Diagnostic contribution of 18F-FDG-PET/CT in fever of unknown origin

Tokmak, Handan; Ergönül, Önder; Demirkol, Mehmet Onur; Çetiner, Mustafa; Ferhanoğlu, Burhan

doi:10.1016/j.ijid.2013.10.009

Cited by 60 publications

(28 citation statements)

References 27 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%

“…Continuous data are presented as mean ( SD) and categorical data are presented as n (%). CT, computed tomography; ranging between 3 and 20% [23,25]. In the present study, 22% of the cases were attributed to neoplasia.…”

Section: Discussionsupporting

confidence: 42%

“…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: Discussionsupporting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Unfortunately, these standard approaches generally exhibit a relative low sensitivity and specificity9). PET-CT has been used in some studies for the diagnosis and management of FUO, owing to its ability to assess the morphology and functional characteristics of the tissues simultaneously910). In Tokmak et al9)'s study reported that the estimated diagnostic accuracy, sensitivity and specificity of PET-CT for FUO were 90.5%, 93.8% and 80%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center

Kim

Kang

et al. 2017

Korean J Pediatr

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PurposeFever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories.MethodsAmong the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included.ResultsTotal 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%).ConclusionAlmost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.

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“…Overall, no predictive model was validated. Three studies (28,34,46) reported how often scans altered diagnosis, and 2 studies (37,46) reported how often scans altered therapeutic decisions (Supplemental Table 10). For example, 18 F-FDG PET or PET/CT affected diagnostic and therapeutic management in 44% (46) and 36% of cases (37), respectively.…”

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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Diagnostic contribution of 18F-FDG-PET/CT in fever of unknown origin

Abstract: Further studies to confirm the high diagnostic yield of (18)F-FDG-PET/CT observed in the present study would lend support to the inclusion of this imaging modality in the initial diagnostic work-up of patients with suspected FUO.

Cited by 60 publications

References 27 publications

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center

Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis

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