Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study.

Kim-Heang Ly,Boris Bienvenu,Olivier Decaux,Nathalie Morel,Stéphanie Dumonteil,Antoinette Perlat,Jacques Monteil,Thomas Papo,Marc Lambert,Olivier Lidove,Jonathan Boutémy ,J.p Ducroix ,Nathalie Costedoat‐Chalumeau ,Pierre‐Yves Hatron ,E Dénes ,L Sailler ,А Смаил ,É Vidal ,Pierre‐Marie Preux ,É Liozon ,A Cypierre ,L Astudillo ,Anne‐Laure Fauchais

doi:10.3390/jcm11020386

Abstract

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

Highlights

Fever of Unknown Origin (FUO), Inflammation of Unknown Origin (IUO) and Episodic Fever of Unknown Origin (EFUO) are three of the most challenging diagnostic problems for internal medicine physicians
The primary endpoint was the proportion of patients for whom a PET/CT or Chest-Abdomen-Pelvis CT (CAPCT)
Continuous quantitative variables were represented as means and standard deviation (SD), qualitative variables as percentages

Summary

Introduction

Fever of Unknown Origin (FUO), Inflammation of Unknown Origin (IUO) and Episodic Fever of Unknown Origin (EFUO) are three of the most challenging diagnostic problems for internal medicine physicians. These three entities are defined, respectively, as (I) body temperature over 38.3 ◦ C on several occasions, with symptoms for at least three weeks and no specific diagnosis after extended hospitalization and/or outpatient investigations [1,2] (FUO), (II) the same criteria for FUO in patients with a body temperature below 38.3 ◦ C and raised acute phase reactants (IUO), (III) recurrent or episodic fever in patients with FUO criteria in whom the fever abates spontaneously with fever-free intervals of at least 48 h (EFUO) [3,4]. The proportion of patients without a diagnosis is growing and represents up to 20% of patients with FUO [4,6,7,8,9,10,11] and up to 50% of patients with EFUO.

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