FDG-PET in Fever of Unknown Origin
Section snippets
FDG-PET
Scintigraphic imaging is a noninvasive method allowing delineation of both the localization and the number of foci in all parts of the body based on functional or molecular changes of tissues and cells. It plays an important role in the diagnosis of patients with FUO in clinical practice. Conventional scintigraphic methods are 67Ga-citrate scintigraphy and 111In-labeled or 99mTc-labeled leukocyte scintigraphy. However, these techniques have their disadvantages and limitations, such as handling
FDG-PET in FUO
The value of FDG-PET has been studied in 3 retrospective and 6 prospective studies in 396 patients with FUO (Table 1).14, 15, 16, 17, 18, 19, 20, 21, 22 Two studies prospectively compared FDG-PET with 67Ga-citrate scintigraphy in patients with FUO and found FDG-PET to be helpful in 55%14 and 41%15of patients. In the study of Meller et al14 sensitivity, specificity, PPV, and NPV of FDG-PET were 81%, 86%, 92%, and 75%, respectively. A small retrospective study of 16 patients with FUO showed that
FDG-PET/CT in FUO
FDG-PET/CT in FUO has been investigated in 9 retrospective studies and 1 prospective study in 407 patients (Table 2).25, 26, 27, 28, 29, 30, 31, 32, 33, 34 Keidar et al25 investigated the role of FDG-PET/CT in a prospective study of 48 patients in FUO. PET/CT identified the underlying etiology of FUO in 22 patients (46%). Sensitivity was 100%, specificity was 81%, PPV was 81%, and NPV was 100%. In this prospective study, FDG-PET/CT was considered less helpful in the diagnostic process than in
Conclusions
Although scintigraphic techniques do not directly provide a definitive diagnosis, that is, a histologic or a microbiological diagnosis, they often provide the anatomical localization where a particular metabolic process is ongoing and with the help of other techniques, such as biopsy and culture, facilitate timely definitive diagnosis and therapy. On the basis of the data in the literature and the favorable characteristics of FDG-PET, conventional scintigraphic techniques should be replaced by
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Cited by (67)
PET/MRI in paediatric disease
2021, European Journal of RadiologySuspected systemic rheumatic diseases in adults presenting with fever
2019, Best Practice and Research: Clinical RheumatologyCitation Excerpt :With the increased availability of FDG-PET-CT scanners, there are newer studies investigating its role in the investigation of PUO. It appears that its improved anatomical views will make it a very useful tool in the future [67,72]. Many studies on PUO suggest doing a temporal artery biopsy in those above the age of 55 years in whom the diagnosis remains unclear [63,73], as it is a fairly safe procedure with a very high specificity.
Radionuclide Imaging of Infection and Inflammation in Children: a Review
2018, Seminars in Nuclear MedicineCitation Excerpt :Figure 11 is an example of the utility of 18F-FDG PET/CT in children with FUO. A recent meta-analysis by Kouijzer et al132 reviewed the literature on the use of 18F-FDG and 18F-FDG PET/CT in adults with FUO addressing their comparative sensitivity, specificity, positive, and negative predictive values, as well as their advantages and disadvantages compared to other scintigraphic methods. In addition to 13 review articles, they identified nine studies investigating the use of 18F-FDG in 396 adult patients with FUO and 10 studies using 18F-FDG PET/CT to assess 407 adult patients with FUO.
The efficacy of <sup>18</sup>F-FDG PET/CT and <sup>67</sup>Ga SPECT/CT in diagnosing fever of unknown origin
2017, International Journal of Infectious DiseasesDiagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise
2017, Clinical RadiologyCitation Excerpt :This meta-analysis suggests that a diagnostic yield was achieved in 56% (95% CI: 50–61%). The results are consistent with previous results of 54% “overall helpfulness” (synonymous with diagnostic yield) in a meta-analysis of 10 studies.28 Two meta-analyses reviewing sensitivity reported 85% (95% CI: 81–88%; 15 studies) and 98% (95% CI: 94–99%; nine studies).
Nuclear Medicine Imaging in Pediatric Infection or Chronic Inflammatory Diseases
2017, Seminars in Nuclear MedicineCitation Excerpt :However, several studies have shown that [18F]-FDG-PET is a promising and accurate technique for diagnosing OM without hardware in situ (Fig. 2).30,31 Furthermore, [18F]-FDG-PET is the radionuclide modality of choice in the evaluation of spinal OM, in occult bacterial infections, and when hematogenous spread is suspected.32-35 [ 18F]-FDG-PET or PET/CT is a nonspecific imaging technique, owing to the uptake mechanism of [18F]-FDG, and cannot differentiate between inflammatory and infection lesions, neither between infections and malignancies.