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Do clinical and laboratory variables have any impact on the diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin?

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Abstract

Objective

To assess the influence of clinical features and laboratory test results on the determination of fever of unknown origin (FUO) by means of 18F-FDG PET/CT.

Methods

Retrospective and longitudinal analysis, including all the PET/CT studies requested for FUO. Reference standard was established by serology, cultures or biopsy with other laboratory tests or clinical follow-up when necessary. Clinical variables, inflammation markers, protein analysis, serology and culture results close to the PET scan were obtained. The final diagnosis was classified into three groups attending to the etiology; group 1: infection or neoplasm, group 2: vasculitis, autoimmune disease or non-infectious inflammatory disease and group 3: auto-limited fever or persistent fever without diagnosis. PET/CT scans were classified as positive or negative and helpful or not in the diagnosis of the fever origin. The effect of clinical features and laboratory variables on the PET/CT results was analyzed.

Results

Sixty-seven patients were evaluated. The final diagnosis was: Group 1 (25), Group 2 (20) and Group 3 (22). 89.6% of patients had a positive inflammation marker, 28.4% proteinogram alterations and 20.9% positive cultures. PET/CT was positive in 52/67 patients. PET/CT helped in the establishment of the fever origin in 35 cases and was especially helpful in groups 1 and 2. Sensitivity, specificity and accuracy of PET/CT were: 84, 31 and 61%. PET results shown significant relations with the final diagnosis (p = 0.035) and culture results (p = 0.037). No significant relations were observed with the rest of clinical or laboratory variables.

Conclusions

18F-FDG PET/CT had a high sensitivity but a low specificity in the diagnosis of the fever origin, probably due to the high rate of diffuse and auto-limited aetiologies. Patients who are most likely to benefit from the PET/CT study would be those with several positive inflammation markers, reflecting a higher pre-test probability of active disease.

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Authors and Affiliations

  1. Nuclear Medicine Department, University General Hospital, C/ Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain

    Ana María García-Vicente, María Jesús Tello-Galán, German Andrés Jiménez-Londoño, Francisco José Pena-Pardo & Ángel Soriano-Castrejón

  2. Mathematics Department, Castilla-La Mancha University, Ciudad Real, Spain

    Mariano Amo-Salas

  3. Internal Medicine Department, University General Hospital, C/ Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain

    Juan Ros-Izquierdo, Beatriz La Rosa Salas & Guadalupe Prado-Serrano Pradas

Authors
  1. Ana María García-Vicente
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  2. María Jesús Tello-Galán
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  3. Mariano Amo-Salas
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  4. Juan Ros-Izquierdo
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  9. Ángel Soriano-Castrejón
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Correspondence to Ana María García-Vicente.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all the individual participants included in the study.

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García-Vicente, A.M., Tello-Galán, M.J., Amo-Salas, M. et al. Do clinical and laboratory variables have any impact on the diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin?. Ann Nucl Med 32, 123–131 (2018). https://doi.org/10.1007/s12149-017-1226-8

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  • DOI: https://doi.org/10.1007/s12149-017-1226-8

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