Utility of positron emission tomography-computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation

被引:6
作者
Das, Sohini [1 ]
Sathyendra, Sowmya [1 ]
Hephzibah, Julie [1 ]
Karuppusami, Reka [2 ]
Gunasekaran, Karthik [1 ]
Shanthly, Nylla [1 ]
Miraclin, Angel [1 ]
Iyadurai, Ramya [1 ]
机构
[1] Christian Med Coll & Hosp, Dept Med, Unit 3, Vellore 632004, Tamil Nadu, India
[2] Christian Med Coll & Hosp, Dept Biostat, Vellore, Tamil Nadu, India
关键词
Fever of unknown origin; positron emission tomography-computed tomography; positron emission tomography-computed tomography in fever of unknown origin; C-REACTIVE PROTEIN; F-18; FDG-PET/CT; DIAGNOSTIC PERFORMANCE; 18F-FDG PET/CT; VARIABLES; SPECTRUM;
D O I
10.4103/wjnm.WJNM_99_20
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Positron emission tomography-computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations.
引用
收藏
页码:237 / 246
页数:10
相关论文
共 48 条
[1]  
Ali-Eldin Fatma A., 2011, Journal of the Egyptian Society of Parasitology, V41, P379
[2]   The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin [J].
Balink, Hans ;
Veeger, Nic J. G. M. ;
Bennink, Roel J. ;
Slart, Riemer H. J. A. ;
Holleman, Frits ;
van Eck-Smit, Berthe L. F. ;
Verberne, Hein J. .
NUCLEAR MEDICINE COMMUNICATIONS, 2015, 36 (06) :604-609
[3]   Etiological Study of Fever of Unknown Origin in Patients Admitted to Medicine Ward of a Teaching Hospital of Eastern India [J].
Bandyopadhyay, Dipanjan ;
Bandyopadhyay, Ramtanu ;
Paul, Rudrajit ;
Roy, Deeptarka .
JOURNAL OF GLOBAL INFECTIOUS DISEASES, 2011, 3 (04) :329-333
[4]  
Bedmutha A, 2016, INDIAN J NUCL MED, V31, P201, DOI [10.4103/0972-3919.183610, 10.4103/0972-3919.158528]
[5]  
Bleeker-Rovers C., 2018, HARRISONS PRINCIPLES, V20
[6]  
Bleeker-Rovers CP, 2007, MEDICINE, V86, P26, DOI [10.1097/MD.0b013e31802fe858, 10.1097/md.0b013e31802fe858]
[7]   The changing pattern of fever of unknown origin in the Republic of North Macedonia [J].
Bosilkovski, Mile ;
Dimzova, Marija ;
Cvetkova, Marija ;
Poposki, Kostadin ;
Spasovska, Katerina ;
Vidinic, Ivan .
ROMANIAN JOURNAL OF INTERNAL MEDICINE, 2019, 57 (03) :248-253
[8]  
Casarrubias-Ramirez Moises, 2015, Rev Med Inst Mex Seguro Soc, V53 Suppl 1, pS6
[9]   C-reactive protein - An activator of innate immunity and a modulator of adaptive immunity [J].
Du Clos, TW ;
Mold, C .
IMMUNOLOGIC RESEARCH, 2004, 30 (03) :261-277
[10]   Fever of unknown origin: Discrimination between infectious and non-infectious causes [J].
Efstathiou, Stamatis P. ;
Pefanis, Angelos V. ;
Tsiakou, Aphrodite G. ;
Skeva, Irini I. ;
Tsioulos, Dimitrios I. ;
Achimastos, Apostolos D. ;
Mountokalakis, Theodore D. .
EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2010, 21 (02) :137-143