Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin

Sheng, Jifang; Sheng, Zhonghua; Shen, Xiao-Min; Bi, Sheng; Li, Junjie; Sheng, Guo‐Ping; Yu, Huili; Huang, Haijun; Liu, Jun; Xiang, Da‐Xiong; Dong, Meng‐Jie; Zhao, Kui; Li, Lanjuan

doi:10.1016/j.ejim.2010.09.015

Cited by 61 publications

(36 citation statements)

References 23 publications

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“…In patients with an FUO, PET scans should be used as a second-line test after initial testing has failed to identify a source. 61 In contrast, PET has been relatively unreliable in diagnosing bone marrow involvement. Diffuse bone marrow uptake at initial staging of Hodgkin lymphoma could be due to bone marrow involvement but more likely is due to bone marrow inflammatory change.…”

Section: Fever Of Unknown Origin or Bone Marrow Involvementmentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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The use of sensitive and specific imaging techniques for accurate initial staging and evaluation of response to therapy in patients with lymphoma is essential for their optimal management. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) has emerged as a powerful imaging tool and is being routinely used in staging, response evaluation, and posttreatment surveillance in patients with non-Hodgkin lymphoma and Hodgkin lymphoma. PET/CT is currently widely used in clinical practice, but the established clinical benefit is currently restricted to the posttreatment evaluation of Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Although used in other histologic subtypes and in other clinical situations including response assessment, its impact on patient outcome remains to be demonstrated. We performed a literature search of PubMed from 1999 to 2011 using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. This review addresses the challenges and controversies in the use of PET/CT scans in the management of patients with lymphoma. I n most patients with lymphoma, positron emission tomographic (PET) scans show abnormalities at diagnosis. Normal findings on the scan after therapy is highly predictive of a good prognosis, particularly in patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Hodgkin lymphoma. However, the optimal application of PET scans to the management of all patients with lymphoma remains problematic. The major controversies include the optimal timing of PET scans (for staging, during therapy, after completion of therapy, surveillance in remission), standardization of PET scan interpretation (visual interpretation compared with standard uptake value [SUV] calculation), what constitutes a positive PET scan result, and whether PET scans should be used to direct management (eg, does changing therapy in patients with positive findings on PET change outcome, should biopsies of sites with positive PET results be done routinely before a management change). Although a large body of literature addressing these topics exists, the studies are often difficult to compare, making definitive conclusions on all these issues difficult. The previously published studies often used different designs and variable reporting, making interpretation and comparison of the results difficult. In the early studies particularly, heterogeneous populations with different stages of disease and different histologic subtypes were included, making the clinical applicability of the studies' results difficult. More recent studies focusing on efforts to standardize the conduct and interpretation of PET scans and on riskadapted therapies based on interim PET scan results will, it is hoped, improve the management and outcome of patients with lymphoma. A literature search of PubMed from 1999 to 2011 was performed using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. We highlight the current standard use ...

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Section: Fever Of Unknown Origin or Bone Marrow Involvementmentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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“…A negative 18 F-FDG PET/CT finding was present when tracer activity was only detectable in areas of physiologic uptake of 18 F-FDG and when no sites of increased uptake were visible. In line with previous studies [3,[22][23][24], the diagnostic performance was defined as follows: a true positive finding was considered when 18 F-FDG PET/CT showed a pathological tracer uptake as the cause of FUO, which was confirmed by further investigations (biopsy) or clinical follow-up. A pathological 18 F-FDG uptake, which was not confirmed as the cause of FUO, was considered false positive.…”

Section: F-fdg Pet/ctmentioning

confidence: 99%

“…Studies have indicated that 18 F-FDG PET is a valuable imaging technique for the diagnosis of infection and inflammation, and is a promising tool in the diagnostic work-up of FUO [5,13 -16]. Although the first combined PET/computed tomography (CT) system became operational in 2001 already [17], only a small number of studies have assessed 18 F-FDG PET/CT in patients with FUO [18][19][20][21][22][23][24][25][26][27]. Furthermore, it is not clear when to perform an 18 F-FDG PET/CT for diagnostic work-up of FUO.…”

Section: Introductionmentioning

confidence: 99%

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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“…• Evaluation of fever of unknown origin (FUO) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), including true FUO (defined according to the criteria of Durack and Street (44)), postoperative fever and recurrent sepsis, immunodeficiency (both induced and acquired)-related FUO, neutropenic fever, and isolated acute-phase inflammation markers (persistently raised C-reactive protein and/or erythrocyte sedimentation rate).…”

Section: Common Clinical Indicationsmentioning

confidence: 99%