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.
OBJECTIVE
Since (18)F-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).


CONCLUSIONS
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.
Bleeker-Rovers
Chantal P
CP
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. c.bleeker-rovers@AIG.umcn.nl.|Department of Internal Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. c.bleeker-rovers@AIG.umcn.nl.|Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands. c.bleeker-rovers@AIG.umcn.nl.
Vos
Fidel J
FJ
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.|Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands.
Mudde
Aart H
AH
Department of Internal Medicine, Slingeland Hospital, Doetinchem, The Netherlands.
Dofferhoff
Anton S M
ASM
Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
de Geus-Oei
Lioe-Fee
LF
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Rijnders
Anton J
AJ
Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Krabbe
Paul F M
PFM
Department of Medical Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Corstens
Frans H M
FHM
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands.
van der Meer
Jos W M
JWM
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.|Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands.
Oyen
Wim J G
WJG
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009683:Nuclear Medicine; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18