Abstract
Purpose To date, several meta-analyses have reported data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases. This article aims to summarize the published evidence-based data about the diagnostic performance of 18F-FDG PET/CT in this setting. Methods A comprehensive computer literature search of meta-analyses published in PubMed/MEDLINE and Cochrane library database from January 2009 through December 2018 and regarding the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases was carried out. This combination of key words was used: (i) “PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” AND (ii) meta-analysis. Only records on inflammatory or infectious diseases were selected. Results The diagnostic performance of 18F-FDG PET/CT in detecting inflammatory and infectious diseases has been summarized taking into account 36 meta-analyses published in the literature. Evidence-based data demonstrated good diagnostic performance of 18F-FDG PET/CT for several inflammatory and infectious diseases, in particular cardiovascular infectious and inflammatory diseases and some musculoskeletal infections. Conclusions Evidence-based data about the diagnostic performance of 18F-FDG PET/CT in infectious and inflammatory diseases are increasing, with good diagnostic performance of this imaging method for some indications. More prospective multicenter studies and cost-effective analyses are warranted.
Highlights
Nuclear medicine techniques are noninvasive tools that can early detect pathophysiological changes in a ected tissues in patients with in ammatory or infectious diseases. ese changes usually occur before clinical onset of symptoms and before the development of anatomical changes detected by radiological techniques [1, 2]
A search algorithm based on the combination of the following terms was used: (i) “PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” AND (ii) meta-analysis. e literature search was updated until December 31st, 2018
Fever of Unknown Origin (FUO) is commonly defined as temperature ≥38.3°C on at least two occasions, duration of illness ≥3 weeks or multiple febrile episodes in ≥3 weeks, not immunocompromised patient, and uncertain diagnosis despite thorough history-taking, physical examination, and obligatory investigations [42]. e diagnosis in patients with FUO is a challenging medical problem; the causes of FUO may be infectious diseases, noninfectious inflammatory diseases, or tumours, and 18F-FDG positron emission tomography/computed tomography (PET/CT) detecting foci of increased glucose metabolism may be used for revealing the source of fever [42]
Summary
Nuclear medicine techniques are noninvasive tools that can early detect pathophysiological changes in a ected tissues in patients with in ammatory or infectious diseases. ese changes usually occur before clinical onset of symptoms and before the development of anatomical changes detected by radiological techniques [1, 2]. Hybrid imaging techniques as positron emission tomography/computed tomography (PET/CT) may provide functional and morphological information for early diagnosis of infectious and in ammatory diseases [1, 2]. E ability of 18F-FDG PET/ CT to identify sites of in ammation and infection is mainly related to the glycolytic activity of the cells involved in the in ammatory response [3]. 18F-FDG PET/CT has been proposed for imaging of infectious or in ammatory diseases (Figure 1) because it has been demonstrated that cells involved in infection and inammation, especially neutrophils and the monocyte/ macrophage family, are able to express high levels of glucose transporters and hexokinase activity [3,4,5]. Titles and abstracts of the retrieved articles were reviewed, applying the inclusion criteria mentioned above
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