18F-FDG PET/CT在侵袭性真菌感染诊疗中的应用进展：从临床证据到决策转化

doi:10.3969/j.issn.1006-5725.2026.18.011

Abstract

Abstract:

Invasive fungal infection （IFI） is an important infectious complication in patients with hematologic malignancies， hematopoietic stem cell transplantation， solid organ transplantation， and long-term immunosuppression. Conventional diagnosis mainly relies on host risk factors， chest high-resolution computed tomography （CT）， culture， histopathology， serological biomarkers， and molecular testing. However， in the context of neutropenia， prophylactic antifungal therapy， or disseminated multi-site involvement， microbiological evidence is often delayed， negative， or difficult to localize.18F-fluorodeoxyglucose （18F-FDG） positron emission tomography/computed tomography （PET/CT） can reflect the activity of inflammatory responses through whole-body metabolic imaging. It provides important complementary information for detecting occult lesions， assessing the extent of dissemination， selecting biopsy targets， monitoring treatment response， and evaluating pre-transplantation risk.This review summarizes the clinical value， implementation considerations， and limitations of PET/CT in the diagnostic and therapeutic pathway of IFI， based on recent clinical cohort studies， guidelines， consensus statements， and advances in novel fungal-specific probes. It should be emphasized that PET/CT is not intended to replace microbiological evidence. Rather， it provides functional imaging evidence that can be translated into clinical decision-making at key diagnostic and therapeutic time points， thereby offering a reference for early identification， accurate assessment， and timely intervention in IFI.

Key words: positron emission tomography/computed tomography, 18F-fluorodeoxyglucose, invasive fungal infection, aspergillosis, candidiasis, mucormycosis, hematology

CLC Number:

R519

Shuai Su, Yi Xiao. Advances in 18F-FDG PET/CT for the diagnosis and management of invasive fungal infections： From clinical evidence to decision-making[J]. The Journal of Practical Medicine, 2026, 42(18): 3330-3338.

Figures/Tables 2

References 69

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研究	设计与样本	主要结果	临床建议
Leroy-Freschini等^［6］	单中心回顾；51例免疫抑制IFI患者，83次PET/CT	敏感度93%，特异度81%，总体准确度90%；初始分期影响16/29例诊断流程	可用于初始分期、活检靶点选择和治疗随访
Douglas等^［7］	回顾性比较；PET/CT与常规CT对照	定位隐匿感染40%，显示播散38%；播散灶检出率35% vs 5%	有助于发现CT未覆盖部位和肺外播散
Ankrah等^［8］	28例患者，98次PET/CT治疗随访	改变14例（50%）抗真菌治疗；19例完全代谢缓解	代谢缓解可辅助停药、换药和疗程判断
Ankrah等^［9］	双中心回顾；PET/CT与解剖影像互补评价	48.6%扫描发现常规影像未覆盖病灶；74%患者获得管理增量	强调全身分期和决策增量
Fernández Cruz等^［10］	2018—2023年三级医院IFI事件队列	PET/CT在超过半数IFI事件中增加管理价值	支持在复杂IFI中流程化使用PET/CT

Advances in 18F-FDG PET/CT for the diagnosis and management of invasive fungal infections： From clinical evidence to decision-making

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