[18F]FDG-PET/CT for the diagnosis of patients with fever of unknown origin

A. Gafter-Gvili*, S. Raibman, A. Grossman, T. Avni, M. Paul, L. Leibovici, B. Tadmor, D. Groshar, H. Bernstine

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: The diagnosis of patients with fever of unknown origin (FUO) remains a challenging medical problem. We aimed to assess the diagnostic contribution of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) for the evaluation of FUO. Methods: We performed a 4-year retrospective single-center study of all hospitalized patients that underwent FDG-PET/CT for evaluation of FUO. The final diagnosis of the febrile disease was based on clinical, microbiological, radiological and pathological data available at the final follow-up. Predictors for a contributory exam were sought. Results: One hundred and twelve patients underwent FDG-PET/CT for the investigation of FUO in the years 2008-2012 and were included in the study. A final diagnosis was determined in 83 patients (74%) and included: infectious disease in 49 patients (43%), non-infectious inflammatory disease in 17 patients (16%), malignancies in 15 patients (14%), other diagnoses in 2 patients (1.7%), FUO resolved with no diagnosis and no evidence of disease during a 6-month follow-up in 23 patients (20%), and death with fever and with no diagnosis in 6 patients (5%). Seventy-four FDG-PET/CT studies (66%) were considered clinically helpful and contributory to diagnosis (46% positive contributory value and 20.5% contributory to exclusion of diagnosis). PET/CT had a sensitivity of 72.2%, a specificity of 57.5%, a positive predictive value (PPV) of 74.2% and a negative predictive value (NPV) of 53.5%. On multivariable analysis, significant predictors of a positive PET/CT contributory to diagnosis were a short duration of fever and male gender. Conclusions: PET/CT is an important diagnostic tool for patients with FUO.

Original languageEnglish
Pages (from-to)289-298
Number of pages10
JournalQJM - Monthly Journal of the Association of Physicians
Volume108
Issue number4
DOIs
StatePublished - 1 Apr 2015

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