FDG-PET for the diagnosis of fever of unknown origin

A Japanese multi-center study

Kazuo Kubota, Yuji Nakamoto, Nagara Tamaki, Kakuko Kanegae, Hiroshi Fukuda, Tomohiro Kaneda, Kazuhiro Kitajima, Ukihide Tateishi, Miyako Morooka, Kimiteru Ito, Ryogo Minamimoto, Koji Murakami

Research output: Contribution to journalArticle

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Abstract

Objective To evaluate the clinical value of 2-[18F]fluoro- 2-deoxy-D-glucose positron emission tomography (FDGPET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey. Methods A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated. Results The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/ autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100%(7/7), 89%(24/27), 65%(11/17), 0%(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76%(22/29), 75%(6/8), 43%(9/21), 23%(5/22), respectively]. The O/U group showed a high specificity (84%, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70%, 31/44 vs. 30%, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50% (22/44) of the patients in the NH group and 13.5% (5/37) of the patients in the UH group. The sensitivity (91%, 30/33; 63%, 12/19) and specificity (60%, 6/10; 86%, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81% (42/52), specificity was 75% (18/24). The NH group included a large number of cases with infectious diseases (50%, 23/44), while the UH group included a large number of A/V cases (38%, 14/37) and O/U cases (41%, 15/37). Conclusion FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in caseswith unknown or othermiscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness ofFDG-PETfor the diagnosis ofFUO.FDGPET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.

Original languageEnglish
Pages (from-to)355-364
Number of pages10
JournalAnnals of Nuclear Medicine
Volume25
Issue number5
DOIs
Publication statusPublished - 2011 Jun

Fingerprint

Fever of Unknown Origin
Granuloma
Fluorodeoxyglucose F18
Positron-Emission Tomography
Communicable Diseases
Neoplasms
Infection
Steroids
Collagen Diseases
Masks
Vasculitis
Autoimmune Diseases
Arthritis
Fever
Therapeutics

Keywords

  • FDG-PET
  • Fever of unknown origin
  • Infectious disease
  • Inflammation
  • Multi-center study

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Kubota, K., Nakamoto, Y., Tamaki, N., Kanegae, K., Fukuda, H., Kaneda, T., ... Murakami, K. (2011). FDG-PET for the diagnosis of fever of unknown origin: A Japanese multi-center study. Annals of Nuclear Medicine, 25(5), 355-364. https://doi.org/10.1007/s12149-011-0470-6

FDG-PET for the diagnosis of fever of unknown origin : A Japanese multi-center study. / Kubota, Kazuo; Nakamoto, Yuji; Tamaki, Nagara; Kanegae, Kakuko; Fukuda, Hiroshi; Kaneda, Tomohiro; Kitajima, Kazuhiro; Tateishi, Ukihide; Morooka, Miyako; Ito, Kimiteru; Minamimoto, Ryogo; Murakami, Koji.

In: Annals of Nuclear Medicine, Vol. 25, No. 5, 06.2011, p. 355-364.

Research output: Contribution to journalArticle

Kubota, K, Nakamoto, Y, Tamaki, N, Kanegae, K, Fukuda, H, Kaneda, T, Kitajima, K, Tateishi, U, Morooka, M, Ito, K, Minamimoto, R & Murakami, K 2011, 'FDG-PET for the diagnosis of fever of unknown origin: A Japanese multi-center study', Annals of Nuclear Medicine, vol. 25, no. 5, pp. 355-364. https://doi.org/10.1007/s12149-011-0470-6
Kubota, Kazuo ; Nakamoto, Yuji ; Tamaki, Nagara ; Kanegae, Kakuko ; Fukuda, Hiroshi ; Kaneda, Tomohiro ; Kitajima, Kazuhiro ; Tateishi, Ukihide ; Morooka, Miyako ; Ito, Kimiteru ; Minamimoto, Ryogo ; Murakami, Koji. / FDG-PET for the diagnosis of fever of unknown origin : A Japanese multi-center study. In: Annals of Nuclear Medicine. 2011 ; Vol. 25, No. 5. pp. 355-364.
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abstract = "Objective To evaluate the clinical value of 2-[18F]fluoro- 2-deoxy-D-glucose positron emission tomography (FDGPET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey. Methods A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated. Results The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/ autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100{\%}(7/7), 89{\%}(24/27), 65{\%}(11/17), 0{\%}(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76{\%}(22/29), 75{\%}(6/8), 43{\%}(9/21), 23{\%}(5/22), respectively]. The O/U group showed a high specificity (84{\%}, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70{\%}, 31/44 vs. 30{\%}, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50{\%} (22/44) of the patients in the NH group and 13.5{\%} (5/37) of the patients in the UH group. The sensitivity (91{\%}, 30/33; 63{\%}, 12/19) and specificity (60{\%}, 6/10; 86{\%}, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81{\%} (42/52), specificity was 75{\%} (18/24). The NH group included a large number of cases with infectious diseases (50{\%}, 23/44), while the UH group included a large number of A/V cases (38{\%}, 14/37) and O/U cases (41{\%}, 15/37). Conclusion FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in caseswith unknown or othermiscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness ofFDG-PETfor the diagnosis ofFUO.FDGPET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.",
keywords = "FDG-PET, Fever of unknown origin, Infectious disease, Inflammation, Multi-center study",
author = "Kazuo Kubota and Yuji Nakamoto and Nagara Tamaki and Kakuko Kanegae and Hiroshi Fukuda and Tomohiro Kaneda and Kazuhiro Kitajima and Ukihide Tateishi and Miyako Morooka and Kimiteru Ito and Ryogo Minamimoto and Koji Murakami",
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TY - JOUR

T1 - FDG-PET for the diagnosis of fever of unknown origin

T2 - A Japanese multi-center study

AU - Kubota, Kazuo

AU - Nakamoto, Yuji

AU - Tamaki, Nagara

AU - Kanegae, Kakuko

AU - Fukuda, Hiroshi

AU - Kaneda, Tomohiro

AU - Kitajima, Kazuhiro

AU - Tateishi, Ukihide

AU - Morooka, Miyako

AU - Ito, Kimiteru

AU - Minamimoto, Ryogo

AU - Murakami, Koji

PY - 2011/6

Y1 - 2011/6

N2 - Objective To evaluate the clinical value of 2-[18F]fluoro- 2-deoxy-D-glucose positron emission tomography (FDGPET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey. Methods A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated. Results The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/ autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100%(7/7), 89%(24/27), 65%(11/17), 0%(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76%(22/29), 75%(6/8), 43%(9/21), 23%(5/22), respectively]. The O/U group showed a high specificity (84%, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70%, 31/44 vs. 30%, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50% (22/44) of the patients in the NH group and 13.5% (5/37) of the patients in the UH group. The sensitivity (91%, 30/33; 63%, 12/19) and specificity (60%, 6/10; 86%, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81% (42/52), specificity was 75% (18/24). The NH group included a large number of cases with infectious diseases (50%, 23/44), while the UH group included a large number of A/V cases (38%, 14/37) and O/U cases (41%, 15/37). Conclusion FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in caseswith unknown or othermiscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness ofFDG-PETfor the diagnosis ofFUO.FDGPET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.

AB - Objective To evaluate the clinical value of 2-[18F]fluoro- 2-deoxy-D-glucose positron emission tomography (FDGPET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey. Methods A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated. Results The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/ autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100%(7/7), 89%(24/27), 65%(11/17), 0%(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76%(22/29), 75%(6/8), 43%(9/21), 23%(5/22), respectively]. The O/U group showed a high specificity (84%, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70%, 31/44 vs. 30%, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50% (22/44) of the patients in the NH group and 13.5% (5/37) of the patients in the UH group. The sensitivity (91%, 30/33; 63%, 12/19) and specificity (60%, 6/10; 86%, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81% (42/52), specificity was 75% (18/24). The NH group included a large number of cases with infectious diseases (50%, 23/44), while the UH group included a large number of A/V cases (38%, 14/37) and O/U cases (41%, 15/37). Conclusion FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in caseswith unknown or othermiscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness ofFDG-PETfor the diagnosis ofFUO.FDGPET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.

KW - FDG-PET

KW - Fever of unknown origin

KW - Infectious disease

KW - Inflammation

KW - Multi-center study

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