Abstract
Background: Adult-onset still's disease (AOSD) and lymphoma are the most common benign and malignant causes of fever of unknown origin (FUO), respectively. This study aimed to establish a reliable and easy-to-used scoring model based on clinical information, laboratory characteristics and 18 F-FDG PET/CT images for the differential diagnosis of these two diseases. Methods: A development cohort including AOSD (n=70) and lymphoma (n=37) patients was used to establish a scoring model based on the features of 18 F-FDG PET/CT images. The scoring model was then validated in a validation cohort of 15 AOSD and 12 lymphoma patients. The features of involved bone marrow, spleen, lymph nodes, and other organs or tissues displayed on PET/CT images were compared. Multiple logistics regression and decision tree analysis were used to establish the scoring model. Findings: Six features that could significantly differentiate these two diseases were selected to establish a scoring model discriminating AOSD from lymphoma, including (1) WBC count ≤ 10×10 9 /L (one point); (2) Ferritin ≤ ULN (one point); (3) No abnormal bone marrow metabolism (one point); (4) TLG total > 9·0 (one point). After decision tree analysis, it showed that a score ≤ 1 indicates AOSD, and a score ≥ 3 strongly suggested lymphoma, with a sensitivity of 81·1% and specificity of 90·0% in the development cohort, and a sensitivity of 58·3% and specificity of 100% in the validation cohort. Interpretation: Our scoring model showed good diagnosis performance in distinguishing AOSD from lymphoma. Funding: (YG2017QN58, YG2017MS61), Shanghai Municipal Key Clinical Specialty (shslczdzk03403), and Shanghai Garden Rising Star Youth Medical Talent Training Funding Program. Declaration of Interest: We declare no competing interest. Ethical Approval: This study was approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
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