Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography / computed tomography in fever of unknown origin

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1 F-FDG PET /CT 1* 2* F-FDG PET /CT fever of unknown origin FUO FUO FDG PET /CT 3 FDG PET /CT t 51 FUO FDG PET FUO % % % % PET CT PET /CT % % % 0 0 PET /CT 97. 3% 36 / / % 36 /51 PET PET /CT % 9 /9 maximum standardized uptake value SUVmax 3. 7 ± 2. 7 vs ± 3. 5 P = t = 3. 6SUVmax FDG PET /CT FUO F18 R doi /j. issn X A X Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography / computed tomography in fever of unknown origin KANG Lei 1* XU Xiao-jie 2* FAN Yan 1 WANG Rong-fu 1 MA Chao 1 FU Zhan-li 1 ZHANG Jian-hua 1 ZHANG Xu-chu 1 1. Department of Nuclear Medicine Peking University First Hospital Beijing China 2. Department of Medical Molecular Biology Institute of Biotechnology Academy of Military Medical Sciences Beijing China ABSTRACT Objective To evaluate the diagnostic value of fluorine-18 fluorodeoxyglucose 18 F-FDG positron emission tomography /computed tomography PET /CT in fever of unknown origin FUO in a Chinese hospital. Methods The records of 51 patients with FUO 32 men and 19 women mean age 54 years with a range between 3 and 81 years were analyzed retrospectively. All the patients were examined by 18 F-FDG PET /CT scan and the results were compared with the final diagnosis which was established by additional procedures including pathology laboratory examination and clinical follow-up for more than 3 months. The t test was used for statistical analysis. Results A final diagnosis was established for 48 patients including 32 patients with infectious diseases 9 with malignancies and 7 with noninfectious inflammatory diseases. By FDG PET scan alone the rates of true positive false positive false negative and true negative were 52. 9% 27. 5% 17. 6% and 2. 0% respectively. By FDG PET / CT scan the rates of true positive false positive false negative and true negative were 70. 6% 27. 5% 2. 0% and 0 respectively. 18 F-PET /CT had a sensitivity of 97. 3% 36 /37 specificity of 0 0 /14 and accuracy of 70. 6% 36 /51 in FUO especially a high sensitivity and accuracy of 100% 9 /9 in the diagnosis of malignant tumor. Moreover the maximum standardized uptake value SUVmax in tumor was significant higher than that in infection 3. 7 ± 2. 7 vs ± 3. 5 P = t = 3. 6 which implied that SUVmax might be useful in differential diagnosis in FUO. Conclusion FDG PET /CT is a valuable imaging tool for the identification and location of the potential lesion in FUO and is helpful for the etiological diagnosis especially in the diagnosis of malignant lesions. KEY WORDS Fever of unknown origin Fluorodeoxyglucose F18 Positron-emission tomography YQ Supported by the National Natural Science Foundation of China National Major Scientific Equipment Special Fund 2011YQ and the Higher Education Doctoral Program of China Research Fund for New Teacher Corresponding author s rongfu_wang@ 163. com fanyan980618@ sina. com http / /www. cnki. net /kcms /detail / R html

2 176 fever of unknown origin FUO CT MRI PET /CT F-FDG PET /CT FUO PET /CT 6 h 1 /4 18 F-FDG 3. 7 ~ MBq /kg 2 50 ~ 70 min F-fluorodeoxyglucose 18 F-FDG glucose transporter GLUT 6-P-FDG 120 kv 100 ma 2 mm PET 7 ~ 10 GLUT FDG PET PET /CT FDG 3 PET /CT CT CT PET /CT 4 FDG PET /CT FUO FDG PET /CT FUO PET /CT Philips GXL-16 PET /CT Version 3. 5 CT 1. 5 min 1. 4 PET /CT FDG PET PET /CT PET PET /CT 1 FUO PET /CT FUO FUO PET PET /CT FUO PET /CT 62. 7% % 3 ~ ± FDG ~ 40 d maximum standardized PET /CT 6. 9 ± uptake value SUVmax SUVmax Philips 1. 2 mmol /L SPSS t P < C 2 X 2. 1 FUO

3 18 F-FDG PET /CT % % % % % % % 6. 7% 54. 9% PET 1 2 CT PET /CT 3 Castleman PET /CT % % % PET /CT 97. 3% % % 11. 8% % 17 PET /CT 9 CT PET /CT 3 1 PET % FDG PET PET PET /CT 51 FUO PET % PET % % 14 PET 33. 3% % PET /CT 9 Figure mm /h PET /CT 18 F-FDG Male 72 years old suffered chronic lower fever and his erythrocyte sedimentation rate is 32 mm /h. PET /CT scan showed part of aorta wall thickened with increased FDG uptake. He was finally diagnosed as giant cell artery inflammation and treated effectively by hormone and cyclophosphamide. Arrows point to lesions 32 PET PET/CT 43. 8% 71. 9% PET 63. 6% 14/ % 23/23 PET/CT % 9/9

4 178 PET PET /CT 3. 6 P = t = % 4 / % 4 /7 PET /CT FUO 0. 3 SUVmax SUVmax PET /CT % PET /CT FDG SUVmax SUVmax FDG SUVmax 7. 7 ± SUVmax SUVmax 6. 0 ± 2. 7 FDG SUVmax 3. 7 ± ~ SUVmax 7. 7 ± ~ SUVmax 3. 3 ± ~ FDG P = t = FDG P = t = 51 FUO FDG PET /CT P = t = PET /CT 18 F-FDG B Ⅳ B PET CT Figure 2 A 46-year-old female suffered with fever for more than 20 days and sometimes high fever with chills. The antibiotic treatment was not effective. PET /CT showed the enlargement of liver and spleen but no swelling lymph nodes. 18 F-FDG uptake increased diffusely in liver spleen and whole-body bone marrow. Diffuse large B cell lymphoma stage Ⅳ group B was finally diagnosed by bone marrow biopsy. Upper row were PET images and lower row were CT images 3 FUO FUO 1 FUO FUO 62. 7% 17. 7%

5 18 F-FDG PET /CT % FUO FDG GLUT-1 FDG GLUT-3 3 FDG ~ 41 PET /CT A B C D E F Figure 3 Male 56 years old suffered anti-neutrophil cytoplasmic antibodies-associated small vessel vasculitis for 8 years and treated by hormone and immune inhibitor for 3 years. High fever was found for 5 month lately with a temperature of degrees. PET /CT scan illustrated multiple lesions with high abnormal glucose metabolism A such as enlarged lymph nodes B and C spleen D and bone marrow E and F. Finally tuberculosis was diagnosed by lymph node biopsy and anti-tuberculosis treatment was shown effective PET /CT PET CT 5 - CT FUO 11 FDG PET /CT 6 Jasper 7 Keidar 8 FDG PET /CT FUO 5-53% 46% FUO 11 FDG 64% 60% PET /CT FDG PET / PET /CT CT Dong 10 PET /CT meta PET /CT 81. 5% PET 39 FUO 98% 11 PET / CT % PET /CT 71. 9% Ferda 9 PET /CT FDG PET /CT CT 89. 6% 3 PET /CT FUO SUVmax PET / PET /CT CT FDG PET PET /CT %

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