Abstract
Fever of unknown origin (FUO) is a syndrome of fever without obvious cause, and it is regarded as a difficult diagnostic challenge. Inflammation of unknown origin (IUO) is similar to FUO, except that it is not associated with elevated body temperature. FDG-PET/CT may cover the diagnosis of a wide spectrum of diseases causing FUO/IUO, namely tumors and inflammation, under the conditions that the disease is active (consuming a lot of glucose), and the lesion is focal and of a size that is sufficiently larger than the limit of detectability. Promising results of FDGPET/CT for the diagnosis of FUO/IUO have been reported from many institutions. FDGPET/CT is very helpful for recognizing and excluding diseases, directing further diagnostic decisions, and avoiding unnecessary invasive examinations. If confirmed by further studies, FDG-PET/CT may become established as an initial, noninvasive diagnostic tool in the evaluation of FUO/IUO.
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References
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine. 1961;40:1–30.
Durack DT, Street AC. Fever of unknown origin-reexamined. Curr Clin Top Infect Dis. 1991;11:35–51.
Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Intern Med. 2003;253:263–75.
Perrin AE, Goichot B, Andès E, et al. [Development and long-term prognosis of unexplained persistent inflammatory biologic syndromes] in French. Rev Med Interne. 2002;23(8):683–9.
Vanderschueren S, Biondo ED, Ruttens D, et al. Inflammation of unknown origin versus fever of unknown origin: two of a kind. Eur J Intern Med. 2009;20:415–8.
Muto G, Yamashita H, Takahashi Y, et al. Large vessel vasculitis in elderly patients: early diagnosis and steroid-response evaluation with FDG-PET/CT and contrast-enhanced CT. Rheumatol Int. 2014;34(11):1545–54.
Balink H, Veeger NJ, Bennink RJ, et al. The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin. Nucl Med Commun. 2015;36:604–9.
Garcia-Vincent AM, Tello-Galán MJ, Amo-Salas M, et al. Do clinical and laboratory variables have any impact on the diagnostic performance of 18F-FDGPET/CT in patients with fever of unknown origin? Ann Nucl Med. 2018;32:123–31.
Schönau V, Vogel K, Englbrecht M, et al. The value of 18F-FDGPET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis. 2018;77:70–7.
Bleeker-Rovers CP, Vos FJ, Mudde AH, et al. 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. Eur J Nucl Med Mol Imaging. 2007;34:694–703.
Takeuchi M, Dahabreh IJ, Nihashi T, et al. Nuclear imaging for classic fever of unknown origin: meta-analysis. J Nucl Med. 2016;57:1913–9.
Besson FL, Chaumet-Riffaud P, Playe M, et al. Contribution of 18F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis. Eur J Nucl Med Mol Imaging. 2016;43:1887–95.
Takeuchi M, Nihashi T, Gafter-Gvili A, et al. Association of 18F-FDG PET or PET/CT results with spontaneous remission in classic fever of unknown origin; a systematic review and meta-analysis. Medicine. 2018;97(43):e12909.
Palestro CJ, Love C. Nuclear medicine imaging in fever of unknown origin: the new paradigm. Curr Pharm Des. 2017; https://doi.org/10.2174/1381612824666171129194507.
Kan Y, Wang W, Liu J, et al. Contribution of 18F-FDGPET/CT in a case-mix of fever of unknow origin and inflammation of unknown origin: a meta-analysis. Acta Radiol. 2019;60:716–25. https://doi.org/10.1177/0284185118799512.
Kubota K, Nakamoto Y, Tamaki N, et al. FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study. Ann Nucl Med. 2011;25:355–64.
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961;40:1–30.
Bleeker-Rovers CP, van der Meer JWM. Fever of unknown origin. In: Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J, Kasper D, editors. Harrison’s principles of internal medicine. 19th ed. New York: McGraw Hill; 2015. p. 135–42.
Varghese GM, Trowbridge P, Doherty T. Investigating and managing pyrexia of unknown origin in adults. BMJ. 2010;341:C5470.
Horowitz HW. Fever of unknown origin or fever of too many origins? N Engl J Med. 2013;368(3):197–9.
Hicks RJ, Hofman MS. Is there still a role for SPECT–CT in oncology in the PET–CT era? Nat Rev Clin Oncol. 2012;9(12):712–20.
Rennen HJM, Bleeker-Rovers C, Oyen WG. Imaging infection and inflammation. In: Baert AL, Sartor K, Schiepers C, editors. Diagnostic nuclear medicine. Berlin Heidelberg: Springer; 2006. p. 113–26.
Takeuchi M, Nihashi T, Gafter-Gvili A, García-Gómez FJ, Andres E, Blockmans D, et al. Association of 18F-FDG PET or PET/CT results with spontaneous remission in classic fever of unknown origin. Medicine. 2018;97(43):e12909.
Dong MJ, Zhao K, Liu ZF, Wang GL, Yang SY, Zhou GJ. A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol. 2011;80(3):834–44.
Hao R, Yuan L, Kan Y, Li C, Yang J. Diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin: a meta-analysis. Nucl Med Commun. 2013;34(7):682–8.
van der Ende EL, Punwasia RVG, van Daeleb PLA, Schurinkc KAM. Diagnostic value of FDG-PET/CT in fever of unknown origin. Erasmus J Med. 2013;3:32–7.
Sioka C, Assimakopoulos A, Fotopoulos A. The diagnostic role of18F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin. Eur J Clin Investig. 2015;45(6):601–8.
Mulders-Manders C, Simon A, Bleeker-Rovers C. Fever of unknown origin. Clin Med (Lond). 2015;15(3):280–4.
Schönau V, Vogel K, Englbrecht M, et al. The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis. 2018;77:70–7.
Chinese Society of Nuclear Medicine. Basic requirements of clinical quality control and quality assurance on SPECT (/CT) and PET/CT (2014 edition). Chin J Nucl Med Mol Imaging. 2014:343–448.
Tan XY, He QY. Chinese literature review of etiology distribution of adult patients with fever of unknown origin from1979 to 2012. Chin J Intern Med. 2013;52:1013–7.
Keidar Z, Gurman-Balbir A, Gaitini D, et al. Fever of unknown origin: the role of 18F-FDG PET/CT. J Nucl Med. 2008;49:1980–5.
Ergül N, Halac M, Cermik TF, et al. The diagnostic role of FDG PET/CT in patients with fever of unknown origin. Mol Imaging Radionucl Ther. 2011;20:19–25.
Mulders-Manders CM, Simon A, Bleeker-Rovers CP. Rheumatologic diseases as the cause of fever of unknown origin. Best Pract Res Clin Rheumatol. 2016;30:789–801.
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Kubota, K., Takeuchi, M., Wang, Q., Nakamoto, Y. (2020). FDG-PET/CT in Patients with Inflammation or Fever of Unknown Origin (IUO and FUO). In: Toyama, H., Li, Y., Hatazawa, J., Huang, G., Kubota, K. (eds) PET/CT for Inflammatory Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-15-0810-3_2
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DOI: https://doi.org/10.1007/978-981-15-0810-3_2
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