Georga Stamata, Exadaktylou Paraskevi, Petrou Ioannis, Katsampoukas Dimitrios, Mpalaris Vasilios, Moralidis Efstratios-Iordanis, Arvaniti Kostoula, Papastergiou Christos, Arsos Georgios
3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece.
ICU and Antimicrobial Stewardship Unit, Papageorgiou General Hospital, 56403 Thessaloniki, Greece.
J Clin Med. 2020 Jul 4;9(7):2112. doi: 10.3390/jcm9072112.
Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation.
在相当一部分不明原因发热（FUO）患者中，传统诊断成像往往无法有效揭示潜在病因。本研究旨在评估氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG-PET/CT）对FUO患者的诊断价值。我们回顾性分析了连续50例因经典FUO转诊至我科进行进一步检查的成年患者的F-FDG-PET/CT扫描结果。最终诊断基于组织病理学和微生物学检查结果、临床标准或临床随访。50例患者中有39例（78%）确诊。50例患者中，FUO的病因是感染的有20例（40%），非感染性炎症性疾病的有11例（22%），恶性肿瘤的有8例（16%）。11例（22%）患者发热原因仍不明。F-FDG-PET/CT扫描在70%的患者诊断中发挥了重要作用，要么通过确定FUO的潜在病因，要么通过指导前往最合适的活检部位。F-FDG-PET/CT对FUO患者活动性疾病检测的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为94.7%、50.0%、84.0%、85.7%和75.0%。总之，全身F-FDG-PET/CT是一种高度敏感的方法，可用于检测FUO的潜在病因或正确定位可疑病变以进行进一步评估。
