PET Index of Bone Glucose Metabolism (PIBGM) Classification of PET/CT Data for Fever of Unknown Origin Diagnosis

Jian Yang,Xinxin Liu,Jingfan Fan,Li Huo,Youjing Zheng,Yongtian Wang,Fang Li,Danni Ai,Heye Zhang

doi:10.1371/journal.pone.0130173

Abstract

ObjectivesFever of unknown origin (FUO) remains a challenge in clinical practice. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is helpful in diagnosing the etiology of FUO. This paper aims to develop a completely automatic classification method based on PET/CT data for the computer-assisted diagnosis of FUO.MethodsWe retrospectively analyzed the FDG PET/CT scan of 175 FUO patients, 79 males and 96 females. The final diagnosis of all FUO patients was achieved through pathology or clinical evaluation, including 108 normal patients and 67 FUO patients. CT anatomic information was used to acquire bone functional information from PET images. The skeletal system of FUO patients was classified by analyzing the standardized uptake value (SUV) and the PET index of bone glucose metabolism (PIBGM). The SUV distributions in the bone marrow and the bone cortex were also studied in detail.ResultsThe SUV and PIBGM of the bone marrow only slightly differed between the FUO patients and normal people, whereas the SUV of whole bone structures and the PIBGM of the bone cortex significantly differed between the normal people and FUO patients. The method detected 43 patients from 67 FUO patients, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 64.18%, 95%, 93.48%, 72.73%, and 83.33%, respectively.ConclusionThe experimental results demonstrate that the study can achieve automatic classification of FUO patients by the proposed novel biomarker of PIBGM, which has the potential to be utilized in clinical practice.

Highlights

Fever of unknown origin (FUO) is characterized by an increase in temperature to > 38.3°C on several occasions for more than 3 weeks; the etiology behind FUO cannot be diagnosed even after at least a week of hospital stay [1]
The experimental results demonstrate that the study can achieve automatic classification of FUO patients by the proposed novel biomarker of PET index of bone glucose metabolism (PIBGM), which has the potential to be utilized in clinical practice
18F-FDG positron emission tomography (FDG-PET) can be utilized as a powerful non-invasive approach to detect various cancers according to the metabolic changes of human body [6]. 18F-FDG–PET (FDG-PET) has been used to detect the etiology of FUO in clinical practice

Summary

Introduction

Fever of unknown origin (FUO) is characterized by an increase in temperature to > 38.3°C on several occasions for more than 3 weeks; the etiology behind FUO cannot be diagnosed even after at least a week of hospital stay [1]. On the basis of possible causes, FUO is mainly classified under four categories, namely, infection, neoplasm, non-infectious inflammatory disease, and unknown cause [4]. Timely and accurately identification the cause of FUO is very important for further effective treatment of the disease [5]. 18F-FDG positron emission tomography (FDG-PET) can be utilized as a powerful non-invasive approach to detect various cancers according to the metabolic changes of human body [6]. 18F-FDG–PET (FDG-PET) has been used to detect the etiology of FUO in clinical practice. The simultaneous acquisition and alignment of the whole-body anatomical and functional images of PET/computed tomography (CT) allow physicians to accurately locate the lesions of the FUO patients [7]

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