Utility of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Fever of Unknown Origin Diagnosed as Lymphoma

Abstract

Objective: To assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)/computed tomography (CT) in the diagnosis of patients with fever of unknown origin (FUO), who were finally diagnosed as lymphoma. Subjects and Methods: A retrospective study was performed in the First Affiliated Hospital, School of Medicine of Zhejiang University, China, from March 2009 to March 2012. The PET/CT images of consecutive patients with FUO were analyzed. Within 1 week of PET/CT scanning, additional histological tests were also performed if clinically needed. Results: A total of 73 consecutive patients were included. Of these, 34 (47%) had a PET/CT finding suggestive of the presence of lymphoma and 29 (85%) had a diagnosis of confirmed lymphoma; 39 (53%) had a PET/CT result revealing the absence of lymphoma and 4 (10%) were diagnosed by biopsy as having lymphoma, . The most frequent lymphoma diagnosis was peripheral T cell lymphoma (n = 16; 55%), followed by diffuse large B cell lymphoma (n = 9; 31%). The accuracy of PET/CT was 88%. Conclusion: In this study, PET/CT had high diagnostic accuracy in patients with FUO resulting from lymphoma, which indicated that PET/CT scanning was a valuable diagnostic tool for these groups of patients with FUO.

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

“…[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.…”

“…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.…”

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

“…Previous studies have demonstrated that PET-CT is a crucial tool in patients with FUO resulting from lymphoma. Unlike other imaging technique, PET-CT can provide functional as well as anatomical data for suspicious areas [7,9]. However, the diagnosis of lymphoproliferative diseases relies principally on histology, thus, in 50% of the cases the diagnosis would probably have been reached based on the CT scan alone which demonstrated multiple enlarged lymph nodes, which would have been sampled regardless of FDG uptake.…”

“…PET-CT appears to be a helpful modality for specific etiologies of FUO. For example, in a retrospective study of 73 patients with FUO who underwent PET-CT due to the suspicion of lymphoma, PET-CT was positive in 88% of the patients with confirmed lymphoma [7].…”

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

“…PET scanning is non-invasive, scans a large proportion of the body, and may help identify targets for biopsy in patients who do not have palpable adenopathy. 45 The cost-effectiveness of such an approach and its benefit compared to conventional anatomical imaging are currently unknown.…”