Place of 18F-FDG-PET with computed tomography in the diagnostic algorithm of patients with fever of unknown origin

  • J. Crouzet
  • V. Boudousq
  • C. Lechiche
  • J. P. Pouget
  • P. O. Kotzki
  • L. Collombier
  • J. P. Lavigne
  • A. Sotto


There is evidence for the interest of 18F-fluoro-deoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) in fever of unknown origin (FUO) clinical investigation. However, little and conflicting data exist about its place in the investigation procedure. The aim of this work was to evaluate the clinical value of 18F-FDG-PET/CT in patients with FUO and identify patients who need early 18F-FDG-PET/CT rather than a last-resort procedure. We performed a 2-year retrospective cohort study at the Nîmes University Hospital, France. A total of 79 patients (36 men, 43 women, mean age 54.0 ± 16.2 years) with FUO underwent 18F-FDG-PET/CT. A final diagnosis was established in 61 (77.2 %) cases. Aetiologies of FUO were determined using 18F-FDG-PET/CT findings in 45 (73.8 % of patients with diagnosis) cases. The sensibility and specificity value were 98 % and 87 %, respectively. The presence of adenopathy, low haemoglobin and increased C-reactive protein (CRP) were predictors of high-yield 18F-FDG-PET/CT. 18F-FDG-PET/CT may help to detect most causes of FUO. The predictors of high-yield 18F-FDG-PET/CT found in this study can help identify patients likely to benefit from specific and early imaging techniques.


Final Diagnosis Giant Cell Arteritis Compute Tomography Slice Periodic Fever Temporal Artery Biopsy 
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Conflict of interest



  1. 1.
    Gaeta GB, Fusco FM, Nardiello S (2006) Fever of unknown origin: a systematic review of the literature for 1995–2004. Nucl Med Commun 27(3):205–211PubMedCrossRefGoogle Scholar
  2. 2.
    Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, Smilde TJ, Krabbe PF, Oyen WJ, van der Meer JW (2007) A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore) 86(1):26–38CrossRefGoogle Scholar
  3. 3.
    Knockaert DC, Vanderschueren S, Blockmans D (2003) Fever of unknown origin in adults: 40 years on. J Intern Med 253(3):263–275PubMedCrossRefGoogle Scholar
  4. 4.
    de Kleijn EM, Vandenbroucke JP, van der Meer JW (1997) Fever of unknown origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore) 76(6):392–400CrossRefGoogle Scholar
  5. 5.
    Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, Bobbaers H (2003) From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med 163(9):1033–1041PubMedCrossRefGoogle Scholar
  6. 6.
    Bleeker-Rovers CP, van der Meer JW, Oyen WJ (2009) Fever of unknown origin. Semin Nucl Med 39(2):81–87PubMedCrossRefGoogle Scholar
  7. 7.
    Bleeker-Rovers CP, de Kleijn EM, Corstens FH, van der Meer JW, Oyen WJ (2004) Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 31(1):29–37PubMedCrossRefGoogle Scholar
  8. 8.
    Mansueto P, Di Lorenzo G, Rizzo M, Di Rosa S, Vitale G, Rini G, Mansueto S, Affronti M (2008) Fever of unknown origin in a Mediterranean survey from a division of internal medicine: report of 91 cases during a 12-year-period (1991–2002). Intern Emerg Med 3(3):219–225PubMedCrossRefGoogle Scholar
  9. 9.
    Tolia J, Smith LG (2007) Fever of unknown origin: historical and physical clues to making the diagnosis. Infect Dis Clin North Am 21(4):917–936, viiiPubMedCrossRefGoogle Scholar
  10. 10.
    Meller J, Sahlmann CO, Scheel AK (2007) 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 48(1):35–45PubMedGoogle Scholar
  11. 11.
    Kumar R, Basu S, Torigian D, Anand V, Zhuang H, Alavi A (2008) Role of modern imaging techniques for diagnosis of infection in the era of 18F-fluorodeoxyglucose positron emission tomography. Clin Microbiol Rev 21(1):209–224PubMedCrossRefGoogle Scholar
  12. 12.
    De Winter F, Vogelaers D, Gemmel F, Dierckx RA (2002) Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis 21(4):247–257PubMedCrossRefGoogle Scholar
  13. 13.
    Blockmans D, Knockaert D, Maes A, De Caestecker J, Stroobants S, Bobbaers H, Mortelmans L (2001) Clinical value of [(18)F]fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin. Clin Infect Dis 32(2):191–196PubMedCrossRefGoogle Scholar
  14. 14.
    Buysschaert I, Vanderschueren S, Blockmans D, Mortelmans L, Knockaert D (2004) Contribution of (18)fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin. Eur J Intern Med 15(3):151–156PubMedCrossRefGoogle Scholar
  15. 15.
    Balink H, Collins J, Bruyn GA, Gemmel F (2009) F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med 34(12):862–868PubMedCrossRefGoogle Scholar
  16. 16.
    Federici L, Blondet C, Imperiale A, Sibilia J, Pasquali JL, Pflumio F, Goichot B, Blaison G, Weber JC, Christmann D, Constantinesco A, Andrès E (2010) Value of (18)F-FDG-PET/CT in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome: a single centre analysis experience. Int J Clin Pract 64(1):55–60PubMedCrossRefGoogle Scholar
  17. 17.
    Ferda J, Ferdová E, Záhlava J, Matejovic M, Kreuzberg B (2010) Fever of unknown origin: a value of (18)F-FDG-PET/CT with integrated full diagnostic isotropic CT imaging. Eur J Radiol 73(3):518–525PubMedCrossRefGoogle Scholar
  18. 18.
    Andres E, Federici L, Imperiale A (2010) Value of 18 FDG-PET/CT in clinical practice in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome. Eur J Radiol 75(1):122PubMedCrossRefGoogle Scholar
  19. 19.
    Durack DT, Street AC (1991) Fever of unknown origin—reexamined and redefined. Curr Clin Top Infect Dis 11:35–51PubMedGoogle Scholar
  20. 20.
    Fearon KC, Voss AC, Hustead DS; Cancer Cachexia Study Group (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83(6):1345–1350PubMedGoogle Scholar
  21. 21.
    Dong MJ, Zhao K, Liu ZF, Wang GL, Yang SY, Zhou GJ (2010) A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol (in press)Google Scholar
  22. 22.
    Blockmans D, Stroobants S, Maes A, Mortelmans L (2000) Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 108(3):246–249PubMedCrossRefGoogle Scholar
  23. 23.
    Zerizer I, Tan K, Khan S, Barwick T, Marzola MC, Rubello D, Al-Nahhas A (2010) Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis. Eur J Radiol 73(3):504–509PubMedCrossRefGoogle Scholar
  24. 24.
    Love C, Tomas MB, Tronco GG, Palestro CJ (2005) FDG PET of infection and inflammation. Radiographics 25(5):1357–1368PubMedCrossRefGoogle Scholar
  25. 25.
    Bleeker-Rovers CP, Vos FJ, Mudde AH, Dofferhoff AS, de Geus-Oei LF, Rijnders AJ, Krabbe PF, Corstens FH, van der Meer JW, Oyen WJ (2007) 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 34(5):694–703PubMedCrossRefGoogle Scholar
  26. 26.
    Lorenzen J, Buchert R, Bohuslavizki KH (2001) Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun 22(7):779–783PubMedCrossRefGoogle Scholar
  27. 27.
    Kjaer A, Lebech AM, Eigtved A, Højgaard L (2004) Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 31(5):622–626PubMedCrossRefGoogle Scholar
  28. 28.
    Jaruskova M, Belohlavek O (2006) Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states. Eur J Nucl Med Mol Imaging 33(8):913–918PubMedCrossRefGoogle Scholar
  29. 29.
    Knockaert DC, Vanneste LJ, Bobbaers HJ (1993) Recurrent or episodic fever of unknown origin. Review of 45 cases and survey of the literature. Medicine (Baltimore) 72(3):184–196Google Scholar
  30. 30.
    Simons KS, Pickkers P, Bleeker-Rovers CP, Oyen WJ, van der Hoeven JG (2010) F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with suspected infection. Intensive Care Med 36(3):504–511PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • J. Crouzet
    • 1
  • V. Boudousq
    • 2
    • 3
  • C. Lechiche
    • 1
  • J. P. Pouget
    • 2
    • 4
  • P. O. Kotzki
    • 2
  • L. Collombier
    • 2
  • J. P. Lavigne
    • 5
    • 6
  • A. Sotto
    • 1
    • 5
  1. 1.Service des Maladies Infectieuses et TropicalesCHU CaremeauNîmes cedexFrance
  2. 2.Service de Médecine NucléaireCHU CaremeauNîmesFrance
  3. 3.INSERM, U896 Université Montpellier 1NîmesFrance
  4. 4.Direction de la Radioprotection de l’HommeIRSNFontenay-aux-RosesFrance
  5. 5.UFR de MédecineINSERM, U0147, Université Montpellier 1NîmesFrance
  6. 6.Laboratoire de BactériologieCHU CaremeauNîmesFrance

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