Diagnostic Utility of 18F-FDG PET/CT in Inflammation of Unknown Origin

Balink, Hans; Bennink, Roel J.; Veeger, Nic J. G. M.; Eck-Smit, Berthe L. F. van; Verberne, Hein J.

doi:10.1097/rlu.0000000000000423

Cited by 33 publications

(45 citation statements)

References 32 publications

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“…For example, in patients with IUO, 18 F-FDG PET/CT had a higher positive predictive value (PPV) in those patients with either a CRP higher than 20 mg/l or an erythrocyte sedimentation rate (ESR) more than 20 mm/h. In addition, in these patients with IUO, CRP was the only independent predictor for the outcome of 18 F-FDG PET/CT [6]. However, there is no consensus on the cutoff value for CRP in relation to the diagnostic yield and accuracy of 18 F-FDG PET/CT in patients with IUO or FUO.…”

Section: Introductionmentioning

confidence: 88%

“…The specific inclusion and exclusion criteria for these studies are described in detail in previous published reports [2,6,7].…”

Section: Patientsmentioning

confidence: 99%

“…IUO was defined as prolonged and perplexing inflammation -that is, either a CRP higher than 20 mg/l or an ESR more than 20 mm/h, body temperatures less than 38.3°C (100.9°F) on multiple occasions and without a diagnosis after a variety of conventional diagnostic procedures [6].…”

Section: Patientsmentioning

confidence: 99%

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The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

Balink

Veeger²,

Bennink

et al. 2015

Nuclear Medicine Communications

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Section: Introductionmentioning

confidence: 88%

“…The specific inclusion and exclusion criteria for these studies are described in detail in previous published reports [2,6,7].…”

Section: Patientsmentioning

confidence: 99%

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The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

Balink

Veeger²,

Bennink

et al. 2015

Nuclear Medicine Communications

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“…The disturbance of etiological reasons is affected by geographic and climate characteristics, economical and social factors. In Western Europe infectious diseases (ID) and NIID are almost equal, fallowing by neoplasm and undiagnosed cases [6][7][8]. In contrast, from a few reports from SouthEast Europe the ID are the most frequent causes of FUO and the undiagnosed cases are not so many [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Fever of Unknown Origin in a Bulgarian Hospital: Evaluation of 54 Cases for a Four Year-Period

Baymakova¹,

Plochev²,

Dikov³

et al. 2016

Ann Clin Anal Med

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Aim: The aim of this study was to describe the etiological distribution, clinical and laboratory characteristics of patients with Fever of unknown origin (FUO), admitted to one Bulgarian hospital. Material and Method: A retrospective study was done for a period of four years. The modified criteria of Petersdorf and Beeson were applied. Complete history, physical examination and basic laboratory investigations were done. According to the potentially diagnostic clues, specific tests, immunological and imaging methods were performed. The invasive procedures were the last step. Results: Fifty-four patients met the inclusion criteria. The estimated causes were: infection 59.3%, neoplasm 3.7%, non-infectious inflammatory disease 14.8%, miscellaneous 5.5% and undiagnosed cases 16.7%, respectively. The mean age was 44.3 years. The leading clinical features were fever, chills, sweats and fatigue. The association of clinical signs, physical exam and laboratory results were discussed. Discussion: The infectious diseases were the leading cause of FUO. The etiological distribution of causes was near to results reported from South-East Europe. Some geographic, climatic, zoonotic and social factors influenced the results.

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“…18 F-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is one preferred imaging modality because of its comparably high detectability of primary sites, reaching approximately 30%. [5][6][7][8] PET/CT is reimbursed in several countries for this indication, despite absence of evidence that PET/CT is truly costeffective. 9,10 Other options would be whole-body CT or MRI.…”

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confidence: 99%

PET/MR Outperforms PET/CT in Suspected Occult Tumors

Sekine

Barbosa

Sah

et al. 2017

Clinical Nuclear Medicine

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BACKGROUND To compare the diagnostic accuracy of PET/MR and PET/CT in patients with suspected occult primary tumors. METHODS This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors. Patients were assessed with PET/CT and PET/MR for the presence of a primary tumor, lymph node metastases, and distant metastases. Wilcoxon signed-rank test was performed to compare the diagnostic accuracy of PET/CT and PET/MR. RESULT According to the standard of reference, a primary lesion was found in 14 patients. In 16 patients, the primary lesion remained occult. In the remaining 13 patients, lesions proved to be benign. PET/MR was superior to PET/CT for primary tumor detection (sensitivity/specificity, 0.85/0.97 vs 0.69/0.73; P = 0.020) and comparable to PET/CT for the detection of lymph node metastases (sensitivity/specificity, 0.93/1.00 vs 0.93/0.93; P = 0.157) and distant metastases (sensitivity/specificity, 1.00/0.97 vs 0.82/1.00; P = 0.564). PET/CT tended to misclassify physiologic FDG uptake as malignancy compared with PET/MR (8 patients vs 1 patient). CONCLUSIONS PET/MR outperforms PET/CT in the workup of suspected occult malignancies. PET/MR may replace PET/CT to improve clinical workflow. Methods: This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors. Patients were assessed with PET/CT and PET/MR for the presence of a primary tumor, lymph node metastases, and distant metastases. Wilcoxon signed-rank test was performed to compare the diagnostic accuracy of PET/CT and PET/MR. Result: According to the standard of reference, a primary lesion was found in 14 patients. In 16 patients, the primary lesion remained occult. In the remaining 13 patients, lesions proved to be benign. PET/MR was superior to PET/CT for primary tumor detection (sensitivity/specificity, 0.85/0.97 vs 0.69/0.73; P = 0.020) and comparable to PET/CT for the detection of lymph node metastases (sensitivity/specificity, 0.93/1.00 vs 0.93/0.93; P = 0.157) and distant metastases (sensitivity/specificity, 1.00/0.97 vs 0.82/1.00; P = 0.564). PET/CT tended to misclassify physiologic FDG uptake as malignancy compared with PET/MR (8 patients vs 1 patient). Conclusions: PET/MR outperforms PET/CT in the workup of suspected occult malignancies. PET/MR may replace PET/CT to improve clinical workflow.

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Diagnostic Utility of 18F-FDG PET/CT in Inflammation of Unknown Origin

Abstract: F-FDG PET/CT correctly identified or excluded a causal explanation in approximately 90% of patients with IUO. However, a negative F-FDG PET/CT is indicative for a self-limiting condition only after systemic diseases are excluded by other diagnostic tests.

Cited by 33 publications

References 32 publications

The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

Fever of Unknown Origin in a Bulgarian Hospital: Evaluation of 54 Cases for a Four Year-Period

PET/MR Outperforms PET/CT in Suspected Occult Tumors

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