Nature：恙虫病与系统性红斑狼疮F-18 FDG PET/CT图像的比较分析-动脉网

Nature：Comparative analysis of F-18 FDG PET/CT images between scrub typhus and systemic lupus erythematosus

Nature 等信源发布 2024-07-03 13:33

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AbstractThis study evaluated the use of F-18 fluorodeoxyglucose (FDG) PET/CT imaging to differentiate between scrub typhus and systemic lupus erythematosus (SLE) in patients presenting with lymphadenopathy. We carried out a retrospective analysis of 18 scrub typhus patients and seven SLE patients, using various imaging parameters, including lymph node size, spleen and liver lengths, the distance between the two farthest lesions (Dmax), and assessments of glucose metabolism.

摘要本研究评估了使用F-18氟脱氧葡萄糖（FDG）PET/CT成像来区分患有淋巴结病的患者的恙虫病和系统性红斑狼疮（SLE）。我们使用各种成像参数对18例恙虫病患者和7例SLE患者进行了回顾性分析，包括淋巴结大小，脾脏和肝脏长度，两个最远病变之间的距离（Dmax）以及葡萄糖代谢评估。

On FDG PET images, we measured the maximum standardized uptake value (SUVmax) of the lymph nodes, spleen, and liver and the mean standardized uptake value (SUVmean) of the liver and spleen. The Dmax values of scrub typhus patients were significantly longer than those of SLE patients, indicating that lymphadenopathy is more generalized in the patients with scrub typhus.

在FDG PET图像上，我们测量了淋巴结，脾脏和肝脏的最大标准摄取值（SUVmax）以及肝脏和脾脏的平均标准摄取值（SUVmean）。。

The SUVmax values for the lymph node, spleen, and liver were also higher in patients with scrub typhus, while the SUVmean of the liver and spleen did not differ between the two groups. This study is the first to compare FDG PET/CT images between these two conditions, suggesting the potential of this imaging modality to provide critical diagnostic distinctions..

恙虫病患者的淋巴结，脾脏和肝脏的SUVmax值也较高，而肝脏和脾脏的SUVmean在两组之间没有差异。。。

IntroductionThe etiologies of lymphadenopathy (LAP) encompass a wide variety of conditions, such as infection, malignancy, autoimmune diseases, and certain medications1,2. Differentiating among these conditions is a significant clinical challenge, with multiple studies confirmed the difficulty in distinguishing benign LAPs from malignant ones, such as sarcoidosis versus lymphoma3,4,5,6.Imaging techniques, particularly fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), play a vital role in diagnosing different LAPs7,8,9,10,11.

引言淋巴结病（LAP）的病因包括多种疾病，如感染，恶性肿瘤，自身免疫性疾病和某些药物1,2。区分这些疾病是一个重大的临床挑战，多项研究证实难以区分良性LAPs和恶性LAPs，如结节病与淋巴瘤3,4,5,6。成像技术，特别是氟-18（F-18）氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT），在诊断不同的LAPs中起着至关重要的作用7,8,9,10,11。

Although developed for use in oncology, FDG PET/CT, is now used for infectious and inflammatory diseases. Patients with acute scrub typhus, an infection caused by the bacterium Orientia tsutsugamushi, exhibit hypermetabolic generalized LAPs in FDG PET/CT images12. This condition, which affects approximately 1 million people annually, primarily in the Asia–Pacific region, can be fatal if not treated promptly13,14,15.

尽管开发用于肿瘤学，但FDG PET/CT现在用于感染性和炎性疾病。急性恙虫病（一种由恙虫病东方体引起的感染）患者在FDG PET/CT图像中表现出高代谢性全身LAPs 12。。

Its symptoms, which are often under-recognized, necessitate early detection and effective treatment.Systemic lupus erythematosus (SLE), a complex autoimmune disorder, also presents with LAP in its acute phase. This similarity to scrub typhus can lead to diagnostic confusion. SLE is characterized by diverse symptoms, ranging from mild cutaneous and constitutional symptoms to severe organ involvement16.

它的症状通常被低估，因此需要早期发现和有效治疗。系统性红斑狼疮（SLE）是一种复杂的自身免疫性疾病，在急性期也出现LAP。这种与恙虫病的相似性可能导致诊断混乱。SLE的特征是症状多样，从轻微的皮肤和体质症状到严重的器官受累16。

LAP is a frequent, albeit nonspecific, manifestation in SLE patients, making careful assessment crucial for accurate diagnosis and for preventing the acceleration of disease activity17,18.Despite extensive research efforts to distinguish among malignant LAPs, few studies have attempted to differentiate between various benign LAPs, including those caused by infections such as scrub typhus,.

LAP在SLE患者中是一种常见但非特异性的表现，因此仔细评估对于准确诊断和预防疾病活动加速至关重要17,18。尽管进行了广泛的研究来区分恶性LAP，但很少有研究试图区分各种良性LAP，包括由恙虫病等感染引起的良性LAP，。

Table 1 Clinical characteristics and laboratory values of the patients with Scrub Typhus and those with SLE.Full size tableF-18 FDG PET/CT parametersAn analysis of lengths found no statistical differences in the maximal short axis of the involved lymph node, the maximal length of the spleen, or the maximal anterior–posterior length of the liver between patients with scrub typhus and those with SLE.

表1恙虫病患者和SLE患者的临床特征和实验室检查值。全尺寸表F-18 FDG PET/CT参数对长度的分析发现，恙虫病患者和SLE患者在受累淋巴结的最大短轴，脾脏的最大长度或肝脏的最大前后长度方面没有统计学差异。

However, the Dmax of scrub typhus patients was longer at 72.2 cm compared with 57.5 cm in SLE patients, indicating that LAP is more generalized in scrub typhus patients compared with those with SLE. The Dmax of scrub typhus patients was ≥ 70 cm in 15 of 18 cases, while, only one of the seven SLE patients showed a Dmax > 70 cm.

然而，恙虫病患者的Dmax较长，为72.2厘米，而SLE患者为57.5厘米，这表明与SLE患者相比，恙虫病患者的LAP更为普遍。恙虫病患者的Dmax在18例中有15例≥70 cm，而7例SLE患者中只有1例显示Dmax>70 cm。

In a comparison of metabolic parameters, the SUVmax of the lymph nodes, spleen, and liver was significantly higher in patients with scrub typhus, while the SUVmean for the liver and spleen did not differ between the two groups. Various FDG PET/CT parameters are listed in Table 2, and Fig. 1 depicts typical cases of acute-phase scrub typhus and SLE..

在代谢参数的比较中，恙虫病患者的淋巴结，脾脏和肝脏的SUVmax显着更高，而肝脏和脾脏的SUVmean在两组之间没有差异。表2列出了各种FDG PET/CT参数，图1描绘了急性期恙虫病和SLE的典型病例。。

Table 2 FDG PET/CT parameters in the patients with Scrub Typhus and those with SLE.Full size tableFigure 1FDG PET/CT images of a 49 year-old female patient with scrub typhus and a 63 year-old female patient with SLE. The patient with scrub typhus demonstrates extensive involvement of lymph nodes from both cervical to inguinal areas (A), whereas the patient with SLE shows lymph nodes in the right supraclavicular and mediastinal areas (C).

表2恙虫病和SLE患者的FDG PET/CT参数。。恙虫病患者表现出从颈部到腹股沟区域的淋巴结广泛受累（A），而SLE患者在右锁骨上和纵隔区域显示淋巴结（C）。

FDG uptake levels in the lymph nodes, spleen, and liver are higher in the patient with scrub typhus (B) compared to those in the patient with SLE (D).Full size imageDiscussionThis study investigated FDG PET/CT findings in patients with scrub typhus and SLE, an area largely covered by case reports with limited patient samples22,23.

恙虫病患者（B）的淋巴结，脾脏和肝脏中的FDG摄取水平高于SLE患者（D）。全尺寸图像讨论本研究调查了恙虫病和SLE患者的FDG PET/CT结果，该区域主要由病例报告覆盖，患者样本有限22,23。

Our research incorporated a larger cohort of patients in the acute phase of the disease, allowing for a more robust comparison between scrub typhus and SLE based on FDG PET/CT imaging.An important aspect of this investigation is the identification of distinct discriminative features using FDG PET/CT, particularly between infectious and inflammatory diseases, which often exhibit overlapping characteristics.

我们的研究纳入了该疾病急性期的更多患者队列，从而可以基于FDG PET/CT成像对恙虫病和SLE进行更有力的比较。这项研究的一个重要方面是使用FDG PET/CT识别不同的鉴别特征，特别是在感染性和炎性疾病之间，这些疾病通常表现出重叠的特征。

We found that measurement of the sizes of the lymph node, spleen, and liver via CT does not significantly aid in differentiating between these two conditions. In contrast, the use of SUVmax in FDG PET imaging proved to be a pivotal metric for differentiation, due to its minimal interobserver and intraobserver variability, making it a practical and reliable option in clinical settings.Another innovative aspect of this study is the application of Dmax to a non-lymphoma patient group, where it is traditionally an independent prognostic factor in lymphoma24,25,26.

我们发现通过CT测量淋巴结，脾脏和肝脏的大小并不能显着帮助区分这两种情况。相比之下，在FDG PET成像中使用SUVmax被证明是区分的关键指标，因为它具有最小的观察者间和观察者内变异性，使其成为临床环境中实用且可靠的选择。这项研究的另一个创新方面是将Dmax应用于非淋巴瘤患者组，传统上它是淋巴瘤的独立预后因素24,25,26。

This research demonstrates Dmax's potential as a.

这项研究证明了Dmax作为a的潜力。

Data availability

数据可用性

The datasets generated and/or analysed during the current study are available in the NCBI repository [Accession number to datasets: KY946045, KY946102, KY946106, KY946100, KY946062, KY946099, KY946043, KY946101, KY946009, MK613928, KC424618, KY957849, KY946004, AB751260, MG844361, KY946036, KT957856, KY946004]..

在当前研究期间生成和/或分析的数据集可在NCBI存储库中获得[数据集的登录号：KY946045，KY946102，KY946106，KY946100，KY946062，KY946099，KY946043，KY946101，KY946009，MK613928，KC424618，KY957849，KY946004，AB751260，MG844361，KY946036，KT957856，KY946004]。。

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Download referencesAcknowledgementsThis research was supported by the Biomedical Research Institute of Jeonbuk National University Hospital and the Basic Science Research Programs (NRF 2015R1D1A1A01060251 and 2018R1D1A3B07049557) of the National Research Foundation of Korea, which is funded by the Ministry of Education.Author informationAuthors and AffiliationsDepartment of Nuclear Medicine, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, 54896, Republic of KoreaYeon-Hee HanDepartment of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, 54896, Republic of KoreaJoo-Hee Hwang & Chang-Seop LeeDivision of Rheumatology, Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, 54896, Republic of KoreaYunjung ChoiResearch Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of KoreaYeon-Hee Han, Joo-Hee Hwang, Yunjung Choi & Chang-Seop LeeAuthorsYeon-Hee HanView author publicationsYou can also search for this author in.

下载参考文献致谢本研究得到了全北国立大学医院生物医学研究所和韩国国家研究基金会基础科学研究项目（NRF 2015R1D1A1A01060251和2018R1D1A3B07049557）的支持，该项目由教育部资助。作者信息作者和附属机构全州国立大学医学院和医院核医学系，回旋加速器研究中心，分子成像和治疗医学研究中心，全州54896，韩国全州大学医学院和医院内科，全州54896，韩国全州大学医学院和医院，全州54896，全州国立大学医学院和医院内科，全州54896，韩国全州大学生物医学研究所全州国立大学医院临床医学研究所，全州54896 Jeonju，54907，韩国共和国，Joo Hee Hwang，Yunjung Choi＆Chang Seop LeeAuthorsYeon Hee HanView作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarJoo-Hee HwangView author publicationsYou can also search for this author in

PubMed Google ScholarJoo Hee HwangView作者出版物您也可以在

PubMed Google ScholarYunjung ChoiView author publicationsYou can also search for this author in

PubMed Google ScholarChang-Seop LeeView author publicationsYou can also search for this author in

PubMed Google ScholarChang Seop LeeView作者出版物您也可以在

PubMed Google ScholarContributionsY.H.H., Y.C., and C.S.L. contributed to the acquisition of data, analysis, and drafting. Y.H.H. and C.S.L. helped analyze the results and participated in discussions. J.H.H., Y.C., and C.S.L. performed a revision of the article. J.H.H. also provided helpful comments.

PubMed谷歌学术贡献。H、 H.，Y.C.和C.S.L.为数据的获取，分析和起草做出了贡献。Y、。J、 H.H.，Y.C。和C.S.L.对该文章进行了修订。J、 H.H.也提供了有益的意见。

All authors contributed to the study's conception, design, and drafting. All authors read and approved the final manuscript.Corresponding authorsCorrespondence to.

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Reprints and permissionsAbout this articleCite this articleHan, YH., Hwang, JH., Choi, Y. et al. Comparative analysis of F-18 FDG PET/CT images between scrub typhus and systemic lupus erythematosus.

转载和许可本文引用本文Han，YH。，。，Choi，Y.等人。恙虫病和系统性红斑狼疮之间F-18 FDG PET/CT图像的比较分析。

Sci Rep 14, 15264 (2024). https://doi.org/10.1038/s41598-024-65256-1Download citationReceived: 31 January 2024Accepted: 18 June 2024Published: 03 July 2024DOI: https://doi.org/10.1038/s41598-024-65256-1Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1415264（2024）。https://doi.org/10.1038/s41598-024-65256-1Download引文接收日期：2024年1月31日接受日期：2024年6月18日发布日期：2024年7月3日OI：https://doi.org/10.1038/s41598-024-65256-1Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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