Abstract
Fever of unknown origin (FUO) poses a diagnostic challenge, and 18-fluorodexoyglucose positron emission tomography with computed tomography (18FDG-PET/CT) may identify the source. We aimed to evaluate the diagnostic yield of 18FDG-PET/CT in the work-up of FUO. The records of patients admitted to Sheba Medical Center between January 2013 and January 2018 who underwent 18FDG-PET/CT for the evaluation of FUO were reviewed. Following examination of available medical test results, 18FDG-PET/CT findings were assessed to determine whether lesions identified proved diagnostic. Of 225 patients who underwent 18FDG-PET/CT for FUO work-up, 128 (57%) met inclusion criteria. Eighty (62.5%) were males; mean age was 59 ± 20.3 (range: 18–93). A final diagnosis was made in 95 (74%) patients. Of the 128 18FDG-PET/CT tests conducted for the workup of FUO, 61 (48%) were true positive, 26 (20%) false positive, 26 (20%) true negative, and 15 (12%) false negative. In a multivariate analysis, weight loss and anemia were independently associated with having a contributary results of 18FDG-PET/CT. The test yielded a sensitivity of 70%, specificity of 37%, positive predictive value of 70%, and negative predictive value of 37%. 18FDG-PET/CT is a valuable tool in the diagnostic workup of FUO. It proved effective in diagnosing almost half the patients, especially in those with anemia and weight loss.
Highlights
Licensee MDPI, Basel, Switzerland.Fever of unknown origin (FUO) is a frequently encountered condition on internal medicine wards
Imaging data was obtained from the picture archive and communication system (PACS, Carestream Health 11.0, Rochester, NY, USA) and clinical data were obtained from the computerized medical records within our medical center
Our study found that the contributiveness of 18FDG-PET/CT did not differ in the just under half of patients who had undergone extensive prior CT imaging
Summary
Fever of unknown origin (FUO) is a frequently encountered condition on internal medicine wards. It was first defined in 1961 as a fever greater than 38.3 ◦ C (101 ◦ F) for at least 3 weeks, whose origin is not identified despite thorough work-up [1]. Despite the abundance of medical tests available to aid in the diagnosis, FUO often poses a great challenge to clinicians, and nearly half of patients do not receive a definitive diagnosis [2,3,4].
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