title: Role and interpretation of fluorodeoxyglucose-positron emission tomography/computed tomography in HIV-infected patients with fever of unknown origin: a prospective study.
abstract: OBJECTIVE
  The aim of the study was to evaluate prospectively the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in investigation of fever of unknown origin (FUO) in HIV-positive patients and to determine whether HIV viraemia impacts on FDG-PET/CT performance.
  
  
  METHODS
  The FDG-PET/CT results of 20 HIV-infected patients with FUO were analysed and compared with the FDG-PET/CT results of 10 HIV-infected viraemic patients without FUO. The performance of FDG-PET/CT for identifying the aetiology of FUO was assessed. Final diagnosis for FUO was based on histopathology, microbiological assays, or clinical and imaging follow-up.
  
  
  RESULTS
  FDG-PET/CT contributed to the diagnosis or exclusion of a focal aetiology of the febrile state in 80% of patients with FUO. The presence of increased FDG uptake in the central lymph node has 100% specificity for focal aetiology of fever, even in viraemic patients. The absence of hypermetabolic central lymph nodes in FUO patients has 100% negative predictive value for focal disease. Lymph node biopsy in central hypermetabolic areas allowed, in 100% of cases, identification of underlying disease in patients with FUO. Biopsy of peripheral lymph nodes should be performed in lymph nodes with maximum standardized uptake value (SUVmax) ≥ 6-8 (sensitivity 62.5%; specificity 75%) and avoided in lymph nodes with SUVmax = 0-4 (specificity 0%). High HIV viraemia does not prevent correct interpretation of FDG-PET/CT.
  
  
  CONCLUSIONS
  As in HIV-negative patients, we confirm the usefulness of FDG-PET/CT in investigation of FUO in HIV-positive patients even if they are viraemic.
authors.affiliation: Infectious Diseases Department, Saint-Pierre University Hospital, 100 Brussels, Belgium. charlotte_martin@stpierre-bru.be
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: C
authors.initials: C
authors.lastname: Castaigne
authors.forename: M
authors.initials: M
authors.lastname: Tondeur
authors.forename: P
authors.initials: P
authors.lastname: Flamen
authors.forename: S
authors.initials: S
authors.lastname: De Wit
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging; D019788:Fluorodeoxyglucose F18; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography / Q000379:methods* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: HIV; fever of unknown origin; positron emission tomography/computed tomography; viraemia