Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Semin Nucl Med. 2023 Jan;53(1):4-17. doi: 10.1053/j.semnuclmed.2022.07.002. Epub 2022 Jul 26.
F-FDG PET/CT, Ga-citrate and white blood cell (WBC) scintigraphy are molecular imaging techniques currently used in the diagnostic workup of fever of unknown origin. However, it is unknown which technique fits which patient group best. A systematic literature search has been performed for original articles regarding the use of molecular imaging in fever of unknown origin. A total of 820 eligible studies were screened of which 63 articles evaluating 5094 patients met the inclusion criteria. F-FDG PET/CT provided good diagnostic accuracy (with a weighted mean sensitivity, specificity, positive predicting value, negative predictive value, accuracy and helpfulness of 84.4%, 61.8%, 80.7%, 67.8%, 76.3%, and 61.1%, respectively). Even within specific patient groups such as children, elderly, patients with connective tissue diseases, patients on renal replacement therapy, and HIV-infected patients, F-FDG PET/CT provided good diagnostic values. For Ga-citrate scintigraphy, the weighted mean sensitivity, specificity, positive predictive value, negative predictive value, and helpfulness were 42.2%, 80.3%, 82.4%, 41.9%, and 42.2%, respectively. WBC scintigraphy shows a weighted mean sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 73.5%, 86.3%, 79.1%, 82.4%, and 79.5%, respectively. However, compared to Ga-citrate and WBC scintigraphy, significantly more research has been performed using F-FDG PET/CT and F-FDG PET/CT has the advantage of relatively short procedural duration; it is therefore the preferred molecular diagnostic imaging technique. Ga-citrate and WBC scintigraphy can only be considered if F-FDG PET/CT is not available.
氟代脱氧葡萄糖正电子发射断层扫描（F-FDG PET/CT）、镓-枸橼酸盐和白细胞（WBC）闪烁显像术是目前用于不明原因发热诊断的分子影像学技术。然而，目前尚不清楚哪种技术最适合哪种患者群体。我们对关于不明原因发热中使用分子影像学的原始文章进行了系统的文献检索。共筛选出 820 篇合格的研究文章，其中 63 篇评估了 5094 例患者的文章符合纳入标准。F-FDG PET/CT 提供了良好的诊断准确性（加权平均敏感度、特异度、阳性预测值、阴性预测值、准确度和有助于诊断的程度分别为 84.4%、61.8%、80.7%、67.8%、76.3%和 61.1%）。即使在特定的患者群体中，如儿童、老年人、结缔组织疾病患者、接受肾脏替代治疗的患者和 HIV 感染患者，F-FDG PET/CT 也提供了良好的诊断价值。对于镓-枸橼酸盐闪烁显像术，加权平均敏感度、特异度、阳性预测值、阴性预测值和有助于诊断的程度分别为 42.2%、80.3%、82.4%、41.9%和 42.2%。白细胞闪烁显像术显示加权平均敏感度、特异度、阳性预测值、阴性预测值和准确度分别为 73.5%、86.3%、79.1%、82.4%和 79.5%。然而，与镓-枸橼酸盐和 WBC 闪烁显像术相比，使用 F-FDG PET/CT 进行的研究明显更多，并且 F-FDG PET/CT 具有程序持续时间相对较短的优势；因此，它是首选的分子诊断影像学技术。如果无法进行 F-FDG PET/CT，则可以考虑使用镓-枸橼酸盐和 WBC 闪烁显像术。
