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European Journal of Nuclear Medicine and Molecular Imaging

Open Access 27-04-2024 | Original Article

EANM consensus document on the use of [18F]FDG PET/CT in fever and inflammation of unknown origin

Authors: Søren Hess, Edel Noriega-Álvarez, Lucia Leccisotti, Giorgio Treglia, Domenico Albano, Anne Roivainen, Andor W.J.M. Glaudemans, Olivier Gheysens

Published in: European Journal of Nuclear Medicine and Molecular Imaging

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Abstract

Purpose

Patients with fever and inflammation of unknown origin (FUO/IUO) are clinically challenging due to variable clinical presentations with nonspecific symptoms and many differential diagnoses. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is increasingly used in FUO and IUO, but the optimal diagnostic strategy remains controversial. This consensus document aims to assist clinicians and nuclear medicine specialists in the appropriate use of [18F]FDG-PET/CT in FUO and IUO based on current evidence.

Methods

A working group created by the EANM infection and inflammation committee performed a systematic literature search based on PICOs with “patients with FUO/IUO” as population, “[18F]FDG-PET/CT” as intervention, and several outcomes including pre-scan characteristics, scan protocol, diagnostic yield, impact on management, prognosis, and cost-effectiveness.

Results

We included 68 articles published from 2001 to 2023: 9 systematic reviews, 49 original papers on general adult populations, and 10 original papers on specific populations. All papers were analysed and included in the evidence-based recommendations.

Conclusion

FUO and IUO remains a clinical challenge and [18F]FDG PET/CT has a definite role in the diagnostic pathway with an overall diagnostic yield or helpfulness in 50–60% of patients. A positive scan is often contributory by directly guiding treatment or subsequent diagnostic procedure. However, a negative scan may be equally important by excluding focal disease and predicting a favorable prognosis. Similar results are obtained in specific populations such as ICU-patients, children and HIV-patients.
Appendix
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Metadata
Title
EANM consensus document on the use of [18F]FDG PET/CT in fever and inflammation of unknown origin
Authors
Søren Hess
Edel Noriega-Álvarez
Lucia Leccisotti
Giorgio Treglia
Domenico Albano
Anne Roivainen
Andor W.J.M. Glaudemans
Olivier Gheysens
Publication date
27-04-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-024-06732-8