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Fever of Unknown Origin: The Role of ¹⁸F-FDG PET/CT

¹ Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; ² B. and R. Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel; ³ B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel; and ⁴ Department of Diagnostic Imaging, Rambam Health Care Campus, Haifa, Israel

Correspondence: For correspondence or reprints contact: Zohar Keidar, Department of Nuclear Medicine, Rambam Health Care Campus, Bat-Galim, Haifa, Israel 35254. E-mail: zohar{at}keidar.net

Fever of unknown origin (FUO) is a challenging diagnostic problem. Timely identification and precise localization of the causing process are critical for appropriate patient management. The present prospective study evaluates the role of PET/CT using ¹⁸F-FDG in the investigation of FUO. Methods: A total of 48 consecutive patients (25 men, 23 women; age range, 24–82 y) with FUO underwent ¹⁸F-FDG PET/CT scans. FUO was defined as a fever of more than 38.3°C that lasted for more than 3 wk and failure to reach diagnosis after more than 1 wk of inpatient investigation. The performance of PET/CT for identifying the etiology of FUO was assessed. Final diagnosis was based on histopathology, microbiologic assays, or clinical and imaging follow-up. Results: PET/CT detected suggestive foci of increased ¹⁸F-FDG uptake in 27 patients. In 22 of these 27 positive studies (81%), PET/CT identified the underlying disease and diagnosed infection in 9 patients, an inflammatory process in 10 patients, and malignancy in 3 patients. ¹⁸F-FDG PET/CT was negative in 21 patients. All these patients were diagnosed as having systemic nonfocal infection or drug-induced fever or showed spontaneous resolution of the febrile state with no further evidence of a localized inflammatory, infectious, or malignant process for a clinical follow-up period of 12–36 mo. Conclusion: ¹⁸F-FDG PET/CT identified the underlying cause of the fever in 46% of the present study population and contributed to the diagnosis or exclusion of a focal pathologic etiology of the febrile state in 90% of patients. ¹⁸F-FDG PET/CT has a high negative predictive value (100%) for assessment of FUO. If confirmed by further studies, ¹⁸F-FDG PET/CT may be used in the future as an initial noninvasive diagnostic modality for assessment of this group of patients.

Key Words: infectious disease • PET • PET/CT • fever • infection • inflammation

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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