European Journal of Nuclear Medicine

, Volume 27, Issue 11, pp 1617–1625

Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET

  • J. Meller
  • G. Altenvoerde
  • U. Munzel
  • A. Jauho
  • M. Behe
  • S. Gratz
  • H. Luig
  • W. Becker
Original Article

DOI: 10.1007/s002590000341

Cite this article as:
Meller, J., Altenvoerde, G., Munzel, U. et al. Eur J Nucl Med (2000) 27: 1617. doi:10.1007/s002590000341

Abstract.

Gallium-67 citrate is currently considered as the tracer of first choice in the diagnostic workup of fever of unknown origin (FUO). Fluorine-18 2'-deoxy-2-fluoro-D-glucose (FDG) has been shown to accumulate in malignant tumours but also in inflammatory processes. The aim of this study was to prospectively evaluate FDG imaging with a double-head coincidence camera (DHCC) in patients with FUO in comparison with planar and single-photon emission tomography (SPET) 67Ga citrate scanning. Twenty FUO patients underwent FDG imaging with a DHCC which included transaxial and longitudinal whole-body tomography. In 18 of these subjects, 67Ga citrate whole-body and SPET imaging was performed. The 67Ga citrate and FDG images were interpreted by two investigators, both blinded to the results of other diagnostic modalities. Forty percent (8/20) of the patients had infection, 25% (5/20) had auto-immune diseases, 10% (2/20) had neoplasms and 15% (3/20) had other diseases. Fever remained unexplained in 10% (2/20) of the patients. Of the 20 patients studied, FDG imaging was positive and essentially contributed to the final diagnosis in 11 (55%). The sensitivity of transaxial FDG tomography in detecting the focus of fever was 84% and the specificity, 86%. Positive and negative predictive values were 92% and 75%, respectively. If the analysis was restricted to the 18 patients who were investigated both with 67Ga citrate and FDG, sensitivity was 81% and specificity, 86%. Positive and negative predictive values were 90% and 75%, respectively. The diagnostic accuracy of whole-body FDG tomography (again restricted to the aforementioned 18 patients) was lower (sensitivity, 36%; specificity, 86%; positive and negative predictive values, 80% and 46%, respectively). 67Ga citrate SPET yielded a sensitivity of 67% in detecting the focus of fever and a specificity of 78%. Positive and negative predictive values were 75% and 70%, respectively. A low sensitivity (45%), but combined with a high specificity (100%), was found in planar 67Ga imaging. Positive and negative predictive values were 100% and 54%, respectively. It is concluded that in the context of FUO, transaxial FDG tomography performed with a DHCC is superior to 67Ga citrate SPET. This seems to be the consequence of superior tracer kinetics of FDG compared with those of 67Ga citrate and of a better spatial resolution of a DHCC system compared with SPET imaging. In patients with FUO, FDG imaging with either dedicated PET or DHCC should be considered the procedure of choice.

Fever of unknown origin Gallium-67 citrate [18F]2'-deoxy-2-fluoro-D-glucose Double-head coincidence camera Single-photon emission tomography 

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Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • J. Meller
    • 1
  • G. Altenvoerde
    • 1
  • U. Munzel
    • 2
  • A. Jauho
    • 1
  • M. Behe
    • 1
  • S. Gratz
    • 1
  • H. Luig
    • 1
  • W. Becker
    • 1
  1. 1.Department of Nuclear Medicine, Georg August University, Göttingen, GermanyGermany
  2. 2.Department of Statistics in Medicine, Georg August University, Göttingen, GermanyGermany
  3. 3.Correspondence to: Department of Nuclear Medicine, University of Göttingen, Robert Koch-Strasse 40, 37075 Göttingen, GermanyGermany

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