Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 34, Issue 5, pp 694-703

A prospective multi-centre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin

  • Chantal P. Bleeker-RoversAffiliated withDepartment of Nuclear Medicine, Radboud University Nijmegen Medical CentreDepartment of Internal Medicine, Radboud University Nijmegen Medical CentreNijmegen University Centre for Infectious Diseases Email author 
  • , Fidel J. VosAffiliated withDepartment of Internal Medicine, Radboud University Nijmegen Medical CentreNijmegen University Centre for Infectious Diseases
  • , Aart H. MuddeAffiliated withDepartment of Internal Medicine, Slingeland Hospital
  • , Anton S. M. DofferhoffAffiliated withDepartment of Internal Medicine, Canisius-Wilhelmina Hospital
  • , Lioe-Fee de Geus-OeiAffiliated withDepartment of Nuclear Medicine, Radboud University Nijmegen Medical Centre
  • , Anton J. RijndersAffiliated withDepartment of Nuclear Medicine, Rijnstate Hospital
  • , Paul F. M. KrabbeAffiliated withDepartment of Medical Technology Assessment, Radboud University Nijmegen Medical Centre
  • , Frans H. M. CorstensAffiliated withDepartment of Nuclear Medicine, Radboud University Nijmegen Medical CentreNijmegen University Centre for Infectious Diseases
  • , Jos W. M. van der MeerAffiliated withDepartment of Internal Medicine, Radboud University Nijmegen Medical CentreNijmegen University Centre for Infectious Diseases
    • , Wim J. G. OyenAffiliated withDepartment of Nuclear Medicine, Radboud University Nijmegen Medical CentreNijmegen University Centre for Infectious Diseases

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Abstract

Purpose

Since 18F-fluorodeoxyglucose (FDG) accumulates in neoplastic cells and in activated inflammatory cells, positron emission tomography (PET) with FDG could be valuable in diagnosing patients with fever of unknown origin (FUO). The aim of this study was to validate the use of FDG-PET as part of a structured diagnostic protocol in the general patient population with FUO.

Methods

From December 2003 to July 2005, 70 patients with FUO were recruited from one university hospital (n=38) and five community hospitals (n=32). A structured diagnostic protocol including FDG-PET was used. A dedicated, full-ring PET scanner was used for data acquisition. FDG-PET scans were interpreted by two staff members of the department of nuclear medicine without further clinical information. The final clinical diagnosis was used for comparison with the FDG-PET results.

Results

Of all scans, 33% were clinically helpful. The contribution of FDG-PET to the final diagnosis did not differ significantly between patients diagnosed in the university hospital and patients diagnosed in the community hospitals. FDG-PET contributed significantly more often to the final diagnosis in patients with continuous fever than in patients with periodic fever. FDG-PET was not helpful in any of the patients with normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Conclusion

FDG-PET is a valuable imaging technique as part of a diagnostic protocol in the general patient population with FUO and a raised ESR or CRP.

Keywords

18F-fluorodeoxyglucose PET Fever of unknown origin Infection Inflammation Diagnosis