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Singh SB, Shrestha N, Bhandari S, Shrestha S, Shrestha B, Shrestha N, Rijal S, Singh R, Hess S, Werner TJ, Alavi A, Revheim ME. [ 18F]FDG PET/CT for identifying the causes of fever of unknown origin (FUO). AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2024; 14:87-96. [PMID: 38737639 PMCID: PMC11087293 DOI: 10.62347/oqqc6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/20/2024] [Indexed: 05/14/2024]
Abstract
Fever of unknown origin (FUO) continues to be a challenging diagnosis in clinical medicine. It has more than 200 known causes, including infections, autoimmune diseases, neoplasia, and other miscellaneous disorders. Despite the development of a wide range of diagnostic tools, a specific diagnostic algorithm for FUO is not yet available. However, [18F]FDG PET/CT, which yields information on cellular metabolism, in addition to details of organ anatomy, has been shown to be successful in the FUO investigation. This study highlights the uses of [18F]FDG PET/CT in diagnosing various causes of FUO. [18F]FDG PET/CT has been increasingly used to detect septic infections, sterile inflammatory processes, and malignancies, occupying a significant portion of the known causes of FUO. It has led to a more definitive identification of the etiology of FUO and accurate clinical management. However, more in-depth studies are crucial to understanding if [18F]FDG PET/CT can be used in the work-up of FUO.
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Affiliation(s)
- Shashi B Singh
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
- Current affiliation: Department of Radiology, Stanford University School of MedicineStanford, CA 94305, USA
| | | | - Sadikshya Bhandari
- Dhulikhel Hospital, Kathmandu University School of Medical SciencesDhulikhel, Kavre 11008, Nepal
| | - Suprita Shrestha
- Nepal Medical College Teaching HospitalAttarkhel, Kathmandu 13344, Nepal
| | | | | | - Swarnima Rijal
- Kathmandu Medical CollegeSinamangal, Kathmandu 21266, Nepal
| | | | - Soren Hess
- Department of Nuclear Medicine, Odense University HospitalOdense 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern DenmarkOdense 5230, Denmark
| | - Thomas J Werner
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Rikshospitalet, Division for Technology and Innovation, Oslo University HospitalOslo 0424, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOslo 0313, Norway
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van Snick JH, van Leer B, Nijsten MWN, Pillay J, Slart RHJA, Glaudemans AWJM, van Rijsewijk ND. Long axial field of view PET/CT in critically ill patients: lessons from a case report. Front Med (Lausanne) 2024; 10:1347791. [PMID: 38239612 PMCID: PMC10794769 DOI: 10.3389/fmed.2023.1347791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
The introduction of new long axial field of view (LAFOV) scanners is a major milestone in positron emission tomography/computed tomography (PET/CT) imaging. With these new systems a revolutionary reduction in scan time can be achieved, concurrently lowering tracer dose. Therefore, PET/CT has come within reach for groups of patients in whom PET/CT previously was undesirable. In this case report we discuss the procedure of a continuous bed motion (CBM) total-body [18F]FDG PET/CT scan in an intensive care patient. We emphasize the clinical and technical possibilities with this new camera system, a matched clinical protocol, and the added value of a dedicated team.
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Affiliation(s)
- J. H. van Snick
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - B. van Leer
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. W. N. Nijsten
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. Pillay
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - R. H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - A. W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - N. D. van Rijsewijk
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Goodman AL, Packham A, Sharkey AR, Cook GJR. Advanced Imaging for Detection of Foci of Infection in Staphylococcus aureus Bacteremia- Can a Scan Save Lives? Semin Nucl Med 2023; 53:175-183. [PMID: 36690574 PMCID: PMC10016027 DOI: 10.1053/j.semnuclmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/23/2023]
Abstract
Bloodstream infection or sepsis is a common cause of mortality globally. Staphylococcus aureus (S. aureus) is of particular concern, through its ability to seed metastatic infections in almost any organ after entering the bloodstream (S. aureus bacteraemia), often without localising signs. A positive blood culture for S. aureus bacteria should lead to immediate and urgent identification of the cause. Failure to detect a precise focus of infection is associated with higher mortality, sometimes despite appropriate antibiotics. This is likely due to the limited ability to effectively target therapy in occult lesions. Early detection of foci of metastatic S. aureus infection is therefore key for optimal diagnosis and subsequent therapeutic management. 18F-FDG-PET/CT and MRI offer us invaluable tools in the localisation of foci of S. aureus infection. Crucially, they may identify unexpected foci at previously unsuspected locations in the body, for example vertebral osteomyelitis in the absence of back pain. S. aureus bloodstream infections are further complicated by their microbiological recurrence; 18F-FDG-PET/CT provide a means of localising, thus enabling source control. More evidence is emerging as to the utility of 18F-FDG-PET/CT in this setting, perhaps even to the point of reducing mortality. 18 F-FDG-PET/MRI may have a similar impact. The available evidence demonstrates a need to investigate the impact of 18F-FDG-PET/CT and MRI scanning in clinical management and outcomes of S. aureus infection further in a randomised prospective clinical trial.
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Affiliation(s)
- Anna L Goodman
- Medical Research Council Clinical Trials Unit at University College London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Alice Packham
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical Research Facility, University Hospitals Birmingham Foundation Trust, London, UK
| | - Amy R Sharkey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gary J R Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Li TY, Lin LF, Pan RY, Cheng SN, Wu YT, Chen LC, Chen YC. 18 F-FDG PET/CT imaging for haemophilic arthropathy compared with clinical, radiological and power Doppler sonographic characteristics of 20 haemophilia patients. Haemophilia 2023; 29:640-647. [PMID: 36580375 DOI: 10.1111/hae.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Repeated joint bleeding in haemophilia patients may lead to haemophilic arthropathy with marked inflammation and synovitis. This study investigated the potential of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET/CT) as a novel diagnostic method for haemophilic arthropathy. MATERIALS AND METHODS We recruited 20 adult haemophilia patients who reported history of hemarthroses in the shoulder, elbow, hip, knee, or ankle joints. All joints were assessed by power Doppler ultrasonography and radiography, and graded by hyperaemia score and Pettersson score, respectively. Joint pain was evaluated by visual analogue score (VAS). Range of motion (ROM), Haemophilia Joint Health Score (HJHS) and annual joint bleeding rate (AJBR) were recorded. Finally, all participants had whole-body 18 F-FDG PET/CT, and maximum standardized uptake value (SUVmax) of the joints being studied was measured. RESULTS Thirteen patients had severe haemophilia, and seven had moderate haemophilia. The mean age was 36 years. PET SUVmax showed significant correlations with VAS, ROM, Pettersson score, hyperaemia score, HJHS score and AJBR in all large joints except hip. Joints with pain, hyperaemia and radiographic changes were found to have higher SUVmax than those without these features. Using Youden's index, the optimal cut-off value for early radiographical arthropathy was found to be between 1.9 and 2.0. CONCLUSION Our study indicates that 18 F-FDG PET/CT imaging correlated well with various conventional diagnostic techniques. It also demonstrated high sensitivity and specificity for early radiographic arthropathy. 18 F-FDG PET/CT imaging may quantitatively evaluate disease activity of most large joints in a single examination and help detect early haemophilic arthropathy.
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Affiliation(s)
- Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Fan Lin
- Department of Nuclear Medicine and PET center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Yu Pan
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Orthopaedics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shin-Nan Cheng
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Paediatrics, Tung's Taichung Metrohabor Hospital, Taiwan, ROC
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yeu-Chin Chen
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Haematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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