Mustafa ALTINKAYNAK, Nevzat KAHVECİ, Yağmur GÖKSOY SOLAK, Emine Göknur IŞIK, Sebile Nilgün ERTEN, Bülent SAKA, Timur AKPINAR

KONSTİTÜSYONEL SEMPTOMLARI OLAN HASTALARDA 18F-FDG-PET/BT’NİN TANIYA KATKISININ ARAŞTIRILMASI

Amaç: Konstitüsyonel semptomları nedeniyle tetkik edilen hastalarda 18F-FDG-PET/BT’nin tanıya katkısı ve ayırıcı tanıdaki rolü araştırıldı. Gereç ve Yöntem: Ocak 2017 ile Aralık 2019 tarihleri arasında İstanbul Tıp Fakültesi’nde konstitüsyonel semptomlarla tetkik edilen ve 18F-FDG-PET/BT çekilen 144 hasta retrospektif olarak incelendi. Görüntülerin değerlendirilmesinde FDG’nin vücuttaki fizyolojik tutulum bölgeleri dışında saptanan tutulumlar pozitif kabul edildi. Tüm hastaların klinik, laboratuvar ve PET/ BT görüntüleme sonuçları geriye dönük incelendi. Hastaların son tanıları malignite, enfeksiyon, romatizmal hastalıklar ve diğer olmak üzere 4 grupta toplandı. Hastalarda PET/BT pozitifliğinin tanıya katkısı araştırıldı. Bulgular: Çalışmaya 59’u (%41) kadın 85’i (%59) erkek olmak üzere 144 hasta dahil edildi. Toplam yaş ortalamaları 58,0±17,2 idi. Hastaların semptom süresi ortalama 4,01±4,46 ay olarak saptandı ve %95,1’inde (n=137) hastalık teşhisi saptanmasına rağmen, %4,9’unda (n=7) herhangi bir hastalık teşhis edilemedi. 18F-FDG-PET/BT bu hastaların %86.8’inde tanıya katkı sağladı. Hastalık teşhis edilebilen olgu grubu incelendiğinde %57,7 (n=79) oranı ile en sık maligniteler; %16,1 (n=22) oranı ile romatizmal hastalıklar, %13,9 (n=19) enfeksiyonlar ve %12,4 (n=17) diğer hastalık gruplarının yer aldığı görüldü. 18F-FDGPET/ BT’nin hastalık teşhisinde %97,5 sensitivite, %31,8 spesifite, %88,8 pozitif prediktif değer ve %70 negatif prediktif değere sahip olduğu görüldü. Sonuç: Konsitüsyonel semptomları olan hastaların tanısında 18F-FDG-PET/BT, duyarlılığının ve pozitif prediktif değerinin yüksek olması nedeniyle değerli bir görüntüleme yöntemidir ve tanısal süreçte kullanılması gereken önemli görüntüleme protokollerden biridir.

Anahtar Kelimeler:

18F-FDG-PET/BT, konstitüsyonel semptomlar, tanı, malignite

THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS

Objective: The contribution of 18F-FDG-PET/CT to diagnosis and its role in differential diagnosis were investigated in patients examined for constitutional symptoms. Materials and Methods: The 18F-FDG-PET/CT scan results and clinical data were analyzed retrospectively in 144 patients with constitutional symptoms examined between January 2017 and December 2019 in our outpatient and inpatient clinics in Istanbul University Istanbul Faculty of Medicine Internal Medicine Department. The FDG uptake other than physiological FDG uptake was considered as PET-positive. Clinical, laboratory data, and 18F-FDGPET/ CT scan results were evaluated retrospectively from records. All patients were classified into four categories as malignancies, infectious diseases, rheumatic diseases and other diseases based on their definitive diagnoses. The contribution of 18F-FDG-PET/CT in establishing a definitive diagnosis was investigated. Results: The 144 patients comprised 85 (59.0%) men and 59 (41.0%) women with a mean age of 58.0±17.2 years. The mean duration of symptoms was 4.01±4.46 months. A definitive diagnosis was established in 95.1% (n=137) of the patients based on physical examination, imaging methods, laboratory tests, and other diagnostic tests. In comparison, no definitive diagnosis was established in the remaining 4.9% (n=7) of the patients. 18F-FDGPET/ CT contributed to diagnosis in 86.8% (n=119) of patients. The patients were classified into four categories based on their diagnoses: (i) malignancies (n=79; 57.7%), (ii) rheumatic diseases (n=22; 16.1%), (iii) infectious diseases (n=19; 13.9%), and (iv) other diseases (n=17; 12.4%). The sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT in the diagnosis of constitutional symptoms were 97.5%, 31.8%, 88.8%, and 70%, respectively. Conclusion: We found that 18F-FDG-PET/CT is a valuable diagnostic tool in diagnosing patients with constitutional symptoms and provides high sensitivity and positive predictive value.

Keywords:

18F-FDG-PET/CT, constitutional symptoms, diagnosis, malignancy,

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