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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 Jul 01

DOI: 10.23736/S1824-4785.19.03129-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Optimal use of [18F]FDG-PET/CT in patients with fever or inflammation of unknown origin

Catharina M. MULDERS-MANDERS 1 , Ilse J. KOUIJZER 1, Marcel J. JANSSEN 2, Wim J. OYEN 2, 3, Anna SIMON 1, Chantal P. BLEEKER-ROVERS 1

1 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; 2 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; 3 Department of Nuclear Medicine, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK


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BACKGROUND: [18F]FDG-PET/CT is one of the most important diagnostic techniques in the work-up of patients with FUO/IUO. Little is known how to optimize the diagnostic value of [18F]FDG-PET/CT in patients with FUO/IUO.
METHODS: Retrospective study in all patients who underwent [18F]FDG-PET/CT during the work-up of FUO/IUO in a tertiary expert center between 2005 and 2014. Data were extracted from medical records.
RESULTS: 104 patients were identified, of whom 68 had a final diagnosis (65.4%), mainly infections (30.8%) and non-infectious inflammatory diseases (30.8%). [18F]FDG-PET/CT contributed to the final diagnosis in 47 of the 68 patients (69.1%). In 21 patients [18F]FDG- PET/CT did not help making a diagnosis. In ten of these patients [18F]FDG-PET/CT was performed while body temperature, CRP and ESR were normal or unknown. Sixteen of 104 patients underwent repeated [18F]FDG-PET/CT. The second scan contributed to the final diagnosis in five of these patients. In two of these patients, the first scan retrospectively was truly non-contributory. In both patients the first [18F]FDG-PET/CT was made while CRP/ESR was low and fever was not present or not measured. A third or fourth scan never contributed to the final diagnosis when the second one did not.
CONCLUSIONS: [18F]FDG-PET/CT contributed to the final diagnosis in 45.2% of patients, but never contributed when both inflammatory parameters and body temperature were normal. Repeat [18F]FDG-PET/CT should only be performed in patients with a non- contributory [18F]FDG-PET/CT when new symptoms or signs appear, or when the first scan was made in absence of fever or elevated inflammatory parameters.


KEY WORDS: Fever of unknown origin; Positron emission tomography computed tomography; PET/CT; C-reactive protein; Diagnosis

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