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

Hao, Ruirui; Yuan, Leilei; Kan, Ying; Li, Chunlin; Yang, Jigang

doi:10.1097/mnm.0b013e328361cd0e

Cited by 59 publications

(45 citation statements)

References 28 publications

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“…Our findings about the test performance of 18 F-FDG PET and 18 F-FDG PET/CT are in general agreement with previous systematic reviews (9)(10)(11)(12). However, we extended previous work by examining diagnostic yield and demonstrating a positive association between yield and the prevalence of infections and neoplasms.…”

Section: Discussionsupporting

confidence: 82%

Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis

et al. 2016

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Several studies have assessed nuclear imaging tests for localizing the source of fever in patients with classic fever of unknown origin (FUO); however, the role of these tests in clinical practice remains unclear. We systematically reviewed the test performance, diagnostic yield, and management decision impact of nuclear imaging tests in patients with classic FUO. Methods: We searched PubMed, Scopus, and other databases through October 31, 2015, to identify studies reporting on the diagnostic accuracy or impact on diagnosis and management decisions of 18 F-FDG PET alone or integrated with CT ( 18 F-FDG PET/CT), gallium scintigraphy, or leukocyte scintigraphy. Two reviewers extracted data. We quantitatively synthesized test performance and diagnostic yield and descriptively analyzed evidence about the impact on management decisions. Results: We included 42 studies with 2,058 patients. Studies were heterogeneous and had methodologic limitations. Diagnostic yield was higher in studies with higher prevalence of neoplasms and infections. Nonneoplastic causes, such as adult-onset Still's disease and polymyalgia rheumatica, were less successfully localized. Indirect evidence suggested that 18 F-FDG PET/CT had the best test performance and diagnostic yield among the 4 imaging tests; summary sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90), specificity 0.52 (95% CI, 0.36-0.67), and diagnostic yield 0.58 (95% CI, 0.51-0.64). Evidence on direct comparisons of alternative imaging modalities or on the impact of tests on management decisions was limited. Conclusion: Nuclear imaging tests, particularly 18 F-FDG PET/CT, can be useful in identifying the source of fever in patients with classic FUO. The contribution of nuclear imaging may be limited in clinical settings in which infective and neoplastic causes are less common. Studies using standardized diagnostic algorithms are needed to determine the optimal timing for testing and to assess the impact of tests on management decisions and patient-relevant outcomes.

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Section: Discussionsupporting

confidence: 82%

Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis

et al. 2016

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“…An I 2 statistic was also analyzed to test for heterogeneity between studies [15]. The statistical analysis of this meta-analysis referred to a previous meta-analysis [16][17][18][19]. Statistical analyses were performed using Meta-DiSc statistical software, version 1.4 (Unit of Clinical Biostatistics, Ramony Cajal Hospital, Madrid, Spain) [20].…”

Section: Discussionmentioning

confidence: 99%

“…The PET/MRI hybrid system combines the excellent anatomical resolution and high soft-tissue contrast of MRI with the highly sensitive evaluation of metabolism and molecular processes achieved with PET. In recent years, 18 F-FDG PET/MRI has been used in head and neck carcinoma [3][4][5][6][7][8][9][10][11][12]. However, these studies had a relatively small sample size and limited power for any individual study.…”

Section: Introductionmentioning

confidence: 98%

The value of fluorine-18 fluorodeoxyglucose PET/MRI in the diagnosis of head and neck carcinoma

Xiao

Chen²,

Shi³

et al. 2015

Nuclear Medicine Communications

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“…The relevance of different diagnostic modalities in these patients has been an active area of research (11)(12)(13)(14)(15)(16). Percutaneous liver biopsy has been shown to be useful diagnostic tool in some earlier studies (14,15).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Percutaneous Liver Biopsy in Fever of Unkown Origin in Patients with Human Immunodeficiency Virus Infection

et al. 2015

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SUMMARY: Fever of unknown origin (FUO) poses a major diagnostic challenge in patients infected with human immunodeficiency virus (HIV). In this retrospective study, we sought to assess the clinical utility of percutaneous liver biopsy as a diagnostic aid for FUO in HIV-infected patients and identify the factors associated with a greater likelihood of a positive diagnostic yield form this procedure. A total of 101 HIV-infected patients with FUO, who had undergone percutaneous liver biopsy in an HIV care hospital, served as the study population. The results obtained from percutaneous liver biopsy were categorized into three groups: (i) diagnostic, (ii) helpful, and (iii) not helpful. Diagnostic and helpful results were classified as useful. The mean (SD) age of patients was 37.6 (6.9) years, and the median (interquartile range [IQR]) CD4 count was 18 (3-62) cells/mm 3 . The median (IQR) duration of fever was 20 (8-30) days. Percutaneous liver biopsy was diagnostic in 51 patients (50.5z), helpful in 12 (11.9z) and not helpful in 38 (37.6z) patients. On multivariate analyses, elevation of serum alkaline phosphatase level (OR 1.27 per one time elevation from the upper normal range; 95z CI, 1.03-1.57; P ＝ 0.023), and fever duration of less than 3 weeks (OR 3.82; 95z CI, 1.03-14.18; P ＝ 0.046) was significantly associated with the likelihood of the biopsy findings being classified as useful. Our study supports the case for percutaneous liver biopsy as a useful diagnostic aid in HIV-infected patients with FUO.

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

Cited by 59 publications

References 28 publications

Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis

Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis

The value of fluorine-18 fluorodeoxyglucose PET/MRI in the diagnosis of head and neck carcinoma

Diagnostic Value of Percutaneous Liver Biopsy in Fever of Unkown Origin in Patients with Human Immunodeficiency Virus Infection

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