The Role of <sup>18</sup>F-FDG PET/CT in the Diagnosis of Fever of Unknown Origin_West China Medical Journal

Authors：

 HUShuang , SHENGuo-hua , GUOJia , JITing , LIUBin ,  KUANGAn-ren

Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

KUANGAn-ren, Email: kuanganren@263.net

Keywords：

¹⁸F-FDG PET/CT; Fever of unknown origin; Diagnosis; Infection; Neoplasm

DOI：

10.7507/1002-0179.20150261

Video：

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Objective To investigate the diagnostic value of ¹⁸F-FDG PET/CT scan for fever of unknown origin. Methods The ¹⁸F-FDG PET/CT scan results and clinical data were analyzed retrospectively in 32 patients with fever of unknown origin examined between January 2011 and October 2013. Final diagnoses were determined with recognized diagnostic standard. Results ¹⁸F-FDG PET/CT scan was able to detect the cause of fever precisely in 53.1% (n=17) of the patients and was helpful in 25 patients (78.1%). The final cause of fever was determined in 20 patients, including infection (40%), malignancy (10%), non-infectious inflammatory disease (40%) and miscellaneous causes (10%). True positive, false positive, true negative and false negative rate of the modality were 17.0%, 4.0%, 8.0% and 3.0%; and the sensitivity and specificity were 85.0% and 66.7%. Conclusion ¹⁸F-FDG PET/CT scan plays an important role in the diagnosis of fever of unknown origin.

Citation： HUShuang, SHENGuo-hua, GUOJia, JITing, LIUBin, KUANGAn-ren. The Role of ¹⁸F-FDG PET/CT in the Diagnosis of Fever of Unknown Origin. West China Medical Journal, 2015, 30(5): 919-924. doi: 10.7507/1002-0179.20150261 Copy

1.	Petersdorf RG, Beeson PB. Fever of unexplained origin:report on 100 cases[J]. Medicine, 1961, 40(1):1-30.
2.	盛瑞媛. 全國發熱性疾病學術研討會紀要[J]. 中華內科雜志, 1999, 38(11):63-64.
3.	Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin:a systematic review of the literature for 1995-2004[J]. Nucl Med Commun, 2006, 27(3):205-211.
4.	賈問櫻, 王紅. ¹⁸F-FDG PET/CT對不明原因發熱病因的診斷價值[J]. 臨床和實驗醫學雜志, 2013, 12(23):1932-1935.
5.	Durack DT, Street AC. Fever of unknown origin:reexamined and redefined[J]. Curr Clin Top Infect Dis, 1991, 11(35):35-51.
6.	Kumar R, Basu S, Torigian D, et al. Role of modern imaging techniques for diagnosis of infection in the era of ¹⁸F-fluorodeoxyglucose positron emission tomography[J]. Clin Microbiol Rev, 2008, 21(1):209-224.
7.	Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults:40 years on[J]. J Intern Med, 2003, 253(3):263-275.
8.	Kim J, Yoo SW, Kang SR, et al. Clinical implication of F-18 FDG PET/CT in patients with secondary hemophagocytic lymphohistiocytosis[J]. Ann Hematol, 2014, 93(4):661-667.
9.	Meller J, Sahlmann CO, Scheel AK. F-18-FDG PET and PET/CT in fever of unknown origin[J]. J Nucl Med, 2007, 48(1):35-45.
10.	Sheng ZK, Ye J, Li JJ, et al. Utility of fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin diagnosed as lymphoma[J]. Med Princ Pract, 2014, 23(5):437-442.
11.	Tokmak H, Ergonul O. The evolving role of PET/CT in fever of unknown origin[J]. Int J Infect Dis, 2014, 27:1-3.
12.	Krem MM, Pan L, Blinder MA. ¹⁸F-FDG-PET-facilitated diagnosis of lymphoma presenting with fever of unknown origin and cold agglutination[J]. Leuk Lymphoma, 2007, 48(3):619-622.
13.	Sollini M, Froio A, Fratemali A et al. FDG PET/CT in the management of patients with fever of unknown origin[J]. Eur J Nucl Med Mol I, 2013, 40:130-140.
14.	Kouijzer IJ, Bleeker-Rovers CP, Oyen WJ. FDG-PET in fever of unknown origin[J]. Semin Nucl Med, 2013, 43(5):333-339.
15.	Bleeker-Rovers CP, De Kleijn E, Corstens FM, et al. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation[J]. Eur J Nucl Med Mol Imaging, 2004, 31(1):29-37.
16.	Ferda J, Ferdova E, Zahlava J, et al. Fever of unknown origin:a value of F-18-FDG-PET/CT with integrated full diagnostic isotropic CT imaging[J]. Eur J Radiol, 2010, 73(3):518-525.
17.	Crouzet J, Boudousq V, Lechiche C, et al. Place of ¹⁸F-FDG-PET with computed tomography in the diagnostic algorithm of patients with fever of unknown origin[J]. Eur J Clin Microbiol Infect Dis, 2012, 31(8):1727-1733.
18.	Pedersen TI, Roed C, Knudsen LS, et al. Fever of unknown origin:a retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT[J]. Scand J Infect Dis, 2012, 44(1):18-23.
19.	Tokmak H, Ergonul O, Demirkol O, et al. Diagnostic contribution of F-18-FDG-PET/CT in fever of unknown origin[J]. Int J Infect Dis, 2014, 19:53-58.

1. Petersdorf RG, Beeson PB. Fever of unexplained origin:report on 100 cases[J]. Medicine, 1961, 40(1):1-30.
2. 盛瑞媛. 全國發熱性疾病學術研討會紀要[J]. 中華內科雜志, 1999, 38(11):63-64.
3. Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin:a systematic review of the literature for 1995-2004[J]. Nucl Med Commun, 2006, 27(3):205-211.
4. 賈問櫻, 王紅. ¹⁸F-FDG PET/CT對不明原因發熱病因的診斷價值[J]. 臨床和實驗醫學雜志, 2013, 12(23):1932-1935.
5. Durack DT, Street AC. Fever of unknown origin:reexamined and redefined[J]. Curr Clin Top Infect Dis, 1991, 11(35):35-51.
6. Kumar R, Basu S, Torigian D, et al. Role of modern imaging techniques for diagnosis of infection in the era of ¹⁸F-fluorodeoxyglucose positron emission tomography[J]. Clin Microbiol Rev, 2008, 21(1):209-224.
7. Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults:40 years on[J]. J Intern Med, 2003, 253(3):263-275.
8. Kim J, Yoo SW, Kang SR, et al. Clinical implication of F-18 FDG PET/CT in patients with secondary hemophagocytic lymphohistiocytosis[J]. Ann Hematol, 2014, 93(4):661-667.
9. Meller J, Sahlmann CO, Scheel AK. F-18-FDG PET and PET/CT in fever of unknown origin[J]. J Nucl Med, 2007, 48(1):35-45.
10. Sheng ZK, Ye J, Li JJ, et al. Utility of fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin diagnosed as lymphoma[J]. Med Princ Pract, 2014, 23(5):437-442.
11. Tokmak H, Ergonul O. The evolving role of PET/CT in fever of unknown origin[J]. Int J Infect Dis, 2014, 27:1-3.
12. Krem MM, Pan L, Blinder MA. ¹⁸F-FDG-PET-facilitated diagnosis of lymphoma presenting with fever of unknown origin and cold agglutination[J]. Leuk Lymphoma, 2007, 48(3):619-622.
13. Sollini M, Froio A, Fratemali A et al. FDG PET/CT in the management of patients with fever of unknown origin[J]. Eur J Nucl Med Mol I, 2013, 40:130-140.
14. Kouijzer IJ, Bleeker-Rovers CP, Oyen WJ. FDG-PET in fever of unknown origin[J]. Semin Nucl Med, 2013, 43(5):333-339.
15. Bleeker-Rovers CP, De Kleijn E, Corstens FM, et al. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation[J]. Eur J Nucl Med Mol Imaging, 2004, 31(1):29-37.
16. Ferda J, Ferdova E, Zahlava J, et al. Fever of unknown origin:a value of F-18-FDG-PET/CT with integrated full diagnostic isotropic CT imaging[J]. Eur J Radiol, 2010, 73(3):518-525.
17. Crouzet J, Boudousq V, Lechiche C, et al. Place of ¹⁸F-FDG-PET with computed tomography in the diagnostic algorithm of patients with fever of unknown origin[J]. Eur J Clin Microbiol Infect Dis, 2012, 31(8):1727-1733.
18. Pedersen TI, Roed C, Knudsen LS, et al. Fever of unknown origin:a retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT[J]. Scand J Infect Dis, 2012, 44(1):18-23.
19. Tokmak H, Ergonul O, Demirkol O, et al. Diagnostic contribution of F-18-FDG-PET/CT in fever of unknown origin[J]. Int J Infect Dis, 2014, 19:53-58.

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The Role of ¹⁸F-FDG PET/CT in the Diagnosis of Fever of Unknown Origin