title: Contribution of (18)F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to quantify the contribution of FDG PET to the diagnostic assessment of fever of unknown origin (FUO), taking into account the diagnostic limitations resulting from the composite nature of this entity.
  
  
  METHODS
  The PubMed/MEDLINE database was searched from 2000 to September 2015. Original articles fulfilling the following criteria were included: (1) FUO as the initial diagnosis, (2) no immunosuppressed or nosocomial condition, (3) final diagnosis not based on PET, (4) a follow-up period specified, (5) adult population, and (6) availability of adapted data for calculation of odds ratios (ORs). ORs were computed for each study and then pooled using a random effects model. Stratification-based sensitivity analyses were finally performed using the following prespecified criteria: (a) study design, (b) PET device, (c) geographic area, and (d) follow-up period.
  
  
  RESULTS
  A meta-analysis of the 14 included studies showed that normal PET findings led to an increase in the absolute final diagnostic rate of 36 % abnormal PET findings to an increase of 83 %, corresponding to a pooled OR of 8.94 (95 % CI 4.18 - 19.12, Z = 5.65; p < 0.00001). The design of the studies influenced the results (OR 2.92, 95 % CI 1.00 - 8.53 for prospective studies; OR 18,57, 95 % CI 7.57 - 45.59 for retrospective studies; p = 0.01), whereas devices (dedicated or hybrid), geographic area and follow-up period did not.
  
  
  CONCLUSIONS
  Abnormal PET findings are associated with a substantially increased final diagnostic rate in FUO. Consequently, FDG PET could be considered for inclusion in the first-line diagnostic work-up of FUO. Further randomized prospective studies with standardized FDG PET procedures are warranted to confirm this first-line position.
authors.affiliation: Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France. florent.besson@aphp.fr.|IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France. florent.besson@aphp.fr.
authors.forename: Florent L
authors.initials: FL
authors.lastname: Besson
authors.affiliation: Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.|IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chaumet-Riffaud
authors.affiliation: Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.
authors.forename: Margot
authors.initials: M
authors.lastname: Playe
authors.affiliation: Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noel
authors.affiliation: Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lambotte
authors.affiliation: Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.affiliation: Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.|IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prigent
authors.affiliation: Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.|IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Durand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods* / Q000706:statistics & numerical data*; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG PET; FDG PET/CT; FUO; Meta-analysis