Skip to main content

Advertisement

SpringerLink
Log in

A prospective multi-centre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Since 18F-fluorodeoxyglucose (FDG) accumulates in neoplastic cells and in activated inflammatory cells, positron emission tomography (PET) with FDG could be valuable in diagnosing patients with fever of unknown origin (FUO). The aim of this study was to validate the use of FDG-PET as part of a structured diagnostic protocol in the general patient population with FUO.

Methods

From December 2003 to July 2005, 70 patients with FUO were recruited from one university hospital (n=38) and five community hospitals (n=32). A structured diagnostic protocol including FDG-PET was used. A dedicated, full-ring PET scanner was used for data acquisition. FDG-PET scans were interpreted by two staff members of the department of nuclear medicine without further clinical information. The final clinical diagnosis was used for comparison with the FDG-PET results.

Results

Of all scans, 33% were clinically helpful. The contribution of FDG-PET to the final diagnosis did not differ significantly between patients diagnosed in the university hospital and patients diagnosed in the community hospitals. FDG-PET contributed significantly more often to the final diagnosis in patients with continuous fever than in patients with periodic fever. FDG-PET was not helpful in any of the patients with normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Conclusion

FDG-PET is a valuable imaging technique as part of a diagnostic protocol in the general patient population with FUO and a raised ESR or CRP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Barbado FJ, Vazquez JJ, Pena JM, Arnalich F, Ortiz-Vazquez J. Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series. Postgrad Med J 1992;68:884–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kazanjian PH. Fever of unknown origin: review of 86 patients treated in community hospitals. Clin Infect Dis 1992;15:968–73.

    Article  CAS  PubMed  Google Scholar 

  3. Knockaert DC, Vanneste LJ, Vanneste SB, Bobbaers HJ. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med 1992;152:51–5.

    Article  CAS  PubMed  Google Scholar 

  4. de Kleijn EM, van der Meer JW. Fever of unknown origin (FUO): report on 53 patients in a Dutch university hospital. Neth J Med 1995;47:54–60.

    Article  PubMed  Google Scholar 

  5. de Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:392–400.

    Article  Google Scholar 

  6. Tabak F, Mert A, Celik AD, Ozaras R, Altiparmak MR, Ozturk R, et al. Fever of unknown origin in Turkey. Infection 2003;31:417–20.

    CAS  PubMed  Google Scholar 

  7. Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Dumez A, Blockmans D, et al. From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med 2003;163:1033–41.

    Article  PubMed  Google Scholar 

  8. Saltoglu N, Tasova Y, Midikli D, Aksu HS, Sanli A, Dundar IH. Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study. J Infect 2004;48:81–5.

    Article  PubMed  Google Scholar 

  9. Ergonul O, Willke A, Azap A, Tekeli E. Revised definition of ‘fever of unknown origin’: limitations and opportunities. J Infect 2005;50:1–5.

    Article  PubMed  Google Scholar 

  10. Bar-Shalom R, Valdivia AY, Blaufox MD. PET imaging in oncology. Semin Nucl Med 2000;30:150–85.

    Article  CAS  PubMed  Google Scholar 

  11. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–80.

    CAS  PubMed  Google Scholar 

  12. Brown RS, Leung JY, Fisher SJ, Frey KA, Ethier SP, Wahl RL. Intratumoral distribution of tritiated fluorodeoxyglucose in breast carcinoma: I. Are inflammatory cells important? J Nucl Med 1995;36:1854–61.

    CAS  PubMed  Google Scholar 

  13. Blockmans D, Knockaert D, Maes A, De Caestecker J, Stroobants S, Bobbaers H, et al. Clinical value of [18F]fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin. Clin Infect Dis 2001;32:191–6.

    Article  CAS  PubMed  Google Scholar 

  14. Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, et al. Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET. Eur J Nucl Med 2000;27:1617–25.

    Article  CAS  PubMed  Google Scholar 

  15. Lorenzen J, Buchert R, Bohuslavizki KH. Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun 2001;22:779–83.

    Article  CAS  PubMed  Google Scholar 

  16. Bleeker-Rovers CP, de Kleijn EM, Corstens FH, van der Meer JW, Oyen WJ. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 2004;31:29–37.

    Article  PubMed  Google Scholar 

  17. Kjaer A, Lebech AM, Eigtved A, Hojgaard L. Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 2004;31:622–6.

    Article  PubMed  Google Scholar 

  18. Buysschaert I, Vanderschueren S, Blockmans D, Mortelmans L, Knockaert D. Contribution of (18)fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin. Eur J Intern Med 2004;15:151–6.

    Article  PubMed  Google Scholar 

  19. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40:1725.

    Article  CAS  PubMed  Google Scholar 

  20. Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33:1122–8.

    Article  CAS  PubMed  Google Scholar 

  21. Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura. Arthritis Rheum 1990;33:1114–21.

    Article  CAS  PubMed  Google Scholar 

  22. Fautrel B, Zing E, Golmard JL, Le Moel G, Bissery A, Rioux C, Proposal for a new set of classification criteria for adult-onset still disease. Medicine (Baltimore) 2002;81:194–200.

    Article  Google Scholar 

  23. Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973;3:55–78.

    Article  CAS  PubMed  Google Scholar 

  24. Kjaer A, Lebech AM. Diagnostic value of 111In-granulocyte scintigraphy in patients with fever of unknown origin. J Nucl Med 2002;43:140–4.

    PubMed  Google Scholar 

  25. de Groot M, Meeuwis AP, Kok PJ, Corstens FH, Oyen WJ. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging 2005;32:98–101.

    Article  PubMed  Google Scholar 

  26. Bleeker-Rovers CP, Boerman OC, Rennen HJ, Corstens FH, Oyen WJ. Radiolabeled compounds in diagnosis of infectious and inflammatory disease. Curr Pharm Des 2004;10:2935–50.

    Article  CAS  PubMed  Google Scholar 

  27. Blockmans D, Stroobants S, Maes A, Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000;108:246–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Elisabeth de Kleijn for her advice on the design of this study. We also thank Dr. Clemens Richter (Rijnstate Hospital), Gerben Ferwerda (Rijnstate Hospital), Dr. Tineke Smilde (Jeroen Bosch Hospital), Dr. Warmold van den Wall Bake (Maxima Medical Centre) and Koen Simons (Maxima Medical Centre) for their help in recruiting patients. This study was funded with internal resources. The experiments comply with the current laws of The Netherlands, inclusive of ethics approval.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Chantal P. Bleeker-Rovers, Lioe-Fee de Geus-Oei, Frans H. M. Corstens & Wim J. G. Oyen

  2. Department of Internal Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Chantal P. Bleeker-Rovers, Fidel J. Vos & Jos W. M. van der Meer

  3. Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands

    Chantal P. Bleeker-Rovers, Fidel J. Vos, Frans H. M. Corstens, Jos W. M. van der Meer & Wim J. G. Oyen

  4. Department of Internal Medicine, Slingeland Hospital, Doetinchem, The Netherlands

    Aart H. Mudde

  5. Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

    Anton S. M. Dofferhoff

  6. Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Anton J. Rijnders

  7. Department of Medical Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Paul F. M. Krabbe

Authors
  1. Chantal P. Bleeker-Rovers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fidel J. Vos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aart H. Mudde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anton S. M. Dofferhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lioe-Fee de Geus-Oei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anton J. Rijnders
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul F. M. Krabbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frans H. M. Corstens
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jos W. M. van der Meer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wim J. G. Oyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chantal P. Bleeker-Rovers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bleeker-Rovers, C.P., Vos, F.J., Mudde, A.H. et al. A prospective multi-centre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin. Eur J Nucl Med Mol Imaging 34, 694–703 (2007). https://doi.org/10.1007/s00259-006-0295-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-006-0295-z

Keywords

Search

Navigation