The yield of F18 FDG PET-CT for the investigation of fever of unknown origin, compared with diagnostic CT

Buchrits, Shira; Gafter‐Gvili, Anat; Eynath, Yair; Bernstine, Hanna; Guz, Dmitri; Avni, Tomer

doi:10.1016/j.ejim.2021.07.014

Cited by 17 publications

(7 citation statements)

References 21 publications

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“…More recent pooled data indicate a substantial contribution of 18 FDG-PET/CT to the final FUO diagnosis, primarily when obtained before conventional imaging modalities [ 39 ]. A recent single-center retrospective study among 303 patients meeting Petersdorf’s FUO criteria reported an overall sensitivity of 88.7% for 18 FDG-PET/CT, compared to conventional CT (75.2%) [ 40 ]. In that same study, the highest specificity for 18 FDG-PET was infectious diseases (83.3%) [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent single-center retrospective study among 303 patients meeting Petersdorf’s FUO criteria reported an overall sensitivity of 88.7% for 18 FDG-PET/CT, compared to conventional CT (75.2%) [ 40 ]. In that same study, the highest specificity for 18 FDG-PET was infectious diseases (83.3%) [ 40 ]. In our study, there were 166 (6.2% [n = 2667]) total participants from 4 studies [ 9 , 28 , 31 , 32 ] who underwent FDG-PET scans, of which only 43 (26%) contributed to a final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Geographic Variation of Infectious Disease Diagnoses Among Patients With Fever of Unknown Origin: A Systematic Review and Meta-analysis

Wright

Yenokyan

Simner

et al. 2022

Open Forum Infectious Diseases

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Background Fever of unknown origin (FUO) investigations yield a substantial number of patients with infectious diseases. This systematic review and meta-analysis aimed to quantify more common FUO infectious diseases etiologies and to underscore geographic variation. Methods Four databases (PubMed, Embase, Scopus, and Web of Science) were searched for prospective studies reporting FUO rates among adult patients from January 1, 1997 to March 31, 2021. The pooled proportion for infectious diseases etiology was estimated using the random effects meta-analysis model. Results Nineteen prospective studies were included with 2667 total cases. No studies were available for Africa or the Americas. Overall, 37.0% (95.0% confidence interval, CI: 30.0 to 44.0%) of FUO patients had an infectious disease etiology. Infections were more likely from Southeastern Asia (pooled proportion = 0.49; 95.0% CI 0.43-0.55) than from Europe (pooled proportion = 0.31; 95.0% CI 0.22-0.41). Among specifically reported infectious diseases (n=832) Mycobacterium tuberculosis complex predominated across all geographic regions (n=285; 34.3%) followed by brucellosis (n=81; 9.7%), endocarditis (n=62; 7.5%), abscesses (n=61; 7.3%), herpesvirus (e.g., CMV and EBV) infections (n=60; 7.2%), pneumonia (n=54; 6.5%), urinary tract infections (n=54; 6.5%), and enteric fever (n=40; 4.8%). Conclusions FUO patients from Southeastern Asia were more likely to have an infectious diseases etiology when compared to other regions. The predominant factor for this finding appears to be differences in disease prevalence among various geographical locations or other factors such as access to timely care and diagnosis. Noting epidemiological disease factors in FUO investigations could improve diagnostic yields and clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Geographic Variation of Infectious Disease Diagnoses Among Patients With Fever of Unknown Origin: A Systematic Review and Meta-analysis

Wright

Yenokyan

Simner

et al. 2022

Open Forum Infectious Diseases

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“…Three retrospective studies compared the contribution of CAPCT and PET/CT in the management of patients with FUO [24,25] and IUO [21]. In these studies, PET/CT provided a higher DC than CAPCT.…”

Section: Discussionmentioning

confidence: 99%

“…A CAPCT scan is often preferred to PET/CT due to its accessibility and cost, which is three times less than PET/CT (respectively $385 vs. $1375 according to Medicare in 2019), especially when the clinician is confronted with a patient presenting atypical symptoms. Very few retrospective studies have explored the diagnostic contribution of standalone CAPCT in these settings, and results have been contradictory [21,24,25].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study

Costédoat-Chalumeau²,

Liozon

et al. 2022

JCM

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Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

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“…The 18 F-FDG-PET/CT is the nuclear imaging technique for diagnosing infectious diseases and tumors. Both of the inflammatory and malignant cells have high glucose metabolism, and cause elevated FDG uptake [3].…”

Section: Introductionmentioning

confidence: 99%

Mycoplasma infection mimicking a malignancy in a waldenstrom macroglobulinemia patient

et al. 2023

BMC Infect Dis

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Background Mycoplasma hominis infection is common in urinary tract. 18F-FDG-PET/CT is a valuable tool for tumor and infection diagnosis. Few studies have shown the 18F-FDG-PET/CT images after mycoplasma infection. Case presentation Here we described a case of Waldenstrom macroglobulinemia with thickened bladder wall. The 18F-FDG-PET/CT showed the SUVmax up to 36.1 mimicking bladder cancer. The results of histopathological examination and metagenomic sequencing of the blood and urinary revealed the Mycoplasma hominis infection. Conclusion The full consideration should be given to the possibility of infection besides tumor in lesions with high SUV value in 18F-FDG-PET/CT, especially in immunodeficiency patients.

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The yield of F18 FDG PET-CT for the investigation of fever of unknown origin, compared with diagnostic CT

Cited by 17 publications

References 21 publications

Geographic Variation of Infectious Disease Diagnoses Among Patients With Fever of Unknown Origin: A Systematic Review and Meta-analysis

Geographic Variation of Infectious Disease Diagnoses Among Patients With Fever of Unknown Origin: A Systematic Review and Meta-analysis

Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study

Mycoplasma infection mimicking a malignancy in a waldenstrom macroglobulinemia patient

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