Fever of unknown origin (FUO) due to deep-venous thrombosis: Diagnostic importance of FDG PET/CT

Güngör, Serkan; Koc, Kevser; Öneş, Tunç; İnanır, Sabahat; Erdıl, Tanju Yusuf; Turoğlu, Halil Turgut

doi:10.1016/j.remn.2014.03.002

Cited by 2 publications

(2 citation statements)

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“…More than half of DVTs occur in calf veins or pelvic veins, where ultrasonography has limited sensitivity and none of the above mentioned techniques address vessels outside the pulmonary and proximal femoral vasculature. FDG-PET/CT provides whole-body assessment, and a mounting number of case reports demonstrate sightings of venous activity consistent with VTE in venous vasculature throughout the body and in various clinical settings: lower extremity veins [24][25][26][27][28], iliac vein [26], upper extremity veins [29][30][31], superior vena cava [32,33], inferior vena cava [34][35][36], portal vein [37,36], renal vein [34], jugular vein [38], brachiocephalic vein [33,39], indwelling catheters [40][41][42], superior sagittal sinus [43,33], pulmonary embolism (including supposed microembolism from injection artefacts) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], lung infarction [59][60][61], right-heart...…”

Section: Discussionmentioning

confidence: 99%

FDG-PET/CT in venous thromboembolism

Hess

Frary

Gerke

et al. 2018

Clin Transl Imaging

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Purpose: Venous thromboembolism (VTE) is common; deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common presentations. VTE may arise in the entire venous bed and the diagnosis may be difficult. VTE is a dynamic disease, inflammation is key, and FDG-PET/CT has been proposed, e.g. to detect thrombi in any anatomic location, to differentiate acute from chronic VTE, and to differentiate bland VTE from tumor thrombosis. The aim of this systematic review was to assess if the potential uses of 18 F-Fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) in VTE are described and documented in the literature. Methods: PubMed and Embase databases were searched. Duplicates and papers in other languages than English and Scandinavian were removed. Remaining papers were screened by title and abstract. Eligible papers were assessed in full-text. Results: The master search yielded 3,897 hits, 316 papers were eligible for full-text assessment. Ten papers were included; six on diagnostic performance of PET/CT in VTE, and four on the ability of PET/CT to differentiate bland VTE from tumor thrombosis. Three papers were prospective, seven were retrospective. Conclusion: If applied early, FDG-PET/CT may have a role in diagnosing DVT, but not PE, to discriminate acute from chronic VTE, and to demonstrate recurrent VTE. FDG-PET/CT is by some considered adept in differentiating bland VTE from tumor thrombosis, but we find this controversial due to FDG avidity in bland VTE. FDG-PET/CT may be feasible when screening for occult malignancy. However, in all mentioned areas, available literature is too sparse and too heterogeneous to allow firm conclusions.

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Section: Discussionmentioning

confidence: 99%

FDG-PET/CT in venous thromboembolism

Hess

Frary

Gerke

et al. 2018

Clin Transl Imaging

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“…PET/CT has also been helpful in diagnosing inflammatory causes of fever including sarcoidosis; lupus; Wegener granulomatosis; subacute thyroiditis; cryptogenic organizing pneumonia; rheumatic fever; pericarditis; autoimmune pancreatitis; inflammatory bowel disease; Henoch-Schönlein purpura; various inflammatory arthritides; various vasculitides; deep venous thrombosis; Castleman disease; Rosai-Dorfman disease; Erdheim-Chester disease; the immune dysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome; the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome; and familial Mediterranean fever (16,17,21,26,28,34,(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68). PET/CT is also useful and cost-effective in the setting of occult bacteremia ( Fig 6); the results from one study demonstrated lower mortality rates and decreased relapse rates in patients who underwent PET/CT for occult bacteremia (69,70).…”

Section: Teaching Pointsmentioning

confidence: 99%

Role of PET/CT in Workup of Fever without a Source

Dibble¹,

Yoo²,

Noto³

2016

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Fever without source is a febrile illness without localizing signs or initial obvious cause. Early workup will often include chest radiography and computed tomography (CT) of the abdomen and pelvis, with or without CT of the chest. To evaluate localizing signs or symptoms or to further evaluate findings from initial studies, targeted imaging according to body part can be performed by using radiography, ultrasonography, CT, or magnetic resonance (MR) imaging. Nuclear medicine studies can provide imaging of the whole body and may be helpful when the clinical and conventional imaging workup findings are negative or equivocal in identifying a source of fever. Nuclear medicine studies can be used to detect pathologic changes early in a disease course, even in the absence of an anatomic abnormality. Gallium 67 scintigraphy, indium 111- and technetium 99m-labeled leukocyte scintigraphy, and fluorine 18 fluorodeoxyglucose positron emission tomography (PET)/CT studies are all useful in the evaluation of fever, but the radiopharmaceutical cost for PET/CT is much lower than that for radiolabeled leukocyte studies. The increased use of bundled payments for inpatient admissions requires updated cost evaluations for the preferred nuclear medicine study. For inpatients in whom the findings from the initial clinical workup and imaging studies are nondiagnostic, PET/CT examination may be preferable to radiolabeled leukocyte studies because of its high sensitivity and lower cost. Negative findings at PET/CT can be helpful in excluding a suspected site of infection, and positive findings at PET/CT can be helpful in confirming a suspected site of infection or in identifying an unexpected cause of fever. (©)RSNA, 2016.

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Fever of unknown origin (FUO) due to deep-venous thrombosis: Diagnostic importance of FDG PET/CT

Cited by 2 publications

References 4 publications

FDG-PET/CT in venous thromboembolism

FDG-PET/CT in venous thromboembolism

Role of PET/CT in Workup of Fever without a Source

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