Contribution of 18fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin

Buysschaert, Ian; Vanderschueren, Steven; Blockmans, Daniel Engelbert; Mortelmans, Luc; Knockaert, Daniël

doi:10.1016/j.ejim.2004.01.018

Cited by 100 publications

(58 citation statements)

References 14 publications

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“…CT, computed tomography; 18 F-FDG, fluorine-18 fluorodeoxyglucose; FUO, fever of unknown origin. remained unclear in 39% of the FUO patients despite performing an 18 F-FDG PET/CT, which is within the average range of other publications of between 34 and 46% [14,15,28]. Furthermore, in 17% of the cases, 18 F-FDG PET/CT detected a cause of FUO, which had not been suspected on the basis of preceding reasoning and examinations including abdominal and chest CT.…”

Section: Discussionsupporting

confidence: 48%

“…The influence of the duration of fever on the success rate is an inconsistent finding of three earlier studies [14,26,28]. Whereas the diagnostic performance of 18 F-FDG PET/CT was not associated with the duration of FUO in the prospective studies of Bleeker-Rovers et al [14] and Buysschaert et al [28], there was a significant improvement in the success rate of 18 F-FDG PET/CT in patients, with a mean of 19 compared with 30 days of fever in the study of Gafter-Gvili et al [26]. According to others [4,20,27], we support the recommendation of performing PET/CT early in the diagnostic work-up of FUO, albeit the duration of fever does not seem to influence its diagnostic performance.…”

Section: Discussionmentioning

confidence: 71%

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Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Pereira¹,

Husmann²,

Sah³

et al. 2016

Nuclear Medicine Communications

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OBJECTIVES There is uncertainty about patient selection and the adequate timing at which fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is indicated in the diagnostic work-up of fever of unknown origin (FUO). The aim of this study was to determine the diagnostic performance of F-FDG PET/CT in patients with FUO. METHODS All consecutive patients who underwent F-FDG PET/CT at the University Hospital Zurich because of FUO between 2006 and 2012 were included in this retrospective, observational study. RESULTS A total of 76 patients [70% men, median (interquartile range) age 60 (47-67) years] were included. F-FDG PET/CT showed characteristically increased F-FDG activity in 56 patients (74%), leading to confirmation of or change in the suspected cause of FUO in 57 and 17%, respectively. The final diagnosis after F-FDG PET/CT included infection (21%), malignancy (22%), noninfectious inflammatory disease (12%), others (5%), or an unknown cause (40%). The success rate, sensitivity, and specificity of F-FDG PET/CT were 60, 77, and 31%, respectively. Sensitivity was highest in patients with suspected malignancy (100%, 95% confidence interval 79-100%). Diagnostic performance was independent of the investigated variables other than suspected infection as a cause of FUO (odds ratio 0.1, 95% confidence interval 0.01-0.8, P=0.033). CONCLUSION The diagnostic performance of F-FDG PET/CT was significantly higher in patients with suspected malignancy causing a FUO compared with suspected infection or noninfectious inflammatory disease. However, it was independent of the baseline characteristics and duration of fever. This supports the recommendation to perform F-FDG PET/CT early in the diagnostic work-up of FUO, which may shorten disease duration and lower health costs, particularly when infection or malignancy is suspected.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 71%

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Pereira¹,

Husmann²,

Sah³

et al. 2016

Nuclear Medicine Communications

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“…Although it is difficult to compare those studies because of the differences in inclusion criteria and the different time points in the diagnostic work-up at which PET was performed, 18 F-FDG PET showed an overall helpfulness, corrected for study population, of approximately 35%-40%, which is high compared with radiologic techniques and 67 Ga-citrate scintigraphy (73,(75)(76)(77)(78)(79). In 1 prospective study, all patients had undergone a clearly defined standardized diagnostic evaluation before PET was performed.…”

Section: Imaging In Fuomentioning

confidence: 99%

“…In 1 prospective study, all patients had undergone a clearly defined standardized diagnostic evaluation before PET was performed. In addition, that study compared PET/CT with CT of the abdomen and chest (76). The study clearly showed that 18 F-FDG PET is superior to CT in patients with FUO.…”

Section: Imaging In Fuomentioning

confidence: 99%

Imaging of Inflammation by PET, Conventional Scintigraphy, and Other Imaging Techniques

Gotthardt¹,

Bleeker‐Rovers²,

Boerman³

et al. 2010

J Nucl Med

236

167

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Nuclear medicine imaging procedures play an important role in the assessment of inflammatory diseases. With the advent of 3-dimensional anatomic imaging, there has been a tendency to replace traditional planar scintigraphy by CT or MRI. Furthermore, scintigraphic techniques may have to be combined with other imaging modalities to achieve high sensitivity and specificity, and some may require time-consuming labeling procedures. On the other hand, new developments such as combined SPECT/CT increase the diagnostic power of scintigraphy. Also, the advent of PET had a considerable impact on the use of nuclear medicine imaging techniques. In this review, we aim to provide nuclear medicine specialists and clinicians with the relevant information on rational and efficient use of nuclear medicine imaging techniques in the assessment of patients with osteomyelitis, infected vascular prostheses, metastatic infectious disease, rheumatoid arthritis, vasculitis, inflammatory bowel disease, sarcoidosis, and fever of unknown origin.

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“…Several studies have supported the use of PET using 18 F-fluorodeoxyglucose ( 18 F-FDG) when conventional, baseline investigations have not been successful in diagnosing PUO. 5,6 In this case, the source of inflammation in the colon was highlighted on PET scanning and the diagnosis of UC in the absence of gastrointestinal symptoms was made on the basis of the recent flexible sigmoidoscopy and biopsy results.…”

Section: Lesson Of the Month (1)mentioning

confidence: 99%

Ulcerative colitis presenting as pyrexia of unknown origin (PUO) without bowel symptoms

2012

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Contribution of 18fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin

Cited by 100 publications

References 14 publications

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Imaging of Inflammation by PET, Conventional Scintigraphy, and Other Imaging Techniques

Ulcerative colitis presenting as pyrexia of unknown origin (PUO) without bowel symptoms

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