Romano Gargarella Elena, Vocaturo Flaminia, Guarneri Andrea, Calcagni Maria Lucia, Leccisotti Lucia
Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2025 Aug 19;14(16):5861. doi: 10.3390/jcm14165861.
Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) remain complex diagnostic challenges due to their heterogeneous presentations and broad differential diagnoses. FUO was first described by Petersdorf and Beeson in 1961 and later redefined by Durack and Street, while IUO was introduced more recently by Vanderschueren et al. in 2009. Despite thorough investigations, a significant proportion of patients remain without a clear diagnosis, often resulting in prolonged hospital stays and increased healthcare costs. In recent years, [F]FDG PET/CT has emerged as a valuable tool in the diagnostic workup of FUO and IUO, offering both metabolic and anatomical insights in a single scan. This review evaluates the diagnostic utility of [F]FDG PET/CT, based on an analysis of 55 studies encompassing 6681 patients. The scan was found to be clinically helpful in 59% of cases, with diagnostic contributions from both true-positive and true-negative findings. Negative scans were frequently associated with spontaneous symptom resolution and fewer unnecessary interventions. However, differences in study design and definitions of diagnostic value make it difficult to compare results across studies. Overall, [F]FDG PET/CT has proven to be a useful tool in the evaluation of FUO and IUO, and future research should focus on standardizing how its clinical benefit is measured and directly comparing its effectiveness with conventional imaging in well-designed prospective studies.
不明原因发热（FUO）和不明原因炎症（IUO）因其表现多样且鉴别诊断范围广泛，仍然是复杂的诊断难题。FUO最早由彼得斯多夫和比森于1961年描述，后来由杜拉克和斯特里特重新定义，而IUO则是由范德舒伦等人于2009年最近提出的。尽管进行了全面检查，但仍有相当一部分患者没有明确诊断，这常常导致住院时间延长和医疗费用增加。近年来，[F]FDG PET/CT已成为FUO和IUO诊断检查中的一种有价值的工具，在一次扫描中即可提供代谢和解剖学信息。本综述基于对55项研究（涵盖6681例患者）的分析，评估了[F]FDG PET/CT的诊断效用。结果发现，该扫描在59%的病例中对临床有帮助，真阳性和真阴性结果均有诊断贡献。阴性扫描结果常常与症状自发缓解以及不必要的干预减少相关。然而，研究设计和诊断价值定义的差异使得不同研究结果难以比较。总体而言，[F]FDG PET/CT已被证明是评估FUO和IUO的有用工具，未来的研究应专注于规范其临床益处的衡量方式，并在精心设计的前瞻性研究中直接将其有效性与传统成像进行比较。
