Boulu Xavier, El Esper Isabelle, Meyer Marc-Etienne, Duhaut Pierre, Salle Valery, Schmidt Jean
Department of Internal Medicine, Amiens University Medical Center, Amiens, France.
RECIF Amiens, Amiens University Medical Center, Amiens, France.
Mayo Clin Proc Innov Qual Outcomes. 2023 May 4;7(3):178-186. doi: 10.1016/j.mayocpiqo.2023.04.001. eCollection 2023 Jun.
To evaluate the usefulness of positron emission tomography (PET) coupled with computed tomography (CT) in the diagnostic workup for inflammatory syndrome of undetermined origin (IUO) and to determine the diagnostic delay in an internal medicine department.
We retrospectively studied a cohort of patients for whom a PET/CT scan had been prescribed in an indication of IUO in an internal medicine department (Amiens University Medical Center, Amiens, France) between October 2004 and April 2017. The patients were grouped according to the PET/CT findings: very useful (enabling an immediate diagnosis), useful, not useful, and misleading.
We analyzed 144 patients. The median (interquartile range) age was 67.7 years (55.8-75.8 years). The final diagnosis was an infectious disease in 19 patients (13.2%), cancer in 23 (16%), inflammatory disease in 48 (33%), and miscellaneous diseases in 12 (8.3%). No diagnosis was made in 29.2% of the cases; half of the remaining had a spontaneously favorable outcome. Fever was observed in 63 patients (43%). Positron emission tomography coupled with CT was determined to be very useful in 19 patients (13.2%), useful in 37 (25.7%), not useful in 63 (43.7%), and misleading in 25 (17.4%). The median diagnostic delay (ie, the time interval between the first admission and a confirmed diagnosis) was significantly shorter in the useful (71 days [38-170 days]) and very useful (55 days [13-79 days]) groups than that in the not useful group (175 days [51-390 days]; P<.001). The median time interval between the PET/CT scan and the diagnosis was twice as long in the not useful group than that in the pooled misleading, useful, or very useful groups (P=.03). In a univariate analysis, the poor overall condition (P=.007) and the absence of fever (P=.005) were predictive of usefulness of PET/CT.
Positron emission tomography coupled with CT seems to be useful in the diagnosis of IUO and might shorten the diagnostic delay.
评估正电子发射断层扫描（PET）联合计算机断层扫描（CT）在不明原因炎症综合征（IUO）诊断检查中的作用，并确定内科的诊断延迟情况。
我们回顾性研究了2004年10月至2017年4月期间在法国亚眠大学医学中心内科因IUO指征而接受PET/CT扫描的一组患者。根据PET/CT检查结果将患者分组：非常有用（可立即确诊）、有用、无用和有误导性。
我们分析了144例患者。年龄中位数（四分位间距）为67.7岁（55.8 - 75.8岁）。最终诊断为传染病19例（13.2%），癌症23例（16%），炎症性疾病48例（33%），杂病12例（8.3%）。29.2%的病例未明确诊断；其余病例中有一半自发好转。63例患者（43%）有发热。PET联合CT检查结果判定为非常有用的有19例（13.2%），有用的37例（25.7%），无用的63例（43.7%），有误导性的25例（17.4%）。有用组（71天[38 - 170天]）和非常有用组（55天[13 - 79天]）的诊断延迟中位数（即首次入院至确诊的时间间隔）显著短于无用组（175天[51 - 390天]；P<0.001）。PET/CT扫描至诊断的时间间隔中位数在无用组是合并的有误导性、有用或非常有用组的两倍（P = 0.03）。单因素分析显示，总体状况差（P = 0.007）和无发热（P = 0.005）可预测PET/CT检查的有用性。
PET联合CT似乎对IUO的诊断有用，且可能缩短诊断延迟。
