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題名 | PET in Vascular Diseases: Applications of FDG PET/CT in Vasculitis and Therapeutic Response=正子造影於血管疾病之應用:氟化去氧葡萄糖正子斷層造影應用在血管炎及評估其治療反應 |
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作者 | 林立凡; 蔡建松; 陳明容; 吳興鏞; 鄭澄意; 黃文盛; Lin, Li-fan; Tsai, Chuen-sung; Chen, Ming-rong; Ho, Eugene C.; Wu, Sing-yung; Cheng, Cheng-yi; Huang, Wen-sheng; |
期刊 | 核子醫學雜誌 |
出版日期 | 20060600 |
卷期 | 19:2 民95.06 |
頁次 | 頁91-98 |
分類號 | 415.38 |
語文 | eng |
關鍵詞 | 正子氟化去氧葡萄糖斷層造影; 血管炎; 自體免疫疾病; 不明熱; 類固醇治療; FDG PET/CT; Vasculitis; Autoimmune disease; FUO; Steroid therapy; |
中文摘要 | 如同許多惡性腫瘤,活化的發炎細胞也會增加葡萄糖之攝取,過去的研究顯示,氟-18氟化去氟葡萄糖(18F-FDG)會在包括自體免疫等原因引起之血管炎中的發炎組織堆積。因此,正子氟化去氧葡萄糖斷層造影(FDG-PET)在評估發炎及感染疾病方面的應用也更顯得重要。與傳統診斷工具相比,FDG-PET/CT在評估血管炎方面的優點包括,(1)安全,非侵入性;(2)全身性的評估;(3)病灶/背景之對比度較高;(4)不受金屬植入物干擾並且無常見顯影劑造成之副作用。雖然其較昂貴的檢查成本可能使得應用受到某些限制,但近來(2000)核子醫學年會在此主題部分論文數量的增加,正反映出大眾對此主題的濃厚興趣。血管炎導因於動脈發炎過程中,白血球浸潤血管壁並造成壁層結構的破壞。診斷血管炎通常相當困難,因為缺乏典型的症狀與徵候,且無特殊專一的生化標記及影像學檢查。血管炎的分類標準是以美國風濕學學會準則(ACR criteria 1990)為依據,然而實際上在診斷某些特殊的血管炎時,仍然是有限制的。在某些大血管之血管炎,例如巨細胞動脈炎(GCA)及高安氏動脈炎(Takayasu's arteritis; TA),目前的診斷工具在診斷與評估疾病的活動性以及其影響範圍,尤其是對無明顯臨床典型症狀及特殊生化發現的病人,仍然不盡理想。合併使用正子造影與電腦斷層(PET/CT)能比單純使用PET提供更佳的解析度來定位較小的病灶,因此在影像判讀上能更為準確。雖然FDG-PET/CT在評估血管炎的臨床應用尚未完整建立,但使用FDG-PET/CT在評估發炎過程,包括早期診斷、評估疾病活動性與監控治療效果等相關的研究已經有明顯的進展。 |
英文摘要 | Like many malignancies, increased glucose uptake is also found in activated inflammatory cells that raise great interest in the applications of FDG in evaluating inflammatory and infectious disorders. 18F-FDG has been shown to accumulate in inflamed tissue including autoimmune induced vasculitis and inflamed atherosclerotic lesions. Advantages of FDG PET/CT compared with other imaging modalities in this aspect including: (1) safe and, non-invasive; (2) whole-body detection; (3) high target contrast; (4) function oriented; (5) absence of metallic interference and contrast medium related side-effects. Higher cost is probably its hindrance. However, a steady growth of interest in this field reflected by the number of submitted papers in Annual Meeting of the Society of Nuclear Meeting has been noticed since 2000. The fact was highlighted by Dr. Henry Wagner in 2005 SNM Highlights Lecture. Vasculitis is referring as diseases causing an arterial inflammatory process with leukocytes infiltration in the wall and damages the mural structures. Diagnosis of vasculitis is often difficult owing to the lack of characteristic symptoms and signs, specific biochemical markers and imaging modalities. The American College of Rheumatology 1990 criteria (ACR criteria) are considered to be the gold standard for the classification of vasculitis. However, in practice, the criteria are still limited in diagnosing specific type of vasculitis. For those of large vessel vasculitis such as giant cell arteritis (GCA) and Takayasu's arteritis (TA), the diagnosis and the assessment of its activity and extent remain under-optimal. It is especially true when patients present non-specific clinical characteristics and laboratory results. Integrated or hybrid PET/CT provides a better resolution for allocating small lesions than PET alone and thus gain more confidence in image interpretations. While clinical implications of 18F-FDG PET/CT in the evaluation of inflammatory vascular diseases are still not well established, related studies using FDG PET/CT have expanded quickly in the assessment of inflammatory processes including early diagnosis, disease activity evaluation and therapeutic responsiveness monitor. |
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