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Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy

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Abstract

The diagnostic work-up in patients with fever of unknown origin (FUO) is often challenging and frequently includes nuclear medicine procedures. Whereas a role for leucocyte or granulocyte scintigraphy in FUO is generally accepted, a possible role of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in these patients remains to be established. To study this, we compared prospectively, on a head-to-head basis, the diagnostic value of FDG-PET and indium-111 granulocyte scintigraphy in patients with FUO. Nineteen patients with FUO underwent both FDG-PET and 111In-granulocyte scintigraphy within 1 week. FDG-PET scans and granulocyte scintigrams were reviewed by different doctors who were blinded to the result of the other investigation. The diagnostic values of FDG-PET and granulocyte scintigraphy were evaluated with regard to identification of a focal infectious/inflammatory or malignant cause of FUO. The sensitivity of granulocyte scintigraphy and FDG-PET were 71% [95% confidence interval (CI): 37–85%] and 50% (CI: 16–84%), respectively. The specificity of granulocyte scintigraphy was 92% (71–100%), which was significantly higher than that of FDG-PET, at 46% (34–62%). Positive and negative predictive values for granulocyte scintigraphy were both 85%. Positive and negative predictive values for FDG-PET were 30% and 67%, respectively. 111In-granulocyte scintigraphy has a superior diagnostic performance compared to FDG-PET for detection of a localised infectious/inflammatory or neoplastic cause of FUO. The poorer performance of FDG-PET is in particular attributable to a high percentage of false positive scans, leading to low specificity.

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Acknowledgement

Donation of PET facilities by the John and Birthe Meyer Foundation is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Andreas Kjaer, Annika Eigtved & Liselotte Højgaard

  2. Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark

    Anne-Mette Lebech

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  1. Andreas Kjaer
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  2. Anne-Mette Lebech
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  3. Annika Eigtved
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  4. Liselotte Højgaard
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Correspondence to Andreas Kjaer.

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Kjaer, A., Lebech, AM., Eigtved, A. et al. Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 31, 622–626 (2004). https://doi.org/10.1007/s00259-003-1425-5

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  • DOI: https://doi.org/10.1007/s00259-003-1425-5

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