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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

View larger version (21K): [in this window] [in a new window]   FIGURE 1.  A 41-y-old woman presented with 3 wk of fever. CT demonstrated small amounts of pleural, pericardial, and peritoneal fluids and 2-cm hypodense lesion in left pelvis adjacent to uterus. Transaxial 18F-FDG PET (left) demonstrates focus of increased tracer uptake in right pelvis (arrow) localized by PET/CT image (center) to right ovary on CT (right, arrow), suggesting abscess. Previously reported hypodense lesion in left pelvis and demonstrated on CT component as well (right, arrowhead) is not metabolically active. Diagnosis of right ovarian abscess and left ovarian cyst was confirmed at surgery.

View larger version (67K): [in this window] [in a new window]   FIGURE 2.  A 78-y-old woman presented with 6 wk of fever, night sweats, and weight loss. Coronal 18F-FDG PET (left), PET/CT (center), and CT (right) slices demonstrate intense linear 18F-FDG uptake along walls of thoracic aorta and brachiocephalic and subclavian arteries (arrows) consistent with arteritis. Giant-cell arteritis was diagnosed on temporal artery biopsy.

View larger version (20K): [in this window] [in a new window]   FIGURE 3.  A 64-y-old man presented with 3 wk of fever, weight loss, confusion, and left adrenal enlargement of unclear etiology on CT. Transaxial 18F-FDG PET (left) demonstrates foci of increased tracer uptake in upper abdomen localized by PET/CT (center) to both adrenals, of higher intensity in enlarged left gland seen on CT (right, arrows). Biopsy revealed diffused large-cell non-Hodgkin lymphoma. Repeat PET/CT performed after 2 courses of chemotherapy became normal.