Becker Kristian Kimer, Søholm Jacob, Hess Søren
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark.
IRIS-Imaging Research Initiative Southwest, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark.
Diagnostics (Basel). 2024 Jul 3;14(13):1420. doi: 10.3390/diagnostics14131420.
Suspected infection or inflammation of unknown origin in in-patients remains challenging. Literature on [F]FDG-PET/CT is abundant in classic fever of unknown origin (FUO), but evidence is complex and may not always reflect clinical reality. This study explores the application of [F]FDG-PET/CT in a diverse clinical population of in-patients with suspected infection not defined by stringent FUO-criteria.
Retrospective chart review of consecutive in-patients who underwent [F]FDG-PET/CT in the workup of suspected infection or inflammation from 1 July 2022 to 31 December 2022 was conducted. We evaluated indications, diagnostic yield, and clinical impact of [F]FDG-PET/CT, and compared the findings of [F]FDG-PET/CT and stand-alone CT. Univariate logistic regression assessed associations between [F]FDG-PET/CT outcome and clinical parameters. Receiver operating characteristic curve (ROC) analysis evaluated diagnostic performance.
77 patients met the inclusion criteria. [F]FDG-PET/CT established a diagnosis in 35% of cases, ruled out focal infection in 26%, and thus was helpful in 61% of patients. It prompted 72 additional examinations resulting in seven incidental diagnoses, including two cancers. Antibiotic treatment was changed in 26% of cases. Regression analysis found white blood cell counts (WBC) associated with true positive outcomes. [F]FDG-PET/CT was compared to stand-alone CT findings, and was concordant in 69% of cases.
Results were comparable to findings in more classic FUO. [F]FDG-PET/CT was clinically helpful in 61% of cases but also prompted many additional examinations with relatively few clinically important findings. WBC count was a predictor of true positive outcome. CT and [F]FDG-PET/CT were discordant in 31%, of cases, especially in cases of endocarditis and spondylodiscitis.
住院患者中病因不明的疑似感染或炎症仍然具有挑战性。关于[F]FDG-PET/CT的文献在经典的不明原因发热（FUO）中很丰富，但证据复杂，可能并不总是反映临床实际情况。本研究探讨了[F]FDG-PET/CT在一组多样化的、不符合严格FUO标准的疑似感染住院患者中的应用。
对2022年7月1日至2022年12月31日期间因疑似感染或炎症而接受[F]FDG-PET/CT检查的连续住院患者进行回顾性病历审查。我们评估了[F]FDG-PET/CT的检查指征、诊断率和临床影响，并比较了[F]FDG-PET/CT和单纯CT的检查结果。单因素逻辑回归分析评估了[F]FDG-PET/CT结果与临床参数之间的关联。受试者操作特征曲线（ROC）分析评估了诊断性能。
77例患者符合纳入标准。[F]FDG-PET/CT在35%的病例中明确了诊断，在26%的病例中排除了局灶性感染，因此对61%的患者有帮助。它促使进行了另外72项检查，其中有7项意外诊断，包括2例癌症。26%的病例改变了抗生素治疗方案。回归分析发现白细胞计数（WBC）与真阳性结果相关。将[F]FDG-PET/CT与单纯CT的检查结果进行比较，69%的病例结果一致。
结果与在更典型的FUO中的发现相当。[F]FDG-PET/CT在61%的病例中对临床有帮助，但也促使进行了许多额外检查，而具有临床重要意义的发现相对较少。白细胞计数是真阳性结果的一个预测指标。CT和[F]FDG-PET/CT在31%的病例中结果不一致，特别是在心内膜炎和脊椎椎间盘炎病例中。
