Highlights
- •PET-CT is recommended as a first or a second-line imaging method for the evaluation of patients with FUO. We evaluated the yield of PET-CT vs. contrast enhanced CT (alone) for the diagnosis of classical FUO.
- •A single center, 8-year retrospective cohort study. All hospitalized patients who underwent PET-CT for the investigation of classical FUO between were included. For each case, we determined whether the diagnosis would have been reached based on the CT scan alone, or based on the PET-CT
- •A total of 303 patients with classical FUO were referred for PET-CT.
- •PET-CT had superior sensitivity vs CT (p=0.00) for all subgroups, with generally decreased specificity than CT for infections and inflammatory conditions. PET-CT was determined as necessary in 26% (79/303) of the patients.
- •Endovascular infection, hematological malignancy and large vessel vasculitis were the only factors associated with PET-CT necessity on multivariable analysis.
Abstract
Background
18F-Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography, with contrast enhanced
CT (PET-CT), is recommended as a first or a second-line imaging method for the evaluation
of patients with fever of unknown origin (FUO). We evaluated the yield of PET-CT vs.
contrast enhanced CT (alone) for the diagnosis of classical FUO.
Methods
A single center, 8-year retrospective cohort study. All hospitalized patients who
underwent PET-CT for the investigation of classical FUO between 1/2012-1/2020 were
included. The final diagnosis, based on clinical, microbiological, radiological and
pathological data available at the latest follow-up, at least six months after discharge,
was determined. For each case, we determined whether the diagnosis would have been
reached based on the CT scan alone, or based on the PET-CT (thus, defining PET-CT
as necessary). We compared the overall sensitivity and specificity results for both
PET-CT and CT scan. Variables that were found to be significantly associated with
PET-CT necessity on univariable analysis were entered into a multivariable logistic
regression analysis. The results of the regression model were reported in odds ratios
(OR) and 95% confidence intervals (CI).
Result
A total of 303 patients with classical FUO were referred for PET-CT. The final diagnoses
included infectious diseases in 111/303 patients (36.5%), malignancies in 56/303 patients
(18.4%) and non-infectious inflammatory conditions in 52/303 patients (17.1%). FUO
resolved without diagnosis in 84/303 patients (28%). The overall sensitivity and specificity
of the PET-CT scans were 88.7% and 80.9%, respectively, and for the CT scans were
75.2% and 90.2%, respectively. PET-CT had superior sensitivity vs CT (p=0.00) for
all subgroups, with generally decreased specificity than CT for infections and inflammatory
conditions. PET-CT was determined as necessary in 26% (79/303) of the patients. Endovascular
infection, hematological malignancy and large vessel vasculitis were the only factors
associated with PET-CT necessity on multivariable analysis.
Conclusions
PET-CT offers superior sensitivity with slightly decreased specificity for the diagnosis
of classical FUO compared to diagnostic CT. We recommend PET-CT as the imaging modality
of choice for patients with classical FUO, when endovascular infection, hematological
malignancy or large vessel vasculitis are suspected.
Keywords
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Article info
Publication history
Published online: August 20, 2021
Accepted:
July 13,
2021
Received in revised form:
July 11,
2021
Received:
May 25,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
