1
|
Chin J, Vali R, Charron M, Shammas A. Update on Pediatric Nuclear Medicine in Acute Care. Semin Nucl Med 2023; 53:820-839. [PMID: 37211467 DOI: 10.1053/j.semnuclmed.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
Various radiopharmaceuticals are available for imaging pediatric patients in the acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. 99mTc-pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. 99mTcred blood cell scintigraphy generally is useful for assessing lower GI bleeding in patients from any cause. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. 99mTc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. 99mTcmercaptoacetyltriglycine scintigraphy is used to evaluate for early and late complications of renal transplantation. Bone scintigraphy is a sensitive and noninvasive technique for diagnosis of bone disorders such as osteomyelitis and fracture. 18F-fluorodeoxyglucose-positron emission tomography could be valuable in the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than a gallium scan. Moving forward, further refinement of pediatric radiopharmaceutical administered activities, including dose reduction, greater radiopharmaceutical applications, and updated consensus guidelines is warranted, with the use of radionuclide imaging likely to increase.
Collapse
Affiliation(s)
- Joshua Chin
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Reza Vali
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Martin Charron
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amer Shammas
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Palestro CJ, Brandon DC, Dibble EH, Keidar Z, Kwak JJ. FDG PET in Evaluation of Patients With Fever of Unknown Origin: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:151-162. [PMID: 36722759 DOI: 10.2214/ajr.22.28726] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fever of unknown origin (FUO) is a diagnostic challenge, with its cause remaining undiagnosed in approximately half of patients. Nuclear medicine tests typically are performed after a negative or inconclusive initial workup. Gallium-67 citrate and labeled leukocytes were previous mainstays of radionuclide imaging for FUO, although they had limited diagnostic performance. FDG PET/CT has subsequently emerged as the nuclear medicine imaging test of choice, supported by a growing volume of evidence. A positive FDG PET/CT result contributes useful information by identifying potential causes of fever, localizing sites for further evaluation, and guiding further management; a negative result contributes useful information by excluding focal disease as the cause of fever and predicts a favorable prognosis. In 2021, CMS rescinded a prior national noncoverage determination for FDG PET for infection and inflammation, leading to increasing national utilization of FDG PET/CT for FUO workup. This article reviews the current status of the role of FDG PET/CT in the evaluation of patients with FUO. The literature reporting the diagnostic performance and yield of FDG PET/CT in FUO workup is summarized, with comparison with historically used nuclear medicine tests included. Attention is also given to the test's clinical impact; protocol, cost, and radiation considerations; and application in children.
Collapse
Affiliation(s)
- Christopher J Palestro
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Division of Nuclear Medicine & Molecular Imaging, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040
| | - David C Brandon
- Department of Radiology, Division of Nuclear Medicine, Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Jennifer J Kwak
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
3
|
Zhu W, Cao W, Zheng X, Li X, Li Y, Chen B, Zhang J. The diagnostic value of 18F-FDG PET/CT in identifying the causes of fever of unknown origin. Clin Med (Lond) 2021; 20:449-453. [PMID: 32934036 DOI: 10.7861/clinmed.2020-0268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study investigated the clinical significance of 18F-fluorodeoxyglucose positron emission tomography / computed tomography (18F-FDG PET/CT) in identifying the causes of fever of unknown origin (FUO). METHODS Patients with a fever who received an 18F-FDG PET/CT examination were retrospectively selected. The means of the two groups were compared using an independent-samples t-test. RESULTS Among the 89 included patients, 66 were diagnosed using 18F-FDG PET/CT. The sensitivity, specificity and diagnostic accuracy of 18F-FDG PET/CT for the diagnosis of patients with FUO were 84.5%, 25.8%, and 64.0%, respectively. The detection rates of 18F-FDG PET/CT for neoplastic diseases, infectious diseases and non-infectious inflammatory diseases were 100%, 61.3%, and 75%, respectively. The difference in C-reactive protein (CRP) levels between the two groups was statistically significant. CONCLUSIONS 18F-FDG PET/CT has great clinical importance in diagnosing and identifying causes of FUO and improves the accuracy of FUO diagnosis when combined with serum CRP levels.
Collapse
Affiliation(s)
- Wan Zhu
- The First Hospital of China Medical University, Shenyang, China
| | - Wenxia Cao
- The First Hospital of China Medical University, Shenyang, China
| | - Xuting Zheng
- The First Hospital of China Medical University, Shenyang, China
| | - Xuena Li
- The First Hospital of China Medical University, Shenyang, China
| | - Yaming Li
- The First Hospital of China Medical University, Shenyang, China
| | - Baiyi Chen
- The First Hospital of China Medical University, Shenyang, China
| | - Jingping Zhang
- The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
4
|
Abstract
Purpose of Review The main goal of the article is to familiarize the reader with commonly and uncommonly used nuclear medicine procedures that can significantly contribute to improved patient care. The article presents examples of specific modality utilization in the chest including assessment of lung ventilation and perfusion, imaging options for broad range of infectious and inflammatory processes, and selected aspects of oncologic imaging. In addition, rapidly developing new techniques utilizing molecular imaging are discussed. Recent Findings The article describes nuclear medicine imaging modalities including gamma camera, SPECT, PET, and hybrid imaging (SPECT/CT, PET/CT, and PET/MR) in the context of established and emerging clinical applications. Areas of potential future development in nuclear medicine are discussed with emphasis on molecular imaging and implementation of new targeted tracers used in diagnostics and therapeutics (theranostics). Summary Nuclear medicine and molecular imaging provide many unique and novel options for the diagnosis and treatment of pulmonary diseases. This article reviews current applications for nuclear medicine and molecular imaging and selected future applications for radiopharmaceuticals and targeted molecular imaging techniques.
Collapse
|
5
|
Mabey E, Rutherford A, Galloway J. Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer? Curr Rheumatol Rep 2018; 20:70. [PMID: 30225546 PMCID: PMC6153569 DOI: 10.1007/s11926-018-0779-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Fever is common within rheumatology but it is often challenging to identify its source. To do so correctly is paramount in patients with an underlying inflammatory condition receiving immunosuppressive therapy. This review article looks at the available evidence and merits of both 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and new proposed biomarkers in determining the cause of fever within rheumatology. RECENT FINDINGS 18F-FDG PET/CT scans are already an established tool in the detection and diagnosis of malignancy and are emerging for use in fever of unknown origin. More recently, they have been used to identify rheumatological causes of fever such as large vessel vasculitis and adult-onset Still's disease. Within these conditions, biomarkers such as procalcitonin and presepsin may help to differentiate endogenous from exogenous pyrogens. 18F-FDG PET/CT scanning shows promise in locating the source of pyrogens and may be superior to other conventional forms of imaging. As evidence and test availability increases, its use is likely to become commonplace in the diagnostic work-up of fever. Once a source is located, selected biomarkers may be used to confirm a cause.
Collapse
Affiliation(s)
| | | | - James Galloway
- Department of Inflammation Biology, King’s College London, New Hunt’s House, Great Maze Pond, London, SE1 1UL UK
| |
Collapse
|
6
|
Selvaraj A, Francis N, Harky A, Goli G, Bashir M. Imaging modalities in the management of aortitis. Indian J Thorac Cardiovasc Surg 2018; 35:67-71. [PMID: 33061068 DOI: 10.1007/s12055-018-0710-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
Aortitis is a pathological term that refers to the inflammation of one or more layers of the aortic wall. It is associated with a wide spectrum of inflammatory diseases of infectious and non-infectious origins, and often present with vague clinical findings and non-specific laboratory results that can model other entities. As a result, aortitis may not form part of the initial workup and appropriate treatment can be delayed or missed. Therefore, imaging modalities are required to assess for inflammation and structural changes in the aorta to support or exclude the diagnosis of aortitis. This review presents current literature on the imaging modalities utilized in the diagnosis and management of aortitis, which surgeons and physicians should be familiar with for providing optimal patient care.
Collapse
Affiliation(s)
- Andrew Selvaraj
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Niroshan Francis
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Amer Harky
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL UK
| | - Giridhara Goli
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, M13 9WL UK
| |
Collapse
|
7
|
Grobman M, Cohn L, Knapp S, Bryan JN, Reinero C. 18
F-FDG-PET/CT as adjunctive diagnostic modalities in canine fever of unknown origin. Vet Radiol Ultrasound 2017; 59:107-115. [DOI: 10.1111/vru.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 05/20/2017] [Accepted: 07/01/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Megan Grobman
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine; University of Missouri; Columbia MO 65211
| | - Leah Cohn
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine; University of Missouri; Columbia MO 65211
| | - Stephanie Knapp
- Veterinary Specialty Hospital of the Carolinas; Raleigh NC 27616
| | - Jeffrey N. Bryan
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine; University of Missouri; Columbia MO 65211
| | - Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine; University of Missouri; Columbia MO 65211
| |
Collapse
|
8
|
Chandra P, Nath S, Chakravarthy S, Kingsley J. Type 2 Lepra Reaction Presenting as Fever of Unknown Origin Identified on 18F-fluoro-2-deoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2017; 32:253-254. [PMID: 28680225 PMCID: PMC5482037 DOI: 10.4103/ijnm.ijnm_46_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Satish Nath
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | | | - Jemima Kingsley
- Department of Microbiology, MIOT International, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
"To be or not to be" for PET in rheumatology. A marriage of love or of convenience? Reumatologia 2017; 55:1-3. [PMID: 28386135 PMCID: PMC5380765 DOI: 10.5114/reum.2017.66679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 11/17/2022] Open
|
10
|
|
11
|
Febrile syndrome of unknown origin: Indications for 18F-FDG PET/CT in inflammatory and infectious processes. RADIOLOGIA 2016; 59:253-263. [PMID: 27671947 DOI: 10.1016/j.rx.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 12/17/2022]
Abstract
Fever of unknown origin is defined as a body temperature greater than 38.3°C lasting more than three weeks for which the cause could not be found within one week of hospital admission. More than 200 causes have been reported, and these can be classified into four categories: infections, inflammatory diseases, oncologic processes, and miscellaneous conditions. Noninvasive diagnostic techniques are used in 69.2% of cases and invasive techniques in 30.8%. Structural imaging techniques show the morphological changes from infectious, inflammatory, and tumor-related processes, but they do not allow the detection of the early changes brought about by these processes. The metabolic information provided by 18F-FDG PET/CT has a promising role in these patients. 18F-FDG uptake is based on the cells' use of glucose as a source of energy, so it can be observed in infectious, inflammatory, and tumor-related processes. The established non-oncologic indications for 18F-FDG PET/CT are sarcoidosis, osteomyelitis, spondylodiscitis, fever of unknown origin, and vasculitis, which together account for more than 85% of studies.
Collapse
|
12
|
Tek Chand K, Chennu KK, Amancharla Yadagiri L, Manthri Gupta R, Rapur R, Vishnubotla SK. Utility of 18 F-FDG PET/CT scan to diagnose the etiology of fever of unknown origin in patients on dialysis. Hemodial Int 2016; 21:224-231. [DOI: 10.1111/hdi.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kalawat Tek Chand
- Department of Nuclear Medicine; Sri Venkateswara Institute of Medical Sciences; Tirupati, 517507, India
| | - Krishna Kishore Chennu
- Department of Nephrology; Sri Venkateswara Institute of Medical Sciences; Tirupati, 517507, India
| | | | - Ranadheer Manthri Gupta
- Department of Nuclear Medicine; Sri Venkateswara Institute of Medical Sciences; Tirupati, 517507, India
| | - Ram Rapur
- Department of Nephrology; Sri Venkateswara Institute of Medical Sciences; Tirupati, 517507, India
| | - Siva Kumar Vishnubotla
- Department of Nephrology; Sri Venkateswara Institute of Medical Sciences; Tirupati, 517507, India
| |
Collapse
|
13
|
Abstract
OBJECTIVE Fever of unknown origin continues to be a diagnostic challenge for clinicians. The aim of this study was to confirm whether (18)F-fluorodeoxyglucose ((18)F-FDG)-PET/computed tomography (CT) is a helpful tool in patients suffering from this condition. PATIENTS AND METHODS Fifty-seven patients with fever of unknown origin were examined with (18)F-FDG-PET/CT as part of their diagnostic workup at the clinicians' discretion. The medical records were read retrospectively to establish the final diagnosis and evaluate the degree to which PET/CT contributed to the diagnosis. RESULTS The examination was considered helpful if it corresponded to the final diagnosis by showing uptake in an organ considered responsible for the condition, or if it was without focal findings, thereby excluding the patient from having focal infection or malignancy. It was perceived false positive if it pointed towards an organ not regarded by the clinicians as being related to the final diagnosis. It was perceived not helpful if the cause of fever was not visible on (18)F-FDG-PET/CT. We found (18)F-FDG-PET/CT helpful in 75% of patients, not helpful in 4%, and false positive in 21% of patients. CONCLUSION (18)F-FDG-PET/CT is a useful tool in the investigation of fever of unknown origin; it can reduce patient inconvenience and possibly costs to society if used earlier in the diagnostic process.
Collapse
|
14
|
García-Gómez FJ, Acevedo-Báñez I, Martínez-Castillo R, García-Gutiérrez M, Tirado-Hospital JL, Borrego-Dorado I. Utilidad de la tomografía por emisión de positrones con 18 F-Fluorodesoxiglucosa combinada con tomografía computarizada en la orientación diagnóstica de la fiebre de origen desconocido. Med Clin (Barc) 2015; 145:62-6. [DOI: 10.1016/j.medcli.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/25/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
|
15
|
Cho CY, Lai CC, Lee ML, Hsu CL, Chen CJ, Chang LY, Lo CW, Chiang SF, Wu KG. Clinical analysis of fever of unknown origin in children: A 10-year experience in a northern Taiwan medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:40-45. [PMID: 25735796 DOI: 10.1016/j.jmii.2015.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 11/27/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) was first described in 1961 as fever >38.3°C for at least 3 weeks with no apparent source after 1 week of investigations in the hospital. Infectious disease comprises the majority of cases (40-60%). There is no related research on FUO in children in Taiwan. The aim of this study is to determine the etiologies of FUO in children in Taiwan and to evaluate the relationship between the diagnosis and patient's demography and laboratory data. METHODS Children under 18 years old with fever >38.3°C for >2 weeks without apparent source after preliminary investigations at Taipei Veterans General Hospital during 2002-2012 were included. Fever duration, symptoms and signs, laboratory examinations, and final diagnosis were recorded. The distribution of etiologies and age, fever duration, laboratory examinations, and associated symptoms and signs were analyzed. RESULTS A total of 126 children were enrolled; 60 were girls and 66 were boys. The mean age was 6.7 years old. Infection accounted for 27.0% of cases, followed by undiagnosed cases (23.8%), miscellaneous etiologies (19.8%), malignancies (16.6%), and autoimmune disorders (12.7%). Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were the most commonly found pathogens for infectious disease, and Kawasaki disease (KD) was the top cause of miscellaneous diagnosis. CONCLUSIONS Infectious disease remains the most common etiology. Careful history taking and physical examination are most crucial for making the diagnosis. Conservative treatment may be enough for most children with FUO, except for those suffering from malignancies.
Collapse
Affiliation(s)
- Ching-Yi Cho
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chou-Cheng Lai
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Luen Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Lun Hsu
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Jen Chen
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Lo-Yi Chang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chiao-Wei Lo
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Sheng-Fong Chiang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Keh-Gong Wu
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
| |
Collapse
|
16
|
Kim CY, Jeong S, Lee SW, Park TI, Lee J, Ahn BC. Pathologically proven infective endocarditis demonstrated on 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
17
|
Hartlage GR, Palios J, Barron BJ, Stillman AE, Bossone E, Clements SD, Lerakis S. Multimodality Imaging of Aortitis. JACC Cardiovasc Imaging 2014; 7:605-19. [DOI: 10.1016/j.jcmg.2014.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
|
18
|
Kaya A, Ergul N, Kaya SY, Kilic F, Yilmaz MH, Besirli K, Ozaras R. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther 2014; 11:805-15. [PMID: 23977936 DOI: 10.1586/14787210.2013.814436] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still's disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.
Collapse
Affiliation(s)
- Abdurrahman Kaya
- Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
19
|
Kim CY, Jeong SY, Lee SW, Park TI, Lee J, Ahn BC. Pathologically proven infective endocarditis demonstrated on ¹⁸F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 33:388-9. [PMID: 24636632 DOI: 10.1016/j.remn.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/16/2022]
Affiliation(s)
- C-Y Kim
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - S Y Jeong
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - S-W Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - T-I Park
- Department of Pathology, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - J Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea
| | - B-C Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea.
| |
Collapse
|
20
|
|
21
|
Thevenet H, Jehanno N, Maunoury C, Weinmann P. [Increased uptake on PET/CT]. Rev Med Interne 2012. [PMID: 23195910 DOI: 10.1016/j.revmed.2012.10.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Thevenet
- Service de médecine nucléaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | | | | | | |
Collapse
|
22
|
Intraperitoneal Spilled Gallstones Presenting as Fever of Unknown Origin After Laparoscopic Cholecystectomy. Clin Nucl Med 2012; 37:819-20. [DOI: 10.1097/rlu.0b013e31824c6042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
The role of 18F-FDG PET or PET/CT in the detection of fever of unknown origin. Eur J Radiol 2012; 81:3524-9. [PMID: 22766321 DOI: 10.1016/j.ejrad.2012.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022]
Abstract
Even with the recent advance in diagnostic tools and techniques, fever of unknown origin (FUO) remains a clinical challenge. A wide range of diseases, mainly infections, autoimmune conditions (inflammatory diseases), malignancies and miscellaneous can cause FUO. Positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) scanning makes a great contribution to the diagnosis and differential diagnosis of FUO due to the high sensitivity of pathological accumulation of 18F-FDG. The diagnostic yield of PET/CT is higher than traditional radiographic imaging and other nuclear medicine scanning. Owing to the numerous advantages of PET/CT including high sensitivity and the ability to perform whole-body scans, many rare diseases presenting with FUO can be detected and the spectrum of diseases that can exhibit FUO has been increasing. Recent studies utilizing FUO are discussed in this paper. However, there are limited data available about the role of 18F-FDG PET or PET/CT in evaluation of FUO.
Collapse
|
24
|
Koh KC, Slavin MA, Thursky KA, Lau E, Hicks RJ, Drummond E, Wong PS, Worth LJ. Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on diagnosis and antimicrobial utilization in patients with high-risk febrile neutropenia. Leuk Lymphoma 2012; 53:1889-95. [PMID: 22448920 DOI: 10.3109/10428194.2012.677533] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early and targeted antimicrobial therapy improves outcomes in patients with febrile neutropenia (FN). We evaluated the impact of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) on antimicrobial utilization in the management of FN. A cohort of patients with FN and hematological malignancy was identified. Cases (in whom FDG-PET was performed, n = 37) were compared with controls (in whom conventional investigations excluding FDG-PET were performed, n = 76). An underlying cause for FN was determined in 94.6% of cases, compared to 69.7% of controls. FDG-PET had a significant impact on antimicrobial utilization compared to conventional imaging (35.1% vs. 11.8%; p = 0.003), and was associated with shorter duration of liposomal amphotericin-B therapy for systemic fungal infection (median 4.0 days cases vs. 10.0 days controls; p = 0.001). Cases had a longer length of hospitalization (p = 0.016). In the management of patients with high-risk FN, FDG-PET improves diagnostic yield and allows rationalization of antifungal therapy. The impact upon healthcare costs associated with antimicrobial therapy for FN requires further evaluation.
Collapse
Affiliation(s)
- Kwee Choy Koh
- Department of Internal Medicine, International Medical University, Seremban, Negeri Sembilan, Malaysia.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Treglia G, Maggi F, Bonomo L, Giordano A. Usefulness of fluorine-18 fluorodeoxyglucose PET/computed tomography in diagnosis of aortitis and treatment response evaluation in a patient with aortic prosthesis. J Cardiovasc Med (Hagerstown) 2012; 12:814-6. [PMID: 21934523 DOI: 10.2459/jcm.0b013e32834ba0fd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of an 82-year-old man with aortic prosthesis inflammation in whom fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography has been useful in the detection of the cause of fever of unknown origin. We also describe the correlation between decrease of FDG uptake in the vascular prosthesis after treatment and clinical improvement with normalization of the serological levels of inflammatory markers.
Collapse
Affiliation(s)
- Giorgio Treglia
- Department of Bioimaging and Radiological Sciences, Institute of Nuclear Medicine, Italy.
| | | | | | | |
Collapse
|