18F-FDG PET/CT in fever and inflammation of unknown origin
20 February 2015
Number of pages
Faculty of Medicine (AMC-UvA)
H.J. VerberneR.J. Bennink
This thesis describes the role and the interpretation of imaging results with hybrid 18F-FDG PET/CT in patients with non-localizing
or non-specific signs and symptoms like fever, weight loss, malaise and prolonged increased inflammatory parameters, without
a diagnosis after routine diagnostic evaluation. Patients with either fever or inflammation of unknown origin (FUO or IUO)
are a diagnostic dilemma, as the aetiology may vary from a self-limiting condition to occult malignancy. An important feature
of 18F-FDG is its non-specificity: 18F-FDG shows increased uptake not only in malignant cells, but also in cells involved
in infectious and inflammatory processes. Furthermore 18F-FDG PET/CT imaging is able to reveal functional alterations that
precede the morphological changes and the integration of anatomical and functional images allows improved interpretation of
both abnormal 18F-FDG uptake and suspicious morphological findings.
Research conducted at: Medical Center Leeuwarden
The heterogeneity of FUO and IUO aetiologies and
the abundance of diagnostic possibilities have blurred an unambiguous diagnostic strategy in FUO and IUO. 18F-FDG PET/CT,
however, shows a high diagnostic yield despite the heterogeneity of underlying aetiologies of the syndromes. After exclusion
of systemic (non-focal) diseases 18F-FDG PET/CT has a high negative predictive value and is helpful in identifying patients
with benign self-limiting conditions. Notwithstanding the relatively high costs 18F-FDG PET/CT has the potential to become
a cost-effective routine imaging technique indicating the direction for further diagnostic decisions and thereby avoiding
unnecessary, invasive, and expensive diagnostic investigations.
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