The value of <sup>18</sup>F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study

Schönau, Verena; Vogel, Kristin; Englbrecht, Matthias; Wacker, Jochen; Schmidt, Daniela; Manger, Bernhard; Kuwert, Torsten; Schett, Georg

doi:10.1136/annrheumdis-2017-211687

Cited by 133 publications

(116 citation statements)

References 53 publications

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“…[3][4][5]11 There is increasing evidence in the literature on the utility of FDG-PET with or without CT in investigations for FUO, due to its effectiveness in identifying sites of lymphoma and potential in diagnosing infections, hence contributing to the eventual diagnosis or exclusion of diagnosis in 46-75% of cases. [12][13][14][15][16][17][18][19][20][21] FDG-PET/CT is found to be better than FDG-PET alone due to better anatomic information obtained from CT. In our cohort, FDG-PET contributed to making the diagnosis in eight patients (25%), a much lower rate than that reported in the literature.…”

Section: Discussionmentioning

confidence: 94%

“…There is increasing evidence in the literature on the utility of FDG‐PET with or without CT in investigations for FUO, due to its effectiveness in identifying sites of lymphoma and potential in diagnosing infections, hence contributing to the eventual diagnosis or exclusion of diagnosis in 46–75% of cases . FDG‐PET/CT is found to be better than FDG‐PET alone due to better anatomic information obtained from CT.…”

Section: Discussionmentioning

confidence: 99%

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Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Hong

Fox

Chai

et al. 2019

Internal Medicine Journal

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Background Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18‐fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. Aim To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. Methods Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. Results Seventy‐three patients were included in the study. Fifty‐one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B‐cell lymphoma had normal BMB. FDG‐PET was helpful in making a diagnosis in eight (25%) out of 32 patients. Conclusion Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG‐PET, may be more likely to help establish a definitive diagnosis.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Hong

Fox

Chai

et al. 2019

Internal Medicine Journal

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“…The early detection of these diseases might lead to more effective treatment options and could improve patient survival. Furthermore, some significant infectious/inflammatory diseases were detected (27) and appropriately treated or referred for follow-up. In addition to those histologically proven cases, two examinees with stoneinduced hydronephrosis and marked hydrocephalus on PET/CT went on to receive immediate manipulations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of FDG-PET/CT for Cancer Detection in Populations With Different Risks of Underlying Malignancy

Chan

Liu

Liou

et al. 2019

In Vivo

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Background/Aim: Whole-body positron-emission tomography/computed tomography with the glucose analog 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) has been used to screen examinees for underlying malignancy in many countries. The aim of this study was to compare the potential value of FDG-PET/CT application in asymptomatic individuals with those with suspected malignancy. Patients and Methods: A total of 9,408 examinees underwent wholebody FDG-PET/CT at our hospital from July 2006 to August 2013. Three thousand and seven hundred asymptomatic individuals and 848 individuals with laboratory and clinical/radiologicaI suspicion of malignancy who had undergone FDG-PET/CT for cancer screening were recruited. The final confirmation of cancer and outcomes were based on a pathological report and continuous followup. Results: Forty-five out of 3,700 asymptomatic individuals (1.2%) had proven malignancy, and 42 of them (93.3%) were found by FDG-PET/CT. Two hundred and twelve out of 848 with suspected malignancy (25%) had proven malignancy, and 196 of them (92.5%) were detected by FDG-PET/CT. Most of these cancers in asymptomatic individuals were clinically at an early stage. The discovery rate in asymptomatic individuals and those with suspected malignancy was 1.1% and 23.1%, respectively. The overall survival of patients with cancer diagnosed with PET/CT was higher than those with suspected malignancy (78.6% vs.

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“…Where a diagnosis is reached, the main causes can be divided into infection, malignancy and non-infectious inflammation. It is estimated that 20% cases worldwide are caused by a non-infectious inflammatory disorder, most commonly large vessel vasculitis and adult-onset Still’s disease (AOSD) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?

2018

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Purpose of reviewFever is common within rheumatology but it is often challenging to identify its source. To do so correctly is paramount in patients with an underlying inflammatory condition receiving immunosuppressive therapy. This review article looks at the available evidence and merits of both 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and new proposed biomarkers in determining the cause of fever within rheumatology.Recent findings18F-FDG PET/CT scans are already an established tool in the detection and diagnosis of malignancy and are emerging for use in fever of unknown origin. More recently, they have been used to identify rheumatological causes of fever such as large vessel vasculitis and adult-onset Still’s disease. Within these conditions, biomarkers such as procalcitonin and presepsin may help to differentiate endogenous from exogenous pyrogens.Summary18F-FDG PET/CT scanning shows promise in locating the source of pyrogens and may be superior to other conventional forms of imaging. As evidence and test availability increases, its use is likely to become commonplace in the diagnostic work-up of fever. Once a source is located, selected biomarkers may be used to confirm a cause.

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The value of ¹⁸F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study

Abstract: F-FDG-PET/CT scanning is helpful in ascertaining the correct diagnosis in more than 50% of the cases presenting with FUO and IUO. Absence of intermittent fever, higher age and elevated CRP level increase the likelihood for a diagnostic F-FDG-PET/CT.

Cited by 133 publications

References 53 publications

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Comparison of FDG-PET/CT for Cancer Detection in Populations With Different Risks of Underlying Malignancy

Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?

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The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study

Abstract: F-FDG-PET/CT scanning is helpful in ascertaining the correct diagnosis in more than 50% of the cases presenting with FUO and IUO. Absence of intermittent fever, higher age and elevated CRP level increase the likelihood for a diagnostic F-FDG-PET/CT.

Cited by 133 publications

References 53 publications

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Comparison of FDG-PET/CT for Cancer Detection in Populations With Different Risks of Underlying Malignancy

Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?

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The value of ¹⁸F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study