<sup>[18F]</sup>FDG-PET/CT for the diagnosis of patients with fever of unknown origin

Gafter‐Gvili, Anat; Raibman, S.; Grossman, A; Avni, Tomer; Leibovici, Leonard; Tadmor, Boaz; Groshar, David; Bernstine, Hanna

doi:10.1093/qjmed/hcu193

Cited by 72 publications

(60 citation statements)

References 32 publications

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“…The reported success rate and sensitivity of 18 F-FDG PET/CT in patients with FUO ranges between 33 and 75% and 72 and 100%, respectively [14,19,20,[23][24][25][26][27]. This is in line with our own findings of a success rate of 61% and a sensitivity of 77%.…”

Section: Discussionsupporting

confidence: 89%

“…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: 93%

“…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%

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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: 89%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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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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“…Five studies of 18 F-FDG PET/CT (31,(39)(40)(41)(42), 3 studies of 18 F-FDG PET (28,29,37), and 3 studies of leukocyte scintigraphy (43-45) performed univariable or multivariable analyses to identify predictors of the impact of tests on diagnosis or therapeutic management (Supplemental Table 9). The 3 most commonly assessed predictors were c-reactive protein, leukocyte counts, and erythrocyte sedimentation rate, although studies were highly heterogeneous regarding how candidate predictors were measured and how they were incorporated in the models (e.g., dichotomized or transformed).…”

Section: Assessment Of Study Risk Of Bias and Applicabilitymentioning

confidence: 99%

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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“…Although this nonspecificity makes FDG PET not reliably distinguish between infection and malignancy, it is advantageous in localizing unknown fever focus in FUO where conventional methods have failed (6)(7)(8). Also, FDG PET/CT showed superior spatial resolution, less imaging time (within 2 hr), and better radiation dosimetry than the whole-body inflammation scan (9)(10)(11). To date, a limited number of studies have investigated the role of FDG PET/CT in the evaluation of FUO in pediatric patients, especially in critically ill children with underlying diseases (12)(13)(14).…”

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confidence: 99%