目的:非结核分枝杆菌(NTM)感染是一个日益严重的健康问题,由于延误了有效的治疗。然而,关于18F-FDGPET/CT评估NTM患者状态的数据很少。这项研究的目的是探讨18F-FDGPET/CT在指导NTM患者治疗策略中的潜在价值。
方法:回顾性分析23例NTM患者行18F-FDGPET/CT的临床资料。临床数据,包括免疫状态和NTM肺病(NTM-PD)的严重程度,被审查了。18F-FDG的代谢参数包括最大标准化摄取值(SUVmax),FDG最强烈病变的SUVmax(SUVTop),肝脏的SUVTop/SUVmax(SURLiver),SUVTop/SUVmax的血液(surblood),代谢病变体积(MLV),和总病变糖酵解(TLG)。使用接收器工作特性曲线确定这些参数的最佳截止值。
结果:局部肺部疾病6例(26.09%),播散性疾病17例(73.91%)。NTM病变具有高或中等的18F-FDG摄取(中值SUVTop:8.2±5.7)。至于免疫状态,免疫功能低下和免疫功能正常患者的SUVTop中位数分别为5.2±2.5和10.0±6.4,差异有统计学意义(P=0.038)。至于病变受累的程度,SURLiver和SURBlood在局部肺部和播散性疾病中的比率为1.9±1.1。3.8±1.6和2.7±1.8vs.5.5±2.6,分别为差异有统计学意义(P=0.016和0.026)。此外,对于疾病的严重程度,重症组肺部病变的SUVmax(SUVI-lung)和骨髓的SUVmax(SUVMarrow)分别为7.7±4.3和4.4±2.7,显著高于非重度组(分别为4.4±2.0和2.4±0.8)(P=0.027和0.036)。ROC曲线显示SUVTop,SURLiver,surblood,SUVI-肺,和SUVMarrow对免疫状态的鉴定有很高的敏感性和特异性,病变范围,NTM患者的疾病严重程度。
结论:18F-FDGPET/CT是诊断的有用工具,疾病活动评估,免疫状态,NTM患者的病变受累程度,并有助于规划NTM的适当治疗。
OBJECTIVE: Non-tuberculous mycobacteria (NTM) infection is an increasing health problem due to delaying an effective treatment. However, there are few data on 18F-FDG PET/CT for evaluating the status of NTM patients. The aim of this study was to investigate the potential value of 18F-FDG PET/CT in guiding the treatment strategy of NTM patients.
METHODS: We retrospectively analyzed the cases of 23 NTM patients who underwent 18F-FDG PET/CT. The clinical data, including immune status and severity of NTM pulmonary disease (NTM-PD), were reviewed. The metabolic parameters of 18F-FDG included maximum standardized uptake value (SUVmax), SUVmax of the most FDG-avid lesion (SUVTop), SUVTop/SUVmax of the liver (SURLiver), SUVTop/SUVmax of the blood (SURBlood), metabolic lesion volume (MLV), and total lesion glycolysis (TLG). The optimal cut-off values of these parameters were determined using receiver operating characteristic curves.
RESULTS: There were 6 patients (26.09%) with localized pulmonary diseases and 17 patients (73.91%) with disseminated diseases. The NTM lesions had high or moderate 18F-FDG uptake (median SUVTop: 8.2 ± 5.7). As for immune status, the median SUVTop in immunocompromised and immunocompetent patients were 5.2 ± 2.5 and 10.0 ± 6.4, respectively, with a significant difference (P = 0.038). As for extent of lesion involvement, SURLiver and SURBlood in localized pulmonary and disseminated diseases were 1.9 ± 1.1 vs. 3.8 ± 1.6, and 2.7 ± 1.8 vs. 5.5 ± 2.6, respectively, with a significant difference (P = 0.016 and 0.026). Moreover, for disease severity, SUVmax of the lung lesion (SUVI-lung) and SUVmax of the marrow (SUVMarrow) in the severe group were 7.7 ± 4.3 and 4.4 ± 2.7, respectively, significantly higher than those in the non-severe group (4.4 ± 2.0 and 2.4 ± 0.8, respectively) (P = 0.027 and 0.036). The ROC curves showed that SUVTop, SURLiver, SURBlood, SUVI-lung, and SUVMarrow had a high sensitivity and specificity for the identification of immune status, lesion extent, and severity of disease in NTM patients.
CONCLUSIONS: 18F-FDG PET/CT is a useful tool in the diagnosis, evaluation of disease activity, immune status, and extent of lesion involvement in NTM patients, and can contribute to planning the appropriate treatment for NTM.