmax in differential diagnosis of AOSD and lymphoma by drawing ROC curve.Results1. A total of 54 patients with AOSD and 27 patients with lymphoma were enrolled.FDG accumulation occurs mainly in bone marrow (88.89%,SUVmax: 3.91±1.16),spleen (79.63%, SUVmax: 3.24±0.89) and lymph node (77.78%, SUVmax: 3.83±1.97) in AOSD.2. Compared with the nonglucocorticoid group, SUVmax of the spleen, bone marrow and lymph node were significantly decreased in the glucocorticoid group with or without fever(P<0.05), whereas the SUVmax of liver, spleen, bone marrow and lymph node between the two glucocorticoid groups were not statistically different(P>0.05). There was no significant difference in SUVmax of liver, spleen, bone marrow and lymph nodes between two groups with or without Dexamethasone (P>0.05).3. The SUVmax of liver, spleen, bone marrow and lymph node between two groups with or without disease-modifying anti-rheumatic drugs were not statistically different(P>0.05).4. Spleen SUVmax and lactate dehydrogenase, bone marrow SUVmax and C reactive protein (r=0.33, 0.30,P<0.05) were positively correlated. There was also a correlation between the SUVmax and the size of lymph nodes involved(r=0.41,P<0.05).5. FDG accumulation also occurs spleen (70.4%, SUVmax 3.8 of the median, four percentile interval 3), bone marrow (85.2%, 4.8, 2.9), lymph node (92.6%, 13.8, 8.1) in Patients with lymphoma.But compared with AOSD, the difference was not statistically significant (P>0.05). There was no significant difference in the extent of lymph node involved between lymphoma group and AOSD group (P>0.05).6. Compared with AOSD group, the SUVmax of liver, spleen and lymph nodes in lymphoma group was significantly higher (P<0.05), and the SUVmax of bone marrow was not significantly different between the two groups (P>0.05).7. The receiver operating characteristic (ROC) curve analysing the highest SUVmax in the whole body between the AOSD group and the lymphoma group showed that the area under the curve (AUC) was 0.900, and the cutoff point of SUVmax is 10.2 in In differential diagnosis between AOSD and lymphoma.Conclusion1. 18F-FDG PET/ CT manifestations of both AOSD and lymphoma patients showed the spleen, bone marrow and lymph node FDG uptake. Lymph node involvement is similar,but the SUVmax of liver, spleen and lymph node in lymphoma was significantly higher than that of AOSD group, PET/CT can be used for differential diagnosis of AOSD and lymphoma.2. GC treatment could reduce the SUVmax of spleen, bone marrow and lymph nodes in patients with AOSD. The temporary use of Dexamethasone had no effect on SUVmax. |
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